Sham Exercise Research Articles

Efficacy of interferential current therapy plus exercise compared to sham interferential current plus exercise for pain relief in patients with knee osteoarthritis: A randomised controlled trial.

To compare the efficacy of interferential current (IFC) therapy combined with quadriceps strengthening exercise versus sham IFC plus exercise for pain relief and functional improvement in patients with knee osteoarthritis. Double-blind randomised controlled trial. Outpatient rehabilitation clinic. Knee osteoarthritis patients aged 50-85 years with a pain score ≥4/10. One hundred forty-four participants were randomly allocated into the study and control groups. The study group received 20 min of IFC therapy (carrier frequency: 4000 Hz, beat frequency: 100 Hz) five times per week for three weeks, while the control group received sham IFC following the same protocol, followed by 10 min of exercise in both groups. Outcome measures included Numeric Rating Scale for Pain, Western Ontario and McMaster Universities Index (WOMAC) score, gait speed, and EuroQol-Five Dimensions-Five Levels questionnaire assessed at baseline, Week 3, and Week 6. Adverse events and patient satisfaction were evaluated at Week 3. At Week 3, the study group demonstrated statistical improvement compared to the control group for Numeric Rating Scale for Pain, WOMAC Total, WOMAC Pain, and WOMAC Stiffness. The mean difference (95% confidence interval) between groups was 0.76 (0.21-1.30), 0.49 (0.03-0.95), 0.63 (0.13-1.13), and 0.62 (0.04-1.20), respectively. However, the mean differences between groups were below the Minimally Clinically Important Difference values for each outcome. Additionally, there were no significant differences between groups at Week 6 for any outcome measure. IFC had no effect on pain reduction and functional improvement in patients with mild to moderate knee osteoarthritis.

Tongue exercise ameliorates structural and functional upper airway deficits in a rodent model of hypoglossal motor neuron loss.

Tongue weakness and atrophy can lead to deficits in the vital functions of breathing and swallowing in patients with motor neuron diseases (MNDs; e.g., amyotrophic lateral sclerosis (ALS) and pseudobulbar palsy), often resulting in aspiration pneumonia, respiratory failure, and death. Available treatments for patients with MNDs are largely palliative; thus, there is a critical need for therapies targeting preservation of upper airway function and suggesting a role for tongue exercise in patients with MNDs. Here, we leveraged our inducible rodent model of hypoglossal (XII) motor neuron degeneration to investigate the effects of a strength endurance tongue exercise program on upper airway structure and function. Our model was created through intralingual injection of cholera toxin B conjugated to saporin (CTB-SAP) into the genioglossus muscle of the tongue to induce targeted death of XII motor neurons. Rats in this study were allocated to 4 experimental groups that received intralingual injection of either CTB-SAP or unconjugated CTB + SAP (i.e., control) +/- tongue exercise. Following tongue exercise exposure, we evaluated the effect on respiratory function (via plethysmography), macrostructure [via magnetic resonance imaging (MRI) of the upper airway and tongue], and ultrafine structure [via ex vivo magnetic resonance spectroscopy (MRS) of the tongue] with a focus on lipid profiles. Results showed that sham exercise-treated CTB-SAP rats have evidence of upper airway restriction (i.e., reduced airflow) and structural changes present in the upper airway (i.e., airway compression) when compared to CTB-SAP + exercise rats and control rats +/- tongue exercise, which was ameliorated with tongue exercise. Additionally, CTB-SAP + sham exercise rats have evidence of increased lipid expression in the tongue consistent with previously observed tongue hypertrophy when compared to CTB-SAP + exercise rats or control rats +/- tongue exercise. These findings provide further evidence that a strength endurance tongue exercise program may be a viable therapeutic treatment option in patients with XII motor neuron degeneration in MNDs such as ALS. Future directions will focus on investigating the underlying mechanism responsible for tongue exercise-induced plasticity in the hypoglossal-tongue axis, particularly inflammatory associated factors such as BDNF.

