The Decline of Physical Activity with Age in School-Aged Children with Cerebral Palsy: A Single-Center Cross-Sectional Observational Study.

Maintaining physical activity is important for children with cerebral palsy (CP). This study examined whether age predicted habitual physical activity (HPA) or cardiorespiratory fitness (CRF) in school-aged children with CP and clarified the relationship between HPA and CRF. We utilized cross-sectional data from 39 children with CP (18 girls and 21 boys; mean age 7.44 years; mean body weight 24.76 kg; mean body mass index 15.97 kg/m2; hemiplegic or diplegic CP). The participants wore an accelerometer (ActiGraph) for five days to measure HPA, physical activity energy expenditure (kcal/kg/d), sedentary physical activity (%SPA), light physical activity, moderate-to-vigorous physical activity (%MVPA), and activity counts (counts/min). Participants underwent cardiopulmonary exercise tests on a treadmill using a modified Naughton protocol. Linear regression and correlation analyses were performed. p-value (two-tailed) < 0.05 was considered statistically significant. Age was positively associated with SPA. MVPA negatively correlated with resting heart rate (HR), and activity counts were negatively correlated with resting HR. In conclusion, our study found strong evidence of a negative association between HPA and age in school-aged children with CP. It highlights the importance of creating and improving recreational opportunities that promote physical activity in all children with CP, regardless of whether they are considered therapeutic.

Physical Activity Energy Expenditure Predicts Quality of Life in Ambulatory School-Age Children with Cerebral Palsy.

BACKGROUND: Participation in physical activities is positively associated with better quality of life in children with cerebral palsy (CP). The objective of this study was to elucidate the relationship between the intensity of habitual physical activity (HPA) measured with an accelerometer and health-related quality of life (HRQOL) in school-age children with CP. METHOD: A secondary analysis of the cross-sectional data of 46 ambulatory children with CP was conducted. The participants wore an accelerometer for seven days to measure HPA: activity counts (counts/min) and physical activity energy expenditure (PAEE, kcal/kg/day), as well as %moderate-to-vigorous intensity physical activity (%MVPA), %light intensity physical activity (%LPA), and %sedentary physical activity (%SPA) were measured. Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and Child Health Questionnaire Parent Form 50 Questions (CHQ-PF50) were used to measure HRQOL. A Pearson analysis and a hierarchical regression analysis were performed. RESULTS: PAEE significantly predicted the results of the PedsQL(child) physical domain (ß = 0.579, p = 0.030), PedsQL(child) emotional domain (ß = 0.570, p = 0.037), PedsQL(child) social domain (ß = 0.527, p = 0.043), and PedsQL(child) total (ß = 0.626, p = 0.017). However, other HPA parameters could not predict any other HRQOL. CONCLUSIONS: PAEE could be used as a biomarker in studies on HRQOL and HPA in ambulatory school-age children with CP.

Effect of Equine-Assisted Activities and Therapies on Cardiorespiratory Fitness in Children with Cerebral Palsy: A Randomized Controlled Trial.

Abstract Objectives: To determine the effects of an equine-assisted activities and therapies (EAAT) program on cardiorespiratory fitness (CRF) in children with cerebral palsy (CP). Design: An evaluator-blinded, parallel, two-arm, randomized controlled clinical trial with 1:1 randomization. Settings/Location: A tertiary university hospital and a local arena. Subjects: Forty-six children with CP (24 boys and 22 girls) classified as Gross Motor Function Classification System levels I, II, or III were included. Interventions: The EAAT program was conducted for 40 min twice a week for 16 weeks (32 lessons). Outcome measures: Clinical global impression scales, motor capacity, cardiopulmonary fitness, and habitual physical activity was measured on both groups before and after the 16-week period. Results: Changes in the Clinical Global Impression-Severity scale and Clinical Global Impression-Improvement scale scores were not different between the groups after the intervention. Analysis of covariance revealed statistically significant differences in Gross Motor Function Measure 66 (GMFM 66) (p < 0.05) and Pediatric Balance Scale (p < 0.001) in motor capacity and resting heart rate (HRrest) (p < 0.001) in CRF, between the EAAT group and the control group. Subgroup analysis using multiple linear regression analysis revealed that the GMFM 66 changes had a statistically significant effect on the HRrest changes in the EAAT group (p < 0.05). Conclusions: The present study showed decreased HRrest in children with CP after completing the 16-week EAAT program. This improvement was explained by the improvement of GMFM 66 in the EAAT group. Thus, EAAT may be among the endurance training programs that could be offered to children with CP to improve their CRF. Clinical Trial Registration number: NCT03870893.

