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Moncion K, Rodrigues L, De Las Heras B, Noguchi KS, Wiley E, Eng JJ, MacKay-Lyons M, Sweet SN, Thiel A, Fung J, Stratford P, Richardson JA, MacDonald MJ, Roig M, Tang A. Cardiorespiratory Fitness Benefits of High-Intensity Interval Training After Stroke: A Randomized Controlled Trial. Stroke 2024; 55:2202-2211. [PMID: 39113181 DOI: 10.1161/strokeaha.124.046564] [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: 02/12/2024] [Revised: 05/17/2024] [Accepted: 06/03/2024] [Indexed: 08/28/2024]
Abstract
BACKGROUND Limited evidence supports the effects of short-interval high-intensity interval training (HIIT) for improving cardiorespiratory fitness (V̇O2peak) after stroke. We aimed to compare the effects of 12 weeks of short-interval HIIT versus moderate-intensity continuous training (MICT) on V̇O2peak, cardiovascular risk factors, and mobility outcomes among individuals ≥6 months poststroke. METHODS This study was a multi-site, 12-week randomized controlled trial (NCT03614585) with an 8-week follow-up. Participants were randomized into 3 d/wk of HIIT (10×1 minute 80%-100% heart rate reserve interspersed with 1 minute 30% heart rate reserve [19 minutes]) or MICT (20-30 minutes 40%-60% heart rate reserve). Secondary outcomes of the trial, including V̇O2peak, cardiovascular risk factors (carotid-femoral pulse wave velocity, blood pressure, and waist-hip ratio), and mobility (6-minute walk test, 10 m gait speed), were reported. Linear mixed model analyses with a group×study time point interaction evaluated between-group differences. RESULTS Of the 305 potential participants, 82 consented (mean [SD] age 64.9 [9.3] years, 32 females [39%], 1.8 [1.2] years poststroke) and were randomized to HIIT (n=42, mean [SD] baseline V̇O2peak 17.3 [5.9] mL/kg·min) or MICT (n=40, mean [SD] baseline V̇O2peak 17.2 [6.0] mL/kg·min). Participants attended 82% of visits (n=2417/2952). No adverse events occurred during the study period. A significant group×study time point interaction was found (χ2=8.46; P=0.015) for V̇O2peak at 12 weeks (mean difference, 1.81 [95% CI, 0.58-3.04]; P=0.004) whereby the HIIT group had greater gains in V̇O2peak (∆3.52 mL/kg·min [95% CI, 2.47-4.57]; P<0.001) compared with the MICT group (∆1.71 mL/kg·min [95% CI, 0.55-2.86]; P=0.001). There was no between-group difference in V̇O2peak (mean difference, 1.08 [95% CI, -0.26 to 2.42]; P=0.11) at 8-week follow-up. No group×study time point interactions were found for cardiovascular risk factors or mobility outcomes. CONCLUSIONS Short-interval HIIT may be an effective alternative to MICT for improving V̇O2peak at 12 weeks postintervention. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT03614585.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Lynden Rodrigues
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, Canada (L.R., B.D.L.H., M.R.)
| | - Bernat De Las Heras
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, Canada (L.R., B.D.L.H., M.R.)
| | - Kenneth S Noguchi
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columba and Rehabilitation Research Program, GF Strong Rehab Centre, Vancouver, Canada (J.J.E.)
| | - Marilyn MacKay-Lyons
- School of Physiotherapy, Dalhousie University, Faculty of Health, Halifax, Canada (M.M.K.-L.)
| | - Shane N Sweet
- Department of Kinesiology and Physical Education (S.N.S.), McGill University, Montreal, Canada
| | - Alexander Thiel
- Department of Neurology and Neurosurgery, McGill University and Jewish General Hospital Montréal, Canada (A. Thiel)
| | - Joyce Fung
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
| | - Paul Stratford
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
| | - Julie A Richardson
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
- Department of Health Research Methods Evidence and Impact (J.A.R.), Faculty of Science, McMaster University, Hamilton, Canada
| | - Maureen J MacDonald
- Department of Kinesiology (M.J.M.D.), Faculty of Science, McMaster University, Hamilton, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, Faculty of Medicine (L.R., B.D.L.H., J.F., M.R.), McGill University, Montreal, Canada
- Memory and Motor Rehabilitation Laboratory, Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Laval, Canada (L.R., B.D.L.H., M.R.)
| | - Ada Tang
- School of Rehabilitation Sciences (K.M., K.S.N., E.W., P.S., J.A.R., A. Tang), Faculty of Science, McMaster University, Hamilton, Canada
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Moncion K, Rodrigues L, Wiley E, Noguchi KS, Negm A, Richardson J, MacDonald MJ, Roig M, Tang A. Aerobic exercise interventions for promoting cardiovascular health and mobility after stroke: a systematic review with Bayesian network meta-analysis. Br J Sports Med 2024; 58:392-400. [PMID: 38413134 DOI: 10.1136/bjsports-2023-107956] [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] [Accepted: 02/08/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To determine the superiority of aerobic exercise (AE) interventions on key outcomes of stroke recovery, including cardiorespiratory fitness (V̇O2peak, primary outcome), systolic blood pressure (SBP) and mobility (6 min Walk Test (6MWT) distance and 10 m Usual Gait Speed) after stroke. DATA SOURCES MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO and AMED Allied and Complementary Medicine were searched from inception to February 2023. ELIGIBILITY CRITERIA Randomised controlled trials were included that compared the effects of any AE interventions (low-intensity, moderate-intensity, high-intensity continuous training (HICT), high-intensity interval training (HIIT)) to no exercise, usual care or other AE interventions in individuals poststroke. ANALYSES Systematic review with Bayesian network meta-analysis (NMA) methodology was employed. Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. The Grading of Recommendations, Assessment, Development and Evaluation minimally contextualised framework for NMA was followed. RESULTS There were 28 studies (n=1298) included in the NMA for V̇O2peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT and 18 (n=775) for the 10 m Usual Gait Speed. The greatest effect on V̇O2peak, 6MWT and 10 m Usual Gait Speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all outcomes of interest. HIIT was the most effective intervention for improving V̇O2peak (2.9 mL/kg/min (95% credible interval 0.8 to 5.0) moderate certainty) compared with usual care. CONCLUSION This NMA suggests that higher-intensity AE is superior to traditional low-intensity to moderate-intensity AE for improving outcomes after stroke.
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Affiliation(s)
- Kevin Moncion
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Lynden Rodrigues
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Ahmed Negm
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Julie Richardson
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
- Department of Health Research Methods Evidence and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Maureen Jane MacDonald
- Department of Kinesiology, McMaster University Faculty of Science, Hamilton, Ontario, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
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Sugawara J, Hashimoto T, Tsukamoto H, Secher NH, Ogoh S. Attenuated pulsatile transition to the cerebral vasculature during high-intensity interval exercise in young healthy men. Exp Physiol 2023; 108:1057-1065. [PMID: 37309084 PMCID: PMC10988493 DOI: 10.1113/ep091119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023]
Abstract
NEW FINDINGS What is the central question of this study? High-intensity interval exercise (HIIE) is recommended for its favourable haemodynamic stimulation, but excessive haemodynamic fluctuations may stress the brain: is the cerebral vasculature protected against exaggerated systemic blood flow fluctuation during HIIE? What is the main finding and its importance? Time- and frequency-domain indices of aortic-cerebral pulsatile transition were lowered during HIIE. The findings suggest that the arterial system to the cerebral vasculature may attenuate pulsatile transition during HIIE as a defence mechanism against pulsatile fluctuation for the cerebral vasculature. ABSTRACT High-intensity interval exercise (HIIE) is recommended because it provides favourable haemodynamic stimulation, but excessive haemodynamic fluctuations may be an adverse impact on the brain. We tested whether the cerebral vasculature is protected against systemic blood flow fluctuation during HIIE. Fourteen healthy men (age 24 ± 2 years) underwent four 4-min exercises at 80-90% of maximal workload (Wmax ) interspaced by 3-min active rest at 50-60% Wmax . Transcranial Doppler measured middle cerebral artery blood velocity (CBV). Systemic haemodynamics (Modelflow) and aortic pressure (AoP, general transfer function) were estimated from an invasively recorded brachial arterial pressure waveform. Using transfer function analysis, gain and phase between AoP and CBV (0.39-10.0 Hz) were calculated. Stroke volume, aortic pulse pressure and pulsatile CBV increased during exercise (time effect: P < 0.0001 for all), but a time-domain index of aortic-cerebral pulsatile transition (pulsatile CBV/pulsatile AoP) decreased throughout the exercise bouts (time effect: P < 0.0001). Furthermore, transfer function gain reduced, and phase increased throughout the exercise bouts (time effect: P < 0.0001 for both), suggesting the attenuation and delay of pulsatile transition. The cerebral vascular conductance index (mean CBV/mean arterial pressure; time effect: P = 0.296), an inverse index of cerebral vascular tone, did not change even though systemic vascular conductance increased during exercise (time effect: P < 0.0001). The arterial system to the cerebral vasculature may attenuate pulsatile transition during HIIE as a defence mechanism against pulsatile fluctuation for the cerebral vasculature.
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Affiliation(s)
- Jun Sugawara
- Human Informatics and Interaction Research InstituteNational Institute of Advanced Industrial Science and TechnologyTsukubaJapan
| | - Takeshi Hashimoto
- Graduate School of Sport and Health ScienceRitsumeikan UniversityShigaJapan
| | | | - Niels H. Secher
- Department of Anesthesia, Rigshospitalet, Institute for Clinical MedicineUniversity of CopenhagenDenmark
| | - Shigehiko Ogoh
- Graduate School of EngineeringToyo UniversitySaitamaJapan
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Bonuzzi GMG, Bastos FH, Schweighofer N, Wade E, Winstein CJ, Torriani-Pasin C. Moderate-intensity cardiovascular exercise performed before motor practice attenuates offline implicit motor learning in stroke survivors but not age-matched neurotypical adults. Exp Brain Res 2023:10.1007/s00221-023-06659-w. [PMID: 37395857 DOI: 10.1007/s00221-023-06659-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
The acute impact of cardiovascular exercise on implicit motor learning of stroke survivors is still unknown. We investigated the effects of cardiovascular exercise on implicit motor learning of mild-moderately impaired chronic stroke survivors and neurotypical adults. We addressed whether exercise priming effects are time-dependent (e.g., exercise before or after practice) in the encoding (acquisition) and recall (retention) phases. Forty-five stroke survivors and 45 age-matched neurotypical adults were randomized into three sub-groups: BEFORE (exercise, then motor practice), AFTER (motor practice, then exercise), and No-EX (motor practice alone). All sub-groups practiced a serial reaction time task (five repeated and two pseudorandom sequences per day) on three consecutive days, followed 7 days later by a retention test (one repeated sequence). Exercise was performed on a stationary bike, (one 20-min bout per day) at 50% to 70% heart rate reserve. Implicit motor learning was measured as a difference score (repeated-pseudorandom sequence response time) during practice (acquisition) and recall (delayed retention). Separate analyses were performed on the stroke and neurotypical groups using linear mixed-effects models (participant ID was a random effect). There was no exercise-induced benefit on implicit motor learning for any sub-group. However, exercise performed before practice impaired encoding in neurotypical adults and attenuated retention performance of stroke survivors. There is no benefit to implicit motor learning of moderately intense cardiovascular exercise for stroke survivors or age-matched neurotypical adults, regardless of timing. Practice under a high arousal state and exercise-induced fatigue may have attenuated offline learning in stroke survivors.
