Early Exercise Through Telerehabilitation After Bariatric Surgery: Is It Feasible?

PURPOSE: The feasibility of early telerehabilitation after bariatric surgery is unknown. The objective of this study was to assess the feasibility and perception of engaging in the online exercise protocol in patients during the first month after bariatric surgery. MATERIAL AND METHODS: A total of 67 patients, enrolled in a telerehabilitation program following bariatric surgery, completed a survey assessing their perception of the intensity, discomfort, and safety during exercise sessions. RESULTS: Forty percent of participants began exercising between 5 and 10 days after surgery. Seventy-one percent of patients did not experience discomfort during the first month of exercise, and those who reported discomfort mainly mentioned dizziness and abdominal pain. No significant differences were found in the presence of discomfort among different types of surgeries performed. There was a significant difference in the presence of discomfort between patients who started exercising before and after 15 days of surgery, with less discomfort reported in the group that started after 15 days. Ninety-eight percent of patients felt safe during online exercise sessions. Most participants perceived the intensity of the sessions as moderate. The most frequently mentioned benefits of exercise were increased energy, mood, and feeling more active. CONCLUSION: Telerehabilitation conducted during the first month after bariatric surgery was feasible and well tolerated by patients, providing a safe alternative for those patients who face difficulties with in-person interventions.

Early exercise intervention promotes myelin repair in the brains of ischemic rats by inhibiting the MEK/ERK pathway.

Our previous studies have shown that early exercise intervention after stroke increases neural activity and synaptic plasticity and promotes the recovery of nerve fiber bundle integrity in the brain. However, the effect of exercise on the repair of myelin in the brain and the related mechanism are still unclear. In this study, we randomly divided the rats into three groups. Before and after 28 days of intervention, body weight, nerve function, the infarct size, white matter fiber bundle integrity, and nerve myelin structure and function were observed by measuring body weight, analysis of modified neurological severity score, CatWalk gait analysis, MRI, luxol fast blue staining, immunofluorescence, and transmission electron microscopy. Changes in the expression of proteins in the MEK/ERK pathway were assessed. The results showed that early exercise intervention resulted in neurological recovery, decreased the infarct volume and increased nerve fiber integrity, the myelin coverage area, myelin basic protein (MBP) fluorescence intensity expression, and myelin thickness. Furthermore, the expression level of MBP was significantly increased after early exercise intervention, while the expression levels of p-MEK1/2 and p-ERK1/2 were significantly reduced. In the cell study, MBP expression levels were significantly higher in the oxygen and glucose deprivation and administration group.In summary, early exercise intervention after stroke can promote myelin repair by inhibiting the MEK/ERK signaling pathway.

Lessons Learned From a Systematic, Hospital-Wide Implementation of the ABCDEF Bundle: A Survey Evaluation.

Objective: We recently reported the first part of a study testing the impact of data literacy training on "assessing pain, spontaneous awakening and breathing trials, choice of analgesia and sedation, delirium monitoring/management, early exercise/mobility, and family and patient empowerment" [ABCDEF [A-F]) compliance. The purpose of the current study, part 2, was to evaluate the effectiveness of the implementation approach by surveying clinical staff to examine staff knowledge, skill, motivation, and organizational resources. DESIGN: The Clark and Estes Gap Analysis framework was used to study knowledge, motivation, and organization (KMO) influences. Assumed influences identified in the literature were used to design the A-F bundle implementation strategies. The influences were validated against a survey distributed to the ICU interprofessional team. SETTING: Single-center study was conducted in eight adult ICUs in a quaternary academic medical center. SUBJECTS: Interprofessional ICU clinical team. INTERVENTIONS: A quantitative survey was sent to 386 participants to evaluate the implementation design postimplementation. An exploratory factor analysis was performed to understand the relationship between the KMO influences and the questions posed to validate the influence. Descriptive statistics were used to identify strengths needed to sustain performance and weaknesses that required improvement to increase A-F bundle adherence. MEASUREMENT AND RESULTS: The survey received an 83% response rate. The exploratory factor analysis confirmed that 38 of 42 questions had a strong relationship to the KMO influences, validating the survey's utility in evaluating the effectiveness of implementation design. A total of 12 KMO influences were identified, 8 were categorized as a strength and 4 as a weakness of the implementation. CONCLUSIONS: Our study used an evidence-based gap analysis framework to demonstrate key implementation approaches needed to increase A-F bundle compliance. The following drivers were recommended as essential methods required for successful protocol implementation: data literacy training and performance monitoring, organizational support, value proposition, multidisciplinary collaboration, and interprofessional teamwork activities. We believe the learning generated in this two-part study is applicable to implementation design beyond the A-F bundle.

