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Purpose: Concussion management is shifting away from a rest-is-best approach, as data now suggest that exercise-is-medicine for this mild brain injury. Despite this, we have limited data on habitual physical activity following concussion. Therefore, our objective was to quantify accelerometer-measured physical activity and sedentary time in children with concussion (within the first month of injury) and healthy controls. We hypothesized that children with concussion would be less active than their healthy peers., Methods: We performed a secondary analysis of prospectively collected accelerometer data. Our sample included children with concussion (n = 60, 31 females) and historical controls (n = 60) matched for age, sex, and season of accelerometer wear., Results: Children with concussion were significantly more sedentary than controls (mean difference [MD], 38.3 min/d, P = .006), and spent less time performing light physical activity (MD, -19.5 min/d, P = .008), moderate physical activity (MD, -9.8 min/d, P < .001), and vigorous physical activity (MD, -12.0 min/d, P < .001); these differences were observed from 8:00 AM to 9:00 PM. Sex-specific analyses identified that girls with concussion were less active and more sedentary than both boys with concussion (P = .010) and healthy girls (P < .010)., Conclusion: There is an activity deficit observed within the first month of pediatric concussion. Physical activity guidelines should address this while considering sex effects.

Purpose: Dynamic phosphorus MR spectroscopic imaging ( 31 P-MRSI) experiments require temporal resolution on the order of seconds to concurrently assess different muscle groups. A highly accelerated pulse sequence combining flyback echo-planar spectroscopic imaging (EPSI) and compressed sensing was developed and tested in a phantom and healthy humans during an exercise-recovery challenge of the lower leg muscles, using a clinical 3T MRI., Methods: A flyback EPSI readout designed to achieve 2.25 × 2.25 cm 2 resolution over a 18 × 18 cm 2 field of view (i.e., 8 × 8 matrix) was combined with compressed sensing through the inclusion of pseudorandom gradient blips to sub-sample the ky-kt dimensions by a factor of 2.7×, achieving a temporal resolution of 9 s. The sequence was first tested in a phantom to assess performance compared to fully sampled EPSI (fidEPSI) and phase encoded chemical shift imaging (fidCSI). Then, tests were performed in 11 healthy volunteers during an exercise-recovery challenge of the lower leg muscles. Voxels containing tissue from different muscle groups were evaluated measuring percentage phosphocreatine (%PCr) depletion, time constant of PCr recovery (τPCr) and intracellular pH at rest and following exercise., Results: The sequence was capable to track the dynamic PCr response of multiple muscles simultaneously. No statistical differences were found in the metabolite ratio, pH or linewidth when compared with fidEPSI and fidCSI in the phantom study. Dynamic experiments showed differences in PCr depletion when comparing soleus with gastrocnemius muscles. Intracellular pH, τPCr and %PCr decrease were consistent with reported values., Conclusion: Highly accelerated 31 P-MRSI combining flyback EPSI and compressed sensing is capable of assessing concurrent energy metabolism in multiple muscle groups using a clinical 3T MR system., (© 2019 International Society for Magnetic Resonance in Medicine.)

Object: To assess post-exercise recovery of human calf muscles using dynamic diffusion tensor imaging (dDTI)., Materials and Methods: DTI data (6 directions, b = 0 and 400 s/mm 2 ) were acquired every 35 s from seven healthy men using a 3T MRI, prior to (4 volumes) and immediately following exercise (13 volumes, ~7.5 min). Exercise consisted of 5-min in-bore repetitive dorsiflexion-eversion foot motion with 0.78 kg resistance. Diffusion tensors calculated at each time point produced maps of mean diffusivity (MD), fractional anisotropy (FA), radial diffusivity (RD), and signal at b = 0 s/mm 2 (S 0 ). Region-of-interest (ROI) analysis was performed on five calf muscles: tibialis anterior (ATIB), extensor digitorum longus (EDL) peroneus longus (PER), soleus (SOL), and lateral gastrocnemius (LG)., Results: Active muscles (ATIB, EDL, PER) showed significantly elevated initial MD post-exercise, while predicted inactive muscles (SOL, LG) did not (p < 0.0001). The EDL showed a greater initial increase in MD (1.90 × 10 -4 mm 2 /s) than ATIB (1.03 × 10 -4 mm 2 /s) or PER (8.79 × 10 -5 mm 2 /s) (p = 7.40 × 10 -4 ), and remained significantly elevated across more time points than ATIB or PER. Significant increases were observed in post-exercise EDL S 0 relative to other muscles across the majority of time points (p < 0.01 to p < 0.001)., Conclusions: dDTI can be used to differentiate exercise-induced changes between muscles. These differences are suggested to be related to differences in fiber composition.

