**4. Discussion**

The purpose of our qualitative screening was to demonstrate the negative impact on the motor outcomes and on the emotional and psychological functions [3] of the isolation period at home as well as the subsequent restrictions imposed by the fight against the spread of the new coronavirus infection on healthy adults but also of patients with neurodegenerative diseases such as: Parkinson's disease, Alzheimer' disease, Lewy body

disease, and associated diseases (Vascular dementia, Myasthenia gravis), Frontotemporal dementia [6].

Through technological communication systems, such as intervention smartphones and online platforms (Google online, Instagram, Facebook, Tik Tok, Snapchat, WhatsApp, ResearchGate, Twitter, LinkedIn) semi-structured questionnaires had been delivered, online interviews in surveys in multiple languages [13–16].

In the largest online study for the COVID-19 outbreak, ECBL was conducted in Africa (40%), Asia (36%) and Europe (21%), before and after lockdown, and discussed in four trials [13–16], in multiple languages. The physical activities performed included exercise classes, or gym classes, walking training, workouts of different intensity (slow, moderate or vigorous intensity, outdoor and indoor physical activity and ADL). The results obtained were interpreted by IPAQ-SF and STBQL and demonstrated in general, declining ongoing weekly physical activity in terms of duration, power and endurance. In terms of ADLs, these were moderate in frequency and velocity [13–16].

However, there have been challenges in supporting physical activities at home, organizing online exercise groups for performing exercise patterns delivered through questionnaires or telerehabilitation interventions, including training with different intensities and that which is ongoing (such as carried out weekly) as well as in providing support [8,19].

Another study showed that increase of daily physical activities in young people with the diversification of actions, especially food-related actions, allowed for improvement in the diets for adolescents in lockdown compared to the period of direct participation in social life [18].

The most significant changes were related to accentuation, the cognitive function disorders and emotional status, impaired wellbeing quality of life, sleep and unhealthy eating behaviors. The quantification of the outcomes was measured by the instruments: SWEMWBS, SMFQ, SLSQOL, SSPQOL, PSQI and SDBQL, which reported worsening wellbeing and satisfaction of life, increasing mental tensions related to quality of life, depression symptoms, anxiety, lack of communication, enhanced sleep impairments, mental disorders and bad feelings [2,5,9,13]. More pronounced changes in emotional status and mental wellbeing were found especially in women.

Most of the mental and emotional disorders occurred as a result of the cessation of professional activities, lack of communication and socialization, imposed by combating the spread of the SARS-CoV-2 infection by respecting the rules of social distancing.

Along with these came unhealthy eating habits, with the increase in the number of daily meals, rich in fat, carbohydrates and low in protein, excessive alcohol consumption and smoking, which led to weight gain, increased functional disorders and exposure to future morbidity [5,6,25].

Patients with neurodegenerative diseases carrying out different types of physical activities: dance and fitness training, yoga, walking workout, light, moderate or high intensity aerobic exercise and daily activities for living, showed improvements in cardiovascular function, physical performance of the gait pattern, speed and length of the step and balance as well as delays in the decline of motor skills [10,23,35].

Regarding PD patients with improved cardiovascular function, the physical performance of the gait pattern, the dysfunctions of the four cardinal points of the disease, namely, tremor, rigidity, bradykinesia and postural instability, have been shown to be delayed in their evolution by sustained and correctly performed physical exercises [10,20] with instructions from online platforms, and in some situations, supervised by specialist therapists through video applications.

However, in patients with Alzheimer's disease [33], Lewy body dementia [34], or Frontotemporal dementia and associated Myasthenia Gravis or those with Vascular dementia, who no longer received institutionalized care with therapists but caregivers at home or through information and communication technology that delivered instructions with physical activity programs, there were obvious declines in motor dysfunctions. In these situations, caregivers at home have also been observed to worsen their motor performance

by decreasing the physical training and the motor rehabilitation patterns that were imposed on their patients and in which they directly participated.

On the other hand, apart from the degradation of the motor functions, the most significant dysfunctions were registered in the sphere of the cognitive functions and of the neuropsychic, affective and emotional status of both patients and their caregivers [38].

Moreover, the marked disturbances in the sleep/wake circadian rhythm as well as the behavioral changes in the home confinement period, determined the progressive decline in quality of lifestyle, satisfaction and mental wellbeing as affective disorders with depression, sadness, anxiety and feelings of loneliness that reflected lack of socialization from organized communities to emotional rehabilitation programs [40,41]. In addition to COVID-19 as a secondary stressor to the primary stressor, cognitive dysfunction, negative emotions, frustration and mental disorders had been exacerbated.

The cognitive tools through their scores, used clearly, showed an increase in neuropsychiatric symptoms with worsening of depressive symptoms, anxiety and reduced mental wellbeing and speech neurocognitive tasks (MMSE, MoCA, GDS, PASE, HADS, QOL, etc.) [14,15].

Impairment of motor and cognitive status has been shown to be similar, in both healthy adults and patients with neurodegenerative pathology during isolation at home (Figure 4).

**Figure 4.** Dynamic of motor and cognitive impairments in healthy adults and patients with neurodegenerative diseases.

The external stressor represented by the COVID-19 pandemic is secondary for patients with neurodegenerative diseases because in terms of neuropathological mechanisms, they are more resistant to the negative impact on cognitive functions and for healthy adults, emotional, affective and neurocognitive functions are more important [27]. Decreasing physical activities affects both types of participants equally, causing impaired motor function in healthy people and the worsening of neuromotor symptoms in patients.

By carefully processing the studies approached, we have found that through the intervention of physical activity, beneficial results are obtained on both motor and neurocognitive functions.

The use of online technology and tools that can measure vital functions of motion sensors that quantify physical activity at home has had a considerable advantage in home confinement due to remotely monitoring the varying degrees of dysfunction in healthy adults and the progression of neurodegenerative diseases [32,39].

However, the use of online e-learning platforms that provide standardized information, programs and questionnaires that help monitor the motor and cognitive coordinates of healthy adults and patients with neurodegenerative diseases, is conditioned by limited

access to these technologies, costly financial commitments as well as the educational level of the participants who can understand the foreign language and apply these models.
