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Li L, Wang P, Zhao Q, Liu Z, Li S, Wang X. Latent profile analysis of depressive symptoms in college students and its relationship with physical activity. J Affect Disord 2024; 351:364-371. [PMID: 38296059 DOI: 10.1016/j.jad.2024.01.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE To explore the classification of depressive symptoms in college students and the relationship between those symptoms and physical activity. METHODS A convenience sampling method was employed to enlist college students from Songjiang University Town in Shanghai to complete in the General Information Questionnaire, Patient Health Questionnaire-9, and Physical Activity Scale-3. RESULTS A total of 3541 students were analyzed, averaging 19.34 years of age with a male composition of 53 %. The participants can be classified into four categories, namely: Group 1, which exhibits the most severe depressive symptoms, including suicidal ideation and cognitive symptoms (11.07 %); Group 2, which only manifests cognitive symptoms without suicidal ideation (14.35 %); Group 3, which presents mild depressive symptoms (23.61 %); and Group 4, consisting of normal college students (50.97 %). Students with strained family and interpersonal relationships, high levels of academic stress, and low frequency of social activities were at higher risk for detecting suicidal intention and cognitive symptoms. The level of physical activity was significantly higher in the normal group than in the other groups (all P < 0.001), and only the frequency of exercise was significantly different among the remaining three groups (χ2 = 14.716, P = 0.005). The detection rate of cognitive symptoms was significantly lower when exercising >3 times per week for 30-59 min (OR = 0.740, 95 % CI: 0.590-0.928; OR = 0.596, 95 % CI: 0.427-0.831).The detection rate of suicidal thoughts was significantly lower when exercising 2 times per month to 2 times per week or >3 times per week (OR = 0.585, 95 % CI: 0.404-0.847; OR = 0.392, 95 % CI: 0.258-0.595). CONCLUSION Suicidal ideation and cognitive symptoms can differentiate between various categories of depressive symptoms among college students. Engaging in physical activity serves as a protective factor against depressive symptoms among college students.
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Affiliation(s)
- Lili Li
- Shanghai University Of Engineering Science, Shanghai 201620, China
| | - Peng Wang
- Shanghai University of Sport, Shanghai 200438, China
| | - Qun Zhao
- Donghua University, Shanghai 201620, China.
| | - Zuhong Liu
- Shanghai Sanda University, Shanghai 314199, China
| | - Shufan Li
- Shanghai University of Sport, Shanghai 200438, China.
| | - Xing Wang
- Shanghai University of Sport, Shanghai 200438, China.
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Weston ME, Barker AR, Tomlinson OW, Coombes JS, Bailey TG, Bond B. Agreement between left and right middle cerebral artery blood velocity responses to incremental and constant work-rate exercise in healthy males and females. Physiol Meas 2023; 44:074001. [PMID: 37406643 DOI: 10.1088/1361-6579/ace49d] [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: 03/14/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023]
Abstract
Objective.To quantify the agreement between left and right middle cerebral artery blood velocity (MCAv) responses to incremental and constant work-rate exercise in adults.ApproachSeventeen healthy adults (23.8 ± 2.4 years, 9 females) completed a ramp incremental test to exhaustion on a cycle ergometer, three 6-minute transitions at a moderate-intensity, and three at a heavy-intensity, all on separate days. Bilateral MCAv was measured throughout using transcranial Doppler ultrasonography, with left and right MCAv data analysed separately. Data were analysed at baseline, gas exchange threshold, respiratory compensation point and exhaustion during ramp incremental exercise. MCAv responses to constant work-rate exercise were analysed using a mono-exponential model, to determine time- and amplitude-based kinetic response parameters.Main ResultsLeft and right MCAv responses to incremental and constant work-rate exercise were significantly, strongly and positively correlated (r≥ 0.61,P< 0.01). Coefficient of variation (left versus right) ranged from 7.3%-20.7%, 6.4%-26.2% and 5.9%-22.5% for ramp, moderate and heavy-intensity exercise, respectively. The relative change in MCAv from baseline was higher in the right compared to left MCAv during ramp, moderate and heavy-intensity exercise (allP< 0.05), but the effect sizes were small (d≤ 0.4). Small mean left-right differences were present during ramp incremental exercise at all time-points (<6 cm s-1; <4%), and for all kinetic parameters during moderate and heavy-intensity exercise (<3 cm s-1, <3%, <4 s).SignificanceThese findings demonstrate similarities between left and right MCAv responses to incremental and constant-work rate exercise in adults on a group-level, but also highlight individual variation in the agreement between left and right MCAv exercise responses.
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Affiliation(s)
- Max E Weston
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- Physiology and Ultrasound Laboratory in Science and Exercise, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Alan R Barker
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Owen W Tomlinson
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Jeff S Coombes
- Physiology and Ultrasound Laboratory in Science and Exercise, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Tom G Bailey
- Physiology and Ultrasound Laboratory in Science and Exercise, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- School of Nursing Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Bert Bond
- Children's Health and Exercise Research Centre, Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
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3
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Li L, Wang P, Li S, Liu Q, Yu F, Guo Z, Jia S, Wang X. Canonical correlation analysis of depression and anxiety symptoms among college students and their relationship with physical activity. Sci Rep 2023; 13:11516. [PMID: 37460562 DOI: 10.1038/s41598-023-38682-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/12/2023] [Indexed: 07/20/2023] Open
Abstract
To explore the association between depression and anxiety symptoms among college students and the relationship between the two and physical activity. A cross-sectional study design was used to survey 1790 enrolled university students using the Depression Self-Rating Scale, Anxiety Self-Rating Scale and Physical Activity Rating Scale. 37.75% of male students and 39.73% of female students detected depressive symptoms, 17.65% of male students and 17.86% of female students detected anxiety symptoms, 11.89% of male students and 11.75% of female students detected both depressive and anxiety symptoms. Canonical correlation between depression and anxiety symptoms of college students were significant. The depression and anxiety score of college students in the high level group was significantly lower than that in the low and medium level groups, and no significant difference was found between the low and medium level groups. Affective disorder and anxious mood of male students correlated most closely with intensity, while somatic disorder, psychomotor disorder and depressive psychological disorder correlated most closely with duration. Affective disorder of female students correlated most closely with frequency, depressive psychological disorder and anxious mood correlated most closely with intensity, while premonition of misfortune and frequent urination correlated most closely with duration. Depression and anxiety symptoms of college students were closely related and co-occurrence was common. Students with high level of physical activity had milder symptoms. Different exercise interventions are recommended for different symptoms.
