Posts Tagged Exercise

[Abstract] Physical activity in people with epilepsy: A systematic review

Abstract

This study aimed to systematically review studies focusing on levels of physical activity (PA) in people with epilepsy (PWE) compared with non‐epilepsy controls, and identify factors associated with PA in PWE.

Intervention studies were also reviewed to consider the effects of psychological interventions on levels of PA, and the effects of PA‐based interventions on seizure activity, psychiatric comorbidity, and health‐related quality of life (HRQoL). PRISMA guidelines were followed. Searches were conducted using PubMed, Cochrane Controlled Register of Trials, PsycINFO, and Embase.

Forty‐six studies met inclusion criteria, including case‐control, cross‐sectional, and intervention studies. Assessment measures included questionnaires, activity trackers, and measures of physiological fitness. Twelve of 22 (54.5%) case‐control studies utilizing self‐report questionnaire measures reported that PWE were performing lower levels of PA, less likely to be engaging in PA, or less likely to meet PA guidelines than controls. The remaining studies did not find a difference between PWE and controls. Eight of 12 (67%) case‐control studies utilizing exercise/fitness tests reported that PWE performed significantly poorer than controls, whereas in two studies PWE performed better than controls. One of three studies investigating the relationship between PA and seizure frequency found that increased self‐reported PA was associated with having fewer seizures, whereas two did not find a significant relationship.

All seven cross‐sectional studies that included measures of HRQoL and depression/anxiety found a positive relationship between levels of PA and HRQoL/reduced levels of depression and anxiety. All four studies that used PA‐based interventions demonstrated improvements in levels of PA and increased HRQoL. Study quality was almost universally low. In conclusion, there is some evidence that PWE engage in less PA than peers, and that interventions can improve PA levels and HRQoL. However, there is a need for more robust study designs to better understand PA in individuals with epilepsy.

Source: https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.16517

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[Abstract] Physical activity in people with epilepsy: A systematic review

Abstract

This study aimed to systematically review studies focusing on levels of physical activity (PA) in people with epilepsy (PWE) compared with non-epilepsy controls, and identify factors associated with PA in PWE. Intervention studies were also reviewed to consider the effects of psychological interventions on levels of PA, and the effects of PA-based interventions on seizure activity, psychiatric comorbidity, and health-related quality of life (HRQoL). PRISMA guidelines were followed. Searches were conducted using PubMed, Cochrane Controlled Register of Trials, PsycINFO, and Embase. Forty-six studies met inclusion criteria, including case-control, cross-sectional, and intervention studies. Assessment measures included questionnaires, activity trackers, and measures of physiological fitness. Twelve of 22 (54.5%) case-control studies utilizing self-report questionnaire measures reported that PWE were performing lower levels of PA, less likely to be engaging in PA, or less likely to meet PA guidelines than controls. The remaining studies did not find a difference between PWE and controls. Eight of 12 (67%) case-control studies utilizing exercise/fitness tests reported that PWE performed significantly poorer than controls, whereas in two studies PWE performed better than controls. One of three studies investigating the relationship between PA and seizure frequency found that increased self-reported PA was associated with having fewer seizures, whereas two did not find a significant relationship. All seven cross-sectional studies that included measures of HRQoL and depression/anxiety found a positive relationship between levels of PA and HRQoL/reduced levels of depression and anxiety. All four studies that used PA-based interventions demonstrated improvements in levels of PA and increased HRQoL. Study quality was almost universally low. In conclusion, there is some evidence that PWE engage in less PA than peers, and that interventions can improve PA levels and HRQoL. However, there is a need for more robust study designs to better understand PA in individuals with epilepsy.

Source: https://pubmed.ncbi.nlm.nih.gov/32396216/

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[ARTICLE] Contributions of Stepping Intensity and Variability to Mobility in Individuals Poststroke – Full Text

Abstract

Background and Purpose—

The amount of task-specific stepping practice provided during rehabilitation poststroke can influence locomotor recovery and reflects one aspect of exercise dose that can affect the efficacy of specific interventions. Emerging data suggest that markedly increasing the intensity and variability of stepping practice may also be critical, although such strategies are discouraged during traditional rehabilitation. The goal of this study was to determine the individual and combined contributions of intensity and variability of stepping practice to improving walking speed and distance in individuals poststroke.

