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This systematic review aimed to identify the characteristics and determine the effects of exercise interventions on improving health-related physical fitness in adults with asthma.A systematic search was completed in MEDLINE, CINAHL, Embase, and SPORTDiscus for peer-reviewed publications of experimental studies that investigated the effects of an exercise training intervention on performance-based health-related physical fitness outcomes in adults with asthma. Two reviewers independently screened studies for inclusion according to predetermined criteria and performed data extraction and quality assessment of included studies.Forty-five articles were included, in which results for 39 unique studies were reported. Subjects (n = 2135) were aged 22 ± 4 to 71 ± 11 yr with mild-severe asthma. Most exercise programs used aerobic exercise, either alone or in combination with resistance or breathing/stretching exercises. The most common exercise program characteristics were supervised moderate-to-vigorous intensity aerobic exercise performed for 30-45 min 3 d/wk. Meta-analyses revealed significant improvements in cardiorespiratory fitness (V˙o2peak: unstandardized mean difference [MD] 3.1 mL/kg/min, 95% CI, 1.9-4.3), functional fitness (walking distance: MD 41 m, 95% CI, 27-54), and overall health-related physical fitness (standardized mean difference [SMD] 0.67, 95% CI, 0.46-0.89) in favor of groups who underwent experimental exercise training interventions. Aerobic exercise elicited superior improvements in health-related physical fitness compared with breathing/stretching exercise (SMD 0.47, 95% CI, 0.14-0.81).Supervised exercise training programs, particularly those aerobic in nature, are effective in eliciting clinically meaningful improvements in cardiorespiratory and functional fitness in adults with asthma.PROSPERO registration ID number = CRD42018092828.

BackgroundObesity is associated with more severe asthma, however, the mechanisms responsible are poorly understood. Obesity is also associated with low-grade systemic inflammation; it is possible that this inflammation extends to the airways of adults with asthma, contributing to worse asthma outcomes. Accordingly, the aim of this review was to examine whether obesity is associated with increased airway and systemic inflammation and adipokines, in adults with asthma.MethodsMedline, Embase, CINAHL, Scopus and Current Contents were searched till 11 August 2021. Studies reporting measures of airway inflammation, systemic inflammation and/or adipokines in obese versus non-obese adults with asthma were assessed. We conducted random effects meta-analyses. We assessed heterogeneity using the I2statistic and publication bias using funnel plots.ResultsWe included 40 studies in the meta-analysis. Sputum neutrophils were 5% higher in obese versus non-obese asthmatics (mean difference (MD)=5.0%, 95% CI: 1.2 to 8.9, n=2297, p=0.01, I2=42%). Blood neutrophil count was also higher in obesity. There was no difference in sputum %eosinophils; however, bronchial submucosal eosinophil count (standardised mean difference (SMD)=0.58, 95% CI=0.25 to 0.91, p2=0%) and sputum interleukin 5 (IL-5) (SMD=0.46, 95% CI=0.17 to 0.75, p2=0%) were higher in obesity. Conversely, fractional exhaled nitric oxide was 4.5 ppb lower in obesity (MD=−4.5 ppb, 95% CI=−7.1 ppb to −1.8 ppb, p2=40%). Blood C reactive protein, IL-6 and leptin were also higher in obesity.ConclusionsObese asthmatics have a different pattern of inflammation to non-obese asthmatics. Mechanistic studies examining the pattern of inflammation in obese asthmatics are warranted. Studies should also investigate the clinical relevance of this altered inflammatory response.PROSPERO registeration numberCRD42021254525.

Animal models suggest physical activity (PA) has intergenerational effects on brain health and neurocognition. This scoping review compiles the human literature in this area, identifies knowledge gaps, and makes recommendations for future research.We systematically searched for experimental or observational studies conducted in humans, published in English, and reporting parental PA exposure (preconception or prenatal) and subsequent offspring brain and neurocognition. Two reviewers independently screened studies according to predetermined inclusion criteria.Fourteen articles were included (four experimental and 10 observational). All studies reported maternal characteristics, whereas only one (7%) study reported paternal characteristics (but not paternal PA). Prenatal maternal PA exposure was examined in 10 (71%) studies, while preconception and prenatal PA exposure was examined in four (29%) studies. Maternal PA exposure was positively related to offspring brain and neurocognitive development in most studies.Little is known about the intergenerational effects of parental PA on offspring brain and neurocognition in humans, particularly paternal preconception PA. More experimental studies with longer offspring follow-up and more objective and/or mechanistic assessments are required.HIGHLIGHTSAnimal models suggest physical activity has intergenerational neurobiological effectsAll observational human studies report a positive relationship between maternal physical activity and offspring brain and neurocognitionMost experimental human studies report no effects of maternal physical activity on offspring brain and neurocognition

