Posts Tagged Exercise

[WEB] Exercise and Brain Repair

By Dr. Osman Shabir, PhD, Reviewed by Emily Henderson, B.Sc.

Physical activity is essential in maintaining a healthy lifestyle and is associated with reducing the likelihood of many diseases. Increasing evidence points towards the benefits of exercise on brain structure and function and could even delay or prevent the onset of many neurological conditions including Alzheimer’s and stroke.

Physical Activity
Physical Activity. Image Credit: Halfpoint/Shutterstock.com

Regular aerobic exercise and/or moderate physical activity (such as brisk walking) is associated with better overall health compared to those who have a sedentary lifestyle. In combination with a healthy balanced diet, exercise promotes improved cardiovascular, metabolic, and immune health and therefore is associated with a reduced likelihood of developing cardiovascular diseases and metabolic diseases such as diabetes mellitus.

Since the brain is a highly metabolically active organ with intricate links to the cardiovascular system, any susceptibilities to systemic diseases also have a negative impact on the brain, for example, cardiovascular diseases and stroke. Therefore, promoting a healthy lifestyle with exercise also has a beneficial impact on the brain’s health by enhancing neurovascular, neuroimmune, and neurometabolic function.

Cognitive Function

Many studies have found that adults (especially >65 years of age) who regularly exercise or perform some form of physical activity (walking, gardening, swimming, etc) tend to perform better in cognitive tests and as such are at a reduced risk of cognitive impairment and dementia compared to those who do not regularly perform some form of physical activity. Furthermore, performing physical activity and exercise can improve some level of cognitive and executive functions in patients with earlier stages of dementia.

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One of the main neuroprotective chemicals found in the brain are called neurotrophic factors which support neuronal and synaptic health and can improve cognition and mood. Reduction in neurotrophic factors can be detrimental to neuronal health and synaptic plasticity and may be implicated in the onset of neurodegenerative disorders. Even mild physical activity such as walking through to intense aerobic exercise all increase the levels of neurotrophic factors such as BDNF, and higher levels due to higher intensity exercise is positively correlated with better neural health and function.

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Rodent studies have given us mechanistic insights into how exercise is able to confer neuroprotective properties. For example, one month of voluntary wheel running in mice reduced the pathological and behavioral deficits associated with aging by increasing levels of BDNF as well as enhancing neurogenesis in the hippocampus. In addition, voluntary wheel running also led to the upregulation of nerve growth factor (NGF), insulin-like growth factor (IGF-1), and tight junction proteins in maintaining the blood-brain barrier.

Physical exercise has a direct effect not only on levels of BDNF and other neurotrophic factors but also upregulates levels of p75NTR and CREB – both involved in synaptic plasticity. Improving synaptic plasticity mechanisms directly leads to improvements in memory and cognition, whereas normal aging suppresses these mechanisms. Furthermore, aerobic exercise e.g., treadmill, increases the expression of pNDMA, PSD 95 & decreases DNA damage all contributing to stabilizing and preventing cognitive decline in healthy aging. However, it is important to note that “over-training” can lead to negative consequences with more DNA damage, for example.

Together, these maintain the cerebrovasculature preventing the infiltration of toxic compounds and chemokines that promote neuroinflammation, as well as enhancing both neuronal and synaptic function. Furthermore, the activation of microglia (the brain’s immune cells) was reduced by exercise thus protecting key brain regions from insult. Interestingly, exercise in mice modeling Alzheimer’s has been shown to reduce the levels of soluble beta-amyloid by enhancing glymphatic clearance as well as reducing white matter pathology leading to enhanced cognitive performance. These preclinical findings mirror clinical findings described earlier and provide a mechanism by which exercise can protect the brain, but also enhance its function, even in disease.

Stroke

Many of the above findings not only protect the brain but are able to repair and stabilize neurological damage such as through the increased production of neurotrophic factors for example. As such, exercise in the early stages of dementia can slow down and even reverse some of the damage.

Depending on the severity and location of a stroke, different challenges can present including impairments to activities of daily living. As areas of the brain are damaged, it is important to rehabilitate and repair some of the reversible damage as soon as possible for a better prognosis. Aerobic exercise has been shown to reduce the lesion size (volume) and protect the surrounding perilesional tissue from oxidative damage and inflammation in addition to increasing neurogenesis in the short term. This can be achieved by moderate forced exercise of around 10 minutes a day 5-7 times a week initiated within 48 hours after stroke. The earlier the better when it comes to forced exercise in the short-term outlook. The higher the intensity of exercise, the better the recovery and higher levels of angiogenesis within the perilesional area to support recovery.

