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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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Kim SH, Ji DM, Hwang IS, Ryu J, Jin S, Kim SA, Kim MS. Three-Dimensional Magnetic Rehabilitation, Robot-Enhanced Hand-Motor Recovery after Subacute Stroke: A Randomized Controlled Trial. Brain Sci 2023; 13:1685. [PMID: 38137133 PMCID: PMC10742112 DOI: 10.3390/brainsci13121685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
We developed an end-effector-type rehabilitation robot that can uses electro- and permanent magnets to generate a three-way magnetic field to assist hand movements and perform rehabilitation therapy. This study aimed to investigate the therapeutic effect of a rehabilitation program using a three-dimensional (3D) magnetic force-based hand rehabilitation robot on the motor function recovery of the paralyzed hands of patients with stroke. This was a double-blind randomized controlled trial in which 36 patients with subacute stroke were assigned to intervention and control groups of 18 patients each. The intervention group received 30 min of rehabilitation therapy per day for a month using a 3D magnetic force-driven hand rehabilitation robot, whereas the control group received 30 min of conventional occupational therapy to restore upper-limb function. The patients underwent three behavioral assessments at three time points: before starting treatment (T0), after 1 month of treatment (T1), and at the follow-up 1-month after treatment completion (T2). The primary outcome measure was the Wolf Motor Function Test (WMFT), and secondary outcome measures included the Fugl-Meyer Assessment of the Upper Limb (FMA_U), Modified Barthel Index (MBI), and European Quality of Life Five Dimensions (EQ-5D) questionnaire. No participant safety issues were reported during the intervention. Analysis using repeated measures analysis of variance showed significant interaction effects between time and group for both the WMFT score (p = 0.012) and time (p = 0.010). In post hoc analysis, the WMFT scores and time improved significantly more in the patients who received robotic rehabilitation at T1 than in the controls (p = 0.018 and p = 0.012). At T2, we also consistently found improvements in both the WMFT scores and times for the intervention group that were superior to those in the control group (p = 0.024 and p = 0.018, respectively). Similar results were observed for FMA_U, MBI, and EQ-5D. Rehabilitation using the 3D hand-rehabilitation robot effectively restored hand function in the patients with subacute stroke, contributing to improvement in daily independence and quality of life.
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Affiliation(s)
- Sung-Hoon Kim
- Department of Electronics & Information Engineering, Korea University, Sejong 30019, Republic of Korea;
| | - Dong-Min Ji
- Department of Electronics Convergence Engineering, Wonkwang University, Iksan 54538, Republic of Korea;
| | - In-Su Hwang
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Jinwhan Ryu
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Sol Jin
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Soo-A Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Republic of Korea; (I.-S.H.); (J.R.); (S.J.); (S.-A.K.)
- Department of Regenerative Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, Republic of Korea
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Luo Q, Zheng J, Fan B, Liu J, Liao W, Zhang X. Enriched environment attenuates ferroptosis after cerebral ischemia/reperfusion injury by regulating iron metabolism. Brain Res Bull 2023; 203:110778. [PMID: 37812906 DOI: 10.1016/j.brainresbull.2023.110778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/11/2023]
Abstract
Preventing neuronal death after ischemic stroke (IS) is crucial for neuroprotective treatment, yet current management options are limited. Enriched environment (EE) is an effective intervention strategy that promotes the recovery of neurological function after cerebral ischemia/reperfusion (I/R) injury. Ferroptosis has been identified as one of the mechanisms of neuronal death during IS, and inhibiting ferroptosis can reduce cerebral I/R injury. Our previous research has demonstrated that EE reduced ferroptosis by inhibiting lipid peroxidation, but the underlying mechanism still needs to be investigated. This study aims to explore the potential molecular mechanisms by which EE modulates iron metabolism to reduce ferroptosis. The experimental animals were randomly divided into four groups based on the housing environment and the procedure the animals received: the sham-operated + standard environment (SSE) group, the sham-operated + enriched environment (SEE) group, the ischemia/reperfusion + standard environment (ISE) group, and the ischemia/reperfusion + enriched environment (IEE) group. The results showed that EE reduced IL-6 expression during cerebral I/R injury, hence reducing JAK2-STAT3 pathway activation and hepcidin expression. Reduced hepcidin expression led to decreased DMT1 expression and increased FPN1 expression in neurons, resulting in lower neuronal iron levels and alleviated ferroptosis. In addition, EE also reduced the expression of TfR1 in neurons. Our research suggested that EE played a neuroprotective role by modulating iron metabolism and reducing neuronal ferroptosis after cerebral I/R injury, which might be achieved by inhibiting inflammatory response and down-regulating hepcidin expression.
