Explore the vast range of titles available.

Outcomes of training are thought to be related to the amount of training (training dose). Although various approaches to locomotor training have been used to improve walking function in persons with spinal cord injury (SCI), little is known about the relationship between dose of locomotor training and walking outcomes. This secondary analysis aimed to identify the relationship between training dose and improvement in walking distance and speed associated with locomotor training in participants with chronic motor-incomplete spinal cord injury (MISCI). We compared the dose-response relationships associated with each of four different locomotor training approaches. Participants were randomized to either: treadmill-based training with manual assistance (TM = 17), treadmill-based training with stimulation (TS = 18), overground training with stimulation (OG = 15), and treadmill-based training with locomotor robotic device assistance (LR = 14). Subjects trained 5 days/week for 12 weeks, with a target of 60 training sessions. The distance-dose and time-dose were calculated based on the total distance and total time, respectively, participants engaged in walking over all sessions combined. Primary outcome measures included walking distance (traversed in 2 min) and walking speed (over 10 m). Only OG training showed a good correlation between distance-dose and change in walking distance and speed walked over ground (r = 0.61, p = 0.02; r = 0.62, p = 0.01). None of the treadmill-based training approaches were associated with significant correlations between training dose and improvement of functional walking outcome. The findings suggest that greater distance achieved over the course of OG training is associated with better walking outcomes in the studied population. Further investigation to identify the essential elements that determine outcomes would be valuable for guiding rehabilitation.

Virtual reality (VR) technology has emerged as a promising tool for studying and rehabilitating gait and balance impairments in people with Parkinson disease (PD) as it allows users to be engaged in an enriched and highly individualized complex environment. This Review examines the rationale and evidence for using VR in the assessment and rehabilitation of people with PD, makes recommendations for future research and discusses the use of VR in the clinic. In the assessment of people with PD, VR has been used to manipulate environments to enhance study of the behavioural and neural underpinnings of gait and balance, improving understanding of the motor–cognitive neural circuitry involved. Despite suggestions that VR can provide rehabilitation that is more effective and less labour intensive than non-VR rehabilitation, little evidence exists to date to support these claims. Nevertheless, much unrealized potential exists for the use of VR to provide personalized assessment and rehabilitation that optimizes motor learning in both the clinic and home environments and adapts to changes in individuals over time. Design of such systems will require collaboration between all stakeholders to maximize useability, engagement, safety and effectiveness.This Review examines the rationale for the use of virtual reality in research and rehabilitation of people with Parkinson disease. The authors provide a critical appraisal of the current state of the art, make recommendations for future research and outline clinical implications.

Background Increased physical exercise improves cognitive function and reduces pathology associated with Alzheimer’s disease (AD). However, the mechanisms underlying the beneficial effects of exercise in AD on the level of specific brain cell types remain poorly investigated. The involvement of astrocytes in AD pathology is widely described, but their exact role in exercise-mediated neuroprotection warrant further investigation. Here, we investigated the effect of long-term voluntary physical exercise on the modulation of the astrocyte state. Methods Male 5xFAD mice and their wild-type littermates had free access to a running wheel from 1.5 to 7 months of age. A battery of behavioral tests was used to assess the effects of voluntary exercise on cognition and learning. Neuronal loss, impairment in neurogenesis, beta-amyloid (Aβ) deposition, and inflammation were evaluated using a variety of histological and biochemical measurements. Sophisticated morphological analyses were performed to delineate the specific involvement of astrocytes in exercise-induced neuroprotection in the 5xFAD mice. Results Long-term voluntary physical exercise reversed cognitive impairment in 7-month-old 5xFAD mice without affecting neurogenesis, neuronal loss, Aβ plaque deposition, or microglia activation. Exercise increased glial fibrillary acid protein (GFAP) immunoreactivity and the number of GFAP-positive astrocytes in 5xFAD hippocampi. GFAP-positive astrocytes in hippocampi of the exercised 5xFAD mice displayed increases in the numbers of primary branches and in the soma area. In general, astrocytes distant from Aβ plaques were smaller in size and possessed simplified processes in comparison to plaque-associated GFAP-positive astrocytes. Morphological alterations of GFAP-positive astrocytes occurred concomitantly with increased astrocytic brain-derived neurotrophic factor (BDNF) and restoration of postsynaptic protein PSD-95. Conclusions Voluntary physical exercise modulates the reactive astrocyte state, which could be linked via astrocytic BDNF and PSD-95 to improved cognition in 5xFAD hippocampi. The molecular pathways involved in this modulation could potentially be targeted for benefit against AD.