Methods—

This phase 2, randomized, blinded assessor clinical trial was performed between May 2015 and November 2018. Individuals between 18 and 85 years old with hemiparesis poststroke of >6 months duration were recruited. Of the 152 individuals screened, 97 were randomly assigned to 1 of 3 training groups, with 90 completing >10 sessions. Interventions consisted of either high-intensity stepping (70%–80% heart rate reserve) of variable, difficult stepping tasks (high variable), high-intensity stepping performing only forward walking (high forward), and low-intensity stepping in variable contexts at 30% to 40% heart rate reserve (low variable). Participants received up to 30 sessions over 2 months, with testing at baseline, post-training, and a 3-month follow-up. Primary outcomes included walking speeds and timed distance, with secondary measures of dynamic balance, transfers, spatiotemporal kinematics, and metabolic measures.

Results—

All walking gains were significantly greater following either high-intensity group versus low-variable training (all P<0.001) with significant correlations with stepping amount and rate (r=0.48–60; P<0.01). Additional gains in spatiotemporal symmetry were observed with high-intensity training, and balance confidence increased only following high-variable training in individuals with severe impairments.

Conclusions—

High-intensity stepping training resulted in greater improvements in walking ability and gait symmetry than low-intensity training in individuals with chronic stroke, with potential greater improvements in balance confidence.

Introduction

The increasing incidence1 and current survival rates of individuals who experience a stroke have resulted in a substantial patient population with neurological deficits that limit locomotor capacity and postural stability.2,3 In individuals with chronic (>6 months) stroke, mobility limitations4,5 lead to reduced cardiopulmonary capacity that can further exacerbate locomotor deficits.3 Previous work6,7 suggests specific exercise training parameters, including the frequency, intensity, time, and type, can influence changes in health and fitness in individuals with and without neurological injury.8 These parameters represent the dose of exercise interventions, although their contributions to locomotor recovery poststroke are uncertain. Early studies advocated that large amounts of stepping practice with focus on normalizing gait patterns was a critical determinant of improved mobility.9–11 Unfortunately, a multicenter trial using this strategy revealed limited gains beyond conventional approaches.12 Additional research indicates treadmill exercise at submaximal aerobic intensities determined during baseline testing can improve walking endurance poststroke,13–15 although changes in walking speed or other mobility outcomes (balance or transfers) are inconsistent or negligible. The combined findings imply that these dosage parameters may not be critical to locomotor recovery poststroke.

An alternative hypothesis is that specific training variables can influence locomotor recovery when their manipulation substantially challenges the physiological demands associated with functional mobility. In particular, pilot studies indicate stepping training at cardiovascular intensities that are oftentimes greater than those achieved during baseline testing can improve multiple measures of locomotor and cardiopulmonary function.16–18 In addition, increasing the variability and difficulty of stepping tasks (eg, multidirectional walking, stair climbing, overground walking on uneven, or compliant surfaces) requires increased neuromuscular coordination and postural control that may improve mobility and dynamic stability.16,17,19

Despite these findings, clinical implementation of high-intensity stepping training in variable contexts is limited. Specific concerns include the potential for cardiovascular events,20 despite data indicating no additional risks compared to standard interventions.21 Additional concerns include practice of abnormal kinematic strategies, particularly in those with severe neuromuscular impairments during difficult, variable tasks. Such training deviates considerably from traditional interventions that focus on correcting abnormal gait patterns,9,10,12 although available data suggest gait kinematics can improve with variable stepping training.16,17,22

The present study examined the relative contributions of stepping intensity and variability on mobility outcomes in ambulatory individuals with chronic stroke. Using a randomized, controlled trial design, we hypothesized that high-intensity stepping training in variable contexts would result in greater gains in locomotor outcomes as compared to more traditional training focused on forward walking or low-intensity training of variable stepping tasks. Additional outcomes included alterations in transfers, dynamic balance and balance confidence, spatiotemporal kinematics, peak metabolic capacity, and potential adverse events. Results from this trial could indicate the potential utility of high-intensity training of variable, difficult tasks to improve mobility poststroke.[…]

Full Text

Source: https://www.ahajournals.org/doi/10.1161/STROKEAHA.119.026254

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[Abstract] Exergames in people with major neurocognitive disorder: a systematic review

Purpose

To systematically evaluate the efficacy of exergames in individuals with major neurocognitive disorder.

