Authors: Prof Samira Bulcão Carvalho Domingues*, Prof Flávia Porto** and Prof Jonas Lírio Gurgel****Master's Degree student, Exercise and Sports Sciences/Institute of Physical Education & Sports/UERJ When faced with the COVID-19 global pandemic, a reduction in the numbers of people circulating is essential. It’s important to know there are differences between social distancing, isolation, quarantine and total lockdown, however, all of these strategies have one goal in common, which is to contain the speed at which the virus spreads and limit the collapse of health systems. In extended social distancing, those establishments considered to be non-essential are closed to avoid the gathering together of people, while in selective social distancing, people belonging to at-risk groups, especially the elderly, are encouraged to stay at home. In isolation, sick people (with suspected or confirmed disease) are separated from the non-sick, whether in a domestic or hospital environment. Quarantine is carried out by those people who have come into contact with or are suspected of having come into contact with the virus and, even if not presenting symptoms, they are isolated from others. When none of these measures work, a total lockdown is declared, like a community quarantine. Although essential, staying at home involves a radical change in the habits of a population, which may harm health in some way. Within the context of epidemiological normality, work, academic and leisure activities require a variety of effort that, taken together, maintain the minimum level of daily physical activity necessary for health, especially for sedentary individuals. An immediate interruption of these activities has a negative impact on the cardiorespiratory and muscle systems, responsible for maintaining functional capacity. This, in turn, is directly related to quality of life and the development of comorbidities. Similarly, and at the same time, physically active individuals are compelled to abruptly interrupt their exercise routines during this period. The damage caused by this halt in training includes losses in muscle strength and mass, aerobic capacity, and joint flexibility and mobility, in addition to alterations in body composition. The change from a physically active to sedentary life can affect important variables for health maintenance, including blood pressure, blood glucose and cholesterol levels. It is therefore advisable to use countermeasure strategies to combat the disuse. One of these is the practice of exercise - known to be the best non-drug health promotion strategy. The American College of Sports Medicine (ACSM) has already taken a position on the importance of staying physically active during isolation. The weekly recommendation for asymptomatic individuals is 150 to 300 minutes of aerobic exercise, plus two strength training sessions. One could, for example, do 5 workouts a week of 30 to 60 minutes, adding muscle strengthening exercises to two of them. The intensity should be moderate, as very light stimuli may not promote benefits, while very high intensities are associated with impaired immunity.
Although many people doubt the feasibility and efficiency of home training, the literature shows that results similar to those obtained in traditional gyms can be achieved by using one's own bodyweight as a load. Routines can include exercises based on calisthenics, both in aerobic (stationary running, climbing stairs, jumping jacks) and strength (squats, push-ups, planks) training. Accessible materials can help: elastic bands, skipping ropes, and even household items to increase the workload (water bottles, backpacks with books, bags with groceries). Authors: Prof Samira Bulcão Carvalho Domingues*, Prof Flávia Porto** and Prof Jonas Lírio Gurgel****Master's Degree student, Exercise and Sports Sciences/Institute of Physical Education & Sports/UERJ Diante da pandemia mundial de COVID-19, diminuir a circulação das pessoas é algo essencial. É importante saber que existe diferença entre distanciamento, isolamento social, quarentena e bloqueio total, porém, todas essas estratégias têm o objetivo comum de conter a velocidade de propagação do vírus e evitar o colapso dos sistemas de saúde. No distanciamento social ampliado, estabelecimentos considerados não essenciais são fechados para evitar aglomerações, enquanto que, no distanciamento social seletivo, pessoas pertencentes a grupos de risco, em especial, idosos, são estimuladas a ficar em casa. Já no isolamento, pessoas doentes (com suspeita ou confirmação da doença) são separadas das não doentes, seja em ambiente doméstico ou hospitalar. A quarentena é realizada por pessoas que tiveram contato ou suspeito de contato com o vírus e, mesmo não apresentando sintomas, ficam isoladas das demais. Quando nenhuma dessas medidas funciona, finalmente, é decretado o bloqueio total, como uma quarentena comunitária. Apesar de imprescindível, a permanência em casa implica em uma mudança radical nos hábitos da população, o que pode prejudicar, de alguma forma, a saúde. Em um contexto de normalidade epidemiológica, atividades laborais, acadêmicas e de lazer solicitam esforços variados que, somados, mantêm o nível mínimo de atividade física diária necessário para a saúde, especialmente de indivíduos sedentários. A interrupção imediata dessas atividades impacta negativamente os sistemas cardiorrespiratório e muscular, responsáveis pela manutenção da capacidade