1
|
Li G, Tao X, Lei B, Hou X, Yang X, Wang L, Zhang S, Lv Y, Wang T, Yu L. Effects of exercise on post-stroke cognitive function: a systematic review and meta-analysis of randomized controlled trials. Top Stroke Rehabil 2024; 31:645-666. [PMID: 38825881 DOI: 10.1080/10749357.2024.2356393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/23/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND A growing body of research examining the effect of exercise on cognitive function in stroke patients, while findings of available studies were conflicting. OBJECTIVES We aimed to estimate the effect of exercise on cognitive function in stroke patients. METHODS For this systematic review and meta-analysis, we searched PubMed, Web of Science, Embase, Cochrane, and Scopus electronic databases, through 13 March 2023. The three-level restricted maximum likelihood random effects model was used to synthesize the data. RESULTS Twenty-five studies met the inclusion criteria. There was a significant effect of exercise on improving cognitive function in stroke patients (Cohen's d = 0.37, 95% CI, 0.16 to 0.58, p < 0.01, I2 = 22.12%). Subgroup analysis showed that exercise significantly improved memory. In addition, aerobic exercise, exercise conducted 12 weeks or more, 3 times or more per week, less than 60 minutes per session, less than 180 minutes per week, and up to 12 months post-stroke increased cognitive function significantly. CONCLUSIONS Exercise improved cognitive function in stroke patients. To improve cognitive function, this meta-analysis provides clinicians with evidence to recommend that stroke patients participate in aerobic exercise at least 3 times per week for 30-60 minutes, with a goal of 180 minutes per week being achieved by increasing the frequency of exercise. Exercise initiated within 12 months post-stroke and continued for 12 weeks or more is most beneficial for improving cognitive function.
Collapse
Affiliation(s)
- Gen Li
- School of Physical Education & Sports Science, South China Normal University, Guangzhou, China
| | - Xifeng Tao
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Bingkai Lei
- School of Physical Education, Xihua University, Chengdu, China
| | - Xiao Hou
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Xiaoguang Yang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Leiyuyang Wang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Yuanyuan Lv
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| | - Tongling Wang
- Institute of Physical Education, Huzhou University, Huzhou, China
| | - Laikang Yu
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing, China
| |
Collapse
|
2
|
Abo-Zaid NA, El-Gendy AM, Hewidy I, Essam Ali M, Sabbahi A. Influence of aerobic exercise on inhibitory control of executive functions in children with hemiplegic cerebral palsy: A randomized controlled trial. Clin Rehabil 2024; 38:337-346. [PMID: 37885221 DOI: 10.1177/02692155231208578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVE This study investigates the influence of aerobic exercise training on inhibitory control of executive functions in children with hemiplegic cerebral palsy. DESIGN Single-blind randomized controlled trial. SETTING Outpatient Physical Therapy Clinic. PARTICIPANTS Children aged 7-11 with left-sided hemiplegic cerebral palsy with emotional and behavioral dysregulation evidenced by scores >28 on Paediatric Symptom Checklist and GMFCS I or II (n = 60). INTERVENTION Participants were randomly allocated into two equal groups. The control group received standard-of-care physical therapy for 1 h, and the aerobic exercise group received standard-of-care physical therapy for 30 min and moderate-intensity continuous exercise on a bicycle ergometer for 30 min. All groups received treatment three times a week for 12 weeks. MAIN MEASURES The Eriksen Flanker test and Stroop Color-Word test were used to assess inhibitory control of executive function at the baseline and after 12 weeks. RESULTS Differences between pre- and post-treatment values in the exercise group showed significant improvement in Flanker response accuracy and Stroop response accuracy (p = 0.001) and significant decreases in Flanker congruent reaction time and Stroop congruent reaction time (p < 0.05). However, there were no significant differences between both groups in Flanker incongruent reaction time and Stroop incongruent reaction time (p > 0.05). CONCLUSIONS Aerobic exercise has a promising effect on inhibitory control of executive function in children with left-sided hemiplegic cerebral palsy.
Collapse
Affiliation(s)
- Nehad A Abo-Zaid
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, South Valley University, Qena, Egypt
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Badr University, Assuit, Egypt
| | - Amira M El-Gendy
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Islam Hewidy
- Department of Physical Therapy, School of Health Sciences and Practice, New York Medical College, Valhalla, NY, USA
| | - Mohammed Essam Ali
- Department of Physical Therapy for Integumentary System Disorders and Burns, Faculty of Physical Therapy, South Valley University, Qena, Egypt
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
- School of Physical Therapy, South College, Knoxville, TN, USA
| |
Collapse
|
3
|
Anderson VR, Kakuske K, Thompson C, Ivanova MV. Pilot study of a high-intensity interval training program in older adults: Safety, feasibility, functional fitness and cognitive effects. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.09.23299774. [PMID: 38260605 PMCID: PMC10802633 DOI: 10.1101/2024.01.09.23299774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Exercise can boost physical and cognitive health in older adults. However, there are a lack of accessible exercise programs that foster adherence among older adults. In this study, we aimed to establish the safety and feasibility of APEX, a new exercise program designed to optimize fitness and cognitive gains for older adults, in addition to evaluating its acute physiological effects, and assessing its possible effects on functional fitness and cognition among healthy older adults. APEX utilizes a multimodal progressive high-intensity interval training (HIIT) design, with high-intensity intervals focused on enhancing cardiovascular fitness and muscle strength, and recovery intervals that incorporate balance and mobility exercises. The APEX training was tested in healthy older adults (n=4) over the course of four weeks. Ultimately, APEX was found to be safe and feasible, with no adverse events and high adherence. Participants met heart rate targets for all of the high-intensity exercises, and all intervals had a significant difference in heart rates between high-intensity and recovery periods in linear effects models (p<0.001). Improvements in functional fitness were observed in aerobic endurance, lower body strength, and balance. The intervention was also associated with positive trends in the cognitive domains of information processing, working memory, executive control, and attention. APEX offers a promising alternative to traditional cardiovascular exercise modalities for older adults with additional benefits for functional fitness and cognition. These results encourage further testing of the APEX program in older adults and different clinical populations.
Collapse
|
4
|
Marzolini S, Robertson AD, MacIntosh BJ, Corbett D, Anderson ND, Brooks D, Koblinsky N, Oh P. Effect of High-Intensity Interval Training and Moderate-Intensity Continuous Training in People With Poststroke Gait Dysfunction: A Randomized Clinical Trial. J Am Heart Assoc 2023; 12:e031532. [PMID: 37947080 PMCID: PMC10727274 DOI: 10.1161/jaha.123.031532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The exercise strategy that yields the greatest improvement in both cardiorespiratory fitness (V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ ) and walking capacity poststroke has not been determined. This study aimed to determine whether conventional moderate-intensity continuous training (MICT) or high-intensity interval training (HIIT) have different effects on V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6-minute walk distance (6MWD). METHODS AND RESULTS In this 24-week superiority trial, people with poststroke gait dysfunction were randomized to MICT (5 days/week) or HIIT (3 days/week with 2 days/week of MICT). MICT trained to target intensity at the ventilatory anaerobic threshold. HIIT trained at the maximal tolerable treadmill speed/grade using a novel program of 2 work-to-recovery protocols: 30:60 and 120:180 seconds. V̇O2 and heart rate was measured during performance of the exercise that was prescribed at 8 and 24 weeks for treatment fidelity. Main outcomes were change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ and 6MWD. Assessors were blinded to the treatment group for V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ but not 6MWD. Secondary outcomes were change in ventilatory anaerobic threshold, cognition, gait-economy, 10-meter gait-velocity, balance, stair-climb performance, strength, and quality-of-life. Among 47 participants randomized to either MICT (n=23) or HIIT (n=24) (mean age, 62±11 years; 81% men), 96% completed training. In intention-to-treat analysis, change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ for MICT versus HIIT was 2.4±2.7 versus 5.7±3.1 mL·kg-1·min-1 (mean difference, 3.2 [95% CI, 1.5-4.8]; P<0.001), and change in 6MWD was 70.9±44.3 versus 83.4±53.6 m (mean difference, 12.5 [95% CI, -17 to 42]; P=0.401). HIIT had greater improvement in ventilatory anaerobic threshold (mean difference, 2.07 mL·kg-1·min-1 [95% CI, 0.59-3.6]; P=0.008). No other between-group differences were observed. During V̇O2 monitoring at 8 and 24 weeks, MICT reached 84±14% to 87±18% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ while HIIT reached 101±22% to 112±14% of V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ (during peak bouts). CONCLUSIONS HIIT resulted in more than a 2-fold greater and clinically important change in V ̇ O 2 peak $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ than MICT. Training to target (ventilatory anaerobic threshold) during MICT resulted in ~3 times the minimal clinically important difference in 6MWD, which was similar to HIIT. These findings show proof of concept that HIIT yields greater improvements in cardiorespiratory fitness than conventional MICT in appropriately screened individuals. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT03006731.
Collapse
Affiliation(s)
- Susan Marzolini
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- Faculty of Kinesiology and Physical Education, University of TorontoONCanada
| | | | - Bradley J. MacIntosh
- Sandra E Black Centre for Brain Resilience and Repair, Hurvitz Brain Sciences, Physical Sciences Platform, Sunnybrook Research InstituteTorontoONCanada
| | - Dale Corbett
- Department of Cellular and Molecular MedicineUniversity of OttawaONCanada
| | - Nicole D. Anderson
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Dina Brooks
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
- Rehabilitation Sciences Institute, University of TorontoONCanada
- McMaster University, Faculty of Health SciencesHamiltonONCanada
| | - Noah Koblinsky
- Rotman Research Institute, Baycrest Academy for Research and EducationTorontoONCanada
| | - Paul Oh
- KITE Research Institute, Toronto Rehabilitation Institute, University Health NetworkTorontoONCanada
| |
Collapse
|
5
|
Dong Q, Yang Y, Tang Q, Yang M, Lan A, Xiao H, Wei J, Cao X, Xian Y, Yang Q, Chen D, Zhao J, Li S. Effects of early cognitive rehabilitation training on cognitive function and quality of life in critically ill patients with cognitive impairment: A randomised controlled trial. Aust Crit Care 2023; 36:708-715. [PMID: 36470777 DOI: 10.1016/j.aucc.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients often develop cognitive dysfunction during admission to the ICU and after being transferred out of the ICU, which leads to physical disorders, sleep disorders, and psychological stress.Cognitive rehabilitation training can significantly improve patients' planning, decision-making ability, and executive function. OBJECTIVE The aim of this study was to explore the role of early cognitive rehabilitation training in improving cognitive impairment in critically ill patients. METHODS This study was a prospective, randomised, controlled clinical trial conducted from January 2017 to June 2021. Critically ill patients with cognitive impairment admitted to the Department of Intensive Care Medicine of The Third Hospital of Mianyang were randomly divided into the control (n = 68) and intervention groups (n = 68). Cognitive rehabilitation training (including digital operating system training, music therapy, aerobic training, and mental health intervention) was applied to the patients in the intervention group for 6 months, while the control group did not receive any cognitive intervention. Before 3 and 6 months after enrolment, the Montreal Cognitive Assessment and the 36-Item Short Form Health Survey Scale were used to evaluate cognitive function and quality of life, respectively, in both groups. RESULTS A total of 136 critical patients were included in the final analysis. There were no significant differences in sex, age, years of education, complications, intensive care unit hospitalisation time, mechanical ventilation time, or the total score of the Montreal Cognitive Assessment scale when transferred out of the intensive care unit in 24 hours between the two groups. Six months later, the results of the follow-up showed that the cognitive function score in the intervention group was significantly higher than that in the control group (26.69 ± 2.49 vs. 23.03 ± 3.79). The analysis of quality of life showed that the scores in all areas in the intervention group improved. There were significant differences in physical functioning (69.02 ± 8.14 vs. 63.38 ± 11.94), role physical (62.02 ± 12.18 vs. 58.09 ± 8.83), general health (46.00 ± 15.21 vs. 40.38 ± 13.77), vitality (61.00 ± 11.01 vs. 54.38 ± 13.80), social functioning (70.00 ± 10.29 vs. 64.41 ± 13.61), role emotional (78.00 ± 8.00 vs. 72.15 ± 12.18), and mental health (71.00 ± 12.33 vs. 55.37 ± 10.76) between the two groups (P < 0.05). CONCLUSION Early cognitive rehabilitation training can improve cognitive impairment in critically ill patients and their quality of life.
