1
|
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.
Collapse
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
| |
Collapse
|
2
|
Adebero T, Omana H, Somerville L, Lanting B, Hunter SW. Effectiveness of prehabilitation on outcomes following total knee and hip arthroplasty for osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Disabil Rehabil 2024; 46:5771-5790. [PMID: 38349251 DOI: 10.1080/09638288.2024.2313128] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 11/28/2024]
Abstract
PURPOSE To quantify the effectiveness of prehabilitation prior to total knee and hip arthroplasty (TKA/THA) for osteoarthritis on postoperative outcomes assessed by self-report and performance-based measures. METHODS Embase, MEDLINE, CENTRAL, CINAHL and Scopus (inception-August 2022) were searched for randomized controlled trials. Self-report outcomes were function, health-related quality of life (HRQoL), and pain. Performance-based outcomes were strength, range of motion (ROM), balance, and functional mobility. The RoB 2.0 assessed risk of bias. Random-effects meta-analysis was performed up to 52 weeks after TKA/THA. RESULTS High risk of bias was found in 24 of 28 trials. Prehabilitation improved function (SMD = 0.50 [95%CI: 0.23, 0.77]), pain (SMD = 0.44 [95%CI: 0.17, 0.71]), HRQoL (SMD = 0.28 [95%CI: 0.12, 0.43]), strength (SMD = 0.72 [95%CI: 0.47, 0.98]), ROM (SMD = 0.31 [95%CI: 0.02, 0.59]), and functional mobility (SMD = 0.39 [95%CI: 0.05, 0.73]) post-TKA. No significant effect of prehabilitation on balance (SMD = 0.28 [95%CI: -0.11, 0.66]) post-TKA. All outcomes assessed had significant heterogeneity (p < 0.01). There were limited and contradictory trials (n = 2) for THA. CONCLUSION High risk of bias and significant heterogeneity observed in our meta-analysis prevent conclusions regarding prehabilitation effectiveness on outcomes up to one year after TKA/THA.
Collapse
Affiliation(s)
- Tony Adebero
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
| | - Humberto Omana
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
| | - Lyndsay Somerville
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, Canada
| | - Brent Lanting
- Schulich School of Medicine & Dentistry, Department of Surgery, University of Western Ontario, London, Canada
| | - Susan W Hunter
- Faculty of Health Sciences, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- School of Physical Therapy, University of Western Ontario, London, Canada
| |
Collapse
|
3
|
Kajankova M, Tsaousides T, Dudek E, Ashman T. Evaluation of the Implementation of a Day-Treatment Program for Executive Functioning for Individuals With Traumatic Brain Injury in Rehabilitation Settings Using the Consolidated Framework for Implementation Research. J Head Trauma Rehabil 2024; 39:446-457. [PMID: 39177480 DOI: 10.1097/htr.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
OBJECTIVE To identify barriers and facilitators to implementation of a cognitive rehabilitation intervention (Short-Term Executive Plus [STEP]) into routine clinical practice using the Consolidated Framework for Implementation Research (CFIR) by comparing high (HI) and low implementation (LI) sites. SETTING Qualitative interviews conducted with professionals who work with people who have sustained brain injuries at various rehabilitations sites across the United States. PARTICIPANTS Seven sites completed training, consultation, and agreed to implement STEP. DESIGN Retrospective qualitative study. MAIN MEASURES Qualitative interview developed for the purposes of this study and the CFIR for evaluation of implementation efforts and identification of barriers and facilitators. RESULTS Out of 7 sites, 6 completed interviews. Out of the 39 CFIR constructs, 4 distinguished between HI and LI sites. Four distinguishing factors included evidence strength and quality, needs and resources of those served by the organization, leadership engagement, and engaging champions. Five common factors were identified (4 positive and 1 negative) across HI and LI sites, which may reflect aspects of implementation that could inform future implementation efforts. Ten inconclusive factors were identified, having both a positive and a negative influence on implementation. CONCLUSIONS While there were several factors that were viewed positively by all sites, only 4 factors made a difference in implementation outcomes. These distinguishing factors can help inform future implementation efforts, highlighting a need for strong evidence supporting an intervention, a match between the intervention and the needs of the population served, engaging those in leadership and decision-making roles and ensuring their buy-in, and having a strong champion directly involved in implementation. In addition, taking a closer look at common and inconclusive factors may enable us to identify areas in which the implementation efforts could be strengthened.
Collapse
Affiliation(s)
- Maria Kajankova
- Author Affiliations: Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York State (Drs Kajankova and Tsaousides; Department of Psychology, University of Houston, Houston, Texas (Dudek); Physical Medicine and Rehabilitation, Rusk Rehabilitation, NYU Langone Medical Center, New York, New York State (Dr Ashman)
| | | | | | | |
Collapse
|
4
|
Kim SH, Cho SH. Effects of cardiorespiratory physiotherapy on lung function in stroke: a network meta-analysis. Top Stroke Rehabil 2024:1-13. [PMID: 39436741 DOI: 10.1080/10749357.2024.2417647] [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: 02/27/2024] [Accepted: 10/13/2024] [Indexed: 10/25/2024]
Abstract
BACKGROUND The efficacy of various physiotherapy interventions for improving lung function has not been compared. OBJECTIVES To evaluate cardiorespiratory physiotherapy interventions on lung function in patients with stroke, prioritize intervention types, and establish hierarchy. METHODS Twelve randomized controlled trials published during 2000-2022 in PubMed, EMBASE, Cochrane Library, and Web of Science were selected. Interventions included aerobic training (AT), combined inspiratory and expiratory training (CIET), inspiratory training (IT), combined aerobic and breadth training (CABT), and conventional training (CT). Outcome variables were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. RESULTS CIET and IT were more effective than CT for FEV1 and FVC. CIET and IT showed larger effect sizes compared to AT for FEV1. The intervention rankings were as follows: IT (86.62%), CIET (63.31%), CABT (50.79%), AT (28.72%), and CT (20.55%) for FEV1; IT (93.89%), CIET (75.06%), CT (42.38%), CABT (37.73%), and AT (0.94%) for FVC; and IT (78.30%), CT (54.14%), CABT (42.62%), CIET (41.65%), and AT (33.29%) for FEV1/FVC. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years. CONCLUSIONS Besides FEV1/FVC, IT and CIET inhalation exercises improved lung function more effectively than other therapies, with IT or CIET being more effective than AT or CT. CIET and IT were more effective than CT for FVC in patients with stroke aged ≥60 years than in those <60 years. These findings highlight the significance of breathing training for patients with stroke and support clinical decision-making.
Collapse
Affiliation(s)
- So-Hyun Kim
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Republic of Korea
| | - Sung-Hyoun Cho
- Department of Physical Therapy, Nambu University, Gwangju Republic of Korea
| |
Collapse
|
5
|
Chacon-Barba JC, Moral-Munoz JA, De Miguel-Rubio A, Lucena-Anton D. Effects of Resistance Training on Spasticity in People with Stroke: A Systematic Review. Brain Sci 2024; 14:57. [PMID: 38248272 PMCID: PMC10813883 DOI: 10.3390/brainsci14010057] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Resistance training induces neuromuscular adaptations and its impact on spasticity remains inadequately researched. This systematic review (PROSPERO: CRD42022322164) aimed to analyze the effects of resistance training, compared with no treatment, conventional therapy, or other therapies, in people with stroke-related spasticity. A comprehensive search was conducted up to October 2023 in PubMed, PEDro, Cochrane, Web of Science, and Scopus databases. Selection criteria were randomized controlled trials involving participants with stroke-related spasticity intervened with resistance training. The PEDro scale was used to evaluate the methodological quality. From a total of 274 articles, 23 full-text articles were assessed for eligibility and nine articles were included in the systematic review, involving 225 participants (155 males, 70 females; mean age: 59.4 years). Benefits were found to spasticity after resistance training. Furthermore, studies measuring spasticity also reported benefits to function, strength, gait, and balance. In conclusion, resistance training was superior to, or at least equal to, conventional therapy, other therapies, or no intervention for improving spasticity, as well as function, strength, gait, and balance. However, the results should be taken with caution because of the heterogeneity of the protocols used. Further research is needed to explore the effects of resistance training programs on people with stroke.
Collapse
Affiliation(s)
- Juan Carlos Chacon-Barba
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cadiz, Spain; (J.C.C.-B.); (D.L.-A.)
| | - Jose A. Moral-Munoz
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cadiz, Spain; (J.C.C.-B.); (D.L.-A.)
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cadiz, Spain
| | - Amaranta De Miguel-Rubio
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain;
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cadiz, Spain; (J.C.C.-B.); (D.L.-A.)
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cadiz, Spain
| |
Collapse
|
6
|
Goncalves S, Le Bourvellec M, Mandigout S, Duclos NC. Impact of Active Physiotherapy on Physical Activity Level in Stroke Survivors: A Systematic Review and Meta-Analysis. Stroke 2023; 54:3097-3106. [PMID: 37909205 DOI: 10.1161/strokeaha.123.043629] [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: 04/20/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Stroke survivors are frequently physically inactive. However, evidence of the effectiveness of active physiotherapy on physical activity level in stroke survivors is scarce. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement, covering electronic searches from inception to March 16, 2022. Participants: Stroke survivors living in the community. Intervention: Any active physiotherapy, that is, involving exercises that require voluntary effort. Outcome measure: Objective and subjective physical activity level. RESULTS Of 5590 identified references, 25 randomized controlled trials were eligible, and 21 had available data. The random-effects meta-analysis resulted in a small, significant effect size in favor of active physiotherapy measured using objective or subjective tools (21 studies, 1834 participants, standardized mean difference, 0.22 [95% CI, 0.04-0.40]; heterogeneity I2=65%), and a medium significant effect when objective tools were used (9 studies, 424 participants, standardized mean differences, 0.48 [95% CI, 0.03-0.92]; I2=73%). Meta-regression showed that 35% of the variance in trial outcome was explained by the measurement tool (objective or subjective) and 23% by age. None of the variances were associated with a specific dosage in terms of frequency, time, exercise duration, or the severity of the disability. CONCLUSIONS Active physiotherapy seems to increase objective physical activity in community-dwelling stroke survivors. However, the evidence is of very low certainty. REGISTRATION URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42022315639.
Collapse
Affiliation(s)
- Stéphanie Goncalves
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
| | - Morgane Le Bourvellec
- MOVE, Poitiers University, Faculty of Sport Sciences, UR20296, F-86000, France (M.L.B.)
| | - Stéphane Mandigout
- HAVAE, Limoges University, Department of Physical Activity and Sport Sciences, UR20217, F-87000, France (S.G., S.M.)
- ILFOMER, Limoges University, F-87000, France (S.M.)
| | - Noémie C Duclos
- Bordeaux University, INSERM, BPH, U1219, Team ACTIVE, F-33000, France (N.C.D.)
| |
Collapse
|
7
|
Michalski AC, de Freitas Fonseca G, Midgley AW, Billinger SA, Costa VAB, Dos Santos TR, Farinatti P, Cunha FA. Can mixed circuit training elicit the recommended exercise intensity and energy expenditure in people after stroke? Top Stroke Rehabil 2023; 30:751-767. [PMID: 36787495 DOI: 10.1080/10749357.2023.2178128] [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: 08/31/2022] [Accepted: 02/05/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE To investigate whether mixed circuit training (MCT) elicits the recommended exercise intensity and energy expenditure in people after stroke, and to establish the between-day reproducibility for the percentages of heart rate reserve (%HRR), oxygen uptake reserve (%VO2R), and energy expenditure elicited during two bouts of MCT. METHODS Seven people aged 58 (12) yr, who previously had a stroke, performed a cardiopulmonary exercise test, a non-exercise control session, and two bouts of MCT. The MCT included 3 circuits of 10 resistance exercises at 15-repetition maximum intensity, with each set of resistance exercise interspersed with 45-s of walking. Expired gases were collected during the MCT and control session and for 40 min afterward. Control session was necessary to calculate the net energy expenditure associated with each bout of MCT. RESULTS Mean %VO2R (1st MCT: 51.1%, P = .037; 2nd MCT: 54.0%, P = .009) and %HRR (1st MCT: 66.4%, P = .007; 2nd MCT: 67.9%, P = .010) exceeded the recommended minimum intensity of 40%. Both %VO2R (P = .586 and 0.987, respectively) and %HRR (P = .681 and 0.237, respectively) during the 1st and 2nd bouts of MCT were not significantly different to their corresponding gas exchange threshold values derived from cardiopulmonary exercise testing. Mean net total energy expenditure significantly exceeded the minimum recommend energy expenditure in the 1st (P = .048) and 2nd (P = .023) bouts of MCT. Between-day reproducibility for %HRR, %VO2R, and energy expenditure was excellent (ICC: 0.92-0.97). CONCLUSIONS MCT elicited physiological strain recommended for improving health-related fitness in people after stroke and these responses demonstrated excellent between-day reproducibility.
