I too liked the BIG therapy section. I assume theres not a lot of evidence for the cellular mechanisms behind it. After doing all this research on the treatment, can you make any educated guess as to why it works? Also, I wonder how this could be studied in an animal model… Very interesting and thought provoking page-nice work!
Love this page, it has a great organizational format and the amount of research is stellar. I will be using some of this for my own practice. A small critique, the section on acute exercise and apoptosis states,
"Since elevated apoptotic levels is not desirable in AD pathology, strenuous, high intensity exercise should be avoided in this population. Moderate intensity exercise may result in slightly elevated apoptotic levels initially but return to baseline levels within 48 hours. This level of intensity may not result in a change in apoptosis based on the body’s response. It is recommended that exercise be initiated at low-moderate intensity levels (~60% VO2 max or less) to prevent any initial harmful effects."
I agree with all of this, except the universal assertion that, "strenuous exercise should be avoided in this population." Although this may be true for most folks with dementia, I do not feel that the evidence can be translated that far. At most you could say, acute strenuous exercise should be avoided. Since none of your studies specifically looked at chronic strenuous exercise and apoptosis, it remains to be seen whether a training regimen that worked up to this intensity would be positive or negative.
Again, great page with lots of useful information for those interested in geriatrics and such.
common theme: thank goodness for MPTP! so many specific exercise recommendations were able to come about due to multiple animal studies using it! also i liked the little tid bit on cognition, an aspect that might get overlooked sometimes but I was excited to see the positive benefits! Great Job at working through animal and human studies and touching on things that are specific to PD like BIG therapy - I have actually used some BIG techniques we learned in class, in my SNF clinical and it helped! I enjoyed reading more in depth about it i that section!
I like that you thought outside the box when it came to what to include on your page, for example with exercise effects on medication and nutrition sections - I have heard anecdotally that those with DMII who exercise regularly are able to decrease their medications, I was hoping to read more about that in the medications section - like which one they could reduce or how long they exercise until a reduction is possible, but although that wasn't there I liked your approach of studying if there were adverse effects of taking them together and that information is valuable in the clinic and to pass along to patients of such a common disease in the US
it was interesting to me that you want to encourage more salt content in drinks consumed with exercise as it is the sodium that causes increased mucus production - but I learned an importance lesson about balance:) good information to know too for working with patients with CF! Also great job on the cytokines section - I'm not sure if you considered the anti-inflammatory affects of IL-6 when released from the skeletal muscle during exercise - but if a study wasn't differentiating between sites of release of IL-6, maybe that was a reason it was elevated with exercise - and if that's the case I wonder if it would still have a detrimental affect for CF, just a thought - I loved how great a job your group did with sticking to exercise's affects on cell bio and cautioning results if there were glaring limitations in the studies - great job!
wow - very comprehensive! i liked how you tied articles from class into your analysis of cell bio mechanisms affected by exercise - like with the HSPs and sex differences and then expanded on them - it was a great compliment to how the class was structured!
Also very interesting about contractility and how quickly the training benefits can be lost! Great reminder. I know you put a TON of hard work into the page and it truly shows - if I were to offer a critique though, as much as I love learning about SCD, maybe take out the parts of how it is treated medically or diagnosed… trying to keep with cell bio mechanisms and exercise - also probably don't have to list out ACSM guidelines as pactitiones should know this, but maybe just have them refer to a specific section of the guidelines for reference. Overall, great job
I see in the ROS section you discuss glucose and fat. Glucose clearance is increased, and cholesterol levels are reduced. Did you find any research on the rate of fat/glucose metabolism in the mitochondria? In RA, there was some research indicating that patients relied more heavily on fat as a substrate, which increased ROS levels as a byproduct. I see ROS levels are reduced with exercise, so does that mean that mitochondria are using less fat for energy? Or is it perhaps through an increase in antioxidant production. If exercise switches the spectrum toward more glucose metabolism, I wonder if that makes it more difficult for people for diabetes to lose weight, even through improved diet and exercise. Just a thought. Nice page! I would also like to give my vote in favor of image 3.
Even though there is not a ton of research out there being done on the human ALS population - it was cool to see how much could be learned and extrapolated from other studies on various cell bio mechanisms - I also like how you tie in other diseases that are related and could benefit from the research that you compiled like MS and muscular dystrophy - Great Job!
