Background. Paired exercise and cognitive training have the potential to enhance cognition by “priming” the brain and upregulating neurotrophins. Methods. Two-site randomized controlled trial. Fifty-two patients >6 months poststroke with concerns about cognitive impairment trained 50 to 70 minutes, 3× week for 10 weeks with 12-week follow-up. Participants were randomized to 1 of 2 physical interventions: Aerobic (>60% VO_2peak using 6 months poststroke. Participants with more robust improvements in cognition were able to upregulate higher levels of serum IGF-1 suggesting that this neurotrophin may be involved in behaviorally induced plasticity.

Reactive balance training is an emerging approach to reducing falls risk in people with balance impairments. The purpose of this study was to determine the effect of reactive balance training on falls in daily life among individuals at increased risk of falls and to document associated adverse events. Databases searched were Ovid MEDLINE (1946-March 2022), Embase Classic and Embase (1947-March 2022), Cochrane Central Register of Controlled Trials (2014-March 2022), Physiotherapy Evidence Database (PEDro; searched on 22 March 2022). Randomized controlled trials of reactive balance training were included. The literature search was limited to English language. Records were screened by 2 investigators separately. Outcome measures were number of participants who reported falls after training, number of falls reported after training, and the nature, frequency, and severity of adverse events. Authors of included studies were contacted to obtain additional information. Twenty-nine trials were included, of which 17 reported falls and 21 monitored adverse events. Participants assigned to reactive balance training groups were less likely to fall compared to control groups (fall risk ratio = 0.76; 95% CI = 0.63–0.92; I² = 32%) and reported fewer falls than control groups (rate ratio = 0.61; 95% CI = 0.45– 0.83]; I² = 81%). Prevalence of adverse events was higher in reactive balance training (29%) compared with control groups (20%). Reactive balance training reduced the likelihood of falls in daily life for older adults and people with balance impairments. More adverse events were reported in reactive balance training than control groups. Balance training that evokes balance reactions can reduce falls among people at increased risk of falls. Older adults and individuals with balance problems were less likely to fall in daily life after participating in reactive balance training compared to traditional balance training. If you are an older adult and or have balance problems, your physical therapist may prescribe reactive balance training rather than traditional balance training in order to reduce your likelihood of falling in daily life.

Physical sedentarism is linked to elevated levels of circulating cytokines, whereas exercise upregulates growth-promoting proteins such as brain-derived neurotrophic factor (BDNF). The shift towards a ‘repair’ phenotype could protect against neurodegeneration, especially in diseases such as multiple sclerosis (MS). We investigated whether having higher fitness or participating in an acute bout of maximal exercise would shift the balance of BDNF and interleukin-6 (IL-6) in serum samples of people with progressive MS (n = 14), compared to matched controls (n = 8). Participants performed a maximal graded exercise test on a recumbent stepper, and blood samples were collected at rest and after the test. We assessed walking speed, fatigue, and maximal oxygen consumption (${\displaystyle \stackrel{·}{\mathrm{V}}{\mathrm{O}}_{2\max }}$). People with MS achieved about 50% lower ${\displaystyle \stackrel{·}{\mathrm{V}}{\mathrm{O}}_{2\max }}$ (p = 0.003) than controls. At rest, there were no differences in BDNF between MS and controls; however, IL-6 was significantly higher in MS. Higher ${\displaystyle \stackrel{·}{\mathrm{V}}{\mathrm{O}}_{2\max }}$ was associated with a shift in BDNF/IL-6 ratio from inflammation to repair (R = 0.7, p = 0.001) when considering both groups together. In the MS group, greater ability to upregulate BDNF was associated with faster walking speed and lower vitality. We present evidence that higher fitness indicates a shift in the balance of blood biomarkers towards a repair phenotype in progressive MS.