Pulmonary exercise testing, including six-minute walk tests, exercise oximetry, and independent exercise assessments, are critical tools for managing chronic respiratory and cardiac conditions, evaluating treatment response, and determining long-term oxygen therapy needs. During the COVID-19 pandemic, testing was reduced to limit viral spread. This study aimed to evaluate post-pandemic trends of pulmonary exercise testing utilization in Ontario overall and across demographic groups. We conducted a population-based cohort study using Ontario administrative data between April 2015 and December 2023 to evaluate pulmonary exercise testing before, during, and after the COVID-19 pandemic. We used an Auto-Regressive Integrated Moving Average Model (ARIMA) model and incidence rate ratios to evaluate recovery trends. Subgroup analysis examined if trends were similar in different groups. During the study period, 505,902 tests were performed for 362,888 individuals. As of December 2023, testing rates were still 21% below pre-pandemic levels (IRR 0.79, 95%CI 0.70-0.89). Recovery was lower in males (IRR 0.76, 95%CI 0.66-0.86) and individuals living in lower socioeconomic status neighborhoods (IRR 0.71, 95%CI 0.58-0.86). Northern Ontario saw the most pronounced shortfall compared to other regions, with testing rates one-third of pre-pandemic levels (IRR 0.33, 95% CI 0.26-0.43). More than three years after the pandemic began, pulmonary exercise testing rates have yet to return to pre-pandemic levels, with certain groups disproportionately affected. This highlights a significant and ongoing disruption in diagnostic capacity and quality of care for people with respiratory and cardiac diseases.

Background Maintaining physical fitness (PF) is essential for preserving functional independence in later life. However, longitudinal evidence describing multidomain PF trends among Asian older adults remains limited. This study aimed to investigate temporal changes in PF among community-dwelling older adults in Taiwan and factors influencing these changes. Methods The longitudinal study cohort included 403 adults (age ≥ 65 years; mean age: 72.8 ± 0.4 years) who participated in a community health promotion program. Handgrip strength, 30-s arm curl, 30-s chair stand, single-leg stance, 8-foot up-and-go, 2-min step, 6-min walk, back scratch, and chair sit-and-reach tests were repeatedly conducted at three time points to assess key PF parameters. PF trends over time were analyzed using repeated measures analysis of variance. When significant main effects were detected, post hoc pairwise comparisons were performed using the least significant difference method. To examine the influence of covariates on PF trends, we used generalized linear mixed models, incorporating fixed effects for sex, age, height, weight, physical activity level, and measurement time, along with random intercepts to account for within-subject correlations and between-subject variability. Results Upper limb strength (handgrip strength and 30-s arm curl tests) improved and remained higher across assessments, whereas lower limb strength and balance (30-s chair stand and single-leg stance tests) improved initially but plateaued later. Agility (8-foot up-and-go test) remained unchanged, whereas flexibility (chair sit-and-reach and back scratch tests), aerobic endurance (2-min step test), and gait speed (6-min walk test) declined significantly (all p  < 0.05). Age and body weight were negatively associated with most PF parameters. Higher physical activity levels were associated with greater strength, endurance, and mobility (all p  < 0.05). Conclusion Distinct domain-specific PF trends were noted among Taiwanese community-dwelling older adults, with maintenance of strength and agility but progressive declines in endurance and flexibility. Sustained engagement in community-based, multicomponent exercise programs may mitigate age-related decline and support healthy aging in later life.

