A Proposal of Physical Performance Tests Adapted as Home Workout Options during the COVID-19 Pandemic

applied sciences Article A Proposal of Physical Performance Tests Adapted as Home Workout Options during the COVID-19 Pandemic Danúbia da Cunha de Sá-Caputo 1,2 , Redha Taiar 3,* , Adérito Seixas 4, Borja Sanudo 5, Anelise Sonza 6and Mario Bernardo-Filho 1 1Departamento de Biofísica e Biometria, Laboratório de Vibrações Mecânicas e Práticas Integrativas, Policlínica Piquet Carneiro and Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20950-003, Brazil; [email protected] (D.d.C.d.S.-C.); [email protected] (M.B.-F.) 2Faculdade Bezerra de Araújo, Rio de Janeiro 23052-180, Brazil 3Champagne Ardenne, Universitéde Reims Champagne Ardenne, 51100 Reims, France 4Departamento de Fisioterapia, Escola Superior de Saúde, Universidade Fernando Pessoa, 4200-253 Porto, Portugal; [email protected] 5Departamento de Educación Física y Deporte, Universidad de Sevilla, 41013 Seville, Spain; [email protected] 6Departamento de Fisioterapia, Programa de Pós-Graduação (PPG) em Fisioterapia e PPG em Ciências do Movimento Humano, Centro de Ci ê ncias da Sa ú de e do Esporte, Universidade do Estado de Santa Catarina, Florianópolis 88080-350, SC, Brazil; [email protected] *Correspondence: r[email protected] Received: 13 May 2020; Accepted: 7 July 2020; Published: 10 July 2020   Featured Application: Several countries adopted social isolation and home confinement as measures to slow down the infection rates of the new coronavirus disease. This measure may decrease the levels of physical activity and general health of the individuals. This manuscript proposes the use of known and simple physical tests adapted as home-based exercises to avoid sedentary behavior and decrease in quality of life of the population. Abstract: Social isolation and physical distancing measures, such as quarantine, local confinement, lockdown and isolation, aim to slow the spread of the coronavirus disease (COVID-19). This condition is necessary; however, sedentary behaviors are stimulated. The aim of this manuscript is to propose simple home-based exercises that everyone, considering their individual limitations, could perform. Moreover, individuals might monitor their performance daily. Feasible and useful home-based exercise strategies, to counter-balance the negative impact of the sedentary lifestyle during confinement, will stimulate the population to perform some exercises wherever possible. For this, home-based exercises were proposed based on physical tests, such as a stair climb test, balance test, single-leg-stance-test, gait speed, five-chair stand, free walking, free run, six-minute walk test, timed up and go, sit-and-reach, fingertip-to-floor test, and free physical exercises. It is important to consider that when the individual is performing the test, physical exercise is also being done. In conclusion, several exercises that consider the clinical conditions of the individuals and can reduce their sedentary behavior, considering COVID-19 confinement, are suggested to improve the population’s quality of life. Keywords: COVID-19; social distancing; physical exercise; home-based exercise; home; confinement Appl. Sci. 2020,10, 4755; doi:10.3390/app10144755 www.mdpi.com/journal/applsci Appl. Sci. 2020,10, 4755 2 of 17 1. Introduction To decrease the spread of the coronavirus disease (COVID-19) and to reduce the interaction between unrecognized infected and non-infected individuals, different strategies have been proposed, ranging from quarantine, local confinement, lockdown, and isolation. Although people may have sedentary behaviors and be physically active, it has been suggested that, while confined at home, individuals reduce their daily activities outside and, consequently, the level of physical activity is thought to decrease. This may have a negative impact in general heath and contribute to sedentary behaviors [1]. COVID-19 is caused by a respiratory virus called SARS-COV2 and was first described in Wuhan, China in December 2019. This condition has characteristics (pathogen transmissibility and virulence) that favor the pandemic potential and its rapid global spread [ 2 , 3 ]. Individuals with COVID-19 can present mild to moderate respiratory illness and recover without requiring special treatment. Some people have more chances to develop serious illness, as older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer [ 3 ]. Actions have been proposed to try to avoid the COVID-19 infection, such as: (i) washing hands frequently; (ii) maintaining social distancing; (iii) avoiding touching the denoted facial T-zone (eyes, nose, mouth), as this is the access point for virus into the upper respiratory tract; and (iv) practicing respiratory hygiene [ 4 , 5 ]. Considering the World Health Organization (WHO) advice related to social distancing, to prevent the spread of the infection to a large number of people at the same time, which would cause a collapse in the health systems of the affected countries and the death of many people, the possibility to perform physical exercise (PEx) is reduced. PEx can be defined as a systematic sequence of movements executed with a predefined purpose. It impacts not only circulatory adaptations, but also neuronal integration with the potential to influence cognition [ 6 ]. In addition, the importance of PEx practice to prevent overall mortality [ 7 , 8 ], as well as cardiovascular disease-related mortality [ 9 ], or cancer-related mortality have been pointed out [9–11]. Some physical tests, if performed regularly, can be compared to physical exercises due to the biomechanical stimulus promoted. When tests are used to improve physical performance, there are advantages related to the same “exercise” that can be performed to improve