About Course
This course features several research articles that show correlation between rowing for cardiovascular endurance and BDNF increases. Adjacently it highlights the benefits of utilizing a rowing ergometer for postural benefits in gamers.
Instructor
Dr. Elliot Smithson PT, DPT, MS, ATC, EMT received his undergraduate degree from University of Central Florida in Athletic Training, his Masters from Marshall University in Athletic Training, and his doctorate in Physical Therapy from University of St. Augustine for Health Sciences. He has been working in sports and entertainment medicine since 2013 (Walt Disney World) and Division 1 level (UCF, Marshall University), and transitioned into esports medicine in 2019. He has worked with professional esports teams such as 100 Thieves, Counter Logic Gaming, and Immortals. He is passionate about advancing the line of knowledge in the esports industry and cultivating the next generation of professionals.
COURSE PREVIEW
The pursuit of performance optimization in esports is of utmost importance to professional organizations and the clinicians involved with working with the players. Integrating daily exercise for the players at the organizational level is becoming more common in esports. With this comes questions about “What kind of exercise is most beneficial and why?”. BDNF levels are linked to positive outcomes on executive functions and rowing is a biomechanically effective way to reduce the effects of postural syndrome, which makes it an ideal exercise for esports athletes to engage in.
The clinical question explored in this critically appraised review, “Is rowing exercise an effective intervention for improving plasma BDNF levels in healthy human populations?” The search criteria used for this critical appraisal is listed in Table 1.
Population: Healthy Human Patients
Intervention: Rowing Exercise
Outcome Measured: Plasma BDNF Levels
| Databases/Sources of Articles | Search Terms | Limits Used |
| Pubmed
Google Scholar ProQuest PEDro *Reference sections of related articles |
“BDNF
Rowing” ”Brain-Derived Neurotophic Factor” ” Healthy” ” Endurance Exercise” |
English language, publication date 2000-2018, Peer reviewed, Clinical Trial |
Table 1. Search criteria for literature pertaining to the clinical question being examined.
Esports has been defined as “A static, endurance sport which tests executive functions through a virtual environment.”1 As such, sport performance and rehabilitation professionals (physical therapists, chiropractors, athletic trainers and strength and conditioning specialists) working with these athletes must understand the importance of not only addressing the musculoskeletal system but also the neurocognitive system. Rehabilitation as well as performance enhancement benefits that can be provided to this patient population through exercise prescription, has extrapolatory evidence based in existing literature in the fields of neuropsychology, and exercise physiology. There has been a connection shown between exercise and Brain-Derived Neurotrophic Factor (BDNF) activity in humans.2
Image: https://home.hellodriven.com/articles/neuroplasticity-why-you-should-care-about-your-bdnf/
BDNF is a protein that is found in the central nervous system as well as the periphery and can cross the blood brain barrier. It is found in high concentrations in the brain regions of the hippocampus, cerebral cortex, hypothalamus, and cerebellum3 and is faciliatory in neuronal repair4, long term potentiation5, and promotion of synaptic plasticity and neurogenesis6. BDNF is particularly notable due to its positive correlations with executive function7 which is an umbrella term for basic cognitive functions such as cognitive flexibility, inhibitory control, working memory, attentional control, and cognitive inhibition.8 These cognitive functions are linked to video game play9 and it can be reasoned that they are relied on heavily during high levels of Esports performance but more research in needed in this area.
Due to the nature of the sport, esports athletes are prone to upper crossed syndrome due to poor ergonomics10 during long hours (8-14 hours a day) of practice at the computer.11 Upper crossed syndrome as described by Dr. Janda, is a postural imbalance that usually presents with forward head posture, extended cervical lordosis and thoracic kyphosis, raised and developed shoulders, and unrest or seizing and winging of the scapulae.12 An optimal exercise to prescribe these athletes would not only improve neurocognitive effects but also decrease the musculoskeletal postural deficits that are prevalent in these populations.13 Rowing was chosen for this investigation simply because it potentially is an exercise that combines the positive effects of exercise on neurocognitive measures as well as increased muscle activation of the posterior scapular muscles14 which can help to reduce the symptoms associated with upper crossed syndrome.15,16
| Study | (Rasmussen et al. 2009)17 |
| Design | Single group tested at rest, at 2h of rowing, at 4h of rowing, and 1h into recovery |
| Sample | n=8 |
| Intervention | 4 hours of wind‐braked rowing ergometer at 10-15% below the lactate threshold |
| Outcome
Measures |
Arterial and venous plasma BDNF samples via radial artery and internal jugular vein catheter respectively.
