Aerobic exercise as add-on treatment in depressed inpatients improves cognitive domains but has no additional effect on symptom severity

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]

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A randomized trial of aerobic exercise for major depression: examining neural indicators of reward and cognitive control as predictors and treatment targets

Psychological Medicine ◽

10.1017/s0033291720002573 ◽

2020 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

C. J. Brush ◽

Greg Hajcak ◽

Anthony J. Bocchine ◽

Andrew A. Ude ◽

Kristina M. Muniz ◽

...

Keyword(s):

Depressive Symptoms ◽

Depressive Symptom ◽

Major Depression ◽

Cognitive Control ◽

Aerobic Exercise ◽

Symptom Severity ◽

Reward Processing ◽

Symptom Reduction ◽

Depressive Symptom Severity ◽

Pre Treatment

Abstract Background Aerobic exercise has demonstrated antidepressant efficacy among adults with major depression. There is a poor understanding of the neural mechanisms associated with these effects. Deficits in reward processing and cognitive control may be two candidate targets and predictors of treatment outcome to exercise in depression. Methods Sixty-six young adults aged 20.23 years (s.d. = 2.39) with major depression were randomized to 8 weeks of moderate-intensity aerobic exercise (n = 35) or light stretching (n = 31). Depressive symptoms were assessed across the intervention to track symptom reduction. Reward processing [reward positivity (RewP)] and cognitive control [error-related negativity (ERN)] were assessed before and after the intervention using event-related brain potentials. Results Compared to stretching, aerobic exercise resulted in greater symptom reduction (gs = 0.66). Aerobic exercise had no impact on the RewP (gav = 0.08) or ERN (gav = 0.21). In the aerobic exercise group, individuals with a larger pre-treatment RewP [odds ratio (OR) = 1.45] and increased baseline depressive symptom severity (OR = 1.18) were more likely to respond to an aerobic exercise program. Pre-treatment ERN did not predict response (OR = 0.74). Conclusions Aerobic exercise is effective in alleviating depressive symptoms in adults with major depression, particularly for those with increased depressive symptom severity and a larger RewP at baseline. Although aerobic exercise did not modify the RewP or ERN, there is preliminary support for the utility of the RewP in predicting who is most likely to respond to exercise as a treatment for depression.

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How do social cognition dimensions relate to DSM-5 dimensions of psychosis?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.607 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s241-s241

Author(s):

A. Arous ◽

J. Mrizak ◽

R. Trabelsi ◽

A. Aissa ◽

H. Ben Ammar ◽

...

Keyword(s):

Social Cognition ◽

Symptom Severity ◽

Social Cognitive ◽

Cognitive Empathy ◽

Affective Empathy ◽

Cognitive Domains ◽

Diagnostic And Statistical Manual ◽

Dsm 5 ◽

The Face ◽

Competing Interest

IntroductionExisting research shows that individuals with schizophrenia (SCZ) show substantial deficits in social cognitive domains, including facial emotion recognition (FER), empathy, and Theory of Mind (ToM). Their exact relationship with the different dimensions included in the “Clinician- Rated Dimensions of Psychosis Symptom Severity” of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) remains unexplored.ObjectivesTo investigate the relationship between different social cognition dimensions and the dimensions of psychosis included in the DSM-5.MethodsFifty-eight outpatients with stable SCZ completed the Intention-Inferencing Task (IIT), a non-verbal ToM task and the Questionnaire of Cognitive and Affective Empathy (QCAE). They also completed a newly developed and validated FER task constructed from photographs of the face of a famous Tunisian actress and evaluating the ability to correctly identify Ekman's six basic facial emotions. The clinician-rated dimensions of psychosis symptom severity was used to evaluate 8 dimensions of psychosis.ResultsThe patients presenting higher cognitive empathy capacities had less present abnormal psychomotor behaviour scores (P = 0.05). Higher levels of affective empathy were correlated to lower present delusions score (P = 0.037). Better scores in the IIT were correlated to less present negative scores (P = 0.013) and less impaired cognition scores (P = 0.009). FER task score didn’t correlated with any clinical dimension.ConclusionsOur results suggest the existence of specific relationships between social cognition dimensions and psychosis dimensions. Further studies are needed to confirm these relationships.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cognitive impairment in schizophrenia: relationships with cortical thickness in fronto-temporal regions, and dissociability from symptom severity

npj Schizophrenia ◽

10.1038/s41537-021-00149-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Erkan Alkan ◽

