Posts Tagged Exercise

[Abstract] Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States

Background. As stroke survival improves, there is an increasing need for effective, low-cost programs to reduce deconditioning and improve mobility.

Objective. To conduct a phase II trial examining whether the community-based Italian Adaptive Physical Activity exercise program for stroke survivors (APA-Stroke) is safe, effective, and feasible in the United States.

Methods. In this single-blind, randomized controlled trial, 76 stroke survivors with mild to moderate hemiparesis >6 months were randomized to either APA-Stroke (N = 43) or Sittercise (N = 33). APA-Stroke is a progressive group exercise regimen tailored to hemiparesis that includes walking, strength, and balance training. Sittercise, a seated, nonprogressive aerobic upper body general exercise program, served as the control. Both interventions were 1 hour, 3 times weekly, in 5 community locations, supervised by exercise instructors.

Results. A total of 76 participants aged 63.9 ± 1.2 years, mean months poststroke 61.8 ± 9.3, were included. There were no serious adverse events; completion rates were 58% for APA-Stroke, 70% for Sittercise. APA-Stroke participants improved significantly in walking speed. Sample size was inadequate to demonstrate significant between-group differences. Financial and logistical feasibility of the program has been demonstrated. Ongoing APA classes have been offered to >200 participants in county Senior Centers since study completion.

Conclusion. APA-Stroke shows great promise as a low-cost, feasible intervention. It significantly increased walking speed. Safety and feasibility in the US context are demonstrated. A pivotal clinical trial is required to determine whether APA-Stroke should be considered standard of care.

via Adaptive Physical Activity for Stroke: An Early-Stage Randomized Controlled Trial in the United States – Mary Stuart, Alexander W. Dromerick, Richard Macko, Francesco Benvenuti, Brock Beamer, John Sorkin, Sarah Chard, Michael Weinrich, 2019

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[VIDEO] Exercise as a Treatment for Depression [Scientific Review] – YouTube

In this short episode, Dr. Patrick discusses some of the compelling science including observational studies, randomized controlled trials, and human mechanistic studies that suggests exercise is a powerful tool for preventing or managing the symptoms of depression and mental illness. Moreover, she talks about the specific types of exercise and exercise parameters that evidence suggests might be the most helpful for depression.

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DISCLAIMER: This video is not meant to be a substitute for expert diagnosis or treatment of clinical conditions.

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[Abstract] Soymilk ingestion immediately after therapeutic exercise enhances rehabilitation outcomes in chronic stroke patients: A randomized controlled trial. – NeuroRehabilitation

Abstract

Study investigated the effects of an 8-week rehabilitation exercise program combined with soymilk ingestion immediately after exercise on functional outcomes in chronic stroke patients.

Twenty-two stroke patients were randomly allocated to either the soymilk or the placebo (PLA) group and received identical 8-weeks rehabilitation intervention (3 sessions per week for 120 minutes each session) with corresponding treatment beverages. The physical and functional outcomes were evaluated before, during, and after the intervention. The 8-week rehabilitation program enhanced functional outcomes of participants.

The immediate soymilk ingestion after exercise additionally improved hand grip strength, walking speed over 8 feet, walking performance per unit lean mass, and 6-Minute Walk Test performance compared with PLA after the intervention. However, the improvements in the total score for Short Physical Performance Battery and lean mass did not differ between groups.

This study demonstrated that, compared with rehabilitation alone, the 8-week rehabilitation program combined with immediate soymilk ingestion further improved walking speed, exercise endurance, grip strength, and muscle functionality in chronic stroke patients.
 

via Articles, Books, Reports, & Multimedia: Search REHABDATA | National Rehabilitation Information Center

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[Abstract] A novel neurocognitive rehabilitation tool in the recovery of hemiplegic hand grip after stroke: a case report.

