Posts Tagged Exercise

[BLOG POST] Strength training improves the nervous system’s ability to drive muscles

Imagine that the New Year has just begun. You’ve made a resolution to improve your physical fitness. In particular, you want to improve your muscle strength. You’ve heard that people with stronger muscles live longer and have less difficulty standing, walking, and using the toilet when they get older (Rantanen et al. 1999; Ruiz et al. 2008). So, you join a fitness centre and hire a personal trainer. The trainer assesses your maximal strength, and then guides you through a 4-week program that involves lifting weights which are about 80% of your maximum.

Sure enough, after the program, you become stronger (probably around 20% stronger) (Carroll et al. 2011). You think this is great – and it is! You are so excited, you decide to stand in front of your mirror, flex your biceps, and take a selfie (your plan is to post the picture to Facebook to show your friends how much bigger your muscles got). However, after examining the picture, you realise your muscles did not get bigger. Or perhaps they did get a little bigger, but not enough to explain your substantial improvement in strength. You are somewhat disappointed in this, but then you remember your goal was to get stronger, not necessarily bigger, so you post the picture, anyway.

Magnetic stimulation of the brain can be used to test how well a person can voluntarily drive their muscles.

Interestingly, the observations you made are completely consistent with the scientific literature. Within the first weeks of strength training, muscle strength can improve without a change in the size or architecture of the muscle (e.g., Blazevich et al. 2007). Consequently, researchers have speculated that initial improvements in muscle strength from strength training are due primarily to changes in the central nervous system. One hypothesis has been that strength training helps the nervous system learn how to better “drive” or communicate with muscles. This ability is termed voluntary activation, and it can be tested by stimulating the motor area of an individual’s brain while they perform a maximal contraction (Todd et al. 2003). If the stimulation produces extra muscle force, it means that the individual’s nervous system was not maximally activating their muscles. Currently, there is no consensus as to whether voluntary activation can actually be improved by strength training.

Therefore, we conducted a randomised, controlled trial in which one group of participants completed four weeks of strength training, while a control group did not complete the training (Nuzzo et al. in press). For the group who performed the training, each exercise session consisted of four sets of strong contractions of the elbow flexor muscles (i.e., the muscles that bend the elbow, such as the biceps). Before and after the four week intervention, both groups were tested for muscle strength, voluntary activation, and several other measures. The participants were healthy, university-aged, and they had limited or no experience with strength training.


Prior to the intervention, the strength training and control groups had similar levels of muscle strength and activation of the elbow flexor muscles. After the intervention, the group who performed the strength training improved their strength by 13%. They also improved their voluntary activation from 88.7% to 93.4%. The control group did not improve muscle strength or voluntary activation.


The results from our study show that four weeks of strength training improves the brain’s ability to “drive” the elbow flexor muscles to produce their maximal force. This helps to explain how muscles can become stronger, without a change in muscle size or architecture. Moreover, the results suggest that clinicians should consider strength training as a treatment for patients with motor impairments (e.g., stroke), as these individuals are likely to have poor voluntary activation (Bowden et al. 2014).


Nuzzo JL, Barry BK, Jones MD, Gandevia SC, Taylor JL. Effects of four weeks of strength training on the corticomotoneuronal pathway. Med Sci Sports Exerc,  doi: 10.1249/MSS.0000000000001367.


Blazevich AJ, Gill ND, Deans N, Zhou S. Lack of human muscle architectural adaptation after short-term strength training. Muscle Nerve 35: 78-86.

Bowden JL, Taylor JL, McNulty PA. Voluntary activation is reduced in both the more- and less-affected upper limbs after unilateral stroke.Front Neurol 5: 239, 2014.

Carroll TJ, Selvanayagam VS, Riek S, Semmler RG. Neural adaptations to strength training: moving beyond transcranial magnetic stimulation and reflex studies. Acta Physiol 202: 119-140, 2011.

Rantanen T, Guralnik JM, Foley D, Masaki K, Leveille S, Curb JD, White L. Midline hand grip strength as a predictor of old age disability.JAMA 281: 558-560, 1999.

Ruiz JR, Sui X, Lobelo F, Morrow Jr. JR, Jackson AW, Sjöström M, Blair SN. Association between muscular strength and mortality in men: prospective cohort study. BMJ 337: a439, 2008.

Todd G, Taylor JL, Gandevia SC. Measurement of voluntary activation of fresh and fatigued human muscles using transcranial magnetic stimulation. J Physiol 555: 661-671, 2003.


Jim Nuzzo is a Postdoctoral Fellow at Neuroscience Research Australia (NeuRA). His research investigates how strength training alters the neural connections between the brain and muscles. Click here to read Jim’s other blogs.

Source: Strength training improves the nervous system’s ability to drive muscles – Motor Impairment


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[WEB SITE] UC study explores how low risk stress reduction treatments may benefit epilepsy patients

Patients with epilepsy face many challenges, but perhaps the most difficult of all is the unpredictability of seizure occurrence. One of the most commonly reported triggers for seizures is stress.