Effects of acupuncture on pain and function in patients with subacromial impingement syndrome: A randomized sham-controlled trial

BackgroundSubacromial impingement syndrome (SIS) is the most common cause of shoulder pain. Acupuncture is a traditional medicine that is effective on pain. This study aimed to evaluate the effect of acupuncture treatment on pain, function, range of motion (ROM) and quality of life compared to sham acupuncture in patients diagnosed with SIS. MethodsA randomized, prospective, double-blinded, sham-controlled trial was conducted. In acupuncture group 40 participants received acupuncture treatment plus exercise therapy while in control group 40 participants received sham acupuncture plus exercise therapy. Primary outcomes included pain-rest, activity and night pain. Secondary outcomes included function [Shoulder Pain and Disability Index (SPADI) and The Disabilities of the Arm, Shoulder and Hand Score (Quick DASH)], ROM, and quality of life [The Western Ontario Rotator Cuff Index (WORC)] in patients with SIS. ResultsBoth groups had significant improvements for pain-rest, activity night pain scores, SPADI, Quick DASH and WORC after treatment and at the first month follow-up. Significant improvements were recorded in the acupuncture group for all ROM after treatment and at the first month follow-up while in control group only in passive internal rotation. Acupuncture group had better improvements for Quick DASH, WORC and all ROM parameters after the treatment, as well as for all parameters except pain-night and passive flexion at the first month follow-up. ConclusionThis study suggest that acupuncture treatment is a safe, effective and non-invasive treatment option in patients with SIS. Trial registrationThe study protocol is registered at clinicaltrials.gov (NCT05794633).

Cognitive rehabilitation effects on grey matter volume and Go-NoGo activity in progressive multiple sclerosis: results from the CogEx trial

BackgroundResearch on cognitive rehabilitation (CR) and aerobic exercise (EX) to improve cognition in progressive multiple sclerosis (PMS) remains limited. CogEx trial investigated the effectiveness of CR and EX in PMS:...

Vocal and tongue exercise in early to mid-stage Parkinson disease using the Pink1-/- rat

Vocal and swallowing deficits are common in Parkinson disease (PD). Because these impairments are resistant to dopamine replacement therapies, vocal and lingual exercise are the primary treatment, but not all individuals respond to exercise and neural mechanisms of treatment response are unclear. To explore putative mechanisms, we used the progressive Pink1-/- rat model of early to mid-stage PD and employed vocal and lingual exercises at 6- and 10-months of age in male Pink1-/- and wild type (WT) rats. We hypothesized that vocal and lingual exercise would improve vocal and tongue use dynamics and increase serotonin (5HT) immunoreactivity in related brainstem nuclei. Rats were tested at baseline and after 8 weeks of exercise or sham exercise. At early-stage PD (6 months), vocal exercise resulted in increased call complexity, but did not change intensity, while at mid-stage (10 months), vocal exercise no longer influenced vocalization complexity. Lingual exercise increased tongue force generation and reduced relative optical density of 5HT in the hypoglossal nucleus at both time points. The effects of vocal and lingual exercise at these time points are less robust than in prodromal stages observed in previous work, suggesting that early exercise interventions may yield greater benefit. Future work targeting optimization of exercise at later time points may facilitate clinical translation.

The effects of lumbar self-sustained natural apophyseal glides on lumbar spine range of motion and hip muscle flexibility in asymptomatic college students: a crossover study

Background: Patients with low back pain (LBP) tend to have prolonged treatment periods, which increase the cost of medical care. Several studies have reported that lumbar spine range of motion (ROM) and hip muscle flexibility are factors in LBP. Sustained natural apophyseal glides (SNAGs) have reportedly improved the lumbar spine ROM and hip flexibility of LBP patients. Moreover, self- SNAGs can be performed by the patients themselves. Aim: This study aimed to evaluate the short-term effects of self-SNAGs on lumbar spine ROM compared to a repeated movement procedure in asymptomatic college students. Methods: A prospective crossover study was conducted on 14 asymptomatic male college students. The asymptomatic participants performed self-SNAGs or repeated movements (i.e., three sets per day, 6 times a day over 1 week), and the compliance rate for both exercises was recorded. The lumbar spine ROM (i.e., flexion, extension, lateral bending, and rotation) was measured using the back ROM instrument, and hip muscle flexibility was measured using the Thomas test, heel-buttock distance, finger-floor distance, and straight leg raise test (SLR). Measurements were taken before commencement, immediately after, and 1 week later. Results: Left lateral bending and left SLR were excluded from the between-group comparison (self- SNAG and sham) due to a carryover effect (P < 0.05). A comparison between the self-SNAG and sham groups displayed no significant differences in the lumbar spine ROM and hip muscle flexibility (P > 0.05). Conclusion: Our study revealed that lumbar self-SNAGs had no significant effect on lumbar spine ROM or hip muscle flexibility in the short term, suggesting that such movements should be avoided when stretching to prevent LBP. However, this study did not include subjects with limited lumbar spine ROM and hip muscle flexibility due to pain, warranting further validation in future studies. Relevance for Patients: The effects of lumbar self-SNAGs were similar to that of sham exercises in healthy individuals without joint ROM restrictions in the trunk or lower extremities due to LBP

