Physical fitness training after stroke, time to implement what we know: more research is needed

Stroke survivors experience marked reduction in physical activity and fitness. Regular physical fitness training, started early poststroke, could help recovery in the long term and is recommended in many clinical guidelines. However, implementation of programs is hampered by our current lack of knowledge about what interventions are most effective and how best to support stroke survivors to exercise. In the United Kingdom and Australia, there are educational programs for exercise professionals to enable them to safely and effectively deliver exercise to stroke survivors; and in the United Kingdom, community exercise training programs are being developed to follow-on from usual rehabilitation. As with many areas of life after stroke, further research is still needed. We need to know more about the effect of exercise training on common poststroke problems such as fatigue, depression and falls. Importantly, we need to understand the perceived barriers and motivators to exercise after stroke, and how to enhance adherence to the exercise programs that are in current development. However, these knowledge gaps should not prevent us from implementing what we know; and we would urge health professionals to work with exercise professionals to develop pathways into exercise for stroke survivors.     

The Practice and Process of Healthy Exercise: An Investigation of the Treatment of Exercise Abuse in Women with Eating Disorders

This study investigates the effectiveness of an exercise program designed to reduce exercise abuse in women who are in residential treatment for eating disorders. One hundred and twenty-seven women who participated in the exercise program were compared to 127 non-participants on weight gain and self-reported obligatory attitudes and beliefs about exercise. The exercise participants were women who were medically cleared and attended at least two exercise groups during treatment. The control group were women who were medically cleared, but did not attend any exercise groups during treatment. Significant group × diagnosis interactions revealed that women in the exercise group who were diagnosed with anorexia nervosa gained more than one-third as much weight as those in the control group. Also, women in the exercise group demonstrated significantly reduced obligatory attitudes toward exercise compared to the control group. These findings suggest that the use of an exercise program that targets exercise abuse in women with eating disorders is feasible during residential treatment and results in positive change without interfering with weight gain. Limitations that result from the lack of random assignment to the exercise and control group are discussed.     

The practice and process of healthy exercise: an investigation of the treatment of exercise abuse in women with eating disorders

This study investigates the effectiveness of an exercise program designed to reduce exercise abuse in women who are in residential treatment for eating disorders. One hundred and twenty-seven women who participated in the exercise program were compared to 127 non-participants on weight gain and self-reported obligatory attitudes and beliefs about exercise. The exercise participants were women who were medically cleared and attended at least two exercise groups during treatment. The control group were women who were medically cleared, but did not attend any exercise groups during treatment. Significant group × diagnosis interactions revealed that women in the exercise group who were diagnosed with anorexia nervosa gained more than one-third as much weight as those in the control group. Also, women in the exercise group demonstrated significantly reduced obligatory attitudes toward exercise compared to the control group. These findings suggest that the use of an exercise program that targets exercise abuse in women with eating disorders is feasible during residential treatment and results in positive change without interfering with weight gain. Limitations that result from the lack of random assignment to the exercise and control group are discussed.     

Exercise,sleep and cytokines: Is there a relation?

Physical exercise is a modality of non-pharmacological treatment for sleep disorders. Contradicting results are still found in studies of the effect of exercise on sleep. Among the substances that have been described as sleep modulators, cytokines produced during the recovery period after an acute exercise session are very important. Various studies have verified that physical exercise may alter the plasma concentration of the many pro-inflammatory cytokines that may in turn modulate sleep. A number of factors seem to mediate this effect of exercise, including duration, intensity, and form of exercise, in addition to temperature and metabolic alterations. The mechanisms through which exercise promotes alterations in sleep architecture remain to be clarified. Researchers speculate that many hormones and substances produced by metabolism may affect sleep. Therefore, the object of this review is to discuss the effects of exercise and cytokines on sleep, and the relation between these two sleep-regulating components, raising the hypothesis that the alterations in sleep promoted by exercise are mediated by cytokines, which, by increasing the nREM sleep phase, would stimulate the regenerating characteristics of sleep.     

Exercise-induced changes of the upper extremity in chronic stroke survivors

Problems with daily activities due to decreased aerobic capacity and decreased strength are common in people who survive a stroke. Implementation of exercise for the upper extremity is challenging because of weakness and other impairments that limit performance of exercise activities. Although maximal exercise testing protocols are difficult to administer, submaximal testing may be a safe and effective means for prescribing exercise. Research studies have demonstrated that people with stroke can improve aerobic capacity and upper extremity muscle strength with exercise intervention, although the number of randomized controlled trials is limited and this area requires further investigation.     