Over the last decade, a growing body of research has examined the link between physical activity, fitness, and cognitive function in children and adolescents. Physical activity experimental research conducted with children and adolescents has identified selectively greater effects for tasks requiring higher order executive functions. As such, the primary aim of our chapter is to provide an overview of findings from systematic reviews and meta-analyses that have examined the effects of physical activity on measures of executive function in child and adolescent populations. We begin our chapter with definitions of key concepts associated with physical activity, fitness and cognitive function. We then provide a synthesis of systematic reviews and meta-analyses that have examined the acute and chronic effect of physical activity on EFs. Following this, we discuss the quantitative (e.g., time, intensity) and qualitative (e.g., type) characteristics of physical activity that may moderate effects. The next section focuses on the neurobiological, psychosocial and behavioral mechanisms responsible for the effect of physical activity on executive functions. We conclude by highlighting the limitations of the existing evidence base and providing recommendations for future research.

Background: Modifiable cardiovascular risk factors are prevalent and poorly managed in people after stroke. Aerobic exercise is effective in reducing many modifiable cardiovascular risk factors after stroke but is challenging and under-researched in nonambulant persons. This pilot study aimed to investigate the feasibility of aerobic interval training in nonambulant persons after stroke. Methods: Aerobic exercise was performed on an upright or semi-recumbent cycle ergometer. Participants were prescribed 4 × 4-min intervals of exercise at 85% maximum age-predicted heart rate (APHRmax) with a 3-min active recovery at 70%APHRmax per 30-min session, 3 times per week for 10 weeks. Heart rate, rating of perceived exertion, workload, cadence, and duration of exercise achieved were recorded for each interval. Results: Nine participants (mean ± SD; age 62 ± 12 y; 5 males) unable to walk without assistance after stroke (2.9 ± 3.9 y) were recruited. There were no adverse events reported, but there was one dropout (due to bronchitis). Attendance for the remaining participants was 93 ± 6%. The mean training %APHRmax was 72 ± 14% for the higher intensity interval and 57 ± 21% for the recovery interval. The mean increase in training workload between weeks 1 and 10 was 11.2 ± 11.6 W (27 ± 28%) for the higher intensity interval and 4.0 ± 7.7W (17 ± 33%) for the recovery interval. The mean increase in VO2peak was 2.3 ± 2.9 mL·kg−1·min−1 (18 ± 22%) over the 10-week intervention. Conclusion: Aerobic interval training at a moderate-vigorous intensity on an upright or recumbent cycle ergometer is feasible for nonambulant persons after stroke. Aerobic interval training should be further investigated to determine its potential to improve cardiorespiratory fitness after stroke and risk factors for recurrent stroke.

Background: Upper limb (UL) hemiparesis is a common, disabling and persistent problem, and a major contributor to poor well-being and quality of life in persons after stroke. Conventional U...

Over the last decade, a growing body of research has examined the link between physical activity, fitness, and cognitive function in children and adolescents. Physical activity experimental research conducted with children and adolescents has identified selectively greater effects for tasks requiring higher order executive functions. As such, the primary aim of our chapter is to provide an overview of findings from systematic reviews and meta-analyses that have examined the effects of physical activity on measures of executive function in child and adolescent populations. We begin our chapter with definitions of key concepts associated with physical activity, fitness and cognitive function. We then provide a synthesis of systematic reviews and meta-analyses that have examined the acute and chronic effect of physical activity on EFs. Following this, we discuss the quantitative (e.g., time, intensity) and qualitative (e.g., type) characteristics of physical activity that may moderate effects. The next section focuses on the neurobiological, psychosocial and behavioral mechanisms responsible for the effect of physical activity on executive functions. We conclude by highlighting the limitations of the existing evidence base and providing recommendations for future research.

