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Aerobic Exercise: Benefits Following Brain Injury

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Following a traumatic brain injury (TBI), aerobic exercise promotes cardiovascular fitness, cognitive recovery, and reductions in mood disorders.1

Cardiorespiratory Fitness

Physical inactivity, increased sedentary behavior, and greater perceived fatigue are commonly reported following TBI.2 Chin et al3 enrolled a small sample of adults with nonpenetrating TBI in a 12-week aerobic training program to assess the impact of vigorous exercise on cardiorespiratory fitness. Participants (N=10) completed a cardiopulmonary exercise test measuring gas exchange during exercise (ie, oxygen consumption and carbon dioxide output), and completed the Fatigue Severity Scale (FSS) at baseline and following the 12-week exercise training. Participants engaged in supervised exercise training on a treadmill for 30 minutes, 3 times per week at a vigorous intensity, maintaining 70% to 80% of heart rate reserve. At the training completion, statistically significant changes were noted in peak oxygen consumption, time to fatigue, and peak work rate. Participants also reported considerably lower fatigue as evidenced by statistically significant decreases in FSS composite scores.

Cognition

Exercise may promote cognitive recovery via mechanisms such as increasing neural repair and neuroplasticity, modulating neurotransmitter systems, and decreasing neuroinflammation.1In a systematic review of controlled clinical trials and randomized controlled trails with adults with neurologic disorders, McDowell et al reported that aerobic exercise improved cognition, particularly attention and cognitive flexibility in adults with TBI.4

Chin et al enrolled a small volunteer sample of ambulatory adults with chronic, nonpenetrating TBI into a 12-week aerobic exercise training program to determine the effect of exercise on cognitive performance.5 Participants (N = 7) received 30 minutes of supervised vigorous aerobic exercise training on a treadmill, 3 times per week. Cognitive function was assessed at baseline prior to the beginning of aerobic exercise training, and at the completion of the 12-week intervention. Cognitive function was assessed using the Trail Making Test, parts A and B, and the Repeatable Battery for the Assessment of Neuropsychological Status.

Mood

About 50% of individuals with TBI report clinically significant levels of anxiety and depression within the first year of injury.6

Weinstein et al7 enrolled 12 ambulatory adults with nonpenetrating TBI into a 12-week aerobic exercise training program to determine the effect of exercise on mood. Changes in mood before and after exercise were measured using the Profile of Mood Status—Short Form (POMS-SF), obtained at baseline (week 1), week 4, week 8, and week 12 (conclusion). The POMS-SF scoring generates a total mood disturbance (TMD) score, with higher scores indicating a more negative mood state. Participants were engaged in 30 minutes of intensive aerobic exercise, 3 times per week. Participants also engaged in a 5- to 10-minute warm-up and cooldown period. The exercise sessions were maintained at 70% to 80% of the participants’ heart rate reserve, which was continuously monitored during exercise. Target range was maintained by adjusting the speed and/or grade of the treadmill. Analyses showed improvement in mood as evidenced by significantly lower TMD scores between weeks 1 and 12. Improvements in mood were detectable after a single exercise bout in week 1. The greatest changes in POMS-SF scores were noted in the Fatigue-Inertia and the Anger-Hostility subscales.

In a pilot study to determine the feasibility of aerobic exercise for lowering depressive symptoms, Schwandt et al enrolled a small sample (N = 4) of community dwelling adults with TBI and residual physical impairments in a 12-week supervised aerobic exercise program.8 The primary outcome measure was the Hamilton Depression Rating Scale (HAMD), administered at baseline, midpoint, and 12 weeks following the conclusion. Additional measures obtained at baseline and at 12 weeks included assessment of functional aerobic capacity (heart rate above 70% of age-predicted maximum), perceived exertion as assessed by the Borg Rating of Perceived Exertion scale, the Rosenberg Self-Esteem Scale, and frequency of attendance. The intervention consisted of a warm-up (stretching or below target heart rate aerobic activity), 30 minutes of intensive aerobic exercise (intensity determined by a score of 5 to 6 on the Borg scale and a heart rate of 60% to 75% of age-predicted maximum), and a 10-minute cooldown. The intervention was delivered 3 times per week for 12 weeks. Participants worked with a research physical therapist to choose from a cycle, treadmill, or recumbent step machine to reach aerobic thresholds. After the 12-week intervention, HAMD scores decreased from the moderate-to-severe and severe levels of depression at baseline, to mild-to-moderate level or no symptoms at program completion. Additionally, heart rate was lower at post intervention, Borg scores were lower indicating less perceived effort, and self-esteem improved as evidenced by higher Rosenberg Self-Esteem Scale scores.