Collapse
Affiliation(s)
- André C Michalski
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Guilherme de Freitas Fonseca
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Adrian W Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
- KU Alzheimer's Disease Center, Fairway, Kansas, USA
| | - Victor A B Costa
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Tatiana R Dos Santos
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Paulo Farinatti
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| | - Felipe A Cunha
- Laboratory of Physical Activity and Health Promotion, Graduate Program in Exercise Science and Sports, University of Rio de Janeiro State, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Biel P, Ewertowska P, Stastny P, Krzysztofik M. Effects of Complex Training on Jumping and Change of Direction Performance, and Post-Activation Performance Enhancement Response in Basketball Players. Sports (Basel) 2023; 11:181. [PMID: 37755858 PMCID: PMC10534482 DOI: 10.3390/sports11090181] [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: 07/18/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
Exercise order is one of the significant factors modulating training effects. Therefore, the aim of this study was to compare the effectiveness of an 8-week complex (CPX) training program utilizing intra-CPX active recovery with compound training (CMP) on bilateral and single-leg jumping performance, change of direction test time (shuttle test), and the post-activation performance enhancement (PAPE) response in a group of basketball players. Thirteen participants were performing CPX bi-weekly combined with regular pre-season basketball practice, while eleven participants were performing CMP for 8 weeks. Before and after the interventions, the following fitness tests were assessed: (i) bilateral countermovement jump, (ii) single-leg countermovement jump, (iii) shuttle run test. All tests were performed pre- and post-conditioning activity (CA-three sets of five drop jumps). The results showed a statistically significant increase in non-dominant (p = 0.019) and dominant single-leg jump relative peak power (p = 0.001), and in non-dominant single-leg jump height (p = 0.022) post-training compared to pre-training. The CA was significantly and similarly effective in eliciting a PAPE response in all tests before and after each intervention (p < 0.039; for all). However, the magnitude of improvement in CMJ and shuttle test time was trivial to small and did not reach statistical significance. Both 8 weeks of CPX and CMP training led to significant improvements in the SLJ power output of both the dominant and non-dominant limbs as well as the height of the non-dominant SLJ. Neither of the training methods had significant impacts on the magnitude of the PAPE response.
Collapse
Affiliation(s)
- Piotr Biel
- Department of Sport and Physical Education, AGH University of Science and Technology, 30-059 Kraków, Poland;
| | - Paulina Ewertowska
- Division of Clinical Physiotherapy, Faculty of Physical Education, Gdansk University of Physical Education and Sport, 80-336 Gdańsk, Poland;
| | - Petr Stastny
- Department of Sport Games, Faculty of Physical Education and Sport, Charles University in Prague, 110 00 Prague, Czech Republic;
| | - Michał Krzysztofik
- Department of Sport Games, Faculty of Physical Education and Sport, Charles University in Prague, 110 00 Prague, Czech Republic;
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland
| |
Collapse
|
9
|
Luo J, Liao W, Lei D, Xing Z, Wang T, Xu W, Wang X, Yang R, Wang J, Gong H, Yang B, Ma Y, Jiao L, Chen Y. Transcarotid versus transfemoral access for cerebrovascular intervention: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e071820. [PMID: 37316322 DOI: 10.1136/bmjopen-2023-071820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Cerebrovascular intervention is an excellent option to treat cerebrovascular diseases. Interventional access is a prerequisite and a foundation for cerebrovascular intervention, which is crucial to the success of an intervention. Although transfemoral arterial access (TFA) has become a popular and acceptable method of access for cerebrovascular angiography and intervention in clinical practice, it has some drawbacks that limit the usage in cerebrovascular interventions. Therefore, transcarotid arterial access (TCA) has been developed in cerebrovascular interventions. We aim to conduct a systematic review to compare the safety and efficacy of TCA with TFA for cerebrovascular intervention. METHODS AND ANALYSIS In this protocol, Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols were followed. PubMed, Embase, Web of Science and the Cochrane Central Register of Controlled Trials will be searched mainly from 1 January 2004, to the formal search date. Additionally, reference lists and clinical trial registries will be searched. We will include clinical trials with more than 30 participants, which reported the endpoints of stroke, death and myocardial infarction. Two investigators will independently select studies, extract data and assess bias risk. A standardised mean difference with 95% CI will be presented for continuous data, and a risk ratio with 95% CI will be presented for dichotomous data. On inclusion of sufficient studies, subgroup analysis and sensitivity analysis will be conducted. The funnel plot and Egger's test will be used to assess publication bias. ETHICS AND DISSEMINATION As only published sources will be used in this review, ethical approval is not required. We will publish the results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022316468.
Collapse
Affiliation(s)
- Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Wanying Liao
- Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Dong Lei
- Department of Neurology, Tianjin Baodi Hospital, Tianjin, China
| | - Zixuan Xing
- Health Science Center, Xi'an Jiaotong University, Shaanxi, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Wenlong Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Xue Wang
- Medical Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Jie Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Haozhi Gong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
- Department of Interventional Radiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanfei Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
- China International Neuroscience Institute (China-INI), Beijing, China
| |
Collapse
|
10
|
Fuchita M, Ridgeway KJ, Kimzey C, Melanson EL, Fernandez-Bustamante A. Accelerometer-measured Inpatient Physical Activity and Associated Outcomes after Major Abdominal Surgery: A Systematic Review (Preprint). Interact J Med Res 2023; 12:e46629. [PMID: 37184924 DOI: 10.2196/46629] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND It remains unclear how inpatient physical activity after major abdominal surgery affects outcomes. Accelerometer research may provide further evidence for postoperative mobilization. OBJECTIVE We aimed to summarize the current literature evaluating the impact of accelerometer-measured postoperative physical activity on outcomes after major abdominal surgery. METHODS We searched PubMed and Google Scholar in October 2021 to conduct a systematic review. Studies were included if they used accelerometers to measure inpatient physical behaviors immediately after major abdominal surgery, defined as any nonobstetric procedures performed under general anesthesia requiring hospital admission. Studies were eligible only if they evaluated the effects of physical activity on postoperative outcomes such as postoperative complications, return of gastrointestinal function, hospital length of stay, discharge destination, and readmissions. We excluded studies involving participants aged <18 years. Risk of bias was assessed using the risk-of-bias assessment tool for nonrandomized studies (RoBANS) for observational studies and the revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for randomized controlled trials (RCTs). Findings were summarized by qualitative synthesis. RESULTS We identified 15 studies. Risk of bias was high in 14 (93%) of the 15 studies. Most of the studies (11/15, 73%) had sample sizes of <100. Of the 15 studies, 13 (87%) included the general surgery population, 1 (7%) was a study of patients who had undergone gynecologic surgery, and 1 (7%) included a mixed (abdominal, thoracic, gynecologic, and orthopedic) surgical population. Of the 15 studies, 12 (80%) used consumer-grade accelerometers to measure physical behaviors. Step count was the most commonly reported physical activity outcome (12/15, 80%). In the observational studies (9/15, 60%), increased physical activity during the immediate postoperative period was associated with earlier return of gastrointestinal function, fewer surgical and pulmonary complications, shorter hospital length of stay, and fewer readmissions. In the RCTs (6/15, 40%), only 1 (17%) of the 6 studies demonstrated improved outcomes (shorter time to flatus and hospital length of stay) when a mobility-enhancing intervention was compared with usual care. Notably, mobility-enhancing interventions used in 4 (67%) of the 6 RCTs did not result in increased postoperative physical activity. CONCLUSIONS Although observational studies show strong associations between postoperative physical activity and outcomes after major abdominal surgery, RCTs have not proved the benefit of mobility-enhancing interventions compared with usual care. The overall risk of bias was high, and we could not synthesize specific recommendations for postoperative mobilization. Future research would benefit from improving study design, increasing methodologic rigor, and measuring physical behaviors beyond step counts to understand the impact of postoperative mobilization on outcomes after major abdominal surgery.
Collapse
|
11
|
Fuest KE, Ulm B, Daum N, Lindholz M, Lorenz M, Blobner K, Langer N, Hodgson C, Herridge M, Blobner M, Schaller SJ. Clustering of critically ill patients using an individualized learning approach enables dose optimization of mobilization in the ICU. Crit Care 2023; 27:1. [PMID: 36597110 PMCID: PMC9808956 DOI: 10.1186/s13054-022-04291-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/21/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND While early mobilization is commonly implemented in intensive care unit treatment guidelines to improve functional outcome, the characterization of the optimal individual dosage (frequency, level or duration) remains unclear. The aim of this study was to demonstrate that artificial intelligence-based clustering of a large ICU cohort can provide individualized mobilization recommendations that have a positive impact on the likelihood of being discharged home. METHODS This study is an analysis of a prospective observational database of two interdisciplinary intensive care units in Munich, Germany. Dosage of mobilization is determined by sessions per day, mean duration, early mobilization as well as average and maximum level achieved. A k-means cluster analysis was conducted including collected parameters at ICU admission to generate clinically definable clusters. RESULTS Between April 2017 and May 2019, 948 patients were included. Four different clusters were identified, comprising "Young Trauma," "Severely ill & Frail," "Old non-frail" and "Middle-aged" patients. Early mobilization (< 72 h) was the most important factor to be discharged home in "Young Trauma" patients (ORadj 10.0 [2.8 to 44.0], p < 0.001). In the cluster of "Middle-aged" patients, the likelihood to be discharged home increased with each mobilization level, to a maximum 24-fold increased likelihood for ambulating (ORadj 24.0 [7.4 to 86.1], p < 0.001). The likelihood increased significantly when standing or ambulating was achieved in the older, non-frail cluster (ORadj 4.7 [1.2 to 23.2], p = 0.035 and ORadj 8.1 [1.8 to 45.8], p = 0.010). CONCLUSIONS An artificial intelligence-based learning approach was able to divide a heterogeneous critical care cohort into four clusters, which differed significantly in their clinical characteristics and in their mobilization parameters. Depending on the cluster, different mobilization strategies supported the likelihood of being discharged home enabling an individualized and resource-optimized mobilization approach. TRIAL REGISTRATION Clinical Trials NCT03666286, retrospectively registered 04 September 2018.
Collapse
Affiliation(s)
- Kristina E. Fuest
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany
| | - Bernhard Ulm
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany
| | - Nils Daum
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Maximilian Lindholz
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Marco Lorenz
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Kilian Blobner
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany ,grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Orthopedics, Munich, Germany
| | - Nadine Langer
- grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| | - Carol Hodgson
- grid.1002.30000 0004 1936 7857Acute and Critical Care, Monash University, Melbourne, VIC Australia
| | - Margaret Herridge
- grid.231844.80000 0004 0474 0428Interdepartmental Division of Critical Care Medicine, University of Toronto, University Health Network, Toronto, ON Canada
| | - Manfred Blobner
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany ,grid.410712.10000 0004 0473 882XFaculty of Medicine, Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Ulm, Germany
| | - Stefan J. Schaller
- grid.15474.330000 0004 0477 2438Technical University Munich, School of Medicine, Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, Munich, Germany ,grid.6363.00000 0001 2218 4662Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Berlin, Germany
| |
Collapse
|
12
|
Moecke DP, Zhu K, Gill J, Brar S, Petlitsyna P, Kirkham A, Girt M, Chen J, Peters H, Denson-Camp H, Crosbie S, Camp PG. A systematic review of exercise studies for individuals hospitalized with an acute exacerbation of chronic obstructive pulmonary disease: Focus on the principles of exercise training. Chron Respir Dis 2023; 20:14799731231215363. [PMID: 37967847 PMCID: PMC10655651 DOI: 10.1177/14799731231215363] [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: 06/28/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND For exercise interventions to be effectively reproduced or applied in a "real world" clinical setting, clinical trials must thoroughly document all components of the exercise prescription and ensure that participants adhere to each component. However, previous reviews have not critically examined the quality of exercise prescription of inpatient Pulmonary Rehabilitation (PR) programs. OBJECTIVE The objectives of this review were to evaluate the (a) application of the principles of exercise training, (b) reporting of the frequency, intensity, time and type (FITT) components of exercise prescription, and (c) reporting of patient's adherence to the FITT components in intervention studies for patients admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS Relevant scientific databases were searched for randomized controlled trials (RCTs) that compared in-hospital PR with usual care for people hospitalized with AECOPD. Title and abstract followed by full-text screening were conducted independently by two reviewers. Data were extracted and synthesized to evaluate the application of the principles of exercise training and the reporting/adherence of the FITT components. RESULTS Twenty-seven RCTs were included. Only two applied all principles of exercise training. Specificity was applied by 70%, progression by 48%, overload by 37%, initial values by 89% and diminishing returns and reversibility by 37% of trials. Ten trials adequately reported all FITT components. Frequency and type were the components most reported (85% and 81%, respectively), while intensity was less frequently reported (52%). Only three trials reported on the patient's adherence to all four components. CONCLUSIONS Studies have not adequately reported the exercise prescription in accordance with the principles of exercise training nor reported all the FITT components of the exercise prescription and patient's adherence to them. Therefore, interpretation of the current literature is limited and information for developing exercise prescriptions to individuals hospitalized with an AECOPD is lacking.