Tested at rest, at 2h of rowing, at 4h of rowing, and 1h into recovery |
| Main Results | Arterial BDNF ↑ during rowing (P < 0.05)
Venous BDNF concentration ↑ from 442 ± 272 pg ml−1 at rest to 1172 ± 968 pg ml−1 after 4 h of exercise (P < 0.05) |
| PEDro Score | NA due to single arm design without comparator group |
| Eligibility
Criteria |
Included age 22-40, males, healthy |
Table 2.1:Evidence for a release of brain‐derived neurotrophic factor from the brain during exercise, Experimental Physiology
| Study | (Seifert et al. 2010)18 |
| Design | RCT |
| Sample | n=12 |
| Intervention | Group 1: (n=7) 3 mo of 1hr/d endurance training,
Exercises performed (all exercises performed with no one specified allocation) biking, rowing ergometer, running, swimming Control: (n=5) Continued sedentary lifestyle, given diet aiming at creating a negative energy balance of ~600 kcal/day |
| Outcome
Measures |
Plasma BDNF Samples via the brachial artery and the right internal jugular vein
Baseline and 3 month follow up plasma levels were tested at rest and during/post exercise |
| Main Results | resting arterial BDNF levels were not affected by 3 months of endurance training or
by sedentary living training increased the jugular venous BDNF level (P < 0.05) and to a higher level than in the control group (P < 0.05), in which there was no change Release of BDNF from the brain was enhanced by 3 months of endurance training (P < 0.05; Fig. 1) both compared with the baseline level and to the control group (P < 0.05) |
| PEDro Score | 6/10; No concealed allocation, no blinding of subjects and therapists and no intention-to-treat analysis. allocation was not concealed, there was no blinding of all subjects, there was not blinding of all therapists who administered the therapy, there was not blinding of all assessors who measured at least one key outcome |
| Eligibility
Criteria |
Eligibility criteria included subjects with no use of medication, normal levels of fasting plasma glucose (<5.6 mM), and arterial blood pressure (<130/85 mmHg, systolic/diastolic, respectively) with no predisposition to Type 2 diabetes |
Table 2.2:Endurance training enhances BDNF release from the human brain, American Journal of Physiology
| Study | (Schiffer et al. 2009)19 |
| Design | RCT |
| Sample | n=27 |
| Intervention | Group 1 control: no activity modification
Group 2 strength training: 70– 80% 1RM @ 8 to 10 reps leg extension, leg curl, chest press, leg press, lat pulley, seated row, lateral raise, crunches, and hyperextension 3 times per week for 12 weeks Group 3 moderate interval-type endurance training: 45 min running with a heart rate (HR) of 80% aerobic-anaerobic threshold 3 times per week for 12 weeks |
| Outcome
Measures |
Plasma BDNF Samples via the cubital vein at baseline and post 12 weeks |
| Main Results | No significant changes for BDNF
There were no significant influences proven by time [F(2,24) = 0.940, p = 0.342, f = 0.356], group [F(2,24) = 0.250, p = 0.781, f = 0.25] and interaction of time x group [F(2,24) = 0.157, p = 0.855, f = 0.293] on BDNF |
| PEDro Score | 5/10; eligibility criteria was not specified, No concealed allocation, no blinding of subjects and therapists and no intention-to-treat analysis. allocation was not concealed, there was no blinding of all subjects, there was not blinding of all therapists who administered the therapy, there was not blinding of all assessors who measured at least one key outcome |
| Eligibility
Criteria |
Not specified |
Table 2.3: Effects of Strength and Endurance Training on Brain-derived Neurotrophic Factor and Insulin-like Growth Factor 1 in Humans, Hormone and Metabolic Research
Rowing as an Intervention Regardless of Program Mode and BDNF Measures
All three studies examined the effects of rowing as at least one of the tested interventions and the effects it has on levels of BDNF in the blood. Much variety was seen in the outcomes of the study due to the varied multifactorial nature of the methods. These studies showed consistency in the results with the current body of literature that mainly deals with more generalized intervention modes, specifically endurance and strength training correlations with BDNF levels. The general consensus among the literature is that aerobic but not resistance training interventions increased resting BDNF concentrations in peripheral blood.20 Rowing exercise applied to these program types showed similar results.
Rowing as a 1-Time Prolonged Endurance Exercise Intervention and BDNF Measures
Rasmussen et al. 2009 (Table 2.1) examined the effects of 1-time prolonged (4h) rowing exercise on blood BDNF levels and found a positive correlation that suggest that a single bout of aerobic rowing exercise has significant effects on plasma BDNF concentrations only after 4 hours. The clinical implications are that more than 2 hours of aerobic exercise are needed to increase the cerebral BDNF release. Since there was no measurement between 2 hours and 4 hours the exact duration required to effect a change is not clear based on these results. There was a significant reduction in BDNF levels during recovery which indicated that these increases are transitory in nature.17
Rowing as a 3 Month Endurance Exercise Program Intervention and BDNF Measures
Seifert et al. 2010 (Table 2.2) investigated the effects of rowing as part of a 1 hour daily endurance program executed over a period of 3 months. The findings of this study made a strong case for the clinical benefits of regular rowing endurance exercise and it’s effects on improving resting levels of BDNF. When compared with the sedentary control group, the brain released more BDNF (venous) at rest when compared to baseline measurements. Significant differences were not seen when comparing exercise BDNF releases with the control group.18 This is consistent with the data from Rasmussen et al. 2009 which showed that a bout of endurance exercise must be performed for greater than 2 hours before any significant changes can be detected in BDNF levels.17
Rowing as a Strength Training Exercise Intervention and BDNF Measures
Schiffer et al. 2009 (Table 2.3) examined rowing as part of an intensive resistance training program performed 3 times a week over 12 weeks. Although the study participants demonstrated increased isotonic strength at the end of the training program, the effects of the resistance training program on resting BDNF levels were not significant when compared to the sedentary control group.19 This is consistent with the body of literature that suggests that strength training is inferior to endurance training for improving latent levels of BDNF.20
It is reasonable though to make extrapolations that endurance training has been well established in the literature to show resting and short-term elevations in BDNF levels. Rasmussen et al. makes the statement “We did not consider the exercise mode of importance because we did not have any a priori indications that exercise modality would impact BDNF response as long as the subjects are familiar with the activity.”17 I believe that this statement has been upheld by the literature critically appraised here. Based on the evidence, rowing does not appear to be any more effective at improving BDNF outcomes than other endurance exercises such as cycling or running. It is the obligation of the individual clinician to prescribe exercise that is evidenced and effective. Aerobic rowing falls into these categorizations well and has the added benefit of reducing the negative effects of upper crossed syndrome, thus making it an excellent choice for prescribing to esports athletes.2,16
1. Hwu M. Healthcare in eSports – A definition for eSports. 1-hp. 2016. http://www.1-hp.org/2016/09/11/can-we-talk-about-healthcare-in-esports/.
