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Sakakima H, Nojima N, Tani A, Nakanishi K, Matsuoka T, Matsuzaki R, Kakimoto S, Kato Y, Tachibe Y, Inadome M, Kawatani T, Otsuka S, Mizuno K, Maruyama I. Effects of Ninjin'yoeito and physical exercise on serum corticosterone and hippocampal BDNF/proBDNF and neuroinflammation in post-stroke depression in rats. BMC Complement Med Ther 2025; 25:171. [PMID: 40361157 PMCID: PMC12070628 DOI: 10.1186/s12906-025-04915-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 05/08/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Ninjin'yoeito (NYT), a traditional Japanese Kampo medicine, improves the depression and anxiety in humans and animals, rendering it a novel therapeutic option for post-stroke depression (PSD). Furthermore, physical exercise is an important nonpharmacological therapy for major depressive disorder. The components of NYT or exercise exert antidepressant effects through the increased expression of neurotrophic factors and reduced neuroinflammation in the brain. However, the mechanisms underlying the antidepressant effects of NYT and exercise in PSD remain unclear. Therefore, we examined the effects of NYT and physical exercise in a rat model of PSD. METHODS Rats were divided into five groups: PSD, PSD with NYT, PSD with exercise (Ex), PSD with NYT and exercise (NYT + Ex), and control (sham). PSD was induced by the microinjection of endothelin-1 into the left medial prefrontal cortex and chronic unpredictable mild stress 3 days per week. A diet containing 3% NYT was administered to rats one day after stroke induction. Exercise was conducted using a motorized treadmill for three days per week, starting three days after the stroke. The therapeutic interventions lasted for four weeks. Serum corticosterone levels, depression-like behavior, and hippocampal pathophysiology, including the expression of brain-derived neurotrophic factor (BDNF), precursor BDNF (proBDNF), doublecortin (DCX), NeuN, glial cell activation, and tumor necrosis factor-α (TNF-α), were examined. RESULTS Serum corticosterone levels were lower in the treatment group than those in the PSD group. Notably, serum corticosterone levels were significantly lower in the NYT group than those in the PSD group. BDNF expression in the CA1 region was significantly higher in the Ex group than that in the PSD group. The NYT + Ex group showed a significantly higher hippocampal BDNF/proBDNF ratio than the other groups. DCX and NeuN expression levels were significantly higher in the NYT + Ex group than those in the NYT and PSD groups. Hippocampal glial cell activation and TNF-α expression increased in the PSD group and decreased in the intervention groups. CONCLUSIONS NYT ameliorates serum corticosterone levels and hippocampal neuroinflammation in PSD. Additionally, this study suggested that NYT, together with exercise therapy, may improve neurogenesis, the BDNF/proBDNF ratio, and neuroinflammation in the hippocampus in PSD. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Nao Nojima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Akira Tani
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Kazuki Nakanishi
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Teruki Matsuoka
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Ryoma Matsuzaki
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Shogo Kakimoto
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yuki Kato
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Yuta Tachibe
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Masaki Inadome
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Takuya Kawatani
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Shotaro Otsuka
- Faculty of Welfare and Health Science, Oita University, Oita, Japan
| | - Keita Mizuno
- Kampo Research and Development Division, Tsumura Kampo Research Laboratories, Tsumura and Co., Ibaraki, Japan
| | - Ikuro Maruyama
- Department of Laboratory and Vascular Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Barrett CME, Zeidy Z, Farrell A, Cahill LS, Wadden KP. Maternal brain plasticity, physiology and exercise science: A scoping narrative review. Front Neuroendocrinol 2025; 77:101185. [PMID: 39978421 DOI: 10.1016/j.yfrne.2025.101185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 02/06/2025] [Accepted: 02/15/2025] [Indexed: 02/22/2025]
Abstract
INTRODUCTION The perinatal period is characterized by extreme shifts in hormones, neurochemistry, and life experiences that drive significant changes in the brain, known as maternal plasticity. Due to rising maternal health conditions, such as postpartum depression, there is a critical need to investigate factors, such as engagement in physical activity and exercise, that may mitigate susceptibility to maladaptive maternal plasticity. This scoping review aims to analyze exercise interventions and maternal brain outcomes during reproduction. METHODS A systematic search was completed in Medline, Embase, CINAHL, PsycINFO, SportDiscuss. The key concepts of the search were (i) brain plasticity, (ii) maternal reproductive period including pre-conception, pregnancy, and postpartum, and (iii) exercise interventions. Due to the limited amount of evidence available on this topic, the review findings were discussed using a combined scoping and narrative review approach. RESULTS The search produced 2,167 unique articles after removing 2588 duplicates. Covidence software was used for the screening procedure. Following title and abstract screening, 2160 articles were deemed irrelevant and removed. Seven articles moved forward to full-text screening. One article was excluded during full-text screening for wrong outcomes, leaving six papers for extraction. Extraction revealed that four out of six studies were conducted in the rodent alone, one was conducted in humans alone and one was conducted in both a human and a rodent model. DISCUSSION The methodological inconsistencies in the limited number of studies within this field highlight the need for standardization, which motivated the development of the Consensus on Exercise Reporting Template for animal research. Moreover, the present review highlights future directions and knowledge gaps, emphasizing the critical need for high-quality research to address the many unanswered questions regarding the impact of exercise on the maternal brain.
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Affiliation(s)
- Catherine M E Barrett
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Zohreh Zeidy
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Alison Farrell
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Lindsay S Cahill
- Department of Chemistry, Faculty of Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katie P Wadden
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John's, NL, Canada.
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Fedor BA, Sander NH, MacLaren M, Liddle LJ, MacLellan CL, Colbourne F. Motor Rehabilitation Provides Modest Functional Benefits After Intracerebral Hemorrhage: a Systematic Review and Meta-Analysis of Translational Rehabilitation Studies. Transl Stroke Res 2025; 16:484-511. [PMID: 37981635 PMCID: PMC11976355 DOI: 10.1007/s12975-023-01205-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
Few certainties exist regarding the optimal type, timing, or dosage of rehabilitation after stroke. Despite differing injury mechanisms and recovery patterns following ischemic and hemorrhagic stroke, most translational stroke research is conducted after ischemia. As we enter the era of personalized medicine, exploring subtype-specific treatment efficacy is essential to optimizing recovery. Our objective was to characterize common rehabilitation interventions used after in vivo preclinical intracerebral hemorrhage (ICH) and assess the impact of post-ICH rehabilitation (vs. no-rehabilitation) on recovery of motor function. Following PRISMA guidelines, a systematic review (Academic Search Complete, CINAHL, EMBASE, Medline, PubMed Central) identified eligible articles published up to December 2022. Risk of bias (SYRCLE) and study quality (CAMARADES) were evaluated, and random-effects meta-analysis was used to assess treatment efficacy in recovery of forelimb and locomotor functions. Thirty articles met inclusion criteria, and 48 rehabilitation intervention groups were identified. Most used collagenase to model striatal ICH in young, male rodents. Aerobic exercise, enriched rehabilitation, and constraint-induced movement therapy represented ~ 70% of interventions. Study quality was low (median 4/10, range 2-8), and risk of bias was unclear. Rehabilitation provided modest benefits in skilled reaching, spontaneous impaired forelimb use, and locomotor function; however, effects varied substantially by endpoint, treatment type, and study quality. Rehabilitation statistically improves motor function after preclinical ICH, but whether these effects are functionally meaningful is unclear. Incomplete reporting and variable research quality hinder our capacity to analyze and interpret how treatment factors influence rehabilitation efficacy and recovery after ICH.
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Affiliation(s)
- Britt A Fedor
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Noam H Sander
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Maxwell MacLaren
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Lane J Liddle
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Crystal L MacLellan
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Frederick Colbourne
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
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Yang Z, Qin S, Li J, Li C, Lu Y, He P, Liu J, Pei L. The effect of exercise interventions on reducing the risk of depressive and cognitive disorders in post-stroke-a systematic review and meta-analysis. Front Neurol 2025; 16:1564347. [PMID: 40196866 PMCID: PMC11973079 DOI: 10.3389/fneur.2025.1564347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2025] [Accepted: 02/21/2025] [Indexed: 04/09/2025] Open
Abstract
Background Stroke patients often experience sequelae such as depressive symptoms, cognitive impairment, and abnormal physical function. Exercise intervention may be an effective and safe non-drug treatment to address these health issues. Objective The aim of this meta-analytical review was to explore the effects of exercise intervention programs on depressive symptoms, cognitive function, physical function, and quality of life in stroke patients, as well as to identify appropriate exercise programs. Methods Seven databases were searched from the library's construction until 30 August 2024. A meta-analysis was performed, and the risk of bias was assessed using Review Manager 5.4. Sensitivity analysis was conducted using Stata 16.0 software, and the overall certainty of the evidence was rated using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methods. Results A total of 11,607 studies were identified. Among these, 20 studies, which included 1,848 patients, were considered eligible for this network meta-analysis. Compared to the control group, exercise significantly improved cognitive function (standard mean difference [SMD] = 1.08, 95% confidence interval [CI] = 0.40-1.75, p = 0.002), physical balance ability (mean difference [MD] = 0.80, 95% CI = 0.23-1.37, p < 0.01), physical walking ability (MD = 48.39, 95% CI = 8.06-88.72, p = 0.02), and quality of life. However, exercise had no significant effect on depressive symptoms (SMD = -0.2, 95% CI = -0.46-0.05, p = 0.11). A subgroup analysis indicated that a longer duration of exercise (> 3 months) can effectively improve depressive symptoms in stroke patients. Conclusion The results indicated that cognitive function, balance, walking speed, and quality of life of stroke patients improved following exercise intervention, and longer exercise duration (> 3 months) contributed to alleviating the depressive symptoms of stroke patients. Therefore, we recommend that stroke patients engage in physical exercise 3 times a week for 1 h each session. The exercise duration should continue for at least 3 months to ensure the best therapeutic effect. Furthermore, determining exercise intensity should be a personalized process-carefully customized to align with the physical capabilities and limitations of each patient. Systematic review registration https://www.crd.york.ac.uk/prospero, CRD42024520778.
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Affiliation(s)
- Zixian Yang
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Shaokun Qin
- Section of Science and Education, The Second Affiliated Hospital of Hebei University of Chinese Medicine, Dingzhou, Hebei, China
| | - Jiaxing Li
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Cong Li
- Shijiazhuang Medical College, Shijiazhuang, Hebei, China
| | - Ye Lu
- Key Research Laboratory of Phlegm Stagnation Syndrome and Treatment in Hebei Province, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, China
- The Fourth Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Pei He
- Key Research Laboratory of Phlegm Stagnation Syndrome and Treatment in Hebei Province, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, China
- The Fourth Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Jia Liu
- Key Research Laboratory of Phlegm Stagnation Syndrome and Treatment in Hebei Province, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, China
- The Fourth Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
| | - Lin Pei
- Key Research Laboratory of Phlegm Stagnation Syndrome and Treatment in Hebei Province, Hebei Academy of Chinese Medicine Sciences, Shijiazhuang, China
- The Fourth Affiliated Hospital of Hebei University of Chinese Medicine, Shijiazhuang, Hebei, China
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Huber SK, Knols RH, Held JPO, Betschart M, Gartmann S, Nauer N, de Bruin ED. PEMOCS: effects of a concept-guided, PErsonalized, MOtor-Cognitive exergame training on cognitive functions and gait in chronic Stroke-a randomized, controlled trial. Front Aging Neurosci 2025; 17:1514594. [PMID: 40182756 PMCID: PMC11965908 DOI: 10.3389/fnagi.2025.1514594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 02/27/2025] [Indexed: 04/05/2025] Open
Abstract
Purpose Motor-cognitive exergames may be beneficial for addressing both motor and cognitive residual impairments in chronic stroke, however, effective training schedules are yet to be determined. Therefore, this study investigates the effects of a concept-guided, personalized, motor-cognitive exergame training on cognitive functions and gait in chronic stroke survivors. Methods In this single-blind, randomized, controlled trial, stroke survivors (at least six-months post-stroke and able to perform step-based exergaming) were allocated either to the intervention (usual care + concept-guided, personalized, motor-cognitive exergame training) or the control group (usual care only). Global cognitive functioning was primarily targeted, while health-related quality of life (HRQoL), cognitive functions, mobility, and gait were evaluated secondarily. Analyses were performed with linear-mixed effect models. Results Effects on global cognitive functioning were non-significant, with no differences between responders (participants exhibiting a clinically relevant change) and non-responders (participants exhibiting no clinically relevant change). Among secondary outcomes, the mobility domain of the HRQoL questionnaire, intrinsic visual alertness, cognitive flexibility, working memory, and outdoor walking speed as well as swing width (unaffected side) showed significant interaction effects in favour of the exergame group. Discussion Additional exergaming helped maintaining global cognitive functioning and showed encouraging effects in mobility and cognitive outcomes. Responders and non-responders did not differ in adherence, baseline values or age. Enhancing the frequency and intensity of sessions could unlock more substantial benefits. Adopting a blended therapy approach may be key to maximizing positive effects. Clinical trial registration clinicaltrials.gov, identifier NCT05524727.
