title: Mild exercise reduces cerebral vasospasm after aneurysm subarachnoid hemorrhage: a retrospective clinical study and correlation with laboratory investigation.
abstract: BACKGROUND
  Aneurysmal subarachnoid hemorrhage (SAH) is a leading cause of death and disability and is often complicated by cerebral vasospasm (CV). Conventional management to prevent CV includes bedrest; however, inactivity places the patient at risk for nonneurological complications. We investigated the effect of mild exercise after SAH in clinical and laboratory settings.
  
  
  METHODS
  Clinical: Data from 80 patients with SAH were analyzed retrospectively. After aneurysms were secured, physical therapy was initiated as tolerated. CV and complications were compared by the timing of active physical therapy. Laboratory: 18 Rodents were divided into three groups: (1) control, (2) SAH without exercise, and (3) SAH plus mild exercise. On day 5, brainstems were removed and analyzed for the injury marker inducible nitric oxide synthase (iNOS).
  
  
  RESULTS
  Clinical: Mild exercise before day 4 significantly lowered the incidence of symptomatic CV compared with the nonexercised group. There was no difference in the incidence of additional complications based upon exercise. Laboratory: Staining for iNOS was significantly higher in the SAH group than the control group, but there was no difference between exercised and nonexercised SAH groups, confirming that exercise did not promote neuronal injury.
  
  
  CONCLUSIONS
  Early mobilization significantly reduced clinical CV. The relationship should be studied further in a prospective trial with defined exercise regimens.
authors.affiliation: Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Riordan
authors.forename: Michele
authors.initials: M
authors.lastname: Kyle
authors.forename: Christina
authors.initials: C
authors.lastname: Dedeo
authors.forename: Mark R
authors.initials: MR
authors.lastname: Villwock
authors.forename: Matthew
authors.initials: M
authors.lastname: Bauer
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Vallano
authors.forename: Eric M
authors.initials: EM
authors.lastname: Deshaies
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D010805:Physical Conditioning, Animal / Q000502:physiology*; D017207:Rats, Sprague-Dawley; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D020301:Vasospasm, Intracranial / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control*