Investigating the effects of aerobic exercise primed anodal transcranial direct current stimulation on γ‐aminobutyric acid concentrations in mild vascular cognitive impairment

AbstractBackgroundMild vascular cognitive impairment (mVCI) is characterized by minor deficits in cognition and memory due to underlying vascular pathology. Anodal transcranial direct current stimulation (atDCS), a non‐invasive neuromodulation technique, has been demonstrated to improve cognition. The effects of atDCS have been suggested to be mediated by γ‐aminobutyric acid (GABA)–a major inhibitory neurotransmitter associated with cerebral perfusion and oxygenation, and cognition and memory. However, previous studies have reported mixed results regarding changes in GABA concentrations following atDCS. Physical activity has been reported to increase cortical GABA levels, and in particular, aerobic exercise (AE) is associated with improved cognition in older adults. Preliminary data from an ongoing trial (EXPRESS‐V) was used to evaluate whether GABA concentration in the motor cortex was altered following AE and/or atDCS and whether this was associated with changes in global cognition in mVCI.MethodIn this double‐blind, randomized clinical trial, participants received one of four interventions for two weeks: AE and atDCS, AE and sham atDCS, exercise education and atDCS, or exercise education and sham atDCS. mVCI was determined based on a modified Gorelick criteria. At baseline and endpoint, GABA concentration in the motor cortex was measured using magnetic resonance spectroscopy and quantified with the Mescher‐Garwood point resolved spectroscopy pulse sequence, and global cognition was assessed using the Montreal Cognitive Assessment. Wilcoxon signed rank test was used to determine changes in GABA concentrations (ΔGABA). Spearman correlation was used to determine the association between ΔGABA and changes in global cognition (ΔMoCA).ResultTen participants have enrolled so far, with nine participants having completed the study (22.2% female, age = 66.4(9.8), years of education = 8.8(3.4), 55.6% White, baseline MoCA score = 22.8(3.1)). To date, ΔGABA was insignificant between baseline and endpoint (Z = 23.0, p = 0.953). However, a positive trend between ΔGABA and ΔMoCA was observed (ρ = 0.650, p = 0.058).ConclusionPreliminary results from nine participants showed a positive trend between ΔGABA and ΔMoCA. Since the trial is ongoing, with the target of recruiting 80 participants by 2024, analyses on unblinded data upon study completion will determine whether AE and atDCS leads to greater ΔGABA, and whether this is accompanied by greater ΔMoCA in mVCI.

Cognitive and Exercise Training Improves Intraindividual Variability in Cognitive Performance in Older Adults: Secondary Findings of A Randomized Controlled Trial