Activation of BDNF- and VEGF-mediated Neuroprotection by Treadmill Exercise Training in Experimental Stroke.

Early treatment of ischemic stroke is one of the most effective ways to reduce brains' cell death and promote functional recovery. This study was designed to examine the effect of aerobic exercise on post ischemia/reperfusion injury on concentration and expression of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) after inducing a neuronal loss in CA1 region of hippocampus in Male Wistar rats. Three experimental groups including sham(S), ischemia/reperfusion-control (IRC) and ischemia/reperfusion exercise (IRE) were used for this purpose. The rats in the IRE group received a bilateral carotid artery occlusion treatment. They ran for 45 minutes on a treadmill five days per week for eight consecutive weeks. Cresyl violet (Nissl), Hematoxylin (H & E) and Eosin staining procedure were used to determine the extent of damage. A ladder rung walking task was used to assess the functional impairments and recovery after the ischemic lesion. ELISA and immunohistochemistry method were employed to measure BDNF and VEGF protein expressions. The result showed that the brain ischemia/reperfusion condition increased the cell death in hippocampal CA1 neurons and impaired motor performance on the ladder rung task whereas the aerobic exercise program significantly decreased the brain cell's death and improved motor skill performance. It was concluded that ischemic brain lesion decreased the BDNF and VEGF expression. It seems that the aerobic exercise following the ischemia/reperfusion potentially promotes neuroprotective mechanisms and neuronal repair and survival mediated partly by BDNF and other pathways.

A Randomized Controlled Trial for the Intervention Effect of Early Exercise Therapy on Axial Pain after Cervical Laminoplasty.

Introduction: Cervical isometric muscle strengthening and cervical range of motion (ROM) training are recommended after laminoplasty (LP). However, their preventive effects on axial pain are unclear. We examined whether neck extension muscle strengthening and cervical ROM training from the early postoperative period effectively suppress postoperative axial pain. Methods: Sixty-one patients undergoing a muscle-preserving LP attached to C2 and C7 for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament were randomly allocated to the cervical exercise (33 patients) or nonexercize (28 patients) groups. Postoperative cervical collars were not worn in any cases. The cervical exercise group underwent neck extension isometric muscle strengthening and cervical ROM exercises for 3 months starting on postoperative day 2. Changes in axial pain (visual analog scale [VAS]) from baseline at 2 weeks and 3 months after surgery were evaluated as the primary outcome. Cervical muscle strength, cervical ROM, and Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) scores were evaluated as secondary outcomes. Results: Axial pain was significantly exacerbated at 2 weeks after LP compared with before surgery, and then, a significant improvement was observed at 3 months after surgery. No significant interaction was observed between the intervention and nonintervention groups. There was no difference in secondary outcomes between groups. The change in the VAS of axial pain from before surgery to 3 months after surgery showed a greater decreased neck extension muscle strength resulting in severer axial pain. Conclusions: Cervical muscle strengthening and cervical ROM exercise from the early postoperative period did not relieve axial pain at 2 weeks and 3 months after a muscle-preserving LP attached to C2 and C7. No significant difference in neck extension muscle and cervical movement was observed between the intervention and nonintervention groups. Therefore, a muscle-preserving LP attached to C2 and C7 is a good strategy to prevent axial pain in the early postoperative period.Clinical Trials Registration Number: UMIN000040692.

The effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients: A systematic review and meta-analysis.

