The role of exercise in the treatment of depression: biological underpinnings and clinical outcomes.

Globally, depression is a leading cause of disability and has remained so for decades. Antidepressant medications have suboptimal outcomes and are too frequently associated with side effects, highlighting the need for alternative treatment options. Although primarily known for its robust physical health benefits, exercise is increasingly recognized for its mental health and antidepressant benefits. Empirical evidence indicates that exercise is effective in treating individuals with depression; however, the mechanisms by which exercise exerts anti-depressant effects are not fully understood. Acute bouts of exercise have been shown to transiently modulate circulating levels of serotonin and norepinephrine, brain-derived neurotrophic factor, and a variety of immuno-inflammatory mechanisms in clinical cohorts with depression. However, exercise training has not been demonstrated to consistently modulate such mechanisms, and evidence linking these putative mechanisms and reductions in depression is lacking. The complexity of the biological underpinnings of depression coupled with the intricate molecular cascade induced by exercise are significant obstacles in the attempt to disentangle exercise's effects on depression. Notwithstanding our limited understanding of these effects, clinical evidence uniformly argues for the use of exercise to treat depression. Regrettably, exercise remains underutilized despite being an accessible, low-cost alternative/adjunctive intervention that can simultaneously reduce depression and improve overall health. To address the gaps in our understanding of the clinical and molecular effects of exercise on depression, we propose a model that leverages systems biology and multidisciplinary team science with a large-scale public health investment. Until the science matches the scale of complexity and burden posed by depression, our ability to advance knowledge and treatment will continue to be plagued by fragmented, irreproducible mechanistic findings and no guidelines for standards of care.

The Effects of Multiple-Joint Isokinetic Resistance Training on Maximal Isokinetic and Dynamic Muscle Strength and Local Muscular Endurance.

The transfer of training effects of multiple-joint isokinetic resistance training to dynamic exercise performance remain poorly understood. Thus, the purpose of the present study was to investigate the magnitude of isokinetic and dynamic one repetition-maximum (1RM) strength and local muscular endurance increases after 6 weeks of multiple-joint isokinetic resistance training. Seventeen women were randomly assigned to either an isokinetic resistance training group (IRT) or a non-exercising control group (CTL). The IRT group underwent 6 weeks of training (2 days per week) consisting of 5 sets of 6-10 repetitions at 75-85% of subjects' peak strength for the isokinetic chest press and seated row exercises at an average linear velocity of 0.15 m s(-1) [3-sec concentric (CON) and 3-sec eccentric (ECC) phases]. Peak CON and ECC force during the chest press and row, 1RM bench press and bent-over row, and maximum number of modified push-ups were assessed pre and post training. A 2 x 2 analysis of variance with repeated measures and Tukey's post hoc tests were used for data analysis. The results showed that 1RM bench press (from 38.6 ± 6.7 to 43.0 ± 5.9 kg), 1RM bent-over row (from 40.4 ± 7.7 to 45.5 ± 7.5 kg), and the maximal number of modified push-ups (from 39.5 ± 13.6 to 55.3 ± 13.1 repetitions) increased significantly only in the IRT group. Peak isokinetic CON and ECC force in the chest press and row significantly increased in the IRT group. No differences were shown in the CTL group for any measure. These data indicate 6 weeks of multiple-joint isokinetic resistance training increases dynamic muscle strength and local muscular endurance performance in addition to specific isokinetic strength gains in women. Key pointsMultiple-joint isokinetic resistance training increases dynamic maximal muscular strength, local muscular endurance, and maximal isokinetic strength in women.Multiple-joint isokinetic resistance training increased 1RM strength in the bench press (by 10.2%), bent-over barbell row (by 11.2%), and maximal modified push-up performance (by 28.6%) indicating a carryover of training effects to dynamic exercise performance.The carryover effects may be attractive to strength training and conditioning professionals seeking to include alternative modalities such as multiple-joint isokinetic dynamometers to resistance training programs.

Comparison of the acute metabolic responses to traditional resistance, body-weight, and battling rope exercises.

