Home-based aerobic conditioning program for well-population adults amidst COVID-19

SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 23 Home-based aerobic conditioning program for well-population adults amidst COVID-19 Maria Ella A. Salazar*, Patricia Nicole T. Dagum, Hannah Chelsea B. Dela Torre, Marciano G. Lipana, John Adriane A. Nava, Sean Gabrielle M. Pinon, Marizza Isabel C. Riego De Dios, Roland L. Sardan Physical Therapy Department, School of Health Science Professions, St. Dominic College of Asia, Bacoor, Cavite, Philippines *Corresponding author Abstract The main objective of this study is to determine the relevance and importance of knowing the proper prescription of home-based aerobic exercises for well-populated adults amidst COVID-19 pandemic. This study aims to provide recommendations for improvements of home-based aerobic exercise as well as the development of the program’s strong points. It also aims to determine the strength, weaknesses, opportunities, and threats of a homebased aerobic conditioning program for well-populated adults during the COVID-19 pandemic. Purposive sampling design was used for selecting the participants in this study. This method was used because it is one of the most timeand cost-effective sampling methods available. The researchers were able to gather 50 participants, who were aged 16-30 years old, should have home-based work and school, and were residing in Bacoor City, Cavite, Philippines. The researchers divided the exercise routine into three components: Intensity, Frequency, and Duration. Based on the results, conditioning exercise has significant effects in improving the overall health, immune system, and cognitive abilities of well-populated adults. Furthermore, providing an appropriate dosage of exercise prescription, as well as determination of proper information on the current condition of the clients, is the key to having the best possible outcomes of a conditioning program. Not only does this improve and maximize the physical capabilities of clients, but it also improves their mental and cognitive abilities. Keywords: Home-based aerobic conditioning; Well-population adults; Frequency; Intensity; Duration. To cite this article: Salazar, M. E. A., Dagum, P. N. T., Dela Torre, H. C. B., Lipana, M. G., Nava, J. A. A., Pino, S. G. M., Riego de Dios, M. I. C., & Sardan, R. L. (2022). Home-based aerobic conditioning program for well-population adults amidst COVID-19. SDCA Journal of Physical Therapy, 3, 23-31. Introduction People were used to living their normal lives and doing activities without limitations and restrictions in the past, however all these things changed abruptly. Last December 1, 2019, the first person infected with COVID-19 was detected in Wuhan City, Hubei Province in China. Unfortunately, it was not until late December 2019, that Chinese doctors started to realize the gravity of the situation and how they were suddenly faced with an entirely new and deadly virus. Wuhan was placed under quarantine as hospitals began struggling with many infected patients who were manifesting with unknown symptoms akin to that of pneumonia. In March 2020, the World Health Organization (WHO) officially declared the COVID-19 outbreak a nationwide pandemic because the virus kept spreading across the country. For most people who are healthy and get infected, the symptoms are usually mild to moderate, and they often recover without needing any special medical care. Older adults and people who already have other health problems, such as heart disease, diabetes, chronic lung disease, or cancer, are more likely to face serious symptoms if they get sick (Cucinotta & Vanelli, 2020). SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 24 During the time wherein all was normal, most people exercised. May it be a simple jog, walking, and other means of making our bodies sweat. Getting sufficient physical activity can prevent one in ten premature deaths, yet only half of older adults engage in the level of physical activity needed to reduce and prevent chronic diseases. But because of the pandemic, many of the things that people do normally before have changed. Due to the ongoing pandemic, a lot of establishments including gyms have been closed or are restricted, making it more challenging for people to engage in physical fitness activities (Kaur et al., 2020). Nonetheless, finding a way to adapt to these new conditions is vital to maintaining our health and improving our overall well-being. Since most people are forced to stay inside their homes, it is beneficial that they continue to exercise and prevent themselves from having a sedentary lifestyle. Regular exercise and physical activity offer many benefits. These include helping to manage weight, making the heart, bones, and muscles stronger, improving blood flow, lowering the risk of heart disease, boosting mental health and mood, lowering the chances of certain cancers like colon, breast, uterine, and lung cancer, reducing the risk of falls in older people, improving sleep and sexual health, and decreasing the risk of early death from major causes such as heart disease and cancer (Miller et al., 2016; Nystoriak & Bhatnagar, 2018). One way to keep the brain as sharp as it can is doing physical activity. Physical activities or exercises aid in keeping the brain sharp