Syllabus for Clinical Exercise Physiology (KINE 4700 )

Sample syllabus for course in Clinical Exercise Physiology (KINE 4700

Cardiorespiratory response to continuous passive motion exercise in people with spinal cord injury

Includes bibliographical references (pages 42-45)PURPOSE: To investigate cardiorespiratory responses to continuous passive motion (CPM) exercises in individuals with spinal cord injury (SCI). Two different types of passive exercises were investigating the study purpose. METHODS: A total of 11 individuals with SCI (age 40.72 ?? 11.76) and 11 healthy controls (age 29.27 ?? 11.36) participated in this study. All participants completed two different passive exercise modes; i) seated passive bike exercise (Flexicizer International corp. Inc., 2007) and ii) supine passive walking-like exercise (Cross-crawl brain pattern machine, Center of Achievement, 2001) and active arm cycling exercise (Monarch Inc. 2006). All research variables were collected while participants completed 20-minutes of passive exercises and of active arm cycling exercise. A telemetric metabolic system (Cosmed,Cosmed USA Inc., 2006) was used to obtain research variables including, oxygen consumption (VO2, ml/kg/min), carbon dioxide production (VCO2, ml/min), minute ventilation (VE, l/min), and heart rate (HR, beats/min). Blood pressure (BP, mmHg) was measured by wrist blood pressure monitor (Omron Healthcare, Inc, 2007) throughout the exercise session. Each exercise session was at least 24 hours apart to avoid the effect of previous exercise session. Participants were asked to avoid strenuous exercise within 24 hours prior to each exercise session that can affect the research variables. Collected data were reduced and processed using a Cosmed gas analysis program. A Multivariate analysis of variance (MANOVA) was used for statistical analysis. RESULTS: There were significant increase in VO2 (p<0.05) and VCO2 (p<0.05) level in both SCI and control groups during the seated cycling exercise, as well as in a supine walking-like exercise. There was no statistical difference in other variables. When the two passive exercise modes were compared, both supine position walking-like exercise and seated cycling exercise showed similar changes in VO2 and VCO2 in SCI group. (p< 0.05). Pulled statistical analysis showed that there are significant changes in VO2 and VCO2 during both seated cycling exercise. CONCLUSION: CPM exercise can promote cardiovascular response in both SCI population and able-bodied population. Our results indicate that both seated and supine position passive exercises alter cardiovascular aspects such as VO2 and VCO2 that further can elicit cardiorespiratory improvement in people with SCI

Effect of Aerobic Exercise on Cerebral Blood Flow and Cognitive Function in Persons with Down Syndrome

Down syndrome (DS), the leading genetic condition of intellectual disability, is associated with high risk of cognitive decline, dementia, and Alzheimer’s disease (AD). Cognitive decline with dementia and AD hinders not only the wellbeing of individuals with DS, but also the independence of the aging population with DS. Cognitive function is related to brain perfusion, with higher pulsatile blood flow having a detrimental effect on brain microvasculature. Exercise can improve cerebral blood flow and cognitive function in individuals without DS. However, it is unknown if the cerebral blood flow (CBF) characteristics are related to cognitive function in individuals with DS at rest and post exercise. Thus, we investigated the difference in cognitive function and CBF and its relationship in individuals with and without DS. We further investigated the effects of a single bout of moderate intensity aerobic exercise on cognitive function and CBF in these individuals. Cognitive function and CBF characteristics were measured before, immediately after, and 30 minutes following a 20 minute bout of moderate intensity treadmill walking. Cognitive function was significantly lower (p0.05). Exercise did not alter the cognitive function (p>0.05) or mMCAv (p>0.05) in individuals with DS. Individuals without DS exhibited significant improvement in cognitive function following exercise (p<0.05). Time of completion for the cognitive task was not related to CBF velocity (r= -0.085, p=0.61), but was inversely related to aerobic capacity (r= -0.411, p=0.01) in the overall cohort. However, these correlations were no longer significant when the analysis was conducted within the DS group and control group separately. Our data show that cognitive function was not related to CBF velocity. Moderate intensity exercise did not improve CBF velocity and cognitive function in individuals with DS, whereas individuals without DS showed significant cognitive function improvement. Furthermore, individuals with DS are more exposed to pulsatile blood flow, which may be detrimental to the cerebral vasculature

P145 Central Hemodynamic Response to Lower Body Negative Pressure in Individuals with Down Syndrome

Abstract Introduction Individuals with Down syndrome (DS) have autonomic dysfunction, which impacts heart rate and blood pressure regulation. Initial evidence also suggests an impaired ability to peripherally vasoconstrict during lower body negative pressure (LBNP). Given the relationship between vessel caliber and wave reflection, this may alter central hemodynamics and hemodynamic load. We aimed to investigate aortic hemodynamics and wave reflection during LBNP in individuals with DS and controls. Methods Radial applanation tonometry was performed on 15 individuals with DS (male n = 12, age 24 ± 1 yrs, BMI 29.4 ± 2.0 kg/m2) and 21 control participants (male n = 12, age 24 ± 1 yrs, BMI 24.4 ± 1.0 kg/m2) before, during and after a 5-min LBNP stimulus of –20 mmHg. Waveforms were calibrated to mean and diastolic brachial pressures. Generalized transfer function was used to estimate aortic pressures (systolic aSBP, diastolic aDBP and mean pressure aMAP), augmentation index (Aix), augmentation index normalized for HR (Aix@HR75), augmentation pressure (AP), reflection index (Rix) and forward (Pf) and reflected wave magnitude (Pb). Results Interaction effects were observed for AP, Aix, AIX@75, Rix and Pb (p < 0.05) in which DS had reductions in the outcome during LBNP whereas controls had little or no change. Although trending towards a larger drop in aSBP in individuals with DS, no significant interaction effects were found for aSBP, aDBP, aMAP, HR or Pf in response to LBNP. Conclusion These results show individuals with DS exhibited greater reductions in aortic pressure waveform characteristics and wave reflections in response to LBNP, indicative of reduced sympathetic control resulting in less peripheral vasoconstriction