A recent review article in the European journal Seizure, by researchers at University of Cincinnati Epilepsy Center at the UC Gardner Neuroscience Institute, looks at the stress-seizure relationship and how adopting stress reduction techniques may provide benefit as a low risk form of treatment.

The relationship between stress and seizures has been well documented over the last 50 years. It has been noted that stress can not only increase seizure susceptibility and in rare cases a form of reflex epilepsy, but also increase the risk of the development of epilepsy, especially when stressors are severe, prolonged, or experienced early in life.

“Studies to date have looked at the relationship from many angles,” says Michael Privitera, MD, director of the UC Epilepsy Center and professor in the Department of Neurology and Rehabilitation Medicine at the UC College of Medicine. “The earliest studies from the 1980s were primarily diaries of patients who described experiencing more seizures on ‘high-stress days’ than on ‘low-stress days.'”

Privitera and Heather McKee, MD, an assistant professor in the Department of Neurology and Rehabilitation Medicine, looked at 21 studies from the 1980s to present–from patients who kept diaries of stress levels and correlation of seizure frequency, to tracking seizures after major life events, to fMRI studies that looked at responses to stressful verbal/auditory stimuli.

“Most all [of these studies] show increases in seizure frequency after high-stress events. Studies have also followed populations who have collectively experienced stressful events, such as the effects of war, trauma or natural disaster, or the death of a loved one,” says Privitera. All of which found increased seizure risk during such a time of stress.

For example, a 2002 study evaluated the occurrence of epileptic seizures during the war in Croatia in the early 1990s. Children from war-affected areas had epileptic seizures more often than children not affected by the war. Additionally, the 10-year follow up showed that patients who had their first epileptic seizure during a time of stress were more likely to have controlled epilepsy or even be off medication years later.

“Stress is a subjective and highly individualized state of mental or emotional strain. Although it’s quite clear that stress is an important and common seizure precipitant, it remains difficult to obtain objective conclusions about a direct causal factor for individual epilepsy patients,” says McKee.

Another aspect of the stress-seizure relationship is the finding by UC researchers that there were higher anxiety levels in patients with epilepsy who report stress as a seizure precipitant. The researchers suggest patients who believe stress is a seizure trigger may want to talk with their health care provider about screening for anxiety.

“Any patient reporting stress as a seizure trigger should be screened for a treatable mood disorder, especially considering that mood disorders are so common within this population,” adds McKee.

The researchers report that while some small prospective trials using general stress reduction methods have shown promise in improving outcomes in people with epilepsy, large-scale, randomized, controlled trials are needed to convince both patients and providers that stress reduction methods should be standard adjunctive treatments for people with epilepsy.

“What I think some of these studies point to is that efforts toward stress reduction techniques, though somewhat inconsistent, have shown promise in reducing seizure frequency. We need future research to establish evidence-based treatments and clarify biological mechanisms of the stress-seizure relationship,” says Privitera.

Overall, he says, recommending stress reduction methods to patients with epilepsy “could improve overall quality of life and reduce seizure frequency at little to no risk.”

Some low risk stress reduction techniques may include controlled deep breathing, relaxation or mindfulness therapy, as well as exercise, or establishing routines.

Source: UC study explores how low risk stress reduction treatments may benefit epilepsy patients

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[Abstract] Exergaming for individuals with neurological disability: a systematic review

Introduction: Exergames have the potential to enable persons with disabilities to take part in physical activities that are of appropriate “dose-potency” and enjoyable within a relatively safe home environment. It overcomes some of the challenges regarding transportation difficulties in getting to commercial gymnasium facilities, reducing physical activities perceived as “boring” or getting access into the built environment that may be “wheelchair unfriendly”. Objective: This systematic review assessed available evidence whether “exergaming” could be a feasible modality for contributing to a recommended exercise prescription according to current ACSM™ or WHO guidelines for physical activity. Methods: Strategies used to search for published articles were conducted using separate search engines (Google Scholar™, PubMed™ and Web of Science™) on cardiometabolic responses and perceived exertion during exergaming among neurologically-disabled populations possessing similar physical disabilities. Each study was categorized using the SCIRE-Pedro evidence scale. Results: Ten of the 144 articles assessed were identified and met specific inclusion criteria. Key outcome measures included responses, such as energy expenditure, heart rate and perceived exertion. Twelve out of the 17 types of exergaming interventions met the ACSM™ or WHO recommendations of “moderate intensity” physical activity. Exergames such as Wii Jogging, Bicycling, Boxing, DDR and GameCycle reported moderate physical activity intensities. While Wii Snowboarding, Skiing and Bowling only produced light intensities. Conclusion: Preliminary cross-sectional evidence in this review suggested that exergames have the potential to provide moderate intensity physical activity as recommended by ACSM™ or WHO in populations with neurological disabilities. However, more research is needed to document exergaming’s efficacy from longitudinal observations before definitive conclusions can be drawn.