Collapse
Affiliation(s)
- Débora Petry Moecke
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kai Zhu
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jagdeep Gill
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Shanjot Brar
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Mirha Girt
- University of Queensland, Brisbane, QLD, Australia
| | - Joel Chen
- University of Calgary, Calgary, AB, Canada
| | - Hannah Peters
- University of British Columbia, Vancouver, BC, Canada
| | | | | | - Pat G Camp
- University of British Columbia, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
13
|
Wang D, Li L, Pan H, Huang L, Sun X, He C, Wei Q. Comparison of the Effects of Constraint-Induced Movement Therapy and Unconstraint Exercise on Oxidative Stress and Limb Function-A Study on Human Patients and Rats with Cerebral Infarction. Brain Sci 2022; 13:brainsci13010004. [PMID: 36671986 PMCID: PMC9856592 DOI: 10.3390/brainsci13010004] [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: 10/29/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Most conventional post-stroke rehabilitation treatments do not involve imposed constraints of the unaffected limb. In contrast, Constraint-Induced Movement Therapy (CIMT) is comprised of massed task practice with the affected limb and constraint of the unaffected limb. CIMT is a promising rehabilitation technique used for motor recovery of affected limbs after stroke, but its effectiveness and mechanism are not fully understood. We compared the effects of the two exercise modes on limb function post-stroke in animal models and human subjects, and investigated whether oxidative stress response was involved in regulating the effects. We first conducted a randomized controlled trial (RCT), in which 84 subjects with cerebral infarction were assigned to dose-matched constraint-induced movement therapy (CIMT), or unconstraint exercise (UE), or conventional rehabilitation treatment. Motor functions of the limb are primary outcomes of the RCT measured using Brief Fugl-Meyer upper extremity score (FMA-UE), Ashworth score, and Barthel scale. Psychological influence of CIMT and UE was also examined using Self-Rating Depression Scale (SDS). Next, we investigated the effects of CIMT and UE in rats undergoing middle cerebral artery occlusion and reperfusion (MCAO/R). Motor function, infarct volume, and pathohistological changes were investigated by mNSS, MRI, and histological studies. The role of Keap1-Nrf2-ARE was investigated using qRT-PCR, Western blot, immunochemistry, immunofluorescence, and ELISA experiments. In RCT, patients taking CIMT had a higher score in FMA-UE, Barthel index, and SDS, and a lower score in modified Ashworth, compared to those taking UE. In rats receiving CIMT, motor function was increased, and infarct volume was decreased compared to those receiving UE. The expression of Keap1 protein and mRNA in the peri-infarct tissue was decreased, and Nrf2 and ARE protein and mRNA were increased in rats receiving CIMT compared with UE. Nrf2 agonist t-BHQ increased the benefits of CIMT. In conclusion, CIMT is more effective than UE in improving upper limb motor function, reducing muscle spasm in patients with cerebral infarction compared to UE, but patients receiving CIMT may feel depressed. Moreover, both CIMT and UE are beneficial to limb function recovery and limit the infarct expansion in MCAO/R rats, but CIMT was more effective than UE. Oxidative stress reaction has an essential role in regulating the CIMT induced benefits.
Collapse
Affiliation(s)
- Dong Wang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Department of Rehabilitation Medicine, Affiliated Hospital of Chengdu University, Chengdu 610081, China
| | - Lijuan Li
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Hongxia Pan
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Liyi Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Xin Sun
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 611135, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Sichuan University, Chengdu 611135, China
- Correspondence: ; Tel.: +86-2885422847
| |
Collapse
|
14
|
Stassen G, Baulig L, Müller O, Schaller A. Attention to Progression Principles and Variables of Exercise Prescription in Workplace-Related Resistance Training Interventions: A Systematic Review of Controlled Trials. Front Public Health 2022; 10:832523. [PMID: 35400069 PMCID: PMC8990091 DOI: 10.3389/fpubh.2022.832523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe workplace is an important setting for adult health promotion including exercise training such as resistance training (RT). Since the reporting of exercise training interventions is generally inconsistent, the objective of this systematic review was to investigate the attention to principles of RT progression and variables of RT exercise prescription in workplace-related RT interventions.MethodsA systematic literature search was conducted in the databases LIVIVO, PubMed, SPORTDiscus, and Web of Science (2000–2020). Controlled trials with apparently healthy “employees” and a main focus on RT were included. RT principles and variables were extracted and rated by two reviewers (reported, not reported, or unclear). Sum scores for each RT intervention and percentages regarding each principle and variable were calculated.ResultsOverall, 21 articles were included (18 primary studies, 3 protocols). Summarized narratively, the interventions showed different positive effects on strength- or performance-related and/or health- or complaint-related outcomes. The reporting of the RT principles and variables was varied [progressive overload: 94% of the studies, specificity: 78%, variation (periodization): 39%, muscle action: 94%, loading: 94%, volume; 67%, exercise selection: 89%, exercise order: 47%, rest periods between sets: 33%, rest periods between exercises: 27%, repetition velocity: 44%, and frequency: 100%].ConclusionSeveral key RT principles and variables were reported inconsistently, reducing reproducibility and pointing to the need for standardized RT intervention reporting in workplace-related interventions. Exercise science and workplace promotion should be further linked, since accurate reporting is a prerequisite for transferring robust findings into practice.
Collapse
|
15
|
Deutsch JE, Gill-Body KM, Schenkman M. Updated Integrated Framework for Making Clinical Decisions Across the Lifespan and Health Conditions. Phys Ther 2022; 102:6497836. [PMID: 35079823 DOI: 10.1093/ptj/pzab281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/16/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022]
Abstract
The updated Integrated Framework for Clinical Decision Making responds to changes in evidence, policy, and practice since the publication of the first version in 2008. The original framework was proposed for persons with neurological health conditions, whereas the revised framework applies to persons with any health condition across the lifespan. In addition, the revised framework (1) updates patient-centered concepts with shared clinical decision-making; (2) frames the episode of care around the patient's goals for participation; (3) explicitly describes the role of movement science; (4) reconciles movement science and International Classification of Function language, illustrating the importance of each perspective to patient care; (5) provides a process for movement analysis of tasks; and (6) integrates the movement system into patient management. Two cases are used to illustrate the application of the framework: (1) a 45-year-old male bus driver with low back pain whose goals for the episode of care are to return to work and recreational basketball; and (2) a 65-year-old female librarian with a fall history whose goals for the episode of care are to return to work and reduce future falls. The framework is proposed as a tool for physical therapist education and to guide clinical practice for all health conditions across the lifespan.
Collapse
Affiliation(s)
- Judith E Deutsch
- Rivers Lab, Department of Rehabilitation and Movement Science, School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | | | - Margaret Schenkman
- Department of Physical Medicine and Rehabilitation, Physical Therapy Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| |
Collapse
|
16
|
Bengtsson L, Dotevall H, Sjögreen L, Ragnemalm L, Tuomi L. Effects of oral screen exercise on orofacial and pharyngeal activity: An exploratory study using videofluoroscopy and surface electromyography in healthy adults. Clin Exp Dent Res 2022; 8:519-528. [PMID: 35106972 PMCID: PMC9033549 DOI: 10.1002/cre2.538] [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: 06/28/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/12/2022] Open
Abstract
Objective The oral screen is a device commonly used for treatment of orofacial disorders. The objective of this exploratory study was to examine the effect of oral screen exercise on the muscle activity in the lips, submental complex, masseter muscle, and kinematic activity of the tongue base, soft palate, pharynx, and larynx in healthy adults. This was compared with the kinematic activity during a dry swallow. It was hypothesized that not only the lip musculature but also other structures in the oral and pharyngeal cavities are activated while using an oral screen device. Method Ten healthy subjects used an oral screen during examination with videofluoroscopy and surface electromyography (EMG). Three different instructions for oral screen application and a dry swallow were examined. Results The lip muscles showed the highest activity during oral screen exercise. The other muscle groups were activated to a lesser degree. The pattern of activation differed between individuals. Compared with a dry swallow, the range of motion of the tongue base, posterior pharyngeal wall, and the larynx was significantly smaller during oral screen activation. No major differences were found between three different instructions. Conclusion This study indicates that the lips and submental complex and, to a lesser degree, oral, pharyngeal, and laryngeal structures are activated with the oral screen, but the pattern of activation varied between individuals. In comparison to the activity during a dry swallow, range of motion during oral screen exercise is small.
Collapse
Affiliation(s)
- Lisa Bengtsson
- Region Västra Götaland, Public Dental Service, Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Dotevall
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lotta Sjögreen
- Region Västra Götaland, Public Dental Service, Mun-H-Center, Orofacial Resource Centre for Rare Diseases, Gothenburg, Sweden
| | - Lena Ragnemalm
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| |
Collapse
|
17
|
Feng C, Adebero T, DePaul VG, Vafaei A, Norman KE, Auais M. A Systematic Review and Meta-Analysis of Exercise Interventions and Use of Exercise Principles to Reduce Fear of Falling in Community-Dwelling Older Adults. Phys Ther 2022; 102:6383647. [PMID: 34636923 DOI: 10.1093/ptj/pzab236] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 06/14/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Fear of falling (FOF) contributes to activity restriction and institutionalization among older adults, and exercise interventions are linked to reduction in FOF. Adhering to exercise principles and adapting optimal exercise parameters are fundamental to optimizing the effectiveness of exercise interventions. The purpose of this review was to describe FOF exercise interventions in community-dwelling older adults, evaluate the extent to which these interventions followed the exercise principles and reported exercise parameters, and quantify the effect of these interventions on reducing FOF. METHODS Randomized controlled trials (RCTs) of FOF exercise interventions in older adults (≥65 years) were identified from 4 databases. The methodological quality of RCTs was assessed using the Physiotherapy Evidence Database scale. A random-effect model was used in the meta-analysis. RESULTS Seventy-five RCTs were included in this review. With regard to reporting exercise principles, specificity was reported in 92% of trials, progression in 72%, reversibility in 32%, overload in 31%, diminished return in 21%, and initial value in 8%. For exercise parameters, 97% of RCTs reported exercise type; 89%, frequency; and 85%, time. Only 25% reported the intensity. The pooled effect of exercise interventions on FOF among all included studies was a standard mean difference of -0.34 (95% CI = -0.44 to -0.23). CONCLUSION This study showed a significant small to moderate effect size of exercise interventions in reducing FOF among community-dwelling older adults. Most exercise principles and intensity of exercises were not adequately reported in included trials. IMPACT These inadequate reports could undermine efforts to examine the optimal dosage for exercise prescription. More attention must be given to designing and reporting components of therapeutic exercise programs to facilitate evidence-based practice.
Collapse
Affiliation(s)
- Chengying Feng
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Tony Adebero
- Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada
| | - Vincent G DePaul
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Afshin Vafaei
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Kathleen E Norman
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Mohammad Auais
- School of Rehabilitation Therapy, Queen's University, Faculty of Health Sciences, Kingston, Ontario, Canada
| |
Collapse
|
18
|
Small R, Wilson PH, Wong D, Rogers JM. Who, what, when, where, why, and how: a systematic review of the quality of post-stroke cognitive rehabilitation protocols. Ann Phys Rehabil Med 2021; 65:101623. [PMID: 34933125 DOI: 10.1016/j.rehab.2021.101623] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 11/01/2021] [Accepted: 11/28/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND . Rehabilitation research findings are not routinely incorporated into clinical practice. A key barrier is the quality of reporting in the original study, including who provided the intervention, what it entailed, when and where it occurred, how patient outcomes were monitored, and why the intervention was efficacious. OBJECTIVES . To facilitate clinical implementation of post-stroke cognitive rehabilitation research, we undertook a review to examine the quality of intervention reporting in this literature. METHODS . Four databases were systematically searched, identifying 27 randomised controlled trials of post-stroke cognitive rehabilitation. The quality of intervention protocol descriptions in each study was independently rated by 2 of the authors using the 12-item Template for Intervention Description and Replication (TIDieR) checklist. RESULTS .Why, when, and where items were reported in more than 70% of interventions, what materials and procedures used was described in 50% to 70%, how items were described in approximately half of the interventions, and who provided interventions was reported in 22% of studies. No study addressed all 12 TIDieR items. "Active ingredients" that may further characterise an intervention and the potential mechanisms of action included restorative training, massed practice, feedback, and tailoring demands (present in approximately 50% of studies). CONCLUSIONS . Descriptions of intervention protocols are variable and frequently insufficient, thereby restricting the ability to understand, replicate, and implement evidence-based cognitive rehabilitation. Use of reporting checklists to address this barrier to research translation is a readily achievable and effective means to advance post-stroke care.
Collapse
Affiliation(s)
- Rebecca Small
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Peter H Wilson
- Centre for Disability and Development Research, Australian Catholic University, Australia
| | - Dana Wong
- School of Psychology & Public Health, La Trobe University, Bundoora, Australia
| | - Jeffrey M Rogers
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; neuroCare Group, Sydney, Australia.
| |
Collapse
|
19
|
Schüler J, Wolff W, Pfeifer J, Rihm R, Reichel J, Rothacher G, Dettmers C. The Role of Perceived Energy and Self-Beliefs for Physical Activity and Sports Activity of Patients With Multiple Sclerosis and Chronic Stroke. Front Psychol 2021; 11:570221. [PMID: 33584409 PMCID: PMC7876439 DOI: 10.3389/fpsyg.2020.570221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Physical activity counteracts some of the negative consequences associated with chronic neurological diseases. Here, we describe the levels of physical activity (PA) and sports activity (Sport) in patients with multiple sclerosis (pMS, n = 59) and chronic stroke (pStroke, n = 67) and test compliance with the recommendation for health-promoting physical activity of the World-Health Organization (WHO). Secondly, we tested for differences between the groups of patients, and thirdly, we examined relationships between PA and Sport with psychological indicators of perceived energy (fatigue and vitality) and self-beliefs (self-efficacy and self-control). Psychological constructs were assessed with validated measures from different disciplines in Psychology. A statistical aim was to describe interpretations gained by (non-) parametric Bayesian and Null-Hypothesis-Significance Testing statistics (NHST) on the example of the conducted tests for differences and relationships. Descriptive analyses revealed that pMS and pStroke complied with recommendations of the WHO, but with large variance indicating that patient groups are not homogenous. Tests for differences showed that the PA difference between pMS and pStroke can be attributed to the higher proportion of women in the pMS sample as they engage more in household chores (important part of PA). Tests for relationships showed that for pStroke, vitality, self-control, and self-efficacy were positively related to the level of sports activity. Furthermore, pStroke who were sport active had lower fatigue and higher self-control and self-efficacy scores than sport inactive people. Although they address slightly different questions, the Bayesian and the NHST approach led to similar general conclusions.