Cognitive Enhancement Strategies for Older Adults: An Evaluation of Different Training Modalities to Improve Executive Function—A Systematic Review and Meta-Analysis

(1) Background: The aging population is expected to triple by 2050. Executive functions decline with age, impacting daily tasks, and this is associated with neurodegenerative diseases. Aerobic and resistance exercises positively affect cognitive function in older adults by influencing growth markers. However, the modalities of exercise and the optimal parameters for maximum cognitive benefits remain unclear. (2) Methods: A meta-analysis of randomized clinical trials (RCTs) was conducted. The systematic search was on slowing cognitive decline and performed in the PubMed/MEDLINE and Cochrane Library databases. Articles were included if participants were ≥65 years, healthy, and performing resistance or aerobic exercise, and they were excluded if there was a combination of training and if they have neurological disease or cognitive impairment. (3) Results: The search strategy found a total of 1635 studies. After removing duplicates and assessing the inclusion and exclusion criteria, eight articles were included in the meta-analysis, with a total of 463 healthy older adults analyzed. No significant differences between the intervention groups and the control groups after the aerobic or resistance programs were found. (4) Conclusions: Aerobic exercise interventions improved executive function more than resistance training in older adults, but without statistically significant differences. This can serve as a guide to see, with caution, whether we need a multidisciplinary approach to be more effective in improving the cortical health of older adults

Recovery of Corneal Endothelial Cells from Periphery after Injury

<div><p>Background</p><p>Wound healing of the endothelium occurs through cell enlargement and migration. However, the peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium in endothelial injury.</p><p>Aim</p><p>To investigate the recovery process of corneal endothelial cells (CECs) from corneal endothelial injury.</p><p>Methods</p><p>Three patients with unilateral chemical eye injuries, and 15 rabbit eyes with corneal endothelial chemical injuries were studied. Slit lamp examination, specular microscopy, and ultrasound pachymetry were performed immediately after chemical injury and 1, 3, 6, and 9 months later. The anterior chambers of eyes from New Zealand white rabbits were injected with 0.1 mL of 0.05 N NaOH for 10 min (NaOH group). Corneal edema was evaluated at day 1, 7, and 14. Vital staining was performed using alizarin red and trypan blue.</p><p>Results</p><p>Specular microscopy did not reveal any corneal endothelial cells immediately after injury. Corneal edema subsided from the periphery to the center, CEC density increased, and central corneal thickness decreased over time. In the animal study, corneal edema was greater in the NaOH group compared to the control at both day 1 and day 7. At day 1, no CECs were detected at the center and periphery of the corneas in the NaOH group. Two weeks after injury, small, hexagonal CECs were detected in peripheral cornea, while CECs in mid-periphery were large and non-hexagonal.</p><p>Conclusions</p><p>CECs migrated from the periphery to the center of the cornea after endothelial injury. The peripheral corneal endothelium may act as a cell resource for the recovery of corneal endothelium.</p></div

Photographs of anterior segments (A) and central corneal thickness data (CCT; B).

<p>A. Chemical injury of the cornea causes severe corneal edema and endothelial damage immediately after chemical injury. Slit lamp examination shows severe edematous and opaque cornea, and Descemet’s membrane folds. Endothelial cells are absent under specular microscopy. Corneal edema is reduced from the periphery to the center over time. Case 1 shows severe corneal edema and Descemet’s membrane fold immediately after injury, central edema and peripheral transparency 1 month after injury, and a clear cornea 6 months after injury. Case 2 shows severe corneal edema and Descemet’s membrane folds immediately after injury; the cornea becomes more transparent from periphery 1 month after injury. Case 3 shows severe corneal edema and Descemet’s membrane folds immediately after injury and the cornea becoming clear from the periphery 1 month after injury. This case also shows transparency of the central edema and periphery 6 months after injury. B. CCT is greater immediately after injury but decreases significantly 6 and 9 months later (p = 0.014 and 0.012, respectively, paired t-test) * Statistically significant by paired t-test</p

Evaluation of corneal endothelial cells using specular microscopy.

<p>A. Corneal endothelial cells are absent immediately after chemical injury; however, they are present 3 months (case 2) or 6 months (case 1 and case 3) later. B. CECD increased significantly 6 months following injury compared to immediately and 1 month after injury (p = 0.008 and p = 0.008, respectively, paired t-test), and 9 months after injury compared to those immediately or 1 months after injury (p = 0.005 and p = 0.005, respectively, paired t-test). C. Average cell area generally decreases over time, although not significantly. D. CV does not change and hexagonal cells are absent 3 to 9 months after injury. * Statistically significant by paired t-test</p

Specular microscopy study on corneal endothelial cells after chemical injury.

<p>CCT = central corneal thickness; CECD = central endothelial cell density; CV = coefficient of variation; N/A = not available</p><p>Specular microscopy study on corneal endothelial cells after chemical injury.</p