Acute exercise and cognition: A review with testable questions for future research into cognitive enhancement with blood flow restriction

Effects of Blood Flow Restriction Training on Cognitive Flexibility in Adolescent Volleyball Players

Cognitive flexibility is crucial for volleyball athletes, enabling swift adaptation to dynamic game situations. While blood flow restriction (BFR) training has been suggested to enhance working memory, its specific effects on cognitive flexibility in volleyball players are not well understood. Therefore, this study investigates the effects of BFR combined with low-intensity aerobic exercise on cognitive flexibility in adolescent athletes, with a focus on the role of peripheral catecholamines. A randomized balanced crossover design was employed, involving 20 participants who completed four intervention conditions: sedentary rest, low-intensity aerobic exercise, moderate-intensity aerobic exercise, and BFR with low-intensity aerobic exercise. Post-intervention assessments included measurements of peripheral catecholamine levels and cognitive flexibility, specifically examining shifting costs. The results revealed significant differences in shifting costs across intervention conditions (p < .001). BFR training was associated with significantly higher shifting costs compared to sedentary rest (p < .001), lowintensity aerobic exercise (p < .001), and moderate-intensity aerobic exercise (p = .003). Correlation analysis demonstrated significant negative associations between post-BFR norepinephrine (R = -0.46) and epinephrine (R = -0.48) levels and shifting costs. These findings highlight the potential of BFR training to improve cognitive flexibility in adolescent volleyball players beyond the effects of moderate-intensity aerobic exercise, with practical implications for optimizing training regimens in this population. Additionally, the observed correlations between norepinephrine and epinephrine levels and cognitive performance offer novel insights into the physiological mechanisms underpinning cognitive function in sports contexts.

Twenty-five years of blood flow restriction training: What we know, what we don't, and where to next?

Blood flow restriction is a technique that involves inflating a cuff at the proximal portion of the limb with the goal of reducing arterial inflow into the muscle and venous outflow from the muscle. Low-load or low-intensity exercise in combination with blood flow restriction has been consistently shown to augment adaptations over the same/similar exercise without restriction, with changes in muscle size and strength being two of the most commonly measured adaptations. The purpose of this manuscript is to provide an updated narrative review on blood flow restriction. Blood flow restriction's history, methodology, safety, and efficacy are highlighted. We discuss the effects of blood flow restriction on changes in muscle size and strength, and also review work completed on other variables (e.g. bone, resting blood flow, tendon, pain sensitivity, cognition, orthostatic intolerance). We finish by highlighting six possible areas for future research: 1) identifying mechanisms for growth and strength; 2) sex differences in the effects of blood flow restriction; 3) individual responses to blood flow restriction; 4) influence of pressure versus amount of blood flow restricted; 5) application of blood flow restriction with higher-loads; and 6) what considerations should be made to test the effects of blood flow restriction.

Various modalities of resistance exercise promote similar acute cognitive improvements and hemodynamic increases in young, healthy adults

The aim was to examine the effects of modalities of acute resistance exercise (RE) on cognition and hemodynamics including internal carotid artery (ICA) blood flow (BF). Twenty adults completed familiarization and experimental visits. One-repetition maximum (1RM) for bilateral leg extension was quantified, and baseline executive functioning was determined from three run-in visits. Subsequent visits included three randomized, volume-equated, acute exercise bouts of 30 %1RM+blood flow restriction (BFR), 30 %1RM, and 70 %1RM. Both 30 %1RM trials completed four sets of exercise (1 × 30, 3 × 15), and the 70 %1RM condition completed four sets of 8 repetitions. BFR was induced with 40 % of the pressure to occlude the femoral arteries. 11 min following each exercise, participants completed the Stroop and Shifting Attention Tests. Baseline and post-exercise values were used to calculate change scores. The resulting mean change scores were evaluated with mixed factorial ANOVAs. A p≤0.05 was considered significant. All measured outcome variables increased in response to exercise. The ANOVAs for cognitive scores indicated no significant (p>0.05) interactions. For cognitive flexibility and executive function index, there were main effects of Sex. Change scores of the females were significantly greater than the males for cognitive flexibility (7.6 ± 5.9 vs. -2.6 ± 8.4 au; p=0.007) and executive function index (7.4 ± 4.6 vs. -2.5 ± 6.5 au; p=0.001). For ICA BF, there was no significant interaction or any main effect. The females exhibited a smaller exercise-induced increase in blood pressure compared to the males (17.7 ± 5.9 vs. 11.0 ± 4.1 mmHg; p=0.010). Each RE modality yielded acute improvements in cognition, but only for females. There were no cognitive improvements related to BFR such that each RE bout yielded similar results.