BACKGROUND: Heart failure can be classified into chronic heart failure and acute heart failure. Rapid onsets or worsening symptoms characterize acute heart failure, while progressive symptoms characterize chronic heart failure. Exercise-based cardiac rehabilitation is recommended for chronic heart failure patients, yet controversies on whether early exercise is safe and advantageous for acute heart failure patients remain unclear. OBJECTIVES: We performed a systematic review and meta-analysis to explore the effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients. METHODS: We searched PubMed, Web Of Science, Embase, the Cochrane Library, CINAHL, PsycINFO, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Dataset and SinoMed Dataset (from the earliest date available to August 2021) for randomized controlled trials that evaluated the effects of early exercise in acute heart failure patients. Studies were selected according to inclusion and exclusion criteria. Data synthesis was performed with Review Manager 5.2. RESULTS: 13 studies met the study criteria, including 1466 patients. Compared to the control group [routine care], early exercise improved 6 min walk distance[mean difference = 33.10, 95% CI (31.43, 34.77), P < 0.001], short physical performance battery scores[mean difference = 1.40, 95% CI (1.36, 1.44), P < 0.001], N-terminal pro-B-type natriuretic peptide[mean difference = -58.84, 95% CI (-89.25, -28.43), P < 0.001], quality of life assessed by Minnesota heart failure quality of life questionnaire [mean difference = -6.55, 95% CI (-9.99, -3.11), P = 0.0002], quality of life assessed by Kansas city cardiomyopathy questionnaire [mean difference = 7.00, 95% CI (6.58, 7.42), P < 0.001], activities of daily living [mean difference = 4.43, 95% CI (2.20, 6.65), P < 0.001], and all-cause related readmission rate [mean difference = 0.69, 95% CI (0.51, 0.94), P = 0.02]. No significant difference in left ventricular ejection fraction [mean difference = 1.93, 95% CI (-2.19, 6.05), P = 0.36], heart failure-related readmission rate [mean difference = 0.76, 95% CI (0.50, 1.17), P = 0.21] and all-cause mortality [mean difference = 0.63, 95% CI (0.18, 2.24), P = 0.47] was found between early exercise group and control group. No adverse events occurred during the intervention. CONCLUSION: Compared to routine care, early exercise could significantly improve the effect of physical capacity, physiological outcomes and clinical outcomes in acute heart failure patients, and appeared to be safe.

Mobilising patients with severe acquired brain injury in intensive care (MAWERIC) - Protocol for a randomised cross-over trial.

INTRODUCTION: In the early phase after severe brain injury, patients are often bedridden in an attempt to control intracranial homeostasis; however, prolonged immobilisation may trigger complications. There is limited knowledge about the physiological effects of mobilisation in this early phase. OBJECTIVE: To investigate changes in brain tissue oxygen tension when patients are mobilised using a Sara Combilizer® in the early phase after severe brain injury, in a randomised cross-over design. METHODS: Patients with traumatic brain injury, subarachnoid haemorrhage or intracranial haematoma, will be randomised to early mobilisation or rest (no mobilisation = control) on the first day that the patient is deemed to be fit for mobilisation, and the opposite on the next day. On both days, patients will undergo continuous multimodal monitoring measuring brain tissue oxygen tension (primary outcome), invasive blood pressure, heart rate, middle cerebral artery blood flow velocity by transcranial Doppler ultrasound, intracranial pressure, and microdialysis markers of cerebral oxidative metabolism. DISCUSSION: Intensive care unit patients with acute brain injury are frequently immobilised in the early phase after the ictus. The optimal timing and intensity of mobilisation is unknown. The present study attempts to establish if early mobilisation is safe with respect to intracranial homeostasis. Protocol version 1.1. Date: 19.02.2022. Ethical registration: H-21002728; approved on August 11, 2021. GDPR registration: P-2021 - 105; approved on February 10, 2021. CLINICALTRIALS: govidentifier:NCT05038930; approved on September 8, 2021. Electronic case report file: REDCap-database; created on August 13, 2021.

Effect of early exercise on inflammatory parameters and apoptosis in CA1 area of the hippocampus following cerebral ischemia-reperfusion in rats.

