Fitness culture

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Fitness_culture 

 

A man and a woman in a health club.

Fitness culture is a sociocultural phenomenon surrounding exercise and physical fitness. It is usually associated with gym culture, as doing physical exercises in locations such as gyms, wellness centres and health clubs is a popular activity. An international survey found that more than 27% of world total adult population attends fitness centres, and that 61% of regular exercisers are currently doing "gym-type" activities. Getting and maintaining physical fitness has been shown to benefit individuals' inner and outer health. Fitness culture has become highly promoted through modern technology and from the rising popularity of social media platforms.

Development

Gymnastics of ancient Greece and Rome

The word gymnastics is derived from the Greek word gymnazein which literally means "to exercise naked". In ancient Greece and Rome, a public place devoted to athletes training, called gymnasion (plural: gymnasia) for Greeks and palaestra (plural: palaestrae) for Romans existed in cities. Fitness was regarded as a concept shaped by two cultural codes: rationalization and asceticism; authenticity and hedonism, respectively. In Greece, gymnastic excellence was regarded as a noble and godly pursuit, and was included in a complete education. Gymnasiums became the center of the community, being associated with the arts, the study of logic, and a source of entertainment. Skilled athletes attained an elevated status and devoted their lives to becoming proficient in exercise. Both men and women participated in various gymnastic exercises. The series of activities include swimming, throwing, wrestling, jumping and weightlifting. After the Romans conquered Greece they developed the activities into a more formal sport and used their gymnasiums to prepare their legions for warfare. However, with the decline of the Roman empire people lost their interest in gymnastics and it now is only known as a form of entertainment.

Nineteenth century

From around 1800, gymnastics developed in Western countries was meant to enhance body in order to sustain public morals and to mold better citizens. Pehr Henrik Ling was a pioneer in the teaching of physical education in Sweden, and he sought to reform and improve the gymnastics of the ancient Greeks. In 1850, the Supreme Medical Board of Russia reported to their emperor on Ling's system, that by improving one's overall fitness, an athlete became superior to those who merely focused on a subset of muscles or actions. In the mid 19th century the world saw the rise of physical culture, a movement that emphasized the importance of physical exercise for men, women, and children alike. Diocletian Lewis, a physician, even advocated for males and females exercising together in the gym. In 1896 Men's gymnastics was on the schedule of the first modern Olympics. The Olympic gymnastic competition for women began in 1928.

World War II

Leading up to and during World War II, totalitarian regimes used gymnastics as a way to promote their ideologies. Physical fitness was at the core of Nazi philosophy, and the German government financed the construction of sports and wellness facilities. In 1922, the Nazi Party established the Hitler Youth, where children and adolescents participated in physical activities to develop both their physical and mental fitness. Nazi sports imagery served the purpose of promoting the idea of "Aryan" racial superiority, and in 1933, an "Aryans only" policy was instituted in all German athletic organizations.

In the Soviet Union, the Leninist Young Communist League created the Ready for Labour and Defence of the USSR in 1931, which was a fitness program that was designed to improve public health and prepare the population for highly productive work and the defense of "the motherland".

The Cold War

During the Cold War, a focus on physical fitness emerged in both the United States and the Soviet Union. Senator Hubert Humphrey gravely warned that communist dominance came from superior sports and fitness programs. His remarks reflected the growing American paranoia of communism. In response, leaders of the military, civilian government, and private sector began crafting a "cult and ritual of toughness". President John F. Kennedy issued a call to the nation urging Americans to prioritize their physical fitness across the country. Fitness was clearly described as a "matter of achieving an optimum state of well-being" that required exercise from both young and old. This focus on fitness also opened the doors for female athletes in both the U.S. and the USSR to become more prominent as contenders in the Olympics.

Mass participation, commercialization

After World War II, a new form of non-organized, individualistic, health-oriented physical and recreational activities such as jogging began to prevail. The Royal Canadian Air Force Exercise Plans, developed by Dr Bill Orban in 1961, sold 23 million copies to the public. United States Air Force Colonel Kenneth Cooper's book Aerobics was released in 1968 and the mass-market version The New Aerobics in 1979. These publications by Orban and Cooper helped to launch modern fitness culture. The Olympics inspired a running boom in the 1970s. After the release of Jane Fonda's Workout exercise videos in 1982, aerobics became a popular form of group gymnastic activity.

Fitness began to be commercialised. Gyms were set up with the goals not to improve public health but to stimulate and exploit the desire of people to keep fit, have fun and improve themselves. It can also be observed in today's gyms where bodybuilders are trying to reach their aesthetic ideas, through muscle development, using weights and other equipment. Growth in bodybuilding as a fitness phenomenon followed the movie and book Pumping Iron in 1977 and the movie Pumping Iron II in 1985.

The term gym is often associated with the term fitness and going to gyms means doing exercises in fitness institutions such as fitness centres, health clubs or gym clubs where people have to pay for membership in order to use fitness equipment and participate in group fitness activities with instructors, such as aerobics and yoga classes.

Technology, specialization, branding

Advances in technology in the twenty-first century have changed the way of doing fitness activities. The Quantified Self has become a new phenomenon, where people use technological devices to support their workouts. It is characterized by the use of gadgets such as pedometer, GPS, heart rate monitor and smartphone apps to quantify or monitor the exerciser's efforts.

There is a decrease in popularity of "pure aerobics" exercises. The attention is moving from aerobics, bodybuilding and traditional technique of exercises, to activities such as yoga, zumba, pilates, spinning and aquacycling, tai chi, kickboxing, and outdoor fitness.

Exercises have been commercialized as branded exercises by fitness institutions. Branded exercises are group workouts developed by fitness institutions for people with different goals of fitness.