  • Implications for Rehabilitation
  • Exergaming can be deployed as physical activity or exercise using commercially available game consoles for neurologically disabled individuals in the convenience of their home environment and at a relatively inexpensive cost

  • Moderate-to-vigorous intensity exercises can be achieved during exergaming in this population of persons with neurological disabilities. Exergaming can also be engaging and enjoyable, yet achieve the recommended physical activity guidelines proposed by ACSM™ or WHO for health and fitness benefits.

  • Exergaming as physical activity in this population is feasible for individuals with profound disabilities, since it can be used even in sitting position for wheelchair-dependent users, thus providing variability in terms of exercise options.

  • In the context of comprehensive rehabilitation, exergaming should be viewed by the clinician as “at least as good as” (and likely more enjoyable) than traditional arm-exercise modalities, with equivalent aerobic dose-potency as “traditional” exercise in clinic or home environments.

Source: Exergaming for individuals with neurological disability: a systematic review: Disability and Rehabilitation: Vol 39, No 8

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[ARTICLE] The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials – Full Text


Physically-active video games (‘exergames’) have recently gained popularity for leisure and entertainment purposes. Using exergames to combine physical activity and cognitively-demanding tasks may offer a novel strategy to improve cognitive functioning. Therefore, this systematic review and meta-analysis was performed to establish effects of exergames on overall cognition and specific cognitive domains in clinical and non-clinical populations. We identified 17 eligible RCTs with cognitive outcome data for 926 participants. Random-effects meta-analyses found exergames significantly improved global cognition (g = 0.436, 95% CI = 0.18–0.69, p = 0.001). Significant effects still existed when excluding waitlist-only controlled studies, and when comparing to physical activity interventions. Furthermore, benefits of exergames where observed for both healthy older adults and clinical populations with conditions associated with neurocognitive impairments (all p < 0.05). Domain-specific analyses found exergames improved executive functions, attentional processing and visuospatial skills. The findings present the first meta-analytic evidence for effects of exergames on cognition. Future research must establish which patient/treatment factors influence efficacy of exergames, and explore neurobiological mechanisms of action.

1. Introduction

Cognition can be broadly defined as the actions of the brain involved in understanding and functioning in our external environment (Hirschfeld and Gelman, 1994). As it is generally accepted that cognition requires multiple mental processes, this broader concept has been theoretically separated into multiple ‘cognitive domains’ (Hirschfeld and Gelman, 1994). Although definitions vary, and the boundaries between domains often overlap, examples of distinct areas of cognitive functioning include the processes for learning and remembering verbal and spatial information, attentional capacities, response speed, problem-solving and planning (Strauss et al., 2006).

Various neuropsychological tests have been developed as tools for assessing and quantifying an individual’s overall cognitive functioning (or ‘global cognition’) along with their performance within the separable domains of cognition (Strauss et al., 2006). Performance in these various cognitive tests has been found to be relatively stable over time in healthy adults, and moderately accurate predictors of real-world functioning and occupational performance (Chaytor and Schmitter-Edgecombe, 2003 ;  Hunter, 1986). Furthermore, neuropsychological tests can detect the deficits in cognitive functioning which arise as a consequence of various psychiatric and neurological diseases (Mathuranath et al., 2000 ;  Nuechterlein et al., 2004). For example, people with Parkinson’s disease show marked impairments in planning and memory tasks (Dubois and Pillon, 1996), whereas those with schizophrenia have cognitive pervasive deficits, 1–2 standard deviations below population norms, which also predict the severity of disability in this population (Green et al., 2000). Additionally, cognitive abilities decline naturally in almost all people during healthy ageing (Van Hooren et al., 2007). In an ageing population, the functional consequences of cognitive decline may ultimately have a severe social and economic impact. Thus, interventions which improve cognition hold promise for the treatment of psychiatric and neurological diseases, an have positive implications for population health.

Fortunately, interventions which stimulate the brain and/or body can improve cognition, or attenuate decline. For instance, physical exercise has been shown to significantly improve global cognition, along with working memory and attentional processes, in both clinical and healthy populations (Firth et al., 2016Smith et al., 2010 ;  Zheng et al., 2016). Interventions can also be designed to target cognition directly, as computerized training programs for memory and other functions have been found to provide significant cognitive benefits, at least in the short term (Hill et al., 2017 ;  Melby-Lervåg and Hulme, 2013). Furthermore, ‘gamification’ of cognitive training programs can maximize their clinical effectiveness, as more complex and interesting programs are capable of better engaging patients in cognitively-demanding tasks while also training multiple cognitive processes simultaneously (Anguera et al., 2013).

Previous studies have found that providing both aerobic exercise and cognitive training together may have additive effects, preventing ageing-related cognitive decline more effectively (Shatil, 2013). This may be due to aerobic and cognitive activity stimulating neurogenesis through independent but complementary pathways; as animal studies show that while exercise stimulates cell proliferation, learning tasks support the survival of these new cells (Kempermann et al., 2010), such that combining these two types of training results in 30% more new neurons than either task alone (Fabel et al., 2009).

