Archive for the ‘Recovery’ Category

Recipe to recover more quickly from exercise: Finish workout, eat pasta, and wash down with five or six cups of strong coffee.

Glycogen, the muscle’s primary fuel source during exercise, is replenished more rapidly when athletes ingest both carbohydrate and caffeine following exhaustive exercise, new research from the online edition of the Journal of Applied Physiology shows. Athletes who ingested caffeine with carbohydrate had 66% more glycogen in their muscles four hours after finishing intense, glycogen-depleting exercise, compared to when they consumed carbohydrate alone, according to the study, published by The American Physiological Society.

The study, “High rates of muscle glycogen resynthesis after exhaustive exercise when carbohydrate is co-ingested with caffeine,” is by David J. Pedersen, Sarah J. Lessard, Vernon G. Coffey, Emmanuel G. Churchley, Andrew M. Wootton, They Ng, Matthew J. Watt and John A. Hawley. Dr. Pedersen is with the Garvan Institute of Medical Research in Sydney, Australia, Dr. Watt is from St. Vincent’s Institute of Medical Research, Fitzroy, Victoria, Australia. All others are with the Royal Melbourne Institute of Technology University (RMIT) in Bundoora, Victoria, Australia.

A fuller audio interview with Dr. Hawley is available in Episode 11 of the APS podcast, Life Lines, at www.lifelines.tv. The show also includes an interview with Dr. Stanley Schultz, whose physiological discovery of how sugar is transported in the gut led to the development of oral rehydration therapy and sports drinks such as Gatorade and Hi-5.

Caffeine aids carbohydrate uptake  

It is already established that consuming carbohydrate and caffeine prior to and during exercise improves a variety of athletic performances. This is the first study to show that caffeine combined with carbohydrates following exercise can help refuel the muscle faster.

“If you have 66% more fuel for the next day’s training or competition, there is absolutely no question you will go farther or faster,” said Dr. Hawley, the study’s senior author. Caffeine is present in common foods and beverages, including coffee, tea, chocolate and cola drinks.

The study was conducted on seven well-trained endurance cyclists who participated in four sessions. The participants first rode a cycle ergometer until exhaustion, and then consumed a low-carbohydrate dinner before going home. This exercise bout was designed to reduce the athletes’ muscle glycogen stores prior to the experimental trial the next day.

The athletes did not eat again until they returned to the lab the next day for the second session when they again cycled until exhaustion. They then ingested a drink that contained carbohydrate alone or carbohydrate plus caffeine and rested in the laboratory for four hours. During this post-exercise rest time, the researchers took several muscle biopsies and multiple blood samples to measure the amount of glycogen being replenished in the muscle, along with the concentrations of glucose-regulating metabolites and hormones in the blood, including glucose and insulin.

The entire two-session process was repeated 7-10 days later. The only difference was that this time, the athletes drank the beverage that they had not consumed in the previous trial. (That is, if they drank the carbohydrate alone in the first trial, they drank the carbohydrate plus caffeine in the second trial, and vice versa.)

The drinks looked, smelled and tasted the same and both contained the same amount of carbohydrate. Neither the researchers nor the cyclists knew which regimen they were receiving, making it a double-blind, placebo-controlled experiment.

Glucose and insulin levels higher with caffeine ingestion
The researchers found the following:  
  • one hour after exercise, muscle glycogen levels had replenished to the same extent whether or not the athlete had the drink containing carbohydrate and caffeine or carbohydrate only
  • four hours after exercise, the drink containing caffeine resulted in 66% higher glycogen levels compared to the carbohydrate-only drink
  • throughout the four-hour recovery period, the caffeinated drink resulted in higher levels of blood glucose and plasma insulin
  • several signaling proteins believed to play a role in glucose transport into the muscle were elevated to a greater extent after the athletes ingested the carbohydrate-plus-caffeine drink, compared to the carbohydrate-only drink

 Dr. Hawley said it is not yet clear how caffeine aids in facilitating glucose uptake from the blood into the muscles. However, the higher circulating blood glucose and plasma insulin levels were likely to be a factor. In addition, caffeine may increase the activity of several signaling enzymes, including the calcium-dependent protein kinase and protein kinase B (also called Akt), which have roles in muscle glucose uptake during and after exercise.

