Tag: 9/1/24

Categories : Cardiovascular Disease ExerciseTags :

High Cholesterol from Childhood Sedentary Time could be Reversed with Light Exercise

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Photo by Victoria Akvarel on Pexels

Increased sedentary time in childhood can raise cholesterol levels by two thirds as an adult, but a new study has found light physical activity may completely reverse the risks and is far more effective than moderate-to-vigorous physical activity.

The study was published in The Journal of Clinical Endocrinology & Metabolism. Researchers used data from the University of Bristol study Children of the 90s (also known as the Avon Longitudinal Study of Parents and Children), which included 792 children aged 11 years who were followed up until the age of 24.

Results from this study found that accumulated sedentary time from childhood can increase cholesterol levels by two thirds (67%) by the time someone reaches their mid-twenties. Elevated cholesterol and dyslipidaemia from childhood and adolescence have been associated with premature death in the mid-forties and heart problems such as subclinical atherosclerosis and cardiac damage in the mid-twenties.

Healthy lifestyles are considered important in the prevention of dyslipidaemia and one of the primary ways of lowering cholesterol, apart from diet, is movement behaviour. For the first time, this study objectively examined the long-term effects of sedentary time, light physical activity, and moderate-to-vigorous physical activity on childhood cholesterol levels.

The World Health Organization currently recommends children and adolescents should accumulate on average 60 minutes of moderate-to-vigorous physical activity a day and reduce sedentary time but have limited guidelines for light physical activity. Yet this new study and other recent studies has found light physical activity – which includes exercises such as long walks, house chores, or slow dancing, swimming, or cycling – is up to five times more effective than moderate-to-vigorous physical activity at promoting healthy hearts and lowering inflammation in the young population.

Dr Andrew Agbaje from the University of Exeter led the study and said: “These findings emphasise the incredible health importance of light physical activity and shows it could be the key to preventing elevated cholesterol and dyslipidaemia from early life. We have evidence that light physical activity is considerably more effective than moderate-to-vigorous physical activity in this regard, and therefore it’s perhaps time the World Health Organization updated their guidelines on childhood exercise — and public health experts, paediatricians, and health policymakers encouraged more participation in light physical activity from childhood.”

During the research, accelerometer measures of sedentary time, light physical activity, and moderate-to-vigorous physical activity were collected at ages 11, 15, and 24 years. High-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, and total cholesterol were repeatedly measured at ages 15, 17, and 24 years. These children also had repeated measurement of dual-energy X-ray absorptiometry assessment of total body fat mass and muscle mass, as well as fasting blood glucose, insulin, and high sensitivity C-reactive protein, with smoking status, socio-economic status, and family history of cardiovascular disease.

During the 13-year follow-up, sedentary time increased from approximately six hours a day to nine hours a day. Light physical activity decreased from six hours a day to three hours a day while moderate-to-vigorous physical activity was relatively stable at around 50 minutes a day from childhood until young adulthood. The average increase in total cholesterol was 0.69 mmol/L. It was observed without any influence from body fat.

An average of four-and-a-half hours a day of light physical activity from childhood through young adulthood causally decreased total cholesterol by (-0.53 mmol/L), however, body fat mass could reduce the effect of light physical activity on total cholesterol by up to 6%. Approximately 50 minutes a day of moderate-to-vigorous physical activity from childhood was also associated with slightly reduced total cholesterol (-0.05 mmol/L), but total body fat mass decreased the effect of moderate-to-vigorous physical activity on total cholesterol by up to 48%. Importantly, the increase in fat mass neutralised the small effect of moderate-to-vigorous physical activity on total cholesterol.

Source: University of Exeter

Categories : Cardiovascular Disease NeurologyTags :

Trial Finds Argatroban Promising in Acute Ischaemic Stroke with Early Neurological Deterioration

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Ischaemic and haemorrhagic stroke. Credit: Scientific Animations CC4.0

Early neurological deterioration (END) within the first 48 hours after acute ischaemic stroke (AIS) onset is relatively common, and is a predictor of poor outcomes. Treatment options are limited and unproven, but but a clinical trial has shown that the anticoagulant argatroban was safe and effective in improving outcomes. The results were published in JAMA Neurology.