Materials and methods

PubMed, EMBASE and PEDro were systematically searched from inception until October 2019 for randomised and clinical controlled trials. Methodological quality of the trials was assessed with the PEDro rating scale or Risk of Bias in Nonrandomised Studies of Interventions-I (ROBINS-I), when appropriate. Grading of Recommendations Assessments, Development and Evaluation (GRADE) was used to assess the overall quality of the evidence.

Results

Eight trials, all of moderate to high methodological quality (i.e., PEDro score of 6 or higher or a Robins-I moderate quality score) were included. The overall quality of evidence was moderate to high according to the GRADE criteria. Improvements in gait, mobility and balance and beneficial effects on activities of daily living performance, cognitive function, fear of falls, quality of life and mood following exergaming were reported. Heterogeneity in outcome measures, intervention characteristics and included participants precluded a meta-analysis.

Conclusions

The current literature is of moderate to high quality and demonstrates that exergames have a wide range of physical and mental benefits in people with major neurocognitive disorder. More controlled trials are however needed to confirm the existing evidence before exergames can be recommended in treatment guidelines for people with major neurocognitive disorder.

Implications for rehabilitation

  • Exergames have many physical and mental benefits in people with major neurocognitive disorder

  • Exergaming can enhance gait, mobility and balance in people with major neurocognitive disorder

  • Evidence for beneficial cognitive effects of exergaming is emerging

via Exergames in people with major neurocognitive disorder: a systematic review: Disability and Rehabilitation: Assistive Technology: Vol 0, No 0

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[Abstract] Examining the effect of virtual reality therapy on cognition post-stroke: a systematic review and meta-analysis

Introduction: Virtual reality (VR) are user-computer interface platforms that implement real-time simulation of an activity or environment, allowing user interaction via multiple sensory modalities. VR therapy may be an effective intervention for improving cognitive function following stroke. The aim of this systematic review was to examine the effectiveness of exercise-based VR therapy on cognition post-stroke.

Methods: Electronic databases were searched for terms related to “stroke”, “virtual reality”, “exercise” and “cognition”. Studies were included if they: (1) were randomized-controlled trials; (2) included VR-based interventions; (3) included individuals with stroke; and (4) included outcome measures related to cognitive function. Data from included studies were synthesised qualitatively and where possible, random effects meta-analyses were performed.

Results: Eight studies involving 196 participants were included in the review, of which five were included in meta-analyses (n = 124 participants). Studies varied in terms of type (combination of VR therapy and conventional therapy, combination of VR therapy and computer-based cognitive training, VR therapy alone) and duration of interventions (20–180 min), sample size (n = 12–42), length of the interventions (4–8 weeks), and cognitive outcomes examined. VR therapy was not more effective than control for improving global cognition (n = 5, SMD = 0.24, 95%CI:−0.30,0.78, p = .38), memory (n = 2 studies, SMD= 0.00, 95%CI: −0.58, 0.59, p = .99), attention (n = 2 studies, MD = 8.90, 95%CI: −27.89, 45.70, p = .64) or language (n = 2 studies, SMD = 0.56, 95%CI: −0.08,1.21, p = .09).

Conclusion: VR therapy was not superior to control interventions in improving cognition in individuals with stroke. Future research should include high-quality and adequately powered trials examining the impact of virtual reality therapy on cognition post-stroke.

Implications for rehabilitation

  • Virtual reality therapy is a promising new form of technology that has been shown to increase patient satisfaction towards stroke rehabilitation.

  • Virtual reality therapy has the added benefits of providing instant feedback, and the difficulty can be easily modified, underscoring the user-friendliness of this form of rehabilitation.

