Cardiopulmonary Response to Exercise Testing in People with Chronic Stroke: A Retrospective Study

Background and Purpose. This study investigated the cardiopulmonary response and safety of exercise testing at peak effort in people during the chronic stage of stroke recovery. Methods. This retrospective study examined data from 62 individuals with chronic stroke (males: 32; mean (SD); age: (12.0) yr) participating in an exercise test. Results. Both males and females had low cardiorespiratory fitness levels. No significant differences were found between gender for peak HR (P = 0.27), or VO2 peak (P = 0.29). Males demonstrated higher values for minute ventilation, tidal volume, and respiratory exchange ratio. No major adverse events were observed in the exercise tests conducted. Discussion and Conclusion. There are differences between gender that may play a role in exercise testing performance and should be considered when developing exercise programs. The low VO2 peak of this cohort of chronic stroke survivors suggests the need for participation in exercise interventions

Reduced Cardiorespiratory Fitness after Stroke: Biological Consequences and Exercise-Induced Adaptations

Evidence from several studies consistently shows decline in cardiorespiratory (CR) fitness and physical function after disabling stroke. The broader implications of such a decline to general health may be partially understood through negative poststroke physiologic adaptations such as unilateral muscle fiber type shifts, impaired hemodynamic function, and decrements in systemic metabolic status. These physiologic changes also interrelate with reductions in activities of daily living (ADLs), community ambulation, and exercise tolerance, causing a perpetual cycle of worsening disability and deteriorating health. Fortunately, initial evidence suggests that stroke participants retain the capacity to adapt physiologically to an exercise training stimulus. However, despite this evidence, exercise as a therapeutic intervention continues to be clinically underutilized in the general stroke population. Far more research is needed to fully comprehend the consequences of and remedies for CR fitness impairments after stroke. The purpose of this brief review is to describe some of what is currently known about the physiological consequences of CR fitness decline after stroke. Additionally, there is an overview of the evidence supporting exercise interventions for improving CR fitness, and associated aspects of general health in this population

Risk of decompression illness among 230 divers in relation to the presence and size of patent foramen ovale

Background The risk of developing decompression illness (DCI) in divers with a patent foramen ovale (PFO) has not been directly determined so far; neither has it been assessed in relation to the PFO's size. Methods In 230 scuba divers (age 39±8 years), contrast trans-oesophageal echocardiography (TEE) was performed for the detection and size grading (0-3) of PFO. Prior to TEE, the study individuals answered a detailed questionnaire about their health status and about their diving habits and accidents. For inclusion into the study, ⩾200 dives and strict adherence to decompression tables were required. Results Sixty-three divers (27%) had a PFO. Overall, the absolute risk of suffering a DCI event was 2.5 per 104 dives. There were 18 divers (29%) with, and 10 divers (6%) without, PFO who had experienced ⩾1 major DCI events \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $(P=0.016)$ \end{document}. In the group with PFO, the incidence per 104 dives of a major DCI, a DCI lasting longer than 24 h and of being treated in a decompression chamber amounted to 5.1 (median 0, interquartile range [IQR] 0-10.0), 1.9 (median 0, IQR 0-4.0) and 3.6 (median 0, IQR 0-9.8), respectively and was 4.8-12.9-fold higher than in the group without PFO \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} $(P{<}0.001)$ \end{document}. The risk of suffering a major DCI, of a DCI lasting longer than 24 h and of being treated by recompression increased with rising PFO size. Conclusion The presence of a PFO is related to a low absolute risk of suffering five major DCI events per 104 dives, the odds of which is five times as high as in divers without PFO. The risk of suffering a major DCI parallels PFO siz

Middle cerebral artery velocity dynamic response profile during exercise is attenuated following multiple ischemic strokes: A case report

A grant from the One-University Open Access Fund at the University of Kansas was used to defray the author's publication fees in this Open Access journal. The Open Access Fund, administered by librarians from the KU, KU Law, and KUMC libraries, is made possible by contributions from the offices of KU Provost, KU Vice Chancellor for Research & Graduate Studies, and KUMC Vice Chancellor for Research. For more information about the Open Access Fund, please see http://library.kumc.edu/authors-fund.xml.Blood flow regulation is impaired in people with stroke. However, the time course of change in middle cerebral artery velocity (MCAv) following repeated stroke at rest and during exercise remains unknown. In this case study, we provide novel characterization of the dynamic kinetic MCAv response profile to moderate‐intensity exercise before and after repeated ischemic MCA stroke. The initial stroke occurred in the left MCA. At 3 months poststroke, left MCAv amplitude (Amp) was ~50% lower than the right. At the 6‐month follow‐up visit, MCAv Amp declined in both MCA with the left MCAv Amp ~50% lower than the right MCAv Amp. Following a second right MCA stroke, we report further decline in Amp for the left MCA. At the 3‐ and 6‐month visit following the second stroke, the left MCAv Amp declined further (~10%). The right MCAv Amp dramatically decreased by 81.3% when compared to the initial study visit. The MCAv kinetic analysis revealed a marked impairment in the cerebrovascular response to exercise following stroke. We discuss potential pathophysiological mechanisms contributing to poststroke cerebrovascular dysfunction and the need to test therapeutic interventions (such as exercise) that might attenuate cerebrovascular decline in people following stroke.Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01HD067318)CTSA grant from NCATS awarded to the University of Kansas for Frontiers: University of Kansas Clinical and Translational Science Institute (# UL1TR002366)CTSA Award # UL1TR000001 from NCRR and NCATSGeorgia Holland Endowment Fun

