Defining Optimal Aerobic Exercise Parameters to Affect Complex Motor and Cognitive Outcomes after Stroke: A Systematic Review and Synthesis

Although poststroke aerobic exercise (AE) increases markers of neuroplasticity and protects perilesional tissue, the degree to which it enhances complex motor or cognitive outcomes is unknown. Previous research suggests that timing and dosage of exercise may be important. We synthesized data from clinical and animal studies in order to determine optimal AE training parameters and recovery outcomes for future research. Using predefined criteria, we included clinical trials of stroke of any type or duration and animal studies employing any established models of stroke. Of the 5,259 titles returned, 52 articles met our criteria, measuring the effects of AE on balance, lower extremity coordination, upper limb motor skills, learning, processing speed, memory, and executive function. We found that early-initiated low-to-moderate intensity AE improved locomotor coordination in rodents. In clinical trials, AE improved balance and lower limb coordination irrespective of intervention modality or parameter. In contrast, fine upper limb recovery was relatively resistant to AE. In terms of cognitive outcomes, poststroke AE in animals improved memory and learning, except when training was too intense. However, in clinical trials, combined training protocols more consistently improved cognition. We noted a paucity of studies examining the benefits of AE on recovery beyond cessation of the intervention

The MoxFo initiative-Mechanisms of action: Biomarkers in multiple sclerosis exercise studies

background: as exercise exerts neurobiological and immunomodulatory effects, it might also act as a disease-modifying intervention in MS. however, a clear mechanistic link between exercise and disease-modifying effects in MS has yet to be established.objective: establish recommendations for future mechanistic exercise studies in MS.Methods: In regular meetings, members of the mechanisms of action group within the MoXFo (Moving eXercise research Forward in MS) initiative evaluated gaps of knowledge and discussed unmet needs in mechanistic MS research.results: we concluded that biomarkers assessed in translational studies in humans and animals are essential to decipher the underlying mechanisms of exercise in MS. consequently, we defined clear definitions of different types of biomarkers examined in MS exercise studies and operationalized their use to align with the research question and optimal testing time points. Furthermore, we provide key considerations to improve the rigor of translational studies and defined minimal reporting criteria for animal studies.conclusion: the resulting recommendations are intended to improve the quality of future mechanistic exercise studies in MS and consequently lead to a better understanding of therapeutic approaches

A Bout of High Intensity Interval Training Lengthened Nerve Conduction Latency to the Non-exercised Affected Limb in Chronic Stroke

Objective: Evaluate intensity-dependent effects of a single bout of high intensity interval training (HIIT) compared to moderate intensity constant-load exercise (MICE) on corticospinal excitability (CSE) and effects on upper limb performance in chronic stroke.Design: Randomized cross-over trial.Setting: Research laboratory in a tertiary rehabilitation hospital.Participants: Convenience sample of 12 chronic stroke survivors.Outcome measures: Bilateral CSE measures of intracortical inhibition and facilitation, motor thresholds, and motor evoked potential (MEP) latency using transcranial magnetic stimulation. Upper limb functional measures of dexterity (Box and Blocks Test) and strength (pinch and grip strength).Results: Twelve (10 males; 62.50 ± 9.0 years old) chronic stroke (26.70 ± 23.0 months) survivors with moderate level of residual impairment participated. MEP latency from the ipsilesional hemisphere was lengthened after HIIT (pre: 24.27 ± 1.8 ms, and post: 25.04 ± 1.8 ms, p = 0.01) but not MICE (pre: 25.49 ± 1.10 ms, and post: 25.28 ± 1.0 ms, p = 0.44). There were no significant changes in motor thresholds, intracortical inhibition or facilitation. Pinch strength of the affected hand decreased after MICE (pre: 8.96 ± 1.9 kg vs. post: 8.40 ± 2.0 kg, p = 0.02) but not after HIIT (pre: 8.83 ± 2.0 kg vs. post: 8.65 ± 2.2 kg, p = 0.29). Regardless of type of aerobic exercise, higher total energy expenditure was associated with greater increases in pinch strength in the affected hand after exercise (R2 = 0.31, p = 0.04) and decreases in pinch strength of the less affected hand (R2 = 0.26 p = 0.02).Conclusion: A single bout of HIIT resulted in lengthened nerve conduction latency in the affected hand that was not engaged in the exercise. Longer latency could be related to the cross-over effects of fatiguing exercise or to reduced hand spasticity. Somewhat counterintuitively, pinch strength of the affected hand decreased after MICE but not HIIT. Regardless of the structure of exercise, higher energy expended was associated with pinch strength gains in the affected hand and strength losses in the less affected hand. Since aerobic exercise has acute effects on MEP latency and hand strength, it could be paired with upper limb training to potentiate beneficial effects

Conditions and strategies influencing sustainability of a community-based exercise program incorporating a healthcare-community partnership for people with balance and mobility limitations in Canada: A collective case study of the Together in Movement and Exercise (TIME™) program

