Background: Poor cardiorespiratory fitness poses the highest risk of mortality. Long-COVID-19 survivors exhibit a reduced cardiorespiratory fitness (CRF). While exercise rehabilitation, such as cardiopulmonary exercise, is used for long-COVID-19 survivors, the effects of exercise on CRF in this population remain inconclusive. In this study, we aim to systematically summarise and synthesise whether exercise rehabilitation improves CRF among long-COVID-19 survivors. Methods: A comprehensive search was performed through PubMed, CINAHL, Embase, Scopus, and the Cochrane Library (since their inception to November 2023) and study reference lists. Studies presenting the effects of exercise rehabilitation on CRF (peak oxygen consumption (VO_2peak) and six-minute walk distance (6MWD)) in long-COVID-19 survivors were identified. The standardised mean difference (SMD), mean difference (MD), and 95% confidence interval (CI) were used for analyses. The certainty of evidence was measured using a Grading of Recommendation Assessment, Development and Evaluation approach. Results: Twelve eligible studies (five RCTs and seven non-RCTs) with 682 participants were analysed. The meta-analysis showed significantly improved 6MWDs (MD 76.47, 95% CI 59.19–93.71, low certainty) and significantly greater 6MWDs (SMD 0.85, 95% CI 0.11–1.59, very low certainty) in the exercise rehabilitation group compared to the control group. A significantly improved 6MWD was found in subgroups of young to middle-aged adults and subgroups of patients who undertook aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. Conclusions: Exercise rehabilitation is effective for improving CRF, as measured by the 6MWD in long-COVID-19 survivors. Improvements are likely to be more pronounced in specific subgroups of young to middle-aged adults and patients undertaking aerobic exercise combined with resistance and respiratory exercise and centre-based training programs. However, recommendations for clinical practice are limited due to the very low evidence certainty.

Physical inactivity is a crucial contributor to the obesity epidemic. Previous studies demonstrated that physical inactivity and obesity have been linked with the impairments of pulmonary and respiratory muscle function. However, the impact of physical activity (PA) on pulmonary and respiratory muscle function in obese young adults remains unclear. The study aimed to compare pulmonary and respiratory muscle function between physically inactive and active obese young adults. Obese young adults (BMI ≥ 25 kg/m2) aged between 18 - 25 years old were included. They were classified into 2 groups, physically inactive obese (IO, n = 16) and active obese (AO, n = 14) groups according to the metabolic equivalent of task (MET) obtained from the global physical activity questionnaire (GPAQ). Then, pulmonary and respiratory muscle function were measured. The results showed that there were no differences in baseline data between groups. The AO group showed significantly higher forced expiratory volume in 1 second (FEV1) (2.90 ± 0.55 vs 3.40 ± 0.79, p = 0.04), and maximal inspiratory pressure (MIP) (96.25 ± 6.18 vs 124.50 ± 12.28, p = 0.01) than those IO group. There were no differences between the groups in regard to FVC, FEV1/FVC ratio, %FVC, %FEV1, MVV, %MVV and maximum expiratory pressure (MEP) (all p > 0.05). In addition, FEV1 (r = 0.43, p = 0.01) and MIP (r = 0.40, p = 0.03) were positively moderately correlated with MET. Higher in FEV1 and MIP which observed in physically active obese young adults indicate that regular PA appears to be beneficial to pulmonary function and inspiratory muscle strength in obese individuals. HIGHLIGHTS Several epidemiological studies showed that obesity increases the prevalence of morbidity and clinical presentation of many respiratory diseases. Physical inactivity is one factor that affect respiratory function The pulmonary and respiratory muscle function between physically inactive and active obese young adults were compared Higher values of FEV1 and MIP were observed in obese young adults who were physically active, suggesting the benefits of PA in maintaining pulmonary function and inspiratory muscle strength GRAPHICAL ABSTRACT

Children,obesity,pulmonary function,respiratory muscle,sleep apnea

Prebiotics may reduce adiposity and inflammation, improving cognitive function in obese rats, mediated by modulation of the gut-brain axis. Banana-based snacks are promising prebiotic foods. However, their effects on gut microbiota, inflammation, brain reactive oxygen species (ROS) production, microglial morphology, dendritic spine density, and cognitive function remain underexplored in high-fat diet (HFD)-induced obese rats. Seventy-two male rats were maintained on either a normal diet (ND) or a HFD for 16-weeks. At week 13, ND-fed rats were subdivided into six groups (n = 6/group) receiving either a vehicle (NDV, 10.5 mL/kg/day twice daily), prebiotic snacks from bananas at ripening stages 2-5 (NDS2-5, 7.47 g in water, 10.5 mL/kg/day twice daily), or inulin (NDI, 2 g/kg/day in water, 10.5 mL/kg/day twice daily). HFD-fed rats were similarly subdivided into six groups (n = 6/group) with either a vehicle (HFV), banana-based prebiotic snacks (HFS2-5), or inulin (HFI), administered for four weeks at the same doses as the ND-fed rats. HFD-fed rats exhibited both obesity and insulin resistance, gut dysbiosis, inflammation, and cognitive impairment. However, rats receiving inulin or banana-based prebiotics from all ripening stages exhibited improved cognitive function by reducing gut dysbiosis, oxidative stress, inflammation, brain ROS, apoptosis, dendritic spine loss, and microglial activation. Prebiotic banana snacks from all ripening stages may protect against HFD-induced cognitive impairment by enhancing gut health and reducing inflammation and oxidative stress, potentially via the gut-brain axis. These findings support their potential use as functional foods to promote both cognitive and metabolic health.

The rising prevalence of obesity among young adults presents significant health challenges, particularly due to its adverse effects on cognitive function and physical mobility. This cross-sectional study examined the effects of physical activity on cognitive performance and gait speed in obese individuals aged 18 to 25 years. Seventy-six participants were categorized as either physically active or sedentary based on the Global Physical Activity Questionnaire. All enrolled participants completed the study, and no data were missing. Anthropometric data, including body mass, height, waist circumference, and hip circumference, were collected using standardized procedures. Cognitive assessments included the Trail Making Test, Stroop Color and Word Test, Hand Reaction Time Test, and Logical Memory Test. Gait speed was evaluated using the 10-meter walk test. The physically active group showed significantly better results in logical memory, executive function, and all Stroop test conditions ( p < 0.05). No group differences were found in reaction time, Stroop interference score, or gait speed ( p > 0.05). These findings suggest that higher physical activity levels are linked to better cognitive performance, highlighting the value of promoting physical activity in young adults with obesity. The lack of observed differences in gait speed and reaction time may indicate that these functions are less sensitive to early changes or require longer periods of inactivity to decline in this population.