Object: There have been no studies to investigate the effects of cycling exercise protocols, as well as repeated bouts of exercise, on the blood oxygen level-dependent (BOLD) response in the quadriceps muscles. This study characterized BOLD signal recovery following non-ischemic bouts of exercise in the quadriceps muscles of healthy adults in order to provide a basis for application of a protocol for clinical populations., Materials and Methods: Healthy male subjects (23.7 ± 2.0 years of age, n = 10) completed three cycles of one-minute exercise (65 % of maximum workload), with two minutes of rest between each bout, on an MRI-compatible ergometer. The BOLD responses during recovery were fitted to a sigmoid model, and response kinetics (post-exercise intensity [S0]), response time (α), change in baseline BOLD signal (κ), and inflection point (β)] were measured., Results: The sigmoid function fit well to the post-exercise BOLD data (r (2) = 0.95 ± 0.04). The mean response time was 10.5 ± 3.8 seconds, change in baseline BOLD intensity was 0.15 ± 0.068, and time to half-peak was 20.2 ± 8.6 seconds., Conclusion: The proposed sigmoid model is a robust method for quantifying quadriceps BOLD response post-exercise without induced ischemia. Extension of this model to evaluate microvascular responses in patients with chronic disease could improve our understanding of exercise intolerance.

Introduction: Structural evidence of exercise-induced muscle disruption has traditionally involved histological analysis of muscle tissue obtained by needle biopsy, however, there are multiple limitations with this technique. Recently, diffusion tensor magnetic resonance imaging (DT-MRI) has been successfully demonstrated to noninvasively assess skeletal muscle abnormalities induced by traumatic injury., Methods: To determine the potential for DT-MRI to detect musculoskeletal changes after a bout of eccentric exercise, 10 healthy men performed 300 eccentric actions on an isokinetic dynamometer. DT-MRI measurements and muscle biopsies from the vastus lateralis were obtained before and 24 h post-exercise., Results: Z-band streaming was higher 24 h post-exercise compared with baseline (P < 0.05). The histological indices of damage coincided with changes in DT-MRI parameters of fractional anisotropy (FA) and apparent diffusion coefficient; reflecting altered skeletal muscle geometry (P < 0.05). Z-band streaming quantified per fiber correlated with FA (r = -0.512; P < 0.05)., Conclusions: DT-MRI can detect changes in human skeletal muscle structure following eccentric exercise., (Copyright © 2012 Wiley Periodicals, Inc.)

Previous studies have reported differences in muscle function and metabolism between patients with cystic fibrosis (CF) and healthy controls (HC), but it is currently unknown whether these abnormalities are specific to CF or also seen in other airway diseases. In this study, we used magnetic resonance spectroscopy (MRS) during exercise to assess muscle metabolism in CF patients. Twenty patients with CF and 20 age, gender, and habitual activity-matched HCs and a respiratory disease comparison group with primary ciliary dyskinesia (PCD; n = 10) were studied. Phosphorus MRS (P-MRS) was used to characterize muscle bioenergetic metabolism at rest and after high-, moderate-, and low-intensity exercise. CF patients exhibited lower resting ATP/phosphocreatine (PCr) ratio and significantly higher end-exercise pH values compared with both HC and PCD patients. Both CF and PCD patients demonstrated significantly slower PCr recovery time constants after high-intensity exercise. Our results suggest that not only there are specific abnormalities of muscle metabolism in CF patients but also there is a nonspecific impact of respiratory disease on muscle function.

Purpose: To evaluate whether the BOLD signal from skeletal muscle can be modulated by exercise and ingestion of vasoactive substances., Materials and Methods: The right calf muscles of healthy adult volunteers were imaged using a GE 1.5-Tesla scanner and a gradient-echo sequence with spiral readout. Time-varying changes in the BOLD signal were induced through cyclic phases of normoxia (90 seconds of 20.8% O2) and hyperoxia (45 seconds of 100% O2 at 22 L/minute). Superimposed on this paradigm were pre- and post-exercise regimes, with and without ingestion of caffeine (100 mg) or antihistamine (4 mg chlorpheniramine). The numbers of voxels within slow-twitch (soleus) and fast-twitch (gastrocnemius) muscles that significantly responded to the paradigms were scored and compared using the AFNI software (NIMH)., Results: Cycling-inspired O2 produced a corresponding BOLD modulation that increased in magnitude with exercise. Chlorpheniramine significantly (P<0.01) prevented the overall increase in exercise-induced soleus muscle BOLD signal, while caffeine accentuated the increase (P<0.05) in the gastrocnemius relative to control (no vasomodulator) conditions., Conclusion: BOLD signal changes with exercise can be modulated by standard doses of chlorpheniramine (antihistamine) and caffeine. We suggest that chlorpheniramine may act detrimentally on slow-twitch muscle contractility, while caffeine appears to improve fast-twitch muscle function., (Copyright (c) 2006 Wiley-Liss, Inc.)

