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People infected with COVID-19 have higher risk of dying after cardiac arrest

The researchers found a 2.7-fold increase in the proportion of OHCAs caused by breathing problems, and an 8.6% increase in compression-only cardiopulmonary resuscitation (CPR) during the pandemic. The percentage of people who were treated with both chest compression as well as mouth-to-mouth resuscitation, fell from 33% pre-pandemic to 23% during the pandemic.

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COVID-19 patients who suffer a cardiac arrest either in or out of hospital are far more likely to die than patients who are not infected with the coronavirus. In particular, women have the highest risk of dying: they are nine times more likely to die after suffering a cardiac arrest in hospital, according to research published in the European Heart Journal [1] [2].

The study from Sweden included 1946 people who suffered a cardiac arrest out of hospital (OHCA) and 1080 who suffered one in hospital (IHCA) between 1 January and 20 July. During the pandemic phase of the study, COVID-19 was involved in at least 10% of all OHCAs and 16% of IHCAs. Coronavirus patients who had an OHCA had a 3.4-fold increased risk of dying within 30 days, while IHCA patients had a 2.3-fold increased risk of dying within 30 days. None of these patients had been discharged alive from hospital by the time the study was written in October 2020. Many had died and the rest were still being treated in hospital.

The first author of the study, Dr Pedram Sultanian, a doctoral student at the University of Gothenburg (Sweden), said: “Our study clearly shows that cardiac arrest and COVID-19 is a very lethal combination. Patients with the coronavirus should be monitored intensively and measures taken to prevent cardiac arrest, for instance with the use of continuous heart monitors for patients at high risk.”

This is the first detailed report of characteristics and outcomes in COVID-19 patients who suffer cardiac arrest. The researchers analysed data from the Swedish Registry for Cardiopulmonary Resuscitation (SRCR), which is a nationwide registry that started to collect data on COVID-19 from 1 April 2020 onwards. The researchers included all cardiac arrests registered in the SRCR from 1 January to 20 July 2020, and divided them into a pre-pandemic group (before 16 March) and a pandemic group (16 March to 20 July).

They found that 7.6% of pre-pandemic patients were still alive 30 days after suffering an OHCA. Once the pandemic started, 9.8% of patients without COVID-19 and 4.7% with COVID-19 survived for 30 days; 83.4% of COVID-19 patients died within 24 hours.

Pre-pandemic, 36.4% of IHCA patients survived for 30 days, but once the pandemic started 39.5% of non-COVID-19 patients and 23.1% of COVID-19 patients survived for 30 days; 60.5% of COVID-19 patients died within 24 hours.

The slightly improved survival for uninfected patients suffering OHCA and IHCA during the pandemic is not statistically significant, but the researchers believe that if there is an actual improvement, it might be explained in part by the 8.2% increase in cardiac arrests witnessed by bystanders and the 47% increase in bystanders using defibrillators.

When they compared pre-pandemic cases with COVID-19 cases, the researchers found that the overall risk of dying following an OHCA nearly tripled; it was increased 4.5-fold for men and by a third for women. The overall risk of dying after an IHCA more than doubled; it was increased by a half in men and more than nine-fold in women.

The researchers also found a 2.7-fold increase in the proportion of OHCAs caused by breathing problems, and an 8.6% increase in compression-only cardiopulmonary resuscitation (CPR) during the pandemic. The percentage of people who were treated with both chest compression as well as mouth-to-mouth resuscitation, fell from 33% pre-pandemic to 23% during the pandemic. In March the European Resuscitation Council and the Swedish Resuscitation Council issued guidelines recommending that bystanders who see a cardiac arrest should avoid mouth-to-mouth resuscitation and concentrate on chest compressions in the case of suspected COVID-19 infection.

Senior author of the study, Dr Araz Rawshani, physician and researcher at the University of Gothenburg, said: “Although previous studies have indicated that compression-only CPR delivered by bystanders may be as effective as compressions and ventilation combined, this may not apply to cases with COVID-19, since they are primarily suffering from respiratory failure. We believe this is an important finding that could possibly help authorities in handling the pandemic. Since COVID-19 transmits through droplets, bystanders should avoid mouth-to-mouth resuscitation in accordance with current recommendations. There is no unanimous answer for how society and healthcare providers should adapt in the light of this issue.”

The study also shows that fewer patients in hospital with COVID-19 were monitored with electrocardiograms, which is potentially life-saving as it enables a cardiac arrest to be spotted immediately. It is believed that COVID-19 patients should be monitored with ECGs and monitored for oxygen saturation, as this would allow for prompt recognition of irregular heartbeats and declining oxygen saturation.

Limitations of the study include the fact that the county of Stockholm, where the majority of coronavirus cases have occurred, had not reported data on OHCAs at the time of the study and this reduced the number of COVID-19 patients in the study; and some cases of COVID-19 may have been misclassified, particularly for cardiac arrests occurring out of hospital.