Safety and feasibility of symptom-limited cardiopulmonary exercise test using the modified Naughton protocol in children with cerebral palsy: An observational study.

ABSTRACT: Variables derived from the cardiopulmonary exercise test (CPX) provide objective information regarding the exercise capacity of children with cerebral palsy (CP), which can be used as the basis for exercise recommendations. Performing maximal CPX might not be appropriate, safe, or practical for children with CP. In the present study, the safety and feasibility of symptom-limited CPX using the modified Naughton protocol, a submaximal protocol, were investigated in children with CP, Gross Motor Function Classification System (GMFCS) level I or II. The present study included 40 children aged 6 to 12 years with CP who underwent symptom-limited CPX. CPX was performed to measure cardiopulmonary fitness using a treadmill with a modified Naughton protocol. Motor capacity was assessed using the Gross Motor Function Measure (GMFM), Pediatric Balance Scale (PBS), Timed Up and Go (TUG) test, and 6-minute walk test. Thirty-seven children with CP successfully completed testing without any adverse events during or immediately after CPX (dropout rate 7.5%). The reason for test termination was dyspnea (51.4%) or leg fatigue (48.6%). Based on the respiratory exchange ratio (RER), 21 of 37 (56.8%) children chose premature termination. The relationship between the reason for test termination and RER was not statistically significant (Spearman rho = 0.082, P = .631). CPX exercise time was strongly correlated with GMFM (Spearman rho = 0.714) and moderate correlation with PBS (Spearman rho = 0.690) and TUG (Spearman rho = 0.537). Peak oxygen uptake during CPX showed a weak correlation with GMFM and a moderate correlation with PBS. This study revealed that symptom-limited CPX using the modified Naughton protocol was safe and feasible for children with CP and GMFCS level I or II.

The association between motor capacity and motor performance in school-aged children with cerebral palsy: An observational study.

BACKGROUND: This study aimed to investigate the association between motor capacity and motor performance in children with cerebral palsy (CP) aged 6-12 years with Gross Motor Function Classification System (GMFCS) levels I to III. METHODS: Forty-six children with CP (24 boys and 22 girls) classified as GMFCS levels Ⅰ, Ⅱ, or Ⅲ were included. Motor capacity was measured by the Gross motor function measure (GMFM), Pediatric balance scale (PBS), Timed up and go (TUG), and 6-min walk test (6MWT). Motor performance was measured by triaxial accelerometers. Estimations of physical activity energy expenditure (PAEE) (kcal/kg/day), percentage of time spent on physical activity (% sedentary physical activity; %SPA; % light physical activity, %LPA; % moderate physical activity, %MPA; % vigorous physical activity %VPA; and moderate-to-vigorous physical activity, %MVPA), and activity counts (counts/minute) were obtained. RESULTS: Children with GMFCS level I showed a significantly higher motor capacity (GMFM-66, GMFM-88, D-dimension and E-dimension, PBS and 6MWT) than those with level II or III. Children with GMFCS level II and/or III had significantly lower physical activity (PAEE, % MPA, % VPA, %MVPA, and activity counts) than children with GMFCS level I. Multiple linear regression analysis (dependent variable, GMFM-66) showed that %MVPA was positively associated with GMFM-66 in the GMFCS level II & III children but not in GMFCS level I children. CONCLUSIONS: These findings highlight the importance of increasing %MVPA in children with CP, especially GMFCS levels II and III.

Effect of Equine-Assisted Activities on Cardiac Autonomic Function in Children with Cerebral Palsy: A Pilot Randomized-Controlled Trial.

Objective: Children with cerebral palsy (CP) have an impaired cardiac autonomic function. Attenuated heart rate recovery (HRR), which is a valuable prognostic parameter for autonomic nervous system, is known to be associated with an increased risk of cardiovascular events and all-cause mortality. However, only few studies have observed the effects of exercise on the cardiac autonomic function in children with CP. The purpose of this pilot study was to examine the effects of equine-assisted activity (EAA) program on cardiac autonomic function in children with CP. Design: A single-blinded, parallel, two-arm pilot trial with 1:1 randomization to the EAA or control group. Setting: A tertiary university hospital and a local arena. Subjects: Twenty-six children with CP (Gross Motor Function Classification System Levels I-II). Intervention: Each lesson of the EAA program for the EAA group was conducted for 40 min twice a week, and the whole program duration was 16 weeks (a total of 32 sessions). Outcome measures: A graded exercise test was performed to measure the resting heart rate (RHR), HRR, and peak oxygen uptake (VO2peak) on both groups before and after the 16-week period. Results: The autonomic nervous function measured by the response of HRR improved at 1 min (p < 0.009), 3 min (p < 0.001), and 5 min (p < 0.004) only in the EAA group. RHR significantly improved in the EAA group (p < 0.013), whereas the VO2peak did not significantly differ between the two groups. Conclusion: The HRR and RHR of the children with CP improved after completing the 16-week EAA program. The results demonstrated that the program had a positive effect on the improvement of cardiac autonomic function in these patients. Clinical Trial Registration Number: NCT03870893.