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Affiliation(s)
- Lili Li
- Shanghai University of Engineering Science, Shanghai, 201620, China
| | - Peng Wang
- Shanghai University of Sport, Shanghai, 200438, China
| | - Shufan Li
- Shanghai University of Sport, Shanghai, 200438, China
| | - Qing Liu
- Shanghai University of Sport, Shanghai, 200438, China
| | - Fen Yu
- Shanghai University of Sport, Shanghai, 200438, China
| | - Zhaohui Guo
- Shanghai University of Sport, Shanghai, 200438, China
| | - Shuqi Jia
- Shanghai University of Sport, Shanghai, 200438, China
| | - Xing Wang
- Shanghai University of Sport, Shanghai, 200438, China.
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4
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Broatch JR, Zarekookandeh N, Glarin R, Strik M, Johnston LA, Moffat BA, Bird LJ, Gunningham K, Churilov L, Johns HT, Askew CD, Levinger I, O'Riordan SF, Bishop DJ, Brodtmann A. Train Smart Study: protocol for a randomised trial investigating the role of exercise training dose on markers of brain health in sedentary middle-aged adults. BMJ Open 2023; 13:e069413. [PMID: 37225276 DOI: 10.1136/bmjopen-2022-069413] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Regular aerobic exercise is associated with improved cognitive function, implicating it as a strategy to reduce dementia risk. This is reinforced by the association between greater cardiorespiratory fitness and larger brain volume, superior cognitive performance and lower dementia risk. However, the optimal aerobic exercise dose, namely the intensity and mode of delivery, to improve brain health and lower dementia risk has received less attention. We aim to determine the effect of different doses of aerobic exercise training on markers of brain health in sedentary middle-aged adults, hypothesising that high-intensity interval training (HIIT) will be more beneficial than moderate-intensity continuous training (MICT). METHODS AND ANALYSIS In this two-group parallel, open-label blinded endpoint randomised trial, 70 sedentary middle-aged (45-65 years) adults will be randomly allocated to one of two 12-week aerobic exercise training interventions matched for total exercise training volume: (1) MICT (n=35) or HIIT (n=35). Participants will perform ~50 min exercise training sessions, 3 days per week, for 12 weeks. The primary outcome will be measured as between-group difference in cardiorespiratory fitness (peak oxygen uptake) change from baseline to the end of training. Secondary outcomes include between-group differences in cognitive function and ultra-high field MRI (7T) measured markers of brain health (brain blood flow, cerebrovascular function, brain volume, white matter microstructural integrity and resting state functional brain activity) changes from baseline to the end of training. ETHICS AND DISSEMINATION The Victoria University Human Research Ethics Committee (VUHREC) has approved this study (HRE20178), and all protocol modifications will be communicated to the relevant parties (eg, VUHREC, trial registry). Findings from this study will be disseminated via peer-review publications, conference presentations, clinical communications and both mainstream and social media. TRIAL REGISTRATION NUMBER ANZCTR12621000144819.
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Affiliation(s)
- James R Broatch
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Navabeh Zarekookandeh
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Rebecca Glarin
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Radiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Myrte Strik
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Leigh A Johnston
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bradford A Moffat
- Melbourne Brain Centre Imaging Unit, Department of Radiology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Bird
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Kate Gunningham
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Hannah T Johns
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Stroke Alliance, Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Christopher D Askew
- Sunshine Coast Health Institute, Sunshine Coast Hospital and Health Service, Nambour, Queensland, Australia
- School of Health, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Itamar Levinger
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
- The Australian Institute of Musculoskeletal Sciences, Melbourne, Victoria, Australia
| | - Shane F O'Riordan
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - David J Bishop
- Institute for Health and Sport (IHES), Victoria University, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Mulser L, Moreau D. Effect of Acute Cardiovascular Exercise on Cerebral Blood Flow: A Systematic Review. Brain Res 2023; 1809:148355. [PMID: 37003561 DOI: 10.1016/j.brainres.2023.148355] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023]
Abstract
A single bout of cardiovascular exercise can have a cascade of physiological effects, including increased blood flow to the brain. This effect has been documented across multiple modalities, yet studies have reported mixed findings. Here, we systematically review evidence for the acute effect of cardiovascular exercise on cerebral blood flow across a range of neuroimaging techniques and exercise characteristics. Based on 52 studies and a combined sample size of 1,174 individuals, our results indicate that the acute effect of cardiovascular exercise on cerebral blood flow generally follows an inverted U-shaped relationship, whereby blood flow increases early on but eventually decreases as exercise continues. However, we also find that this effect is not uniform across studies, instead varying across a number of key variables including exercise characteristics, brain regions, and neuroimaging modalities. As the most comprehensive synthesis on the topic to date, this systematic review sheds light on the determinants of exercise-induced change in cerebral blood flow, a necessary step toward personalized interventions targeting brain health across a range of populations.
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Affiliation(s)
- Lisa Mulser
- School of Psychology The University of Auckland
| | - David Moreau
- School of Psychology and Centre for Brain Research The University of Auckland.
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Taylor JL, Barnes JN, Johnson BD. The Utility of High Intensity Interval Training to Improve Cognitive Aging in Heart Disease Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16926. [PMID: 36554807 PMCID: PMC9778921 DOI: 10.3390/ijerph192416926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Adults with cardiovascular disease and heart failure are at higher risk of cognitive decline. Cerebral hypoperfusion appears to be a significant contributor, which can result from vascular dysfunction and impairment of cerebral blood flow regulation. In contrast, higher cardiorespiratory fitness shows protection against brain atrophy, reductions in cerebral blood flow, and cognitive decline. Given that high intensity interval training (HIIT) has been shown to be a potent stimulus for improving cardiorespiratory fitness and peripheral vascular function, its utility for improving cognitive aging is an important area of research. This article will review the physiology related to cerebral blood flow regulation and cognitive decline in adults with cardiovascular disease and heart failure, and how HIIT may provide a more optimal stimulus for improving cognitive aging in this population.
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Affiliation(s)
- Jenna L. Taylor
- Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN 55902, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
| | - Jill N. Barnes
- Bruno Balke Biodynamics Laboratory, Department of Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Bruce D. Johnson
- Human Integrative and Environmental Physiology Laboratory, Mayo Clinic, Rochester, MN 55902, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55902, USA
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Dong Z, Wang P, Xin X, Li S, Wang J, Zhao J, Wang X. The relationship between physical activity and trait anxiety in college students: The mediating role of executive function. Front Hum Neurosci 2022; 16:1009540. [PMID: 36211122 PMCID: PMC9540794 DOI: 10.3389/fnhum.2022.1009540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesAimed to analyze the mediating effect of executive function between physical activity level and trait anxiety in college students.MethodsThe International Physical Activity Questionnaire, State-Trait Anxiety Inventory, Stroop task, 1-back task, and More-odd shifting task were used to analyze 248 college students.ResultsTrait anxiety were significantly correlated with shifting function (r = 0.182, P = 0.004) and inhibition function (r = 0.163, P = 0.010) and not with working memory (r = 0.056, P = 0.385). Vigorous physical activity (VPA) was most highly correlated with inhibition function (Beta = −0.144, P = 0.024) and working memory (Beta = −0.208, P = 0.001), and light physical activity (LPA) was most highly correlated with shifting function (Beta = −0.211, P = 0.001). Physical activity had a 72.31% association with trait anxiety (B = −0.195), with 11.79% mediated by inhibition function (B = −0.023) and 15.90% by shifting function (B = −0.031).ConclusionCollege students' physical activity promotes both inhibition and shifting functions, which in turn affect trait anxiety. VPA had a direct effect, while the effect of moderate physical activity (MPA) and LPA was completely mediated exclusively through executive functions, and the mediating effect of shifting function was the highest. It is recommended that college workers should motivate students with high trait anxiety to engage in more VPA and pay attention to changes in their inhibition and shifting functions.
