7550fddc865abac5b2567a744dae675d pmc_33917909.pdf 9ef216db8268c8bb4e62c50371e54aa22078bd0e pmc_33917909.pdf 04ab992d26de7dc17ed54442f5422280ce602b27d27a5652ee4cb09b48cb2119 pmc_33917909.pdf Title: Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review Subject: (1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke. Keywords: stroke; aerobic physical exercise; cognitive rehabilitation; combined interventions; cognitive function Author: Laura Amorós-Aguilar, Erica Rodríguez-Quiroga, Sara Sánchez-Santolaya and Margalida Coll-Andreu Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Fri Apr 9 09:58:07 2021 CEST ModDate: Fri Apr 9 10:48:14 2021 CEST Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 17 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 729811 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- KCESTI+URWPalladioL-Ital Type 1 Custom yes yes no 10 0 AOJSCL+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 ZVZLLC+URWPalladioL-Roma Type 1 Custom yes yes no 19 0 PRJKGQ+VnURWPalladioL-Bold Type 1 Custom yes yes no 23 0 MXTWPO+VnURWPalladioL Type 1 Custom yes yes no 28 0 SLUQMQ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 36 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 58 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 62 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 66 0 TNBSFT+CMSY10 Type 1 Builtin yes yes no 81 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 03:20:54 CEST RepresentationInformation: pmc_33917909.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 12:09:46 CEST Size: 729811 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 447 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Methods Destination: section.2 Children: Item: Title: Search Criteria Destination: subsection.2.1 Item: Title: Study Selection Destination: subsection.2.2 Item: Title: Data Collection and Extraction Destination: subsection.2.3 Item: Title: Quality Assessment Destination: subsection.2.4 Item: Title: Results Destination: section.3 Children: Item: Title: Study Characteristics Destination: subsection.3.1 Item: Title: Quality Assessment Destination: subsection.3.2 Item: Title: Participants Destination: subsection.3.3 Item: Title: Aerobic Exercise Intervention Destination: subsection.3.4 Item: Title: Cognitive Training Destination: subsection.3.5 Item: Title: Other Experimental Conditions Destination: subsection.3.6 Item: Title: Duration of the Combined Interventions Destination: subsection.3.7 Item: Title: Cognitive Outcomes Destination: subsection.3.8 Item: Title: Post-Intervention Effects Destination: subsection.3.9 Item: Title: Follow-Up Outcome Destination: subsection.3.10 Item: Title: Discussion Destination: section.4 Item: Title: Conclusions Destination: section.5 Item: Title: References Destination: section.5 Info: Title: Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review Author: Laura Amorós-Aguilar, Erica Rodríguez-Quiroga, Sara Sánchez-Santolaya and Margalida Coll-Andreu Subject: (1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke. Keywords: stroke; aerobic physical exercise; cognitive rehabilitation; combined interventions; cognitive function Creator: LaTeX with hyperref package Producer: pdfTeX-1.40.18 CreationDate: Fri Apr 09 09:58:07 CEST 2021 ModDate: Fri Apr 09 10:48:14 CEST 2021 ID: 