Chronological changes in the expression of phosphorylated tau and 5­AMP­activated protein kinase in the brain of senescence­accelerated P8 mice.

Senescence-accelerated mouse prone 8 (SAMP8), a non­transgenic animal model used for researching sporadic Alzheimer's disease (AD), presents AD pathologies and overall dysregulation in brain energy metabolism, which is one of the early pathogenic characteristics of AD. In the present study, the authors examined chronological changes in the expression patterns of phosphorylated tau and of proteins related to energy metabolism to evaluate the association of tau phosphorylation and metabolism, using young­ (2­months­old), middle­ (5­months­old) and old­aged (10­months­old) SAMP8. The levels of phosphorylated 5'­AMP activated protein kinase at Thr172 (p­AMPK) and phosphorylated glycogen synthase kinase 3ß (p­GSK3ßS9) in the cortex of SAMP8 at 2 months were significantly higher than those in senescence­accelerated mouse resistant 1 (SAMR1). The differences were not detected at 5 and 10 months of age, which were concurrent with the changes in levels of phosphorylated tau at Ser396 (p­tauS396), but not with p­tauS262. The level of p­tauS262 was considerably higher in the cortex of middle­aged SAMP8 when compared with that of SAMR1 and sustained in old­aged SAMP8, but not in the young cortex. The levels of cortical sirtuin1 (Sirt1) and insulin receptor substrate 1 (IRS­1) expression of young SAMP8 were significantly lower, when compared with those in SAMR1. However, in the hippocampus of SAMP8, the patterns of chronological changes and levels of p­tau, p­AMPK, Sirt1 and IRS­1 relative to SAMR1 were different from those in the cortex. Taken together, the results suggested that regulation of tau phosphorylation via the AMPK­GSK3ß pathway concurrent with dysregulation of energy metabolism may precede the pathological tau hyperphosphorylation in the cortex of SAMP8, and that the regulation of AMPK­GSK3ß­mediated tau phosphorylation may be dependent on phosphor­epitope in tau or the region of brain.

Short-term effects of Theracurmin dose and exercise type on pain, walking ability, and muscle function in patients with knee osteoarthritis.

The purpose of this study was to investigate the short-term of Theracurmin dose and exercise type on pain, walking ability, and muscle function in patients with knee osteoarthritis. Twenty-five patients with knee osteoarthritis randomly selected to Theracurmin intake (T) group and Theracurmin in combined with exercise (T+E) group. T group (n= 13) was taken orally a capsule of 700 mg, 3 times per day, (total 2,100 mg, 35 mg/kg-body weight). T+E group (n= 12) performed aerobic training of 30-min walking and weight training for increasing leg muscular strength. After treatment, the number of steps, muscle mass, range of motion of knee, and the muscle strength in flexion and extension significantly increased. The percent body fat, visual analogue scale, The Western Ontario and McMaster score, centers of pressure with closed eye, 10-m walking ability, stair ascending speed were significantly decreased after treatment. Although no difference observed between the T and T+E groups, the 4-week intake of Theracurmin with and without exercise appeared to be effective in reducing the pain and enhancing muscular and balancing function. Therefore, Theracurmin intake for early symptoms and additional exercise as symptoms alleviate might be an effective way of delaying and managing osteoarthritis, and additional studies investigating the effects of Theracurmin and exercise on osteoarthritis could be beneficial.

Up-regulation of lipolysis genes and increased production of AMP-activated protein kinase protein in the skeletal muscle of rats after resistance training.