Collapse
Affiliation(s)
- Qionglan Dong
- Department of Critical Care Medicine, Southwest Medical University, LuZhou, Sichuan Province, 646000, China; Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China.
| | - Yuxin Yang
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Qibing Tang
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Mei Yang
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - An Lan
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Hongjun Xiao
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Jiaxun Wei
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Xiaofang Cao
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Yao Xian
- Department of Critical Care Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Qi Yang
- Department of Rehabilitation Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Dongmei Chen
- Department of Rehabilitation Medicine, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Jun Zhao
- Department of Psychiatry, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| | - Shiyi Li
- Department of Psychiatry, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan Province, 621000, China
| |
Collapse
|
6
|
Tabka O, Sanaa I, Mekki M, Acheche A, Paillard T, Trabelsi Y. Effect of a pulmonary rehabilitation program combined with cognitive training on exercise tolerance and cognitive functions among Tunisian male patients with chronic obstructive pulmonary disease: A randomized controlled trial. Chron Respir Dis 2023; 20:14799731231201643. [PMID: 37691169 PMCID: PMC10494516 DOI: 10.1177/14799731231201643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/21/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Cognitive impairment has been well described in patients with Chronic Obstructive Pulmonary Disease (COPD) in addition to cardiorespiratory disability. To reduce this impairment, researchers have recommended the use of single or combined exercise training. However, the combined effect of cognitive training (CT) and pulmonary rehabilitation (PR) program on selective cognitive abilities in patients with COPD has not been fully evaluated. Therefore, we aimed to assess the impact of PR combined with CT on 6 minutes walking test (6MWT) and cognitive parameters in Tunisian males' patients with COPD. METHODS Thirty-nine patients with COPD were randomly assigned to an intervention group (n = 21, age = 65.3 ± 2.79) and a control group (n = 18, age = 65.3 ± 3.2). The intervention group underwent PR combined with CT, and the control group underwent only PR, three times per week for 3 months. The primary outcomes were 6MWT (6 minutes walking test -6MWT-parameters) and cognitive performance, as evaluated by Montreal cognitive assessments (MOCA) and P300 test. Secondary outcomes were patient's characteristics and spirometric data. These tests were measured at baseline and after 3 months of training programs. RESULTS Results showed a significant improvement of the 6MWT distance after the rehabilitation period in both groups (p < .001). Moreover, both groups showed significant improvement (p < .001) in cognitive performance including MOCA score and P300 test latency in three midline electrodes. However, the improvement in cognitive performance was significantly greater in the PR+CT group than the PR group. CONCLUSION In conclusion, although PR alone improves 6MWT parameters and cognitive function, the addition of CT to PR is more effective in improving cognitive abilities in patients with COPD. This combined approach may provide clinicians with a complementary therapeutic option for improving cognitive abilities in patients with COPD.
Collapse
Affiliation(s)
- Oussama Tabka
- Laboratory of Research: Exercise Physiology and Pathophysiology: from integral to molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Imen Sanaa
- Laboratory of Research: Exercise Physiology and Pathophysiology: from integral to molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Marwa Mekki
- Laboratory of Research: Exercise Physiology and Pathophysiology: from integral to molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Amal Acheche
- Laboratory of Research: Exercise Physiology and Pathophysiology: from integral to molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Thierry Paillard
- Movement, Balance, Performance and Health Laboratory (EA 4445), University of Pau and des Pays de l’Adour, Pau, France
| | - Yassine Trabelsi
- Laboratory of Research: Exercise Physiology and Pathophysiology: from integral to molecular Biology, Medicine and Health (LR19ES09), Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| |
Collapse
|
7
|
Yazdani M, Chitsaz A, Zolaktaf V, Saadatnia M, Ghasemi M, Nazari F, Chitsaz A, Suzuki K, Nobari H. Can Early Neuromuscular Rehabilitation Protocol Improve Disability after a Hemiparetic Stroke? A Pilot Study. Brain Sci 2022; 12:brainsci12070816. [PMID: 35884625 PMCID: PMC9313239 DOI: 10.3390/brainsci12070816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/30/2022] [Accepted: 06/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The impairment of limb function and disability are among the most important consequences of stroke. To date, however, little research has been done on the early rehabilitation trial (ERT) after stroke in these patients. The purpose of this study was to evaluate the impact of ERT neuromuscular protocol on motor function soon after hemiparetic stroke. The sample included twelve hemiparetic patients (54.3 ± 15.4 years old) with ischemic stroke (n = 7 control, n = 5 intervention patients). ERT was started as early as possible after stroke and included passive range of motion exercises, resistance training, assisted standing up, and active exercises of the healthy side of the body, in addition to encouraging voluntary contraction of affected limbs as much as possible. The rehabilitation was progressive and took 3 months, 6 days per week, 2–3 hours per session. Fugle-Meyer Assessment (FMA), Box and Blocks test (BBT) and Timed up and go (TUG) assessments were conducted. There was a significantly greater improvement in the intervention group compared to control: FMA lower limbs (p = 0.001), total motor function (p = 0.002), but no significant difference in FMA upper limb between groups (p = 0.51). The analysis of data related to BBT showed no significant differences between the experimental and control groups (p = 0.3). However, TUG test showed significant differences between the experimental and control groups (p = 0.004). The most important finding of this study was to spend enough time in training sessions and provide adequate rest time for each person. Our results showed that ERT was associated with improved motor function but not with the upper limbs. This provides a basis for a definitive trial.
Collapse
Affiliation(s)
- Mahdi Yazdani
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran
- Correspondence: (M.Y.); (K.S.); or (H.N.)
| | - Ahmad Chitsaz
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.C.); (M.S.); (M.G.)
| | - Vahid Zolaktaf
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.C.); (M.S.); (M.G.)
| | - Majid Ghasemi
- Isfahan Neurosciences Research Centre, Alzahra Research Institute, Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran; (A.C.); (M.S.); (M.G.)
| | - Fatemeh Nazari
- Isfahan Neurosciences Research Centre, Department of Adult Health Nursing, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan 81839-83434, Iran;
| | - Abbas Chitsaz
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan
- Correspondence: (M.Y.); (K.S.); or (H.N.)
| | - Hadi Nobari
- Faculty of Sport Sciences, University of Isfahan, Isfahan 81746-7344, Iran; (V.Z.); (A.C.)
- Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
- Department of Motor Performance, Faculty of Physical Education and Mountain Sports, Transilvania University of Brașov, 500068 Brașov, Romania
- Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil 56199-11367, Iran
- Correspondence: (M.Y.); (K.S.); or (H.N.)
| |
Collapse
|
8
|
Pickersgill JW, Turco CV, Ramdeo K, Rehsi RS, Foglia SD, Nelson AJ. The Combined Influences of Exercise, Diet and Sleep on Neuroplasticity. Front Psychol 2022; 13:831819. [PMID: 35558719 PMCID: PMC9090458 DOI: 10.3389/fpsyg.2022.831819] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/25/2022] [Indexed: 12/11/2022] Open
Abstract
Neuroplasticity refers to the brain's ability to undergo structural and functional adaptations in response to experience, and this process is associated with learning, memory and improvements in cognitive function. The brain's propensity for neuroplasticity is influenced by lifestyle factors including exercise, diet and sleep. This review gathers evidence from molecular, systems and behavioral neuroscience to explain how these three key lifestyle factors influence neuroplasticity alone and in combination with one another. This review collected results from human studies as well as animal models. This information will have implications for research, educational, fitness and neurorehabilitation settings.
Collapse
Affiliation(s)
| | - Claudia V. Turco
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Karishma Ramdeo
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Ravjot S. Rehsi
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Stevie D. Foglia
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Aimee J. Nelson
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
9
|
Mayer JF, Sandberg CW, Mozeiko J, Madden EB, Murray LL. Cognitive and Linguistic Benefits of Aerobic Exercise: A State-of-the-Art Systematic Review of the Stroke Literature. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:785312. [PMID: 36188840 PMCID: PMC9397720 DOI: 10.3389/fresc.2021.785312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 12/03/2022]
Abstract
This systematic review aimed to determine how aerobic exercise affects cognition after stroke, with particular focus on aphasia and language improvement. Methodological quality was assessed with the PEDro+ scale with half of the 27 included studies rated as high quality. Data extraction focused on cognitive effects of aerobic exercise post-stroke, intervention characteristics, outcome measures, and participant characteristics. Whereas attention, memory, and executive functioning measures were common across the included studies, no study included a language-specific, performance-based measure. Seventeen studies reported positive cognitive effects, most frequently in the domains of attention, memory and executive functioning. Variability in outcome measures, intervention characteristics, and participant characteristics made it difficult to identify similarities among studies reporting positive cognitive effects of exercise or among those studies reporting null outcomes. Only three studies provided specific information about the number of individuals with aphasia included or excluded, who comprise approximately one-third of the stroke population. The review identified patent gaps in our understanding of how aerobic exercise may affect not only the cognitive domain of language post-stroke but also the broader cognitive functioning of individuals with post-stroke aphasia. Methodological limitations of the reviewed studies also warrant further examination of the direct impact of aerobic exercise on cognition post-stroke with careful attention to the selection and reporting of population, intervention, and outcomes.
Collapse
Affiliation(s)
- Jamie F. Mayer
- School of Allied Health and Communicative Disorders, Northern Illinois University, DeKalb, IL, United States
- *Correspondence: Jamie F. Mayer
| | - Chaleece W. Sandberg
- Department of Communication Sciences and Disorders, Penn State University, University Park, PA, United States
| | - Jennifer Mozeiko
- Department of Speech, Language and Hearing Science, University of Connecticut, Mansfield, CT, United States
| | - Elizabeth B. Madden
- School of Communication Science and Disorders, Florida State University, Tallahassee, FL, United States
| | - Laura L. Murray
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| |
Collapse
|
10
|
Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review. Brain Sci 2021; 11:brainsci11040473. [PMID: 33917909 PMCID: PMC8068294 DOI: 10.3390/brainsci11040473] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/26/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke.
Collapse
|
11
|
Yang X, Yang S, Xu H, Liu D, Zhang Y, Wang G. Superoxide Dismutase Gene Polymorphism is Associated With Ischemic Stroke Risk in the China Dali Region Han Population. Neurologist 2021; 26:27-31. [PMID: 33646985 PMCID: PMC8041563 DOI: 10.1097/nrl.0000000000000301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Stroke is a serious cardiovascular disease, a major cause of disability and death in both developed and developing countries. Superoxide dismutases (SODs) are enzymes that catalyze the breakdown of superoxide into oxygen and hydrogen peroxide and play a key role in the antioxidant response. This study explored the relationship between single-nucleotide polymorphisms (SNPs) in SOD genes and the risk of ischemic stroke (IS) in the Chinese Han population of Dali City. METHODS For this case-control study, the authors enrolled 144 patients who had an IS and 128 healthy controls. The SNPs rs17880487 and rs80265967 of the SOD1 gene, rs4880 and rs2842960 of the SOD2 gene, and rs2695232 and rs7655372 of the SOD3 gene were detected through TaqMan polymerase chain reaction. Genotypes and allele frequencies of the 2 groups were compared. Odds ratio and 95% confidence intervals were calculated by unconditional logistic regression, and environmental factors were corrected with multivariate logistic regression analysis. RESULTS Rs7655372 of SOD3 was associated with a significantly increased risk of IS. Moreover, the A and GA genotypes of SNP rs7655372 were associated with increased risk of IS, whereas the A and GA genotypes were risk factors for IS. Furthermore, multivariate logistic regression analysis showed that the rs7655372 GA genotype is the independent risk factor for IS. CONCLUSION The SOD3 gene rs7655372 locus polymorphism is a risk factor for IS in the Dali region.