Collapse
Affiliation(s)
- Julia Schüler
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Wanja Wolff
- Department of Sports Science, University of Konstanz, Konstanz, Germany.,Educational Psychology Lab, University of Bern, Bern, Switzerland
| | - Julian Pfeifer
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Romina Rihm
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Jessica Reichel
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | | | | |
Collapse
|
20
|
Farrell JW, Merkas J, Pilutti LA. The Effect of Exercise Training on Gait, Balance, and Physical Fitness Asymmetries in Persons With Chronic Neurological Conditions: A Systematic Review of Randomized Controlled Trials. Front Physiol 2020; 11:585765. [PMID: 33281619 PMCID: PMC7688661 DOI: 10.3389/fphys.2020.585765] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/23/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Persons with chronic neurological conditions (CNCs) often present with asymmetrical impairments, creating significant differences between contralateral limbs in body functions. These asymmetries have been associated with reduced mobility and balance, and are often targeted for reduction during rehabilitation. Exercise training has established benefits for persons with CNCs, and may have positive effects on asymmetry outcomes. Objectives: The purpose of this review was to summarize the current evidence for the effects exercise training on gait, balance, and physical fitness asymmetry in randomized control trials (RCTs) of persons with CNCs. Methods: A search of four electronic databases (EMBASE, CINAHL, SPORTdiscus, and ovidMEDLINE) was conducted following the structured Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: The search retrieved 3,493 articles, with 465 articles assessed for eligibly, and nine articles meeting the criteria for inclusion. Of the included articles, five incorporated resistance exercise, three incorporated aerobic exercise, and one incorporated combined exercise (i.e., resistance and aerobic exercise). Gait asymmetry improved significantly in four studies after resistance, aerobic, and combined exercise. Significant improvements in weight bearing asymmetry were reported in three studies after resistance exercise. One study reported significant improvements in both gait and balance asymmetry after resistance exercise. Conclusions: Preliminary evidence suggests that exercise training, as a component of rehabilitation, may have positive effects on gait and balance asymmetry in persons with CNCs. Several limitations of the current literature were noted, including a limited number of studies, combination of exercise with other rehabilitation modalities, a lack of reporting on exercise prescriptions (e.g., number of repetitions, intensity), and variability in the calculation of asymmetry outcomes. These limitations prevent definitive conclusions on the effects of exercise training on asymmetry outcomes. Future trials are needed to determine the potential of exercise training for reducing asymmetry in persons with CNCs.
Collapse
Affiliation(s)
- John W Farrell
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jordan Merkas
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lara A Pilutti
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
21
|
Eggenberger P, Annaheim S, Kündig KA, Rossi RM, Münzer T, de Bruin ED. Heart Rate Variability Mainly Relates to Cognitive Executive Functions and Improves Through Exergame Training in Older Adults: A Secondary Analysis of a 6-Month Randomized Controlled Trial. Front Aging Neurosci 2020; 12:197. [PMID: 32760267 PMCID: PMC7373948 DOI: 10.3389/fnagi.2020.00197] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/05/2020] [Indexed: 12/16/2022] Open
Abstract
Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive-motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N-N intervals, SDNN; root mean square of successive R-R interval differences, RMSSD; and absolute power of high-frequency band (0.15-0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8-12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R2 = 0.082, p = 0.016; RMSSD: R2 = 0.121, p = 0.013; HF power: R2 = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, ΔR 2 = 0.020 and RMSSD p = 0.052 one-tailed (trend), ΔR 2 = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, ΔR 2 = 0.035, RMSSD p = 0.017 one-tailed, ΔR 2 = 0.012, and HF power p = 0.011 one-tailed, ΔR 2 = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures.
Collapse
Affiliation(s)
- Patrick Eggenberger
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Simon Annaheim
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
| | - Kerstin A Kündig
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - René M Rossi
- Empa, Swiss Federal Laboratories for Materials Science and Technology, Laboratory for Biomimetic Membranes and Textiles, St. Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland.,Department of Geriatric Medicine, University of Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
22
|
Santoso A, Maulana R, Alzahra F, Prameswari HS, Ambari AM, Hartopo AB, Arso IA, Radi B. The Effects of Aerobic Exercise on N-terminal Pro-B-type Natriuretic Peptide and Cardiopulmonary Function in Patients With Heart Failure: A Meta-Analysis of Randomised Clinical Trials. Heart Lung Circ 2020; 29:1790-1798. [PMID: 32665172 DOI: 10.1016/j.hlc.2020.05.098] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/24/2020] [Accepted: 05/11/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Aerobic exercise (AEx) improves outcomes in heart failure (HF). N-terminal pro B-type natriuretic peptide (NT-pro-BNP) is a prognosticator in HF. There are few data on the association of AEx, NT-pro-BNP, and cardiopulmonary function; hence, robust evidence is needed. The aim of this study was to measure the effects of AEx on NT-pro-BNP levels and cardiopulmonary function in HF. METHOD Databases (Pubmed, EMBASE, Medline, Cochrane Central Registry, and Scopus) were systematically searched for randomised controlled trials (RCTs) that assessed the association of AEx with NT-pro-BNP and cardiopulmonary function (VE/VCO2 slope, peak VO2, maximal workload, and left ventricular ejection fraction [LVEF]) in HF. RevMan 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, 2014) was used to produce forest plots, and the random-effect model was applied with the effects measure of weighted mean differences (WMD) and 95% confidence interval (CI). RESULTS Thirteen (13) RCTs recruited 1,503 patients and 1,494 controls. Aerobic exercise was significant in lowering NT-pro-BNP (pg/mL) compared with control group (WMD=-741.69, 95% CI -993.10 to -490.27 [p<0.00001; I2=63%]). VE/VCO2 slope was also significantly reduced (WMD=-3.57, 95% CI -6.48 to -0.67 [p=0.02; I2=97%]). Peak VO2 (mL/kg/min) significantly improved (WMD=3.68, 95% CI 2.39-4.96 [p<0.00001; I2=96%]). Maximal workload (watt) significantly increased following AEx (WMD=22.80, 95% CI 18.44-27.17 [p<0.00001; I2=78%]). Furthermore, there was a significant enhancement of LVEF (%) in the AEx group (WMD=2.42, 95% CI 0.64-4.19 [p=0.008; I2=71%]). CONCLUSIONS Aerobic exercise improves the NT-pro-BNP, ventilatory efficiency, aerobic capacity, maximal workload, and the left ventricular function in patients with HF.
Collapse
Affiliation(s)
- Anwar Santoso
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia.
| | - Rido Maulana
- Faculty of Medicine, University of Muhamadiyah, Jakarta, Indonesia
| | - Fatimah Alzahra
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, University of Airlangga, Surabaya, Indonesia
| | - Hawani Sasmaya Prameswari
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ade Meidian Ambari
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | - Anggoro Budi Hartopo
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, University of Gadjah Mada, Jogyakarta, Indonesia
| | - Irsad Andi Arso
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, University of Gadjah Mada, Jogyakarta, Indonesia
| | - Basuni Radi
- Department of Cardiology, Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| |
Collapse
|
23
|
Neuroprotective effect of regular swimming exercise on calretinin-positive striatal neurons of Parkinsonian rats. Anat Sci Int 2020; 95:429-439. [DOI: 10.1007/s12565-020-00538-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 03/08/2020] [Indexed: 01/29/2023]
|
24
|
Saunders DH, Sanderson M, Hayes S, Johnson L, Kramer S, Carter DD, Jarvis H, Brazzelli M, Mead GE, Cochrane Stroke Group. Physical fitness training for stroke patients. Cochrane Database Syst Rev 2020; 3:CD003316. [PMID: 32196635 PMCID: PMC7083515 DOI: 10.1002/14651858.cd003316.pub7] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Levels of physical activity and physical fitness are low after stroke. Interventions to increase physical fitness could reduce mortality and reduce disability through increased function. OBJECTIVES The primary objectives of this updated review were to determine whether fitness training after stroke reduces death, death or dependence, and disability. The secondary objectives were to determine the effects of training on adverse events, risk factors, physical fitness, mobility, physical function, health status and quality of life, mood, and cognitive function. SEARCH METHODS In July 2018 we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO, and four additional databases. We also searched ongoing trials registers and conference proceedings, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing either cardiorespiratory training or resistance training, or both (mixed training), with usual care, no intervention, or a non-exercise intervention in stroke survivors. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, assessed quality and risk of bias, and extracted data. We analysed data using random-effects meta-analyses and assessed the quality of the evidence using the GRADE approach. Diverse outcome measures limited the intended analyses. MAIN RESULTS We included 75 studies, involving 3017 mostly ambulatory participants, which comprised cardiorespiratory (32 studies, 1631 participants), resistance (20 studies, 779 participants), and mixed training interventions (23 studies, 1207 participants). Death was not influenced by any intervention; risk differences were all 0.00 (low-certainty evidence). There were few deaths overall (19/3017 at end of intervention and 19/1469 at end of follow-up). None of the studies assessed death or dependence as a composite outcome. Disability scores were improved at end of intervention by cardiorespiratory training (standardised mean difference (SMD) 0.52, 95% CI 0.19 to 0.84; 8 studies, 462 participants; P = 0.002; moderate-certainty evidence) and mixed training (SMD 0.23, 95% CI 0.03 to 0.42; 9 studies, 604 participants; P = 0.02; low-certainty evidence). There were too few data to assess the effects of resistance training on disability. Secondary outcomes showed multiple benefits for physical fitness (VO2 peak and strength), mobility (walking speed) and physical function (balance). These physical effects tended to be intervention-specific with the evidence mostly low or moderate certainty. Risk factor data were limited or showed no effects apart from cardiorespiratory fitness (VO2 peak), which increased after cardiorespiratory training (mean difference (MD) 3.40 mL/kg/min, 95% CI 2.98 to 3.83; 9 studies, 438 participants; moderate-certainty evidence). There was no evidence of any serious adverse events. Lack of data prevents conclusions about effects of training on mood, quality of life, and cognition. Lack of data also meant benefits at follow-up (i.e. after training had stopped) were unclear but some mobility benefits did persist. Risk of bias varied across studies but imbalanced amounts of exposure in control and intervention groups was a common issue affecting many comparisons. AUTHORS' CONCLUSIONS Few deaths overall suggest exercise is a safe intervention but means we cannot determine whether exercise reduces mortality or the chance of death or dependency. Cardiorespiratory training and, to a lesser extent mixed training, reduce disability during or after usual stroke care; this could be mediated by improved mobility and balance. There is sufficient evidence to incorporate cardiorespiratory and mixed training, involving walking, within post-stroke rehabilitation programmes to improve fitness, balance and the speed and capacity of walking. The magnitude of VO2 peak increase after cardiorespiratory training has been suggested to reduce risk of stroke hospitalisation by ˜7%. Cognitive function is under-investigated despite being a key outcome of interest for patients. Further well-designed randomised trials are needed to determine the optimal exercise prescription, the range of benefits and any long-term benefits.
Collapse
Affiliation(s)
- David H Saunders
- University of EdinburghPhysical Activity for Health Research Centre (PAHRC)St Leonards LandHolyrood RoadEdinburghMidlothianUKEH8 8AQ
| | - Mark Sanderson
- University of the West of ScotlandInstitute of Clinical Exercise and Health ScienceRoom A071A, Almada BuildingHamiltonUKML3 0JB
| | - Sara Hayes
- University of LimerickSchool of Allied Health, Ageing Research Centre, Health Research InstituteLimerickIreland
| | - Liam Johnson
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Sharon Kramer
- University of MelbourneThe Florey Institute of Neuroscience and Mental HealthHeidelbergAustralia3084
| | - Daniel D Carter
- University of LimerickSchool of Allied Health, Faculty of Education and Health SciencesLimerickIreland
| | - Hannah Jarvis
- Manchester Metropolitan UniversityResearch Centre for Musculoskeletal Science and Sports Medicine, Faculty of Science and EngineeringJohn Dalton BuildingChester StreetManchesterUKM1 5GD
| | - Miriam Brazzelli
- University of AberdeenHealth Services Research UnitHealth Sciences BuildingForesterhillAberdeenUKAB25 2ZD
| | - Gillian E Mead
- University of EdinburghCentre for Clinical Brain SciencesRoom S1642, Royal InfirmaryLittle France CrescentEdinburghUKEH16 4SA
| | | |
Collapse
|
25
|
Chavarrias M, Carlos-Vivas J, Barrantes-Martín B, Pérez-Gómez J. Effects of 8-week of fitness classes on blood pressure, body composition, and physical fitness. J Sports Med Phys Fitness 2020; 59:2066-2074. [PMID: 31933345 DOI: 10.23736/s0022-4707.19.09886-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Fitness activities such as indoor cycling (IC), Zumba® (ZU) and body pump (BP) are practiced by large segments of population. There are no studies showing which kind of fitness activity can produce more health benefits. The purpose of this study was to compare the effects of 8-week of IC, alone or combined with ZU (IC+ZU), or BP (IC+BP), on blood pressure, body composition, and physical fitness. METHODS Forty-eight participants were randomly assigned to four groups: IC, IC+ZU, IC+BP or control group (CG). Before and after 8-week of training, systolic (SBP) and diastolic blood pressure (DBP), fat, lean and bone mass, body circumferences, resting heart rate, aerobic fitness, limbs strength and vertical jump height (VJH) were assessed. RESULTS The IC and IC+ZU experienced significant decreases in SBP and DBP, which were significantly greater, compared to CG. Between-group comparisons showed greater decreases in body mass (BM) and body fat mass percentage (BFM) in IC compared to all groups, also significant differences were observed between IC+ZU and IC+B with CG. Decreases in neck, pectoral, waist and hip circumferences were found in IC, IC+ZU and IC+BP compared to CG. All experimental groups significantly increased 10RM leg press and leg flexion, VJH and VO2max compared to CG. CONCLUSIONS Fitness classes of IC, alone or combined with ZU or BP, are effective in reducing blood pressure and improving body composition and physical fitness. The IC is the most effective in reducing BM and BFM.