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Affiliation(s)
- S. K. Huber
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zürich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - R. H. Knols
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zürich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - J. P. O. Held
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zürich, Switzerland
- Bellevue Medical Group, Zürich, Switzerland
| | - M. Betschart
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Institute of Therapy and Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - S. Gartmann
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zürich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - N. Nauer
- Physiotherapy Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zürich, Switzerland
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - E. D. de Bruin
- Motor Control and Learning Group, Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
- Department of Health, OST – Eastern Swiss University of Applied Sciences, St. Gallen, Switzerland
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Garcia Oliveira S, Nogueira SL, Uliam NR, Girardi PM, Russo TL. Measurement properties of activity monitoring for a rehabilitation (AMoR) platform in post-stroke individuals in a simulated home environment. Top Stroke Rehabil 2025; 32:119-129. [PMID: 39003747 DOI: 10.1080/10749357.2024.2377520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 07/02/2024] [Indexed: 07/16/2024]
Abstract
AIM The aim of this study was to evaluate the measurement properties of activity monitoring for a rehabilitation (AMoR) platform for step counting, time spent in sedentary behavior, and postural changes during activities of daily living (ADLs) in a simulated home environment. METHODS Twenty-one individuals in the post-stroke chronic phase used the AMoR platform during an ADL protocol and were monitored by a video camera. Spearman's correlation coefficient, mean absolute percent error (MAPE), intraclass correlation coefficient (ICC), and Bland-Altman plot analyses were used to estimate the validity and reliability between the AMoR platform and the video for step counting, time spent sitting/lying, and postural changes from sit-to-stand (SI-ST) and sit-to-stand (ST-SI). RESULTS Validity of the platform was observed with very high correlation values for step counting (rs = 0.998) and time spent sitting/lying (rs = 0.992) and high correlation for postural change of SI-ST (rs = 0.850) and ST-SI (rs = 0.851) when compared to the video. An error percentage above 5% was observed only for the SI-ST postural change (7.13%). The ICC values show excellent agreement for step counting (ICC3, k = 0.999) and time spent sitting/lying (ICC3, k = 0.992), and good agreement for SI-ST (ICC3, k = 0.859) and ST-SI (ICC3, k = 0.936) postural change. Values of the differences for step counting, sitting/lying time, and postural change were within the limits of agreement according to the analysis of the Bland-Altman graph. CONCLUSION The AMoR platform presented validity and reliability for step counting, time spent sitting/lying, and identification of SI-ST and ST-SI postural changes during tests in a simulated environment in post-stroke individuals.
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Affiliation(s)
| | | | - Nicoly Ribeiro Uliam
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Paulo Matheus Girardi
- Department of Electrical Engineering, Federal University of São Carlos, São Carlos, Brazil
| | - Thiago Luiz Russo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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Khalil MH. The Impact of Walking on BDNF as a Biomarker of Neuroplasticity: A Systematic Review. Brain Sci 2025; 15:254. [PMID: 40149776 PMCID: PMC11940261 DOI: 10.3390/brainsci15030254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 02/11/2025] [Accepted: 02/26/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND/OBJECTIVES The brain-derived neurotrophic factor (BDNF) is a critical exercise-induced modulator of various neuroplasticity processes, including adult hippocampal neurogenesis. Environmental affordance for physical activity is a novel theory that aims to increase the BDNF through walking or climbing stairs, stimulated by the urban and interior environment. In a systematic review, this paper explores the association between walking, as a structured or free-living form of physical activity, and changes in the BDNF in humans with healthy locomotion. METHOD A systematic review with a registered protocol, INPLASY2024110093, and following the PRISMA guidelines, includes English-language original research articles on adult and older adult human subjects who are locomotor-healthy, studies on walking as a structured exercise or free-living physical activity that is presented in a non-combined intervention, and must report changes in the BDNF as a dependent variable. The search was conducted using three databases: PubMed, Web of Science, and Scopus, resulting in 21 eligible studies. RESULTS This systematic review finds that the impact of walking on the BDNF is evidenced, but subject to moderate to high intensities in single bouts. At the same time, the long-term effects are yet to be fully understood, potentially due to the uptake of the BDNF for functional brain improvements, neuroplasticity processes, or muscle repair, instead of an accumulation of the BDNF itself, yet still confirm the important role of the BDNF for neurosustainability. Age and environmental factors such as heat are also found to affect the increase in the BDNF. The narrative synthesis provides elaborate explanations for understanding those complex dynamics before reaching future conclusions on the impact of walking or environmental affordance for physical activity on the changes in the BDNF concentrations. CONCLUSIONS This systematic review highlights the potential role played by moderate- and high-intensity walking as a lifestyle intervention that can be utilised through the built environment to promote adaptive brain changes, through the sustainable regulation of the BDNF.
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Smith J, Nagy P, Tod D, Holland C, Jarvis H. The effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function: Protocol for an overview of reviews. PLoS One 2025; 20:e0318567. [PMID: 39879170 PMCID: PMC11778714 DOI: 10.1371/journal.pone.0318567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 01/17/2025] [Indexed: 01/31/2025] Open
Abstract
BACKGROUND Strokes are becoming more common, and with improving survival rates, the prevalence of stroke survivors has increased. Almost half of chronic stroke survivors are cognitively impaired, and healthcare services are struggling to manage these patients, leaving some feeling "abandoned". Several systematic reviews have investigated the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive impairment, and have produced conflicting findings, making it difficult for clinicians and guideline producers to make evidence-based decisions. This overview of reviews aims to provide a comprehensive overview of systematic reviews investigating the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function, assess methodological quality and certainty of evidence, and identify sources of discordance between these reviews. METHODS Eight databases-Embase, Medline, CINAHL, Psycinfo, SPORTDiscus, The Cochrane Database of Systematic reviews, Epistemonikos, and Scopus-plus grey literature sources will be searched. The eligibility criteria include systematic reviews of trials that included an adult stroke population and investigated physical exercise and/or cognition-orientated interventions. Only reviews that assessed at least one of the DSM-5 neurocognitive domains will be included. Screening, data extraction, and quality appraisal will be conducted by two independent reviewers. Methodological quality, certainty of evidence, and primary study overlap will be assessed using the AMSTAR-2, GRADE, and GROOVE tools, respectively. Interventions will be grouped into exercise, cognition-orientated, and combined interventions, and findings will be synthesised narratively. Heterogeneity assessment will be conducted to identify factors causing discordance between reviews. DISCUSSION The findings of this overview will allow decision makers to make evidence-based decisions, stratified by methodological quality and certainty of evidence. Heterogeneity assessment may identify factors causing discordance between systematic reviews, which could inform the design of future studies. TRIAL REGISTRATION Registration: PROSPERO CRD42024534179.
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Affiliation(s)
- James Smith
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Philip Nagy
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - David Tod
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Carol Holland
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Hannah Jarvis
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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Liu F, Han X, Cheng Y, Zhu N, Jiang S, Li J, Zhao J, Luo G. Association of physical activity level and all-cause mortality among stroke survivors: evidence from NHANES 2007-2018. Environ Health Prev Med 2025; 30:27. [PMID: 40268471 PMCID: PMC12041438 DOI: 10.1265/ehpm.24-00322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Accepted: 03/19/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Post-stroke disability diminishes the physical activity (PA) level of survivors, potentially affecting their long-term prognosis. This study endeavors to explore the correlation between daily PA level and the all-cause mortality in patients with a history of stoke in the United States. METHODS Data of stroke survivors were sourced from the National Health and Nutritional Examination Survey (NHANES) 2007-2018. The population was stratified into three groups based on their PA level. Kaplan-Meier method with log-rank tests for significance was used for survival analysis. Weighted Cox proportional hazards regression models were employed to estimate the hazard ratios (HRs) for all-cause mortality. Subgroup analysis was conducted to strengthen the results. RESULTS A total of 1395 participants were recruited, comprising 679 males and 716 females, with a median age of 68 years. Based on their PA levels, 779 individuals were classified as inactive, 156 as insufficiently active, and 460 as sufficiently active. Following a median observation period of 59 months, there were 476 recorded deaths, with 349, 47, and 80 cases in the three respective groups. Compared to the inactive group, the HRs and 95% confidence intervals (CIs) for all-cause mortality in participants who were insufficiently active and sufficiently active were 0.58 (0.40, 0.84) and 0.47 (0.33, 0.67), respectively. The Kaplan-Meier curve revealed a significant difference in overall survival between the three groups, as confirmed by the log-rank test (P < 0.0001). Subgroup analysis further validated our results and demonstrated that the protective impact of PA on stroke prognosis varies according to distinct characteristics. CONCLUSIONS The results indicate that increased levels of PA are associated with a protective effect on long-term mortality among stroke survivors. Further prospective longitudinal studies are necessary to elucidate the optional PA level and special exercise guideline targeting this population.
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Affiliation(s)
- Fude Liu
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiangning Han
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yawen Cheng
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ning Zhu
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Shiliang Jiang
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jiahao Li
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jin Zhao
- Department of Nephrology, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Guogang Luo
- Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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10
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Sütçü Uçmak G, Kılınç M. The effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. Top Stroke Rehabil 2024; 31:788-794. [PMID: 38529783 DOI: 10.1080/10749357.2024.2333159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 03/17/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Physical activity decreases after stroke due to various factors and the causes and effects of these factors remain unclear. OBJECTIVES This study aimed todetermine the effects of kinesiophobia, fatigue, and quality of life on physical activity in patients with stroke. METHODS The study included 32 patients (13 females/19 males), all evaluated using the Stroke Rehabilitation Assessment of Movement, Barthel Index, Tampa Kinesiophobia Scale-fatigue, Fatigue Impact Scale and Stroke-Specific Quality of Life Scale. The SenseWear multisensory activity monitor was worn on the arm of the patients for 1 week to evaluate active energy expenditure, step count, and rest periods in relation to physical activity. Multiple linear regression analysis was used to examine the effects of the independent variables kinesiophobia, fatigue, and quality of life on the dependent variables of active energy expenditure, step count, and rest periods. RESULTS The mean age of the patients was 52.31 ± 14.76 years. According to the multiple regression analysis results, kinesiophobia (p = 0.011) and quality of life (p = 0.009) are significant determinants of active energy expenditure and quality of life (p = 0.001) is a significant determinant of the step count in patients with stroke. Kinesiophobia, fatigue, and quality of life were not determinants of rest periods (p > 0.05). CONCLUSIONS The study results showed that kinesiophobia and quality of life are important determinants of physical activity in patients with stroke. Combined evaluation in the clinic of motor findings and non-motor factors, which are often ignored, and the application of target-oriented approaches to these problems will make a significant contribution to the success of stroke rehabilitation.
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Affiliation(s)
- Gülşah Sütçü Uçmak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Akdeniz University, Antalya, Turkey
| | - Muhammed Kılınç
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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11
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Li G, Tao X, Lei B, Hou X, Yang X, Wang L, Zhang S, Lv Y, Wang T, Yu L. Effects of exercise on post-stroke cognitive function: a systematic review and meta-analysis of randomized controlled trials. Top Stroke Rehabil 2024; 31:645-666. [PMID: 38825881 DOI: 10.1080/10749357.2024.2356393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/23/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND A growing body of research examining the effect of exercise on cognitive function in stroke patients, while findings of available studies were conflicting. OBJECTIVES We aimed to estimate the effect of exercise on cognitive function in stroke patients. METHODS For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, Cochrane, and Scopus electronic databases, through 13 March 2023. The three-level restricted maximum likelihood random effects model was used to synthesize the data. RESULTS Twenty-five studies met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in stroke patients (Cohen's d = 0.37, 95% CI, 0.16 to 0.58, p < 0.01, I2 = 22.12%). Subgroup analysis showed that exercise significantly improved memory. In addition, aerobic exercise, exercise conducted 12 weeks or more, 3 times or more per week, less than 60 minutes per session, less than 180 minutes per week, and up to 12 months post-stroke increased cognitive function significantly. CONCLUSIONS Exercise improved cognitive function in stroke patients. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that stroke patients participate in aerobic exercise at least 3 times per week for 30-60 minutes, with a goal of 180 minutes per week being achieved by increasing the frequency of exercise. Exercise initiated within 12 months post-stroke and continued for 12 weeks or more is most beneficial for improving cognitive function.