0x4eb52017665020a9d14c0be05ffe42f8, 0x4eb52017665020a9d14c0be05ffe42f8 Filters: FilterPipeline: FlateDecode Fonts: Type1: Font: BaseFont: TNBSFT+CMSY10 FontSubset: true FirstChar: 6 LastChar: 21 FontDescriptor: FontName: TNBSFT+CMSY10 Flags: Symbolic FontBBox: -29, -960, 1116, 775 FontFile: true Font: BaseFont: ZVZLLC+URWPalladioL-Roma FontSubset: true FirstChar: 2 LastChar: 248 FontDescriptor: FontName: ZVZLLC+URWPalladioL-Roma Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: PRJKGQ+VnURWPalladioL-Bold FontSubset: true FirstChar: 161 LastChar: 226 FontDescriptor: FontName: PRJKGQ+VnURWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: KCESTI+URWPalladioL-Ital FontSubset: true FirstChar: 45 LastChar: 121 FontDescriptor: FontName: KCESTI+URWPalladioL-Ital Flags: Symbolic FontBBox: -170, -305, 1010, 941 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: MXTWPO+VnURWPalladioL FontSubset: true FirstChar: 161 LastChar: 225 FontDescriptor: FontName: MXTWPO+VnURWPalladioL Flags: Symbolic FontBBox: -166, -283, 1021, 943 FontFile: true EncodingDictionary: Differences: true Font: BaseFont: AOJSCL+URWPalladioL-Bold FontSubset: true FirstChar: 3 LastChar: 122 FontDescriptor: FontName: AOJSCL+URWPalladioL-Bold Flags: Symbolic FontBBox: -152, -301, 1000, 935 FontFile: true EncodingDictionary: Differences: true Pages: Page: Sequence: 1 Annotations: Annotation: Subtype: Link Rect: 35, 759, 174, 795 Annotation: Subtype: Link Rect: 515, 759, 560, 795 Annotation: Subtype: Link Rect: 505, 641, 516, 654 Annotation: Subtype: Link Rect: 51, 358, 154, 367 Annotation: Subtype: Link Rect: 35, 348, 89, 355 Annotation: Subtype: Link Rect: 35, 162, 97, 184 Annotation: Subtype: Link Rect: 153, 89, 154, 98 Annotation: Subtype: Link Rect: 35, 77, 147, 86 Annotation: Subtype: Link Rect: 215, 232, 222, 241 ActionDest: 119 Annotation: Subtype: Link Rect: 238, 170, 245, 178 ActionDest: 119 Annotation: Subtype: Link Rect: 246, 169, 253, 178 ActionDest: 119 Annotation: Subtype: Link Rect: 397, 144, 404, 153 ActionDest: 119 Annotation: Subtype: Link Rect: 425, 132, 432, 141 ActionDest: 119 Annotation: Subtype: Link Rect: 432, 132, 439, 141 ActionDest: 119 Annotation: Subtype: Link Rect: 198, 82, 205, 91 ActionDest: 119 Annotation: Subtype: Link Rect: 196, 69, 203, 78 ActionDest: 119 Annotation: Subtype: Link Rect: 117, 17, 269, 28 Annotation: Subtype: Link Rect: 406, 17, 558, 28 Annotation: Subtype: Link Rect: 35, 470, 87, 489 Page: Sequence: 2 Annotations: Annotation: Subtype: Link Rect: 436, 719, 443, 728 ActionDest: 119 Annotation: Subtype: Link Rect: 443, 719, 450, 728 ActionDest: 119 Annotation: Subtype: Link Rect: 234, 694, 246, 703 ActionDest: 122 Annotation: Subtype: Link Rect: 212, 657, 224, 666 ActionDest: 122 Annotation: Subtype: Link Rect: 274, 644, 286, 653 ActionDest: 122 Annotation: Subtype: Link Rect: 524, 594, 536, 603 ActionDest: 122 Annotation: Subtype: Link Rect: 537, 594, 549, 603 ActionDest: 122 Annotation: Subtype: Link Rect: 444, 494, 456, 503 ActionDest: 122 Annotation: Subtype: Link Rect: 457, 493, 469, 503 ActionDest: 122 Annotation: Subtype: Link Rect: 472, 494, 484, 503 ActionDest: 122 Annotation: Subtype: Link Rect: 401, 443, 413, 452 ActionDest: 122 Annotation: Subtype: Link Rect: 416, 443, 428, 452 ActionDest: 122 Annotation: Subtype: Link Rect: 531, 431, 543, 440 ActionDest: 122 