AbstractBackgroundIncreased intraindividual variability of cognitive performance is a marker of cognitive decline. Whether computerized cognitive training (CCT) and aerobic exercise counteracts cognitive decline by reducing intraindividual variability is unknown. We investigated the effects of CCT with or without aerobic exercise on reaction time intraindividual variability in older adults.MethodThis was a secondary analysis of an 8‐week randomized controlled trial. Older adults (aged 65‐85 years) were randomized to CCT alone (n = 41), CCT with aerobic exercise (n = 41), or an active control group (n = 42). The CCT group trained using the Fit Brains® platform 3×/week for 1 hour (plus 3×/week of home‐based training). The CCT with aerobic exercise group received 15 min of walking plus 45 min of Fit Brains® 3×/week (plus 3×/week of home‐based training). The control group received sham exercise and cognitive training (3×/week for 1 hour). We extracted reaction times from the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test (Flanker), and Pattern Comparison Processing Speed Test (PACPS). Intraindividual variability was measured as residual intraindividual standard deviation (residual ISD) of raw reaction time latencies. Residual ISD is an unbiased measure of variability that accounts for within and between participant source of variation that could influence reaction time latencies. We also calculated reaction time intraindividual SD (raw‐score ISD) and intraindividual coefficient of variation (ICV).ResultCompared with the control group, residual ISD improved in a processing speed task (PACPS) following CCT alone (mean difference [95% confidence interval]: ‐0.147 [‐0.230 to ‐0.065], p<0.001) and CCT with aerobic exercise (‐0.111 [‐0.195 to ‐0.027], p<0.01). Also, for processing speed, both CCT (‐0.173 [‐0.261 to ‐0.084], p<0.001) and CCT with aerobic exercise (‐0.122 [‐0.213 to ‐0.032], p<0.01) showed greater reduction in raw‐score ISD compared with controls, while only CCT reduced ICV for this task (‐0.108 [‐0.176 to ‐0.040], p<0.001). Inhibitory attention (Flanker) improved only after CCT with aerobic exercise (congruent = ‐0.128 [‐0.250 to ‐0.006], incongruent = ‐0.121 [‐0.237 to ‐0.005], both p<0.05).ConclusionA CCT program promoted cognitive health via reductions in intraindividual variability of cognitive performance and combining it with aerobic exercise resulted in broader benefits.

Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial.

This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.

Are manual therapies effective at reducing chronic tension headache frequency in adults?

MAYBE. Among patients with chronic tension headaches, manual therapies may reduce headache frequency more than sham manual therapy, usual care, or exercise treatments-by 1.5 to 4.2 headaches or days with headache per week (strength of recommendation, B; preponderance of evidence from primarily small, heterogeneous randomized controlled trials [RCTs]).

Cognitive rehabilitation and aerobic exercise for cognitive impairment in people with progressive multiple sclerosis (CogEx): a randomised, blinded, sham-controlled trial

Cognitive dysfunction in people with relapsing-remitting multiple sclerosis can improve with cognitive rehabilitation or exercise. Similar effects have not been clearly shown in people with progressive multiple sclerosis. We aimed to investigate the individual and synergistic effects of cognitive rehabilitation and exercise in patients with progressive multiple sclerosis. CogEx was a randomised, sham-controlled trial completed in 11 hospital clinics, universities, and rehabilitation centres in Belgium, Canada, Denmark, Italy, UK, and USA. Patients with progressive multiple sclerosis were eligible for inclusion if they were aged 25-65 years and had an Expanded Disability Status Scale (EDSS) score of less than 7. All had impaired processing speed defined as a performance of 1·282 SD or greater below normative data on the Symbol Digit modalities Tests (SDMT). Participants were randomly assigned (1:1:1:1), using an interactive web-response system accessed online from each centre, to cognitive rehabilitation plus exercise, cognitive rehabilitation plus sham exercise, exercise plus sham cognitive rehabilitation, or sham exercise plus sham cognitive rehabilitation. The study statistician created the randomisation sequence that was stratified by centre. Participants, outcome assessors, and investigators were blinded to group allocation. The study statistician was masked to treatment during analysis only. Interventions were conducted two times per week for 12 weeks: cognitive rehabilitation used an individualised, computer-based, incremental approach to improve processing speed; sham cognitive rehabilitation consisted of internet training provided individually; the exercise intervention involved individualised aerobic training using a recumbent arm-leg stepper; and the sham exercise involved stretching and balance tasks without inducing cardiovascular strain. The primary outcome measure was processing speed measured by SDMT at 12 weeks; least squares mean differences were compared between groups using linear mixed model in all participants who had a 12-week assessment. The trial is registered with ClinicalTrials.gov, NCT03679468, and is completed. Between Dec 14, 2018, and April 2, 2022, 311 people with progressive multiple sclerosis were enrolled and 284 (91%) completed the 12-week assessment (117/311 [38%] male and 194/311 [62%] female). The least squares mean group differences in SDMT at 12 weeks did not differ between groups (p=0·85). Compared with the sham cognitive rehabilitation and sham exercise group (n=67), differences were -1·30 (95% CI -3·75 to 1·16) for the cognitive rehabilitation plus exercise group (n=70); -2·78 (-5·23 to -0·33) for the sham cognitive rehabilitation plus exercise group (n=71); and -0·71 (-3·11 to 1·70) for the cognitive rehabilitation plus sham exercise group (n=76). 11 adverse events possibly related to the interventions occurred, six in the exercise plus sham cognitive rehabilitation group (pain, dizziness, and falls), two in the cognitive rehabilitation plus sham exercise group (headache and pain), two in the cognitive rehabilitation and exercise group (increased fatigue and pain), and one in the dual sham group (fall). Combined cognitive rehabilitation plus exercise does not seem to improve processing speed in people with progressive multiple sclerosis. However, our sham interventions were not inactive. Studies comparing interventions with a non-intervention group are needed to investigate whether clinically meaningful improvements in processing speed might be attainable in people with progressive multiple sclerosis. MS Canada.