Novice Lifters Exhibit A More Kyphotic Lifting Posture Than Experienced Lifters In Straight-Leg Lifting

As torso flexion and repetitive lifting are known risk factors for low back pain and injury, it is important to investigate lifting techniques that might reduce injury during repetitive lifting. By normalizing lumbar posture to a subject’s range of motion (ROM), as a function of torso flexion, this research examined when subjects approached their range of motion limits during dynamic lifting tasks. For this study, it was hypothesized that experienced lifters would maintain a more neutral lumbar angle relative to their range of motion, while novice lifters would approach the limits of their lumbar ROM during the extension phase of a straight-leg lift. The results show a statistically significant difference in lifting patterns for these two groups supporting this hypothesis. The novice group maintained a much more kyphotic lumbar angle for both the flexion (74% of the lumbar angle ROM) and extension phases (86% of the lumbar angle ROM) of the lifting cycle, while the experienced group retained a more neutral curvature throughout the entire lifting cycle (37% of lumbar angle ROM in flexion and 48% of lumbar angle ROM in extension). By approaching the limits of their range of motion, the novice lifters could be at greater risk of injury by placing greater loads on the supporting soft tissues of the spine. Future research should examine whether training subjects to assume more neutral postures during lifting could indeed lower injury risks

Preliminary Evidence for the Impact of Combat Experiences on Gray Matter Volume of the Posterior Insula

Background: Combat-exposed veteran populations are at an increased risk for developing cardiovascular disease. The anterior cingulate cortex (ACC) and insula have been implicated in both autonomic arousal to emotional stressors and homeostatic processes, which may contribute to cardiovascular dysfunction in combat veteran populations. The aim of the present study was to explore the intersecting relationships of combat experiences, rostral ACC and posterior insula volume, and cardiovascular health in a sample of combat veterans. Method: Twenty-four male combat veterans completed clinical assessment of combat experiences and posttraumatic stress symptoms. Subjects completed a magnetic resonance imaging scan and autosegmentation using FreeSurfer was used to estimate regional gray matter volume (controlling for total gray matter volume) of the rostral ACC and posterior insula. Flow-mediated dilation (FMD) was conducted to assess cardiovascular health. Theil-sen robust regressions andWelch’s analysis of variance were used to examine relationships of combat experiences and PTSD symptomology with (1) FMD and (2) regional gray matter volume. Results: Increased combat experiences, deployment duration, and multiple deployments were related to smaller posterior insula volume. Combat experiences were marginally associated with poorer cardiovascular health. However, cardiovascular health was not related to rostral ACC or posterior insula volume. Conclusion: The present study provides initial evidence for the relationships of combat experiences, deployment duration, and multiple deployments with smaller posterior insula volume. Results may suggest that veterans with increased combat experiences may exhibit more dysfunction regulating the autonomic nervous system, a key function of the posterior insula. However, the relationship between combat and cardiovascular health was not mediated by regional brain volume. Future research is warranted to further clarify the cardiovascular or functional impact of smaller posterior insula volume in combat veterans

Does the Friel Anaerobic Threshold Test Accurately Detect Heart Rate Deflection in Trained Cyclists?

The Friel Anaerobic Threshold Test (FATT) has been used to determine anaerobic threshold (AT). The FATT suggests AT occurs near the heart rate deflection point (HRDP) at a rating of perceived exertion (RPE) of 17. Purpose: The primary purpose of this study was to determine 1) whether the HRDP could be determined using the FATT, 2) examine differences between HRVT and HR that coincided Borg’s rating of perceived exertion (RPE) of 17, and 3) if riding position (hoods or aero) would influence performance. Methods: Fourteen male cyclists (30.4 ± 7.41years of age; 151.8 ± 60.4 cycled miles/week) participated in the study. Each subject performed the FATT on two occasions within one week. Results: The findings of this study suggest that the FATT can determine HRDP in trained cyclists while riding in the hoods position but not the aero position. No significant difference was found between the hoods and aero position for HRVT as measured by the metabolic cart. Our data suggest that HR at an RPE of 15 more accurately reflects the HRVT than the RPE of 17. A low, non-significant correlation was found for both the hoods and aero (0.41 and 0.44, respectively; p \u3e 0.20) for the HR at RPE of 17. Conclusion: The findings of this study suggest that the FATT can determine HRDP in trained cyclists. However, HRDP was identified in the cyclists preferred riding position. When performing the FATT, HRVT at an RPE of 15 should be used to estimate VT over the suggested RPE of 17