INTRODUCTION & OBJECTIVE: Ischemic/reperfusion (I/R) causes severe brain injury, especially in the cornu Ammonis (CA1) region of the hippocampus. The purpose of this study was to evaluate the effect of early exercise on inflammatory parameters and apoptosis in the CA1 area of the hippocampus following cerebral I/R in adult male rats. METHODS: Male Wistar rats were randomly divided into four groups: (Sham, Exercise [Exe], Ischemia [ISC], and Ischemia + Early Exercise [ISC+EE]). The ISC+EE group initiated forced treadmill training at 24 h after surgery. Ischemia was induced by occlusion of both common carotid arteries for 45 min 48 h after the last training session, apoptotic cells were detected by TUNEL. Hematoxylin & Eosin (H&E) and Cresyl violet staining were used to assess the damage of the CA1region of the hippocampus. Caspase-3, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and Tumor necrosis factor-alpha (TNF-a) were determined by Immunofluorescence. NF-κB, TNF-a, B-cell lymphoma 2 (Bcl-2), Bcl-2-associated X protein (Bax), Neuronal Nuclear (NeuN) were evaluated by western blotting. Motor function was evaluated by a horizontal ladder test. RESULTS: The results showed that early exercise could decrease the number of apoptotic cells, decrease the expression of NF-κB, TNF-a, caspase-3, Bax and Bax/Bcl-2 ratio as well as increase Bcl-2 and NeuN (p < 0.05, n = 8). These data were consistent with improved motor function (p < 0.05, n = 8). CONCLUSION: This study showed that early exercise prevents lesions induced by ischemia in the CA1 region via inhibiting inflammation and apoptosis and supports functional recovery following IR.

Morphological Changes in Flexor Tendon Adhesion Following Early Exercise After Tendon Repair.

Adhesion is a common complication following surgical repair of flexor tendons, resulting in the restriction of tendon gliding. We investigated the effect of early exercise on adhesion formation. To create an adhesion model, the proximal region of the second phalanx of the third toe in 4-month-old White Leghorn chickens was cut. The gliding side of the flexor digitorum profundus was hemiresected and the bony floor was crushed to enhance adhesion formation. The resected area was fixed in an extended position for 1, 2, or 3 weeks. Following 1, 2, or 3 weeks of active exercise, the chickens were sacrificed and morphological changes in the adhesions were assessed. In the 1- and 2-week fixed groups, 1, 2, or 3 weeks of active exercise resulted in mesotenon-like adhesion that was elastic and had no effect on tendon gliding. However, in the 3-week fixed group, a mature adhesion remained with limited change and tendon gliding was inhibited even after 3 weeks of active exercise. Thus, we concluded that adhesions become more elastic with early exercise within 2 weeks after tendon repair, but that adhesions following tendon repair tend not to show any further elastic changes when exercise is started 3 weeks after the repair.

Early Wearing of Knee-Ankle-Foot Orthosis Improves Functional Prognosis in Patients after Stroke.

OBJECTIVES: Knee-ankle-foot orthosis (KAFO) is sometimes used for gait training in stroke patients. The impact of the time of wearing KAFO on activities of daily living (ADL) recovery has not been clarified. This study aimed to examine the relationship between the days from onset to KAFO wearing and functional prognosis in patients after stroke. MATERIALS AND METHODS: This retrospective, observational study was conducted with stroke patients who were prescribed a KAFO. Patients were divided into early and delayed groups according to the median days from onset to KAFO wearing. Baseline characteristics were evaluated at the initiation of KAFO wearing. The primary outcome was the Functional Independence Measure (FIM) gain, which was scored by the nurse at baseline and discharge. RESULTS: 112 participants (mean age 67.9 ± 14.0 years, 51.8% male) were included. The time period measure from day of onset to KAFO wearing for the early group was significantly shorter than the delayed group (35.8 ± 6.6 days vs. 73.5 ± 28.9 days). The early group had a higher FIM at discharge (84.9 ± 28.0% vs. 65.1 ± 29.0%, P < 0.001) and higher FIM gain (36.9 ± 19.8% vs. 26.8 ± 22.3, P = 0.013) than did the delayed group. Multiple regression analysis showed that the early group was associated with FIM gain (coefficient = 8.607, P = 0.032). CONCLUSIONS: Early wearing of KAFO, irrespective of the difference in ADL at the time of KAFO wearing, may have a positive impact on the improvement of ADL in patients after stroke.