funcional. Esta, por sua vez, está diretamente relacionada à qualidade de vida e ao desenvolvimento de comorbidades. Da mesma maneira, no momento, indivíduos fisicamente ativos precisaram interromper bruscamente suas rotinas de exercícios neste período. Os prejuízos do destreinamento incluem perdas sobre força e massa musculares, capacidade aeróbia, flexibilidade e mobilidade articular, além de alterações na composição corporal. A mudança de uma vida fisicamente ativa para o sedentarismo pode impactar variáveis importantes para a manutenção da saúde, entre elas, pressão arterial, glicose sanguínea e taxas de colesterol. Assim, é oportuno lançar mão de estratégias de contramedida ao desuso. Uma delas é a prática de exercícios - sabidamente a melhor estratégia não-medicamentosa de promoção da saúde. O Colégio Americano de Medicina Esportiva (ACSM) já se posicionou quanto à importância de se manter fisicamente ativo durante o isolamento. A recomendação semanal, para indivíduos assintomáticos, é de 150 a 300 minutos de exercícios aeróbios, além de duas sessões de treinamento de força. Pode-se, por exemplo, realizar 5 treinos semanais de 30 a 60 minutos e, em dois deles, acrescentar exercícios de fortalecimento muscular. A intensidade deve ser moderada, pois estímulos muito leves podem não promover benefícios, e intensidades muito altas estão associadas a prejuízos à imunidade. Authors: Prof Flávia Porto*, Prof Nádia Souza Lima da Silva* and Prof Jonas Lírio Gurgel***Institute of Physical Education and Sports, State University of Rio de Janeiro (UERJ) There are few known coping strategies for dealing with the coronavirus pandemic (COVID-19), but social isolation stands out. While this provides an effective way to reduce the spread of the virus, it also brings a range of problems for individuals and families, especially the elderly, such as limiting their in-person participation in health promotion programs. In a society highly connected through the Internet, a large number of seniors form part of the group that is digitally excluded, showing greater resistance to the use of digital technology tools. The current situation has imposed changes in our behaviour, serving as a catalyst for alterations in everyone's habits and leading to increased use of digital tools in order to mitigate social distancing. In this context, it is essential for health maintenance that physical exercise programs are continued during social isolation, particularly so for the elderly population, and should be part of public policy. Given this scenario, telehealth resurfaces as an instrument for health promotion and prevention, which are even more essential in the current situation. The strategy of using digital tools, like videos and web conferencing, enables continuity in physical exercise health promotion programs, which are essential to overcome the disuse imposed by confinement. In this sense, we would like to share our experience of using telehealth for the continuity of the program Elderly in Movement: Maintaining Autonomy (IMMA). How did IMMA come about? On October 17, 1989, Professor Dr. Alfredo Gomes Faria Júnior (22/08/1937 - 11/06/2019), Doctor Honoris Causa from the University of Porto, created the IMMA Project, which offers regular and free physical activities and assessments to people over 60 years of age, at the State University of Rio de Janeiro (UERJ), Brazil. It was a little early at that time to be thinking about the ageing process experienced by retired people in our country. The Brazilian demographic pyramid and entire socioeconomic context back then showed that caring for older people "was not important”. Times have changed and scientific evolution and world society has proven that longevity can (and should) be accompanied by more autonomy and quality of life for the individual. The creation of the IMMA was one of the historical milestones in Brazil, disrupting the thinking about health promotion for the elderly, predicting that, yes, these people would retire, but they would still be a part of society and, therefore, should be included. With a great chronological leap, IMMA continues to innovate and try to include the elderly in a society that is once again discussing the importance of older people in the composition of our community. When Brazilian President Jair Bolsonaro proposes vertical isolation, i.e., the elderly remain at home without contact with younger members, who can continue generating the necessary wealth for the country; and when recent speeches by the new Minister of Health suggest that if faced with a choice between saving an elderly person or an adolescent, priority should be given to the young for economic reasons, it is time to return to defending the portion of the population that is most vulnerable. The IMMA in current times This new coronavirus has left us living in a time of crisis and local authorities are asking us to remain isolated at home whenever possible, and for this reason, activities at the UERJ have been suspended. Nonetheless, given this scenario and considering the importance of its students remaining physically active, the IMMA decided to continue functioning. In an innovative way, physical activities always guided in person, in addition to "live" hugs and greetings, gave space for a greater exchange of messages via WhatsApp. The IMMA team's major concern was to minimise the functional losses that physical inactivity could cause in the elderly, both from a cognitive