scholarly journals Subsymptomatic Aerobic Exercise for Patients With Postconcussion Syndrome: A Critically Appraised Topic

2019 ◽  
Vol 28 (2) ◽  
pp. 211-216 ◽  
Author(s):  
Katrina G. Ritter ◽  
Matthew J. Hussey ◽  
Tamara C. Valovich McLeod
Keyword(s):  
Aerobic Exercise ◽  
Perceived Exertion ◽  
Case Series ◽  
Rating Of Perceived Exertion ◽  
Symptom Improvement ◽  
Clinical Question ◽  
Postconcussion Syndrome ◽  
Exercise Protocol ◽  
Current Standard ◽  
Bottom Line

Clinical Scenario: Patients who experience prolonged concussion symptoms can be diagnosed with postconcussion syndrome (PCS) when those symptoms persist longer than 4 weeks. Aerobic exercise protocols have been shown to be effective in improving physical and mental aspects of health. Emerging research suggests that aerobic exercise may be useful as a treatment for PCS, where exercise allows patients to feel less isolated and more active during the recovery process. Clinical Question: Is aerobic exercise more beneficial in reducing symptoms than current standard care in patients with prolonged symptoms or PCS lasting longer than 4 weeks? Summary of Key Findings: After a thorough literature search, 4 studies relevant to the clinical question were selected. Of the 4 studies, 1 study was a randomized control trial and 3 studies were case series. All 4 studies investigated aerobic exercise protocol as treatment for PCS. Three studies demonstrated a greater rate of symptom improvement from baseline assessment to follow-up after a controlled subsymptomatic aerobic exercise program. One study showed a decrease in symptoms in the aerobic exercise group compared with the full-body stretching group. Clinical Bottom Line: There is moderate evidence to support subsymptomatic aerobic exercise as a treatment of PCS; therefore, it should be considered as a clinical option for reducing PCS and prolonged concussion symptoms. A previously validated protocol, such as the Buffalo Concussion Treadmill test, Balke protocol, or rating of perceived exertion, as mentioned in this critically appraised topic, should be used to measure baseline values and treatment progression. Strength of Recommendation: Level C evidence exists that the aerobic exercise protocol is more effective than the current standard of care in treating PCS.

Drink-Flavor Change’s Lack of Effect on Endurance Cycling Performance in Trained Athletes

2007 ◽  
Vol 17 (4) ◽  
pp. 315-327 ◽  
Author(s):  
Ben Desbrow ◽  
Clare Minahan ◽  
Michael Leveritt
Keyword(s):  
Perceived Exertion ◽  
Time Trial ◽  
Cycling Performance ◽  
Rating Of Perceived Exertion ◽  
Controlled Trials ◽  
Exercise Protocol ◽  
Male Athletes ◽  
Subsequent Performance ◽  
Sports Drink ◽  
Endurance Cycling

This study investigated whether a change in beverage favor during endurance cycling improves subsequent performance. Eight trained male athletes (age 24.3 ± 3.9 y, weight 74.7 ± 6.0 kg, peak O2 uptake [VO2peak] 65.4 ± 5.4 mL·kg−1·min−1; mean ± SD) undertook 3 trials, with training and diet being controlled. Trials consisted of 120 min of steady-state (SS) cycling at ~70% VO2peak, immediately followed by a 7-kJ/kg time trial (TT). During exercise subjects were provided with fluids every 20 min. After 80 min of SS cycling subjects either continued drinking the same-favor sports drink or changed to an alternate favor—either an alternate-favor sports drink (AFSD) or cola. All beverages were carbohydrate and volume matched. Changing drink favor caused no significant change in TT time (sports drink 27:16 ± 03:12, AFSD 27:06 ± 03:16, cola 27:03 ± 02:42; min: s). The various favors produced no treatment effects on heart rate, blood glucose, or rating of perceived exertion throughout the SS exercise protocol. The influence of other taste variables such as palatability, bitterness, or timing of favor change on endurance-exercise performance requires more rigorous investigation.