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[1] “Cardiac arrest in COVID-19: characteristics and outcomes of in- and out-of-hospital cardiac arrest. A report from the Swedish Registry for Cardiopulmonary Resuscitation”, by Pedram Sultanian et al. European Heart Journal. doi:10.1093/eurheartj/ehaa1067

[2] A cardiac arrest is when the heart suddenly stops pumping blood, leading to the patient collapsing unconscious and either stop breathing or gasp for air. It is different to a heart attack, which occurs when the blood supply to the heart is cut off, often because of a clot in one of the coronary arteries. The heart will still be pumping blood round the body and the patient will be conscious and breathing. A heart attack can lead to a cardiac arrest.

Fitness

5 Ways to find your morning workout motivation

If you’re looking to make your early workout successful and one you’ll actually stick with, consider these tips.

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Photo by Anastase Maragos from Unsplash.com

For many people, hitting the gym in the morning leaves less time for excuses or interferences.

However, finding the motivation to get up and work out first thing can be a huge hurdle. If you’re looking to make your early workout successful and one you’ll actually stick with, consider these tips:

1. Get Out of Bed, No Matter What

Making the first move may be the hardest part. Try setting two alarms and keeping them away from your bed. Walking across the room immediately after your alarm sounds gets you up and helps deter you from pressing snooze. Even sleeping in your (clean) workout clothes can make it easier to get going once you’re up.

2. Find a Workout Buddy

Having a partner can be motivational and help hold you accountable. It’s oftentimes easier to push through a tough workout when someone else is keeping you in check.

3. Commit to a Class

There are many ways to work out in the morning, and it’s up to you to decide what kind of exercise is best suited for your fitness goals. Consider the potential benefits of a scheduled class: working out with a group gives you an appointment to keep, a set time and place and an instructor and team to push and encourage you even when you feel like giving up.

4. Refuel for the Day (and Workouts) Ahead

Post-workout nutrition is critical to refueling your body after a tough workout, allowing you to take on the day ahead. Try lowfat chocolate milk. Its carb-to-protein ratio has been scientifically shown to effectively refuel exhausted muscles. The sugar in chocolate milk is the secret to its ratio, one that elite athletes have trusted for years. And you may be surprised to learn that chocolate milk also naturally contains the same electrolytes added to commercial sports drinks.

5. Give Yourself a Break

Keep in mind that after exhaustive endurance exercise, your body needs rest time (24-48 hours) to adequately replace your depleted glycogen stores. Take some time to let your body and mind prep for the next workout.

For additional workout and recovery inspiration, visit BuiltWithChocolateMilk.com.

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Fitness

Resistance training paired with peanut protein affects muscle health in older adults

Evidence-based and cost-effective lifestyle interventions, such as resistance training (RT) and ensuring optimal dietary protein intake, aim to increase muscle mass in older individuals, and support healthy aging and longevity.

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Declines in muscle mass and strength can begin in early adulthood, unnoticeable at first, and eventually progress until functionality, endurance, and general health may be compromised. Evidence-based and cost-effective lifestyle interventions, such as resistance training (RT) and ensuring optimal dietary protein intake, aim to increase muscle mass in older individuals, and support healthy aging and longevity.

Now, as the popularity and consumer demand for plant-based protein to support exercise training grows, the full array of essential and non-essential amino acids and high protein digestibility of defatted peanut protein powder (PP) makes it an exceptional plant-based protein option. Yet, no studies to date have examined if PP combined with RT can enhance training adaptations and measures of muscle mass, function and strength, especially in an older population. For the first time, a randomized controlled clinical trial from researchers at Auburn University published in the Journal of the International Society of Sports Nutrition demonstrates that in combination with RT, intake of PP positively affects select markers of muscle growth and strength among untrained, older adults.

“Many of the previous studies in this space have looked at how animal-based or soy protein-based supplements enhance the response to resistance training,” says Dr. Roberts, PhD, a co-principal investigator on the study from Auburn University in the School of Kinesiology. “This study suggests that pairing resistance training with supplemental peanut powder may be an effective plant-based protein solution to meet protein needs and perhaps slow or prevent age-related loss of muscle in older adults.”

Thirty-nine older, untrained individuals completed a six-week or ten-week supervised RT program, where full-body training was implemented twice weekly. Participants were also randomly assigned to consume either a PP supplement mixed with 16 fl. oz. of water once per day (75 total grams of powder providing 30 grams protein, >9.2 grams of essential amino acids, ~315 calories) or be a “wait-list” control who did not receive any supplement (CTL). On workout days, PP supplements were provided immediately following exercise and compliance was monitored by trained study personnel. Skeletal muscle biopsies and other markers of muscle quality, body composition and strength, as well as three-day self-reported habitual food intake, were collected.