Collapse
Affiliation(s)
- Manuel Chavarrias
- Faculty of Sport Sciences, University of Extremadura, Caceres, Spain
| | - Jorge Carlos-Vivas
- UCAM Research Center for High Performance Sport, Catholic University of Murcia, Murcia, Spain -
| | | | - Jorge Pérez-Gómez
- Faculty of Sport Sciences, University of Extremadura, Caceres, Spain
| |
Collapse
|
26
|
Adcock M, Sonder F, Schättin A, Gennaro F, de Bruin ED. A usability study of a multicomponent video game-based training for older adults. Eur Rev Aging Phys Act 2020; 17:3. [PMID: 31938075 PMCID: PMC6955093 DOI: 10.1186/s11556-019-0233-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/19/2019] [Indexed: 12/31/2022] Open
Abstract
Background Aging is often accompanied by a decline in sensory, motor and cognitive functions. These age- and lifestyle-related impairments may lead to reduced daily life functioning including gait disturbances, falling and injuries. Most daily life activities, e.g. walking, are tasks which require the concurrent interplay of physical and cognitive functions. Promising options for combined physical-cognitive training are video game-based physical exercises, so-called exergames. This study aimed to [i] determine the usability of a newly developed multicomponent exergame and [ii] explore its effects on physical functions, cognition and cortical activity. Methods Twenty-one healthy and independently living older adults were included (10 female, 71.4 ± 5.8 years, range: 65–91) and performed 21 training sessions (each 40 min) over seven weeks. The multicomponent exergame included strength and balance training with Tai Chi-inspired and dance exercises. Participants rated the usability of the exergame (System Usability Scale) and reported on their emotional experience (Game Experience Questionnaire). Attendance and attrition rates were calculated to determine training compliance. Before and after the intervention, physical and cognitive functions as well as resting state electroencephalography (EEG) were assessed. Results Results showed a high training attendance rate (87.1%, 18/21 training sessions on average) and a low attrition rate (9.5%, 2 drop-outs). System usability was rated high with a mean score of 75/100. Affective game experience was rated favorable. Gait speed under dual-task condition, lower extremity muscle strength and reaction times in a cognitive task (divided attention) showed significant improvements (p < .05). No significant pre-post differences were found for resting state EEG. Conclusions The newly developed exergame seems usable for healthy older adults. Nevertheless, some aspects of the exergame prototype can and should be improved. The training showed to positively influence physical and cognitive functions in a small convenience sample. Future trials are warranted which evaluate the feasibility and usability of the exergame training in a more “real-life” in-home setting and assess the behavioral and neuroplastic changes in a larger population after a longer training period with comparison to a control group.
Collapse
Affiliation(s)
- Manuela Adcock
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Floriana Sonder
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Alexandra Schättin
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Federico Gennaro
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland
| | - Eling D de Bruin
- 1Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Leopold-Ruzicka-Weg 4, 8093 Zurich, Switzerland.,2Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Alle 23, 14183 Huddinge, Sweden
| |
Collapse
|
27
|
Fishbein P, Hutzler Y, Ratmansky M, Treger I, Dunsky A. A Preliminary Study of Dual-Task Training Using Virtual Reality: Influence on Walking and Balance in Chronic Poststroke Survivors. J Stroke Cerebrovasc Dis 2019; 28:104343. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/24/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
|
28
|
Moss-Morris R, Harrison AM, Safari R, Norton S, van der Linden ML, Picariello F, Thomas S, White C, Mercer T. Which behavioural and exercise interventions targeting fatigue show the most promise in multiple sclerosis? A systematic review with narrative synthesis and meta-analysis. Behav Res Ther 2019; 137:103464. [PMID: 31780252 DOI: 10.1016/j.brat.2019.103464] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 01/12/2023]
Abstract
Fatigue is a common and highly debilitating symptom of multiple sclerosis (MS). This meta-analytic systematic review with detailed narrative synthesis examined randomised-controlled (RCTs) and controlled trials of behavioural and exercise interventions targeting fatigue in adults with MS to assess which treatments offer the most promise in reducing fatigue severity/impact. Medline, EMBASE and PsycInfo electronic databases, amongst others, were searched through to August 2018. Thirty-four trials (12 exercise, 16 behavioural and 6 combined; n = 2,434 participants) met inclusion criteria. Data from 31 studies (n = 1,991 participants) contributed to the meta-analysis. Risk of bias (using the Cochrane tool) and study quality (GRADE) were assessed. The pooled (SMD) end-of-treatment effects on self-reported fatigue were: exercise interventions (n = 13) -.84 (95% CI -1.20 to -.47); behavioural interventions (n = 16) -.37 (95% CI -.53 to -.22); combined interventions (n = 5) -.16 (95% CI: -.36 to .04). Heterogeneity was high overall. Study quality was very low for exercise interventions and moderate for behavioural and combined interventions. Considering health care professional time, subgroup results suggest web-based cognitive behavioural therapy for fatigue, balance and/or multicomponent exercise interventions may be the cost-efficient therapies. These need testing in large RCTs with long-term follow-up to help define an implementable fatigue management pathway in MS.
Collapse
Affiliation(s)
- Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, SE1 9RT, UK.
| | - Anthony M Harrison
- Clinical Psychology Training Programme, Institute of Health Sciences, University of Leeds, School of Medicine, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Reza Safari
- Health and Social Care Research Centre, University of Derby, Kedleston Road, Derby, DE22 1GB, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, SE1 9RT, UK
| | - Marietta L van der Linden
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU, UK
| | - Federica Picariello
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, 5th Floor Bermondsey Wing, Guy's Campus, King's College London, SE1 9RT, UK
| | - Sarah Thomas
- Bournemouth University Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK
| | - Claire White
- School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, SE1 1UL, UK
| | - Tom Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Queen Margaret University Drive, Edinburgh, EH21 6UU, UK
| |
Collapse
|
29
|
Luo L, Meng H, Wang Z, Zhu S, Yuan S, Wang Y, Wang Q. Effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors: A systematic review and meta-analysis. Ann Phys Rehabil Med 2019; 63:59-68. [PMID: 31465865 DOI: 10.1016/j.rehab.2019.07.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 07/04/2019] [Accepted: 07/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Knowledge of the optimal protocol and safety of particularly high-intensity exercise applied to individuals with stroke is lacking. OBJECTIVE This systematic review and meta-analysis aimed to investigate the effect of high-intensity exercise on cardiorespiratory fitness in stroke survivors. METHODS We performed a systematic electronic search for articles in MedLine via PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, and SPORTSDiscus up to April 1, 2019. Peak oxygen consumption (VO2peak), 6-min walk test (6MWT), fastest 10-m walk test (10MWT), and adverse events were assessed. The standardized mean difference (SMD), weighted mean difference (WMD), and odds ratios (ORs) were used to compute the effect size, and subgroup analysis was conducted to test the consistency of results as well as sensitivity analysis to assess the robustness of the results. The quality of evidence was assessed with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS We included 17 studies (PEDro score≥4) in the meta-analysis. Post-intervention, high-intensity exercise had a significant effect on peak oxygen uptake (VO2peak; SMD=0.56, P<0.01, I2=8%; WMD=2.53mL/kg/min; high quality of evidence) and 6MWT (SMD=0.26, P<0.01, I2=40%; WMD=17.08m; moderate quality of evidence) but not fastest 10MWT (SMD=0.33, P=0.27, I2=77%; WMD=0.05m/s; low quality of evidence). Subgroup analysis showed better effects of higher-intensity treadmill training (≥70% heart rate reserve/VO2peak) for a longer duration (≥12 weeks) on VO2peak and 6MWT in sub-acute or chronic stroke survivors. The high-intensity exercise and control groups did not differ in adverse events including falls [odds ratio (OR) 1.40, P=0.35, I2=11%; low quality of evidence], pain (OR 3.34, P=0.09, I2=0%; moderate quality of evidence), or skin injuries (OR 1.08, P=0.90, I2=0%; low quality of evidence). CONCLUSIONS Our meta-analysis suggests that high-intensity exercise is beneficial for cardiorespiratory fitness in stroke survivors and might be safe as a novel intervention in cardiopulmonary rehabilitation after stroke.
Collapse
Affiliation(s)
- Lu Luo
- Department of Rehabilitation Medicine, Qingdao University, Qingdao, China; Department of Rehabilitation Medicine, Fudan University, Shanghai, China
| | - Haining Meng
- Department of Special Medicine, School of Basic Medical College, Qingdao University, Qingdao, China
| | - Ziwei Wang
- The Ohio State University, Columbus, OH, United States
| | - Shiqiang Zhu
- Department of Rehabilitation Medicine, Ningxia Medical University, Ningxia, China
| | - Song Yuan
- Department of Rehabilitation Medicine, Taihe Hospital, Hubei, China
| | - Yuyang Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huangdao District, 266000 Qingdao, Shandong, China
| | - Qiang Wang
- Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, 1677, Wutaishan Road, Huangdao District, 266000 Qingdao, Shandong, China.
| |
Collapse
|
30
|
Regan EW, Handlery R, Beets MW, Fritz SL. Are Aerobic Programs Similar in Design to Cardiac Rehabilitation Beneficial for Survivors of Stroke? A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012761. [PMID: 31409176 PMCID: PMC6759893 DOI: 10.1161/jaha.119.012761] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/18/2019] [Indexed: 01/17/2023]
Abstract
Background Survivors of stroke face movement disability and increased cardiovascular disease and stroke risk. Treatment includes rehabilitation focused on functional movement with less emphasis on aerobic capacity. After rehabilitation, survivors of stroke must self-manage activity with limited appropriate community programs. Lack of structured activity contributes to sedentary behavior. The objective of this systematic review and meta-analysis is to review aerobic programs for stroke survivors similar in activity and dosage to cardiac rehabilitation programs to determine their efficacy for improving aerobic and walking capacity. Methods and Results Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to review 5 databases. Group interventions for survivors of stroke with a primary aerobic component and dosage from 18 to 36 visits over 8 to 18 weeks (matching cardiac rehabilitation requirements in the United States) were included. The 6-minute walk test, maximal oxygen consumption (VO2) peak, and walking speed were included as measures of aerobic capacity. Summary effect sizes and outcome measure mean differences were calculated for preintervention to postintervention, and summary effect sizes were calculated for preintervention to follow-up. Activity type and initial 6-minute walk test moderator analyses were performed. Nineteen studies with 23 eligible groups were selected. Survivors of stroke improved their composite aerobic capacity with an effect size of 0.38 (95% CI, 0.27-0.49). Studies including 6-minute walk test demonstrated a pooled difference in means of 53.3 m (95% CI, 36.8-69.8 m). Follow-up data were inconclusive. Conclusions Survivors of stroke benefit from aerobic programs with similar dosing to cardiac rehabilitation in the United States. The potential integration into existing programs could expand the community exercise options.
Collapse
Affiliation(s)
| | - Reed Handlery
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| | - Michael W. Beets
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| | - Stacy L. Fritz
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| |
Collapse
|
31
|
Pogrebnoy D, Dennett A. Exercise Programs Delivered According to Guidelines Improve Mobility in People With Stroke: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2019; 101:154-165. [PMID: 31400308 DOI: 10.1016/j.apmr.2019.06.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 06/20/2019] [Accepted: 06/26/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine if prescribing a combined aerobic and resistance training exercise program in accordance with American Stroke Association physical activity guidelines improves mobility and physical activity levels of people after stroke. DATA SOURCES Online database search from earliest available date to August 27, 2018. STUDY SELECTION Randomized controlled trials evaluating the effectiveness of exercise programs prescribed in accordance with guidelines for improving mobility and physical activity levels in adults with subacute or chronic stroke. DATA EXTRACTION Two independent reviewers completed data extraction. Risk of bias was assessed using the Physiotherapy Evidence Database Scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development, and Evaluation approach. DATA SYNTHESIS Data was pooled from a total of 499 participants for meta-analysis. There was high-level evidence that exercise programs adhering to guidelines improve habitual walking speed (mean difference, 0.07m/s; 95% CI, -0.01 to 0.16) and walking endurance (mean difference, 39.2m, 95% CI, 17.2-61.2). A sensitivity analysis demonstrated high-level evidence of improvements in walking endurance (mean difference, 51.1m; 95% CI, 19.96-82.24) and moderate-level evidence of improvements on the Timed Up and Go test (standardized mean difference, 0.57; 95% CI, 0.16-0.99). No differences were detected for other mobility outcome measures or physical activity levels. Adherence was high and few adverse events were reported. CONCLUSION A combined exercise program comprising aerobic and resistance training that adheres to the American Stroke Association guidelines is safe and should be prescribed in addition to usual care to improve mobility. Further research is needed to understand the relationship between exercise programs and behavior change requirements to improve long-term physical activity levels.
