Moderate-intensity cardiovascular exercise performed before motor practice attenuates offline implicit motor learning in stroke survivors but not age-matched neurotypical adults.

The acute impact of cardiovascular exercise on implicit motor learning of stroke survivors is still unknown. We investigated the effects of cardiovascular exercise on implicit motor learning of mild-moderately impaired chronic stroke survivors and neurotypical adults. We addressed whether exercise priming effects are time-dependent (e.g., exercise before or after practice) in the encoding (acquisition) and recall (retention) phases. Forty-five stroke survivors and 45 age-matched neurotypical adults were randomized into three sub-groups: BEFORE (exercise, then motor practice), AFTER (motor practice, then exercise), and No-EX (motor practice alone). All sub-groups practiced a serial reaction time task (five repeated and two pseudorandom sequences per day) on three consecutive days, followed 7 days later by a retention test (one repeated sequence). Exercise was performed on a stationary bike, (one 20-min bout per day) at 50% to 70% heart rate reserve. Implicit motor learning was measured as a difference score (repeated-pseudorandom sequence response time) during practice (acquisition) and recall (delayed retention). Separate analyses were performed on the stroke and neurotypical groups using linear mixed-effects models (participant ID was a random effect). There was no exercise-induced benefit on implicit motor learning for any sub-group. However, exercise performed before practice impaired encoding in neurotypical adults and attenuated retention performance of stroke survivors. There is no benefit to implicit motor learning of moderately intense cardiovascular exercise for stroke survivors or age-matched neurotypical adults, regardless of timing. Practice under a high arousal state and exercise-induced fatigue may have attenuated offline learning in stroke survivors.

Does dual task merged in a mixed physical exercise protocol impact the mobility under dual task conditions in mild impaired stroke survivors? A feasibility, safety, randomized, and controlled pilot trial.

PURPOSE: To investigate the feasibility, safety, and effects of dual task (DT) in a mixed physical exercise protocol on mobility under DT in stroke survivors. MATERIALS AND METHODS: Twenty-six chronic mild-impaired stroke survivors (age 51.57 ± 12.55; men= 13, women= 13) were randomly assigned into Experimental Group participating in a 15-week mixed (aerobic and resistance exercises performing a cognitive DT condition simultaneously) physical exercise protocol (30 sessions, 2x/week, duration of 60-90 min), and Control Group engaged in the same protocol without DT. Feasibility and outcome measures were assessed before and after the intervention and in a 5-week follow-up. RESULTS: DT physical exercise protocol was viable and safe. This protocol also improved mobility and gait when performed under DT, which was not found in the control group. DT does not influence aerobic resistance, strength, and balance responsiveness. It does not present any improvement in cognition, self-efficacy for falls, and quality of life. CONCLUSION: The results indicate that mixed physical exercise under DT is feasible and safe for mild-impaired stroke survivors. Stroke survivors demonstrate more significant improvement in the mobility performance under DT when submitted to a DT mixed physical exercise protocol than the standard physical exercise intervention. TRIAL REGISTRATION: Brazilian clinical trials registry (RBR-4mvzz6); WHO trial record (U1111-1198-7173)IMPLICATIONS FOR REHABILITATIONDT training can be prescribed by using clear and precise parameters for stroke survivors.Physical Exercise without DT requirements did not improve mobility performing and cognitive tasks simultaneously in stroke survivors.Clinicians are encouraged to incorporate DT requirements into the exercise routines to enhance mobility under DT to mild-moderate stroke survivors.

Effects of the brain-damaged side after stroke on the learning of a balance task in a non-immersive virtual reality environment.