The article presents a study that aims at exploring the relationship between resting-state intra-network connectivity and accelerometer-measured physical activity in pediatric concussion. Presents the preliminary findings that suggest that there is a positive association between the intra-network connectivity of the DMN and device-measured physical activity in children with concussion.

Magnetic Resonance Imaging (MRI) is well‐suited for imaging peripheral blood flow due to its non‐invasive nature and excellent spatial resolution. Although MRI is routinely used in adults to assess physiological changes in chronic diseases, there are currently no MRI‐based data quantifying arterial flow in pediatric or adolescent populations during exercise. Therefore the current research sought to document femoral arterial blood flow at rest and following exercise in a pediatric‐adolescent population using phase contrast MRI, and to present test‐retest reliability data for this method. Ten healthy children and adolescents (4 male; mean age 14.8 ± 2.4 years) completed bloodwork and resting and exercise MRI. Baseline images consisted of PC‐MRI of the femoral artery at rest and following a 5 × 30 s of in‐magnet exercise. To evaluate test‐retest reliability, five participants returned for repeat testing. All participants successfully completed exercise testing in the MRI. Baseline flow demonstrated excellent reliability (ICC = 0.93, p = 0.006), and peak exercise and delta rest‐peak flow demonstrated good reliability (peak exercise ICC = 0.89, p = 0.002, delta rest‐peak ICC = 0.87, p = 0.003) between‐visits. All three flow measurements demonstrated excellent reliability when assessed with coefficients of variance (CV's) (rest: CV = 6.2%; peak exercise: CV = 7.3%; delta rest‐peak: CV = 7.1%). The mean bias was small for femoral arterial flow. There was no significant mean bias between femoral artery flow visits 1 and 2 at peak exercise. There were no correlations between age or height and any of the flow measurements. There were no significant differences between male and female participants for any of the flow measurements. The current study determined that peripheral arterial blood flow in children and adolescents can be evaluated using non‐invasive phase contrast MRI. The MRI‐based techniques that were used in the current study for measuring arterial flow in pediatric and adolescent patients demonstrated acceptable test‐retest reliability both at rest and immediately post‐exercise. [ABSTRACT FROM AUTHOR]

Objective: Certain exercises could overload the osteoarthritic knee. We developed an exercise program from yoga postures with a minimal knee adduction moment for knee osteoarthritis. The purpose was to compare the effectiveness of this biomechanically-based yoga exercise (YE), with traditional exercise (TE), and a no-exercise attention-equivalent control (NE) for improving pain, self-reported physical function and mobility performance in women with knee osteoarthritis. Design: Single-blind, three-arm randomized controlled trial. Setting: Community in Southwestern Ontario, Canada. Participants: A convenience sample of 31 women with symptomatic knee osteoarthritis was recruited through rheumatology, orthopaedic and physiotherapy clinics, newspapers and word-of-mouth. Interventions: Participants were stratified by disease severity and randomly allocated to one of three 12-week, supervised interventions. YE included biomechanically-based yoga exercises; TE included traditional leg strengthening on machines; and NE included meditation with no exercise. Participants were asked to attend three 1-hour group classes/sessions each week. Measurements: Primary outcomes were pain, self-reported physical function and mobility performance. Secondary outcomes were knee strength, depression, and health-related quality of life. All were assessed by a blinded assessor at baseline and immediately following the intervention. Results: The YE group demonstrated greater improvements in KOOS pain (mean difference of 22.9 [95% CI, 6.9 to 38.8; p = 0.003]), intermittent pain (mean difference of -19.6 [95% CI, -34.8 to -4.4; p = 0.009]) and self-reported physical function (mean difference of 17.2 [95% CI, 5.2 to 29.2; p = 0.003]) compared to NE. Improvements in these outcomes were similar between YE and TE. However, TE demonstrated a greater improvement in knee flexor strength compared to YE (mean difference of 0.1 [95% CI, 0.1 to 0.2]. Improvements from baseline to follow-up were present in quality of life score for YE and knee flexor strength for TE, while both also demonstrated improvements in mobility. No improvement in any outcome was present in NE. Conclusions: The biomechanically-based yoga exercise program produced clinically meaningful improvements in pain, self-reported physical function and mobility in women with clinical knee OA compared to no exercise. While not statistically significant, improvements in these outcomes were larger than those elicited from the traditional exercise-based program. Though this may suggest that the yoga program may be more efficacious for knee OA, future research studying a larger sample is required. Trial registration: ClinicalTrials.gov () [ABSTRACT FROM AUTHOR]