The Effectiveness of Hyperbaric Oxygen Therapy as a Treatment for Postconcussion Symptoms

2017 ◽  
Vol 26 (3) ◽  
pp. 290-294 ◽  
Author(s):  
Jeremy R. Hawkins ◽  
Kayla E. Gonzalez ◽  
Kristin J. Heumann
Keyword(s):  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Neuropsychiatric Symptoms ◽  
Effective Means ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Postconcussion Syndrome ◽  
Bottom Line ◽  
Level 1

Clinical Scenario:Concussions are a prevalent topic in medicine. Concussion symptoms include headaches, dizziness, nausea, neuropsychiatric symptoms, and cognitive impairments, the persistence of which is referred to as postconcussion syndrome. Hyperbaric oxygen therapy (HBOT) has been proposed and evaluated as an additional treatment of these symptoms. HBOT is an innovative approach that has been considered by many but has received both criticism and acceptance.Clinical Question:Is HBOT an effective means of reducing symptoms for individuals suffering from postconcussion syndrome (persistence of symptoms for >3 mo)?Summary of Search:The literature was searched for studies that were relevant to the clinical question. Literature provided 5 level 1 studies that were relevant enough to be considered.Clinical Bottom Line:Based on the research that is available, the authors conclude that there is more evidence to refute the use of HBOT for postconcussion syndrome than to support it.Strength of Recommendation:Four studies disprove the use of HBOT; 1 study supported the use of HBOT. These 5 studies are the same level of evidence (level 1) and provide significant findings in their studies. The strength of this recommendation is a B according to the Centre for Evidence-Based Medicine.

scholarly journals Effects of Terbutaline Sulfate on Physiological and Biomechanical as Well as Perceived Exertion in Healthy Active Athletes: A Pilot Study

2019 ◽  
Vol 69 (1) ◽  
pp. 169-178 ◽  
Author(s):  
Hanen Hafedh ◽  
Maamer Slimani ◽  
Bianca Miarka ◽  
Ramzi Bettayeb ◽  
Nicola Luigi Bragazzi
Keyword(s):  
Heart Rate ◽  
Aerobic Exercise ◽  
Exercise Performance ◽  
Perceived Exertion ◽  
Female Athletes ◽  
Blood Glucose Concentration ◽  
Rating Of Perceived Exertion ◽  
Double Blind ◽  
Terbutaline Sulfate ◽  
Cardiovascular Variables

Abstract This study aimed to investigate the effects of beta2‐agonist terbutaline sulfate (TER) at a supra‐therapeutic dose (8 mg) on aerobic exercise performance. Twelve (6 females and 6 males) amateur athletes familiarized with all experimental procedures had their anthropometric data obtained on day 1. On days 2 and 3 either 8 mg of TER or a placebo (PLA) was administered orally (double‐blind manner) to participants who had rested for 3 h prior to aerobic exercise performance 20 m multistage fitness test (MSFT)]. This test was used to predict maximal oxygen uptake (VO2max) and velocity at which VO2max occurs (vVO2max). The Borg rating of perceived exertion (RPE), cardiovascular variables [heart rate (HR) and blood pressure (BP)] and blood glucose concentration [BGC] were obtained 15 min pre‐ and immediately post‐MSFT. Significant mean group differences were reported between PLA and TER groups (p < 0.05), respectively, in the RPE (15.6 ± 1.2 vs. 17.3 ± 1.5 a.u.), maximum heart rate (HRmax: 191.2 ± 7.1 vs. 197.2 ± 8.6 bpm) and BGC (118.4 ± 18.3 vs. 141.2 ± 15.8 mg/dL) post‐MSFT. The main effect of gender (male vs. female) in TER and PLA groups (p< 0.05) was observed, with higher estimated VO2max, vVO2max, HRmax and a lower mean HR pre‐test in male than female athletes. For these reasons, the inclusion of TER in the Prohibited List should be re‐discussed because of the lack of ergogenic effects.

scholarly journals Early Controlled Exercise and Timing of Treatment Following Concussion: A Critically Appraised Topic

2020 ◽  
Vol 29 (3) ◽  
pp. 360-366 ◽  
Author(s):  
Nicholas Hattrup ◽  
Hannah Gray ◽  
Mark Krumholtz ◽  
Tamara C. Valovich McLeod
Keyword(s):  
Aerobic Exercise ◽  
Interdisciplinary Approach ◽  
Rehabilitation Program ◽  
Psychological State ◽  
Sufficient Evidence ◽  
Symptom Duration ◽  
Clinical Question ◽  
Bottom Line ◽  
Duration Of Symptoms ◽  
Symptom Intensity

