Lars Donath

Effects of different endurance exercise modalities on migraine days and cerebrovascular health in episodic migraineurs: A randomized controlled trial

Aerobic exercise training is a promising complementary treatment option in migraine and can reduce migraine days and improve retinal microvascular function. Our aim was to elucidate whether different aerobic exercise programs at high vs moderate intensities distinctly affect migraine days as primary outcome and retinal vessel parameters as a secondary. In this randomized controlled trial, migraine days were recorded by a validated migraine diary in 45 migraineurs of which 36 (female: 28; age: 36 (SD:10)/BMI: 23.1 (5.3) completed the training period (dropout: 20%). Participants were assigned (Strata: age, gender, fitness and migraine symptomatology) to either high intensity interval training (HIT), moderate continuous training (MCT), or a control group (CON). Intervention groups trained twice a week over a 12‐week intervention period. Static retinal vessel analysis, central retinal arteriolar (CRAE) and venular (CRVE) diameters, as well as the arteriolar‐to‐venular diameter ratio (AVR) were obtained for cerebrovascular health assessment. Incremental treadmill testing yielded maximal and submaximal fitness parameters. Overall, moderate migraine day reductions were observed ( ηP2 = .12): HIT revealed 89% likely beneficial effects (SMD = 1.05) compared to MCT (SMD = 0.50) and CON (SMD = 0.59). Very large intervention effects on AVR improvement ( ηP2 = 0.27), slightly favoring HIT (SMD=‐0.43) over CON (SMD=0), were observed. HIT seems more effective for migraine day reduction and improvement of cerebrovascular health compared to MCT. Intermittent exercise programs of higher intensities may need to be considered as an additional treatment option in migraine patients.

I Can Stand Learning: A Controlled Pilot Intervention Study on the Effects of Increased Standing Time on Cognitive Function in Primary School Children

Sedentarism is considered an independent cardiovascular risk factor. Thus, the present study investigated the effects of employing standing desks in classrooms on cognitive function. The intervention class (IG; n = 19) was supplied with standing desks and balance pads for 11 weeks. The control class (CG; n = 19) received lessons as usual. Standing time was assessed objectively (accelerometers) and subjectively (self-report sheets, external classroom observers). The impact of standing on the digit span task and Eriksen flanker task was analysed. The standing time of the IG was higher during the school day in comparison to the CG (lesson: p = 0.004; break: p = 0.003). The intra-class correlation coefficient between self-reports and external observation was high (ICC = 0.94). The IG improved slightly on the Digit Span Task compared to CG. Employing standing desks for at least 1 h per school day serves as a feasible and effective opportunity to improve cognitive function.

Effects of Endurance Exercise Modalities on Arterial Stiffness in Patients Suffering from Unipolar Depression: A Randomized Controlled Trial

Background Psychiatric disorders are associated with a higher prevalence of cardiovascular disease and mortality. Regular exercise has been shown to reduce depressive symptoms and improve arterial stiffness as a biomarker of cardiovascular risk. We aimed to investigate the effects of different exercise modalities on depression severity index and arterial stiffness in patients suffering from unipolar depression. Methods 34 patients suffering from unipolar depression [female: 25, male: 9, age: 37.8, Beck-Depression-Inventory-II (BDI-II) score: 31.0] were enrolled in this two-armed randomized controlled trial. Central hemodynamics, augmentation index at heart rate 75/min (AIx@75) and aortic pulse wave velocity (PWV) were obtained by an oscillometric monitoring device. Maximal bicycle ergometer exercise testing yielded maximal fitness parameters. Patients were assigned to either high-intensity low volume (HILV) or moderate continuous aerobic training (MCT). Both intervention groups trained three times a week during a 4-week intervention period. BDI-II were filled out by the patients before and after the intervention period. Results We found moderate interaction effects on depression severity reduction (ηp2=0.10). HILV showed a 85% beneficial effect in lowering BDI-II scores compared to MCT (HILV: pre: 28.8 (9.5), post: 15.5 (8.5), SMDu2009=u20091.48), MCT: (pre: 33.8 (8.5), post: 22.6 (7.5), SMDu2009=u20091.40). Reduction of AIx@75 was more pronounced after MCT (SMDu2009=u20090.61) compared to HILV (SMDu2009=u20090.08), showing 37% possibly beneficial effects of MCT over HILV. PWV remained unchanged in both training groups. Conclusion Both training regimes showed large effects on the reduction of depressive symptoms. While HILV was more effective in lowering depression severity, MCT was more effective in additionally lowering peripheral arterial stiffness. Exercise should be considered an important strategy for preventive as well as rehabilitative treatment in depression.