A Combined Measure of Vascular Risk for White Matter Lesions

This is the author's accepted manuscript.Background Though hypertension is a commonly studied risk factor for white matter lesions (WMLs), measures of blood pressure may fluctuate depending on external conditions resulting in measurement error. Indicators of arterial stiffening and reduced elasticity may be more sensitive indicators of risk for WMLs in aging; however the interdependent nature of vascular indicators creates statistical complications. Objective The purpose of the study was to determine whether a factor score comprised of multiple vascular indicators would be a stronger predictor of WMLs than traditional measures of blood pressure. Methods In a sample of well-characterized nondemented older adults, we used a factor analytic approach to account for variance common across multiple vascular measures while reducing measurement error. The result was a single factor score reflecting arterial stiffness and reduced elasticity. We used this factor score to predict white matter lesion volumes acquired via fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging. Results The combined vascular factor score was a stronger predictor of deep WML (β = 0.42, p < 0.001) and periventricular WML volumes (β = 0.49, p < 0.001). After accounting for the vascular factor, systolic and diastolic blood pressure measurements were not significant predictors. Conclusions This suggests that a combined measure of arterial elasticity and stiffening may be a stronger predictor of WMLs than systolic and diastolic blood pressure accounting for the multicollinearity associated with a variety of interrelated vascular measures

Pilot Study of Endurance Runners and Brain Responses Associated with Delay Discounting

International Journal of Exercise Science 10(5): 690-701, 2017. High levels of endurance training have been associated with potentially negative health outcomes and addictive-like symptoms such as exercise in the presence of injury and higher levels of impulsivity. This pilot study examined the relationships among self-report measures of addictive symptoms related to exercise and behavioral and neural measures of impulsivity in endurance runners. We hypothesized endurance runners would have increased preference for immediate rewards and greater activation of cognitive control regions when making decisions involving delayed rewards. Twenty endurance runners (at least 20 miles/week) were recruited to undergo measures of self-report exercise addiction symptoms, impulsive decision-making (delay discounting) and functional magnetic resonance imaging (fMRI). During behavioral and fMRI examinations, participants chose between a small hypothetical amount of money given immediately ($0 – 100) compared to a larger hypothetical amount of money ($100) given after a delay (2-12 weeks). On half of the trials participants were instructed that if they chose the delayed reward they would not be able to exercise during the delay period. Eighteen participants were included in the analysis. Results indicated that 94% of endurance runners reported high levels of exercise addiction symptoms, and 44% were “at-risk” for exercise addiction. In addition, endurance runners demonstrated increased preference for immediately available compared to delayed rewards (p \u3c 0.001) and greater recruitment of cognitive control regions (dorsomedial prefrontal cortex and anterior cingulate) when making decisions involving rewards when exercise was delayed (p \u3c 0.05). Together, these results indicate that endurance runners not only report addictive symptoms related to exercise, but also demonstrate addictive-like behaviors

Aerobic fitness and neurocognitive performance in older adults from Kansas and Costa Rica

Background and Objectives: There is a dearth of comparative studies on the association between aging, cognitive function and cardiorespiratory fitness in older adults from developed and developing countries. The purpose of the study was to determine the association between aerobic power and neurocognitive performance in older adults from the Kansas (KS, USA) and Costa Rica (CR). Research Design and Methods: In a cross-sectional study, older adults from CR (n = 78) and KS (n = 100) underwent a maximal cardiopulmonary function test to determine aerobic power and a comprehensive battery of cognitive function dimensions including a cognitive screen, and tests of simple speed of processing, spatial visualization, visuospatial processing, episodic memory and verbal abilities, executive functioning and cognitive control, and working memory tasks. Raw data from the dimensions were z-transformed to compute an overall index of global neurocognitive performance. Results: Aerobic power was similar between male and female older adults from CR and KS. Regardless of gender, elderly from CR scored lower in cognitive measures than elderly from KS. For the entire sample, a small correlation was found between aerobic power and Visuospatial processing/fluid ability (r = 0.197, p = 0.009). Discussion and Implications: Elderly males and females from KS and CR reported similar aerobic power. The association between aerobic power and cognitive domains was inconsistent between genders and groups studied. More comparative ethnic/racial studies are needed to determine potential lifestyle factors related to cognitive decline in the elderly living in different societies.Universidad de Costa Rica/[838-B4-364]/UCR/Costa RicaNational Institutes of Health/[1R21TW009665–01]/NIH/Estados UnidosNational Institutes of Health/[R01 AG034614]/NIH/Estados UnidosNational Institutes of Health/[UL1 TR000001]/NIH/Estados UnidosNational Institutes of Health/[KL2 TR000119]/NIH/Estados UnidosNational Institutes of Health/[P30 AG035982]/NIH/Estados UnidosNational Institutes of Health/[K01HD067318]/NIH/Estados UnidosUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro de Investigación en Ciencias del Movimiento Humano (CIMOHU)UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigaciones Psicológicas (IIP