Personalising exercise recommendations for brain health: considerations and future directions

From energy metabolism to mood regulation: The rise of lactate as a therapeutic target

BACKGROUND

Disruption of cerebral energy metabolism is increasingly recognized as a key factor in the pathophysiology of mood disorders. Lactate, beyond its role as a metabolic byproduct, is now understood to be a critical player in brain energy homeostasis and a modulator of neuronal function. Recent advances in understanding lactate shuttling between astrocytes and neurons have opened new avenues for exploring its multifaceted roles in mood regulation. Exercise, known to modulate brain lactate levels, further underscores the potential of lactate as a therapeutic target in mood disorders.

AIM OF REVIEW

This review delves into the alterations in cerebral lactate associated with mood disorders, emphasizing their implications for brain energy dynamics and signaling pathways. Additionally, we discuss the therapeutic potential of lactate in mood disorders, particularly through its capacity to remodel cerebral function. We conclude by assessing the promise of exercise-induced lactate production as a novel strategy for mood disorder treatment.

KEY SCIENTIFIC CONCEPTS OF THE REVIEW

Alterations in brain lactate may contribute to the pathogenesis of mood disorders. In several studies, lactate is not only a substrate for brain energy metabolism, but also a molecule that triggers signaling cascades. Specifically, lactate is involved in the regulation of neurogenesis, neuroplasticity, endothelial cell function, and microglia lysosomal acidification, therefore improving mood disorders. Meanwhile, exercise as a low-risk intervention strategy can improve mood disorders through lactate regulation. Thus, the evidence from this review supports that lactate could be a potential therapeutic target for mood disorder, contributing to a deeper understanding of mood disorder pathogenesis and intervention.

Effects of Mental Imagery on Quality of Life, Cognitive, and Emotional Status in Older Adults with Early-Stage Alzheimer's Disease Dementia: A Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Dementia is a syndrome which involves cognitive and motor problems such as memory and motor control that impacts the individuals' quality of life. In mental imagery (MI) technique, motor acts are mentally rehearsed without any overt body movements. The aim of this study was to investigate the effectiveness of MI on the quality of life, cognitive, and emotional status of older adults with an early stage of dementia.

METHODS

The present randomized controlled trial consisted of 160 participants. The sample from an Athens Day Care Center of the Alzheimer Association was randomized to (a) the MI and exercise group (intervention group, n = 55), (b) the only exercise group (1st control group, n = 52), and (c) the neither MI nor exercise group (2nd control group, n = 53). Participants engaged in a total of 24 physiotherapy sessions, each lasting approximately 45 min, scheduled twice weekly over a 12-week period. They performed three assessments: (a) one week prior to the program, (b) one and a half months, and (c) after the program. The intervention group performed a 30 min MI with exercise program content immediately following every physiotherapy exercise session. Walking While Talking Test (WWITT), the Euro-Qol 5-Dimensions 5-Level of severity scale (Euro-Qol 5D-5L scale), the Short-Form of Geriatric Depression Scale (SF-GDS), and the Short Anxiety Screening Test (SAST) were used to assess cognitive status, emotional status, and quality of life.

RESULTS

A total of 160 participants (43 men, 117 women, with MMSE M = 23.20 SD = 0.15) took part in this study in which most reported holding a university degree (n = 77), were married (n = 101), and had loss of memory as the 1st symptom of dementia (n= 117). The Friedman test revealed statistically significant differences across the three groups on (a) the WWITTmistakes (X2 = 14.95, df = 2, p = 0.001) and WWITTtime (X2 = 13.35, df = 2, p = 0.01), (b) the total Euro-Qol 5D-5L scale (X2 = 11.87.62, df = 2, p = 0.003) and quality of life on the measuring day (X2 = 25.59, df = 2, p = 0.00), (c) the SF-GDS (X2 = 6.54, df = 2, p = 0.038), and (d) the SAST (X2 = 39.907.62, df = 2, p = 0.00). The Friedman test with post hoc Wilcoxon analysis revealed that the mean scores for the intervention group and the 1st control were significantly better than the 2nd control group in many dependent variables.

CONCLUSIONS

The results indicate that incorporating MI can positively influence cognitive status, emotional status, and the quality of life in older adults diagnosed with early-stage dementia.

Biological sex as a tailoring variable for exercise prescription in hospitalized older adults

BACKGROUND

Sex-based differences in the clinical presentation and outcomes are well-established in patients hospitalized for geriatric syndromes. We aimed to investigate sex differences in response to in-hospital exercise on function, strength, cognition, and quality of life in acute care admissions.

METHODS

570 patients (mean age 87 years, 298 females [52.3%]) admitted to acute care for elderly units were randomized to multicomponent exercise emphasizing progressive resistance training or usual care. Functional assessments included Short Physical Performance Battery (SPPB), grip strength, Mini-Mental State Examination (MMSE), and health-related quality of life (EQ-VAS).

RESULTS

Exercising females showed more significant SPPB improvements than males (between-group difference 1.48 points, p = 0.027), exceeding the minimal clinically significant difference. While female participants significantly increased handgrip strength and male patients improved cognition after in-hospital exercise compared to the control group (all p < 0.001), no sex differences occurred.

CONCLUSIONS

Females demonstrate more excellent physical function improvements compared to male older patients. Findings highlight the importance of tailored exercise incorporating patient factors like biological sex in geriatric medicine.

TRIAL REGISTRATION

NCT04600453.

Comparative efficacy of various exercise types and doses for depression in older adults: a systematic review of paired, network and dose-response meta-analyses

OBJECTIVES

We assessed the effects of different exercise modalities and doses on depression levels in older adults.

METHODS

Systematic searches of the PubMed, Web of Science, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases were conducted from the start of database construction until December 2023. Studies were included if they were randomised controlled trials (RCTs) of exercise interventions in older adults. Pairwise, network and dose-network meta-analyses were conducted using random-effects models for the outcome of depression in older adults.

RESULTS

A total of 80 RCTs with 5536 participants were included in this study. Network meta-analyses showed that resistance exercise [standardized mean difference (SMD) = - 0.68, 95% confidence interval (CI): - 0.90, - 0.46] and mind-body exercise (MBE; SMD = - 0.54, 95% CI: - 0.72, - 0.37) were the most effective forms of exercise for improving depression in older adults, followed by aerobic exercise (SMD = - 0.31, 95% CI: - 0.50, - 0.13) and mixed exercise (SMD = - 0.23, 95% CI: - 44, - 0.01). In addition, a U-shaped dose-response relationship was found between overall exercise dose and depression levels in older adults, and a significant response was seen after 390 metabolic equivalent (MET)-min/week.

CONCLUSIONS

Our study determined the effectiveness of different exercises in improving levels of older adults and found that resistance exercise and MBE were more effective adjunctive treatments. By providing the most effective treatments, older adults can reap the benefits of improving depression in older adults at doses lower than the World Health Organization guidelines.

Relationship between domain-specific physical activity and cognitive function in older adults - findings from NHANES 2011-2014

Objective

To determine the relationship between domain-specific physical activity (PA) (e.g., occupational PA [OPA], transport-related PA [TPA], and recreational PA [RPA]) and cognitive function in older adults.

Methods

The data was obtained from the 2011-2014 cycle of the NHANES. We utilized weighted multivariate linear regression models among the included 2,924 people aged 60 years or older for our purposes.

