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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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Helping people living with dementia ‘flourish’ through dance

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Dr. Pia Kontos, a Senior Scientist at UHN’s KITE Research Institute, is co-leading an initiative to help people living with dementia flourish. (Photo: Tim Fraser/UHN KITE Studio)

Dr. Pia Kontos believes in the power of the arts to support people to live well with dementia.

The Senior Scientist at UHN’s KITE Research Institute focuses on challenging policies and practices that discriminate against those living with dementia and developing and evaluating arts-based and digital knowledge translation initiatives to reduce stigma, improve social inclusion and quality of care for them.

“The predominant assumption is people living with dementia don’t have the capacity to be creative,” says Dr. Kontos, who is also a professor in the Dalla Lana School of Public Health at the University of Toronto. “However, we know through extensive research that dance…powerfully supports people living with dementia to be creative and to flourish.

“And flourishing should be a goal that we all have.”

Dr. Kontos co-produced in 2023 Dancer Not Dementia, a short documentary film. It captured the power of a dance program for seniors – Sharing Dance Older Adults (SDOA) – to challenge the stigma associated with dementia, support social inclusion and enrich lives. It’s told through the eyes of residents and staff at Alexis Lodge Dementia Care Residence and Cedarhurst Dementia Care Home in Toronto.

SDOA was jointly developed by Canada’s National Ballet School (NBS) and Baycrest Centre in 2013 for older adults with a range of physical and cognitive abilities, including dementia.

Typically, dance programs in dementia care settings are provided as a therapeutic intervention for older adults. However, SDOA’s goal is to provide a creative outlet for participants and opportunities for social interaction with other people living with dementia, staff and loved ones.

Now, Dr. Kontos will look to incorporate traditions from marginalized communities into SDOA through a $750,000 Canadian Institutes of Health Research (CIHR) Institute of Aging Implementation Science Team Grant. Dr. Rachel Bar, Director of Research and Health at NBS is co-principal applicant for the grant.

This CIHR funding supports projects that evaluate the effectiveness of existing programs, services and models of care that show promise for those impacted by cognitive impairment and dementia. An important focus is improving equitable and inclusive access to care and support.

The three-year grant to Drs. Kontos and Bar will support SDOA efforts to partner with organizations in Black, Chinese and South Asian communities to integrate their cultural practices into its programming.

Training dancers from these communities to teach the adapted program is central to these partnerships.

“People living with dementia from marginalized communities rarely have their traditions honoured with art and leisure programming,” says Dr. Kontos.

“It’s important to align dance programs with the cultural traditions of these communities. Otherwise, the music and movements wouldn’t reflect the experiences of ethno-culturally diverse populations, and the programs wouldn’t be inclusive.

“We wouldn’t be supporting their capacity to be creative or to be in relationships with others through dance. We would be falling short.”

SDOA has already partnered with Alexis Lodge, Alzheimer Society of Canada, Baycrest, NBS, Indus Community Services, Social Planning Council of Ottawa, and Yee Hong for this initiative.

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CDC: Heat may have contributed to four human cases of bird flu in Colorado

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Credit: Alexas Fotos from Pexels

Heat probably played a role in at least four cases of bird flu in poultry workers confirmed by U.S. health officials Sunday—the first cases in poultry workers in two years.

Sweltering temperatures in Colorado rose to at least 104 degrees, which is suspected to have contributed to the human cases, according to Dr. Nirav Shah, principal deputy director at the Centers for Disease Control and Prevention. The barns where poultry workers were culling chickens were “no doubt even hotter,” Shah said during a press conference on the most recent outbreak of bird flu in humans.

The new cases bring the U.S. total to at least nine cases since the first human case of the current outbreak was detected in 2022, also in a Colorado poultry worker. Eight of the nine were reported this year.

The workers were separating chickens that were going to be killed to stop the spread of the virus. The fans may also have contributed to the human infections because, while helping to keep the environment cooler, they “also spread things like feathers around which are known to carry the virus,” Shah added.

The large and strong fans also make it difficult for protective goggles and face masks to stay in place, he said.

About 60 workers at the poultry farm showed symptoms of illness and were tested for bird flu. Four tested positive for bird flu and one additional presumptive case is awaiting confirmation.

The illnesses were relatively mild, with symptoms including conjunctivitis and common respiratory infection symptoms like fever, chills, coughing, and runny nose, according to the CDC. None were hospitalized, officials said. The other U.S. cases have also been mild.

Officials said they are bracing for more cases.

The CDC says the risk to the general public remains low and the health agency is not recommending livestock workers be vaccinated against bird flu given the “mild symptoms noted thus far,” Shah said.

An initial analysis of virus samples from an infected poultry worker does not show any changes in the virus that would make it easier to spread among people and there is no evidence of person-to-person spread in the U.S.

“It’s important to note that this assessment is based on what we know today and may change,” Shah said. “CDC is constantly looking for key changes that may alter our risk assessment of the virus, such as the severity of illness that it causes, the ease with which it can transmit to humans or changes to its genetic fingerprint.”