Concluding Thoughts

Aerobic exercise is associated with improved outcomes following TBI, not only in cardiovascular fitness but also in cognitive performance and mood disorders. However, many studies are proof-of-concept, pilot, or pre-post observational studies with small sample sizes, and have numerous methodological limitations. Well-designed randomized controlled trials are needed to test the efficacy of aerobic exercise and rehabilitation outcomes.

Dr Seale is the regional director of clinical services at the Centre for Neuro Skills, which operates post-acute brain injury rehabilitation programs in California and Texas. He is licensed in Texas as a chemical dependency counselor and psychological associate with independent practice. He also holds a clinical appointment at the University of Texas Medical Branch (UTMB) in Galveston in the Department of Rehabilitation Sciences.

References

1. Zang Y, Huang Z, Xia H, et al. The benefits of exercise for outcome improvement following traumatic brain injury: evidence, pitfalls and future perspectives. Exp Neurol. 2022;349:113958.

2. Driver S, Ede A, Dodd Z, et al. What barriers to physical activity do individuals with a recent brain injury face? Disabil Health J. 2012;5(2):117-125.

3. Chin LMK, Chan L, Woolstenhulme JG, et al. Improved cardiorespiratory fitness with aerobic exercise training in individuals with traumatic brain injury. J Head Trauma Rehabil. 2015;30(6):382-390.

4. McDonnell MN, Smith AE, Mackintosh SF. Aerobic exercise to improve cognitive function in adults with neurologic disorders: a systematic review. Arch Phys Med Rehabil. 2011;92(7):1044-1052.

5. Chin LM, Keyser RE, Dsurney J, Chan L. Improved cognitive performance following aerobic exercise training in people with traumatic brain injury. Arch Phys Med Rehabil. 2015;96(4):754-759.

6. Masel BE, DeWitt DS. Traumatic brain injury: a disease process, not an event. J Neurotrauma. 2010;27(8):1529-1540.

7. Weinstein AA, Chin LKM, Collins J, et al. Effect of aerobic exercise training on mood in people with traumatic brain injury: a pilot study. J Head Trauma Rehabil. 2017;32(3):E49-E56.

8. Schwandt M, Harris JE, Thomas S, et al. Feasibility and effect of aerobic exercise for lowering depressive symptoms among individuals with traumatic brain injury: a pilot study. J Head Trauma Rehabil. 2012;27(2):99-103.

 

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Health-care announcements expected with two weeks to go in N.B. election race

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New Brunswick‘s Liberal and Green parties are set to make announcements about health care on the campaign trail today as the provincial election race enters its second half.

Liberal leader Susan Holt is scheduled to hold her announcement this morning in Saint John, N.B., followed by lunch at the city’s market.

A spokesperson with the Progressive Conservative party shared few details about the event scheduled for leader Blaine Higgs in Fredericton this morning.

Green Party Leader David Coon will hold a news conference this morning about “local health-care decision-making” alongside deputy leader Megan Mitton in her Sackville, N.B. riding.

On Saturday, Coon said he was proud to put forward a gender-balanced slate among the party’s 46 candidates.

While the Liberals and Progressive Conservatives are running with full slates, the Greens are three candidates short and will not have full representation when the province’s residents go to the polls on Oct. 21.

This report by The Canadian Press was first published Oct. 7, 2024.

The Canadian Press. All rights reserved.

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Alberta Health Services’ snag leads to potential delay of patient referrals

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EDMONTON – The Health Quality Council of Alberta is investigating how some medical referrals weren’t properly processed, potentially affecting 14,000 patients over the last five years across the province.

The referrals were made to specialists outside of Alberta Health Services, such as physiotherapists and dietitians.

The health authority’s CEO, Athana Mentzelopoulos, says it does an average 100,000 referrals per year, but in some cases it can’t confirm if patients received referral services.

She says the problem was flagged in late September, and a preliminary estimate suggests 31 patients may have experienced a potential negative outcome due to the delays.

The provincial government requested the investigation, and the quality council is to find out how the snag occurred and how it can be prevented in the future.

The health authority says it has begun notifying patients who may have been affected by the disruption, and the cases could date back to 2019.

This report by The Canadian Press was first published Oct. 4, 2024.