Although cardiopulmonary exercise (CPX) testing in patients with heart failure and reduced ejection fraction is well established, there are limited data on the value of CPX variables in patients with HF and preserved ejection fraction (HFpEF). We sought to determine the prognostic value of select CPX measures in patients with HFpEF. This was a retrospective analysis of patients with HFpEF (ejection fraction ≥ 50%) who performed a CPX test between 1997 and 2010. Selected CPX variables included peak oxygen uptake (VO2), percent predicted maximum oxygen uptake (ppMVO2), minute ventilation to carbon dioxide production slope (VE/VCO2 slope) and exercise oscillatory ventilation (EOV). Separate Cox regression analyses were performed to assess the relationship between each CPX variable and a composite outcome of all-cause mortality or cardiac transplant. We identified 173 HFpEF patients (45% women, 58% non-white, age 54 ± 14 years) with complete CPX data. During a median follow-up of 5.2 years, there were 42 deaths and 5 cardiac transplants. The 1-, 3-, and 5-year cumulative event-free survival was 96%, 90%, and 82%, respectively. Based on the Wald statistic from the Cox regression analyses adjusted for age, sex, and β-blockade therapy, ppMVO2 was the strongest predictor of the end point (Wald χ2 = 15.0, hazard ratio per 10%, P < .001), followed by peak VO2 (Wald χ2 = 11.8, P = .001). VE/VCO2 slope (Wald χ2= 0.4, P = .54) and EOV (Wald χ2 = 0.15, P = .70) had no significant association to the composite outcome. These data support the prognostic utility of peak VO2 and ppMVO2 in patients with HFpEF. Additional studies are needed to define optimal cut points to identify low- and high-risk patients.

Background While continuous exercise (CE) induces greater ventilation ( V ̇ E ) when compared to intermittent exercise (IE), little is known of the consequences on airway damage. Our aim was to investigate markers of epithelial cell damage – i.e. serum levels of CC16 and of the CC16/SP-D ratio - during and following a bout of CE and IE of matched work. Methods Sixteen healthy young adults performed a 30-min continuous (CE) and a 60-min intermittent exercise (IE; 1-min work: 1-min rest) on separate occasions in a random order. Intensity was set at 70% of their maximum work rate (WR max ). Heart rate (HR) and V ̇ E were measured throughout both tests. Blood samples were taken at rest, after the 10th min of the warm-up, at the end of both exercises, half way through IE (matched time but 50% work done for IE) as well as 30- and 60-min post-exercise. Lactate and CC16 and SP-D were determined. Results Mean V ̇ E was higher for CE compared to IE (85 ± 17 l.min − 1 vs 50 ± 8 l.min − 1 , respectively; P  < 0.001). Serum-based markers of epithelial cell damage remained unchanged during IE. Interaction of test × time was observed for SP-D ( P = 0.02 ), CC16 (μg.l − 1 ) ( P = 0.006 ) and CC16/SP-D ratio ( P = 0.03 ). Maximum delta CC16/SP-D was significantly correlated with mean V ̇ E sustained ( r  = 0.83, P  < 0.001) during CE but not during IE. Conclusion The 30-min CE performed at 70% WR max induced mild airway damage, while a time- or work-matched IE did not. The extent of the damage during CE was associated with the higher ventilation rate.