Results

RPA and total PA according to WHO guidelines were associated with verbal fluency (RPA β: 1.400, 95% CI: 0.776, 2.024, p = 0.002; total PA β: 1.115, 95% CI: 0.571, 1.659, p = 0.001), processing speed and executive function (RPA β: 2.912, 95% CI. 1.291, 4.534, p = 0.005; total PA β: 2.974, 95% CI: 1.683, 4.265, p < 0.001) were positively correlated, and total PA was correlated with delayed memory performance (β: 0.254, 95% CI: 0.058, 0.449, p = 0.019). No significant association was observed between OPA, TPA, and various aspects of cognitive function among individuals over 60 years.

Conclusion

There was no noteworthy correlation discovered between OPA and TPA in relation to cognitive function. However, RPA and total PA exhibited significant associations with verbal fluency, processing speed, and executive function. Additionally, maintaining PA levels ranging from 600 to 1,200 MET-min/week would yield the most favorable outcomes for cognitive function.

Comparative efficacy of seven nonpharmacological interventions on global cognition in older adults with and without mild cognitive impairment: a network meta-analysis of randomized controlled trials

To maintain current cognitive function and access greater cognitive reserves, nonpharmacological interventions may be a viable alternative for older adults with or without cognitive impairment. This study aimed to compare different nonpharmacological interventions for enhancing global cognition, including mind-body exercise, physical exercise, non-invasive brain stimulation, cognitive training intervention (CTI), acutherapy (ACU), meditation, and music therapy, by applying a network meta-analysis (NMA). Sixty-one randomized controlled trials evaluating the efficacy of interventions on global cognition in older adults with or without mild cognitive decline were selected. An NMA was conducted to compare the efficacy of different nonpharmacological interventions. The NMA revealed that mind-body exercise (standardized mean difference, 1.384; 95% confidence interval, 0.777-1.992); ACU (1.283; 0.478-2.088); meditation (0.910; 0.097-1.724); non-invasive brain stimulation (1.242; 0.254-2.230); CTI (1.269; 0.736-1.802); and physical exercise (0.977; 0.212-1.742), showed positive effects compared to passive controls. There were no significant differences between the efficacies of other interventions. Nonpharmacological interventions may potentially enhance and maintain global cognition through various pathways, such as memorizing movements and enhancing brain plasticity by reducing stress in the older adult population. Additional studies are needed to clarify the impact of other variables, including intervention methods or psychological variables.

Effects of a Two-Month Exercise Training Program on Concurrent Non-Opiate Substance Use in Opioid-Dependent Patients during Substitution Treatment

BACKGROUND

This randomized controlled trial aimed to evaluate the effects of a two-month exercise intervention on the concurrent non-opiate substance use (alcohol, cocaine, cannabis, and benzodiazepines) in opioid users during their medication treatment.

METHODS

Ninety opioid users (41 females) in methadone and buprenorphine medication treatment were randomly divided into four groups: (a) buprenorphine experimental (BEX; n = 26, aged 41.9 ± 6.1 yrs); (b) buprenorphine control (BCON; n = 25, aged 41.9 ± 5.6 yrs); (c) methadone experimental (MEX; n = 20, aged 46.7 ± 6.6 yrs); and (d) methadone control (MCON; n = 19, aged 46.1 ± 7.5 yrs). The experimental groups (BEX and MEX) followed an aerobic exercise training program on a treadmill for 20 min at 70% HRmax, 3 days/week for 8 weeks. Socio-demographic, anthropometric, and clinical characteristics, as well as non-opioid drug use in days and quantity per week, were assessed before and after the intervention period.

RESULTS

Following the exercise training, the weekly non-opioid substance consumption (days) decreased (p < 0.05) in both exercise groups and was lower in BEX compared to MEX, while no differences were observed (p > 0.05) between the control groups (BCON vs. MCON) or compared to their baseline levels. Similarly, the daily amount of non-opiate substance intake was reduced (p < 0.05) post-training in BEX and MEX, whereas it did not differ (p > 0.05) in BCON and MCON compared to the baseline.

CONCLUSIONS

The two-month exercise intervention reduced the non-opioid drug use in both the methadone and buprenorphine substitution groups compared to the controls, suggesting that aerobic exercise training may be an effective strategy for treating patients with OUDs.

Knowledge mapping of trends and hotspots in the field of exercise and cognition research over the past decade

Exercise elicits a wide range of physiological responses in mammalian tissues that enhance a broad range of functions, particularly in improving cognitive performance. However, the field lacks a comprehensive bibliometric analysis that clarifies its knowledge structure and research hotspots. This study aims to address this gap and map the research landscape regarding the role of exercise in cognitive function enhancement. Firstly, the frequencies and co-occurrence of keywords were analysed to identify six main clusters: aging, cognitive impairment, rehabilitation, obesity, fatigue, and hippocampus. Secondly, reference timeline co-citation analysis revealed that hippocampus and aging were the major bursts with high intensity and long attention span while children had recently emerged as a topical subject. Finally, the evolution of themes from 2012 to 2022 was analysed, and found that older adults had been the leading research theme for exercise affecting cognition. Childhood obesity was an emerging theme that attracted increasing research attention in recent years while the hippocampus research theme expanded rapidly during the decade but remained a niche topic with less relevance to others. This research identified and summarised research priorities and evolutionary trends in exercise to improve cognition by constructing knowledge networks through visual analysis. It provides researchers with a comprehensive insight into the current state of the field to facilitate further research.

Brain Health and Cognition in Older Adults: Roadmap and Milestones towards the Implementation of Preventive Strategies

In this narrative review, we delve into the evolving concept of brain health, as recognized by the WHO, focusing on its intersection with cognitive decline. We emphasize the imperative need for preventive strategies, particularly in older adults. We describe the target population that might benefit the most from risk-based approaches-namely, people with subjective cognitive decline. Additionally, we consider universal prevention in cognitively unimpaired middle-aged and older adults. Delving into multidomain personalized preventive strategies, we report on empirical evidence surrounding modifiable risk factors and interventions crucial in mitigating cognitive decline. Next, we highlight the emergence of brain health services (BHS). We explain their proposed role in risk assessment, risk communication, and tailored interventions to reduce the risk of dementia. Commenting on ongoing BHS pilot experiences, we present the inception and framework of our own BHS in Monza, Italy, outlining its operational structure and care pathways. We emphasize the need for global collaboration and intensified research efforts to address the intricate determinants of brain health and their potential impact on healthcare systems worldwide.

Effect of Multicomponent Exercise on Cognition, Physical Function and Activities of Daily Life in Older Adults With Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-analysis

OBJECTIVE

To review the evidence for the effectiveness of multicomponent exercise (an exercise program combining aerobic, endurance, balance, and flexibility exercises) on cognition, physical function, and activities of daily living in people with dementia and mild cognitive impairment (MCI).

DATA SOURCES AND STUDY SELECTION

We conducted this study under the guidance of a designated protocol (PROSPERO CRD42022324641). Pertinent randomized controlled trials were selected from PubMed, Embase, Web of Science, and the Cochrane Library by 2 independent authors through May 2022.

DATA EXTRACTION

Two authors independently extracted the data and assessed the quality of the included studies following the Cochrane Risk of Bias tool. Outcome data were extracted in a random effects model and estimated as Hedges' g and 95% confidence interval (CI). To validate specific results, the Egger test combined the Duval and Tweedie "trim and fill" method and sensitivity analysis with study removed were performed.