Abstract

Stroke has significant physical, psychological and social consequences. Recent rehabilitation approaches suggest that cognitive exercises with dual-task (sensory-motor) exercises positively influence the recovery and function of the hemiplegic hand grip. The purpose of this study was to describe a rehabilitation protocol involving the use of a new neurocognitive tool called “UOVO” for hand grip recovery after stroke. A 58-year-old right-handed male patient in the chronic stage of stroke, presenting with left-sided hemiparesis and marked motor deficits at the level of the left hand and forearm, was treated with the UOVO, a new rehabilitation instrument based on the neurocognitive rehabilitation theory of Perfetti. The patient was evaluated at T0 (before treatment), T1 (after treatment) and T2 (2 months of follow-up). At T2, the patient showed improvements of motor functions, shoulder, elbow and wrist spasticity, motility and performance. This case report explores the possibility of improving traditional rehabilitation through a neurocognitive approach with a dual-task paradigm (including motor and somato-sensory stimulation), specifically one involving the use of an original rehabilitation aid named UOVO, which lends itself very well to exercises proposed through the use of motor imagery. The results were encouraging and showed improvements in hemiplegic hand grip function and recovery. However, further studies, in the form of randomized controlled trials, will be needed to further explore and confirm our results.

 

via A novel neurocognitive rehabilitation tool in the recovery of hemiplegic hand grip after stroke: a case report. – PubMed – NCBI

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[NEWS] New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

News-MedicalA Virtual Reality Therapy game (iVRT) which could introduce relief for patients suffering from chronic pain and mobility issues has been developed by a team of UK researchers.

Dr Andrew Wilson and colleagues from Birmingham City University built the CRPS app in collaboration with clinical staff at Sandwell and West Birmingham Hospitals NHS Trust for a new way to tackle complex regional pain syndrome and to aid people living with musculoskeletal conditions.

Using a head mounted display and controllers, the team created an immersive and interactive game which mimics the processes used in traditional ‘mirror therapy’ treatment. Within the game, players are consciously and subconsciously encouraged to stretch, move and position the limbs that are affected by their conditions.

Mirror therapy is a medical exercise intervention where a mirror is used to create areflective illusion that encourages patient’s brain to move their limb more freely. This intervention is often used by occupational therapists and physiotherapists to treat CRPS patients who have experienced a stroke. This treatment has proven to be successful exercises are often deemed routine and mundane by patients, which contributes to decline in the completion of therapy.

Work around the CRPS project, which could have major implications for other patient rehabilitation programmes worldwide when fully realised, was presented at the 12th European Conference on Game Based Learning (ECGBL) in France late last year.

Dr Wilson, who leads Birmingham City University’s contribution to a European research study into how virtual reality games can encourage more physical activity, and how movement science in virtual worlds can be used for both rehabilitation and treatment adherence, explained, “The first part of the CRPS project was to examine the feasibility of being able to create a game which reflects the rehabilitation exercises that the clinical teams use on the ground to reduce pain and improve mobility in specific patients.”

“By making the game enjoyable and playable we hope family members will play too and in doing so encourage the patient to continue with their rehabilitation. Our early research has shown that in healthy volunteers both regular and casual gamers enjoyed the game which is promising in terms of our theory surrounding how we may support treatment adherence by exploiting involvement of family and friends in the therapy processes.”

The CRPS project was realized through collaborative working between City Hospital, Birmingham, and staff at the School of Computing and Digital Technology, and was developed following research around the provision of a 3D virtual reality ophthalmoscopy trainer.

Andrea Quadling, Senior Occupational Therapist at Sandwell Hospital, said “The concept of using virtual reality to treat complex pain conditions is exciting, appealing and shows a lot of potential. This software has the potential to be very helpful in offering additional treatment options for people who suffer with CRPS.”

via New Virtual Reality Therapy game could offer relief for patients with chronic pain, mobility issues

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[WEB SITE] How to stretch your hands and wrists – Videos

Wrist pain can be frustrating and inconvenient. It can also make work or basic day-to-day activities, such as using a computer or cooking a meal, more difficult.

Exercises can improve mobility and decrease the chance of injury or reinjury. Wrist stretches are easy to do at home or at the office. When done properly, they can benefit a person’s overall wrist and hand health.

Anyone experiencing chronic pain or pain with numbness should visit a doctor for a thorough diagnosis.