Background The Six-minute walk (6MW) and Timed-Up-and-Go (TUG) are short walk tests commonly used to evaluate functional recovery after total knee arthroplasty (TKA). However, little is known about walking capacity of TKA recipients over extended periods typical of everyday living and whether these short walk tests actually predict longer, more functional distances. Further, short walk tests only correlate moderately with patient-reported outcomes. The overarching aims of this study were to compare the performance of TKA recipients in an extended walk test to healthy age-matched controls and to determine the utility of this extended walk test as a research tool to evaluate longer term functional mobility in TKA recipients. Methods The mobility of 32 TKA recipients one year post-surgery and 43 healthy age-matched controls were assessed using the TUG, 6MW and 30-minute walk (30MW) tests. The latter test was repeated one week later. Self-reported function was measured using the WOMAC Index and a physical activity questionnaire. Results 30MW distance was significantly shorter amongst TKA recipients (mean 2108 m [95% CI 1837 to 2381 m]; Controls 3086 m [2981 to 3191 m], P < 0.001). Test-retest repeatability was high (ICC = 0.97, TKA; 0.96, Controls). Amongst TKA recipients, the 30MW distance correlated strongly with the shorter tests (6MW, r = 0.97, P < 0.001; TUG, r = −0.82, P < 0.001). Multiple regression modeling found 6MW distance to be the only significant predictor (P < 0.001) of 30MW distance, explaining 96% of the variability. The TUG test models were moderate predictors of WOMAC function (55%) and physical activity (36%) and were stronger predictors than 6MW and 30 MW tests. Conclusions Though TKA recipients are able to walk for 30 minutes one year post-surgery, their performance falls significantly short of age-matched norms. The 30MW test is strongly predicted by 6MW test performance, thus providing strong construct validity for the use of the 6MW test in the TKA population. Neither a short nor long walk test is a strong predictor of patient-reported function after TKA.

To identify temporal trends in the use of exercise treadmill testing (ETT) and cardiorespiratory fitness (CRF) estimated by ETT in metabolic equivalents (METs). We compiled an ETT database of all available treadmill tests—including those with concomitant stress echocardiography and nuclear perfusion imaging studies—performed at Duke University Hospital from January 1, 1970- December 31, 2012. Six different ramp protocols were used in these combined modalities. CRF at maximal exertion was estimated using established metrics. Eligible patients were required to have no missing data on maximal treadmill speed, grade, and protocol. The most commonly used ETT protocol was the Bruce (n = 28,877), followed by manual test (n = 7390). Since the 1980’s, the use of ETT for clinical purposes declined substantially; there was a decreased trend in utilization of 9.4% over the decades 1990–1999 and 2000–2009. When standard protocol (Bruce) was assessed in isolation, trends in CRF decreased progressively from 1970 to 2012 (mean METs (standard deviation): 11.7 (4.3) to 10.5 (3.5)). After adjusting for baseline comorbidities, the trend was reduced to a lesser degree. The use of ETT at our institution has declined over time, perhaps due to changes in clinical practice. In patients undergoing ETT using the standard Bruce protocol, CRF decreased progressively over the last five decades. Future studies are needed to clarify the etiology of the decrease in use of such a powerful predictor of clinical outcomes in our medical care environment.

Repeated or prolonged use of general anesthetics in pregnant women may disturb the neurodevelopment of infants. Compelling evidence indicates that maternal exercise during pregnancy has positive effects on the cognitive function of offspring. We previously confirmed the preventive potential of maternal treadmill training for cognitive deficits induced by in utero exposure to sevoflurane in rat pups. However, the underlying mechanism(s) needed further clarification. Thus, the aim of the present study was to investigate the effects of maternal exercise on the epigenetic regulation of genes linked to brain plasticity and function. Pregnant rats on gestational day 13 (GD 13) received 2 h of 3% sevoflurane or 30% oxygen daily on three consecutive days (GD 13–15). Pregnant rats in the exercise groups were forced to run on a treadmill for 60 min/day, 5 days/week, for a duration of 3 weeks. On postnatal day 0 (PND 0), the brains of rat pups were harvested for biochemical and histochemical studies. On PNDs 28–33, the learning and memory ability of rat pups was assessed using Morris water maze task. Maternal exercise ameliorated sevoflurane-induced decreases in p300 histone acetyltransferase (HAT) expression and inhibition of BDNF signaling. Maternal exercise improved performance in the Morris water maze task. However, these effects were reversed by p300 inhibitor. Our results indicated that maternal treadmill exercise during pregnancy can ameliorate cognitive dysfunction induced by prenatal sevoflurane exposure; p300 HAT-mediated BDNF signaling activation might contribute to the neuroprotective effects of maternal exercise.