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Affiliation(s)
- Giordano Marcio Gatinho Bonuzzi
- Department of Physical Education, State University of Piauí, Professor Barros Araújo Campus, BR-316, KM 299, Altamira, Picos, Piaui, 64602-000, Brazil.
- Department of Physical Education, Federal University of Vale Do São Francisco, Petrolina, Pernambuco, Brazil.
- School of Physical Education and Sport, University of Sao Paulo, São Paulo, São Paulo, Brazil.
| | - Flavio Henrique Bastos
- School of Physical Education and Sport, University of Sao Paulo, São Paulo, São Paulo, Brazil
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Eric Wade
- Department of Mechanical Engineering, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Carolee Joyce Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Camila Torriani-Pasin
- School of Physical Education and Sport, University of Sao Paulo, São Paulo, São Paulo, Brazil
- Neurorehabilitation, Exercise Science and Learning (NEUROEXCEL), Department of Physical Therapy and Movement Sciences, The University of Texas at El Paso, El Paso, TX, USA
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5
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Chen Z, Yan J, Song X, Qiao Y, Loh YJ, Xie Q, Niu CM. Heavier Load Alters Upper Limb Muscle Synergy with Correlated fNIRS Responses in BA4 and BA6. CYBORG AND BIONIC SYSTEMS 2023; 4:0033. [PMID: 37275578 PMCID: PMC10233656 DOI: 10.34133/cbsystems.0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
In neurorehabilitation, motor performances may improve if patients could accomplish the training by overcoming mechanical loads. When the load inertia is increased, it has been found to trigger linear responses in motor-related cortices. The cortical responses, however, are unclear whether they also correlate to changes in muscular patterns. Therefore, it remains difficult to justify the magnitude of load during rehabilitation because of the gap between cortical and muscular activation. Here, we test the hypothesis that increases in load inertia may alter the muscle synergies, and the change in synergy may correlate with cortical activation. Twelve healthy subjects participated in the study. Each subject lifted dumbbells (either 0, 3, or 15 pounds) from the resting position to the armpit repetitively at 1 Hz. Surface electromyographic signals were collected from 8 muscles around the shoulder and the elbow, and hemodynamic signals were collected using functional near-infrared spectroscopy from motor-related regions Brodmann Area 4 (BA4) and BA6. Results showed that, given higher inertia, the synergy vectors differed farther from the baseline. Moreover, synergy similarity on the vector decreased linearly with cortical responses in BA4 and BA6, which associated with increases in inertia. Despite studies in literature that movements with similar kinematics tend not to differ in synergy vectors, we show a different possibility that the synergy vectors may deviate from a baseline. At least 2 consequences of adding inertia have been identified: to decrease synergy similarity and to increase motor cortical activity. The dual effects potentially provide a new benchmark for therapeutic goal setting.
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Affiliation(s)
- Zhi Chen
- Department of Rehabilitation Medicine, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- School of Medicine,
Shanghai Jiao Tong University, Shanghai 200025, China
| | - Jin Yan
- Department of Rehabilitation Medicine, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- School of Medicine,
Shanghai Jiao Tong University, Shanghai 200025, China
| | - Xiaohui Song
- Department of Rehabilitation Medicine, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yongjun Qiao
- Department of Rehabilitation Medicine, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yong Joo Loh
- Department of Rehabilitation Medicine,
Tan-Tock-Seng Hospital, Singapore
| | - Qing Xie
- Department of Rehabilitation Medicine, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- School of Medicine,
Shanghai Jiao Tong University, Shanghai 200025, China
| | - Chuanxin M. Niu
- Department of Rehabilitation Medicine, Ruijin Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- School of Medicine,
Shanghai Jiao Tong University, Shanghai 200025, China
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Affiliation(s)
- David J Lin
- Department of Neurology, Division of Neurocritical Care and Stroke Service, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Veterans Affairs, Rehabilitation Research and Development Service, Center for Neurorestoration and Neurotechnology, Providence, Rhode Island
| | - Joel Stein
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York
- Department of Rehabilitation Medicine, Weill Cornell Medical College, New York, New York
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Boyne P, Billinger SA, Reisman DS, Awosika OO, Buckley S, Burson J, Carl D, DeLange M, Doren S, Earnest M, Gerson M, Henry M, Horning A, Khoury JC, Kissela BM, Laughlin A, McCartney K, McQuaid T, Miller A, Moores A, Palmer JA, Sucharew H, Thompson ED, Wagner E, Ward J, Wasik EP, Whitaker AA, Wright H, Dunning K. Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke: A Randomized Clinical Trial. JAMA Neurol 2023; 80:342-351. [PMID: 36822187 PMCID: PMC9951105 DOI: 10.1001/jamaneurol.2023.0033] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/08/2022] [Indexed: 02/25/2023]
Abstract
Importance For walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization. Objective To assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke. Design, Setting, and Participants This multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled. Interventions Participants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated. Main Outcomes and Measures The main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training. Results Of 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, -9 to 33 m]; mean difference, 15 m [95% CI, -13 to 42 m]; P = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m]; P = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m]; P = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue. Conclusions and Relevance These findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains. Trial Registration ClinicalTrials.gov Identifier: NCT03760016.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Sandra A. Billinger
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
- Department of Cell Biology and Integrative Physiology, School of Medicine, University of Kansas Medical Center, Kansas City
- University of Kansas Alzheimer’s Research Disease Center, Fairway
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sofia Buckley
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jamiah Burson
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Matthew DeLange
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Melinda Earnest
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Myron Gerson
- Department of Internal Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Department of Cardiology, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Madison Henry
- Department of Physical Therapy, Rehabilitation Sciences, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City
| | - Alli Horning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brett M. Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Abigail Laughlin
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Kiersten McCartney
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Thomas McQuaid
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Allison Miller
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Alexandra Moores
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Jacqueline A. Palmer
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Heidi Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth D. Thompson
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jaimie Ward
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City
| | - Emily Patton Wasik
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Alicen A. Whitaker
- Department of Physical Therapy, Rehabilitation Sciences, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City
| | - Henry Wright
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio
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Boyne P, Miller A, Schwab SM, Sucharew H, Carl D, Billinger SA, Reisman DS. Training parameters and longitudinal adaptations that most strongly mediate walking capacity gains from high-intensity interval training post-stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.20.23286194. [PMID: 36865178 PMCID: PMC9980231 DOI: 10.1101/2023.02.20.23286194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Background Locomotor high-intensity interval training (HIIT) has been shown to improve walking capacity more than moderate-intensity aerobic training (MAT) after stroke, but it is unclear which training parameter(s) should be prioritized (e.g. speed, heart rate, blood lactate, step count) and to what extent walking capacity gains are the result of neuromotor versus cardiorespiratory adaptations. Objective Assess which training parameters and longitudinal adaptations most strongly mediate 6-minute walk distance (6MWD) gains from post-stroke HIIT. Methods The HIT-Stroke Trial randomized 55 persons with chronic stroke and persistent walking limitations to HIIT or MAT and collected detailed training data. Blinded outcomes included 6MWD, plus measures of neuromotor gait function (e.g. fastest 10-meter gait speed) and aerobic capacity (e.g. ventilatory threshold). This ancillary analysis used structural equation models to compare mediating effects of different training parameters and longitudinal adaptations on 6MWD. Results Net gains in 6MWD from HIIT versus MAT were primarily mediated by faster training speeds and longitudinal adaptations in neuromotor gait function. Training step count was also positively associated with 6MWD gains, but was lower with HIIT versus MAT, which decreased the net 6MWD gain. HIIT generated higher training heart rate and lactate than MAT, but aerobic capacity gains were similar between groups, and 6MWD changes were not associated with training heart rate, training lactate, or aerobic adaptations. Conclusions To increase walking capacity with post-stroke HIIT, training speed and step count appear to be the most important parameters to prioritize.
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Lapointe T, Houle J, Sia YT, Payette M, Trudeau F. Addition of high-intensity interval training to a moderate intensity continuous training cardiovascular rehabilitation program after ischemic cerebrovascular disease: A randomized controlled trial. Front Neurol 2023; 13:963950. [PMID: 36686521 PMCID: PMC9846748 DOI: 10.3389/fneur.2022.963950] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/01/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Moderate intensity continuous training (MICT) is usually recommended for stroke or transient ischemic attack (TIA) patients. High intensity interval training (HIIT) has emerged as a potentially effective method for increasing cardiorespiratory fitness (CRF) among clinical populations. Its effectiveness remains to be demonstrated after stroke. A combined program of HIIT and MICT was designed to create a realistic exercise program implemented for a clinical setting to help patients become more active. Purpose This study aimed to compare the effects of a 6-month exercise program with either MICT only or a combination of HIIT and MICT and a control group in terms of CRF, cardiovascular risk factors, functionality, cognitive function (Montreal Cognitive Assessment) and depression markers (Hospital Anxiety and Depression Scale). Methods This randomized controlled trial started with 52 participants (33 men and 19 women, mean age: 69.2 ± 10.7) divided into three groups: HIIT + MICT combined, MICT, and control. Both exercise groups consisted of 4 weekly sessions including supervised and at-home exercise. Outcomes were assessed at T0 (baseline measure), T6 (end of exercise protocols), and T12 (follow-up), 40 participants having completed the 12-month follow-up. Results At T6, both HIIT+MICT and MICT programs provided a similar increase of CRF (3 ml·min-1·kg-1) from baseline (p < 0.01), while the control group showed a global slight decrease. Despite some decrease of CRF at T12 compared to T6, improvement persisted 6 months post-intervention (HIIT + MICT: p < 0.01 and MICT: p < 0.05). The control group decreased compared with baseline (p < 0.05). The two exercise programs induced a comparable increase in self-reported physical activity and a decrease in anxiety and depression markers. Participants in HIIT + MICT and MICT programs declared a good degree of acceptability assessed by the Acceptability and Preferences Questionnaire. Conclusion A 6-month HIIT + MICT combined program and a standard MICT program induced similar improvements in CRF, self-reported physical activity and anxiety and depression markers among patients with prior ischemic stroke or TIA compared with a control group. These effects appear to persist over time. Addition of HIIT was safe and considered acceptable by participants. Our results do not support any superiority of the combination HIIT + MICT nor disadvantage vs. MICT in this population.
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Affiliation(s)
- Thalia Lapointe
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Ying-Tung Sia
- Integrated University Center for Health and Social Services Mauricie- and Centre-du-Québec, Trois-Rivières, QC, Canada
| | - Marika Payette
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - François Trudeau
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada,*Correspondence: François Trudeau ✉
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10
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Rodrigues L, Moncion K, Eng JJ, Noguchi KS, Wiley E, de Las Heras B, Sweet SN, Fung J, MacKay-Lyons M, Nelson AJ, Medeiros D, Crozier J, Thiel A, Tang A, Roig M. Intensity matters: protocol for a randomized controlled trial exercise intervention for individuals with chronic stroke. Trials 2022; 23:442. [PMID: 35610659 PMCID: PMC9127488 DOI: 10.1186/s13063-022-06359-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Rationale Cardiovascular exercise is an effective method to improve cardiovascular health outcomes, but also promote neuroplasticity during stroke recovery. Moderate-intensity continuous cardiovascular training (MICT) is an integral part of stroke rehabilitation, yet it may remain a challenge to exercise at sufficiently high intensities to produce beneficial adaptations to neuroplasticity. High-intensity interval training (HIIT) could provide a viable alternative to achieve higher intensities of exercise by using shorter bouts of intense exercise interspersed with periods of recovery. Methods and design This is a two-arm, parallel-group multi-site RCT conducted at the Jewish Rehabilitation Hospital (Laval, Québec, Canada) and McMaster University (Hamilton, Ontario, Canada). Eighty participants with chronic stroke will be recruited at both sites and will be randomly allocated into a HIIT or MICT individualized exercise program on a recumbent stepper, 3 days per week for 12 weeks. Outcomes will be assessed at baseline, at 12 weeks post-intervention, and at an 8-week follow-up. Outcomes The primary outcome is corticospinal excitability, a neuroplasticity marker in brain motor networks, assessed with transcranial magnetic stimulation (TMS). We will also examine additional markers of neuroplasticity, measures of cardiovascular health, motor function, and psychosocial responses to training. Discussion This trial will contribute novel insights into the effectiveness of HIIT to promote neuroplasticity in individuals with chronic stroke. Trial registration ClinicalTrials.govNCT03614585. Registered on 3 August 2018 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06359-w.