Apart from straightforward causes, such as intracerebral haemorrhage and malignant oedema, the mechanism of END remains mostly unclear. Interventions for unexplained END can include plasma volume expansion, induced hypertension, and intensified antithrombotic therapy, but none has been formally proved so far.

The direct thrombin inhibitor argatroban is rapid acting, short acting, and has low bleeding rates, which could help prevent thrombus propagation and provide additional benefit after stroke/TIA. Argatroban has been associated with a reduction in ischaemic stroke damage but the safety and efficacy of argatroban is not well established for AIS treatment, and evidence is lacking for the effect of argatroban in patients with AIS and END.

Researchers conducted a randomised clinical trial that initially included 628 patients, average age 65 and 400 (63.7%) male. Eligible patients were adults with AIS who experienced END, which was defined as an increase of 2 or more points on the National Institutes of Health Stroke Scale within 48 hours from symptom onset.

Patients were randomly assigned to the argatroban group and control group within 48 hours of symptom onset. Both groups received standard therapy based on guidelines, including oral mono or dual antiplatelet therapy. The argatroban group received intravenous argatroban for 7 days (continuous infusion at a dose of 60mg per day for 2 days, followed by 20mg per day for 5 days) in addition to standard therapy.

The results showed that good neurological function at 90 days in those randomised to receive argatroban plus antiplatelet compared with antiplatelet alone was observed in 80.5% vs 73.7%)of participants, a statistically significant difference.

The authors concluded that the trial “shows that the combination of argatroban and antiplatelet therapy resulted in a significantly greater likelihood of good functional outcome at 90 days in patients with END after AIS, with no additional risk of major intracranial or extracranial haemorrhage.”

Categories : Cardiovascular Disease NeurologyTags : Leave a comment

Vigorous Exercise Improves Walking in Chronic Stroke Patients

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Photo by Kampus Production on Pexels

When 67-year-old Larry Christian suffered a sudden loss of balance, he was diagnosed with a haemorrhagic stroke, and referred to the University of Delaware’s Physical Therapy Clinic for rehabilitation. 

“Initially, I had a lot of balance problems that we worked pretty intensely to correct,” Christian said. 

He enrolled in a clinical trial at UD, led by co-investigator Darcy Reisman, professor and chair of the Department of Physical Therapy, that sought to explore whether high-intensity interval training (HIIT) aids in improved gait post-stroke. UD was one of three sites selected for the clinical trial led by primary investigator and associate professor Pierce Boyne of the University of Cincinnati. Sandra Billinger, professor and vice chair of stroke translation research at the University of Kansas Medical Center, is also a co-investigator and represents the third site involved in the clinical trial. 

Now, seven years later, Christian is walking better. 

“Participating in this study got me to a point where I could walk better and even take a walk outside,” Christian said. “I’ve been pretty healthy all my life, and while I can’t play volleyball anymore, walking again made me feel great.”

Christian is among the lucky ones. Among 7 million stroke survivors in the US, fewer than 10% have adequate walking speed and endurance to complete normal daily activities like grocery shopping. 

Reisman said the results of the multi-million-dollar, five-year clinical trial showed HIIT helped more people than just Christian. The results, published in JAMA Neurology, show that chronic stroke survivors who engaged in high-intensity exercise with bursts of maximum-speed walking alternated with recovery periods saw a significant difference in their walking capacity over 12 weeks. The improvements were so dramatic Boyne and Reisman have secured a clinical trial grant renewal to triple the size of their study to 165 participants. 

She added HIIT looks different for each stroke survivor, and the optimal exercise program for each person with stroke remains unknown. 

“We want them to train at the fastest possible speed, which varies from person to person,” Reisman said. “But we don’t want them running.”

For those already walking at a reasonably fast pace, research associate Henry Wright in Reisman’s lab will add an incline or a weighted vest or wrap a bungee cord around their waist to create resistance. 