Timing and dosage of FES cycling early after acute spinal cord injury: A case series report.

OBJECTIVE: To understand the progression in parameters of functional electrical stimulation (FES) cycling dosage (including duration, velocity, stimulation amplitudes, power output), and the resulting changes in muscle mass early after acute spinal cord injury (SCI). METHODS: Three participants, 24-38 years old, with neurological injury level C4-T4, severity AIS (American Spinal Injury Association Impairment Scale) A-C, started FES cycling 16-20 days post injury while admitted at a level-1 trauma center in Canada, and continued for 8-13 weeks in a rehabilitation hospital. They performed three sessions/week of 15-45 min FES cycling, supine or sitting. FES parameters, cycling performance, and muscle cross-sectional area (CSA) in thighs and calves were measured every 2 weeks. RESULTS: Progression in power output, but not in session duration, was limited in two participants who experienced stimulation-associated referred pain or apprehension, requiring limitation of stimulation amplitudes for up to 65 days after the start of FES cycling. Participants started with 15 min cycling at 20 RPM with no resistance (0 W), and progressed to 30-45 min at 30 RPM producing 8.8-19.0 W average power/session after 2-3 months. Initially, muscle CSA decreased in all 3 participants (up to 16% after 6 weeks), and recovered later after a variable period of FES cycling (up to 16% at 13.3 weeks). CONCLUSION: Progression of FES cycling in the first 3 months after injury required a highly individualized approach, guided by participant response, rather than standardized increments in stimulation intensity or duration. Changes in muscle CSA did not always correspond with the dose of FES cycling.

Very Early Exercise Rehabilitation After Intracerebral Hemorrhage Promotes Inflammation in the Brain.

BACKGROUND: Very early exercise has been reported to exacerbate motor dysfunction; however, its mechanism is largely unknown. OBJECTIVE: This study examined the effect of very early exercise on motor recovery and associated brain damage following intracerebral hemorrhage (ICH) in rats. METHODS: Collagenase solution was injected into the left striatum to induce ICH. Rats were randomly assigned to receive placebo surgery without exercise (SHAM) or ICH without (ICH) or with very early exercise within 24 hours of surgery (ICH+VET). We observed sensorimotor behaviors before surgery, and after surgery preexercise and postexercise. Postexercise brain tissue was collected 27 hours after surgery to investigate the hematoma area, brain edema, and Il1b, Tgfb1, and Igf1 mRNA levels in the striatum and sensorimotor cortex using real-time reverse transcription polymerase chain reaction. NeuN, PSD95, and GFAP protein expression was analyzed by Western blotting. RESULTS: We observed significantly increased skillful sensorimotor impairment in the horizontal ladder test and significantly higher Il1b mRNA levels in the striatum of the ICH+VET group compared with the ICH group. NeuN protein expression was significantly reduced in both brain regions of the ICH+VET group compared with the SHAM group. CONCLUSION: Our results suggest that very early exercise may be associated with an exacerbation of motor dysfunction because of increased neuronal death and region-specific changes in inflammatory factors. These results indicate that implementing exercise within 24 hours after ICH should be performed with caution.

Implementation of the "awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility" bundle in the pediatric intensive care unit of tertiary hospitals in southwestern China: a cross-sectional survey.