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Affiliation(s)
- Lynden Rodrigues
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada.,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Bernat de Las Heras
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada.,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada
| | - Shane N Sweet
- Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada.,Department of Kinesiology and Physical Education, McGill University, Montréal, Québec, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada
| | | | - Aimee J Nelson
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada
| | - Diogo Medeiros
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada.,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada
| | - Jennifer Crozier
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Alexander Thiel
- Department of Neurology & Neurosurgery, McGill University, Montréal, Québec, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Marc Roig
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Québec, Montréal, Canada. .,Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Montréal, Québec, Canada. .,Feil/Oberfeld/CRIR Research Centre, Jewish Rehabilitation Hospital site of CISSS-Laval, Laval, Québec, Canada.
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11
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Humphreys L, Carter A, Sharrack B, Copeland R. High-intensity interval training in people with mild multiple sclerosis: a mixed-methods feasibility study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2021.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims High-intensity interval training has received increased attention as a mode of exercise, including as a therapy in clinical populations. This study investigated the acceptability of a high-intensity interval training intervention in people with mild multiple sclerosis. Methods Participants attended two sessions a week for the 6-week intervention. Each session consisted of 6–10 sets of 60-second high-intensity intervals interspersed with 120 seconds of recovery. The acceptability, intervention adherence and safety of the high-intensity interval training protocol and estimates of treatment effects (fitness, physical activity levels, fatigue and quality of life) were used to determine intervention feasibility. Qualitative interviews were used to explore the acceptability of the intervention. Results A total of 11 people with mild multiple sclerosis consented to participate in a 6-week high-intensity interval intervention. One participant dropped out of the intervention. The participants expressed apprehension before the intervention but attendance at the exercise sessions was high (87%). Participants experienced some symptom exacerbation following sessions, although none were serious. Improvements were seen in fitness, physical activity, fatigue and health-related quality of life. Conclusions The study findings suggest that high-intensity interval training is acceptable, safe and may offer disease-related benefits for the participants. Participants did experience some symptom exacerbation and further studies are needed to determine the long-term appeal of high-intensity interval training for people with mild multiple sclerosis.
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Affiliation(s)
- Liam Humphreys
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, UK
| | - Anouska Carter
- Academy of Sport and Physical Activity, Sheffield Hallam University, Sheffield, UK
| | - Basil Sharrack
- Neurology Department, Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - Robert Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
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12
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Boyne P, Doren S, Scholl V, Staggs E, Whitesel D, Carl D, Shatz R, Sawyer R, Awosika OO, Reisman DS, Billinger SA, Kissela B, Vannest J, Dunning K. Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke. Front Neurol 2022; 13:812875. [PMID: 35185766 PMCID: PMC8854218 DOI: 10.3389/fneur.2022.812875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Locomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT. MATERIALS AND METHODS Ten participants >6 months post-stroke were assessed before and after a 4-week no-intervention control phase and a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT. RESULTS Overground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33-89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes. CONCLUSIONS These findings reinforce the potential of locomotor HIIT research for stroke rehabilitation and provide guidance for more definitive studies. Based on the current results, future locomotor HIIT studies should consider including: (1) both overground and treadmill training; (2) measures of cognition, fatigue and brain volume, to complement typical motor and fitness assessment; and (3) baseline gait speed as a covariate.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Staggs
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Russell Sawyer
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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13
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Li W, Weng L, Xiang Q, Fan T. Trends in Research on Traditional Chinese Health Exercises for Improving Cognitive Function: A Bibliometric Analysis of the Literature From 2001 to 2020. Front Public Health 2022; 9:794836. [PMID: 35071171 PMCID: PMC8770942 DOI: 10.3389/fpubh.2021.794836] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/14/2021] [Indexed: 12/11/2022] Open
Abstract
Although previous studies have investigated the ability of traditional Chinese health exercises (TCHEs) to improve cognitive function, few have utilized bibliometric analyses to address this topic. We aimed to investigate the current status of and developmental trends in this field from 2001 to 2020. We searched the Web of Science Core Collection (WoSCC) for all research publications on cognitive function in relation to TCHEs. CiteSpace V was used to analyze the number of papers, countries, institutions, journals, authors, and citations. We identified hotspots and trends in the field by drawing co-citation reference and co-occurrence keyword maps. From 2001 to 2020, 406 relevant articles were published in the WoSCC, with a gradual increase in the annual number of publications. The three countries/regions with the most publications were the Chinese mainland, the United States, and Canada. Six universities from China and four from the United States were identified as the top 10 institutions. Most research was conducted at universities. Evidence-based Complementary and Alternative Medicine was identified as the most productive journal. Together, these findings indicate that TCHEs have received increasing attention as a method for improving cognition.
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Affiliation(s)
- Wenlong Li
- College of Chinese Wushu, Shanghai University of Sport, Shanghai, China
| | - Linman Weng
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Qiuping Xiang
- College of Chinese Wushu, Shanghai University of Sport, Shanghai, China
| | - Tonggang Fan
- College of Chinese Wushu, Shanghai University of Sport, Shanghai, China
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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14
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Espinoza F, Wheeler B. Handgrip as a measure of muscle strength and its physiological dependence on therapeutic variables: A randomized case. HAND SURGERY & REHABILITATION 2021; 41:31-36. [PMID: 34752971 DOI: 10.1016/j.hansur.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Clinical and medical data findings have traditionally been more representative of male than female subjects, and when combined, have not clearly differentiated between the groups. In this study there were no research questions initially contemplated, as the data were obtained from an educational setting, where participants completed tasks as part of a pedagogical program of preparation. The nature of the post-hoc analysis renders the study as a hypothesis-generating type rather than a hypothesis-testing one. It began as a cross-sectional quantitative analysis of performance on a task to explore the relationship between hand grip and three independent physiological variables. The data collected from all subjects were randomized since the total group of participants contained a disproportionate number of females as compared to males, this being a result of a demographic predominance of female students in a program of teacher preparation. Graphical analysis with the slope taken as a measure of hand grip dependence on three independent variables, and the correlation value used as a measure of association between variables yielded discernible differences. The grip strength dependence on the hand size as well as the wrist thickness show consistently significant differences for females only, with t test of significance (p < .001), and large effect size differences based on Cohen's d values of 3.08 and 1.92, respectively. The significance of the finding that female grip strength depends the most on wrist thickness has implications for rehabilitative and therapeutic settings.
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Affiliation(s)
- Fernando Espinoza
- Departments of Adolescence Education and Chemistry-Physics, State University of New York-College at Old Westbury, P.O. Box 210, Old Westbury, NY 11568, USA.
| | - Brandon Wheeler
- Pre-Medical Program, Stony Brook University, 100 Nichols Road, Stony Brook, NY, 11794 USA
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15
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You Y, Li W, Liu J, Li X, Fu Y, Ma X. Bibliometric Review to Explore Emerging High-Intensity Interval Training in Health Promotion: A New Century Picture. Front Public Health 2021; 9:697633. [PMID: 34368063 PMCID: PMC8342813 DOI: 10.3389/fpubh.2021.697633] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background: High-intensity interval training (HIIT) is an emerging exercise strategy and is considered to be a recipe for health promotion. This study aimed to systematically identify collaboration networks, track research trends, highlight current hotspots, and predict future frontiers in HIIT and its applications in health promotion since the start of the new century. Methods: Relevant original publications were obtained from the Science Citation Index Expanded of the Web of Science Core Collection (WoSCC) database between 2001 and 2020. CiteSpace and VOSviewer software were used to perform bibliometric visualization and comparative analysis of involved indexes that included countries, institutions, journals, authors, references, and keywords. Results: A total of 572 papers were included, and the trend of annual publications showed a remarkable growth. The United States and the University of Exeter were the most productive country and institutions, respectively, with 107 and 18 publications, respectively. European Journal of Applied Physiology took the lead in the number of published articles, and Medicine and Science in Sports and Exercise ranked first in the cocitation counts. Barker AR and Gibala MJ were considered as the most productive and the most highly-cited authors. Conclusions: “Health risks,” “adolescent,” and “aging” are the three noteworthy topics during the evolution of HIIT-health promotion (HIIT-HP) research. The current research hotspots of HIIT and its practices in the health promotion domain lies in “metabolic diseases,” “cardiovascular diseases,” “neurological diseases,” and “musculoskeletal diseases.” The authors summarize that “prevention and rehabilitation,” “micro and molecular level,” and “cognition and mental health” are becoming frontiers and focus on the health topics related to HIIT in the upcoming years, which are worthy of further exploration.
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Affiliation(s)
- Yanwei You
- Division of Sport Science & Physical Education, Tsinghua University, Beijing, China
| | - Wenkai Li
- China Table Tennis College, Shanghai University of Sport, Shanghai, China
| | - Jianxiu Liu
- Division of Sport Science & Physical Education, Tsinghua University, Beijing, China
| | - Xingtian Li
- Division of Sport Science & Physical Education, Tsinghua University, Beijing, China
| | - Yingyao Fu
- Division of Sport Science & Physical Education, Tsinghua University, Beijing, China
| | - Xindong Ma
- Division of Sport Science & Physical Education, Tsinghua University, Beijing, China
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16
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Miller A, Reisman DS, Billinger SA, Dunning K, Doren S, Ward J, Wright H, Wagner E, Carl D, Gerson M, Awosika O, Khoury J, Kissela B, Boyne P. Moderate-intensity exercise versus high-intensity interval training to recover walking post-stroke: protocol for a randomized controlled trial. Trials 2021; 22:457. [PMID: 34271979 PMCID: PMC8284012 DOI: 10.1186/s13063-021-05419-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Stroke results in neurologic impairments and aerobic deconditioning that contribute to limited walking capacity which is a major barrier post-stroke. Current exercise recommendations and stroke rehabilitation guidelines recommend moderate-intensity aerobic training post-stroke. Locomotor high-intensity interval training is a promising new strategy that has shown significantly greater improvements in aerobic fitness and motor performance than moderate-intensity aerobic training in other populations. However, the relative benefits and risks of high-intensity interval training and moderate-intensity aerobic training remain poorly understood following stroke. In this study, we hypothesize that locomotor high-intensity interval training will result in greater improvements in walking capacity than moderate-intensity aerobic training. Methods Using a single-blind, 3-site randomized controlled trial, 50 chronic (> 6 months) stroke survivors are randomly assigned to complete 36 locomotor training sessions of either high-intensity interval training or moderate-intensity aerobic training. Main eligibility criteria are age 40–80 years, single stroke for which the participant received treatment (experienced 6 months to 5 years prior to consent), walking speed ≤ 1.0 m/s, able to walk at least 3 min on the treadmill at ≥ 0.13 m/s (0.3 mph), stable cardiovascular condition (American Heart Association class B), and the ability to walk 10 m overground without continuous physical assistance. The primary outcome (walking capacity) and secondary outcomes (self-selected and fast gait speed, aerobic fitness, and fatigue) are assessed prior to initiating training and after 4 weeks, 8 weeks, and 12 weeks of training. Discussion This study will provide fundamental new knowledge to inform the selection of intensity and duration dosing parameters for gait recovery and optimization of aerobic training interventions in chronic stroke. Data needed to justify and design a subsequent definitive trial will also be obtained. Thus, the results of this study will inform future stroke rehabilitation guidelines on how to optimally improve walking capacity following stroke. Trial registration ClinicalTrials.govNCT03760016. Registered on November 30, 2018.