Lower dose is next step  

In this study, the researchers used a high dose of caffeine to establish that it could help the muscles convert ingested carbohydrates to glycogen more rapidly. However, because caffeine can have potentially negative effects, such as disturbing sleep or causing jitteriness, the next step is to determine whether smaller doses could accomplish the same goal.

Hawley pointed out that the responses to caffeine ingestion vary widely between individuals. Indeed, while several of the athletes in the study said they had a difficult time sleeping the night after the trial in which they ingested caffeine (8 mg per kilogram of body weight, the equivalent of drinking 5-6 cups of strong coffee), several others fell asleep during the recovery period and reported no adverse effects.

Athletes who want to incorporate caffeine into their workouts should experiment during training sessions well in advance of an important competition to find out what works for them.

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Article adapted by MD Sports from original press release.
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Contact: Christine Guilfoy
American Physiological Society

Physiology is the study of how molecules, cells, tissues and organs function to create health or disease. The American Physiological Society (APS) has been an integral part of this scientific discovery process since it was established in 1887.

A University of Colorado at Boulder study of a space-age, low-gravity training machine used by several 2008 Olympic runners showed it reduced impacts on muscles and joints by nearly half when subjects ran at the equivalent of 50 percent of their body weight.

The new study has implications for both competitive runners rehabilitating from injuries and for ordinary people returning from knee and hip surgeries, according to Associate Professor Rodger Kram of CU-Boulder’s integrative physiology department.

Known as the “G-Trainer,” the machine consists of a treadmill surrounded by an inflatable plastic chamber that encases the lower body of the runner, said Kram. Air pumped into the chamber increases the pressure and effectively reduces the weight of runners, who are sealed in the machine at the waist in a donut-shaped device with a special zipper and “literally lifted up by their padded neoprene shorts,” he said.

Published in the August issue of the Journal of Applied Biomechanics, the study is the first to quantify the effects of running in the G-Trainer, built by Alter-G Inc. of Menlo Park, Calif., using technology developed at NASA’s Ames Research Center in California. The paper was authored by Kram and former CU-Boulder doctoral student Alena Grabowski, now a postdoctoral researcher at the Massachusetts Institute of Technology.

Although G-Trainers have been used in some sports clinics and college and professional sports training rooms since 2006, the new study is the first scientific analysis of the device as a training tool for running, said Grabowski.

“The idea was to measure which levels of weight support and speeds give us the best combination of aerobic workout while reducing the impact on joints,” said Kram. “We showed that a person can run faster in the G-Trainer at a lower weight and still get substantial aerobic benefits while maintaining good neuromuscular coordination.”

The results indicated a subject running at the equivalent of half their weight in the G-Trainer at about 10 feet per second, for example — the equivalent of a seven-minute mile — decreased the “peak” force resulting from heel impact by 44 percent, said Grabowski. That is important, she said, because each foot impact at high speed can jar the body with a force equal to twice a runner’s weight.

Several former CU track athletes participating in the 2008 Olympics in Beijing have used the machine, said Kram. Alumna Kara Goucher, who will be running the 5,000- and 10,000-meter races in Beijing, has used the one in Kram’s CU-Boulder lab and one in Eugene, Ore., for rehabilitation, and former CU All-American and Olympic marathoner Dathan Ritzenhein also uses a G-Trainer in his home in Oregon. Other current CU track athletes who have been injured have tried the machine in Kram’s lab and found it helpful to maintain their fitness as they recovered, Kram said.

For the study, the researchers retrofitted the G-Trainer with a force-measuring treadmill invented by Kram’s team that charts vertical and horizontal stress load on each foot during locomotion, measuring the variation of biomechanical forces on the legs during running. Ten subjects each ran at three different speeds at various reduced weights, with each run lasting seven minutes. The researchers also measured oxygen consumption during each test, Kram said.

Grabowski likened the effect of the G-Trainer on a runner to pressurized air pushing on the cork of a bottle. “If you can decrease the intensity of these peak forces during running, then you probably will decrease the risk of injury to the runner.”

The G-Trainer is a spinoff of technology originally developed by Rob Whalen, who conceived the idea while working at NASA Ames as a National Research Council fellow to help astronauts maintain fitness during prolonged space flight. While the NASA technology was designed to effectively increase the weight of the astronauts to stem muscle atrophy and bone loss in low-gravity conditions, the G-Trainer reverses the process, said Grabowski.

