Influence of Aerobic Exercise Volume on Postconcussion Symptoms

2021 ◽  
pp. 036354652110057
Author(s):  
David R. Howell ◽  
Danielle L. Hunt ◽  
Stacey E. Aaron ◽  
William P. Meehan ◽  
Can Ozan Tan
Keyword(s):  
Aerobic Exercise ◽  
Exercise Test ◽  
Symptom Severity ◽  
Exercise Intervention ◽  
Standard Of Care ◽  
Secondary Outcome ◽  
Initial Visit ◽  
Target Heart Rate ◽  
Level Of Evidence ◽  
Symptom Resolution

Background: Aerobic exercise has emerged as a useful treatment to improve outcomes among individuals who experience a concussion. However, compliance with exercise recommendations and the effect of exercise volume on symptom recovery require further investigation. Purpose: To examine (1) if an 8-week aerobic exercise prescription, provided within 2 weeks of concussion, affects symptom severity or exercise volume; (2) whether prescription adherence, rather than randomized group assignment, reflects the actual effect of aerobic exercise in postconcussion recovery; and (3) the optimal volume of exercise associated with symptom resolution after 1 month of study. Study Design: Cohort study; Level of evidence, 2. Methods: Individuals randomized to an exercise intervention (n = 17; mean age, 17.2 ± 2.0 years; 41% female; initially tested a mean of 11.3 ± 2.8 days after injury) or standard of care (n = 20; mean age, 16.8 ± 2.2 years; 50% female; initially tested a mean of 10.7 ± 3.2 days after injury) completed an aerobic exercise test within 14 days of injury. They returned for assessments 1 month and 2 months after the initial visit. The aerobic exercise group was instructed to exercise 5 d/wk, 20 min/d (100 min/wk), at a target heart rate based on an exercise test at the initial visit. Participants reported their exercise volume each week over the 8-week study period and reported symptoms at each study visit (initial, 1 month, 2 months). Because of low compliance in both groups, there was no difference in the volume of exercise between the 2 groups. Results: There were no significant symptom severity differences between the intervention and standard-of-care groups at the initial (median Post-Concussion Symptom Inventory, 15 [interquartile range = 10, 42] vs 20 [11, 35.5]; P = .26), 1-month (4 [0, 28] vs 5.5 [0.5, 21.5]; P = .96), or 2-month (6.5 [0, 27.5] vs 0 [0, 4]; P = .11) study visits. Exercise volume was similar between groups (median, 115 [54, 225] vs 88 [28, 230] min/wk for exercise intervention vs standard of care; P = .52). Regardless of group, those who exercised <100 min/wk reported significantly higher symptom severity at the 1-month evaluation compared with those who exercised ≥100 min/wk (median, 1.5 [0, 7.5] vs 12 [4, 28]; P = .03). Exercising ≥160 min/wk successfully discriminated between those with and those without symptoms 1 month after study commencement (classification accuracy, 81%; sensitivity, 90%; specificity, 78%). Conclusion: Greater exercise volume was associated with lower symptom burden after 1 month of study, and an exercise volume >160 min/wk in the first month of the study was the threshold associated with symptom resolution after the first month of the study. Because our observation on the association between exercise volume and symptom level is a retrospective and secondary outcome, it is possible that participants who were feeling better were more likely to exercise more, rather than the exercise itself driving the reduction in symptom severity.

scholarly journals AEROBIC EXERCISE VOLUME, NOT PRESCRIPTION, INFLUENCES POST-CONCUSSION SYMPTOMS: A RANDOMIZED CLINICAL TRIAL

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0014
Author(s):  
David R. Howell ◽  
Danielle Hunt ◽  
Stacey E. Aaron ◽  
William P. Meehan ◽  
Can Ozan Tan
Keyword(s):  
Clinical Trial ◽  
Aerobic Exercise ◽  
Symptom Severity ◽  
Exercise Prescription ◽  
Standard Of Care ◽  
Care Group ◽  
Initial Symptom ◽  
Initial Visit ◽  
Severity Scores ◽  
Text Figure