The purpose of this study was to investigate the expression of lipogenesis- and lipolysis-related genes and proteins in skeletal muscles after 12 weeks of resistance training. Sprague-Dawley rats (n=12) were randomly divided into control (resting) and resistance training groups. A tower-climbing exercise, in which rats climbed to the top of their cage with a weight applied to their tails, used for resistance training. After 12 weeks, rats from the resistance training group had lower body weights (411.66±14.71 g vs. 478.33±24.63 g in the control), there was no significant difference between the two groups in the concentrations of total cholesterol, and high or low density lipoprotein cholesterol. However, the concentration of triglyceride was lower in resistance-trained rats (59.83±14.05 µg/mL vs 93.33±33.89 µg/mL in the control). The mRNA expression levels of the lipogenesis-related genes sterol regulatory element binding protein-1c, acetyl-CoA carboxylase, and fatty acid synthase were not significantly different between the resistance-trained and control rats; however, mRNA expression of the lipolysis-related carnitine palmitoyl transferase 1 and malonyl-CoA decarboxylase increased significantly with resistance training. AMP-activated protein kinase protein levels also significantly increased in resistance training group compared with in the control group. These results suggested that resistance exercise training contributing to reduced weight gain may be in part be due to increase the lipolysis metabolism and energy expenditure in response to resistance training.

Comparison of tests for measuring maximal exercise ability in elite swimmers.

The purpose of this study was to compare of tests for measuring maximal exercise ability in elite swimmers. The high-school male elite swimmers (n=17) were performed maximal exercise ability tests. The experimental method consisted of a crossover design at 1-week intervals with the swimming tests (field test, water VAMEVAL test, 200-m test, and 400-m test) in random order. It measured the heart rate, ratings of perceived exertion (RPE), and lactate level by physiological factors, and swimming velocity (SV), stroke rate (SR), and stroke length (SL) by mechanical factors. The change of SV, SR, and SL in swimming tests was no significantly different. To compare tests, however, the lactate level and RPE in 200-m test was higher than water VAMEVAL test. The RPE of the 200-m and 400-m tests were higher than the field test and the water VAMEVAL test. Correlations showed between the field test and the 400-m test in heart rate and RPE. Moreover, a correlation observed between the field test and 200-m test in heart rate. In this study, 200-m and 400-m tests were suit to apply the test methods for establishing the exercise intensity appropriate for the underwater training of swimmers.

Effect of a 12-week walking exercise program on body composition and immune cell count in patients with breast cancer who are undergoing chemotherapy.

PURPOSE: The purpose of this study was to examine the effect of a 12-week walking exercise program on body composition and immune cell count in patients with breast cancer who are undergoing chemotherapy. METHODS: Twenty patients (age, 47.8 ± 3.12) participated in the study. Body composition (weight, body mass index, muscle weight, body fat mass, and percent body fat) and the cell counts for immune cells (white blood corpuscles, lymphocytes, helper T cells, cytotoxic T cells, natural killer cells, and natural killer T cells) were measured before and after the 12-week walking exercise program. SPSS 17.0 statistical software was used. The two-way repeated ANOVA with post hoc was used to determine the difference between time and interaction. RESULTS: There were significant reductions in the weight (p < .05), BMI (p < .01), and percent body fat (p < .05) after the 12-week walking exercise program. However, the immune cell counts did not change significantly. CONCLUSION: These results indicated that the 12-week walking exercise program had an effect on the balances among weight, BMI and percent body fat in patients with breast cancer.

Maximal Fat Oxidation Rate during Exercise in Korean Women with Type 2 Diabetes Mellitus.

BACKGROUND: The purpose of this study was to determine the appropriate exercise intensity associated with maximum fat oxidation, improvement of body composition, and metabolic status in Korean women with type 2 diabetes mellitus (T2DM). METHODS: The study included a T2DM group (12 women) and a control group (12 women). The groups were matched in age and body mass index. The subjects performed a graded exercise test on a cycle ergometer to measure their maximal fat oxidation (Fatmax). We also measured their body composition, metabolic profiles, and mitochondrial DNA (mtDNA). RESULTS: The exercise intensity for Fatmax was significantly lower in the T2DM group (34.19% maximal oxygen uptake [VO2 max]) than the control group (51.80% VO2 max). Additionally, the rate of fat oxidation during exercise (P<0.05) and mtDNA (P<0.05) were significantly lower in the T2DM group than the control group. The VO2 max level (P<0.001) and the insulin level (P<0.05) were positively correlated with the rate of fat oxidation. CONCLUSION: The results of this study suggest lower exercise intensity that achieves Fatmax is recommended for improving fat oxidation and enhancing fitness levels in Korean women with T2DM. Our data could be useful when considering an exercise regimen to improve health and fitness.

Effects of combined linear and nonlinear periodic training on physical fitness and competition times in finswimmers.