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Affiliation(s)
- Qihang Luo
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jun Zheng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Fan
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jingying Liu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weijing Liao
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
| | - Xin Zhang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
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Abdullahi A, Wong TWL, Ng SSM. Variation in the rate of recovery in motor function between the upper and lower limbs in patients with stroke: some proposed hypotheses and their implications for research and practice. Front Neurol 2023; 14:1225924. [PMID: 37602245 PMCID: PMC10435271 DOI: 10.3389/fneur.2023.1225924] [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: 05/20/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Stroke results in impairment of motor function of both the upper and lower limbs. However, although it is debatable, motor function of the lower limb is believed to recover faster than that of the upper limb. The aim of this paper is to propose some hypotheses to explain the reasons for that, and discuss their implications for research and practice. Method We searched PubMED, Web of Science, Scopus, Embase and CENTRAL using the key words, stroke, cerebrovascular accident, upper extremity, lower extremity, and motor recovery for relevant literature. Result The search generated a total of 2,551 hits. However, out of this number, 51 duplicates were removed. Following review of the relevant literature, we proposed four hypotheses: natural instinct for walking hypothesis, bipedal locomotion hypothesis, central pattern generators (CPGs) hypothesis and role of spasticity hypothesis on the subject matter. Conclusion We opine that, what may eventually account for the difference, is the frequency of use of the affected limb or intensity of the rehabilitation intervention. This is because, from the above hypotheses, the lower limb seems to be used more frequently. When limbs are used frequently, this will result in use-dependent plasticity and eventual recovery. Thus, rehabilitation techniques that involve high repetitive tasks practice such as robotic rehabilitation, Wii gaming and constraint induced movement therapy should be used during upper limb rehabilitation.
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García-Muñoz C, González-García P, Casuso-Holgado MJ, Martínez-Calderón J, Heredia-Rizo AM. Are movement-based mindful exercises (QIGONG, TAI CHI, AND YOGA) beneficial for stroke and Parkinson's disease? A scoping review. Complement Ther Med 2023; 72:102912. [PMID: 36565791 DOI: 10.1016/j.ctim.2022.102912] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To synthesize evidence from systematic reviews on the effects of qigong, tai chi, and yoga in people with neurological diseases. METHODS A systematic search was conducted in PubMed, PsycINFO, Embase, CINAHL and Cochrane Library until September 2022. Methodological quality was assessed using the AMSTAR 2 tool. A qualitative synthesis of included reviews and meta-analyses was performed. Citation matrices and the corrected covered area were used to explore the overlap of randomized controlled trials among reviews. RESULTS Nineteen systematic reviews (containing 74 trials and 80 meta-analyses) in people with Parkinson's disease (PD) or stroke were included. The critical domains of the AMSTAR 2 were not satisfied in more than half of the reviews, and only 4 evaluated the certainty of the evidence. The overlap was very high (21.7%) and high (11%) for tai chi studies in PD and stroke, respectively. In people with PD, qigong, yoga, and tai chi can improve balance, with tai chi being beneficial to increase functional mobility. For stroke patients, tai chi was better than controls to enhance motor function and independence, but not for health-related quality of life and quality of sleep. Findings on balance, walking ability and depression were inconclusive in stroke population. CONCLUSIONS Qigong, tai chi, and yoga appear to be effective to improve balance performance in people with PD. Tai chi practice enhances motor function and independency in stroke patients.
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Affiliation(s)
- Cristina García-Muñoz
- Departamento de Enfermería y Fisioterapia, Facultad de Enfermería y Fisioterapia, Universidad de Cádiz, Avda. Ana de Viya 52, 11009 Cádiz, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Paula González-García
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBIS), Sevilla, Spain..
| | - María Jesús Casuso-Holgado
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Javier Martínez-Calderón
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
| | - Alberto Marcos Heredia-Rizo
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/ Avicena s/n, 41009 Sevilla, Spain; Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain
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Ross RE, Hart E, Williams ER, Gregory CM, Flume PA, Mingora CM, Woodbury ML. Combined Aerobic Exercise and Virtual Reality-Based Upper Extremity Rehabilitation Intervention for Chronic Stroke: Feasibility and Preliminary Effects on Physical Function and Quality of Life. Arch Rehabil Res Clin Transl 2023; 5:100244. [PMID: 36968163 PMCID: PMC10036233 DOI: 10.1016/j.arrct.2022.100244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives To (1) examine the feasibility of combining lower extremity aerobic exercise (AEx) with a virtual reality (VR) upper extremity (UE) rehabilitation intervention and (2) provide an estimate of effect size for the combined intervention on UE function, aerobic capacity, and health-related quality of life. Design Single-group feasibility trial. Setting Research laboratory. Participants Community-dwelling individuals with mild to moderate impairment of the UE at least 6 months post stroke (N=10; male, n=6; female n=4; mean age, 54 years). Intervention All participants received 18 sessions over a nominal 2-3 sessions per week schedule of a combined AEx and VR-UE rehabilitation intervention. During each session, participants completed 15 minutes of lower extremity AEx followed by playing a VR-UE rehabilitation game for approximately 20 minutes. Main Outcome Measures Feasibility was evaluated by metrics of adherence, retention, treatment acceptability, data completeness, and adverse events. UE function, aerobic capacity (peak oxygen consumption [Vo2peak]), and quality of life were assessed with the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), expired gas exchange analysis, and Stroke Impact Scale (SIS), respectively. Results Adherence was 100%, and there were no withdrawals or losses to follow-up to report. Participants completed the intervention in 49±14 days. Cohen's dz effect size calculations indicated the intervention elicited medium effects on FMA-UE (dz =0.50) and SIS memory domain (dz =0.46) and large effects on absolute Vo2peak (dz =1.46), relative Vo2peak (dz =1.21), SIS strength (dz =1.18), and SIS overall recovery domains (dz =0.81). Conclusions Combining lower extremity AEx and VR-UE rehabilitation appears feasible in the clinical research setting. Fifteen minutes of lower extremity AEx performed at vigorous intensity appears to elicit clinically meaningful benefits in chronic stroke. Further examination of the combination of lower extremity AEx and VR-UE rehabilitation and its effects on physical function and quality of life is warranted.
