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The multisystem impairment promoted by COVID-19 may be associated with a reduction in exercise capacity. Cardiopulmonary abnormalities can change across the acute disease severity spectrum. We aimed to verify exercise physiology differences between COVID-19 survivors and SARS-CoV-2-naïve controls and how illness severity influences exercise limitation. A single-centre cross-sectional analysis of prospectively collected data from COVID-19 survivors who underwent cardiopulmonary exercise testing (CPET) in their recovery phase (x = 50[36;72] days). Patients with COVID-19 were stratified according to severity as mild [M-Cov (outpatient)] vs severe/critical [SC-Cov(inpatients)] and were compared with SARS-CoV-2-naïve controls (N-Cov). Collected information included demographics, anthropometrics, previous physical exercise, comorbidities, lung function test and CPET parameters. A multivariate logistic regression analysis was performed to identify low aerobic capacity (LAC) predictors post COVID-19. Of the 702 included patients, 310 (44.2%), 305 (43.4%) and 87 (12.4%) were N-Cov, M-Cov and SC-Cov, respectively. LAC was identified in 115 (37.1%), 102 (33.4%), and 66 (75.9%) of N-CoV, M-CoV and SC-CoV, respectively (p < 0.001). SC-Cov were older, heavier with higher body fat, more sedentary lifestyle, more hypertension and diabetes, lower forced vital capacity, higher prevalence of early anaerobiosis, ventilatory inefficiency and exercise-induced hypoxia than N-Cov. M-Cov had lower weight, fat mass, and coronary disease prevalence and did not demonstrate more CEPT abnormalities than N-Cov. After adjustment for covariates, SC-Cov was an independent predictor of LAC (OR = 2.7; 95% CI, 1.3-5.6). Almost two months after disease onset, SC-CoV presented several exercise abnormalities of oxygen uptake, ventilatory adaptation and gas exchange, including a high prevalence of LAC.Highlights Weeks after the acute disease phase, one-third of mild and three-quarters of severe and critical patients with COVID-19 presented a reduced aerobic capacity. Previous studies including SARS-CoV-1 survivors observed much lower values.A severe or critical COVID-19 case was an independent predictor for low aerobic capacity.In our sample, pre-COVID-19 exercise significantly reduced the odds of post-COVID-19 low aerobic capacity. Even severe or critical patients who exercised regularly had a prevalence of low aerobic capacity 2.5 times lower than those who did not have this routine before sickening.

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The post-acute phase of coronavirus disease 2019 (COVID-19) is often marked by several persistent symptoms and exertional intolerance, which compromise survivors' exercise capacity. This was a cross-sectional study aiming to investigate the impact of COVID-19 on oxygen uptake (V̇o2) kinetics and cardiopulmonary function in survivors of severe COVID-19 about 3-6 mo after intensive care unit (ICU) hospitalization. Thirty-five COVID-19 survivors previously admitted to ICU (5 ± 1 mo after hospital discharge) and 18 controls matched for sex, age, comorbidities, and physical activity level with no prior history of SARS-CoV-2 infection were recruited. Subjects were submitted to a maximum-graded cardiopulmonary exercise test (CPX) with an initial 3-min period of a constant, moderate-intensity walk (i.e., below ventilatory threshold, VT). V̇o2 kinetics was remarkably impaired in COVID-19 survivors as evidenced at the on-transient by an 85% (P = 0.008) and 28% (P = 0.001) greater oxygen deficit and mean response time (MRT), respectively. Furthermore, COVID-19 survivors showed an 11% longer (P = 0.046) half-time of recovery of V̇o2 (T1/2V̇o2) at the off-transient. CPX also revealed cardiopulmonary impairments following COVID-19. Peak oxygen uptake (V̇o2peak), percent-predicted V̇o2peak, and V̇o2 at the ventilatory threshold (V̇o2VT) were reduced by 17%, 17%, and 12% in COVID-19 survivors, respectively (all P < 0.05). None of the ventilatory parameters differed between groups (all P > 0.05). In addition, COVID-19 survivors also presented with blunted chronotropic responses (i.e., chronotropic index, maximum heart rate, and heart rate recovery; all P < 0.05). These findings suggest that COVID-19 negatively affects central (chronotropic) and peripheral (metabolic) factors that impair the rate at which V̇o2 is adjusted to changes in energy demands.NEW & NOTEWORTHY Our findings provide novel data regarding the impact of COVID-19 on submaximal and maximal cardiopulmonary responses to exercise. We showed that V̇o2 kinetics is significantly impaired at both the onset (on-transient) and the recovery phase (off-transient) of exercise in these patients. Furthermore, our results suggest that survivors of severe COVID-19 may have a higher metabolic demand at a walking pace. These findings may partly explain the exertional intolerance frequently observed following COVID-19.