Collapse
Affiliation(s)
- Xitong Yang
- Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali, Yunnan
| | - Sulian Yang
- Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali, Yunnan
| | - Hongyang Xu
- Hospital of Traditional Chinese Medicine Guangde, Guangde, Anhui, China
| | - Dan Liu
- Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali, Yunnan
| | - Yuanyuan Zhang
- Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali, Yunnan
| | - Guangming Wang
- Genetic Testing Center, The First Affiliated Hospital of Dali University, Dali, Yunnan
| |
Collapse
|
12
|
Morton A, Myers M, Whitaker AA, Kempf KS, Eickmeyer S, Abraham M, Rippee M, Billinger SA. Optimizing Recruitment Strategies and Physician Engagement for Stroke Recovery Research. J Neurol Phys Ther 2021; 45:41-45. [PMID: 32969840 PMCID: PMC7895449 DOI: 10.1097/npt.0000000000000334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE A major challenge for stroke rehabilitation and recovery research is the recruitment and retention of participants. Our prior challenges and successes have influenced our team to rethink our approach and the potential for large-scale stroke recruitment. SUMMARY OF KEY POINTS In this special interest article, we highlight how the adoption and implementation of recruitment strategies such as physician engagement and a streamlined "customer service" approach helped us improve our enrollment and maximize efficiency. Another positive outcome of enrollment was increased representation of those who identify as underrepresented minority or live in rural areas. RECOMMENDATIONS FOR CLINICAL PRACTICE Rethinking our recruitment processes and infrastructure allowed for greater interprofessional interactions, minimal burden for our stroke physician team members, and maximized enrollment into our stroke studies.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A324).
Collapse
Affiliation(s)
- Allegra Morton
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City
| | - Moira Myers
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City
| | - Alicen A. Whitaker
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City
| | - Katie S. Kempf
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City
| | - Sarah Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City
| | - Michael Abraham
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Michael Rippee
- Department of Neurology, University of Kansas Medical Center, Kansas City
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City
- Department of Neurology, University of Kansas Medical Center, Kansas City
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City
| |
Collapse
|
13
|
Abba MA, Olaleye OA, Hamzat TK. Effect of aerobic exercise on post-stroke cognitive function: a systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2018.0080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background/Aims Literature suggests that aerobic exercise improves cognitive impairments post stroke. This systematic review was conducted to analyse evidence on the effectiveness of aerobic exercise in improving post-stroke cognitive impairments. Methods Online databases (PubMed, EMBASE and Web of Science) were systematically searched from inception until 13 July 2017 using the keywords stroke/exercise/cognition. Clinical trials that met the inclusion criteria were assessed for methodological quality using the PEDro scale. Extracted data were synthesised for evidence. Results A total of seven studies met the inclusion criteria. Participants in most of the studies were aged over 60 years and the majority had ischaemic stroke. The most commonly used measure for assessing cognition was the Mini Mental State Examination. The majority of studies included moderate to high intensity exercise (50–70% of VO2max) for 30–60 minutes three to five times per week. There is moderate evidence that aerobic exercise enhances global cognitive function, attention and working memory. Evidence that aerobic exercise improves memory, levels of brain-derived neurotrophic factor and executive function is conflicting and limited. Conclusions Aerobic exercise is moderately effective in improving post-stroke cognitive impairments. More clinical trials are needed in view of the methodological limitations and paucity of existing studies.
Collapse
Affiliation(s)
| | | | - Talhatu Kolapo Hamzat
- Department of Physiotherapy, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
14
|
Abba MA, Olaleye OA, Hamzat TK. Effects of over-ground walking and cognitive rehabilitation on cognition, brain-derived neurotrophic factor, participation and quality of life among stroke survivors: a study protocol. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2020. [DOI: 10.1080/21679169.2020.1808056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Muhammad Aliyu Abba
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University Kano, Kano, Nigeria
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olubukola A. Olaleye
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Talhatu K. Hamzat
- Department of Physiotherapy, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
15
|
Marzolini S, Robertson AD, Oh P, Goodman JM, Corbett D, Du X, MacIntosh BJ. Aerobic Training and Mobilization Early Post-stroke: Cautions and Considerations. Front Neurol 2019; 10:1187. [PMID: 31803129 PMCID: PMC6872678 DOI: 10.3389/fneur.2019.01187] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 10/25/2019] [Indexed: 12/14/2022] Open
Abstract
Knowledge gaps exist in how we implement aerobic exercise programs during the early phases post-stroke. Therefore, the objective of this review was to provide evidence-based guidelines for pre-participation screening, mobilization, and aerobic exercise training in the hyper-acute and acute phases post-stroke. In reviewing the literature to determine safe timelines of when to initiate exercise and mobilization we considered the following factors: arterial blood pressure dysregulation, cardiac complications, blood-brain barrier disruption, hemorrhagic stroke transformation, and ischemic penumbra viability. These stroke-related impairments could intensify with inappropriate mobilization/aerobic exercise, hence we deemed the integrity of cerebral autoregulation to be an essential physiological consideration to protect the brain when progressing exercise intensity. Pre-participation screening criteria are proposed and countermeasures to protect the brain from potentially adverse circulatory effects before, during, and following mobilization/exercise sessions are introduced. For example, prolonged periods of standing and static postures before and after mobilization/aerobic exercise may elicit blood pooling and/or trigger coagulation cascades and/or cerebral hypoperfusion. Countermeasures such as avoiding prolonged standing or incorporating periodic lower limb movement to activate the venous muscle pump could counteract blood pooling after an exercise session, minimize activation of the coagulation cascade, and mitigate potential cerebral hypoperfusion. We discuss patient safety in light of the complex nature of stroke presentations (i.e., type, severity, and etiology), medical history, comorbidities such as diabetes, cardiac manifestations, medications, and complications such as anemia and dehydration. The guidelines are easily incorporated into the care model, are low-risk, and use minimal resources. These and other strategies represent opportunities for improving the safety of the activity regimen offered to those in the early phases post-stroke. The timeline for initiating and progressing exercise/mobilization parameters are contingent on recovery stages both from neurobiological and cardiovascular perspectives, which to this point have not been specifically considered in practice. This review includes tailored exercise and mobilization prescription strategies and precautions that are not resource intensive and prioritize safety in stroke recovery.
Collapse
Affiliation(s)
- Susan Marzolini
- KITE, Toronto Rehab-University Health Network, Toronto, ON, Canada
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Andrew D. Robertson
- Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Paul Oh
- KITE, Toronto Rehab-University Health Network, Toronto, ON, Canada
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
| | - Jack M. Goodman
- KITE, Toronto Rehab-University Health Network, Toronto, ON, Canada
- Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Dale Corbett
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Xiaowei Du
- KITE, Toronto Rehab-University Health Network, Toronto, ON, Canada
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Bradley J. MacIntosh
- Canadian Partnership for Stroke Recovery, Toronto, ON, Canada
- Sunnybrook Health Sciences Center, Toronto, ON, Canada
| |
Collapse
|
16
|
Lee J, Stone AJ. Combined Aerobic and Resistance Training for Cardiorespiratory Fitness, Muscle Strength, and Walking Capacity after Stroke: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2019; 29:104498. [PMID: 31732460 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104498] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/11/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiorespiratory fitness, measured as peak oxygen consumption, is a potent predictor of stroke risk. Muscle weakness is the most prominent impairment after stroke and is directly associated with reduced walking capacity. There is a lack of recommendations for optimal combined aerobic training and resistance training for those patients. The purpose of this study was to systematically review and quantify the effects of exercise training on cardiorespiratory fitness, muscle strength, and walking capacity after stroke. METHODS Five electronic databases were searched (until May 2019) for studies that met the following criteria: (1) adult humans with a history of stroke who ambulate independently; (2) structured exercise intervention based on combined aerobic training and resistance training; and (3) measured cardiorespiratory fitness, muscle strength, and/or walking capacity. RESULTS Eighteen studies (602 participants, average age 62 years) met the inclusion criteria. Exercise training significantly improved all 3 outcomes. In subgroup analyses for cardiorespiratory fitness, longer training duration was significantly associated with larger effect size. Likewise, for muscle strength, moderate weekly frequency and lower training volume were significantly associated with larger effect size. Furthermore, in walking capacity, moderate weekly frequency and longer training duration were significantly associated with larger effect size. CONCLUSIONS These results suggest that an exercise program consisting of moderate-intensity, 3 days per week, for 20 weeks should be considered for greater effect on cardiorespiratory fitness, muscle strength, and walking capacity in stroke patients.
Collapse
Affiliation(s)
- Junghoon Lee
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas
| | - Audrey J Stone
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas.
| |
Collapse
|
17
|
Regan EW, Handlery R, Beets MW, Fritz SL. Are Aerobic Programs Similar in Design to Cardiac Rehabilitation Beneficial for Survivors of Stroke? A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e012761. [PMID: 31409176 PMCID: PMC6759893 DOI: 10.1161/jaha.119.012761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/18/2019] [Indexed: 01/17/2023]
Abstract
Background Survivors of stroke face movement disability and increased cardiovascular disease and stroke risk. Treatment includes rehabilitation focused on functional movement with less emphasis on aerobic capacity. After rehabilitation, survivors of stroke must self-manage activity with limited appropriate community programs. Lack of structured activity contributes to sedentary behavior. The objective of this systematic review and meta-analysis is to review aerobic programs for stroke survivors similar in activity and dosage to cardiac rehabilitation programs to determine their efficacy for improving aerobic and walking capacity. Methods and Results Preferred Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to review 5 databases. Group interventions for survivors of stroke with a primary aerobic component and dosage from 18 to 36 visits over 8 to 18 weeks (matching cardiac rehabilitation requirements in the United States) were included. The 6-minute walk test, maximal oxygen consumption (VO2) peak, and walking speed were included as measures of aerobic capacity. Summary effect sizes and outcome measure mean differences were calculated for preintervention to postintervention, and summary effect sizes were calculated for preintervention to follow-up. Activity type and initial 6-minute walk test moderator analyses were performed. Nineteen studies with 23 eligible groups were selected. Survivors of stroke improved their composite aerobic capacity with an effect size of 0.38 (95% CI, 0.27-0.49). Studies including 6-minute walk test demonstrated a pooled difference in means of 53.3 m (95% CI, 36.8-69.8 m). Follow-up data were inconclusive. Conclusions Survivors of stroke benefit from aerobic programs with similar dosing to cardiac rehabilitation in the United States. The potential integration into existing programs could expand the community exercise options.
Collapse
Affiliation(s)
| | - Reed Handlery
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| | - Michael W. Beets
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| | - Stacy L. Fritz
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSC
| |
Collapse
|
18
|
Johnson L, Basilakos A, Yourganov G, Cai B, Bonilha L, Rorden C, Fridriksson J. Progression of Aphasia Severity in the Chronic Stages of Stroke. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:639-649. [PMID: 30958970 PMCID: PMC6802862 DOI: 10.1044/2018_ajslp-18-0123] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/21/2018] [Accepted: 11/02/2018] [Indexed: 05/21/2023]
Abstract
Background and Purpose The severity of aphasic impairment in chronic stroke survivors is typically thought to be stable by 6 months postonset. However, a recent study showed that stroke survivors with aphasia experience language improvement or decline in the chronic phase, years beyond onset. Little is known about why some individuals improve whereas others remain stable or decline. Additionally, no study has tracked changes in aphasia from assessments completed at multiple time points across many years. The current study offers a comprehensive analysis of potential predictive demographic and health information to determine which factors predict dynamic changes in aphasia severity in chronic stroke. Methods Individuals in the chronic stage of a single-event, left-hemisphere ischemic stroke were identified from an archival database and included for study ( N = 39). Participants were included if they had undergone 2 or more standardized language assessments acquired at time points at least 6 months apart, with the 1st assessment at least 6 months postinjury. A linear mixed-effects model was used to determine the impact of treatment and a variety of demographic and health factors on language change. Results Over time, half of the participants improved (51%), whereas approximately a quarter (26%) decreased, and a quarter (23%) remained stable. A greater number of aphasia treatment hours significantly predicted language improvement ( p = .03), whereas older stroke age was associated with long-term decline ( p = .04). Two interactions were found to be significant in predicting improvement in individuals with diabetes: Increased exercise and younger age at stroke were significant in predicting outcomes ( p < .05). Conclusions Factors that significantly influence language recovery in chronic aphasia include stroke age and receiving aphasia treatment. For those with diabetes, increased exercise was shown to improve outcomes. Results from this study offer clinicians greater insight into the influence of patient factors on long-term recovery from stroke aphasia while suggesting a potential adjunct to language therapy: exercise. Supplemental Material https://doi.org/10.23641/asha.7849304.