Background: Current recommendations for sport-related concussion uniformly emphasize the importance of physical activity. However, specifics of this recommendation remain vague and do not account for an exercise dosage or compliance. Purposes: First, we examined if an 8-week individualized sub-symptom threshold aerobic exercise prescription, initiated within the first two weeks of concussion, alleviates symptom severity or affects the amount of exercise performed during the study. Second, we examined whether prescription adherence, rather than randomized group assignment, reflects the actual impact of aerobic exercise in post-concussion recovery. Methods: For this single-site prospective randomized clinical trial, participants completed an aerobic exercise test within 14 days of injury, and were randomized to an individualized aerobic exercise program or standard-of-care, and returned for assessments 1 month and 2 months after the initial visit (Table 1). The aerobic exercise group was instructed to exercise 5 days/week, 20 minutes/day, at a target heart rate based on an exercise test at the initial visit. Participants reported their symptom exercise volume each week over the 8-week study period, and reported symptoms at each study visit (initial, 1 month, 2 month). Results: Initial symptom severity was not different between randomized groups (Figure 1A), and no significant differences in symptom severity were found at the 4-week (Figure 1B) or 8-week (Figure 1C) assessment. In addition, there was no significant differences between groups for average weekly exercise volume during the first four weeks (Figure 2A) or second four weeks (Figure 2B) of the study. During the first four weeks of the study, 65% (n=11/17) of the exercise intervention participants were compliant with their exercise recommendation (≥100 min/week), compared to 45% (n=9/20) of the standard-of-care group (p=0.33). During the second four weeks of the study, 71% (n=12/17) of the exercise prescription group exercised ≥100 min/week, compared to 55% (n=11/20) of the standard-of-care group (p=0.50). When grouped by exercise volume, the group who exercised ≥100 minutes/week during the first month of the study reported significantly lower symptom severity scores than those who exercised <100 minutes/week (Figure 3B), despite similar initial symptom severity scores (Figure 3A). Conclusion: Participant randomization within 14 days of concussion did not lead to a significant reduction in symptoms, or greater exercise volume. Given that greater exercise volume was associated with lower symptoms after one month of the study, researchers and clinicians should pay particular attention to adherence to aerobic exercise programs for the treatment of concussion. [Table: see text][Figure: see text][Figure: see text][Figure: see text]

scholarly journals EFFECT OF AEROBIC EXERCISE ON FATIGUE AND DEPRESSION IN INDIVIDUALS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 8 (6) ◽  
pp. 3674-3679
Author(s):  
Sanjeev Kumar Singh ◽  
◽  
Afsha Mulla ◽  
Farheen Farooque Khan ◽  
Ronika Agrawal ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Aerobic Exercise ◽  
Outcome Measures ◽  
Exercise Intervention ◽  
Depression Scale ◽  
Joint Disease ◽  
Exercise Session ◽  
P Value ◽  
Target Heart Rate ◽  
Convenience Sample

Background: Rheumatoid arthritis (RA) is an autoimmune, systemic, inflammatory condition causing pain, disability, and psychological distress. It is the most common chronic inflammatory joint disease, affecting 0.1-1% of the population. Women are affected 3 times more than men. Because of its chronic, painful, and disabling character, RA tends to have a profound impact on health-related quality of life (HRQOL). Materials and methods: In the present study a convenience sample of 30 individuals between 30 to 60 years of age group according to the inclusion and exclusion criteria. The exercise intervention was participation in aerobic exercise session 3 times weekly for 6 weeks. The session consisted of 3 phases –1)Warm-up phase 2).Aerobic period 3) Cool down phase.Subjects were given their target heart rate for 40% and 60% of their HRmax. They were instructed to start exercising at 40% and progress to 60% as tolerated given their subjective exertion using the Talk Test (being able to talk while exercising without being short of breath). Global Fatigue Index Of The Multidimensional Assessment Of Fatigue Questionnaire (GFI) and The Center for Epidemiologic Studies- Depression Scale (CES-D)were used as outcome measures for evaluating fatigue and severity of depression respectively in the subjects and the data was statistically analysed. Results: Paired t-test was done for pre and post mean values for MAF-GFI scale. The results showed statistically significant values for both the outcome measures (p value < 0.05). Conclusion: The present study concludes that 6 weeks of aerobic exercise showed significant effect in decreasing fatigue and depression in individuals with rheumatoid arthritis. KEY WORDS: Rheumatoid Arthritis, Fatigue, Depression, Aerobic Exercise.

