ABSTRACT
Ischemic stroke is a leading cause of death and disability. Tissue plasminogen activator is the only U.S. Food and Drug Administration approved thrombolytic therapy for ischemic stroke patients till date. However, its use is limited due to increased risk of bleeding and narrow therapeutic window. Most of the preclinically tested pharmacological agents failed to be translated to the clinic. This drives the need for alternative therapeutic approaches that not only provide enhanced neuroprotection, but also reduce the risk of stroke. Physical exercise is a sort of preconditioning that provides the body with brief ischemic episodes that can protect the body from subsequent severe ischemic attacks like stroke. Physical exercise is known to improve cardiovascular health. However, its role in providing neuroprotection in stroke is not clear. Clinical observational studies showed a correlation between regular physical exercise and reduced risk and severity of ischemic stroke and better outcomes after stroke. However, the underlying mechanisms through which prestroke exercise can reduce the stroke injury and improve the outcomes are not completely understood. The purpose of this review is to: demonstrate the impact of exercise on stroke outcomes and show the potential role of exercise in stroke prevention and recovery; uncover the underlying mechanisms through which exercise reduces the neurovascular injury and improves stroke outcomes aiming to develop novel therapeutic approaches.
ABSTRACT
Ischemic stroke is a leading cause of death and disability. Tissue plasminogen activator is the only U.S. Food and Drug Administration approved thrombolytic therapy for ischemic stroke patients till date. However, its use is limited due to increased risk of bleeding and narrow therapeutic window. Most of the preclinically tested pharmacological agents failed to be translated to the clinic. This drives the need for alternative therapeutic approaches that not only provide enhanced neuroprotection, but also reduce the risk of stroke. Physical exercise is a sort of preconditioning that provides the body with brief ischemic episodes that can protect the body from subsequent severe ischemic attacks like stroke. Physical exercise is known to improve cardiovascular health. However, its role in providing neuroprotection in stroke is not clear. Clinical observational studies showed a correlation between regular physical exercise and reduced risk and severity of ischemic stroke and better outcomes after stroke. However, the underlying mechanisms through which prestroke exercise can reduce the stroke injury and improve the outcomes are not completely understood. The purpose of this review is to: demonstrate the impact of exercise on stroke outcomes and show the potential role of exercise in stroke prevention and recovery; uncover the underlying mechanisms through which exercise reduces the neurovascular injury and improves stroke outcomes aiming to develop novel therapeutic approaches.
ABSTRACT
ImportanceGiven the rapid rise of COVID-19 cases in the U.S. during March 2020 there has been a severe burden on the health care systems and care providers in the country. The impact of the virus so far was higher on the population aged 65+. Hospitalizations were higher among those with underlying medical conditions, namely, hypertension, cardiovascular and lung diseases. Hence, to have an idea of the number of new COVID-19 infections among these high-risk populations that could occur in the short-term could assist promptly to the countrys health care system for immediate health care planning. These estimates may aid us in better understanding the potential volumes of patients requiring inpatient care. ObjectiveTo provide immediate and short-term model-based predictions of COVID-19 patients in the U.S. population aged 65+ during April-June, 2020, those with the prior medical conditions of hypertension, cardiovascular and lung diseases. Design, Setting, and ParticipantsWe developed age-structured dynamic mathematical combined with wavelet analysis to understand the number of new cases that may emerge in the U.S. population aged 65+. We have estimated the number of people aged 65+ who might have three underlying conditions mentioned and a possible number of hospitalizations among them due to COVID-19 if they get infected. We have used publicly available data sources for developing our framework and estimates. ResultsWe estimate that there are 13 million individuals aged 65+ who have one or a combination of three major prior medical conditions in the U.S. who need to be protected against COVID-19 to reduce a large number of hospitalizations and associated deaths. Hospitalizations of patients both with and without ICU-admissions with more prevalent underlying conditions could range between 31,633 (20,310 non-ICU hospitalizations and 11,323 ICU-admissions) to 94,666 (60,779 non-ICU hospitalizations and 33,866 ICU-admissions) cases during the same period. Under a rapid spread of the virus environment, these hospitalizations could be beyond 430,000 within the above three-month period. Conclusions and RelevanceCOVID-19 continues to dramatically and adversely affect the lives of people aged 65+ in the U.S. During the next three months which could result in thousands of hospitalizations if precautions against the virus spread are not implemented and adhered to.