OBJECTIVE: To investigate management and implementation of the "awakening and breathing trials, choice of drugs, delirium management, and early exercise/mobility" (ABCDE) bundle in the pediatric intensive care unit (PICU) in southwestern China. METHODS: A self-designed questionnaire for determining implementation of the ABCDE bundle was distributed to healthcare professionals in the PICU. Multiple linear regression was used to analyze results. RESULTS: A total of 270 questionnaires were collected. There was no significant difference in the awareness of the ABCDE bundle rate among Sichuan, Guizhou, and Yunnan workers. Only dynamic adjustment of drug dose accounted for more than half (55.5%) of "frequent implementation" and "general implementation", followed by implementation of sedation assessment, pain assessment, and spontaneous breathing trials (46.4%, 39.3%, and 35.6%, respectively). A total of 80.4% of healthcare professionals never performed screening of delirium. Multivariate analysis showed that the healthcare professionals' scores of ABCDE bundle behavior significantly differed regarding awareness of the ABCDE bundle, years of work at the hospital, the region of hospitals, and occupational category. CONCLUSION: Implementation of the ABCDE bundle in the PICU in southwestern China is not sufficient. Existing problems need to be identified and a standardized sedation and analgesia management model needs to be established.

Early Exercise after Intracerebral Hemorrhage Inhibits Inflammation and Promotes Neuroprotection in the Sensorimotor Cortex in Rats.

The present study examined the effect of early exercise on brain damage and recovery of motor function following intracerebral hemorrhage (ICH) in rats. Subjects were randomly assigned to no training after ICH (ICH), no training after sham surgery (SHAM), early treadmill exercise after ICH (ICH + ET), and late treadmill exercise after ICH (ICH + LT) groups. The ICH + ET and ICH + LT groups were trained for seven consecutive days starting on day 2 and day 9 after surgery, respectively. At post surgery day 16, the brain was surgically excised, and lesion volume, cortical thickness, neuronal number, dendritic length, and dendritic complexity were analyzed. Expression levels of IL-1b, TGF-b1, and IGF-1 mRNAs in ipsilateral sensorimotor cortex were measured by RT-PCR. The recovery of motor function in the ICH + ET group was the most accelerated. Cortical thickness and neuronal number were significantly higher in the ICH + ET group than the ICH and ICH + LT groups. The length and complexity of dendrites were also significantly greater in the ICH + ET group compared with the ICH and ICH + LT groups. Expression of IL-1b mRNA was significantly lower in the ICH + ET group than that in the ICH group. Collectively, these results suggest that early treadmill exercise after ICH promotes recovery of sensorimotor function by preventing neuronal death and ensuing cortical atrophy and by preserving dendritic structure compared with late treadmill exercise and no exercise. Early exercise may prevent neurodegeneration and functional loss by inhibiting neuroinflammation.

Early treadmill exercise increases macrophage migration inhibitory factor expression after cerebral ischemia/reperfusion.

The neuroprotective function of macrophage migration inhibitory factor (MIF) in ischemic stroke was rarely evaluated. This study aimed to investigate the effects of early treadmill exercise on recovery from ischemic stroke and to determine whether these effects are associated with the expression levels of MIF and brain-derived neurotrophic factor (BDNF) in the ischemic area. A total of 40 male Sprague-Dawley rats were randomly assigned to the ischemia and exercise group [middle cerebral artery occlusion (MCAO)-Ex, n = 10), ischemia and sedentary group (MCAO-St, n = 10), sham-surgery and exercise group (Sham-Ex, n = 10), or sham-surgery and sedentary group (Sham-St, n = 10). The MCAO-Ex and MCAO-St groups were subjected to MCAO for 60 minutes, whereas the Sham-Ex and Sham-St groups were subjected to an identical operation without MCAO. Rats in the MCAO-Ex and Sham-Ex groups then ran on a treadmill for 30 minutes once a day for 5 consecutive days. After reperfusion, the hanging time tested by the wire hang test was longer and the relative fractional anisotropy determined by MRI was higher in the peri-infarct region of the MCAO-Ex group compared with the MCAO-St group. The expression levels of MIF and BDNF in the peri-infarct region were upregulated in the MCAO-Ex group. Increased MIF and BDNF levels were positively correlated with relative fractional anisotropy changes in the peri-infarct region. There was no significant difference in the levels of MIF and BDNF in the peri-infarct region between the Sham-Ex and Sham-St groups. Our study demonstrated that early exercise (initiated 48 hours after the MCAO) could improve motor and neuronal recovery after ischemic stroke. Furthermore, the increased levels of MIF and BDNF in the peri-infarct region (penumbra) may be one of the mechanisms of enhanced neurological function recovery. All experiments were approved by the Institutional Animal Care and Use Committee in Asan Medical Center in South Korea (2016-12-126).