the physical performance of the individual and, itself, can be used to measure its effects on the individual. It is important to consider that when the individual is performing the test, an exercise is also being done. Exercise can be defined as any bodily activity that enhances or maintains physical fitness and overall health, wellness, and productivity [ 12 ]. This would increase the performance of the individual in that particular PEx and the same test can be used to assess the improvements in physical fitness. In this context, attempting to avoid the growing and undesirable consequences due to sedentary behavior in the period of the COVID-19 pandemic, it is important to stimulate the practice of PEx at home. The aim of this manuscript is to present a proposal of simple home-based exercises that everyone could perform. Moreover, as it is possible to measure outcomes, such as time and/or distances, the individuals might register their performance daily. 2. General Considerations This manuscript will suggest feasible and useful strategies to counter-balance the negative impact of sedentary behavior during the COVID-19 pandemic that can be done at home and, in the future, to stimulate the population to exercise wherever or whenever possible. The selected modalities of PEx activities are deeply related to physical tests used to assess the physical performance of individuals. They are safe, simple, valid, scientifically supported by evidence in publications found in PubMed, PEDro, and Scopus databases, and can be performed at home. The physical tests, stair climb test (SCT), balance test, single-leg-stance-test (SLST), gait speed, five-chair stand (5CS), free walking, free run, six-minute walk test (6MWT), timed up and go (TUG), sit-and-reach (SR), fingertip-to-floor test, and free physical exercises, are presented as PEx, with their aim, description, feasibility, and clinical practice for the home-based exercises. The exercises should be Appl. Sci. 2020,10, 4755 3 of 17 chosen based on the preferences and fitness of the individuals, and several exercises were proposed, providing several options to the individuals. In general, to practice the exercises at home, the individual will need a timer or a watch to time the activity, or an application, such as Nike Run Club ® or similar. Furthermore, it is important to point out the relevance of a safe place (with other persons nearby, or with objects to support the individual, if necessary). Individuals with motor and/or cognitive limitations, and that do not feel confident in being able to perform the exercise must have the help of family or caregivers to perform the exercises, even if they are practical and simple to perform. Another general recommendation is that exercises can be adapted in terms of difficulty, for instance, exercises on stairs can be started on stairs with handrails to provide support if needed and when the individual is confident the support can be avoided, and in exercises with chairs the individuals may use chairs with armrests to provide support if needed and when the individual is confident the support can be avoided. In plank exercises the individuals may start with the knees on the floor, progressing to the normal plank posture. These are some examples, but the main idea is that individuals must feel comfortable while doing the exercise. An additional and important recommendation is that, although PEx is very relevant, the individual must drink sufficient water or juice and have good nutrition. In addition, the time spent to perform the exercises per day must consider the individual characteristics, and a time about 30 min would be desirable [13]. 3. Self-Progress Registration A simple system can be used to record the variables of interest for the selected exercises (Figure 1). The date of the activity, the type and the time (min or s) and/or the distance during the activity would be collected daily. Moreover, the individual can report some undesirable condition, such as fatigue, dyspnea, pain, and vertigo. Figure 2shows a spreadsheet suggestion for the individual to register the aims, feasibility, and practical application to guide the home-based exercises adapted from the physical tests. Appl. Sci. 2020, 10, x FOR PEER REVIEW 3 of 18 be chosen based on the preferences and fitness of the individuals, and several exercises were proposed, providing several options to the individuals. In general, to practice the exercises at home, the individual will need a timer or a watch to time the activity, or an application, such as Nike Run Club® or similar. Furthermore, it is important to point out the relevance of a safe place (with other persons nearby, or with objects to support the individual, if necessary). Individuals with motor and/or cognitive limitations, and that do not feel confident in being able to perform the exercise must have the help of family or caregivers to perform the exercises, even if they are practical and simple to perform. Another general recommendation is that exercises can be adapted in terms of difficulty, for instance, exercises on stairs can be started on stairs with handrails to provide support if needed and when the individual is confident the support can be avoided, and in exercises with chairs the individuals may use chairs with armrests to provide support if needed and when the individual is confident the support can be avoided. In plank exercises the individuals may start with the knees on the floor, progressing to the normal plank posture. These are some examples, but the main idea is that individuals must feel comfortable while doing the exercise. An additional and important recommendation is that, although PEx is very relevant, the individual must drink sufficient water or juice and have good nutrition. In addition, the time spent to perform the exercises per day must consider the individual characteristics, and a time about 30 minutes would be desirable [13]. 