Stroke contributing factors may include losing temper, extreme exercise: study

 I'm sure your doctor already warned you against high intensity exercise as soon as Andrew Marr stated that HIT caused his stroke.

Do you really want to do high intensity training?

Because Andrew Marr blames high-intensity training for his stroke. 

Can too much exercise cause a stroke? April 2013

Stroke contributing factors may include losing temper, extreme exercise: study

 

Losing one's temper or exercising too rigorously could be contributing factors for a stroke, according to new research.

In a study published Wednesday in the European Society of Cardiology's "European Heart Journal," a team of international researchers looked at more than 13,000 stroke patients in 32 countries as part of the INTERSTROKE study.

10 DIETARY TIPS TO REDUCE HEART DISEASE AND STROKE RISK, ACCORDING TO NEW RESEARCH

Using a "case-crossover approach," the team determined whether a trigger within one hour of symptom onset was associated with acute stroke, versus the same time period on the previous day.

"Stroke prevention is a priority for physicians, and despite advances it remains difficult to predict when a stroke will occur. Many studies have focused on medium to long-term exposures, such as hypertension, obesity or smoking. Our study aimed to look at acute exposures that may act as triggers," lead researcher and National University of Ireland Galway professor Andrew Smyth said in a statement.

The research analyzed patterns in patients who suffered an ischemic stroke and the less common intracerebral hemorrhage.

One in 11 survivors experienced a period of anger or upset in the one hour leading up to it, and the global INTERSTROKE study found that one in 20 patients had engaged in heavy physical exertion.

The paper, co-led by the National University of Ireland Galway, suggested that anger or emotional upset was linked to around a 30% increase in the risk of stroke during one hour after an episode – with a greater increase if the patient did not have a history of depression and larger odds for those with a lower level of education.

Heavy physical exertion was linked to around a 60% increase in the risk of intracerebral hemorrhage (ICH) – a rare form of stroke that causes bleeding in the brain – during that same period after heavy exertion, but not with all strokes or ischemic strokes.

There was a greater increase for women and less risk for those with a normal body mass index (BMI).

VEGETABLE FATS LINKED TO LOWER STROKE RISKS, REPORTS SAY

"Acute anger or emotional upset was associated with the onset of all stroke, ischemic stroke, and ICH, while acute heavy physical exertion was associated with ICH only," the authors wrote.

"The study also concluded that there was no increase with exposure to both triggers of anger and heavy physical exertion," Smythe said.

The study pointed out that there was no modifying effect by region, prior cardiovascular disease, risk factors, cardiovascular medications, time or day of symptom onset.

"Compared with exposure to neither trigger during the control period, the odds of stroke associated with exposure to both triggers were not additive," the study noted.

Co-author and Galway University Hospitals consultant stroke physician Dr. Michelle Canavan said that people should practice mental and physical wellness at all ages, but added that it is "also important for some people to avoid heavy physical exertion, particularly if they are high-risk of cardiovascular, while also adopting a healthy lifestyle of regular exercise."

In the U.S., the Centers for Disease Control and Prevention (CDC) says that someone has a stroke every 40 seconds and someone dies of stroke every four minutes.

Nearly 800,000 people in America have a stroke every year. About 87% of all strokes are ischemic strokes, in which blood flow to the brain is blocked.

"Some of the best ways to prevent stroke are to maintain a healthy lifestyle, treat high blood pressure and not to smoke, but our research also shows other events such as an episode of anger or upset or a period of heavy physical exertion independently increase the short-term risk." study co-leader and National University of Ireland Galway Professor Martin O'Donnell said.

"We would emphasize that a brief episode of heavy physical exertion is different to getting regular physical activity, which reduces the long-term risk of stroke," he explained.

Commentary: High Intensity Physical Rehabilitation Later Than 24 h Post Stroke Is Beneficial in Patients: A Pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke

Why wouldn't it be beneficial? Earlier studies showing showing bad results obviously didn't account for the neuronal cascade of death occurring in the first week. This commentary doesn't even discuss the neuronal cascade of death, so from that I conclude these people don't even know what they are talking about. 