Collapse
Affiliation(s)
- Lisa Johnson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| | | | - Bo Cai
- Department of Biostatistics, University of South Carolina, Columbia
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia
| |
Collapse
|
19
|
Pallesen H, Bjerk M, Pedersen AR, Nielsen JF, Evald L. The Effects of High-Intensity Aerobic Exercise on Cognitive Performance After Stroke: A Pilot Randomised Controlled Trial. J Cent Nerv Syst Dis 2019; 11:1179573519843493. [PMID: 31040737 PMCID: PMC6477759 DOI: 10.1177/1179573519843493] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/21/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Aerobic exercise is an effective treatment to improve aerobic capacity
following stroke and might also improve cognitive impairments in sub-acute
stroke survivors. The aim of the study was to assess the effect of
high-intensity aerobic exercise on cognitive impairments in sub-acute stroke
survivors. Methods: A pilot, randomised controlled trial on the effects of aerobic exercise on
cognitive impairments of stroke patients in the sub-acute (1-3 months) phase
was conducted. Thirty patients with moderate cognitive impairments (maximum
score of 5 on at least two items on the cognitive subscales of the
Functional Independence Measure [FIM]) were included in the study and
randomly assigned to either the intervention group – performing
high-intensity aerobic exercise (above 70% of maximum heart rate), or the
control group – performing low-intensity aerobic exercise (below 60%).
Patients in both groups exercised for 50 min twice a week for 4 weeks.
Primary neuropsychological outcome: Trail Making Test B. Results: Thirty stroke patients completed the interventions. The results showed that
the high-intensity group, compared with the low-intensity group, achieved
significant improvements on Trail Making Test B, which assesses processing
speed and divided attention (P = .04 after training and
P = .01 at follow-up). However, the significant
improvements on Trail Making Test B might relate to a ceiling effect in the
control group. Conclusions: This study does not provide evidence to support that aerobic exercise can
improve cognition in stroke survivors, even though significant improvement
was revealed on the primary outcome in sub-acute stroke survivors following
high-intensity aerobic exercise compared with low-intensity general
exercise.
Collapse
Affiliation(s)
- Hanne Pallesen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, Aarhus University, Hammel, Denmark
| | - Maria Bjerk
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
| | - Asger Roer Pedersen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, Aarhus University, Hammel, Denmark
| | - Jørgen Feldbæk Nielsen
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, Aarhus University, Hammel, Denmark
| | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, RM, Aarhus University, Hammel, Denmark
| |
Collapse
|
20
|
Gao N, Guo T, Luo H, Tu G, Niu F, Yan M, Xia Y. Association of the MMP-9 polymorphism and ischemic stroke risk in southern Chinese Han population. BMC Neurol 2019; 19:67. [PMID: 30992065 PMCID: PMC6469199 DOI: 10.1186/s12883-019-1285-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 03/26/2019] [Indexed: 02/05/2023] Open
Abstract
Background Stroke is a serious cardiovascular disease and is also the leading cause of long-term disability in developing and developed countries. Because matrix metalloproteinase-9 (MMP-9) is associated with the risk of many cardiovascular diseases, we investigated the relationship between single nucleotide polymorphisms (SNPs) in MMP-9 and the risk of Ischemic stroke (IS) in a southern Chinese Han population. Methods This study included 250 stroke patients and 250 healthy controls. Genotyping was performed using the Agena MassARRAY system, and chi-squared tests and genetic models were used to evaluate the associations between MMP-9 SNPs and the risk of IS. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated by unconditional logistic regression adjusted for age. Results Polymorphism rs3787268 was associated with increased the risk of IS. Specifically, the genotype “G/A” significantly correlated with IS risk in the co-dominant model [odds ratio (OR) = 1.62; 95% confidence interval (CI) = 1.10–2.41; p = 0.035)], while genotypes “G/A” and “A/A” may increase the risk of IS based on the dominant model (OR = 1.62; 95% CI = 1.12–2.35; p = 0.0097). This SNP was also significantly associated with IS risk in the log-additive model (OR = 1.33; 95% CI = 1.03–1.70; p = 0.026). Conversely, haplotype “C/G” appears to reduce the risk of IS (OR = 0.71; 95% CI = 0.54–0.95; p = 0.019). Conclusions Our study showed that the rs3787268 locus in the MMP-9 gene may increase risk of IS in a southern Chinese Han population and thus provide insight into the IS pathogenesis.
Collapse
Affiliation(s)
- Ning Gao
- Department of Neurosurgery, Affiliated Haikou Hospital of Xiangya Medical College in Central South University, Haikou, Hainan, 570208, China
| | - Tie Guo
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Han Luo
- Department of Neurosurgery, Affiliated Haikou Hospital of Xiangya Medical College in Central South University, Haikou, Hainan, 570208, China
| | - Guolong Tu
- Department of Neurosurgery, Affiliated Haikou Hospital of Xiangya Medical College in Central South University, Haikou, Hainan, 570208, China
| | - Fanglin Niu
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi, China
| | - Mengdan Yan
- Key Laboratory of Resource Biology and Biotechnology in Western China, Northwest University, Ministry of Education, Xi'an, Shaanxi, China
| | - Ying Xia
- Department of Neurosurgery, Affiliated Haikou Hospital of Xiangya Medical College in Central South University, Haikou, Hainan, 570208, China.
| |
Collapse
|
21
|
The Effectiveness of Exercise on Cognitive Performance in Individuals with Known Vascular Disease: A Systematic Review. J Clin Med 2019; 8:jcm8030294. [PMID: 30832238 PMCID: PMC6463048 DOI: 10.3390/jcm8030294] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/23/2019] [Accepted: 02/24/2019] [Indexed: 12/11/2022] Open
Abstract
Patients with known vascular disease are at increased risk for cognitive impairments. Exercise has been shown to improve cognition in healthy elderly populations and those with mild cognitive impairments. We explored the literature to understand exercise as a modality to improve cognition in those with vascular disease, focusing on dose-responses. A systematic review was conducted through 2017 using Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Ovid Embase, and Ovid MEDLINE databases. Eligible studies examined effects of exercise on memory and cognition in cardiovascular (CVD) or cerebrovascular disease (CBVD). Data extracted included group characteristics, exercise dosage and outcomes measures employed. Twenty-two studies (12 CVD, 10 CBVD) met the inclusion criteria. Interventions included aerobic, resistance, or mixed training, with neuropsychological test batteries assessing cognition. In CVD populations, five studies demonstrated improved cardiovascular fitness and cognition with aerobic training, and another seven studies suggested a dose-response. In CBVD trials, four studies reported improved cognition, with no effects observed in the fifth study. Another study found enhanced cognition with resistance training and four demonstrated a positive association between functional capacity and cognition following combined aerobic and resistance training. Exercise is able to positively affect cognitive performance in those with known vascular disease. There is evidence to suggest a dose–response relationship. Further research is required to optimize prescription.
Collapse
|
22
|
Ofori EK, Frimpong E, Ademiluyi A, Olawale OA. Ergometer cycling improves the ambulatory function and cardiovascular fitness of stroke patients-a randomized controlled trial. J Phys Ther Sci 2019; 31:211-216. [PMID: 30936633 PMCID: PMC6428648 DOI: 10.1589/jpts.28.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/14/2016] [Indexed: 01/29/2023] Open
Abstract
[Purpose] The aim of this study was to assess the effects of ergometer cycling on the ambulatory function and cardiovascular fitness of patients with stroke in the sub-acute phase. [Participants and Methods] Twenty (20) patients with stroke in the sub-acute phase were randomly allocated to either an ergometer cycling group (n=10) or a control group (n=10). The experimental (ergometer cycling) group performed cycling exercises in addition to conventional physiotherapy for 60 minutes per session, three times per week for 8 weeks. The control group only received conventional physiotherapy for the same duration as the experimental group. Assessments of participants' functional ambulatory category, ambulatory velocity, 6-minute walk test, heart rate and blood pressure were conducted at baseline and at the end of the 8-week intervention. [Results] The means of the ambulatory velocity and distance walked in 6 minutes were significantly higher in the ergometer cycling group than those of the control group at week 8. However, the increase in the FAC score was not significant. The means of heart rate, systolic and diastolic blood pressures significantly decreased in the ergometer cycling group compared to the control group at the end of the 8-week of intervention. [Conclusion] This study demonstrated that ergometer cycling improved the ambulatory function and cardiovascular fitness of patients with stroke in the sub-acute phase.
Collapse
Affiliation(s)
- Ernest Kwesi Ofori
- Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois at Chicago, USA
| | - Emmanuel Frimpong
- Movement Physiology Research Laboratory, School of
Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg,
South Africa
| | - Adeolu Ademiluyi
- Department of Physical Therapy, College of Applied Health
Sciences, University of Illinois at Chicago, USA
| | - Olajide Ayinla Olawale
- Department of Physiotherapy, Faculty of Clinical Sciences,
College of Medicine, University of Lagos, Nigeria
| |
Collapse
|
23
|
Ploughman M, Eskes GA, Kelly LP, Kirkland MC, Devasahayam AJ, Wallack EM, Abraha B, Hasan SMM, Downer MB, Keeler L, Wilson G, Skene E, Sharma I, Chaves AR, Curtis ME, Bedford E, Robertson GS, Moore CS, McCarthy J, Mackay-Lyons M. Synergistic Benefits of Combined Aerobic and Cognitive Training on Fluid Intelligence and the Role of IGF-1 in Chronic Stroke. Neurorehabil Neural Repair 2019; 33:199-212. [PMID: 30816066 DOI: 10.1177/1545968319832605] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Paired exercise and cognitive training have the potential to enhance cognition by "priming" the brain and upregulating neurotrophins. METHODS Two-site randomized controlled trial. Fifty-two patients >6 months poststroke with concerns about cognitive impairment trained 50 to 70 minutes, 3× week for 10 weeks with 12-week follow-up. Participants were randomized to 1 of 2 physical interventions: Aerobic (>60% VO2peak using <10% body weight-supported treadmill) or Activity (range of movement and functional tasks). Exercise was paired with 1 of 2 cognitive interventions (computerized dual working memory training [COG] or control computer games [Games]). The primary outcome for the 4 groups (Aerobic + COG, Aerobic + Games, Activity + COG, and Activity + Games) was fluid intelligence measured using Raven's Progressive Matrices Test administered at baseline, posttraining, and 3-month follow-up. Serum neurotrophins collected at one site (N = 30) included brain-derived neurotrophic factor (BDNF) at rest (BDNFresting) and after a graded exercise test (BDNFresponse) and insulin-like growth factor-1 at the same timepoints (IGF-1rest, IGF-1response). RESULTS At follow-up, fluid intelligence scores significantly improved compared to baseline in the Aerobic + COG and Activity + COG groups; however, only the Aerobic + COG group was significantly different (+47.8%) from control (Activity + Games -8.5%). Greater IGF-1response at baseline predicted 40% of the variance in cognitive improvement. There was no effect of the interventions on BDNFresting or BDNFresponse; nor was BDNF predictive of the outcome. CONCLUSIONS Aerobic exercise combined with cognitive training improved fluid intelligence by almost 50% in patients >6 months poststroke. Participants with more robust improvements in cognition were able to upregulate higher levels of serum IGF-1 suggesting that this neurotrophin may be involved in behaviorally induced plasticity.