scholarly journals Exercise for Sport-Related Concussion and Persistent Postconcussive Symptoms

2020 ◽  
pp. 194173812094601
Author(s):  
Mohammad Nadir Haider ◽  
Itai Bezherano ◽  
Alex Wertheimer ◽  
Akas H. Siddiqui ◽  
Emily C. Horn ◽  
...  
Keyword(s):  
Physical Activity ◽  
Aerobic Exercise ◽  
Exercise Tolerance ◽  
Standard Of Care ◽  
Current Standard ◽  
Level Of Evidence ◽  
Early Exercise ◽  
Postconcussive Symptoms ◽  
Specific Search ◽  
Diagnostic And Prognostic Value

Context: Emerging research supports the use of mild to moderate aerobic exercise for treating sport-related concussion (SRC) and persistent postconcussive symptoms (PPCS), yet the current standard of care remains to be strict rest. The purpose of this review is to summarize the existing literature on physical activity and prescribed exercise for SRC and PPCS. Evidence Acquisition: PubMed and Embase were searched in April of 2019 for studies assessing rest or prescribed exercise for SRC and PPCS. No specific search syntax was used. Study Design: Clinical review. Level of Evidence: Level 4. Results: A majority of studies show that spontaneous physical activity is safe after SRC and that subsymptom threshold aerobic exercise safely speeds up recovery after SRC and reduces symptoms in those with PPCS. Exercise tolerance can safely be assessed using graded exertion test protocols within days of injury, and the degree of early exercise tolerance has diagnostic and prognostic value. Conclusion: Subsymptom threshold aerobic exercise is safe and effective for the treatment of SRC as well as in athletes with PPCS. Further research is warranted to establish the most effective method and dose of aerobic exercise for the active treatment of SRC and whether early exercise treatment can prevent PPCS in athletes. Strength of Recommendation Taxonomy: 2.

scholarly journals THE THERAPEUTIC EFFECTS OF SPORTS ON ARTERIAL STIFFNESS

2021 ◽  
Vol 27 (8) ◽  
pp. 837-840
Author(s):  
Qi Huang ◽  
Xiaowei Zou ◽  
Zhijun Ma
Keyword(s):  
Arterial Stiffness ◽  
Acute Exercise ◽  
Exercise Intervention ◽  
Intermittent Exercise ◽  
Therapeutic Effects ◽  
Target Heart Rate ◽  
Treatment Results ◽  
Level Of Evidence ◽  
Continuous Exercise ◽  
Healthy Young People

ABSTRACT Introduction: Cardiovascular disease has become a significant condition affecting human health. Increased arterial stiffness is a leading stage in the occurrence and development of many cardiovascular diseases. Objective: To observe the effect of different acute exercise programs on arterial stiffness of healthy young people under the same amount of exercise. Methods: We selected 16 healthy boys to conduct a blank control test, continuous exercise test, and intermittent exercise. They were divided into blank schemes. Car plan and running plan. Arterial stiffness was repeatedly measured immediately after exercise and 40 minutes after the end. Results: In the three exercise intervention experiments, the heart-ankle vascular index decreased significantly immediately after exercise. After 60 minutes of rest, the heart-ankle vascular index rebounded. Conclusion: Physical exercise can significantly reduce arterial stiffness. Changing the training intensity in sports with the same target heart rate does not affect arterial stiffness. Level of evidence II; Therapeutic studies - investigation of treatment results.

scholarly journals Aerobic exercise improves hippocampal blood flow for hypertensive APOE4 carriers

2020 ◽  
Author(s):  
Carolyn S Kaufman ◽  
Robyn A Honea ◽  
Joseph Pleen ◽  
Rebecca J Lepping ◽  
Amber Watts ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Aerobic Exercise ◽  
Genetic Risk ◽  
Significant Interaction ◽  
Exercise Intervention ◽  
Secondary Outcome ◽  
Control Group ◽  
Carrier Status ◽  
Exercise Interventions