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Affiliation(s)
- Allison Miller
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA
| | - Darcy S Reisman
- Department of Biomechanics and Movement Sciences Program, University of Delaware, Newark, DE, 19713, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Jaimie Ward
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Henry Wright
- Department of Physical Therapy, University of Delaware, Newark, DE, 19713, USA
| | - Erin Wagner
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA
| | - Myron Gerson
- Departments of Cardiology and Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Oluwole Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jane Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, 3225 Eden Avenue, Cincinnati, OH, USA.
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17
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Cleland B, Madhavan S. Changes in Walking Speed After High-Intensity Treadmill Training Are Independent of Changes in Spatiotemporal Symmetry After Stroke. Front Neurol 2021; 12:647338. [PMID: 33868151 PMCID: PMC8049178 DOI: 10.3389/fneur.2021.647338] [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: 12/29/2020] [Accepted: 03/11/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: Decreased walking speeds and spatiotemporal asymmetry both occur after stroke, but it is unclear whether and how they are related. It is also unclear whether rehabilitation-induced improvements in walking speed are associated with improvements in symmetry or greater asymmetry. High-intensity speed-based treadmill training (HISTT) is a recent rehabilitative strategy whose effects on symmetry are unclear. The purpose of this study was to: (1) assess whether walking speed is cross-sectionally associated with spatiotemporal symmetry in chronic stroke, (2) determine whether HISTT leads to changes in the spatiotemporal symmetry of walking, and (3) evaluate whether HISTT-induced changes in walking speed are associated with changes in spatiotemporal symmetry. Methods: Eighty-one participants with chronic stroke performed 4 weeks of HISTT. At pre, post, and 3-month follow-up assessments, comfortable and maximal walking speed were measured with the 10-meter walk test, and spatiotemporal characteristics of walking were measured with the GAITRite mat. Step length and swing time were expressed as symmetry ratios (paretic/non-paretic). Changes in walking speed and symmetry were calculated and the association was determined. Results: At pre-assessment, step length and swing time asymmetries were present (p < 0.001). Greater temporal symmetry was associated with faster walking speeds (p ≤ 0.001). After HISTT, walking speeds increased from pre-assessment to post-assessment and follow-up (p ≤ 0.002). There were no changes in spatiotemporal symmetry (p ≥ 0.10). Change in walking speed was not associated with change in spatial or temporal symmetry from pre- to post-assessment or from post-assessment to follow-up (R2 ≤ 0.01, p ≥ 0.37). Conclusions: HISTT improves walking speed but does not systematically improve or worsen spatiotemporal symmetry. Clinicians may need to pair walking interventions like HISTT with another intervention designed to improve walking symmetry simultaneously. The cross-sectional relation between temporal symmetry and walking speed may be mediated by other factors, and not be causative.
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Affiliation(s)
- Brice Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
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18
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Ogoh S, Washio T, Suzuki K, Iemitsu M, Hashimoto T, Iwamoto E, Bailey DM. Greater increase in internal carotid artery shear rate during aerobic interval compared to continuous exercise in healthy adult men. Physiol Rep 2021; 9:e14705. [PMID: 33463912 PMCID: PMC7814484 DOI: 10.14814/phy2.14705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/26/2022] Open
Abstract
Interval exercise has been determined to be more effective than continuous exercise for achieving improvement in the cardiovascular function of individuals suffering from cardiovascular disease. However, whether interval exercise improves the cerebrovascular function remains unclear. As per our hypothesis, interval exercise induces a higher cerebrovascular shear rate (SR) than continuous exercise. In this study, 11 adult men randomly performed continuous exercise for 12 min or work-equivalent (57.6 kJ/exercise session) interval exercise of semi-recumbent cycling. The SR in the internal carotid artery (ICA) represents an index of the cerebrovascular SR, which was measured during both the exercises using Doppler ultrasonography. Both the aerobic exercise modes increased the ICA SR. Moreover, the average ICA SR of the interval exercise for the final 4 min of exercise or 2 min of recovery was significantly higher than that for continuous exercise (exercise, 351 ± 75 vs. 330 ± 61/s, p = .038; recovery, 327 ± 86 vs. 290 ± 56/s, p = .014). To our knowledge, this is the first study to show that aerobic interval exercise increased the ICA SR more than equivalent work volume of aerobic continuous exercise. Thus, aerobic interval exercise may be more effective at stimulating the cerebrovasculature, resulting in greater improvements in cerebrovascular function as compared to continuous aerobic exercise in healthy adult men. These findings provide some important information that would help enhance exercise therapy programs for patients with arteriosclerosis, especially in the cerebral circulation.
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Affiliation(s)
- Shigehiko Ogoh
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiJapan
- Neurovascular Research LaboratoryUniversity of South WalesPontypriddUK
| | - Takuro Washio
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiJapan
- Research Fellow of Japan Society for the Promotion of ScienceTokyoJapan
| | - Kazuya Suzuki
- Department of Biomedical EngineeringToyo UniversityKawagoe‐ShiJapan
| | - Motoyuki Iemitsu
- Faculty of Sport and Health ScienceRitsumeikan UniversityShigaJapan
| | | | - Erika Iwamoto
- School of Health SciencesSapporo Medical UniversitySapporoJapan
| | - Damian M. Bailey
- Neurovascular Research LaboratoryUniversity of South WalesPontypriddUK
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19
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Hubbard EA, Motl RW, Elmer DJ. Feasibility and initial efficacy of a high-intensity interval training program using adaptive equipment in persons with multiple sclerosis who have walking disability: study protocol for a single-group, feasibility trial. Trials 2020; 21:972. [PMID: 33239079 PMCID: PMC7687792 DOI: 10.1186/s13063-020-04887-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background There is considerable evidence for the efficacy of moderate-intensity continuous exercise benefitting clinically relevant outcomes in persons with multiple sclerosis (MS). However, persons with MS who have walking disability (pwMS-wd) are severely deconditioned and may achieve superior benefits by engaging in high-intensity interval training (HIIT), especially while utilizing adaptive equipment, such as recumbent arm/leg stepping (RSTEP). The proposed study will assess the feasibility of a 12-week, RSTEP HIIT program in pwMS-wd. The secondary aim will examine changes in aerobic fitness, physical activity, ambulation, upper arm function, cognition, fatigue, and depression as clinically relevant efficacy outcomes following the 12-week, RSTEP HIIT intervention. Methods The study will recruit 15 pwMS-wd. Feasibility will be measured via process, resource, management, and scientific outcomes throughout the entirety of the research study. The secondary, clinically relevant outcomes will consist of a neurological exam, aerobic capacity, physical activity, ambulation, cognition, upper arm function, fatigue, and depression. Outcomes will be assessed at baseline (T1), midpoint (T2, following 6 weeks), and post-intervention (T3, following 12 weeks). The intervention will involve 12 weeks of supervised, individualized HIIT sessions two to three times per week. The individual HIIT sessions will each involve 10 cycles of 60-s intervals at the wattage associated with 90% VO2peak followed by 60 s of active recovery intervals at 15 W, totaling 20 min in length plus 5-min warm-up and cool-down periods. Discussion The feasibility design of the proposed study will provide experience and preliminary data for advancing towards a proof-of-concept study comparing HIIT to moderate-intensity continuous RSTEP for improving clinically relevant outcomes in a randomized control trial design. The results will be disseminated via manuscripts for publication and a report for distribution among the National Multiple Sclerosis Society. Trial registration ClinicalTrials.gov NCT04416243. Retrospectively registered on June 4, 2020
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Affiliation(s)
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David J Elmer
- Department of Kinesiology, Berry College, Mount Berry, GA, USA
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20
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High-Intensity Interval Training for Adults With Chronic Stroke: A Pilot Feasibility Study. Cardiopulm Phys Ther J 2020. [DOI: 10.1097/cpt.0000000000000152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Boyne P, Scholl V, Doren S, Carl D, Billinger SA, Reisman DS, Gerson M, Kissela B, Vannest J, Dunning K. Locomotor training intensity after stroke: Effects of interval type and mode. Top Stroke Rehabil 2020; 27:483-493. [PMID: 32063178 DOI: 10.1080/10749357.2020.1728953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and Objectives: High-intensity interval training (HIIT) is a promising strategy for improving gait and fitness after stroke, but optimal parameters remain unknown. We tested the effects of short vs long interval type and over-ground vs treadmill mode on training intensity. Methods: Using a repeated measures design, 10 participants with chronic hemiparesis performed 12 HIIT sessions over 4 weeks, alternating between short and long-interval HIIT sessions. Both protocols included 10 minutes of over-ground HIIT, 20 minutes of treadmill HIIT and another 10 minutes over-ground. Short-interval HIIT involved 30 second bursts at maximum safe speed and 30-60 second rest periods. Long-interval HIIT involved 4-minute bursts at ~90% of peak heart rate (HRpeak) and 3-minute recovery periods at ~70% HRpeak. Results: Compared with long-interval HIIT, short-interval HIIT had significantly faster mean overground speeds (0.75 vs 0.67 m/s) and treadmill speeds (0.90 vs 0.51 m/s), with similar mean treadmill HR (82.9 vs 81.8%HRpeak) and session perceived exertion (16.3 vs 16.3), but lower overground HR (78.4 vs 81.1%HRpeak) and session step counts (1481 vs 1672). For short-interval HIIT, training speeds and HR were significantly higher on the treadmill vs. overground. For long-interval HIIT, the treadmill elicited HR similar to overground training at significantly slower speeds. Conclusions: Both short and long-interval HIIT elicit high intensities but emphasize different dosing parameters. From these preliminary findings and previous studies, we hypothesize that overground and treadmill short-interval HIIT could be optimal for improving gait speed and overground long-interval HIIT could be optimal for improving gait endurance.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
| | - Sandra A Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center , Kansas City, KS, USA
| | - Darcy S Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware , Newark, DE, USA
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati , Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati , Cincinnati, OH, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA.,Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center , Cincinnati, OH, USA
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati , Cincinnati, OH, USA
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22
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Boyne P, Meyrose C, Westover J, Whitesel D, Hatter K, Reisman DS, Carl D, Khoury JC, Gerson M, Kissela B, Dunning K. Effects of Exercise Intensity on Acute Circulating Molecular Responses Poststroke. Neurorehabil Neural Repair 2020; 34:222-234. [PMID: 31976813 DOI: 10.1177/1545968319899915] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Exercise intensity can influence functional recovery after stroke, but the mechanisms remain poorly understood. Objective. In chronic stroke, an intensity-dependent increase in circulating brain-derived neurotrophic factor (BDNF) was previously found during vigorous exercise. Using the same serum samples, this study tested acute effects of exercise intensity on other circulating molecules related to neuroplasticity, including vascular-endothelial growth factor (VEGF), insulin-like growth factor-1 (IGF1), and cortisol, with some updated analyses involving BDNF. Methods. Using a repeated-measures design, 16 participants with chronic stroke performed 3 exercise protocols in random order: treadmill high-intensity interval training (HIT-treadmill), seated-stepper HIT (HIT-stepper), and treadmill moderate-intensity continuous exercise (MCT-treadmill). Serum molecular changes were compared between protocols. Mediation and effect modification analyses were also performed. Results. VEGF significantly increased during HIT-treadmill, IGF1 increased during both HIT protocols and cortisol nonsignificantly decreased during each protocol. VEGF response was significantly greater for HIT-treadmill versus MCT-treadmill when controlling for baseline. Blood lactate positively mediated the effect of HIT on BDNF and cortisol. Peak treadmill speed positively mediated effects on BDNF and VEGF. Participants with comfortable gait speed ≥0.4 m/s had significantly lower VEGF and higher IGF1 responses, with a lower cortisol response during MCT-treadmill. Conclusions. BDNF and VEGF are promising serum molecules to include in future studies testing intensity-dependent mechanisms of exercise on neurologic recovery. Fast training speed and anaerobic intensity appear to be critical ingredients for eliciting these molecular responses. Serum molecular response differences between gait speed subgroups provide a possible biologic basis for previously observed differences in training responsiveness.
