To examine the effects of 8‐week unsupervised, home‐based inspiratory muscle training (IMT) on the balance and physical performance of healthy older adults. Fifty‐nine participants (74 ± 6 years) were assigned randomly in a double‐blinded fashion to either IMT or sham‐IMT, using a pressure threshold loading device. The IMT group performed 30‐breath twice daily at ~50% of maximal inspiratory pressure (MIP). The sham‐IMT group performed 60‐breaths once daily at ~15% MIP; training was home‐based and unsupervised, with adherence self‐reported through training diaries. Respiratory outcomes were assessed pre‐ and postintervention, including forced vital capacity, forced expiratory volume, peak inspiratory flow rate (PIFR), MIP, and inspiratory peak power. Balance and physical performance outcomes were measured using the shortened version of the Balance Evaluation System test (mini‐BEST), Biodex^® postural stability test, timed up and go, five sit‐to‐stand, isometric “sit‐up” and Biering–Sørensen tests. Between‐group effects were examined using two‐way repeated measures ANOVA, with Bonferroni correction. After 8‐week, the IMT group demonstrated greater improvements (P ≤ 0.05) in: PIFR (IMT = 0.9 ± 0.3 L sec⁻¹; sham‐IMT = 0.3 L sec⁻¹); mini‐BEST (IMT = 3.7 ± 1.3; sham‐IMT = 0.5 ± 0.9) and Biering–Sørensen (IMT = 62.9 ± 6.4 sec; sham‐IMT = 24.3 ± 1.4 sec) tests. The authors concluded that twice daily unsupervised, home‐based IMT is feasible and enhances inspiratory muscle function and balance for community‐dwelling older adults.

The first case of pneumonia was reported on 8 December 2019 and identified on 7 January 2020 as COVID-19. On 9 March 2020, to stop the spread of COVID-19 cases, the Italian government declared a health emergency, forcing all citizens to go into lockdown. Suddenly, schools were constrained to using distance learning strategies with little or limited experience on the topic. Particularly, in the southern regions of Italy, approximately 20% of the students did not have access to any devices and were excluded from learning, producing a direct risk of increased adolescent delinquency. This research team intended to report the results of an observational study that focused on the perceptions of distance learning in adolescents from secondary school in Naples (Italy) between April and May 2020. The questionnaire comprised 11 questions focused on the perceptions of distance learning in comparison to live classrooms, relationships with peers and teachers, and levels of anxiety. The study is amongst the first to report the effect of the pandemic from a student-centred perspective and hopes to produce information to develop future research on asynchronous learning.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltrationviaangiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.

The inspiratory muscles contribute to balance via diaphragmatic contraction and by increasing intra-abdominal pressure. We have shown inspiratory muscle training (IMT) improves dynamic balance significantly with healthy community-dwellers. However, it is not known how the magnitude of balance improvements following IMT compares to that of an established balance program. This study compared the effects of 8-week of IMT for community-dwellers, to 8-week of the Otago exercise program (OEP) for care-residents, on balance and physical performance outcomes. Nineteen healthy community-dwellers (74 ± 4 years) were assigned to self-administered IMT. Eighteen, healthy care-residents (82 ± 4 years) were assigned to instructor-led OEP. The IMT involved 30 breaths twice-daily at ~50% of maximal inspiratory pressure (MIP). The OEP group undertook resistance and mobility exercises for ~60 minutes, twice-weekly. Balance and physical performance were assessed using the mini Balance Evaluation System Test (mini-BEST) and time up and go (TUG). After 8-week, both groups improved balance ability significantly (mini-BEST: IMT by 24 ± 34%; OEP by 34 ± 28%), with no between-group difference. Dynamic balance sub-tasks improved significantly more for the IMT group (P < 0.01), than the OEP group and vice versa for static balance sub-tasks (P = 0.01). The IMT group also improved MIP (by 66 ± 97%), peak inspiratory power (by 31 ± 12%) and TUG (by -11 ± 27%); whereas the OEP did not. IMT and OEP improved balance ability similarly, with IMT eliciting greater improvement in dynamic balance, whilst OEP improved static balance more than IMT. Unlike IMT, the OEP did not provide additional benefits in inspiratory muscle function and TUG performance. Our findings suggest that IMT offers a novel method of improving dynamic balance in older adults, which may be more relevant to function than static balance and potentially a useful adjunct to the OEP in frailty prevention.

