The Effect of Aerobic Exercise on Immune Biomarkers and Symptoms Severity and Progression in Patients With COVID-19: A Pilot Randomized Control Trial
Condition: Covid19
MeSH terms: COVID-19
Study type: Interventional

Summary: 
      Participants were assigned randomly into two groups, exercise and control groups. All
      participants in both groups followed the WHO guidelines of quarantine and used standardized
      medications given by the physician according to the Turkish Ministry of Health guidelines,
      including the Hydroxyclorocin Sulphate 200 Mg Film Tablet (Plaquenil 200 Mg Film Tablet). The
      dose was 2 times/ day, 200Mg/time, for 5 days. Besides, the exercise group performed
      moderate-intensity aerobic exercises for 40 min/ 3 sessions/week, 40 minute/session.
    

Detailed description: 
      Evaluative procedures There were two main dependent variables including blood immune markers
      and severity of respiratory symptoms. These measurements were collected at the baseline after
      one week and 48 h after the end of the exercise program (two weeks).

      A lab technician was asked to visit the patient at home (quarantine). The lab technician wore
      special protective equipment recommended by WHO. Three visits were performed, one at the
      beginning of the research procedures, one week after, and the last visit at the 48 hours
      after the end of the exercise program (two weeks). The technician collected blood and saliva
      samples to be analyzed.

      Blood sample collection Blood samples were taken in the morning (8:30-9:30). 10mL of venous
      blood was collected. Participants were asked to stop any exercise for at least 24 hours
      before blood sampling. Also, participants were asked to stop eating any food or liquid from
      22:00 the prior day of measurement. Samples were collected in vacutainer tubes with sodium
      ethylenediaminetetraacetic acid (EDTA) for plasma separation. The blood was centrifuged at
      3,000 rpm for 15 min at 4◦C. We measured total lymphocytes, leukocytes, and monocytes from
      total-blood samples utilizing a multichannel hemocyte analysis system (SE-9000; Sysmex Corp,
      Hyogo, Japan). The concentrations of IL-6, IL-10, and TNF-α were analyzed by using ELISA
      commercial kits assay (R&D Systems, Minneapolis, USA) following the manufacturer's
      instructions for analysis on an EZ-Reader microplate reader at 450 nm. The samples were
      stored at -20◦C for further analysis.

      Saliva sample collection A saliva sample was collected to measure the salivary IgA-S
      concentration. The saliva sample was taken without any saliva stimulation methods, the
      participant was asked to rinse their mouths with distilled water and to evacuate their mouth
      just before collection. We used the passive drainage method for the collection, in which the
      participant slightly flexed their head forward to allow the saliva to move into a sterilized
      and pre-weighed Falcon tube for 5min. The weight of tubes were measured again following
      collection, to estimate the volume and the saliva flow rate. The tubes were weighed with
      0.1mg accuracy with proposed saliva density as 1.0 g.mL-1. The samples were stored at -80◦C
      for further analysis. The S-IgA concentration were analyzed utilizing commercial ELISA kits
      (IgA Salivary, DRG, Minneapolis, USA). The IgA-S secretion rate (ng/min) was measured by
      multiplying the whole concentration of IgA-S present in the mucosal surface per unit of time
      by the saliva flow rate (mL/min).

      Wisconsin Upper Respiratory Symptom Survey The Wisconsin Upper Respiratory Symptom Survey
      (WURSS) is an empirically derived patient-oriented illness-specific quality-of-life
      evaluative outcomes instrument. The development process of this survey was described in
      detail by Barrett et al. WURSS-24 is designed to evaluate the negative effect of acute upper
      respiratory infection, presumed viral (the common cold). Its a valid and reliable measurement
      tool to evaluate the measure items and domains that change over time including influenza-like
      illness symptoms of headache, body aches, and fever. The participants were asked to fill the
      survey before starting the study and the 2 times/week.

      Treatment Procedures Participants were assigned randomly into two groups, exercise and
      control groups. All participants in both groups followed the WHO guidelines of quarantine and
      used standardized medications given by the physician according to the Turkish Ministry of
      Health, including the Hydroxyclorocin Sulphate 200 Mg Film Tablet (Plaquenil 200 Mg Film
      Tablet). The dose was 2 times/ day, 200Mg/time, for 5 days Besides, the exercise group
      performed a moderate-intensity aerobic exercises for 40 min/ 3 sessions/week, 40
      minute/session.

      Participants in the exercise group performed a two weeks aerobic exercise program. The
      exercise program consisted of walking/running on a treadmill or bicycling on a stationary
      bicycle. Each session is composed of five-minute warm-up slow walking or bicycling. Then the
      main intervention which composed of thirty-minutes of moderate-intensity aerobic exercises
      (walking/running or bicycling). Lastly, a five-minute of cool-down exercise (walking/running
      or bicycling). The exercise intensity was 60-75% of the predicted MHR (calculated as
      MHR=210-age).

      The Borg Rating of Perceived Exertion (RPE) scale was used to control the exercise intensity.
      PRE is a reliable and validated scale to allow individuals to monitor and guide the exercise
      intensity by rating their level of exertion during exercise. After explaining the scale in
      detail for the patients, we asked them to keep the exertion rating level between 12 to 14
      (light - somewhat hard) on the Borg Scale, which suggests that the patient is exercising on a
      moderate exercise level. The exercise was stopped if the patients experienced any of the
      following signs and symptoms: chest pain, shortness of breath, fainting, claudication,
      fatigue, ataxia, dizziness, cyanosis, or pallor.
    

Intervention name(s): Moderate Intensity Aerobic Exercises
Intervention type(s): Other
Intervention description(s): Participants in the exercise group performed a two weeks aerobic exercise program. The exercise program consisted of walking/running on a treadmill or bicycling on a stationary bicycle. Each session is composed of five-minute warm-up slow walking or bicycling. Then the main intervention which composed of thirty-minutes of moderate-intensity aerobic exercises (walking/running or bicycling). Lastly, a five-minute of cool-down exercises (walking/running or bicycling). The exercise intensity was 60-75% of the predicted MHR (calculated as MHR=210-age).
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Prevention