Collapse
Affiliation(s)
- Dina Pogrebnoy
- Community Rehabilitation Program, Eastern Health, Victoria, Australia.
| | - Amy Dennett
- Allied Health Clinical Research Office, Eastern Health, Victoria, Australia
| |
Collapse
|
32
|
Hermand E, Tapie B, Dupuy O, Fraser S, Compagnat M, Salle JY, Daviet JC, Perrochon A. Prefrontal Cortex Activation During Dual Task With Increasing Cognitive Load in Subacute Stroke Patients: A Pilot Study. Front Aging Neurosci 2019; 11:160. [PMID: 31312136 PMCID: PMC6614381 DOI: 10.3389/fnagi.2019.00160] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Stroke patients often exhibit difficulties performing a cognitive task while walking, defined as a dual task (DT). Their prefrontal cortex (PFC) activity is higher in DT than in single task (ST). The effects of an increasing load on PFC activity during DT in subacute stroke patients remains unexplored. Our objective was to assess the effects of N-back tasks (low/high load) on cerebral activity, gait parameters, and cognitive performances. Eleven subacute stroke patients (days post-stroke 45.8 ± 31.6) participated in this pilot study (71.4 ± 10 years, BMI 26.7 ± 4.8 kg.m-2, Barthel index 81.8 ± 11.0). Patients completed a STwalk, and 4 conditions with 1-back (low load) and 2-back (high load): STlow, SThigh, DTlow, and DThigh. Overground walking was performed at a comfortable pace and -N-back conditions were carried out verbally. Both gait (speed, stride variability) and cognitive (rate of correct answers) performances were recorded. Changes in PFC oxyhemoglobin (ΔO2Hb) and deoxyhemoglobin (ΔHHb) were measured by functional near infrared spectroscopy (fNIRS). Results showed an increase of ΔO2Hb while walking, which was not augmented by cognitive loads in DT. Walking speed was reduced by low and high cognitive loads in DT compared to STwalk (P < 0.05), but was not different between DTlow and DThigh. Cognitive performances were negatively impacted by both walking (P < 0.05) and cognitive load (between "low" and "high," P < 0.001). These data highlight a "ceiling" effect in ΔO2Hb levels while walking, leaving no available resources for simultaneous cognitive tasks, during the early recovery period following stroke. In these patients, cognitive, but not motor, performances declined with a higher cognitive load.
Collapse
Affiliation(s)
- Eric Hermand
- Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France
| | - Bertrand Tapie
- Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France.,Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Limoges, France
| | - Olivier Dupuy
- Laboratoire Move, EA6314, Poitiers University, Poitiers, France
| | - Sarah Fraser
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Maxence Compagnat
- Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France.,Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Limoges, France
| | - Jean Yves Salle
- Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France.,Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Limoges, France
| | - Jean Christophe Daviet
- Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France.,Médecine Physique et de Réadaptation, Centre Hospitalier Universitaire, Limoges, France
| | - Anaick Perrochon
- Laboratoire HAVAE, EA6310, Université de Limoges, Limoges, France
| |
Collapse
|
33
|
Galloway M, Marsden DL, Callister R, Erickson KI, Nilsson M, English C. What Is the Dose-Response Relationship Between Exercise and Cardiorespiratory Fitness After Stroke? A Systematic Review. Phys Ther 2019; 99:821-832. [PMID: 30834439 DOI: 10.1093/ptj/pzz038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/30/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exercise after stroke improves cardiorespiratory fitness and walking capacity; however, the effect of altering exercise dose (via frequency, intensity, time, and type) on fitness or walking capacity is unclear. PURPOSE The purpose of this study was to synthesize the current evidence for the effects of different doses of exercise on cardiorespiratory fitness and walking capacity in people after stroke. DATA SOURCES Seven relevant electronic databases were searched using keywords relating to stroke and cardiorespiratory fitness. STUDY SELECTION Trials that compared more than 1 dose of exercise for people (≥ 18 years old) after stroke and measured peak oxygen consumption or 6-minute walk test distance as an outcome were included. Two reviewers independently appraised all trials. DATA EXTRACTION Two reviewers independently extracted data from included articles. Intervention variables were extracted in accordance with the Template for Intervention Description and Replication checklist. DATA SYNTHESIS Data were synthesized narratively. Nine trials involving 279 participants were included. Three of 5 trials comparing exercise intensity showed that higher-intensity training was associated with greater improvements in cardiorespiratory fitness. The effects of other exercise dose components (frequency, time, and type) on fitness were not determined. Overall, walking capacity improved as program length increased. LIMITATIONS All trials had a high risk of bias, and most had a high rate of attrition. Most trials included people more than 6 months after stroke and who walked independently, limiting the generalizability of the findings. CONCLUSIONS Exercising at an intensity greater than 70% of heart rate reserve can be more effective in increasing cardiorespiratory fitness after stroke than exercising at lower intensities. More trials that compare exercise doses by manipulating only 1 dose parameter at a time for people after stroke are needed.
Collapse
Affiliation(s)
- Margaret Galloway
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, University Drive, Callaghan, New South Wales 2305, Australia; and Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Dianne L Marsden
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle; Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute; and Hunter Stroke Service, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Robin Callister
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute; and School of Biomedical Sciences and Pharmacy and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Nilsson
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute; and Faculty of Health and Medicine, University of Newcastle
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle; and Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Hunter Medical Research Institute
| |
Collapse
|
34
|
Alarie C, Gagnon IJ, Quilico E, Swaine B. Characteristics and outcomes of physical activity interventions for individuals with mild traumatic brain injury: a scoping review protocol. BMJ Open 2019; 9:e027240. [PMID: 31221883 PMCID: PMC6589025 DOI: 10.1136/bmjopen-2018-027240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/19/2019] [Accepted: 05/23/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Traumatic brain injury (TBI) is a major public health problem, and it is estimated that 85% of TBIs are diagnosed as mild and are commonly referred to as a concussion. In adults, symptoms are expected to resolve within 10-14 days after the injury, but up to 15% of individuals continue to have symptoms beyond this period. Recent clinical recommendations suggest the use of physical activity (PA) as a therapy to manage persisting symptoms. However, the recommendations regarding PA lack clarity about important intervention parameters to help clinicians deliver the intervention. The objectives of this scoping review are thus to identify the characteristics, the measurement tools, the health-related outcomes and the reported effectiveness of PA-based interventions for adults with persisting symptoms of a mild TBI (mTBI). METHODS AND ANALYSIS This scoping review protocol will follow Arksey and O'Malley's six-step iterative process enhanced by another study and will be conducted by a team of researchers and clinical experts. Five databases (MEDLINE, CINAHL, PsycINFO, SPORTDiscuss and Embase), as well as Google, will be searched using an extensive search strategy to capture relevant scientific and grey literature. Articles will be selected if they report on an intervention designed to have an impact on health-related outcomes or participation among individuals having sustained an mTBI. A data extraction form based on the Consensus on Exercise Reporting Template and the Template for Intervention Description and Replication checklists will be created. Quantitative and qualitative data will be analysed accordingly, synthesised and collated in tables. ETHICS AND DISSEMINATION This scoping review generates new knowledge from published and publicly available literature; thus, an ethical approval is unnecessary to conduct this research. Dissemination of the results will involve all team members in activities aimed to facilitate knowledge uptake among TBI rehabilitation clinical experts locally, nationally and internationally.
Collapse
Affiliation(s)
- Christophe Alarie
- École de Réadaptation, Université de Montréal, Montréal, Québec, Canada
| | - Isabelle J Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Department of Trauma, Montreal Children’s Hospital of the McGill University Health Center, Montréal, Québec, Canada
| | - Enrico Quilico
- Rehabilitation Science Institute, University of Toronto, Toronto, Canada
| | - Bonnie Swaine
- École de Réadaptation, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche interdisciplinaire en réadaptation du Montréal metropolitain, Montréal, Québec, Canada
| |
Collapse
|
35
|
Young RE, Broom D, Sage K, Crossland K, Smith C. Experiences of venue based exercise interventions for people with stroke in the UK: a systematic review and thematic synthesis of qualitative research. Physiotherapy 2019; 110:5-14. [PMID: 31492446 DOI: 10.1016/j.physio.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND The physical benefits of exercise following stroke are research evidenced and the UK stroke population is increasingly encouraged to engage with exercise interventions. A synthesis of qualitative research is required to further understand the perceived experience and psychosocial effect of exercise for people with stroke. OBJECTIVES To provide a systematic search and synthesis of evidence about the experiences and reported impact of participation in venue based exercise following stroke in the UK. DATA SOURCES Eligible studies were identified through a rigorous search of Medline, Cinahl, AMED, PsycINFO, SportDiscus, Proquest and ETHOS from January 2000 until December 2017. STUDY ELIGIBILITY CRITERIA Full text qualitative studies or service evaluations conducted in the UK which explored the reported experience of venue based exercise amongst people with stroke. STUDY SYNTHESIS AND APPRAISAL Included studies were evaluated through application of the Consolidated Criteria for Reporting Qualitative Research. Data synthesis using a thematic approach generated descriptive and analytical themes. RESULTS Six research studies and one service evaluation met the inclusion criteria; methodological quality was variable. These studies highlighted that people with stroke gain confidence and renewed identity through exercise participation. Perceived improvements in physical function were reported and participants enjoyed stroke specific exercise programmes in de-medicalised venues. LIMITATIONS The studies only accessed people who had completed the exercise programmes; non-completers were not represented. CONCLUSION Venue based exercise programmes have a positive effect on perceived wellbeing following stroke. Further research into the reasons for discontinuation of exercise participation following stroke is required. Systematic Review Registration Number PROSPERO 2017:CRD42017072483.
Collapse
Affiliation(s)
- Rachel E Young
- Sheffield Neuro Physiotherapy, Mayfield Farm, Mayfield Road, Fulwood, Sheffield, S10 4PR, United Kingdom.
| | - David Broom
- Faculty of Health and Wellbeing, Collegiate Hall, Sheffield Hallam University, S10 2BP, United Kingdom
| | - Karen Sage
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Robert Winston Building, Sheffield Hallam University, S10 2BP, United Kingdom
| | - Kay Crossland
- Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, United Kingdom
| | - Christine Smith
- Department of Allied Health Professions, Faculty of Health and Wellbeing, Robert Winston Building, Sheffield Hallam University, S10 2BP, United Kingdom
| |
Collapse
|
36
|
Fiogbé E, Carnavale BF, Takahashi ACDM. Exercise training in older adults, what effects on muscle force control? A systematic review of randomized clinical trials. Arch Gerontol Geriatr 2019; 83:138-150. [PMID: 31026723 DOI: 10.1016/j.archger.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 04/02/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
Abstract
AIM To determine the magnitude of the effects of different exercise training (ET) modalities on variables of muscle force control in older adults. METHODS Relevant articles were searched in PubMed, Web of Science, Science Direct and Scopus, using the keywords: Aged AND "Exercise Movement Techniques" AND ("Complexity of torque" OR "Complexity of force" OR "Variability of torque" OR "Variability of force" OR "Force Steadiness" OR "Force fluctuations"). To be included in the full analysis, the studies had to be randomized controlled trials in which older adults were submitted to ET programs and muscle force control assessment. RESULTS The searches resulted in 702 articles from which 6 met all the inclusion criteria. The trials involved 171 healthy and functionally limited older adults (71.64 ± 1.53 years). Studies included resistance, steadiness and functional training programs. Training sessions were 2-3 time per week, lasted 6-16 months with intensities determined as percentage of the one repetition maximum loads. There is a heterogeneity regarding experimental set-up and data analysis parameters between studies. The findings show an improved muscle force control in older adults after ET. Such response is better evidenced by the assessment of the coefficient of variation (CV) of the force signals. There is moderate evidence that resistance training programs are effective to decrease CV of knee extensor force signals at lower force targets. CONCLUSIONS The findings from this review suggest that ET programs are effective to improve muscle force control in older adults.
Collapse
Affiliation(s)
- Elie Fiogbé
- Department of Physiotherapy, Federal University of Sao Carlos, Rodovia Washington Luiz, km 235, São Carlos, SP, CEP: 13565-905, Brazil.
| | | | | |
Collapse
|
37
|
Possible Improvement of the Sagittal Spinopelvic Alignment and Balance through "Locomotion Training" Exercises in Patients with "Locomotive Syndrome": A Literature Review. Adv Orthop 2019; 2019:6496901. [PMID: 31210991 PMCID: PMC6532306 DOI: 10.1155/2019/6496901] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/17/2019] [Accepted: 03/27/2019] [Indexed: 12/22/2022] Open
Abstract
On the basis of rapid population aging, in 2007, the Japanese Orthopaedic Association (JOA) proposed a new disease concept "locomotive syndrome" as a degenerative condition of reduced mobility due to the impairment of the musculoskeletal system. Worsened locomotive components, which consist of bones, joints, and intervertebral discs, and muscles and nerves, can lead to symptoms such as pain, limited range of motion, malalignment, impaired balance, and difficulty in walking, ultimately resulting in the requirement of nursing care. "Locomotive syndrome" has gained increased interest in Japan but still not worldwide. Hence, in this brief review, we summarize an updated definition, assessment, and management of "locomotive syndrome". The JOA recommends "locomotion training" exercise intervention to be effective in maintaining motor function that comprises two simple exercises-squatting and single-leg standing. However, the extent to which exercises affect "locomotive syndrome" is unknown. Here, we further report hypothesis-generating patient cases who presented the improved sagittal spinopelvic alignment in standing radiographs and postural stability in piezoelectric force-plate measurements through our 6-month "locomotion training" outpatient rehabilitation program. It is noteworthy that "locomotion training" facilitated these improvements despite the presence of specific disorders including thoracic kyphosis and symptomatic lumbar spinal canal stenosis. This raises the need for further investigations to clarify effects of "locomotion training" exercises on the spinal alignment, global balance, and quality of life in patients with "locomotive syndrome".
