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Exercise, protein intake, sleep quality, and stress management all become critical factors in continued progress

Mechanisms underlying cardiac protection include enhanced coronary angiogenesis, antioxidant effects reducing oxidative damage, anti-inflammatory modulation limiting inflammatory cell infiltration, and direct cardiomyocyte protection

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Additionally, increased energy or mild mood elevation some patients experience may create a sense of restlessness before sleep begins

The mechanism depends on substrate availability from adipose breakdown

J Neurol Neurosurg Psychiatry 76(8):10461057