Collapse
Affiliation(s)
- Michelle Ploughman
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Gail A Eskes
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Liam P Kelly
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Megan C Kirkland
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | | | - Elizabeth M Wallack
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Beraki Abraha
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - S M Mahmudul Hasan
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Matthew B Downer
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Laura Keeler
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Graham Wilson
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Elaine Skene
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Ishika Sharma
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | - Arthur R Chaves
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Marie E Curtis
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Emily Bedford
- 2 Dalhousie University, Halifax, Nova Scotia, Canada NL, Canada
| | | | - Craig S Moore
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Jason McCarthy
- 1 Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | | |
Collapse
|
24
|
Unibaso-Markaida I, Iraurgi I, Ortiz-Marqués N, Amayra I, Martínez-Rodríguez S. Effect of the Wii Sports Resort on the improvement in attention, processing speed and working memory in moderate stroke. J Neuroeng Rehabil 2019; 16:32. [PMID: 30819204 PMCID: PMC6394083 DOI: 10.1186/s12984-019-0500-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/17/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Stroke is the most common neurological disease in the world. After the stroke, some people suffer a cognitive disability. Commercial videogames have been used after stroke for physical rehabilitation; however, their use in cognitive rehabilitation has hardly been studied. The objectives of this study were to analyze attention, processing speed, and working memory in patients with moderate stroke after an intervention with Wii Sports Resort and compared these results with a control group. METHODS A pre-post design study was conducted with 30 moderate stroke patients aged 65 ± 15. The study lasted eight weeks. 15 participated in the intervention group and 15 belong to the control group. They were assessed in attention and processing speed (TMT-A and B) and working memory (Digit Span of WAIS-III). Parametric and effect size tests were used to analyze the improvement of those outcomes and compared both groups. RESULTS At the baseline, there was no difference between TMT-A and B. A difference was found in the scalar score of TMT-B, as well as in Digit Backward Span and Total Digit Task. In TMT-A and B, the intervention group had better scores than the control group. The intervention group in the Digit Forward Span and the Total Digit obtained a moderate effect size and the control group also obtained a moderate effect size in Total Digit. In the Digit scalar scores, the control group achieved better results than the intervention group. CONCLUSIONS The results on attention, processing speed and working memory improved in both groups. However, according to the effect sizes, the intervention group achieved better results than the control group. In addition, the attention and processing speed improved more than the working memory after the intervention. Although more studies are needed in this area, the results are encouraging for cognitive rehabilitation after stroke.
Collapse
Affiliation(s)
- Iratxe Unibaso-Markaida
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Ioseba Iraurgi
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Nuria Ortiz-Marqués
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Imanol Amayra
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| | - Silvia Martínez-Rodríguez
- Faculty of Psychology at University of Deusto (Office DARC 1 BIS), 24 Avda. Universidades, 48007 Bilbao, Basque Country Spain
| |
Collapse
|
25
|
Johnson L, Werden E, Shirbin C, Bird L, Landau E, Cumming T, Churilov L, Bernhardt JA, Thijs V, Brodtmann A. The Post Ischaemic Stroke Cardiovascular Exercise Study: Protocol for a randomised controlled trial of fitness training for brain health. Eur Stroke J 2018; 3:379-386. [PMID: 31236486 PMCID: PMC6571508 DOI: 10.1177/2396987318785845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/05/2018] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Compared to healthy individuals, stroke patients have five times the rate of dementia diagnosis within three years. Aerobic exercise may induce neuroprotective mechanisms that help to preserve, and even increase, brain volume and cognition. We seek to determine whether aerobic fitness training helps to protect brain volume and cognitive function after stroke compared to an active, non-aerobic control. METHODS In this Phase IIb, single blind, randomised controlled trial, 100 ischaemic stroke participants, recruited at two months post-stroke, will be randomly allocated to either the intervention (aerobic and strength exercise) or active control (stretching and balance training). Participants will attend one-hour, individualised exercise sessions, three days-per-week for eight weeks. Assessments at two months (baseline), four months (post-intervention), and one year (follow-up) post-stroke will measure brain volume, cognition, mood, cardiorespiratory fitness, physical activity, blood pressure and blood biomarkers.Study outcome: Our primary outcome measure is hippocampal volume at four months after stroke. We hypothesise that participants who undertake the prescribed intervention will have preserved hippocampal volume at four months compared to the control group. We also hypothesise that this group will have preserved total brain volume and cognition, better mood, fitness, and higher levels of physical activity, than those receiving stretching and balance training. DISCUSSION The promise of exercise training to prevent, or slow, the accelerated rates of brain atrophy and cognitive decline experienced by stroke survivors needs to be tested. Post Ischaemic Stroke Cardiovascular Exercise Study has the potential, if proven efficacious, to identify a new treatment that could be readily translated to the clinic.
Collapse
Affiliation(s)
- Liam Johnson
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
- Faculty of Health Sciences, Australian Catholic University,
Melbourne, Australia
| | - Emilio Werden
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
| | - Chris Shirbin
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
| | - Laura Bird
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
| | - Elizabeth Landau
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
| | - Toby Cumming
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
| | - Leonid Churilov
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
| | - Julie A Bernhardt
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
| | - Vincent Thijs
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
- Neurology Department, University of Melbourne, Heidelberg,
Australia
| | - Amy Brodtmann
- The Florey Institute of Neuroscience and Mental Health,
Heidelberg, Australia
- Neurology Department, University of Melbourne, Heidelberg,
Australia
| |
Collapse
|
26
|
Malá H, Rasmussen CP. The effect of combined therapies on recovery after acquired brain injury: Systematic review of preclinical studies combining enriched environment, exercise, or task-specific training with other therapies. Restor Neurol Neurosci 2018; 35:25-64. [PMID: 27858724 DOI: 10.3233/rnn-160682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acquired brain injuries (ABI) have devastating effects for the affected individual as well as society. Many studies have investigated the effect of different monotherapies. However, functional recovery is typically only partial. One possible strategy to promote a greater degree of recovery is to apply monotherapies in combination with one or more treatments. OBJECTIVE The objective of this systematic review is to investigate if approaches combining enriched environment (EE), exercise, or task-specific training with other monotherapies, further enhance the degree of recovery after ABI. METHOD Scopus, PsychINFO, and PubMed databases were searched in March 2016 with the following search strings: exercise (or) enriched environment (or) environmental enrichment (or) rehabilitation (and) traumatic brain injury (or) ischemia (or) stroke (and) rat (or) rodent. Studies were included if they (1) were in English, (2) used adult animals subjected to brain injury, (3) included EE, and/or exercise, and/or task-specific training as post-injury treatment strategies, (4) included at least one group receiving another monotherapy. Out of 2.168 hits, 29 studies fulfilled the inclusion criteria. RESULTS Despite several trends for enhanced recovery after combined therapies, this systematic review of 29 studies does not indicate that combined therapies confer consistent combined effects on motor, cognitive, or cerebral recovery according to present criteria for combined effect. CONCLUSION Combined treatments continue to provide hope for enhanced recovery after ABI, however, the research area is in its infancy. This systematic review does not provide conclusive evidence. This is likely due to sparse knowledge regarding optimal treatment parameters. Combined treatments, however, hold the best promise regarding treatment of the complex changes induced by ABI.
Collapse
|
27
|
Harnish SM, Rodriguez AD, Blackett DS, Gregory C, Seeds L, Boatright JH, Crosson B. Aerobic Exercise as an Adjuvant to Aphasia Therapy: Theory, Preliminary Findings, and Future Directions. Clin Ther 2017; 40:35-48.e6. [PMID: 29277374 DOI: 10.1016/j.clinthera.2017.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE This study investigated whether participation in aerobic exercise enhances the effects of aphasia therapy, and the degree to which basal serum brain-derived neurotropic factor (BDNF) concentrations fluctuate after the beginning of aerobic exercise or stretching activities in individuals with poststroke aphasia. METHODS The study used a single-subject, multiple-baseline design. Seven individuals with chronic poststroke aphasia participated in 2 Blocks of aphasia therapy: aphasia therapy alone (Block 1), followed by aphasia therapy with the addition of aerobic activity via bicycle ergometer (n = 5) or stretching (n = 2) (Block 2). Serum BDNF concentrations from blood draws were analyzed in 4 participants who exercised and in 1 participant who stretched. FINDINGS Three of the five exercise participants demonstrated larger Tau-U effects when aphasia therapy was paired with aerobic exercise, whereas 1 of the 2 stretching participants demonstrated a larger effect size when aphasia therapy was paired with stretching. Group-level comparisons revealed a greater overall increase in effect size in the aerobic exercise group, as indicated by differences in Tau-U weighted means. BDNF data showed that all 4 exercise participants demonstrated a decrease in BDNF concentrations during the first 6 weeks of exercise and an increase in BDNF levels near or at baseline during the last 6 weeks of exercise. The stretching participant did not show the same pattern. IMPLICATIONS Additional research is needed to understand the mechanism of effect and to identify the factors that mediate response to exercise interventions, specifically the optimal dose of exercise and timing of language intervention with exercise. ClinicalTrials.gov identifier: NCT01113879.
Collapse
Affiliation(s)
- Stacy M Harnish
- Department of Speech and Hearing Science, The Ohio State University, Columbus, Ohio.
| | - Amy D Rodriguez
- Atlanta VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia
| | | | - Christopher Gregory
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Lauren Seeds
- Department of Physical Therapy, Brooks Rehabilitation, Jacksonville, Florida
| | - Jeffrey H Boatright
- Atlanta VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia; Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Bruce Crosson
- Atlanta VA RR&D Center for Visual and Neurocognitive Rehabilitation, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Psychology, Georgia State University, Atlanta, Georgia
| |
Collapse
|
28
|
The Effect of Aerobic Exercise on Brain-Derived Neurotrophic Factor in People with Neurological Disorders: A Systematic Review and Meta-Analysis. Neural Plast 2017; 2017:4716197. [PMID: 29057125 PMCID: PMC5625797 DOI: 10.1155/2017/4716197] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/09/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To determine the effect of aerobic exercise on brain-derived neurotrophic factor (BDNF) levels in people with neurological disorders. DATA SOURCES Six electronic databases (CINAHL, PubMed, Cochrane, PsycINFO, SportDiscus, and Web of Science) were searched until the end of December 2016. STUDY SELECTION Experimental or observational studies of people with neurological disorders who undertook an exercise intervention with BDNF as an outcome measure. The search strategy yielded 984 articles. DATA EXTRACTION Study data were independently extracted from each article. Methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. A meta-analysis was planned based on the assessment of predetermined criteria. DATA SYNTHESIS Eleven articles were included. Studies employed either a program of aerobic exercise, a single bout of aerobic exercise, or both. A meta-analysis of studies comparing a program of aerobic exercise against usual care/nil therapy showed a large effect (SMD: 0.84, 95% CI 0.47-1.20, p < 0.001) in favour of aerobic exercise to increase levels of BDNF. Findings for a single bout of aerobic exercise were mixed. Quality of studies was low (PEDro average score 4.3/10). CONCLUSIONS A program of aerobic exercise may contribute to increased levels of BDNF in neurological populations.
