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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Reviews
Full Version
Beneficial Effects of Physical Activity on Stroke: A Narrative Review
Correspondence Address :
Dr. Mansi Soni,
Assistant Professor, Department of Physiotherapy, Ashok & Rita Patel Institute of Physiotherapy, CHARUSAT, Changa, Anand-388421, Gujarat, India.
E-mail: dr.mansi.soni@gmail.com
Stroke is a major health issue in the category of non communicable diseases, placing a significant burden on developed and developing countries in terms of long-term and specialised care. In today’s era, controlling the highly prevalent non communicable diseases is a primary focus, with preventive strategies taking precedence over treatment strategies. Physical inactivity is one of the contributing factors to stroke, highlighting the immense significance of physical activity for stroke survivors. Therefore, it is crucial to investigate and understand the positive effects of physical activity in preventing and managing stroke. This narrative review aims to explore and summarise the beneficial effects of physical activity in stroke prevention and management. By narrating these benefits, we hope to encourage stroke survivors to engage in sufficient physical activity to maximise their advantages.
Active lifestyle, Active time, Activity level, Cerebrovascular accident, Positive effect, Sedentary time
Stroke is associated with a wide range of impairments and disabilities, and these stroke-related disabilities often persist for an extended period of time. The burden of stroke on a global scale is a significant and growing public health concern. According to the Global Burden of Disease 2019 report, stroke ranked as the third-leading cause of death and disability combined, accounting for over 5.5% of total disability-adjusted life-years worldwide. Additionally, stroke remained the second-leading cause of death, accounting for more than 11.5% of total deaths (1). Low-income countries were disproportionately affected, with mortality rates 3.6 times higher and disability-adjusted life years 3.7 times higher compared to high-income countries. Without concerted efforts, the burden of stroke is expected to continue increasing. It is imperative to implement recommended guidelines for primary and secondary stroke prevention (1).
Physical inactivity is a prominent risk factor for stroke (2). Conversely, physical activity has been reported to have a wide range of beneficial effects in mitigating stroke risks (3). Emerging evidence from a large-scale study in America suggests that increasing daily physical activities effectively reduces stroke risk and warrants recommendation (4). While several studies and reviews have examined the effects of physical activity on stroke patients in specific affected areas [5,6], there remains a scarcity of comprehensive research on the overall beneficial effects of physical activity among stroke participants.
This review aims to explore the beneficial effects of physical activity in preventing and rehabilitating stroke. Electronic databases such as PubMed, Cochrane Library, and EBSCOhost were searched for studies and reviews investigating the effects of physical activity on stroke, focusing on three areas:
1. What are the benefits of physical activity for stroke prevention?
2. What are the beneficial effects of physical activity in poststroke rehabilitation?
3. How much physical activity is required to achieve desired beneficial effects?
Physical activity benefits in Stroke Prevention
The effect of physical activity on reducing stroke risk is significant. Stroke is a prevalent non communicable disease, with estimated prevalence rates ranging from 84-262/100,000 to 334-424/100,000 in rural and urban areas of India, respectively (7). Considering the high prevalence rate, the best approach to address this issue is to focus on preventive measures to lower the occurrence rate. There is a wealth of high-quality research evidence that has demonstrated a significant reduction in stroke risk with high-level physical activity. Highly active individuals have a 27% lower risk of stroke incidence or mortality compared to low-active individuals, while moderately active individuals have a 20% lower stroke risk compared to inactive individuals. Moderate to high levels of physical activity have been shown to reduce the incidence and mortality associated with both subtypes of stroke (8). These findings are supported by a meta-analysis of the global burden of disease study in 2013, which revealed a dose-response relationship between levels of physical activity and stroke risk (9). Compared to sedentary individuals, low, moderate, and highly active individuals experience a 16%, 19%, and 26% reduction in ischaemic stroke risk, respectively (9). Thus, higher levels of physical activity have beneficial effects on stroke prevention. Additionally, domain-specific physical activity, such as occupational and leisure-time physical activity, has been found to have a protective effect on total stroke (10). While there have been encouraging results from high-quality studies, most of them have focused on ischaemic stroke (8),(9). Further investigation is still needed to comment on the haemorrhagic subtype of stroke.
Variations in Stroke Risk Reduction among Gender with Physical Activity
It has been documented that an increase in physical activity reduces stroke risk and its after-effects. The perceived level of physical activity, as well as physiological factors, may impact stroke risk differently in males and females. The evaluation of physical activity requirements for risk reduction in males and females has revealed that males experience stroke risk reduction when engaged in moderate and high physical activity, while females only experience risk reduction with high physical activity (11). The study reports a 12% and 19% reduction in stroke risk for males with moderate and high physical activity levels, respectively. In females, a 24% risk reduction was observed with high physical activity, but no risk reduction was observed with moderate physical activity. The mentioned meta-analysis reported limitations, including the limited number of relevant studies found, heterogeneity of data, and variation in the definition of physical activity levels. The findings of the meta-analysis suggest that females require a higher level of physical activity compared to males to achieve the desired reduction in stroke risk (11). Therefore, management plans for stroke risk reduction should incorporate different levels of physical activity based on the gender of the patient.
Physical Activity Benefits in Stroke Rehabilitation
Benefits of physical activity on poststroke functional recovery: Various exercise interventions combined with physical activity have shown a beneficial role in improving cognition, arm function, balance, and gait after stroke (5). Emerging evidence suggests that physical activity also has a positive impact on fatigue and confidence (5). A review of different exercise modes to improve musculoskeletal function has indicated that aerobic exercise and resistance training are effective for enhancing strength, balance, and mobility. However, further exploration of technology-assisted exercises like biofeedback and treadmill training is needed. Overall, exercise and physical activity have been reported to positively affect functional recovery. It is important to note that improvement in motor function may not be equally reflected in day-to-day activities (6).