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Affiliation(s)
- Gen Li
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, China
| | - Xifeng Tao
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Bingkai Lei
- School of Physical Education, Xihua University, Chengdu, China
| | - Xiao Hou
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xiaoguang Yang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Leiyuyang Wang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Tongling Wang
- Institute of Physical Education, Huzhou University, Huzhou, China
| | - Laikang Yu
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
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12
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Sánchez-Martín T, Costa-Miserachs D, Coll-Andreu M, Portell-Cortés I, García-Brito S, Torras-Garcia M. Treating Traumatic Brain Injury with Exercise: Onset Delay and Previous Training as Key Factors Determining its Efficacy. Neurorehabil Neural Repair 2024; 38:715-728. [PMID: 39143847 DOI: 10.1177/15459683241270023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
PURPOSE Exercise reduces cognitive deficits in traumatic brain injury (TBI), but early post-trauma exercise is often discouraged due to potential harm. The purpose was to evaluate the interaction between pre- and post-injury physical exercise on cognition, neuronal survival and inflammation. METHODS Rats were either sham-operated and kept sedentary (Sham) or subjected to controlled cortical impact injury and then distributed into sedentary (Tbi), pre-injury exercise (Pre-Tbi), post-injury exercise with early (24 hours, Tbi-early) or late (6 days, Tbi-late) onset, and a combination of pre- and post-injury exercise with early (Pre-Tbi-early) or late (Pre-Tbi-late) onset. Object recognition memory, hippocampal volume, neuronal survival (NeuN+) in the hippocampus and perirhinal cortex, and microglial activity (Iba-1) in the hippocampus were evaluated. RESULTS All exercise conditions, except TBI-early, attenuated the significant memory impairment at 24-hour retention caused by TBI. Additionally, Pre-TBI-early treatment led to memory improvement at 3-hour retention. Pre-TBI reduced neuronal death and microglial activation in the hippocampus. TBI-late, but not TBI-early, mitigated hippocampal volume loss, loss of mature neurons in the hippocampus, and inflammation. Combining pre-injury and early-onset exercise reduced memory deficits but did not affect neuronal death or microglial activation. Combining pre-injury and late-onset exercise had a similar memory-enhancing effect than late post-injury treatment alone, albeit with reduced effects on neuronal density and neuroinflammation. CONCLUSIONS Pre-TBI physical exercise reduces the necessary onset delay of post-TBI exercise to obtain cognitive benefits, yet the exact mechanisms underlying this reduction require further research.
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Affiliation(s)
- Tanit Sánchez-Martín
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - David Costa-Miserachs
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Margalida Coll-Andreu
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Isabel Portell-Cortés
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Soleil García-Brito
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Meritxell Torras-Garcia
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Spain
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13
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Liu S, Yang Y, Wang K, Zhang T, Luo J. A study on the impact of acute exercise on cognitive function in Alzheimer's disease or mild cognitive impairment patients: A narrative review. Geriatr Nurs 2024; 59:215-222. [PMID: 39053163 DOI: 10.1016/j.gerinurse.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 07/27/2024]
Abstract
This narrative review follows the JBI approach and comprehensively explores the effects and mechanisms of acute exercise on cognitive function in Alzheimer's disease (AD) and Mild cognitive impairment (MCI) patients. The results showed that the combination of acute exercise and cognitive training improved the cognitive function of AD patients better than aerobic exercise or resistance training alone. For patients with MCI, moderate intensity acute aerobic exercise and resistance exercise were beneficial to enhance Inhibitory control (IC), but high-intensity acute exercise was adverse to improve IC; Brain-derived neurotrophic factor (BDNF) and Insulin-like growth factor 1 (IGF-1) may assume the potential mediating mechanism of acute exercise on cognitive function in AD and MCI patients, but more research is needed to further confirm this mechanism.
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Affiliation(s)
- Shiqi Liu
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Yi Yang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Kun Wang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Tingran Zhang
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
| | - Jiong Luo
- Research Centre for Exercise Detoxification, College of Physical Education, Southwest University, Chongqing, 400715, China
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14
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Raghavan P. Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke. Phys Med Rehabil Clin N Am 2024; 35:235-257. [PMID: 38514216 DOI: 10.1016/j.pmr.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Stroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early closure of the sensitive period and downstream changes in muscles, such as sarcopenia, muscle stiffness, and reduced cardiovascular capacity, and blood flow that impede recovery.
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Affiliation(s)
- Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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15
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Simmons SB, Skolaris A, Love R, Fricker T, Penko AL, Li Y, Lapin B, Streicher M, Bethoux F, Linder SM. Intensive Aerobic Cycling Is Feasible and Elicits Improvements in Gait Velocity in Individuals With Multiple Sclerosis: A Preliminary Study. Int J MS Care 2024; 26:119-124. [PMID: 38765298 PMCID: PMC11096857 DOI: 10.7224/1537-2073.2023-042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Aerobic exercise (AEx) has many potential benefits; however, it is unknown whether individuals with multiple sclerosis (MS) can attain the optimal intensity and duration to harness its effects. Forced-rate exercise (FE) is a novel paradigm in which the voluntary pedaling rate during cycling is supplemented to achieve a higher exercise intensity. The aim of this pilot trial was to investigate the feasibility and initial efficacy of a 12-week FE or voluntary exercise (VE) cycling intervention for individuals with MS. METHODS Twenty-two participants with MS (Expanded Disability Severity Scale [EDSS] 2.0-6.5) were randomly assigned to FE (n = 12) or VE (n = 10), each with twice weekly 45-minute sessions at a prescribed intensity of 60% to 80% of maximum heart rate (HR). RESULTS Eighteen individuals (FE = 11; VE = 7) completed the intervention, however, adaptations were required in both groups to overcome barriers to cycling. Overall, participants exercised for an average of 42.2 ± 2.3 minutes at an aerobic intensity of 65% ± 7% of maximum HR and a pedaling cadence of 67.3 ± 13.3 RPM. Cycling led to improved treadmill walking speed (0.61 to 0.68 m/sec, P = .010), with somewhat greater improvement with FE compared to VE (increase of 0.09 vs 0.03 m/s, respectively, P = .17) post intervention. Notably, the participant with the highest disability level (EDSS 6.5) tolerated FE but not VE. CONCLUSIONS Aerobic exercise is feasible for individuals with MS, although those with increased disability may require novel paradigms such as FE to achieve targeted intensity. Further trials are warranted to investigate the effects of FE across the MS disability spectrum.
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Affiliation(s)
- Sarah B. Simmons
- From the Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Mellen Center for Multiple Sclerosis Treatment and Research
| | | | - Ryan Love
- Department of Physical Medicine and Rehabilitation
| | - Tori Fricker
- Department of Physical Medicine and Rehabilitation
| | - Amanda L. Penko
- Department of Physical Medicine and Rehabilitation
- Department of Biomedical Engineering
| | - Yadi Li
- Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Brittany Lapin
- Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH
| | | | - Francois Bethoux
- Mellen Center for Multiple Sclerosis Treatment and Research
- Department of Physical Medicine and Rehabilitation
| | - Susan M. Linder
- Department of Physical Medicine and Rehabilitation
- Department of Biomedical Engineering
- and Concussion Center, Cleveland Clinic, Cleveland, OH
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16
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Linder SM, Bischof-Bockbrader A, Davidson S, Li Y, Lapin B, Singh T, Lee J, Bethoux F, Alberts JL. The Utilization of Forced-Rate Cycling to Facilitate Motor Recovery Following Stroke: A Randomized Clinical Trial. Neurorehabil Neural Repair 2024; 38:291-302. [PMID: 38420848 PMCID: PMC11071159 DOI: 10.1177/15459683241233577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND The potential for aerobic exercise (AE) to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate AE (FE) paired with upper extremity (UE) repetitive task practice (FE + RTP) compared to time-matched UE RTP (RTP only) on motor recovery. METHODS A single center randomized clinical trial was conducted from April 2019 to December 2022. Sixty individuals ≥6 months post-stroke with UE hemiparesis were randomized to FE + RTP (N = 30) or RTP only (N = 30), completing 90-minute sessions, 3×/week for 8 weeks. The FE + RTP group underwent 45-minute of FE (5-minute warm-up, 35-minute main set, and 5-minute cool down) followed by 45-minute of UE RTP. The RTP only group completed 90-minute of RTP. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). The 6-minute Walk Test (6MWT, secondary outcome) assessed walking capacity. RESULTS Sixty individuals enrolled and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8 ± 44.4 vs 222.8 ± 28.4, P < .001) and time (72.7 ± 6.7 vs 37.8 ± 2.4 minutes, P < .001) versus FE + RTP. There was no significant difference between groups on the FMA (FE + RTP, 36.2 ± 10.1-44.0 ± 11.8 and RTP only, 34.4 ± 11.0-41.2 ± 13.4, P = .43) or ARAT (FE + RTP, 32.5 ± 16.6-37.7 ± 17.9 and RTP only, 32.8 ± 18.6-36.4 ± 18.5, P = .88). The FE + RTP group demonstrated greater improvements on the 6MWT (274.9 ± 122.0-327.1 ± 141.2 m) versus RTP only (285.5 ± 160.3-316.9 ± 170.0, P = .003). CONCLUSIONS There was no significant difference between groups in the primary outcomes. The FE + RTP improved more on the 6MWT, a secondary outcome. TRIAL REGISTRATION ClinicalTrials.gov: NCT03819764.
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Affiliation(s)
- Susan M. Linder
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Sara Davidson
- Concussion Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yadi Li
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tamanna Singh
- Department of Cardiovascular Medicine; Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John Lee
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Francois Bethoux
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH, USA
| | - Jay L. Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Concussion Center, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
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17
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English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2024; 19:133-144. [PMID: 37424273 PMCID: PMC10811972 DOI: 10.1177/17474930231189135] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/27/2023] [Indexed: 07/11/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
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Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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18
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De Las Heras B, Rodrigues L, Cristini J, Moncion K, Ploughman M, Tang A, Fung J, Roig M. Measuring Neuroplasticity in Response to Cardiovascular Exercise in People With Stroke: A Critical Perspective. Neurorehabil Neural Repair 2024:15459683231223513. [PMID: 38291890 DOI: 10.1177/15459683231223513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Rehabilitative treatments that promote neuroplasticity are believed to improve recovery after stroke. Animal studies have shown that cardiovascular exercise (CE) promotes neuroplasticity but the effects of this intervention on the human brain and its implications for the functional recovery of patients remain unclear. The use of biomarkers has enabled the assessment of cellular and molecular events that occur in the central nervous system after brain injury. Some of these biomarkers have proven to be particularly valuable for the diagnosis of severity, prognosis of recovery, as well as for measuring the neuroplastic response to different treatments after stroke. OBJECTIVES To provide a critical analysis on the current evidence supporting the use of neurophysiological, neuroimaging, and blood biomarkers to assess the neuroplastic response to CE in individuals poststroke. RESULTS Most biomarkers used are responsive to the effects of acute and chronic CE interventions, but the response appears to be variable and is not consistently associated with functional improvements. Small sample sizes, methodological variability, incomplete information regarding patient's characteristics, inadequate standardization of training parameters, and lack of reporting of associations with functional outcomes preclude the quantification of the neuroplastic effects of CE poststroke using biomarkers. CONCLUSION Consensus on the optimal biomarkers to monitor the neuroplastic response to CE is currently lacking. By addressing critical methodological issues, future studies could advance our understanding of the use of biomarkers to measure the impact of CE on neuroplasticity and functional recovery in patients with stroke.
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Affiliation(s)
- Bernat De Las Heras
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Lynden Rodrigues
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Jacopo Cristini
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Kevin Moncion
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
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19
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Kuppuswamy A, Billinger S, Coupland KG, English C, Kutlubaev MA, Moseley L, Pittman QJ, Simpson DB, Sutherland BA, Wong C, Corbett D. Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:52-61. [PMID: 38156702 PMCID: PMC10798014 DOI: 10.1177/15459683231219266] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Post-stroke fatigue (PSF) is a significant and highly prevalent symptom, whose mechanisms are poorly understood. The third Stroke Recovery and Rehabilitation Roundtable paper on PSF focussed primarily on defining and measuring PSF while mechanisms were briefly discussed. This companion paper to the main paper is aimed at elaborating possible mechanisms of PSF. METHODS This paper reviews the available evidence that potentially explains the pathophysiology of PSF and draws parallels from fatigue literature in other conditions. We start by proposing a case for phenotyping PSF based on structural, functional, and behavioral characteristics of PSF. This is followed by discussion of a potentially significant role of early inflammation in the development of fatigue, specifically the impact of low-grade inflammation and its long-term systemic effects resulting in PSF. Of the many neurotransmitter systems in the brain, the dopaminergic systems have the most evidence for a role in PSF, along with a role in sensorimotor processing. Sensorimotor neural network dynamics are compromised as highlighted by evidence from both neurostimulation and neuromodulation studies. The double-edged sword effect of exercise on PSF provides further insight into how PSF might emerge and the importance of carefully titrating interventional paradigms. CONCLUSION The paper concludes by synthesizing the presented evidence into a unifying model of fatigue which distinguishes between factors that pre-dispose, precipitate, and perpetuate PSF. This framework will help guide new research into the biological mechanisms of PSF which is a necessary prerequisite for developing treatments to mitigate the debilitating effects of post-stroke fatigue.
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Affiliation(s)
- Annapoorna Kuppuswamy
- Queen Square Institute of Neurology, University College London, London, UK
- Department of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sandra Billinger
- Department of Neurology, University of Kansas Medical Center, University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, MO, USA
| | - Kirsten G. Coupland
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | | | - Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J. Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dawn B. Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Brad A. Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TS, Australia
| | - Connie Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Brain and Mind Institute, University of Ottawa, Ottawa, ON, Canada
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English C, Simpson DB, Billinger SA, Churilov L, Coupland KG, Drummond A, Kuppuswamy A, Kutlubaev MA, Lerdal A, Mahmood A, Moseley GL, Pittman QJ, Riley EA, Sutherland BA, Wong CHY, Corbett D, Mead G. A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2024; 38:7-18. [PMID: 37837346 PMCID: PMC10798034 DOI: 10.1177/15459683231209170] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
RATIONALE Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities. METHODS We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed. RESULTS We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool. CONCLUSIONS By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.