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Affiliation(s)
- Zhiwei Dong
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Peng Wang
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Xin Xin
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Shufan Li
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
| | - Jing Wang
- School of Physical Education, Lixin University of Accounting and Finance, Shanghai, China
| | - Jinlei Zhao
- School of Physical Education, Lixin University of Accounting and Finance, Shanghai, China
| | - Xing Wang
- School of Physical Education and Training, Shanghai University of Sport, Shanghai, China
- *Correspondence: Xing Wang
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Maroofi A, Moro T, Agrimi J, Safari F. Cognitive decline in heart failure: Biomolecular mechanisms and benefits of exercise. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166511. [PMID: 35932891 DOI: 10.1016/j.bbadis.2022.166511] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022]
Abstract
By definition, heart failure (HF) is a human pathological condition affecting the structure and function of all organs in the body, and the brain is not an exception to that. Failure of the heart to pump enough blood centrally and peripherally is at the foundation of HF patients' inability to attend even the most ordinary daily activities and progressive deterioration of their cognitive capacity. What is more, between heart and brain exists a bidirectional relationship that goes well beyond hemodynamics and concerns bioelectric and endocrine signaling. This increasingly consolidated evidence makes the scenario even more complex. Studies have mainly chased how HF impairs cognition without focusing much on preventive measures, notably cardio-cerebral health proxies. Here, we aim to provide a brief account of known and hypothetical factors that may explain how exercise can help obviate cognitive dysfunction associated with HF in its different forms. As we shall see, there is a stringent need for a deeper grasp of such mechanisms. Indeed, gaining this new knowledge will automatically shed new light on the inner workings of HF itself, thus resulting in more effective prevention and treatment of this escalating syndrome.
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Affiliation(s)
- Abdulbaset Maroofi
- Department of Exercise Physiology, Faculty of Physical Education & Sport Sciences, University of Guilan, Rasht, Iran
| | - Tatiana Moro
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy
| | - Jacopo Agrimi
- Department of Biomedical Sciences, University of Padua, 35131 Padua, Italy.
| | - Fatemeh Safari
- Department of Physiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Kennedy CM, Burma JS, Newel KT, Brassard P, Smirl JD. Time course recovery of cerebral blood velocity metrics post aerobic exercise: A systematic review. J Appl Physiol (1985) 2022; 133:471-489. [PMID: 35708702 DOI: 10.1152/japplphysiol.00630.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Currently, the standard approach for restricting exercise prior to cerebrovascular data collection varies widely between 6-24 hours. This universally employed practice is a conservative approach to safeguard physiological alterations that could potentially confound one's study design. Therefore, the purpose of this systematic review was to amalgamate the literature that examines the extent and duration cerebrovascular function is impacted following aerobic exercise measured via transcranial Doppler ultrasound. Further, an exploratory aim was to scrutinize and discuss common biases/limitations in the previous studies to help guide future investigations. Search strategies were developed and imported into PubMed, SPORTDiscus, and Medline databases. A total of 595 records were screened and 35 articles met the inclusion criteria in this review, which included assessments of basic cerebrovascular metrics (n=35), dynamic cerebral autoregulation (dCA; n=9), neurovascular coupling (NVC; n=2); and/or cerebrovascular reactivity (CVR-CO2; n=1) following acute bouts of aerobic exercise. Across all studies, it was found NVC was impacted for 1-hour, basic cerebrovascular parameters and CVR-CO2 parameters 2-hours, and dCA metrics 6-hours post-exercise. Therefore, future studies can provide participants with these evidence-based time restrictions, regarding the minimum time to abstain from exercise prior to data collection. However, it should be noted, other physiological mechanisms could still be altered (e.g., metabolic, hormonal, and/or autonomic influences), despite cerebrovascular function returning to baseline levels. Thus, future investigations should seek to control for as many physiological influences when employing cerebrovascular assessments, immediately following these time restraints. The main limitations/biases were lack of female participants, cardiorespiratory fitness, and consideration for vessel diameter.
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Affiliation(s)
- Courtney M Kennedy
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Joel S Burma
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
| | - Kailey T Newel
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Faculty of Health and Exercise Science, University of British Columbia, Kelowna, BC, Canada
| | - Patrice Brassard
- Department of Kinesiology, Université Laval, Québec, Québec, Canada.,Research center of the Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Québec, Canada
| | - Jonathan David Smirl
- Cerebrovascular Concussion Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.,Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute of Alberta, University of Calgary, Alberta, Canada
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10
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Liu QQ, Xie WQ, Luo YX, Li YD, Huang WH, Wu YX, Li YS. High Intensity Interval Training: A Potential Method for Treating Sarcopenia. Clin Interv Aging 2022; 17:857-872. [PMID: 35656091 PMCID: PMC9152764 DOI: 10.2147/cia.s366245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/14/2022] [Indexed: 11/23/2022] Open
Abstract
Sarcopenia, an age-related disease characterized by loss of muscle strength and muscle mass, has attracted the attention of medical experts due to its severe morbidity, low living quality, high expenditure of health care, and mortality. Traditionally, persistent aerobic exercise (PAE) is considered as a valid way to attenuate muscular atrophy. However, nowadays, high intensity interval training (HIIT) has emerged as a more effective and time-efficient method to replace traditional exercise modes. HIIT displays comprehensive effects on exercise capacity and skeletal muscle metabolism, and it provides a time-out for the recovery of cardiopulmonary and muscular functions without causing severe adverse effects. Studies demonstrated that compared with PAE, HIIT showed similar or even higher effects in improving muscle strength, enhancing physical performances and increasing muscle mass of elder people. Therefore, HIIT might become a promising way to cope with the age-related loss of muscle mass and muscle function. However, it is worth mentioning that no study of HIIT was conducted directly on sarcopenia patients, which is attributed to the suspicious of safety and validity. In this review, we will assess the effects of different training parameters on muscle and sarcopenia, summarize previous papers which compared the effects of HIIT and PAE in improving muscle quality and function, and evaluate the potential of HIIT to replace the status of PAE in treating old people with muscle atrophy and low modality; and point out drawbacks of temporary experiments. Our aim is to discuss the feasibility of HIIT to treat sarcopenia and provide a reference for clinical scientists who want to utilize HIIT as a new way to cope with sarcopenia.