and engaged as it increases oxygen intake; therefore, it also helps in decreasing risks of developing conditions such as diabetes and cardiovascular illnesses. Exercise also improves growth factors and helps in stimulating new neuronal connections, therefore plays a significant role in terms of neuroplasticity and decreases the release of stress hormones. What is good for the heart is also good for the brain and our overall well-being and immunity (De Sousa et al., 2021). Aerobic exercise is a type of conditioning exercise that aims to target the cardiovascular system. Activities such as running, walking or cycling are examples of exercises that get our cardiovascular system going by requiring oxygenated blood from the heart to circulate through our bodies and deliver said oxygenated blood to the targeted muscles used during exercise (Romero et al., 2017). A study concluded that Tae Bo exercise specifically improves a person’s cognitive ability while performing aerobic exercise (Carlos et al., 2013). While this study found that aerobic exercise improves a person’s cardiovascular health, regional CBF, and memory, it is also found that it has negative effects. As a result, short-term aerobic exercise increases brain function and cognition (Chapman et al., 2013). According to Mackay-Lyons et al., (2020), the primary goal of aerobic exercise is not just to increase the heart rate of the person performing aerobic exercise, but also to target that person’s heart rate and maintain that level for at least a minimum of 20 minutes for the body to feel an aerobic effect. Not being active or leading a sedentary lifestyle can harm health, well-being, and overall quality of life. Staying in self-quarantine can cause more stress and worsen mental health. Physical and relaxation exercises can be useful strategies to help maintain relaxation and health during this period. During this cycle of crisis and behavioral risk reduction, it is important to prioritize wellbeing, which requires regular exercise. Most adults know about physical and mental health advantages of exercise, and how important it is to be active regularly. Even when things get tough, public health experts say that exercise is still essential for staying healthy and feeling good mentally. During the COVID-19 pandemic, regular exercise remains essential under normal circumstances. Exercise is particularly helpful for older adults who are more likely to get sick and for people with long-term conditions like diabetes, arthritis, or heart disease. Doing regular exercise can improve balance, flexibility, strength, mobility, and heart health, and also make people boost energy levels and improve their general well-being. The World Health Organization recommends 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity activity each week, or a mix of both, which can be done at home without special equipment (WHO-Europe, 2020). Humans are perfectly designed to move and function without limitations, not to engage in a sedentary lifestyle. The greatest risk of COVID-19 infections is exposure. It is important for people to find creative ways to stay active while keeping safe by following social distancing rules, good hygiene practices, and government guidelines (Simpson & Katsanis, 2020). While exercise may not prevent infection if exposed, SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 25 it is likely that staying active can boost the immune system, helping to minimize the negative effects of the virus, alleviate symptoms, speed up recovery times, and reduce the likelihood of transmission among those in contact. Exercise is an innovative use of physical movements that improves overall health and wellness, including cognitive skills and strengthens the immune system. Aerobic exercise can be utilized to enhance overall quality of life. It has been shown that this form of exercise is one of the most preferred exercises by the people, especially popular among patients with high-grade glioma due to its relatively low intensity, which allows healthy and sicker population to perform various physical activities without exerting much effort as compared to anaerobic forms such as strengthening exercises. In aerobic exercise, large muscles are used continuously and rhythmically, which also causes the heart and lungs to work harder (Culos-Reed et al., 2017). Studies show that regular aerobic exercise can improve the immune system and brain function, even in healthy people. The structure of the brain, which supports cognitive abilities, can be strengthened through exercise. There is strong evidence showing that aerobic exercise is closely linked to improvements in key areas of brain function, such as switching tasks, focusing attention, controlling impulses, and remembering information (Guiney & Machado, 2013). VO2max is the key factor in determining success in aerobic exercise. Peak oxygen uptake varies depending on the intensity of the activity. A study by Helgerud et al. (2007) compared the improvement of VO2max between high-intensity interval training and moderate training involving long slow distance, lactate threshold, 15/15 interval running, and 4x4 minute interval running. Findings showed that highintensity aerobic endurance interval training (15/15 and 4x4 minute training groups) was more effective after eight weeks (Helgerud