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Affiliation(s)
- Coralie English
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Dawn B Simpson
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Centre, University of Kansas Alzheimer’s Disease Research Centre, Kansas City, KS, USA
| | - Leonid Churilov
- Department of Medicine (RMH), University of Melbourne, Heidelberg, VIC, Australia
| | - Kirsten G Coupland
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Anners Lerdal
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Department, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Amreen Mahmood
- Faculty of Health, Health and Education, Manchester Metropolitan University, Manchester, UK
| | - G Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Quentin J Pittman
- Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Ellyn A Riley
- Department of Communication Sciences and Disorders, Syracuse University, Syracuse, NY, USA
| | - Brad A Sutherland
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Connie HY Wong
- Centre for Inflammatory Diseases, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa Roger Guindon Hall, Ottawa, ON, Canada
| | - Gillian Mead
- Ageing and Health, Usher Institute, University of Edinburgh, Edinburgh, UK
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Hill G, Johnson F, Uy J, Serrada I, Benyamin B, Van Den Berg M, Hordacre B. Moderate intensity aerobic exercise may enhance neuroplasticity of the contralesional hemisphere after stroke: a randomised controlled study. Sci Rep 2023; 13:14440. [PMID: 37660093 PMCID: PMC10475034 DOI: 10.1038/s41598-023-40902-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023] Open
Abstract
Upregulation of neuroplasticity might help maximize stroke recovery. One intervention that appears worthy of investigation is aerobic exercise. This study aimed to determine whether a single bout of moderate intensity aerobic exercise can enhance neuroplasticity in people with stroke. Participants were randomly assigned (1:1) to a 20-min moderate intensity exercise intervention or remained sedentary (control). Transcranial magnetic stimulation measured corticospinal excitability of the contralesional hemisphere by recording motor evoked potentials (MEPs). Intermittent Theta Burst Stimulation (iTBS) was used to repetitively activate synapses in the contralesional primary motor cortex, initiating the early stages of neuroplasticity and increasing excitability. It was surmised that if exercise increased neuroplasticity, there would be a greater facilitation of MEPs following iTBS. Thirty-three people with stroke participated in this study (aged 63.87 ± 10.30 years, 20 male, 6.13 ± 4.33 years since stroke). There was an interaction between Time*Group on MEP amplitudes (P = 0.009). Participants allocated to aerobic exercise had a stronger increase in MEP amplitude following iTBS. A non-significant trend indicated time since stroke might moderate this interaction (P = 0.055). Exploratory analysis suggested participants who were 2-7.5 years post stroke had a strong MEP facilitation following iTBS (P < 0.001). There was no effect of age, sex, resting motor threshold, self-reported physical activity levels, lesion volume or weighted lesion load (all P > 0.208). Moderate intensity cycling may enhance neuroplasticity in people with stroke. This therapy adjuvant could provide opportunities to maximize stroke recovery.
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Affiliation(s)
- Gabrielle Hill
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia
| | - Finn Johnson
- Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Jeric Uy
- Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Ines Serrada
- Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
| | - Beben Benyamin
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, 5000, Australia
- South Australian Health and Medical Research Institute, Adelaide, 5000, Australia
| | - Maayken Van Den Berg
- Clinical Rehabilitation, College of Nursing and Health Sciences, Flinders University, Adelaide, 5042, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, University of South Australia, City East Campus, GPO Box 2471, Adelaide, 5001, Australia.
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Buvarp D, Viktorisson A, Axelsson F, Lehto E, Lindgren L, Lundström E, Sunnerhagen KS. Physical Activity Trajectories and Functional Recovery After Acute Stroke Among Adults in Sweden. JAMA Netw Open 2023; 6:e2310919. [PMID: 37126346 PMCID: PMC10152305 DOI: 10.1001/jamanetworkopen.2023.10919] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Importance The optimum level and timing of poststroke physical activity interventions to enhance functional recovery remain unclear. Objective To assess the level of physical activity in the first 6 months after stroke among individuals with similar physical activity patterns over time and to investigate the association between physical activity trajectories and functional recovery at 6 months after stroke. Design, Setting, and Participants This cohort study obtained data from the Efficacy of Fluoxetine-a Randomized Controlled Trial in Stroke, which was conducted in 35 stroke and rehabilitation centers across Sweden from October 2014 to June 2019. Adult participants (aged >18 years) were recruited between 2 and 15 days after stroke onset and followed up for 6 months. Participants who withdrew or were lost to follow-up were excluded from the longitudinal analysis. Data analyses were performed between August 15 and October 28, 2022. Exposures Physical activity was assessed at 1 week, 1 month, 3 months, and 6 months. Multiple factors associated with physical activity trajectories were investigated. Association of the distinct trajectories with functional recovery was assessed in multivariable logistic regression. Main Outcomes and Measures The primary outcomes were the distinct physical activity trajectories over time, which were identified using group-based trajectory modeling. The secondary outcome was the functional recovery at 6 months after stroke, which was assessed using the modified Rankin Scale. Results Of the 1367 included participants (median [IQR] age, 72 years [65-79] years; 844 males [62%]), 2 distinct trajectory groups were identified: increaser (n = 720 [53%]) and decreaser (647 [47%]). The increaser group demonstrated a significant increase in physical activity level (mean difference, 0.27; linear slope β1 = 0.46; P < .001) and sustained it at light intensity from 1 week to 6 months, whereas the decreaser group showed a decline in physical activity and eventually became inactive (mean difference, -0.26; linear slope β1 = 1.81; P < .001). Male participants and those with normal cognition had higher odds of being in the increaser group, regardless of stroke severity. Increasing physical activity and sustaining it at light intensity were associated with a good functional outcome at 6 months (adjusted odds ratio, 2.54; 99% CI, 1.72-3.75; P < .001). Conclusions ad Relevance Results of this study suggest that increased physical activity was associated with functional recovery 6 months after stroke. Interventions targeting individuals with decreasing physical activity in the subacute phase of stroke may play a role in improved functional outcomes.
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Affiliation(s)
- Dongni Buvarp
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Viktorisson
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Felix Axelsson
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Elias Lehto
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Linnea Lindgren
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Erik Lundström
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Katharina S Sunnerhagen
- Rehabilitation Medicine Research Group, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
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23
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Cheon DY, Han KD, Kim CH, Oh MS, Lee BC, Kim Y, Lee SH, Kim C, Lim JS, Lee M, Yu KH. Association between exercise habit changes and incident dementia after ischemic stroke. Sci Rep 2023; 13:3959. [PMID: 36894695 PMCID: PMC9998861 DOI: 10.1038/s41598-023-31229-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/08/2023] [Indexed: 03/11/2023] Open
Abstract
We aimed to investigate the effects of exercise habit changes on the risk of incident dementia after ischemic stroke using the Korean National Health Insurance Services Database. This study included 223,426 patients with a new diagnosis of ischemic stroke between 2010 and 2016 who underwent two serial ambulatory health checkups. The participants were divided into four categories according to their habit change or regular exercise: persistent non-exercisers, new exercisers, exercise dropouts, and exercise maintainers. The primary outcome was new diagnosis of dementia. Multivariate Cox proportional models were used to assess the effects of changes in exercise habits on the risk of incident dementia. After a median of 4.02 years of follow-up, 22,554 (10.09%) dementia cases were observed. After adjusting for covariates, exercise dropouts, new exercisers, and exercise maintainers were significantly associated with a lower risk of incident dementia than persistent non-exercisers (adjusted hazard ratio [aHR] 0.937; 95% confidence interval [CI] 0.905-0.970, aHR 0.876; 95% CI 0.843-0.909, aHR 0.705; 95% CI 0.677-0.734, respectively). The impact of changes in exercise habit was more prominent in the 40-65 years age group. An energy expenditure ≥ 1000 metabolic equivalents of task-min/wk post-stroke, regardless of pre-stroke physical activity status, was mostly associated with a lower risk of each outcome. In this retrospective cohort study, initiating or continuing moderate-to-vigorous exercise after ischemic stroke was associated with a lower risk of dementia development. Further, pre-stroke regular physical activity also reduced the risk of incident dementia. The promotion of exercise in ambulatory stroke patients may reduce their future risk of incident dementia.
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Affiliation(s)
- Dae Young Cheon
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hwaseong, South Korea
| | - Kyung do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Chi-Hun Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Mi Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, Ulsan University College of Medicine, Seoul, South Korea
| | - Minwoo Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea.
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Ploughman M, Melam GR, Buragadda S, Lohse KR, Clift F, Stefanelli M, Levin M, Donkers SJ. Translingual neurostimulation combined with physical therapy to improve walking and balance in multiple sclerosis (NeuroMSTraLS): Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 127:107142. [PMID: 36878390 DOI: 10.1016/j.cct.2023.107142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Physical rehabilitation restores lost function and promotes brain plasticity in people with Multiple Sclerosis (MS). Research groups worldwide are testing the therapeutic effects of combining non-invasive neuromodulation with physical therapy (PT) to further improve functional outcomes in neurological disorders but with mixed results. Whether such devices enhance function is not clear. We present the rationale and study design for a randomized controlled trial evaluating if there is additional benefit to the synergistic pairing of translingual neurostimulation (TLNS) with PT to improve walking and balance in MS. METHODS AND ANALYSIS A parallel group [PT + TLNS or PT + Sham], quadruple-blinded, randomized controlled trial. Participants (N = 52) with gait and balance deficits due to relapsing-remitting or progressive MS, who are between 18 and 70 years of age, will be recruited through patient registries in Newfoundland & Labrador and Saskatchewan, Canada. All participants will receive 14 weeks of PT while wearing either a TLNS or sham device. Dynamic Gait Index is the primary outcome. Secondary outcomes include fast walking speed, subjective ratings of fatigue, MS impact, and quality of life. Outcomes are assessed at baseline (Pre), after 14 weeks of therapy (Post), and 26 weeks (Follow Up). We employ multiple methods to ensure treatment fidelity including activity and device use monitoring. Primary and secondary outcomes will be analyzed using linear mixed-effect models. We will control for baseline score and site to test the effects of Time (Post vs. Follow-Up), Group and the Group x Time interaction as fixed effects. A random intercept of participant will account for the repeated measures in the Time variable. Participants must complete the Post testing to be included in the analysis. ETHICS AND DISSEMINATION The Human Research Ethics Boards in Newfoundland & Labrador (HREB#2021.085) & Saskatchewan (HREB Bio 2578) approved the protocol. Dissemination avenues include peer-reviewed journals, conferences and patient-oriented communications.
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Affiliation(s)
- Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd., St. John's, NL A1A 1E5, Canada.
| | - Ganeswara Rao Melam
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd., St. John's, NL A1A 1E5, Canada
| | - Syamala Buragadda
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, 100 Forest Rd., St. John's, NL A1A 1E5, Canada
| | - Keith R Lohse
- Program in Physical Therapy, Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Fraser Clift
- Department of Neurology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Mark Stefanelli
- Department of Neurology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michael Levin
- Department of Neurology and Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Sarah J Donkers
- School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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25
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Maguire C, Betschart M, Pohl J, Primani F, Taeymans J, Hund-Georgiadis M. Effects of moderate-intensity aerobic exercise on serum BDNF and motor learning in the upper-limb in patients after chronic-stroke: A randomized, controlled feasibility study with embedded health economic evaluation. NeuroRehabilitation 2023; 52:485-506. [PMID: 36806518 DOI: 10.3233/nre-220239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) promotes activity-dependent neuroplasticity and is released following aerobic-exercise. OBJECTIVE Feasibility and efficacy of 1.Moderate-Intensity Cycle-Ergometer-Training (MI-ET) and 2.Low-Intensity Circuit-Training (LI-CT) on BDNF-serum-concentration in chronic-stroke and consequently efficacy of motor-learning in varying BDNF-concentrations (neuroplasticity being the substrate for motor-learning) via upper-limb robotic-training (RT) in both groups. METHODS Randomised-control feasibility-study. 12-week, 3x/week intervention, 17 chronic-stroke-survivors randomized into: (1) MI-ET&RT or (2) LI-CT&RT. Both groups completed 40 mins MI-ET or LI-CT followed by 40 mins RT. Feasibility outcomes: (1) screening and enrollment-rates, (2) retention-rates, (3) adherence: (i) attendance-rates, (ii) training-duration, (4) adverse events. Primary clinical outcomes: 1. serum-BDNF changes pre-post training (immediate) and pre-training basal-levels over 12-weeks (long-term). 2.upper-limb performance with Action-Research-Arm-Test (ARAT). Additionally, feasibility of an embedded health economic evaluation (HEE) to evaluate health-costs and cost-effectiveness. OUTCOMES cost-questionnaire return-rates, cost-of-illness (COI) and Health-Utitility-Index (HUI). RESULTS 21.5% of eligible and contactable enrolled. 10 randomized to MI-ET and 7 to LI-CT. 85% of training-sessions were completed in MI-ET (306/360) and 76.3% in LI-CT-group (165/216). 12-weeks: Drop-outs MI-ET-10%, LI-CT-43%. CLINICAL OUTCOMES No significant changes in immediate or long-term serum-BDNF in either group. Moderate-intensity aerobic-training did not increase serum-BDNF post-stroke. Individual but no group clinically-relevant changes in ARAT-scores. HEE outcomes at 12-weeks: 100% cost-questionnaires returned. Group-costs baseline and after treatment, consistently favouring MI-ET group. COI: (1-year-time-frame): MI-ET 67382 SD (43107) Swiss-Francs and LI-CT 95701(29473) Swiss-Francs. CONCLUSION The study is feasible with modifications. Future studies should compare high-intensity versus moderate-intensity aerobic-exercise combined with higher dosage arm-training.
