Approach to investigation and treatment of persistent symptoms following sport-related concussion: a systematic review

OBJECTIVE: To conduct a systematic review of the literature regarding assessment and treatment modalities in patients with persistent symptoms following sport-related concussion (SRC). DATA SOURCES: We searched Medline, Embase, SPORTSDiscus, PsycINFO, CINAHL, Cochrane library and ProQuest Dissertation & Theses Global electronic databases. STUDY ELIGIBILITY CRITERIA: Studies were included if they were original research, reported on SRC as the primary source of injury, included patients with persistent postconcussive symptoms (>10 days) and investigated the role of assessment or treatment modalities. RESULTS: Of 3225 articles identified in the preliminary search, 25 articles met the inclusion criteria. 11 articles were concerned with assessment and 14 articles with treatment of persistent symptoms following SRC. There were three randomised control trials and one quasi-experimental study. The remainder consisting of cross-sectional studies, historical cohorts and case series. SUMMARY: 'Persistent symptoms' following SRC can be defined as clinical recovery that falls outside expected time frames (ie, >10-14 days in adults and >4 weeks in children). It does not reflect a single pathophysiological entity, but describes a constellation of non-specific post-traumatic symptoms that may be linked to coexisting and/or confounding pathologies. A detailed multimodal clinical assessment is required to identify specific primary and secondary processes, and treatment should target specific pathologies identified. There is preliminary evidence supporting the use of symptom-limited aerobic exercise, targeted physical therapy and a collaborative approach that includes cognitive behavioural therapy. Management of patients with persistent symptoms is challenging and should occur in a multidisciplinary collaborative setting, with healthcare providers with experience in SRC

The effects of aerobic exercise timing on sleep architecture

It is well known that the quality of sleep has direct effects on the manifestations of disease. Further, exercise has been shown to enhance the quality of sleep, yet little is known regarding how exercise effects sleep stages. Our laboratory has shown that the timing of exercise is important for cardiovascular benefits which may be derived from the improved quality of sleep. Therefore, the purpose of this study was to investigate the effects of aerobic exercise timing on sleep architecture. Thirteen subjects, with no self-reported sleep disorders and not on any medications participated in this study. Visit one consisted of informed consent and a graded exercise test to exhaustion (VO2peak) and equipment familiarization. During visits 2-4 subjects reported for 3 pre-determined exercise times at 7am, 1pm, and 7pm in a random counterbalanced order to perform a 30 minute treadmill protocol at 65% of their predetermined VO2peak. A Zeo™ ambulatory sleep EEG monitoring headband was worn during sleep. This system transmitted brainwave data to a receiver which was analyzed for sleep stage time and quality of sleep. Aerobic exercise at 7am invoked significantly greater time spent in light and deep sleep and the greatest frequency of sleep cycles compared to exercise in the afternoon or evening. However, exercise at 7pm showed less time in Rapid Eye Movement sleep compared to 7am and 1pm exercise times. These data show that engaging in aerobic exercise during the early morning hours may be the most beneficial epoch of time for greater quality of sleep

Chronic fatigue syndrome; an approach combining self-management with graded exercise to avoid exacerbations.

Controversy regarding the aetiology and treatment of patients with chronic fatigue syndrome (CFS) continues to affect the medical professions. The Cochrane collaboration advises practitioners to implement graded exercise therapy for CFS sufferers using cognitive behavioural principles. In contrast there is evidence that exercise can induce symptom exacerbations in CFS where too vigorous exercise/activity promotes immune dysfunction, which in turn increases symptoms in patients with CFS. When designing and implementing an exercise programme it is important to be aware of both these seemingly opposing view points in order to deliver a programme without any detrimental effects on CFS pathophysiology. Using evidence from both the biological and clinical sciences, the present manuscript explains that graded exercise therapy for people with CFS can be safely undertaken without detrimental effects to the immune system. Exercise programs should be designed to cater for individual physical capabilities and should also account for the fluctuating nature of symptoms commonly reported by people with CFS. In line with cognitive behaviourally and graded exercise-based strategies, self-management for people with CFS involves encouraging the patients to pace their activities and respect their physical and mental limitations with the ultimate aim of improving their everyday function

The relationship between physical exercise and cognition in children with typical development and neurodevelopmental disorders