Rather than delivering aerobic and cognitive training in separate training sessions, recent advances in technology has presented an opportunity for combining physical activity with cognitively-challenging tasks in a single session through ‘exergames’. Exergames are considered as interactive video-games which require the player to produce physical body movements in order to complete set tasks or actions, in response to visual cues (Oh and Yang, 2010). Common examples include the ‘Nintendo Wii’ (along with ‘Wii Fit’ or ‘Wii Sports software’) or the ‘Microsoft Xbox Kinect’. Additionally, virtual reality systems which use exercise bikes and/or treadmills as a medium for players to interact with three-dimensional worlds have also been developed to provide immersive training experiences (Sinclair et al., 2007).

Along with their popular usage for leisure and entertainment, there is growing interest in the application of exergame systems to improve clinical outcomes. Recent systematic reviews and meta-analyses of this growing literature have provided preliminary evidence that exergames can improve various health-related outcomes, including reducing childhood obesity, improving balance and falls risk factors in elderly adults, facilitating functional rehabilitation in people with parkinson’s disease, and even reduce depression (Barry et al., 2014Li et al., 2016 ;  van’t Riet et al., 2014). However, the effects of exergames on cognitive functioning have not been systematically reviewed, despite many individual studies in this area.

Therefore, the aim of this study was to systematically review all existing trials of exergames for cognition, and apply meta-analytic techniques to establish the effects of exergames on global cognition along with individual cognitive domains. We also sought to (i) examine the effects of exergames on cognition in healthy and clinically-impaired populations, and (ii) investigate if the effects of exergames differed from those of aerobic exercise alone, by comparing exergames to traditional physical activity control conditions.

Fig. 1

Fig. 1. PRISMA flow diagram of systematic search and study selection.

Continue —> The effect of active video games on cognitive functioning in clinical and non-clinical populations: A meta-analysis of randomized controlled trials

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[OPINION ARTICLE] Enhancing Our Lives with Immersive Virtual Reality – Full Text


Virtual reality (VR) started about 50 years ago in a form we would recognize today [stereo head-mounted display (HMD), head tracking, computer graphics generated images] – although the hardware was completely different. In the 1980s and 1990s, VR emerged again based on a different generation of hardware (e.g., CRT displays rather than vector refresh, electromagnetic tracking instead of mechanical). This reached the attention of the public, and VR was hailed by many engineers, scientists, celebrities, and business people as the beginning of a new era, when VR would soon change the world for the better. Then, VR disappeared from public view and was rumored to be “dead.” In the intervening 25 years a huge amount of research has nevertheless been carried out across a vast range of applications – from medicine to business, from psychotherapy to industry, from sports to travel. Scientists, engineers, and people working in industry carried on with their research and applications using and exploring different forms of VR, not knowing that actually the topic had already passed away.

The purpose of this article is to survey a range of VR applications where there is some evidence for, or at least debate about, its utility, mainly based on publications in peer-reviewed journals. Of course not every type of application has been covered, nor every scientific paper (about 186,000 papers in Google Scholar): in particular, in this review we have not covered applications in psychological or medical rehabilitation. The objective is that the reader becomes aware of what has been accomplished in VR, where the evidence is weaker or stronger, and what can be done. We start in Section 1 with an outline of what VR is and the major conceptual framework used to understand what happens when people experience it – the concept of “presence.” In Section 2, we review some areas where VR has been used in science – mostly psychology and neuroscience, the area of scientific visualization, and some remarks about its use in education and surgical training. In Section 3, we discuss how VR has been used in sports and exercise. In Section 4, we survey applications in social psychology and related areas – how VR has been used to throw light on some social phenomena, and how it can be used to tackle experimentally areas that cannot be studied experimentally in real life. We conclude with how it has been used in the preservation of and access to cultural heritage. In Section 5, we present the domain of moral behavior, including an example of how it might be used to train professionals such as medical doctors when confronting serious dilemmas with patients. In Section 6, we consider how VR has been and might be used in various aspects of travel, collaboration, and industry. In Section 7, we consider mainly the use of VR in news presentation and also discuss different types of VR. In the concluding Section 8, we briefly consider new ideas that have recently emerged – an impossible task since during the short time we have written this page even newer ideas have emerged! And, we conclude with some general considerations and speculations.

Throughout and wherever possible we have stressed novel applications and approaches and how the real power of VR is not necessarily to produce a faithful reproduction of “reality” but rather that it offers the possibility to step outside of the normal bounds of reality and realize goals in a totally new and unexpected way. We hope that our article will provoke readers to think as paradigm changers, and advance VR to realize different worlds that might have a positive impact on the lives of millions of people worldwide, and maybe even help a little in saving the planet.

Continue —> Frontiers | Enhancing Our Lives with Immersive Virtual Reality | Virtual Environments

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[WEB SITE] Brain Derived Neurotrophic Factor (BDNF) and Exercise

Brain Derived Neurotrophic Factor (BDNF) has been referred to as a fertilizer for your brain. Find out how exercise can help you to get more of it.