The purpose of this study was to quantify and compare the acute metabolic responses to resistance exercise protocols comprising free-weight, body-weight, and battling rope (BR) exercises. Ten resistance-trained men (age = 20.6 ± 1.3 years) performed 13 resistance exercise protocols on separate days in random order consisting of only one exercise per session. For free-weight exercise protocols, subjects performed 3 sets of up to 10 repetitions with 75% of their 1 repetition maximum. For the push-up (PU) and push-up on a BOSU ball protocols, subjects performed 3 sets of 20 repetitions. For the burpee and PU with lateral crawl protocols, subjects performed 3 sets of 10 repetitions. For the plank and BR circuit protocols, subjects performed 3 sets of 30-second bouts. A standard 2-minute rest interval (RI) was used in between all sets for each exercise. Data were averaged for the entire protocol including work and RIs. Mean oxygen consumption was significantly greatest during the BR (24.6 ± 2.6 ml·kg·min) and burpee (22.9 ± 2.1 ml·kg·min) protocols. For the free-weight exercises, highest mean values were seen in the squat (19.6 ± 1.8 ml·kg·min), deadlift (18.9 ± 3.0 ml·kg·min), and lunge (17.3 ± 2.6 ml·kg·min). No differences were observed between PUs performed on the floor vs. on a BOSU ball. However, adding a lateral crawl to the PU significantly increased mean oxygen consumption (19.5 ± 2.9 ml·kg·min). The lowest mean value was seen during the plank exercise (7.9 ± 0.7 ml·kg·min). These data indicate performance of exercises with BRs and a body-weight burpee exercise elicit relatively higher acute metabolic demands than traditional resistance exercises performed with moderately heavy loading.

Effectiveness of different postactivation potentiation protocols with and without whole body vibration on jumping performance in college athletes.

This study examined the acute effects of different parallel squat postactivation potentiation protocols with and without whole body vibration on jumping performance in college athletes. Fifteen men (20.3 ± 1.3 years, 179.50 ± 5.3 cm, 81.0 ± 10.8 kg) performed 3 repetitions of a countermovement jump (CMJ) and best drop jump after 3 conditions: (a) parallel squat with 80% 1 repetition maximum without vibration (NV-PS), (b) parallel squat with 80% 1 repetition maximum on a whole body vibration platform (WBV-PS) (1.963-mm amplitude and 40 Hz), and (c) control (C). Each condition was performed under both low-volume (LV) (1 set of 3 repetitions) and high-volume (HV) (3 sets of 3 repetitions) protocols that were followed by both 1- and 4-minute rest periods. Significant improvements were observed for the CMJ height (p = 0.005) after 4 minutes of recovery and the LV protocol (p = 0.015) regardless of the condition. Additionally, for the WBV-PS condition, a significantly lower drop jump height was observed after 1 minute (p = 0.0022) after both low (p = 0.022) and HV (0.010) protocols. In conclusion, 4 minutes of recovery was adequate for improving CMJ height after an LV protocol regardless of the condition and restoring drop jump height performance after WBV-PS regardless of the protocol in male college athletes.

Acute oxygen uptake and resistance exercise performance using different rest interval lengths: the influence of maximal aerobic capacity and exercise sequence.

The purpose of this study was to examine the relationship between VO2max and acute resistance exercise performance and the acute metabolic effects of exercise sequencing. Seventeen resistance-trained men were tested for VO2max and 1 repetition maximum (1RM) strength. Subjects were randomly assigned to either a group that performed the squat first in sequence followed by the bench press (S; n = 8) or a group that performed the bench press first followed by the squat (BP; n = 9). Each group performed 3 protocols (using 1-, 2-, or 3-minute rest intervals [RIs] between sets in random order) consisting of 5 sets of each exercise with 75% of their 1RM for up to 10 repetitions while oxygen consumption was measured. Total repetitions completed were highest with 3-minute RI and lowest with 1-minute RI. Mean VO2 was significantly highest with 1-minute RI and lowest using 3-minute RI. Analysis of each exercise revealed a tendency (p = 0.07) for mean bench press VO2 to be higher when it was performed after the squat using 1- and 2-minute RIs. VO2max was significantly negatively correlated to 1RM bench press and squat (r = -0.79 and -0.60, respectively) and was significantly correlated to squat repetitions (r = 0.43-0.57) but did not correlate to bench press performance. It seems that VO2max is related to lower-body resistance exercise performance when short RIs are used, and the metabolic response to the bench press is augmented when it follows the squat in sequence using short RIs.

Acute effects of aerobic exercise on corticomotor plasticity in individuals with and without depression.