Collapse
|
38
|
Seydyousefi M, Fallahmohammadi Z, Moazzami M, Yaghoubi A, Faghfoori Z. Positive Effects of Post-ischemic Forced Treadmill Training on Sensorimotor and Learning Outcomes Following Transient Global Cerebral Ischemia. MEDICAL LABORATORY JOURNAL 2019. [DOI: 10.29252/mlj.13.2.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
39
|
Gelisanga MAP, Gorgon EJR. Measurement properties of the upright motor control test in adults with subacute stroke. Top Stroke Rehabil 2018; 26:18-23. [PMID: 30325722 DOI: 10.1080/10749357.2018.1534454] [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: 10/28/2022]
Abstract
BACKGROUND Previous studies have distilled the Upright Motor Control Test Knee Extension and Knee Flexion subscales (UMCT-KE and UMCT-KF, respectively) from the original 6-item instrument and examined these as stand-alone rapid tests of voluntary movement control in the standing position. Systematic review evidence suggests that the UMCT-KE and UMCT-KF may have value in predicting walking ability after stroke. OBJECTIVE To examine the interrater and intrarater reliability, and concurrent validity of the UMCT-KE and UMCT-KF, and associations with walking ability in adults with subacute stroke. METHODS A prospective repeated assessments design was implemented in a rehabilitation department in a public teaching hospital. A consecutive sample of patients with subacute first-time stroke (N = 50; mean age = 51 ± 12 years; 20 females; mean time post-stroke = 68 ± 48 days) completed the study. Three physical therapists independently administered the UMCT-KE and UMCT-KF on two testing occasions 2 days apart (t1 and t2). On t2, a fourth rater administered the Leg subscale of the Motricity Index (MI-Leg) as criterion standard. RESULTS The UMCT-KE and UMCT-KF demonstrated substantial to almost perfect interrater and intrarater reliability (W = 0.77-0.95), with lower limits of 95% confidence intervals extending to no lower than the substantial level. Both the UMCT-KE and UMCT-KF showed high correlations with the MI-Leg (ρ = 0.747-0.775) and significant associations with walking ability. p Values for all tests were <0.001. CONCLUSIONS The UMCT-KE and UMCT-KF are reliable and valid tests for rapidly estimating voluntary movement control of the lower limbs in adults with subacute stroke.
Collapse
Affiliation(s)
- Maribeth Anne P Gelisanga
- a Section of Physical Therapy, Department of Rehabilitation Medicine , Philippine General Hospital , Manila , Philippines.,b Department of Physical Therapy, College of Allied Medical Professions , University of the Philippines Manila , Manila , Philippines
| | - Edward James R Gorgon
- b Department of Physical Therapy, College of Allied Medical Professions , University of the Philippines Manila , Manila , Philippines
| |
Collapse
|
40
|
McGregor G, Powell R, Finnegan S, Nichols S, Underwood M. Exercise rehabilitation programmes for pulmonary hypertension: a systematic review of intervention components and reporting quality. BMJ Open Sport Exerc Med 2018; 4:e000400. [PMID: 30364456 PMCID: PMC6196941 DOI: 10.1136/bmjsem-2018-000400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 02/02/2023] Open
Abstract
Objectives To identify the components, and assess the reporting quality, of exercise training interventions for people living with pulmonary hypertension. Design Systematic review with analysis of intervention reporting quality using the Consensus on Exercise Reporting Template (CERT). Data sources Eligible studies in the Cochrane Systematic Review of exercise-based rehabilitation for pulmonary hypertension, updated with a new search of relevant databases from 1 August 2016 to 15 January 2018. Eligibility criteria Peer-reviewed journal articles of randomised and non-randomised controlled trials, and non-controlled prospective observational studies, investigating dynamic exercise training interventions in adult humans with diagnosed pulmonary hypertension, reporting on at least one physiological and/or psychosocial outcome. Results Interventions typically involved cycle ergometry and walking. They were delivered as 3-week inpatient, or outpatient and/or home-based programmes, lasting for 4–15 weeks. Components relating specifically to exercise prescription were described satisfactorily and in more detail than motivational/behavioural change strategies, adherence and fidelity. Mean CERT score was 13.1 (range 8–17) out of a possible maximum score of 19. No studies fully reported every aspect of an exercise intervention to the standard recommended by CERT. Summary/conclusion Considerable variability was evident in the components and reporting quality of interventions for exercise rehabilitation studies in pulmonary hypertension. Interventional studies using exercise training should pay greater attention to describing motivational/behavioural change strategies, adherence and fidelity. Detailed description of these parameters is essential for the safe and effective replication of exercise rehabilitation interventions for pulmonary hypertension in clinical practice. Trial registration number CRD42018085558.
Collapse
Affiliation(s)
- Gordon McGregor
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK.,School of Health & Life Sciences, Coventry University, Coventry, UK
| | - Richard Powell
- Department of Cardiopulmonary Rehabilitation, Centre for Exercise & Health, University Hospital, Coventry, UK
| | - Susanne Finnegan
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| |
Collapse
|
41
|
Knols RH, Fischer N, Kohlbrenner D, Manettas A, de Bruin ED. Replicability of Physical Exercise Interventions in Lung Transplant Recipients; A Systematic Review. Front Physiol 2018; 9:946. [PMID: 30079028 PMCID: PMC6062962 DOI: 10.3389/fphys.2018.00946] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: This systematic review aimed to assess the replicability of physical exercise interventions in lung transplantation patients. For replicability we focused on (1) the description of training principles, (2) the description of FITT components and adherence to the interventions, (3) the amount of detailed information given on the physical exercise intervention, and (4) reporting the methodological quality of the included works. Methods: Relevant databases (Medline-Ovid, EMBASE, CINAHL, PsychInfo, Cochrane Library) were searched. Author dyads selected and systematically analyzed the included studies independent from each other. A purpose developed checklist was used to assess the details of the exercise interventions and their methodological quality. Results: From the seven included manuscripts, three described resistance training, one endurance, and three combined training approaches. All manuscripts reported specificity and initial values, six manuscripts mention progression and overload. The exercise principle reversibility was reported once and diminishing returns was not reported at all. All studies reported the type of exercise, three studies reported intensity and one study reported time for training. Not any study completely reported frequency or described adherence to the intervention. Lack of detailed reporting was identified as the cause for murky description of the interventions. The highest score for intervention description was 5 of possible 12 items. Conclusions: Replicability of many exercise interventions in LTX is not warranted due too poor descriptions of important items related to training. In particular there were insufficiently detailed reporting of training principles and FITT components in programs developed for LTX. Future interventions that aim to train LTX patients should spent effort in writing reports in which the intervention is detailed to such an extent that full replicability in clinical settings can be guaranteed.
Collapse
Affiliation(s)
- Ruud H Knols
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas Fischer
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Dario Kohlbrenner
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Anastasios Manettas
- Department of Physiotherapy and Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
42
|
Takeda E, Yamaguchi T, Mizuguchi H, Fujitani J, Liu M. Development of a toileting performance assessment test for patients in the early stroke phase. Disabil Rehabil 2018; 41:2826-2831. [PMID: 29958010 DOI: 10.1080/09638288.2018.1479455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose: The study aimed to develop a toileting performance assessment test to measure the toileting performance ability of patients in the early phase after stroke.Methods: In this study, 214 stroke patients were enrolled. Cronbach's α, Spearman's rank correlations (ρ values) with the toileting-related items of the functional independence measure and Barthel Index, interrater reliability (weighted κ), and responsiveness (standardized response mean) were evaluated. Receiver operating characteristic and the area under the curves were utilized to determine the cutoff scores for the significance of the independence of toilet ability with the functional independence measure and Barthel Index.Results: Cronbach's α was ≥0.90. The p values between toileting performance assessment test and Barthel Index and between toileting performance assessment test and functional independence measure were 0.88 and 0.86, respectively. The weighted κ for each item was ≥0.61. The standardized response means were 0.81 for the functional independence measure, 0.70 for the Barthel Index, and 0.93 for the toileting performance assessment test. Cutoff scores of the toileting performance assessment test were 18 points.Conclusions: The toileting performance assessment test has acceptable psychometric properties and proved useful in assessing toileting performance ability of patients in the early phase after stroke.Implications for rehabilitationToileting performance assessment test demonstrated acceptable psychometric properties, and it can be useful for assessing the toileting ability of patients in the early phase after stroke.Toileting performance assessment test should provide information that leads to lowered risk of falls while toileting, and the information gathered can assist patients in achieving early toileting independence after stroke.As the development of toileting performance assessment test excluded patients with cognitive disabilities, the item for cognitive function should be developed as well.
Collapse
Affiliation(s)
- Eriko Takeda
- Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomofumi Yamaguchi
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Neuroscience, University of Copenhagen, Copenhagen, Denmark.,JSPS Overseas Research Fellow, Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Hiroko Mizuguchi
- Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Junko Fujitani
- Department of Rehabilitation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Meigen Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
43
|
de Queiroz RS, Saquetto MB, Martinez BP, Andrade EA, da Silva PAMP, Gomes-Neto M. Evaluation of the description of active mobilisation protocols for mechanically ventilated patients in the intensive care unit: A systematic review of randomized controlled trials. Heart Lung 2018; 47:253-260. [PMID: 29609834 DOI: 10.1016/j.hrtlng.2018.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The complete description of exercise interventions is essential to allow for the replication of clinical trials and to the correct application in clinical practice. OBJECTIVES The aim of this review was to evaluate of the description of the active mobilisation protocols in patients on invasive mechanical ventilation at intensive care units (ICU). METHODS Systematic review of randomised controlled trials (RCTs) using the Consensus on Exercise Reporting Template. RESULTS We identified 16 RCTs (n = 1,850). None sufficiently described the intervention for all items required for replication. The frequency, intensity, time, volume, and progression of active mobilisation as well as other important components of the intervention such as the instructor's qualifications/expertise, the types and incidence of adverse events, and the adherence to the exercise intervention were not adequately reported. CONCLUSION Active mobilisation interventions were only incompletely described in RCTs, which can compromise replication in both, clinical and research settings. REGISTRATION PROSPRERO (CRD42017068762).
Collapse
Affiliation(s)
| | | | | | - Edil Alves Andrade
- Pediatric Intensive Care Unit of the General Hospital of Vitória da Conquista Bahia, Vitória da Conquista, Brazil
| | | | - Mansueto Gomes-Neto
- Department of Physical Therapy, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
44
|
Knols RH, Swanenburg J, De Bon D, Gennaro F, Wolf M, Krüger B, Bettex D, de Bruin ED. Investigating the Usability and Acute Effects of a Bedside Video Console to Prefrontal Cortical Activity Alterations: A Preclinical Study in Healthy Elderly. Front Syst Neurosci 2017; 11:85. [PMID: 29234277 PMCID: PMC5712300 DOI: 10.3389/fnsys.2017.00085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/07/2017] [Indexed: 12/16/2022] Open
Abstract
Elderly people at risk of developing cognitive decline; e.g., following surgery, may benefit from structured, challenging, and repetitive cognitive video training. This study assessed usability and acute effects of a newly developed bedside console (COPHYCON). Fifteen healthy elderly individuals performed a one-time 80-min intervention, including cognitive video games aimed at improving awareness and selective attention. Perceived usefulness and perceived ease of use (Technology Acceptance Model) were assessed together with measures of the achieved game level, reaction times, (in-) correct responses during ALERT and SELECT game play. Further, prefrontal cortical involvement of the regional cerebral hemoglobin saturation (rS02%) assessed with functional near infrared spectroscopy (fNIRS) (n = 5) and EEG power (n = 10) was analyzed. All participants completed the study without any adverse events. Perceived usefulness and perceived ease of use (TAM scores range 1-7) of the system varied between 3.9 and 6.3. The game levels reached for awareness varied between 9 and 11 (initial score 8-10), for reaction speed between 439 and 469 ms, and for correct responses between 74.1 and 78.8%. The highest level for the selective attention games was 2 (initial score 1), where reaction speed varied between 439 and 469 ms, correct responses between 96.2 and 98.5%, respectively. The decrease of rS02% in the right prefrontal cortex during gameplay was significantly (p < 0.001) lower, compared to the left prefrontal cortex. Four participants yielded significant lower rS02% measures after exergaming with the ALERT games (p < 0.000), but not with the SELECT games. EEG recordings of theta power significantly decreased in the averaged ~0.25-0.75 time interval for the left prefrontal cortex sensor across the cognitive game levels between the ALERT 1 and SELECT 1, as well as between SELECT 1 and 2 games. Participants rated the usability of the COPHYCON training positively. Further results indicate that video gaming may be an effective measure to affect prefrontal cortical functioning in elderly. The results warrant a clinical explorative study investigating the feasibility of the COPHYCON in a clinical setting.