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Affiliation(s)
| | | | | | | | - Kristal Hatter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Daniel Carl
- University of Cincinnati, Cincinnati, OH, USA
| | - Jane C Khoury
- University of Cincinnati, Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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23
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Hafez S, Khan MB, Awad ME, Wagner JD, Hess DC. Short-Term Acute Exercise Preconditioning Reduces Neurovascular Injury After Stroke Through Induced eNOS Activation. Transl Stroke Res 2019; 11:851-860. [PMID: 31858409 DOI: 10.1007/s12975-019-00767-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/24/2019] [Accepted: 12/05/2019] [Indexed: 12/18/2022]
Abstract
Physical exercise is known to reduce cardiovascular risk but its role in ischemic stroke is not clear. It was previously shown that an acute single bout of exercise reduced increased eNOS activation in the heart and reduced myocardial infarction. However, the impact of a single bout or short-term exercise on eNOS-induced neuroprotection after stroke was not previously studied. Accordingly, this study was designed to test the hypothesis that short-term acute exercise can provide "immediate neuroprotection" and improve stroke outcomes through induced eNOS activation. Male Wistar rats (300 g) were subjected to HIIT treadmill exercise for 4 days (25 min/day), break for 2 days, and then one acute bout for 30 min. Exercised animals were subjected to thromboembolic stroke 1 h, 6 h, 24 h, or 72 h after the last exercise session. At 24 h after stroke, control (sedentary) and exercised rats were tested for neurological outcomes, infarct size, and edema. The expression of active eNOS (p-S1177-eNOS) and active AMPK (p-T172-AMPK) was measured in the brain, cerebral vessels, and aorta. In an additional cohort, animals were treated with the eNOS inhibitor, L-NIO (I.P, 20 mg/kg), and stroked 1 h after exercise and compared with non-exercise animals. Acute exercise significantly reduced infarct size, edema, and improved functional outcomes, and significantly increased the expression of peNOS and pAMPK in the brain, cerebral vessels, and aorta. eNOS inhibition abolished the exercise-induced improvement in outcomes. Short-term acute preconditioning exercise reduced the neurovascular injury and improved functional outcomes after stroke through eNOS activation.
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Affiliation(s)
- Sherif Hafez
- Department of Neurology, Augusta University, Augusta, GA, 30912, USA. .,Department of Pharmaceutical Sciences, College of Pharmacy, Larkin University, 18301 N Miami Ave Suite 1, Miami, FL, 33169, USA.
| | | | - Mohamed E Awad
- Department of Oral Biology, Augusta University, Augusta, GA, 30912, USA
| | - Jesse D Wagner
- Department of Neurology, Augusta University, Augusta, GA, 30912, USA
| | - David C Hess
- Department of Neurology, Augusta University, Augusta, GA, 30912, USA
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24
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Exercise training augments Sirt1-signaling and attenuates cardiac inflammation in D-galactose induced-aging rats. Aging (Albany NY) 2019; 10:4166-4174. [PMID: 30582744 PMCID: PMC6326662 DOI: 10.18632/aging.101714] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/06/2018] [Indexed: 01/25/2023]
Abstract
Exercise is known to be beneficial in controlling aging associated disorders however, the consequence of long-term exercise on cardiac health among aging population is not much clear. In this study the protective effect of exercise on aging associated cardiac disorders was determined using a D-galactose-induced aging model. Eight weeks old Sprague Dawley rats were given intraperitoneal injection of 150 mL/kg D-galactose. Swimming exercise was provided in warm water for 60 min/day for five days per week. Hematoxylin and eosin staining of cardiac tissue sections revealed cardiomyocyte disarrangements in the aging rat hearts but long-term exercise training showed improvements in the cardiac histology. Exercise training also enhanced the expression levels of proteins such as SIRT1, PGC-1α and AMPKα1 that are associated with energy homeostasis and further suppressed aging associated inflammatory cytokines. Our results show that long-term exercise training potentially enhances SIRT1 associated anti-aging signaling and provide cardio-protection against aging.
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25
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Gladstone E, Narad ME, Hussain F, Quatman-Yates CC, Hugentobler J, Wade SL, Gubanich PJ, Kurowski BG. Neurocognitive and Quality of Life Improvements Associated With Aerobic Training for Individuals With Persistent Symptoms After Mild Traumatic Brain Injury: Secondary Outcome Analysis of a Pilot Randomized Clinical Trial. Front Neurol 2019; 10:1002. [PMID: 31620073 PMCID: PMC6759771 DOI: 10.3389/fneur.2019.01002] [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: 02/22/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To report secondary neurocognitive and quality of life outcomes for a pilot randomized clinical trial (RCT) of aerobic training for management of prolonged symptoms after a mild traumatic brain injury (mTBI) in adolescents. Setting: Outpatient research setting. Participants: Thirty adolescents between the ages of 12 and 17 years who sustained a mTBI and had between 4 and 16 weeks of persistent post-concussive symptoms. Design: Secondary outcome analysis of a partially masked RCT of sub-symptom exacerbation aerobic training compared with a full-body stretching program highlighting cognitive and quality of life outcomes. Main Measures: The secondary outcomes assessed included neurocognitive changes in fluid and crystallized age-adjusted cognition using the National Institutes of Health (NIH) toolbox and self and parent-reported total quality of life using the Pediatric Quality of Life Inventory. Results: Twenty-two percent of eligible participants enrolled in the trial. General linear models did not reveal statistically significant differences between groups. Within group analyses using paired t-tests demonstrated improvement in age-adjusted fluid cognition [t (13) = 3.39, p = 0.005, Cohen's d = 0.61] and crystallized cognition [t (13) = 2.63, p = 0.02, Cohen's d = 0.70] within the aerobic training group but no significant improvement within the stretching group. Paired t-tests demonstrated significant improvement in both self-reported and parent-reported total quality of life measures in the aerobic training group [self-report t (13) = 3.51, p = 0.004, Cohen's d = 0.94; parent-report t (13) = 6.5, p < 0.0001, Cohen's d = 1.80] and the stretching group [self-report t (14) = 4.20, p = 0.0009, Cohen's d = 1.08; parent-report t (14) = 4.06, p = 0.0012, Cohen's d = 1.045]. Conclusion: Quality of life improved significantly in both the aerobic exercise and stretching groups; however, this study suggests that only sub-symptom exacerbation aerobic training was potentially beneficial for neurocognitive recovery, particularly the fluid cognition subset in the NIH Toolbox. Limited sample size and variation in outcomes measures limited ability to detect between group differences. Future research should focus on developing larger studies to determine optimal timing post-injury and intensity of active rehabilitation to facilitate neurocognitive recovery and improve quality of life after mTBI. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02035579.
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Affiliation(s)
- Emily Gladstone
- Department of Physical Medicine and Rehabilitation, MetroHealth and Case Western Reserve College of Medicine, Cleveland, OH, United States
| | - Megan E Narad
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Fadhil Hussain
- College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Catherine C Quatman-Yates
- Division of Occupational Therapy and Physical Therapy, Department of Physical Therapy, Cincinnati Children's Hospital Medical Center, The Ohio State University, Columbus, OH, United States.,Division of Physical Therapy, Sports Medicine Research Institute, and Chronic Brain Injury Program, Columbus, OH, United States
| | - Jason Hugentobler
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Paul J Gubanich
- Division of Sports Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University College of Medicine, Cincinnati, OH, United States.,Department of Internal Medicine, University College of Medicine, Cincinnati, OH, United States
| | - Brad G Kurowski
- Division of Pediatric Rehabilitation Medicine, Departments of Pediatrics and Neurology and Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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26
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Soh SH, Joo MC, Yun NR, Kim MS. Randomized Controlled Trial of the Lateral Push-Off Skater Exercise for High-Intensity Interval Training vs Conventional Treadmill Training. Arch Phys Med Rehabil 2019; 101:187-195. [PMID: 31562872 DOI: 10.1016/j.apmr.2019.08.480] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/13/2019] [Accepted: 08/30/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine the therapeutic effects of the lateral push-off skater exercise vs conventional treadmill training on health-related quality of life, cardiorespiratory fitness (CRF), and balance. DESIGN Single-blinded, randomized controlled trial. SETTING Outpatient clinic at a tertiary hospital. PARTICIPANTS Patients after minor stroke (N=36) with National Institutes of Health Stroke Scale scores≤3 between 20 and 65 years of age were randomly assigned to the intervention group (n=18) or the control group (n=18). INTERVENTIONS Thirty-minute sessions of the skater exercise were performed 3 times weekly for 12 weeks in the intervention group. Conventional treadmill aerobic exercise was conducted in the control group at the same frequency and duration as the experimental group exercise. MAIN OUTCOME MEASURES The primary outcome was measured using the European Quality of Life-5 Dimension (EQ-5D). Secondary outcomes included CRF and balance indicators. Assessments were performed at baseline (T0), 12 weeks from T0 (T1), and 16 weeks from T0 (T2). RESULTS Significant improvements in EQ-5D, peak oxygen uptake (VO2peak), peak oxygen pulse, peak minute ventilation (VE), Dynamic Gait Index (DGI), and Berg Balance Scale (BBS) were found in the intervention group after performing the skater exercise (P<.05, all), and these improvements were sustained at T2 (P<.05, all). Between-group comparisons demonstrated greater improvements in EQ-5D, VO2peak, peak oxygen pulse, peak VE, DGI, and BBS in the intervention group than those in the control group at both T1 (P<.05, all) and T2 (P<0.05, all). Correlation analysis showed significant relationships between EQ-5D and VO2peak, peak VE, DGI, and BBS (P<.05, all). CONCLUSIONS The skater exercise improved health-related quality of life, CRF, and balance in patients after minor stroke more effectively than conventional treadmill-based aerobic exercise. We recommend the skater exercise as a high-intensity interval training program for patients after minor stroke.
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Affiliation(s)
- Soo-Hyun Soh
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Na Ri Yun
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea
| | - Min-Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine and Institute of Wonkwang Medical Science, Iksan, Republic of Korea.