Brain Derived Neurotrophic Factor (BDNF) has been referred to as a fertilizer for your brain. It is a substance that is found in your brain and helps to maintain the life of your brain cells, as well as grow new ones. You’ve probably heard all about ‘neuroplasticity’ and how we used to think our brains, once adult, were like a lump of concrete – unable to change and grow. Scientists now believe our brains are more like plastic – able to adapt, grow and change depending on what we do with them. BDNF is widely accepted as being a key player in this ‘plastic’ ability of the brain – its presence has been shown to make brain cells in petri dishes sprout new branches (necessary activity for a cell to make new connections!).

Low levels of BDNF have been associated with depression, anxiety, poor memory and brain degeneration as seen in conditions such as Alzheimer’s and dementia.


Why would you want more BDNF?

  • Improved learning and memory
  • May trigger the production of more serotonin (hello happy feelings!)
  • Helps with new skill acquisition
  • Improved mood (exercise increases BDNF as much or even more than taking antidepressants does)
  • Lower rates of Alzheimer’s disease and dementia in older age may be related to higher levels of BDNF.

Are you getting the picture? Better mood, better mental performance, healthier brain as you age…

How do you get more BDNF?

One word: STIMULATION.  Stimulation of your brain and all its cells can come in many forms. Of course, traditional brain exercise has been thought of as activities such as cross words and Sudoku (which are definitely good!) but here’s another aspect you can add to the list: exercise. As little as 30 minutes of jogging on three days a week has been shown to improve brain functioning, but even better gains have been suggested with more complex activity, which requires you to build or acquire a skill. An example of this is exercise that challenges your balance or thinking, like rock climbing or dancing.

The ultimate brain booster? A bit of aerobic exercise (at least ten minutes) to increase levels of BDNF and other neurotransmitters, as well as all those other wonderful benefits of aerobic exercise, followed by a skill-based exercise to get the new brain cells creating new networks with each other.

TIP: Want to maximize the increased learning capacity of your brain? Don’t try to learn something while exercising (stop taking your study notes to the spin bike!) – blood flow increases to the brain post-exercise, while BDNF levels are still increased, meaning immediately after exercise is the perfect time to take in new information. Put on that French language podcast on the way home from the gym…



  • 1. Indoor rock-climbing – especially if you actively commute to the rock wall!
  • 2. Trail running – something with twists, turns and great views is awesome
  • 3. Dancing – where you’re learning new moves and also working your fitness
  • 4. Functional movement – wait until the after school rush has finished then go check out (and play on) your nearest playground – think monkey bars, crawling through tunnels and balancing on beams
  • 5. Team sports – they require you to be getting great aerobic gains by running around, whilst also working your brain in terms of strategy and quick thinking


Aisen, P. S. (2014). Serum brain-derived neurotrophic factor and the risk for dementia. JAMA, 311(16), 1684-1685. doi: 10.1001/jama.2014.3120

Binder, Devin K., & Scharfman, Helen E. (2004). Brain-derived Neurotrophic Factor. Growth factors (Chur, Switzerland), 22(3), 123-131. doi: 10.1080/08977190410001723308

Hagerman, Eric, & Ratey, Dr John J. (2010). Spark! How Exercise Will Improve the Performance of Your Brain (Kindle Edition ed.).

Source: Brain Derived Neurotrophic Factor (BDNF) and Exercise

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[ARTICLE] A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Full Text

Although motor learning theory has led to evidence-based practices, few trials have revealed the superiority of one theory-based therapy over another after stroke. Nor have improvements in skills been as clinically robust as one might hope. We review some possible explanations, then potential technology-enabled solutions.

Over the Internet, the type, quantity, and quality of practice and exercise in the home and community can be monitored remotely and feedback provided to optimize training frequency, intensity, and progression at home. A theory-driven foundation of synergistic interventions for walking, reaching and grasping, strengthening, and fitness could be provided by a bundle of home-based Rehabilitation Internet-of-Things (RIoT) devices.

A RIoT might include wearable, activity-recognition sensors and instrumented rehabilitation devices with radio transmission to a smartphone or tablet to continuously measure repetitions, speed, accuracy, forces, and temporal spatial features of movement. Using telerehabilitation resources, a therapist would interpret the data and provide behavioral training for self-management via goal setting and instruction to increase compliance and long-term carryover.

On top of this user-friendly, safe, and conceptually sound foundation to support more opportunity for practice, experimental interventions could be tested or additions and replacements made, perhaps drawing from virtual reality and gaming programs or robots. RIoT devices continuously measure the actual amount of quality practice; improvements and plateaus over time in strength, fitness, and skills; and activity and participation in home and community settings. Investigators may gain more control over some of the confounders of their trials and patients will have access to inexpensive therapies.

Neurologic rehabilitation has been testing a motor learning theory for the past quarter century that may be wearing thin in terms of leading to more robust evidence-based practices. The theory has become a mantra for the field that goes like this. Repetitive practice of increasingly challenging task-related activities assisted by a therapist in an adequate dose will lead to gains in motor skills, mostly restricted to what was trained, via mechanisms of activity-dependent induction of molecular, cellular, synaptic, and structural plasticity within spared neural ensembles and networks.