The following stretches can help improve strength and mobility:

Wrist and hand stretches

A person should do the exercises below slowly and gently, focusing on stretching and strengthening. If the stretch hurts, stop.

The following wrist and hand stretches may improve strength and mobility:

1. Raised fist stretch

Raised fist stretch

To do this stretch:

  1. Start with your arm up beside your head, with your hand open.
  2. Make a fist, keeping your thumb outside of it.
  3. Slide your fingers toward your wrist until you feel a stretch.

2. Wrist rotations

Wrist rotations

To do this stretch:

  1. Stretch your arm out in front of you.
  2. Slowly, point the fingers down until you feel a stretch. Use the other hand to gently pull the raised hand toward the body. Hold this position for 3–5 seconds.
  3. Point the fingers toward the ceiling until you feel a stretch. Use the other hand to gently pull the raised hand toward the body. Hold this position for 3–5 seconds.
  4. Repeat this three times.

3. Prayer position

Prayer position

To do this stretch:

  1. Sit with your palms together and your elbows on the table in a prayer position.
  2. Lower the sides of the hands toward the table until you feel a stretch. Keep your palms together. Hold this position for 5–7 seconds.
  3. Relax.
  4. Repeat this three times.

4. Hooked stretch

Hooked stretch

To do this stretch:

  1. Hook one elbow under the other and pull both arms towards the center of the torso. You should feel a stretch in your shoulders.
  2. Wrap one arm around the other so that the palms are touching.
  3. Hold the position for 25 seconds.
  4. Switch arms and repeat it on the other side.

5. Finger stretch

finger stretch

To do this stretch:

  1. Bring the pinky and ring fingers together.
  2. Separate the middle and index fingers from the ring finger.
  3. Repeat the stretch 10 times.

6. Fist-opener

Fist opener

To do this stretch:

  1. Make a fist and hold it in front of you.
  2. Stretch your fingers until your hand is flat and open, with the fingers together.
  3. Repeat the movements 10 times.

7. Sponge-squeeze

Sponge squeeze

To do this stretch:

  1. Squeeze a sponge or stress ball, making a fist.
  2. Hold the position for 10 seconds.
  3. Relax.
  4. Repeat this 10 times.

8. Windshield wiper wrist movement

To do this stretch:

  1. Start with your hand face down on a table.
  2. Gently, point the hand to one side as far as it can go without moving the wrist. Hold it there for 3–5 seconds.
  3. Do the same on the other side.
  4. Repeat the movement three times on each side.

9. Thumb pull

To do this stretch:

  1. Grab your thumb with the other hand.
  2. Gently pull the thumb backward, away from the hand.
  3. Hold the stretch for 25 seconds.
  4. Repeat it on the other thumb.

10. Flower stretch

To do this stretch:

  1. Stretch the arms in front of you, with the backs of the hands and wrists touching.
  2. Imagine an invisible force pulling the fingers further from the body. Feel the stretch.
  3. Hold it for 25 seconds.

11. Finger fan

To do this stretch:

  1. Make a fist.
  2. Stretch your fingers outwards as far as they can go, like a fan.
  3. Repeat the movements 10 times.

12. Imaginary piano

To do this stretch:

  1. Pretend to play a piano.
  2. Flip your hands over and play an upside-down piano.

13. Finger pulls

To do this stretch:

  1. Lay your hand flat on a table.
  2. Gently pull a finger upward so that it points toward the ceiling.
  3. Hold the position for 5 seconds.
  4. Release the finger.
  5. Repeat this on all the other fingers.

14. Alternate finger stretch

To do this stretch:

  1. Bring the middle and ring fingers together.
  2. Separate the pinky and index fingers from them.
  3. Repeat the stretch 10 times.

15. Wrist-strengthener

To do this stretch:

  1. Get into position on your hands and knees, with the fingers pointing toward the body.
  2. Slowly lean forward, keeping your elbows straight.
  3. Hold the position for 20 seconds.
  4. Relax, then repeat the stretch.

Takeaway

Working with computers, writing, and doing manual labor put strain on the hands and wrists and can cause problems over time, such as tendonitis and carpal tunnel syndrome.