Interplay of physical and recognition performance using hierarchical continuous-time dynamic modeling and a dual-task training regime in Alzheimer's patients

Training studies typically investigate the cumulative rather than the analytically challenging immediate effect of exercise on cognitive outcomes. We investigated the dynamic interplay between single-session exercise intensity and time-locked recognition speed-accuracy scores in older adults with Alzheimer's dementia (N = 17) undergoing a 24-week dual-task regime. We specified a state-of-the-art hierarchical Bayesian continuous-time dynamic model with fully connected state variables to analyze the bi-directional effects between physical and recognition scores over time. Higher physical performance was dynamically linked to improved recognition (-1.335, SD = 0.201, 95% Bayesian credible interval [BCI] [-1.725, -0.954]). The effect was short-term, lasting up to 5 days (-0.368, SD = 0.05, 95% BCI [-0.479, -0.266]). Clinical scores supported the validity of the model and observed temporal dynamics. Higher physical performance predicted improved recognition speed accuracy in a day-by-day manner, providing a proof-of-concept for the feasibility of linking exercise training and recognition in patients with Alzheimer's dementia.

Highlights

Hierarchical Bayesian continuous-time dynamic modeling approachA total of 72 repeated physical exercise (PP) and integrated recognition speed-accuracy (IRSA) measurementsPP is dynamically linked to session-to-session variability of IRSAHigher PP improved IRSA in subsequent sessions in subjects with Alzheimer's dementiaShort-term effect: lasting up to 4 days after training session.

Physical exercise frequency and cognition: a multicenter cross-sectional cohort study

Background and aims

Dementia imposes a heavy burden on society and families, therefore, effective drug treatments, exploring and preventing factors associated with dementia, are paramount. To provide reference points for the best frequency of physical exercise (physical exercise), we investigated the association between frequency of PE and cognition in Chinese old adults.

Methods

16,181 Chinese participants aged 65 years or older were included in this study. Associations between PE and cognition were estimated multivariate logistic and linear regression analyses. Associations were further investigated across dementia subtypes (Alzheimer dementia, vascular dementia, and other types of dementia). Subgroup analyses were performed in different age groups, in populations with and without stroke, and those with and without hypertension.

Results

PE associated with dementia after adjusting for full covariates (OR: 0.5414, 95% CI: 0.4536-0.6491, p < 0.001). Exercise performed at ≥3 times/week associated with lower risk of dementia (OR: 0.4794-0.6619, all p value <0.001). PE was associated with improved cognition (β: 12851, p < 0.001), and any PE frequency contributed to cognitive improvement (p values for exercise performed ≥1 time/week were <0.001). Similar conclusions were identified when we repeated analyses in different dementia subtypes and age groups. Subgroup analyses suggested that the cognition of individuals without hypertension also benefitted from exercising 1-2 times/week (OR: 0.6168, 95% CI: 0.4379-0.8668, p = 0.005).

Conclusion

The best exercise frequency is exercising ≥3 times/week for individuals from different dementia subtypes and age groups. While for those without hypertension, PE at 1-2 times /week is also beneficial.

Improved interference control after exercise with blood flow restriction and cooling is associated with but not mediated by increased lactate

BACKGROUND

To evaluate the effects of recumbent sprint interval exercise with and without blood flow restriction and body cooling on interference control and whether the changes in interference control can be explained by the changes in blood lactate.

METHODS

85 participants (22 SD 3 years old) completed 1 familiarization visit and then 5 experimental visits in a randomized order: exercise only (Ex), exercise with blood flow restriction (ExB), exercise with cooling (ExC), and exercise with blood flow restriction and cooling (ExBC), and non-exercise control (Con). Measurements of blood lactate and the Stroop Color Word Test were performed before and after exercise. Each bout began with a 15-minute low-moderate intensity warm-up, followed by five 20-second "all out" sprints separated by 40 s of active recovery. Bayes Factors (BF10) quantified evidence for or against the null hypothesis. Within-subject mediation analysis quantified the indirect effect of changes in blood lactate (mediator) on the change in interference control (each exercise condition vs. Con).

RESULTS

Bayesian pairwise comparisons found that only ExC [σ: -0.37 (-0.59, -0.15)] and ExBC [σ: -0.3 (-0.53, -0.09)] produced changes in incongruent reaction time different from that of Con. There was also evidence that all exercise conditions increased blood lactate (BF10 = 8.65e+29 - 1.9e+32) and improved congruent reaction time (BF10 = 4.01 - 15.371) compared to that of Con. There was no evidence to show that changes in lactate mediated the change in incongruent reaction time.

CONCLUSIONS

Both exercise with body cooling and when body cooling was combined with blood flow restriction presented favorable changes in incongruent reaction time (a marker of interference control), which might not be explained by the changes in systemic blood lactate concentration.