This theory has led to a range of evidence-based therapies, as well as to caricatures of the mantra (eg, a therapist says to patient, “Do those plasticity reps!”). A mantra can become too automatic, no longer apt to be reexamined as a testable theory. A recent Cochrane review of upper extremity stroke rehabilitation found “adequately powered, high-quality randomized clinical trials (RCTs) that confirmed the benefit of constraint-induced therapy paradigms, mental practice, mirror therapy, virtual reality paradigms, and a high dose of repetitive task practice.”1 The review also found positive RCT evidence for other practice protocols. However, they concluded, no one strategy was clearly better than another to improve functional use of the arm and hand. The ICARE trial2 for the upper extremity after stroke found that both a state-of-the-art Accelerated Skill Acquisition Program (motor learning plus motivational and psychological support strategy) compared to motor learning-based occupational therapy for 30 hours over 10 weeks led to a 70% increase in speed on the Wolf Motor Function Test, but so did usual care that averaged only 11 hours of formal but uncharacterized therapy. In this well-designed RCT, the investigators found no apparent effect of either the dose or content of therapy. Did dose and content really differ enough to reveal more than equivalence, or is the motor-learning mantra in need of repair?

Walking trials after stroke and spinal cord injury,38 such as robot-assisted stepping and body weight-supported treadmill training (BWSTT), were conceived as adhering to the task-oriented practice mantra. But they too have not improved outcomes more than conventional over-ground physical therapy. Indeed, the absolute gains in primary outcomes for moderate to severely impaired hemiplegic participants after BWSTT and other therapies have been in the range of only 0.12 to 0.22 m/s for fastest walking speed and 50 to 75 m for 6-minute walking distance after 12 to 36 training sessions over 4 to 12 weeks.3,9 These 15% to 25% increases are just as disappointing when comparing gains in those who start out at a speed of <0.4 m/s compared to >0.4 to 0.8 m/s.3

Has mantra-oriented training reached an unanticipated plateau due to inherent limitations? Clearly, if not enough residual sensorimotor neural substrate is available for training-induced adaptation or for behavioral compensation, more training may only fail. Perhaps, however, investigators need to reconsider the theoretical basis for the mantra, that is, whether they have been offering all of the necessary components of task-related practice, such as enough progressively difficult practice goals, the best context and environment for training, the behavioral training that motivates compliance and carryover of practice beyond the sessions of formal training, and blending in other physical activities such as strengthening and fitness exercise that also augment practice-related neural plasticity? These questions point to new directions for research….

Continue —> A Rehabilitation-Internet-of-Things in the Home to Augment Motor Skills and Exercise Training – Mar 01, 2017

Figure 1. Components of a Rehabilitation-Internet-of-Things: wireless chargers for sensors (1), ankle accelerometers with gyroscopes (2) and Android phone (3) to monitor walking and cycling, and a force sensor (4) in line with a stretch band (5) to monitor resistance exercises.


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[WEB SITE] Exercise Prescription Software – Physical Therapy Web

Any tool that can help people be more active and involved in their own rehabilitation is worthwhile. An increase in patient compliance can be achieved by making exercise programs easier to adhere to. Clear descriptions of how to perform exercises correctly is also critical to the success of any exercise program. Here is a list of software applications that allow physical therapists to create specific exercise programs for their patients. The list is not complete. If you know of a product that should be included or if you’d like to have your exercise prescription software reviewed, please let us know.

exercise prescription software - diagram

By Udrekeli [Public domain], via Wikimedia Commons


Arena Health Systems: Creators of Phys-X software

“Phys-X Advanced includes over 900 of the most often prescribed range of motion, stabilization and strengthening exercises (categories listed below) and includes Full Color Photographs for most exercises! Each exercise includes an illustration and specific easy to follow instructions that allow on-the-fly modification. The exercises can even be printed with Spanish instructions.”

BPM Rx: Exercise prescription for health and fitness professionals

“Whether you’re a personal trainer or physical therapist, exercise prescription is your life. BPM Rx is the ultimate PT Software that allows you to craft stunning exercise handouts that will inspire like never before! Try it out-the first week is free!”

BioEx Systems Inc.: Easy to use home exercise database

“Exercise, Fitness Assessment, Nutrition and Management software for Physical Therapists, Personal Trainers, Dietitians, Nutritionists and other professionals. Windows based software.”

Exercise Prescriber: Provide home exercises and information advice

“…an essential clinical tool for health professionals who routinely provide home exercises and information advice for their clients.”

Exercise Pro Live : Personalized Video and Printed Exercise Programs for Rehabilitation and Fitness

“…designed by physical therapists and other fitness professionals to provide video exercise programs with clear exercise instructions, proper exercise form and improved compliance and communication between health professionals and their clients.” HEP for rehab pro’s

“For rehabilitation professionals such as physical therapists, occupational therapists, athletic trainers, etc. to create home exercise programs for patients and or clients.” iHomeExerciseProgram

“Innovative Video + Web-based Platform = Better HEP Management & Better Patient Education

Mavenlive: Intelligent exercise prescription, customizable images, and documentation (free-trial available)

“Using Mavenlive will benefit you not only from a clinical standpoint, but it will help you improve relationships with your patients and your referral sources. Mavenlive clients tell us that physicians love getting professional correspondence. “

myclinicspace: High quality image and video exercises for patient rehabilitation

“myclinicspace is an online exercise prescription package for health professionals.”