and physical point of view. Therefore, daily cognitive games were initially proposed, giving the team the necessary time to set up the training routines to be performed at home by the elderly. Participation was immediate, interaction was great, and everyone’s mood lifted in these times of uncertainty. Good-humoured reports and thanks also came from family members of the participating elderly. After the round of cognitive games came the first physical exercise classes, which were joined by parents of the Physical Education students, members of the IMMA team, who served as models in their videos and instructional photos (as a university project, it is worth mentioning that the IMMA serves as a field of pedagogical activity for Physical Education academics at UERJ). The adherence of participants was inspiring, especially as the elderly began to send videos and photos of their individual routines. Finally, in these confusing and difficult times, the IMMA continues to maintain its social commitment, innovating, stimulating and contributing to the health and quality of life of its users, demonstrating that we can unite, even at a distance, to combat the adverse effects of confinement. Authors: Prof Flávia Porto*, Prof Nádia Souza Lima da Silva* and Prof Jonas Lírio Gurgel***Instituto de Educação Física e Desportos, Universidade do Estado do Rio de Janeiro (UERJ) A pandemia do coronavírus (COVID-19) nos impõe poucas estratégias de enfrentamento, das quais se destaca o isolamento social. Se por um lado tal medida proporciona uma eficaz forma para reduzir a proliferação do vírus, por outro, traz uma gama de problemas para os indivíduos e para as famílias, em especial para os idosos, como limitá-los a participarem presencialmente de programas de promoção da saúde. Em uma sociedade altamente conectada, através da internet, boa parte dos idosos ainda compõe o grupo dos excluídos digitais, apresentando uma maior resistência ao uso de ferramentas de tecnologia digital. A atual conjuntura vem impondo mudanças em nosso comportamento, servindo de catalisador para modificações dos hábitos de todos, levando-nos a aumentar o uso de ferramentas digitais de modo a mitigar o distanciamento social. Neste contexto, formas visando a continuidade de programas de exercícios físicos durante o isolamento social, principalmente para a população idosa, são essenciais para a manutenção da saúde, devendo fazer parte das políticas públicas. Diante desse quadro, a telessaúde ressurge como mais uma ferramenta de promoção e prevenção da saúde, as quais são ainda mais essenciais na atual conjuntura. A estratégia de utilizar ferramentas digitais, como vídeos e webconferência, possibilita a continuidade dos programas de promoção da saúde através do exercício físico, que são essenciais para superar o desuso imposto pelo confinamento. Neste sentido, gostaríamos de dividir nossa experiência com o uso da telessaúde para a continuidade do programa Idosos em Movimento: Mantendo a Autonomia (IMMA). Prof. K. GanapathyInnovaSpace Advisory Board member, Past President Telemedicine Society of India, Former Secretary/Past President Neurological Society of India & Indian Society for Stereotactic & Functional Neurosurgery, Emeritus Professor Tamilnadu Dr MGR Medical University, Former Adjunct Professor IIT Madras & Anna University Madras, Founder Director, Apollo Telemedicine Networking Foundation & Apollo Tele Health. Could Telehealth be the way forward in helping to manage the COVID-19 pandemic in India?
InnovaSpace thanks Dr. T V Gopal for bringing attention to the use of drone technology in healthcare. The popularity of drones has been boosted greatly over the past decade, with huge advances in technology leading to drone weight reductions, lower costs, and improved capabilities and performance, particularly through the introduction of an autopilot, and softwares capable of analysing flight dynamics in real-time and ensuring flight stability. We publish here some of his thoughts related to the Integration Challenges of Healthcare and Technology with Drones.
The art of healing, the healing process itself, started with quaint symbolisms. The concepts of "Uniformity in Practice" and "Repeatability of a Cure" gradually emerged as the two dominant principles in Medical Sciences, and the development of new technologies promises to meet the expectations on both these principles.
However, the integration between technology and medicine is not a simple task. It is believed that the key enablers for this integration to happen are:
Blog author, Dr. K Ganapathay is a Past President of the Telemedicine Society of India, Neurological Society of India & Indian Society for Stereotactic & Functional Neurosurgery. Emeritus Professor, Tamilnadu Dr MGR Medical University, he has 43 YEARS of clinical experience. He is on the Board of Directors of Apollo Telemedicine Networking Foundation and Apollo Telehealth Services – the largest and oldest multi specialty telehealth network in South Asia, an Advisory Board member of InnovaSpace, and recognised as a staunch advocate par excellence in promoting telehealth. For more details see www.kganapathy.com. I am thankful to Prof. Thais Russomano, Space doctor, for rekindling my dormant interest in outer space. 11 years ago I started taking my grandson to the terrace in my house and repeatedly showed him the moon and said "I want you to work there as a doctor". Who knows? This may actually happen in my life time.