BackgroundCommunity-based exercise programs delivered through healthcare-community partnerships (CBEP-HCPs) are beneficial to individuals with balance and mobility limitations. For the community to benefit, however, these programs must be sustained over time.PurposeTo identify conditions influencing the sustainability of CBEP-HCPs for people with balance and mobility limitations and strategies used to promote sustainability based on experiences of program providers, exercise participants, and caregivers.MethodsUsing a qualitative collective case study design, we invited stakeholders (program providers, exercise participants, and caregivers) from sites that had been running a CBEP-HCP for people with balance and mobility limitations for ≥4 years; and sites where the CBEP-HCP had been discontinued, to participate. We used two sustainability models to inform development of interview guides and data analysis. Qualitative data from each site were integrated using a narrative approach to foster deeper understanding of within-organization experiences.ResultsTwenty-nine individuals from 4 sustained and 4 discontinued sites in Ontario (n = 6) and British Columbia (n = 2), Canada, participated. Sites with sustained programs were characterized by conditions such as need for the program in the community, presence of secure funding or cost recovery mechanisms, presence of community partners, availability of experienced and motivated instructors, and the capacity to allocate resources towards program marketing and participant recruitment. For sites where programs discontinued, diminished participation and/or enrollment and an inability to allocate sufficient financial, human, and logistical resources towards the program affected program continuity. Participants from discontinued sites also identified issues such as staff with low motivation and limited experience, and presence of competing programs within the organization or the community. Staff associated the absence of referral pathways, insufficient community awareness of the program, and the inability to recover program cost due to poor participation, with program discontinuation.ConclusionSustainability of CBEP-HCPs for people with balance and mobility limitations is influenced by conditions that exist during program implementation and delivery, including the need for the program in the community, and organization and community capacity to bear the program's financial and resource requirements. Complex interactions among these factors, in addition to strategies employed by program staff to promote sustainability, influence program sustainability

An examination of constraint-induced therapy as a method to intensify intervention and improve functional outcome during the rehabilitation phase of stroke

Studies have shown that constraint-induced therapy (CIT) improves recovery of the impaired upper extremity and influences neuroplastic changes in the recovering brain, primarily in chronic stroke populations and when paired with six hours of additional therapy per day. A protocol of mitten constraint was developed in which subjects, during the rehabilitation phase of stroke, wore a mitten on the sound hand rather than a sling and splint as used previously, gradually increasing wearing time, without hours of additional therapy. The purpose of this exploratory study was to evaluate the effectiveness of this constraint protocol and compliance to the treatment. Subjects were randomly assigned to CIT plus conventional therapy or conventional therapy only. Upper extremity, lower extremity and trunk motor control and strength were evaluated along with shoulder pain, compliance and level of dependence on caregivers. CIT appeared to significantly improve recovery of postural control and augmented recovery of the impaired upper extremity. The constraint protocol was most effective in male subjects and subjects with left hemiplegia. Compliance varied according to level of disability on admission but was not related to overall recovery. CIT did not induce increased dependence on caregivers and was not associated with adverse events however there was a trend toward increased hemiplegic shoulder pain in some subgroups that was associated with poorer outcome. It was concluded that this constraint protocol was a clinically relevant and practical method to apply CIT in the acute rehabilitation setting

Building an Evidence-Based Framework for the Development of a Newfoundland and Labrador Centre on Aging

Life expectancies are increasing and populations are aging in all western industrialized countries. Given the demographics, the health and well-being of older adults and the provision of services for seniors are major priorities for all levels of government and will become increasingly so. Newfoundland and Labrador (NL) has one of the highest proportions (13.9%) of seniors of any province and that percentage is expected to increase to 20% by 2017 (Provincial Healthy Aging Policy Framework, 2007). Statistics Canada has recently projected that by 2031, NL will have the highest proportion of older adults in Canada. The Government of Newfoundland and Labrador has acknowledged the need to address the challenges of an aging population in the Healthy Aging Policy Framework. There are approximately 18 Canadian research centres involved in the study of aging. The only province without a centre dedicated to the study of aging is NL1. The establishment of a NL Centre on Aging would be an important development given the demographics and the unique circumstances of the province and its people. A NL Centre on Aging would facilitate aging-related research and education, thereby assisting the government of NL in achieving the goals of the Healthy Aging Policy Framework. The present document describes a qualitative descriptive investigation funded by the Healthy Aging Research Program (HARP) of the NL Centre for Applied Health Research (NLCAHR) and by the Grenfell Campus of Memorial University

Comparing Three Dual-Task Methods and the Relationship to Physical and Cognitive Impairment in People with Multiple Sclerosis and Controls

Dual-tasking (DT) is a measure to detect impairments in people with multiple sclerosis (MS). We compared three DT methods to determine whether cognitive (Montreal Cognitive Assessment (MoCA)) or physical disability (Expanded Disease Severity Scale; EDSS) was related to DT performance. We recruited MS participants with low disability (<3 EDSS

The Liberation Procedure Decision-Making Experience for People With Multiple Sclerosis

Despite the absence of scientific evidence demonstrating the efficacy of the “liberation procedure” in treating multiple sclerosis (MS), thousands of MS patients worldwide have undergone the procedure. The study objective was to explore the experience of liberation procedure decision making for individuals with MS. Fifteen adults in Newfoundland and Labrador, Canada, each participated in an in-depth interview. The data analysis revealed three groups of people: “waiters,” “early embracers,” and “late embracers.” Using van Manen’s hermeneutic phenomenological approach, we identified three themes each in the stories of the early and late embracers and four themes in the waiters’ stories. A characteristic of the late embracers and waiters was skepticism, whereas desperation set the embracers apart from the waiters. With a deeper understanding of the experience, nurses can be more attuned to the perspectives of MS patients while helping them make informed decisions about undergoing the liberation procedure