Background: Post-stroke survivors with right hemisphere injury have more impairments in postural control and balance. However, the impact of the hemisphere injured on the process of balance reacquisition has not been fully explored. We hypothesized that stroke survivors could learn balance tasks (H1), but right hemisphere damaged patients would show poor motor learning if compared to left hemisphere damaged patients (H2)Objective: To investigate whether the brain-damaged side after stroke affects the learning of a balance task. Methods: Three groups were recruited: twenty stroke survivors (ten left and ten right hemisphere damage) and twenty healthy volunteers. The participants practiced a balance task for thirty minutes, four consecutive days. The task was the Table Tilt game (NintendoTM Company), which induces balance demands with a progression of complexity. Motor performance was assessed at baseline, post-practice and after one week (retention test). Accuracy, errors, and complexity of the task achieved during the trial were assessedResults: Participants in all groups improved their performance (p < .001) and maintained it at the retention test. The control group showed better performance if compared to the right and left hemisphere damaged stroke survivors (p < .05). There was no difference between individuals with right and left hemisphere damaged, but the right hemisphere damaged patients demonstrated more errors at higher levels of complexityConclusion: Stroke survivors can learn balance tasks (H1), and the right hemisphere damaged patients demonstrate more errors than those with left hemisphere injury in higher complexity conditions (H2).

Cardiovascular exercise and motor learning in non-disabled individuals: A systematic review with a behavioral emphasis

Abstract Aim: This systematic review aimed to investigate the acute effects of cardiovascular exercise on motor learning of non-disabled individuals. Methods: Forty studies were identified through database searching (PsycINFO, CENTRAL, Google Scholar, Scielo, and PUBMED). The studies demonstrated heterogeneity and were classified into two categories to guide the analyses: (1) - studies that investigated the effects of exercise-induced fatigue during practice on the performance in the retention test; (2) - studies that verified the acute impact of the cardiovascular exercise in close temporal proximity to the task practice on motor learning. Results: The studies demonstrated that (1) - the practice under fatigue conditions did not impair motor learning and that (2) - the cardiovascular exercise bout performed in close temporal proximity to task practice enhances the motor learning processes. Conclusion: Cardiovascular exercise enhances motor learning processes; however, these priming effects are dependents on the timing between practice and exercise, type of exercise, and task characteristics.

The role of nocturnal sleep on the retention, adaptability, and relearning rate of a motor skill

Abstract Aim: The influence of sleep on the adaptability and relearning rate during learning of complex motor skills is still unknown, limiting the comprehension of the sleep role in motor memory consolidation. Thus, we aimed to investigate the nocturnal sleep influence on retention, adaptability, and relearning rate of the dart-throwing task. Methods: Sixty healthy adults were divided into two groups: SLEEP and WAKE. Both groups practiced an under-arm dart-throwing task. However, WAKE practiced in the morning and performed a retention phase in the evening, and SLEEP practiced in the evening and performed a retention phase in the morning of the next day. The practice and retention phases were separated by 12 h in both groups. There were analyses regarding retention (retention test), adaptability (delayed transfer test), and relearning rate (savings). Results: Both groups improved their performance across the acquisition phase and maintained it in the retention test. The groups did not demonstrate adaptability and did not demonstrate a significant difference in relearning rate. Conclusion: We conclude that nocturnal sleep did not modulate the consolidation of motor memories related to ballistic discrete motor skills.

The influence of maturational and morphological status pre- and post-menarche on the 100-m freestyle swimming performance of competitive teenagers

Abstract Aim: This study investigated whether the difference anthropometric of swimmers pre- and post-menarche influence the motor performance of a 100-m freestyle swimming test. Methods: Twenty-five female swimmers participated in this study, nine swimmers have not had menarche (age 11.7 ± 0.63), and sixteen swimmers already have had it (age 15.17 ± 1.36). Body composition (skinfold thickness), anthropometrical parameters (height and weight), and biological age (Tanner self-assessment) were measured. A univariate and multivariate linear regression analysis was run to assess which personal or anthropometric variable predicts the motor performance (time trial) on a 100-m freestyle swimming test in pre- and post-menarche participants. As well, it was performed a Pearson's correlation test between the maturational status on Tanner self-assessment and the motor performance. Results: Post-menarche swimmers demonstrated better motor performance than pre-menarche swimmers. Anthropometric characteristics did not predict the motor performance of pre-menarche swimmers. Age, height, and weight predicted 47.8% of the motor performance of post-menarche swimmers. The Tanner classification demonstrated a strong negative correlation with swimming performance. Conclusion: Anthropometric characteristics only impacted the motor performance of post-menarche swimmers.