The purpose of this study was to investigate the effect of combined linear and nonlinear periodic training on physical fitness and competition times in finswimmers. The linear resistance training model (6 days/week) and nonlinear underwater training (4 days/week) were applied to 12 finswimmers (age, 16.08± 1.44 yr; career, 3.78± 1.90 yr) for 12 weeks. Body composition measures included weight, body mass index (BMI), percent fat, and fat-free mass. Physical fitness measures included trunk flexion forward, trunk extension backward, sargent jump, 1-repetition-maximum (1 RM) squat, 1 RM dead lift, knee extension, knee flexion, trunk extension, trunk flexion, and competition times. Body composition and physical fitness were improved after the 12-week periodic training program. Weight, BMI, and percent fat were significantly decreased, and trunk flexion forward, trunk extension backward, sargent jump, 1 RM squat, 1 RM dead lift, and knee extension (right) were significantly increased. The 50- and 100-m times significantly decreased in all 12 athletes. After 12 weeks of training, all finswimmers who participated in this study improved their times in a public competition. These data indicate that combined linear and nonlinear periodic training enhanced the physical fitness and competition times in finswimmers.

Exercise training inducibility of MnSOD protein expression and activity is retained while reducing prooxidant signaling in the heart of senescent rats.

While the stress response to heat and exercise is limited in the heart with progressive aging, recent data indicate that acute or short-term exercise upregulates the Mn isoform of superoxide dismutase (MnSOD), which may provide protection against ischemia-reperfusion injury and cell death by reducing oxidative stress. Growing evidence indicates that inducible nitric oxide synthase (iNOS) contributes to age-induced increases in oxidative stress and risk of heart failure. We postulated that oxidative stress and iNOS levels would be related to the ability of the aging heart to upregulate MnSOD in response to long-term exercise training. Six- and twenty-seven-mo-old Fischer-344 rats had been assigned to young sedentary (YS), young exercise (YE), old sedentary (OS), or old exercise (OE) groups. ET groups ran on a treadmill for 60 min/day, 5 days/wk for a total of 12 wk. MnSOD protein expression in the left ventricle was increased (+43%) by 12 wk of exercise training in the old age group, with no changes in Cu,ZnSOD. Exercise training also increased MnSOD activity in left ventricles from old and young rats. HSP70 was inducible by exercise training in hearts exclusively from the young age group. iNOS protein expression increased markedly with aging (+548%), while exercise training decreased iNOS levels by -73% in OE compared with OS. In addition, 4-hydroxynonenal protein adducts in the left ventricle increased by 237% with aging, while 12 wk of exercise training resulted in attenuation (-55%). These data indicate that inducibility of MnSOD is preserved with long-term exercise training in the aging rat heart. Moreover, upregulation of MnSOD in the aging heart was directly associated with attenuated levels of oxidative stress, including iNOS.

Comparison of Lactate Threshold, Glucose, and Insulin Levels Between OLETF and LETO Rats After All-Out Exercise.

Otsuka Long-Evans Tokushima Fatty (OLETF) rats are an animal model for obesity and Non Insulin Dependent Diabetes Mellitus by hyperphagia. The lactate threshold (LT) is used to determinate aerobic capacity and exercise intensity in individuals. The purpose of this study was to determine whether velocity at the LT (VLT), glucose, and insulin levels of OLETF differs from Long-Evans Tokushima (LETO) rats after all-out exercise on treadmill running. In the results, we found that VLT level of OLETF rats (17.8 ± 1.39 m·min(-1)) was significantly lower than that of the LETO rats (20.5 ± 1.33 m·min(-1)). The blood glucose levels immediately after all-out exercise increased in OLETF (from 7.23 ± 0.36 to 9.38 ± 1.77 mmol·L(-1)) and decreased in LETO rats (from 6.36 ± 0.27 to 4.42 ± 0.71 mmol·L(-1)), and the insulin level was decreased in both the OLETF (from 34.4 ± 7.7 to 20.13 ± 8.63 µU·mL(-1)) and LETO (from 15.29 ± 2.6 to 5.72 ± 1.49 µU·mL(-1)) rats immediately after the all-out exercise, but the difference was not significant. Our results suggest that the different VLT, blood glucose and insulin levels should be considered to compensate for the differences between the OLETF and LETO rats. Moreover, the VLT will be a useful reference for the future studies on exercise training of OLETF rats. Key pointsThe VLT of OLETF was significantly lower than that of LETO rats.The changes of the blood lactate levels from rest to all-out exercise showed significant difference between OLETF and LETO rats.The result of low VLT in the OLETF compared to LETO rats implies that the application of relatively low exercise intensity is suitable for OLETF rats.The different VLT should be recognized to compensate for the differences between the OLETF and LETO rats.