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Affiliation(s)
- Qian-Qi Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, 410083, People’s Republic of China
| | - Wen-Qing Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
| | - Yu-Xuan Luo
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, 410083, People’s Republic of China
| | - Yi-Dan Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, 410083, People’s Republic of China
| | - Wei-Hong Huang
- Mobile Health Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital Central South University, Changsha, Hunan, 410008, People’s Republic of China
| | - Yu-Xiang Wu
- Department of Health and Kinesiology, School of Physical Education, Jianghan University, Wuhan, Hubei, 430056, People’s Republic of China
- Yu-Xiang Wu, Department of Health and Kinesiology, School of Physical Education, Jianghan University, No. 8, Sanjiaohu Road, Wuhan, Hubei, 430056, People’s Republic of China, Tel +86 27 8422 6921, Email
| | - Yu-Sheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
- Correspondence: Yu-Sheng Li, Department of Orthopedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, People’s Republic of China, Tel +86-13975889696, Email
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Moncion K, Allison EY, Al-Khazraji BK, MacDonald MJ, Roig M, Tang A. What are the effects of acute exercise and exercise training on cerebrovascular hemodynamics following stroke? A systematic review and meta-analysis. J Appl Physiol (1985) 2022; 132:1379-1393. [PMID: 35482325 DOI: 10.1152/japplphysiol.00872.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Limited data exist regarding the effects of acute exercise and exercise training on cerebrovascular hemodynamic variables post-stroke. PURPOSE This systematic review and meta-analysis 1) examined the effects of acute exercise and exercise training on cerebrovascular hemodynamic variables reported in the stroke exercise literature; and 2) synthesized the peak middle cerebral artery blood velocity (MCAv) achieved during an acute bout of moderate-intensity exercise in individuals post-stroke. METHODS Six databases (MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, AMED) were searched from inception to December 1st 2021, for studies that examined the effect of acute exercise or exercise training on cerebrovascular hemodynamics in adults post-stroke. Two reviewers conducted title and abstract screening, full-text evaluation, data extraction, and quality appraisal. Random effects models were used in meta-analysis. RESULTS Nine studies, including 4 acute exercise (n=61) and 5 exercise training studies (n=193), were included. Meta-analyses were not statistically feasible for several cerebrovascular hemodynamic variables. Descriptive analysis reveals that exercise training may increase cerebral blood flow and cerebrovascular reactivity to carbon dioxide among individuals post-stroke. Meta-analysis of three acute exercise studies revealed no significant changes in MCAv during acute moderate intensity exercise (n=48 participants, mean difference = 5.2 cm/s, 95% CI [-0.6, 11.0], P=0.08) compared to resting MCAv values. CONCLUSION This review suggests that individuals post-stroke may have attenuated cerebrovascular hemodynamics as measured by the MCAv during acute moderate-intensity exercise. Higher quality research utilizing agreed upon hemodynamic variables are needed to synthesize the effects of exercise training on cerebrovascular hemodynamics post-stroke.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Elric Y Allison
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Baraa K Al-Khazraji
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Maureen J MacDonald
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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12
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Thomas HJ, Marsh CE, Scurrah KJ, Naylor LH, Smith KJ, Green DJ. Studies of twin responses to understand exercise THerapy (STRUETH): Cerebrovascular function. J Physiol 2022; 600:2729-2746. [PMID: 35474455 DOI: 10.1113/jp282998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Characterising individual responses to resistance and endurance exercise training can inform optimal strategies for exercise prescription. This study utilised monozygotic and dizygotic twins in a randomised cross-over study to determine individual responsiveness to different modalities of exercise training. The influence of environment versus genetics in cerebrovascular responses to training was determined. It is apparent that individuals respond differently to distinct exercise stimuli and that switching modality may be a beneficial way to obtain positive responses in cerebrovascular function. This study has implications for improving individualised exercise prescription to maintain or improve cerebral structure and function. ABSTRACT Introduction We studied monozygotic (MZ) and dizygotic (DZ) twin pairs following resistance (RES) and endurance (END) training to assess genetic and environmental contributions to cerebrovascular function. Methods Cerebrovascular function (rest, autoregulation, hypercapnia, exercise) was assessed in 86 healthy same-sex MZ (30 pairs) and DZ (13 pairs) twins, who underwent three-months of END and RES. Carbon dioxide (PET CO2 ), mean arterial pressure (MAP) and middle cerebral artery velocity (MCAv) were measured and MCAv resistance (MCACVRi ) was calculated. Results Resting MCAv reduced by -2.8 cm/s following RES (P = 0.024), with no change following END (-0.3 cm/s, P = 0.758). Change in MCACVRi following RES was +0.11 mmHg/cm/s (P < 0.001), which was significantly greater than END (+0.02 mmHg/cm/s, P = 0.030). MAP also increased following RES (+4 mmHg, P = 0.010), but not END (+1 mmHg, P = 0.518). No changes were apparent in PET CO2 . At rest, positive response rates following RES ranged from 27-71% and 40-64% following END. Intraclass correlations between twins were moderate for most variables at baseline. In response to training, only MZ pairs were significantly correlated for change in MCAv (P = 0.005) and low frequency phase (P = 0.047) following RES. Conclusion This study is the first to compare cerebrovascular function following RES and END in MZ and DZ twins. Most individuals who did not respond to one modality were able to respond by switching modality and baseline heritability estimates were higher than training response. Exercise professionals should therefore consider modality and environmental factors when optimising interventions. Abstract figure legend Schematic summary of the assessment battery of cerebrovascular measures of function and health developed by Ainslie and Green. Transcranial Doppler (TCD) measures are complemented by contemporaneous assessment of whole brain blood flow, derived from simultaneous high-resolution ultrasound via insonation of the internal carotid and vertebral arteries. Results show that group response does not always reflect individual responses, and that switching exercise modality can increase individual responsiveness to exercise training. Low twin correlations in response to exercise training indicate nurture has a larger contribution to training response than nature. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hannah J Thomas
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Channa E Marsh
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Katrina J Scurrah
- Twins Research Australia, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Louise H Naylor
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Kurt J Smith
- Cerebrovascular Health, Exercise, and Environmental Research Sciences Laboratory, School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
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13
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Miller GD, Maxwell JD, Thompson A, Cable NT, Low DA, George KP, Jones H. The effects of exercise training in the cold on cerebral blood flow and cerebrovascular function in young healthy individuals. Auton Neurosci 2022; 238:102945. [PMID: 35176639 DOI: 10.1016/j.autneu.2022.102945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 11/09/2021] [Accepted: 01/16/2022] [Indexed: 11/17/2022]
Abstract
Exercise elicits acute increases in cerebral blood flow velocity (CBFv) and provokes long-term beneficial effects on CBFv, thereby reducing cerebrovascular risk. Acute exposure to a cold stimulus also increases CBFv. We compared the impact of exercise training in cold and thermoneutral environments on CFBv, cerebrovascular function and peripheral endothelial function. Twenty-one (16 males, 22 ± 5 years) individuals were randomly allocated to either a cold (5 °C) or thermoneutral (15 °C) exercise intervention. Exercise consisted of 50-min cycling at 70% heart rate max, three times per week for eight weeks. Transcranial Doppler was used to determine pre and post intervention CBFv, dynamic cerebral autoregulation (dCA) and cerebrovascular reactivity (CVRCO2). Conduit endothelial function, microvascular function and cardiorespiratory fitness were also assessed. Cardiorespiratory fitness improved (2.91 ml.min.kg-1, 95%CI 0.49, 5.3; P = 0.02), regardless of exercise setting. Neither intervention had an impact on CBFv, CVRCO2, FMD or microvascular function (P > 0.05). There was a significant interaction between time and condition for dCA normalised gain with evidence of a decrease by 0.192%cm.s-1.%mmHg-1 (95%CI -0.318, -0.065) following training in the cold and increase (0.129%cm.s-1.%mmHg-1, 95%CI 0.011, 0.248) following training in the thermoneutral environment (P = 0.001). This was also evident for dCA phase with evidence of an increase by 0.072 rad (95%CI -0.007, 0.152) following training in the cold and decrease by 0.065 (95%CI -0.144, 0.014) radians following training in the thermoneutral environment (P = 0.02). Both training interventions improved fitness but CBFv, CVRCO2 and peripheral endothelial function were unaltered. Exercise training in the cold improved dCA whereas thermoneutral negated dCA.