BACKGROUND: Although complex in nature, the pathophysiology of depression involves reduced or impaired neuroplastic capabilities. Restoring or enhancing neuroplasticity may serve as a treatment target for developing therapies for depression. Aerobic exercise (AEx) has antidepressant benefits and may enhance neuroplasticity in depression although the latter has yet to be substantiated. Therefore, we sought to examine the acute effect of AEx on neuroplasticity in depression. METHODS: Sixteen individuals with (DEP; 13 female; age = 28.5 ± 7.3; Montgomery-Äsberg Depression Rating Scale [MADRS] = 21.3 ± 5.2) and without depression (HC; 13 female; age 27.2 ± 7.5; MADRS = 0.8 ± 1.2) completed three experimental visits consisting of 15 min of low intensity AEx (LO) at 35% heart rate reserve (HRR), high intensity AEx (HI) at 70% HRR, or sitting (CON). Following AEx, excitatory paired associative stimulation (PAS25ms) was employed to probe neuroplasticity. Motor evoked potentials (MEP) were assessed via transcranial magnetic stimulation before and after PAS25ms to indicate acute changes in neuroplasticity. RESULTS: PAS25ms primed with HI AEx led to significant increases in MEP amplitude compared to LO and CON. HI AEx elicited enhanced PAS25ms-induced neuroplasticity for up to 1-h post-PAS. There were no significant between-group differences. CONCLUSION: HI AEx enhances PAS measured neuroplasticity in individuals with and without depression. HI AEx may have a potent influence on the brain and serve as an effective primer, or adjunct, to therapies that seek to harness neuroplasticity.

Relative handgrip strength as a vitality measure in US stroke survivors.

PURPOSE: Stroke is a leading cause of long-term disability in the US, yet a feasible assessment measure with predictive value for components of the International Classification of Functioning, Disability, and Health (ICF) Core Set for Stroke is lacking. The purpose of the present study was to explore the predictive value of potential assessment measures on factors within each ICF component in stroke survivors. MATERIALS AND METHODS: Demographic, anthropometric, blood-based biomarker, physical functioning, and Global Physical Activity Questionnaire data were collected on stroke survivors in the 2011-2018 NHANES cycles. Potential predictors (handgrip strength relative to weight, age, sex, race, education level, marital status, poverty ratio, stroke chronicity) of physical function, activities of daily living (ADLs), participation in social activities, metabolic syndrome, and meeting physical activity recommendations were evaluated using weighted linear and ordinal logistic regression. RESULTS: Relative handgrip strength was a significant predictor of physical function, difficulty participating in ADLs and social activities, and odds of meeting physical activity recommendations. As relative handgrip strength increased, these factors improved among stroke survivors. CONCLUSIONS: To decrease disability rates and optimize function among stroke survivors, the use of assessment measures like relative handgrip strength that may predict multiple ICF components is warranted.

Handgrip strength relative to weight may be a significant predictor of multiple components of the International Classification of Functioning, Disability, and Health (ICF) Core Set for Stroke, including physical function, difficulty completing activities of daily living, difficulty participating in social activities, and the odds of meeting physical activity recommendations.Environmental and personal factors, such as income and education, may influence outcomes; thus, education and appropriate resources may need to be included as an aspect of stroke rehabilitation.The heterogenous and pervasive effects of chronic stroke highlight the need to identify outcome measures, like relative handgrip strength, that can influence multiple domains of stroke recovery.

Effects of a competitive wrestling season on body composition, endocrine markers, and anaerobic exercise performance in NCAA collegiate wrestlers.

Few data exist examining the body composition, endocrine, and anaerobic exercise performance changes over a competitive wrestling season. Eighteen NCAA wrestlers were tested for endocrine markers, body composition, hydration, grip strength, and power on four occasions: prior to pre-season training (T1); after pre-season training 3 days prior to the first seasonal meet (T2); mid-season one day prior to a meet (T3); and at the end of the season 2-3 days following the last meet (T4). Body mass, percent body fat (BF %), and fat mass were significantly lower (P ≤ 0.05) at T2 and T3 compared to T1 but were not different between T1 and T4. Lean body mass was significantly reduced at T2 only. Urine specific gravity was significantly elevated at T3 compared to T1, T2, and T4. Resting cortisol concentrations did not change but resting testosterone concentrations were significantly reduced at T2, T3, and T4. Maximal grip strength was significantly reduced at T2. Vertical jump peak power was significantly reduced at T2, T3, and T4. Wingate peak power was significantly reduced at T2 and T3. However, Wingate average power and total work did not significantly change. Fatigue rate during the Wingate test was significantly improved at T2, T3, and T4 compared to T1. In conclusion, body mass, BF %, and measures of peak force and power were reduced for most of the competitive wrestling season. Competitive wrestling reduces resting total testosterone concentrations throughout the entire season.