Annotation: Subtype: Link Rect: 543, 431, 555, 440 ActionDest: 122 Annotation: Subtype: Link Rect: 350, 418, 362, 427 ActionDest: 122 Annotation: Subtype: Link Rect: 296, 406, 308, 415 ActionDest: 122 Annotation: Subtype: Link Rect: 544, 406, 556, 415 ActionDest: 122 Annotation: Subtype: Link Rect: 223, 355, 235, 364 ActionDest: 122 Annotation: Subtype: Link Rect: 238, 356, 250, 364 ActionDest: 122 Page: Sequence: 3 Annotations: Annotation: Subtype: Link Rect: 358, 418, 370, 427 ActionDest: 122 Annotation: Subtype: Link Rect: 370, 418, 382, 427 ActionDest: 122 Annotation: Subtype: Link Rect: 509, 402, 516, 414 ActionDest: 78 Annotation: Subtype: Link Rect: 224, 103, 236, 113 ActionDest: 122 Page: Sequence: 4 Annotations: Annotation: Subtype: Link Rect: 436, 668, 448, 677 ActionDest: 122 Annotation: Subtype: Link Rect: 453, 593, 460, 602 ActionDest: 94 Annotation: Subtype: Link Rect: 491, 593, 498, 602 ActionDest: 103 Annotation: Subtype: Link Rect: 280, 527, 287, 539 ActionDest: 106 Annotation: Subtype: Link Rect: 356, 517, 368, 526 ActionDest: 125 Annotation: Subtype: Link Rect: 347, 341, 359, 350 ActionDest: 122 Annotation: Subtype: Link Rect: 360, 341, 372, 350 ActionDest: 125 Annotation: Subtype: Link Rect: 372, 341, 384, 350 ActionDest: 125 Annotation: Subtype: Link Rect: 385, 341, 397, 350 ActionDest: 125 Annotation: Subtype: Link Rect: 501, 341, 513, 350 ActionDest: 125 Annotation: Subtype: Link Rect: 371, 303, 383, 312 ActionDest: 122 Annotation: Subtype: Link Rect: 473, 303, 485, 312 ActionDest: 125 Annotation: Subtype: Link Rect: 293, 291, 305, 300 ActionDest: 125 Annotation: Subtype: Link Rect: 308, 291, 320, 300 ActionDest: 125 Annotation: Subtype: Link Rect: 183, 266, 195, 275 ActionDest: 125 Annotation: Subtype: Link Rect: 198, 266, 210, 275 ActionDest: 125 Annotation: Subtype: Link Rect: 253, 178, 265, 187 ActionDest: 122 Annotation: Subtype: Link Rect: 266, 178, 278, 187 ActionDest: 125 Annotation: Subtype: Link Rect: 278, 178, 290, 187 ActionDest: 125 Annotation: Subtype: Link Rect: 289, 165, 301, 174 ActionDest: 125 Annotation: Subtype: Link Rect: 196, 153, 208, 162 ActionDest: 125 Annotation: Subtype: Link Rect: 299, 115, 311, 124 ActionDest: 125 Annotation: Subtype: Link Rect: 311, 115, 323, 124 ActionDest: 125 Annotation: Subtype: Link Rect: 461, 115, 473, 124 ActionDest: 125 Annotation: Subtype: Link Rect: 544, 115, 555, 124 ActionDest: 125 Annotation: Subtype: Link Rect: 466, 102, 478, 112 ActionDest: 125 Annotation: Subtype: Link Rect: 407, 90, 419, 99 ActionDest: 122 Annotation: Subtype: Link Rect: 420, 90, 432, 99 ActionDest: 125 Annotation: Subtype: Link Rect: 432, 90, 444, 99 ActionDest: 125 Annotation: Subtype: Link Rect: 288, 77, 300, 86 ActionDest: 125 Page: Sequence: 5 Annotations: Annotation: Subtype: Link Rect: 480, 669, 492, 678 ActionDest: 125 Annotation: Subtype: Link Rect: 495, 669, 507, 678 ActionDest: 125 Annotation: Subtype: Link Rect: 225, 656, 237, 665 ActionDest: 122 Annotation: Subtype: Link Rect: 256, 644, 268, 653 ActionDest: 125 Annotation: Subtype: Link Rect: 433, 644, 445, 653 ActionDest: 122 Annotation: Subtype: Link Rect: 403, 631, 415, 640 ActionDest: 125 Annotation: Subtype: Link Rect: 415, 631, 427, 640 ActionDest: 125 Annotation: Subtype: Link Rect: 428, 631, 440, 640 ActionDest: 125 Annotation: Subtype: Link Rect: 203, 619, 215, 