  • Virtual reality therapy has the potential to improve various motor, cognitive and physical deficits following stroke, highlighting its usefulness in rehabilitation settings.

via Examining the effect of virtual reality therapy on cognition post-stroke: a systematic review and meta-analysis: Disability and Rehabilitation: Assistive Technology: Vol 0, No 0

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[Abstract + References] Unilateral Dorsiflexor Strengthening With Mirror Therapy to Improve Motor Function After Stroke: A Pilot Randomized Study

Abstract

Background: Independently, cross-education, the performance improvement of the untrained limb following unilateral training, and mirror therapy have shown to improve lower limb functioning poststroke. Mirror therapy has shown to augment the cross-education effect in healthy populations. However, this concept has not yet been explored in a clinical setting.

Objectives: This study set out to investigate the feasibility and potential efficacy of applying cross-education combined with mirror therapy compared with cross-education alone for lower limb recovery poststroke.

Methods: Thirty-one chronic stroke participants (age 61.7 ± 13.3) completed either a unilateral strength training (ST; n = 15) or unilateral strength training with mirror-therapy (MST; n = 16) intervention. Both groups isometrically strength trained the less-affected ankle dorsiflexors three times per week for 4 weeks. Only the MST group observed the mirror reflection of the training limb. Patient eligibility, compliance, treatment reliability, and outcome measures were assessed for feasibility. Maximal voluntary contraction (MVC; peak torque, rate of torque development, and average torque), 10-m walk test, timed up and go (TUG), Modified Ashworth Scale (MAS), and the London Handicap Scale (LHS) were assessed at pretraining and posttraining.

Results: Treatment and assessments were well tolerated without adverse effects. No between group differences were identified for improvement in MVC, MAS, TUG, or LHS. Only the combined treatment was associated with functional improvements with the MST group showing an increase in walking velocity.

Conclusion: Cross-education plus mirror therapy may have potential for improving motor function after stroke. This study demonstrates the feasibility of the combination treatment and the need for future studies with larger sample sizes to investigate the effectiveness of the treatment.

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    1. Zult, T., Howatson, G., Kadar, E. E., Farthing, J. P., & Hortobagyi, T. (2014). Role of the mirror-neuron system in cross-education. Sports Medicine, 44(2), 159-178. https://doi.org/10.1007/s40279-013-0105-2
    1. Whitehead, A. L., Julious, S. A., Cooper, C. L., & Campbell, M. J. (2016). Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Statistical Methods in Medical Research, 25(3), 1057-1073. https://doi.org/10.1177/0962280215588241

via Unilateral Dorsiflexor Strengthening With Mirror Therapy to Improve Motor Function After Stroke: A Pilot Randomized Study – PubMed

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[TED-Ed] The brain-changing benefits of exercise – Wendy Suzuki

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.

via The brain-changing benefits of exercise – Wendy Suzuki | TED-Ed

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[ARTICLE] Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review – Full Text PDF

Digital biofeedback systems (DBSs) are used in physical rehabilitation to improve outcomes by engaging and educating patients and have the potential to support patients while doing targeted exercises during home rehabilitation. The components of feedback (mode, content, frequency and timing) can influence motor learning and engagement in various ways. The feedback design used in DBSs for targeted exercise home rehabilitation, as well as the evidence underpinning the feedback and how it is evaluated, is not clearly known. To explore these concepts, we conducted a scoping review where an electronic search of PUBMED, PEDro and ACM digital libraries was conducted from January 2000 to July 2019. The main inclusion criteria included DBSs for targeted exercises, in a home rehabilitation setting, which have been tested on a clinical population. Nineteen papers were reviewed, detailing thirteen different DBSs. Feedback was mainly visual, concurrent and descriptive, frequently providing knowledge of results. Three systems provided clear rationale for the use of feedback. Four studies conducted specific evaluations of the feedback, and seven studies evaluated feedback in a less detailed or indirect manner. Future studies should describe in detail the feedback design in DBSs and consider a robust evaluation of the feedback element of the intervention to determine its efficacy.