Clinical Scenario: Recent systematic reviews have shown that extended rest may not be beneficial to patients following concussion. Furthermore, recent evidence has shown that patient with postconcussion syndrome benefit from an active rehabilitation program. There is currently a gap between the ability to draw conclusions to the use of aerobic exercise during the early stages of recovery along with the safety of these programs. Clinical Question: Following a concussion, does early controlled aerobic exercise, compared with either usual care or delayed exercise, improve recovery as defined by symptom duration and severity? Summary of Key Findings: After a thorough literature search, 5 studies relevant to the clinical question were selected. Of the 5 studies, 1 study was a randomized control trial, 2 studies were pilot randomized controlled trials, and 2 studies were retrospective. All 5 studies showed that implementing controlled aerobic exercise did not have an adverse effect on recovery. One study showed early aerobic exercise had a quicker return to school, and another showed a 2-day decrease in symptom duration. Clinical Bottom Line: There is sufficient evidence to suggest that early controlled aerobic exercise is safe following a concussion. Although early aerobic exercise may not always result in a decrease in symptom intensity and duration, it may help to improve the psychological state resulting from the social isolation of missing practices and school along with the cessation of exercise. Although treatments continue to be a major area of research following concussion, management should still consist of an interdisciplinary approach to individualized patient care. Strength of Recommendation: There is grade B evidence to support early controlled aerobic exercise may reduce the duration of symptoms following recovery while having little to no adverse events.

Quantification method influences training load change in high school cross-country runners across a competitive season

2021 ◽  
Author(s):  
Micah C. Garcia ◽  
Brett S. Pexa ◽  
Kevin R. Ford ◽  
Mitchell J. Rauh ◽  
David M. Bazett-Jones
Keyword(s):  
High School ◽  
Perceived Exertion ◽  
Case Series ◽  
Training Load ◽  
Rating Of Perceived Exertion ◽  
Internal Load ◽  
Time Distance ◽  
Cross Country ◽  
Cross Country Runners ◽  
External Loads

Abstract Context: Running programs traditionally monitor external loads (e.g., time, distance). There has been a recent movement to encompass a more comprehensive approach to also monitor training loads that account for internal loads (e.g., intensity, measured as session rating of perceived exertion [sRPE]). The combination of an external and internal load accounts for the potential interaction between these loads. While differences in weekly change in training loads have been reported between external loads and the combination of an external and internal load during 2- and 4-week training cycles, there are no reports whether these differences are apparent during an entire cross-country season in high school runners. Objective: To compare change in training loads, as measured by external loads and combinations of an external and internal load, in high school runners during an interscholastic cross-country season. Design: Case-series. Setting: Community-based with daily online surveys. Participants: Twenty-four high school cross-country runners (female=14, male=10, age=15.9±1.1 years, running experience=9.9±3.2 years). Main Outcome Measure(s): Week-to-week percent change in training load when measured by external loads (time, distance) and the combination of an external and internal load (timeRPE, distanceRPE). Results: Overall, the average weekly change was 7.1% greater for distanceRPE compared to distance (p=.04, d=0.18). When decreasing weekly running duration, the average weekly change was 5.2% greater for distanceRPE compared to timeRPE (p=.03, d=0.24). When maintaining or increasing weekly running duration, the average weekly change was 10–15% greater when an external load was combined with an internal load compared to external loads alone, but these differences were non- significant (p=.11–.22, d=0.19–0.34). Conclusions: Our results demonstrate that progression in training load may be underestimated when relying solely on external loads. The interaction between internal loads (sRPE) and external loads (distance or time) appears to provide a different measure of training stresses experienced by runners than external loads alone.

Efficacy of Cold Water Immersion Prior to Endurance Cycling or Running to Increase Performance: A Critically Appraised Topic

2018 ◽  
Vol 23 (1) ◽  
pp. 3-9
Author(s):  
Connor A. Burton ◽  
Christine A. Lauber
Keyword(s):  
Perceived Exertion ◽  
Cold Water ◽  
Water Immersion ◽  
Endurance Performance ◽  
Cold Water Immersion ◽  
Rating Of Perceived Exertion ◽  
Control Group ◽  
Time To Exhaustion ◽  
Bottom Line ◽  
Endurance Cycling

Clinical Question: Is there evidence to support precooling with cold water immersion prior to endurance cycling and running in hot, humid environments to enhance performance? Clinical Bottom Line: There is moderate evidence suggesting cold water immersion (CWI) as a precooling intervention improves endurance performance in cyclists and runners in a hot, humid environment. All five included studies reported significant improvements in endurance performance regarding time to exhaustion or distance traveled. In all included studies, core temperature was significantly decreased in the CWI group versus the control group during the fifth and twentieth minutes of exercise. No significant differences were reported for the rating of perceived exertion (RPE) between the CWI and control groups.