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Affiliation(s)
- G D Miller
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - J D Maxwell
- Manchester University NHS Foundation Trust, Manchester, UK
| | - A Thompson
- Wolfson Centre for Personalised Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - N T Cable
- The Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - D A Low
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - K P George
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - H Jones
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK.
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14
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Whitaker AA, Aaron SE, Kaufman CS, Kurtz BK, Bai SX, Vidoni ED, Montgomery RN, Billinger SA. Cerebrovascular response to an acute bout of low-volume high-intensity interval exercise and recovery in young healthy adults. J Appl Physiol (1985) 2022; 132:236-246. [PMID: 34882027 PMCID: PMC8759972 DOI: 10.1152/japplphysiol.00484.2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
High-intensity interval exercise (HIIT) is performed widely. However, there is a gap in knowledge regarding the acute cerebrovascular response to low-volume HIIT. Our objective was to characterize the middle cerebral artery blood velocity (MCAv) response during an acute bout of low-volume HIIT in young healthy adults. We hypothesized that MCAv would decrease below the baseline (BL), 1) during HIIT, 2) immediately following HIIT, and 3) 30 min after HIIT. As a secondary objective, we investigated sex differences in the MCAv response during HIIT. Twenty-four young healthy adults completed HIIT [12 males, age = 25 (SD = 2)]. HIIT included 10 min of 1-min high intensity (∼70% estimated maximal Watts) and active recovery (10% estimated maximal Watts) intervals on a recumbent stepper. MCAv, mean arterial pressure (MAP), heart rate (HR), and end-tidal carbon dioxide ([Formula: see text]) were recorded at BL, during HIIT, immediately following HIIT, and 30 min after HIIT. Contrary to our hypothesis, MCAv remained above BL during HIIT. MCAv peaked at minute 3 then decreased concomitantly with [Formula: see text]. MCAv was lower than BL immediately following HIIT (P < 0.001). Thirty minutes after HIIT, MCAv returned to BL (P = 0.47). Compared with men, women had a higher MCAv at BL (P = 0.001), during HIIT (P = 0.009), immediately following HIIT (P = 0.004), and 30 min after HIIT (P = 0.001). MCAv did not decrease below BL during low-volume HIIT. However, MCAv decreased below BL immediately following HIIT and returned to resting values 30 min after HIIT. MCAv also differed between sexes.NEW & NOTEWORTHY We are the first, to our knowledge, to characterize the cerebrovascular and hemodynamic response to low-volume high-intensity interval exercise (HIIT, 1-min intervals) in young healthy adults. Middle cerebral artery blood velocity (MCAv) decreased during the HIIT bout and rebounded during active recovery. Women demonstrated a significantly higher resting MCAv than men and the difference remained during HIIT. Here, we report a novel protocol and characterized the MCAv response during an acute bout of low-volume HIIT.
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Affiliation(s)
- Alicen A. Whitaker
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Stacey E. Aaron
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Carolyn S. Kaufman
- 2Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Brady K. Kurtz
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen X. Bai
- 3Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas
| | - Eric D. Vidoni
- 4University of Kansas Alzheimer’s Disease Research
Center, Fairway, Kansas
| | - Robert N. Montgomery
- 5Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas
| | - Sandra A. Billinger
- 1Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas,2Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas,3Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas,4University of Kansas Alzheimer’s Disease Research
Center, Fairway, Kansas,6Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas
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15
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Wang S, Liu HY, Cheng YC, Su CH. Exercise Dosage in Reducing the Risk of Dementia Development: Mode, Duration, and Intensity-A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413331. [PMID: 34948942 PMCID: PMC8703896 DOI: 10.3390/ijerph182413331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022]
Abstract
Senile dementia, also known as dementia, is the mental deterioration which is associated with aging. It is characterized by a decrease in cognitive abilities, inability to concentrate, and especially the loss of higher cerebral cortex function, including memory, judgment, abstract thinking, and other loss of personality, even behavior changes. As a matter of fact, dementia is the deterioration of mental and intellectual functions caused by brain diseases in adults when they are mature, which affects the comprehensive performance of life and work ability. Most dementia cases are caused by Alzheimer’s disease (AD) and multiple infarct dementia (vascular dementia, multi-infarct dementia). Alzheimer’s disease is characterized by atrophy, shedding, and degenerative alterations in brain cells, and its occurrence is linked to age. The fraction of the population with dementia is smaller before the age of 65, and it increases after the age of 65. Since women live longer than men, the proportion of women with Alzheimer’s disease is higher. Multiple infarct dementia is caused by a cerebral infarction, which disrupts blood supply in multiple locations and impairs cerebral cortex function. Researchers worldwide are investigating ways to prevent Alzheimer’s disease; however, currently, there are no definitive answers for Alzheimer’s prevention. Even so, research has shown that we can take steps to reduce the risk of developing it. Prospective studies have found that even light to moderate physical activity can lower the risk of dementia and Alzheimer’s disease. Exercise has been proposed as a potential lifestyle intervention to help reduce the occurrence of dementia and Alzheimer’s disease. Various workout modes will be introduced based on various physical conditions. In general, frequent exercise for 6–8 weeks lessens the risk of dementia development.