3. Self-progress registration A simple system can be used to record the variables of interest for the selected exercises (Figure 1). The date of the activity, the type and the time (min or s) and/or the distance during the activity would be collected daily. Moreover, the individual can report some undesirable condition, such as fatigue, dyspnea, pain, and vertigo. Figure 2 shows a spreadsheet suggestion for the individual to register the aims, feasibility, and practical application to guide the home-based exercises adapted from the physical tests. Figure 1. Spreadsheet suggestion to allow the individual to register the daily “self-progress” of the home-based exercises adapted from the physical tests. Figure 1. Spreadsheet suggestion to allow the individual to register the daily “self-progress” of the home-based exercises adapted from the physical tests. Appl. Sci. 2020,10, 4755 4 of 17 Appl. Sci. 2020, 10, x FOR PEER REVIEW 4 of 18 Figure 2. Spreadsheet suggestion to allow the individual to register the aims, feasibility and practical application to guide the home-based exercises adapted from the physical tests. 4. Physical tests adapted as home-based exercises 4.1. Stair Climb Test (SCT) 4.1.1. Aim and Description The aim of the SCT is to assess the ability of an individual to ascend and descend some steps of a stair. This will provide important information related to lower extremity strength, power, and balance. There are some variations of the SCT, considering several aspects, such as (i) the clinical conditions of different populations, (ii) the number of steps of the stair, (iii) the task requirement (ascent only or ascent/decent combined), and (iv) whether the test is timed over a set number of steps or the step count is recorded for a set period of time [14]. The measurements used to the individual performs the exercise will be important to a control and to try to improve in subsequent attempts. 4.1.2. Feasibility No formal instructions and place are required. If the individual lives in a flat, the stairs between two floors could be used to do the exercise. In addition, a timer or a watch could be used to time the activity, or an application, such as Nike Run Club®. If the individual lives in a house, buying a simple stair of wood or iron may be an option. The use of a handrail is not required for this test but may be considered for security reasons. The individual will be able to follow the progress day by day. Figure 3 shows the conditions for the individual to perform the SCT. Figure 2. Spreadsheet suggestion to allow the individual to register the aims, feasibility and practical application to guide the home-based exercises adapted from the physical tests. 4. Physical Tests Adapted as Home-Based Exercises 4.1. Stair Climb Test (SCT) 4.1.1. Aim and Description The aim of the SCT is to assess the ability of an individual to ascend and descend some steps of a stair. This will provide important information related to lower extremity strength, power, and balance. There are some variations of the SCT, considering several aspects, such as (i) the clinical conditions of different populations, (ii) the number of steps of the stair, (iii) the task requirement (ascent only or ascent/decent combined), and (iv) whether the test is timed over a set number of steps or the step count is recorded for a set period of time [ 14 ]. The measurements used to the individual performs the exercise will be important to a control and to try to improve in subsequent attempts. 4.1.2. Feasibility No formal instructions and place are required. If the individual lives in a flat, the stairs between two floors could be used to do the exercise. In addition, a timer or a watch could be used to time the activity, or an application, such as Nike Run Club ® . If the individual lives in a house, buying a simple stair of wood or iron may be an option. The use of a handrail is not required for this test but may be considered for security reasons. The individual will be able to follow the progress day by day. Figure 3 shows the conditions for the individual to perform the SCT. 4.1.3. Practical Application As a modality of PEx, it is important to improve muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. In general, the SCT adapted for a home-based exercise works for lower limb and trunk muscles, balanced by the upper limbs. Climbing stairs represents mostly concentric contraction (e.g., gluteus maximus, quadriceps, and triceps surae); walking down the stairs, an eccentric contraction of the quadriceps muscles in the leg will be performed. The slower the movement (walking down the stairs), the more eccentric the contraction of the muscles. Appl. Sci. 2020,10, 4755 5 of 17 Appl. Sci. 2020, 10, x FOR PEER REVIEW 5 of 18 Figure 3. Environmental conditions for the individual to perform the SCT. (A) the stair and the arrows indicate in (a) is the first step and in (b) the last step; (B) the movement to climb the stair, (C) the movement to descend the stair, and (D) a timer, that could be a chronometer or a watch. 4.1.3. Practical Application As a modality of PEx, it is important to improve muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. In general, the SCT adapted for a home-based exercise works for lower limb and trunk muscles, balanced by the upper limbs. Climbing stairs represents mostly concentric contraction (e.g., gluteus maximus, quadriceps, and triceps surae); walking down the stairs, an eccentric contraction of the quadriceps muscles in the leg will be performed. The slower the movement (walking down the stairs), the more eccentric the contraction of the muscles. 