This research project sought to investigate the relationship between physical exercise and cognition in children with and without a neurodevelopmental condition. To achieve this aim, three approaches were undertaken to explore the exercise and cognition relationship. The first approach sought to understand the efficacy of exercise interventions on cognition in individuals with a neurodevelopmental disorder. The second approach was to understand the effectiveness of an exercise activity when compared to a cognitively-engaging tablet game activity on measures of implicit learning and attention in children with and without a neurodevelopmental condition. The third approach was to investigate if psychophysiological measures could account for the cognitive effect observed after exercising in children with and without a neurodevelopmental condition. Taking the approaches together, this research project focused on investigating the efficacy, effect, and mechanism of the exercise-cognition relationship. To investigate the efficacy of the exercise interventions, a meta-analytic review was conducted on 22 studies from the neurodevelopmental literature. The main findings from this meta-analysis revealed an overall small-to-medium effect size of exercise on cognition, supporting the efficacy of applying exercise interventions to young individuals with a neurodevelopmental disorder. Similar to the general population, physical exercise has been demonstrated to improve some but not all cognitive functions, with some individuals demonstrating no change in cognitive function after exercising. In terms of the effects of physical exercise, this project conducted an experimental study comparing a moderate-intensity exercise activity with a tablet game activity for a period of 12 minutes in 35 children aged 6-11 years. Overall, the study found that the effect of exercise was comparable to the tablet activity across the reaction time measures, but not on the accuracy performance of the implicit learning and attention tasks. Overall, exercise activity led to a better accuracy performance on implicit learning and executive attention compared to the tablet activity, particularly in children with a neurodevelopmental condition. The last part of this project was an extension of the experimental study whereby psychophysiological measures were investigated based on a proposed detrended fluctuation analysis (DFA). This investigation found that galvanic skin response (GSR), as indexed by its scaling exponent, was related to whether children revealed a change in cognitive function after receiving the exercise activity, particularly on executive attention. Importantly, this relationship was also able to account for children who did not demonstrate a cognitive effect of exercise. This result was not evident in the electroencephalogram (EEG) measures. This investigation concluded that the effect of exercise on executive attention was dependent on the interplay between an individual’s arousal system, cognitive task demand, and the novelty of the exercise activity. Taking the findings together, this project highlights the importance of individual differences to the exercise and cognition relationship. Specifically, this project demonstrated the feasibility of investigating the scaling exponent, via fractal analysis (e.g., DFA), as an index of individual differences. Additionally, fractal analysis is a valuable tool to assist in further understanding the mechanism underlying the exercise-cognition relationship, particularly on the influence of individual difference

Beneficial effects of acute high-intensity exercise on electrophysiological indices of attention processes in young adult men

This is the final version. Available on open access from Elsevier via the DOI in this recordBackground: Emerging research suggests that a single bout of aerobic exercise can improve cognition, brain function and psychological health. Our aim was to examine the effects of high-intensity exercise on cognitive-performance and brain measures of attention, inhibition and performance-monitoring across a test-battery of three cognitive tasks. Method: Using a randomised cross-over design, 29 young men completed three successive cognitive tasks (Cued Continuous Performance Task [CPT-OX]; Eriksen Flanker Task; four-choice reaction-time task [Fast Task]) with simultaneous electroencephalogram (EEG) recording before and after a 20-min high-intensity cycling exercise and resting control session. Cognitive-performance measures, EEG power and event-related potential measures, were obtained during the tasks. Random-intercept linear models were used to investigate the effects of exercise, compared to rest, on outcomes. Results: A single bout of exercise significantly (p < 0.05) increased the amplitude of the event-related potential Go P3, but had no effect on the contingent negative variation (CNV), Cue P3 or NoGo P3, during the CPT-OX. Delta power, recorded during the CPT-OX, also significantly increased after exercise, whereas there was no effect on cognitive-performance in this task. Exercise did not influence any cognitive-performance or brain measures in the subsequent Flanker or Fast Tasks. Conclusion: Acute high-intensity exercise improves brain-indices reflecting executive and sustained attention during task performance (Go P3 and delta activity), in the CPT-OX, but not anticipatory attention (Cue P3 and CNV) or response inhibition (NoGo P3) in young-adult men. Exercise had no effect on cognitive-performance or brain measures in the subsequent Flanker and Fast tasks, which may potentially be explained by the time delay after exercise.Medical Research Council (MRC)National Institute for Health Research (NIHR

Aerospace medicine and biology: A continuing bibliography with indexes, supplement 197, September 1979

This bibliography lists 193 reports, articles, and other documents introduced into the NASA scientific and technical information system in August 1979

Aerospace medicine and biology: A continuing bibliography with indexes (supplement 299)

This bibliography lists 96 reports, articles, and other documents introduced into the NASA scientific and technical information system in June, 1987

Pairing cognitive training and exercise

The research on the cognitive benefits of exercise has shown that regular participation in physical activity can improve performance for cognitive activities. Recently, animal research has shown that combining physical activity (PA) with cognitive training concomitantly, produces greater increases in cognitive performance than either done alone. The human research that has been designed to explore the effects of combined exercise and cognitive training has implemented the training on separate days and in separate locations. Thus, the human research has not looked at combining PA and cognitive engagement during exercise in the same way the animal research has. Therefore, the current study investigated the cognitive benefits of a cognitive training protocol performed during an exercise task as compared to cognitive training or exercise training alone. Participants (N = 24) were randomized to one of three groups that engaged in a 6-day training protocol. There was a bike group that exercised at a moderate intensity, a game group that engaged in an interactive learning software protocol, and a both group that completed the interactive learning software protocol while simultaneously exercising. All participants were tested before and after the 6 day training session on the Wonderlic Personnel Test, the Stroop Test, the Trail Making Tests A and B (TMTA, TMTB) and the Paced Auditory Serial Addition Test (PASAT). The results of the Repeated Measures ANOVA for the Stroop test showed there was a significant interaction of time x test x group, p &lt; .05 indicating that while the two exercise groups (bike and both) had improvements in scores on all subtests over time, the game group did improve on the color subtest but did not improve on the word and color-word subtests. Analysis of the Stroop interference score also showed a significant time x group interaction, p &lt; .05. Examination of the means showed that the bike group and the both group reduced their time to completion from pretest to posttest, but the game group increased their completion time and therefore performed worse at posttest. An examination of the set-switch score for the TMT indicated that the interaction of time x group approached significance, p = .062. Examination of the means indicated that the bike group and the both group reduced their time to completion from pretest to posttest, but the game group increased their completion time from pretest to posttest. The findings suggest that combining exercise and a cognitive training protocol can produce significant results on cognitive measures after a 6-day intervention