Proinflammatory cytokines correlate with early exercise attenuating anxiety-like behavior after cerebral ischemia.

Background and Objective: Stroke may cause neuropsychiatric problems, which have negative effects on cognitive functions and behavior. Exercise plays an important role in reducing the occurrence and development of stroke, the concrete mechanism is not fully clarified. In this study, we attempted to determine whether early treadmill exercise attenuates anxiety-like behavior by regulation of inflammation after brain ischemia. Method: We subjected adult male rats to middle cerebral artery occlusion (MCAO) for 90 min and trained rats started to run on a treadmill from postoperative day 1 to day 14. The effects of treadmill on cognitive functions, anxiety-like behavior, and immune activation were analyzed by Morris water maze test, open field test, elevated plus maze test, and enzyme-linked immunosorbent assay. Results: Early treadmill exercise significantly improved cognitive function, alleviated anxiety-like behavior in ischemic rats model; this improvement was associated with significantly decreased activation of astrocytes and microglia cells and proinflammatory markers (platelet-activating factor [PAF], interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-α], intercellular adhesion molecule-1 [ICAM-1], and vascular cell adhesion molecule-1 [VCAM-1]). Conclusion: Our results indicated that early treadmill exercise attenuated anxiety-like behavior by decreasing inflammation response, exercise conferred a great benefit of attenuating anxiety-like behavior via anti-inflammatory treatment may prove to be a novel neuroprotective strategy for stroke.

Radiological study of the secondary reduction effect of early functional exercise on displaced intra-articular calcaneal fractures after internal compression fixation.

PURPOSE: Early post-operative exercise and weight-bearing activities are found to improve the functional recovery of patients with displaced intra-articular calcaneal fractures (DIACFs). We hypothesized that early functional exercise after surgery might have a secondary reduction effect on the subtalar joint, in particular the smaller fracture fragments that were not fixed firmly. A prospective study was conducted to verify this hypothesis. METHODS: From December 2012 to September 2013, patients with unilateral DIACFs were enrolled and received a treatment consisting of percutaneous leverage and minimally invasive fixation. After surgery, patients in the study group started exercising on days two to three, using partial weight bearing starting week three, and full weight bearing starting week 12. Patients in the control group followed a conventional post-operative protocol of partial weight bearing after week six and full weight bearing after the bone healed. Computed tomography (CT) scanning was performed at post-operative day one, week four, week eight, and week 12 to reconstruct coronal, sagittal, and axial images, on which the maximal residual displacements of the fractures were measured. Function was evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) scoring scale at the 12th post-operative month. RESULTS: Twenty-eight patients in the study group and 32 in the control group were followed up for more than 12 months; their data were collected and used for the final analysis. Repeated-measures analysis of variance (ANOVA) of the maximal residual displacements of the fracture measured on CT images revealed significant differences between the study and the control groups. There were interaction effects between group and time point. Except for the first time point, the differences between the groups at all studied time points were significant. In the study group, the differences between all studied time points were significant. Strong correlations were observed between the AOFAS score at post-operative month 12 and the maximal residual displacement of the fractures on the CT images at postoperative week 12. CONCLUSIONS: Early functional exercise and weight bearing activity can smooth and shape the subtalar joint and reduce the residual displacement of the articular surface, improving functional recovery of the affected foot. Therefore, early rehabilitation functional exercise can be recommended in clinical practice.

SCIPA Switch-On: A Randomized Controlled Trial Investigating the Efficacy and Safety of Functional Electrical Stimulation-Assisted Cycling and Passive Cycling Initiated Early After Traumatic Spinal Cord Injury.