2. Szuhany KL, Bugatti M, Otto MW. A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor. J Psychiatr Res. 2015;60:56-64.
3. Murer MG, Yan Q, Raisman-Vozari R. Brain-derived neurotrophic factor in the control human brain, and in Alzheimer’s disease and Parkinson’s disease. Prog Neurobiol. 2001;63(1):71-124.
4. Yang JL, Lin YT, Chuang PC, Bohr VA, Mattson MP. BDNF and exercise enhance neuronal DNA repair by stimulating CREB-mediated production of apurinic/apyrimidinic endonuclease 1. Neuromolecular Med. 2014;16(1):161-174.
5. Diogenes MJ, Costenla AR, Lopes LV, et al. Enhancement of LTP in aged rats is dependent on endogenous BDNF. Neuropsychopharmacology. 2011;36(9):1823-1836.
6. Vaynman S, Ying Z, Gomez-Pinilla F. Hippocampal BDNF mediates the efficacy of exercise on synaptic plasticity and cognition. Eur J Neurosci. 2004;20(10):2580-2590.
7. Leckie RL, Oberlin LE, Voss MW, et al. BDNF mediates improvements in executive function following a 1-year exercise intervention. Front Hum Neurosci. 2014;8:985.
8. Chan RC, Shum D, Toulopoulou T, Chen EY. Assessment of executive functions: review of instruments and identification of critical issues. Arch Clin Neuropsychol. 2008;23(2):201-216.
9. Buelow T, Okdie B, Cooper A. The influence of video games on executive functions in college students. Computers in Human Behavior. 2015;Volume 45(April 2015):228-234.
10. Evens O, Patterson K. Predictors of neck and shoulder pain in non-secretarial computer users. International Journal of Industrial Ergonomics. 2000;26(3):357-365.
11. Hollist K. Time to Be Grown-Ups about Video Gaming: The Rising eSports Industry and the Need for Regulation. AZ L REV. 2015;57(3).
12. Page P, Frank CC, Lardner R. Assessment and treatment of muscle imbalance : the Janda approach. Leeds: Human Kinetics; 2010.
13. Hwu M. Good Posture, Better Performance: What you need to know about Gaming Posture. 1-hp. 2017. http://www.1-hp.org/2017/01/10/good-posture-better-performance-what-you-need-to-know-about-gaming-posture/.
14. Moseley JB, Jr., Jobe FW, Pink M, Perry J, Tibone J. EMG analysis of the scapular muscles during a shoulder rehabilitation program. Am J Sports Med. 1992;20(2):128-134.
15. Singla D, Veqar Z. Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. J Chiropr Med. 2017;16(3):220-229.
16. Valli J. Chiropractic management of a 46-year-old type 1 diabetic patient with upper crossed syndrome and adhesive capsulitis. J Chiropr Med. 2004;3(4):138-144.
17. Rasmussen P, Brassard P, Adser H, et al. Evidence for a release of brain-derived neurotrophic factor from the brain during exercise. Exp Physiol. 2009;94(10):1062-1069.
18. Seifert T, Brassard P, Wissenberg M, et al. Endurance training enhances BDNF release from the human brain. Am J Physiol Regul Integr Comp Physiol. 2010;298(2):R372-377.
19. Schiffer T, Schulte S, Hollmann W, Bloch W, Struder HK. Effects of strength and endurance training on brain-derived neurotrophic factor and insulin-like growth factor 1 in humans. Horm Metab Res. 2009;41(3):250-254.
20. Dinoff A, Herrmann N, Swardfager W, et al. The Effect of Exercise Training on Resting Concentrations of Peripheral Brain-Derived Neurotrophic Factor (BDNF): A Meta-Analysis. PLoS One. 2016;11(9):e0163037.
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