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Affiliation(s)
- Clare Maguire
- REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.,Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland
| | - Martina Betschart
- REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.,Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland.,Kantonal Hospital Winterthur, Winterthur, Switzerland
| | - Johannes Pohl
- Department of Neurology, University Hospital Zurich, Zurich Switzerland
| | - Francesca Primani
- REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.,Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland
| | - Jan Taeymans
- Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland.,Faculty of Movement and Rehabilitation Sciences, Universiteit Brussel, Brussel, Belgium
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Tani A, Sakakima H, Otsuka S, Mizuno K, Nakanishi K, Norimatsu K, Takada S, Matsuoka T, Matsuzaki R, Nakakogawa T, Maruyama I. Stimulation of functional recovery via neurorepair mechanisms by the traditional Japanese Kampo medicine, Ninjin'yoeito, and physical exercise in a rat ischemic stroke model. JOURNAL OF ETHNOPHARMACOLOGY 2023; 302:115927. [PMID: 36402237 DOI: 10.1016/j.jep.2022.115927] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/22/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ninjin'yoeito (NYT), a traditional Japanese Kampo medicine consisting of 12 herbs, has been reported to improve cognitive dysfunction, depression, and neurological recovery in patients with neurovascular diseases such as Alzheimer's disease and stroke. Several studies have reported that the NYT components exert neurotrophic, neurogenic, and neuroprotective effects. In addition, exercise enhances neuroprotection and functional recovery after stroke. Rehabilitative exercises and pharmacological agents induce neurophysiological plasticity, leading to functional recovery in stroke patients. These reports indicate that NYT treatment and exercise may promote functional recovery following stroke through their beneficial effects. However, no study has determined the effects of NYT and the possible mechanisms of neurorepair and functional recovery after stroke. AIM OF THE STUDY This study aimed to investigate the combined effects of NYT and exercise on neuroprotection and functional recovery and the underlying mechanisms in a rat ischemic stroke model. MATERIALS AND METHODS Stroke was induced with 60-min middle cerebral artery occlusion (MCAO) followed by reperfusion in adult male Sprague-Dawley rats. After stroke, the rats were assigned to four groups: ischemia reperfusion (IR), NYT, exercise (Ex), and NYT + Ex. NYT-treated rats were fed a diet containing 1% NYT one day after stroke. Exercise was performed using a motorized treadmill for 5 days a week (8-15 m/min, 20 min/day), starting 3 days after stroke. The NYT treatment and exercise were continued for 4 weeks after the stroke. Infarct volume, neurological deficits, sensorimotor functions, expression of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), tropomyosin receptor kinase A (TrkA) and B (TrkB), caspase-3 activity, and the p-Akt/Akt ratio were examined by immunohistochemistry and western blotting. RESULTS Compared to the IR group, all treated groups indicated reduced infarct volumes. The NYT + Ex group showed significantly improved waking time and beam walking score compared with the IR group. The expression of NGF/TrkA/p-TrkA and BDNF/TrkB was significantly increased in the NYT + Ex group compared with those in the IR group, whereas the number of caspase-3 positive cells around the lesion was significantly lower in the NYT + Ex group than in the IR group. In addition, the ratio of p-Akt/Akt was significantly higher in the NYT + Ex group than in the IR group. CONCLUSIONS This study suggests that NYT in combination with exercise provides neuroprotective effects and improves sensorimotor function by stimulating NGF/TrkA and BDNF/TrkB, and by activating the Akt pathway in ischemic stroke of rats. NYT may be an effective adjunctive agent in post-stroke rehabilitation.
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Affiliation(s)
- Akira Tani
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan.
| | - Shotaro Otsuka
- Department of Systems Biology in Thromboregulation, Kagoshima University, Japan
| | - Keita Mizuno
- Tsumura Kampo Research Laboratories, Kampo Research & Development Division, Tsumura & Co., Ibaraki, Japan
| | - Kazuki Nakanishi
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Kosuke Norimatsu
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Seiya Takada
- Department of Systems Biology in Thromboregulation, Kagoshima University, Japan
| | - Teruki Matsuoka
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Ryoma Matsuzaki
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Tomomi Nakakogawa
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Japan
| | - Ikuro Maruyama
- Department of Systems Biology in Thromboregulation, Kagoshima University, Japan
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27
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Henriette B, Marianne N, Rønne PJ, Glavin KM, Wesenberg KT, Thorgaard SS, Troels W. Test-Retest Reliability and Agreement of Single Pulse Transcranial Magnetic Stimulation (TMS) for Measuring Activity in Motor Cortex in Patients With Acute Ischemic Stroke. Neurosci Insights 2022; 17:26331055221145002. [PMID: 36578525 PMCID: PMC9791285 DOI: 10.1177/26331055221145002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/28/2022] [Indexed: 12/25/2022] Open
Abstract
Background Transcranial magnetic stimulation (TMS) is often used to examine neurophysiology. We aimed to investigate the inter-rater reliability and agreement of single pulse TMS in hospitalised acute ischemic stroke patients. Methods Thirty-one patients with first-time acute ischemic stroke (median age 72 (IQR 64-75), 35% females) underwent TMS motor threshold (MT) assessment in 4 muscles bilaterally, conducted by 1 of 2 physiotherapists. Test-retest reliability was evaluated using a two-way random effects model (2,1) absolute agreement-type Interclass Correlation Coefficient (ICC). Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC) were used to evaluate agreement. Results Reliability, SEM, and SDC of TMS was found to be moderate in right opponens pollicis (0.78 [CI 95% 0.55-0.89], SEM: 4.51, SDC: 12.51), good in right vastus medialis and tibial anterior (0.88 [CI 95% 0.72-0.96], SEM: 2.89, SDC: 8.01 and 0.88 [CI 95% 0.76-0.94], SEM: 2.88, SDC: 7.98 respectively), and excellent in right and left biceps brachii (0.98 [CI 95% 0.96-0.99], SEM: 1.79 SDC: 4.96, and 0.94 [CI 95% 0.89-0.97], SEM: 2.17 SDC: 6.01), opponens pollicis (0.92 [CI 95% 0.83-0.96], SEM: 2.68 SDC: 8.26, vastus medialis (0.92 [CI 95% 0.84-0.96], SEM: 2.87 SDC: 7.95), and tibial anterior (0.93 [CI 95% 0.86-0.96], SEM: 2.51 SDC: 6.95). Conclusion The TMS demonstrated moderate to excellent inter-rater reliability confirming the ability of these measures to reliably discriminate between individuals in the current study sample. Improvements of less than 4.96 to 12.51 could be a result of measurement error and may therefore not be considered a true change.
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Affiliation(s)
- Busk Henriette
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark,Department of Neurology, Zealand University Hospital, Roskilde, Sjaelland, Denmark,Busk Henriette, Department of Neurology, Zealand University Hospital, Sygehusvej 10, Roskilde DK 4000, Denmark.
| | - Nilsen Marianne
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Pedersen Julie Rønne
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | | | | | - Skou Søren Thorgaard
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Wienecke Troels
- Department of Neurology, Zealand University Hospital, Roskilde, Sjaelland, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hortobágyi T, Vetrovsky T, Balbim GM, Sorte Silva NCB, Manca A, Deriu F, Kolmos M, Kruuse C, Liu-Ambrose T, Radák Z, Váczi M, Johansson H, Dos Santos PCR, Franzén E, Granacher U. The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease. Ageing Res Rev 2022; 80:101698. [PMID: 35853549 DOI: 10.1016/j.arr.2022.101698] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effects of low- vs. high-intensity aerobic and resistance training on motor and cognitive function, brain activation, brain structure, and neurochemical markers of neuroplasticity and the association thereof in healthy young and older adults and in patients with multiple sclerosis, Parkinson's disease, and stroke. DESIGN Systematic review and robust variance estimation meta-analysis with meta-regression. DATA SOURCES Systematic search of MEDLINE, Web of Science, and CINAHL databases. RESULTS Fifty studies with 60 intervention arms and 2283 in-analyses participants were included. Due to the low number of studies, the three patient groups were combined and analyzed as a single group. Overall, low- (g=0.19, p = 0.024) and high-intensity exercise (g=0.40, p = 0.001) improved neuroplasticity. Exercise intensity scaled with neuroplasticity only in healthy young adults but not in healthy older adults or patient groups. Exercise-induced improvements in neuroplasticity were associated with changes in motor but not cognitive outcomes. CONCLUSION Exercise intensity is an important variable to dose and individualize the exercise stimulus for healthy young individuals but not necessarily for healthy older adults and neurological patients. This conclusion warrants caution because studies are needed that directly compare the effects of low- vs. high-intensity exercise on neuroplasticity to determine if such changes are mechanistically and incrementally linked to improved cognition and motor function.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany; Hungarian University of Sports Science, Department of Kinesiology, Budapest, Hungary.
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Guilherme Moraes Balbim
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Nárlon Cássio Boa Sorte Silva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy
| | - Mia Kolmos
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Zsolt Radák
- Research Center of Molecular Exercise Science, Hungarian University of Sport Science, Budapest, Hungary
| | - Márk Váczi
- Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
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Sargent B, Harbourne R, Moreau NG, Sukal-Moulton T, Tovin M, Cameron JL, Stevenson RD, Novak I, Heathcock J, Participants from RSV. Research Summit V: Optimizing Transitions From Infancy to Early Adulthood in Children With Neuromotor Conditions. Pediatr Phys Ther 2022; 34:411-417. [PMID: 35653258 PMCID: PMC9250600 DOI: 10.1097/pep.0000000000000912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of this executive summary is to review the process and outcomes of the Academy of Pediatric Physical Therapy Research Summit V, "Optimizing transitions from infancy to young adulthood in children with neuromotor disabilities: biological and environmental factors to support functional independence." SUMMARY OF KEY POINTS An interdisciplinary group of researchers, representatives from funding agencies, and individuals with neuromotor disabilities and their parents participated in an intensive 2.5-day summit to determine research priorities to optimize life transitions for children with neuromotor disabilities. Recommended priorities for research included (1) promoting self-determination and self-efficacy of individuals with neuromotor disabilities and their families, (2) best care at the right time: evidence-based best practice care, led and navigated by families seamlessly across the lifespan, (3) strengthening connections between developmental domains to enhance function and participation, and (4) optimal dosing and timing to support adaptive bone, muscle, and brain plasticity across the lifespan.
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Affiliation(s)
- Barbara Sargent
- University of Southern California, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles, California, USA
| | - Regina Harbourne
- Duquesne University, Rangos School of Health Sciences, Department of Physical Therapy, Pittsburgh, Pennsylvania, USA
| | - Noelle G. Moreau
- Louisiana State University Health Sciences Center – New Orleans, Department of Physical Therapy, School of Allied Health, New Orleans, Louisiana USA
| | - Theresa Sukal-Moulton
- Northwestern University, Departments of Physical Therapy and Human Movement Sciences and Pediatrics, Feinberg School of Medicine, Chicago, IL, USA
| | - Melissa Tovin
- Nova Southeastern University, Department of Physical Therapy, Fort Lauderdale, FL, USA
| | - Judy L. Cameron
- University of Pittsburgh, Department of Psychiatry, Pittsburgh, Pennsylvania, USA
| | - Richard D. Stevenson
- University of Virginia School of Medicine, Department of Pediatrics, Charlottesville, VA, USA
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jill Heathcock
- The Ohio State University, School of Health and Rehabilitation Sciences, Division of Physical Therapy, Columbus, OH, USA
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The Effect of Endurance Training on Serum BDNF Levels in the Chronic Post-Stroke Phase: Current Evidence and Qualitative Systematic Review. J Clin Med 2022; 11:jcm11123556. [PMID: 35743624 PMCID: PMC9225034 DOI: 10.3390/jcm11123556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/14/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Research in modern neurorehabilitation focusses on cognitive and motor recovery programmes tailored to each stroke patient, with particular emphasis on physiological parameters. The objectives of this review were to determine whether a single bout of endurance activity or long-term endurance activity regulates exercise-dependent serum brain-derived neurotrophic factor (BDNF) levels and to evaluate the methodological quality of the studies. To assess the effectiveness of endurance exercise among patients in the chronic post-stroke phase, a systematic review was performed, including searching EBSCOhost, PEDro, PubMed, and Scopus for articles published up to the end of October 2021. The PRISMA 2020 outline was used, and this review was registered on PROSPERO. Of the 180 papers identified, seven intervention studies (comprising 200 patients) met the inclusion criteria. The methodological quality of these studies was evaluated by using the Physiotherapy Evidence Database (PEDro) criteria. The effect of exercise was evaluated in four studies with a single bout of endurance activity, two studies with long-term endurance activity, and one study with a single bout of endurance activity as well as long-term endurance activity. The results of our systematic review provide evidence that endurance exercise might augment the peripheral BDNF concentration in post-stroke individuals.