Background. Substantial skeletal muscle atrophy after spinal cord injury (SCI) carries significant repercussions for functional recovery and longer-term health. Objective. To compare the efficacy, safety, and feasibility of functional electrical stimulation-assisted cycling (FESC) and passive cycling (PC) to attenuate muscle atrophy after acute SCI. Methods. This multicenter, assessor-blinded phase I/II trial randomized participants at 4 weeks post-SCI to FESC or PC (4 sessions per week, 1 hour maximum per session, over 12 weeks). The primary outcome measure was mean maximum cross-sectional area (CSA) of thigh and calf muscles (magnetic resonance imaging), and secondary outcome measures comprised body composition (dual energy X-ray absorptiometry), anthropometry, quality of life, and adverse events (AEs). Results. Of 24 participants, 19 completed the 12-week trial (10 FESC, 9 PC, 18 male). Those participants completed >80% of training sessions (FESC, 83.5%; PC, 85.9%). No significant between-group difference in postintervention muscle CSA was found. No significant between-group difference was found for any other tissue, anthropometric parameter, or behavioral variable or AEs. Six participants experienced thigh hypertrophy (FESC = 3; PC = 3). Atrophy was attenuated (<30%) in 15 cases (FESC = 7; PC = 8). Conclusions. Both cycle ergometry regimens examined were safe, feasible, and well tolerated early after SCI. No conclusions regarding efficacy can be drawn from our data. Further investigation of both modalities early after SCI is required.

Recovery of calf muscle endurance 3 months after an Achilles tendon rupture.

The purpose of this study was to evaluate calf muscle endurance in a seated position 3 months after an Achilles tendon rupture and to evaluate how the ability to perform standardized seated heel-rises correlated to the single-leg standing heel-rise test and to patient-reported symptoms evaluated with the Achilles tendon Total Rupture Score (ATRS) 3 and 6 months after the injury. Ninety-three patients were included from a cohort of 101 patients participating in a prospective, randomized controlled trial comparing surgical and nonsurgical treatment after Achilles tendon rupture. Forty-seven patients were treated surgically and 46 nonsurgically. Ninety-one patients out of 93 (98%) could perform the standardized seated heel-rises. At the 3-month follow-up, there was a significant difference (P < 0.001) between the injured and the healthy side performing standardized seated heel-rises. There were also significant correlations (r = 0.29-0.37, P = < 0.05) between the standardized seated heel-rises and ATRS 3 and 6 months after injury in the group who could not perform single-leg standing heel-rises. There were no significant differences between the surgical and nonsurgical treatment groups. The evaluation of standardized seated heel-rises appears to be a useful tool to quantify progress and predict future functional performance and patient-reported symptoms.

Systematic review of early exercise in intensive care: A qualitative approach.

INTRODUCTION: Practice guidelines recommend early physical therapy in intensive care units (ICU). Feasibility, safety and efficacy are confirmed by growing evidence-based data. PURPOSE: To perform a qualitative systematic literature review on early exercise in ICUs, focused on the subject areas of "how to do", "for which patients" and "for what benefits". METHODS: Articles were obtained from the PubMed, Google Scholar, Physiotherapy Evidence Database (PEDro), Embase, CINAHL, CENTRAL, Cochrane and ReeDOC databases. The full texts of references selected according to title and abstract were read. Data extraction and PEDro scoring were performed. Consort recommendations were used for the drafting of the systematic review, which was declared on the Prospero website. RESULTS: We confirm the feasibility and safety of early exercise in the ICU. Convergent evidence-based data are in favour of the efficacy of early exercise programs in ICUs. But the potential benefit of earlier program initiation has not been clearly demonstrated. Our analysis reveals tools and practical modalities that could serve to standardize these programs. The scientific literature mainly emphasizes the heterogeneity of targeted populations and lack of precision concerning multiple criteria for early exercise programs. CONCLUSION: Changes in the professional culture of multidisciplinary-ICU teams are necessary as concerns early exercise. Physical therapists must be involved and their essential role in the ICU is clearly justified. Although technical difficulties and questions remain, the results of the present qualitative review should encourage the early and progressive implementation of exercise programs in the ICU.