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Affiliation(s)
- Ryan E. Ross
- Ralph H. Johnson Veterans Affairs Health Care System, Research Service, Charleston, SC
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | - Emerson Hart
- Ralph H. Johnson Veterans Affairs Health Care System, Research Service, Charleston, SC
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | - Ewan R. Williams
- Ralph H. Johnson Veterans Affairs Health Care System, Research Service, Charleston, SC
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | - Chris M. Gregory
- Ralph H. Johnson Veterans Affairs Health Care System, Research Service, Charleston, SC
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
| | - Patrick A. Flume
- Department of Medicine, Medical University of South Carolina, Charleston, SC
| | | | - Michelle L. Woodbury
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC
- Divison of Occupational Therapy, Medical University of South Carolina, Charleston, SC
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Li Y, Lu T, Wei W, Lin Z, Ding L, Li Z, Xue X. Swimming Training Mitigates Neurological Impairment of Intracerebral Haemorrhage in Mice via the Serine-Threonine Kinase/Glycogen Synthase Kinase 3β Signalling Pathway. Neuroscience 2022; 501:72-84. [PMID: 35961525 DOI: 10.1016/j.neuroscience.2022.07.027] [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: 02/07/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022]
Abstract
Swimming training (ST) can mitigate functional disorders in neurological diseases, but the effect and mechanism of ST in improving the neurological function of intracerebral haemorrhage (ICH) have not been reported. Our study aimed to explore the protective effect of early ST on ICH mice and its relationship with the serine-threonine kinase (Akt)/glycogen synthase kinase 3β (GSK3β) pathway. Our findings showed that the ICH model mice had poor behavioural manifestations in the Y maze test and open field test compared to the ST group and sham group. The modified neurological severity score was increased in the ICH mice, and 7 days of ST intervention significantly attenuated the neurological deficits. The ratios of myo-inositol/creatine, lactate/creatine and glutamate/creatine were decreased, and the ratios of N-acetylaspartate/creatine and choline/creatine were increased in the ICH mice with ST intervention. ST intervention decreased the expression of Iba1 and GFAP. Seven days of ST significantly increased the expression of p-Akt/Akt compared to that in the ICH mice. Furthermore, the Akt kinase inhibitor GSK690693 exacerbated neurological impairment, increased the expression of Iba1, GFAP and Bax/Bcl-2, and reversed the anti-apoptotic effects and anti-glia activation of ST, which was associated with the inhibition of p-Akt/Akt and p-GSK3β/GSK3β expression. These results indicated that the protective role of ST in ICH was mediated via the Akt/GSK3β pathway. In conclusion, ST displayed neuroprotection by inhibiting apoptosis and glial activation in ICH mice by activating the Akt/GSK3β signalling pathway.
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Affiliation(s)
- Yongxu Li
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, China; College of Rehabilitation Medicine, Fujian University of Chinese Medicine, China
| | - Taotao Lu
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, China; College of Rehabilitation Medicine, Fujian University of Chinese Medicine, China
| | - Wei Wei
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, China
| | - Zhicheng Lin
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, China
| | - Linlin Ding
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, China
| | - Zhaohui Li
- Anxi County Hospital of Traditional Chinese Medicine, Quanzhou, Fujian Province, China.
| | - Xiehua Xue
- Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, China; Fujian Key Laboratory of Rehabilitation Technology and Cognition Rehabilitation, China.