Influences

Further information: Social influences on fitness behavior

Mass media

Mass media plays an important role in shaping fitness culture because of the messages of an ideal body image they convey. Media such as TV, magazines and book publications, tend to promote slimness or even thinness as the ideal standards of female body image and slenderness or muscularity as the ideal male body image. Commercial advertisements have also created an influential and powerful force in promoting a stereotype of ideal body image which is not limited to fashion advertisements. Advertisements on commodities such as watches, smartphones and household appliances, have promoted an idealized body image of women and men as well. The perception of being slim and thin for women and slender and muscular for men became a stereotype in society, creating sociocultural pressures and influencing people to engage in fitness in order to pursue the ideal body image promoted by the mass media.

Exercising and dieting is often seen as the best way to achieve such ideal body image. For instance, fitness publications promote an idea that doing physical exercise is the natural medicine to your body and health. On the other hand, fashion magazines promote slimness and thinness as the ideal female image: to promote high fashion, models are usually slim and thin. There is also a significant increase of diet and weight loss articles in magazines. In addition, the shape of models has changed dramatically towards a “more tubular female form” in high fashion culture, often sparking controversies.

Peer influence

People who regularly attend fitness institutions tend to make friends at these locations. They want to feel part of a group, which can be referred to community feeling, as the behaviour of group membership is transmitted from member to member within a group. However, this kind of friendship usually remains restricted within the fitness institution. Besides, the atmosphere in fitness institutions created by people with the same goal becomes a force of motivation. When people go to fitness institutions or start a new activity, they can be encouraged by others and give support to each other.

In addition, fitness institutions can function as dating agencies, creating chances to meet people apart from workplaces. Music, body movement and costumes of people exercising, can easily draw attention and become an occasion to engage with each other.

Another important aspect of fitness culture is the gender differentiation in exercises performed. One study showed that women prefer to do cardiovascular exercise over weight training because it allows them to gain strength without transgressing norms for feminine physical appearance, whereas men prefer other exercises like bodybuilding or boxing in order to be more muscular.

Personal trainers

Main article: Personal trainer

Fitness institutions are places where people can cultivate their individual needs in terms of keeping fit and having fun with other people. They have been developed as a commercial environment since 1980s. The concept beyond this commercial aspect can be explained by the idea of making the best use of time because people must pay for their membership in order to join a fitness institution. Thus, they are considered customers. Fitness institutions are trying to explore the market by providing extra services such as personal trainers, coaches and experts.

Personal trainers act as representative roles that represent the fitness club. It is a kind of representation for customers in term of satisfaction and loyalty to that particular fitness institution. Trainers also act as brokers, or agents, to create a link between the activities of their customers and the purchase of extra goods and services that their customers need for particular activities such as shoes for specific training, clothing, or home equipment. Trainers are also motivators of the goods and services. They are required to have technical skills in order to provide professional fitness services to their customers and they need to have good communication skills meant to persuade their customers to do more in the fitness institution, which in turn means purchasing more goods and services. Finally, personal trainers also act as entrepreneurs: creating a large network of customers for different goods and services in order to produce profits. From this point of view, personal trainers are intermediaries between customers and the fitness institution, playing a crucial role in the commercialization of fitness culture.

The popularity of personal trainers can be explained by the analysis of rule-governed behaviour in terms of evolutionary thinking. From this perspective, personal trainers act as speaker to give rules, while trainees are listeners to follow the rules. Much human behaviour starts out from rule-governed behaviour and switches to long-term control. Whether the trainees will continue the training depends on the reinforcement by following the rule of personal trainers, because being fit and bodily well-being is a long-term contingency of fitness activities.

The role of personal trainers has also revealed a phenomenon which can be explained from the sociological perspective of "outsourced-self". This means “transferring our own responsibility to other”. Keeping healthy and well are people's own responsibility, however people are hiring personal trainers to be responsible for it. It is also relevant to the perspective of "body work" in the sociology of body: people are outsourcing their own bodies to the paid workers in order to keep healthy and prevent illness.

Fitness fashion

Further information: Sportswear and Athleisure

Fitness fashion is a product created by commercialization of fitness culture. As mentioned above, personal trainers also act as agents to sell different goods and services. An example is the case of Body Training System (BTS). BTS instructors are suggested to change their costume according to the programmes in order to show the differences in character. The aim is to aspire the trainees to purchase the same costume offered by the programmes.

Fitness fashion and athletic footwear has become the fastest growing segment in the apparel market. The athleisure trend frames it not only for sport activities but also as daywear or weekend wear. While classic sport brands continue to expand their market share in the industry, high fashion brands have also joined the competition.

Impacts

Gender

Female athletes and sports that adhere to the feminine ideal receive increased benefits, including positive media attention, fan adoration, sponsorships, and reduced heterosexist discrimination.

Women must present a body and appearance that conforms to heterosexist social norms.

Men usually prefer to underline their strength through a visual way, using yoga pants and not wearing shirts.

On the other hand,

boys are taught that masculinity in sports is defined in terms of "toughness and dominance and to express disdain for females and any boy seen as weak or unwilling to take risks on or off the playing field".

Society and media emphasize athletic women's physical appearance and sexual attractiveness, through representing them as women first and athletes second. Thus, the feminine athletic ideal consists of an attractive appearance, thin body, and sexual appeal, which is conveyed also through clothing: women sportswear must fit snugly, but, most important must be sheath, exaggerating the female shape. In health/fitness magazines are included four stereotypes for masculinity: physical action, power, stance, and muscles. While for female it included three stereotypes: thin ideal, glistening/"wet" look, and feminine face. Thus, the health-fitness magazines tended to use the masculine and feminine ideals through stereotypes more than fashion magazines. Thus, those who practice health-fitness tended to be less dressed or used close-fitting with the intention to emphasize the appeal.

