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Archives of Clinical and Medical Case Reports, Volume 5, pp 84-90; doi:10.26502/acmcr.96550330

Abstract:
For much of mankind, the COVID-19 pandemic created an extraordinary condition, with a severe impact on almost all domains of life. Physical activity (PA) was no exception, and disturbing findings showing the deleterious effect of lockdown measures on PA were recorded in relevant studies conducted in several different countries. It appears that society has overlooked or underestimated the advantages of PA in developing a defense against the virus and the incremental trend of non-communicable diseases (NCDs), and the prevalence of physical inactivity has presented many major challenges to public health authorities. In this article, in the presence of COVID-19, we briefly remember and highlight the beneficial impact of a physically active life and daily exercise training on public health, even more so for the most vulnerable groups. In this respect, we should not underestimate the role of PA and non-exhaustive exercise as a countermeasure and an indirect therapeutic agent against the virus, as well as against NCDs and mental health issues arising from the COVID-19 crisis.
Antonella Marchetti, Cinzia Di Dio, Davide Massaro,
Published: 24 September 2020
Frontiers in Psychology, Volume 11; doi:10.3389/fpsyg.2020.02245

Abstract:
The coronavirus disease 2019 (COVID-19) pandemic has prompted much research on the possible use of robots in different areas of intervention. One of them is related to the deployment of social robots to cope with different needs elicited by and depending on the emergency. According to a recent article published in Science (Yang et al., 2020, p. 1) “social robots could be deployed to provide continued social interactions and adherence to treatment regimens without fear of spreading disease.” In this context, social isolation and quarantine—often significantly prolonged due to the duration of the infection—have plausibly exerted a negative impact on well-being and perhaps mental health, whose jeopardy was even more likely if a previous psychological vulnerability was present. If historically robots have been employed in dangerous and risky duties, presently, some of the most promising domains of robots' development also include rehabilitation, caring, and educational and clinic intervention. We are witnessing a shift from the concept of “robot as slaves” to “robots as companions, nurses, teachers…” that, in a word, behave, interact, and work “like us” (cfr. Marchetti et al., 2018). Yang et al. argue that social robots used to “adherence to treatment regimens without spreading of fear” need to be implemented following sophisticated human models, including mental states like emotions and beliefs, as well as the context and environment of the interaction (p. 2). In our opinion, the “environments” are the affordances strictly linked to survival in an evolutionary sense. The “context” is represented by everyday life socio-material and socio-cognitive cues. Furthermore, we believe that the implementation of social robots based on every possible human model cannot merely be the product of “a fusion of engineering and infectious disease professionals” (Yang et al., 2020, p. 2). The model would require an interdisciplinary perspective that includes also the contribution of psychologists. The recent pandemic has in fact laid the foundations for rereading our daily relationships from the point of view of not only human relations but also other agents, such as robots. In the present Opinion, we therefore suggest that the use of robots is not only a purely technical issue but also supported by important changes in the way we view relationships, particularly with those who are close to us. With this aim in mind, we focused on identifying some psychological components most subject to change due to the current global situation. Let's take, for example, the emotion of fear mentioned above. Fear will probably take (if not already has) a different form because of the virus. Fear is a primary (Ekman and Friesen, 1971) and adaptive emotion developed through evolution to enable coping with danger and ensure survival. Predators, contaminants, and invaders are the potentially dangerous enemies that are all risky variables toward which close relationships usually act as protective factors. In case of fear, the options for the individual are represented by the so-called “fight or flight” behaviors. On the relational level, it is the search for a secure base (Bowlby, 1988), where a place can be found for reassurance and affective supply. This tendency persists also in adulthood due to the transgenerational transmission of attachment patterns. Nonetheless, COVID-19 pandemic confronted us with a scenario where “fear has no face.” Now, it also involves close relationship partners, i.e., people who potentially are sources or recipients of care. This profoundly contrasts with a series of fundamental developmental achievements that make physical proximity the embodied prototype of psychological proximity. The individual undertakes a path in which the “known social other”/“unknown social other” dichotomy acts as an organizer of beliefs and attitudes, thus contributing to the construction of the Self as a distinct and separate entity from the Other. From a sensorineural point of view, the human baby is equipped to recognize and trustfully orient herself/himself toward primary figures of care and protection; it is precisely on this basis that trust is built in others and ourselves (Di Dio et al., 2019, 2020a,b; Manzi et al., 2020a,b). The so-called “anguish of the stranger” (Spitz, 1945; Schaffer, 1966) emerges around 8 months of age. It marks the distinction between the caregivers and all the others: before becoming a neutral agent that the child will observe and know, the “other” per se is perceived as scary (worthy of fear in other words). This step appears to be in line with the older child's behavior observed within the Strange Situation (a paradigm aimed at evaluating attachment; Ainsworth et al., 1978): the response of distress and fear toward the stranger, who is generally more accepted if the mother is at the child's presence, and the reactions toward whom are predicted by the security of the child's attachment to the mother. Later in life, the developing child can establish attachment bonds with other people in her/his life contexts: friends, schoolmates, relatives of the extended family, teachers, and educators in various contexts, from school to sports activities (Pianta, 1999). While the theoretical perspective of multiple attachments postulates that the widening of the “known social other” sphere is characterized by a differentiation of the functional roles played by multiple relationships, it maintains the fundamental developmental ability to identify the other as a “secure-safe social partner,” distinguishing him/her from the “risky-unsafe social partner.” The possibility to create multiple attachments prevents a series of developmental risks and acts as an enhancer of positive primary...
, Thiago Santos Rosa, Caio Victor Sousa, Samuel Da Silva Aguiar, Daisy Motta-Santos, Hans Degens, Marko T. Korhonen, Carmen Silvia Grubert Campbell
Frontiers in Sports and Active Living, Volume 2; doi:10.3389/fspor.2020.00087