Background: Obesity is associated with cardiometabolic disturbances, which may have significant implications for musculoskeletal health and exercise tolerance. Objective: We sought to determine the association between muscle structure, function, and metabolism in adolescents across the weight spectrum. Methods: This cross‐sectional case–control study included overweight and obese participants (n = 24) 8–18 years of age with a body mass index (BMI) ≥ 85th percentile for age and gender, and non‐obese participants (n = 24) with a BMI < 85th percentile. Body composition, physical activity, peak aerobic capacity, cardiometabolic blood markers and insulin resistance (measured by the homeostatic model assessment of insulin resistance, HOMA‐IR), skeletal muscle mitochondrial oxidative capacity (via 31Phosphorous‐Magnetic Resonance Spectroscopy, 31P‐MRS, to assess phosphocreatine (PCr) recovery after exercise), and extramyocellular and intramyocellular lipid (IMCL) levels (via 1Hydrogen‐MRS) were assessed. Stepwise regression was performed to examine the factors associated with oxidative capacity. Results: bese and overweight patients had similar age, height, and physical activity to non‐obese controls, but obese and overweight participants exhibited higher insulin resistance. Obese and overweight participants had longer PCr recovery than non‐obese controls following 5x30s of moderate‐intensity exercise (51.2 ± 20.1 s vs. 23.9 ± 7.5 s, p = 0.004). In univariate correlation analysis, impaired PCr recovery was associated with a higher BMI z‐score (rs = 0.51, p < 0.001), circulating triglycerides (rs = 0.41, p = 0.005), and HOMA‐IR (rs = 0.46, p = 0.001). In stepwise multivariate regression analysis, impaired PCr recovery was associated with a higher BMI z‐score (β = 0.47, p = 0.002), but not insulin resistance (β = 0.07, p = 0.07) or circulating triglycerides (β = 0.16 p = 0.33). Conclusion: A slower phosphocreatine recovery following aerobic exercise is strongly associated with increasing adiposity. A slower metabolic recovery following aerobic exercise stress suggests that endurance exercise training in obese adolescents may be an optimal strategy to target exercise intolerance in this cohort. [ABSTRACT FROM AUTHOR]

Background Individuals with knee osteoarthritis have elevated circulating inflammatory markers and altered cartilage properties but it is unclear if these features adapt to exercise. We aimed to determine (1) whether inflammatory markers, cartilage transverse relaxation time and thickness mediate the effect of body mass index (BMI) on quadriceps strength at baseline; and (2) whether these changes explain variance in quadriceps strength improvements after 12 weeks of exercise in women with knee osteoarthritis. Methods This secondary analysis (17 women with clinical knee osteoarthritis) of a randomized control trial compared supervised group interventions, 3 times/week for 12 weeks (36 sessions): (a) weight-bearing progressive resistive quadriceps exercise or (b) attention control. (1) From baseline, separate linear regressions were conducted with strength (Nm/kg) as the dependent, BMI as the predictor, and c-reactive protein, tumor necrosis factor, interleukin-6, cartilage transverse relaxation time or thickness as potential mediators. (2) Multiple linear regression analyses were completed with 12-week strength change (post-pre) as the dependent, change in serum inflammatory markers and cartilage measurements as predictors, and age, BMI and adherence as covariates. Findings (1) At baseline, there was no mediation. (2) A decrease in each of interleukin-6 (β = −0.104 (95% confidence intervals: −0.172, −0.036), R 2 = 0.51, P < 0.007) and tumor necrosis factor (β = −0.024 (−0.038, −0.009), R 2 = 0.54, P < 0.005) was associated with strength gains. Interpretation At baseline, inflammatory markers and cartilage measurements do not act as mediators of BMI on quadriceps strength. After 12 weeks of exercise, reduced interleukin-6 and tumor necrosis factor were associated with increased quadriceps strength in women with knee osteoarthritis. • People with osteoarthritis have altered serum inflammatory markers and cartilage. • It is unclear how these factors influence muscle adaptations to strengthening. • After a strengthening intervention, strength gains are associated with reduced serum inflammation. • No mediation effect of body mass index on muscle capacity after a strengthening intervention. [ABSTRACT FROM AUTHOR]