As a 'Made in India', totally indigenous product, who has worked only in India, I am absolutely thrilled to learn about INDIA’S FIRST MANNED SPACE MISSION - Gaganyaan, scheduled for launch in December 2021. The mission, which was announced by Prime Minister Narendra Modi in his Independence Day speech, is set to be a turning point in space history, as it will make India one of only four countries in the world, after Russia, USA and China, to launch a manned space flight. The plan involves sending three Indians into space for 5 to 7 days on a Low-Earth-Orbit mission (altitude of 300-400 km). At 27,000 km/h, a spacecraft completes an orbit around the Earth every 90 minutes. Costing within 1.5 billion US$, this 40-month project will employ 15,000 individuals, including 13,000 from industries and 1,000 from academic institutes – and of course, Indians!! Vyomanuts (Indian astronauts) for this mission are likely to be selected from 200 shortlisted Indian Air Force pilots, with just 4 being selected and trained. The best among the superhuman test pilots will get the golden ticket. On the seventh day after launch, the crew module will re-orient and separate itself from the service module, landing on Earth within 36 minutes, in the Arabian Sea, close to Ahmedabad. One of the six largest space agencies in the world with the largest fleet of communication (INSAT) and remote sensing (IRS) satellites, ISRO has already developed most of the technologies required for manned flight. In 2018, it performed a Crew Module Atmospheric Re-entry Experiment and Pad Abort Test for the mission, while the Defence Food Research Laboratory (DFRL) has already worked on producing space food, and has been conducting trials on astronaut G-suits
Blog written by Prof. Dr. Thais Russomano, InnovaSpace Co-Founder & CEO
Telemedicine is a rapidly emerging and growing area of health assistance, research, and education that uses information and communications technologies to provide remote assistance to communities that currently lack specialist healthcare, or access to any form of medical assistance. Imagine living hundreds of miles from specialist doctors, such as cardiologists, dermatologists, and radiologists, to name but a few. This very situation occurs in many thousands of places all over the world; it is a huge problem that can impact very negatively on people's lives. In such circumstances, telemedicine is a potentially powerful tool that can not only improve the quality of healthcare, but also help in reducing the costs of healthcare delivery. While travelling in India at the end of 2017 and visiting the Apollo Hospital in Chennai, I came across a classic example of a place where telemedicine fits in perfectly - an extremely remote area high in the Himalayas.
At an altitude of around 13,500 feet sits the world's highest altitude Telemedicine Centre, implemented by Apollo Telehealth Services. This outstanding telemedicine program was established by Apollo under the directorship of Dr. K Ganapathy (President, Apollo Telemedicine Networking Foundation; Director of Apollo Telehealth Services; and InnovaSpace Advisory Board member), and aims to make quality healthcare accessible to the unreached populations of the towns of Keylong and Kaza, both in the Himalayan state of Himachal Pradesh, and with a total population of around seven thousand people.
The main health services provided are the delivery of medical assistance in emergencies, and primary and specialist tele-consultations. As of the 14th December 2017, a total of 9,389 consultations between the two remote towns and the Apollo Hospitals in Chennai had taken place (666 emergencies; 8723 outpatient consults). One such emergency involved local farmer Ram Singh who began to feel short of breath one day while out tending his cows. Fortunately for him he was able to attend the Apollo Telehealth service in Keylong and was treated remotely by a cardiac specialist in Chennai. Thankfully Mr Singh survived his heart attack and is able to tell his story in the above video, which makes him a classic example of how telemedicine can save lives!
Blog written by Anna E. Schmaus-Klughammer, Director, Klughammer GmbH Mongolia is a huge country, being four times bigger than Germany, with nomadic cattle ranchers (herders) making up a large part of the Mongolian rural population. Due to the vast distances between cities, these populations living and working in the remote desolate regions of the country have very limited access to specialist doctors and hospitals, and the rural-based doctors work in isolation and are often left to make their own decisions in difficult cases. Although a hospital is located in each of the 21 provinces (Aimags) of Mongolia, each Aimag is three to four times the size of Switzerland, meaning that, in general, a journey of several hundred kilometres is required to reach it. Upon arrival at a hospital, the facilities encountered are fairly limited and the health care professionals often inexperienced, as it is state policy to send young doctors to the provinces. This situation can leave the medical professionals handicapped when faced with complex cases; with no specialist doctors to consult, patients are frequently referred on to hospitals in the major cities. This in itself is a problematic and costly procedure due to the great distances involved, let alone the additional difficulties faced when travelling whilst sick. As an example, the city of Ölgii, which is the major city of the Bayan-Ölgii Aimag in the extreme west of Mongolia, is 1636 kilometers from Ulaanbaatar, Mongolia’s capital city. Logistically, therefore, a journey between these two cities will take 3-4 days and will frequently involve travelling on overcrowded buses driven on unpaved roads. Camels, yaks and the herders live in desolate regions
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