广东省老年人5 663名体质现状及体育行为调查

采集2000年国家及广东省国民体质监测报告中体质监测和问卷调查的数据，对广东省老年人的体质状况及体育锻炼行为进行统计分析。结果显示，广东省老年人各项指标整体变化趋势与全国一致，大多数指标均比全国同龄人群小(P < 0.05,0.01)；广东省老年人群对参加体育锻炼的意识较强，参加体育锻炼的人数达60.3%，无兴趣和家务繁重是不锻炼的主要原因。参加锻炼人群体育活动频率较高，时间也较长，主要锻炼方式为健身操和长走；主要锻炼场所为公园、空地、体育场馆。     

Growth Factors as Mediators of Exercise Actions on the Brain

Physical exercise has long been recognized as highly beneficial for brain and body health. The molecular mechanisms responsible for translation of exercise stimuli in the brain have claimed attention due to mounting evidence for the neuroprotective actions of the exercise and its positive effects in preventing both ageing and neurodegenerative disease. These molecular mediators are currently under investigation with new tools able to yield deep insights into the neurobiology of exercise. In the present work we focus on the evidence pertaining to the mediation of exercise effects by insulin-like growth factor 1 (IGF1), as recent reports suggest that this growth factor shows brain area-specific, temporal rank-sensitive, and behavioural task-dependent features in response to exercise.     

Muscle responses to exercise in health and disease

Exercise intolerance is a common presenting symptom. The physiology of exercise intolerance in illustrative neurologic diseases is reviewed. Roles for exercise testing are identified, particularly in the evaluation of metabolic myopathies. The potential benefits of low intensity aerobic exercise training are described.     

Influences of exercise and training on the circulating concentration of prolactin in humans

Physical activity has an impact on several endocrine functions. During exercise, certain endocrine adjustments are required to maintain the homeostasis. It is well known that, depending on the intensity and duration, exercise stimulates the release of the hormone prolactin (PRL). After the cessation of acute exercise, this effect persist and continues during the recovery period. Chronic exercise can affect the PRL basal concentration and/or the PRL response to acute exercise. The main functions of PRL are associated with the maintenance of homeostasis and processes of reproduction. A role for PRL also has been recognised as an important regulator of cellular proliferation. The present review examines the exercise-induced acute or adaptive responses of PRL secretion. It is also hypothesised that increased concentrations of PRL during exercise could play an important role for neuroplasticity as a result of involvement of the hormone in the neurogenesis in subventricular zone of the adult brain.     

Exercise alleviates Parkinsonism: clinical and laboratory evidence

The present review examines the putative benefits for individuals afflicted with Parkinsonism, whether in the clinical setting or in the animal laboratory, accruing from different exercise regimes. The tendency for patients with Parkinson's disease (PD) to express either normal or reduced exercise capacity appears regulated by factors such as fatigue, quality-of-life and disorder severity. The associations between physical exercise and risk for PD, the effects of exercise on idiopathic Parkinsonism and quality-of-life, the effects of exercise on animal laboratory models of Parkinsonism and dopamine (DA) loss following neurotoxic insults, and the effects of exercise on the DA precursor, L-Dopa, efficacy are examined. It would appear to be case that in view of the particular responsiveness of the dopaminergic neurons to exercise, the principle of 'use it or lose' may be of special applicability among PD patients.     

The protective effects of voluntary exercise against the behavioral consequences of uncontrollable stress persist despite an increase in anxiety following forced cessation of exercise

Humans who exercise are less likely to suffer from stress-related mood disorders. Similarly, rats allowed voluntary access to running wheels have constrained corticosterone responses to mild stressors and are protected against several behavioral consequences of uncontrollable stress which resemble symptoms of human anxiety and depression, including exaggerated fear and deficits in shuttle box escape learning. Although exercise conveys clear stress resistance, the duration of time the protective effects of exercise against the behavioral consequences of uncontrollable stress persist following exercise cessation is unknown. The current studies investigated (1) whether exercise-induced stress resistance extends to social avoidance, another anxiety-like behavior elicited by uncontrollable stressor exposure, and (2) the duration of time the protective effects of exercise persist following forced cessation of exercise. Six weeks of wheel running constrained the increase in corticosterone elicited by social exploration testing, and prevented the reduction in social exploration, exaggerated shock-elicited fear, and deficits in escape learning produced by uncontrollable stress. The protective effect of voluntary exercise against stress-induced interference with escape learning persisted for 15 days, but was lost by 25 days, following cessation of exercise. An anxiogenic effect, as revealed by a reduction in social exploration and an increase in fear behavior immerged as a function of time following cessation of exercise. Results demonstrate that the protective effect of voluntary exercise against the behavioral consequences of uncontrollable stress extends to include social avoidance, and can persist for several days following exercise cessation despite an increase in anxiety produced by forced cessation of exercise.     