In the past, sports trainers and researchers have used climbing harnesses over treadmills or flotation devices in deep-water swimming pools to help support the weight of subjects, said Kram. Harnesses are cumbersome, while pool exercises don’t provide sufficient aerobic stimulation and biomechanical loading on the legs, he said.

Marathon world-record holder Paula Radcliffe of Great Britain is currently using a G-Trainer in her high-altitude training base in Font-Remeu, France. Radcliffe is trying to stay in top running shape while recovering from a stress fracture in her femur in time for the 2008 Olympic women’s marathon on Aug. 17, according to the London Telegraph.

Kram and Grabowski have begun a follow-up study of walking using the G-Trainer. By studying subjects walking at various weights and speeds in the machine, the researchers should be able to quantify its effectiveness as a rehabilitation device for people recovering from surgeries, stress fractures and other lower body injuries, Kram said.

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Article adapted by MD Sports from original press release.
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Contact: Rodger Kram
University of Colorado at Boulder

Lower muscle mass and an increase in body fat are common consequences of growing older.

While exercise is a proven way to prevent the loss of muscle mass, a new study led by McMaster researcher Dr. Mark Tarnopolsky shows that taking a combination of creatine monohydrate (CrM) and conjugated linoleic acid (CLA) in addition to resistance exercise training provides even greater benefits.

The study to be published on Oct. 3 in PLoS One, an international, peer-reviewed online journal of the Public Library of Science, involved 19 men and 20 women who were 65 years or older and took part in a six-month program of regular resistance exercise training.

In the randomized double blind trial, some of the participants were given a daily supplement of creatine (a naturally produced compound that supplies energy to muscles) and linoleic acid (a naturally occurring fatty acid), while others were given a placebo. All participants took part in the same exercise program.

The exercise training resulted in improvements of functional ability and strength in all participants, but those taking the CrM and CLA showed even greater gains in muscle endurance, an increase in fat-free mass and a decrease in the percentage of body fat.

“This data confirms that supervised resistance exercise training is safe and effective for increasing strength and function in older adults and that a combination of CrM and CLA can enhance some of the beneficial effects of training over a six month period,” said Tarnopolsky, a professor of pediatrics and medicine.

This study provides functional outcomes that build on an earlier mechanistic study co-led by Tarnopolsky and Dr. S. Melov at the Buck Institute of Age Research, published in PLoS One this year, which provided evidence that six months of resistance exercise reversed some of the muscle gene expression abnormalities associated with the aging process.
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Article adapted by MD Sports Weblog from original press release.
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Contact: Veronica McGuire
McMaster University

Trying to reap the health benefits of exercise? Forget treadmills and spin classes, researchers at the Salk Institute for Biological Studies may have found a way around the sweat and pain. They identified two signaling pathways that are activated in response to exercise and converge to dramatically increase endurance.

The team of scientists, led by Howard Hughes Medical Investigator Ronald M. Evans, Ph.D., a professor in the Salk Institute’s Gene Expression Laboratory report in the July 31 advance online edition of the journal Cell that simultaneously triggering both pathways with oral drugs turned laboratory mice into long-distance runners and conferred many of exercise’s other benefits.

In addition to their allure for endurance athletes, drugs that mimic the effects of exercise have therapeutic potential in treating certain muscle diseases, such as wasting and frailty, hospital patients unable to exercise, veterans and others with disabilities as well as obesity and a slew of associated metabolic disorders where exercise is known to be beneficial.

Previous work with genetically engineered mice in the Evans lab had revealed that permanently activating a genetic switch known as PPAR delta turned mice into indefatigable marathon runners. In addition to their super-endurance, the altered mice were resistant to weight gain, even when fed a high-fat diet that caused obesity in ordinary mice. On top of their lean and mean physique, their response to insulin improved, lowering levels of circulating glucose.

“We wanted to know whether a drug specific for PPAR delta would have the same beneficial effects,” says Evans. “Genetic engineering in humans, commonly known as gene doping when mentioned in connection with athletic performance, is certainly feasible but very impractical.”

An investigational drug, identified only as GW1516 (and not commercially available), fit the bill. When postdoctoral researcher and lead author Vihang A. Narkar, Ph.D., fed the substance to laboratory mice over a period of four weeks, the researchers were in for a surprise.