Social media's fitness culture and its effect on body image

Social media has impacted society in various ways throughout modern history. In relation to fitness, social media has become one of the most impactful outlets for fitness culture. The influence of social media expands further than any individual to much larger political, economic, and cultural areas of society. Fitspiration on social media platforms does provide individuals with a sense of community and support, which can be beneficial in encouraging them to exercise, stick to dietary and/or fitness plans, strive to achieve a fit body, and expose them to helpful lifestyle tips.

Fitspiration Fitness related content on social media, such as Facebook or Instagram, does influence peoples' lifestyle, fitness habits, and the way they compare themselves to other people. When women view fitness content, they tend to develop a more negative body image and are quicker to compare their bodies to the ones they are seeing on social media. Men are subject to this as well, however it is less common.

Sedentary lifestyle

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Sedentary_lifestyle

 

Exercise trends such as watching television are a common characteristic of a sedentary lifestyle

Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like socializing, watching TV, playing video games, reading or using a mobile phone or computer for much of the day. A sedentary lifestyle contributes to poor health quality, diseases as well as many preventable causes of death.

Sitting time is a common measure of a sedentary lifestyle. A global review representing 47% of the global adult population found that the average person sits down for 4.7 to 6.5 hours a day with the average going up every year. The CDC found that 25.3% of all American adults are physically inactive.

Screen time is a term for the amount of time a person spends looking at a screen such as a television, computer monitor, or mobile device. Excessive screen time is linked to negative health consequences.

Definition

Sedentary behavior enables less energy expenditure than active behavior.

Sedentary behavior is not the same as physical inactivity: sedentary behavior is defined as "any waking behavior characterized by an energy expenditure less than or equal to 1.5 metabolic equivalents (METs), while in a sitting, reclining or lying posture". Spending most waking hours sitting does not necessarily mean that an individual is sedentary, though sitting and lying down most frequently are sedentary behaviors. Esmonde-White defines a sedentary lifestyle as a lifestyle that involves "longer than six hours a day" of sedentary behavior.

Health effects

Effects of a sedentary work life or lifestyle can be either direct or indirect. One of the most prominent direct effect of a sedentary lifestyle is an increased BMI leading to obesity. A lack of physical activity is one of the leading causes of preventable death worldwide.

At least 300,000 premature deaths, and $90 billion in direct healthcare costs are caused by obesity and sedentary lifestyle per year in the US alone. The risk is higher among those that sit still more than 5 hours per day. It is shown to be a risk factor on its own independent of hard exercise and BMI. People that sit still more than 4 hours per day have a 40 percent higher risk than those that sit fewer than 4 hours per day. However, those that exercise at least 4 hours per week are as healthy as those that sit fewer than 4 hours per day.

Indirectly, an increased BMI due to a sedentary lifestyle can lead to decreased productivity and increased absenteeism from necessary activities like work.

A sedentary lifestyle contributes to or can be a risk factor for:

• Anxiety
• Cardiovascular disease
• Migraines
• Breast cancer
• Colon cancer
• Computer vision syndrome (only from excessive electronic use)
• Depression
• Diabetes
• Gout
• High blood pressure
• Lipid disorders
• Skin problems such as hair loss
• Mortality in adults
• Obesity
• Osteoporosis
• Scoliosis
• Spinal disc herniation (low back pain)
• Weight gain

Prevention

Gastineau Elementary Bike to School Day in Alaska

Adults and children spend long amounts of time sitting in a workplace or at a school, which is why interventions have been focused in these two areas. Mass media campaigns might also be able to reduce the amount of time spent sitting or lying down and positively affect the intention to be active physically.

In urban spaces

Some evidence has been found of a negative association between exposure to an existing urban motorway and moderate to vigorous physical activity. The proportion of physically active individuals was higher in high- versus low-walkability neighborhoods. Rising rates of overweight, obesity, and physical inactivity in China's rapidly growing cities and urban populations have been due to urban development practices and policies.

In a work environment

Occupational sedentary behaviour accounts for a significant proportion of sitting time for many adults. Some workplaces have implemented exercise classes at lunch, walking challenges among coworkers, or allowing employees to stand rather than sit at their desks during work. Workplace interventions such as alternative activity workstations, sit-stand desks, and promotion of stair use are among measures implemented to counter the harms of a sedentary workplace. A 2018 Cochrane review concluded that "At present there is low‐quality evidence that sit‐stand desks may reduce sitting at work in the first year of their use. However, the effects are likely to reduce with time. There is generally insufficient evidence to draw conclusions about such effects for other types of interventions and for the effectiveness of reducing workplace sitting over periods longer than one year."

In education

The majority of time children are in a classroom, they are seated (60% of the time). Children who regularly engage in physical activity are more likely to become healthy adults; children benefit both physically and mentally when they replace sedentary behavior with active behavior. Despite this knowledge and due in part to an increase in sedentary behaviors, children have 8 fewer hours of free play each week than they did 20 years ago.

Several studies have examined the effects of adding height-adjustable standing desks to classrooms, which have reduced the time spent sitting. However, associating the reduction in sitting with health effects is challenging. In one study conducted on Australian school children, known as the Transform-Us! study, interventions reduced the amount of time children spent sitting in the classroom, which was associated with lower body mass index and waist circumference. The interventions used in the study included stand-up desks and easels, the use of timers, and sport and circus equipment in the classroom. Teachers also made lessons more active, and added breaks to lessons to promote active time. In the US, another intervention for children is promoting the use of active transportation to and from school, such as through the Safe Routes to School program.