Background: Aerobic training has the potential to restore function, stimulate brain repair, and reduce inflammation in people with Multiple Sclerosis (MS). However, disability, fatigue, and heat sensitivity are major barriers to exercise for people with MS. We aimed to determine the feasibility of conducting vigorous harness-supported treadmill training in a room cooled to 16 °C (10 weeks; 3times/week) and examine the longer-term effects on markers of function, brain repair, and inflammation among those using ambulatory aids.Methods: Ten participants (9 females) aged 29 to 74 years with an Expanded Disability Status Scale ranging from 6 to 7 underwent training (40 to 65% heart rate reserve) starting at 80% self-selected walking speed. Feasibility of conducting vigorous training was assessed using a checklist, which included attendance rates, number of missed appointments, reasons for not attending, adverse events, safety hazards during training, reasons for dropout, tolerance to training load, subjective reporting of symptom worsening during and after exercise, and physiological responses to exercise. Functional outcomes were assessed before, after, and 3 months after training. Walking ability was measured using Timed 25 Foot Walk test and on an instrumented walkway at both fast and self-selected speeds. Fatigue was measured using fatigue/energy/vitality sub-scale of 36-Item Short-Form (SF-36) Health Survey, Fatigue Severity Scale, modified Fatigue Impact Scale. Aerobic fitness (maximal oxygen consumption) was measured using maximal graded exercise test (GXT). Quality-of-life was measured using SF-36 Health Survey. Serum levels of neurotrophin (brain-derived neurotrophic factor) and cytokine (interleukin-6) were assessed before and after GXT.Results: Eight of the ten participants completed training (attendance rates ≥ 80%). No adverse events were observed. Fast walking speed (cm/s), gait quality (double-support (%)) while walking at self-selected speed, fatigue (modified Fatigue Impact Scale), fitness (maximal workload achieved during GXT), and quality-of-life (physical functioning sub-scale of SF-36) improved significantly after training, and improvements were sustained after 3-months. Improvements in fitness (maximal respiratory exchange ratio and maximal oxygen consumption during GXT) were associated with increased brain-derived neurotrophic factor and decreased interleukin-6.Conclusion: Vigorous cool room training is feasible and can potentially improve walking, fatigue, fitness, and quality-of-life among people with moderate to severe MS-related disability.Trial registration: The study was approved by the Newfoundland and Labrador Health Research Ethics Board (reference number: 2018.088) on 11/07/2018 prior to the enrollment of first participant (retrospectively registered at ClinicalTrials.gov:NCT04066972. Registered on 26 August 2019.

Introduction. Walking is of high priority for people with multiple sclerosis (PwMS). It remains unclear whether aerobic exercise can improve walking ability and upregulate neurotrophins. This review aims to consolidate evidence to develop optimal aerobic training parameters to enhance walking outcomes and neuroplasticity in PwMS.Methods. Clinical studies examining aerobic exercise for ≥3 weeks, having outcomes on walking with or without neurotrophic markers, were included. Studies utilizing animal models of MS were included if they employed aerobic exercise with outcomes on neurological recovery and neurotrophins. From a total of 1783 articles, 12 clinical and 5 animal studies were included.Results. Eleven clinical studies reported improvements in walking ability. Only two clinical studies evaluated both walking and neurotrophins, and neither found an increase in neurotrophins despite improvements in walking. Patients with significant walking impairments were underrepresented. Long-term follow-up revealed mixed results. Two animal studies reported a positive change in both neurological recovery and neurotrophins.Conclusion. Aerobic exercise improves walking ability in PwMS. Gains are not consistently maintained at 2- to 9-month follow-up. Studies examining levels of neurotrophins are inconclusive, necessitating further research. Aerobic exercise enhances both neurological recovery and neurotrophins in animal studies when started 2 weeks before induction of MS.

Objective: to determine whether stroke survivors could maintain workloads during functional task practice that can reach moderate levels of cardiometabolic stress (i.e. ≥ 40% oxygen uptake reserve (V̇O2R) for ≥ 20 min) without the use of ergometer-based exercise. Design: cross-sectional study using convenience sampling Setting: research laboratory in a tertiary rehabilitation hospital Participants: chronic hemiparetic stroke survivors (>6-months) who could provide consent and walk with or without assistance Intervention: a single bout of intermittent functional training (IFT). The IFT protocol lasted 30 min and involved performing impairment specific multi-joint task-oriented movements structured into circuits lasting approximately 3 min and allowing 30-45 sec recovery between circuits. The aim was to achieve an average heart rate (HR) 30-50 beats above resting without using traditional ergometer-based aerobic exercise. Outcome measures: attainment of indicators for moderate intensity aerobic exercise. Oxygen uptake (V̇O2), carbon dioxide production (V̇CO2), and HR were recorded throughout the 30 min IFT protocol. Values were reported as percentage of V̇O2R, HR reserve (HRR) and HRR calculated from predicted maximum HR (HRRpred), which were determined from a prior maximal graded exercise test. Results: Ten (3-female) chronic (38±33 months) stroke survivors (70% ischemic) with significant residual impairments (NIHSS: 3±2) and a high prevalence of comorbid conditions (80% ≥1) participated. IFT significantly increased all measures of exercise intensity compared to resting levels: V̇O2 (∆ 820 ± 290 ml min-1, p<0.001), HR (∆ 42 ± 14 bpm, p<0.001), and energy expenditure (EE; ∆ 4.0 ± 1.4 kcal min-1, p<0.001). Also, mean values for percentage of V̇O2R (62±19), HRR (55±14), and HRRpred (52±18) were significantly higher than the minimum threshold (40%) indicating achievement of moderate intensity aerobic exercise (p= 0.004, 0.016, and 0.043, respectively). Conclusion: Sufficient workloads to achieve moderate levels of cardiometabolic stress can be maintained in chronic stroke survivors using impairment-focused functional movements that are not dependent on ergometers or other specialized equipment.