DATA SYNTHESIS

A total of 21 publications were eligible for the quantitative analysis. In dementia, estimates of Hedges' g showed effects on global cognition (g=0.403; 95% CI, 0.168-0.638; P<.05), especially executive function (g=0.344; 95% CI, 0.111-0.577; P<.05), flexibility (g=0.671; 95% CI, 0.353-0.989; P<.001), agility and mobility (g=0.402; 95% CI, 0.089-0.714; P<.05), muscle strength (g=1.132; 95% CI, 0.420-1.845; P<.05), and activities of daily living (g=0.402; 95% CI, 0.188-0.615; P<.05). Also, a positive trend was observed in gait speed. Additionally, multicomponent exercise had positive effects on global cognition (g=0.978; 95% CI, 0.298-1.659; P<.05) and executive function (g=0.448; 95% CI, 0.171-0.726; P<.05) in patients with MCI.

CONCLUSIONS

Our findings confirm the viability of multicomponent exercise as a management strategy for patients with dementia and MCI.

The Relationship Between Exercise, Cathepsin B, and Cognitive Functions: Systematic Review

Exercise has been shown repeatedly to improve cognitive functions. Many investigators have reported that peripheral signal molecules play an important role in regulating exercise-induced cognitive improvement. In this review we aimed to evaluate and clarify the literature to date that has focused on the relationship between Cathepsin B, cognitive functions, and exercise. We conducted a systematic review of the following databases from their inception until 10 April 2022: Pubmed, Web of Science, Scopus, Cochrane Library, Physiotherapy Evidence Database. The search strategy was comprised of ("cathepsin b") AND (exercise OR "physical activity") AND (cognit*). We followed three different quality appraisal tools to ensure the quality of the included studies. Eight studies assessing the effects of exercise on peripheral Cathepsin B levels and cognitive outcomes were included. Half of these studies indicated that exercise increased peripheral Cathepsin B levels and improved cognitive function. Further carefully designed studies focusing on the effects of exercise on peripheral Cathepsin B levels and cognitive performance are needed to better comprehend the underlying mechanisms of these relationships.

Data-driven physical actigraphy patterns relate to cognitive and vascular health in older adults

Health benefits of physical activity (PA) are well known; however, specific PA patterns that relate most strongly to cognitive aging outcomes are poorly understood. We characterized latent profiles of PA among older adults and examined associations with cognition and vascular burden. 124 functionally normal older adults wore a Fitbit™ for 30 days. Daily average step count, sedentary time (0 steps/min), and high-intensity time (≥120 steps/min) were calculated. Participants completed neurocognitive testing assessing cognitive domains of executive functioning and memory; medical history, from which vascular burden (i.e., a count of cardiovascular conditions) was calculated; and brain MRI (n = 44). Subgroups with similar PA patterns were identified via latent profile analysis. Three latent PA classes emerged: Class 1Low PA (n = 49), Class 2Average PA (n = 59), and Class 3High-intensity PA (n = 16). PA class related to executive functioning and vascular burden, driven by better outcomes in Class 3 than Class 1. Sex-stratified analyses revealed these associations were strongest in males. Post hoc analyses showed a positive association between high-intensity PA and white matter integrity among males. High-intensity PA related to better cognitive and vascular health, particularly among males. Findings inform physical activity-specific and person-specific recommendations for optimal cognitive aging.

Aerobic exercise improves executive functions in females, but not males, without the BDNF Val66Met polymorphism

BACKGROUND

Aerobic exercise promotes cognitive function in older adults; however, variability exists in the degree of benefit. The brain-derived neurotropic factor (BDNF) Val66Met polymorphism and biological sex are biological factors that have been proposed as important modifiers of exercise efficacy. Therefore, we assessed whether the effect of aerobic exercise on executive functions was dependent on the BDNFval66met genotype and biological sex.

METHODS

We used data from a single-blind randomized controlled trial in older adults with subcortical ischemic vascular cognitive impairment (NCT01027858). Fifty-eight older adults were randomly assigned to either the 6 months, three times per week progressive aerobic training (AT) group or the usual care plus education control (CON) group. The secondary aim of the parent study included executive functions which were assessed with the Trail Making Test (B-A) and the Digit Symbol Substitution Test at baseline and trial completion at 6 months.

RESULTS

Analysis of covariance, controlling for baseline global cognition and baseline executive functions performance (Trail Making Test or Digit Symbol Substitution Test), tested the three-way interaction between experimental group (AT, CON), BDNFval66met genotype (Val/Val carrier, Met carrier), and biological sex (female, male). Significant three-way interactions were found for the Trail Making Test (F(1,48) = 4.412, p < 0.04) and Digit Symbol Substitution Test (F(1,47) = 10.833, p < 0.002). Posthoc analyses showed female Val/Val carriers benefited the most from 6 months of AT compared with CON for Trail Making Test and Digit Symbol Substitution Test performance. Compared with CON, AT did not improve Trail Making Test performance in male Val/Val carriers or Digit Symbol Substitution Test performance in female Met carriers.

CONCLUSIONS

These results suggest that future randomized controlled trials should take into consideration BDNF genotype and biological sex to better understand the beneficial effects of AT on cognitive function in vascular cognitive impairment to maximize the beneficial effects of exercise and help establish exercise as medicine for cognitive health.

Effects of a 12-Week Periodized Resistance Training Program on Resting Brain Activity and Cerebrovascular Function: A Nonrandomized Pilot Trial

Resistance training is a promising strategy to promote healthy cognitive aging; however, the brain mechanisms by which resistance training benefits cognition have yet to be determined. Here, we examined the effects of a 12-week resistance training program on resting brain activity and cerebrovascular function in 20 healthy older adults (14 females, mean age 69.1 years). In this single group clinical trial, multimodal 3 T magnetic resonance imaging was performed at 3 time points: baseline (preceding a 12-week control period), pre-intervention, and post-intervention. Along with significant improvements in fluid cognition (d = 1.27), 4 significant voxelwise clusters were identified for decreases in resting brain activity after the intervention (Cerebellum, Right Middle Temporal Gyrus, Left Inferior Parietal Lobule, and Right Inferior Parietal Lobule), but none were identified for changes in resting cerebral blood flow. Using a separate region of interest approach, we provide estimates for improved cerebral blood flow, compared with declines over the initial control period, in regions associated with cognitive impairment, such as hippocampal blood flow (d = 0.40), and posterior cingulate blood flow (d = 0.61). Finally, resistance training had a small countermeasure effect on the age-related progression of white matter lesion volume (rank-biserial = -0.22), a biomarker of cerebrovascular disease. These proof-of-concept data support larger trials to determine whether resistance training can attenuate or even reverse salient neurodegenerative processes.

Effects of aerobic exercise on event-related potentials related to cognitive performance: a systematic review

Introduction

Aerobic exercise interventions may affect different cognitive domains such as attention, working memory, inhibition, etc. However, the neural mechanisms underlying this relationship, remains uncertain.

Objective

To perform a systematic review on exercise intervention studies that use event-related potentials (ERPs) as outcome for cognitive performance.

Methods

We identified studies through searches in four databases reporting the effects of either an acute bout or chronic exercise on any ERP associated with cognitive performance. Study population included participants >17 years of age with or without a diagnosis.

Results

A total of 5,797 records were initially identified through database searching of which 52 were eligible for inclusion. Most studies were of acute aerobic exercise with moderate intensity. Results were heterogenious across studies, but there was a trend that ERP amplitude increased and (to a lesser extent) latencies decreased post-exercise. The P3 ERP was the most often reported ERP.

Conclusion

Heterogeneity across studies regarding methodology limited the possibility to draw definitive conclusions but the most consistent findings were that acute aerobic exercise was associated with higher amplitudes, and to a lesser extent shorter latencies, of ERPs.

