Serum concentrations of ketones increase after hand-ergometer exercise in persons with cervical spinal cord injuries: a preliminary prospective study.

STUDY DESIGN: Experimental study. OBJECTIVES: To compare lipid profiles during moderate-intensity exercise between persons with cervical spinal cord injuries (SCIC) and able-bodied controls (AB). SETTING: Wakayama Medical University, Japan. METHODS: Six participants with SCIC and six AB performed 30-min arm-crank exercise at 50% VO2peak. Blood samples were collected before (PRE), immediately (POST), and 60 min after exercise (REC). Concentrations of serum free fatty acids ([FFA]s), total ketone bodies ([tKB]s), acetoacetic acid ([AcAc]s), insulin ([Ins]s), and plasma catecholamines and glucose ([Glc]p) were assessed. RESULTS: Catecholamine concentrations in SCIC were lower than AB throughout the experiment (P < 0.001) and remained unchanged, while increased at POST in AB (P < 0.01). [FFA]s remained unchanged in both groups with no differences between groups. [tKB]s in SCIC tended to increase at REC from PRE (P = 0.043), while remaining unchanged in AB (P > 0.42). [AcAc]s in SCIC increased at REC from PRE and POST (P < 0.01) while remaining unchanged in AB (interactions of Group × Time P = 0.014). [Glc]p and [Ins]s were comparable between the groups throughout the study. CONCLUSION: Serum ketone bodies in SCIC increased after exercise while remaining unchanged in AB, suggesting that suppressed uptakes of serum ketone bodies from blood to the muscles in SCIC would partially contribute the increased serum ketones.

Dose-response Rehabilitation Organized By Pror In Out-patients With Chronic Cerebrovascular Disorder: A single-center retrospective cohort study.

PURPOSE: We aimed to investigate whether out-patient rehabilitation with the same concept as physiatrist and registered therapist operating rehabilitation (PROr) would improve activities of daily living in out-patients with chronic cerebrovascular disorder and whether the improvements were related to the frequency and/or time of therapy. METHODS: Out-patients with chronic cerebrovascular disorder, who visited a clinic affiliated with a university hospital for at least a month between April 2010-September 2020, were retrospectively selected. Changes in the functional independence measure (FIM) from the first visit to the 12th month were calculated. Patients were stratified into two subgroups: improved and non-improved groups. The frequency and time of physical and occupational therapies and total rehabilitation were compared between the groups. RESULTS: Initially, 174 patients were selected and 125 were excluded based on the exclusion criteria. Three patients terminated rehabilitation because of improvements. In 18 of 49 patients, FIM improved at the 12th month by 4.9 [3.1-6.8] (mean [95% CI]). The frequency was ∼2 times/week with no differences between the groups. Physical therapy time/day was higher in the improved group (74.7 [66.7-82.7] min) than the non-improved group (50.7 [44.3-57.0] min; P<0. 001). The total rehabilitation time/day was 121.9 [107.8-136.0] min in the improved group, which was higher than the non-improved group: 97.9 [87.7-107.9] (P=0.001). CONCLUSIONS: Approximately 40% of the patients displayed improved FIM even during the chronic phase, and the improved out-patients took PROr for at least 108 min/day and twice a week. A longer rehabilitation time would be reinforced by patients' motivation.

Noninvasive positive pressure ventilation enhances the effects of aerobic training on cardiopulmonary function.

PURPOSE: The purpose of this study was to determine the effect of aerobic training under noninvasive positive pressure ventilation (NPPV) on maximal oxygen uptake ([Formula: see text]). METHODS: Ten healthy young male volunteers participated in the study. Before the training, stroke volume (SV) and cardiac output (CO) were measured in all subjects under 0, 4, 8, and 12 cmH2O NPPV at rest. Then, the subjects exercised on a cycle ergometer at 60% of pre-training [Formula: see text] for 30 min daily for 5 consecutive days with/without NPPV. The 5-day exercise protocol was repeated after a three-week washout period without/with NPPV. The primary endpoint was changes in [Formula: see text]. The secondary endpoints were changes in SV, CO, maximum heart rate (HRmax), maximum respiratory rate (RRmax), maximum expiratory minute volume (VEmax) and the percent change in plasma volume (PV). RESULTS: NPPV at 12 cmH2O significantly reduced SV and CO at rest. [Formula: see text] significantly increased after 5 days training with and without NPPV, but the magnitude of increase in [Formula: see text] after training under 12 cmH2O NPPV was significantly higher than after training without NPPV. VEmax significantly increased after training under NPPV, but not after training without NPPV. HRmax and RRmax did not change during training irrespective of NPPV. The percent change in PV was similar between training with and without NPPV. The 5-day training program with NPPV resulted in greater improvement in [Formula: see text] than without NPPV. CONCLUSIONS: Aerobic training under NPPV has add-on effects on [Formula: see text] and exercise-related health benefits in healthy young men.

Aerobic Exercise Combined With Noninvasive Positive Pressure Ventilation Increases Serum Brain-Derived Neurotrophic Factor in Healthy Males.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) has been implicated in enhancing neuronal health. Exercise and noninvasive positive-pressure ventilation (NPPV) are known to independently alter BDNF levels in patients with depression, dementia, type 2 diabetes, chronic obstructive pulmonary disease, and obstructive sleep apnea syndrome. However, the combined effects of exercise and NPPV on serum BDNF in normal subjects are unknown. OBJECTIVE: To determine the effects of the combination of acute aerobic exercise under NPPV on serum BDNF in normal adults. DESIGN: Cross-over design study. SETTING: Wakayama Medical University. PARTICIPANTS: Ten healthy young men. INTERVENTION: The subjects exercised on a cycle ergometer at 60% of pretraining maximal oxygen uptake (V.O2max) for 30 minutes daily for 5 consecutive days with or without NPPV (12 cmH2O). The 5-day exercise protocol was repeated after a 3-week washout period with or without NPPV. MAIN OUTCOME MEASUREMENTS: Serum BDNF, plasma cortisol, and platelet, lymphocyte, and monocyte counts were measured at 24 hours before the first day exercise with or without NPPV and 24 hour after last day exercise with or without NPPV at resting condition. Measurements were also made on the first day exercise; serum BDNF level was measured immediately before and immediately after exercise, as well as at 1, 2, and 3 hours after exercise with or without NPPV. RESULTS: The 5-day exercise protocol significantly (P < .05) increased serum BDNF when combined with NPPV, but not without NPPV, and did not change plasma cortisol level, platelet, or lymphocyte counts, with or without NPPV. The 5-day exercise protocol also significantly (P < .05) decreased monocyte count without NPPV, but not with NPPV, relative to baseline. Changes noticed immediately after the first day of exercise included significant (P < .05) increase in serum BDNF compared with immediately before the exercise, with or without NPPV. CONCLUSIONS: The results indicated that a 5-day exercise protocol combined with NPPV increased serum BDNF, suggesting that NPPV synergistically enhances the effect of aerobic exercise on serum BDNF level. LEVEL OF EVIDENCE: II.