Feasibility of performing a multi-arm clinical trial examining the novel combination of repetitive transcranial magnetic stimulation and aerobic exercise for post-stroke depression.

BACKGROUND: Post-stroke depression (PSD) occurs in approximately one-third of chronic stroke survivors. Although pharmacotherapy reduces depressive symptoms, side effects are common and stroke survivors have increased likelihood of multimorbidity and subsequent polypharmacy. Thus, alternative non-pharmacological treatments are needed. Combining two non-pharmacological anti-depressant treatments, aerobic exercise (AEx) and repetitive transcranial magnetic stimulation (rTMS), has been demonstrated to be feasible and well-tolerated in chronic stroke survivors. OBJECTIVES: The purpose of this trial was to determine the feasibility of conducting a multi-arm combinatorial trial of rTMS and AEx and to provide an estimate of effect size of rTMS+AEx on PSD symptoms. METHODS: Twenty-four participants were allocated to one of four treatment arms AEx, rTMS, rTMS+AEx, or non-depressed Control receiving AEx. All participants received a total of 24 treatment sessions. Participant adherence was the primary outcome measure for feasibility and within group effect sizes in Patient Health Questionnaire-9 (PHQ-9) score was the primary outcome for preliminary efficacy. RESULTS: Mean adherence rates to the exercise intervention for AEx, rTMS+AEx, and Control subjects were 83%, 98%, and 95%, respectively. Mean adherence rates for rTMS and rTMS+AEx subjects were 97% and 99%, respectively. The rTMS and rTMS+AEx treatment groups demonstrated clinically significant reductions of 10.5 and 6.2 points in PHQ-9 scores, respectively. CONCLUSION: Performing a multi-arm combinatorial trial examining the effect of rTMS+AEx on PSD appears feasible. All treatment arms demonstrated strong adherence to their respective interventions and were well received. rTMS and the combination of AEx with rTMS may be alternative treatments for PSD.

Effect of power training on rate of torque development and spatiotemporal gait parameters post stroke.

BACKGROUND: Maximizing independence and function post-stroke are two common therapy goals. Rate of torque development in lower-extremity muscles was recently reported to be associated with walking speed; however, trainability and subsequent effect on gait is unknown. This study aimed to determine effect of power training on paretic and non-paretic limb torque parameters, spatiotemporal gait parameters, and walking speed in chronic stroke survivors. METHODS: Individuals with chronic stroke (n = 22; 7 females; 62.7 ± 8.8 yrs) completed 24 progressive power-training sessions over 8 weeks with pre and post assessments. Knee extensor strength was assessed via dynamometry with torque parameters measured from maximal voluntary isometric contractions. Gait speed and spatiotemporal gait parameters were assessed via an instrumented gait mat, and a 6-min walk test was performed. FINDINGS: Rate of torque development at 200 ms and peak torque improved 58.6% and 14.1%, respectively, in the quadricep of the paretic limb (p < 0.05); conversely the non-paretic limb was unchanged. On average, self-selected walking speed, fastest-comfortable walking speed, and 6-min walk test improved 21.7%, 21.1%, and 19.5%, respectively (all p < 0.05). Change in torque development at 100 ms in the quadricep of the non-paretic limb was positively associated with improvements in self-selected and fastest-comfortable walking speeds (both r = 0.70, p < 0.05) and 6-min walk (r = 0.78, p < 0.001). INTERPRETATIONS: These findings suggest power training may be an effective intervention for improving torque development in the quadricep of the paretic limb in individuals with chronic stroke. Further research to explore utility and mechanistic aspects of force development for gait function in chronic stroke survivors is warranted.

Combined Aerobic Exercise and Virtual Reality-Based Upper Extremity Rehabilitation Intervention for Chronic Stroke: Feasibility and Preliminary Effects on Physical Function and Quality of Life.