4.2. Balance Test 4.2.1. Aim and Description Balance is an ability of a body to maintain itself in the line of gravity (the vertical line from the center of mass) standing on the base of support with minimal postural sway. Sway is the movement of the body in relation to the center of gravity. Naturally, there is a certain amount of sway related to breathing, shifting body weight from one foot to the other, or from forefoot to rearfoot, or from external triggers, such as visual distortions and floor translations. An increase in sway is not necessarily an indicator of dysfunctional balance but it is an indicator of decreased sensorimotor control [15]. Maintaining balance requires coordination of input from multiple sensory systems including the vestibular, somatosensory, and visual systems [16]. In addition, in different positions, the muscles will work and exercise will be done. The purpose of this exercise is to offer a suggestion that permits self-evaluation, such as measuring the time to perform each part of the test. In this case, all the tests were adapted. 4.2.2. Feasibility The balance test can be performed with different positions of the feet: i) side-by-side stand; ii) semi-tandem stand, when the individual places one foot partially in front of another, touching the heel of the partially front foot with hallux from behind standing; iii) tandem stand, when the individual stands with one foot in front of the other one, touching the toes (Figure 4). Time in each position, without losing balance, should be noted. It is considered a good time if each position is maintained for more than 10 seconds. Safety while performing this exercise is essential, with another person nearby or with objects to support the individual, if necessary. Figure 3. Environmental conditions for the individual to perform the SCT. ( A ) the stair and the arrows indicate in (a) is the first step and in (b) the last step; ( B ) the movement to climb the stair, ( C ) the movement to descend the stair, and (D) a timer, that could be a chronometer or a watch. 4.2. Balance Test 4.2.1. Aim and Description Balance is an ability of a body to maintain itself in the line of gravity (the vertical line from the center of mass) standing on the base of support with minimal postural sway. Sway is the movement of the body in relation to the center of gravity. Naturally, there is a certain amount of sway related to breathing, shifting body weight from one foot to the other, or from forefoot to rearfoot, or from external triggers, such as visual distortions and floor translations. An increase in sway is not necessarily an indicator of dysfunctional balance but it is an indicator of decreased sensorimotor control [ 15 ]. Maintaining balance requires coordination of input from multiple sensory systems including the vestibular, somatosensory, and visual systems [ 16 ]. In addition, in different positions, the muscles will work and exercise will be done. The purpose of this exercise is to offer a suggestion that permits self-evaluation, such as measuring the time to perform each part of the test. In this case, all the tests were adapted. 4.2.2. Feasibility The balance test can be performed with different positions of the feet: (i) side-by-side stand; (ii) semi-tandem stand, when the individual places one foot partially in front of another, touching the heel of the partially front foot with hallux from behind standing; (iii) tandem stand, when the individual stands with one foot in front of the other one, touching the toes (Figure 4). Time in each position, without losing balance, should be noted. It is considered a good time if each position is maintained for more than 10 s. Safety while performing this exercise is essential, with another person nearby or with objects to support the individual, if necessary. 4.2.3. Practical Application As a modality of PEx, it is important to improve the balance, the muscular strength of lower limbs, and to prevent the risk of falls. The base of support reduction (feet together) requires a better balance in the sagittal plane; consequently, mainly the muscles from the anterior-posterior chains will be activated. Semi-tandem and tandem positions require a better balance in the frontal plane; consequently, mainly the muscles from the lateral chains will be activated. Crossed arms in front of the trunk require a greater balance effort. Appl. Sci. 2020,10, 4755 6 of 17 Appl. Sci. 2020, 10, x FOR PEER REVIEW 6 of 18 Figure 4. The individual standing feet side-by-side (A) or in semi-tandem (B) or in tandem position (C). The arrows indicate the position of a foot in relation to the other foot in (A), (B), and (C). 4.2.3. Practical Application As a modality of PEx, it is important to improve the balance, the muscular strength of lower limbs, and to prevent the risk of falls. The base of support reduction (feet together) requires a better balance in the sagittal plane; consequently, mainly the muscles from the anterior-posterior chains will be activated. Semi-tandem and tandem positions require a better balance in the frontal plane; consequently, mainly the muscles from the lateral chains will be activated. Crossed arms in front of the trunk require a greater balance effort. 4.3. Single-leg-stance-test (SLST) 4.3.1. Aim and Description SLST, or single-legged stance, is a simple assessment tool used to evaluate balance and postural stability while transiently standing on a single limb [15]. Subjects are timed on their ability to stand on a single leg with their eyes open, wearing tennis shoes or not. Subjects are instructed to lift one foot just off the floor, focus on a point on a nearby wall in front of them, and stand for as long as they are able, up to a maximum of one min. The time that an individual can stand on one lower limb (Figure 5) should be noted. After that, the individual would do the same with the other foot. Figure 4. The individual standing feet side-by-side ( A ) or in semi-tandem ( B ) or in tandem position (C). The arrows indicate the position of a foot in relation to the other foot in (A), (B), and (C). 