Cognitive behavioural techniques reduce exercise anxiety and improve adherence to a resistance training program for people with anxiety-related disorders: A randomized controlled trial

Exercise is a cost-efficient alternative to other interventions for anxiety-related disorders (ARDs; e.g., psychotherapy, pharmaceutical) that is also associated with health benefits. Several exercise modalities, including resistance training (RT), have demonstrated efficacy at reducing symptoms of ARDs; however, there are challenges associated with effectively implementing such protocols, most notably, exercise avoidance or early discontinuation. Researchers have identified exercise anxiety as a contributor to exercise avoidance for people with ARDs. Exercise-based interventions for people with ARDs may need to include strategies for helping these individuals cope with exercise anxiety to facilitate long-term exercise engagement; however, research in this area is lacking. The primary purpose of this randomized controlled trial (RCT) was to examine the effects of combining cognitive behavioural techniques (CBT) with a RT program on changes in exercise anxiety, exercise frequency, disorder-specific anxiety symptoms, and physical activity for people with ARDs. A secondary purpose was to explore group differences in exercise motivation and exercise self-efficacy across time. A total of 59 physically inactive individuals with ARDs were randomized into either RT + CBT, RT, or waitlist (WL). Primary measures were assessed at baseline, weekly during the 4-week active phase, and at 1-week, 1-month, and 3-month follow-ups. Findings indicate both RT and RT + CBT can reduce exercise anxiety; however, the addition of CBT techniques may help facilitate improvements in exercise self-efficacy, reductions in disorder-specific anxiety, and increases in long-term exercise behaviour and vigorous physical activity. These techniques may be useful for researchers and clinicians alike in supporting individuals with ARDs interested in using exercise to cope with elevated anxiety.     

Myoglobin is a sensitive marker of increased muscle membrane vulnerability

Summary Changes in muscle proteins in serum after exercise were studied to evaluate the use of such proteins as indicators of increased muscle membrane vulnerability. Seventy-one women were asked to perform bicycle exercise for 45 min at a moderate load; four proteins (creatine kinase — CK, myoglobin — Mb, aldolase — Ald and pyruvate kinase — PK) were measured in serum up to 24 h after exercise. Twenty-one women were carriers of Duchenne's muscular dystrophy (DMD); these are known to show an elevated serum CK activity at rest, as well as an increased CK response after exercise. Fifty women without a family history of neuromuscular disease were tested to obtain normal values: they showed a small peak (18%) of CK activity 8h after exercise, and an even smaller peak of Mb (9%) 1h after exercise. The mean post-exercise increase for both CK and Mb in the 21 DMD carriers was significantly higher than in controls; the maximum of Mb, on average 70% of baseline levels, was reached 1h after exercise and was higher than that for CK (48%), which was reached 8 h after exercise. It is concluded that myoglobin levels after exercise are a good index of increased vulnerability of the muscle membrane.     

An Adjunct Exercise Program for Serious Mental Illness: Who Chooses to Participate and is it Feasible?

Despite evidence that exercise is beneficial for serious mental illness, it continues to be an under utilized adjunct treatment strategy. Thus, the aims of this study were to examine if self-selected or volunteer exercise programs are feasible in a structured outpatient program and who might choose to participate in such a program. Individuals with serious mental illness admitted to a partial hospital program were offered an adjunct exercise group or a control, psychoeducation group. The exercise group (N = 38) met three times a week for 50 min. Individuals who chose not to exercise (N = 28), attended a psychoeducational control group. Those who self-selected the exercise group tended to have a higher level of education, employment rate and to be Caucasian. The control group had more medical problems, a higher body mass index and alcohol intake. The groups did not differ on age, sex, or use of cigarettes and caffeine. The exercise group was regularly attended. Both groups improved equally on all outcomes symptom and psychological well-being outcomes. These data highlight that certain individuals with serious mental illness may be more likely to exercise based on demographic opposed to clinical features, or illness characteristics. Thus, adjunct exercise programs for individuals with serious mental illness seem to be feasible, but certain groups of individuals (i.e., ethnic minorities, unemployed) should be targeted for recruitment as they are less likely to volunteer for such adjunct exercise programs.     