MyPhysioRehab: A global community of therapists helping to speed your recovery (free-demo available)

“MyPhysioRehab allows you as a health professional to provide your patients with an injury profile and a rehabilitation programme to aid rapid recovery.”

PacPacs+: Online Rehabilitation Exercise and Client Management

“Manage your patient aftercare. Prescribe rehabilitation routines with multi-angle videos. Track consultation history and make notes for future sessions.”

Patient Care HEP: MedBridge

“Patient Care HEP is the fast, easy, comprehensive, and engaging home exercise program for rehabilitation professionals.”

Physiotec: Exercise and patient education database software

“Physiotec offers a health and fitness software with exercise programs for physiotherapy, rehabilitation and therapeutic exercises and distributes it across Canada, United-States (USA) and United-Kingdoms.”

PTX – PhysioTherapy eXercises: Create custom programs or choose ready made programs

“A free tool to create exercise programs for people with injuries and disabilities”

PhysioTools Software: Comprehensive and easy to use exercise software

“Exercise software for health and fitness professionals to print and email over 15,000 exercises for rehabilitation, physiotherapy, sports and education”

Physioview: Features professionally produced photographs, audio, video and text

“Physioview redefines the home exercise program from the fundamental to highly customized creation of rehabilitation exercise protocols. “

Physitrack: A mobile phone exclusively for practitioners

“Provides Physical Therapists with the ability to prescribe exercises, send messages to their patients”

The Rehab Lab: Online Exercise Prescription Software

“The Rehab Lab is an online exercise prescription software application that enables physiotherapists to create customised rehabilitation programmes for clients and patients.”

Simple Therapy: video exercise therapy that matches your needs, when and where you want it

“SimpleTherapy® offers more than 20 video-based exercise therapy programs designed by doctors.”

SimpleSet Pro: Advanced Exercise Prescription Software

“SimpleSet Pro is the ultimate online tool for professional exercise program design. With SimpleSet Pro you can create comprehensive exercise programs for your clients, and email or print them in minutes!”

SHAPES: Spatially and Human Aware Performance Evaluation System.

“SHAPES is an interactive, assistive technology (using the Microsoft Xbox Kinect) that enhances exercise routines.”

TheraVid: Connect. Discover. Recover.

“Use our expanding database of HD exercise videos and unique online interface to build better client relationships today. Free while in beta.”

WebExercises: Exercise Prescription Made Easy™

“WebExercises® will promote more frequent and proper form of all prescribed rehabilitation and corrective exercises – resulting in improved recovery and stronger happier patients and clients.”

wellpepper: gives your health a kick

“Wellpepper for iPad and iPhone enables healthcare professionals to prescribe physical therapy exercises and encourages people to complete exercises at home to help speed recovery”

Source: Exercise Prescription Software – Physical Therapy Web

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[Abstract] Caregiver-mediated exercises for improving outcomes after stroke (Cochrane review) [with consumer summary]

BACKGROUND: Stroke is a major cause of long-term disability in adults. Several systematic reviews have shown that a higher intensity of training can lead to better functional outcomes after stroke. Currently, the resources in inpatient settings are not always sufficient and innovative methods are necessary to meet these recommendations without increasing healthcare costs. A resource efficient method to augment intensity of training could be to involve caregivers in exercise training. A caregiver-mediated exercise programme has the potential to improve outcomes in terms of body function, activities, and participation in people with stroke. In addition, caregivers are more actively involved in the rehabilitation process, which may increase feelings of empowerment with reduced levels of caregiver burden and could facilitate the transition from rehabilitation facility (in hospital, rehabilitation centre, or nursing home) to home setting. As a consequence, length of stay might be reduced and early supported discharge could be enhanced.

OBJECTIVES: To determine if caregiver-mediated exercises (CME) improve functional ability and health-related quality of life in people with stroke, and to determine the effect on caregiver burden.

SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (October 2015), CENTRAL (the Cochrane Library, 2015, issue 10), Medline (1946 to October 2015), Embase (1980 to December 2015), CINAHL (1982 to December 2015), SPORTDiscus (1985 to December 2015), three additional databases (two in October 2015, one in December 2015), and six additional trial registers (October 2015). We also screened reference lists of relevant publications and contacted authors in the field.

SELECTION CRITERIA: Randomised controlled trials comparing CME to usual care, no intervention, or another intervention as long as it was not caregiver-mediated, aimed at improving motor function in people who have had a stroke.

DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials. One review author extracted data, and assessed quality and risk of bias, and a second review author cross-checked these data and assessed quality. We determined the quality of the evidence using GRADE. The small number of included studies limited the pre-planned analyses.

