Intro
Aerobic exercise can be defines as „planned, structured repetitive physical activity for extended periods and at a sufficient intensity to improve or maintain physical fitness” (M.Mackay-Lyons, , 2013) Parameters of AE include, duration, intensity, frequency, mode and the timing of exercise onset after the stroke occurred. (mahmudul hasan, 2016). Intensity level can be measured using perceived levels of exertion, heart rate or respiration rate (mahamudul hasan, 2016)
Cognition is affected by aging, especially in terms of memory and attention. Exectutive Function, skills that help you to get things done including time management and the ability to pay attention, depends on the prefrontal cortex. The cortex reduces in size with age. Bonavita (2016) associates better cognitive performance amongst older people who have active rather than sedentary lifestyles.
Liu-Ambrose (2007) highlights that cognitive impairments impede motor learning. It is important to understand the positive impact of exercise on cognitive impairments as this can help to increase independence, reduce disability and prevent institutionalisation (Patel, Coshall, Rudd et al, 2002). Mahmadal Hasan states that after stroke, „cognitive health and the recovery of complex motor skills are intertwined”..
Commonly used measures of cognition in Irish and Australian hospitals include the MMSE and the Montreal Cognitive Assessment. These are questionaires… Forms of cognition important to rehabilitation: Working Memory, Attention, Executive function (mahmadul hasan)
Studies using Neuroimagery show that there is a link between being fit in terms of cardiorespiratory and aerobic health, and brain structure and function (especially in pre-cortical areas and areas where neural circuits related to EF are located) (SOURCE).
Timing Rand et al’s (63) study suggests that while aerobic exercise may help early into recovery, 8 weeks after the end of a 6 month treatment, there were no significant improvements to note. 65 suggests that longer tratment time reports more consistant benefits. In this study a 12 week home exercise program combining 30 mins of AE with 90 mins of cognitive exercises improved cognition in terms of the MMSE.
Level of Intensity Mahmudul Hasan compared the intensity of various program in his systematic review. The found that programs of low intensity did not show significant improvements on cognitive outcomes such as working memory. This study found that moderate intensity and combination programs resulted in more substantial improvements in memory and learning. Moderate intensity exercise includes treadmill walking, overground walking and stationary cycling sessions, ranging from 20 to 60 minutes depending on patients levels of perceived exertion (1).
Exercise type Marzolini (2013) states that while there is little evicence to prove that AE alone will improve executive function in stroke patients, as a combination therapy the results are very promising. Combination therapy means other interventions used to for stroke rehabilitation, including physiothrapy, speech and language therapy and occupational therapy.
Gaps in research Lack of control groups in many of these studies as it would unethical to deprive a patient of treatment for the sake of research.
References Marzolini, McIlroy, Brooks, the effects of an aerobic and resistance exercise training program on cognition following stroke, Neurorehabilitation and Neural Repair, vol 27, no. 5, pp. 392-402, 2013 T. Liu-Ambrose,M. Y. C. Pang, and J. J. Eng, “Executive function is independently associated with performances of balance and mobility in community-dwelling older adults after mild stroke: implications for falls prevention,” Cerebrovascular Diseases, vol. 23, no. 2-3, pp. 203–210, 2007.
M.Mackay-Lyons, R.Macko, J. Eng et al., “AEROBICS: Aerobic exercise recommendations to optimize best practices in care after stroke,” 2012, http://strokebestpractices.ca/wp-content/ uploads/2013/07/AEROBICS-FINAL-July-2013.pdf. Bonavita, S., Tedeschi G, (2016). Physical Activity and the Aging Brain. Chapter 12 – Neural Structure, Connectivity, and Cognition Changes Associated to Physical Exercise, 1st ed. Arizona: Academic Press, pp.121-131 M. D. Patel, C. Coshall, A. G. Rudd, and C. D. A. Wolfe, “Cognitive impairment after stroke: clinical determinants and its associations with long-term stroke outcomes,”Journal of the American Geriatrics Society, vol.50, no.4, pp.700–706, 2002.
D. Rand, J. J. Eng, T. Liu-Ambrose, and A. E. Tawashy, “Feasibility of a 6-month exercise and recreation program to improve executive functioning and memory in individuals with chronic stroke,”Neurorehabilitation and Neural Repair, vol.24, no.8, pp. 722–729,2010