et al., 2007). This study is crucial as it can positively impact the overall health and cardiovascular endurance. It serves as a tool to enhance health, potential, and understanding of exercise prescription, especially in preventing injury during physical activities. They may use the knowledge gained within this research as a guide whenever they perform aerobic exercise to boost their immune system and to nurture their health, which is timely and necessary during this ongoing onslaught of the current COVID-19 pandemic. Objectives of the Study This study aims to determine the relevance and importance of knowing the proper prescription for home based aerobic exercises for well populated adults. Specifically, it aims: 1. To determine the importance of proper exercise prescription for home-based aerobic conditioning programs for well-populated adults during COVID-19. 2. To provide recommendations for improvements of the weak points of the home-based aerobic exercise and for the development of the strong points of the program. 3. To determine the strength, weaknesses, opportunities, and threats of home-based aerobic conditioning programs for well-populated adults during the midst of COVID-19. Research questions were made for this study: 1. What is the respondents’ demographic profile in terms of age and sex? 2. What is the respondent’s exercise profile in terms of intensity, frequency, and duration? 3. Is there any association between the respondents’ perceived exercise among intensity, frequency, and duration? 3.1 Frequency and Intensity 3.2 Frequency and Duration 3.3 Intensity and Duration SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 26 Hypothesis Null Hypothesis The intensity, frequency, and duration as perceived by the participants are independent of each other. Alternative Hypothesis The intensity, frequency and duration as perceived by the participants are associated with each other. Scope and Limitation of the Study The study will be conducted through online facilitated surveys in the respective residences of the participants and researchers. The researchers will be gathering well-populated adults (ages 16 to 30 years old) in Bacoor City, Cavite. The participants will be randomized to answer the survey questionnaire for the importance of Aerobic exercise amidst COVID-19. This study is limited to 50 respondents. Other factors such as demographic profile as to their mental and social activities and healthy diet are not included in the study. Each of the respondents are given the same set of questionnaires to answer. The study focuses only on the importance of a home-based aerobic conditioning program for well-populated adults. Methodology Research Design The researchers chose to use quantitative analysis to create a good controlled and non-randomized sample. Quantitative research is a type of social research that employs coherent techniques and statements. According to Cohen et al. (2018), an empirical statement illustrates a real-world case, rather than what it is meant to be. Another feature of quantitative analysis is the use of empirical measurement, where it is determined how well a program or policy meets a given standard or norm. Creswell and Creswell (2017) describe quantitative research by explaining a phenomena by collecting numerical data and analyzing it using mathematical methods, especially statistics. The study was not blinded, and both the researchers and the respondents were aware of the survey to prevent any misunderstandings about their experience of homebased conditioning programs. Eligibility Criteria Inclusion Criteria • Healthy female or male young adults, within ages 16-30 years old. • Respondents should be residing within Bacoor City, Cavite. • Respondents should be working from home or attending online classes during the duration of the research. • Respondents should be physically able. • All answers in the Par-Q & Health Information part of the survey should be “No”. SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 27 Exclusion Criteria • Respondents should not have any underlying comorbidities (e.g., hypertension, diabetes, kidney problems, cardiovascular and/or respiratory illnesses) and should be stated as such in the health questionnaire part of the survey. • Respondents should not be taking any medications for any underlying illness. • Respondents who have been hospitalized or injured within the past three months are to be excluded. • Illiterate or insufficient cognitive abilities to understand or comprehend questions written in the survey. • Severe behavioral problems and/or psychological illnesses. Sampling Procedures Purposive sampling design was used for selecting the participants in this study. This method was used because it is one of the most timeand cost-effective sampling methods available. Researchers planned to strictly follow the existing eligibility requirements for a more controlled sample. This was achieved by selecting participants that are based on the required criteria: physically able young adults with no existing comorbidities and within ages 16-30 years old who are currently studying or working in a home-based setting and reside in Bacoor City, Cavite. The researchers gathered 50 participants that met the criteria to answer the questionnaire. Since it is well suited for quantitative research design, a non-probability sampling approach was used because the researchers did not have access to a list of Bacoor populations. Instruments The researchers used an online medium to administer a multiple choice questionnaire to determine the respondent’s ability to perform aerobic exercises. This includes the following: 1. Informed Consent. The informed consent was utilized for the respondent’s protection that all the data gathered will be on the property of the students and the university and will only be seen in the eyes of the concerned individuals regarding the study. No civilian or outside people will have access to this information and will be fully classified. 