Commentary: High Intensity Physical Rehabilitation Later Than 24 h Post Stroke Is Beneficial in Patients: A Pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke

Mari Nakao^1,2,3*, Masahiro Banno^4,5,6, Yuki Kataoka^6,7,8,9 and Shunsuke Taito^6,10

• ¹Rehabilitation Department, Niigata Rehabilitation Hospital, Niigata, Japan
• ²Rehabilitation Department, Tohoku University Graduate School of Medicine, Sendai, Japan
• ³Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
• ⁴Department of Psychiatry, Seichiryo Hospital, Nagoya, Japan
• ⁵Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
• ⁶Systematic Review Workshop Peer Support Group (SRWS-PSG), Japan
• ⁷Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
• ⁸Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
• ⁹Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
• ¹⁰Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan

A Commentary on
High Intensity Physical Rehabilitation Later Than 24 h Post Stroke Is Beneficial in Patients: A Pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke

by Tong, Y., Cheng, Z., Rajah, G. B., Duan, H., Cai, L., Zhang, N., et al. (2019). Front. Neurol. 10:113. doi: 10.3389/fneur.2019.00113

Introduction

This article is a general commentary on “High Intensity Physical Rehabilitation Later Than 24 h Post Stroke is Beneficial in Patients: A pilot Randomized Controlled Trial (RCT) Study in Mild to Moderate Ischemic Stroke (1). A recent, current Cochrane review (2) concluded that very early intervention is not beneficial for patients, although the adequate dose of rehabilitation is unknown. Tong et al. (1) reported that early intensive mobilization after stroke was beneficial compared with very early mobilization and early routine mobilization. This finding is important for clinicians who prescribe rehabilitation for acute stroke patients. However, we believe that several concerns should be noted regarding the methods in Tong's study.

Methods

To focus on potential biases in the present study, we evaluated the risk of bias (3). In a recent, current Cochrane review entitled “Very early vs. delayed mobilization after stroke” (2), nine studies were selected as eligible for meta-analysis, and the risk of bias was evaluated. We adopted the same method as this Cochrane review.

Results

From the evaluation, we found several points that could affect the results of the present study (Table 1).

Outcome Variables and the Assessment of Outcomes

There was no report on the outcome of variables registered in the protocol (4) in the manuscript (1), and this causes a high selective reporting bias. The primary outcome defined in the manuscript (1) was a modified Rankin Scale (mRS) score, which was not listed in the protocol (4). The outcomes described in the study protocol (4) included the NIHSS, Barthel Index, Rivermead Motor Assessment, Fugl-Meyer Assessment, and MRI brain scans. The authors should clearly report the outcomes to be assessed in the trial protocol (4) and should also describe the measurement methods (1) to reduce biases.

The authors explained in the manuscript (1) that they estimated the sample size from the prevalence of the primary outcome (mRS score [0–2]) at 3 months after stroke onset. The process of determining the sample size for the trial protocol (4) was not mentioned. The sample size calculation and outcome variables should be determined before registration to reduce the risk of bias.

Additionally, no information on whether the outcome assessor was blinded was provided in the manuscript (1) or the protocol (4). This can result in unclear detection bias. The authors should state whether the assessor was blinded in the outcome assessment section (1).

Method of Intervention

The unclear intervention period for each patient causes a high risk of performance bias. The intervention periods ranged from 10 to 14 days depending on cases. The intervention period for each patient and the method of determining this period were not described in the protocol (4) or the manuscript (1). Moreover, blinding of this type of intervention is impossible because of its nature. If therapists were not blinded, the intervention period in the Early Intensive Mobilization (EIM) group could have been several days longer than that in the other two groups, which could cause a high risk of performance bias. Therefore, the authors should clarify the median and quartile of the intervention period for each group.

