Role Of Exercise

Question 1

What are some benefits of Aerobic exercise?

Answer 1

• increased energy consumption
• changes in functional performance
• increased ROM
• decreased psychological effects [depression, anxiety, memory,etc]

Question 2

Aerobic Training - 1.Increased energy consumption

Answer 2

Increased energy use improves fat loss, helps prevent/treat metabolic diseases [diabetes, CVD]
Many forms of aerobic ex can be ‘low impact’ to minimise chances of inflammatory reactions and injury
Benefits of ex @ high intensities - increased energy expenditure and reduced CVD
-need to progress slowly to high intensities
- competition/games a good way to achieve higher intensities
- HITT training, new kid on the block

Renewing of epithelial lining in blood vessels - ex causes high speed blood flow, which stimulates renewal of damaged cells and reduces arterial stiffness
Up regulation of mitochondrial number and enzyme activities within mitochondria
-key to reduce metabolic diseases, including progression of diabetes
Improved autonomic function - greater HR variability, lower noradrenaline levels. - linked to hypertension and arterial stiffness

Question 3

Aerobic Training - 2. Changes to function performance

Answer 3

Decreases in central and peripheral fatigue improve the performance in ADL’s
- increased pain threshold [analgesic effect, CNS fatigue], increased O2 binding in blood, increased myoglobin to grab O2, increased oxidative enzymes/mitochondrial density for improved cellular respiration

Question 4

Aerobic Training - 3. Effects on ROM and movement capacity

Answer 4

Many patients will exhibit significant spatiscity

• large ROM movements can improve ROM by increasing the working range of muscles [specificity of training]
• slow, rather than fast, movements minimise hypertonia in spastic muscles

Most forms of ex help train muscle recruitment and strategies for muscle activation - use progressive complex training modes

Question 5

Aerobic Training - 4. Other [cognitive] benefits

Answer 5

Aerobic ex, especially outdoors [i.e. Environmental enrichment], has been shown to improve performance in memory and cognitive tasks in previously untrained adults - greater effect in elderly

• evidence that ex stimulates neurogenesis in hippocampus while environmental enrichment helps to maintain neurones
• increased brain-derived neurotrophic factor [BDNF] and glial derived neurotrophic factor [GDNF], and others
• also increases dendritic connectivity
• both prevention and treatment for Alzheimer’s and Parkinson’s patients
• increase in BDFN and cognitive function not as signifying in younger adults or over-exercises

Question 6

Endurance training Effects:

Answer 6

The release of hormones [endorphins, testosterone, etc] increase positive feelings
Important in depression management
Depression associated with lower level of serontonin and catcholamines [noradrenaline] - both are released during ex by stimulation of sympathetic NS
Endorphins are released by pituitary gland in response to stress or pain
-interferes with pain transmission in the brain
- addictive effect of endorphins : addicted to ex

Question 7

What are the effects of walking?

Answer 7

Numerous studies in mice show improvements in models of neurodegenerative diseases
Mice ‘walk fast’, not run, on their treadmills
Fast walking causes release of GDNF, promotes survival of neurones in CNS

Question 8

Neuroplasticity and Ex intensity

Answer 8

Hippocampus important for learning, but also stress response, pattern recognition,etc
Lower intensity running in rats more effective in high HRT and low responder LRT groups but minimal effect of high intensity training.
HITT not effective?

Question 9

Strength Training - benefits of ST

Answer 9

Muscle Strength and power well related to functional performance in disabled and older adults
Plantar flexors play major role in locomotion! - best predictor of improvement
Low strength levels associated with increased risk of falls - hip fracture in older adults a mortality risk [500-800% increased risk of death in 6 months after hip fracture]
A minimum of strength is required to perform CV ex, and thus derive health benefits from ex
Muscle mass an strength loss is a big problem in patient populations

Question 10

Strength Training - 1. Macroscopic Adaptations

Answer 10

Increases in muscle size
Increases in fascicle angle and length
Increases in tendon stiffness [vital for transfer of force to skeleton, spring like behaviour]

Question 11

Strength Training - 2. Endocrine adaptations - NB

Answer 11

Hormones : key role in muscle mass and strength gain
ST causes release of growth hormone, testosterone for tissue growth and repair
NB - Muscles a reservoir of anti-inflammatory myokines - proteins [cytokines] released by the muscle with local and non-local effects - NB
Important effects on health and immune function - therefore diabetes and CVD

Question 12

Strength Training - 2. Endocrine adaptations - Growth factors

Answer 12

In addition to secreting immune, fat metabolising and growth factors:

• a muscle-derived IGF variant [IGF 1-Ec… liver derived is IGF 1-Ea] is produced locally in the muscle and acts at the site [autocrine] and nearby [paracrine]
• responds to mechanical stress, so also called Mechanoreceptors Growth Factor [MGF].. muscle damage not needed!
• binding with IGF receptor increases protein synthesis and satellite cell proliferation
• the release of this variant in the muscle probably explains our ability to increase size in individual muscles [or regions of them]
• shown to be more important than endocrine hormones [testosterone, GH, IGF] for muscle mass gain.