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The effects of short sprint interval training (sSIT) with efforts of ≤10 s on maximal oxygen consumption (V̇O2 max), aerobic and anaerobic performances remain unknown. To verify the effectiveness of sSIT in physically active adults and athletes, a systematic literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases PubMed/MEDLINE, ISI Web of Science, and SPORTDiscus were systematically searched on May 9, 2020, and updated on September 14, 2021. Inclusion criteria were based on PICO and included healthy athletes and active adults of any sex (≤40 years), performing supervised sSIT (≤10 s of "all-out" and non-"all-out" efforts) of at least 2 weeks, with a minimum of 6 sessions. As a comparator, a non-sSIT control group, another high-intensity interval training (HIIT) group, or a continuous training (CT) group were required. A total of 18 studies were deemed eligible. The estimated SMDs based on the random-effects model were -0.56 (95% CI: -0.79, -0.33, p < 0.001) for V̇O2 max, -0.43 (95% CI: -0.67, -0.20, p < 0.001) for aerobic performance, and -0.44 (95% CI: -0.70, -0.18, p < 0.001) for anaerobic performance after sSIT vs. no exercise/usual training. However, there were no significant differences (p > 0.05) for all outcomes when comparing sSIT vs. HIIT/CT. Our findings indicate a very high effectiveness of sSIT protocols in different exercise modes (e.g., cycling, running, paddling, and punching) to improve V̇O2 max, aerobic, and anaerobic performances in physically active young healthy adults and athletes.

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OBJECTIVE: To evaluate the exercise capacity of children and adolescents with severe therapy resistant asthma (STRA) aiming to identify its main determinants. METHODS: Cross-sectional study including individuals aged 6-18 years with a diagnosis of STRA. Clinical (age and gender), anthropometric (weight, height and body mass index) and disease control data were collected. Lung function (spirometry), cardiopulmonary exercise testing (CPET) and exercise-induced bronchoconstriction (EIB) test were performed. RESULTS: Twenty-four patients aged 11.5 ± 2.6 years were included. The mean forced expiratory volume in one second (FEV1) was 91.3 ± 9.2%. EIB occurred in 54.2% of patients. In CPET, the peak oxygen uptake (VO2peak) was 34.1 ± 7.8 mL kg-1 min-1. A significant correlation between ventilatory reserve and FEV1 (r = 0.57; p = 0.003) was found. Similarly, there was a significant correlation between CPET and percent of FEV1 fall in the EIB test for both VE/VO2 (r = 0.47; p = 0.02) and VE/VCO2 (r = 0.46; p = 0.02). Patients with FEV1<80% had lower ventilatory reserve (p = 0.009). In addition, resting heart rate correlated with VO2peak (r=-0.40; p = 0.04), VE/VO2 (r = 0.46; p = 0.02) and VE/VCO2 (r = 0.48; p = 0.01). CONCLUSIONS: Exercise capacity is impaired in approximately 30% of children and adolescents with STRA. The results indicate that different aspects of aerobic fitness are influenced by distinct determinants, including lung function and EIB.