Lack of Information on Patients During the Observation Period and an Unknown Accumulative Dose Effect of Rehabilitation Before Outcome Measurement

Without controlling the accumulative dose of rehabilitation during the observation period, it is difficult to evaluate whether early or very early intervention were effective. We assumed that the accumulative dose of rehabilitation from the endpoint of the intervention to the time of outcome measurement had a greater effect on the outcome than the timing of the intervention. In the manuscript (1), no information was provided about patients during the observation period. The length of hospital stay, the number of patients transferred to inpatient rehabilitation, and the accumulative volume of rehabilitation before evaluation at 3 months could affect the outcome. According to a previous study (5) a higher rehabilitation dose results in a better outcome. Another previous study (6) reported the accumulative dose effect on stroke patients during the recovery period (2 to 6 months after stroke onset). The authors should describe this information as the AVERT Trial Collaboration group did in their report (7, 8).

Lack of Intervention Fidelity

The study (1) has a possible high risk of attribution bias because of the policy regarding participant dropout and a lack of adherence to the intervention.

In the Early Routine Mobilization (ERM) group 16 patients dropped out because of “excessive mobilization.” In the Very Early Intensive Mobilization (VEIM) and EIM groups, 13 and 10 patients, dropped out because they could not achieve mobilization. Tong et al. (1) removed these participants from the analysis because they did not complete the intervention that was intended for their group. This can cause high risk of attribution bias, which can change the outcomes. To correct this bias, the authors should undertake an intention-to-treat analysis that includes all randomized participants in the intervention groups to which they were randomized, regardless of the intervention that they actually received. “Drop outs” should only refer to participants who actively chose to withdraw from the study or who were lost to follow-up for other reasons.

Discussion

From the risk of bias evaluation (3), we determined that the conclusion of the manuscript (1) was vulnerable, and more information is needed to show the clear usefulness of high-dose (intensive) early intervention after stroke. High risks of selective reporting, attribution and performance bias (Table 1) could distort the study design described in the protocol (4) and affect the interpretation of the results. The number of high-risk biases in the study by Tong et al. (1) surpassed those of the nine studies included in a recent, current Cochrane review (2). A considerable difference between the study protocol (4) and the manuscript (1) was observed for some outcome variables. The accumulative dose during the observational period for each patient group needs to be considered, and detailed information about rehabilitation exposure during the recovery period should be disclosed.

 

Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study

But do you want  high-intensity? Because Andrew Marr blames high-intensity training for his stroke. 

Can too much exercise cause a stroke?

 

You might want to consult your doctor on this. Bet s/he doesn't even know about Andrew Marr.

Before I could do anything like this I would need my leg spasticity cured.

Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study

Show all authors

Jacqueline C Outermans, Roland PS van Peppen, Harriet Wittink, ...

First Published August 18, 2010 Research Article Find in PubMed

https://doi.org/10.1177/0269215509360647

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Abstract

Objective: To investigate the feasibility and the effects on gait of a high intensity task-oriented training, incorporating a high cardiovascular workload and large number of repetitions, in patients with subacute stroke, when compared to a low intensity physiotherapy-programme.
Design and subjects: Randomized controlled clinical trial: Forty-four patients with stroke were recruited at 2 to 8 weeks after stroke onset.
Measures: Maximal gait speed assessed with the 10-metre timed walking test (10MTWT), walking capacity assessed with the six-minute walk test (6MWT). Control of standing balance assessed with the Berg Balance Scale and the Functional Reach test. Group differences were analysed using a Mann—Whitney U-test.
Results: Between-group analysis showed a statistically significant difference in favour of the high intensity task-oriented training in performance on the 10MTWT (Z = -2.13, P = 0.03) and the 6MWT (Z = -2.26, P = 0.02). No between-group difference were found for the Berg Balance Scale (Z = —0.07, P = 0.45) and the Functional Reach test (Z = —0.21, P = 0.84).
Conclusion: A high-intensity task-oriented training programme designed to improve hemiplegic gait and physical fitness was feasible in the present study and the effectiveness exceeds a low intensity physiotherapy-programme in terms of gait speed and walking capacity in patients with subacute stroke. In a future study, it seems appropriate to additionally use measures to evaluate physical fitness and energy expenditure while walking.

Dobkin BH Clinical practice. Rehabilitation after stroke. N Engl J Med 2005; 352: 1677-84.