Geoff Davies ◽

Simon L. Evans

Keyword(s):

Cognitive Impairment ◽

Cognitive Performance ◽

Cortical Thickness ◽

Symptom Severity ◽

Visual Learning ◽

Brain Regions ◽

Antipsychotic Treatment ◽

Neural Basis ◽

Cognitive Domains ◽

Attention Performance

AbstractCognitive impairments are a core and persistent characteristic of schizophrenia with implications for daily functioning. These show only limited response to antipsychotic treatment and their neural basis is not well characterised. Previous studies point to relationships between cortical thickness and cognitive performance in fronto-temporal brain regions in schizophrenia patients (SZH). There is also evidence that these relationships might be independent of symptom severity, suggesting dissociable disease processes. We set out to explore these possibilities in a sample of 70 SZH and 72 age and gender-matched healthy controls (provided by the Center of Biomedical Research Excellence (COBRE)). Cortical thickness within fronto-temporal regions implicated by previous work was considered in relation to performance across various cognitive domains (from the MATRICS Cognitive Battery). Compared to controls, SZH had thinner cortices across most fronto-temporal regions and significantly lower performance on all cognitive domains. Robust relationships with cortical thickness were found: visual learning and attention performance correlated with bilateral superior and middle frontal thickness in SZH only. Correlations between attention performance and right transverse temporal thickness were also specific to SZH. Findings point to the importance of these regions for cognitive performance in SZH, possibly reflecting compensatory processes and/or aberrant connectivity. No links to symptom severity were observed in these regions, suggesting these relationships are dissociable from underlying psychotic symptomology. Findings enhance understanding of the brain structural underpinnings and possible aetiology of cognitive impairment in SZH.

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Association of Hemodynamic and Cerebrovascular Responses to Exercise With Symptom Severity in Adolescents and Young Adults With Concussion

Neurology ◽

10.1212/wnl.0000000000012929 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012929

Author(s):

David R Howell ◽

Danielle L Hunt ◽

Stacey E Aaron ◽

Jason W Hamner ◽

William P Meehan ◽

...

Keyword(s):

Heart Rate ◽

Young Adults ◽

Aerobic Exercise ◽

Symptom Severity ◽

Adolescents And Young Adults ◽

Exercise Protocol ◽

Exercise Tests ◽

Cerebrovascular Function ◽

Symptom Exacerbation ◽

Exercise Induced

Background and Objectives:Aerobic exercise has become a useful method to assist with post-concussion management. Exercise can exacerbate concussion symptoms even when symptoms are not apparent at rest. Few studies have examined the reasons for symptom exacerbation during exercise following a concussion. We had two primary objectives. 1) To delineate cardiopulmonary and cerebrovascular responses to exercise in adolescents and young adults with a concussion and healthy controls. 2) To determine the association between cerebrovascular responses and symptom burden.Methods:We recruited participants with a recent concussion from a sport concussion clinic between 9/1/2018-2/22/2020. They were included if their concussion occurred <3 weeks before initial testing and if they were symptomatic at rest. Participants were excluded if they sustained a concussion in the past year (excluding index injury), reported history of neurological disorders, or were using medications/devices that may alter neurological function. Participants completed a progressive, symptom-limited, sub-maximal exercise protocol on a stationary bike. We assessed heart rate, blood pressure, fraction of end tidal CO2 (FETCO2) and middle cerebral artery blood flow velocity (CBF) and cerebrovascular function (vasoreactivity and autoregulation) at seated rest and during exercise.Results:We conducted 107 exercise tests (40 concussed, 37 healthy participants initially; 30 concussed at follow-up). Concussed participants were tested initially (mean=17.6±2.2 [SD] years old; 55% female; mean=12.5±4.7 days post-concussion) and again 8 weeks later (mean=73.3±9.5 days post-concussion). Control participants (mean=18.3±2.4 years; 62% female) were tested once. FETCO2 increased throughout the exercise protocol as heart rate increased, reached a plateau, and declined at higher exercise intensities. CO2 explained >25% of the variation in resting CBF (R2>0.25; p<0.01) in most (73% individuals). Within the concussion group, resting symptom severity and the heart rate at which FETCO2 reached a plateau explained ∼two-thirds of variation in exercise-induced symptom exacerbation (R2=0.65; FETCO2 β=-1.210±0.517[S.E.], p<0.05). There was a moderate, statistically significant relationship between cerebrovascular responses to CO2 at rest (cerebral vasoreactivity) and cerebrovascular responses to exercise-induced changes in FETCO2 (R2=0.13, p=0.01).Discussion:The arterial CO2 response and symptom exacerbation relationship during post-concussion aerobic exercise may be mediated by increased sensitivity of cerebral vasculature to exercise-related increase in CO2.