Taking frequent breaks and stretching before and while using the hands and wrists can help prevent strain. Improving flexibility and strength gradually can help people avoid wrist and hand injuries.

via Medical News Today: How to stretch your hands and wrists

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[Abstract] Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription

Abstract

The purpose of this paper is to discuss how knowledge of the biomechanics of walking can be used to inform the prescription of resistance exercises for people with mobility limitations. Muscle weakness is a key physical impairment that limits walking in commonly occurring neurological conditions such as cerebral palsy, traumatic brain injury and stroke. Few randomised trials to date have shown conclusively that strength training improves walking in people living with these conditions. This appears to be because

1) the most important muscle groups for forward propulsion when walking have not been targeted for strengthening, and

2) strength training protocols have focused on slow and heavy resistance exercises, which do not improve the fast muscle contractions required for walking.

We propose a theoretical framework to improve exercise prescription by integrating the biomechanics of walking with the principles of strength training outlined by the American College of Sports Medicine (ACSM), to prescribe exercises that are specific to improving the task of walking. The high angular velocities that occur in the lower limb joints during walking indicate that resistance exercises targeting power generation would be most appropriate. Therefore, we propose the prescription of plyometric and ballistic resistance exercise, applied using the ACSM guidelines for task-specificity, once people with neurological conditions are ambulating, to improve walking outcomes. This new theoretical framework for resistance training ensures that exercise prescription matches how the muscles work during walking.

via Improving walking ability in people with neurological conditions: A theoretical framework for biomechanics driven exercise prescription – Archives of Physical Medicine and Rehabilitation

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[Abstract] Adherence to a Long-Term Physical Activity and Exercise Program After Stroke Applied in a Randomized Controlled Trial

Abstract

Background: Persistent physical activity is important to maintain motor function across all stages after stroke.
Objective: The objective of this study was to investigate adherence to an 18-month physical activity and exercise program.
Design: The design was a prospective, longitudinal study including participants who had had a stroke randomly allocated to the intervention arm of a randomized controlled trial.
Methods: The intervention consisted of individualized monthly coaching by a physical therapist who motivated participants to adhere to 30 minutes of daily physical activity and 45 minutes of weekly exercise over an 18-month period. The primary outcome was the combination of participants’ self-reported training diaries and adherence, as reported by the physical therapists. Mixed-effect models were used to analyze change in adherence over time. Intensity levels, measured by the Borg scale, were a secondary outcome.
Results: In total, 186 informed, consenting participants who had had mild-to-moderate stroke were included 3 months after stroke onset. Mean age was 71.7 years (SD = 11.9). Thirty-four (18.3%) participants withdrew and 9 (4.8%) died during follow-up. Adherence to physical activity and exercise each month ranged from 51.2% to 73.1%, and from 63.5% to 79.7%, respectively. Adherence to physical activity increased by 2.6% per month (odds ratio = 1.026, 95% CI = 1.014–1.037). Most of the exercise was performed at moderate-to-high intensity levels, ranging from scores of 12 to 16 on the Borg scale, with an increase of 0.018 points each month (95% CI = 0.011–0.024).
Limitations: Limitations included missing information about adherence for participants with missing data and reasons for dropout.
Conclusions: Participants with mild and moderate impairments after stroke who received individualized regular coaching established and maintained moderate-to-good adherence to daily physical activity and weekly exercise over time.

 

via Adherence to a Long-Term Physical Activity and Exercise Program After Stroke Applied in a Randomized Controlled Trial | Physical Therapy | Oxford Academic

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[BLOG POST] Antidepressants help us understand why we get fatigued during exercise

In general, the term ‘fatigue’ is used to describe any exercise-induced decline in the ability of a muscle to generate force. To identify the causes of fatigue, it is common to examine two divisions of the body that might be affected during exercise. The central component of fatigue includes the many nerves that travel throughout the brain to the spinal cord. The peripheral component predominantly reflects elements in the muscle itself. If there is a problem with either of these components, the ability to contract a muscle might be compromised. For many years, there has been suggestion that central fatigue is heavily influenced by neurotransmitters that get released in the central nervous system (such as dopamine and serotonin). However, little research has been performed in this area.