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Genetic Expression between Ageing and Exercise: Secreted Protein Acidic and Rich in Cysteine as a Potential “Exercise Substitute” Antiageing Therapy. Genes (Basel) 2022; 13:genes13060950. [PMID: 35741712 PMCID: PMC9223223 DOI: 10.3390/genes13060950] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 02/04/2023] Open
Abstract
Ageing is the effect of time on biological entities. It represents a risk factor for a variety of diseases and health disorders; thus, therapeutic options are required to tackle ageing issues. Modern geriatric medicine prescribes exercise to counteract ageing effects. This work presents secreted protein acidic and rich in cysteine (SPARC) as a potential antiageing therapy. Indeed, SPARC declines with ageing, exercise induces SPARC, and SPARC overexpression in mice mimics exercise. Thus, we hypothesize that SPARC is an exercise-induced factor that is beyond—at least part of—the antiageing effects induced by exercise. This could become a potential antiageing therapy for the elderly that counteracts ageing by mimicking the effects of exercise without needing to perform exercise. This is of particular importance because ageing usually reduces mobility and age-related diseases can reduce the ability to perform the required physical activity. On the other hand, the possibilities of mimicking exercise benefits via SPARC are not limited to ageing, and can be applied in various contexts in which exercise cannot be performed because of physical disabilities, health disorders, or limited mobility.
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Jia Y, Yao Y, Zhuo L, Chen X, Yan C, Ji Y, Tao J, Zhu Y. Aerobic Physical Exercise as a Non-medical Intervention for Brain Dysfunction: State of the Art and Beyond. Front Neurol 2022; 13:862078. [PMID: 35645958 PMCID: PMC9136296 DOI: 10.3389/fneur.2022.862078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022] Open
Abstract
Brain disorders, including stroke, Alzheimer's disease, depression, and chronic pain, are difficult to effectively treat. These major brain disorders have high incidence and mortality rates in the general population, and seriously affect not only the patient's quality of life, but also increases the burden of social medical care. Aerobic physical exercise is considered an effective adjuvant therapy for preventing and treating major brain disorders. Although the underlying regulatory mechanisms are still unknown, systemic processes may be involved. Here, this review aimed to reveal that aerobic physical exercise improved depression and several brain functions, including cognitive functions, and provided chronic pain relief. We concluded that aerobic physical exercise helps to maintain the regulatory mechanisms of brain homeostasis through anti-inflammatory mechanisms and enhanced synaptic plasticity and inhibition of hippocampal atrophy and neuronal apoptosis. In addition, we also discussed the cross-system mechanisms of aerobic exercise in regulating imbalances in brain function, such as the “bone-brain axis.” Furthermore, our findings provide a scientific basis for the clinical application of aerobic physical exercise in the fight against brain disorders.
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Affiliation(s)
- Yuxiang Jia
- School of Medicine and School of Life Sciences, Shanghai University, Shanghai, China
| | - Yu Yao
- School of Medicine and School of Life Sciences, Shanghai University, Shanghai, China
| | - Limin Zhuo
- School of Medicine and School of Life Sciences, Shanghai University, Shanghai, China
| | - Xingxing Chen
- Department of Neurology and Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cuina Yan
- Department of Neurology and Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yonghua Ji
- School of Medicine and School of Life Sciences, Shanghai University, Shanghai, China
- *Correspondence: Yonghua Ji
| | - Jie Tao
- Department of Neurology and Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Jie Tao
| | - Yudan Zhu
- Department of Neurology and Central Laboratory, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yudan Zhu
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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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Exercise for People with Acquired Brain Injury: An ICF Perspective. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12083862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exercise is an important element in the process of recovery from an acquired brain injury (ABI). However, specific guidance for exercise prescription and interventions in this population are missed. The aim of this study was to establish the key parameters to design and implement exercise programs based on the International Classification of Functioning, Disability, and Health (ICF) domains. A panel of experts that consisted of 13 professionals from neuro-rehabilitation centers evaluated the key parameters of this original proposal. The Heinemann methodology was used for all qualitative analyses. Additionally, Cronbach’s alpha was applied to the statistical analyses. According to the results, Cronbach’s alpha (0.97) indicated excellent internal consistency, and the experts perceptions ratified the proposed criteria to develop exercise programs for people with ABI. The proposed key parameters for the development of exercise programs for people with ABI based in ICF domains (body functions, activity—participation and environmental factors) bring a new, solid, and innovative tool for methodological design of these programs in sub-acute and chronic rehabilitation settings.