Cardiovascular, perceived exertion and affective responses during aerobic exercise performed with imposed and a self-selected intensity in patients with Parkinson’s disease

2021 ◽  
pp. 1-6
Author(s):  
Hélcio Kanegusuku ◽  
Marilia de Almeida Correia ◽  
Paulo Longano ◽  
Erika Okamoto ◽  
Maria Elisa Pimentel Piemonte ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Aerobic Exercise ◽  
Perceived Exertion ◽  
Exercise Adherence ◽  
Random Order ◽  
Cycle Ergometer ◽  
Affective Responses ◽  
Rating Of Perceived Exertion

BACKGROUND: Exercise with self-selected intensity (SSI) has emerged as a new strategy for exercise prescription aiming to increase exercise adherence in Parkinson’s disease (PD). OBJECTIVE: We compared the cardiovascular, perceived exertion and affective responses during traditional aerobic exercise and with SSI in PD. METHODS: Twenty patients with PD performed two aerobic exercise sessions in random order with an interval of at least 72 h between them: Traditional session (cycle ergometer, 25 min, 50 rpm) with imposed intensity (II) (60–80% maximum heart rate [HR]) and SSI: (cycle ergometer, 25 min, 50 rpm) with SSI. The HR (Polar V800 monitor), systolic blood pressure (auscultatory method), rating of perceived exertion (Borg scale 6–20) and affective responses (feeling scale) were assessed during the exercise at 8th and 18th minute. The Generalized Estimating Equation Model was used for comparison between both sessions (P <  0.05). RESULTS: The exercise intensity was not significantly different between both exercise sessions (8th minute: II –76.3±1.0 vs. SSI –76.5±1.3 % of maximal HR; 18th minute: II –78.9±0.9 vs. SSI –79.1±1.3 % of maximal HR, p = 0.93). Blood pressure, perceived exertion and affective responses were also not significantly different between both sessions (P >  0.05). CONCLUSIONS: Cardiovascular and psychophysiological responses were not different during aerobic exercise performed with II and with SSI in patients with PD.

The Effectiveness of Nonoperative Rehabilitation Programs for Athletes Diagnosed With Osteitis Pubis

2016 ◽  
Vol 25 (4) ◽  
pp. 399-403
Author(s):  
Scott W. Cheatham ◽  
Morey J. Kolber ◽  
Kathryn Kumagai Shimamura
Keyword(s):  
Case Series ◽  
Nonoperative Treatment ◽  
Rehabilitation Program ◽  
Ice Hockey ◽  
Clinical Scenario ◽  
Clinical Question ◽  
Bottom Line ◽  
High Quality Research ◽  
Osteitis Pubis ◽  
Rehabilitation Programs

Clinical Scenario:The differential diagnosis of groin pain can be very challenging due to the many causative pathologies. Osteitis pubis is a pathology that is becoming more recognized in athletes who participate in sports such as soccer, ice hockey, rugby, and football. Conservative nonoperative treatment is often prescribed first before surgical intervention. Of particular interest are the outcomes of nonoperative rehabilitation programs and their effectiveness to return athletes to preinjury levels of participation. The most recent systematic review in 2011 examined the spectrum of treatments for osteitis pubis and found only level 4 (case report or case series) evidence with varying approaches to treatment. Due to the amount of time since the last published review, there is a need to critically appraise the recent literature to see if more high-quality research has been published that measured nonoperative interventions for athletes with osteitis pubis.Focused Clinical Question:Is there evidence to suggest that nonoperative rehabilitation programs for osteitis pubis are effective at returning athletes to their preinjury levels of participation?Summary of Key Findings:Four studies met the inclusion criteria. Only level 4 evidence was found. All studies reported using a structured nonoperative rehabilitation program with a successful return to preinjury participation between 4 and 14 wk, except for 1 study reporting a successful return at 30 wk. Successful long-term follow-up was reported at 6–48 mo for all patients.Clinical Bottom Line:There is weak evidence to support the efficacy of nonoperative rehabilitation programs at returning athletes to their preinjury levels of participation.Strength of Recommendation:There is grade D evidence that a nonoperative program for osteitis pubis is effective at helping athletes return to their preinjury level of participation. The Centre of Evidence Based Medicine recommends a grade D for level 4 evidence with consistent findings.

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