I think its interesting that we are going to (hopefully) be PT's who specialize in movement, yet when we start looking at the cellular effects we don't think much about the movement of the cells-specifically, tissue deformation and the effect on cellular mechanisms. I know I totally overlooked it until last week, but since then I have seen how it plays a role in RA. You addressed it here in you section on P2Y2. You discuss the effect of shear stress on ATP release during coughing, and its effect on mechanosensitive ion channels. I wonder if it doesnt play a role in percussive airway techniques as well. Maybe its a bit of a stretch, but what if the vibratory effect from percussion serves to activate the channels in a similar manner? In doing my research, I wondered if the effectiveness of joint mobilizations is not as much due to the promotion of fluid movement in the joint, but the effect of tissue deformation on cellular processes. Some of the stuff I studied named b-integrin and focal adhesion complexes as being implicated in the process-now im kind of curious about that. Gives you a whole other way of thinking about things, I guess…
I mentioned it on your cell bio page, and it came up again. The 2011 Brown et al article used 6 normal sweaters and 6 very salty sweaters as subjects. Maybe its because its 12:08 at night, or maybe its because I have been staring at research articles for the past 10 days straight, or maybe its because im 33 and going on 15, but everytime I see that I have to chuckle! How do they know they are salty! I am going to read that article just to figure it out. Ha Ha! I love cell biology, its so interesting! Great work on the page. Its obvious you guys really worked hard on this, and it shows!
I agree with everyone else's comments about liking the bullet-point list for considerations. The only comment I have is to add a space to separate all of the paragraphs. This is mostly done throughout, but missing in a couple of the beginning sections (i.e. overview of evidence and recommendations). Very interesting page that I will have to revisit when working with patient's with PD!
Great point Cara. In reading some of the pages I see there is a bit of controversy (at least among ourselves) as to what moderate and maximal exercise is. It puts an interesting spin on things, especially when you are trying to apply adult studies to a pediatric population.
Prevention is key in this disease and I am glad you incorporated this since exercise is so strongly correlated with decreased risk. We as PT's need to give some of this information to our patients because health promotion in my opinion should be a trend in PT since we see so many patients with so many medical problems and potential for medical problems. I would have liked to see your recommendation in the first section on how much and what type of exercise you think could work as prevention even though the research is unclear
Very well done! I particularly like how you clearly stated implications, recommendations, and limitations throughout the page. I noticed that each of the exercise studies in humans focused on one specific mode of exercise. Are there any studies on combinations of exercise modes for individuals with ALS? This was certainly an area lacking high-quality evidence in regards to DM2. Just wondering if this is a possible trend across conditions.
Another great page for the importance of promoting lifelong physical activity! My only recommendations would be an intro sentence for some of the sections (i.e. Glut4 and Apoptosis) to refresh the reader with a short definition or a link to the cell bio, and I think some of the paragraphs need a space in between for aesthetics (specifically, the intro and areas for further research). Awesome job!
I really enjoyed reading this page. I love reading about how aerobic exercise improves so many things like cognition and even the size of the brain (which I really liked the brain picture too!). I think you guys did a great job synthesizing the literature, and this is definitely a page I will refer to in the future…great information for promoting physical activity!
Since the exercise research for cystic fibrosis in animal models and humans is very limited, I enjoyed reading about a variety of human exercise studies as well as those with animal models in a very applicable to PT presentation. I appreciated that you included the randomized controlled trial regarding resistance exercise even though it did not provide the specific intervention parameters. I think it is important for clinicians to be aware of this study, especially because it did demonstrate benefits over a stretching program. Additionally, maybe the parameters could be located in another resource or the researchers could be contacted if this is something clinicians would like to implement with their patients. Well done ALS group!
I would like to know who wrote that paragraph right above the remodeling section-I want to buy you a burrito! That is so interesting-decreased oxidative capacity at 6 weeks, normal at 10 weeks, and possible significant improvement at 14 weeks. Since the mitocondria are so important to heart function, that seems like it is huge when working with these patients. I am curious to know what the cellular changes are during that period. Also, the ACSM guidelines do seem out of place. Actually, I think you can eliminate them completely. You have a lot of current and valid research on your disorder-in light of what you present here, you may actually be ahead of the game.
Great picture and organization of the information. It is easy to follow though the information is very complicated.
Susie, there were 5 session per week for 4 weeks. I guess that makes 20! :)
I found the neuroprotective effects of IGF-1 and SMN protein very interesting. I'd be interested in retrospective studies in humans that look at prior activity (before diagnosis) to see if it is associated with longevity after diagnosis. I found the summary for implications and recommendations very concise and easy to follow. Great job!