628 ActionDest: 125 Annotation: Subtype: Link Rect: 433, 619, 445, 628 ActionDest: 122 Annotation: Subtype: Link Rect: 433, 568, 445, 577 ActionDest: 122 Annotation: Subtype: Link Rect: 445, 568, 457, 577 ActionDest: 125 Annotation: Subtype: Link Rect: 457, 568, 469, 577 ActionDest: 125 Annotation: Subtype: Link Rect: 470, 568, 482, 577 ActionDest: 125 Annotation: Subtype: Link Rect: 391, 556, 403, 565 ActionDest: 125 Annotation: Subtype: Link Rect: 298, 518, 310, 527 ActionDest: 122 Annotation: Subtype: Link Rect: 545, 493, 556, 502 ActionDest: 125 Annotation: Subtype: Link Rect: 321, 430, 333, 439 ActionDest: 125 Annotation: Subtype: Link Rect: 412, 417, 424, 426 ActionDest: 125 Annotation: Subtype: Link Rect: 544, 417, 556, 426 ActionDest: 125 Annotation: Subtype: Link Rect: 531, 379, 543, 388 ActionDest: 125 Annotation: Subtype: Link Rect: 544, 379, 555, 388 ActionDest: 125 Annotation: Subtype: Link Rect: 213, 367, 226, 376 ActionDest: 122 Annotation: Subtype: Link Rect: 227, 367, 239, 376 ActionDest: 125 Annotation: Subtype: Link Rect: 213, 354, 225, 363 ActionDest: 125 Annotation: Subtype: Link Rect: 275, 314, 282, 326 ActionDest: 103 Annotation: Subtype: Link Rect: 448, 304, 460, 313 ActionDest: 125 Annotation: Subtype: Link Rect: 531, 304, 543, 313 ActionDest: 122 Annotation: Subtype: Link Rect: 543, 304, 555, 313 ActionDest: 125 Annotation: Subtype: Link Rect: 218, 291, 230, 300 ActionDest: 122 Annotation: Subtype: Link Rect: 231, 291, 243, 300 ActionDest: 125 Annotation: Subtype: Link Rect: 327, 291, 339, 300 ActionDest: 122 Annotation: Subtype: Link Rect: 207, 279, 219, 288 ActionDest: 125 Annotation: Subtype: Link Rect: 432, 266, 444, 275 ActionDest: 125 Annotation: Subtype: Link Rect: 284, 253, 296, 263 ActionDest: 125 Annotation: Subtype: Link Rect: 296, 253, 308, 263 ActionDest: 125 Annotation: Subtype: Link Rect: 464, 253, 476, 263 ActionDest: 125 Annotation: Subtype: Link Rect: 232, 241, 244, 250 ActionDest: 125 Page: Sequence: 6 Annotations: Annotation: Subtype: Link Rect: 43, 425, 53, 433 ActionDest: 122 Annotation: Subtype: Link Rect: 43, 354, 53, 361 ActionDest: 125 Annotation: Subtype: Link Rect: 43, 292, 53, 300 ActionDest: 125 Annotation: Subtype: Link Rect: 43, 231, 53, 238 ActionDest: 125 Annotation: Subtype: Link Rect: 43, 160, 53, 167 ActionDest: 125 Annotation: Subtype: Link Rect: 75, 160, 85, 167 ActionDest: 125 Page: Sequence: 7 Annotations: Annotation: Subtype: Link Rect: 43, 355, 54, 364 ActionDest: 125 Annotation: Subtype: Link Rect: 43, 153, 54, 162 ActionDest: 122 Page: Sequence: 8 Annotations: Annotation: Subtype: Link Rect: 43, 361, 54, 369 ActionDest: 125 Annotation: Subtype: Link Rect: 43, 170, 54, 178 ActionDest: 125 Page: Sequence: 9 Annotations: Annotation: Subtype: Link Rect: 43, 361, 54, 369 ActionDest: 125 Annotation: Subtype: Link Rect: 43, 350, 54, 358 ActionDest: 125 Page: Sequence: 10 Annotations: Annotation: Subtype: Link Rect: 57, 676, 68, 684 ActionDest: 122 Annotation: Subtype: Link Rect: 57, 665, 68, 673 ActionDest: 125 Annotation: Subtype: Link Rect: 57, 654, 68, 662 ActionDest: 125 Annotation: Subtype: Link Rect: 57, 643, 68, 651 ActionDest: 125 Annotation: Subtype: Link Rect: 57, 632, 68, 640 ActionDest: 125 Annotation: Subtype: Link Rect: 405, 549, 417, 558 ActionDest: 122 Annotation: Subtype: Link Rect: 188, 537, 200, 