Plasma levels of BDNF and EGF are reduced in acute stroke patients

Stroke affects almost 14 million people worldwide each year. It is the second leading cause of death and a major cause of acquired disability. The degree of initial impairment in cognitive and motor functions greatly affects the recovery, but idiosyncratic factors also contribute. These are largely unidentified, which contributes to making accurate prediction of recovery challenging. Release of soluble regulators of neurotoxicity, neuroprotection and repair are presumably essential. Here we measured plasma levels of known regulators of neuroprotection and repair in patients with mild acute ischemic stroke and compared them to the plasma levels in healthy age and gender matched controls. We found that the levels of BDNF and EGF were substantially lower in stroke patients than in healthy controls, while the levels of bFGF and irisin did not differ between the groups. The lower levels of growth factors highlight that during the acute phase of stroke, there is a mismatch between the need for neuroprotection and repair, and the brain's ability to induce these processes. Large individual differences in growth factor levels were seen among the stroke patients, but whether these can be used as predictors of long-term prognosis remains to be investigated.

The feasibility and efficacy of the home-based exercise programs in patients with cognitive impairment: A pilot study

OBJECTIVE

To examine the feasibility and efficacy of home-based aerobic and resistance exercise interventions for geriatric individuals with cognitive impairment.

METHODS

Fourteen participants with cognitive impairment were allocated to either the aerobic group (n = 8) or the resistance group (n = 6), after which they implemented a two-month home-based training program. Feasibility and efficacy outcomes were evaluated. A semi-structured interview was performed after the intervention.

RESULTS

All fourteen participants completed the two-month training program. The adherence rate was 0.94 for the aerobic group and 0.96 for the resistance group. No adverse events occurred. The results revealed a trend of group×time interaction effect on delayed recall. Significant group×time interaction effects were revealed on simple physical performance and body composition. Semi-structured interviews identified four motivators for participating in this program, four facilitators for and three barriers to keeping exercising, and some perceived benefits.

CONCLUSION

Home-based aerobic and resistance exercise programs are feasible for geriatric individuals with cognitive impairment. The efficacy needs to be further examined.

Optimal dose and type of exercise to improve cognitive function in older adults: A systematic review and bayesian model-based network meta-analysis of RCTs

OBJECTIVE

To examine the dose-response relationship between overall and specific types of exercise with cognitive function in older adults.

DESIGN

Systematic Review and Bayesian Model-Based Network Meta-Analysis.

DATA SOURCES

Systematic search of MEDLINE, Web of Science, Scopus, PsycINFO and SPORTDiscus.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomized controlled trials of exercise interventions in participants aged 50 years or over, and that reported on at least one global cognition outcome.

RESULTS

The search returned 1998 records, of which 44 studies (4793 participants; 102 different effect sizes) were included in this review with meta-analysis. There was a non-linear, dose-response association between overall exercise and cognition. We found no minimal threshold for the beneficial effect of exercise on cognition. The estimated minimal exercise dose associated with clinically relevant changes in cognition was 724 METs-min per week, and doses beyond 1200 METs-min per week provided less clear benefits. We also found that the dose-response association was exercise type dependent, and our results show that clinically important effects may occur at lower doses for many types of exercise. Our findings also highlighted the superior effects of resistance exercises over other modalities.

CONCLUSIONS

If provided with the most potent modalities, older adults can get clinical meaningful benefits with lower doses than the WHO guidelines. Findings support the WHO recommendations to emphasise resistance training as a critical component of interventions for older adults.

Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis

BACKGROUND

Exercise is a promising nonpharmacological therapy for cognitive dysfunction, but it is unclear which type of exercise is most effective. The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment (MCI) or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.

METHODS

We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia. Primary outcomes included global cognition, executive cognition, and memory cognition. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, and quality of life. Pairwise analyses and network meta-analyses were performed using a random effects model.

RESULTS

A total of 73 articles from 71 trials with 5606 participants were included. All types of exercise were effective in increasing or maintaining global cognition, and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition (standard mean difference (SMD) = 1.05, 95% confidence interval (95%CI): 0.56-1.54), executive function (SMD = 0.85, 95%CI: 0.21-1.49), and memory function (SMD = 0.32, 95%CI: 0.01-0.63) in patients with cognitive dysfunction. Subgroup analyses for patients with MCI revealed different effects, and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition (SMD = 0.99, 95%CI: 0.44-1.54) and executive function (SMD = 0.72, 95%CI: 0.06-1.38). However, only resistance exercise showed significant effects on memory function for patients with MCI (SMD = 0.35, 95%CI: 0.01-0.69). Exercise interventions also showed various effects on the secondary outcomes.

CONCLUSION

Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive decline in patients with cognitive dysfunction, especially in patients with dementia. Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.

Physical activity attenuates negative effects of short-term exposure to ambient air pollution on cognitive function

BACKGROUND

As physical activity benefits brain health whereas air pollution damages it, the cognitive response to these exposures may interact.

PURPOSE

This study aimed to assess the short-term joint effect of physical activity and air pollution on cognitive function in a panel of healthy young adults.

METHODS

We followed ninety healthy subjects aged around 22 years from September 2020 to June 2021 and measured their personal exposure to fine particulate matter (PM_2.5) (μg/m³) and daily accelerometer-based moderate-to-vigorous physical activity (MVPA) (min/day) in 4 one-week-long sessions over the study period. At the end of each measurement session, we assessed executive function using Stroop color-word test and collected resting-state electroencephalogram (EEG) signals.

RESULTS

We found short-term PM_2.5 exposure damaged executive function (β_PM25 = 0.0064, p = 0.039) but physical activity could counterbalance it (β_MVPA = -0.0047, p = 0.048), whereby beta-3 wave played as a potential mediating role. MVPA-induced improvement on executive function was larger in polluted air (β_MVPA = -0.010, p = 0.035) than that in clean air (β_MVPA = -0.003, p = 0.45). To offset the negative effect of air pollution on cognitive function, individuals should do extra 13.6 min MVPA every day for every 10 μg/m³ increase in daily PM_2.5.

CONCLUSION

This study implies that physical activity could be used as a preventive approach to compensate the cognitive damages of air pollution.

EEG as a marker of brain plasticity in clinical applications

Neural networks are dynamic, and the brain has the capacity to reorganize itself. This capacity is named neuroplasticity and is fundamental for many processes ranging from learning and adaptation to new environments to the response to brain injuries. Measures of brain plasticity involve several techniques, including neuroimaging and neurophysiology. Electroencephalography, often used together with other techniques, is a common tool for prognostic and diagnostic purposes, and cortical reorganization is reflected by EEG measurements. Changes of power bands in different cortical areas occur with fatigue and in response to training stimuli leading to learning processes. Sleep has a fundamental role in brain plasticity, restoring EEG bands alterations and promoting consolidation of learning. Exercise and physical inactivity have been extensively studied as both strongly impact brain plasticity. Indeed, EEG studies showed the importance of the physical activity to promote learning and the effects of inactivity or microgravity on cortical reorganization to cope with absent or altered sensorimotor stimuli. Finally, this chapter will describe some of the EEG changes as markers of neural plasticity in neurologic conditions, focusing on cerebrovascular and neurodegenerative diseases. In conclusion, neuroplasticity is the fundamental mechanism necessary to ensure adaptation to new stimuli and situations, as part of the dynamicity of life.