Background: Evidence increasingly suggests cerebrovascular dysfunction plays an early and important role in the pathogenesis of Alzheimer′s disease (AD). Studies have shown the strongest known genetic risk factor for sporadic AD, Apolipoprotein E4 (APOE4), may act synergistically with vascular risk factors to promote dementia development. Aerobic exercise may attenuate cognitive decline at least partially through improvements in cerebral blood flow. Therefore, exercise interventions that improve vascular health may be particularly beneficial for APOE4 carriers. Objectives: To test the hypothesis that exercise would more effectively increase hippocampal blood flow (HBF) in hypertensive APOE4 carriers than non carriers, we performed an analysis of arterial spin labeling MRI data (ASL MRI) from a randomized controlled trial (secondary outcome). Additionally, we tested the hypothesis that changes in systolic blood pressure (ΔSBP) would be more negatively associated with ΔHBF for APOE4 carriers than non carriers. Methods: We assigned cognitively normal adults (65 to 87 years) to a 52-week aerobic exercise intervention or education only. Genotyping was performed by Taqman SNP allelic discrimination assay. ASL MRI measured HBF before and after the 52 week intervention. We selected participants with hypertension at enrollment (n ≡ 44), defined as SBP ≥ 130mmHg or diastolic blood pressure (DBP) ≥ 80mmHg. Results: A two way ANCOVA showed a significant interaction between APOE4 carrier status and treatment group on change in HBF (ΔHBF) over the 52 weeks, controlling for age and sex (p = 0.040). For APOE4 carriers, ΔHBF was significantly (p = 0.006) higher for participants who underwent the exercise intervention (4.09 mL/100g/min) than for the control group (-2.08 mL/100g/min). There was no difference in ΔHBF between the control (-0.32 mL/100g/min) and exercise (-0.54 mL/100g/min) intervention groups for APOE4 non carriers (p = 0.918). Additionally, a multiple linear regression showed a significant interaction between ΔSBP and APOE4 carrier status on ΔHBF (p = 0.035), with a reduction in SBP associated with an increase in HBF for APOE4 carriers only. Conclusions: Aerobic exercise significantly improved HBF for hypertensive APOE4 carriers only. Additionally, only APOE4 carriers exhibited an inverse relationship between ΔSBP and ΔHBF. This suggests exercise interventions, particularly those that lower SBP, may be beneficial for individuals at highest genetic risk of AD.

scholarly journals Regular Vigorous-Intensity Physical Activity and Walking Are Associated with Divergent but Not Convergent Thinking in Japanese Young Adults

2021 ◽  
Vol 11 (8) ◽  
pp. 1046
Author(s):  
Chong Chen ◽  
Yasuhiro Mochizuki ◽  
Kosuke Hagiwara ◽  
Masako Hirotsu ◽  
Shin Nakagawa
Keyword(s):  
Physical Activity ◽  
Young Adults ◽  
Aerobic Exercise ◽  
Creative Thinking ◽  
Divergent Thinking ◽  
Exercise Intervention ◽  
Convergent Thinking ◽  
Intervention Effects ◽  
Cross Sectional ◽  
Vigorous Intensity

The beneficial effects of regular physical activity (PA) on cognitive functions have received much attention. Recent research suggests that regular PA may also enhance creative thinking, an indispensable cognitive factor for invention and innovation. However, at what intensity regular PA brings the most benefits to creative thinking remains uninvestigated. Furthermore, whether the levels of regular PA affect the acute PA effects on creative thinking is also unclear. In the present study, using a previous dataset that investigated the effects of an acute bout of aerobic exercise on creative thinking in healthy Japanese young adults (22.98 ± 1.95 years old) in the year 2020, we tested the association between different intensities of regular PA (i.e., vigorous, moderate, and walking) and creative thinking with the cross-sectional baseline data using multiple linear regression. We also investigated whether regular PA levels were associated with the acute aerobic exercise intervention effects on creative thinking. The results showed that cross-sectionally, the regular PAs were differentially associated with divergent but not convergent thinking. Specifically, whereas the amount of vigorous-intensity PA was positively associated with fluency and flexibility, the amount of walking was positively associated with novelty on the alternate uses test (AUT) measuring divergent thinking. Importantly, the explained variances of fluency, flexibility, and novelty were 20.3% (p = 0.040), 18.8% (p = 0.055), and 20.1% (p = 0.043), respectively. None of the regular PAs predicted convergent thinking (i.e., an insight problem-solving task), nor were they associated with the acute aerobic exercise intervention effects on divergent and convergent thinking. These findings suggest that engaging in regular vigorous-intensity PA and walking may be useful strategies to enhance different aspects of divergent thinking in daily life.