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Lin H, Liu H, Dai Y, Yin X, Li Z, Yang L, Tao J, Liu W, Chen L. Effect of Physical Activity on Cognitive Impairment in Patients With Cerebrovascular Diseases: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:854158. [PMID: 35599737 PMCID: PMC9120585 DOI: 10.3389/fneur.2022.854158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose This study investigates the effect of physical activity (PA) on cognition in patients with cerebrovascular disease and explored the maximum benefit of different PA characteristics. Methods Databases, such as Pubmed, Web of Science, Embase, and Cochrane Library, were searched from their inception to May 31, 2021. Standardized mean difference (SMD) and 95% confidence intervals (CIs) were calculated to generate a forest plot. In addition, subgroup analysis, moderation analysis, and regression analysis were performed to explore the possible adjustment factors. Results In total, 22 studies that met the criteria were included, demonstrating data from 1,601 participants. The results indicated that PA produced a positive effect on the global cognition for patients with cerebrovascular disease (SMD: 0.20 [95% CI: 0.12-0.27]), at the same time, PA training prominently improved executive function (SMD: 0.09 [95% CI: 0.00-0.17]) and working memory (SMD: 0.25 [95% CI: 0.10-0.40]). Furthermore, patients with baseline cognitive impairment received the greater benefit of PA on cognition (SMD: 0.24 [95% CI: 0.14-0.34]) than those without cognitive impairment before intervention (SMD: 0.15 [95% CI: 0.04-0.26]). For patients in the acute stage (≤ 3 months), PA did not rescue impairment dysfunction significantly (SMD: 0.08 [95% CI: -0.04-0.21]) and remarkable cognitive gains were detected in the chronic stage of participants (>3 months) (SMD: 0.25 [95% CI: 0.16-0.35]). Moderate intensity PA showed a larger pooled effect size (SMD: 0.23 [95% CI: 0.11-0.36]) than low intensity (SMD: -0.01 [95% CI: -0.44-0.43]) and high intensity (SMD: 0.16 [95% CI: 0.03-0.29]). However, the different types, duration, and frequency of PA resulted in no differences in the improvement of cognitive function. Further regression analysis demonstrated that the beneficial effects of PA on cognition are negatively correlated with age (p < 0.05). Conclusions This study revealed that PA can prominently improve the cognitive ability in patients with cerebrovascular diseases and strengthened the evidence that PA held promise as a widely accessible and effective non-drug therapy for vascular cognitive impairment (VCI).
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Affiliation(s)
- Huawei Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - HuanHuan Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yaling Dai
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xiaolong Yin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Zuanfang Li
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lei Yang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Weilin Liu
- The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lidian Chen
- The Academy of Rehabilitation Industry, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Seidler K, Barrow M. Intermittent fasting and cognitive performance - Targeting BDNF as potential strategy to optimise brain health. Front Neuroendocrinol 2022; 65:100971. [PMID: 34929259 DOI: 10.1016/j.yfrne.2021.100971] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/11/2021] [Accepted: 12/12/2021] [Indexed: 12/26/2022]
Abstract
Aging is the major risk factor for neurodegenerative diseases, accelerated by excessive calorie consumption and sedentary lifestyles. Bioenergetic challenges such as intermittent fasting (IF) have shown to promote lifespan and healthspan via an adaptive stress response. Activity-dependent brain-derived neurotrophic factor (BDNF) has emerged as key regulator of cognitive performance and brain health. This review aims to investigate the pathophysiological mechanisms linking IF and cognitive function with a focus on the role of BDNF, evaluating evidence from pre-clinical and human studies. A systematic literature search was performed. 82 peer-reviewed papers were accepted, critically appraised and summarised in a narrative analysis. Aging-related loss of BDNF has been associated with reduced synaptic plasticity, memory and learning as well as increased risk of cognitive impairment and Alzheimer's disease. IF was consistently reported to upregulate BDNF and improve cognitive performance in animal models. Further research is required to assess cognitive outcomes of IF in humans.
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Affiliation(s)
- Karin Seidler
- Centre for Nutrition Education and Lifestyle Management, Chapel Gardens, 14 Rectory Road, Wokingham RG40 1DH, United Kingdom.
| | - Michelle Barrow
- Centre for Nutrition Education and Lifestyle Management, Chapel Gardens, 14 Rectory Road, Wokingham RG40 1DH, United Kingdom
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Busk H, Holm P, Skou S, Seitner S, Siemsen T, Wienecke T. Inter-rater reliability and agreement of 6 Minute Walk Test and 10 Meter Walk Test at comfortable walk speed in patients with acute stroke. Physiother Theory Pract 2022; 39:1024-1032. [PMID: 35109744 DOI: 10.1080/09593985.2022.2030830] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Remediation of gait problems is a key feature of neurological physiotherapy We aimed to investigate the inter-rater reliability and agreement of the Six Minute Walk Test (6MWT) and Ten Meter Walk Test (10MWT), at comfortable walking speed, in hospitalized acute ischemic stroke patients. METHOD Forty acute first-time patients with brain stem or hemispheric ischemic stroke aged 67.4 ± 12.5 (SD), able to walk with or without an assistive device, were tested by one of three physiotherapists. Test-retest reliability was evaluated using a one-way random effects single measures model (1,1) absolute agreement-type Interclass Correlation Coefficient (ICC). Agreement was evaluated using the Standard Error of Measurement (SEM) and Smallest Detectable Change (SDC). RESULTS Both tests demonstrated good reliability; ICC1,1 0.83 (CI 95% 0.70-0.90) (6MWT) and 0.76 (CI 95% 0.59-0.87) (10MWT). The 6MWT-SEM was 27.2 m (m) and the SDC was 75.4 m. The 10MWT-SEM was 0.36 meters per second (m/s) and the SDC was 1.0 m/s. CONCLUSION Both tests demonstrated good inter-rater reliability, confirming their discriminative ability on a group of hospitalized first-time acute ischemic stroke patients. However, the measurement error was large for both tests, which is likely due to spontaneous neurological recovery and stress in the acute phase severely affecting the individual-level agreement estimate.
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Affiliation(s)
- Henriette Busk
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Department of Neurology, Zealand University Hospital, Roskilde, Denmark.,Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark
| | - Paetur Holm
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Simon Seitner
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Troels Siemsen
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark
| | - Troels Wienecke
- Department of Neurology, Zealand University Hospital, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Inoue T, Takamatsu Y, Nishio T, Soma K, Okamura M, Tohyama H, Maejima H. Combined treatment with exercise and α5GABA AR inhibitor promotes motor function recovery after intracerebral hemorrhage. Neurosci Lett 2022; 766:136344. [PMID: 34785309 DOI: 10.1016/j.neulet.2021.136344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/07/2021] [Accepted: 11/09/2021] [Indexed: 11/17/2022]
Abstract
The present study aimed to examine the synergistic effects of exercise and pharmacological inhibition of the α5 subunit-containing gamma-aminobutyric acid (GABA)A receptors (α5GABAAR) on motor function recovery after intracerebral hemorrhage (ICH). Wistar rats were divided into five groups (n = 8 per group): SHAM, ICH, ICH + exercise (ICH + EX), ICH + L-655,708 (ICH + L6), and ICH + L-655,708 and exercise (ICH + L6EX) groups. ICH was induced by microinjection of a collagenase solution. The ICH + EX and ICH + L6EX groups exercised on a treadmill (12 m/min for 30 min/day). L-655,708 (0.5 mg/kg), a negative allosteric modulator of α5GABAAR, was administered intraperitoneally to the ICH + L6 and ICH + L6EX groups. Each intervention was initiated 1 week after the ICH surgery and was performed for 3 weeks, followed by tissue collection, including the motor cortex and spinal cord. At 4 weeks after ICH, significant motor recovery was found in the ICH + L6EX group compared to the ICH group. L-655,708 administration increased brain-derived neurotrophic factor (BDNF) expression in the cortex. Regarding neuroplastic changes in the spinal cord, rats in the ICH + L6EX group showed a significant increase in several neuroplastic markers: 1) BDNF, 2) growth-associated protein 43 as an axonal sprouting marker, 3) synaptophysin as a synaptic marker, and 4) Nogo-A as an axonal growth inhibitor. This study is the first to demonstrate that combined treatment with exercise and α5GABAAR inhibitor effectively promoted motor function recovery after ICH. Regarding the underlying mechanism of post-ICH recovery with the combined treatment, the present study highlights the importance of both growth and inhibitory modification of axonal sprouting in the spinal cord.
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Affiliation(s)
- Takahiro Inoue
- Graduate School of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan; Research Fellow of Japan Society for the Promotion of Science, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo 102-0083, Japan
| | - Yasuyuki Takamatsu
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Taichi Nishio
- Graduate School of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Kiho Soma
- Graduate School of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Misato Okamura
- Graduate School of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Harukazu Tohyama
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan
| | - Hiroshi Maejima
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Kita 12 Nishi 5, Kita-ku, Sapporo 060-0812, Japan.
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Kooncumchoo P, Namdaeng P, Hanmanop S, Rungroungdouyboon B, Klarod K, Kiatkulanusorn S, Luangpon N. Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:224. [PMID: 35010482 PMCID: PMC8750435 DOI: 10.3390/ijerph19010224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 06/14/2023]
Abstract
Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl-Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.
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Affiliation(s)
- Patcharee Kooncumchoo
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
| | - Phuwarin Namdaeng
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Somrudee Hanmanop
- Department of Physical Therapy, Faculty of Allied Health Sciences, Thammasat University, Pathumthani 12120, Thailand; (P.K.); (P.N.); (S.H.)
| | - Bunyong Rungroungdouyboon
- Center of Excellence in Creative Engineering Design and Development, Thammasat University, Pathumthani 12120, Thailand;
- Department of Mechanical Engineering, Faculty of Engineering, Thammasat University, Pathumthani 12120, Thailand
| | - Kultida Klarod
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Sirirat Kiatkulanusorn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
| | - Nongnuch Luangpon
- Department of Physical Therapy, Faculty of Allied Health Sciences, Burapha University, Chonburi 20131, Thailand; (K.K.); (S.K.)
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Mayer JF, Sandberg CW, Mozeiko J, Madden EB, Murray LL. Cognitive and Linguistic Benefits of Aerobic Exercise: A State-of-the-Art Systematic Review of the Stroke Literature. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:785312. [PMID: 36188840 PMCID: PMC9397720 DOI: 10.3389/fresc.2021.785312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022]
Abstract
This systematic review aimed to determine how aerobic exercise affects cognition after stroke, with particular focus on aphasia and language improvement. Methodological quality was assessed with the PEDro+ scale with half of the 27 included studies rated as high quality. Data extraction focused on cognitive effects of aerobic exercise post-stroke, intervention characteristics, outcome measures, and participant characteristics. Whereas attention, memory, and executive functioning measures were common across the included studies, no study included a language-specific, performance-based measure. Seventeen studies reported positive cognitive effects, most frequently in the domains of attention, memory and executive functioning. Variability in outcome measures, intervention characteristics, and participant characteristics made it difficult to identify similarities among studies reporting positive cognitive effects of exercise or among those studies reporting null outcomes. Only three studies provided specific information about the number of individuals with aphasia included or excluded, who comprise approximately one-third of the stroke population. The review identified patent gaps in our understanding of how aerobic exercise may affect not only the cognitive domain of language post-stroke but also the broader cognitive functioning of individuals with post-stroke aphasia. Methodological limitations of the reviewed studies also warrant further examination of the direct impact of aerobic exercise on cognition post-stroke with careful attention to the selection and reporting of population, intervention, and outcomes.
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Affiliation(s)
- Jamie F. Mayer
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, IL, United States
- *Correspondence: Jamie F. Mayer
| | - Chaleece W. Sandberg
- Department of Communication Sciences and Disorders, Penn State University, University Park, PA, United States
| | - Jennifer Mozeiko
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, CT, United States
| | - Elizabeth B. Madden
- School of Communication Science and Disorders, Florida State University, Tallahassee, FL, United States
| | - Laura L. Murray
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
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Exercise-induced neuroprotection against cerebral ischemia/reperfusion injury is mediated via alleviating inflammasome-induced pyroptosis. Exp Neurol 2021; 349:113952. [PMID: 34921847 DOI: 10.1016/j.expneurol.2021.113952] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022]
Abstract
As a primary nonpharmacological tool, exercise training is neuroprotective after experimental ischemic stroke by relieving neuroinflammation. However, the specific mechanism of which and anti-inflammatory effect of exercise at different intensities require in-depth investigations. To explore the issue, middle cerebral artery occlusion-reperfusion (MCAO-r) in mice were utilized, with subsequent exercise training at different intensities (high-intensity interval training versus moderate-intensity continuous training, i.e. HIIT vs. MICT) during an early phase post-modeling. The neurobehavioral assessment showed that MICT improved the performance of neurological deficit scores and rotarod test earlier, while HIIT appeared to be more efficacious to meliorate locomotor impairments and aerobic fitness at the end of intervention. Both exercise regimens inhibited the expressions of NLRP3 inflammasome components (NLRP3, ASC, and Cl.caspase-1) and pyroptosis-associated proteins (GSDMD, Cl.IL-1β, and Cl.IL-18) as indicated by western blot and immunofluorescence co-staining. Multiplex assay panel revealed that both exercise regimens reduced the levels of pro-inflammatory cytokines and upregulated anti-inflammatory cytokine. Furthermore, an increased proportion of M2-like microglia and a diminished proportion of M1-like microglia in the peri-infarct zone were observed by colocalization analysis, which was jointly validated by western blot. Here, for the first time, our study demonstrated that HIIT elicited better improvements at functional and cardiovascular levels than MICT after ischemic stroke, and anti-inflammatory effect of exercise might result from suppression in inflammasome-mediated pyroptosis by shifting microglial polarization toward neuroprotective M2 phenotype.