The Central Mechanisms of Resistance Training and Its Effects on Cognitive Function

Resistance exercise is used extensively in athletic and general populations to induce neuromuscular adaptations to increase muscle size and performance. Exercise parameters such as exercise frequency, intensity, duration and modality are carefully manipulated to induce specific adaptations to the neuromuscular system. While the benefits of resistance exercise on the neuromuscular system are well documented, there is growing evidence to suggest that resistance exercise, even when performed acutely, can lead to neuroplastic changes within the central nervous system (CNS) and improve cognitive functioning. As such, resistance exercise has been proposed as a novel adjuvant rehabilitation strategy in populations that suffer from neurological or neurocognitive impairments (i.e. Parkinson's and Alzheimer's dementia) or even to attenuate age-related declines in cognitive health. In this review, we present evidence for the neuroplastic effects and cognitive benefits of resistance exercise and propose some of the underlying mechanisms that drive neuroplasticity following resistance training. We will further discuss the effects of exercise parameters, in particular exercise frequency, intensity, duration and modality to improve cognitive health. Lastly, we will highlight some of the existing limitations in the literature surrounding the use of resistance exercise to improve cognitive function and propose considerations to improve future studies in this field. In summary, the current evidence supports the role of resistance exercise, as a stand alone or in combination with aerobic exercise, for benefiting cognitive health and that it should be considered as an adjuvant therapy to treat age- or disease-related cognitive declines.

Neuroinflammation in autism spectrum disorders: Exercise as a "pharmacological" tool

The worldwide prevalence of ASD is around 1%. Although the pathogenesis of ASD is not entirely understood, it is recognized that a combination of genetic, epigenetics, environmental factors and immune system dysfunction can play an essential role in its development. It has been suggested that autism results from the central nervous system derangements due to low-grade chronic inflammatory reactions associated with the immune system activation. ASD individuals have increased microglial activation, density, and increased proinflammatory cytokines in the several brain regions. Autism has no available pharmacological treatments, however there are pedagogical and psychotherapeutic therapies, and pharmacological treatment, that help to control behavioral symptoms. Recent data indicate that exercise intervention programs may improve cognitive and behavioral symptoms in children with ASD. Exercise can also modify inflammatory profiles that will ameliorate associated metabolic disorders. This review highlights the involvement of neuroinflammation in ASD and the beneficial effects of physical exercise on managing ASD symptoms and associated comorbidities.

Linking objective measures of physical activity and capability with brain structure in healthy community dwelling older adults

Maintaining high levels of daily activity and physical capability have been proposed as important constituents to promote healthy brain and cognitive aging. Studies investigating the associations between brain health and physical activity in late life have, however, mainly been based on self-reported data or measures designed for clinical populations. In the current study, we examined cross-sectional associations between physical activity, recorded by an ankle-positioned accelerometer for seven days, physical capability (grip strength, postural control, and walking speed), and neuroimaging based surrogate markers of brain health in 122 healthy older adults aged 65-88 years. We used a multimodal brain imaging approach offering complementary structural MRI based indicators of brain health: global white matter fractional anisotropy (FA) and mean diffusivity (MD) based on diffusion tensor imaging, and subcortical and global brain age based on brain morphology inferred from T1-weighted MRI data. In addition, based on the results from the main analysis, follow-up regression analysis was performed to test for association between the volume of key subcortical regions of interest (hippocampus, caudate, thalamus and cerebellum) and daily steps, and a follow-up voxelwise analysis to test for associations between walking speed and FA across the white matter Tract-Based Spatial Statistics (TBSS) skeleton. The analyses revealed a significant association between global FA and walking speed, indicating higher white matter integrity in people with higher pace. Voxelwise analysis supported widespread significant associations. We also found a significant interaction between sex and subcortical brain age on number of daily steps, indicating younger-appearing brains in more physically active women, with no significant associations among men. These results provide insight into the intricate associations between different measures of brain and physical health in old age, and corroborate established public health advice promoting physical activity.

12 weeks of strength training improves fluid cognition in older adults: A nonrandomized pilot trial

Objectives

Resistance training (RT) is a promising strategy to slow or prevent fluid cognitive decline during aging. However, the effects of strength-specific RT programs have received little attention. The purpose of this single-group proof of concept clinical trial was to determine whether a 12-week strength training (ST) program could improve fluid cognition in healthy older adults 60 to 80 years of age, and to explore concomitant physiological and psychological changes.

Methods

Twenty participants (69.1 ± 5.8 years, 14 women) completed this study with no drop-outs or severe adverse events. Baseline assessments were completed before an initial 12-week control period, then participants were re-tested at pre-intervention and after the 12-week ST intervention. The NIH Toolbox Cognition Battery and standard physical and psychological measures were administered at all three time points. During the 36 sessions of periodized ST (3 sessions per week), participants were supervised by an exercise specialist and challenged via autoregulatory load progression.

Results

Test-retest reliability over the control period was good for fluid cognition and excellent for crystallized cognition. Fluid composite scores significantly increased from pre- to post-intervention (8.2 ± 6.1%, p < 0.01, d = 1.27), while crystallized composite scores did not (-0.5 ± 2.8%, p = 0.46, d = -0.34). Performance on individual fluid instruments, including executive function, attention, working memory, and processing speed, also significantly improved. Surprisingly, changes in fluid composite scores had small negative correlations with changes in muscular strength and sleep quality, but a small positive correlation with changes in muscular power.

Conclusions

Thus, improvements in fluid cognition can be safely achieved in older adults using a 12-week high-intensity ST program, but further controlled studies are needed to confirm these findings. Furthermore, the relationship with other widespread physiological and psychological benefits remains unclear.

Causes and Consequences of Interindividual Response Variability: A Call to Apply a More Rigorous Research Design in Acute Exercise-Cognition Studies

The different responses of humans to an apparently equivalent stimulus are called interindividual response variability. This phenomenon has gained more and more attention in research in recent years. The research field of exercise-cognition has also taken up this topic, as shown by a growing number of studies published in the past decade. In this perspective article, we aim to prompt the progress of this research field by (i) discussing the causes and consequences of interindividual variability, (ii) critically examining published studies that have investigated interindividual variability of neurocognitive outcome parameters in response to acute physical exercises, and (iii) providing recommendations for future studies, based on our critical examination. The provided recommendations, which advocate for a more rigorous study design, are intended to help researchers in the field to design studies allowing them to draw robust conclusions. This, in turn, is very likely to foster the development of this research field and the practical application of the findings.

Hippocampal maintenance after a 12-month physical activity intervention in older adults: The REACT MRI study

BACKGROUND

Physical activity interventions have had varying results on modifying hippocampal volume.

METHODS

The Retirement in Action (REACT) study conducted a randomised-controlled trial of a 12-month physical activity and behaviour maintenance intervention in older adults at risk of mobility impairments. The physical activity sessions were delivered twice weekly for the first twelve weeks, and then reduced to once weekly, to groups of 15 participants. Activities included cardiovascular, strength, balance and flexibility exercises. A sub-sample of participants in the physical activity (N = 54) and control arms (N = 48) underwent a 3 T MRI brain scan and cognitive assessments at baseline, 6- and 12-months (mean age = 76.6 years, 6.8 SD). It was hypothesised that the intervention would lead to a reduced rate of decline in hippocampal volume. Group differences in changes in cognition were also examined.

RESULTS

As hypothesised, we found a maintenance in left hippocampal volume in the intervention arm, in comparison with the control arm after 12 months (p = 0.027). In a secondary analysis, this effect was attenuated after including age, sex and education level as covariates (p = 0.057). There was no significant between-group difference in the right hippocampus (p = 0.405). Contrary to our hypothesis, we did not find a beneficial effect of the intervention on cognitive outcomes.

CONCLUSIONS

Our findings suggest that a community-based physical activity intervention can significantly ward-off hippocampal atrophy in older adults. While the lack of effects on cognition may limit the interpretability of our results, our findings of hippocampal maintenance are promising given the potential clinical relevance of protecting the hippocampus from age-related decline.