“It’s self-reported data, but participants tell me they have more energy, or they’re able to do more around the house, or they’re not winded when they go shopping,” Wright said. “By the end of the training, I can see their walking is smoother, they’re getting farther on clinical testing, and it’s rewarding to see their gains.”  

The results from the initial clinical trial showed Reisman and collaborators that HIIT was feasible and safe in a small group of stroke survivors, who saw sustained gains in walking capacity, more so than patients engaged in moderate-intensity exercise. 

However, further study of the intervention in larger populations is crucial to change the standard of care.

“Many physical therapists were trained during a time when patients with neurologic conditions, particularly stroke, were treated with kid gloves, partly because they say stroke is the heart attack of the brain,” Reisman said. “It’s common they also have cardiovascular conditions, so people tend to be extra careful with those patients in terms of pushing them.

“But what we know now is at least moderate-intensity, and likely high-intensity interval training, is essential not only for stroke survivors’ cardiovascular system but also for their brain,” Reisman said. “The evidence shows that intensity is linked to the release of neurotrophins in the brain that help the brain remodel after a stroke.” 

Kiersten McCartney, a physical therapist obtaining her doctorate in biomechanics and movement science, worked on the clinical trial with Reisman. She spent the 2022 Winter Session at Magee Rehabilitation Hospital in Philadelphia, helping them implement moderate-to-high-intensity exercise and saw the benefits first-hand. 

“I’ll never be able to say there’s no risk of heart attack. Even the fittest people can have a heart attack when exercising,” McCartney said. “Still, the data points to the idea that you’re doing more harm than good by not engaging your patients with stroke in high-intensity exercise when we talk about those longer-term outcomes.”

The HIIT-Stroke Trial 2 will continue to examine dosing to confirm whether a full 12 weeks of vigorous exercise is needed to see significant improvements in walking. Reisman and collaborators will identify whether differences in sex and other factors played a role in rehabilitation. If the five-year study results are similar and show significant gains from high-intensity interval exercise in a larger population, investigators would next work with NIH Strokenet to launch a nationwide clinical trial in people with stroke.  

“We’ve known about the value of moderate-intensity exercise for more than a decade, and it’s still not the standard of care,” Reisman said. “If we find that HIIT is the optimal intervention, the next phase would be the knowledge translation phase, where we’d systematically develop a methodology to get HIIT into clinics.” 

For HIIT to work as an intervention, Reisman said therapists will need the proper tools. She’s been pushing for commercially available heart rate monitors, placed around the chest during exercise, to be the standard of care in clinics for years.

“They’re already a standard of care for people in the community,” Reisman said. “Getting them into clinics is imperative so PTs can monitor patients’ heart rate the entire time they exercise. That constant monitoring gives therapists data on how a person is responding beyond visible signs and symptoms, and in turn, more peace of mind.” 

But beyond tools and training, Reisman said, it comes down to evidence and education. 

“If we have hundreds and hundreds of stroke survivors who’ve gone through our high-intensity exercise intervention, and we’ve seen no major adverse events – that will help,” Reisman said. “The more data we have to show therapists, the better we can implement this intervention that will change lives.”

Source: University of Delaware

Categories : Emergency Medicine Injury & TraumaTags :

Optimal Placement for Bleeding Control Kits for the Public in Disaster Situations

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Photo by Camilo Jimenez on Unsplash

In the event of an accident or an attack, members of the public can save lives by performing first aid measures until the arrival of emergency medical services. But those people willing and able to serve as first responders will also need access to first aid equipment.

“There must also be certain equipment available to manage major bleeding. The question then is where this equipment should be placed, so that people who want to help can quickly access bleeding control kits,” says Carl-Oscar Jonson, adjunct senior associate professor at the Department of Biomedical and Clinical Sciences at Linköping University and head of research at the Center for Disaster Medicine and Traumatology in Linköping.

The first recommendations

Until now, there have been no guidelines for where such bleeding control kits should be located to ensure maximal utility. The current study, published in the journal Disaster Medicine and Public Health Preparedness, now contributes research-based recommendations.