Motor function may be enhanced if aerobic exercise is paired with motor training. One potential mechanism is that aerobic exercise increases levels of brain-derived neurotrophic factor (BDNF), which is important in neuroplasticity and involved in motor learning and motor memory consolidation. This study will examine the feasibility of a parallel-group assessor-blinded randomised controlled trial investigating whether task-specific training preceded by aerobic exercise improves upper limb function more than task-specific training alone, and determine the effect size of changes in primary outcome measures. People with upper limb motor dysfunction after stroke will be allocated to either task-specific training or aerobic exercise and consecutive task-specific training. Both groups will perform 60 hours of task-specific training over 10 weeks, comprised of 3 × 1 hour sessions per week with a therapist and 3 × 1 hours of home-based self-practice per week. The combined intervention group will also perform 30 minutes of aerobic exercise (70–85%HRmax) immediately prior to the 1 hour of task-specific training with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events will be recorded. Clinical outcome measures will be performed pre-randomisation at baseline, at completion of the training program, and at 1 and 6 months follow-up. Primary clinical outcome measures will be the Action Research Arm Test (ARAT) and the Wolf Motor Function Test (WMFT). If aerobic exercise prior to task-specific training is acceptable, and a future phase 3 randomised controlled trial seems feasible, it should be pursued to determine the efficacy of this combined intervention for people after stroke. Keywords: Stroke, Motor function, Aerobic exercise, Task-specific training

Objective This study examined the feasibility of a parallel-group assessor-blinded randomized controlled trial investigating whether task-specific training preceded by aerobic exercise (AEX + TST) improves upper limb function more than task-specific training (TST) alone. Methods People with upper limb motor dysfunction after stroke were allocated to TST or AEX + TST. Both groups were prescribed 60 hr of TST over 10 weeks (3 × 1-hr sessions with a therapist per week and 3 × 1 hr of home-based self-practice per week). The AEX + TST group performed 30 minutes of aerobic exercise immediately prior to the 1 hr of TST with the therapist. Recruitment, adherence, retention, participant acceptability, and adverse events were recorded. Clinical measures were performed prerandomization at baseline, on completion of the intervention, and at 1- and 6-month follow-up. Results Fifty-nine persons after stroke were screened, 42 met the eligibility criteria, and 20 (11 male; mean [SD] age: 55.4 [16.0] years; time since stroke: 71.7 [91.2] months) were recruited over 17 months. The mean Wolf Motor Function Test Functional Ability Score at baseline was 27.4 (max = 75) and the mean Action Research Arm Test score was 11.2 (max = 57). Nine were randomized to AEX + TST and 11 to TST. There were no adverse events, but there was one drop out. Retention at 1- and 6-month follow-up was 80% and 85%, respectively. Attendance was 93% (6) for the AEX + TST group, and 89% (9) for the TST group. AEX + TST was perceived as acceptable (100%) and beneficial (87.5%). Exertional fatigue (visual analogue scale) prior to TST was worse in the AEX + TST group (3.5 [0.7] out of 10) than the TST group (1.7 [1.4] out of 10). The TST group performed 31% more repetitions per session than the AEX + TST group. Conclusion A subsequent Phase III study is feasible, but modifications to eligibility criteria, outcome measures, and intervention delivery are recommended.

CONTEXT: Advances in neuroimaging techniques have resulted in an exponential increase in the number of studies investigating the effects of physical activity on brain structure and function. Authors of studies have linked physical activity and fitness with brain regions and networks integral to cognitive function and scholastic performance in children and adolescents but findings have not been synthesized. OBJECTIVE: To conduct a systematic review of studies in which the impact of physical activity on brain structure and function in children and adolescents is examined. DATA SOURCES: Six electronic databases (PubMed, PsychINFO, Scopus, Ovid Medline, SportDiscus, and Embase) were systematically searched for experimental studies published between 2002 and March 1, 2019. STUDY SELECTION: Two reviewers independently screened studies for inclusion according to predetermined criteria. DATA EXTRACTION: Two reviewers independently extracted data for key variables and synthesized findings qualitatively. RESULTS: Nine studies were included (task-based functional MRI [n = 4], diffusion tensor imaging [n = 3], arterial spin labeling [n = 1], and resting-state functional MRI [n = 1]) in which results for 5 distinct and 4 similar study samples aged 8.7 ± 0.6 to 10.2 ± 1.0 years and typically of relatively low socioeconomic status were reported. Effects were reported for 12 regions, including frontal lobe (n = 3), parietal lobe (n = 3), anterior cingulate cortex (n = 2), hippocampus (n = 1), and several white matter tracts and functional networks. LIMITATIONS: Findings need to be interpreted with caution as quantitative syntheses were not possible because of study heterogeneity. CONCLUSIONS: There is evidence from randomized controlled trials that participation in physical activity may modify white matter integrity and activation of regions key to cognitive processes. Additional larger hypothesis-driven studies are needed to replicate findings.

