Understanding the mechanisms of disease modifying effects of aerobic exercise in people with Alzheimer's disease.

Alzheimer's disease (AD) is a very disabling disease. Pathologically, it is characterized by the presence of amyloid plaques and neurofibrillary tangles in the brain that results in neurodegeneration. Its clinical manifestations include progressive memory impairment, language decline and difficulty in carrying out activities of daily living (ADL). The disease is managed using interventions such as pharmacological interventions and aerobic exercise. Use of aerobic exercise has shown some promises in reducing the risk of developing AD, and improving cognitive function and the ability to carry out both basic and instrumental ADL. Although, the mechanisms through which aerobic exercise improves AD are poorly understood, improvement in vascular function, brain glucose metabolism and cardiorespiratory fitness, increase in antioxidant capacity and haemoglobin level, amelioration of immune-related and inflammatory responses, modulation of concentration of circulating Neurotrophins and peptides and decrease in concentration of tau protein and cortisol level among others seem to be the possible mechanisms. Therefore, understanding these mechanisms is important to help characterize the dose and the nature of the aerobic exercise to be given. In addition, they may also help in finding ways to optimize other interventions such as the pharmacological interventions. However, more quality studies are needed to verify the mechanisms.

Combination of noninvasive brain stimulation and constraint-induced movement therapy in patients with stroke: a systematic review and meta-analysis.

INTRODUCTION: Constraint-induced movement therapy (CIMT) and noninvasive brain stimulation (NIBS) are used to counteract learned nonuse phenomenon and imbalance in interhemispheric inhibition following stroke. The aim of this study is to summarize the available evidence on the effects of combining NIBS with CIMT in patients with stroke. METHOD: PubMed, Embase, Web of Science (WoS), PEDro, OTSeeker, and CENTRAL were searched for randomized controlled trials comparing the use of NIBS+CIMT with sham NIBS+CIMT. Data on variables such as time since stroke and mean scores and standard deviations on outcomes assessed such as motor function were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risk of bias and methodological quality of the included studies. RESULTS: The results showed that both NIBS+CIMT and sham NIBS+CIMT improved all outcomes post-intervention and at follow-up. However, NIBS+CIMT is superior to sham NIBS+CIMT at improving level of motor impairment (SMD = 1.75, 95% CI = 0.49 to 3.01, P = 0.007) post-intervention and hand function (SMD = 1.21, 95% CI = 0.07 to 2.35, P = 0.04) at follow-up. CONCLUSIONS: The addition of NIBS to CIMT seems to provide additional benefits to the recovery of function following stroke.

Efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor function outcomes in patients with stroke: a systematic review and meta-analysis.

Background: Stroke disrupts the functions carried out by the brain such as the control of movement, sensation, and cognition. Disruption of movement control results in hemiparesis that affects the function of the diaphragm. Impaired function of the diaphragm can in turn affect many outcomes such as respiratory, cognitive, and motor function. The aim of this study is to carry out a systematic review and meta-analysis to determine the efficacy of diaphragmatic breathing exercise on respiratory, cognitive, and motor outcomes after stroke. Method: The study was registered in PROSPERO (CRD42023422293). PubMED, Embase, Web of Science (WoS), PEDro, Scopus, and CENTRAL databases were searched until September 2023. Only randomized controlled trials comparing diaphragmatic breathing exercise with a control were included. Information on the study authors, time since stroke, mean age, height, weight, sex, and the protocols of the experimental and control interventions including intensity, mean scores on the outcomes such as respiratory, cognitive, and motor functions were extracted. Cochrane risks of bias assessment tool and PEDro scale were used to assess the risks of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were used to summarize the results, which were then presented in tables, risk-of-bias graph, and forest plots. The meta-analysis was carried out on respiratory function [forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF)] and motor function (trunk impairment, and internal and external oblique muscles activity). Results: Six studies consisting of 151 participants were included. The results of the meta-analyses showed that diaphragmatic breathing exercise is only superior to the control at improving respiratory function, FVC (MD = 0.90, 95% CI = 0.76 to 1.04, P < 0.00001), FEV1 (MD = 0.32, 95% CI = 0.11 to 0.52, P = 0.002), and PEF (MD = 1.48, 95% CI = 1.15 to 1.81, P < 0.00001). Conclusion: There is limited evidence suggesting that diaphragmatic breathing exercise may help enhance respiratory function, which may help enhance recovery of function post stroke. Systematic Review Registration: PROSPERO, identifier CRD42023422293.

Testing the psychometric properties of the Chinese version of the Neurological Fatigue Index-Stroke.