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Onose G, Anghelescu A, Blendea CD, Ciobanu V, Daia CO, Firan FC, Munteanu C, Oprea M, Spinu A, Popescu C. Non-invasive, non-pharmacological/bio-technological interventions towards neurorestoration upshot after ischemic stroke, in adults-systematic, synthetic, literature review. FRONT BIOSCI-LANDMRK 2021; 26:1204-1239. [PMID: 34856764 DOI: 10.52586/5020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 11/09/2022]
Abstract
Considering its marked life-threatening and (not seldom: severe and/or permanent) disabling, potential, plus the overall medico-psycho-socio-economic tough burden it represents for the affected persons, their families and the community, the cerebrovascular accident (CVA)-including with the, by far more frequent, ischemic type-is subject to considerable scientific research efforts that aim (if possible) at eliminating the stroke induced lesions, and consist, as well, in ambitious-but still poorly transferable into medical practice-goals such as brain neuroregeneration and/or repair, within related corollary/upshot of neurorestoration. We have conducted, in this respect, a systematic and synthetic literature review, following the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)" concept. Accordingly, we have interrogated five internationally renowned medical data bases: Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science (the last one to check whether the initially identified articles are published in ISI indexed journals), based on a large (details in the body text) number of most appropriate, to our knowledge, key word combinations/"syntaxes"-used contextually-and subsequently fulfilling the related, on five steps, filtering/selection methodology. We have thereby selected 114 fully eligible (of which contributive: 83-see further) papers; at the same time, additionally, we have enhanced our documentation-basically, but not exclusively, for the introductive part of this work (see further)-with bibliographic resources, overall connected to our subject, identified in the literature within a non-standardized search. It appears that the opportunity window for morph-functional recovery after stroke is larger than previously thought, actually being considered that brain neurorestoration/repair could occur, and therefore be expected, in later stages than in earlier ones, although, in this context, the number of cases possibly benefitting (for instance after physical and/or cognitive rehabilitation-including with magnetic or direct current transcranial stimulation) is quite small and with more or less conflicting, related outcomes, in the literature. Moreover, applying especially high intense, solicitating, rehabilitation interventions, in early stages post (including ischemic) stroke could even worsen the functional evolution. Accordingly, for clarifications and validation of more unitary points of view, continuing and boosting research efforts in this complex, interdisciplinary domain, is necessary. Until finding (if ever) effective modalities to cure the lesions of the central nervous system (CNS)-including post ischemic stroke-it is reasonable and recommendable-based on rigorous methodologies-the avail of combined ways: physiatric, pharmacologic, possibly also bio-technologic. On a different note, but however connected to our subject: periodic related systematic, synthetic literature reviews reappraisals are warranted and welcome.
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Affiliation(s)
- Gelu Onose
- Physical and Rehabilitation Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania
| | - Aurelian Anghelescu
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania
- Specific Disciplines Department, Faculty of Midwifes and Nursing, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania
| | - Corneliu Dan Blendea
- Medical-Surgical and Prophylactic Disciplines Department - Medical Rehabilitation, Recovery and Medical Physical Culture Discipline, Faculty of Medicine, University "Titu Maiorescu", 040051 Bucharest, Romania
- Physical and Rehabilitation Medicine & Balneology Clinic Division - The Neuro-Rehabilitation Compartment, Teaching Emergency Hospital of the Ilfov County, 22104 Bucharest, Romania
| | - Vlad Ciobanu
- Politehnica University of Bucharest, Computer Science Department, 060042 Bucharest, Romania
| | - Cristina Octaviana Daia
- Physical and Rehabilitation Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania
| | - Florentina Carmen Firan
- Physical and Rehabilitation Medicine & Balneology Clinic Division - The Neuro-Rehabilitation Compartment, Teaching Emergency Hospital of the Ilfov County, 22104 Bucharest, Romania
| | - Constantin Munteanu
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, 700454 Iasi, Romania
| | - Mihaela Oprea
- Physical and Rehabilitation Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania
| | - Aura Spinu
- Physical and Rehabilitation Medicine Department, Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 020022 Bucharest, Romania
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania
| | - Cristina Popescu
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital "Bagdasar-Arseni", 041915 Bucharest, Romania
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Espinoza F, Wheeler B. Handgrip as a measure of muscle strength and its physiological dependence on therapeutic variables: A randomized case. HAND SURGERY & REHABILITATION 2021; 41:31-36. [PMID: 34752971 DOI: 10.1016/j.hansur.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Clinical and medical data findings have traditionally been more representative of male than female subjects, and when combined, have not clearly differentiated between the groups. In this study there were no research questions initially contemplated, as the data were obtained from an educational setting, where participants completed tasks as part of a pedagogical program of preparation. The nature of the post-hoc analysis renders the study as a hypothesis-generating type rather than a hypothesis-testing one. It began as a cross-sectional quantitative analysis of performance on a task to explore the relationship between hand grip and three independent physiological variables. The data collected from all subjects were randomized since the total group of participants contained a disproportionate number of females as compared to males, this being a result of a demographic predominance of female students in a program of teacher preparation. Graphical analysis with the slope taken as a measure of hand grip dependence on three independent variables, and the correlation value used as a measure of association between variables yielded discernible differences. The grip strength dependence on the hand size as well as the wrist thickness show consistently significant differences for females only, with t test of significance (p < .001), and large effect size differences based on Cohen's d values of 3.08 and 1.92, respectively. The significance of the finding that female grip strength depends the most on wrist thickness has implications for rehabilitative and therapeutic settings.
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Affiliation(s)
- Fernando Espinoza
- Departments of Adolescence Education and Chemistry-Physics, State University of New York-College at Old Westbury, P.O. Box 210, Old Westbury, NY 11568, USA.
| | - Brandon Wheeler
- Pre-Medical Program, Stony Brook University, 100 Nichols Road, Stony Brook, NY, 11794 USA
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Penna LG, Pinheiro JP, Ramalho SHR, Ribeiro CF. Effects of aerobic physical exercise on neuroplasticity after stroke: systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:832-843. [PMID: 34669820 DOI: 10.1590/0004-282x-anp-2020-0551] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Stroke is among the leading causes of death and disability worldwide. Interventions for stroke rehabilitation aim to minimize sequelae, promote individuals' independence and potentially recover functional damage. The role of aerobic exercise as a facilitator of post-stroke neuroplasticity in humans is still questionable. OBJECTIVE To investigate the impact of aerobic exercise on neuroplasticity in patients with stroke sequelae. METHODS A systematic review of randomized clinical trials and crossover studies was performed, with searches for human studies in the following databases: PUBMED, EMBASE, LILACS and PeDRO, only in English, following the PRISMA protocol. The keywords used for selecting articles were defined based on the PICO strategy. RESULTS This systematic review evaluated the impacts of aerobic exercise on neuroplasticity through assessment of neural networks and neuronal excitability, neurotrophic factors, or cognitive and functional assessment. Studies that evaluated the effects of aerobic exercise on neuroplasticity after stroke measured through functional resonance (fMRI) or cortical excitability have shown divergent results, but aerobic exercise potentially can modify the neural network, as measured through fMRI. Additionally, aerobic exercise combined with cognitive training improves certain cognitive domains linked to motor learning. Studies that involved analysis of neurotrophic factors to assess neuroplasticity had conflicting results. CONCLUSIONS Physical exercise is a therapeutic intervention in rehabilitation programs that, beyond the known benefits relating to physical conditioning, functionality, mood and cardiovascular health, may also potentiate the neuroplasticity process. Neuroplasticity responses seem more robust in moderate to high-intensity exercise training programs, but dose-response heterogeneity and non-uniform neuroplasticity assessments limit generalizability.
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Affiliation(s)
- Leandro Goursand Penna
- Universidade de Coimbra, Faculdade de Medicina, Departamento de Medicina do Desporto, Coimbra, Província de Coimbra, Portugal
| | - João Pascoa Pinheiro
- Universidade de Coimbra, Faculdade de Medicina, Departamento de Medicina do Desporto, Coimbra, Província de Coimbra, Portugal
| | | | - Carlos Fontes Ribeiro
- Universidade de Coimbra, Faculdade de Medicina, Departamento de Medicina do Desporto, Coimbra, Província de Coimbra, Portugal
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Neuromuscular Electric Stimulation in Addition to Exercise Therapy in Patients with Lower Extremity Paresis Due to Acute Ischemic Stroke. A proof-of-concept randomised controlled trial. J Stroke Cerebrovasc Dis 2021; 30:106050. [PMID: 34418670 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Exercise therapy and neuromuscular electrical stimulation (NMES) during the initial 14 days after stroke may benefit recovery of gait. We aimed to determine whether poststroke NMES of vastus medial and tibial muscles during exercise therapy is more effective than exercise therapy alone. MATERIALS AND METHODS In this proof-of-concept randomised trial patients with first-ever acute ischemic stroke and a leg paresis (40-85 years of age) were randomised (1:1) to 10 min of daily NMES + exercise therapy or exercise therapy alone. Primary outcome was the between-group difference in change in 6 min Walk Test (6MWT) at 90 days post stroke estimated with a mixed regression model. Secondary outcomes included 10 m Walk Test, Fugl-Meyer Motor Assessment, Guralnik Timed Standing Balance, Sit to Stand, Timed Up and Go, EQ-5D-5L, Montreal Cognitive Assessment and Becks Depression Inventory. RESULTS 50 stroke survivors (25 in each group) with a mean age of 67 years (range 43-83) were included. An insignificant between-group difference in change of 28.3 m (95%CI -16.0 to 72.6, p = 0.23, adjusted for baseline) in 6MWT at 90-days follow-up was found, in favour of the NMES group. All secondary outcomes showed no statistically significant between-group difference. The conclusion was that adding NMES to exercise therapy had no effect on poststroke walking distance measured by the 6 MWT or any of the secondary outcomes. CONCLUSIONS In this proof-of-concept RCT, we demonstrated that NMES in addition to exercise therapy during the first 14 days after onset of ischemic stroke did not improve walking distance or any of the secondary outcomes. Future studies with a longer trial period, stratifying patients into subgroups with comparable patterns of expected spontaneous recovery - if possible within 48 h post stroke, and greater sample size, than in this study are suggestions of how rehabilitation research could go on exploring the potential for NMES as an amplifier in stroke recovery.
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Limaye NS, Carvalho LB, Kramer S. Effects of Aerobic Exercise on Serum Biomarkers of Neuroplasticity and Brain Repair in Stroke: A Systematic Review. Arch Phys Med Rehabil 2021; 102:1633-1644. [PMID: 33992633 DOI: 10.1016/j.apmr.2021.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 04/20/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To provide a novel overview of the literature and to summarize the evidence for the effects of aerobic exercise (AE) on serum biomarkers neuroplasticity and brain repair in survivors of stroke. DATA SOURCES We conducted a systematic review and searched MEDLINE, Embase, and Cochrane CENTRAL using terms related to AE, neuroplasticity, brain repair, and stroke. STUDY SELECTION Titles, abstracts, and selected full texts were screened by 2 independent reviewers against the following inclusion criteria: including adult survivors of stroke, completing an AE intervention working within the AE capacity, and measuring at least 1 blood biomarker outcome of interest. DATA EXTRACTION Two independent reviewers extracted data and assessed risk of bias using Risk of Bias in Nonrandomized Studies-of Interventions and Cochrane's Risk of Bias 2 tools. DATA SYNTHESIS Nine studies (n=215 participants) were included, reporting on the following outcomes: brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), vascular endothelial growth factor (VEGF), cortisol, interleukin 6, and myeloperoxidase. A single bout of high-intensity interval training significantly increased BDNF, IGF-1, and VEGF levels, and a 40-45-minute, 24-session, continuous 8-week AE training program significantly increased BDNF levels. No significant difference in response to any other AE intervention was found in other serum biomarkers. CONCLUSIONS AE can significantly increase BDNF, IGF-1, and VEGF across different AE protocols in survivors of stroke. However, more research is needed to determine the optimal exercise intensity and modalities, specifically in survivors of acute and subacute stroke, and how this may relate to functional outcomes.