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Don’t fall for fake dentists offering veneers and other dental work on social media

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WASHINGTON (AP) — If you have stained or chipped teeth, you might be considering veneers, customized teeth coverings that can restore a photogenic smile without more extensive dental work.

But dentists warn that these pricey cosmetic enhancements are at the center of a worrisome online trend: unlicensed practitioners without proper training or supervision offering low-cost veneers.

These self-described “veneer techs” often promote themselves on Instagram and TikTok, promising a full set of veneers for less than half of what dentists typically charge. Some also market their own training courses and certifications for people looking to get into the business.

It’s misleading, health professionals warn — and illegal. All states require dental work, including veneers, to be performed under the supervision of a licensed dentist.

On Thursday, Georgia law enforcement officials arrested Brandon Diller, who promoted himself to 158,000 Instagram followers as “Atlanta’s top veneer specialist and trainer.” Diller practiced dentistry without a license and sold “training and certificates, which were worthless” and “provided no legitimate or legal credentials,” according to an arrest warrant from Fulton County’s District Attorney’s office.

Here’s what to know about veneers and how to avoid bogus providers and services:

What are dental veneers?

Veneers are thin, custom-made dental coverings used to hide minor imperfections or to fill in gaps between teeth. Unlike crowns or more invasive dental implants, veneers are almost always considered cosmetic dentistry and generally aren’t covered by insurance.

Dentists usually charge between $1,000 and $2,000 per tooth for veneers, with higher prices for those made from porcelain compared with lower-grade materials.

Placing veneers involves stripping some of the natural enamel from the tooth and bonding the new covering into place. Because of that process, getting veneers is considered an irreversible procedure, according to the American Dental Association. They are not permanent, and can be expected to last between 5 to 15 years before they degrade and need to be replaced.

In recent months the ADA has been stepping up warnings about the risks of veneer procedures done by unlicensed individuals.

“Quality control is lost without the involvement of a licensed dentist,” said Dr. Ada Cooper, a New York-based dentist and ADA spokesperson. “We undergo years of education and training and need to be licensed by various regulatory bodies before we can practice.”

What are the risks of getting veneers from someone who isn’t licensed?

Improper veneer procedures can cause a range of health problems, including severe pain, nerve damage and tooth loss.

Patients need to be anesthetized before the enamel is removed from their teeth.

“It could be incredibly painful if they’re not anesthetized correctly,” said Dr. Zach Truman, who runs an orthodontics practice in Las Vegas. “You can also go too deep into the tooth and penetrate what’s called the pulp chamber, which contains blood vessels and nerves.”

One of the biggest problems Truman sees with unregulated veneer work is that customers aren’t getting screened for existing dental problems, such as gum disease and cavities.

“If you put a veneer on a tooth that has an active cavity, you’re just going to seal it in there and eventually it’s going to progress to tooth loss,” Truman said.

Dental veneers aren’t the only option for improving the appearance of teeth. Over-the-counter whitening kits can help with minor stains and discoloration. And dentists can sometimes use composite materials to reshape chipped or uneven teeth. But Truman says those fillings are prone to crack and won’t last as long as veneers.

How can I spot bogus veneer providers online?

One clue: Many individuals performing unlicensed dental work promote themselves on social media as “veneer technicians.”

Instead of working out of a dental office they often perform treatments at beauty salons, hotel rooms or private homes. Some advertise multi-city tours and encourage clients to message them to book an appointment in advance.

Much of the appeal of the services is in their pricing, with some offering a full set of veneers for a flat fee of $4,000 or $5,000. That’s less than half of what patients can generally expect to pay at a dental office.

Performing dental work without an appropriate license is illegal, the ADA notes.

Dentists and hygienists are licensed by state governments, who also define the work dental assistants can perform. But in all cases, veneers and other dental procedures must be supervised by a licensed dentist.

Earlier this year, Illinois law enforcement officials arrested a woman running a business called the Veneer Experts after she posted videos of herself fitting braces, veneers and other dental products without a license. She was previously arrested in Nevada on similar allegations of practicing dentistry without a license.

What are the best ways to find legitimate dental providers?

The ADA maintains a website detailing the training and licensing requirements for dentists across the U.S. Most states also maintain websites where you can lookup and verify licensure information and find any past disciplinary actions for dentists and other health professionals.

“It’s really critical to understand that dentistry is a regulated health care profession that requires formal educations and licensure,” Cooper said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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