History

Over the last hundred years, there has been a large shift from manual labor jobs (e.g. farming, manufacturing, building) to office jobs which is due to many contributing factors including globalization, outsourcing of jobs and technological advances (specifically internet and computers). In 1960, there was a decline of jobs requiring moderate physical activity from 50% to 20%, and one in two Americans had a physically demanding job, while in 2011 this ratio was one in five. From 1990 to 2016, there was a decrease of about one third in manual labor jobs/employment. In 2008, the United States American National Health Interview Survey found that 36% of adults were inactive, and 59% of adult respondents never participated in vigorous physical activity lasting more than 10 minutes per week. According to a 2018 study, office based workers typically spend 70-85% sitting. In the US population, prevalence of sitting watching television or videos at least 2 h/d was high in 2015-2016 (ranging from 59% to 65%); the estimated prevalence of computer use outside school or work for at least 1 h/d increased from 2001 to 2016 (from 43% to 56% for children, from 53% to 57% among adolescents, and from 29% to 50% for adults); and estimated total sitting time increased from 2007 to 2016 (from 7.0 to 8.2 h/d among adolescents and from 5.5 to 6.4 h/d among adults).

Acquired brain injury

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Acquired_brain_injury 

 

See also: Brain injury

 

Acquired brain injury
Brain injury with herniation MRI

Acquired brain injury (ABI) is brain damage caused by events after birth, rather than as part of a genetic or congenital disorder such as fetal alcohol syndrome, perinatal illness or perinatal hypoxia. ABI can result in cognitive, physical, emotional, or behavioural impairments that lead to permanent or temporary changes in functioning. These impairments result from either traumatic brain injury (e.g. physical trauma due to accidents, assaults, neurosurgery, head injury etc.) or nontraumatic injury derived from either an internal or external source (e.g. stroke, brain tumours, infection, poisoning, hypoxia, ischemia, encephalopathy or substance abuse). ABI does not include damage to the brain resulting from neurodegenerative disorders.

While research has demonstrated that thinking and behavior may be altered in virtually all forms of ABI, brain injury is itself a very complex phenomenon having dramatically varied effects. No two persons can expect the same outcome or resulting difficulties. The brain controls every part of human life: physical, intellectual, behavioral, social and emotional. When the brain is damaged, some part of a person's life will be adversely affected.

Consequences of ABI often require a major life adjustment around the person's new circumstances, and making that adjustment is a critical factor in recovery and rehabilitation. While the outcome of a given injury depends largely upon the nature and severity of the injury itself, appropriate treatment plays a vital role in determining the level of recovery.

Signs and symptoms

• Anhedonia
• Apraxia
• Aphasia
• Amnesia

Behavioral manifestations:

• Adynamia
• Disinhibition
• Emotional flooding
• Perseveration

Emotional

ABI has been associated with a number of emotional difficulties such as depression, issues with self-control, managing anger impulses and challenges with problem-solving, these challenges also contribute to psychosocial concerns involving social anxiety, loneliness and lower levels of self esteem. These psychosocial problems have been found to contribute to other dilemmas such as reduced frequency of social contact and leisure activities, unemployment, family problems and marital difficulties.

How the patient copes with the injury has been found to influence the level at which they experience the emotional complications correlated with ABI. Three coping strategies for emotions related to ABI have presented themselves in the research, approach-oriented coping, passive coping and avoidant coping. Approach-oriented coping has been found to be the most effective strategy, as it has been negatively correlated with rates of apathy and depression in ABI patients; this coping style is present in individuals who consciously work to minimize the emotional challenges of ABI. Passive coping has been characterized by the person choosing not to express emotions and a lack of motivation which can lead to poor outcomes for the individual. Increased levels of depression have been correlated to avoidance coping methods in patients with ABI; this strategy is represented in people who actively evade coping with emotions. These challenges and coping strategies should be kept in consideration when seeking to understand individuals with ABI.

Memory

Following acquired brain injury it is common for people to experience memory loss; memory disorders are one of the most prevalent cognitive deficits experienced in affected people. However, because some aspects of memory are directly linked to attention, it can be challenging to assess what components of a deficit are caused by memory and which are fundamentally attention problems. There is often partial recovery of memory functioning following the initial recovery phase; however, permanent handicaps are often reported with ABI patients reporting significantly more memory difficulties when compared people without an acquired brain injury.

In order to cope more efficiently with memory disorders many people with ABI use memory aids; these included external items such as diaries, notebooks and electronic organizers, internal strategies such as visual associations, and environmental adaptations such as labelling kitchen cupboards. Research has found that ABI patients use an increased number of memory aids after their injury than they did prior to it and these aids vary in their degree of effectiveness. One popular aid is the use of a diary. Studies have found that the use of a diary is more effective if it is paired with self-instructional training, as training leads to more frequent use of the diary over time and thus more successful use as a memory aid.

Children

In children and youth with pediatric acquired brain injury the cognitive and emotional difficulties that stem from their injury can negatively impact their level of participation in home, school and other social situations, participation in structured events has been found to be especially hindered under these circumstances. Involvement in social situations is important for the normal development of children as a means of gaining an understanding of how to effectively work together with others. Furthermore, young people with ABI are often reported as having insufficient problem solving skills. This has the potential to hinder their performance in various academic and social settings further. It is important for rehabilitation programs to deal with these challenges specific to children who have not fully developed at the time of their injury.