OBJECTIVE: To test the psychometric properties of a Chinese version of the Neurological Fatigue Index-Stroke (C-NFI-Stroke) in stroke survivors. DESIGN: This was a validation study. Cross-cultural adaptation of the scale was conducted according to standard guidelines. Reliability, validity, responsiveness, and interpretability were measured. SETTING: Self-help groups and a community center. SUBJECTS: One hundred and twelve Chinese stroke survivors and 65 healthy Chinese older people living in the community. INTERVENTIONS: Not applicable. MAIN MEASURES: The C-NFI-Stroke, Fatigue Severity Scale, Mental Fatigue Scale, General Self-Efficacy Scale, and Geriatric Depression Scale were used. RESULTS: Cronbach's α coefficients were 0.69-0.88; the item-level agreement was 70.4%-88.9%; the weighted Kappa value was 0.47-0.79; and the intra-class correlation coefficients were 0.88-0.93. The C-NFI-Stroke had no ceiling and floor effects. It had good content validity and had two factors, "lack of energy" and "tiredness/weakness." The confirmatory factor analysis showed a good fit to the model. The C-NFI-Stroke significantly correlated with existing fatigue scales (rs = 0.55-0.63), self-efficacy (rs = -0.31 to -0.37), and depressive symptoms (rs = 0.53-0.60). The C-NFI-Stroke could discern differences between stroke survivors and healthy older people. CONCLUSIONS: The C-NFI-Stroke is a reliable and valid tool for clinical and research use on people who have been diagnosed with stroke for a year or more, although its factor structure differs from that of the original English version.

Transcutaneous electrical nerve stimulation improves walking capacity and reduces spasticity in stroke survivors: a systematic review and meta-analysis.

OBJECTIVE: To evaluate (1) the effectiveness of transcutaneous electrical nerve stimulation (TENS) at improving lower extremity motor recovery in stroke survivors and (2) the optimal stimulation parameters for TENS. REVIEW METHODS: A systematic search was conducted for studies published up to October 2017 using eight electronic databases (CINAHL, ClinicalTrials.gov, the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PEDro, PubMed and Web of Science). Randomized controlled trials that evaluated the effectiveness of the application of TENS at improving lower extremity motor recovery in stroke survivors were assessed for inclusion. Outcomes of interest included plantar flexor spasticity, muscle strength, walking capacity and balance. RESULTS: In all, 11 studies met the inclusion criteria which involved 439 stroke survivors. The meta-analysis showed that TENS improved walking capacity, as measured by either gait speed or the Timed Up and Go Test (Hedges' g = 0.392; 95% confidence interval (CI) = 0.178 to 0.606) compared to the placebo or no-treatment control groups. TENS also reduced paretic plantar flexor spasticity, as measured using the Modified Ashworth Scale and Composite Spasticity Scale (Hedges' g = -0.884; 95% CI = -1.140 to -0.625). The effect of TENS on walking capacity in studies involving 60 minutes per sessions was significant (Hedges' g = 0.468; 95% CI = 0.201-0.734) but not in study with shorter sessions (20 or 30 minutes) (Hedges' g = 0.254; 95% CI = -0.106-0.614). CONCLUSION: The results support the use of repeated applications of TENS as an adjunct therapy for improving walking capacity and reducing spasticity in stroke survivors.

Optimal frequency/time combination of whole body vibration training for developing physical performance of people with sarcopenia: a randomized controlled trial.

OBJECTIVE: To determine whether frequency and exposure time to whole body vibration influenced its effects on physical performance in seniors with sarcopenia. DESIGN: Randomized controlled trial Setting: A university sports training laboratory. SUBJECTS: Eighty community dwelling seniors with sarcopenia were recruited. INTERVENTIONS: Participants were randomly divided into 4 groups, namely, low-frequency (LG: 20Hz x 720s), medium-frequency (MG: 40Hz x 360s), high-frequency (HG: 60Hz x 240s) and control (CG: no extra training) for 12 weeks of whole body vibration training and 12 weeks of follow-up. MAIN MEASURES: Assessments were done at baseline, mid-intervention, post-intervention, mid-follow-up, and final follow-up for five-repetition sit-to-stand, 10-meter walking test with self-preferred speed and timed-up-and-go test. RESULTS: There was significant time × group interaction effect in timed-up-and-go test (F12, 304 = 3.333, effect size = 0.116, p < 0.001). Between-group differences in percentage change from baseline were significant between medium-frequency group and control group on all outcome variables after 12-week whole body vibration training (Five-repetition sit-to-stand test: 10.46 ± 2.28 (-16.12%), p = 0.008; 10-meter walking test: 1.05 ± 0.16 (11.18%), p = 0.04; Timed-up-and-go test: 11.32 ± 1.72 (-15.08%), p = 0.001). CONCLUSION: With the total number of vibrations controlled, the combination of 40Hz and 360s of whole body vibration has the best outcome on physical performance of people with sarcopenia.

