Background
The potential for aerobic exercise (AE) to enhance neuroplasticity post-stroke has been theorized but not systematically investigated. Our aim was to determine the effects of forced-rate ...AE (FE) paired with upper extremity (UE) repetitive task practice (FE + RTP) compared to time-matched UE RTP (RTP only) on motor recovery.
Methods
A single center randomized clinical trial was conducted from April 2019 to December 2022. Sixty individuals ≥6 months post-stroke with UE hemiparesis were randomized to FE + RTP (N = 30) or RTP only (N = 30), completing 90-minute sessions, 3×/week for 8 weeks. The FE + RTP group underwent 45-minute of FE (5-minute warm-up, 35-minute main set, and 5-minute cool down) followed by 45-minute of UE RTP. The RTP only group completed 90-minute of RTP. Primary outcomes were the Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT). The 6-minute Walk Test (6MWT, secondary outcome) assessed walking capacity.
Results
Sixty individuals enrolled and 56 completed the study. The RTP only group completed more RTP in terms of repetitions (411.8 ± 44.4 vs 222.8 ± 28.4, P < .001) and time (72.7 ± 6.7 vs 37.8 ± 2.4 minutes, P < .001) versus FE + RTP. There was no significant difference between groups on the FMA (FE + RTP, 36.2 ± 10.1-44.0 ± 11.8 and RTP only, 34.4 ± 11.0-41.2 ± 13.4, P = .43) or ARAT (FE + RTP, 32.5 ± 16.6-37.7 ± 17.9 and RTP only, 32.8 ± 18.6-36.4 ± 18.5, P = .88). The FE + RTP group demonstrated greater improvements on the 6MWT (274.9 ± 122.0-327.1 ± 141.2 m) versus RTP only (285.5 ± 160.3-316.9 ± 170.0, P = .003).
Conclusions
There was no significant difference between groups in the primary outcomes. The FE + RTP improved more on the 6MWT, a secondary outcome.
Trial Registration:
ClinicalTrials.gov: NCT03819764.
To examine the cardiorespiratory effects of a forced-rate aerobic exercise (FE) intervention among individuals with chronic stroke compared with an upper extremity repetitive task practice (UE RTP) ...control group.
Secondary analysis of data from a randomized controlled trial.
Research laboratory.
Individuals with chronic stroke (N=60).
Participants completed 24 sessions of FE followed by RTP (FE+RTP, N=30) or time matched RTP alone (N=30). The FE+RTP group was prescribed exercise at 60%-80% of heart rate reserve on a motorized stationary cycle ergometer for 45 minutes followed by 45 minutes of RTP. The control group completed 90 minutes of RTP.
Metabolic exercise stress tests on a cycle ergometer were conducted at baseline and post-intervention. Outcomes included peak oxygen consumption (peak V̇o
) and anaerobic threshold (AT).
Fifty participants completed the study intervention and pre/post stress tests. The FE+RTP group demonstrated significantly greater improvements in peak V̇o
from 16.4±5.7 to 18.3±6.4 mL/min/kg compared with the RTP group (17.0±5.6 to 17.2±5.6 mL/min/kg, P=.020) and significantly greater improvements in AT from 10.3±2.8 to 11.5±3.6 mL/min/kg compared with the RTP group (10.8±3.9 to 10.4±3.2 mL/min/kg, P=.020). In analyzing predictors of post-intervention peak V̇o
, the multivariable linear regression model did not reveal a significant effect of age, sex, body mass index, or beta blocker usage. Similarly, bivariate linear regression models for the FE group only did not find any exercise variables (aerobic intensity, power, or cycling cadence) to be significant predictors of peak V̇o
.
While the aerobic exercise intervention was integrated into rehabilitation to improve UE motor recovery, it was also effective in eliciting significant and meaningful improvements in cardiorespiratory fitness. This novel rehabilitation model may be an effective approach to improve motor and cardiorespiratory function in persons recovering from stroke.
•A parametric study of radiative transfer in thermotropic materials is conducted.•The study provides a basis for the selection of thermotropic material combinations.•The key predictor of optical ...behavior is the relative refractive index.•A potential thermotropic combination is short chain alkanes in polycarbonate.
Thermotropic materials offer the potential to provide passive overheat protection for polymer solar absorbers. These materials are comprised of a matrix in which a second material, referred to as the scattering domain, is dispersed as small particles. Overheat protection is provided by a change in transmittance and reflectance at elevated temperature. The magnitude of this change depends on the change in the relative refractive index between the matrix and the scattering domain, the volume fraction and size of the dispersed particles, and the thickness of the material. To predict the effect of these parameters on the normal-hemispherical transmittance and reflectance, thermotropic materials are modeled as a non-absorbing slab comprised of discrete, anisotropic scattering, spherical particles embedded in a matrix material. A Monte Carlo ray tracing algorithm predicts the transmittance and reflectance of the slab. The model predictions are compared with: the analytical solution for a slab of non-absorbing, non-scattering media, and the measured transmittance of 0.3mm thick polymer samples containing 400nm particles. A parametric study of the effects of the design parameters on the transmittance is presented to identify potential material combinations which will produce a thermotropic composite capable of providing overheat protection for flat plate solar collectors. Relatively short chain alkanes or low molecular mass polyethylene in a matrix of polycarbonate are identified as promising materials.