Management

Rehabilitation following an acquired brain injury does not follow a set protocol, due to the variety of mechanisms of injury and structures affected. Rather, rehabilitation is an individualized process that will often involve a multi-disciplinary approach. The rehabilitation team may include but is not limited to nurses, neurologists, physiotherapists, psychiatrists (particularly those specialized in Brain Injury Medicine), occupational therapists, speech-language pathologists, music therapists, and rehabilitation psychologists. Physical therapy and other professions may be utilized post- brain injury in order to control muscle tone, regain normal movement patterns, and maximize functional independence. Rehabilitation should be patient-centered and guided by the individual's needs and goals.

There is some evidence that rhythmic auditory stimulation is beneficial in gait rehabilitation following a brain injury. Music therapy may assist patients to improve gait, arm swing while walking, communication, and quality of life after experiencing a stroke. Newer treatment methods such as virtual reality and robotics remain under-researched; however, there is reason to believe that virtual reality in upper limb rehabilitation may be useful, following an acquired brain injury.

Due to few random control trials and generally weak evidence, more research is needed to gain a complete understanding of the ideal type and parameters of therapeutic interventions for treatment of acquired brain injuries.

For more information on therapeutic interventions for acquired brain injury, see stroke and traumatic brain injury.

Memory

Some strategies for rehabilitating the memory of those affected by ABI have used repetitive tasks to attempt to increase the patients' ability to recall information. While this type of training increases performance on the task at hand, there is little evidence that the skills translate to improved performance on memory challenges outside of the laboratory. Awareness of memory strategies, motivation and dedication to increasing memory have been related to successful increases in memory capability among patients an example of this could be the use of attention process training and brain injury education in patients with memory disorders related to brain injury. These have been shown to increase memory functioning in patients based on self-report measures.

Another strategy for improvement amongst individuals with poor memory functioning is the use of elaboration to improve encoding of items, one form of this strategy is called self-imagining whereby the patient imagines the event to be recalled from a more personal perspective. Self-imagining has been found to improve recognition memory by coding the event in a manner that is more individually salient to the subject. This effect has been found to improve recall in individuals with and without memory disorders.

There is research evidence to suggest that rehabilitation programs that are geared toward the individual may have greater results than group-based interventions for improving memory in ABI patients because they are tailored to the symptoms experienced by the individual.

More research is necessary in order to draw conclusions on how to improve memory among individuals with ABI that experience memory loss.

Notable cases

Phineas Gage's accident

There have been many popularized cases of various forms of ABI such as:

• Phineas Gage's case of traumatic brain injury that greatly stimulated discussion on brain function and physiology
• Henry Molaison, formerly known as patient H.M., underwent neurosurgery to remove scar tissue in his brain that was causing debilitating epileptic seizures, neurosurgeon William Beecher Scoville performed the surgery which created bilateral lesions near the hippocampus. These lesions helped remove symptoms of the epilepsy in Molaison but resulted in anterograde amnesia. Molaison has been studied by hundreds of researchers since this time, most notably Brenda Milner, and has been greatly influential in the study of memory and the brain.
• Zasetsky injured in the Battle of Smolensk, bullet entered his left parieto-occipital area and resulted in a long coma. Following this, he developed a form of agnosia and became unable to perceive the right side of things.

Chronic traumatic encephalopathy

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Chronic_traumatic_encephalopathy

 

Chronic traumatic encephalopathy
Other names	Traumatic encephalopathy syndrome, dementia pugilistica, punch drunk syndrome
Specialty	Neurology, psychiatry, sports medicine
Symptoms	Behavioral problems, mood problems, problems with thinking
Complications	Brain damage, dementia, aggression, depression, suicide
Usual onset	Years after initial injuries
Causes	Repeated head injuries
Risk factors	Contact sports, military service, domestic abuse, repeated banging of the head
Diagnostic method	Autopsy
Differential diagnosis	Alzheimer's disease, Parkinson's disease
Treatment	Supportive care
Prognosis	Worsens over time
Frequency	Uncertain

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease linked to repeated trauma to the head. The encephalopathy symptoms can include behavioral problems, mood problems, and problems with thinking. The disease often gets worse over time and can result in dementia. It is unclear if the risk of suicide is altered.

Most documented cases have occurred in athletes involved in striking-based combat sports, such as boxing, kickboxing, mixed martial arts, and Muay Thai—hence its original name dementia pugilistica (Latin for "fistfighter's dementia")—and contact sports such as American football, Australian rules football, professional wrestling, ice hockey, rugby, and association football (soccer), in semi-contact sports such as baseball and basketball, and military combat arms occupations. Other risk factors include being in the military, prior domestic violence, and repeated banging of the head. The exact amount of trauma required for the condition to occur is unknown, and as of 2022 definitive diagnosis can only occur at autopsy. The disease is classified as a tauopathy.

There is no specific treatment for the disease. Rates of CTE have been found to be about 30% among those with a history of multiple head injuries; however, population rates are unclear. Research in brain damage as a result of repeated head injuries began in the 1920s, at which time the condition was known as dementia pugilistica or "fistfighter's dementia", "boxer's madness", or "punch drunk syndrome". It has been proposed that the rules of some sports be changed as a means of prevention.

Signs and symptoms

Symptoms of CTE, which occur in four stages, generally appear eight to ten years after an individual experiences repetitive mild traumatic brain injuries.

First-stage symptoms are confusion, disorientation, dizziness, and headaches. Second-stage symptoms include memory loss, social instability, impulsive behavior, and poor judgment. Third and fourth stages include progressive dementia, movement disorders, hypomimia, speech impediments, sensory processing disorder, tremors, vertigo, deafness, depression and suicidality.

Additional symptoms include dysarthria, dysphagia, cognitive disorders such as amnesia, and ocular abnormalities, such as ptosis. The condition manifests as dementia, or declining mental ability, problems with memory, dizzy spells or lack of balance to the point of not being able to walk under one's own power for a short time and/or Parkinsonism, or tremors and lack of coordination. It can also cause speech problems and an unsteady gait. Patients with CTE may be prone to inappropriate or explosive behavior and may display pathological jealousy or paranoia.