MAIN RESULTS: We included nine trials about CME, of which six trials with 333 patient-caregiver couples were included in the meta-analysis. The small number of studies, participants, and a variety of outcome measures rendered summarising and combining of data in meta-analysis difficult. In addition, in some studies, CME was the only intervention (CME-core), whereas in other studies, caregivers provided another, existing intervention, such as constraint-induced movement therapy. For trials in the latter category, it was difficult to separate the effects of CME from the effects of the other intervention. We found no significant effect of CME on basic ADL when pooling all trial data post intervention (4 studies; standardised mean difference (SMD) 0.21, 95% confidence interval (CI) -0.02 to 0.44; p = 0.07; moderate-quality evidence) or at follow-up (2 studies; mean difference (MD) 2.69, 95% CI -8.18 to 13.55; p = 0.63; low-quality evidence). In addition, we found no significant effects of CME on extended ADL at post intervention (two studies; SMD 0.07, 95% CI -0.21 to 0.35; p = 0.64; low-quality evidence) or at follow-up (2 studies; SMD 0.11, 95% CI -0.17 to 0.39; p = 0.45; low-quality evidence). Caregiver burden did not increase at the end of the intervention (2 studies; SMD -0.04, 95% CI -0.45 to 0.37; p = 0.86; moderate-quality evidence) or at follow-up (1 study; MD 0.60, 95% CI -0.71 to 1.91; p = 0.37; very low-quality evidence). At the end of intervention, CME significantly improved the secondary outcomes of standing balance (3 studies; SMD 0.53, 95% CI 0.19 to 0.87; p = 0.002; low-quality evidence) and quality of life (1 study; physical functioning MD 12.40, 95% CI 1.67 to 23.13; p = 0.02; mobility MD 18.20, 95% CI 7.54 to 28.86; p = 0.0008; general recovery MD 15.10, 95% CI 8.44 to 21.76; p < 0.00001; very low-quality evidence). At follow-up, we found a significant effect in favour of CME for Six-Minute Walking Test distance (1 study; MD 109.50 m, 95% CI 17.12 to 201.88; p = 0.02; very low-quality evidence). We also found a significant effect in favour of the control group at the end of intervention, regarding performance time on the Wolf Motor Function test (2 studies; MD -1.72, 95% CI -2.23 to -1.21; p < 0.00001; low-quality evidence). We found no significant effects for the other secondary outcomes (ie, patient: motor impairment, upper limb function, mood, fatigue, length of stay and adverse events; caregiver: mood and quality of life). In contrast to the primary analysis, sensitivity analysis of CME-core showed a significant effect of CME on basic ADL post intervention (2 studies; MD 9.45, 95% CI 2.11 to 16.78; p = 0.01; moderate-quality evidence). The methodological quality of the included trials and variability in interventions (eg, content, timing, and duration), affected the validity and generalisability of these observed results.

AUTHORS’ CONCLUSIONS: There is very low- to moderate-quality evidence that CME may be a valuable intervention to augment the pallet of therapeutic options for stroke rehabilitation. Included studies were small, heterogeneous, and some trials had an unclear or high risk of bias. Future high-quality research should determine whether CME interventions are (cost-)effective.

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Source: PEDro – Search Detailed Search Results

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[Abstract] Parallels between astronauts and terrestrial patients – Taking physiotherapy rehabilitation “To infinity and beyond”


    Neuro-musculoskeletal changes in astronauts parallel changes in patients on Earth.

    Motor control training for low back pain patients is applicable to astronauts.

    Astronaut reconditioning principles may be relevant to intensive care patients.

    Benefits of exchanging physiotherapy practices between space and Earth are reciprocal.


Exposure to the microgravity environment induces physiological changes in the cardiovascular, musculoskeletal and sensorimotor systems in healthy astronauts. As space agencies prepare for extended duration missions, it is difficult to predict the extent of the effects that prolonged exposure to microgravity will have on astronauts. Prolonged bed rest is a model used by space agencies to simulate the effects of spaceflight on the human body, and bed rest studies have provided some insights into the effects of immobilisation and inactivity. Whilst microgravity exposure is confined to a relatively small population, on return to Earth, the physiological changes seen in astronauts parallel many changes routinely seen by physiotherapists on Earth in people with low back pain (LBP), muscle wasting diseases, exposure to prolonged bed rest, elite athletes and critically ill patients in intensive care. The medical operations team at the European Space Agency are currently involved in preparing astronauts for spaceflight, advising on exercises whilst astronauts are on the International Space Station, and reconditioning astronauts following their return. There are a number of parallels between this role and contemporary roles performed by physiotherapists working with elite athletes and muscle wasting conditions. This clinical commentary will draw parallels between changes which occur to the neuromuscular system in the absence of gravity and conditions which occur on Earth. Implications for physiotherapy management of astronauts and terrestrial patients will be discussed.

Source: Parallels between astronauts and terrestrial patients – Taking physiotherapy rehabilitation “To infinity and beyond”

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