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Affiliation(s)
- Sukai Wang
- College of Physical Education, Huaqiao University, Quanzhou 362021, China;
| | - Hong-Yu Liu
- Department of Exercise and Health Promotion, Chinese Culture University, Taipei 111369, Taiwan; (H.-Y.L.); (Y.-C.C.)
| | - Yi-Chen Cheng
- Department of Exercise and Health Promotion, Chinese Culture University, Taipei 111369, Taiwan; (H.-Y.L.); (Y.-C.C.)
| | - Chun-Hsien Su
- College of Kinesiology and Health, Chinese Culture University, Taipei 111369, Taiwan
- Correspondence: ; Tel.: +886-975159678
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16
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Thomas HJ, Marsh CE, Naylor LH, Ainslie PN, Smith KJ, Carter HH, Green DJ. Resistance, but not endurance exercise training, induces changes in cerebrovascular function in healthy young subjects. Am J Physiol Heart Circ Physiol 2021; 321:H881-H892. [PMID: 34559581 DOI: 10.1152/ajpheart.00230.2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It is generally considered that regular exercise maintains brain health and reduces the risk of cerebrovascular diseases such as stroke and dementia. Since the benefits of different "types" of exercise are unclear, we sought to compare the impacts of endurance and resistance training on cerebrovascular function. In a randomized and crossover design, 68 young healthy adults were recruited to participate in 3 mo of resistance and endurance training. Cerebral hemodynamics through the internal carotid, vertebral, middle and posterior cerebral arteries were measured using Duplex ultrasound and transcranial Doppler at rest and during acute exercise, dynamic autoregulation, and cerebrovascular reactivity (to hypercapnia). Following resistance, but not endurance training, middle cerebral artery velocity and pulsatility index significantly decreased (P < 0.01 and P = 0.02, respectively), whereas mean arterial pressure and indices of cerebrovascular resistance in the middle, posterior, and internal carotid arteries all increased (P < 0.05). Cerebrovascular resistance indices in response to acute exercise and hypercapnia also significantly increased following resistance (P = 0.02), but not endurance training. Our findings, which were consistent across multiple domains of cerebrovascular function, suggest that episodic increases in arterial pressure associated with resistance training may increase cerebrovascular resistance. The implications of long-term resistance training on brain health require future study, especially in populations with pre-existing cerebral hypoperfusion and/or hypotension.NEW & NOTEWORTHY Three months of endurance exercise did not elicit adaptation in any domain of cerebrovascular function in young healthy inactive volunteers. However, resistance training induced decreased pulsatility in the extracranial arteries and increased indices of cerebrovascular resistance in cerebral arteries. This increase in cerebrovascular resistance, apparent at baseline and in response to both hypercapnia and acute exercise, may reflect a protective response in the face of changes in arterial pressure during resistance exercise.
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Affiliation(s)
- Hannah J Thomas
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Channa E Marsh
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Louise H Naylor
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kurt J Smith
- Integrative Physiology Laboratory, Department of Kinesiology and Nutrition, University of Illinois, Chicago, Illinois.,Department of Exercise Science, Physical and Health Education, Faculty of Education, University of Victoria, Victoria, British Columbia, Canada
| | - Howard H Carter
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
| | - Daniel J Green
- School of Human Sciences (Exercise and Sport Science), The University of Western Australia, Perth, Western Australia, Australia
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17
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Effects of a Brief Stair-Climbing Intervention on Cognitive Functioning and Mood States in Older Adults: A Randomized Controlled Trial. J Aging Phys Act 2021; 30:455-465. [PMID: 34510025 DOI: 10.1123/japa.2021-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/25/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022]
Abstract
Despite an abundance of evidence that exercise benefits cognition and mood, physical activity levels among older adults remain low, with time and inaccessibility posing major barriers. Interval stair climbing is an accessible time-efficient form of physical activity demonstrated to benefit cognition and mood in young adults, but effectiveness in older adults remains unknown. To address this, 28 older adults (Mage = 69.78 years, 16 females) undertook cognitive and mood assessments twice, 1 week apart, once preceded by interval stair climbing. A fairly large, albeit only marginally significant, effect size (ηp2=.12) indicated improved cognition following the moderate- to high-intensity intervention; however, rather than improving mood, older adults reported feeling more tired (g = 0.51). These outcomes provide initial indications that this mode of exercise that can easily translate to naturalistic settings offers promise as an intervention strategy, but more research is needed to optimize the protocol to suit aged populations (ACTRN1261900169014).
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18
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Black RD, Bell RP, Riska KM, Spankovich C, Peters RW, Lascola CD, Whitlow CT. The Acute Effects of Time-Varying Caloric Vestibular Stimulation as Assessed With fMRI. Front Syst Neurosci 2021; 15:648928. [PMID: 34434093 PMCID: PMC8381736 DOI: 10.3389/fnsys.2021.648928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
We describe preliminary results from the application of time-varying caloric vestibular stimulation (tvCVS) to volunteers during a continuous blood oxygen level dependent (BOLD) functional MRI (fMRI) acquisition, recording baseline, during-tvCVS and post-tvCVS epochs. The modifications necessary to enable the use of this novel device in a 3-Tesla magnetic field are discussed. Independent component analysis (ICA) was used as a model-free method to highlight spatially and temporally coherent brain networks. The ICA results are consistent with tvCVS induction being mediated principally by thermoconvection in the vestibular labyrinth and not by direct thermal effects. The activation of hub networks identified by ICA is consistent with the concept of sensory neuromodulation, which posits that a modulatory signal introduced to a sensory organ is able to traverse the regions innervated (directly and indirectly) by that organ, while being transformed so as to be “matched” to regional neuronal dynamics. The data suggest that regional neurovascular coupling and a systemic cerebral blood flow component account for the BOLD contrast observed. The ability to modulate cerebral hemodynamics is of significant interest. The implications of these initial findings for the use of tvCVS therapeutically are discussed.
