Open Access
Resistance training and clinical status in patients with postdischarge symptoms after COVID-19: protocol for a randomized controlled crossover trial 'The EXER-COVID Crossover Study'.
(BMC, 2022) Ramírez Vélez, Robinson; Oteiza Olaso, Julio; Casas Fernández de Tejerina, Juan Manuel; García Alonso, Nora; Legarra Gorgoñón, Gaizka; Oscoz Ochandorena, Sergio; Arasanz Esteban, Hugo; García Alonso, Yesenia; Correa Rodríguez, María; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Background: physical exercise induces a coordinated response of multiple organ systems, including the immune system. In fact, it has been proposed that physical exercise may modulate the immune system. However, the potential effect of an exercise program on COVID-19 survivors has not been investigated. Thus, the aim of this study is to evaluate the modifications in immunological parameters, physical condition, inflammatory profile, and perceived persistent symptoms after 6 weeks of supervised resistance training (RT), in addition to the standard care on the clinical status of patients with persistent COVID-19 symptoms. The objective of this protocol is to describe the scientific rationale in detail and to provide information about the study procedures. Methods/design: a total of 100 patients with postdischarge symptoms after COVID-19 will be randomly allocated into either a group receiving standard care (control group) or a group performing a multicomponent exercise program two times a week over a period of 6 weeks. The main hypothesis is that a 6-week multicomponent exercise program (EXER-COVID Crossover Study) will improve the immunological and inflammatory profile, physical condition, and persistent perceived symptoms (fatigue/tiredness, musculoskeletal pain, and shortness of breath) in patients with postdischarge symptoms after COVID-19. Discussion: our results will provide insights into the effects of a multicomponent exercise program on immunological parameters, physical condition, inflammatory profile, and persistent perceived symptoms in patients with postdischarge symptoms after COVID-19. Information obtained by this study will inform future guidelines on the exercise training rehabilitation of patients with postdischarge symptoms after COVID-19.
Open Access
Factor structure of the 10-item CES-D scale among patients with persistent COVID-19
(Wiley, 2022) Ramírez Vélez, Robinson; Olabarrieta Landa, Laiene; Rivera, Diego; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
The presence of persistent coronavirus disease 2019 (COVID-19) might beassociated with significant levels of psychological distress that would meet thethreshold for clinical relevance. The Center for Epidemiologic Studies DepressionScale (CES-D) version 10 has been widely used in assessing psychological distressamong general and clinical populations from different cultural backgrounds. To ourknowledge, however, researchers have not yet validated these findings amongpatients with persistent COVID-19. A cross-sectional validation study wasconducted with 100 patients from the EXER-COVID project (69.8% women;mean (±standard deviation) ages: 47.4 ± 9.5 years). Confirmatory factor analyses(CFAs) were performed on the 10-item CES-D to test four model fits: (a)unidimensional model, (b) two-factor correlated model, (c) three-factor correlatedmodel, and (d) second-order factor model. The diagonal-weighted least-squares estimator was used, as it is commonly applied to latent variable modelswith ordered categorical variables. The reliability indices of the 10-item CES-D in patients with persistent COVID-19 were as follows: depressive affect factor(α=0.82Ord;ω=0.78u−cat), somatic retardation factor (α=0.78Ord;ω=0.56u−cat),and positive affect factor (α=0.56Ord;ω=0.55u−cat). The second‐order model fitshowed good Omega reliability (ω=0.87ho). Regarding CFAs, the unidimensional‐factor model shows poor goodness of fit, especially residuals analysis (root meansquare error of approximation [RMSEA] = 0.081 [95% confidence interval,CI = 0.040–0.119]; standardized root mean square residual [SRMR] = 0.101). The two‐factor correlated model, three‐factor correlated model, and second‐order factormodel showed adequate goodness of fit, and theχ2difference test (∆X2) did not show significant differences between the goodness of fit for these models(∆X= 4.11282;p= 0.127). Several indices showed a good fit with the three‐factor correlated model: goodness‐of‐fit index = 0.974, comparative fit index = 0.990,relative noncentrality index = 0.990, and incremental fit index = 0.990, which were all above 0.95, the traditional cut‐off establishing adequate fit. On the other hand RMSEA = 0.049 (95% CI = 0.000–0.095), where an RMSEA < 0.06–0.08 indicates anadequate fit. Item loadings on the factors were statistically significant (λ≥0.449j;p's < 0.001), indicating that the items loaded correctly on the corresponding factors and the relationship between factors (φ≥0.382;p's≤0.001. To our knowledge, thisis the first study to provide validity and reliability to 10‐item CES‐D in a persistentCOVID‐19 Spanish patient sample. The validation and reliability of this shortscreening tool allow us to increase the chance of obtaining complete data in aparticular patient profile with increased fatigue and brain fog that limit patients' capacity to complete questionnaires.

Ramírez Vélez, Robinson

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