Moderate-intensity cardiovascular exercise performed before motor practice attenuates offline implicit motor learning in stroke survivors but not age-matched neurotypical adults

The acute impact of cardiovascular exercise on implicit motor learning of stroke survivors is still unknown. We investigated the effects of cardiovascular exercise on implicit motor learning of mild-moderately impaired chronic stroke survivors and neurotypical adults. We addressed whether exercise priming effects are time-dependent (e.g., exercise before or after practice) in the encoding (acquisition) and recall (retention) phases. Forty-five stroke survivors and 45 age-matched neurotypical adults were randomized into three sub-groups: BEFORE (exercise, then motor practice), AFTER (motor practice, then exercise), and No-EX (motor practice alone). All sub-groups practiced a serial reaction time task (five repeated and two pseudorandom sequences per day) on three consecutive days, followed 7 days later by a retention test (one repeated sequence). Exercise was performed on a stationary bike, (one 20-min bout per day) at 50% to 70% heart rate reserve. Implicit motor learning was measured as a difference score (repeated-pseudorandom sequence response time) during practice (acquisition) and recall (delayed retention). Separate analyses were performed on the stroke and neurotypical groups using linear mixed-effects models (participant ID was a random effect). There was no exercise-induced benefit on implicit motor learning for any sub-group. However, exercise performed before practice impaired encoding in neurotypical adults and attenuated retention performance of stroke survivors. There is no benefit to implicit motor learning of moderately intense cardiovascular exercise for stroke survivors or age-matched neurotypical adults, regardless of timing. Practice under a high arousal state and exercise-induced fatigue may have attenuated offline learning in stroke survivors.

Serum BDNF and Selenium Levels in Elite Athletes Exposed to Blows

Background and Objectives: The study aimed to investigate the combined acute and long-term effects of exposure to blows and exercise on serum BDNF (brain-derived neurotrophic factor) and selenium levels. Materials and Methods: Serum BDNF and selenium levels were determined in 40 male elite athletes before and after vigorous exercise (training match) with a probability of exposure to blows and in 10 sedentary men subjected to exercise (Astrand running protocol). Results: Serum BDNF levels were found 11.50 ± 3.50 ng/mL before exercise and 14.02 ± 3.15 ng/mL after exercise in the athlete group (p = 0.02), and 12.18 ± 4.55 ng/ mL and 11.74 ± 2.48 ng/ mL before and after exercise in the sedentary group, respectively (p = 0.873). Serum BDNF (pre-exercise, baseline) levels were slightly lower in the athlete group than those in the sedentary group (11.50 ± 3.50 and 12.18 ± 4.55 ng/mL, respectively, p = 0.796). Pre-exercise serum selenium levels in athletes were significantly higher compared to those of sedentary participants (130.53 ± 36.79 and 95.51 ± 20.57 µg/L, respectively, p = 0.011). There was no difference in selenium levels after exercise (124.01 ± 29.96 µg/L) compared to pre-exercise (130.53 ± 36.79 µg/L) in the athlete group (p = 0.386). Similarly, there was no difference in selenium levels after exercise (113.28 ± 25.51 µg/L) compared to pre-exercise (95.51 ± 20.57 µg/L) in the sedentary group (p = 0.251). Conclusions: BDNF results show that even if athletes are exposed to blows, they may be protected from the long-term effects of blows thanks to the protective effect of their non-sedentary lifestyle. Regular exercise may have a protective effect on maintaining serum selenium levels in athletes even exposed to blows chronically.

Effects of isometric handgrip exercise with or without blood flow restriction on interference control and feelings

The purpose of this study was to investigate whether isometric handgrip exercise, with or without blood flow restriction, would alter interference control and feelings. 60 healthy young adults completed three experimental visits, consisting of four sets of 2 min isometric handgrip exercise, at 30% of maximal strength with or without blood flow restriction (50% of arterial occlusion pressure), or a non-exercise/time-matched control. Exercise-induced feeling inventory and Stroop Color Word Test were performed at pre- and ~10-min post-exercise, respectively. Bayes factors (BF₁₀ ) quantified the evidence for or against the null. There were no changes or differences between conditions for interference control following exercise with or without blood flow restriction (Incongruent BF₁₀ : 0.155; Stroop Interference BF₁₀ : 0.082). There were also no differences in the error rate as well as no differences between conditions for changes in 'positivity' or 'revitalization'. Feelings of 'tranquility' were reduced relative to a control following exercise with (median δ [95% credible interval]: -0.74 (-1.05, -0.45), BF₁₀ : 5515.7) and without (median δ: -0.72 [-1.02, -0.41], BF₁₀ : 571.3) blood flow restriction. These changes were not different between exercise conditions. Feelings of 'physical exhaustion' were increased relative to a control following exercise without blood flow restriction (median δ: 0.35[0.09, 0.61], BF₁₀ : 5.84). However, this increase was not different from the same exercise with blood flow restriction. These results suggest that 1) isometric handgrip exercise could be performed without impairing interference control, even when blood flow restriction is added, and that 2) changes in feelings occur independent of changes in interference control.