Serotonin is a chemical that can improve mood, and increasing the amount of serotonin that circulates in the brain is a common therapy for depression. However, serotonin also plays a vital role in activating neurons in the spinal cord which tell the muscle to contract. With the correct amount of serotonin release, a muscle will activate efficiently. However, if too much serotonin is released, there is a possibility that the muscle will rapidly fatigue. Recent animal studies indicate that moderate amounts of serotonin release, which are common during exercise, can promote muscle contractions (Cotel et al. 2013). However, massive serotonin release, which may occur with very large bouts of exercise, could further exacerbate the already fatigued muscle (Perrier et al. 2018).

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. These medications keep serotonin levels high in the central nervous system by stopping the chemical from being reabsorbed by nerves (reuptake inhibition). Instead of using SSRIs to relieve symptoms of depression, we used them in our recent study (Kavanagh et al. 2019) to elevate serotonin in the central nervous system, and then determine if characteristics of fatigue are enhanced when serotonin is elevated. We performed three experiments that used maximal voluntary contractions of the biceps muscle to cause fatigue in healthy young individuals. Our main goal was to determine if excessive serotonin limits the amount of exercise that can be performed, and then determine which central or peripheral component was compromised by excessive serotonin.

WHAT DID WE FIND?

Given that SSRIs influence neurotransmitters in the central nervous system, it was not surprising that peripheral fatigue was unaltered by the medication. However, central fatigue was influenced with enhanced serotonin. The time that a maximum voluntary contraction could be held was reduced with enhanced serotonin, whereby the ability of the central nervous system to drive the muscle was compromised by 2-5%. We further explored the location of dysfunction and found that the neurons in the spinal cord that activate the muscle were 4-18% less excitable when fatiguing contractions were performed in the presence of enhanced serotonin.

SIGNIFICANCE AND IMPLICATIONS

The central nervous system is diverse, and the fatigue that is experienced during exercise is not just restricted to the brain. Instead, the spinal cord plays an integral role in activating muscles, and mechanisms of fatigue also occur in these lower, often overlooked, neural circuits. This is the first study to provide evidence that serotonin released onto the motoneurones contributes to central fatigue in humans.

PUBLICATION REFERENCE

Kavanagh JJ, McFarland AJ, Taylor JL. Enhanced availability of serotonin increases activation of unfatigued muscle but exacerbates central fatigue during prolonged sustained contractions. J Physiol. 597:319-332, 2019.

If you cannot access the paper, please click here to request a copy.

KEY REFERENCES

Cotel F, Exley R, Cragg SJ, Perrier JF. Serotonin spillover onto the axon initial segment of motoneurons induces central fatigue by inhibiting action potential initiation. Proc Natl Acad Sci U S A. 110:4774-4779, 2013.

Perrier JF, Rasmussen HB, Jørgensen LK, Berg RW. Intense activity of the raphe spinal pathway depresses motor activity via a serotonin dependent mechanism. Front Neural Circuits. 11:111, 2018.

AUTHOR BIO

Associate Professor Justin Kavanagh is a researcher and lecturer at Griffith University. His team explores how the central nervous system controls voluntary and involuntary movement, and he has particular interests in understanding how medications can be used to study mechanisms of human movement.

via Antidepressants help us understand why we get fatigued during exercise – Motor Impairment

 

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[TED Talk] The Brain-Changing Effects of Exercise

What’s the most transformative thing that you can do for your brain today? Exercise! says neuroscientist Wendy Suzuki. Get inspired to go to the gym as Suzuki discusses the science of how working out boosts your mood and memory — and protects your brain against neurodegenerative diseases like Alzheimer’s.

This talk was presented at an official TED conference, and was featured by our editors on the home page.

ABOUT THE SPEAKER
Wendy Suzuki · Neuroscientist, author Wendy Suzuki is researching the science behind the extraordinary, life-changing effects that physical activity can have on the most important organ in your body: your brain.

Transcript

03:54
05:02
07:13
09:41
11:13
12:12
12:43
12:46
12:47

via The Brain-Changing Effects of Exercise

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