Objectives: To (1) examine the feasibility of combining lower extremity aerobic exercise (AEx) with a virtual reality (VR) upper extremity (UE) rehabilitation intervention and (2) provide an estimate of effect size for the combined intervention on UE function, aerobic capacity, and health-related quality of life. Design: Single-group feasibility trial. Setting: Research laboratory. Participants: Community-dwelling individuals with mild to moderate impairment of the UE at least 6 months post stroke (N=10; male, n=6; female n=4; mean age, 54 years). Intervention: All participants received 18 sessions over a nominal 2-3 sessions per week schedule of a combined AEx and VR-UE rehabilitation intervention. During each session, participants completed 15 minutes of lower extremity AEx followed by playing a VR-UE rehabilitation game for approximately 20 minutes. Main Outcome Measures: Feasibility was evaluated by metrics of adherence, retention, treatment acceptability, data completeness, and adverse events. UE function, aerobic capacity (peak oxygen consumption [Vo2peak]), and quality of life were assessed with the Fugl-Meyer Assessment of Upper Extremity (FMA-UE), expired gas exchange analysis, and Stroke Impact Scale (SIS), respectively. Results: Adherence was 100%, and there were no withdrawals or losses to follow-up to report. Participants completed the intervention in 49±14 days. Cohen's dz effect size calculations indicated the intervention elicited medium effects on FMA-UE (dz =0.50) and SIS memory domain (dz =0.46) and large effects on absolute Vo2peak (dz =1.46), relative Vo2peak (dz =1.21), SIS strength (dz =1.18), and SIS overall recovery domains (dz =0.81). Conclusions: Combining lower extremity AEx and VR-UE rehabilitation appears feasible in the clinical research setting. Fifteen minutes of lower extremity AEx performed at vigorous intensity appears to elicit clinically meaningful benefits in chronic stroke. Further examination of the combination of lower extremity AEx and VR-UE rehabilitation and its effects on physical function and quality of life is warranted.

The effects of rest interval length manipulation of the first upper-body resistance exercise in sequence on acute performance of subsequent exercises in men and women.

The purpose of the present study was to investigate the effects of manipulating rest interval (RI) length of the first upper-body exercise in sequence on subsequent resistance exercise performance. Twenty-two men and women with at least 1 year of resistance training experience performed resistance exercise protocols on 3 occasions in random order. Each protocol consisted of performing 4 barbell upper-body exercises in the same sequence (bench press, incline bench press, shoulder press, and bent-over row) for 3 sets of up to 10 repetitions with 75% of 1 repetition maximum. Bench press RIs were 1, 2, or 3 minutes, whereas other exercises were performed with a standard 2-minute rest interval. The number of repetitions completed, average power, and velocity for each set of each exercise were recorded. Gender differences were observed during the bench press and incline press as women performed significantly (p ≤ 0.05) more repetitions than men during all RIs. The magnitude of decline in velocity and power over 3 sets of the bench press and incline press was significantly higher in men than women. Manipulation of RI length during the bench press did not affect performance of the remaining exercises in men. However, significantly more repetitions were performed by women during the first set of the incline press using 3-minute rest interval than 1-minute rest interval. In men and women, performance of the incline press and shoulder press was compromised compared with baseline performances. Manipulation of RI length of the first exercise affected performance of only the first set of 1 subsequent exercise in women. All RIs led to comparable levels of fatigue in men, indicating that reductions in load are necessary for subsequent exercises performed in sequence that stress similar agonist muscle groups when 10 repetitions are desired.

The effects of rest interval length on acute bench press performance: the influence of gender and muscle strength.