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Aerobic exercise improves cognition and cerebrovascular regulation in older adults

Neurology ◽

10.1212/wnl.0000000000009478 ◽

2020 ◽

Vol 94 (21) ◽

pp. e2245-e2257 ◽

Cited By ~ 5

Author(s):

Veronica Guadagni ◽

Lauren L. Drogos ◽

Amanda V. Tyndall ◽

Margie H. Davenport ◽

Todd J. Anderson ◽

...

Keyword(s):

Older Adults ◽

Aerobic Exercise ◽

Exercise Intervention ◽

Cerebral Blood Flow Velocity ◽

Resistance Index ◽

Submaximal Exercise ◽

Cognitive Domains ◽

Cerebrovascular Function ◽

Before And After ◽

Cerebrovascular Regulation

ObjectiveTo test the hypothesis that aerobic exercise is associated with improvements in cognition and cerebrovascular regulation, we enrolled 206 healthy low-active middle-aged and older adults (mean ± SD age 65.9 ± 6.4 years) in a supervised 6-month aerobic exercise intervention and assessed them before and after the intervention.MethodsThe study is a quasi-experimental single group pre/postintervention study. Neuropsychological tests were used to assess cognition before and after the intervention. Transcranial Doppler ultrasound was used to measure cerebral blood flow velocity. Cerebrovascular regulation was assessed at rest, during euoxic hypercapnia, and in response to submaximal exercise. Multiple linear regression was used to examine the association between changes in cognition and changes in cerebrovascular function.ResultsThe intervention was associated with improvements in some cognitive domains, cardiorespiratory fitness, and cerebrovascular regulation. Changes in executive functions were negatively associated with changes in cerebrovascular resistance index (CVRi) during submaximal exercise (β = −0.205, p = 0.013), while fluency improvements were positively associated with changes in CVRi during hypercapnia (β = 0.106, p = 0.03).ConclusionThe 6-month aerobic exercise intervention was associated with improvements in some cognitive domains and cerebrovascular regulation. Secondary analyses showed a novel association between changes in cognition and changes in cerebrovascular regulation during euoxic hypercapnia and in response to submaximal exercise.

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Influence of Aerobic Exercise Volume on Postconcussion Symptoms

The American Journal of Sports Medicine ◽

10.1177/03635465211005761 ◽

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.

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Hormone Replacement Therapy and Voice

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig3-2018-0007 ◽

2019 ◽

Vol 4 (4) ◽

pp. 607-614

Author(s):

Jean Abitbol

Keyword(s):

Replacement Therapy ◽

Symptom Severity ◽

Low Dose ◽

Hormone Replacement ◽

Clinical Signs ◽

Female Voice ◽

Fat Cells ◽

High Pitch ◽

Endocrine Effects ◽

The Voice

The purpose of this article is to update the management of the treatment of the female voice at perimenopause and menopause. Voice and hormones—these are 2 words that clash, meet, and harmonize. If we are to solve this inquiry, we shall inevitably have to understand the hormones, their impact, and the scars of time. The endocrine effects on laryngeal structures are numerous: The actions of estrogens and progesterone produce modification of glandular secretions. Low dose of androgens are secreted principally by the adrenal cortex, but they are also secreted by the ovaries. Their effect may increase the low pitch and decease the high pitch of the voice at menopause due to important diminution of estrogens and the privation of progesterone. The menopausal voice syndrome presents clinical signs, which we will describe. I consider menopausal patients to fit into 2 broad types: the “Modigliani” types, rather thin and slender with little adipose tissue, and the “Rubens” types, with a rounded figure with more fat cells. Androgen derivatives are transformed to estrogens in fat cells. Hormonal replacement therapy should be carefully considered in the context of premenopausal symptom severity as alternative medicine. Hippocrates: “Your diet is your first medicine.”

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