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BackgroundOlder individuals (over 60 years) with hypertension, diabetes, cardiovascular disease, chronic respiratory disease, and cancer are at the highest risk of contracting and dying from Coronavirus (COVID-19). Compromised immunity (both innate and adaptive) and increased inflammatory response (cytokine-storm syndrome) are predictors for high mortality among this population group. Exercise/physical activity seems to be a plausible way to decrease both the risk of transmission and mortality, and improve health outcomes among this population since there is no available treatment for COVID-19. The study will investigate the effectiveness of physical activity/exercise in improving the immune parameters and reducing the inflammatory biomarkers in proxy conditions that make individuals susceptible to COVID-19.MethodsThe Preferred Reporting Items for systematic reviews and Meta-Analyses Protocol (PRISMA-P) 2015 will guide this review. We will search ten databases (until August 2020) to include randomized control trials articles that explored the effectiveness of physical activity/exercise in improving immune parameters and reducing inflammatory biomarkers in proxy conditions (hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer). Two review authors will independently screen citations (title and abstract), extract data (using standardized forms), assess the risk of bias (using Cochrane risks of bias) and quality of data (using GRADE). Homogenous studies will be analyzed using the fixed-effect model of meta-analysis, while a narrative synthesis will be conducted for heterogeneous studies.DiscussionThere are no specific physical activity/exercise parameters (frequency, intensity, type of exercise and time- FITT) for interventionists to use when developing high-quality RCT for individuals vulnerable to COVID-19. Therefore, it is important to review the literature to identify and highlight the exercise FITT parameters that increase the immune outcomes and reduce inflammatory biomarkers for proxy conditions that make individuals susceptible to COVID-19. It is also important to identify the specific exercise regimen suitable and beneficial for each proxy group.Systematic review registrationPROSPERO CRD42020196907

Background HIV infection and chronic use of highly active antiretroviral therapy have been associated with increased expression of pro-inflammatory biomarkers (e.g. high-sensitivity C-reactive protein) and major affective disorders (e.g. depression). There is a growing research interest in aerobic exercise as an adjunct therapy on inflammatory outcomes and depression in people living with HIV (PLHIV) who are undergoing antiretroviral therapy. Synthesizing and appraising available evidence may be essential to guide practice and future research on exercise intervention to this population. This review evaluated the effects of aerobic exercises on serum levels of high-sensitivity C-reactive protein (hs-CRP) and depressive symptoms in PLHIV. Methods Cochrane Central Register of Controlled Trials, MEDLINE, PEDRO, EMBASE, AMED, CINAHL, and Web of Science were systematically searched to include clinical trials that investigated the effects of aerobic exercises on hs-CRP and/or depression in PLWH. Two reviewers independently screened all the articles for eligibility and also evaluated the risk of bias using the Cochrane Collaboration risk of bias assessment tool. Data were extracted and meta-analyses conducted using Review Manager Software. Results Six studies (261 participants) met the inclusion criteria and were included in the review. Four of the studies reported on depressive symptoms and two on hs-CRP outcome The meta-analysis result showed a significant (Z=3.78, p<0.0002) decrease in depression scores in PLWH; implying that aerobic exercise interventions reduce depressive symptoms among PLWH. The two studies that reported on hs-CRP outcome, found no significant effect of aerobic exercise on hs-CRP. Overall, the GRADE evidence for this review was of moderate quality. Conclusion There was evidence that aerobic exercises of about 24-60 minutes duration, two to five times per week can lead to a significant improvement in depression level but not hs-CRP in PLWH. However, it should not be concluded as ‘no evidence of effect’ because the included trials do not have sufficient power to detect treatment effects. Thus, further homogenous research with enough “power” is necessary for a conclusive estimate of effects.

Background HIV infection and chronic use of highly active antiretroviral therapy have been associated with increased expression of pro-inflammatory biomarkers (e.g. high-sensitivity C-reactive protein) and major affective disorders (e.g. depression). There is a growing research interest in aerobic exercise as an adjunct therapy on inflammatory outcomes and depression in people living with HIV (PLHIV) who are undergoing antiretroviral therapy. Synthesizing and appraising available evidence may be essential to guide practice and future research on exercise intervention to this population. This review evaluated the effects of aerobic exercises on serum levels of high-sensitivity C-reactive protein (hs-CRP) and depressive symptoms in PLHIV. Methods Cochrane Central Register of Controlled Trials, MEDLINE, PEDRO, EMBASE, AMED, CINAHL, and Web of Science were systematically searched to include clinical trials that investigated the effects of aerobic exercises on hs-CRP and/or depression in PLWH. Two reviewers independently screened all the articles for eligibility and also evaluated the risk of bias using the Cochrane Collaboration risk of bias assessment tool. Data were extracted and meta-analyses conducted using Review Manager Software. Results Six studies (261 participants) met the inclusion criteria and were included in the review. Four of the studies reported on depressive symptoms and two on hs-CRP outcome The meta-analysis result showed a significant (Z=3.78, p<0.0002) decrease in depression scores in PLWH; implying that aerobic exercise interventions reduce depressive symptoms among PLWH. The two studies that reported on hs-CRP outcome, found no significant effect of aerobic exercise on hs-CRP. Overall, the GRADE evidence for this review was of moderate quality. Conclusion There was evidence that aerobic exercises of about 24-60 minutes duration, two to five times per week can lead to a significant improvement in depression level but not hs-CRP in PLWH. However, it should not be concluded as ‘no evidence of effect’ because the included trials do not have sufficient power to detect treatment effects. Thus, further homogenous research with enough “power” is necessary for a conclusive estimate of effects.