2. Physical Activity Readiness Questionnaire (PAR-Q). Standardized PAR-Q was utilized to assess whether the respondents were physically ready. 3. Health Information. Health information was used to assess whether respondents have preexisting symptoms and/or comorbidities. 4. General and Medical Questionnaire. General and medical questionnaires were utilized to inform the researchers of the respondents basic information regarding their occupation that will probably be the most affected on the respondents daily life. It is also used to assess the overall health status of a respondent. Data Collection The surveying process was used by researchers. This approach entails using an online medium to collect responses from people aged 16 to 25 in Bacoor, Cavite (Google Forms). Participants were required to fill out their health details first, then complete the following questionnaires: Physical Activity Readiness Questionnaire (PAR-Q), General and Medical Questionnaire, Informed Consent, Participants Undertaking, Input Type, and finally the assessment survey. SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 28 The researchers utilized the Chi-Square Test of Independence. It is a non-parametric statistical analysis tool used to test the independence or association of two categorical data types. As shown in the research, the data types used were all categorical. As for the intensity, it was further classified as extremely light, somewhat hard, and very hard; for the frequency duration was classified as never, 1-2 days, 3-4 days, 5-6 days, and every day. Results and Discussion Table 1. Respondent’s Profile (n=50) Profile Group Frequency Percentage Age 16 1 2% 17 1 2% 20 1 2% 21 9 18% 22 21 42% 23 11 22% 24 2 4% 25 2 4% 26 1 2% NA 1 2% Sex Male 18 36% Female 31 62% NA 1 2% Table 1 reveals the respondent’s profile in terms of age and sex. The researchers gathered a total of 50 participants with the age group that varies from sixteen (16) to twenty-six (26). There is one (1) participant for each age such as ages 16, 17, 20 and 26. Two (2) participants each for ages twenty-four (24) and twenty-five (25), nine (9) for the age 21 and eleven (11) for age 23. The age with the most respondents is from the age 23 which has twenty-one (21) participants, and one (1) participant decided not to reveal their age. In terms of sex, a total of eighteen (18) participants with the percentage of thirty-six percent (36%) are males and thirty-one (31) participants with the percentage of sixty-two percent (62%) are females. A single participant did not specify their gender. Table 2. Exercise Profile (n=50) Profile Group Frequency Percentage Intensity Extremely Light 23 46.0 Somewhat Hard 16 32.0 Very Hard 2 4.0 Not Applicable 9 18.0 Frequency Never 7 14.0 1-2 days 23 46.0 3-4 days 14 28.0 5-6 days 4 8.0 Everyday 2 4.0 Duration Less than 15 minutes 15 30.0 20-30 minutes 13 26.0 30-45 minutes 6 12.0 1 hour 11 22.0 2 hours 5 10.0 Table 1 shows the exercise profile of the respondents. In terms of intensity, 23 of the respondents are doing extremely light exercises, which accounts for 46% of the total samples, 16 performed exercises that are somewhat hard and only 2 are doing very hard exercises or 32% and 4% respectively based on their SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 29 perception of exercises done. While 9 participants or 18% do not have routine exercises done. The majority of participants reported engaging in “extremely light” exercises. In contrast, fewer participants were engaged in “very hard” exercises. This supports the study by Jakicic et al. (2018) that light-intensity physical activity (1.5–3.0 METs) affects weight loss and weight loss maintenance. It can be noted that light physical activity would not have extensive effects on body weight; however, it is suggested that they should combine exercise with dietary modification to control their weight. In terms of frequency, only 7 participants answered that they never did exercise in the survey, which accounts for 14%. Meanwhile 23 of the participants are doing routine exercises at least 1-2 days a week, and 14 are doing 3-4 days a week, or 46% and 28% respectively. While only 4 or 8% of the total respondents are doing exercises 5-6 days a week, and only 2 or 4% do it on a day to day basis. It is implied that most respondents exercised twice a week, wherein doing limited exercises can help them maintain their weight at a healthy level. Bakker et al. (2017) revealed that low amounts of resistance exercise, for instance, less than an hour spread over 1 to 2 sessions each week, as seen in the “weekend warrior” style, led to the highest reduction in the risk of