546 ActionDest: 125 Annotation: Subtype: Link Rect: 276, 537, 288, 546 ActionDest: 125 Annotation: Subtype: Link Rect: 289, 537, 301, 546 ActionDest: 125 Annotation: Subtype: Link Rect: 370, 537, 382, 546 ActionDest: 125 Annotation: Subtype: Link Rect: 227, 524, 239, 533 ActionDest: 125 Annotation: Subtype: Link Rect: 319, 512, 331, 521 ActionDest: 122 Annotation: Subtype: Link Rect: 350, 486, 362, 496 ActionDest: 125 Annotation: Subtype: Link Rect: 363, 486, 375, 496 ActionDest: 125 Annotation: Subtype: Link Rect: 522, 486, 534, 496 ActionDest: 122 Annotation: Subtype: Link Rect: 544, 461, 556, 470 ActionDest: 122 Annotation: Subtype: Link Rect: 544, 436, 556, 445 ActionDest: 125 Annotation: Subtype: Link Rect: 386, 399, 398, 408 ActionDest: 125 Annotation: Subtype: Link Rect: 324, 386, 336, 395 ActionDest: 125 Annotation: Subtype: Link Rect: 337, 386, 349, 395 ActionDest: 125 Annotation: Subtype: Link Rect: 378, 361, 390, 370 ActionDest: 125 Annotation: Subtype: Link Rect: 483, 323, 495, 332 ActionDest: 125 Annotation: Subtype: Link Rect: 242, 273, 253, 282 ActionDest: 122 Annotation: Subtype: Link Rect: 399, 273, 411, 282 ActionDest: 125 Annotation: Subtype: Link Rect: 321, 135, 333, 144 ActionDest: 125 Annotation: Subtype: Link Rect: 334, 135, 346, 144 ActionDest: 125 Annotation: Subtype: Link Rect: 412, 135, 424, 144 ActionDest: 122 Page: Sequence: 11 Annotations: Annotation: Subtype: Link Rect: 207, 744, 219, 754 ActionDest: 125 Annotation: Subtype: Link Rect: 282, 719, 294, 728 ActionDest: 125 Annotation: Subtype: Link Rect: 295, 644, 307, 653 ActionDest: 122 Annotation: Subtype: Link Rect: 308, 644, 320, 653 ActionDest: 122 Annotation: Subtype: Link Rect: 476, 543, 488, 552 ActionDest: 122 Annotation: Subtype: Link Rect: 488, 543, 500, 552 ActionDest: 125 Annotation: Subtype: Link Rect: 231, 531, 243, 540 ActionDest: 122 Annotation: Subtype: Link Rect: 290, 518, 302, 527 ActionDest: 125 Annotation: Subtype: Link Rect: 302, 518, 314, 527 ActionDest: 125 Annotation: Subtype: Link Rect: 315, 518, 327, 527 ActionDest: 125 Annotation: Subtype: Link Rect: 211, 430, 223, 439 ActionDest: 125 Annotation: Subtype: Link Rect: 224, 430, 236, 439 ActionDest: 125 Annotation: Subtype: Link Rect: 341, 418, 353, 427 ActionDest: 125 Annotation: Subtype: Link Rect: 544, 393, 556, 402 ActionDest: 125 Annotation: Subtype: Link Rect: 444, 355, 456, 364 ActionDest: 125 Annotation: Subtype: Link Rect: 238, 318, 250, 326 ActionDest: 122 Annotation: Subtype: Link Rect: 251, 318, 263, 326 ActionDest: 125 Annotation: Subtype: Link Rect: 266, 317, 278, 326 ActionDest: 125 Annotation: Subtype: Link Rect: 320, 267, 332, 276 ActionDest: 125 Annotation: Subtype: Link Rect: 349, 204, 361, 214 ActionDest: 125 Annotation: Subtype: Link Rect: 532, 142, 544, 151 ActionDest: 125 Page: Sequence: 12 Annotations: Annotation: Subtype: Link Rect: 450, 707, 462, 716 ActionDest: 125 Annotation: Subtype: Link Rect: 337, 657, 349, 666 ActionDest: 125 Annotation: Subtype: Link Rect: 256, 606, 268, 616 ActionDest: 125 Annotation: Subtype: Link Rect: 314, 544, 325, 553 ActionDest: 122 Annotation: Subtype: Link Rect: 430, 519, 442, 528 ActionDest: 122 Annotation: Subtype: Link Rect: 443, 519, 455, 528 ActionDest: 125 Annotation: Subtype: Link Rect: 247, 506, 259, 515 ActionDest: 122 Annotation: Subtype: Link Rect: 346, 506, 