Abstract:
We are waging a war against a deadly virus that has already resulted in the death of thousands of people worldwide (Burn-Murdoch, 2020). Against this invisible enemy, we have a sophisticated defense: our immune system. After infection, leukocytes proliferate and send signals to other immune cells to replicate and differentiate and, hence, increasing recruits to the army to combat the invaders in an attempt to ensure survival (Immunology, 2013). During every cell division, telomeres shorten and this shortening will over time result in dysfunctional proteins and cells, leading to apoptosis, cell senescence, and ultimately death (Arbeev et al., 2020). This shortening is accelerated during chronic inflammation and oxidative stress, as they stimulate cell division for tissue repair and the immunological response (Blackburn et al., 2015). Shortened leucocyte telomeres, a marker of immunosenescence, may hamper the effectiveness of these cells to replicate and contribute to the diminished resistance to infections often seen in older individuals, particularly if their immune system is already challenged by chronic diseases, systemic inflammation, or other morbidities (Castelo-Branco and Soveral, 2014). Given the above observations, it is not surprising that most deaths caused by COVID-19 occur among frail sedentary elderly people with comorbidities (Abduljalil and Abduljalil, 2020). Lymphopenia, characterized by a low number of CD4+ and CD8+ T lymphocytes, may well-contribute to the poor prognosis in more severe cases of COVID-19 (Tan et al., 2020), and may be the consequence of replicative failure and early lymphocyte senescence. This then supports the importance of telomerase activity and long leukocyte telomeres for immune homeostasis and a better outcome while facing infections (Helby et al., 2017). It is thus not surprising that longer leukocyte telomeres are indeed associated with better survival from sepsis and a lower severity of acute respiratory syndrome in critically ill patients (Liu et al., 2020). In this context it is interesting to note that older individuals engaged in high levels of physical activity (Puterman et al., 2010; Sjogren et al., 2014), have longer leukocyte telomeres and are biologically younger and healthier than age-matched sedentary older people (i.e., better blood pressure, autonomic balance, body composition, and lipid profile; Simoes et al., 2017; Deus et al., 2019; Sousa et al., 2019). They also have a preserved proportion of naive CD4+ cells without senescent T-cells accumulation than age-matched sedentary people (Minuzzi et al., 2018). This may at least partly be due to their lower level of systemic inflammation and oxidative damage (Aguiar et al., 2019, 2020). It is to be expected that such a profile will significantly enhance the ability of master athletes to combat infections, including COVID-19, above that seen in their unfit age-matched peers (Figure 1). Taken together, the increased antioxidant defenses and anti-inflammatory cytokines lead to an attenuated telomere attrition over life and attenuate biological aging, including that of the immune system (Figure 1), and will preserve immune homeostasis and proper lymphocyte replication (Pedersen and Toft, 2000; Bopp et al., 2004), possibly preventing COVID-induced lymphopenia, in master athletes. Figure 1. Physical fitness and age-related biomarkers in regards to immune function, and possible outcomes in case of SARS-CoV-2 infection. (A) For sedentary person telomere length decreases during aging mainly due to associated chronic inflammation (“inflammaging”) and oxidative stress. Shorter telomere lengths lead to dysfunctional cells and immunosenescense that in turn contribute to a higher incidence of chronic diseases and immunosuppression. These conditions lead to a worsened prognosis in case of SARS-CoV-2 infection. (B) On the other hand, well-conditioned Master Athletes have a better anti-inflammatory profile and improved anti-oxidant defenses that are associated with longer leukocyte telomere lengths, preserved cellular function, immunosenescence prevention, and increased levels of nitric oxide compared to sedentary peers. These positive adaptations reduce the risk of developing chronic diseases and, if infected by SARSCoV-2, Master Athletes will possibly have a better outcome while facing COVID-19. (C) Illustrative representation of telomere length in leukocytes of young adults, middle-aged master athletes and sedentary peers. According to recent studies, the telomere length of master athletes is greater than that of age-matched sedentary, and may not differ from young adults, suggesting that master athletes are biologically younger than their chronological age (Simoes et al., 2017; Aguiar et al., 2019; Sousa et al., 2019). Master athletes are individuals who continue to train and compete in sporting events beyond middle age. Currently, it is not rare to see octogenarians and even centenarians running and jumping at master athletics competitions, evidencing a healthy-functional aging induced by lifelong training routines. In addition to the health benefits of regular exercise, we also observed elevated levels of circulating nitric oxide (NO) in middle-aged master athletes (Sousa et al., 2019). This is significant, as NO has antibacterial and antiviral properties that are effective against hepatitis virus and, more to the point for the present time, was effective against the coronavirus in vitro, during African Green monkey cells infection (Keyaerts et al., 2004). Given this observation and that previous research has used inhaled NO to treat acute respiratory syndrome (Chen et al., 2004), NO could diminish the complications of a COVID-19 infection. These benefits of higher NO bioavailability could be mediated by enhancing vasodilation, reduction of edema in the alveoli, its antithrombotic effects and inhibition of both neutrophils activation and cytokine release (Green, 2020; Kobayashi...
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