4.3. Single-leg-Stance-Test (SLST) 4.3.1. Aim and Description SLST, or single-legged stance, is a simple assessment tool used to evaluate balance and postural stability while transiently standing on a single limb [15]. Subjects are timed on their ability to stand on a single leg with their eyes open, wearing tennis shoes or not. Subjects are instructed to lift one foot just offthe floor, focus on a point on a nearby wall in front of them, and stand for as long as they are able, up to a maximum of one min. The time that an individual can stand on one lower limb (Figure 5) should be noted. After that, the individual would do the same with the other foot. Appl. Sci. 2020, 10, x FOR PEER REVIEW 7 of 18 Figure 5. The individual is in single-legged stance with the right (A) or with the left (B) leg as the arrows indicate. 4.3.2. Feasibility No formal instructions and place to perform the PEx are required. A timer, or a watch, to quantify the time required to perform the exercise is necessary. The comparison of the time of each day will allow the individual to follow the progress. To perform this test, is important to consider to be in a safe place (with other person near or with objects to support the individual, if it is necessary). A timer or a watch is important to the measurement of time. No formal instructions or special setup is required, just a timer or a watch to assess performance during the test. Daily analysis allows for monitoring performance changes. 4.3.3. Practical application As a modality of PEx, it is important to improve the balance, the muscular strength of lower limbs, and to prevent the risk of falls. This adapted test being used as one of the home-based exercises works mainly in the frontal plane for balance improvement and ankle muscle strengthening, such as the posterior tibial muscle and fibular muscles. Additionally, in the sagittal plane, tibialis anterior, toe flexors, and triceps surae will be used. Crossed arms in front of the trunk require a greater balance effort. 4.4. Gait Speed 4.4.1. Aim and Description Gait or walking speed is an important objective measure of functional mobility [17] and can also be considered a type of exercise. Gait speed can be quickly and easily measured, and it is described as a reliable and valid measurement for the walking performance of an individual. It is also regarded as a pivotal factor associated with quality of life. In the gait speed test, individuals are instructed to walk a defined distance (3 or 4 m) with normal and usual walking speed from a specific point and to Figure 5. The individual is in single-legged stance with the right ( A ) or with the left ( B ) leg as the arrows indicate. Appl. Sci. 2020,10, 4755 7 of 17 4.3.2. Feasibility No formal instructions and place to perform the PEx are required. A timer, or a watch, to quantify the time required to perform the exercise is necessary. The comparison of the time of each day will allow the individual to follow the progress. To perform this test, is important to consider to be in a safe place (with other person near or with objects to support the individual, if it is necessary). A timer or a watch is important to the measurement of time. No formal instructions or special setup is required, just a timer or a watch to assess performance during the test. Daily analysis allows for monitoring performance changes. 4.3.3. Practical Application As a modality of PEx, it is important to improve the balance, the muscular strength of lower limbs, and to prevent the risk of falls. This adapted test being used as one of the home-based exercises works mainly in the frontal plane for balance improvement and ankle muscle strengthening, such as the posterior tibial muscle and fibular muscles. Additionally, in the sagittal plane, tibialis anterior, toe flexors, and triceps surae will be used. Crossed arms in front of the trunk require a greater balance effort. 4.4. Gait Speed 4.4.1. Aim and Description Gait or walking speed is an important objective measure of functional mobility [ 17 ] and can also be considered a type of exercise. Gait speed can be quickly and easily measured, and it is described as a reliable and valid measurement for the walking performance of an individual. It is also regarded as a pivotal factor associated with quality of life. In the gait speed test, individuals are instructed to walk a defined distance (3 or 4 m) with normal and usual walking speed from a specific point and to come back (Figure 6). A chronometer is used to accurately measure the time. Gait speed is then calculated from distance and time values. Appl. Sci. 2020, 10, x FOR PEER REVIEW 8 of 18 come back (Figure 6). A chronometer is used to accurately measure the time. Gait speed is then calculated from distance and time values. Figure 6. Schematic figure of a home corridor, or a space without furniture. The distance between A and B should be 3 or 4 m. 4.4.2. Feasibility No formal instructions and settings are required. It is necessary to use a timer or a watch to determine the time required to perform the exercise. It is required to define the start (0 m) and finish points, 3 or 4 m apart, depending on the available space. The comparison of daily results will provide feedback regarding individual progression. 4.4.3. Practical Application As a modality of PEx, it is important to improve the muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. 