An investigation of the psychometric properties of the Chinese (Cantonese) version of Subjective Index of Physical and Social Outcome (SIPSO).

OBJECTIVE: The objectives of this study were 1) to translate and make cultural adaptations to the English version of the SIPSO questionnaire to create a Chinese (Cantonese) version, 2) evaluate the internal consistency, test-retest reliability the C-SIPSO questionnaire, and 3) compare the SIPSO-C scores of stroke survivors with different demographic characteristics to establish the discriminant validity of the questionnaire Design: Translation of questionnaire, cross sectional study. SETTING: University-based clinical research laboratory. Subjects Community-dwelling chronic stroke survivors. INTERVENTIONS: Not applicable. MAIN MEASURES: Subjective Index of Physical and Social Outcome, Geriatric Depression Scale, 10-metre Walk test. RESULTS: Two bilingual professional translators translated the SIPSO questionnaire independently. An expert panel comprising five registered physiotherapists verified the content validity of the final version (C-SIPSO). C-SIPSO demonstrated good internal consistency (Cronbach's α = 0.83) and excellent test-retest reliability (ICC3,1 = 0.866) in ninety-two community dwelling chronic stroke survivors. Stroke survivors scored higher than 10 in the Geriatric Depression Scale ( U = 555.0, P < 0.001) and with the comfortable walking speed lower than 0.8ms-1 ( U = 726.5; P = 0.012) scored significantly lower on SIPSO-C. CONCLUSION: SIPSO-C is a reliable instrument that can be used to measure the level of community integration in community-dwelling stroke survivors in Hong Kong and southern China. Stroke survivors who were at high risk of minor depression and with limited community ambulation ability demonstrated a lower level of community integration as measured with SIPSO-C.

Optimal frequency/time combination of whole-body vibration training for improving muscle size and strength of people with age-related muscle loss (sarcopenia): A randomized controlled trial.

AIM: To determine the optimal combination of frequency and exposure time of a whole-body vibration (WBV) training program for improving muscle performance of older people with age-related muscle loss. METHODS: A total of 80 community-dwelling older adults with age-related muscle loss were randomly divided into four equal groups, namely, low-frequency long duration (20 Hz × 720 s), medium-frequency medium duration (40 Hz × 360 s), high-frequency short duration (60 Hz × 240 s) and control (no training) for 12-week WBV training and 12-week follow up. Assessments were carried out at baseline, mid-intervention, post-intervention, mid-follow up, follow up for the cross-sectional area of the vastus medialis, isometric knee extension strength at 90°, and isokinetic knee extension at 60°/s and 180°/s. RESULTS: There was a significant time × group interaction effect in isokinetic knee extension at 180°/s. Significant time effects were found in all muscle strength outcome variables. Group differences in percentage change from baseline were significant between medium-frequency medium duration and control on isokinetic knee extension at 180°/s and 60°/s. No changes were found in the cross-sectional area of the vastus medialis. CONCLUSIONS: With the total number of vibrations controlled, the combination of 40 Hz and 360 s of WBV exercise had the best outcome among all other combinations tested. The improvements in knee extension performance can be maintained for 12 weeks after cessation of WBV training. Geriatr Gerontol Int 2017; 17: 1412-1420.

Reliability and validity of the sideways step test and its correlation with motor function after stroke.

[Purpose] This study investigated the intra-rater, inter-rater and test-retest reliability of the sideways step test (SST), its correlation with other indicators of stroke-specific impairment, and the cut-off count best discriminating subjects with stroke from their healthy counterparts. [Subjects and Methods] Forty-three subjects with chronic stroke and 41 healthy subjects older than 50 years participated in this study. The SST was administered along with the Fugl-Meyer motor assessment for the lower extremities (FMA-LE), the five-times sit to stand (5TSTS) test, the Berg Balance Scale (BBS), the movement velocity (MVL) by the limits of stability (LOS) test, the ten-metre walk (10mW) test, the timed "Up and Go" (TUG) test and the Activities-specific Balance Confidence (ABC) scale. [Results] The SST showed good to excellent intra-rater, inter-rater and test-retest reliability. The SST counts correlated with 5TSTS times, 10mW times, TUG times, and the FMA-LE and BBS scores. SST counts of 11 for the paretic leg and 14 for the non-paretic leg were found to distinguish the healthy adults from subjects with stroke. [Conclusion] The sideways step test is a reliable clinical test, which correlates with the functional strength, gait speed, and functional balance of people with chronic stroke.