Cause

See also: Chronic traumatic encephalopathy in sports

Most documented cases have occurred in athletes with mild repetitive head impacts (RHI) over an extended period of time. Evidence indicates that repetitive concussive and subconcussive blows to the head cause CTE. Specifically contact sports such as boxing, American football, Australian rules football, wrestling, mixed martial arts, ice hockey, rugby, and association football. In association football (soccer), whether this is just associated with prolific headers or other injuries is unclear as of 2017. Other potential risk factors include military personnel (repeated exposure to explosive charges or large caliber ordnance), domestic violence, and repeated impact to the head. The exact amount of trauma required for the condition to occur is unknown although it is believed that it may take years to develop.

Pathology

The neuropathological appearance of CTE is distinguished from other tauopathies, such as Alzheimer's disease. The four clinical stages of observable CTE disability have been correlated with tau pathology in brain tissue, ranging in severity from focal perivascular epicenters of neurofibrillary tangles in the frontal neocortex to severe tauopathy affecting widespread brain regions.

The primary physical manifestations of CTE include a reduction in brain weight, associated with atrophy of the frontal and temporal cortices and medial temporal lobe. The lateral ventricles and the third ventricle are often enlarged, with rare instances of dilation of the fourth ventricle. Other physical manifestations of CTE include anterior cavum septi pellucidi and posterior fenestrations, pallor of the substantia nigra and locus ceruleus, and atrophy of the olfactory bulbs, thalamus, mammillary bodies, brainstem and cerebellum. As CTE progresses, there may be marked atrophy of the hippocampus, entorhinal cortex, and amygdala.

On a microscopic scale, a pathognomonic CTE lesion involves p-tau aggregates in neurons, with or without thorn-shaped astrocytes, at the depths of the cortical sulcus around a small blood vessel, deep in the parenchyma, and not restricted to the subpial and superficial region of the sulcus; the pathognomonic lesion must include p-tau in neurons to distinguish CTE from ARTAG (Aging-related tau astrogliopathy.) Supporting features of CTE are: superficial neurofibrillary tangles (NFTs); p–tau in CA2 and CA4 hippocampus; p-tau in: mammillary bodies, hypothalamic nuclei, amygdala, nucleus accumbens, thalamus, midbrain tegmentum, nucleus basalis of Meynert, raphe nuclei, substantia nigra and locus coeruleus; p-tau thorn-shaped astrocytes (TSA) in the subpial region; p-tau dot-like neurites. Purely astrocytic perivascular p-tau pathology represents ARTAG and does not meet the criteria for CTE.

A small group of individuals with CTE have chronic traumatic encephalomyopathy (CTEM), which is characterized by symptoms of motor-neuron disease and which mimics amyotrophic lateral sclerosis (ALS). Progressive muscle weakness and balance and gait problems (problems with walking) seem to be early signs of CTEM.

Exosome vesicles created by the brain are potential biomarkers of TBI, including CTE.

Loss of neurons, scarring of brain tissue, collection of proteinaceous senile plaques, hydrocephalus, attenuation of the corpus callosum, diffuse axonal injury, neurofibrillary tangles, and damage to the cerebellum are implicated in the syndrome. Neurofibrillary tangles have been found in the brains of dementia pugilistica patients, but not in the same distribution as is usually found in people with Alzheimer's. One group examined slices of brain from patients having had multiple mild traumatic brain injuries and found changes in the cells' cytoskeletons, which they suggested might be due to damage to cerebral blood vessels.

Increased exposure to concussions and subconcussive blows is regarded as the most important risk factor. This exposure can depend on the total number of fights, number of knockout losses, the duration of career, fight frequency, age of retirement, and boxing style.

Diagnosis

Diagnosis of CTE cannot be made in living individuals; a clear diagnosis is only possible during an autopsy. Though there are signs and symptoms some researchers associate with CTE, there is no definitive test to prove the existence in a living person. Signs are also very similar to that of other neurological conditions such as Alzheimer's.

The lack of distinct biomarkers is the reason CTE cannot typically be diagnosed while a person is alive. Concussions are non-structural injuries and do not result in brain bleeding, which is why most concussions cannot be seen on routine neuroimaging tests such as CT or MRI. Acute concussion symptoms (those that occur shortly after an injury) should not be confused with CTE. Differentiating between prolonged post-concussion syndrome (PCS, where symptoms begin shortly after a concussion and last for weeks, months, and sometimes even years) and CTE symptoms can be difficult. Research studies are examining whether neuroimaging can detect subtle changes in axonal integrity and structural lesions that can occur in CTE. By the early 2010s, more progress in in-vivo diagnostic techniques for CTE had been made, using DTI, fMRI, MRI, and MRS imaging; however, more research needs to be done before any such techniques can be validated.

PET tracers that bind specifically to tau protein are desired to aid diagnosis of CTE in living individuals. One candidate is the tracer FDDNP, which is retained in the brain in individuals with a number of dementing disorders such as Alzheimer's disease, Down syndrome, progressive supranuclear palsy, corticobasal degeneration, familial frontotemporal dementia, and Creutzfeldt–Jakob disease. In a small study of 5 retired NFL players with cognitive and mood symptoms, the PET scans revealed accumulation of the tracer in their brains. However, [¹⁸F]FDDNP binds to beta-amyloid and other proteins as well. Moreover, the sites in the brain where the tracer was retained were not consistent with the known neuropathology of CTE. A more promising candidate is the tracer [¹⁸F]-T807, which binds only to tau. It is being tested in several clinical trials.