A single 30 min treadmill exercise session is suitable for 'proof-of concept studies' in adult mdx mice: a comparison of the early consequences of two different treadmill protocols

The extent of muscle pathology in sedentary adult mdx mice is very low and treadmill exercise is often used to increase myofibre necrosis; however, the early events in dystrophic muscle and blood in response to treadmill exercise (leading to myofibre necrosis) are unknown. This study describes in detail two standardised protocols for the treadmill exercise of mdx mice and profiles changes in molecular and cellular events after a single 30 min treadmill session (Protocol A) or after 4 weeks of (twice weekly) treadmill exercise (Protocol B). Both treadmill protocols increased multiple markers of muscle damage. We conclude that a single 30 min treadmill exercise session is a sufficient and conveniently fast screening test and could be used in 'proof-of-concept' studies to evaluate the benefits of pre-clinical drugs in vivo. Myofibre necrosis, blood serum CK and oxidative stress (specifically the ratio of oxidised to reduced protein thiols) are reliable markers of muscle damage after exercise; many parameters demonstrated high biological variation including changes in mRNA levels for key inflammatory cytokines in muscle. The sampling (sacrifice and tissue collection) time after exercise for these parameters is critical. A more precise understanding of the changes in dystrophic muscle after exercise aims to identify biomarkers and new potential therapeutic drug targets for Duchenne Muscular Dystrophy.     

Exercise is brain food: The effects of physical activity on cognitive function

This commentary reviews selected biomedical and clinical research examining the relationship between physical exercise and cognitive function especially in youth with disability. Youth with physical disability may not benefit from the effects of exercise on cardiovascular fitness and brain health since they are less active than their non-disabled peers. In animal models, physical activity enhances memory and learning, promotes neurogenesis and protects the nervous system from injury and neurodegenerative disease. Neurotrophins, endogenous proteins that support brain plasticity likely mediate the beneficial effects of exercise on the brain. In clinical studies, exercise increases brain volume in areas implicated in executive processing, improves cognition in children with cerebral palsy and enhances phonemic skill in school children with reading difficulty. Studies examining the intensity of exercise required to optimize neurotrophins suggest that moderation is important. Sustained increases in neurotrophin levels occur with prolonged low intensity exercise, while higher intensity exercise, in a rat model of brain injury, elevates the stress hormone, corticosterone. Clearly, moderate physical activity is important for youth whose brains are highly plastic and perhaps even more critical for young people with physical disability.     

Antenatal depression: a rationale for studying exercise

Background: Major depressive disorder (MDD) in pregnancy or antenatal depression poses unique treatment challenges and has serious consequences for mothers, unborn babies, and families when untreated. This review presents current knowledge on exercise during pregnancy, antidepressant effects of exercise, and the rationale for the specific study of exercise for antenatal depression. Method: A systematic literature review was performed using English language articles published in Medline, PsycINFO, CINAHL, and the Cochrane Library from 1985 to January 2010. Results: There is a broad literature supporting the antidepressant effects of exercise, but a paucity of studies specifically for antenatal depression. A small number of observational studies have reported that regular physical activities improve self‐esteem and reduce symptoms of anxiety and depression during pregnancy. To date, there have not been randomized controlled studies of exercise for the treatment of MDD in pregnant women. Conclusions: Systematic studies are needed to assess exercise as a treatment alternative for MDD during pregnancy. In consideration of the benefits of exercise for the mother and baby, and the burden of depression, studies are needed to determine the role of exercise for pregnant women with depression. Depression and Anxiety 28:234–242,2011. © 2010 Wiley‐Liss, Inc.     

Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder

Aerobic exercise can acutely influence anxious and depressive mood in both clinical and nonclinical populations. However, there are no existing studies that have examined the acute effect of exercise on mood, anxiety, obsessions, and compulsions in patients with OCD. The primary aim of this study was to examine acute changes in these symptoms after engaging in single exercise sessions during a 12-week exercise intervention for 15 (53% female; mean age = 41.9 years) patients with OCD. Participants reported reductions in negative mood, anxiety, and OCD symptoms at the end of each exercise session relative to the beginning. Changes in the magnitude of the effect of exercise in reducing negative mood and anxiety remained fairly stable while levels of self-reported obsessions and compulsions decreased over the duration of the intervention. Results of this study point toward the promising effect of exercise for acute symptom reduction in patients with OCD.     

Physical exercise as an epigenetic modulator of brain plasticity and cognition

A large amount of evidence has demonstrated the power of exercise to support cognitive function, the effects of which can last for considerable time. An emerging line of scientific evidence indicates that the effects of exercise are longer lasting than previously thought up to the point to affect future generations. The action of exercise on epigenetic regulation of gene expression seem central to building an “epigenetic memory” to influence long-term brain function and behavior. In this review article, we discuss new developments in the epigenetic field connecting exercise with changes in cognitive function, including DNA methylation, histone modifications and microRNAs (miRNAs). The understanding of how exercise promotes long-term cognitive effects is crucial for directing the power of exercise to reduce the burden of neurological and psychiatric disorders.