'Behaviours that challenge others' are attributed to 20% of people with learning disabilities. These behaviours are not a diagnosis, it is something people are labelled with. We conducted qualitative ...interviews with social care staff in the UK within four models of care: independent supported living, residential nursing home, Shared Lives, and living with family and attending a day opportunities centre. We examine how the category of 'behaviours that challenge others' is produced, applied, and contested in adult social care settings. We demonstrate its stickiness and discuss its stigmatising consequences. How behaviours are understood, felt, and talked about matters for the support people with learning disabilities receive and maps onto their consequent inclusion or exclusion from society. We point out the harms the category carries for people who receive it and argue that it should be abandoned. Keywords: behaviours that challenge others, learning disability, social care, affect, stigma
To determine the efficacy of high-intensity cycling to improve walking capacity in individuals with chronic stroke, identify variables that predict improvement in walking capacity, and quantify the ...relationship between the 6-minute walk test (6MWT) and cardiopulmonary exercise (CPX) test variables.
Secondary analysis of data from 2 randomized controlled trials.
Research laboratory.
Individuals with chronic stroke (N=43).
Participants were randomized to 1 of the following time-matched interventions, occurring 3 times per week for 8 weeks: (1) forced aerobic exercise and upper extremity repetitive task practice (FE+RTP n=16), (2) voluntary aerobic exercise and upper extremity repetitive task practice (VE+RTP n=14), or (3) a non-aerobic control group (n=13).
Change in walking capacity as measured by the 6MWT from baseline to the end of treatment (EOT).
Significant increases were observed in distance traveled during the 6MWT at the EOT compared with baseline in the FE+RTP (P<.001) and VE+RTP (P<.001) groups, but not in the control group (P=.21). Among aerobic exercise participants, a multivariate regression analysis revealed that cycling cadence, power output, and baseline 6MWT distance were significant predictors of change in walking capacity.
An 8-week aerobic cycling intervention prescribed at 60% to 80% of heart rate reserve and moderate to high cadence and resistance led to significant improvements in walking capacity in our cohort of individuals with chronic stroke. Individuals with low baseline walking capacity levels may benefit most from aerobic cycling to improve over ground locomotion. Although the 6MWT did not elicit a cardiorespiratory response comparable to the maximal exertion CPX test, the 6MWT can be considered a valid and clinically relevant submaximal test of cardiorespiratory function in individuals with chronic stroke.
Although the cardiopulmonary benefits of aerobic exercise poststroke are well-established, typical stroke rehabilitation does not elicit an aerobic response.
To characterize heart rate response ...during upper extremity repetitive task practice (RTP) and determine factors that predict a higher aerobic intensity during RTP.
Secondary analysis of a subset of data from a randomized clinical trial.
Research laboratory in a large academic medical center.
Patients with chronic stroke (N = 19).
Participants received 90 min of RTP for 24 sessions across 8 wk.
Aerobic intensity as measured by heart rate reserve (HRR) during RTP.
A total of 2,968 tasks were included in the analysis. Of the tasks performed, approximately 79.5% elicited a very light aerobic response (<30% HRR), 10.2% elicited a light aerobic response (30%-39% HRR), and 10.3% elicited a moderate to vigorous intensity aerobic response (≥40% HRR). Of the tasks that elicited a moderate to vigorous intensity aerobic response, 54.1% were performed in standing, 79.7% were gross motor in nature, and 27.9% had targets at or above shoulder height. Standing position, targets at or above shoulder height, and gross motor tasks predicted higher HRR (all ps < .001).
To maximize aerobic intensity during poststroke RTP, therapists should include gross motor tasks trained in standing with targets at or above shoulder height. Plain-Language Summary: The study characterizes heart rate response in stroke rehabilitation and identifies factors that predict a higher aerobic intensity during upper extremity repetitive task practice. Certain task characteristics were more likely to produce an aerobic response, including gross motor, targets at or above the shoulder, and a standing position. Occupational therapists should include gross motor tasks trained in standing with targets at or above shoulder height to maximize aerobic intensity during poststroke repetitive task practice. Monitoring heart rate may improve awareness of aerobic response to training.
Relationship of Abdominal Visceral and Subcutaneous Adipose Tissue With Lipoprotein Particle Number and Size in Type 2 Diabetes
Susan Sam 1 ,
Steven Haffner 2 ,
Michael H. Davidson 3 ,
Ralph B. ...D'Agostino, Sr. 4 ,
Steven Feinstein 5 ,
George Kondos 6 ,
Alfonso Perez 7 and
Theodore Mazzone 1
1 Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, Chicago, Illinois
2 Department of Medicine, University of Texas Health Science Center, San Antonio, Texas
3 Pritzker School of Medicine, The University of Chicago, Chicago, Illinois
4 Department of Mathematics, Statistics and Consulting Unit, Boston University, Boston, Massachusetts
5 Department of Medicine, Section of Cardiology, Rush University Medical Center, Chicago, Illinois
6 Department of Medicine, Section of Cardiology, University of Illinois College of Medicine, Chicago, Illinois
7 Takeda Global Research and Development, Deerfield, Illinois
Corresponding author: Theodore Mazzone, tmazzone{at}uic.edu
Abstract
OBJECTIVE— Insulin resistance and type 2 diabetes are associated with an atherogenic lipoprotein profile. We examined the role of visceral
and subcutaneous fat depots, independent of BMI, on the dyslipidemia associated with type 2 diabetes.