Benefits of physical activity on quality of life and socialisation: Existing evidence supports the importance of physical activity in stroke rehabilitation, as it directly or indirectly improves the health and quality of life of stroke survivors. Physical activity also promotes independence and reduces the risk of recurrence (6). It is recommended that physical activity be conducted in a group setting to facilitate better socialisation and positively influence individual interests (5),(12).
Benefits of physical activity for poststroke bone health: Bone health is adversely affected after stroke, primarily due to limited mobility. Immobility-related bone deterioration is more noticeable in the weakened limb during the acute stage. A systematic review has reported that physical activity is beneficial in maintaining or improving bone health in chronic stroke patients. However, the review acknowledged its limitation of relying on a few low-quality studies. It recommends further exploration of the type and duration of physical activity during the acute stage to optimise its benefits (13).
Physical activity benefits for poststroke cognitive functions: A systematic review has reported that there is limited evidence regarding the impact of physical activity on poststroke cognitive functions, as cognitive recovery is often not the primary focus of stroke rehabilitation. However, the available evidence suggests that physical activity has a positive influence on poststroke cognitive functions. The review also noted the heterogeneity of interventions in the studies conducted in this area (14). The review highlights the need for randomised controlled trials to further explore the effect of physical activity on cognitive functions. A meta-analysis reported that cognitive functions can benefit from physical activity even during the late recovery phase of stroke, with moderate positive effects found in attention/processing speed measures. However, no significant effects were found in executive function and working memory domains. Further research is needed to determine the optimal duration and strategies of physical activity to maximise cognitive gains, taking into consideration the safety and individual needs of patients with cognitive impairments (15).
Recommended Level of Physical Activity for Stroke
Adopting an active physical lifestyle has been found to be beneficial for stroke prevention and recovery. Many studies have shown an inverse relationship between physical activity and stroke risk [8,9]. There are currently no separate guidelines for physical activity prescription specifically for stroke prevention. Recommendations for stroke prevention align with the general preventive guidelines in the United States (US), which suggest engaging in moderate to vigorous-intensity aerobic physical activity for atleast 40 minutes per day, 3-4 days per week (16). For stroke rehabilitation, physical activity plays a crucial role in addressing limitations in activities of daily living. Given the prolonged inactivity associated with stroke, physical activity provides a conditioning effects and improves functional capacity and aerobic endurance.
The American Heart Association (AHA) has documented physical activity recommendations for stroke patients (17). According to the AHA guidelines, stroke patients should engage in aerobic exercise for atleast 3 days per week, for 20-60 minutes per day, at an intensity of 40-70% of their VO2 max or heart rate reserve. The recommended exercise can be performed as continuous sessions or multiple sessions of atleast 10 minutes each, depending on the individual’s capacity. The AHA also recommends strength training to improve independence in daily activities and flexibility training to enhance balance, coordination, and prevent musculoskeletal complications.
In the initial period after a stroke, when a patient is more deconditioned, exercise can lead to a range of complications, including musculoskeletal injury and cardiac issues. Therefore, it is recommended that initial stroke rehabilitation incorporates exercise in an intermittent mode (18). Recent guidelines from AHA in 2021 suggest that stroke patients should reduce their sedentary behaviour to prevent recurrent strokes. The guidelines recommend a minimum of 40 minutes of moderate physical activity for four days a week, or 20 minutes of vigorous physical activity twice a week (19). The World Health Organisation (WHO) recommends a physical activity level of 600 metabolic equivalent (MET) minutes per week for overall health benefits (20). To achieve this, incorporating 75 minutes of running per week or 150 minutes of brisk walking per week into one’s lifestyle is recommended. The global burden of disease study in 2013 also reports that optimal health benefits are seen with a physical activity level of 3000-4000 MET (9).
Factors to Consider to Optimise the Benefits of Physical Activity for Stroke Survivors
Despite the proven benefits of physical activity and exercise across a wide range of conditions, adoption into a lifestyle is still low. The physical activity level of stroke patients is also reported to be very low. Lack of motivation is commonly reported as a barrier, while family support and functional ability are common motivators for physical activity (21). A systematic review from 2017 reported that physical activity levels after a stroke are low at all stages of recovery (22). The review found that time spent walking by stroke patients ranged from 1.8-9% in the subacute and chronic stages, respectively. On the other hand, time spent being inactive and sedentary was high, ranging upto 78% or more at all stages after a stroke. Additionally, physical activity levels were much lower than the recommended requirements following a stroke. Therefore, designing physical activity interventions that incorporate individually perceived barriers and facilitators can increase participation.
The conclusive findings of the review are described in detail in (Table/Fig 1) (3),(5),(6),(8),(9),(11),(12),(13),(14),(15),(21),(22).
Moderate to high-level physical activity has been reported to provide protective benefits against stroke in the general population. The benefits of physical activity for stroke survivors are observed in functional areas such as arm function, balance, and gait at all stages of recovery. These benefits extend to cognitive function and bone health even in the long-term. To further enhance social participation, physical activity is recommended to be practiced in groups. Considering the advantageous effects beyond cardiovascular fitness in the stroke population, it should be recommended as a mode of prevention and rehabilitation for stroke patients. Exercise and physical activity have demonstrated proven benefits among stroke patients. However, there is a need to explore the dose-response relationship to target specific aims for optimal benefits among stroke patients.
DOI: 10.7860/JCDR/2023/65721.18455
Date of Submission: May 30, 2023
Date of Peer Review: Jul 22, 2023
Date of Acceptance: Aug 11, 2023
Date of Publishing: Sep 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 31, 2023
• Manual Googling: Jul 25, 2023
• iThenticate Software: Aug 09, 2023 (14%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com