High-intensity training improves post-stroke walking, balance

What is the definition of high-intensity? Because Andrew Marr blames high-intensity training for his stroke. 

Can too much exercise cause a stroke?

 

You might want to consult your doctor on this. Bet s/he doesn't even know about Andrew Marr.

Before I could do anything like this I would need my leg spasticity cured.

High-intensity training improves post-stroke walking, balance

Hornby GT, et al. Stroke. 2019;doi:10.1161/STROKEAHA.119.026254.

September 13, 2019

High-intensity step training resulted in better improvements in walking, gait and balance confidence compared with low-intensity training, in patients with chronic stroke.
According to the study published in Stroke, all walking gains were greater in patients assigned high-intensity training than in patients assigned low-intensity training (P < .001), and improvements were correlated with the stepping amount and rate of high-intensity training (r = 0.48–60; P < .01). Additional improvements were seen in spatiotemporal symmetry as well as balance confidence, the latter seen only in patients with severe impairments.

See Also

• High-intensity step training improves walking skills after stroke
• Top stories in cardiology: Rivaroxaban fails to reduce embolic stroke recurrence, ablation reduces atrial fibrillation burden in heart failure
• ASA: 20 facts patients may not know about stroke

“Providing stepping training at high intensities with or without the practice of variable, difficult stepping tasks elicits gains in walking function and gait symmetry as compared with lower-intensity activities,” T. George Hornby, PhD, professor of physical medicine and rehabilitation at the Indiana University School of Medicine, and colleagues wrote. “Changes in balance and balance confidence suggest a possible benefit of practicing difficult stepping tasks during high-intensity training in variable contexts.”
In this phase 2, blinded assessor clinical trial, 90 patients with chronic stroke were randomly assigned one of three groups; high-intensity stepping with variable, difficult stepping tasks at 70% to 80% heart rate reserve (mean age, 59 years; 82% men; 68% white); high-intensity stepping performing only forward walking (mean age, 60 years; 57% men; 70% white); and low-intensity stepping in variable contexts at 30% to 40% heart rate reserve (mean age, 56 years; 56% men; 66% white).
Enrolled patients received up to 30 training sessions over the course of 2 months and were tested at baseline, post-training, and a 3-month follow-up, according to the study.
The primary outcomes were walking speeds and timed distance.
“Despite nonsignificant differences in adverse events, future studies should further identify the potential risks for this patient population,” the authors wrote. “The relative contributions of volume, intensity, and variability may be important, and future studies are needed to further define optimal training parameters.” – by Scott Buzby
Disclosures: The authors report no relevant financial disclosures.

Effects of a Bout of High Intensity Interval Versus Moderate Continuous Exercise When Matched In Workload on Brain Excitability of Stroke Survivors

Andrew Marr of the UK however blames high-intensity exercise for his stroke.

Can too much exercise cause a stroke?

You might want to consult your doctor on this. Bet s/he doesn't even know about Andrew Marr. Be careful out there

Effects of a Bout of High Intensity Interval Versus Moderate Continuous Exercise When Matched In Workload on Brain Excitability of Stroke Survivors

High-Intensity Interval Training After Stroke: An Opportunity to Promote Functional Recovery, Cardiovascular Health, and Neuroplasticity

Andrew Marr of the UK however blames high-intensity exercise for his stroke.

Can too much exercise cause a stroke?

You might want to consult your doctor on this. Bet s/he doesn't even know about Andrew Marr.

http://journals.sagepub.com/doi/abs/10.1177/1545968318766663

Show all authors

Jennifer Crozier, Marc Roig, PhD, Janice J. Eng, PhD, , , ...