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12
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Zhao Y, Wang W, Wang M, Gao F, Hu C, Cui B, Yu W, Ren H. Personalized individual-based exercise prescriptions are effective in treating depressive symptoms of college students during the COVID-19: A randomized controlled trial in China. Front Psychiatry 2022; 13:1015725. [PMID: 36699477 PMCID: PMC9869038 DOI: 10.3389/fpsyt.2022.1015725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has seriously increased depression prevalence among the public, including Chinese college students. However, many exercise cannot be performed as usual under the stay-at-home order. This study was a 12-week three-arm randomized controlled trial using the intention-to-treat principle, aiming to explore and compare the feasibility and effect of individual-based personalized aerobic-exercise and resistance-training prescriptions on depressive symptoms in college students, and conclude with some recommendations for individual-based exercise prescriptions. METHODS Eighty-six college students with depressive symptoms were randomized into aerobic-exercise (AE), resistance-training (RT), and wait-list control (WLC) groups. Participants in two experimental groups received 12-week personalized AE and RT prescriptions on their individual situations, respectively. No intervention was implemented on participants in the WLC group. Depressive symptoms and physical activity (PA) were measured by Zung Self-Rating Depression Scale (SDS) and International Physical Activity Questionnaire-Short Form (IPAQ-SF), respectively. All data were collected at the baseline, 4, 8, and 12 weeks, and 4-week post-intervention. RESULTS At 12 weeks, 72.09% of depressive participants improved to "normal." Participants exhibited a statistical reduction in SDS in all 3 groups (p < 0.05) at 12 weeks compared to baseline. Follow-up assessments showed no significant increase in SDS at 4-week post-intervention compared to 12 weeks (p > 0.05). The independent t-test revealed significantly lower SDS in AE and RT group than in WLC group (p AE < 0.001 and p RT < 0.05) at 4, 8, and 12 weeks, and 4-week post-intervention. Furthermore, the PA of participants (including total PA and intensities) in both experimental groups represented a significant improvement at 4-week post-intervention compared to baseline (p < 0.05), while no differences were observed in the PA of participants in the WLC group (p > 0.05). CONCLUSION Personalized exercise prescriptions have good feasibility as they can increase adherence to intervention and reduce serious adverse events. Besides, individual-based personalized aerobic-exercise and resistance-training prescriptions result in a similar effect in relieving depressive symptoms and improving physical activity in college students. The individual-based exercise programs performed in 45- to 60- min with progressive moderate-to-vigorous intensity, 3 times/week for at least 12 weeks, may reduce depressive symptoms in college students during the COVID-19.
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Affiliation(s)
- Yuanhui Zhao
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Wenxing Wang
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Mengdie Wang
- China Institute of Sport Science, Beijing, China
| | - Fang Gao
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Chun Hu
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Bowen Cui
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Wenlang Yu
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Hong Ren
- School of Sport Science, Beijing Sport University, Beijing, China.,Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
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13
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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: 0] [Impact Index Per Article: 0] [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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14
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Children's Neurological Status Epilepticus and Poor Prognostic Factors through Electroencephalogram Image under Composite Domain Analysis Algorithm. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:8201363. [PMID: 34868532 PMCID: PMC8639250 DOI: 10.1155/2021/8201363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to analyze the application of composite domain analysis algorithm for electroencephalogram (EEG) images of children with epilepsy and to investigate the risk factors related to poor prognosis. 70 children with neurological epilepsy admitted to the hospital were selected as the research objects. Besides, the EEG of the children during the intermittent and seizure phases of epilepsy were collected, so as to establish a composite domain analysis algorithm model. Then, the model was applied in EEG analysis. The clinical disease type and prognosis of children were statistically analyzed, and the risk factors that affected the prognosis of children were investigated. The results showed that the EEG signal values of the detail coefficients (d51 and d52) and the approximate coefficient (c5) during the epileptic seizure period were higher markedly than the signal values of the epileptic intermittent period; the EEG signal of the epileptic intermittent period was a transient waveform, which appeared as sharp waves or spikes. The EEG signal of epileptic seizures was continuous, with a composite waveform of sharp waves and spikes, and the change amplitude of the wavelet envelope spectrum during epileptic seizures was also higher hugely than that of intermittent epilepsy. The accurate identification rate, specificity, and sensitivity of EEG analysis with the composite domain algorithm were higher than those without the algorithm. Among the five types of epileptic seizures in children, the proportion of systemic tonic-clonic status was the largest, and the proportion of myoclonic status was equal to that of complex partial epileptic status, both of which were relatively small. The proportion of children with a better prognosis was 75.71% (53/70), which was higher than those with a poor prognosis 24.29% (17/70). Abnormal imaging examination (odds ratio (OR) = 3.823 and 95% confidence interval (CI) = 1.643–8.897); seizure duration greater than 1 hour (OR = 1.855 and 95% CI = 1.076–3.199); C-reactive protein (CRP) (OR = 5.089 and 95% CI = 1.507–17.187); and abnormal blood glucose (OR = 3.077, 95%CI = 1.640–5.773) were all independent risk factors for poor prognosis (all P < 0.05). The composite domain analysis algorithm was helpful for clinicians to find the difference in the EEG signals between the epileptic seizure period and the epileptic intermittent period in a short time, thereby improving the doctor's analysis of the results, which could reflect its marked superiority. In addition, abnormal imaging examinations, convulsion duration greater than 1 hour, CRP, and abnormal blood glucose were independent risk factors for poor prognosis in children. Therefore, the invasion of related risk factors could be reduced clinically by prognostic review with medical advice, attention to food safety and hygiene, and improvement of children's immunity.
