No independent associations between physical activity and clinical outcomes among hospitalized patients with moderate to severe COVID-19

Background:Regular physical activity(PA)has been postulated to improve,or at least maintain,immunity across the life span.However,the link between physical(in)activity and coronavirus disease 2019(COVID-19)remains to be established.This small-scale prospective cohort study is nested within a randomized controlled trial aimed to investigate the possible associations between PA levels and clinical outcomes among hospitalized patients with moderate to severe COVID-19.Methods:Hospitalized patients with COVID-19(mean age:54.9 years)were recruited from the Clinical Hospital of the School of Medicine of the University of Sao Paulo(a quaternary referral teaching hospital)and from Ibirapuera Field Hospital,both located in Sao Paulo,Brazil.PA level was assessed using the Baecke Questionnaire of Habitual Physical Activity.The primary outcome was hospital length of stay.The secondary outcomes were mortality,admission to the intensive care unit(ICU),and mechanical ventilation requirement.Results:The median hospital length of stay was 7.0§4.0 days,median§IQR;3.3%of patients died,13.8%were admitted to the ICU,and 8.6%required mechanical ventilation.Adjusted linear regression models showed that PA indices were not associated with hospital length of stay(work index:b=-0.57(95%confidence interval(95%CI):-1.80 to 0.65),p=0.355;sport index:b=0.43(95%CI:-0.94 to 1.80),p=0.536;leisure-time index:b=1.18(95%CI:-0.22 to 2.59),p=0.099;and total activity index:b=0.20(95%CI:-0.48 to 0.87),p=0.563).None of the PA indices were associated with mortality,admission to the ICU,or mechanical ventilation requirement(all p>0.050).Conclusion:Among hospitalized patients with COVID-19,PA did not independently associate with hospital length of stay or any other clinically relevant outcomes.These findings should be interpreted as meaning that,among already hospitalized patients with more severe forms of COVID-19,being active is a potential protective factor likely outweighed by a cluster of comorbidities(e.g.,type 2 diabetes,hypertension,weight excess)and older age,suggesting that the benefit of PA against the worsening of COVID-19 may vary across stages of the disease.

Nutritional therapy for hospitalized patients with COVID-19:A narrative and integrative review

Hospitalized patients affected by coronavirus disease 19(COVID-19)have a sustained pro-inflammatory state and recurrent gastrointestinal symptoms that correlate with a decline in the nutritional status,which is directly related to poor immune response and clinical evolution.Nutritional therapy has proven crucial in COVID-19 treatment through the provision of adequate amounts of nutrients.Since the beginning of the pandemic,medical societies have mobilized to provide practical nutritional guidelines to support decision-making;despite this,there are only a few studies dedicated to compiling the most relevant recommendations.In this narrative review,we aimed to summarize and stratify the current scientific literature on nutritional support for hospitalized COVID-19 patients.We carried out a literature review from three databases between January 2020 and July 2021,using nutrition therapy(or medical nutrition or enteral nutrition or parental nutrition or nutritional support)and COVID-19(SARS-CoV-2 infection)as the search terms.Only those studies that evaluated adult hospitalized patients with admissions to wards,specific clinics,or intensive care units were included.The nutritional intervention considered was that of specific nutritional support via oral,enteral,or parenteral modes.A total of 37 articles were included.In general,the nutritional care provided to COVID-19 patients follows the same premises as for other patients,i.e.,it opts for the most physiological route and meets nutritional demands based on the clinical condition.However,some protocols that minimize the risk of contamination exposure for the health team have to be considered.Energy requirements varied from 15 kcal/kg/day to 30 kcal/kg/day and protein goals from 1.2 g/kg/day to 2 g/kg/day.In both cases,the ramp protocol for increased supply should be considered.In cases of enteral therapy,ready-to-use diet and continuous mode are recommended.Attention to refeeding syndrome is essential when parenteral nutrition is used.