4.5. Five-chair Stand (5CS) 4.5.1. Aim and Description The 5CS is used to assess lower extremity strength [18]. The individual is asked to fold their upper limbs across their chest and stand up from and sit down on a standard chair without the aid of the upper limbs. The individual is asked to stand up and sit down five times as fast as possible starting in the sitting position and stopping after the fifth repetition and the time to perform the test is determined (Figure 7). The 5CS test correlates well with other measures of physical performance and self-reports. Although, the test considers standing up and sitting down five times, the individual, thinking about the approach of this proposal, can perform any number of times that they choose. Moreover, the time to perform the test can be measured. Figure 6. Schematic figure of a home corridor, or a space without furniture. The distance between A and B should be 3 or 4 m. 4.4.2. Feasibility No formal instructions and settings are required. It is necessary to use a timer or a watch to determine the time required to perform the exercise. It is required to define the start (0 m) and finish points, 3 or 4 m apart, depending on the available space. The comparison of daily results will provide feedback regarding individual progression. Appl. Sci. 2020,10, 4755 8 of 17 4.4.3. Practical Application As a modality of PEx, it is important to improve the muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. 4.5. Five-Chair Stand (5CS) 4.5.1. Aim and Description The 5CS is used to assess lower extremity strength [ 18 ]. The individual is asked to fold their upper limbs across their chest and stand up from and sit down on a standard chair without the aid of the upper limbs. The individual is asked to stand up and sit down five times as fast as possible starting in the sitting position and stopping after the fifth repetition and the time to perform the test is determined (Figure 7). The 5CS test correlates well with other measures of physical performance and self-reports. Although, the test considers standing up and sitting down five times, the individual, thinking about the approach of this proposal, can perform any number of times that they choose. Moreover, the time to perform the test can be measured. Appl. Sci. 2020, 10, x FOR PEER REVIEW 9 of 18 Figure 7. Steps of the five-chair stand and the minimal material required. The arrows indicate in (A) the materials required to the exercise, that are (a) the chair is against a wall, (b) a watch (or a timer), (c) the chair; (B) the movement to sit down; and (C) the movement to stand up. 4.5.2. Feasibility No formal instructions and place to perform the PEx are required. A timer or a watch is necessary to determine the time to perform the exercise. Moreover, a chair (no plastic) is required, placed against the wall for safety reasons. The individual can compare the time to perform a determined number of “stand up and sit down” each day, or to verify this number in a determined time. This information will permit the individual to follow the progress day-by-day. 4.5.3. Practical Application As a modality of PEx, it is important to improve the muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. The 5CS adapted for a home-based exercise will work concentrically and eccentrically on the pelvic girdle and trunk. When moving from a sitting to a standing position, the concentric activity of the triceps surae, quadriceps, gluteus maximus, and extensor spinal muscle activation happens associated with the eccentric hip and trunk flexor muscles. When moving from a standing to a sitting position, the concentric activity of the hip and trunk muscle activation occurs, associated with the eccentric hip and trunk extensors muscles. 4.6. Free Walking 4.6.1. Aim and Description Walking, like cycling, dancing, running, and swimming, is considered an aerobic exercise, that is any physical activity that uses large muscle groups and causes the body to utilize more oxygen than while at rest [19]. The aim of aerobic exercise is to increase cardiovascular endurance. The individual can wear tennis shoes and define a distance to walk freely, without obstacles (Figure 6), considering the approach of this proposal. The goal is to exercise at least between 15 and 30 minutes. 4.6.2. Feasibility No formal instructions and place to perform the PEx are defined. A timer or a watch is necessary to determine the time to perform the exercise. It would be also possible to consider the number of times to go from (A) to (B). It is required to define the place to start (0 m) and to come back (depending on the available space). The comparison of the time of each day will allow the individual to follow Figure 7. Steps of the five-chair stand and the minimal material required. The arrows indicate in ( A ) the materials required to the exercise, that are (a) the chair is against a wall, (b) a watch (or a timer), (c) the chair; (B) the movement to sit down; and (C) the movement to stand up. 4.5.2. Feasibility No formal instructions and place to perform the PEx are required. A timer or a watch is necessary to determine the time to perform the exercise. Moreover, a chair (no plastic) is required, placed against the wall for safety reasons. The individual can compare the time to perform a determined number of “stand up and sit down” each day, or to verify this number in a determined time. This information will permit the individual to follow the progress day-by-day. 4.5.3. Practical Application As a modality of PEx, it is important to improve the muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. The 5CS adapted for a home-based exercise will work concentrically and eccentrically on the pelvic girdle and trunk. When moving from a sitting to a standing position, the concentric activity of the triceps surae, quadriceps, gluteus maximus, and extensor spinal muscle activation happens associated with the