PP supplementation significantly increased knee flexion peak torque – a marker of muscle strength – in the ten-week cohort relative to the CTL group. In looking at the combined data from both the six- and ten-week groups, PP participants experienced significant increases in vastus lateralis (VL) thickness – a measure of muscle growth – compared to CTL participants. Notably, the consumption of protein and fiber significantly increased during the study in the PP group compared to CTL. This is attributed to the ~15 grams per day of fiber and 30 grams per day of protein received from the nutritional supplement. Surprisingly, PP supplementation after one bout of resistance exercise did not enhance muscle protein synthesis rates within a 24-hour period following the first training bout. Body composition was not different between the PP and CTL groups.

“There is strong evidence to suggest protein needs, specifically, the intake of more essential amino acids, increase with age due to many factors,” added co-principal investigator, Drew Frugé, PhD, RD, with the Department of Nutrition, Dietetics and Hospitality Management at Auburn University. “The protein isolated from peanuts contains a full complement of essential amino acids, including the important muscle growth ‘switch’ leucine, that can be delivered in a nutrient-dense package with the functional benefit of being simply incorporated into many easy to consume and tasty food or beverage preparations that meet the dietary needs of older adults.”

This study followed a rigorous methodology by using a randomized design in a laboratory setting and supervising participant training, as well as PP supplement compliance. However, the researchers noted a few limitations, mainly the duration of the intervention of the second cohort. As the original intent was to recruit two separate ten-week cohorts, due to the SARS-CoV-2 pandemic, the researchers voluntarily decided to end the second cohort after only six weeks of training to maintain the health and safety of the participants. The decision to compare PP supplementation to no supplementation was made to establish more “real world” relevance (i.e., people supplement their diets with protein powder, or nothing at all).

Despite such limitations, the researchers concluded that “…peanut protein powder supplementation with 6-10 weeks of resistance training enhance certain aspects of muscle hypertrophy and strength in older adults, compared to a resistance training program alone in the elderly population.” Future studies that are longer in duration are needed to definitively determine if PP supplementation can enhance hypertrophic adaptations with resistance training.

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The article, “The effects of resistance training with or without peanut protein supplementation on skeletal muscle and strength adaptations in older individuals”, is published in Journal of the International Society of Sports Nutrition.

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Fitness

Getting into shape pre-surgery to aid recovery for older patients – study

Older adults about to undergo elective surgery should undertake a sustained programme of targeted exercise beforehand to counteract the muscle-wasting effects of bedrest, new research suggests.

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Older adults about to undergo elective surgery should undertake a sustained programme of targeted exercise beforehand to counteract the muscle-wasting effects of bedrest, new research suggests.

A study published by researchers in the University of Birmingham’s School of Sport, Exercise and Rehabilitation Sciences showed that short term ‘prehabilitation’ strength exercises, undertaken pre-surgery, are insufficient to prevent muscle loss.

In the study, the researchers asked a group of older adults to perform four sessions of weight lifting exercise over one week. The participants did the exercises using only one leg, while the other leg did no exercise at all.

After completing the prehabilitation, the participants underwent five days of bed-rest – a typical length of stay in hospital for an older patient. Although the researchers expected to find that the leg which had undergone the exercise would experience less muscle loss than the other leg, in fact they found muscle loss was about the same in both legs.

The team’s detailed analysis showed that, while short-term exercise prehabilitation does enhance the body’s muscle-building processes, thigh muscle-wasting was about 3-4 per cent in both legs – roughly equivalent to what older adults would typically lose over 3-5 years of ageing.

The researchers recommend that one approach to protect older muscle from wasting during hospitalisation is to perform longer-term strength exercise prehabilitation beforehand.

Dr Leigh Breen, the study’s corresponding author, says: “Although short-term prehabilitation offers a cost-effective and easy-to-implement strategy, it does not prevent muscle wasting among older adults undergoing bed-rest. This muscle loss may be extremely hard to recover from and can lead to long-term health and disease complications.”

The team recommend that prehabilitation exercise programmes should also incorporate aerobic exercise alongside strength training to protect cardiovascular health, and a protein rich diet to increase muscle mass levels in a way that will effectively cancel out the muscle loss that is experienced during bed-rest

They also recommend that, where appropriate and safe, hospitalised older patients should aim to get back on their feet and mobile again as quickly as possible. Post-surgery exercise and dietary strategies will also be important to ensure a return to full health and lower the risk of future health complications.

Dr Benoit Smeuninx, now at Monash University in Australia, is lead author on the paper. He says: “Our study reinforces the need for more research into the benefits of longer term training programmes prior to surgery. In the same was as an athlete would train before a race or a competition, exercise training before hospitalisation is likely to be highly beneficial to older adults undergoing elective surgeries.”

The work was completed in collaboration with colleagues within the Medical Research Council Versus Arthritis Centre for Musculoskeletal Ageing Research, which is a partnership between the University of Birmingham and the University of Nottingham. The work was funded by the Biotechnology and Biological Sciences Research Council.

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