topic 10 - exercise as treatment

Question 1

what were the outcomes in passive cycling in patients admitted to the ICU

Answer 1

can improve patient outcomes as they enter rehab
muscles worked better, healing better, shorter hospital stays

Question 2

what are the exercise benefits on the brain

Answer 2

brain derived neurotrophic factor (BDNF) and IGF1 (growth factor)
increased shear stress and signalling
increased neural activation and metabolism
better function overall
removal of free radicals
better antioxidant uptake

Question 3

what are the direct benefits of exercise

Answer 3

increased CBF, CO2 removal, angiogenesis, vessel compliance, neuronal mass, neuroplasticity, NV coupling, cognitive functioning

Question 4

what are the indirect benefits of exercise

Answer 4

decreased MAP and inflammation
increased systemic metabolism

Question 5

what are effects on recovery

Answer 5

sex, age, history, SES

Question 6

how can we use treatment to move those not recovering to recovery

Answer 6

use of physio, psych, exercise for different deficits

Question 7

what are the effects of exercise in patients with PPCS

Answer 7

most of those who did exercise recovered (>65%)

very few of those who didn’t exercise recovered

Question 8

what is the relationship between sedentary behaviour and recovery

Answer 8

low sedentary behaviour = way faster recovery than high sedentary recovery

need to find optimal level of exercise

Question 9

how are the best outcomes achieved through exercise

Answer 9

prescribed exercise thresholds based on individualised symptom thresholds using BCTT/BCBT

Question 10

how is exercise prescribed

Answer 10

min 20 mins/day at 80-90% of threshold HR reserve achieved on exercise test
once/day for 6-7 days/week

(takes into account resting HR)

Question 11

what does the prescription include

Answer 11

5 min warmup to the target HR
followed by at least 20 min of aerobic exercise at target HR

monitor symptom level (can continue until exacerbation or fatigue if symptoms don’t increase by 2+ points from baseline)

cool down at least 2 mins

new prescription every 1-2 weeks

Question 12

what should be done in the case of drastic symptom increase

Answer 12

stop, rest, exercise at lower HR
contact physician if needed

Question 13

what is the main factor in headache exacerbation during submax exercise

Answer 13

increase in CBF

CBF should follow the same curve as CO2 (NOT BP)

Question 14

what are the effects of exercise on cerebral autoregulation in healthy people

Answer 14

lots of changes - likely exercise induced
longer window than expected after exercise (4-5 hours)

Question 15

what are the effects of exercise on NV coupling in healthy people

Answer 15

deficits in the first hours following

Question 16

what are the effects of exercise on CV reactivity in healthy people

Answer 16

less likely to dilate with changes in CO2 following exercise
stays more constricted - blunted ability to dilate

Question 17

what is the purpose of the vacuum box over the legs during exercise

Answer 17

opens veins - can store more blood in veins and not in the head following exercise

can tilt to make gravity a factor as well as to get blood away from the brain

Question 18

what are the results of the vacuum box

Answer 18

sex differences - but can get everyone back to 0 while still exercising

big changes in HR and little changes in BP without changing CBF

lower scores on total symptoms and symptom severity scale following negative pressure exercise

still get systemic benefits of exercise to promote healing