eccentric hip and trunk flexor muscles. When moving from a standing to a sitting position, the concentric activity of the hip and trunk muscle activation occurs, associated with the eccentric hip and trunk extensors muscles. Appl. Sci. 2020,10, 4755 9 of 17 4.6. Free Walking 4.6.1. Aim and Description Walking, like cycling, dancing, running, and swimming, is considered an aerobic exercise, that is any physical activity that uses large muscle groups and causes the body to utilize more oxygen than while at rest [ 19 ]. The aim of aerobic exercise is to increase cardiovascular endurance. The individual can wear tennis shoes and define a distance to walk freely, without obstacles (Figure 6), considering the approach of this proposal. The goal is to exercise at least between 15 and 30 min. 4.6.2. Feasibility No formal instructions and place to perform the PEx are defined. A timer or a watch is necessary to determine the time to perform the exercise. It would be also possible to consider the number of times to go from (A) to (B). It is required to define the place to start (0 m) and to come back (depending on the available space). The comparison of the time of each day will allow the individual to follow the progress. In addition, an application, such as Nike Run Club ® , would permit one to register the time, the distance, and the gait in m or km per second. 4.6.3. Practical Application As a modality of PEx, it is important to improve the muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. 4.7. Free Running 4.7.1. Aim and Description Running is also considered an aerobic exercise, contributing to increasing one’s cardiovascular endurance, and large muscles are involved. The path to complete the exercise should be defined, free from obstacles (Figure 8) [ 19 ]. The individual can wear tennis shoes and define a distance to run freely without obstacles, considering the approach of this proposal. The goal is to exercise at least between 15 and 30 min. Appl. Sci. 2020, 10, x FOR PEER REVIEW 10 of 18 the progress. In addition, an application, such as Nike Run Club®, would permit one to register the time, the distance, and the gait in m or km per second. 4.6.3. Practical Application As a modality of PEx, it is important to improve the muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. 4.7. Free Running 4.7.1. Aim and Description Running is also considered an aerobic exercise, contributing to increasing one’s cardiovascular endurance, and large muscles are involved. The path to complete the exercise should be defined, free from obstacles (Figure 8) [19]. The individual can wear tennis shoes and define a distance to run freely without obstacles, considering the approach of this proposal. The goal is to exercise at least between 15 and 30 minutes. Figure 8. An example of a room, inside a house, that could be used to perform the free running. (A) represents the starting position for the exercise. 4.7.2. Feasibility No formal instructions and place to perform the PEx are defined, however, it is advisable to seek the advice of a physiotherapist or a physician to be sure that it is safe to perform the exercise. A timer or a watch is necessary to determine the time required to perform the exercise. It is required to define the place to start (0 m) and to come back (depending on the available space). It would also be possible to consider the number of times to go and to return to (A). The comparison of the time required to perform the exercise each day will allow the individual to follow the progress. In addition, an application, such as Nike Run Club®, would permit registering the time, the distance, and the gait in m or km per second. 4.7.3. Practical Application As a modality of PEx, it is important to improve the muscular strength of lower limbs, cardiovascular system, circulation, balance, flexibility, and to prevent the risk of falls. 4.8. Six-minute Walk Test (6MWT) Figure 8. An example of a room, inside a house, that could be used to perform the free running. (A) represents the starting position for the exercise. Appl. Sci. 2020,10, 4755 16 of 17 have a basic understanding of their own body and level of physical conditioning are recommended to perform these PEx without any help. 7. Conclusions The goal of this manuscript was to present recommendations to the individuals in this difficult period of confinement. It provides a collection of home-based exercises based on physical tests to stimulate individuals to alter their daily life by practicing the exercises. The benefits of exercise are important and represent a necessary balance to reduce the stress experienced by people around the world. Researchers have a duty to aid the population with their knowledge as, in this moment, highlighting the contribution of exercise to the improvement of the individuals’ quality of life. In fact, several relatively simple exercises are proposed, considering the clinical conditions of each one and the physical space in each home notwithstanding, they can contribute in reducing the sedentary behavior during COVID-19 confinement. Author Contributions: Conceptualization: D.d.C.d.S.-C. and M.B.-F.; methodology, D.d.C.d.S.-C., M.B.-F., A.S. (Anelise Sonza); formal analysis: R.T., A.S. (Ad é rito Seixas), B.S., A.S. (Anelise Sonza); investigation: D.d.C.d.S.-C., M.B.-F.; resources: D.d.C.d.S.-C., M.B.-F.; writing—original draft preparation: D.d.C.d.S.-C., R.T., A.S. (Ad é rito Seixas), B.S., M.B.-F.; writing—review and editing: A.S. (Anelise Sonza); visualization: D.d.C.d.S.-C., R.T., A.S. (Ad é rito Seixas), B.S., A.S. (Anelise Sonza), M.B.-F.; supervision: M.B.-F.; project administration: D.d.C.d.S.