“We got the expected benefits in lowering fatty acids and blood glucose levels but no effect, absolutely none, on exercise performance,” says Narkar. Undeterred, he put mice treated with GW1516 on a regular exercise regimen and every day had them run up to 50 minutes on a treadmill.

Now the exact same drug that had shown no effect in sedentary animals improved endurance by 77 percent over exercise alone and increased the portion of “non-fatiguing” or “slow twitch” muscle fibers by 38 percent. The result, while very dramatic, gave rise to a vexing question: Why is exercise so important?

First and foremost, exercise depletes muscles’ energy store, a chemical known as ATP. In times of high demand, ATP releases all its energy and forms AMP. Rising AMP levels alert AMPK, a metabolic master regulator, which acts like a gas gauge that the cell is running on empty and revs up the production of ATP. “That led us to consider whether AMPK activation was the critical trigger that allowed PPAR delta to work,” recalls Narkar.

Usually, AMPK can be found in the cytoplasm, the compartment that surrounds the nucleus, but the Salk researchers’ experiment revealed that some exercise-activated AMPK molecules slip into the nucleus. There they physically interact with PPAR delta and increase its ability to turn on the genetic network that increases endurance.

“It essentially puts a turbo charge on PPAR delta, which explains why exercise is so important,” says Evans.

Then came the ultimate couch potato experiment. The researchers fed untrained mice AICAR, a synthetic AMP analog that directly activates AMPK. After only four weeks and without any prior training, these mice got up and ran 44 percent longer than untreated, untrained mice. “That’s as much improvement as we get with regular exercise,” says Narkar.

“Exercise in a pill” might sound tempting to couch potatoes and Olympic contenders alike, but the dreams of the latter might be cut short. Evans developed a test that can readily detect GW1516 and its metabolites as well as AICAR in blood and urine and is already working with officials at the World Anti-Doping Association, who are racing to have a test in place in time for this year’s Summer Olympics.

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Article adapted by MD Sports Weblog from original press release.
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Contact: Gina Kirchweger
Salk Institute

The study was supported by the Howard Hughes Medical Institute, the Hillblom Foundation and the National Institute of Health.

Researchers who contributed to the work include postdoctoral researchers Michael Downes, Ph.D., Ruth T. Yu, Ph.D., doctoral candidate Emi Embler, B.S., research associates Michael C. Nelson, B.S., Yuhua Zou, M.S., Ester Banayo, and Henry Juguilon, in the Gene Expression Laboratory, doctoral candidate M. Mihaylova, and assistant professor Reuben Shaw, Ph.D., in the Molecular and Cell Biology Laboratory, assistant professor Yong-Xu Wang, Ph.D., at the University of Massachusetts Medical School, Massachusetts, and professor Heonjoon Kang, Ph.D., at the School of Earth and Environmental Sciences, Seoul National University, South Korea.

A strained muscle, sprained ankle or foot injury can make even the most motivated exerciser feel discouraged when it comes to working out.

But being injured doesn’t necessarily mean you can’t exercise, says Colleen Greene, wellness coordinator with MFit, the University of Michigan Health System’s health promotion division. By speaking with an expert and finding a plan that will work as you heal, you can still hit the gym while recovering.

“Exercise can definitely be beneficial for a person dealing with an injury. Depending on its type, the injured area should be moved and not left in place for a long period of time,” explains Greene. “Some people think they should just rest and not move at all with an injury. Doing that can actually be worse because—depending on the amount of time one does not move the appendage— the muscle might begin to atrophy.”

Greene notes that the general rule of thumb when initially handling an injury is to follow RICE—Rest, Ice, Compression and Elevation. Once you have done this, consult a doctor to look at the injury as soon as possible. You may be referred to a physical therapist or specialist trainer if the injury is severe enough. These professionals can provide guidance for your recovery, as well as give you tips on how to maintain strength while recovering.  

Greene also notes that there are “dos and don’ts” when it comes to specific injuries. Because each condition is unique, there are certain things a person can do and other activities the injured person should avoid while healing. She offers these tips on three common injuries:

General advice for any injury: See a physician or physical therapist to learn what exercises are possible with your type of injury. Focus on the goal of maintaining strength, not gaining it, while you are recovering. And always be wary of pain as you explore different workouts.