358, 515 ActionDest: 125 Annotation: Subtype: Link Rect: 269, 493, 281, 503 ActionDest: 125 Annotation: Subtype: Link Rect: 281, 493, 293, 503 ActionDest: 125 Annotation: Subtype: Link Rect: 459, 481, 471, 490 ActionDest: 125 Annotation: Subtype: Link Rect: 297, 443, 309, 452 ActionDest: 122 Annotation: Subtype: Link Rect: 212, 355, 224, 364 ActionDest: 122 Annotation: Subtype: Link Rect: 337, 355, 349, 364 ActionDest: 125 Annotation: Subtype: Link Rect: 219, 280, 231, 289 ActionDest: 122 Annotation: Subtype: Link Rect: 250, 192, 262, 201 ActionDest: 125 Annotation: Subtype: Link Rect: 262, 192, 274, 201 ActionDest: 125 Annotation: Subtype: Link Rect: 378, 167, 390, 176 ActionDest: 125 Annotation: Subtype: Link Rect: 493, 104, 505, 113 ActionDest: 122 Page: Sequence: 13 Annotations: Annotation: Subtype: Link Rect: 253, 669, 265, 678 ActionDest: 122 Annotation: Subtype: Link Rect: 218, 632, 230, 641 ActionDest: 125 Annotation: Subtype: Link Rect: 208, 606, 220, 616 ActionDest: 122 Annotation: Subtype: Link Rect: 220, 606, 232, 616 ActionDest: 125 Annotation: Subtype: Link Rect: 233, 606, 245, 616 ActionDest: 125 Annotation: Subtype: Link Rect: 295, 581, 307, 590 ActionDest: 125 Annotation: Subtype: Link Rect: 307, 581, 319, 590 ActionDest: 125 Annotation: Subtype: Link Rect: 485, 531, 497, 540 ActionDest: 128 Annotation: Subtype: Link Rect: 218, 493, 230, 503 ActionDest: 125 Annotation: Subtype: Link Rect: 228, 343, 240, 352 ActionDest: 128 Annotation: Subtype: Link Rect: 440, 318, 452, 327 ActionDest: 125 Annotation: Subtype: Link Rect: 455, 318, 467, 327 ActionDest: 125 Annotation: Subtype: Link Rect: 544, 305, 556, 314 ActionDest: 125 Annotation: Subtype: Link Rect: 544, 280, 556, 289 ActionDest: 125 Annotation: Subtype: Link Rect: 457, 230, 469, 239 ActionDest: 125 Annotation: Subtype: Link Rect: 470, 230, 482, 239 ActionDest: 125 Annotation: Subtype: Link Rect: 330, 217, 342, 226 ActionDest: 125 Annotation: Subtype: Link Rect: 400, 205, 412, 214 ActionDest: 125 Annotation: Subtype: Link Rect: 505, 205, 517, 214 ActionDest: 125 Page: Sequence: 14 Annotations: Annotation: Subtype: Link Rect: 410, 732, 422, 741 ActionDest: 128 Annotation: Subtype: Link Rect: 422, 732, 434, 741 ActionDest: 128 Annotation: Subtype: Link Rect: 253, 270, 291, 281 Annotation: Subtype: Link Rect: 411, 235, 449, 246 Annotation: Subtype: Link Rect: 455, 235, 491, 246 Annotation: Subtype: Link Rect: 392, 212, 429, 223 Annotation: Subtype: Link Rect: 199, 189, 236, 200 Annotation: Subtype: Link Rect: 199, 167, 237, 177 Annotation: Subtype: Link Rect: 482, 155, 519, 166 Annotation: Subtype: Link Rect: 526, 155, 562, 166 Annotation: Subtype: Link Rect: 257, 132, 295, 143 Annotation: Subtype: Link Rect: 396, 109, 433, 120 Annotation: Subtype: Link Rect: 513, 86, 551, 97 Page: Sequence: 15 Annotations: Annotation: Subtype: Link Rect: 446, 731, 483, 742 Annotation: Subtype: Link Rect: 405, 708, 442, 719 Annotation: Subtype: Link Rect: 95, 639, 132, 650 Annotation: Subtype: Link Rect: 95, 605, 133, 615 Annotation: Subtype: Link Rect: 139, 605, 175, 615 Annotation: Subtype: Link Rect: 281, 581, 319, 592 Annotation: Subtype: Link Rect: 325, 581, 361, 592 Annotation: Subtype: Link Rect: 140, 559, 178, 569 Annotation: Subtype: Link Rect: 286, 536, 323, 546 Annotation: Subtype: Link Rect: 494, 512, 532, 523 Annotation: Subtype: Link Rect: 261, 489, 299, 500 Annotation: Subtype: Link Rect: 104, 455, 142, 466 Annotation: Subtype: Link Rect: 148, 455, 184, 466 Annotation: Subtype: Link Rect: 409, 431, 447, 442 Annotation: Subtype: Link Rect: 181, 397, 219, 408 Annotation: Subtype: Link Rect: 225, 397, 261, 408 Annotation: Subtype: Link Rect: 95, 363, 132, 373 Annotation: Subtype: Link Rect: 139, 363, 175, 373 Annotation: Subtype: Link Rect: 239, 328, 277, 339 Annotation: Subtype: Link Rect: 200, 306, 238, 316 Annotation: Subtype: Link Rect: 244, 306, 280, 316 Annotation: Subtype: Link Rect: 256, 270, 294, 281 Annotation: Subtype: Link Rect: 300, 270, 336, 281 Annotation: Subtype: Link Rect: 394, 236, 431, 247 Annotation: Subtype: Link Rect: 437, 236, 473, 247 Annotation: Subtype: Link Rect: 296, 201, 334, 212 Annotation: Subtype: Link Rect: 109, 168, 146, 178 Annotation: Subtype: Link Rect: 446, 144, 484, 155 Annotation: Subtype: Link Rect: 95, 110, 132, 120 Annotation: Subtype: Link Rect: 139, 110, 175, 120 Annotation: Subtype: Link Rect: 154, 76, 192, 86 Annotation: Subtype: Link Rect: 198, 76, 234, 86 Page: Sequence: 16 Annotations: Annotation: Subtype: Link Rect: 248, 719, 285, 730 Annotation: Subtype: Link Rect: 187, 685, 225, 696 Annotation: Subtype: Link Rect: 338, 650, 376, 661 Annotation: Subtype: Link Rect: 235, 616, 272, 627 Annotation: Subtype: Link Rect: 277, 581, 315, 592 Annotation: Subtype: Link Rect: 321, 581, 357, 592 Annotation: Subtype: Link Rect: 519, 559, 557, 569 Annotation: Subtype: Link Rect: 403, 512, 440, 523 Annotation: Subtype: Link Rect: 386, 489, 424, 500 Annotation: Subtype: Link Rect: 430, 489, 466, 500 Annotation: Subtype: Link Rect: 321, 466, 358, 477 Annotation: Subtype: Link Rect: 197, 443, 234, 454 Annotation: Subtype: Link Rect: 241, 443, 277, 454 Annotation: Subtype: Link Rect: 269, 420, 306, 431 Annotation: Subtype: Link Rect: 312, 420, 348, 431 Annotation: Subtype: Link Rect: 163, 386, 201, 396 Annotation: Subtype: Link Rect: 478, 362, 515, 373 Annotation: Subtype: Link Rect: 521, 362, 557, 373 Annotation: Subtype: Link Rect: 95, 340, 133, 350 Annotation: Subtype: Link Rect: 328, 316, 366, 327 Annotation: Subtype: Link Rect: 77, 283, 115, 293 Annotation: Subtype: Link Rect: 411, 260, 448, 270 Annotation: Subtype: Link Rect: 507, 236, 545, 247 Annotation: Subtype: Link Rect: 426, 213, 463, 224 Annotation: Subtype: Link Rect: 469, 213, 505, 224 Annotation: Subtype: Link Rect: 347, 191, 385, 201 Annotation: Subtype: Link Rect: 391, 191, 427, 201 Annotation: Subtype: Link Rect: 266, 167, 303, 178 Annotation: Subtype: Link Rect: 367, 144, 404, 155 Annotation: Subtype: Link Rect: 197, 110, 235, 120 Annotation: Subtype: Link Rect: 400, 86, 438, 97 Page: Sequence: 17 Annotations: Annotation: Subtype: Link Rect: 95, 720, 133, 730 Annotation: Subtype: Link Rect: 139, 720, 175, 730 Annotation: Subtype: Link Rect: 460, 696, 497, 707 Annotation: Subtype: Link Rect: 459, 685, 497, 696 Annotation: Subtype: Link Rect: 503, 685, 539, 696 Annotation: Subtype: Link Rect: 473, 662, 511, 673 Annotation: Subtype: Link Rect: 517, 662, 553, 673 Checksum: a3a85e33 Type: CRC32 Checksum: 7550fddc865abac5b2567a744dae675d Type: MD5 Checksum: 9ef216db8268c8bb4e62c50371e54aa22078bd0e Type: SHA-1 Checksum: 04ab992d26de7dc17ed54442f5422280ce602b27d27a5652ee4cb09b48cb2119 Type: SHA-256