In summary, exercise has a profound neuroprotective effect on the brain and regular exercise (especially aerobic) not only can improve brain function and enhance cognitive function and mood, but also delay, improve, or prevent the onset of neurological disorders such as stroke and dementia. In addition, performing regular exercise in earlier stages of the disease has also been shown to improve pathological and clinical outcomes.

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[Abstract] Implementation and Evaluation of the Graded Repetitive Arm Supplementary Program (GRASP) for People With Stroke in a Real World Community Setting: Case Report

Abstract

Objective: Exercise programs to improve upper extremity function following stroke in the community setting are needed as the length of hospital stay continues to decrease. However, little has been done to increase understanding of how to translate an evidence-based rehabilitation intervention to real-world programs. The purpose of this case report was to describe a process evaluation of the implementation of an evidence-based upper extremity rehabilitation intervention for stroke, the Graded Repetitive Arm Supplementary Program, in a community setting.

Methods (case description): A partnership between a nonprofit support organization and a local community center was established to deliver the program in the community. The Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework with mixed methods was used to evaluate the implementation.

Results: Reach: Twenty people were screened, 14 people met eligibility requirements, and 13 consented to participate. The program reached approximately 1.25% of the potential target population. Effectiveness: Participants with stroke demonstrated significant improvement in upper extremity function and quality of life as measured by the Fugl-Meyer Assessment for upper extremity, Action Research Arm Test, Rating of Everyday Arm-use in the Community and Home Scale, and Stroke Impact Scale. Adoption: Factors that facilitated program uptake were the well-planned implementation and the workplace coaching based on the audit results. Factors contributing to ongoing participation were the social support within the group environment and the instructor’s capability of engaging the group. Implementation: A partnership between a nonprofit organization and a local community center was successfully established. The program was implemented as intended as verified by a fidelity checklist. Participant adherence was high as confirmed by the average attendance and practice time. Maintenance: Both the partner organization and community center continued to offer the program.

Conclusion: The Graded Repetitive Arm Supplementary Program had good fidelity of the critical principles and core components and was effective in improving upper extremity function and quality of life.

Impact: This partnership model may serve as the first step for future larger-scale implementation and could be used to move other stroke rehabilitation interventions into community settings.

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[Abstract] Computer Game Assisted Task Specific Exercises in the Treatment of Motor and Cognitive Function and Quality of Life in Stroke: A Randomized Control Study

Highlights

• Computer game assisted task specific exercises (CGATSE) is a contemporary approach to stroke rehabilitation.

• CGATSE may be used in hospital and home environments in stroke rehabilitation.

• CGATE improved arm motor function and quality of life in stroke rehabilitation.

Abstract

Objectives

Computer game assisted task specific exercises (CGATSE) are rehabilitation gaming systems (RGS) used in stroke rehabilitation to facilitate patient performance of high intensity, task based, repetitive exercises aiming to enhance neuroplasticity. CGATSE maybe an appealing option in home based rehabilitation of stroke patients, especially during the COVID-19 pandemic. This study aimed to determine the effects of CGATSE on hemiplegic arm-hand function, cognitive function and quality of life in stroke.

Materials and methods

Thirty stroke patients were randomized into two groups. All participants received twenty sessions of physical therapy. In addition, the therapy group undertook thirty minutes of CGATSE using the Rejoyce gaming system; while the control group undertook thirty minutes of occupational therapy (OT). Motor function was evaluated before and after treatment using the Fugl Meyer upper extremity (FMUE), Brunnstrom stages of stroke recovery (BSSR) arm and hand. The CGATSE group also completed the Rejoyce arm hand function test (RAHFT). Cognitive function was evaluated using the mini mental state examinationMontreal Cognitive Assessment (MoCA) and Stroke Specific Quality of Life (SS-QOL) scale.

Results

The FMUE, BSSR arm and SSQOL improved in both groups (p < 0.05). BSSR of the hand improved only in the CGATSE group (p = 0.024). RAHFT scores improved in the CGATSE group (p = 0.008). MoCA scores significantly improved in the control group (p = 0.008).

Conclusions

CGATSE may be beneficial in providing continuation of care after stroke, especially during the Covid-19 pandemic when home based rehabilitation options are becoming increasingly important. Benefits of CGATSE in improving cognitive function is less clear. RGS aimed at improving motor function may be compared to gaming systems designed to target cognitive development and more detailed higher cortical function deficit tests can be used as outcome measures.