RESEARCH DESIGN AND METHODS— A total of 382 subjects with type 2 diabetes underwent abdominal computed tomography to evaluate subcutaneous (SAT) and visceral
adipose tissue (VAT) distribution and had anthropometric measurements to determine BMI and waist and hip circumference. Fasting
blood was obtained for lipoprotein particle number and size using nuclear magnetic resonance spectroscopy. The relationship
of lipoprotein particle number and size with BMI, SAT, and VAT was examined using multivariable regression models adjusted
for age, sex, diabetes therapy, duration of diabetes, smoking, statin use, and A1C levels. The relation of VAT to lipoprotein
particle number and size was further evaluated after the addition of BMI, BMI plus SAT, or BMI plus homeostatis is model assessment
of insulin resistance (HOMA-IR) to the model.
RESULTS— VAT was positively related to VLDL particle number ( P < 0.0001), LDL particle number ( P < 0.01), and VLDL size ( P < 0.0001) and negatively related to LDL size ( P < 0.0001) and HDL size ( P < 0.0001). These relationships remained unchanged after addition of BMI and SAT to the model. After addition of HOMA-IR,
VAT remained positively related to VLDL particle number ( P < 0.0001) and size ( P < 0.01) and negatively related to LDL and HDL particle size ( P < 0.0001 for both comparisons). Neither BMI nor SAT was independently related to lipoprotein parameters.
CONCLUSIONS— In patients with type 2 diabetes, higher VAT independent of BMI was associated with higher VLDL and LDL particle number, larger
VLDL particles, and smaller LDL and HDL particles. This lipoprotein pattern has been associated with increased risk for atherosclerosis
and cardiovascular disease.
Footnotes
Published ahead of print at http://diabetes.diabetesjournals.org on 9 May 2008.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work
is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Accepted May 4, 2008.
Received February 4, 2008.
DIABETES
Some guidelines recommend altering glycemic targets in gestational diabetes mellitus (GDM) based on ultrasound measurements of fetal growth, but the impact on outcomes in clinical practice is ...unknown. The aim of this study was to compare the effects of ultrasound-guided and non-ultrasound-guided management on neonatal outcomes.
This was a retrospective, observational study of a random sample of women with GDM and their infants. Outcomes were compared between those who had GDM management tailored according to fetal growth and those who did not.
In the sample of 221 women, 134 had documentation of ultrasound-guided management while 87 did not. There was no significant difference in size-for-gestational age between groups. Fewer neonates in the ultrasound-guided management group were admitted to the Special Care or Intensive Care Nursery (29.1% vs. 48.3%, P = 0.004), had a prolonged hospital stay (3.7% vs. 13.8%, P = 0.006), or had hypoglycemia after birth (42.5% vs. 56.3%, P = 0.045). The reduction in admission rates and prolonged hospital stays remained significant after controlling for confounding variables.
Ultrasound-guided management was independently associated with improvements in some neonatal outcomes.
OBJECTIVE: Both visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) have been linked to systemic inflammation in nondiabetic cohorts. We examined the relationships between VAT and SAT ...and systemic inflammatory markers in a large well-characterized cohort of subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: Three hundred eighty-two subjects with type 2 diabetes in the CHICAGO (Carotid Intima-Media Thickness in Atherosclerosis Using Pioglitazone) study cohort underwent abdominal computed tomography to determine SAT and VAT distribution. Fasting blood was obtained for measurement of inflammatory markers. The relationships between inflammatory markers and BMI, SAT, and VAT were examined using regression models adjusted for age, sex, diabetes treatment, duration of diabetes, smoking, statin use, and A1C. RESULTS: VAT was positively related to CRP, monocyte chemoattractant protein (MCP), intracellular adhesion molecule (ICAM)-1, and plasminogen activator inhibitor type 1 (PAI-1) antigen before adjustment for BMI. After adjustment for BMI, the relationship to CRP was lost but positive associations with MCP (P < 0.01), PAI-1 (P < 0.0001), ICAM-1 (P < 0.01), and vascular cell adhesion molecule (P = 0.01) were evident. BMI was positively related to CRP (P < 0.0001) and IL-6 (P < 0.01) even after adjustment for VAT and SAT. SAT was not related to any inflammatory marker after adjustment for BMI. CONCLUSIONS: In this large group of subjects with type 2 diabetes, BMI was most strongly associated with CRP and IL-6 levels. SAT was not associated with markers of systemic inflammation. The size of the VAT depot provided information additional to that provided by BMI regarding inflammatory markers that are strongly related to vascular wall remodeling and coagulation. Our findings suggest that adipose tissue distribution remains an important determinant of systemic inflammation in type 2 diabetes.
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