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15
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Bohannon RW. Characterization of muscle strength using the strength domain of the stroke impact scale: An integrative review. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-210101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE: Muscle weakness is among the most common and obvious impairments in older adults and individuals with neurologic disorders. Although impairments in muscle strength are typically characterized using performance measures, the impairments have also been described using patient or observer-report. The objective of this review was to summarize literature describing use of a patient-report instrument, the Strength Domain (SD) of the Stroke Impact Scale (SIS), to grade strength impairments. METHODS: Peer-reviewed literature reporting SD scores for the SIS was identified using computerized searches of the CINAHL, PubMed, and Scopus databases followed by hand searches. Potentially relevant articles were then mined for data on the participants tested, the SIS version used, scores documented, and clinimetric properties reported. RESULTS: Sixty-five articles were judged appropriate based on inclusion and exclusion criteria. The articles involved more than 7000 residents of 22 countries. All articles focused on individuals with stroke (usually chronic), although one also included community-dwelling adults without stroke. The SIS version used was frequently unreported, but 3.0 was version most often specified. For articles reporting SD scale scores the mean ranged from 19.7 to 85.5. Construct (known groups, convergent, and discriminant) validity of the SD was supported by the literature as was its internal consistency and test-retest reliability. Responsiveness of the SD was evinced by numerous studies showing increases in SD scores with time or accompanying effective interventions. However, only one study indicated responsiveness using an anchor-based statistic. CONCLUSIONS: The SD of the SIS is a well-established and mostly clinimetrically sound patient-report measure of paretic limb strength among individuals with stroke. Its use with individuals with weakness accompanying aging or diagnoses other than stroke remains to be substantiated.
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16
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Ali A, Tabassum D, Baig SS, Moyle B, Redgrave J, Nichols S, McGregor G, Evans K, Totton N, Cooper C, Majid A. Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis. Stroke 2021; 52:2445-2455. [PMID: 34039033 DOI: 10.1161/strokeaha.120.032979] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Exercise interventions have been shown to help physical fitness, walking, and balance after stroke, but data are lacking on whether such interventions lead to improvements in health-related quality of life (HRQoL). In this systematic review and meta-analysis, 30 randomized controlled trials (n=1836 patients) were found from PubMed, OVID MEDLINE, Web of Science, CINAHL, SCOPUS, The Cochrane Library, and TRIP databases when searched from 1966 to February 2020 that examine the effects of exercise interventions on HRQoL after stroke or transient ischemic attack. Exercise interventions resulted in small to moderate beneficial effects on HRQoL at intervention end (standardized mean difference, -0.23 [95% CI, -0.40 to -0.07]) that appeared to diminish at longer-term follow-up (standardized mean difference, -0.11 [95% CI, -0.26 to 0.04]). Exercise was associated with moderate improvements in physical health (standardized mean difference, -0.33 [95% CI, -0.61 to -0.04]) and mental health (standardized mean difference, -0.29 [95% CI, -0.49 to -0.09]) domains of HRQoL while effects on social or cognitive composites showed little difference. Interventions that were initiated within 6 months, lasted at least 12 weeks in duration, involved at least 150 minutes per week, and included resistance training appeared most effective. Exercise can lead to moderate beneficial effects on HRQoL and should be considered an integral part of stroke rehabilitation.
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Affiliation(s)
- Ali Ali
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience, Sheffield NIHR Biomedical Research Centre, United Kingdom (A.A.)
| | - Dina Tabassum
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Sheharyar S Baig
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Bethany Moyle
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Jessica Redgrave
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
| | - Simon Nichols
- Centre for Sports and Exercise Science, Sheffield Hallam University, United Kingdom (S.N.)
| | - Gordon McGregor
- Cardiac Rehabilitation, University Hospitals Coventry and Warwickshire NHS Trust, University of Coventry, United Kingdom (G.M.)
| | - Katherine Evans
- Department of Geriatrics and Stroke, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (K.E.)
| | - Nikki Totton
- School of Health and Related Research (N.K., C.C.), University of Sheffield, United Kingdom
| | - Cindy Cooper
- School of Health and Related Research (N.K., C.C.), University of Sheffield, United Kingdom
| | - Arshad Majid
- Department of Neuroscience, Sheffield Institute for Translational Neuroscience (D.T., S.S.B., B.M., J.R., A.M.), University of Sheffield, United Kingdom
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17
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Nicolini C, Fahnestock M, Gibala MJ, Nelson AJ. Understanding the Neurophysiological and Molecular Mechanisms of Exercise-Induced Neuroplasticity in Cortical and Descending Motor Pathways: Where Do We Stand? Neuroscience 2020; 457:259-282. [PMID: 33359477 DOI: 10.1016/j.neuroscience.2020.12.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
Exercise is a promising, cost-effective intervention to augment successful aging and neurorehabilitation. Decline of gray and white matter accompanies physiological aging and contributes to motor deficits in older adults. Exercise is believed to reduce atrophy within the motor system and induce neuroplasticity which, in turn, helps preserve motor function during aging and promote re-learning of motor skills, for example after stroke. To fully exploit the benefits of exercise, it is crucial to gain a greater understanding of the neurophysiological and molecular mechanisms underlying exercise-induced brain changes that prime neuroplasticity and thus contribute to postponing, slowing, and ameliorating age- and disease-related impairments in motor function. This knowledge will allow us to develop more effective, personalized exercise protocols that meet individual needs, thereby increasing the utility of exercise strategies in clinical and non-clinical settings. Here, we review findings from studies that investigated neurophysiological and molecular changes associated with acute or long-term exercise in healthy, young adults and in healthy, postmenopausal women.