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Affiliation(s)
| | - Ryan P Bell
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Kristal M Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Christopher Spankovich
- Department of Otolaryngology & Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, United States
| | | | - Christopher D Lascola
- Department of Radiology and Neurobiology, Duke University School of Medicine, Durham, NC, United States
| | - Christopher T Whitlow
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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19
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Tsai CL, Pan CY, Tseng YT, Chen FC, Chang YC, Wang TC. Acute effects of high-intensity interval training and moderate-intensity continuous exercise on BDNF and irisin levels and neurocognitive performance in late middle-aged and older adults. Behav Brain Res 2021; 413:113472. [PMID: 34274372 DOI: 10.1016/j.bbr.2021.113472] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/30/2023]
Abstract
The purposes of the present study were (1) to explore and compare the acute effects of high-intensity interval training (HIIT) and moderate-intensity continuous exercise (MICE) on neurocognitive performance and molecular biomarkers in late middle-aged and older adults, and (2) to examine the relationships of HIIT/MICE exercise-induced neurocognitive changes with changes in circulating irisin and BDNF levels elicited by different acute exercise modes. Using a within-subject design, twenty-one participants completed an acute bout of 30 min of HIIT, MICE, or a non-exercise-intervention (REST) session in a counterbalanced order. The neuropsychological [i.e., accuracy rate (AR) and reaction time (RT)] and neurophysiological [i.e., event-related potential (ERP) P3 latency and amplitude] indices were simultaneously measured when the participants performed a working memory task at baseline and after an intervention mode. Blood samples were also taken before and after the intervention mode. The results showed that, although ARs were significantly increased only via the MICE intervention mode, the acute HIIT and MICE interventions improved RT performance and increased ERP P3 amplitudes in the late middle-aged and older adults under consideration. Serum BDNF levels were significantly increased with the acute HIIT and MICE interventions, and significant irisin level increases were only observed following the HIIT intervention. However, changes in the levels of Irisin and BDNF pre- and post-intervention were not correlated with changes in neurocognitive performance, with the exception of the correlation between the changes in irisin levels and RTs with acute exercise in the MICE intervention mode. The present findings suggested similar beneficial effects on neurocognitive performance (i.e., RTs and ERP P3 amplitudes) and peripheral BDNF levels following MICE and HIIT interventions in the middle-aged and older adults. In terms of ARs and irisin, the two acute exercise modes appear to induce divergent effects. Irisin may play a potential facilitating role in the neuropsychological (e.g., RT) performance of working memory in such a group. However, the mechanisms remain to be determined.
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Affiliation(s)
- Chia-Liang Tsai
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Taiwan.
| | - Chien-Yu Pan
- Department of Physical Education, National Kaohsiung Normal University, Taiwan
| | - Yu-Ting Tseng
- Department of Kinesiology, National Tsing Hua University, Taiwan; Research Center for Education and Mind Sciences, National Tsing Hua University, Taiwan
| | - Fu-Chen Chen
- Department of Physical Education, National Kaohsiung Normal University, Taiwan
| | - Yu-Chuan Chang
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Taiwan
| | - Tsai-Chiao Wang
- Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Taiwan
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20
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Marçal IR, Goessler KF, Buys R, Casonatto J, Ciolac EG, Cornelissen VA. Post-exercise Hypotension Following a Single Bout of High Intensity Interval Exercise vs. a Single Bout of Moderate Intensity Continuous Exercise in Adults With or Without Hypertension: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Front Physiol 2021; 12:675289. [PMID: 34262474 PMCID: PMC8274970 DOI: 10.3389/fphys.2021.675289] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Post-exercise hypotension (PEH) is an important tool in the daily management of patients with hypertension. Varying the exercise parameters is likely to change the blood pressure (BP) response following a bout of exercise. In recent years, high-intensity interval exercise (HIIE) has gained significant popularity in exercise-based prevention and rehabilitation of clinical populations. Yet, to date, it is not known whether a single session of HIIE maximizes PEH more than a bout of moderate-intensity continuous exercise (MICE). Objective: To compare the effect of HIIE vs. MICE on PEH by means of a systematic review and meta-analysis. Methods: A systematic search in the electronic databases MEDLINE, Embase, and SPORTDiscus was conducted from the earliest date available until February 24, 2020. Randomized clinical trials comparing the transient effect of a single bout of HIIE to MICE on office and/or ambulatory BP in humans (≥18 years) were included. Data were pooled using random effects models with summary data reported as weighted means and 95% confidence interval (CIs). Results: Data from 14 trials were included, involving 18 comparisons between HIIE and MICE and 276 (193 males) participants. The immediate effects, measured as office BP at 30- and 60-min post-exercise, was similar for a bout of HIIE and MICE (p > 0.05 for systolic and diastolic BP). However, HIIE elicited a more pronounced BP reduction than MICE [(−5.3 mmHg (−7.3 to −3.3)/ −1.63 mmHg (−3.00 to −0.26)] during the subsequent hours of ambulatory daytime monitoring. No differences were observed for ambulatory nighttime BP (p > 0.05). Conclusion: HIIE promoted a larger PEH than MICE on ambulatory daytime BP. However, the number of studies was low, patients were mostly young to middle-aged individuals, and only a few studies included patients with hypertension. Therefore, there is a need for studies that involve older individuals with hypertension and use ambulatory BP monitoring to confirm HIIE's superiority as a safe BP lowering intervention in today's clinical practice. Systematic Review Registration: PROSPERO (registration number: CRD42020171640).
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Affiliation(s)
- Isabela Roque Marçal
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil.,Research Group for Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, University of Leuven, KU Leuven, Leuven, Belgium
| | - Karla Fabiana Goessler
- Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Faculty of Medicine (FMUSP), University of Saõ Paulo, Saõ Paulo, Brazil
| | - Roselien Buys
- Research Group for Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, University of Leuven, KU Leuven, Leuven, Belgium
| | - Juliano Casonatto
- Research Group in Physiology and Physical Activity, University of Northern Paraná, Londrina, Brazil
| | - Emmanuel Gomes Ciolac
- Exercise and Chronic Disease Research Laboratory, Department of Physical Education, School of Sciences, São Paulo State University (UNESP), Bauru, Brazil
| | - Véronique A Cornelissen
- Research Group for Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, University of Leuven, KU Leuven, Leuven, Belgium
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21
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Weaver SR, Skinner BD, Furlong R, Lucas RAI, Cable NT, Rendeiro C, McGettrick HM, Lucas SJE. Cerebral Hemodynamic and Neurotrophic Factor Responses Are Dependent on the Type of Exercise. Front Physiol 2021; 11:609935. [PMID: 33551835 PMCID: PMC7859714 DOI: 10.3389/fphys.2020.609935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022] Open
Abstract
This study examined acute cerebral hemodynamic and circulating neurotrophic factor responses to moderate intensity continuous exercise (MICT), guideline-based high intensity interval exercise (HIIT), and sprint interval exercise (SIT). We hypothesized that the pattern of middle cerebral artery velocity (MCAv) response would differ between interval and continuous exercise, with SIT inducing the smallest increase from rest, while increases in neurotrophic factors would be intensity-dependent. In a randomized crossover design, 24 healthy adults (nine females) performed three exercise protocols: (i) MICT (30 min), (ii) HIIT (4 × 4 min at 85% HRmax), and (iii) SIT (4 × 30 s supramaximal). MCAv significantly increased from rest across MICT (Δ13.1 ± 8.5 cm⋅s-1, p < 0.001) and all bouts of HIIT (Δ15.2 ± 9.8 cm⋅s-1, p < 0.001), but only for the initial bout of SIT (Δ17.3 ± 11.6 cm⋅s-1, p < 0.001). Immediately following each interval bout, MCAv increased (i.e., rebounded) for the SIT (9-14% above rest, p ≤ 0.04), but not HIIT protocol. SIT alone induced significant elevations from rest to end-exercise in vascular endothelial growth factor (VEGF; Δ28 ± 36%, p = 0.017) and brain-derived neurotrophic factor (BDNF, Δ149% ± 162%, p < 0.001) and there were greater increases in lactate than in either other protocol (>5-fold greater in SIT, p < 0.001), alongside a small significant reduction at the end of active recovery in insulin-like growth factor 1 (IGF-1, Δ22 ± 21%, p = 0.002). In conclusion, while the nature of the response may differ, both guideline-based and sprint-based interval exercise have the potential to induce significant changes in factors linked to improved cerebrovascular and brain health.