Sprint interval training (SIT) substantially reduces depressive symptoms in major depressive disorder (MDD): A randomized controlled trial

Continuous aerobic exercise training (CAT) is considered a complementary treatment option in patients with major depressive disorder (MDD). Intermittent exercise training protocols, such as sprint interval training (SIT) have gained increasing popularity, but no studies on depressive symptoms following SIT in patients with MDD are available. Fifty-nine in-patients with MDD were randomly assigned to a SIT or CAT group. Medication was counterbalanced in both intervention arms. Both intervention groups received 3 weekly training sessions for 4-weeks (12 sessions in total). SIT comprised 25 bouts of 30 seconds at 80% of maximal power, whereas CAT consisted of 20 minutes of physical activity at 60% of maximal power. The training protocols were isocalorically designed. Maximal bicycle ergometer exercise testing yielded maximal and submaximal physical fitness parameters. The Beck-Depression-Inventory-II (BDI-II) was filled out by the patients before and after the intervention period. BDI-II scores substantially decreased in both groups with an effect size pointing towards a large effect (pu202f<u202f0.001, ηp²u202f=u202f0.70) while submaximal (0.07u202f<u202fdu202f<u202f0.89) and maximal (0.05u202f<u202fdu202f<u202f0.85) fitness variables improved in both groups. Short-term SIT leads to similar results as CAT in patients with MDD and can be regarded as a time-efficient and promising exercise-based treatment strategy.

Psychiatric in-patients are more likely to meet recommended levels of health-enhancing physical activity if they engage in exercise and sport therapy programs

Background: People with mental disorders engage in sedentary behaviors more often than their healthy counterparts. In Switzerland, nearly all psychiatric hospitals offer structured exercise and sport therapy as part of their standard therapeutic treatment. However, little is known about the degree to which psychiatric patients make use of these treatment offers. The aim of this study is to examine, in a sample of psychiatric in-patients (a) how many participate in the structured exercise and sport therapy programs offered by the clinic, (b) how many engage in exercise and sport activities on an individual basis, and (c) how many meet recommended levels of health-enhancing physical activity during their stay at the clinic. Furthermore, we examine whether those who engage in exercise and sport activities are more likely to meet internationally accepted physical activity recommendations. Methods: 107 psychiatric in-patients (49% women, Mage = 39.9 years) were recruited at three psychiatric clinics in the German-speaking part of Switzerland. All participants were engaged in treatment and received usual care. Based on accelerometer data, participants were classified as either meeting or not meeting physical activity recommendations (≥150 min of moderate-to-vigorous physical activity per week). Participation in structured and individually performed exercise and sport activities was assessed with the Simple Physical Activity Questionnaire. Results: In total, 57% of all patients met physical activity recommendations. 55% participated in structured exercise and sport therapy activities, whereas only 22% of all patients engaged in exercise and sport activities independently. Psychiatric patients were significantly more likely to meet recommended levels of health-enhancing physical activity if they engaged in at least 60 min per week of structured exercise and sport therapy or in at least 30 min of individually performed exercise and sport activity. Conclusions: Given that prolonged immobilization and sedentary behavior have harmful effects on patients physical and mental well-being, promoting exercise and sport activities is an important endeavor in psychiatric care. Clinics currently succeed in involving between 50 and 60% of all patients in sufficient physical activity. While this is encouraging, more systematic efforts are needed to ensure that all patients get enough physical activity.

Moderating Effects of Exercise Duration and Intensity in Neuromuscular vs. Endurance Exercise Interventions for the Treatment of Depression: A Meta-Analytical Review

Background: Exercise training is a beneficial treatment strategy for depression. Previous meta-analytical reviews mainly examined the effect of aerobic exercise on depressive symptoms neglecting comparisons with neuromuscular training and meta-regression considering relevant exercise training prescriptors such as exercise duration, intensity, number of exercise sessions (volume) and frequency. Methods: A structured literature search was conducted in biomedical and psychological databases and study selection was conducted following the PICOS approach. (Randomized) controlled trials that compared supervised neuromuscular or endurance exercise interventions with an inactive control group (CON) in clinically depressed in- or out-patients over 18 years were included. Eligibility and study quality were evaluated by two independent researchers. Standardized mean differences (SMD) for the reduction of depressive symptoms, measured with different evaluation scales (e.g., BDI, HAM-D, PHQ-9, HRSD, MADRS, GDS) were calculated with the adjusted Hedgesg equation as main outcome for the comparison of endurance and neuromuscular exercise interventions vs. CON. Statistical analyses were conducted using a random effects inverse-variance model. Multivariate meta-regression analysis was performed in order to examine the modulating effects of exercise training prescriptors. Results: Twenty seven trials with 1,452 clinically depressed adults were included. 20 out of 27 included trials reached a PEDro score of at least 6, representing high-quality. Irrespective of the exercise mode and study quality, large effects in favor of exercise compared to the control condition were found. Compared to CON, sensitivity analyses revealed a moderate to large effect in favor of endurance exercise [SMD: −0.79 (90% CI: −1.10, −0.48); p < 0.00001, I2 = 84%] and a large effect size in favor of neuromuscular exercise [SMD: −1.14 (90 CI: −1.50, −0.78); p < 0.00001, I2 = 80%]. These effects decreased to moderate for endurance and remained large for neuromuscular trials when considering studies of high quality, indicating a significant difference (p = 0.04). Multivariate meta- regression revealed that exercise duration in endurance trials and exercise intensity in neuromuscular trials had a significantly moderating effect. Conclusions: Strong neuromuscular exercise interventions can be slightly more effective than endurance exercise interventions. Interestingly, exercise duration and exercise intensity moderated the effect size meaningfully. This result might be used on exercise in depression to increase efficacy.