Effect of regular resistance training on memory in older adults: A systematic review

The purpose of this study was to evaluate the effect of regular resistance training on memory in older adults.

METHODS

Eight databases (PubMed, Cochrane Library, EMBASE, Web of Science, SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP) and Wanfang) were searched from their inception to March 24, 2021. The data included in the study were analysed according to the Cochrane handbook using Review Manager 5.3 software.

RESULTS

Eighteen eligible randomized controlled trials (RCTs) with a total of 1365 older adults were identified that met the inclusion criteria for the systematic review. Compared with no specific exercise or a low intensity exercise control, regular resistance training significantly improved working memory (standardized mean difference (SMD): 0.27, 95% confidence interval (CI): 0.11, 0.42, P < 0.001), immediate memory (SMD: 0.27, 95% CI: 0.01, 0.54, P = 0.04), and short-term memory (SMD: 0.68, 95% CI: 0.23,1.14, P = 0.003) but had no significant impact on verbal memory (SMD: 0.15, 95% CI: -0.40, 0.71, P = 0.59) or delayed memory (SMD: 0.01, 95% CI: -0.39, 0.42, P = 0.18).

CONCLUSIONS

Regular resistance training has a positive beneficial effect on working memory, immediate memory and short-term memory in older adults. However, due to the limitations of the included studies, these findings should be interpreted cautiously.

Long-Term Favorable Effects of Physical Exercise on Burdensome Symptoms in the OptiTrain Breast Cancer Randomized Controlled Trial

Purpose: We evaluate longitudinal changes in symptom clusters and core burdensome symptoms in breast cancer patients who participated in the OptiTrain trial. Methods: 240 women were randomized to 16 weeks of supervised exercise (RT-HIIT or AT-HIIT) or usual care (UC) during adjuvant chemotherapy. Symptom clusters were composed using the Memorial Symptom Assessment Scale (MSAS), assessed at baseline, 16 weeks and 12 months later. Three symptom clusters were formed. Results: Three symptom clusters were identified: "emotional," "treatment-related toxicity," and "physical," with core burdensome symptoms present over time. At 16 weeks, the reported burdens of "feeling sad" (RT-HIIT vs UC: effect size [ES] = -0.69; AT-HIIT vs UC: ES = -0.56) and "feeling irritable" (ES = -0.41 RT-HIIT; ES = -0.31 AT-HIIT) were significantly lower in both intervention groups compared with UC. At 12 months, the AT-HIIT group continued to have significantly lower scores for the core burdensome symptoms "feeling sad" (ES = -0.44), "feeling irritable" (ES = -0.44), and "changes in the way food tastes" (ES = -0.53) compared with UC. No between-group differences were found for physical symptoms. Conclusion: We identified 3 symptom clusters in breast cancer patients during and after adjuvant chemotherapy, composed of "emotional," "treatment-related toxicity," and "physical" symptoms. After treatment completion up to 12 months post-baseline, patients in the physical exercise groups reported lower symptom burden scores for emotional symptoms, compared with UC. Our findings indicate a preserved and long-term beneficial effect of physical exercise on self-reported emotional well-being in chemotherapy-treated breast cancer patients.

Exercise Trials in Pediatric Brain Tumor: A Systematic Review of Randomized Studies

In pediatric brain tumor patients, treatment advances have increased survival rates to nearly 70%, while consequently shifting the burden of disease to long-term management. Exercise has demonstrated potential in improving multiple health impairments secondary to brain tumor treatment. However, these effects have not been consolidated through review. Therefore, we performed a systematic review of 6 health sciences databases (Medline, Embase, PsychINFO, CINAHL, SPORTDiscus, and Cochrane Central Database). Two reviewers screened studies against predefined inclusion criteria, namely that the study must: (i) be pediatric-specific; (ii) examine the effects of an exercise intervention; and (iii) employ a randomized or quasi-randomized trial design. The same 2 reviewers performed data extraction and analyses. From a pool of 4442, 5 articles-based on 2 independent trials-were included in our review (N=41). Exercise interventions were primarily aerobic, but included balance or muscle building components. Exercise had a positive effect on volumetric or diffusion-based neuroimaging outcomes, as well as motor performance and cardiorespiratory fitness. The effects of exercise on cognition remains unclear. Exercise did not worsen any of the outcomes studied. This review captures the state of the science, suggesting a potential role for exercise in children treated for brain tumor.

Brain Health: A Concept Analysis

The concept of brain health has been inconsistently used across disciplines. This concept analysis sought to clarify brain health and construct a unified definition that may lead to consistent use of this concept. The analysis used Walker and Avant's framework to identify scholarly reports on the concept of brain health from various electronic databases. Building on the identified data sources, brain health can be understood as the brain's ability to optimally adapt to internal and external human conditions through cognitive and emotional responses across one's lifespan, which result in sustainable positive changes in brain structures and functional features. This analysis emphasized that maintaining brain health has positive implications on an individual's lifelong quality of health, independence, and delaying cognitive decline. By clarifying uses and definitions of the concept of brain health, this concept analysis may enable researchers and clinicians to evaluate and interpret the concept related data consistently.

Does the Brain-Derived Neurotrophic Factor Val66Met Polymorphism Modulate the Effects of Physical Activity and Exercise on Cognition?

The Val66Met is a polymorphism of the brain-derived neurotrophic factor (BDNF) gene that encodes a substitution of a valine (Val) to methionine (Met) amino acid. Carrying this polymorphism reduces the activity-dependent secretion of the BDNF protein, which can potentially affect brain plasticity and cognition. We reviewed the biology of Val66Met and surveyed 26 studies (11,417 participants) that examined the role of this polymorphism in moderating the cognitive response to physical activity (PA) and exercise. Nine observational studies confirmed a moderating effect of Val66Met on the cognitive response to PA but differences between Val and Met carriers were inconsistent and only significant in some cognitive domains. Only five interventional studies found a moderating effect of Val66Met on the cognitive response to exercise, which was also inconsistent in its direction. Two studies showed a superior cognitive response in Val carriers and three studies showed a better response in Met carriers. These results do not support a general and consistent effect of Val66Met in moderating the cognitive response to PA or exercise. Both Val and Met carriers can improve specific aspects of cognition by increasing PA and engaging in exercise. Causes for discrepancies among studies, effect moderators, and future directions are discussed.

Of Sound Mind and Body: Exploring the Diet-Strength Interaction in Healthy Aging

Strength is a vital component of healthy aging. However, “strength” comes in different forms (includes both physical and mental aspects) and can look different at various phases of adult life. Healthy eating and regular exercise are clearly important pillars for strength. This paper proposes a framework that underlines the value of protein foods and resistance exercise for aging strong.