“Pain is always the indicator; discomfort is OK, but pain tells you when you should stop what you are doing and do something else,” Greene says. “You always want to keep in mind that you should be doing something that doesn’t re-injure or further injure yourself.”

Sprained ankle. When seeking out cardiovascular exercises, Greene suggests sticking with low- impact workouts, such as swimming or riding a stationary bike. She notes that running or aerobics are generally activities that are too high in impact. A person with a sprained ankle can also do upper-body or core impact exercises for strength training.

Plantar faciitis. Plantar faciitis is an overuse injury normally caused by a lack of cross training. For example, a person may develop plantar faciitis by only running when training for a marathon, but not preparing through other exercises, such as swimming or biking. Greene notes that people dealing with this type of injury need to focus on resting in order to heal, but it is possible to explore low-impact core and upper-body exercises while recovering.

“There are not a lot of ways other than physical therapy to recover from plantar faciitis except for resting,” she says. “You want to do things that are low impact without a lot of pressure on the area.”

Grab an ice pack, get some rest and allow your injury to fully recover before trying to get stronger.

Strained and pulled muscle. “The first thing a person with a pulled or strained muscle should know is that they, like everyone, should warm up thoroughly before doing anything,” Greene notes.

She also says that people with this type of injury should stay in a pain-free range by focusing on conditioning the side of the body opposite of the strained or torn muscle. If you have pulled a hamstring, for example, then aim to work on your upper-body.

Greene also notes that there are preventative measures that a person can take to avoid pulling or training a muscle. First, Greene recommends a good warm-up for five to 10 minutes. Second, be sure to cool down at the end of your workout. And don’t forget to stretch.

“We find that as people age, they can actually pull muscles by doing everyday things such as bending over to grab a bag of groceries or leaning over to put something on a shelf,” she explains. “So the preventative measures that can be taken to avoid pulling or tearing a muscle with exercise are also measures that should be taken to avoid tearing or pulling a muscle in everyday life, not just on a basketball court.”

Overall, Greene believes the most important thing injured exercisers can do when hitting the gym is to pay attention to their body. She also advises to stop immediately if a workout becomes painful.  

“One of the basic exercise myths is ‘no pain, no gain.’ We used to think that a long time ago,” says Greene. “If you are actually in pain, you should stop immediately. Now we say, ‘no discomfort, no gain.’ There is a big difference.”

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Article adapted by MD Sports from original press release.
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MFit, the Health Promotion Division of the University of Michigan Health System (UMHS) provides medically-based personalized health and wellness programs and services to UMHS patients, UM employees, the greater Washtenaw County community, and employers in Michigan.

Source: Laura Drouillard
University of Michigan

Baseball team owners, players and fans seem to agree on the importance of drug testing for steroids, according to current reports, but the entire scope of performance-enhancing substances available for all athletes is vastly broader and many of the drugs employed by athletes are not easily detectable, says a Penn State researcher.”The use, misuse and abuse of drugs have long shaken the foundations of amateur and professional sports–baseball, football, track and field, gymnastics and cycling, to name just a few,” says Dr. Charles Yesalis, Penn State professor of exercise and sport science and health policy and administration. “The problem is not new. But like the rest of technology, doping in sport has grown in scientific and ethical complexity. In addition to drugs, we have natural hormones, blood doping, diuretics, nutritional supplements, social and recreational drugs, stimulants and miscellaneous substances, some of which may not even be on any list of banned substances.”

While drug testing technology struggles to keep up, an array of new and emerging technologies has arrived or is on the horizon with potential for abuse by athletes including gene transfer therapy, stem cell transplantation, muscle fiber phenotype transformation, red blood cell substitutes and new drug delivery systems, says Yesalis

“It is not too hard to imagine the day when muscles can be selectively enlarged or contoured,” according to the book. “Just imagine the consequences of a kinesiologist isolating specific muscles and selectively injecting designer genes into those muscles to maximize their function.”

The new book brings together the latest and most comprehensive scientific information about performance-enhancing substances, as well as discussion of drug testing, legal and social issues, and future directions by sports governing organizations.