scholarly journals Randomized controlled trial of convalescent plasma therapy against standard therapy in patients with severe COVID-19 disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Manaf AlQahtani ◽  
Abdulkarim Abdulrahman ◽  
Abdulrahman Almadani ◽  
Salman Yousif Alali ◽  
Alaa Mahmood Al Zamrooni ◽  
...  
Keyword(s):  
Standard Therapy ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Severe Disease ◽  
Pilot Trial ◽  
Standard Of Care ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Open Label ◽  
Plasma Therapy

AbstractConvalescent plasma (CP) therapy in COVID-19 disease may improve clinical outcome in severe disease. This pilot study was undertaken to inform feasibility and safety of further definitive studies. This was a prospective, interventional and randomized open label pilot trial in patients with severe COVID-19. Twenty COVID-19 patients received two 200 ml transfusions of convalescent patient CP over 24-h compared with 20 who received standard of care. The primary outcome was the requirement for ventilation (non-invasive or mechanical ventilation). The secondary outcomes were biochemical parameters and mortality at 28 days. The CP group were a higher risk group with higher ferritin levels (p < 0.05) though respiratory indices did not differ. The primary outcome measure was required in 6 controls and 4 patients on CP (risk ratio 0.67, 95% CI 0.22–2.0, p = 0.72); mean time on ventilation (NIV or MV) did not differ. There were no differences in secondary measures at the end of the study. Two patients died in the control and one patient in the CP arm. There were no significant differences in the primary or secondary outcome measures between CP and standard therapy, although a larger definitive study is needed for confirmation. However, the study did show that CP therapy appears to be safe in hospitalized COVID-19 patients with hypoxia.Clinical trials registration NCT04356534: 22/04/2020.

scholarly journals Brain Structure, Cardiorespiratory Fitness, and Executive Control Changes after a 9-Week Exercise Intervention in Young Adults: A Randomized Controlled Trial

Life ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 292
Author(s):  
Lina Zhu ◽  
Qian Yu ◽  
Fabian Herold ◽  
Boris Cheval ◽  
Xiaoxiao Dong ◽  
...  
Keyword(s):  
Young Adults ◽  
Aerobic Exercise ◽  
Cardiorespiratory Fitness ◽  
Executive Control ◽  
Brain Structure ◽  
Grey Matter ◽  
Exercise Intervention ◽  
Exercise Group ◽  
Control Group ◽  
Younger Adults

Cardiorespiratory fitness (CRF) is assumed to exert beneficial effects on brain structure and executive control (EC) performance. However, empirical evidence of exercise-induced cognitive enhancement is not conclusive, and the role of CRF in younger adults is not fully understood. Here, we conducted a study in which healthy young adults took part in a moderate aerobic exercise intervention program for 9 weeks (exercise group; n = 48), or control condition of non-aerobic exercise intervention (waitlist control group; n = 72). Before and after the intervention period maximal oxygen uptake (VO2max) as an indicator of CRF, the Flanker task as a measure of EC performance and grey matter volume (GMV), as well as cortical thickness via structural magnetic resonance imaging (MRI), were assessed. Compared to the control group, the CRF (heart rate, p < 0.001; VO2max, p < 0.001) and EC performance (congruent and incongruent reaction time, p = 0.011, p < 0.001) of the exercise group were significantly improved after the 9-week aerobic exercise intervention. Furthermore, GMV changes in the left medial frontal gyrus increased in the exercise group, whereas they were significantly reduced in the control group. Likewise, analysis of cortical morphology revealed that the left lateral occipital cortex (LOC.L) and the left precuneus (PCUN.L) thickness were considerably increased in the exercise group, which was not observed in the control group. The exploration analysis confirmed that CRF improvements are linked to EC improvement and frontal grey matter changes. In summary, our results support the idea that regular endurance exercises are an important determinant for brain health and cognitive performance even in a cohort of younger adults.

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