First Published April 20, 2018 Research Article

Article information

Abstract

Introduction. Stroke is the leading cause of adult disability. Individuals poststroke possess less than half of the cardiorespiratory fitness (CRF) as their nonstroke counterparts, leading to inactivity, deconditioning, and an increased risk of cardiovascular events. Preserving cardiovascular health is critical to lower stroke risk; however, stroke rehabilitation typically provides limited opportunity for cardiovascular exercise. Optimal cardiovascular training parameters to maximize recovery in stroke survivors also remains unknown. While stroke rehabilitation recommendations suggest the use of moderate-intensity continuous exercise (MICE) to improve CRF, neither is it routinely implemented in clinical practice, nor is the intensity always sufficient to elicit a training effect. High-intensity interval training (HIIT) has emerged as a potentially effective alternative that encompasses brief high-intensity bursts of exercise interspersed with bouts of recovery, aiming to maximize cardiovascular exercise intensity in a time-efficient manner. HIIT may provide an alternative exercise intervention and invoke more pronounced benefits poststroke.  
Objectives. To provide an updated review of HIIT poststroke through (a) synthesizing current evidence; (b) proposing preliminary considerations of HIIT parameters to optimize benefit; (c) discussing potential mechanisms underlying changes in function, cardiovascular health, and neuroplasticity following HIIT; and (d) discussing clinical implications and directions for future research.  
Results. Preliminary evidence from 10 studies report HIIT-associated improvements in functional, cardiovascular, and neuroplastic outcomes poststroke; however, optimal HIIT parameters remain unknown.  
Conclusion. Larger randomized controlled trials are necessary to establish (a) effectiveness, safety, and optimal training parameters within more heterogeneous poststroke populations; (b) potential mechanisms of HIIT-associated improvements; and (c) adherence and psychosocial outcomes.

Moderate to high intensity exercise does not slow cognitive decline in people with dementia

Well then what does? Your doctor won't know a damn thing, on your own once again.
 https://medicalxpress.com/news/2018-05-moderate-high-intensity-cognitive-decline.html

Moderate to high intensity exercise does not slow cognitive (mental) impairment in older people with dementia, finds a trial published by The BMJ today.

Although the exercise programme improved physical fitness, it cannot be recommended as a treatment option for cognitive impairment in dementia, say the researchers.
Nearly 47.5 million people worldwide have dementia and the view that exercise might slow cognitive decline has gained widespread popularity. But recent reviews of trials of exercise training in people with dementia have shown conflicting results.
To try and resolve this uncertainty, a team of UK researchers decided to estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with dementia.
The trial involved 494 people with mild to moderate dementia (average age 77 years) living in the community across 15 regions of England.
General health and fitness was assessed at the start of the study and participants were randomly assigned to either a supervised exercise and support programme (329 patients) or to usual care (165 patients).
The programme consisted of 60-90 minute group sessions in a gym twice a week for four months, plus home exercises for one additional hour each week with ongoing support.
The main (primary) outcome was an Alzheimer's disease assessment score (ADAS-cog) at 12 months. Other (secondary) outcomes included activities of daily living, number of falls, and quality of life.
Compliance with exercise was good and participants were assessed again at six and 12 months.
After taking account of potentially influential factors, the researchers found that cognitive impairment declined over the 12-month follow-up in both groups.
The exercise group showed improved physical fitness in the short term, but higher ADAS-cog scores at 12 months (25.2 v 23.8) compared with the usual care group, indicating worse cognitive impairment. However, the average difference was small and clinical relevance was uncertain.
No differences were found in secondary outcomes, including number of falls and quality of life, or after further analyses to test the strength of the results.
The researchers point to some trial limitations. For example, participants and carers knew which group they were in, and the period of structured exercise may have been too short to produce positive benefits. However, strengths over previous trials included a substantially larger sample size and high levels of follow-up.
"This trial suggests that people with mild to moderate dementia can engage and comply with moderate to high intensity aerobic and strengthening exercise and improve physical fitness," say the authors.
"These benefits do not, however, translate into improvements in cognitive impairment, activities in daily living, behaviour, or health related quality of life," they add.
They suggest that future trials should explore other forms of exercise, and that investigators "should consider the possibility that some types of exercise intervention might worsen cognitive impairment."

Explore further: New guideline: Try exercise to improve memory, thinking

More information: Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial, BMJ (2018). www.bmj.com/content/361/bmj.k1675

Journal reference: British Medical Journal (BMJ)
Provided by: British Medical Journal