Collapse
|
29
|
Cucarián JD, León LA, Luna GA, Torres MR, Corredor K, Cardenas P. F. CARACTERIZACIÓN TEMPORO-ESPACIAL DEL PATRÓN DE MARCHA EN ROEDORES COMO MODELO ANIMAL DE LESIÓN CEREBRAL CEREBROVASCULAR. ACTA BIOLÓGICA COLOMBIANA 2017. [DOI: 10.15446/abc.v22n3.65244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
En la investigación sobre movimiento, la experimentación animal ha proporcionado fundamentación científica para la investigación clínica, mejorando procedimientos diagnósticos y de rehabilitación. Lesiones cerebrales en roedores pueden ser usadas para modelar síntomas locomotores, sensoriales y/o cognitivos. Con el propósito de determinar la funcionalidad locomotriz y sensorial en roedores, se han propuesto varios métodos de evaluación y pronóstico clínico para identificar y evaluar adaptaciones estructurales y mecanismos de neuro-recuperación. Esto ha permitido que métodos de intervención terapéutica, como el ejercicio físico, sean utilizados para restaurar funciones sensitivo-motoras y cognitivas en roedores y humanos. La extrapolación (translación) de los resultados de investigaciones en ciencias básicas a áreas clínicas supone la continua cooperación y retroalimentación entre investigadores y profesionales de la salud, favoreciendo la formulación de intervenciones terapéuticas más eficaces basadas en resultados obtenidos de la experimentación animal. El objetivo de esta revisión es exponer las principales deficiencias motoras y los métodos empleados para determinar la dificultad motriz en la marcha en roedores con lesión cerebrovascular, para lo cual se realizó una revisión de literatura, sobre términos definidos (MeSH), en las bases de datos PsychINFO, Medline y Web of Science, entre enero de 2000 y enero de 2017. Se excluyeron artículos de carácter cualitativo o narrativo, sin revisión por pares, disertaciones, tesis o trabajos de grado y resúmenes de conferencias. Se revisan algunas manifestaciones clínicas, su efecto en la locomotricidad en roedores, algunas metodologías usadas para generar lesiones y para estudiar la función motriz, los principales métodos de medición y algunos aspectos translacionales.
Collapse
|
30
|
The influence of high intensity exercise and the Val66Met polymorphism on circulating BDNF and locomotor learning. Neurobiol Learn Mem 2017; 144:77-85. [PMID: 28668279 DOI: 10.1016/j.nlm.2017.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/04/2017] [Accepted: 06/20/2017] [Indexed: 11/21/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) has been directly related to exercise-enhanced motor performance in the neurologically injured animal model; however literature concerning the role of BDNF in the enhancement of motor learning in the human population is limited. Previous studies in healthy subjects have examined the relationship between intensity of an acute bout of exercise, increases in peripheral BDNF and motor learning of a simple isometric upper extremity task. The current study examined the role of high intensity exercise on upregulation of peripheral BDNF levels as well as the role of high intensity exercise in mediation of motor learning and retention of a novel locomotor task in neurologically intact adults. In addition, the impact of a single nucleotide polymorphism in the BDNF gene (Val66Met) in moderating the relationship between exercise and motor learning was explored. It was hypothesized that participation in high intensity exercise prior to practicing a novel walking task (split-belt treadmill walking) would elicit increases in peripheral BDNF as well as promote an increased rate and magnitude of within session learning and retention on a second day of exposure to the walking task. Within session learning and retention would be moderated by the presence or absence of Val66Met polymorphism. Fifty-four neurologically intact participants participated in two sessions of split-belt treadmill walking. Step length and limb phase were measured to assess learning of spatial and temporal parameters of walking. Serum BDNF was collected prior to and immediately following either high intensity exercise or 5min of quiet rest. The results demonstrated that high intensity exercise provides limited additional benefit to learning of a novel locomotor pattern in neurologically intact adults, despite increases in circulating BDNF. In addition, presence of a single nucleotide polymorphism on the BDNF gene did not moderate the magnitude of serum BDNF increases with high intensity exercise, nor did it moderate the relationship between high intensity exercise and locomotor learning.
Collapse
|
31
|
Vanderbeken I, Kerckhofs E. A systematic review of the effect of physical exercise on cognition in stroke and traumatic brain injury patients. NeuroRehabilitation 2017; 40:33-48. [PMID: 27814304 DOI: 10.3233/nre-161388] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine whether physical exercise enhances cognition following TBI or stroke. DATA SOURCES Studies were identified through searches of PubMed, ScienceDirect and the reference lists of papers that were included for full-text evaluation. Medical subject headings from three concepts, i.e. brain injury, physical exercise and cognition, were used to incorporate related search terms. STUDY SELECTION Included were all trials published in English that assessed cognition before and after an exercise intervention in human adults with TBI or stroke. Nine randomized and two non-randomized controlled trials, as well as three single group pre-post studies were included. DATA EXTRACTION Relevant data concerning the methods and results of the included studies were extracted. Methodological quality of the RCT's was evaluated using the PEDro scale. Non-randomized trials were assessed using the Downs and Black checklist. DATA SYNTHESIS The included trials were generally of medium methodological quality, though often plagued with issues of internal and external validity. The studies exhibited great heterogeneity, rendering a meta-analysis infeasible. CONCLUSIONS Though well-designed studies are still needed, the preponderance of evidence suggests a positive effect of physical exercise on global cognitive functioning, especially in the chronic stages of a brain injury. Time after injury as well as the duration of the exercise program are mediating factors.
Collapse
Affiliation(s)
- Ines Vanderbeken
- Rehabilitation Center Acquired Brain Injuries Turnhout, Turnhout, Belgium
| | - Eric Kerckhofs
- Center for Neurosciences, Vrije Universiteit Brussels, Brussels, Belgium.,Psychology and Educational Sciences, Vrije Universiteit Brussels, Brussels, Belgium
| |
Collapse
|
32
|
Alkadhi KA. Exercise as a Positive Modulator of Brain Function. Mol Neurobiol 2017; 55:3112-3130. [PMID: 28466271 DOI: 10.1007/s12035-017-0516-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 04/04/2017] [Indexed: 12/24/2022]
Abstract
Various forms of exercise have been shown to prevent, restore, or ameliorate a variety of brain disorders including dementias, Parkinson's disease, chronic stress, thyroid disorders, and sleep deprivation, some of which are discussed here. In this review, the effects on brain function of various forms of exercise and exercise mimetics in humans and animal experiments are compared and discussed. Possible mechanisms of the beneficial effects of exercise including the role of neurotrophic factors and others are also discussed.
Collapse
Affiliation(s)
- Karim A Alkadhi
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX, 77204, USA.
| |
Collapse
|
33
|
Cardiorespiratory fitness and cognitive functioning following short-term interventions in chronic stroke survivors with cognitive impairment: a pilot study. Int J Rehabil Res 2017; 39:153-9. [PMID: 26954991 DOI: 10.1097/mrr.0000000000000161] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study, a quasi-experimental, one-group pretest-post-test design, evaluated the effects on cognitive functioning and cardiorespiratory fitness of 8-week interventions (aerobic exercise alone and aerobic exercise and cognitive training combined) in patients with chronic stroke and cognitive impairment living in the community (participants: n=14, 61.93±9.90 years old, 51.50±38.22 months after stroke, n=7 per intervention group). Cognitive functions and cardiorespiratory fitness were evaluated before and after intervention, and at a 3-month follow-up visit (episodic memory: revised-Hopkins Verbal Learning Test; working memory: Brown-Peterson paradigm; attention omission and commission errors: Continuous Performance Test; cardiorespiratory fitness: peak oxygen uptake during a symptom-limited, graded exercise test performed on a semirecumbent ergometer). Friedman's two-way analysis of variance by ranks evaluated differences in score distributions related to time (for the two groups combined). Post-hoc testing was adjusted for multiple comparisons. Compared with before the intervention, there was a significant reduction in attention errors immediately following the intervention (omission errors: 14.6±21.5 vs. 8±13.9, P=0.01; commission errors: 16.4±6.3 vs. 10.9±7.2, P=0.04), and in part at follow-up (omission errors on follow-up: 3.4±4.3, P=0.03; commission errors on follow-up: 13.2±7.6, P=0.42). These results suggest that attention may improve in chronic stroke survivors with cognitive impairment following short-term training that includes an aerobic component, without a change in cardiorespiratory fitness. Randomized-controlled studies are required to confirm these findings.
Collapse
|
34
|
Han P, Zhang W, Kang L, Ma Y, Fu L, Jia L, Yu H, Chen X, Hou L, Wang L, Yu X, Kohzuki M, Guo Q. Clinical Evidence of Exercise Benefits for Stroke. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1000:131-151. [PMID: 29098620 DOI: 10.1007/978-981-10-4304-8_9] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Even though stroke is the third, not the first, most common cause of disability-adjusted life years in developed countries, it is one of the most expensive to treat. Part of the expense is due to secondary problems in the post-stroke period including: cognition, memory, attention span, pain, sensation loss, psychological issues, and problems with mobility and balance. Research has identified that exercise has both positive physical and psychosocial effects for post-stroke patients. Therefore, this scientific statement provides an overview on exercise rehabilitation for post-stroke patients.We will use systematic literature reviews, clinical and epidemiology reports, published morbidity and mortality studies, clinical and public health guidelines, patient files, and authoritative statements to support this overview.Evidence clearly supports the use of various kinds of exercise training (e.g., aerobic, strength, flexibility, neuromuscular, and traditional Chinese exercise) for stroke survivors. Aerobic exercise, the main form of cardiac rehabilitation, may play an important role in improving aerobic fitness, cardiovascular fitness, cognitive abilities, walking speed and endurance, balance, quality of life, mobility, and other health outcomes among stroke patients. Strength exercise, included in national stroke guidelines and recommended for general health promotion for stroke survivors, can lead to improvements in functionality, psychosocial aspects, and quality of life for post-stroke patients. Flexibility exercises can relieve muscle spasticity problems, improve motor function, range of motion, and prevent contractures. Stretching exercises can also prevent joint contractures, muscle shortening, decrease spasticity, reduce joint stiffness and improve a post-stroke patient's overall function. Neuromuscular exercises can improve activities of daily living (ADL) through coordination and balance activities. Traditional Chinese exercises are used to improve walking and balance ability as well as increase muscle strength, which is important for post-stroke patients.The present evidence strongly supports the power of exercise for post-stroke patients, which in this study combined aerobic exercises, strength training, flexibility exercises, neuromuscular exercises, and traditional Chinese exercises. This research can encourage post-stroke survivors to consider the importance of exercise in the rehabilitation process.
Collapse
Affiliation(s)
- Peipei Han
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China.,Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Wen Zhang
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Li Kang
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Yixuan Ma
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Liyuan Fu
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Liye Jia
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Hairui Yu
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Lin Hou
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Lu Wang
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Xing Yu
- Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Qi Guo
- Department of Rehabilitation Medicine, TEDA International Cardiovascular Hospital, Cardiovascular Clinical College of Tianjin Medical University, Tianjin, China. .,Department of Rehabilitation Medicine, Tianjin Medical University, Tianjin, China.
| |
Collapse
|
35
|
Morrison JD, Mayer L. Physical activity and cognitive function in adults with multiple sclerosis: an integrative review. Disabil Rehabil 2016; 39:1909-1920. [PMID: 27764974 DOI: 10.1080/09638288.2016.1213900] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE To identify and synthesize the research evidence concerning (1) the relationship between physical activity and cognitive performance in persons with multiple sclerosis (MS) and (2) to review the reported effects of physical activity interventions on neurocognitive performance conducted in this population. METHODS Relevant peer-reviewed journal articles were identified by searching PubMed, PsychINFO, and SPORTDiscus through May 2016. Full-text articles meeting the inclusion criteria were evaluated for quality using tools developed by the National Institutes of Health. Studies deemed to be of poor quality were excluded from the review. RESULTS Nineteen studies meeting the inclusion/exclusion criteria were analyzed. Nine studies reported significant relationships between higher levels of physical activity or cardiorespiratory fitness and measures of cognitive function. Data extracted from 10 physical activity intervention studies reported mixed results on the effectiveness of physical activity to improve selected domains of cognitive function in persons with MS. CONCLUSION Although correlational studies provide evidence to support a linkage between physical activity and cognitive function in persons with MS, this linkage is confounded by factors that may have influenced the studies' results. Evidence derived from intervention studies that could support a positive effect of physical activity on cognition in persons with MS is equivocal. Implications for Rehabilitation Physical activity has numerous benefits for persons with multiple sclerosis (MS) including improvements in balance, ambulation, depression, fatigue, and quality of life. Structured physical activity programs may contribute to cognitive function stability or improvement in persons with MS.