Collapse
Affiliation(s)
- Ruud H. Knols
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
| | - Jaap Swanenburg
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital, University of Zürich, Zurich, Switzerland
| | - Dino De Bon
- Directorate of Research and Education, Physiotherapy & Occupational Therapy Research Center, University Hospital Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Federico Gennaro
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| | - Martin Wolf
- Biomedical Optics Research Laboratory, Division of Neonatology, University Hospital Zurich, Zurich, Switzerland
| | - Bernard Krüger
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Eling D. de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
45
|
Tobler-Ammann BC, Surer E, de Bruin ED, Rabuffetti M, Borghese NA, Mainetti R, Pirovano M, Wittwer L, Knols RH. Exergames Encouraging Exploration of Hemineglected Space in Stroke Patients With Visuospatial Neglect: A Feasibility Study. JMIR Serious Games 2017; 5:e17. [PMID: 28842388 PMCID: PMC5591404 DOI: 10.2196/games.7923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/13/2017] [Accepted: 07/31/2017] [Indexed: 01/08/2023] Open
Abstract
Background Use of exergames can complement conventional therapy and increase the amount and intensity of visuospatial neglect (VSN) training. A series of 9 exergames—games based on therapeutic principles—aimed at improving exploration of the neglected space for patients with VSN symptoms poststroke was developed and tested for its feasibility. Objectives The goal was to determine the feasibility of the exergames with minimal supervision in terms of (1) implementation of the intervention, including adherence, attrition and safety, and (2) limited efficacy testing, aiming to document possible effects on VSN symptoms in a case series of patients early poststroke. Methods A total of 7 patients attended the 3-week exergames training program on a daily basis. Adherence of the patients was documented in a training diary. For attrition, the number of participants lost during the intervention was registered. Any adverse events related to the exergames intervention were noted to document safety. Changes in cognitive and spatial exploration skills were measured with the Zürich Maxi Mental Status Inventory and the Neglect Test. Additionally, we developed an Eye Tracker Neglect Test (ETNT) using an infrared camera to detect and measure neglect symptoms pre- and postintervention. Results The median was 14 out of 15 (93%) attended sessions, indicating that the adherence to the exergames training sessions was high. There were no adverse events and no drop-outs during the exergame intervention. The individual cognitive and spatial exploration skills slightly improved postintervention (P=.06 to P=.98) and continued improving at follow-up (P=.04 to P=.92) in 5 out of 7 (71%) patients. Calibration of the ETNT was rather error prone. The ETNT showed a trend for a slight median group improvement from 15 to 16 total located targets (+6%). Conclusions The high adherence rate and absence of adverse events showed that these exergames were feasible and safe for the participants. The results of the amount of exergames use is promising for future applications and warrants further investigations—for example, in the home setting of patients to augment training frequency and intensity. The preliminary results indicate the potential of these exergames to cause improvements in cognitive and spatial exploration skills over the course of training for stroke patients with VSN symptoms. Thus, these exergames are proposed as a motivating training tool to complement usual care. The ETNT showed to be a promising assessment for quantifying spatial exploration skills. However, further adaptations are needed, especially regarding calibration issues, before its use can be justified in a larger study sample.
Collapse
Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute (CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Marco Rabuffetti
- Polo Tecnologico, Istituto di Ricovero e Cura a Carattere Scientifico Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Renato Mainetti
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Michele Pirovano
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Lia Wittwer
- Parkinson Center, Epileptology, Neurorehabilitation, Clinic Bethesda, Tschugg, Switzerland
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
46
|
Tobler-Ammann BC, Surer E, Knols RH, Borghese NA, de Bruin ED. User Perspectives on Exergames Designed to Explore the Hemineglected Space for Stroke Patients With Visuospatial Neglect: Usability Study. JMIR Serious Games 2017; 5:e18. [PMID: 28842390 PMCID: PMC5591406 DOI: 10.2196/games.8013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/12/2017] [Accepted: 07/27/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Visuospatial neglect due to stroke is characterized by the inability to perceive stimuli emerging in the area opposite to the side of brain damage. Besides adopting conventional rehabilitation methods to treat neglect symptoms, the use of virtual reality (VR) is becoming increasingly popular. We designed a series of 9 exergames aimed to improve exploration of the neglected side of space. When new VR interventions are designed, it is important to assess the usability aspects of such management strategies within the target population. To date, most studies used questionnaires to assess user satisfaction with the intervention or product being tested. However, only a combination of both quantitative and qualitative data allows a full picture of user perspective. OBJECTIVE The purpose of this study was to quantitatively and qualitatively assess patient and therapist perspectives of a VR intervention based on the series of 9 exergames designed to explore hemineglected space. Specifically, we wanted to evaluate (1) perceived-user friendliness of the exergames, (2) attitude towards using the exergames, and (3) intention to use the exergames in the future. METHODS A total of 19 participants (7 patients, 12 therapists) evaluated the exergames they had used 5 times a week during 3 weeks. The Technology Acceptance Model (TAM) questionnaire was filled out after the intervention. Based on those responses, we conducted focus group interviews (with therapists) and individual interviews (with patients). To analyze the TAM questionnaires, we used descriptive statistics. We adopted content and comparative analysis to analyze the interviews and drew illustration maps to analyze the focus group interviews. RESULTS The therapists took a more critical stance with a mean TAM questionnaire total score of 48.6 (SD 4.5) compared to the patients who had a mean total score of 56.1 (SD 12.3). The perceived user-friendliness score was 5.6 (SD 1.4) for patients and 4.9 (SD 1.4) for therapists. The attitude towards using the exergames was rated 4.8 (SD 1.9) by patients and 3.6 (SD 1.4) by therapists, respectively. The intention to use the exergames in the future was rated 3.9 (SD 2.1) by patients and 3.7 (SD 1.8) by therapists. We gained information on how to improve the exergames in the interviews. CONCLUSIONS Patients and therapists perceived the exergames as user-friendly; however, using the games further with the actual test version was not perceived as conceivable. The therapists were generally more critical towards future use than the patients. Therefore, involving both users to achieve acceptable and user-friendly versions of game-based rehabilitation for the future is deemed crucial and warranted. TRIAL REGISTRATION Clinicaltrials.gov NCT02353962; https://clinicaltrials.gov/ct2/show/NCT02353962 (Archived by WebCite at http://www.webcitation.org/6soxIJlAZ).
Collapse
Affiliation(s)
- Bernadette C Tobler-Ammann
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland.,Care and Public Health Research Institute [CAPHRI], Maastricht University, Maastricht, Netherlands
| | - Elif Surer
- Graduate School of Informatics, Department of Modeling and Simulation, Middle East Technical University, Ankara, Turkey.,Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Ruud H Knols
- Physiotherapy and Occupational Therapy Research Center, Directorate of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - N Alberto Borghese
- Applied Intelligent Systems Laboratory, Department of Computer Science, Università degli Studi di Milano, Milan, Italy
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| |
Collapse
|
47
|
Abstract
PURPOSE Advances in rehabilitation provide the infrastructure for research and clinical data to improve care and patient outcomes. However, gaps between research and practice are prevalent. Knowledge translation (KT) aims to decrease the gap between research and its clinical use. This special communication summarizes KT-related proceedings from the 2016 IV STEP conference, describes current KT in rehabilitation science, and provides suggestions for its application in clinical care. SUMMARY OF KEY POINTS We propose a vision for rehabilitation clinical practice and research that includes the development, adaptation, and implementation of evidence-based practice recommendations, which will contribute to a learning health care system. A clinical research culture that supports this vision and methods to engage key stakeholders to innovate rehabilitation science and practice are described. CONCLUSIONS Through implementation of this vision, we can lead an evolution in rehabilitation practice to ultimately prevent disabilities, predict better outcomes, exploit plasticity, and promote participation.
Collapse
|
48
|
Neurofeedback as a form of cognitive rehabilitation therapy following stroke: A systematic review. PLoS One 2017; 12:e0177290. [PMID: 28510578 PMCID: PMC5433697 DOI: 10.1371/journal.pone.0177290] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 04/25/2017] [Indexed: 11/19/2022] Open
Abstract
Neurofeedback therapy (NFT) has been used within a number of populations however it has not been applied or thoroughly examined as a form of cognitive rehabilitation within a stroke population. Objectives for this systematic review included: i) identifying how NFT is utilized to treat cognitive deficits following stroke, ii) examining the strength and quality of evidence to support the use of NFT as a form of cognitive rehabilitation therapy (CRT) and iii) providing recommendations for future investigations. Searches were conducted using OVID (Medline, Health Star, Embase + Embase Classic) and PubMed databases. Additional searches were completed using the Cochrane Reviews library database, Google Scholar, the University of Toronto online library catalogue, ClinicalTrials.gov website and select journals. Searches were completed Feb/March 2015 and updated in June/July/Aug 2015. Eight studies were eligible for inclusion in this review. Studies were eligible for inclusion if they: i) were specific to a stroke population, ii) delivered CRT via a NFT protocol, iii) included participants who were affected by a cognitive deficit(s) following stroke (i.e. memory loss, loss of executive function, speech impairment etc.). NFT protocols were highly specific and varied within each study. The majority of studies identified improvements in participant cognitive deficits following the initiation of therapy. Reviewers assessed study quality using the Downs and Black Checklist for Measuring Study Quality tool; limited study quality and strength of evidence restricted generalizability of conclusions regarding the use of this therapy to the greater stroke population. Progression in this field requires further inquiry to strengthen methodology quality and study design. Future investigations should aim to standardize NFT protocols in an effort to understand the dose-response relationship between NFT and improvements in functional outcome. Future investigations should also place a large emphasis on long-term participant follow-up.
Collapse
|
49
|
Dobkin BH. Behavioral self-management strategies for practice and exercise should be included in neurologic rehabilitation trials and care. Curr Opin Neurol 2016; 29:693-699. [PMID: 27608301 PMCID: PMC5842701 DOI: 10.1097/wco.0000000000000380] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE OF REVIEW Rehabilitation trials and postacute care to lessen impairments and disability after stroke, spinal cord injury, and traumatic brain injury almost never include training to promote long-term self-management of skills practice, strengthening and fitness. Without behavioral training to develop self-efficacy, clinical trials, and home-based therapy may fail to show robust results. RECENT FINDINGS Behavioral theories about self-management and self-efficacy for physical activity have been successfully incorporated into interventions for chronic diseases, but rarely for neurologic rehabilitation. The elements of behavioral training include education about the effects of practice and exercise that are relevant to the person, goal setting, identification of possible barriers, problem solving, feedback about performance, tailored instruction, decision making, and ongoing personal or social support. Mobile health and telerehabilitation technologies offer new ways to remotely enable such training by monitoring activity from wearable wireless sensors and instrumented exercise devices to allow real-world feedback, goal setting, and instruction. SUMMARY Motivation, sense of responsibility, and confidence to practice and exercise in the home can be trained to increase adherence to skills practice and exercise both during and after formal rehabilitation. To optimize motor learning and improve long-term outcomes, self-management training should be an explicit component of rehabilitation care and clinical trials.
Collapse
Affiliation(s)
- Bruce H Dobkin
- Geffen School of Medicine at the University of California Los Angeles, Reed Neurologic Research Center, Los Angeles, California, USA
| |
Collapse
|
50
|
Schättin A, Arner R, Gennaro F, de Bruin ED. Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study. Front Aging Neurosci 2016; 8:278. [PMID: 27932975 PMCID: PMC5120107 DOI: 10.3389/fnagi.2016.00278] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/07/2016] [Indexed: 12/20/2022] Open
Abstract
During aging, the prefrontal cortex (PFC) undergoes age-dependent neuronal changes influencing cognitive and motor functions. Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults. Especially, video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults. The aim of this study was to compare conventional balance training with video game-based physical exercise, a so-called exergame, on the relative power (RP) of electroencephalographic (EEG) frequencies over the PFC, executive function (EF), and gait performance. Twenty-seven participants (mean age 79.2 ± 7.3 years) were randomly assigned to one of two groups. All participants completed 24 trainings including three times a 30 min session/week. The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [L(14) = 6.23, p = 0.007]. Comparing pre- vs. post-test, EFs improved both within the exergame (working memory: z = -2.28, p = 0.021; divided attention auditory: z = -2.51, p = 0.009; divided attention visual: z = -2.06, p = 0.040; go/no-go: z = -2.55, p = 0.008; set-shifting: z = -2.90, p = 0.002) and within the balance group (set-shifting: z = -2.04, p = 0.042). Moreover, spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions (speed normal walking: z = -2.90, p = 0.002; speed fast walking: z = -2.97, p = 0.001; cadence normal walking: z = -2.97, p = 0.001; stride length fast walking: z = -2.69, p = 0.005) and within the balance group under single-task conditions (speed normal walking: z = -2.54, p = 0.009; speed fast walking: z = -1.98, p = 0.049; cadence normal walking: z = -2.79, p = 0.003). These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and/or function in varying proportion.
Collapse
Affiliation(s)
- Alexandra Schättin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich Zurich, Switzerland
| | - Rendel Arner
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich Zurich, Switzerland
| | - Federico Gennaro
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich Zurich, Switzerland
| | - Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich Zurich, Switzerland
| |
Collapse
|