-C. All authors have read and agreed to the published version of the manuscript. Funding: This study was financed by the Coordenaç ã o de aperfeiçoamento de pessoal de n í vel superior—Brazil (CAPES) finance code 001. The Brazilian Agencies (CNPq and FAPERJ) also offered financial support. Conflicts of Interest: The authors declare no conflict of interest. References 1. Hall, G.; Laddu, D.R.; Phillips, S.A.; Lavie Carl, J.; Arena, R. A tale of two pandemics: How will COVID-19 and global trends in physical inactivity and sedentary behavior affect one another? Prog. Cardiovasc. Dis. 2020,20, 4–6. 2. Singhal, T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J. Pediatr. 2020 ,87, 281–286. [CrossRef] [PubMed] 3. WHO. Coronavirus. 2020. Available online: https://www.who.int/health-topics/coronavirus#tab=tab_1 (accessed on 5 May 2020). 4. WHO. Coronavirus Disease (COVID-19) Advice for the Public. 2020. Available online: https://www.who.int/ emergencies/diseases/novel-coronavirus-2019/advice-for-public (accessed on 10 May 2020). 5. Kakodkar, P.; Kaka, N. A Comprehensive Literature Review on the Clinical Presentation, and Management of the Pandemic Coronavirus Disease 2019 History of the outbreak. Cureus 2020,12, e7560. [PubMed] 6. Fernandes, R.M.; Correa, M.G.; dos Santos, M.A.R.; Almeida, A.P.C.P.S.C.; Fagundes, N.C.F.; Maia, L.C.; Lima, R.R. The Effects of Moderate Physical Exercise on Adult Cognition: A Systematic Review. Front. Physiol. 2018,9, 667. [CrossRef] [PubMed] 7. Kelly, P.; Kahlmeier, S.; Götschi, T.; Orsini, N.; Richards, J.; Roberts, N.; Scarborough, P.; Foster, C. Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship. Int. J. Behav. Nutr. Phys. Act. 2014,11, 132. [CrossRef] [PubMed] 8. Löllgen, H.; Böckenhoff, A.; Knapp, G. Physical Activity and All-cause Mortality: An Updated Meta-analysis with Different Intensity Categories. Int. J. Sport Med. 2009,30, 213–224. [CrossRef] 9. Je, Y.; Jeon, J.Y.; Giovannucci, E.L.; Meyerhardt, J.A. Association between physical activity and mortality in colorectal cancer: A meta-analysis of prospective cohort studies. Int. J. Cancer 2013 ,133, 1905–1913. [CrossRef] 10. Fong, D.Y.T.; Ho, J.W.C.; Hui, B.P.H.; Lee, A.M.; Macfarlane, D.J.; Sharron, S.K.; Cerin, E.; Chan, W.Y.Y.; Leung, I.P.F.; Lam, S.H.S.; et al. Physical activity for cancer survivors: Meta-analysis of randomised controlled trials. BMJ 2011,344, 1–14. [CrossRef] [PubMed] Appl. Sci. 2020,10, 4755 17 of 17 11. Steffens, D.; Maher, C.G.; Pereira Leani, S.M.; Stevens Matthew, L.; Oliveira Vinicius, C.; Chapple, M.; Teixeira-Salmela Luci, F.; Hancock Mark, J. Prevention of Low Back Pain A Systematic Review and Meta-analysis. JAMA Intern Med. 2016,176, 199–208. [CrossRef] [PubMed] 12. Sjøgaard, G.; Christensen, J.R.; Justesen, J.B.; Murray, M.; Dalager, T.; Fredslund, G.H.; Sogaard, K. Exercise is more than medicine: The working age population’s well-being and productivity. J. Sport Heal. Sci. 2016 ,5, 159–165. [CrossRef] [PubMed] 13. Marcos, A.; Manonelles, P.; Palacios, N.; Wärnberg, J.; Casaj ú s, J.A.; P é rez MSaznar, U.; Benito, P.J.; Mart í nez-G ó mez, D.; Ortega, F.B.; Ortega, E.; et al. Art í culo especial Physical activity, hydration and health. Medicine 2014,29, 1224–1239. 14. Nightingale, E.J.; Pourkazemi, F.; Hiller, C.E. Systematic review of timed stair tests. J. Rehabil. Res. Dev. 2014 , 51, 335–350. [CrossRef] [PubMed] 15. Alonso, C.; Nata, I.; Luna, M.; Dionı, I.F.N.; Andre, M.D. Functional Balance Assessment: Review. Medicalexpress 2014,1, 298–301. [CrossRef] 16. Bennell, K.; Dobson, F.; Hinman, R. Measures of physical performance assessments: Self-Paced Walk Test (SPWT), Stair Climb Test (SCT), Six-Minute Walk Test (6MWT), Chair Stand Test (CST), Timed Up & Go (TUG), Sock Test, Lift and Carry Test (LCT), and Car Task. Arthritis Care Res. 2011,63, 350–370. 17. Kim, H.; Park, I.; On, L. The reliability and validity of gait speed with different walking pace and distances against general health, physical function, and chronic disease in aged adults. J. Exerc. Nutr. Biochem. 2016 , 20, 46–50. [CrossRef] 18. Melo, T.A.; Duarte, A.C.M.; Bezerra, T.S.; França, F.; Soares, N.S.; Brito, D. The Five Times Sit-to-Stand Test: Safety and reliability with older intensive care unit patients at discharge. Rev. Bras. Ter. Intensiva. 2019 ,31, 27–33. [CrossRef] 19. Patel, H.; Alkhawam, H.; Madanieh, R.; Shah, N.; Kosmas, C.E.; Vittorio, T.J. Aerobic versus anaerobic exercise training effects on the cardiovascular system. World J. Cardiol. 2017,9, 134–138. [CrossRef] 20. Baltaci, G.; Un, N.; Tunay, V.; Besler, A.; Gerçeker, S. Comparison of three different sit and reach tests for measurement of hamstring flexibility in female university students. Br. J. Sport Med. 2003 ,37, 59–61. [CrossRef] 21. S á -caputo, D.C.; Ronikeili-costa, P.; Carvalho-lima, R.P.; Bernardo, L.C.; Bravo-monteiro, M.O.; Costa, R.; Moraes-Silva, J.D.; Paiva, D.N.; Machado, C.B.; Mantilla-Giehl, P.; et al. Whole Body Vibration Exercises and the Improvement of the Flexibility in Patient with Metabolic Syndrome. Rehabil. Res. Practice 2014 ,2014. [CrossRef] 22. Yang, Y.J. An Overview of Current Physical Activity Recommendations in Primary Care. Korean J. Fam. Med. 2019,40, 135–142. [CrossRef] 23. Ketels, M.; Bacquer DDe Geens, T.; Janssens, H.; Korshøj, M.; Holtermann, A. Assessing physiological response mechanisms and the role of psychosocial job resources in the physical activity health paradox: Study protocol for the Flemish Employees’ Physical Activity ( FEPA ) study. BMC Public Health 2019 ,19, 1–10. [CrossRef] [PubMed] 24. Booth, F.W.; Roberts, C.K.; Laye, M.J. Lack of exercise is a major cause of chronic diseases. Compr. Physiol. 2012,2, 1143–1211. [PubMed] 25. WHO. Global Strategy on Diet, Physical Activity and Health. Available online: https://www.who.int/ dietphysicalactivity/factsheet_myths/en/(accessed on 17 April 2020). © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).