Home‐based training strategy to maintain muscle function in older adults with diabetes during COVID‐19 confinement

On 11 March 12020, the World Health Organization (WHO) declared a global pandemic caused by a new virus of the family Coronaviridae that later was denominated severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Like others in the coronavirus family, this virus causes various clinical manifestations under the term coronavirus disease 2019 (COVID‐19), including respiratory symptoms that vary from the common cold to severe pneumonia with respiratory distress syndrome, septic shock, and multiorgan failure. ¹ Since the beginning of the epidemic nearly 2 million cases have been detected worldwide and numbers are rapidly increasing (1 934 583, updated data 14 April 2020). ²

Governments in many countries have adopted strategies proposed by Chinese experts and supported by the WHO to contain the virus, which may lead to movement restrictions for most of their citizens. ³ Potential negative health effects of isolation need to be addressed. Studies have shown that prolonged confinement (eg, in submariners) can result in loss of muscle strength in 2 months ⁴ and that only 7 days of bed rest are needed to impair insulin sensitivity and exercise capacity in healthy young men. ⁵ The joint effort of the world scientific community is generating a large amount of information that is rapidly modified with new evidence, most of it regarding interventions to treat and control COVID‐19. ¹ , ⁶ However, there is a lack of information available about strategies to maintain health while confined during this pandemic, especially in at‐risk populations like older adults and people suffering from type 2 diabetes (DM2) and respiratory and cardiovascular diseases. ¹ , ⁶ In addition, those individuals recovering from COVID‐19 can be expected to have even greater loss of muscle strength. Maintaining muscle mass and its principal functions (strength, power, and endurance) is particularly critical in diabetic older adults undergoing a situation of home confinement. ⁷

Physical activity has been shown to be a very effective strategy in the prevention and treatment of DM2, with similar benefits from both endurance and strength training on insulin sensitivity and glycemic control, ⁸ increased fitness levels, ⁹ and decreased risk of disability. ¹⁰ Moreover, strength training focusing on performing the concentric phase of the movement as fast as possible has been shown to improve physical performance in DM2 frail older people. ¹¹

The Supplement provides a simple, well‐structured multicomponent training program that older DM2 adults could follow at home. The exercise protocol has been developed to maintain muscle mass, strength, and therefore glycemic control and functional ability. ⁷ , ¹⁰ Other important aspects like mobility, flexibility, and balance are also included. In general, this training program is suitable for older adults without severe mobility and/or balance limitations, as well as other medical conditions that would prevent them from performing exercises using high movement velocities (ie, recent hip fractures, stroke). In those cases, mobility‐oriented physical activities have been demonstrated to be a better option to improve physical function. ¹⁰ On the other hand, those patients with chronic inflammatory rheumatic and musculoskeletal diseases could benefit from the present training protocol, because of the growing evidence on the anti‐inflammatory effects of exercise that may help manage inflammation. ¹² It is also important to mention that those persons suffering from foot ulcers or advanced neurodegeneration should avoid exercises involving impacts against the floor that could induce microtrauma. ⁷

The protocol consists of 7 warm‐up and activation exercises, followed by 6 lower and upper extremity strength exercises, and a final cooldown composed of 7 exercises. The training session can be performed 2‐3 times/week, in combination with aerobic training 2‐3 times/week as the American Diabetes Association recommends. ⁷ The session should be completed with a moderate level of perceived fatigue but avoiding high levels of perceived intensity and/or pain/discomfort.

DISCLOSURE

We declare no competing interests.

世卫组织于2020年3月11日宣布了由冠状病毒科的一种新病毒引起的全球大流行, 该病毒被命名为严重急性呼吸综合征冠状病毒2(SARS‐CoV‐2)。与冠状病毒家族中的其他病毒一样, 会引起各种临床表现, 包括从普通感冒到严重肺炎并伴有呼吸窘迫综合征, 败血性休克和多器官衰竭的各种呼吸道症状。

许多国家的政府已经采取了由中国专家提出并得到世卫组织支持的策略来遏制病毒, 但这可能会导致大多数人的活动受到限制。研究表明, 长时间隔离(例如, 在潜艇中)会导致肌肉力量在2个月内的丧失, 只需要7天的卧床休息就能削弱健康年轻人的胰岛素敏感性和运动能力。在这次大流行期间, 特别是在像老年人, 2型糖尿病患者(DM2), 以及有呼吸系统和心血管系统疾病的高危人群中, 缺乏关于在隔离期间保持健康的策略信息。那些从新冠肺炎康复的人预计会有更严重的肌肉力量损失。保持肌肉质量及其主要功能(力量, 能量和耐力)对于处于家庭隔离状态的糖尿病老年人尤为重要。

体力活动已被证明是预防和治疗DM2的一种非常有效的策略, 在提高胰岛素敏感性和血糖控制方面, 耐力和力量训练也具有类似的好处, 提高了健康水平, 并降低了残疾的风险。此外, 极快速地进行同心运动为重点的力量训练已被证明可以改善DM2虚弱老年人的体能。

本文提供了一个简单的, 结构良好的多组分训练计划, 2型糖尿病老年人可以在家里遵循, 以保持肌肉的质量和力量, 从而保持血糖控制和活动能力。在其他重要的方面, 如机动性, 灵活性和平衡性也包括在内。一般来说, 该训练计划适用于没有严重活动和/或平衡限制的老年人, 以及其他会阻止这些患者使用高速进行锻炼的医疗状况(例如, 最近的髋部骨折, 中风)。在这些情况下, 以运动为导向的体育活动是改善身体功能的更好选择。另一方面, 那些患有慢性炎症性风湿性和肌肉骨骼疾病的患者, 可以从目前的训练方案中受益, 因为越来越多的证据表明, 锻炼可能有助于控制炎症。同样值得一提的是, 那些患有足部溃疡或晚期神经变性的人应该避免涉及到可能导致微创伤的地板撞击运动。

该方案包括7个热身和激活动作, 然后是6个下肢和上肢力量动作, 以及由7个放松动作。按照美国糖尿病协会的建议, 训练课可以每周进行2‐3次, 结合有氧训练每周2‐3次。训练结束时应感觉到中等程度的疲劳, 但避免感觉到高强度和/或疼痛/不适。

Supporting information

SUPPORTING INFORMATION