Validity, reliability and usefulness of smartphone and kinovea motion analysis software for direct measurement of vertical jump height

Jumping is a simple exercise determined by several biomechanical and physiological factors. Measures of vertical jump height are common and easy to administer tests of lower limb muscle power that are carried out with several types of equipment. This study aimed to validate and address the usefulness of the combination of smartphone and computer-based applications (Smartphone-Kinovea) against a laboratory-based Motion Capture System. One hundred and twelve healthy adults performed three maximal-effort countermovement jumps each. Both instruments measured the heights of the 336 trials concurrently while tracking the excursion of the body center of gravity. The vertical velocity at take-off v_to and the impulse J were computed with jump height h measures. Intraclass correlation coefficient (ICC) results indicated very high agreement for h and v_to (0.985) and almost perfect agreement for J (0.997), and Cronbach's α=0.99. Low mean differences were observed between instruments for h: -0.22 ± 1.15 cm, v_to: -0.01 ± 0.04 m/s, and J: -0.56 ± 2.92 Ns, all p<0.01. The smallest worthwhile change (SWC) and the typical error of measurement (SEM) were 1.34 cm, 0.81 cm for h; 1.15 m/s, 0.03 m/s for v_to, and 2.93 Ns, 2.25 Ns for J, so the usefulness of the method is established (SWC/SEM>1). Bland-Altman plots showed very low mean systematic bias ± random errors (-0.22 ± 2.25 cm; -0.01 ± 0.08 m/s; -0.56 ± 5.73 Ns), without association between their magnitudes (r²=0.005, r²=0.005, r²=0.001). Finally, very high to practically perfect correlation between isntruments were observed (r = 0.985; r = 0.986; r = 0.997). Our results suggest that the Smartphone-Kinovea method is a valid and reliable, low-cost instrument to monitor changes in jump performance in a healthy, active population diverse in gender and physical condition.

Sex differences in exercise efficacy: Is midlife a critical window for promoting healthy cognitive aging?

Dementia is one of the most pressing health care issues of this century. As no curative treatment for dementia exists, research efforts are growing to identify effective lifestyle interventions to prevent or delay onset. One such promising strategy that promotes cognitive and brain health is engaging in physical exercise. However, current exercise recommendations are imprecise. To advance the potential of exercise as a preventative and treatment strategy, important questions regarding moderators (ie, biological sex and age) are being addressed in the literature. Biological sex is recognized as an important variable to consider in exercise efficacy on brain health, with females showing greater cognitive gains. This may be related to sex differences in underlying mechanisms. Here, we argue to better understand the sex differences in exercise efficacy, the timing of exercise intervention should also be considered. Specifically, we present the hypothesis that midlife in females is a critical window for the implementation of exercise as an early intervention to promote brain health and prevent dementia. Further, we speculate that exercise interventions targeting midlife will be of critical importance for the female brain, as females exit this period of the lifespan at greater risk for cognitive impairment. Given the potential sex differences in dementia risk and prevalence, it is imperative to assess potential sex differences in exercise efficacy as an early intervention during midlife.

Perspective of Dose and Response for Individualized Physical Exercise and Training Prescription

Physical interventions are used to increase physical (sports) performance and considered as effective low-cost strategies in the fields of healthcare, disease or injury prevention, and medical treatment. In general, a considerable amount of evidence buttress the application of physical interventions in various fields as it has been demonstrated to contribute to the maintenance and recovery of physical performance, cognitive function, and overall state of health. To implement physical interventions effectively, it is essential to provide an appropriate exercise and training prescription. Exercise and training prescription are key for "dose" specification and for the individualization (personalizing) of physical exercise and training, precisely adjusted and controlled like medication. Since the physiological response to physical interventions is demonstrably individual and dependent on many influencing factors, individualization is an emerging approach aiming to maximize the efficiency of an intervention by accounting for the interindividual heterogeneity. The present brief viewpoint article aims to distinguish and to redefine between the terms dose and response in order to improve the understanding of practitioners, the methodology of study protocols, and to relate future findings to the actual biological (interindividual) variability of acute and chronic responses.

Effect of Maternal Exercise on Diet-induced Redox Imbalance in Hippocampus of Adult Offspring

Physical exercise practice has been increasingly recommended in the prevention and treatment of chronic diseases, causing a positive effect from body weight/fat loss to improved cognitive function. Maternal exercise seems to induce the same positive lifelong adaptations to the offspring. We hypothesized that maternal exercise can prevent redox imbalance in adult offspring's hippocampus exposed to a high-fat diet (HFD). Female Wistar rats were divided into three groups before and during pregnancy: (1) sedentary, (2) swimming exercise, and (3) swimming exercise with overload. On 60 days of age, the male pups were divided into standard diet or HFD for one month, yielding normal and HFD subgroups for each maternal condition. Maternal interventions did not alter gestational parameters, birth outcomes, and offspring weight gain from weaning to 90 days of age. The HFD consumption increased body fat, which was not prevented by maternal exercise. Serum glucose levels were increased by HFD, an effect that was prevented by unload maternal exercise. In the hippocampus, both maternal exercise intensities could increase antioxidant defense. Hippocampal redox homeostasis was impaired by HFD, causing increased superoxide levels, which was prevented by exercise without load, while overload caused only a reduction of the effect. In summary, the practice of swimming exercise without overload during pregnancy seems to be more beneficial when evaluated in animal model, preventing HFD induced redox imbalance and increasing antioxidant defense while overload swimming exercise during pregnancy demonstrated a negative effect on offspring submitted to HFD consumption.

Resting State EEG in Exercise Intervention Studies: A Systematic Review of Effects and Methods

Background: Exercise has been shown to alter brain plasticity and is explored as a therapeutic intervention in a wide variety of neurological diseases. Electroencephalography (EEG) offers an inexpensive method of studying brain electrocortical activity shortly after exercise and thus offers a way of exploring the influence of exercise on the brain. We conducted a systematic review to summarize the current body of evidence regarding methods of EEG analysis and the reported effects of exercise interventions on EEG.

Methods: PubMed, Web of Science and EMBASE were searched for studies investigating resting state EEG in exercise intervention studies carried out in participants >17 years of age and with no history of epilepsy. Further, studies solely investigating event-related potentials as an outcome measure were excluded. Relevant data were extracted, and a risk-of-bias assessment was carried out using the Cochrane risk-of-bias tool. A qualitative synthesis of results was carried out. A protocol for the systematic review was uploaded to https://www.crd.york.ac.uk/PROSPERO/ (ID: CRD42019134570) and the Preferred Reporting Items for Systematic Reviews (PRISMA) statement was followed.

Results: Out of 1,993 records screened, 54 studies were included in a final qualitative synthesis with a total of 1,445 participants. Our synthesis showed that studies were mainly carried out using frequency analysis as an analytical method. Generally, findings across studies were inconsistent and few were adjusted for multiple comparisons. Studies were mainly of low quality and usually carried out in small populations, lowering the significance of results reported.

Conclusions: Changes in the EEG as a result of an exercise intervention are elusive and difficult to replicate. Future studies should provide biologically sound hypotheses underlying assumptions, include larger populations and use standardized EEG methods to increase replicability. EEG remains an interesting methodology to examine the effects of exercise on the brain.

Baseline White Matter Is Associated With Physical Fitness Change in Preclinical Alzheimer's Disease

White matter (WM) microstructure is a sensitive marker to distinguish individuals at risk of Alzheimer's disease. The association of objective physical fitness (PF) measures and WM microstructure has not been explored and mixed results reported with physical activity (PA). Longitudinal studies of WM with PA and PF measures have had limited investigation. This study explored the relationship between objective PF measures over 24-months with "normal-appearing" WM microstructure. Data acquired on magnetic resonance imaging was used to measure "normal-appearing" WM microstructure at baseline and 24-months. Clinical variables such as cognitive and blood-based measures were collected longitudinally. Also, as part of the randomized controlled trial of a PA, extensive measures of PA and fitness were obtained over the 24 months. Bilateral corticospinal tracts (CST) and the corpus callosum showed a significant association between PF performance over 24-months and baseline WM microstructural measures. There was no significant longitudinal effect of the intervention or PF performance over 24-months. Baseline WM microstructural measures were significantly associated with PF performance over 24-months in this cohort of participants with vascular risk factors and at risk of Alzheimer's disease with distinctive patterns for each PF test.