“We found that the largest number of lives saved correlated with bleeding control kits being placed in two or more locations on the premises, but most importantly they shouldn’t be placed at entrances. We also concluded that the equipment must be accessible within 90 seconds’ walking distance,” says Anna-Maria Grönbäck, doctoral student at the Department of Science and Technology at Linköping University, who was involved in developing the simulation.

This means that bleeding control kits should not be placed at entrances, which is often the case with automated external defibrillators (AEDs). The reason for this is that they may be difficult to reach in a situation where many people have to be evacuated at once, such as in the case of attack or major accident. According to attack statistics, roughly 20 injured people will need first aid including a bleeding control kit each. It may be helpful to locate bleeding control kits in the same places as clearly marked AEDs, as long as not located at the entrances.

Bomb consequences simulated

The recommendations are based on conclusions reached by the research team by developing a computer-based simulation of an explosion in a large shopping centre with thousands of simultaneous visitors. In their simulation, the researchers have looked at what happens right after an explosion. The majority of the simulated people try to get out of the premises and move towards the exits. Simulated people close to the blast suffer varying degrees of injury and start bleeding.

In the simulation, some individuals help those injured by applying direct pressure to reduce bleeding, or by trying to find equipment. It is a race against time. Depending on how long it takes to get the equipment, the simulated casualty may die from blood loss.

To find the best strategy for the placement of bleeding control kits, the researchers tested four different scenarios in their simulation. They weighed together the outcomes of the many simulated courses of events for each scenario and compared them to understand which placement of equipment saved the largest number of lives.

Source: Linköping University

Categories : NeurologyTags :

Poor Sleep Quality in Midlife Linked to Cognitive Problems Later on

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Photo by Andrea Piacquadio

People who have more disrupted sleep in their 30s and 40s may be more likely to have memory and thinking problems a decade later, according to new research published in Neurology. The study does not however prove that sleep quality causes cognitive decline, it only shows an association.

“Given that signs of Alzheimer’s disease start to accumulate in the brain several decades before symptoms begin, understanding the connection between sleep and cognition earlier in life is critical for understanding the role of sleep problems as a risk factor for the disease,” said study author Yue Leng, PhD, of the University of California, San Francisco.

“Our findings indicate that the quality rather than the quantity of sleep matters most for cognitive health in middle age.”

The study involved 526 people, average age of 40, who were followed for 11 years. Researchers looked at participants’ sleep duration and quality, and had them perform cognitive tests.

Participants wore a wrist activity monitor for three consecutive days on two occasions approximately one year apart to calculate their averages. Participants slept for an average of six hours.

Participants also reported bedtimes and wake times in a sleep diary and completed a sleep quality survey with scores ranging from zero to 21, with higher scores indicating poorer sleep quality. A total of 239 people, or 46%, reported poor sleep with a score greater than five. Participants also completed a series of memory and thinking tests.

Researchers also looked at sleep fragmentation, which measures repetitive short interruptions of sleep. They looked at both the percentage of time spent moving and the percentage of time spent not moving for one minute or less during sleep. Added together, participants had an average sleep fragmentation of 19%.

Researchers then divided participants into three groups based on their sleep fragmentation score. Of the 175 people with the most disrupted sleep, 44 had poor cognitive performance 10 years later, compared to 10 of the 176 people with the least disrupted sleep.

After adjusting for age, gender, race, and education, people who had the most disrupted sleep had more than twice the odds of having poor cognitive performance when compared to those with the least disrupted sleep.

There was no difference in cognitive performance at midlife for those in the middle group compared to the group with the least disrupted sleep.

“More research is needed to assess the link between sleep disturbances and cognition at different stages of life and to identify if critical life periods exist when sleep is more strongly associated with cognition,” Leng said.

“Future studies could open up new opportunities for the prevention of Alzheimer’s disease later in life.”

The amount of time people slept and their own reports of the quality of their sleep were not associated with cognition in middle age.

Source: American Academy of Neurology