A putative biomarker for CTE is the presence in serum of autoantibodies against the brain. The autoantibodies were detected in football players who experienced a large number of head hits but no concussions, suggesting that even sub-concussive episodes may be damaging to the brain. The autoantibodies may enter the brain by means of a disrupted blood-brain barrier, and attack neuronal cells which are normally protected from an immune onslaught. Given the large numbers of neurons present in the brain (86 billion), and considering the poor penetration of antibodies across a normal blood-brain barrier, there is an extended period of time between the initial events (head hits) and the development of any signs or symptoms. Nevertheless, autoimmune changes in blood of players may constitute the earliest measurable event predicting CTE.

According to 2017 study on brains of deceased gridiron football players, 99% of tested brains of NFL players, 88% of CFL players, 64% of semi-professional players, 91% of college football players, and 21% of high school football players had various stages of CTE. Players still alive are not able to be tested.

Imaging

Although the diagnosis of CTE cannot be determined by imaging, the effects of head trauma may be seen with the use of structural imaging. Imaging techniques include the use of magnetic resonance imaging, nuclear magnetic resonance spectroscopy, CT scan, single-photon emission computed tomography, Diffusion MRI, and Positron emission tomography (PET). One specific use of imaging is the use of a PET scan is to evaluate for tau deposition, which has been conducted on retired NFL players.

Prevention

The use of helmets and mouth-guards has been put forward as a possible preventative measure; though neither has significant research to support its use, both have been shown to reduce direct head trauma. Although there is no significant research to support the use of helmets to reduce the risk of concussions, there is evidence to support that helmet use reduces impact forces. Mouth guards have been shown to decrease dental injuries, but again have not shown significant evidence to reduce concussions. Because repeated impacts are thought to increase the likelihood of CTE development, a growing area of practice is improved recognition and treatment for concussions and other head trauma; removal from sport participation during recovery from these traumatic injuries is essential. Proper return-to-play protocol after possible brain injuries is also important in decreasing the significance of future impacts.

Efforts are being made to change the rules of contact sports to reduce the frequency and severity of blows to the head. Examples of these rule changes are the evolution of tackling technique rules in American football, such as the banning of helmet-first tackles, and the addition of rules to protect defenseless players. Likewise, another growing area of debate is better implementation of rules already in place to protect athletes.

Because of the concern that boxing may cause CTE, there is a movement among medical professionals to ban the sport. Medical professionals have called for such a ban as early as the 1950s.

Management

No cure exists for CTE, and because it cannot be tested for until an autopsy is performed, people cannot know if they have it. Treatment is supportive as with other forms of dementia. Those with CTE-related symptoms may receive medication and non-medication related treatments.

Epidemiology

Rates of disease have been found to be about 30% among those with a history of multiple head injuries. Population rates, however, are unclear.

Professional level athletes are the largest group with CTE, due to frequent concussions and sub-concussive impacts from play in contact sport. These contact-sports include American football, Australian rules football, ice hockey, Rugby football (Rugby union and Rugby league), boxing, kickboxing, mixed martial arts, association football, and wrestling. In association football, only prolific headers are known to have developed CTE.

Cases of CTE were also recorded in baseball.

According to a 2017 study on brains of deceased gridiron football players, 99% of tested brains of NFL players, 88% of CFL players, 64% of semi-professional players, 91% of college football players, and 21% of high school football players had various stages of CTE.

Other individuals diagnosed with CTE were those involved in military service, had a previous history of chronic seizures, were domestically abused, or were involved in activities resulting in repetitive head collisions.

History

CTE was originally studied in boxers in the 1920s as "punch-drunk syndrome." Punch-drunk syndrome was first described in 1928 by a forensic pathologist, Dr. Harrison Stanford Martland, who was the chief medical examiner of Essex County in Newark, New Jersey, in a Journal of the American Medical Association article, in which he noted the tremors, slowed movement, confusion and speech problems typical of the condition. The term "punch-drunk" was replaced with "dementia pugilistica" in 1937 by J.A. Millsbaugh, as he felt the term was condescending to former boxers. The initial diagnosis of dementia pugilistica was derived from the Latin word for boxer pugil (akin to pugnus 'fist', pugnāre 'to fight').

Other terms for the condition have included chronic boxer's encephalopathy, traumatic boxer's encephalopathy, boxer's dementia, pugilistic dementia, chronic traumatic brain injury associated with boxing (CTBI-B), and punch-drunk syndrome.

British neurologist, Macdonald Critchley, wrote a 1949 paper titled "Punch-drunk syndromes: the chronic traumatic encephalopathy of boxers". CTE was first recognized as affecting individuals who took considerable blows to the head, but was believed to be confined to boxers and not other athletes. As evidence pertaining to the clinical and neuropathological consequences of repeated mild head trauma grew, it became clear that this pattern of neurodegeneration was not restricted to boxers, and the term chronic traumatic encephalopathy became most widely used.

In October 2022, the United States National Institutes of Health formally acknowledged there was a causal link between repeated blows to the head and CTE.

Research

In 2005, forensic pathologist Bennet Omalu, along with colleagues in the Department of Pathology at the University of Pittsburgh, published a paper, "Chronic Traumatic Encephalopathy in a National Football League Player", in the journal Neurosurgery, based on analysis of the brain of deceased former NFL center Mike Webster. This was then followed by a paper on a second case in 2006 describing similar pathology, based on findings in the brain of former NFL player Terry Long.