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via Feedback Design in Targeted Exercise Digital Biofeedback Systems for Home Rehabilitation: A Scoping Review – Sensors – X-MOL

 

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[Abstract] Improving Walking Ability in People With Neurologic 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 neurologic conditions such as cerebral palsy, traumatic brain injury, and stroke. Few randomized 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 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 American College of Sports Medicine guidelines for task specificity, once people with neurologic 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 Neurologic Conditions: A Theoretical Framework for Biomechanics-Driven Exercise Prescription. – PubMed – NCBI

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[BLOG POST] Exercise can help your brain injury, not just your muscles – #jumbledbrain

Having suffered a car accident, I had some serious injuries. These included my spine, nerves and my brain. I had foot drop, where when you raise your leg, you can not raise your foot from your ankle, leaving it to hang limply. That means you cannot put any weight on it and it will not offer any support or flexibility. On top of this, due tExerciseo a damaged nerve in my neck, and had weakness down my left side. However after 10 days, the hospital team got me walking with crutches, and sent me home.

I knew that I needed to do some exercise to help rebuild some of my strength. But what I didn’t know was how good exercise is for your brain as well.

We all know that the more you practise at something, the better you will get at it. Well, the brain is just the same. Every time you perform an action, you are creating the building blocks for a new pathway in your brain. Let me give you an example. I used to love painting and drawing. But following my  brain injury, I could barely write legibly. For me this was depressing, as my art was a part of who I was. My partner James, kept badgering me to keep trying although I felt he just didn’t understand. I couldn’t make my hand follow the instructions I gave it properly, leaving me frustrated.

Exercise doesn’t mean you have to hit the gym. Just practise a physical activity.

So many sheets of paper ended up in the bin. (I would like to apologise to the trees who were sacrificed  for my cause.) But in time my writing improved, and I found my artistic flair returning to me. Just by reminding the muscles in my hand and arm how to behave, I had begun to regain my skill. But it wasn’t because the muscles needed to be rebuilt, it was because my brain needed to create new pathways to replace those that were damaged. This is the same process as when you learn a skill for the first time, and why your mother always said “practise makes perfect.” The more we do an action, the more the brain prioritises building pathways which make a shortcut to that action.

Now I know you are saying “but Michelle drawing and writing isn’t exercise.” And yes you are right, but I wanted to share this example with you to help you see that although there is the physical muscles movements, there is much more that needs to happen and I think we can all agree agree creativity is something very much in your brain.

Think about how in sports there is a tactical element, spacial awareness, problem solving… the list goes on.

Think of your favourite teams and how some are better at the element of surprise than others. This is the players having to read the current situation and apply the tactics that they have been practising all whilst dealing with how their opponents are trying to stop them. Yes it helps to be the fastest and strongest person on the pitch, but if you can’t get your timing, accuracy and game plan right, you’re going to still struggle. And whilst you might take the feedback from your coach with, you can only get better at these things by going out there and trying again. Ths that’s why exercise can help your brain injury recovery for other parts of the brain too.

I’m now 5 years on from my accident, and most people wouldn’t notice my slight limp. For someone who struggled to walk for so long, that’s not bad. I still have nerve damage, and I may do for the rest of my life, but I can deal with it. I’d be frightened to go skiing again, but it doesn’t affect my everyday life much at all. Yes I get pain and tire much easier, but I can cope with that.

My brain is still trying to repair my cognitive skills. Bearing in mind I couldn’t read or write to start with, I think it’s fair to say it’s doing a pretty good job. I even set up this website all by myself even though I had no experience of doing this sort of thing before. (If you are thinking of starting a blog but aren’t sure where to start head over to Starting a blog following a brain injury is difficult, but it is achievable to get some ideas on how to get going.)

No matter what your fitness level, or sporting ability never underestimate the importance of exercise.

You don’t need to run like you’re Mo Farah, just find something you enjoy which you can fit into your busy schedule. Dance, yoga and swimming are all great options. As evidence is growing to show regular exercise can stave off dementia, your brain will thank you for it. We all have days when just getting out of bed is an achievement, so don’t feel any shame in taking it easy. But just remember your efforts will encourage enhancements in much more than just becoming physically stronger. Your mental health and general well being will benefit too. Exercise can help your brain injury recovery process and you might even discover a talent for something new that you never knew you had.

Other articles you may like:

What exercises have you found most beneficial following your brain injury?

via Exercise can help your brain injury, not just your muscles #jumbledbrain

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