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Affiliation(s)
- Chiara Nicolini
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Margaret Fahnestock
- Department of Psychiatry & Behavioral Neurosciences, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Martin J Gibala
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON L8S 4K1, Canada.
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18
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Shu Y, He Q, Xie Y, Zhang W, Zhai S, Wu T. Cognitive Gains of Aerobic Exercise in Patients With Ischemic Cerebrovascular Disorder: A Systematic Review and Meta-Analysis. Front Cell Dev Biol 2020; 8:582380. [PMID: 33392183 PMCID: PMC7775417 DOI: 10.3389/fcell.2020.582380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/03/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Cognitive impairment has become an important problem in ischemic cerebrovascular disorder survivors as disease related deaths have been significantly reduced. Aerobic exercise, the most prevalent mode of physical activity, positively contributes to cognition in both healthy population and people with cognitive impairment. However, studies on its associations with cognitive gains in patients with ischemic cerebrovascular disease showed mixed findings. Objective: To explore the cognitive effects of aerobic exercise on ischemic cerebrovascular disorder survivors and investigate the possible moderators on exercise benefits. Method: Randomized controlled trials investigating the effects of sole aerobic exercise on cognitive function in population with ischemic intracranial vascular disorder compared to any control group who did not receive the intervention were enrolled in this systematic review and meta-analysis. Four online database (Pubmed, Cochrane Library, Embase, and Web of Science) were searched. Results: The initial search returned 1,522 citations and ultimately 11 studies were included in the systematic review. Analysis of seven studies showed the beneficial but not statistically significant impact of aerobic exercise on global cognitive function (0.13; 95% Cl −0.09 to 0.35; p = 0.25). Participants already with cognitive impairment benefited more from this intervention (0.31; 95% Cl 0.07–0.55; p = 0.01) and moderate intensity might be the optimal choice (0.34; 95% Cl −0.01 to 0.69; p = 0.06). The program duration and initiation time after stroke occurrence did not predict better cognitive outcome. Aerobic exercise was not associated with improvement of processing speed and executive function, the two subdomains of cognitive function. Conclusions: Aerobic exercise may contribute to cognitive gains in survivors of ischemic cerebrovascular disorder, especially for population already with cognitive decline. Our findings suggest that the adoption of moderate intensity aerobic exercise might improve cognition in such population.
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Affiliation(s)
- Yimei Shu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qing He
- Department of Neurology, Xuzhou First People's Hospital, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yi Xie
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wanrong Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Zhai
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Wu
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Linder SM, Davidson S, Rosenfeldt A, Penko A, Lee J, Koop MM, Phelan D, Alberts JL. Predictors of Improved Aerobic Capacity in Individuals With Chronic Stroke Participating in Cycling Interventions. Arch Phys Med Rehabil 2019; 101:717-721. [PMID: 31778659 DOI: 10.1016/j.apmr.2019.10.187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine demographic and physiological factors that predict improvement in aerobic capacity among individuals with chronic stroke participating in cycling interventions. DESIGN Secondary analysis of data from 2 randomized clinical trials. SETTING Research laboratory. PARTICIPANTS Individuals with chronic stroke (N=44). INTERVENTIONS Participants were randomized to one of the following interventions: forced aerobic exercise and upper extremity repetitive task practice (FE+UERTP, n=16), voluntary aerobic exercise and upper extremity repetitive task practice (VE+UERTP, n=15), or a nonaerobic control group (control, n=13). All interventions were time-matched and occurred 3 times per week for 8 weeks. MAIN OUTCOME MEASURE Aerobic capacity as measured by peak oxygen consumption per unit time (VO2peak) during maximal cardiopulmonary exercise stress testing. RESULTS Significant improvements in VO2peak were observed from baseline to postintervention in the VE+UERTP group (P<.001). Considerable variability was observed among participants relating to postintervention change in VO2peak. Among aerobic exercise participants, a multivariate regression analysis revealed that cycling cadence, baseline VO2peak, and group allocation were significant predictors of change in VO2peak. CONCLUSIONS High exercise rate (cycling cadence) appears to be an important variable in improving aerobic capacity and should be considered when prescribing aerobic exercise for individuals with chronic stroke. Those with low VO2peak at baseline may benefit the most from aerobic interventions as it relates to cardiorespiratory fitness. Further investigation is warranted to understand the precise role of other exercise and demographic variables in the prescription of aerobic exercise for this population and their effects on secondary stroke prevention and mortality.