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The effect of high-intensity interval exercise (HIIE) on affective responses is unclear due to the several variables of HIIE, which may be minimized by using derived variables (e.g. amplitude). The amplitude reflects the difference between stimulus and recovery intensities, being more representative of the physiological changes than central tendency variables such as average intensity. This study aimed to compare the affective responses in HIIE sessions in different amplitudes with a vigorous-intensity continuous exercise (VICE) session. Eleven participants completed five sessions. The peak oxygen consumption (VO2Peak) and peak power (Wpeak) were measured. Participants performed one VICE and three HIIE sessions (10x[1min-90%WPeak/1min-50%WPeak]; 10x[1min-100%WPeak/1min-40%WPeak]; and 10x[1min-110%WPeak/1min-40%WPeak]). The exercise sessions were performed at the same average intensity (70%WPeak) and duration (20 min). The Feeling Scale (FS) was applied in each minute throughout the exercise sessions. Regarding the FS responses, a two-way repeated-measures ANOVA showed no significant interaction for FS (P=0.093) or main effect for condition (P=0.206) and time (P=0.078), indicating that irrespective of the amplitude of the HIIE, FS results were similar between conditions. The effect size (ES) analysis showed a small effect in favour of HIIE-90/50 (ES=0.30) and HIIE-100/40 (ES=0.26) and a null effect on HIIE-110/30 (ES=0.08) when compared to VICE. Chi-squared analysis showed no significant differences between conditions in the number of participants that reduced, maintained, or increased the FS from pre-exercise to last stimulus and recovery indicating a high variability of the affective responses. HIIE sessions provide similar affective responses when performed at the same average intensity, even with different amplitudes.Highlights HIIE amplitude reflects the difference between stimulus and recovery intensities and seems not to modulate the affective responses to HIIE sessions configured with different amplitudes.HIIE sessions performed at the same average intensity and different amplitudes result in similar affective responses.High inter-individual variability of affective responses occurs in HIIE sessions configured based on the amplitude.

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INTRODUCTION: Cardiopulmonary exercise testing (CPET) is increasingly used to determine aerobic fitness in health and disability conditions. Patients with neuromuscular diseases (NMDs) often present with symptoms of cardiac and/or skeletal muscle dysfunction and fatigue that might impede the ability to deliver maximal cardiopulmonary effort. Although an increasing number of studies report on NMDs' physical fitness, the applicability of CPET remains largely unknown. AREAS COVERED: This systematic review synthesized evidence about the quality and feasibility of CPET in NMDs and patient's aerobic fitness. The review followed the PRISMA guidelines (PROSPERO number CRD42020211068). Between September and October 2020 one independent reviewer searched the PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases. Excluding reviews and protocol description articles without baseline data, all study designs using CPET to assess adult or pediatric patients with NMDs were included. The methodological quality was assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations. EXPERT OPINION: CPET is feasible for ambulatory patients with NMDs when their functional level and the exercise modality are taken into account. However, there is still a vast potential for standardizing and designing disease-specific CPET protocols for patients with NMDs. Moreover, future studies are urged to follow the ATS/ACCP recommendations.