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[Abstract + References] A Low-Cost Reaction Time Estimator-Based Hand and Foot Exercises for Stroke Rehabilitation – Conference paper

Abstract

Stroke influences the fine motor skills and impair the person physically, mentally and economically. The physical and mental impairment may vary from slight to sever. In general, stroke influences the functionality of arm and feet and also the cognitive impairment. Stroke influences all the population equally across the globe, but it affects more to the developing nation like India. Very expensive stroke treatment and post-rehabilitation are the primary reason for more deaths in developing countries. Arduino-based low-cost reaction time estimator as an exercise tool is proposed in this study to calculate the time span for stroke rehabilitation. Proposed system is portable, and most importantly, it is low-cost device from which both hands and legs can be exercised based on the doctor’s instruction. This system would be very helpful in gaining the muscular strength of the people over time period.

References

  1. 1.Rosengren, A., Giang, K.W., Lappas, G., Jern, C., Torén, K., Björck, L.: Twenty-four-year trends in the incidence of ischemic stroke in Sweden from 1987 to 2010. Stroke 44(9), 2388–2393 (2013)CrossRefGoogle Scholar
  2. 2.Bonita, R., Beaglehole, R.: Stroke prevention in poor countries. Time for Action. Stroke 38, 2871–2872 (2007)Google Scholar
  3. 3.Pandian, J.D., Srikanth, V., Read, S.J., Thrift, A.G.: Poverty and stroke in India: a time to act. Stroke 38(11), 3063–3069 (2007)CrossRefGoogle Scholar
  4. 4.Mendis, S.: Stroke disability and rehabilitation of stroke: World Health Organization perspective. Int. J. Stroke 8(1), 3–4 (2013)CrossRefGoogle Scholar
  5. 5.Johnston, S.C., Mendis, S., Mathers, C.D.: Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 8(4), 345–354 (2009)CrossRefGoogle Scholar
  6. 6.Banerjee, T.K., Roy, M.K., Bhoi, K.K.: Is stroke increasing in India–preventive measures that need to be implemented. J. Indian Med. Assoc. 103(3), 162–164 (2005)Google Scholar
  7. 7.Prasad, K.: Epidemology of cerebrovascular disorders in India. Recent concepts in stroke by Bansal BC (ed) Indian college of Physicians, New Delhi, 4–19 (1999)Google Scholar
  8. 8.Mishra, N.K., Patel, H., Hastak, S.M.: Comprehensive stroke care: an overview. JAPI 54, 36–41 (2006)Google Scholar
  9. 9.Luengo-Fernandez, R., Gray, A. M., Bull, L., Welch, S., Cuthbertson, F., Rothwell, P.M.: Quality of life after TIA and stroke Ten-year results of the Oxford Vascular Study. Neurology 10–1212 (2013)Google Scholar
  10. 10.Party, I.S.W.: National Clinical Guideline for Stroke, 4th edn. Royal College of Physicians, London (2012)Google Scholar
  11. 11.Care Quality Commission: Special Review. Supporting life after stroke: A review of services for people who have had a stroke and their carers. (2011)Google Scholar
  12. 12.National Audit Office: Progress in improving stroke care, Report on the findings from our modelling of stroke care provision (February 2010). NAO Report (HC 291 2009–2010)Google Scholar

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[Abstract] Effects of home-based dual-hemispheric transcranial direct current stimulation combined with exercise on upper and lower limb motor performance in patients with chronic stroke

Abstract

Purpose

This study aimed to determine the effects of home-based dual-hemispheric transcranial direct current stimulation (dual-tDCS) combined with exercise on motor performance in patients with chronic stroke.

Materials and methods

We allocated 24 participants to the active or sham group. They completed 1-h home-based exercise after 20-min dual-tDCS at 2-mA, thrice a week for 4 weeks. The patients were assessed using the Fugl–Meyer Assessment (FMA), Wolf Motor Function Test, Timed Up and Go test, Five Times Sit-to-Stand Test, Six-meter Walk Test, and muscle strength assessment.

Results

Compared with the sham group, the active group showed improved FMA scores, which were sustained for at least 1 month. There was no between-group difference in the outcomes of the functional tasks.