Exertional heart stroke causes long-term obesity and cardiac hypertrophy in mice

Exertional heat stroke (EHS) is a life-threatening illness that can lead to short- and long-term adverse health outcomes. Several human epidemiology studies have shown that heat stroke exposure is highly associated with the development of cardiovascular disease later in life. However, whether EHS causes heart disease or individuals with predispositions to heart disease are more susceptible to EHS is unknown. Previously, our laboratory demonstrated metabolic abnormalities in the myocardium of mice, two weeks after EHS, characterized by lipid accumulation. In this study, we hypothesized that EHS exposure in mice leads to long-term susceptibilities to cardiovascular disease that is accelerated by co-exposure to a Western diet. METHODS: Sixty-four male (n=32) and female (n=32) C57BL/6 mice were exposed to either EHS (forced wheel running in 34.5°C for males and 37.5°C for females) or sham exercise controls (EXC, forced wheel running in ~22.5°C). Fourteen days later, mice were placed on either a Western diet (WD) or a standard diet (SD) and then followed for 9 additional weeks. At week 12, post interventions (EHS or EXC), animals were euthanized and samples collected for analysis. RESULTS: Male mice exposed to EHS with either WD ( P = 0.0001) or SD ( P = 0.0001) gained more body mass over the 9-week diet period compared to diet matched EXC controls. Also, regardless of diet, male mice exposed to EHS consumed more food compared to matched EXC (WD: P < 0.005 and SD: P < 0.04). However, only female mice exposed to EHS with WD gained more body mass compared to female EXC mice with WD ( P < 0.04). At the end of the study, and regardless of diet, male mice exposed to EHS showed enlarged hearts in terms of absolute mass (WD: P=0.0241, SD: P=0.0069) and relative mass/tibia length (WD: P=0.013, SD P=0.03). On the other hand, EHS female mice exposed to WD showed enlarged heart mass compared to EHS on SD ( P=0.0005). CONCLUSIONS: These results demonstrate that EHS exposure in mice leads to a long-term metabolic disorder characterized by greatly accelerated weight gain, greater appetite and cardiac hypertrophy. Effects were more evident and consistent in males. Such a response is typical of early stages of metabolic syndrome and would likely contribute to eventual cardiac disease. Therefore, the data is consistent with EHS exposure being a risk factor for long term heart disease. U.S. Army Grant BA180078 and from King Saud University, Saudi Arabia This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Dry needling in a multimodal rehabilitation protocol following rotator cuff repair surgery: study protocol for a double-blinded randomized sham-controlled trial

BackgroundRotator cuff tear (RCT) is one of the main causes of shoulder pain and dysfunction. Rotator cuff repair (RCR) is a common surgical procedure for the management of RCTs. Presence of myofascial trigger points (MTrP) as a result of surgical procedure can aggravate postoperative shoulder pain. The purpose of this protocol is to describe a randomized controlled trial design to evaluate the effect of implementing 4 sessions of myofascial trigger point dry needling (MTrP-DN) within a multimodal rehabilitation protocol following RCR surgery.MethodsForty-six participants aged 40–75 will be recruited having postoperative shoulder pain after RCR and meeting the inclusion criteria. Participants will be randomly divided into 2 groups: One group will undergo MTrP-DN, manual therapy, exercise therapy and electrotherapy and the other will receive sham dry needling (S-DN), manual therapy, exercise therapy and electrotherapy. This protocol will cover 4 weeks of intervention. The primary outcome measure will be the Numeric Pain Rating Scale (NPRS) for pain. Secondary outcome measures will be Shoulder Pain and Disability Index (SPDI), range of motion (ROM), strength and adverse events.DiscussionThis is the first study to investigate the use of 4 sessions of MTrP-DN in combination with a multimodal rehabilitation protocol for postoperative shoulder pain, restriction, weakness and dysfunction following RCR. The results of this study may help to determine the effect of MTrP-DN on various outcomes after RCR surgery.Trial registrationThis trial was registered at the (https://www.irct.ir), (IRCT20211005052677N1) on 19/2/2022.