At the request of Colorado’s officials, the CDC sent a 10-person team to Colorado to help the state manage the bird flu outbreak in humans and poultry. The team included epidemiologists, veterinarians, clinicians and industrial hygienists.

Shah also noted it was a bilingual team. Overall in the U.S., it is estimated about half of farm workers are Latino.

An analysis of the virus from an infected worker indicates that the infections at the chicken farm are “largely the same” as the strain detected in dairy herds in Colorado and other states, according to Shah. But an investigation is ongoing to determine exactly how the outbreak is spreading between wild birds, chicken and cattle.

Since 2022, a highly contagious strain of bird flu has spread across the U.S. at an unprecedented rate.

Georgia’s powerhouse poultry industry, which produces more broiler chickens than any other in the country, has mostly dodged the kinds of major outbreaks that have resulted in the deaths of more 90 million birds in commercial and backyard poultry flocks in the U.S.

About 1.8 million chickens will be killed at the Colorado poultry farm after these latest bird flu cases were detected.

In late 2023, ducks at a commercial breeding farm in Sumter County, Georgia, tested positive for H5N1. This year, in March, the virus made a jump to a mammal species that surprised many scientists: cows.

With a significant dairy industry, plus even larger beef and poultry interests, the potential arrival of the virus here threatens Georgia’s economy and the health of residents.

As of Monday, the H5N1 virus has been confirmed in 158 dairy herds in 13 states, according U.S. Agriculture Department.

So far in Georgia, there have been no bird flu cases in cattle, and there have been no human cases.

Since the unprecedented spread of H5N1 in poultry in 2022, the Georgia Department of Public Health has quietly monitored 132 people for signs of the virus, according to DPH spokeswoman Nancy Nydam. Those tracked were either first responders to one of the state’s few virus outbreaks in backyard and commercial poultry flocks or farmworkers where the infections occurred. Of those monitored, fewer than 10 people were tested for H5N1 and none came back positive.

Since the virus was discovered in cattle, a small number of first responders from Georgia who went to other states to help with investigations—fewer than 15—have also been monitored for signs of illness.

Federal officials said Tuesday they still believe they can eliminate the bird flu virus from , even as the number of herds infected continues to grow. The latest state to recently report infected dairy cattle was Oklahoma. North Carolina is the only state adjacent to Georgia to report an infected dairy herd.

Eric Deeble, acting senior adviser for the H5N1 response at the USDA, said investigations show the is spreading among cattle through cattle moved from one herd to another and the shared use of milking equipment. It can be contained through enhanced biosecurity measures such as thoroughly cleaning milking “parlors” and equipment, separating sick cows, and having dairy workers wear protective equipment.

Deeble also noted USDA scientists are also working with partners to develop a cattle-specific H5N1 vaccine—a process requires many steps and will take time.

The USDA is also exploring the possibility of developing a poultry vaccine as the number of cases soar, and outbreaks lead to the slaughter of millions of farmed birds. But USDA and industry stakeholders point to challenges that would hinder a vaccination program.

The biggest sticking point is around trade.

Mike Giles, president of the Georgia Poultry Federation, said mass vaccination would be impractical for several reasons, including the fact that the industry would lose its lucrative export market: The United States and many of its trade partners restrict the import of products or eggs from countries affected by the highly pathogenic strain or flocks that have been vaccinated against it.

“(Bird flu) has been, from an animal health standpoint, our top concern,” Giles said. “The challenge, and I think the industry has responded to it well, has been maintaining the state of preparedness and urgency and focus on biosecurity, and I think that has been accomplished.”

2024 The Atlanta Journal-Constitution. Distributed by Tribune Content Agency, LLC.

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Here is the new guidance for RSV vaccines

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Health officials recently changed the guidelines for respiratory syncytial virus vaccines. Here’s what Canadians need to know about the guidance and the virus itself.

New guidance on vaccines

As of July 12, the National Advisory Committee on Immunization (NACI) now recommends RSV vaccines for individuals who are 75 years old and older, especially those who have a greater risk of developing severe RSV.

Based on current evidence and expert opinion, NACI said in a news release, it also strongly recommends vaccines for those aged 60 and older who live in nursing homes and other chronic care facilities.

What is RSV?

RSV is a common contagious virus that often causes bronchiolitis, a lung infection, and pneumonia.

Infants face the highest risk of developing severe RSV disease, however, this risk also increases with age and with certain medical conditions, according to the Public Health Agency of Canada (PHAC). It can lead to serious complications for older people, including hospitalization and death.

What are the symptoms?

RSV typically causes mild, cold-like symptoms that usually begin two to eight days after exposure to the virus, according to PHAC.

Those with RSV may experience a runny nose, coughing, sneezing, wheezing, fever and less appetite and energy. Infants may be irritable, have trouble breathing and have less appetite and energy.

What is the treatment?

RSV infections are usually mild and last about one to two weeks. If you are infected, health officials recommend you stay home and limit contact with others.

They also recommend lots of rest and drinking plenty of fluids. Take over-the-counter products, such as acetaminophen or ibuprofen, if you have a fever. Seek immediate care or go to the hospital if you’re having trouble breathing or become dehydrated, PHAC adds.

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