In 2008, the Center for the Study of Traumatic Encephalopathy at the BU School of Medicine (now the BU CTE Center) started the VA-BU-CLF Brain Bank at the Bedford Veterans Administration Hospital to analyze the effects of CTE and other neurodegenerative diseases on the brain and spinal cord of athletes, military veterans, and civilians. To date, the VA-BU-CLF Brain Bank is the largest CTE tissue repository in the world, with over 1000 brain donors.

On 21 December 2009, the National Football League Players Association announced that it would collaborate with the BU CTE Center to support the center's study of repetitive brain trauma in athletes. Additionally, in 2010 the National Football League gave the BU CTE Center a $1 million gift with no strings attached. In 2008, twelve living athletes (active and retired), including hockey players Pat LaFontaine and Noah Welch as well as former NFL star Ted Johnson, committed to donate their brains to VA-BU-CLF Brain Bank after their deaths. In 2009, NFL Pro Bowlers Matt Birk, Lofa Tatupu, and Sean Morey pledged to donate their brains to the VA-BU-CLF Brain Bank.

In 2010, 20 more NFL players and former players pledged to join the VA-BU-CLF Brain Donation Registry, including Chicago Bears linebacker Hunter Hillenmeyer, Hall of Famer Mike Haynes, Pro Bowlers Zach Thomas, Kyle Turley, and Conrad Dobler, Super Bowl Champion Don Hasselbeck and former pro players Lew Carpenter, and Todd Hendricks. In 2010, professional wrestlers Mick Foley, Booker T and Matt Morgan also agreed to donate their brains upon their deaths. Also in 2010, MLS player Taylor Twellman, who had to retire from the New England Revolution because of post-concussion symptoms, agreed to donate his brain upon his death. As of 2010, the VA-BU-CLF Brain Donation Registry consists of over 250 current and former athletes.

In 2011, former North Queensland Cowboys player Shaun Valentine became the first Australian National Rugby League player to agree to donate his brain upon his death, in response to recent concerns about the effects of concussions on Rugby League players, who do not use helmets. Also in 2011, boxer Micky Ward, whose career inspired the film The Fighter, agreed to donate his brain upon his death. In 2018, NASCAR driver Dale Earnhardt Jr., who retired in 2017 citing multiple concussions, became the first auto racing competitor agreeing to donate his brain upon his death.

In related research, the Center for the Study of Retired Athletes, which is part of the Department of Exercise and Sport Science at the University of North Carolina at Chapel Hill, is conducting research funded by National Football League Charities to "study former football players, a population with a high prevalence of exposure to prior Mild Traumatic Brain Injury (MTBI) and sub-concussive impacts, in order to investigate the association between increased football exposure and recurrent MTBI and neurodegenerative disorders such as cognitive impairment and Alzheimer's disease (AD)".

In February 2011, former NFL player Dave Duerson committed suicide via a gunshot to his chest, thus leaving his brain intact. Duerson left text messages to loved ones asking that his brain be donated to research for CTE. The family got in touch with representatives of the Boston University center studying the condition, said Robert Stern, the co-director of the research group. Stern said Duerson's gift was the first time of which he was aware that such a request had been made by someone who had committed suicide that was potentially linked to CTE. Stern and his colleagues found high levels of the protein tau in Duerson's brain. These elevated levels, which were abnormally clumped and pooled along the brain sulci, are indicative of CTE.

In July 2010, NHL enforcer Bob Probert died of heart failure. Before his death, he asked his wife to donate his brain to CTE research because it was noticed that Probert experienced a mental decline in his 40s. In March 2011, researchers at Boston University concluded that Probert had CTE upon analysis of the brain tissue he donated. He was the second NHL player from the program at the BU CTE Center to be diagnosed with CTE postmortem.

The BU CTE Center has also found indications of links between amyotrophic lateral sclerosis (ALS) and CTE in athletes who have participated in contact sports. Tissue for the study was donated by twelve athletes and their families to the VA-BU-CLF Brain Bank at the Bedford, Massachusetts VA Medical Center.

In 2013, President Barack Obama announced the creation of the Chronic Effects of Neurotrauma Consortium or CENC, a federally funded research project devised to address the long-term effects of mild traumatic brain injury in military service personnel (SM's) and veterans. The CENC is a multi-center collaboration linking premiere basic science, translational, and clinical neuroscience researchers from the DoD, VA, academic universities, and private research institutes to effectively address the scientific, diagnostic, and therapeutic ramifications of mild TBI and its long-term effects.

Nearly 20% of the more than 2.5 million U.S. service members (SMs) deployed since 2003 to Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have sustained at least one traumatic brain injury (TBI), predominantly mild TBI (mTBI), and almost 8% of all OEF/OIF Veterans demonstrate persistent post-TBI symptoms more than six months post-injury. Unlike those head injuries incurred in most sporting events, recent military head injuries are most often the result of blast wave exposure.

After a competitive application process, a consortium led by Virginia Commonwealth University was awarded funding to study brain injuries in military veterans. The project principal investigator for the CENC is David Cifu, chairman and Herman J. Flax professor of the Department of Physical Medicine and Rehabilitation (PM&R) at Virginia Commonwealth University (VCU) in Richmond, Virginia, with co-principal investigators Ramon Diaz-Arrastia, Professor of Neurology, Uniformed Services University of the Health Sciences, and Rick L. Williams, statistician at RTI International.

In 2017, Aaron Hernandez, a former professional football player and convicted murderer, committed suicide at the age of 27 while in prison. His family donated his brain to the BU CTE Center. Ann McKee, the head of Center, concluded that "Hernandez had Stage 3 CTE, which researchers had never seen in a brain younger than 46 years old."

Research into the genetic component of CTE is evolving, and well summarized in a recent review. Interestingly, the minor allele of TMEM106B has been found to be associated with a protective phenotype.