Study protocol for the BRAIN Training Trial: a randomised controlled trial of Balance, Resistance, And INterval training on cognitive function in older adults with mild cognitive impairment

IntroductionEpidemiological evidence suggests that both poor cardiovascular fitness and low muscle mass or strength markedly increase the rate of cognitive decline and incident dementia in older adults. Results from exercise...

Neuromotor deficits and altered physiological responses to repeated exertional heat stroke exposures in mice.

Exertional heat stroke (EHS) is a life-threatening illness that can lead to negative health outcomes. Using a "severe" preclinical mouse model of EHS, we tested the hypotheses that one EHS exposure results in altered susceptibility to a subsequent EHS and reduced neuromotor performance. Female C57BL/6 mice underwent two protocols, 2 wk apart, either an EHS trial (EHS) or a sham exercise control trial (EXC). For EHS, mice ran in a forced running wheel at 37.5°C/40% relative humidity until loss of consciousness, followed by a slow cooling protocol (2 h recovery at 37.5°C). EXC mice exercised equally but in ∼22°C. Mice were randomized into three groups: 1) EXC-EXC (two consecutive EXC, n = 6, 2) EHS-EXC (EHS followed by EXC, n = 5), and 3) EHS-EHS (repeated EHS, n = 9). Mice underwent noninvasive neuromotor and behavioral tests during recovery and isolated soleus force measurements at the end of recovery. At the first EHS, mice reached average peak core temperatures (Tc,max) of 42.4°C, (46% mortality). On the second EHS, average Tc,max was reduced by ∼0.7°C (P < 0.05; mortality 18%). After the first EHS, both EHS-EX and EHS-EHS showed significant reductions in maximum strength (24 h and 1 wk post). After the second EHS, strength, horizontal rotation, hindlimb tone, suspended hindlimb splay, trunk curl, and provoked biting continued to decline in the EHS-EHS group. In conclusion, exposure to a second EHS after 2 wk leads to increased exercise times in the heat, symptom limitation at a lower Tc,max, and greater deficits in neuromotor and behavioral function during recovery.

Interventions for improving mobility after hip fracture surgery in adults.

Interventions for improving mobility after hip fracture surgery in adults.

The Efficacy of Exercise Training for Cutaneous Microvascular Reactivity in the Foot in People with Diabetes and Obesity: Secondary Analyses from a Randomized Controlled Trial.

It is unclear if cutaneous microvascular dysfunction associated with diabetes and obesity can be ameliorated with exercise. We investigated the effect of 12-weeks of exercise training on cutaneous microvascular reactivity in the foot. Thirty-three inactive adults with type 2 diabetes and obesity (55% male, 56.1 ± 7.9 years, BMI: 35.8 ± 5, diabetes duration: 7.9 ± 6.3 years) were randomly allocated to 12-weeks of either (i) moderate-intensity continuous training [50–60% peak oxygen consumption (VO2peak), 30–45 min, 3 d/week], (ii) low-volume high-intensity interval training (90% VO2peak, 1–4 min, 3 d/week) or (iii) sham exercise placebo. Post-occlusive reactive hyperaemia at the hallux was determined by laser-Doppler fluxmetry. Though time to peak flux post-occlusion almost halved following moderate intensity exercise, no outcome measure reached statistical significance (p > 0.05). These secondary findings from a randomised controlled trial are the first data reporting the effect of exercise interventions on cutaneous microvascular reactivity in the foot in people with diabetes. A period of 12 weeks of moderate-intensity or low-volume high-intensity exercise may not be enough to elicit functional improvements in foot microvascular reactivity in adults with type 2 diabetes and obesity. Larger, sufficiently powered, prospective studies are necessary to determine if additional weight loss and/or higher exercise volume is required.