The purpose of this study was to investigate the effects of rest interval (RI) length on bench press performance in subjects with disparity in maximum strength. Two cohorts of subjects performed 3 bench press protocols in random order consisting of 3 sets of up to 10 repetitions with 75% of 1-repetition maximum (1RM) using either 1-, 2-, or 3-minute RIs between sets. In the first cohort, 22 men and women were studied to investigate gender influence. In the second cohort, 23 men were tested for 1RM bench press strength and placed into a low 1RM (mean = 80.7 ± 7.5 kg) or high 1RM (mean = 140.6 ± 11.9 kg) experimental group. The number of successful repetitions completed, average power, and velocity for each set were recorded. Women performed significantly more repetitions than men with 1-minute (26.9 ± 4.4 vs. 21.1 ± 3.5), 2-minute (29.0 ± 2.0 vs. 24.0 ± 4.5), and 3-minute (29.7 ± 1.8 vs. 25.8 ± 5.1) RIs. The magnitude of decline in average velocity and power was significantly higher in men than in women. Total number of repetitions performed was significantly greater in the low 1RM group than in the high 1RM group at 1-minute (21.6 ± 5.0 vs. 18.1 ± 2.0) and 2-minute RIs (24.2 ± 5.4 vs. 21.3 ± 2.8). Significant negative correlations were observed between 1RM bench press and total number of repetitions completed for 1- and 2-minute RIs (r = -0.558 and -0.490, respectively). These data indicate that maximal strength plays a role in bench press performance with varying RIs and suggest that shorter RIs may suffice in women to attain a specific volume.

The effects of treadmill sprint training and resistance training on maximal running velocity and power.

The purpose of the present study was to examine the independent and combined effects of resistance and treadmill sprint training on maximal sprint velocity and power. Twenty-five male athletes (age = 19.8 +/- 1.5 years, height = 181.2 +/- 7.9 cm, body mass = 88.9 +/- 10.9 kg) were matched for 30-m sprint times and assigned to 1 of 3 training groups: 1) sprint training only (ST), 2) resistance training only (RT), or 3) combined sprint and resistance training (SRT) for 7 weeks. Periodized resistance training was performed 4 d.wk (3-4 sets of 6-10 repetitions). The treadmill sprint training program was performed 2 d.wk and consisted of 8-12 sets of maximal sprints for 40-60 m at 0-25% of each athlete's body mass, with rest intervals of 2-3 minutes on a treadmill that was user driven and that enabled loading via a magnetic braking system. Peak 30-m sprint times, power and average velocity attained during maximal sprint trials on the treadmill, and 1-repetition maximum (1RM) squat were determined pre and post training. The 30-m sprint times improved significantly only in the SRT group, and a trend for improvement (p = 0.06) was observed in the ST group. All groups significantly increased treadmill sprint velocity. However, the SRT and ST groups increased significantly more than RT. Only the SRT group increased treadmill sprint peak power. All training groups increased 1RM squat strength significantly by 6.6-8.4 kg, with no differences observed between groups. The results of this study showed that 7 weeks of sprint training on a newly designed treadmill resulted in significant kinematic and kinetic improvements in sprint performance. Of practical significance, treadmill sprint training enhanced land-based sprint performance.

Physical performance characteristics in National Collegiate Athletic Association Division III champion female lacrosse athletes.

The purpose of this study was to examine performance differences between starters and nonstarters and between different playing positions in collegiate female lacrosse athletes. Twenty-two subjects playing on a two-time defending National Champion National Collegiate Athletic Association Division III female lacrosse team volunteered to participate in this study. Subjects were examined during the preseason period and participated in a total of 5 testing sessions, separated by at least 72 hours. Subjects were tested on their 1 repetition maximum (1RM) (bench press and squat), vertical jump, Wingate anaerobic power test (WAnT), 30-second sprint using a nonmotorized treadmill, maximal aerobic capacity, 40-yd sprint, T-drill, and pro-agility test. No significant differences were observed between starters and nonstarters in any performance variable. Anthropometric analysis revealed that attackers were 15.7% (p < 0.05) heavier than midfielders. A significant difference (10.3%) between defenders and midfielders was seen in 1RM squat, while no other strength differences were noted. Attackers were more powerful in the WAnT (both peak and mean power) than both defenders (19.6 and 13.4%, respectively) and midfielders (21.2 and 13.4%, respectively). No significant differences were noted between the groups in any speed or agility measure. Although physical performance characteristics were not different between starters and nonstarters, results indicate that attackers are heavier and more powerful than the other positions and midfielders appear to be weaker in lower-body strength relative to the other positions in lacrosse.

Comparison between different off-season resistance training programs in Division III American college football players.