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27
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Wiener J, McIntyre A, Janssen S, Chow JTY, Batey C, Teasell R. Effectiveness of High‐Intensity Interval Training for Fitness and Mobility Post Stroke: A Systematic Review. PM R 2019; 11:868-878. [DOI: 10.1002/pmrj.12154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/28/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Joshua Wiener
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Amanda McIntyre
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Scott Janssen
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Jeffrey TY Chow
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
| | - Cristina Batey
- Parkwood InstituteSt. Joseph's Health Care London London ON Canada
- Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Robert Teasell
- Parkwood Institute ResearchLawson Health Research Institute London ON Canada
- Parkwood InstituteSt. Joseph's Health Care London London ON Canada
- Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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28
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HUBBARD ELIZABETHA, MOTL ROBERTW, FERNHALL BO. Acute High-Intensity Interval Exercise in Multiple Sclerosis with Mobility Disability. Med Sci Sports Exerc 2019; 51:858-867. [DOI: 10.1249/mss.0000000000001866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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29
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Luo L, Li C, Du X, Shi Q, Huang Q, Xu X, Wang Q. Effect of aerobic exercise on BDNF/proBDNF expression in the ischemic hippocampus and depression recovery of rats after stroke. Behav Brain Res 2019; 362:323-331. [DOI: 10.1016/j.bbr.2018.11.037] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/09/2018] [Accepted: 11/26/2018] [Indexed: 01/12/2023]
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30
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Effects of high intensity speed-based treadmill training on ambulatory function in people with chronic stroke: A preliminary study with long-term follow-up. Sci Rep 2019; 9:1985. [PMID: 30760772 PMCID: PMC6374472 DOI: 10.1038/s41598-018-37982-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 12/17/2018] [Indexed: 12/12/2022] Open
Abstract
High intensity treadmill training has shown to be beneficial for stroke survivors, yet the feasibility and long-term effects remain unclear. In this study, we aimed to determine whether a 4-week high intensity speed-based treadmill training (HISTT) is feasible for chronic stroke survivors, and we examined its effects on ambulatory function, and long-term retention. Sixteen individuals post-stroke participated in 40 minutes of HISTT for four weeks at a frequency of three sessions per week. Gait speed was measured using the 10-meter walk test, endurance was measured using the 6-minute walk test, and quality of life was assessed using the Stroke Impact Scale (SIS) at baseline, post-training, and at 3-month follow-up. All participants successfully completed the training without any serious adverse events. Participants significantly increased fastest walking speed by 19%, self-selected walking speed by 18%, and walking endurance by 12% after the training. These improvements were maintained for 3 months after the intervention. Our results indicate that this modified speed-based high intensity walking program has the potential to be a feasible and effective method of gait training for stroke survivors. However, the small sample size and lack of a control group warrant caution in interpretation of results. Further studies are recommended to better understand effectiveness of this protocol in combination with other physical therapy interventions for functional recovery after stroke.
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31
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Aaron SE, Gregory CM. Feasibility of single session high-intensity interval training utilizing speed and active recovery to push beyond standard practice post-stroke. Top Stroke Rehabil 2018; 25:1-5. [PMID: 30222072 PMCID: PMC7202081 DOI: 10.1080/10749357.2018.1487156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Improvement in overground walking speed reduces dependency and is a central focus in post-stroke rehabilitation. Previous studies have shown that high-intensity interval training (HIT) can significantly improve functional and health-related outcomes in neurologically health individuals more so than traditional approaches. Emerging evidence suggests the same may be true post-stroke. OBJECTIVE The purpose of this study was to assess the feasibility of a single session, novel HIT design. METHODS Participants walked on a treadmill, alternating between one minute at high-intensity and one minute at low-intensity for 20 minutes, adjusting the speed of the treadmill to dictate intensity. Treadmill speeds were determined from overground self-selected walking speed (SSWS). RESULTS No adverse events occurred during the training sessions. High-intensity treadmill speeds were significantly faster than treadmill SSWS (standard practice; +227%; p < 0.0001) and overground SSWS (+142%; p = 0.003). 15 of the 21 subjects were able to walk on the treadmill at 150% of overground SSWS; with the remaining individuals (n = 6) walking at 123% of overground SSWS. Average peak heart rate during HIT was 90% of age-predicted max. CONCLUSIONS These results demonstrate the feasibility of this single session HIT design and suggest that individuals following stroke are capable of prolonged training at speeds significantly faster than standard practice. Additionally, this training intensity elicited heart rate responses in the upper range of vigorous exercise. Future studies are needed to investigate a progressive HIT intervention applying this design and its effects on functional outcomes as well as cardiovascular fitness.
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Affiliation(s)
- Stacey E Aaron
- a Department of Health Sciences and Research , College of Health Professions, Medical University of South Carolina , Charleston , SC , US
- b Ralph H. Johnson VA Medical Center , Charleston , SC , US
| | - Chris M Gregory
- a Department of Health Sciences and Research , College of Health Professions, Medical University of South Carolina , Charleston , SC , US
- b Ralph H. Johnson VA Medical Center , Charleston , SC , US
- c Division of Physical Therapy , College of Health Professions, Medical University of South Carolina , Charleston , SC , US
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32
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Crozier J, Roig M, Eng JJ, MacKay-Lyons M, Fung J, Ploughman M, Bailey DM, Sweet SN, Giacomantonio N, Thiel A, Trivino M, Tang A. High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity. Neurorehabil Neural Repair 2018; 32:543-556. [PMID: 29676956 DOI: 10.1177/1545968318766663] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Stroke is the leading cause of adult disability. Individuals poststroke possess less than half of the cardiorespiratory fitness (CRF) as their nonstroke counterparts, leading to inactivity, deconditioning, and an increased risk of cardiovascular events. Preserving cardiovascular health is critical to lower stroke risk; however, stroke rehabilitation typically provides limited opportunity for cardiovascular exercise. Optimal cardiovascular training parameters to maximize recovery in stroke survivors also remains unknown. While stroke rehabilitation recommendations suggest the use of moderate-intensity continuous exercise (MICE) to improve CRF, neither is it routinely implemented in clinical practice, nor is the intensity always sufficient to elicit a training effect. High-intensity interval training (HIIT) has emerged as a potentially effective alternative that encompasses brief high-intensity bursts of exercise interspersed with bouts of recovery, aiming to maximize cardiovascular exercise intensity in a time-efficient manner. HIIT may provide an alternative exercise intervention and invoke more pronounced benefits poststroke. OBJECTIVES To provide an updated review of HIIT poststroke through ( a) synthesizing current evidence; ( b) proposing preliminary considerations of HIIT parameters to optimize benefit; ( c) discussing potential mechanisms underlying changes in function, cardiovascular health, and neuroplasticity following HIIT; and ( d) discussing clinical implications and directions for future research. RESULTS Preliminary evidence from 10 studies report HIIT-associated improvements in functional, cardiovascular, and neuroplastic outcomes poststroke; however, optimal HIIT parameters remain unknown. CONCLUSION Larger randomized controlled trials are necessary to establish ( a) effectiveness, safety, and optimal training parameters within more heterogeneous poststroke populations; (b) potential mechanisms of HIIT-associated improvements; and ( c) adherence and psychosocial outcomes.
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Affiliation(s)
| | - Marc Roig
- 2 McGill University, Montreal, Quebec, Canada
| | - Janice J Eng
- 3 University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Joyce Fung
- 2 McGill University, Montreal, Quebec, Canada
| | | | | | - Shane N Sweet
- 2 McGill University, Montreal, Quebec, Canada.,7 Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Quebec, Canada
| | | | | | | | - Ada Tang
- 1 McMaster University, Hamilton, Ontario, Canada
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Four birds with one stone? Reparative, neuroplastic, cardiorespiratory, and metabolic benefits of aerobic exercise poststroke. Curr Opin Neurol 2018; 29:684-692. [PMID: 27661010 DOI: 10.1097/wco.0000000000000383] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Converging evidence from animal models of stroke and clinical trials suggests that aerobic exercise has effects across multiple targets. RECENT FINDINGS The subacute phase is characterized by a period of heightened neuroplasticity when aerobic exercise has the potential to optimize recovery. In animals, low intensity aerobic exercise shrinks lesion size and reduces cell death and inflammation, beginning 24 h poststroke. Also in animals, aerobic exercise upregulates brain-derived neurotrophic factor near the lesion and improves learning. In terms of neuroplastic effects, clinical trial results are less convincing and have only examined effects in chronic stroke. Stroke patients demonstrate cardiorespiratory fitness levels below the threshold required to carry out daily activities. This may contribute to a 'neurorehabilitation ceiling' that limits capacity to practice at a high enough frequency and intensity to promote recovery. Aerobic exercise when delivered 2-5 days per week at moderate to high intensity beginning as early as 5 days poststroke improves cardiorespiratory fitness, dyslipidemia, and glucose tolerance. SUMMARY Based on the evidence discussed and applying principles of periodization commonly used to prepare athletes for competition, we have created a model of aerobic training in subacute stroke in which training is delivered in density blocks (duration × intensity) matched to recovery phases.
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Zhang J, Wallace SJ, Shiu MY, Smith I, Rhind SG, Langlois VS. Human hair follicle transcriptome profiling: a minimally invasive tool to assess molecular adaptations upon low-volume, high-intensity interval training. Physiol Rep 2017; 5. [PMID: 29212859 PMCID: PMC5727284 DOI: 10.14814/phy2.13534] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/08/2017] [Accepted: 11/11/2017] [Indexed: 12/22/2022] Open
Abstract
High‐intensity interval training (HIIT) has become a popular fitness training approach under both civilian and military settings. Consisting of brief and intense exercise intervals, HIIT requires less time commitment yet is able to produce the consistent targeted physical adaptations as conventional endurance training. To effectively characterize and monitor HIIT‐induced cellular and molecular responses, a highly accessible yet comprehensive biomarker discovery source is desirable. Both gene differential expression (DE) and gene set (GS) analyses were conducted using hair follicle transcriptome established from pre and postexercise subjects upon a 10‐day HIIT program by RNA‐Seq, Comparing between pre and posttraining groups, differentially expressed protein coding genes were identified. To interpret the functional significance of the DE results, a comprehensive GS analysis approach featuring multiple algorithms was used to enrich gene ontology (GO) terms and KEGG pathways. The GS analysis revealed enriched themes such as energy metabolism, cell proliferation/growth/survival, muscle adaptations, and cytokine–cytokine interaction, all of which have been previously proposed as HIIT responses. Moreover, related cell signaling pathways were also measured. Specifically, G‐protein‐mediated signal transduction, phosphatidylinositide 3‐kinases (PI3K) – protein kinase B (PKB) and Janus kinase (JAK) – Signal Transducer and Activator of Transcription (STAT) signaling cascades were over‐represented. Additionally, the RNA‐Seq analysis also identified several HIIT‐responsive microRNAs (miRNAs) that were involved in regulating hair follicle‐specific processes, such as miR‐99a. For the first time, this study demonstrated that both existing and new biomarkers like miRNA can be explored for HIIT using the transcriptomic responses exhibited by the hair follicle.
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Affiliation(s)
- Jing Zhang
- Chemistry and Chemical Engineering Department, Royal Military College of Canada, Kingston, ON, Canada
| | - Sarah J Wallace
- Chemistry and Chemical Engineering Department, Royal Military College of Canada, Kingston, ON, Canada
| | - Maria Y Shiu
- Defense Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Ingrid Smith
- Defense Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Shawn G Rhind
- Defense Research and Development Canada, Toronto Research Centre, Toronto, ON, Canada
| | - Valerie S Langlois
- Chemistry and Chemical Engineering Department, Royal Military College of Canada, Kingston, ON, Canada
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Keytsman C, Hansen D, Wens I, O. Eijnde B. Impact of high-intensity concurrent training on cardiovascular risk factors in persons with multiple sclerosis – pilot study. Disabil Rehabil 2017; 41:430-435. [DOI: 10.1080/09638288.2017.1395086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Charly Keytsman
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
| | - Inez Wens
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
| | - Bert O. Eijnde
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
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Nepveu JF, Thiel A, Tang A, Fung J, Lundbye-Jensen J, Boyd LA, Roig M. A Single Bout of High-Intensity Interval Training Improves Motor Skill Retention in Individuals With Stroke. Neurorehabil Neural Repair 2017; 31:726-735. [PMID: 28691645 DOI: 10.1177/1545968317718269] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND One bout of high-intensity cardiovascular exercise performed immediately after practicing a motor skill promotes changes in the neuroplasticity of the motor cortex and facilitates motor learning in nondisabled individuals. OBJECTIVE To determine if a bout of exercise performed at high intensity is sufficient to induce neuroplastic changes and improve motor skill retention in patients with chronic stroke. METHODS Twenty-two patients with different levels of motor impairment were recruited. On the first session, the effects of a maximal graded exercise test on corticospinal and intracortical excitability were assessed from the affected and unaffected primary motor cortex representational area of a hand muscle with transcranial magnetic stimulation. On the second session, participants were randomly assigned to an exercise or a nonexercise control group. Immediately after practicing a motor task, the exercise group performed 15 minutes of high-intensity interval training while the control group rested. Twenty-four hours after motor practice all participants completed a test of the motor task to assess skill retention. RESULTS The graded exercise test reduced interhemispheric imbalances in GABAA-mediated short-interval intracortical inhibition but changes in other markers of excitability were not statistically significant. The group that performed high-intensity interval training showed a better retention of the motor skill. CONCLUSIONS The performance of a maximal graded exercise test triggers only modest neuroplastic changes in patients with chronic stroke. However, a single bout of high-intensity interval training performed immediately after motor practice improves skill retention, which could potentially accelerate motor recovery in these individuals.
