COVID-19-associated Guillain-Barré syndrome in the early pandemic experience in Lombardia (Italy)

Objective To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the frst pandemic wave, Lombardia. Methods Adult patients admitted to 20 Neurological Units between 1/3–30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). Results Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. Conclusions We detected an increased incidence of GBS in COVID-19 patients which can refect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures

Oxygen consumption and muscle fatigue induced by whole-body electromyostimulation compared to equal-duration body weight circuit training

Background: Whole-body electromyostimulation (WB-EMS) has become increasingly popular under the promise to offer a time-saving and effective exercise protocols. Few studies estimating the training intervention intensity of WB-EMS are available in the literature. Aim: The aim of this study was first to estimate the metabolic demand and muscle fatigue induced by a training session with WB-EMS, and second to compare them to a control intervention. Methods: Ten young participants performed two training sessions: an experimental condition constituted by five exercises with superimposed WB-EMS and a control condition constituted by five body weight exercises. Both sessions lasted 15 min and were based on isometric intermittent contraction (6 of contraction interspersed by 4 s of rest). Muscle fatigue was assessed by determining the force decrease in the following tests: isometric mid-thigh pull; plyometric push-up; counter-movement jump. Oxygen consumption and energy expenditure were recorded by measuring respiratory gases exchange to quantify the metabolic demand of the exercises. Results: The WB-EMS intervention required greater volume of oxygen consumed (WB-EMS 1584 \ub1 251 ml/min; control 1465 \ub1 216 ml/min, p = 0.006) and energy expenditure (WB-EMS 470 \ub1 71 kcal/h; control 438 \ub1 61 kcal/h, p = 0.013) than in control intervention. Overall, the WB-EMS training induced muscle fatigue (all PRE vs POST tests p 64 0.02) whereas the body weight exercises did not (all p > 0.14). Conclusions: These results indicate that WB-EMS intervention constituted a vigorous physical activity. The WB-EMS required also a greater metabolic demand and greater muscle fatigue than a traditional body weight circuit training. Thus, WB-EMS can be considered as an alternative training tool for physically active individuals. \ua9 2016, Springer-Verlag Italia

Mechanical energy patterns in nordic walking: comparisons with conventional walking

The use of poles during Nordic Walking (NW) actively engages the upper body to propel the body forward during walking. Evidence suggests that NW leads to a longer stride and higher speed, and sometimes to increased ground reaction forces with respect to conventional walking (W). The aim of this study was to investigate if NW is associated with different changes in body centre of mass (COM) motion and limbs energy patterns, mechanical work and efficiency compared to W. Eight experienced Nordic Walkers performed 5-min W and NW trials on a treadmill at 4kmh(-1). Steady state oxygen consumption and movements of body segments and poles were measured during each trial. We found greater fluctuation of kinetic (KE) and potential (PE) energy associated with COM displacement for NW compared to W. An earlier increase of KE for NW than for W, probably due to the propulsive action of poles, modified the synchronization between PE and KE oscillations so that a 10.9% higher pendular recovery between these energies was found in NW. The 10.2% higher total mechanical work found for NW was mainly due to the greater work required to move upper limbs and poles. NW was 20% less efficient and was metabolically more demanding than W, this difference could be ascribed to isometric contraction and low efficiency of upper musculature. Concluding, NW can be considered a highly dynamic gait, with distinctive mechanical features compared to conventional gait, due to pole propulsion and arm/pole swing

Muscular and metabolic responses to different Nordic walking techniques, when style matters - Fig 1

<p>Mean values for parameters of total poling force (Ftot, upper panel), propulsive component of poling force (Fprop, central panel) and force effectiveness (EFF%, bottom panel). The error bars indicate standard deviation. Horizontal bars indicate significant differences between NW and other conditions (p < 0.001).</p

Muscular and metabolic responses to different Nordic walking techniques, when style matters

<div><p>Due to poling action and upper body engagement, Nordic walking (NW) has additional health benefits with respect to conventional walking. The aim of this study was to evaluate the differences in muscle activation and metabolic responses between NW, performed with the technique suggested by NW instructors, and with some modifications in the way to move upper limb and poles. Ten NW instructors volunteered to walk on a treadmill at 5.5 km•h^-1 in five conditions: walking (W), Nordic walking (NW), NW with a weak poling action (NW_weak), with straight-upper limbs moving the shoulders (NW_shoulder) and with elbow flexion-extension pattern and shoulder freezed (NW_elbow). Poling forces, body segments and poles movement, upper and lower body muscle activation, as well as metabolic parameters were measured.All modified NW techniques elicited lower muscular activation and metabolic responses with respect to the suggested NW technique (P < 0.05). All NW techniques elicited higher muscular activation and metabolic responses than W. All parameters observed with the NWweak were lower than NW. A decreased activation of shoulder extensor muscles and increased activation of anterior deltoid muscle were the main features of NW_shoulder. Lower triceps brachii muscle activation and reduced propulsive poling action with respect to NW were seen for NW_elbow, resulting also in shorter steps.Nordic walking instructors, sport technicians and practitioners should be aware that any deviation from the technique usually suggested might lead to lower benefits. However it is worth to note that any walking technique with poles elicits higher metabolic responses and muscular activation than walking.</p></div

Group-averaged envelopes of electromyographic signals, normalized with respect to the maximum voluntary contraction (MVC), are reported for 15 recorded muscles for conventional walking (grey), NW_weak (blue), NW_shoulder (green), NW_elbow (red), and NW (black).

<p>Each represented pattern consists in the average of 10 cycles of the eleven subjects.</p

Muscular and metabolic responses to different Nordic walking techniques, when style matters - Fig 3

<p>Mean values for VO₂ (upper panel), HR (central panel) and ventilation (VE, bottom panel) for each conditions. The error bars indicate standard deviation. Horizontal bars indicate significant differences between W and all other conditions and between NW and all other conditions (p < 0.001).</p

Mean ±SD of kinematic data.

<p>Mean ±SD of kinematic data.</p

Mean (±SD) of EMG envelopes normalized by the maximum voluntary contraction (%).

<p>Mean (±SD) of EMG envelopes normalized by the maximum voluntary contraction (%).</p