COVID-19 has shaped and changed our normalities, and, with the discovery of new variants, the long-COVID syndrome, and stress disorders, the end of the pandemic seems distant. The current scenario is impacting all aspects of our lives. In particular, many studies reported that the pandemic resulted in increased psychiatric disorders and grief-related symptoms in adolescents. The project developed between Italy and Slovenia investigated students’ experiences during the lockdown and, in particular, reported the perception of distanced learning, producing a transparent qualitative analysis that can inform future research and open to discussions on learning strategies. A survey was conducted with secondary school students in Southern Italy between 1 April and 31 May 2020 and in Central Slovenia between 16 March and 28 February 2021. Qualitative and quantitative data were collected based on students’ perception of distanced learning, via an online survey platform. The results focused on three main aspects: learning experience, relationships with peers and teachers, and anxiety levels. The data showed similarities and differences in the two cohorts and suggested strategies to improve education (e.g., with blended approaches) to prepare students, teachers, and tutors for the challenges of returning to classes. In particular, data showed that it is recommended to foster collaboration between EU countries and to work to prevent students’ social isolation.

Current approaches to support patients living with post-COVID condition, also known as Long COVID, are highly disparate with limited success in managing or resolving a well-documented and long-standing symptom burden. With approximately 2.1 million people living with the condition in the UK alone and millions more worldwide, there is a desperate need to devise support strategies and interventions for patients. A three-round Delphi consensus methodology was distributed internationally using an online survey and was completed by healthcare professionals (including clinicians, physiotherapists, and general practitioners), people with long COVID, and long COVID academic researchers (round 1 n = 273, round 2 n = 186, round 3 n = 138). Across the three rounds, respondents were located predominantly in the United Kingdom (UK), with 17.3-15.2% (round 1, n = 47; round 2 n = 32, round 2 n = 21) of respondents located elsewhere (United States of America (USA), Austria, Malta, United Arab Emirates (UAE), Finland, Norway, Malta, Netherlands, Iceland, Canada, Tunisie, Brazil, Hungary, Greece, France, Austrailia, South Africa, Serbia, and India). Respondents were given ∼5 weeks to complete the survey following enrolment, with round one taking place from 02/15/2022 to 03/28/22, round two; 05/09/2022 to 06/26/2022, and round 3; 07/14/2022 to 08/09/2022. A 5-point Likert scale of agreement was used and the opportunity to include free text responses was provided in the first round. Fifty-five statements reached consensus (defined as >80% agree and strongly agree), across the domains of i) long COVID as a condition, ii) current support and care available for long COVID, iii) clinical assessments for long COVID, and iv) support mechanisms and rehabilitation interventions for long COVID, further sub-categorised by consideration, inclusion, and focus. Consensus reached proposes that long COVID requires specialised, comprehensive support mechanisms and that interventions should form a personalised care plan guided by the needs of the patients. Supportive approaches should focus on individual symptoms, including but not limited to fatigue, cognitive dysfunction, and dyspnoea, utilising pacing, fatigue management, and support returning to daily activities. The mental impact of living with long COVID, tolerance to physical activity, emotional distress and well-being, and research of pre-existing conditions with similar symptoms, such as myalgic encephalomyelitis, should also be considered when supporting people with long COVID. We provide an outline that achieved consensus with stakeholders that could be used to inform the design and implementation of bespoke long COVID support mechanisms. None.