Question 13

Strength Training - 3. Neural Adaptations

Answer 13

Has significant effects on the NS
Increases neural drive from supra-spinal [brain] and spinal nerves
Reduces inhibitory reflex gain, allowing stronger contractions
May reduce spasticity and abnormal reflexes
Allows us to build the human to be able to move- then other rehab exercises [e.g. CIT, gait retraining] more effective

Question 14

Strength Training - Appropriate Activation

Answer 14

Each part of the cortex is associated with a different area of the body

‘Learning’ associated with reduced area of activity on homunculus

Strength training also appears to reduce the required area:

• greater forced produced with less volitional effort
• greater precision in tasks after ST.

Question 15

Strength Training - 4. Other adaptations

Answer 15

Release of testosterone, endorphins and others:

• alleviate depression
• improve self confidence

Question 16

Strength Training: Name some Considerations to take into account.

Answer 16

• may need to watch BP in some patients
• may need stabilisation/support to perform movements, flexibility training to improve ROM, longer periods of learning and clearer instructions
• slower movements more appropriate for minimising hypertonia in spastic muscles - 2s concentric and 4s eccentric phases
• Watch for spasticity of antagonist muscle - agonist may be working hard even if weight/load is small
• Progress more slowly in most instances than with the non-patient population.

Increasing training load [heavier lifts] is more important stimulus [muscle damage isn’t required]

• but need to progress slowly in most patients
• may need to test BP during lifts in some patients - out train Valhalla manoeuvre
• check contra indications for all meds

Question 17

Flexibility Training: why?

What adaptions take place?

Answer 17

Need flexibility because patients have lesser ROM, especially in spastic muscles.
Stretching training increases muscle and muscle connective tissue [not tendon] compliance

After single stretchers theres a greater lengthening of muscle, but lesser extension of tendon, for a given joint ROM
There’s less passive resistance [force], so no change in tendon stiffness [force/elongation]

After long term stretching, theres a slight reduction in muscle [fascicle] stiffness but no change in tendon
Change in ‘stretch tolerance’ most important predictor of ROM gain [can tolerate higher stretch load - no clear change in tissues]
PNF stretching may provide greater benefit - contract relax stretching
Stretching of ‘active’ muscle [e.g. Yoga, tai chi] may be more effective than passive.

Question 18

Flexibility Training: Guidlines

Answer 18

Reduced muscle stiffness improves ROM and Ex performance in spastic muscles

Stretching must be performed daily, progressing to twice daily

Standard protocols effective: 2-3 stretches per muscle group held for 15-30s each

May get short term extra benefit from PNF stretching, but keep muscle contraction light in spastic muscle, watch for DOMS

May need to modify stretches due to postural stabilisation and balance issues, e.g. How can stretches be done in a wheelchair?

Question 19

Balance Training: Specific & Functional Balance Training.

Answer 19

Balance is often comprised in patient populations - due to inactivity, loss of strength, loss of coordination, spasticity/paralysis [hemi-]

Specific balance training:

• standard, repeatable balance tasks
• sitting=standing=single leg=eyes closed
• balance beams, uneven/compliant surfaces

Functional balance training:

• learn balance whilst practicing skills
• e.g. Use bilateral stepper instead of bike - practice weight transfer
• play games requiring balance - 10 pin bowling or ADL’s

May need/benefit from warm-up prior to stretching
Progress slowly, don't push
May incorporate fun/competition
Be creative
Test regularly

Question 20

Nutrition

Answer 20

Many patients may have poor diet, wont respond as well to ex [esp. Strength Training] and may fatigue faster
Can implement healthy eating plans?
Use of protein immediately after ST increases protein synthesis
-timing of protein more important than quantity
Carbohydrates immediately after long/endurance sessions to replenish muscle glycogen
Need vitamins and minerals for enzyme function/health - lots of fruits and vegetables