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Affiliation(s)
- Susan M Linder
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Concussion Center, Cleveland Clinic, Cleveland, Ohio; Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio.
| | - Sara Davidson
- Concussion Center, Cleveland Clinic, Cleveland, Ohio
| | - Anson Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Amanda Penko
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - John Lee
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, Ohio
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Dermot Phelan
- Sports Cardiology Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio; Concussion Center, Cleveland Clinic, Cleveland, Ohio; Center for Neurologic Restoration, Cleveland Clinic, Cleveland, Ohio
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20
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Soh SH, Joo MC, Yun NR, Kim MS. Randomized Controlled Trial of the Lateral Push-Off Skater Exercise for High-Intensity Interval Training vs Conventional Treadmill Training. Arch Phys Med Rehabil 2019; 101:187-195. [PMID: 31562872 DOI: 10.1016/j.apmr.2019.08.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the therapeutic effects of the lateral push-off skater exercise vs conventional treadmill training on health-related quality of life, cardiorespiratory fitness (CRF), and balance. DESIGN Single-blinded, randomized controlled trial. SETTING Outpatient clinic at a tertiary hospital. PARTICIPANTS Patients after minor stroke (N=36) with National Institutes of Health Stroke Scale scores≤3 between 20 and 65 years of age were randomly assigned to the intervention group (n=18) or the control group (n=18). INTERVENTIONS Thirty-minute sessions of the skater exercise were performed 3 times weekly for 12 weeks in the intervention group. Conventional treadmill aerobic exercise was conducted in the control group at the same frequency and duration as the experimental group exercise. MAIN OUTCOME MEASURES The primary outcome was measured using the European Quality of Life-5 Dimension (EQ-5D). Secondary outcomes included CRF and balance indicators. Assessments were performed at baseline (T0), 12 weeks from T0 (T1), and 16 weeks from T0 (T2). RESULTS Significant improvements in EQ-5D, peak oxygen uptake (VO2peak), peak oxygen pulse, peak minute ventilation (VE), Dynamic Gait Index (DGI), and Berg Balance Scale (BBS) were found in the intervention group after performing the skater exercise (P<.05, all), and these improvements were sustained at T2 (P<.05, all). Between-group comparisons demonstrated greater improvements in EQ-5D, VO2peak, peak oxygen pulse, peak VE, DGI, and BBS in the intervention group than those in the control group at both T1 (P<.05, all) and T2 (P<0.05, all). Correlation analysis showed significant relationships between EQ-5D and VO2peak, peak VE, DGI, and BBS (P<.05, all). CONCLUSIONS The skater exercise improved health-related quality of life, CRF, and balance in patients after minor stroke more effectively than conventional treadmill-based aerobic exercise. We recommend the skater exercise as a high-intensity interval training program for patients after minor stroke.
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Affiliation(s)
- Soo-Hyun Soh
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Na Ri Yun
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea.
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21
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Linder SM, Rosenfeldt AB, Davidson S, Zimmerman N, Penko A, Lee J, Clark C, Alberts JL. Forced, Not Voluntary, Aerobic Exercise Enhances Motor Recovery in Persons With Chronic Stroke. Neurorehabil Neural Repair 2019; 33:681-690. [PMID: 31313626 DOI: 10.1177/1545968319862557] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The recovery of motor function following stroke is largely dependent on motor learning-related neuroplasticity. It has been hypothesized that intensive aerobic exercise (AE) training as an antecedent to motor task practice may prime the central nervous system to optimize motor recovery poststroke. Objective. The objective of this study was to determine the differential effects of forced or voluntary AE combined with upper-extremity repetitive task practice (RTP) on the recovery of motor function in adults with stroke. Methods. A combined analysis of 2 preliminary randomized clinical trials was conducted in which participants (n = 40) were randomized into 1 of 3 groups: (1) forced exercise and RTP (FE+RTP), (2) voluntary exercise and RTP (VE+RTP), or (3) time-matched stroke-related education and RTP (Edu+RTP). Participants completed 24 training sessions over 8 weeks. Results. A significant interaction effect was found indicating that improvements in the Fugl-Meyer Assessment (FMA) were greatest for the FE+RTP group (P = .001). All 3 groups improved significantly on the FMA by a mean of 11, 6, and 9 points for the FE+RTP, VE+RTP, and Edu+RTP groups, respectively. No evidence of a treatment-by-time interaction was observed for Wolf Motor Function Test outcomes; however, those in the FE+RTP group did exhibit significant improvement on the total, gross motor, and fine-motor performance times (P ≤ .01 for all observations). Conclusions. Results indicate that FE administered prior to RTP enhanced motor skill acquisition greater than VE or stroke-related education. AE, FE in particular, should be considered as an effective antecedent to enhance motor recovery poststroke.
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Affiliation(s)
| | | | | | | | | | - John Lee
- 1 Cleveland Clinic, Cleveland, OH, USA
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