The purpose of this study was to examine the efficacy of periodization and to compare different periodization models in resistance trained American football players. Fifty-one experienced resistance trained American football players of an NCAA Division III football team (after 10 weeks of active rest) were randomly assigned to 1 of 3 groups that differed only in the manipulation of the intensity and volume of training during a 15-week offseason resistance training program. Group 1 participated in a nonperiodized (NP) training program, group 2 participated in a traditional periodized linear (PL) training program, and group 3 participated in a planned nonlinear periodized (PNL) training program. Strength and power testing occurred before training (PRE), after 7 weeks of training (MID), and at the end of the training program (POST). Significant increases in maximal (1-repetition maximum [1RM]) squat, 1RM bench press, and vertical jump were observed from PRE to MID for all groups; these increases were still significantly greater at POST; however, no MID to POST changes were seen. Significant PRE to POST improvements in the medicine ball throw (MBT) were seen for PL group only. The results do not provide a clear indication as to the most effective training program for strength and power enhancements in already trained football players. Interestingly, recovery of training-related performances was achieved after only 7 weeks of training, yet further gains were not observed. These data indicate that longer periods of training may be needed after a long-term active recovery period and that active recovery may need to be dramatically shortened to better optimize strength and power in previously trained football players.

High-Intensity Aerobic Exercise Acutely Increases Brain-derived Neurotrophic Factor.

Aerobic exercise (AEx) exerts antidepressant effects, although the neurobiological mechanisms underlying such effects are not well understood. Reduced brain-derived neurotrophic factor (BDNF) and elevated cortisol have been implicated in the pathophysiology of depression and appear to normalize with antidepressant treatment. Thus, BDNF and cortisol may serve as biological targets for developing AEx as an antidepressant treatment. PURPOSE: This study examined the effects of AEx, of different intensities, on serum BDNF and cortisol in individuals with and without depression. METHODS: Thirteen participants with depression (10 females; age = 27.2 ± 6.9 yr; Montgomery-Äsberg Depression Rating Scale = 21.7 ± 4.7) and 13 control participants (10 females; age 27.2 ± 7.2 yr; Montgomery-Äsberg Depression Rating Scale = 0.5 ± 0.9) participated. Experimental visits consisted of 15 min of low-intensity cycling (LO) at 35% heart rate reserve, high-intensity cycling (HI) at 70% heart rate reserve, or sitting (CON). During each visit, blood samples were obtained at baseline, immediately postexercise (IP), and then every 15 min postexercise for 1 h (15P, 30P, 45P, and 60P). Group, condition, and time differences in BDNF and cortisol were assessed. RESULTS: There were no group differences in cortisol and BDNF. Secondary analysis revealed that BDNF increased in an intensity-dependent nature at IP, and cortisol was significantly elevated at 15P after HI. Changes in BDNF and cortisol showed significant linear relationships with changes in HR. CONCLUSION: HI AEx can elicit acute, transient increases in BDNF and cortisol in young, healthy, and physically active, nondepressed and mild to moderately depressed individuals. This work suggests that AEx has potential to significantly affect the central nervous system function, and the magnitude of such effect may be directly driven by exercise intensity.

Combining therapeutic approaches: rTMS and aerobic exercise in post-stroke depression: a case series.

Objective and importance Residual effects of stroke include well-documented functional limitations and high prevalence of depression. Repetitive transcranial magnetic stimulation (rTMS) and aerobic exercise (AEx) are established techniques that improve depressive symptoms, but a combination of the two has yet to be reported. The purpose of this case series is to examine the safety, feasibility, and impact of combined rTMS and AEx on post-stroke depression and functional mobility. Clinical presentation Three participants with a history of stroke and at least mild depressive symptoms (Patient Health Questionare-9 ≥5). Intervention Both rTMS and AEx were completed 3 times/week for 8-weeks. rTMS was applied to the left dorsolateral prefrontal cortex, 5000 pulses/session at 10 Hz, at an intensity of 120% of resting motor threshold. AEx consisted of 40 min of treadmill walking at 50-70% of heart rate reserve. Results Depressive symptoms improved in all three participants, with all demonstrating response (≥50% improvement in symptoms) and likely remission. All participants improved their Six Minute Walk Test distance and Participants 1 and 2 also improved Berg Balance Scale scores. Participants 1 and 3 improved overground walking speeds. No serious adverse events occurred with the application of rTMS or AEx and the participants' subjective reports indicated positive responses. Adherence rate for both rTMS and AEx was 98%. Conclusion Combined treatment of rTMS and AEx appears safe, feasible, and tolerable in individuals with a history of stroke and at least mild depressive symptoms. All participants had good compliance and demonstrated improvements in both depressive symptoms and walking capacity.