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Affiliation(s)
- Jean-Francois Nepveu
- 1 Memory and Motor Rehabilitation Laboratory (MEMORY-LAB).,3 Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada
| | - Alexander Thiel
- 4 Jewish General Hospital Lady Davis Institute for Medical Research, Montreal, Quebec, Canada.,5 McGill University, Montreal, Quebec, Canada
| | - Ada Tang
- 6 McMaster University, Hamilton, Ontario, Canada
| | - Joyce Fung
- 2 Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Laval, Quebec, Canada.,3 Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada.,7 School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Jesper Lundbye-Jensen
- 8 Department of Nutrition, Exercise & Sports, University of Copenhagen, Copenhagen, Denmark.,9 Department of Neuroscience & Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Lara A Boyd
- 10 University of British Columbia, Vancouver, British Columbia, Canada
| | - Marc Roig
- 1 Memory and Motor Rehabilitation Laboratory (MEMORY-LAB).,3 Montreal Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Quebec, Canada.,7 School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Carl DL, Boyne P, Rockwell B, Gerson M, Khoury J, Kissela B, Dunning K. Preliminary safety analysis of high-intensity interval training (HIIT) in persons with chronic stroke. Appl Physiol Nutr Metab 2017; 42:311-318. [DOI: 10.1139/apnm-2016-0369] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to assess safety via electrocardiographic (ECG), blood pressure (BP), heart rate (HR), and orthopedic responses to 3 different high-intensity interval training (HIIT) protocols in persons with stroke. Eighteen participants (10 male; 61.9 + 8.3 years of age; 5.8 + 4.2 years poststroke) completed a symptom-limited graded exercise test (GXT) with ECG monitoring to screen for eligibility and determine HR peak. The 3 HIIT protocols involved repeated 30 s bursts of treadmill walking at maximum speed alternated with rest periods of 30 s (P30), 1 min (P60), or 2 min (P120). Sessions were performed in random order and included 5 min warm up, 20 min HIIT, and 5 min cool down. Variables measured included ECG activity, BP, HR, signs and symptoms of cardiovascular intolerance, and orthopedic concerns. Generalized linear mixed models and Tukey–Kramer adjustment were used to compare protocols using p < 0.05. No signs or symptoms of cardiovascular intolerance, significant arrhythmias, ST segment changes, or orthopedic responses resulted in early termination of any HIIT session. HIIT elicited HRs in excess of 88% of measured HRpeak including 6 (P30), 8 (P60), and 2 (P120) participants eliciting a HR response above their GXT HRpeak. Both maximum BP and HR were significantly higher in P30 and P60 relative to P120. Preliminary data indicate that persons with chronic stroke who have been prescreened with an ECG stress test, a symptom-limited GXT, and a harness for fall protection may safely participate in HIIT, generating substantially higher HRs than what is seen in traditional moderate intensity training.
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Affiliation(s)
- Daniel L. Carl
- Department of Rehabilitation Sciences, College of Allied Health Sciences, 3202 Eden Avenue, University of Cincinnati, Cincinnati, OH 45220-0394, USA
| | - Pierce Boyne
- Department of Rehabilitation Sciences, College of Allied Health Sciences, 3202 Eden Avenue, University of Cincinnati, Cincinnati, OH 45220-0394, USA
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bradley Rockwell
- Department of Rehabilitation Sciences, College of Allied Health Sciences, 3202 Eden Avenue, University of Cincinnati, Cincinnati, OH 45220-0394, USA
| | - Myron Gerson
- Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Jane Khoury
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Kari Dunning
- Department of Rehabilitation Sciences, College of Allied Health Sciences, 3202 Eden Avenue, University of Cincinnati, Cincinnati, OH 45220-0394, USA
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Boyne P, Welge J, Kissela B, Dunning K. Factors Influencing the Efficacy of Aerobic Exercise for Improving Fitness and Walking Capacity After Stroke: A Meta-Analysis With Meta-Regression. Arch Phys Med Rehabil 2016; 98:581-595. [PMID: 27744025 DOI: 10.1016/j.apmr.2016.08.484] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/16/2016] [Accepted: 08/26/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the influence of dosing parameters and patient characteristics on the efficacy of aerobic exercise (AEX) poststroke. DATA SOURCES A systematic review was conducted using PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Academic Search Complete. STUDY SELECTION Studies were selected that compared an AEX group with a nonaerobic control group among ambulatory persons with stroke. DATA EXTRACTION Extracted outcome data included peak oxygen consumption (V˙o2peak) during exercise testing, walking speed, and walking endurance (6-min walk test). Independent variables of interest were AEX mode (seated or walking), AEX intensity (moderate or vigorous), AEX volume (total hours), stroke chronicity, and baseline outcome scores. DATA SYNTHESIS Significant between-study heterogeneity was confirmed for all outcomes. Pooled AEX effect size estimates (AEX group change minus control group change) from random effects models were V˙o2peak, 2.2mL⋅kg-1⋅min-1 (95% confidence interval [CI], 1.3-3.1mL⋅kg-1⋅min-1); walking speed, .06m/s (95% CI, .01-.11m/s); and 6-minute walk test distance, 29m (95% CI, 15-42m). In meta-regression, larger V˙o2peak effect sizes were significantly associated with higher AEX intensity and higher baseline V˙o2peak. Larger effect sizes for walking speed and the 6-minute walk test were significantly associated with a walking AEX mode. In contrast, seated AEX did not have a significant effect on walking outcomes. CONCLUSIONS AEX significantly improves aerobic capacity poststroke, but may need to be task specific to affect walking speed and endurance. Higher AEX intensity is associated with better outcomes. Future randomized studies are needed to confirm these results.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio.
| | - Jeffrey Welge
- Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Psychiatry and Behavioral Neuroscience, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Kari Dunning
- Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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High-Intensity Interval Training and Moderate-Intensity Continuous Training in Ambulatory Chronic Stroke: Feasibility Study. Phys Ther 2016; 96:1533-1544. [PMID: 27103222 PMCID: PMC5046191 DOI: 10.2522/ptj.20150277] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 04/14/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Poststroke guidelines recommend moderate-intensity, continuous aerobic training (MCT) to improve aerobic capacity and mobility after stroke. High-intensity interval training (HIT) has been shown to be more effective than MCT among healthy adults and people with heart disease. However, HIT and MCT have not been compared previously among people with stroke. OBJECTIVE The purpose of this study was to assess the feasibility and justification for a definitive randomized controlled trial (RCT) comparing HIT and MCT in people with chronic stroke. DESIGN A preliminary RCT was conducted. SETTING The study was conducted in a cardiovascular stress laboratory and a rehabilitation research laboratory. PATIENTS Ambulatory people at least 6 months poststroke participated. INTERVENTION Both groups trained 25 minutes, 3 times per week, for 4 weeks. The HIT strategy involved 30-second bursts at maximum-tolerated treadmill speed alternated with 30- to 60-second rest periods. The MCT strategy involved continuous treadmill walking at 45% to 50% of heart rate reserve. MEASUREMENTS Measurements included recruitment and attendance statistics, qualitative HIT acceptability, adverse events, and the following blinded outcome variables: peak oxygen uptake, ventilatory threshold, metabolic cost of gait, fractional utilization, fastest treadmill speed, 10-Meter Walk Test, and Six-Minute Walk Test. RESULTS During the 8-month recruitment period, 26 participants consented to participate. Eighteen participants were enrolled and randomly assigned to either the HIT group (n=13) or the MCT group (n=5). Eleven out of the 13 HIT group participants attended all sessions. Participants reported that HIT was acceptable and no serious adverse events occurred. Standardized effect size estimates between groups were moderate to very large for most outcome measures. Only 30% of treadmill speed gains in the HIT group translated into overground gait speed improvement. LIMITATIONS The study was not designed to definitively test safety or efficacy. CONCLUSIONS Although further protocol optimization is needed to improve overground translation of treadmill gains, a definitive RCT comparing HIT and MCT appears to be feasible and warranted.
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Effects of a Single Session of High Intensity Interval Treadmill Training on Corticomotor Excitability following Stroke: Implications for Therapy. Neural Plast 2016; 2016:1686414. [PMID: 27738524 PMCID: PMC5056005 DOI: 10.1155/2016/1686414] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/13/2016] [Accepted: 07/26/2016] [Indexed: 01/02/2023] Open
Abstract
Objective. High intensity interval treadmill training (HIITT) has been gaining popularity for gait rehabilitation after stroke. In this study, we examined the changes in excitability of the lower limb motor cortical representation (M1) in chronic stroke survivors following a single session of HIITT. We also determined whether exercise-induced changes in excitability could be modulated by transcranial direct current stimulation (tDCS) enhanced with a paretic ankle skill acquisition task. Methods. Eleven individuals with chronic stroke participated in two 40-minute treadmill-training sessions: HIITT alone and HITT preceded by anodal tDCS enhanced with a skill acquisition task (e-tDCS+HIITT). Transcranial magnetic stimulation (TMS) was used to assess corticomotor excitability of paretic and nonparetic tibialis anterior (TA) muscles. Results. HIIT alone reduced paretic TA M1 excitability in 7 of 11 participants by ≥ 10%. e-tDCS+HIITT increased paretic TA M1 excitability and decreased nonparetic TA M1 excitability. Conclusions. HIITT suppresses corticomotor excitability in some people with chronic stroke. When HIITT is preceded by tDCS in combination with a skill acquisition task, the asymmetry of between-hemisphere corticomotor excitability is reduced. Significance. This study provides preliminary data indicating that the cardiovascular benefits of HIITT may be achieved without suppressing motor excitability in some stroke survivors.
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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.