Collapse
Affiliation(s)
- Janet D Morrison
- a School of Nursing , the University of Texas at Austin , Austin , TX , USA
| | - Lori Mayer
- b Central Texas Neurology Consultants , MS Clinic of Central Texas , Round Rock , TX , USA
| |
Collapse
|
36
|
Aerobic Exercises for Cognition Rehabilitation following Stroke: A Systematic Review. J Stroke Cerebrovasc Dis 2016; 25:2780-2789. [PMID: 27554073 DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.035] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/18/2016] [Accepted: 07/22/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cognitive impairments are highly prevalent in stroke survivors and can substantially affect their physical rehabilitation and quality of life. The management of these impairments currently remains limited, but increasing studies reported the effect of aerobic exercise on cognitive performance in patients suffering from stroke. The purpose of this review was to assess the effects of aerobic exercise on cognitive function following stroke. METHODS Seven electronic databases (China National Knowledge Infrastructure [CNKI], Chinese Science and Technology Periodical Database [VIP], Wanfang, China Biology Medicine disc [CBM], Science Citation Index [SCI], EMBASE, and PubMed) were searched from their inception to May 31, 2015, for the effects of aerobic exercise on cognitive ability compared to usual physical activity in stroke survivors. RevMan V5.3 (The Nordic Cochrane Centre) was used to analyze the data and to evaluate the methodological quality of the included studies. RESULTS Ten eligible studies including 394 participants were identified. Six studies showed that aerobic exercise significantly improved global cognitive ability in stroke survivors. Four studies reported aerobic exercise to be beneficial in improving memory, but only one showed statistical significance. Two studies investigated the effects of aerobic exercise on attention, and one showed a significant improvement. One study reported a significant benefit of aerobic exercise on visuospatial ability in stroke survivors. No adverse events were reported in the included studies. CONCLUSIONS Aerobic exercise may have a positive effect on improving global cognitive ability and a potential benefit on memory, attention, and the visuospatial domain of cognition in stroke survivors. However, further large, rigorously designed trials are needed to confirm these findings.
Collapse
|
37
|
Constans A, Pin-Barre C, Temprado JJ, Decherchi P, Laurin J. Influence of Aerobic Training and Combinations of Interventions on Cognition and Neuroplasticity after Stroke. Front Aging Neurosci 2016; 8:164. [PMID: 27445801 PMCID: PMC4928497 DOI: 10.3389/fnagi.2016.00164] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/21/2016] [Indexed: 12/17/2022] Open
Abstract
Stroke often aggravated age-related cognitive impairments that strongly affect several aspects of quality of life. However, few studies are, to date, focused on rehabilitation strategies that could improve cognition. Among possible interventions, aerobic training is well known to enhance cardiovascular and motor functions but may also induce beneficial effects on cognitive functions. To assess the effectiveness of aerobic training on cognition, it seems necessary to know whether training promotes the neuroplasticity in brain areas involved in cognitive functions. In the present review, we first explore in both human and animal how aerobic training could improve cognition after stroke by highlighting the neuroplasticity mechanisms. Then, we address the potential effect of combinations between aerobic training with other interventions, including resistance exercises and pharmacological treatments. In addition, we postulate that classic recommendations for aerobic training need to be reconsidered to target both cognition and motor recovery because the current guidelines are only focused on cardiovascular and motor recovery. Finally, methodological limitations of training programs and cognitive function assessment are also developed in this review to clarify their effectiveness in stroke patients.
Collapse
Affiliation(s)
| | - Caroline Pin-Barre
- Aix-Marseille Université, CNRS, ISM, UMR 7287Marseille, France; Université Nice Sophia Antipolis, LAMHESS, UPRES EA 6309Nice, France
| | | | | | - Jérôme Laurin
- Aix-Marseille Université, CNRS, ISM, UMR 7287 Marseille, France
| |
Collapse
|
38
|
Fernandez-Gonzalo R, Fernandez-Gonzalo S, Turon M, Prieto C, Tesch PA, García-Carreira MDC. Muscle, functional and cognitive adaptations after flywheel resistance training in stroke patients: a pilot randomized controlled trial. J Neuroeng Rehabil 2016; 13:37. [PMID: 27052303 PMCID: PMC4823904 DOI: 10.1186/s12984-016-0144-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 04/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Resistance exercise (RE) improves neuromuscular function and physical performance after stroke. Yet, the effects of RE emphasizing eccentric (ECC; lengthening) actions on muscle hypertrophy and cognitive function in stroke patients are currently unknown. Thus, this study explored the effects of ECC-overload RE training on skeletal muscle size and function, and cognitive performance in individuals with stroke. METHODS Thirty-two individuals with chronic stroke (≥6 months post-stroke) were randomly assigned into a training group (TG; n = 16) performing ECC-overload flywheel RE of the more-affected lower limb (12 weeks, 2 times/week; 4 sets of 7 maximal closed-chain knee extensions; <2 min of contractile activity per session) or a control group (CG; n = 16), maintaining daily routines. Before and after the intervention, quadriceps femoris volume, maximal force and power for each leg were assessed, and functional and dual task performance, and cognitive functions were measured. RESULTS Quadriceps femoris volume of the more-affected leg increased by 9.4 % in TG. Muscle power of the more-affected, trained (48.2 %), and the less-affected, untrained limb (28.1 %) increased after training. TG showed enhanced balance (8.9 %), gait performance (10.6 %), dual-task performance, executive functions (working memory, verbal fluency tasks), attention, and speed of information processing. CG showed no changes. CONCLUSION ECC-overload flywheel resistance exercise comprising 4 min of contractile activity per week offers a powerful aid to regain muscle mass and function, and functional performance in individuals with stroke. While the current intervention improved cognitive functions, the cause-effect relationship, if any, with the concomitant neuromuscular adaptations remains to be explored. TRIAL REGISTRATION Clinical Trials NCT02120846.
Collapse
Affiliation(s)
| | - Sol Fernandez-Gonzalo
- Research Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Marc Turon
- Research Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Prieto
- Department of Radiology, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain.,Diagnostic Imaging, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Per A Tesch
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Maria del Carmen García-Carreira
- Department of Neurology, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT. Universitat Autònoma de Barcelona, Sabadell, Spain
| |
Collapse
|
39
|
Landsmann B, Pinter D, Pirker E, Pichler G, Schippinger W, Weiss EM, Mathie G, Gattringer T, Fazekas F, Enzinger C. An exploratory intervention study suggests clinical benefits of training in chronic stroke to be paralleled by changes in brain activity using repeated fMRI. Clin Interv Aging 2016; 11:97-103. [PMID: 26869779 PMCID: PMC4734728 DOI: 10.2147/cia.s95632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Previous studies demonstrated changes in sensorimotor network activation over time after stroke that have been interpreted as partly compensatory. Locomotor and balance trainings may improve both mobility and cognition even in chronic stroke and thereby impact on cerebral activation patterns. We here aimed at testing these assumptions in an exploratory study to inform subsequent larger intervention studies. Patients and methods Eight patients (73.3±4.4 years) with a chronic lacunar stroke (mean interval 3.7 years after the acute event with a range from 2 to 4 years) and residual leg paresis leading to gait disturbance received a guided 5-week training focusing on mobility, endurance, and coordination. Before and afterward, they underwent clinical, neuropsychological, and gait assessments and brain MRI at 3 T including a functional ankle movement paradigm. Sixteen healthy controls (HCs; 68.8±5.4 years) followed the same protocol without intervention. Results After training, patients had improved in mobility, memory, and delayed recall of memory. While cerebral activations in HC remained completely unaltered, patients showed increased activations in the right precentral gyrus, the right and left superior frontal gyri, and the right frontal lobe, with bipedal ankle movements after training. Conclusion In this exploratory study of chronic stroke, we found not only significant effects of physical training on mobility but also distinct aspects of cognition already with a small number of highly selected patients. These improvements were paralleled by alterations in cerebral activity possibly reflecting neuronal plasticity. Larger studies including randomization are needed.
Collapse
Affiliation(s)
- Barbara Landsmann
- Institute of Psychology, University of Graz, Graz, Austria; Department of Neurology, Medical University of Graz, Graz, Austria
| | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Eva Pirker
- Institute of Psychology, University of Graz, Graz, Austria; Department of Neurology, Medical University of Graz, Graz, Austria
| | | | | | | | - Gabriel Mathie
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | - Franz Fazekas
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria; Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| |
Collapse
|
40
|
Hasan SMM, Rancourt SN, Austin MW, Ploughman M. Defining Optimal Aerobic Exercise Parameters to Affect Complex Motor and Cognitive Outcomes after Stroke: A Systematic Review and Synthesis. Neural Plast 2016; 2016:2961573. [PMID: 26881101 PMCID: PMC4736968 DOI: 10.1155/2016/2961573] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/27/2015] [Accepted: 11/29/2015] [Indexed: 01/21/2023] Open
Abstract
Although poststroke aerobic exercise (AE) increases markers of neuroplasticity and protects perilesional tissue, the degree to which it enhances complex motor or cognitive outcomes is unknown. Previous research suggests that timing and dosage of exercise may be important. We synthesized data from clinical and animal studies in order to determine optimal AE training parameters and recovery outcomes for future research. Using predefined criteria, we included clinical trials of stroke of any type or duration and animal studies employing any established models of stroke. Of the 5,259 titles returned, 52 articles met our criteria, measuring the effects of AE on balance, lower extremity coordination, upper limb motor skills, learning, processing speed, memory, and executive function. We found that early-initiated low-to-moderate intensity AE improved locomotor coordination in rodents. In clinical trials, AE improved balance and lower limb coordination irrespective of intervention modality or parameter. In contrast, fine upper limb recovery was relatively resistant to AE. In terms of cognitive outcomes, poststroke AE in animals improved memory and learning, except when training was too intense. However, in clinical trials, combined training protocols more consistently improved cognition. We noted a paucity of studies examining the benefits of AE on recovery beyond cessation of the intervention.
Collapse
Affiliation(s)
- S. M. Mahmudul Hasan
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| | - Samantha N. Rancourt
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| | - Mark W. Austin
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| | - Michelle Ploughman
- Recovery & Performance Laboratory, Faculty of Medicine, Memorial University, L.A. Miller Centre, Room 400, 100 Forest Road, St. John's, NL, Canada A1A 1E5
| |
Collapse
|
41
|
Billinger SA, Boyne P, Coughenour E, Dunning K, Mattlage A. Does aerobic exercise and the FITT principle fit into stroke recovery? Curr Neurol Neurosci Rep 2015; 15:519. [PMID: 25475494 DOI: 10.1007/s11910-014-0519-8] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Sedentary lifestyle after stroke is common which results in poor cardiovascular health. Aerobic exercise has the potential to reduce cardiovascular risk factors and improve functional capacity and quality of life in people after stroke. However, aerobic exercise is a therapeutic intervention that is underutilized by healthcare professionals after stroke. The purpose of this review paper is to provide information on exercise prescription using the FITT principle (frequency, intensity, time, type) for people after stroke and to guide healthcare professionals to incorporate aerobic exercise into the plan of care. This article discusses the current literature outlining the evidence base for incorporating aerobic exercise into stroke rehabilitation. Recently, high-intensity interval training has been used with people following stroke. Information is provided regarding the early but promising results for reaching higher target heart rates.
