Kallen, Victor

The severe consequences of the present Corona Virus Disease 2019 COVID-19 pandemic seem to be closely related to an already ongoing (‘first’) pandemic, directly associated with a sedentary lifestyle. It seems evident that the prognosis after infection is substantially worse for individuals suffering from, for example, (visceral) obesity, cardiovascular disease, and diabetes type 2. Consequently, it may be considered highly relevant to gain insight into the potential beneficial effects of exercise interventions to strengthen the immune system, particularly in high-risk populations. For this reason, the exercise protocols that are suggested to strengthen the immune system, which can be executed by all ages and almost all physical conditions, were reviewed and evaluated. Previously published protocols range from interrupting prolonged sitting, to regular low-to-moderate exercise activities, to high intensity, typically interval, sports formats. Reported positive effects on immune functioning appear to be induced either directly or via beneficial metabolic and/or psychological effects and become measurable after 3 weeks to 3 months. Based in these findings, it appeared possible to design an optimal exercise protocol to maximize effects on immune functioning that should be executable for all, even under restricted (‘lockdown’) circumstances.

BACKGROUND Psycho‐socio stressors may over time result in dominance of the sympathetic nervous system (SNS) over the parasympathetic nervous system (PNS). Reduced PNS control over cardiovascular processes has been associated with decreased health. Heart rate variability (HRV) has been proposed as a technique to quantify SNS and PNS interactions and thus might offer a noninvasive predictive index. OBJECTIVE To investigate the impact of real‐life stressors on HRV fluctuations in independent living elders (EL). METHODS For three months every two weeks EL (N=22; Age=75±9; M/F ratio=17/5) performed autonomic tests consisting of quiet breathing, paced breathing and hand grip. All did a questionnaire assessing depression, positive/negative live events, and isolation. RESULTS Negative events (r=0.36, p=.01) and isolation (r=0.35, p=0.02) are correlated with HR. Personal changes in HRV, SDNN (r=−0.43, p<0.005) and Poincare Width (r= −0.42, p<0.005), are correlated to negative life events. CONCULSION Negative life events reduce HRV which suggests either SNS activation and/or PNS withdrawal. Research was made possible by Healthy for Life, TNO, and the Center for Innovation, Mayo Clinic.

The steadily growing elderly population calls for efficient, reliable and preferably ambulant health supervision. Since cardiovascular risk factors interact with psychosocial strain (e.g., depression), we investigated the potential contribution of psychosocial factors in discriminating generally healthy elderly from those with a cardiovascular condition, on and above routinely applied physiological assessments. Fifteen elderly (aged 60 to 88) with a cardiovascular diagnosis were compared to fifteen age and gender matched healthy peers. Six sequential standardized lab assessments were conducted (one every two weeks), including an autonomic test battery, a 6-min step test and questionnaires covering perceived psychological state and experiences over the previous two weeks. Specific combinations of physiological and psychological factors (most prominently symptoms of depression) effectively predicted (clinical) cardiovascular markers. Additionally, a highly significant prognostic model was found, including depressive symptoms, recently experienced negative events and social isolation. It appeared slightly superior in identifying elderly with or without a cardiovascular condition compared to a model that only included physiological parameters. Adding psychosocial parameters to cardiovascular assessments in elderly may consequently provide protocols that are significantly more efficient, relatively comfortable and technologically feasible in ambulant settings, without necessarily compromising prognostic accuracy.