having a metabolic syndrome. In terms of duration, it shows that out of 50 participants, 15 do their exercise for less than 15 minutes, and 13 for 20-30 minutes. Only 6 or 12% do their exercises for 45 minutes. While only 11 or 22% went for an hour and 5 or 10% for more than an hour. It can be implied that more respondents have exercised for at least 15 minutes for a more manageable and achievable goal. Wen et al. (2014) suggested that spending at least 15 minutes per day in dedicated exercise such as brisk walking or running could decrease the risk of cardiovascular diseases. Table 3. Chi-Square Tests of Variables Variables Statistics Value df Asymptotic Significance (2-sided) Frequency and Intensity Pearson Chi-Square 16.209 12 .182 Likelihood Ratio 18.717 12 .096 Linear-by-Linear Association .028 1 .868 Frequency and Duration Pearson Chi-Square 30.744 16 .015 Likelihood Ratio 30.500 16 .016 Linear-by-Linear Association 10.979 1 .001 Duration and Intensity Pearson Chi-Square 18.537 12 .100 Likelihood Ratio 19.378 12 .080 Linear-by-Linear Association 1.373 1 .241 Table 3 describes the Chi-Square Tests of three variables: intensity, frequency, and duration. When testing frequency and intensity, The p-value for the Pearson Chi-Square test is 0.182, which is greater than the alpha level of 0.05. This shows that findings failed to reject the null hypothesis. Frequency and intensity are independent of each other, as there is no significant association between these two factors. When testing frequency and duration, The p-value for the Pearson Chi-Square test is 0.015, which is less than the alpha level of 0.05. This means that the findings rejected the null hypothesis, meaning that frequency and duration are associated with each other. The linear-by-linear association also has a very low p-value (0.001), which further supports this relationship. Aerobic exercise is mainly based on the time element which is the frequency and duration. When testing duration and intensity, The p-value for the Pearson Chi-Square test is 0.100, which is above 0.05. This means it failed to reject the null hypothesis, wherein duration and intensity are independent of each other. The data also suggests there is no significant association between duration and intensity. This analysis shows that while frequency and duration are connected with each other, intensity does not appear to be closely related to either frequency or duration based on the data. SDCA Journal of Physical Therapy, Volume 3, June 2022 ISSN 2815-164X 30 Conclusion and Recommendations Providing correct prescriptions for well-populated adults has no negative consequences. It is vital to know and identify participants who are physically capable and do not present with any other health issues that can impede their capacity to participate in physical activity. Conditioning exercise is an excellent technique to improve general health and wellness, as well as increase the immune system and improve cognitive abilities. The importance of providing proper prescription of conditioning programs for wellpopulated adults aid in the promotion and improvement of balance, flexibility, strength, mobility, and cardiovascular health, all of which are very timely and relevant today due to COVID-19. Physical therapists should advocate the utmost importance of having a home-based aerobic conditioning program especially during the time of the pandemic. Both the general population and the well population must also be informed of the proper prescription as to different exercise parameters such as intensity, duration, and frequency. Information about precautionary measures, proper techniques, and relevance of having a home-based aerobic conditioning program must also be disseminated to prevent risk of acquiring an injury while maintaining and improving overall physical health. A larger sample size is necessary to generalize the results and have more definite findings among the well population. Randomized sampling should also be used in future research to avoid bias with the results. The researchers also recommend examining the effects of home aerobics on the well population to further identify the importance of home-based aerobic conditioning programs on physiological aspects such as in cardiovascular, pulmonary, mental, and psychosocial terms. The effectiveness of providing homebased aerobic conditioning programs should also be explored to consider proper prescription of the program for the well population. Specific types of aerobic exercises should also be focused on to determine the most appropriate prescription for the target population. Furthermore, future researchers should also consider a different target population who can possibly benefit from home-based aerobic conditioning programs during the pandemic such as those with underlying illnesses and comorbidities. References Bakker, E. A., Lee, D. C., Sui, X., Artero, E. G., Ruiz, J. R., Eijsvogels, T. M., Lavie, C. J., & Blair, S. N. (2017). Association of resistance exercise, independent of and combined with aerobic exercise, with the incidence of metabolic syndrome. Mayo Clinic Proceedings, 92(8), 1214-1222. https://doi.org/10.1016/j.mayocp.2017.02.018 Carlos, R., Gonzales, Y. B., Ilustre, N., Pamittan, R., Wee, J. J., & Nicolas, E. M. (2013). 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