Collapse
Affiliation(s)
- Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, KU Medical Center, 3901 Rainbow Blvd MS 2002, Kansas City, KS, 66160, USA,
| | | | | | | | | |
Collapse
|
42
|
Gäverth J, Parker R, MacKay-Lyons M. Exercise Stress Testing After Stroke or Transient Ischemic Attack: A Scoping Review. Arch Phys Med Rehabil 2015; 96:1349-1359.e12. [DOI: 10.1016/j.apmr.2015.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/02/2015] [Accepted: 03/15/2015] [Indexed: 10/23/2022]
|
43
|
Sandroff BM, Hillman CH, Motl RW. Aerobic fitness is associated with inhibitory control in persons with multiple sclerosis. Arch Clin Neuropsychol 2015; 30:329-40. [PMID: 25910783 DOI: 10.1093/arclin/acv022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2015] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is highly prevalent, disabling, and poorly managed in persons with multiple sclerosis (MS). Aerobic fitness might be a target of exercise training interventions for improving cognition in this population. It is unknown if the well-established pattern of associations between higher aerobic fitness and better inhibitory control in the general population exists among persons with MS. The current cross-sectional study examined the effects of aerobic fitness (VO2peak) on inhibitory control, using a modified flanker task, in 28 persons with MS and 28 healthy controls matched by age, sex, and body mass index. This involved performing bivariate correlations and hierarchical linear regression analyses on measures of aerobic fitness and inhibitory control. Persons with MS demonstrated lower VO2peak (d = -0.45), slower (d = 0.62-0.84), and less accurate (d = -0.60 to 0.71) performance on the flanker task than controls. VO2peak was similarly associated with reaction time measures of inhibitory control in the MS and control samples (ρ = -0.40 to 0.54). VO2peak (p < .01), but not group (p ≥ .08) (MS vs. control), predicted reaction time on the flanker task, irrespective of age, sex, and education. This supports the development of aerobic exercise interventions for improving reaction time on tasks of inhibitory control in persons with MS, much like what has been successfully undertaken in the general population.
Collapse
Affiliation(s)
- Brian M Sandroff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Charles H Hillman
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Robert W Motl
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| |
Collapse
|
44
|
Conti J, Sterr A, Brucki SMD, Conforto AB. Diversity of approaches in assessment of executive functions in stroke: limited evidence? eNeurologicalSci 2015; 1:12-20. [PMID: 26623442 PMCID: PMC4662603 DOI: 10.1016/j.ensci.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Stroke is a leading cause of disability worldwide. Cognitive functions and, in particular, executive function, are commonly affected after stroke, leading to impairments in performance of daily activities, decrease in social participation and in quality of life. Appropriate assessment and understanding of executive dysfunction are important, firstly to develop better rehabilitation strategies for executive functions per se and secondly to consider executive function abilities on rehabilitation strategies in general. The purpose of this review was to identify the most widely used assessment tools of executive dysfunction for patients with stroke, and their psychometric properties. We systematically reviewed manuscripts published in English in databases from 1999 to 2015. We identified 35 publications. The most frequently used instruments were the Stroop, Digit Span and Trail making tests. Psychometric properties were described for the Executive Function Performance Test, Executive Clock Drawing Task, Chinese Frontal Assessment Battery and Virtual Action Planning — Supermarket, and two subtests of the Cambridge Cognitive Examination — Revised. There is a paucity of tools to reliably measure executive dysfunction after stroke, despite the fact that executive dysfunction is frequent. Identification of the best tools for executive dysfunction assessment is necessary to address important gaps in research and in clinical practice.
Collapse
Affiliation(s)
- Juliana Conti
- Neurostimulation Laboratory, Neurology Clinical Division. Hospital das Clínicas/Sao Paulo University
| | - Annette Sterr
- School of Psychology, University of Surrey, Guildford, UK and Visiting Professor, Neurostimulation Laboratory
| | | | - Adriana B Conforto
- Neurostimulation Laboratory, Neurology Clinical Division. Hospital das Clínicas/Sao Paulo University ; Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
45
|
Cleveland S, Driver S, Swank C, Macklin S. Classifying physical activity research following stroke using the behavioral epidemiologic framework. Top Stroke Rehabil 2015; 22:289-98. [PMID: 26258454 DOI: 10.1179/1074935714z.0000000043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individual's co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. OBJECTIVE To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. METHODS Specific key words were identified and then searched through EBSCO host, PubMed, and Google Scholar. Physical activity and stroke literature from 2000-2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. RESULTS A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). CONCLUSION Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.
Collapse
|
46
|
Protocol variations and six-minute walk test performance in stroke survivors: a systematic review with meta-analysis. Stroke Res Treat 2015; 2015:484813. [PMID: 25685596 PMCID: PMC4320847 DOI: 10.1155/2015/484813] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 12/18/2014] [Accepted: 12/18/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To investigate the use of the six-minute walk test (6MWT) for stroke survivors, including adherence to 6MWT protocol guidelines and distances achieved. Methods. A systematic search was conducted from inception to March 2014. Included studies reported a baseline (intervention studies) or first instance (observational studies) measure for the 6MWT performed by stroke survivors regardless of time after stroke. Results. Of 127 studies (participants n = 6,012) that met the inclusion criteria, 64 were also suitable for meta-analysis. Only 25 studies made reference to the American Thoracic Society (ATS) standards for the 6MWT, and 28 reported using the protocol standard 30 m walkway. Thirty-nine studies modified the protocol walkway, while 60 studies did not specify the walkway used. On average, stroke survivors walked 284 ± 107 m during the 6MWT, which is substantially less than healthy age-matched individuals. The meta-analysis identified that changes to the ATS protocol walkway are associated with reductions in walking distances achieved. Conclusion. The 6MWT is now widely used in stroke studies. The distances achieved by stroke patients indicate substantially compromised walking ability. Variations to the standard 30 m walkway for the 6MWT are common and caution should be used when comparing the values achieved from studies using different walkway lengths.
Collapse
|
47
|
Liu-Ambrose T, Eng JJ. Exercise training and recreational activities to promote executive functions in chronic stroke: a proof-of-concept study. J Stroke Cerebrovasc Dis 2015; 24:130-7. [PMID: 25440324 PMCID: PMC4486380 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 03/25/2014] [Accepted: 08/01/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. Both exercise and recreational activities are promising strategies. We assessed the effect of a 6-month exercise and recreation program on executive functions in adults with chronic stroke. METHODS A 6-month ancillary study within a multicentre randomized trial. Twenty-eight chronic stroke survivors (ie, ≥ 12 months since an index stroke) were randomized to 1 of 2 experimental groups: intervention (INT; n = 12) or delayed intervention (D-INT; n = 16). Participants of the INT group received a 6-month community-based structured program that included 2 sessions of exercise training and 1 session of recreation and leisure activities per week. Participants of the D-INT group received usual care. The primary outcome measure was the Stroop Test, a cognitive test of selective attention and conflict resolution. Secondary cognitive measures included set shifting and working memory. Mood, functional capacity, and general balance and mobility were additional secondary outcome measures. RESULTS Compared with the D-INT group, the INT group significantly improved selective attention and conflict resolution (P = .02), working memory (P = .04), and functional capacity (P = .02) at the end of the 6-month intervention period. Improved selective attention and conflict resolution was significantly associated with functional capacity at 6 months (r = .39; P = .04). CONCLUSIONS This is the first randomized study to demonstrate that an exercise and recreation program can significantly benefit executive functions in community-dwelling chronic stroke survivors who are mildly cognitively impaired-a population at high-risk for dementia and functional decline. Thus, clinicians should consider prescribing exercise and recreational activities in the cognitive rehabilitation of chronic stroke survivors.
Collapse
Affiliation(s)
- Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, University of British Columbia, Vancouver, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Brain Research Centre, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Rehab Research Laboratory, GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| |
Collapse
|
48
|
Boss HM, Van Schaik SM, Deijle IA, de Melker EC, van den Berg BTJ, Scherder EJA, Bosboom WMJ, Weinstein HC, Van den Berg-Vos RM. A randomised controlled trial of aerobic exercise after transient ischaemic attack or minor stroke to prevent cognitive decline: the MoveIT study protocol. BMJ Open 2014; 4:e007065. [PMID: 25552615 PMCID: PMC4281539 DOI: 10.1136/bmjopen-2014-007065] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 12/03/2014] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Patients with transient ischaemic attack (TIA) or stroke are at risk for cognitive impairment and dementia. Currently, there is no known effective strategy to prevent this cognitive decline. Increasing evidence exists that physical exercise is beneficial for cognitive function. However, in patients with TIA or stroke who are at risk of cognitive impairment and dementia, only a few trials have been conducted. In this study, we aim to investigate whether a physical exercise programme (MoveIT) can prevent cognitive decline in patients in the acute phase after a TIA or minor ischaemic stroke. METHODS AND ANALYSIS A single-blinded randomised controlled trial will be conducted to investigate the effect of an aerobic exercise programme on cognition compared with usual care. 120 adult patients with a TIA or minor ischaemic stroke less than 1 month ago will be randomly allocated to an exercise programme consisting of a 12-week aerobic exercise programme and regular follow-up visits to a specialised physiotherapist during the period of 1 year or to usual care. Outcome measures will be assessed at the baseline, and at the 1-year and 2-year follow-up. The primary outcome is cognitive functioning measured with the Montreal Cognitive Assessment (MoCA) test and with additional neuropsychological tests. Secondary outcomes include maximal exercise capacity, self-reported physical activity and measures of secondary prevention. ETHICS AND DISSEMINATION The study received ethical approval from the VU University Amsterdam Ethics committee (2011/383). The results of this study will be published in peer-reviewed journals and presented at international conferences. We will also disseminate the main results to our participants in a letter. TRIAL REGISTRATION NUMBER The Nederlands Trial Register NTR3884.
Collapse
Affiliation(s)
- H M Boss
- Department of Neurology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - S M Van Schaik
- Department of Neurology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - I A Deijle
- Department of Physical Therapy, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - E C de Melker
- Department of Cardiology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - B T J van den Berg
- Department of Respiratory Medicine, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - E J A Scherder
- Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - W M J Bosboom
- Department of Neurology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - H C Weinstein
- Department of Neurology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| | - R M Van den Berg-Vos
- Department of Neurology, Sint Lucas Andreas Hospital, Amsterdam, The Netherlands
| |
Collapse
|
49
|
Chin LM, Keyser RE, Dsurney J, Chan L. Improved cognitive performance following aerobic exercise training in people with traumatic brain injury. Arch Phys Med Rehabil 2014; 96:754-9. [PMID: 25433219 DOI: 10.1016/j.apmr.2014.11.009] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/31/2014] [Accepted: 11/13/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine cognitive function in individuals with traumatic brain injury (TBI) prior to and after participation in an aerobic exercise training program. DESIGN Pre-post intervention study. SETTING Medical research center. PARTICIPANTS Volunteer sample of individuals (N=7) (age, 33.3±7.9y) with chronic nonpenetrating TBI (injury severity: 3=mild, 4=moderate; time since most current injury: 4.0±5.5y) who were ambulatory. INTERVENTION Twelve weeks of supervised vigorous aerobic exercise training performed 3 times a week for 30 minutes on a treadmill. MAIN OUTCOME MEASURES Cognitive function was assessed using the Trail Making Test Part A (TMT-A), Trail Making Test Part B (TMT-B), and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Sleep quality and depression were measured with the Pittsburgh Sleep Quality Index (PSQI) and Beck Depression Inventory, version 2 (BDI-II). Indices of cardiorespiratory fitness were used to examine the relation between improvements in cognitive function and cardiorespiratory fitness. RESULTS After training, improvements in cognitive function were observed with greater scores on the TMT-A (10.3±6.8; P=.007), TMT-B (9.6±7.0; P=.011), and RBANS total scale (13.3±9.3; P=.009). No changes were observed in measures of the PSQI and BDI-II. The magnitude of cognitive improvements was also strongly related to the gains in cardiorespiratory fitness. CONCLUSIONS These findings suggest that vigorous aerobic exercise training may improve specific aspects of cognitive function in individuals with TBI and cardiorespiratory fitness gains may be a determinant of these improvements.
Collapse
Affiliation(s)
- Lisa M Chin
- Department of Rehabilitation Science, George Mason University, Fairfax, VA; Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD.
| | - Randall Eugene Keyser
- Department of Rehabilitation Science, George Mason University, Fairfax, VA; Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD
| | - John Dsurney
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD; Center for Neuroscience and Regenerative Medicine, Bethesda, MD
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Clinical Center, Bethesda, MD; Center for Neuroscience and Regenerative Medicine, Bethesda, MD
| |
Collapse
|
50
|
Berretta A, Tzeng YC, Clarkson AN. Post-stroke recovery: the role of activity-dependent release of brain-derived neurotrophic factor. Expert Rev Neurother 2014; 14:1335-44. [DOI: 10.1586/14737175.2014.969242] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|