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Affiliation(s)
- Neeraj S Limaye
- Melbourne Medical School, University of Melbourne, Parkville, Victoria.
| | - Lilian Braighi Carvalho
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Campus, Heidelberg, Victoria
| | - Sharon Kramer
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Austin Campus, Heidelberg, Victoria; School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia
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Otsuka S, Sakakima H, Tani A, Nakanishi K, Takada S, Norimatsu K, Maejima H, Maruyama I. Effects of detraining on preconditioning exercise-induced neuroprotective potential after ischemic stroke in rats. Brain Struct Funct 2021; 226:2169-2180. [PMID: 34114048 DOI: 10.1007/s00429-021-02317-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022]
Abstract
Preconditioning exercise prior to stroke exerts neuroprotection, which is an endogenous strategy that leads the brain cells to express several intrinsic factors and inhibits their apoptosis. However, it is unclear how long these benefits last after exercise cessation. The aim of this study was to investigate the effects of detraining on preconditioning exercise-induced neuroprotective potential after stroke. Rats were trained using a treadmill for aerobic exercise 5 days each week for 3 weeks, and their neuroprotective effects were examined until 3 weeks after exercise cessation. Stroke was induced by 60 min of left middle cerebral artery occlusion at 3 days, 1, 2, and 3 weeks after exercise cessation. Infarct volume, neurological deficits, sensorimotor function, expression levels of brain-derived neurotrophic factor (BDNF), hypoxia-induced factor-1α (HIF-1α), glial fibrillary acidic protein (GFAP), and P2X7 receptors, and apoptosis activity were examined using immunohistochemical and western blot analyses. Preconditioning exercise significantly reduced infarct volume and ameliorated sensorimotor function after stroke, and its beneficial effects were observed until 2 weeks after exercise cessation. The expression level of BDNF in the ischemic brain was significantly upregulated at 3 days after exercise cessation; however, the expression levels of HIF-1α, GFAP, and P2X7 receptor were significantly increased until 2 weeks after exercise cessation; thereby, significant anti-apoptotic effects were lost at 3 weeks of detraining. Our findings suggest that preconditioning exercise-induced neuroprotective potential may be lost shortly after exercise cessation. Neuroprotection through intrinsic protective factors, such as BDNF and HIF-1α, may provide different neuroprotective mechanisms in a time-dependent manner during detraining.
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Affiliation(s)
- Shotaro Otsuka
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - Harutoshi Sakakima
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan.
| | - Akira Tani
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Kazuki Nakanishi
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Seiya Takada
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - Kosuke Norimatsu
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Hiroshi Maejima
- Department of Rehabilitation Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ikuro Maruyama
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
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Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review. Brain Sci 2021; 11:brainsci11040473. [PMID: 33917909 PMCID: PMC8068294 DOI: 10.3390/brainsci11040473] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke.
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Devasahayam AJ, Kelly LP, Williams JB, Moore CS, Ploughman M. Fitness Shifts the Balance of BDNF and IL-6 from Inflammation to Repair among People with Progressive Multiple Sclerosis. Biomolecules 2021; 11:504. [PMID: 33810574 PMCID: PMC8066063 DOI: 10.3390/biom11040504] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 12/21/2022] Open
Abstract
Physical sedentarism is linked to elevated levels of circulating cytokines, whereas exercise upregulates growth-promoting proteins such as brain-derived neurotrophic factor (BDNF). The shift towards a 'repair' phenotype could protect against neurodegeneration, especially in diseases such as multiple sclerosis (MS). We investigated whether having higher fitness or participating in an acute bout of maximal exercise would shift the balance of BDNF and interleukin-6 (IL-6) in serum samples of people with progressive MS (n = 14), compared to matched controls (n = 8). Participants performed a maximal graded exercise test on a recumbent stepper, and blood samples were collected at rest and after the test. We assessed walking speed, fatigue, and maximal oxygen consumption (V·O2max). People with MS achieved about 50% lower V·O2max (p = 0.003) than controls. At rest, there were no differences in BDNF between MS and controls; however, IL-6 was significantly higher in MS. Higher V·O2max was associated with a shift in BDNF/IL-6 ratio from inflammation to repair (R = 0.7, p = 0.001) when considering both groups together. In the MS group, greater ability to upregulate BDNF was associated with faster walking speed and lower vitality. We present evidence that higher fitness indicates a shift in the balance of blood biomarkers towards a repair phenotype in progressive MS.
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Affiliation(s)
- Augustine Joshua Devasahayam
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
| | - Liam Patrick Kelly
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
| | - John Bradley Williams
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
| | - Craig Stephen Moore
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
| | - Michelle Ploughman
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1K 5A1, Canada; (A.J.D.); (L.P.K.)
- Division of BioMedical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1B 3V6, Canada; (J.B.W.); (C.S.M.)
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Chaves AR, Snow NJ, Alcock LR, Ploughman M. Probing the Brain-Body Connection Using Transcranial Magnetic Stimulation (TMS): Validating a Promising Tool to Provide Biomarkers of Neuroplasticity and Central Nervous System Function. Brain Sci 2021; 11:384. [PMID: 33803028 PMCID: PMC8002717 DOI: 10.3390/brainsci11030384] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 01/18/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive method used to investigate neurophysiological integrity of the human neuromotor system. We describe in detail, the methodology of a single pulse TMS protocol that was performed in a large cohort of people (n = 110) with multiple sclerosis (MS). The aim was to establish and validate a core-set of TMS variables that predicted typical MS clinical outcomes: walking speed, hand dexterity, fatigue, and cognitive processing speed. We provide a brief and simple methodological pipeline to examine excitatory and inhibitory corticospinal mechanisms in MS that map to clinical status. Delayed and longer ipsilateral silent period (a measure of transcallosal inhibition; the influence of one brain hemisphere's activity over the other), longer cortical silent period (suggestive of greater corticospinal inhibition via GABA) and higher resting motor threshold (lower corticospinal excitability) most strongly related to clinical outcomes, especially when measured in the hemisphere corresponding to the weaker hand. Greater interhemispheric asymmetry (imbalance between hemispheres) correlated with poorer performance in the greatest number of clinical outcomes. We also show, not surprisingly, that TMS variables related more strongly to motor outcomes than non-motor outcomes. As it was validated in a large sample of patients with varying severities of central nervous system dysfunction, the protocol described herein can be used by investigators and clinicians alike to investigate the role of TMS as a biomarker in MS and other central nervous system disorders.
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Affiliation(s)
| | | | | | - Michelle Ploughman
- L.A. Miller Centre, Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL A1A 1E5, Canada; (A.R.C.); (N.J.S.); (L.R.A.)
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Hugues N, Pellegrino C, Rivera C, Berton E, Pin-Barre C, Laurin J. Is High-Intensity Interval Training Suitable to Promote Neuroplasticity and Cognitive Functions after Stroke? Int J Mol Sci 2021; 22:3003. [PMID: 33809413 PMCID: PMC7998434 DOI: 10.3390/ijms22063003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 12/12/2022] Open
Abstract
Stroke-induced cognitive impairments affect the long-term quality of life. High-intensity interval training (HIIT) is now considered a promising strategy to enhance cognitive functions. This review is designed to examine the role of HIIT in promoting neuroplasticity processes and/or cognitive functions after stroke. The various methodological limitations related to the clinical relevance of studies on the exercise recommendations in individuals with stroke are first discussed. Then, the relevance of HIIT in improving neurotrophic factors expression, neurogenesis and synaptic plasticity is debated in both stroke and healthy individuals (humans and rodents). Moreover, HIIT may have a preventive role on stroke severity, as found in rodents. The potential role of HIIT in stroke rehabilitation is reinforced by findings showing its powerful neurogenic effect that might potentiate cognitive benefits induced by cognitive tasks. In addition, the clinical role of neuroplasticity observed in each hemisphere needs to be clarified by coupling more frequently to cellular/molecular measurements and behavioral testing.
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Affiliation(s)
- Nicolas Hugues
- INMED, INSERM, Aix-Marseille University, 13007 Marseille, France; (N.H.); (C.P.); (C.R.)
- CNRS, ISM, Aix-Marseille University, 13007 Marseille, France; (E.B.); (C.P.-B.)
| | - Christophe Pellegrino
- INMED, INSERM, Aix-Marseille University, 13007 Marseille, France; (N.H.); (C.P.); (C.R.)
| | - Claudio Rivera
- INMED, INSERM, Aix-Marseille University, 13007 Marseille, France; (N.H.); (C.P.); (C.R.)
| | - Eric Berton
- CNRS, ISM, Aix-Marseille University, 13007 Marseille, France; (E.B.); (C.P.-B.)
| | - Caroline Pin-Barre
- CNRS, ISM, Aix-Marseille University, 13007 Marseille, France; (E.B.); (C.P.-B.)
| | - Jérôme Laurin
- INMED, INSERM, Aix-Marseille University, 13007 Marseille, France; (N.H.); (C.P.); (C.R.)
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48
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Landi M, Everitt J, Berridge B. Bioethical, Reproducibility, and Translational Challenges of Animal Models. ILAR J 2021; 62:60-65. [PMID: 33693624 DOI: 10.1093/ilar/ilaa027] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 07/11/2020] [Accepted: 09/09/2020] [Indexed: 01/17/2023] Open
Abstract
There is no prescribed stage or standardized point at which an animal model protocol is reviewed for reproducibility and translatability. The method of review for a reproducible and translatable study is not consistently documented in peer literature, and this is a major challenge for those working with animal models of human diseases. If the study is ill designed, it is impossible to perform an accurate harm/benefit analysis. In addition, there may be an ethical challenge if the work is not reproducible and translatable. Animal welfare regulations and other documents of control clearly state the role of the Institutional Animal Care and Use Committees are to look at science justification within the context of animal welfare. This article, concentrating on models not governed by regulations, outlines issues and offers recommendations for refining animal model review with a goal to improve study reproducibility and translatability.
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Affiliation(s)
- Margaret Landi
- GSK Pharmaceuticals, 1250 S Collegeville Rd, Collegeville, PA 19426, USA
| | - Jeffrey Everitt
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - B Berridge
- National Institute of Environmental Health Sciences, 111 T. W. Alexander Dr. Research Triangle Park, NC 27709, USA
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Kobayashi M, Shinohara T, Usuda S. Accuracy of wrist-worn heart rate monitors during physical therapy sessions among hemiparetic inpatients with stroke. J Phys Ther Sci 2021; 33:45-51. [PMID: 33519074 PMCID: PMC7829560 DOI: 10.1589/jpts.33.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022] Open
Abstract
[Purpose] We aimed to examine the accuracy of heart rate monitors worn on the wrist by
patients with stroke. The wrist worn heart rate monitor could improve the quality of
rehabilitation by monitoring exercise intensity during physical therapy. [Participants and
Methods] Thirty inpatients with subacute hemiparetic stroke wore heart rate monitors on
both (non-paretic and paretic) wrists, as well as a chest heart rate monitor. We recorded
the heart rate values measured at the wrist and chest every minute during physical therapy
sessions. The wrist monitors were an optical heart rate measurement device based on
photoplethysmography, and the chest monitor was a traditional chest device based on
electrocardiography. The relative and absolute reliabilities between the heart rate
measurements from the wrist and chest monitors were calculated. [Results] The intraclass
correlation coefficients for model 2.1 ranged from 0.75 to 0.79. Bland-Altman analysis
revealed a very slight fixed bias; however, no significant proportional bias was observed.
For the non-paretic and paretic sides, the lower and upper limits of agreement ranged from
−21.8 to 23.8 beats/min and from −20.8 to 21.6 beats/min, and the mean absolute percentage
errors were 6.7% and 5.9%, respectively. The Cohen’s d value was small. [Conclusion] The
relative reliability of the wrist heart rate monitors was substantial. The absolute
reliability as bias in wrist heart rate and chest heart rate was small, but heart rates
estimated from wrist monitors were not particularly accurate.
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Affiliation(s)
- Masaki Kobayashi
- Geriatrics Research Institute and Hospital: 3-26-8 Ootomo-Machi, Maebashi 371-0847, Japan
| | | | - Shigeru Usuda
- Gunma University Graduate School of Health Sciences, Japan
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50
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Wang Q, Wills M, Han Z, Geng X, Ding Y. Mini Review (Part I): An Experimental Concept on Exercise and Ischemic Conditioning in Stroke Rehabilitation. Brain Circ 2021; 6:242-247. [PMID: 33506146 PMCID: PMC7821806 DOI: 10.4103/bc.bc_63_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 12/11/2022] Open
Abstract
Stroke remains a leading cause of adult death and disability. Poststroke rehabilitation is vital for reducing the long-term sequelae of brain ischemia. Recently, physical exercise training has been well established as an effective rehabilitation tool, but its efficacy depends on exercise parameters and the patient's capacities, which are often altered following a major cerebrovascular event. Thus, ischemic conditioning as a rehabilitation intervention was considered an “exercise equivalent,” but the investigation is still in its relative infancy. In this mini-review, we discuss the potential for physical exercise or ischemic conditioning and its relation to angiogenesis, neurogenesis, and plasticity in stroke rehabilitation. This allows the readers to understand the context of the research and the application of ischemic conditioning in poststroke rehabilitation.
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Affiliation(s)
- Qingzhu Wang
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Melissa Wills
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Zhenzhen Han
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaokun Geng
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.,Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.,Department of Research and Development Center, John D. Dingell VA Medical Center, Detroit, Michigan, USA
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