How to Construct, Conduct and Analyze an Exercise Training Study?

Randomized controlled trials (RCTs) can be regarded as gold standard in investigating dose-response and causal relationships in exercise science. Recommendations for exercise training routines and efficacy analyses of certain training regimen require valid data derived from robust RCTs. Moreover, meta-analyses rely on RCTs and both RCTs and meta-analyses are considered the highest level of scientific evidence. Beyond general study design a variety of methodological aspects and notable pitfalls has to be considered. Therefore, exercise training studies should be carefully constructed focusing on the consistency of the whole design “package” from an explicit hypothesis or research question over study design and methodology to data analysis and interpretation. The present scoping review covers all main aspects of planning, conducting, and analyzing exercise based RCTs. We aim to focus on relevant aspects regarding study design, statistical power, training planning and documentation as well as traditional and recent statistical approaches. We intend to provide a comprehensive hands-on paper for conceptualizing future exercise training studies and hope to stimulate and encourage researchers to conduct sound and valid RCTs in the field of exercise training.

Acute responses to forearm compression of blood lactate accumulation, heart rate, perceived exertion and muscle pain in elite climbers

Objectives: To evaluate the immediate responses to forearm compression of blood lactate concentration, heart rate, perceived exertion and local forearm muscle pain during severe climbing in elite climbers. Method: Seven elite climbers (18 ± 2 years; 164 ± 5 cm; 57.8 ± 5.3 kg) performed 3 × 3 climbing bouts with maximal intensity on a distinct 8 m boulder wall (lead grade: 7a–8b) in a single blinded, placebo-controlled cross-over design, wearing either forearm sleeves with compression (verum-compression) or placebo forearm sleeves with no compression (falsum-compression). Each climber’s heart rate was recorded during and capillary blood lactate concentration, perceived exertion and forearm muscle pain were assessed directly after climbing. Result: Heart rate (p = 0.45, ηp2 = 0.12), blood lactate concentrations (p = 0.44, ηp2 = 0.10), perceived exertion levels (p = 0.51, ηp2 = 0.08) and pain perception (p = 0.67, ηp2 = 0.03) were not affected by forearm compression. No condition × time interaction effect (compression × time) occurred for heart rate (p = 0.66, ηp2 = 0.04), blood lactate concentration (p = 0.70, ηp2 = 0.02), perceived exertion (p = 0.20, ηp2 = 0.26) and pain perception (p = 0.62, ηp2 = 0.04). Conclusion: In elite climbers performing severe climbing bouts, sleeves with forearm compression do not alter blood lactate concentration, heart rate, perceived exertion and local forearm muscle pain.

Ankle muscle activity modulation during single-leg stance differs between children, young adults and seniors

PurposeIncomplete maturation and aging-induced declines of the neuromuscular system affect postural control both in children and older adults and lead to high fall rates. Age-specific comparisons of the modulation of ankle muscle activation and behavioral center of pressure (COP) indices during upright stance have been rarely conducted. The objective of the present study was to quantify aging effects on a neuromuscular level. Thus, surface electromyography (SEMG) modulation and co-activity of ankle muscles during single-leg standing was compared in healthy children, young adults and seniors.MethodsPostural steadiness (velocity and mean sway frequency of COP), relative muscle activation (SEMG modulation) and co-activation of two ankle muscles (tibialis anterior, TA; soleus, SO) were examined during single-leg stance in 19 children [age, 9.7 (SD 0.5) years], 30 adults [23.3 (1.5) years] and 29 seniors [62.7 (6.1) years].ResultsVelocity of COP in medio-lateral and anterior–posterior directions, mean sway frequency in anterior–posterior direction, relative muscle activation (TA and SO) and co-activation revealed large age effects (Pu2009<u20090.003, ηp2u2009>u20090.14). Post-hoc comparisons indicated higher COP velocities, anterior–posterior frequencies, relative SO activation and co-activation in children and seniors when compared with adults. Relative TA activation was higher in children and adults compared with seniors (Pu2009<u20090.001).ConclusionsIncreased postural sway in children and seniors seems to be counteracted with higher TA/SO co-activity and SO modulation. However, TA modulation is higher in children and adults, whereas seniors’ TA modulation capacity is diminished. An aging-induced decline of TA motor units might account for deteriorations of TA modulation in seniors.