“Sport has a responsibility to maintain a level playing field for the trial of skill,” Yesalis says. “The use of chemical and pharmacologist agents is cheating – just like using a corked baseball bat. But unlike the bat, doping is shrouded in mystery. Athletes and their advisors are constantly seeking ‘gray areas” surrounding the rules, and if something is not explicitly banned, then why not try it. This slippery slope of rationalization is treacherous and appealing to a player or team seeking glory and money rewards.”

In one chapter, “Drug Testing and Sport and Exercise,” author R. Craig Kammerer suggests that improvement in current tests and developments in new methods will assist future policymaking by athletic federations. However, effective testing must become more widespread and include unannounced testing outside of competition. Sanctions against athletes must be more fairly and uniformly applied, with thorough investigation to avoid false positive results and ruin an athlete’s career.

The difficulty of detecting and preventing the abuse of performance enhancing substances by adult athletes may seem futile but remains necessary as part of the effort to discourage abuse by youths who emulate professional athletes and also seek a winning advantage, Yesalis notes.

A recent government study of adolescent drug use shows an alarming increase in anabolic steroid use among middle school youths from 1998-1999 with an estimated 2.7 percent of eighth graders saying they have used the drugs. A larger survey by Blue Cross and Blue Shield estimates that one million U.S. children between the ages of 12 and 17 may have taken performance-enhancing substances including creatine, according to the book.

“Children and teens can seriously harm their future health by misusing these substances,” Yesalis says. “For example, steroids alone can cause scarring acne, hair loss and testicular atrophy, and may increase the risk of stroke and heart disease. It is just as important to note that little is known about the health consequences of many of the other substances used to enhance performance. Yet some coaches and parents look the other way and even actively encourage the use of performance-enhancing substances in pursuit of scholarships and winning.

“There is too much fame and fortune to be gained by being a winner in sports,” he notes. “It’s interesting to see that baseball fans being polled support drug testing and a ban on steroids, but it will take fans of all major sports to take a stand by turning off their TV sets or not buying a ticket to sports events before adult athletes, coaches and team owners stop trying to cheat. And, that’s probably not going to happen.”

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Article adapted by MD Sports Weblog from original press release.
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Contact: Vicki Fong
Penn State

Concussions are common in young athletes but the underlying changes in brain function that occur have been poorly understood. Now, a University of Pittsburgh School of Medicine study is the first to link changes in brain function directly to the recovery of the athlete. Results of the five-year study, funded by the National Institutes of Health, are published in the August issue of the scientific peer-reviewed journal, Neurosurgery, the official journal of the Congress of Neurological Surgeons.

“We found that abnormal brain activity in children and adolescents on functional MRI (fMRI) was clearly related to their performance on neuropsychological tests of attention and memory and to their report of symptoms such as headaches,” said principal investigator Mark Lovell, Ph.D., asssociate professor in the departments of orthopaedic surgery and neurological surgery at the University of Pittsburgh School of Medicine.

“These results confirm crucial objective information that is commonly obtained by neuropsychological testing to help team doctors and athletic trainers make critical decisions about concussion management and safe return to play,” added Dr. Lovell, who is founding director of the University of Pittsburgh Medical Center (UPMC) Sports Medicine Concussion Program, a clinical service and research program focused on the management of sports-related concussions.

“Our findings have several implications for understanding the recovery process after sports-related concussions,” said study co-author Michael (Micky) Collins, Ph.D., assistant professor in the departments of orthopaedic surgery and neurological surgery at Pitt’s School of Medicine, and assistant director of the UPMC program. “Although the results of this study must be considered preliminary, fMRI represents an important evolving technology that is providing further insight now for safe return-to-play decisions in young athletes and may help shape guidelines in the future.”

The study helps define concussion and recovery for safe return-to-play

According to the Centers for Disease Control and Prevention, between 1.4 and 3.6 million sports and recreation-related concussions occur each year, with the majority happening at the high school level. “An explosion of scientific research over the past decade has taught us more about mild traumatic brain injury or concussion than we have ever known,” noted Dr. Lovell, “including the knowledge that mismanagement of even seemingly mild concussions can lead to serious consequences in young athletes.”