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Affiliation(s)
- Samuel R. Weaver
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Bethany D. Skinner
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rhodri Furlong
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Rebekah A. I. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - N. Timothy Cable
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Catarina Rendeiro
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Helen M. McGettrick
- College of Medical and Dental Sciences, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, United Kingdom
- Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
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22
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Whitaker AA, Alwatban M, Freemyer A, Perales-Puchalt J, Billinger SA. Effects of high intensity interval exercise on cerebrovascular function: A systematic review. PLoS One 2020; 15:e0241248. [PMID: 33119691 PMCID: PMC7595421 DOI: 10.1371/journal.pone.0241248] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/11/2020] [Indexed: 12/23/2022] Open
Abstract
High intensity interval exercise (HIIE) improves aerobic fitness with decreased exercise time compared to moderate continuous exercise. A gap in knowledge exists regarding the effects of HIIE on cerebrovascular function such as cerebral blood velocity and autoregulation. The objective of this systematic review was to ascertain the effect of HIIE on cerebrovascular function in healthy individuals. We searched PubMed and the Cumulative Index to Nursing and Allied Health Literature databases with apriori key words. We followed the Preferred Reporting Items for Systematic Reviews. Twenty articles were screened and thirteen articles were excluded due to not meeting the apriori inclusion criteria. Seven articles were reviewed via the modified Sackett’s quality evaluation. Outcomes included middle cerebral artery blood velocity (MCAv) (n = 4), dynamic cerebral autoregulation (dCA) (n = 2), cerebral de/oxygenated hemoglobin (n = 2), cerebrovascular reactivity to carbon dioxide (CO2) (n = 2) and cerebrovascular conductance/resistance index (n = 1). Quality review was moderate with 3/7 to 5/7 quality criteria met. HIIE acutely lowered exercise MCAv compared to moderate intensity. HIIE decreased dCA phase following acute and chronic exercise compared to rest. HIIE acutely increased de/oxygenated hemoglobin compared to rest. HIIE acutely decreased cerebrovascular reactivity to higher CO2 compared to rest and moderate intensity. The acute and chronic effects of HIIE on cerebrovascular function vary depending on the outcomes measured. Therefore, future research is needed to confirm the effects of HIIE on cerebrovascular function in healthy individuals and better understand the effects in individuals with chronic conditions. In order to conduct rigorous systematic reviews in the future, we recommend assessing MCAv, dCA and CO2 reactivity during and post HIIE.
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Affiliation(s)
- Alicen A. Whitaker
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Mohammed Alwatban
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Andrea Freemyer
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Jaime Perales-Puchalt
- University of Kansas Alzheimer’s Disease Center, Fairway, KS, United States of America
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, United States of America
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, United States of America
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, KS, United States of America
- * E-mail:
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23
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Klein T, Bailey TG, Wollseiffen P, Schneider S, Askew CD. The effect of age on cerebral blood flow responses during repeated and sustained stand to sit transitions. Physiol Rep 2020; 8:e14421. [PMID: 32378357 PMCID: PMC7202987 DOI: 10.14814/phy2.14421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Aging is associated with impaired cerebrovascular blood flow and function, attributed to reduced vasodilatory capacity of the cerebrovascular network. Older adults may also have an impaired relationship between changes in blood pressure and cerebral blood flow; however, previous reports conflict. This study aimed to compare the blood pressure and cerebral blood flow responses to both repeated and sustained stand-to-sit transitions in young and older adults, and to assess the relationship with cerebrovascular reactivity. METHODS In 20 young (age: 24 ± 4 years) and 20 older (age: 71 ± 7 years) adults we compared middle cerebral artery flow velocity (MCAv), end-tidal partial pressure of carbon dioxide (PET CO2 ), and blood pressure (mean arterial blood pressure [MAP]) during repeated stand-to-sit (10 s standing and 10 s sitting) and sustained stand-to-sit (3 min standing followed by 2 min sitting) transitions. Cerebrovascular reactivity to changes in carbon dioxide levels was assessed using a repeated breath-hold test. RESULTS The % change in MCAv per % change in MAP (%∆MCAv/%∆MAP) was higher in the older adults than in the young adults during repeated stand-to-sit transitions. During the sustained protocol the %∆MCAv/%∆MAP response was similar in both age groups. A high %∆MCAv/%∆MAP response during the repeated stand-to-sit protocol was associated with low cerebrovascular reactivity to CO2 (r = -.39; p < .01), which was significantly lower in the older adults. CONCLUSION These findings suggest that the higher %∆MCAv/%∆MAP during repeated stand-sit transitions was associated with impaired cerebrovascular reactivity. Impairments in endothelial function and vascular stiffness with age may contribute to the altered transient cerebral pressure-flow responses in older adults.
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Affiliation(s)
- Timo Klein
- VasoActive Research GroupSchool of Health and Sport SciencesUniversity of the Sunshine CoastMaroochydore DCQLDAustralia
- Institute of Movement and NeuroscienceGerman Sport University CologneCologneGermany
| | - Tom G. Bailey
- VasoActive Research GroupSchool of Health and Sport SciencesUniversity of the Sunshine CoastMaroochydore DCQLDAustralia
- Centre for Research on ExercisePhysical Activity and HealthSchool of Human Movement and Nutrition SciencesThe University of QueenslandBrisbaneQLDAustralia
| | - Petra Wollseiffen
- Institute of Movement and NeuroscienceGerman Sport University CologneCologneGermany
| | - Stefan Schneider
- VasoActive Research GroupSchool of Health and Sport SciencesUniversity of the Sunshine CoastMaroochydore DCQLDAustralia
- Institute of Movement and NeuroscienceGerman Sport University CologneCologneGermany
| | - Christopher D. Askew
- VasoActive Research GroupSchool of Health and Sport SciencesUniversity of the Sunshine CoastMaroochydore DCQLDAustralia
- Sunshine Coast Health InstituteSunshine Coast Hospital and Health ServiceBirtinyaQLDAustralia
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