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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
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Wens I, Dalgas U, Vandenabeele F, Grevendonk L, Verboven K, Hansen D, Eijnde BO. High Intensity Exercise in Multiple Sclerosis: Effects on Muscle Contractile Characteristics and Exercise Capacity, a Randomised Controlled Trial. PLoS One 2015; 10:e0133697. [PMID: 26418222 PMCID: PMC4587912 DOI: 10.1371/journal.pone.0133697] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 06/30/2015] [Indexed: 12/22/2022] Open
Abstract
Introduction Low-to-moderate intensity exercise improves muscle contractile properties and endurance capacity in multiple sclerosis (MS). The impact of high intensity exercise remains unknown. Methods Thirty-four MS patients were randomized into a sedentary control group (SED, n = 11) and 2 exercise groups that performed 12 weeks of a high intensity interval (HITR, n = 12) or high intensity continuous cardiovascular training (HCTR, n = 11), both in combination with resistance training. M.vastus lateralis fiber cross sectional area (CSA) and proportion, knee-flexor/extensor strength, body composition, maximal endurance capacity and self-reported physical activity levels were assessed before and after 12 weeks. Results Compared to SED, 12 weeks of high intensity exercise increased mean fiber CSA (HITR: +21±7%, HCTR: +23±5%). Furthermore, fiber type I CSA increased in HCTR (+29±6%), whereas type II (+23±7%) and IIa (+23±6%,) CSA increased in HITR. Muscle strength improved in HITR and HCTR (between +13±7% and +45±20%) and body fat percentage tended to decrease (HITR: -3.9±2.0% and HCTR: -2.5±1.2%). Furthermore, endurance capacity (Wmax +21±4%, time to exhaustion +24±5%, VO2max +17±5%) and lean tissue mass (+1.4±0.5%) only increased in HITR. Finally self-reported physical activity levels increased 73±19% and 86±27% in HCTR and HITR, respectively. Conclusion High intensity cardiovascular exercise combined with resistance training was safe, well tolerated and improved muscle contractile characteristics and endurance capacity in MS. Trial Registration ClinicalTrials.gov NCT01845896
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Affiliation(s)
- Inez Wens
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
- * E-mail:
| | - Ulrik Dalgas
- Section of Sport Science, Dep. Public Health, Aarhus University, Dalgas Avenue 4, 8000, Aarhus, C, Denmark
| | - Frank Vandenabeele
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
| | - Lotte Grevendonk
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
| | - Kenneth Verboven
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
| | - Dominique Hansen
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
| | - Bert O. Eijnde
- REVAL Rehabilitation Research Center, BIOMED Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan Building A, Diepenbeek, Belgium
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Boyne P, Dunning K, Carl D, Gerson M, Khoury J, Kissela B. Within-session responses to high-intensity interval training in chronic stroke. Med Sci Sports Exerc 2015; 47:476-84. [PMID: 24977698 DOI: 10.1249/mss.0000000000000427] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED Poststroke hemiparesis often leads to a vicious cycle of limited activity, deconditioning, and poor cardiovascular health. Accumulating evidence suggests that exercise intensity is a critical factor determining gains in aerobic capacity, cardiovascular protection, and functional recovery after stroke. High-intensity interval training (HIT) is a strategy that augments exercise intensity using bursts of concentrated effort alternated with recovery periods. However, there was previously no stroke-specific evidence to guide HIT protocol selection. PURPOSE This study aimed to compare within-session exercise responses among three different HIT protocols for persons with chronic (>6 months after) stroke. METHODS Nineteen ambulatory persons with chronic stroke performed three different 1-d HIT sessions in a randomized order, approximately 1 wk apart. HIT involved repeated 30-s bursts of treadmill walking at maximum tolerated speed, alternated with rest periods. The three HIT protocols were different on the basis of the length of the rest periods, as follows: 30 s (P30), 60 s (P60), or 120 s (P120). Exercise tolerance, oxygen uptake (V˙O2), HR, peak treadmill speed, and step count were measured. RESULTS P30 achieved the highest mean V˙O2, HR, and step count but with reduced exercise tolerance and lower treadmill speed than P60 or P120 (P30: 70.9% V˙O2peak, 76.1% HR reserve (HRR), 1619 steps, 1.03 m·s(-1); P60: 63.3% V˙O2peak, 63.1% HRR, 1370 steps, 1.13 m·s(-1); P120: 47.5% V˙O2peak, 46.3% HRR, 1091 steps, 1.10 m·s(-1)). P60 achieved treadmill speed and exercise tolerance similar to those in P120, with higher mean V˙O2, HR, and step count. CONCLUSIONS For treadmill HIT in chronic stroke, a combination of P30 and P60 may optimize aerobic intensity, treadmill speed, and stepping repetition, potentially leading to greater improvements in aerobic capacity and gait outcomes in future studies.
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Affiliation(s)
- Pierce Boyne
- 1Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH; 2Departments of Internal Medicine and Cardiology, College of Medicine, University of Cincinnati, Cincinnati, OH; 3Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; 4Department of Neurology, Physical Medicine and Rehabilitation, College of Medicine, University of Cincinnati, Cincinnati, OH
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Ivey FM, Stookey AD, Hafer-Macko CE, Ryan AS, Macko RF. Higher Treadmill Training Intensity to Address Functional Aerobic Impairment after Stroke. J Stroke Cerebrovasc Dis 2015; 24:2539-46. [PMID: 26303787 DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 06/27/2015] [Accepted: 07/07/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Peak aerobic capacity (VO2 peak) is severely worsened after disabling stroke, having serious implications for function, metabolism, and ongoing cardiovascular risk. Work from our laboratory and others has previously shown that modest improvements in VO2 peak are possible in stroke participants with aerobic exercise training. The purpose of the current investigation was to test the extent to which greater enhancements in VO2 peak after stroke are possible using a treadmill protocol with far greater emphasis on intensity progression compared with a protocol without such emphasis. METHODS Using a randomized design, we compared stroke survivors engaged in higher intensity treadmill training (HI-TM, 80% heart rate reserve [HRR]) with those undergoing lower intensity treadmill training (LO-TM, 50% HRR). Measured outcomes were change in VO2 peak, 6-minute walk distance (6MWD), 30-ft walk times (30WT), and 48-hour step counts (48SC). LO-TM participants trained for a longer period of time per session in an effort to approximately match workload/caloric expenditure. Participants were randomized with stratification according to age and baseline walking capacity. RESULTS HI-TM participants (n = 18) had significantly greater gains in VO2 peak (+34%) than LO-TM participants (n = 16; +5%) across the 6-month intervention period (P = .001, group × time interaction). Conversely, there was no statistical difference between groups in the changes observed for 6MWD, 30WT, or 48SC. CONCLUSIONS HI-TM is far more effective than LO-TM for improving VO2 peak after disabling stroke. The magnitude of relative improvement for HI-TM was double compared with previous reports from our laboratory with probable clinical significance for this population.
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Affiliation(s)
- Frederick M Ivey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Alyssa D Stookey
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland
| | - Charlene E Hafer-Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Alice S Ryan
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard F Macko
- Department of Veterans Affairs and Veterans Affairs Medical Center, Maryland Exercise and Robotics Center of Excellence (MERCE) & Geriatric Research, Education and Clinical Center (GRECC), Baltimore, Maryland; Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
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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.
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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,
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Lucas SJE, Cotter JD, Brassard P, Bailey DM. High-intensity interval exercise and cerebrovascular health: curiosity, cause, and consequence. J Cereb Blood Flow Metab 2015; 35:902-11. [PMID: 25833341 PMCID: PMC4640257 DOI: 10.1038/jcbfm.2015.49] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 01/25/2015] [Accepted: 03/01/2015] [Indexed: 12/14/2022]
Abstract
Exercise is a uniquely effective and pluripotent medicine against several noncommunicable diseases of westernised lifestyles, including protection against neurodegenerative disorders. High-intensity interval exercise training (HIT) is emerging as an effective alternative to current health-related exercise guidelines. Compared with traditional moderate-intensity continuous exercise training, HIT confers equivalent if not indeed superior metabolic, cardiac, and systemic vascular adaptation. Consequently, HIT is being promoted as a more time-efficient and practical approach to optimize health thereby reducing the burden of disease associated with physical inactivity. However, no studies to date have examined the impact of HIT on the cerebrovasculature and corresponding implications for cognitive function. This review critiques the implications of HIT for cerebrovascular function, with a focus on the mechanisms and translational impact for patient health and well-being. It also introduces similarly novel interventions currently under investigation as alternative means of accelerating exercise-induced cerebrovascular adaptation. We highlight a need for studies of the mechanisms and thereby also the optimal dose-response strategies to guide exercise prescription, and for studies to explore alternative approaches to optimize exercise outcomes in brain-related health and disease prevention. From a clinical perspective, interventions that selectively target the aging brain have the potential to prevent stroke and associated neurovascular diseases.
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Affiliation(s)
- Samuel J E Lucas
- 1] School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK [2] Department of Physiology, University of Otago, Dunedin, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
| | - Patrice Brassard
- 1] Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, Canada [2] Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Damian M Bailey
- 1] Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, South Wales, UK [2] Université de Provence Marseille, Sondes Moléculaires en Biologie, Laboratoire Chimie Provence UMR 6264 CNRS, Marseille, France
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Zou S, Wu X, Zhu B, Yu J, Yang B, Shi J. The pooled incidence of post-stroke seizure in 102 008 patients. Top Stroke Rehabil 2015; 22:460-7. [PMID: 25920619 DOI: 10.1179/1074935715z.00000000062] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Post-stroke seizures and epilepsy may worsen the recovery and increase the disability of stroke patients during their daily lives. However, few meta-analysis studies have been conducted on post-stroke seizures incidence. We carried on a meta-analysis on the incidence rate of post-stroke seizures and associated factors. METHODS We searched the Medline, Embase, Web of Science, Science Citation Index, and Cochrane Library electronic databases (1990-2013) to identify observational studies of post-stroke seizures. Two authors independently extracted the related information from all included studies. We calculated the pooled incidence by meta-analysis using the software R version 12.3. RESULTS A total of 34 longitudinal cohort studies involving 102 008 patients were included in our meta-analysis. The pooled incidence rate of post-stroke seizures was found to be 0.07 [95% confidence interval (CI), 0.05-0.09] while the rate of post-stroke epilepsy (PSE) was 0.05 (95% CI, 0.04-0.06). The incidence of post-stroke seizures in hemorrhagic stroke (0.10, 0.08-0.13) was much higher than in ischemic stroke (0.06, 0.04-0.08) and when the cortical region was involved (0.15, 0.10-0.21). CONCLUSIONS Our meta-analysis showed that seizures occurred in about 6.93% of people with stroke. Seizures occurred more commonly after hemorrhagic stroke and when stroke occurred in the cortical region.
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Affiliation(s)
- Safeng Zou
- Department of Rehabilitation, Dalian Municipal Central Hospital , Dalian, China
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Adverse events among seniors receiving spinal manipulation and exercise in a randomized clinical trial. ACTA ACUST UNITED AC 2014; 20:335-41. [PMID: 25454683 DOI: 10.1016/j.math.2014.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 09/29/2014] [Accepted: 10/07/2014] [Indexed: 12/16/2022]
Abstract
Spinal manipulative therapy (SMT) and exercise have demonstrated effectiveness for neck pain (NP). Adverse events (AE) reporting in trials, particularly among elderly participants, is inconsistent and challenges informed clinical decision making. This paper provides a detailed report of AE experienced by elderly participants in a randomized comparative effectiveness trial of SMT and exercise for chronic NP. AE data, consistent with CONSORT recommendations, were collected on elderly participants who received 12 weeks of SMT with home exercise, supervised plus home exercise, or home exercise alone. Standardized questions were asked at each treatment; participants were additionally encouraged to report AE as they occurred. Qualitative interviews documented participants' experiences with AE. Descriptive statistics and content analysis were used to categorize and report these data. Compliance was high among the 241 randomized participants. Non-serious AE were reported by 130/194 participants. AE were reported by three times as many participants in supervised plus home exercise, and nearly twice as many as in SMT with home exercise, as in home exercise alone. The majority of AE were musculoskeletal in nature; several participants associated AE with specific exercises. One incapacitating AE occurred when a participant fell during supervised exercise session and fractured their arm. One serious adverse event of unknown relationship occurred to an individual who died from an aneurysm while at home. Eight serious, non-related AE also occurred. Musculoskeletal AE were common among elderly participants receiving SMT and exercise interventions for NP. As such, they should be expected and discussed when developing care plans.
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