Conclusion

Home-based dual-tDCS could facilitate motor recovery in patients with chronic stroke with its effect lasting for at least 1 month. However, its effects on functional tasks remain unclear. tDCS is safe and easy for home-based self-administration for patients who can use their paretic arms. This could benefit patients without access to health care centres or in situations requiring physical distancing. This home-based tDCS combined with exercise has the potential to be incorporated into telemedicine in stroke rehabilitation.

  • IMPLICATIONS FOR REHABILITATION
  • Twelve sessions of home-based dual-tDCS combined with exercises (3 days/week for 4 weeks) facilitated upper and lower limb motor recovery in patients with chronic stroke compared with exercise alone, with a post-effect for at least 1 month.
  • Home-based tDCS could be safe and easily self-administrable by patients who can use their paretic arms.
  • This intervention could be beneficial for patients living in the community without easy access to a health care centre or in situations where physical distancing is required.

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[Abstract] Moderate Intensity Treadmill Exercise Increases Survival of Newborn Hippocampal Neurons and Improves Neurobehavioral Outcomes after Traumatic Brain Injury

Abstract

Physician-prescribed rest after traumatic brain injury (TBI) is both commonplace and an increasingly scrutinized approach to TBI treatment. Although this practice remains a standard of patient care for TBI, research of patient outcomes reveals little to no benefit of prescribed rest after TBI, and in some cases prolonged rest has been shown to interfere with patient well-being. In direct contrast to the clinical advice regarding physical activity after TBI, animal models of brain injury consistently indicate that exercise is neuroprotective and promotes recovery. Here, we assessed the effect of low and moderate intensity treadmill exercise on functional outcome and hippocampal neural proliferation after brain injury. Using the controlled cortical impact (CCI) mouse model of TBI, we show that 10 days of moderate intensity treadmill exercise initiated after CCI reduces anxiety-like behavior, improves hippocampus-dependent spatial memory, and promotes hippocampal proliferation and newborn neuronal survival. Pathophysiological measures including lesion volume and axon degeneration were not altered by exercise. Taken together, these data reveal that carefully titrated physical activity may be a safe and effective approach to promoting recovery after brain injury.

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[Abstract] Associations Between Physical Activity Intensities and Physical Function in Stroke Survivors

Abstract

Purpose 

Impairment caused by stroke is a major cause of disablement in older adults. Physical activity has been shown to improve physical functioning; however, little research has been done to explore how physical activity of different intensities may affect physical function among stroke survivors. The purpose of this study was to examine the patterns of accelerometer-measured physical activity and the relationship between physical activity intensities and objective physical functioning and perceived functional limitations in stroke survivors.

Methods 

Stroke survivors (N = 30, mean age = 61.77 ± 11.17) completed the Short Physical Performance Battery and the Late-Life Function and Disability Instrument. Physical activity intensities were measured objectively using a 7-day actigraph accelerometer wear period and scored using the National Health and Nutrition Examination Survey cutoffs for sedentary (counts/minute ≤100), light (counts/minute 101–2019), and moderate to vigorous (moderate to vigorous physical activity counts/minute ≥2020) activity.

Results 

Multiple linear regressions controlling for age and time since stroke demonstrated that higher levels of moderate to vigorous physical activity predicted better Short Physical Performance Battery performance (β = .43, P = 0.04). For self-reported physical function, light physical activity predicted better basic lower limb function (β = .45, P = 0.009), better advanced lower limb function (β = .53, P = 0.003), better upper limb function (β = .37, P = 0.04), and higher total function score (β = .52, P = 0.002) on the Late-Life Function and Disability Instrument.

Conclusions 

These findings suggest that light activity as well as moderate to vigorous physical activity may contribute to better physical functioning in stroke survivors. Although moderate to vigorous physical activity significantly predicted the objective measure of physical function (Short Physical Performance Battery), light physical activity consistently predicted higher scores on all subscales of the Late-Life Function and Disability Instrument. Disabilities resulting from stroke may limit this population from engaging in moderate to vigorous physical activity, and these findings highlight the importance of light physical activity, which may offer similar perceived functional benefits. Future studies should focus on development of effective exercise interventions for stroke survivors by incorporating and comparing both moderate to vigorous physical activity and light-intensity physical activity.

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[Guide] Working out with AT – NARIC – PDF File

Abstract

This guide describes different types of assistive technology (AT) exercise equipment that are available. There is AT exercise equipment designed specifically for people with disabilities available on the market. Also, some of the workout equipment available is universally designed, which means that it is purposefully designed to support exercisers of varying heights, proportions, and abilities.

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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://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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