IntroductionThis trial aims to investigate the impact of a school-based physical activity programme, involving high-intensity interval training (HIIT), on the physical, mental and cognitive health of senior school students.Methods and analysisThe Burn 2 Learn (B2L) intervention will be evaluated using a two-arm parallel group cluster randomised controlled trial with allocation occurring at the school level (to treatment or wait-list control). Schools will be recruited in two cohorts from New South Wales, Australia. The trial will aim to recruit ~720 senior school students (aged 16–18 years) from 20 secondary schools (ie, 10 schools per cohort). A range of implementation strategies will be provided to teachers (eg, training, equipment and support) to facilitate the delivery of HIIT sessions during scheduled classes. In phase I and II (3 months each), teachers will facilitate the delivery of at least two HIIT sessions/week during lesson-time. In phase III (6 months), students will be encouraged to complete sessions outside of lesson-time (teachers may continue to facilitate the delivery of B2L sessions during lesson-time). Study outcomes will be assessed at baseline, 6 months (primary end point) and 12 months. Cardiorespiratory fitness (shuttle run test) is the primary outcome. Secondary outcomes include: vigorous physical activity, muscular fitness, cognition and mental health. A subsample of students will (i) provide hair samples to determine their accumulated exposure to stressful events and (ii) undergo multimodal MRI to examine brain structure and function. A process evaluation will be conducted (ie, recruitment, retention, attendance and programme satisfaction).Ethics and disseminationThis study has received approval from the University of Newcastle (H-2016–0424) and the NSW Department of Education (SERAP: 2017116) human research ethics committees.Trial registration numberACTRN12618000293268; Pre-results.

BACKGROUND Aerobic exercise can improve upper limb motor function in both healthy and stroke populations. Research in animals after stroke has shown that aerobic exercise combined with forelimb motor training improved forelimb motor function more than aerobic exercise or motor training alone. There is a lack of knowledge about this combined intervention in humans after stroke. PURPOSE These 2 case reports describe the exploratory implementation of a combined aerobic exercise and task-specific training intervention to improve upper limb motor function in one person in subacute stroke recovery and one person in chronic stroke recovery. METHODS Case descriptions Subacute participant: 45-year-old female, 3 months after ischemic stroke resulting in left-sided hemiparesis affecting her non-dominant upper limb, with a baseline Action Research Arm Test (ARAT) score of 10/57 and Wolf Motor Function Test (WMFT) score of 39/75. Chronic participant: 69-year-old female, 14 years after ischemic stroke resulting in right-sided hemiparesis affecting her non-dominant upper limb, with a baseline ARAT score of 13/57 and WMFT score of 34/75. Intervention Participants performed 30 min of lower limb cycling immediately prior to 30 min of upper limb task-specific training. Sessions were undertaken 3 times a week for 8 weeks in a university rehabilitation laboratory. Results The combined intervention was feasible and perceived as acceptable and beneficial. Participants improved their upper limb motor function on the ARAT (subacute participant = 4 points; chronic participant = 2 points) and WMFT (subacute participant = 5 points; chronic participant = 3 points). Participants improved their aerobic fitness (subacute participant = +4.66 ml O2 /kg/min; chronic participant = +7.34 ml O2 /kg/min) and 6-minute walking distance (subacute participant = +50 m; chronic participant = +37 m). Discussion Combining aerobic exercise with task-specific training may be a worthwhile therapeutic approach to improve upper limb motor function suitable for persons in the subacute or chronic phase after stroke.