A concussion can occur when an athlete receives a traumatic force to the head or upper body that causes the brain to shake inside of the skull. Injury is defined as a concussion when it causes a change in mental status such as loss of consciousness, amnesia, disorientation, confusion or mental fogginess. The severity, effects and recovery of concussion are difficult to determine because no two concussions are alike, and symptoms are not always straightforward. In recent years, research has shown that until a concussed brain is completely healed, the brain may be vulnerable to further injury, which has led to published studies that have raised public awareness and significantly changed the way sports concussions are managed. Importantly, much of this research has included data that proves the usefulness of objective neuropsychological test data as part of the comprehensive clinical evaluation to determine clinical recovery following concussion. In fact, recent international concussion management guidelines have emphasized player symptoms and neuropsychological test results as “cornerstones” of the injury evaluation and management process.

While neuropsychological testing has become an increasingly useful tool, no published studies have examined the relationship between changes in computerized neuropsychological testing completed in a medical clinic and brain function as measured by fMRI. The lack of studies using fMRI may be due to the fact that studies of this nature are very expensive and equipment necessary to undertake this research is not readily available outside of a handful of academic medical centers. UPMC is one of few such centers with the capability of collecting both neurophysiological (fMRI) and neuropsychological data from injured and clinically managed athletes. fMRI is one of the few brain scanning tools that can show brain activity, not just the anatomy. Traditional brain scanning techniques such as MRI and CT are helpful in viewing changes to the brain anatomy in more severe cases, but cannot identify subtle brain-related changes that are believed to occur on a metabolic rather than an anatomic level. fMRI can determine, through measurement of cerebral blood flow and metabolic changes, which parts of the brain are activated in response to different cognitive activities.

fMRI reveals preliminary evidence and lays ground work for future research

“In our study, using fMRI, we demonstrate that the functioning of a network of brain regions is significantly associated with both the severity of concussion symptoms and time to recover,” said Jamie Pardini, Ph.D., a neuropsychologist on the clinical and research staff of the UPMC concussion program and co-author of the study. The study documented the link between changes in brain activation and clinical recovery in concussed athletes, which was defined as a complete resolution of symptoms and neuropsychological testing results that appeared within expected levels or back to the athlete’s personal baseline. “It is our view that studies establishing a link between brain physiology and neuropsychological testing help demonstrate the utility of neuropsychological testing as a proxy for direct measurement of brain functioning after concussion,” Dr. Pardini added.

The research project involved 28 concussed high school athletes and 13 age-matched controls. The concussed athletes underwent fMRI evaluation within approximately one week of injury and then again when they met criteria for clinical recovery. During their fMRI exams, the athletes were given working memory tasks to complete while the brain’s activity was observed and recorded. As a group, athletes who demonstrated the greatest degree of hyperactivation at the time of their first fMRI scan also demonstrated a more prolonged clinical recovery than did athletes who demonstrated less hyperactivation during their first fMRI scan. “We identified networks of brain regions where changes in functional activation were associated with performance on computerized neuropsychological testing and certain post-concussion symptoms,” reported Dr. Pardini. “Also, our study confirms previous research suggesting that there are neurophysiological abnormalities that can be measured even after a seemingly mild concussion,” she added. The study utilized a computer-based neuropsychological test called ImPACT™ (Immediate Post-Concussion and Cognitive Testing), which measures cognitive function such as attention, memory, speed of response and decision making. ImPACT was developed by Dr. Lovell and colleagues over the past decade and has been extensively researched by the University of Pittsburgh and other academic institutions throughout the world. Drs. Lovell and Collins have a proprietary interest in the ImPACT test as does UPMC. ImPACT Applications, Inc., is a Pittsburgh-based company that owns and licenses the ImPACT tool.

“Recent years have marked exciting and important discoveries in sports concussion research but there are still many unanswered questions,” said Dr. Lovell. “Continued research designed to evaluate multiple parameters of concussion effects and recovery will further help structure return-to-play guidelines.”

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Article adapted by MD Sports Weblog from original press release.
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Contact: Susan Manko
University of Pittsburgh Schools of the Health Sciences

Other authors of the study include James Becker, Ph.D., of the University of Pittsburgh; Joel Welling, Ph.D., Jennifer Bakal and William Eddy, Ph.D., of Carnegie-Mellon University; Nicole Lazar, Ph.D., of the University of Georgia, Athens, Ga.; and Rebecca Roush, Psychology Software Tools, Pittsburgh. The study was funded by a $3 million grant from the National Institutes of Health.