Physical activity, aerobic fitness, and brain white matter: Their role for executive functions in adolescence

Physical activity and exercise beneficially link to brain properties and cognitive functions in older adults, but the findings concerning adolescents remain tentative. During adolescence, the brain undergoes significant changes, which are especially pronounced in white matter. Studies provide contradictory evidence regarding the influence of physical activity or aerobic-exercise on executive functions in youth. Little is also known about the link between both fitness and physical activity with the brain's white matter during puberty. We investigated the connection between aerobic fitness and physical activity with the white matter in 59 adolescents. We further determined whether white matter interacts with the connection of fitness or physical activity with core executive functions. Our results show that only the level of aerobic fitness, but not of physical activity relates to white matter. Furthermore, the white matter of the corpus callosum and the right superior corona radiata moderates the links of aerobic fitness and physical activity with working memory. Our results suggest that aerobic fitness and physical activity have an unequal contribution to the white matter properties in adolescents. We propose that the differences in white matter properties could underlie the variations in the relationship between either physical activity or aerobic fitness with working memory.

Physical activity for cognitive health: what advice can we give to older adults with subjective cognitive decline and mild cognitive impairment?

Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are common conditions in older age and are associated with an increased risk of future cognitive decline and dementia. As there is currently no effective pharmacological treatment available for SCD and MCI, modifiable risk factors for cognitive decline and dementia have received increasing attention in the literature as a focus for clinical trials. Physical activity (PA) is one of the strongest protective lifestyle factors. This clinical review aims to highlight the accumulating evidence about the benefits of PA for SCD and MCI. Whilst there is agreement that at least 150 minutes of moderate aerobic PA per week in combination with additional resistance training is necessary to support brain health in people with SCD and MCI, future research is required to help inform specific advice on type of exercise, intensity, “dose” and effective strategies to encourage behavior change.

Sex-Specific Relationship Between Long-Term Maintenance of Physical Activity and Cognition in the Health ABC Study: Potential Role of Hippocampal and Dorsolateral Prefrontal Cortex Volume

BACKGROUND

Physical activity (PA) is a promising strategy for the promotion of brain health, although substantial variation exists in the effects of PA at the individual level. Given the greater prevalence and faster progression of Alzheimer's disease in women compared to men, and known sex differences in brain architecture, analysis of sex differences in the relationship between PA, cognition, and brain region volumes is warranted.

METHODS

To address this, we conducted secondary analyses of data from the Health, Aging, and Body Composition study. To determine whether longitudinal changes in PA over 10 years predicted declines in global cognitive functioning and executive functions and processing speed differently in males and females, latent growth curve modeling was utilized. Magnetic resonance imaging was performed at year 10, and the hippocampus and dorsolateral prefrontal cortex were identified as regions of interest.

RESULTS

Maintaining PA over 10 years predicted less declines in executive functions and processing speed in females but not males. Maintaining PA over 10 years was significantly associated with greater volume of the left dorsolateral prefrontal cortex, a brain region involved in executive functions, in year 10 in females only. Maintaining physical activity was associated with better global cognitive function in both males and females, and also predicted volume of the left hippocampus, albeit in different directions with females showing a negative relationship and males showing a positive relationship.

CONCLUSIONS

These findings suggest that the relationship of PA with cognition and its neurobiological correlates differ by sex, with females apparently benefiting from PA to a greater extent than males. Development of personalized, tailored exercise recommendations to promote healthy brain aging should account for sex differences.

Optimal Human Functioning Requires Exercise Across the Lifespan: Mobility in a 1g Environment Is Intrinsic to the Integrity of Multiple Biological Systems

It is widely acknowledged that achieving and maintaining a healthier lifestyle can be enhanced through regular participation in sport and physical activity. Coevally, a growing number of health professionals regard exercise as a legitimate intervention strategy for those who have lost their health. Exercise has been shown to be effective for overweight or obese individuals, who are at risk to lose their health due to development of type II diabetes, cardiovascular disease, as well as, infiltration of muscles, bone and other organs with fat, so it can be considered medicine. However, exercise and associated mobility likely also have a strong prevention component that can effectively contribute to the maintenance of the integrity of multiple biological systems for those who do not have overt risk factors or ongoing disease. While prevention is preferred over intervention in the context of disease, it is clear that exercise and associated mobility, generally, can be an effective influence, although overtraining and excessive loading can be deleterious to health. The basis for the generally positive influence of exercise likely lies in the fact that many of our physiological systems are designed to function in the mechanically dynamic and active 1g environment of Earth (e.g., muscles, cartilage, ligaments, tendons, bones, and cardiovascular system, and neuro-cognitive function), and nearly all these systems subscribe to the "use it or lose it" paradigm. This conclusion is supported by the changes observed over the more than 50 years of space flight and exposure to microgravity conditions. Therefore, the premise advanced is: "exercise is preventative for loss of health due to age-related decline in the integrity of several physiological systems via constant reinforcement of those systems, and thus, optimal levels of exercise and physical activity are endemic to, essential for, and intrinsic to optimal health and wellbeing."

Novel Approach to Characterize Heterogeneity in an Aerobic Exercise Intervention

PURPOSE

Exercise intervention studies for brain health can be difficult to interpret due to heterogeneity in exercise intensity, exercise duration, and in adherence to the exercise intervention. This study aimed to characterize heterogeneity in these components in a cohort of healthy middle-age and older adults who participated in a prescribed 6-month supervised aerobic exercise intervention as part of the Brain in Motion study.

METHODS AND RESULTS

Group-based multitrajectory analysis (GBMTA) was used to characterize variation in the trajectory of exercise intensity and duration for male and female participants in the first 3 months of the exercise program. The GBMTA for males and females revealed two distinct trajectory subgroups, namely, "high-increasing" (HI) and "low-increasing" (LI). Logistic regression was used to assess the association between the identified latent subgroups and (i) demographic characteristics; (ii) physiological characteristics, including cardiovascular and cerebrovascular function; (iii) genetic characteristics; and (iv) adherence with American College of Sports Medicine guidelines on exercise for older adults. Of the 196 participants, 54.1% met the American College of Sports Medicine aerobic exercise targets for intensity and duration during the intervention. Aerobic fitness (maximal oxygen uptake; odds ratio, 1.27; P < 0.01) was significantly different between these trajectory subgroups in males, and cerebrovascular function (cerebrovascular resistance; odds ratio, 0.14; P < 0.01) was significantly different between these trajectory subgroups in females.

CONCLUSION

This novel approach to tracking a prespecified exercise program highlights that there are individual and group-specific variations within a prescribed exercise intervention. Characterizing exercise adherence in this way holds promise in developing optimized exercise prescriptions tailored to individual baseline characteristics, and additionally highlighting those participants at greatest risk of not meeting minimum dosage requirements for physiological and/or cognitive health.

Biological Sex: A Potential Moderator of Physical Activity Efficacy on Brain Health

The number of older people worldwide living with cognitive impairment and neurodegenerative diseases is growing at an unprecedented rate. Despite accumulating evidence that engaging in physical activity is a promising primary behavioral strategy to delay or avert the deleterious effects of aging on brain health, a large degree of variation exists in study findings. Thus, before physical activity and exercise can be prescribed as “medicine” for promoting brain health, it is imperative to understand how different biological factors can attenuate or amplify the effects of physical activity on cognition at the individual level. In this review article, we briefly discuss the current state of the literature, examining the relationship between physical activity and brain health in older adults and we present the argument that biological sex is a potent moderator of this relationship. Additionally, we highlight some of the potential neurobiological mechanisms underlying this sex difference for this relatively new and rapidly expanding line of research.