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The objective of this study was to investigate the association between cardiorespiratory fitness (CRF) and performance in multiple domains of executive functions in school-aged adolescents. A sample of 132 adolescents (43% girls) aged 11-16 years were included in this cross-sectional study. Each participant completed a progressive aerobic cardiovascular endurance running (PACER) test, computerized cognitive tasks (Attentional Network, Berg's Card Sorting, Go/No-Go oddball, Sternberg's Working Memory, and Tower of London) and questionnaire for daytime sleepiness, as well as other factors that might influence cognitive performance (age, sex, school year, pubertal stage, and body mass index - BMI). Generalized linear model was used to calculate the coefficient estimates (ß) and its 95% confidence interval (CI) for the cognitive tasks using PACER laps as a predictor, controlling for potential confounding variables. There was a negatively association of PACER laps with planning (ß = -17.1, 95% CI -31.9, -2.3) and solution (ß = -44.6, 95% CI -75.1, -14.2) time in performing the Tower of London task, as well as with perseverative errors in performing Berg's task (ß = -0.073, 95% CI -0.133, -0.013). Moderating effect of sex was found for the association of PACER laps with completed categories and perseverative errors in Berg's task (p < 0.05). Mediating effect of BMI was found for the association between PACER laps and NoGo task, revealing a full mediator accounted for 81% of the total effect mediated (standardized indirect effect, -0.069, 95% CI -0.140, -0.020; standardized direct effect, 0.011, 95% CI -0.149, 0.165). No association was found for Attentional or Sternberg's tasks. The findings suggest that school-aged adolescents with higher CRF level showed better planning and problem-solving abilities and cognitive flexibility. Additionally, the positive association of CRF with cognitive flexibility was sex-moderated and with inhibitory control was BMI-mediated.

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This study aimed to examine the clustering of 24-h movement behaviors (moderate to vigorous physical activity, screen time, and sleep duration) and their association with cardiorespiratory fitness among adolescents. We evaluated 561 adolescents (52.1% girls; mean age, 13.0 ± 1.0 years) from Florianópolis, Brazil. A 20-m shuttle run was used to assess cardiorespiratory fitness, while a questionnaire was used to measure 24-h movement behaviors. A latent class analysis was performed to identify the clustering of 24-h movement behaviors, while linear Bayesian mixed-effect regression models were applied to identify their association with cardiorespiratory fitness. Two classes were identified: unhealthy (10.4%), characterized as a high probability of practicing less than 300 min/week of moderate to vigorous physical activity, spending more than 4 h/day in front of screens, and sleeping less than 8 h/day; and healthy (89.6%), characterized by a high probability of practicing more than 420 min/week of moderate to vigorous physical activity, spending less than 2 h/day in front of screens, and sleeping 8-10 h/day. Adolescents in the healthy class had a higher cardiorespiratory fitness level than those in the unhealthy class. Most adolescents were grouped in the healthy class and had higher cardiorespiratory fitness levels than those in the unhealthy class. These results suggest that families and professionals should work toward creating healthier lifestyles for adolescents by increasing opportunities to practice moderate to vigorous physical activity, reduce screen time, and favor healthy sleep to increase their cardiorespiratory fitness levels. What is Known: • Moderate to vigorous physical activity, screen time, and sleep duration are positively, negatively, and inconsistently associated with cardiorespiratory fitness, respectively, when analyzed separately. • Little is known about the clustering of 24-h movement behaviors and how they are associated with cardiorespiratory fitness levels in adolescents. What is New: • The 24-h movement behaviors clustered into almost opposite classes among adolescents (healthy and unhealthy classes). • Adolescents in the healthy class had greater cardiorespiratory fitness levels than those in the unhealthy class.

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To describe the pacing pattern of elite 400 m freestyle swimmers, understand how athletes select the first half compared to their 200-m race pace, and correlate critical speed (CS) and D' with pacing parameters. The best all-time 400 m performances were obtained, and 200 m performances were retrieved from the same competition. Twenty-four performances were selected and, when possible, 50 m-splits were obtained. CS and D' were calculated based on the 200 m and 400 m performances. Most athletes adopted a parabolic pacing pattern. Performance in the 400 m correlated with that of the 200 m (rho = 0.418, p = 0.042), the % difference between 200 m performance and 200 m split correlated with CS (rho = -0.595, p = 0.002) and with D' (rho = 0.808, p < 0.001). The correlation between D' and % difference between average speed and CS was nearly perfect (rho = 1.000, p < 0.001). Recommendations of having the first half of the 400 m 4-5 s slower than their 200 m race do not seem to be appropriate for all swimmers and depends on physiological abilities.

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