A Strength Endurance Exercise Paradigm Mitigates Deficits in Hypoglossal-Tongue Axis Function, Strength, and Structure in a Rodent Model of Hypoglossal Motor Neuron Degeneration.

The tongue plays a crucial role in the swallowing process, and impairment can lead to dysphagia, particularly in motor neuron diseases (MNDs) resulting in hypoglossal-tongue axis degeneration (e.g., amyotrophic lateral sclerosis and progressive bulbar palsy). This study utilized our previously established inducible rodent model of dysphagia due to targeted degeneration of the hypoglossal-tongue axis. This model was created by injecting cholera toxin B conjugated to saporin (CTB-SAP) into the genioglossus muscle of the tongue base for retrograde transport to the hypoglossal (XII) nucleus via the hypoglossal nerve, which provides the sole motor control of the tongue. Our goal was to investigate the effect of high-repetition/low-resistance tongue exercise on tongue function, strength, and structure in four groups of male rats: (1) control + sham exercise (n = 13); (2) control + exercise (n = 10); (3) CTB-SAP + sham exercise (n = 13); and (4) CTB-SAP + exercise (n = 12). For each group, a custom spout with adjustable lick force requirement for fluid access was placed in the home cage overnight on days 4 and 6 post-tongue injection. For the two sham exercise groups, the lick force requirement was negligible. For the two exercise groups, the lick force requirement was set to ∼40% greater than the maximum voluntary lick force for individual rats. Following exercise exposure, we evaluated the effect on hypoglossal-tongue axis function (via videofluoroscopy), strength (via force-lickometer), and structure [via Magnetic Resonance Imaging (MRI) of the brainstem and tongue in a subset of rats]. Results showed that sham-exercised CTB-SAP rats had significant deficits in lick rate, swallow timing, and lick force. In exercised CTB-SAP rats, lick rate and lick force were preserved; however, swallow timing deficits persisted. MRI revealed corresponding degenerative changes in the hypoglossal-tongue axis that were mitigated by tongue exercise. These collective findings suggest that high-repetition/low-resistance tongue exercise in our model is a safe and effective treatment to prevent/diminish signs of hypoglossal-tongue axis degeneration. The next step is to leverage our rat model to optimize exercise dosing parameters and investigate corresponding treatment mechanisms of action for future translation to MND clinical trials.

Interventions for preventing falls in Parkinson's disease.

Interventions for preventing falls in Parkinson's disease.

Effect of semi-recumbent vibration exercise on muscle outcomes in older adults: a pilot randomized controlled clinical trial

BackgroundMany older adults with physical limitations living in residential care apartments are unable to exercise in a standing position and are at risk for declining in muscle function leading to falls and injury. Novel approaches to achieve exercise benefits are needed. The purpose of this study was to test the effect of semi-recumbent vibration exercise on muscle outcomes in older adults living in residential care apartment complexes (RCACs).MethodsA randomized, crossover design was used to examine the effect of semi-recumbent vibration exercise on muscle function and mass among 32 RCAC residents (mean age 87.5 years) with physical limitations. Participants received a randomized sequence of two study conditions: sham or vibration for 8 weeks each separated by a 4-week washout. Before and after the 8 weeks of vibration treatment and sham treatment, muscle mechanography was used to assess muscle function including jump power, weight-corrected jump power, and jump height. Short physical performance battery (SPPB) and handgrip strength were also used to measure muscle function. Bioelectrical impedance spectroscopy was used to estimate skeletal muscle mass. The effect of the vibration treatment on muscle outcomes was analyzed through mixed effects linear regression models.ResultsVibration exercise leads to better jump height (p < .05) compared to sham exercise but also poorer chair rise performance (p = 0.012). Other muscle functions tests and muscle mass parameters showed non-significant changes.ConclusionThis small pilot study showed no conclusive results on the effect of semi-recumbent vibration exercise on muscle function and mass in older adults living in RCAC. However, the promising signals of improved jump performance could be used to power larger studies of longer duration with various vibration doses to determine the benefit of vibration exercise in this physically impaired, high-risk population with few exercise capabilities.Trial registrationThe study is registered at clinicaltrials.gov (NCT02533063; date of first registration 26/08/2015).