Effects of the aerobic exercise on the learning of a sports motor skill

Abstract Aims: This study aimed to investigate the effects of aerobic exercise on the learning of a sports motor skill. Methods: Forty individuals were allocated to the Practice + Exercise Group (PEG) and for the Practice Group (PG). All participants practiced the underhand serve of the Volleyball; all of them were naïve regarding the motor task. The participants (age/ years: PEG: 21.7 ± 3.06, PG: 20.25 ± 1.95) performed a pre-test with five trials, an acquisition phase with fifteen blocks/ 5 trials each, a post-test with five trials, and a twenty-four hours retention test composted by five trials. The PEG was submitted to an aerobic exercise session immediately after the acquisition phase. It was provided by running around the sports court, for 20 minutes, with an intensity of 85% of the máx heart rate. The PG rest after the acquisition phase. The score and variable errors were the dependent variables. For the motor improvement during the practice, the Anova two way followed by Tukey posthoc test was run, for the retention test was used a T-test, an alpha of 5% was adopted. Results: All groups increased their score through the practice, with no significant difference between them. In the retention test, the PEG demonstrated better motor performance than PG; it may be related to improvements in the consolidation mechanisms induced by aerobic exercise. Conclusion: The aerobic exercise may be a neuromodulatory strategy to enhance the learning of complex motor skills.

Effects of extrinsic feedback on the motor learning after stroke

Aim: This study aims to investigate the effects of the type of extrinsic feedback provided equally in terms of timing and frequency of delivery on the motor learning after stroke. Methods: Twenty post-stroke individuals were distributed randomly into two groups according to the type of feedback provided: knowledge of performance experimental group (KPEG) and knowledge of results experimental group (KREG). Additionally, a control group (CG) was consisted of 20 healthy individuals age- and feedback-matched with the experimental groups. The task was a pointing skill performed in a virtual reality system. The acquisition phase consisted of 3 days/ 75 trials per day. Two retention tests (ret1 and ret2) were run after four days from the acquisition phase. Dependent variable measures were defined by motor performance and movement pattern. Results: The statistical analysis showed interaction effect F(3,108 = 49.13, p = 0.01) among KPEG and KREG. Based on the motor performance parameters (score) the KPEG improved performance significantly from pre to post (p = 0.001), and maintain it from pre to ret1 (p = 0.002), and from the pre to ret2 (p = 0.001). However, the KREG only showed a difference in motor performance from the pre to post (p = 0.003). Compared to the KREG, the KPEG showed improvement on the movement pattern based on the smoothness (p = 0.004), which suggests that the KPEG performed more corrections of movements in relation to the CG and KREG groups. Conclusion: These findings suggest that KP allowed better motor learning in individuals after stroke.(AU)

Motor learning in post stroke subjects: the effects of practice conditions on the temporal synchronization

Abstract AIMS The aim of this study was to investigate the effects of practice schedule on the motor learning of a synchronization timing task in post-stroke subjects. Subjects and METHODS Seventeen post-stroke individuals were assigned to the experimental group and for the control group were selected seventeen healthy individuals. At the acquisition phase, all participants performed 30 trials of a coincident timing task. Nine individuals from each group practiced constantly and eight from each group practiced randomly, with speed changes in the task. Subsequent phases included: 1) immediate transfer test and 2) long term transfer test after 3 days. Data were analyzed in relation to absolute, variable, and constant errors to assess the performance concerning accuracy, consistence, and direction of responses, respectively. RESULTS All groups increased their accuracy through the practice and were able to adapt it in different speeds. The stroke subjects were more variable in their motor responses. There was no effect of the practice schedule on motor learning, regardless the presence or absence of the neurologic damage. CONCLUSION Post stroke individuals were able to learn a synchronizing task and the capacity of adapt their performance after speed perturbation was preserved. There was no effect of the practice schedule on motor learning.

Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review.

OBJECTIVE: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated. METHOD: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials. RESULTS: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component. DISCUSSION: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.