Effect of multicomponent exercise in cognitive impairment: a systematic review and meta-analysis

Physical exercise, cognition, and brain health in aging

Exercise training is an important strategy to counteract cognitive and brain health decline during aging. Evidence from systematic reviews and meta-analyses supports the notion of beneficial effects of exercise in cognitively unimpaired and impaired older individuals. However, the effects are often modest, and likely influenced by moderators such as exercise training parameters, sample characteristics, outcome assessments, and control conditions. Here, we discuss evidence on the impact of exercise on cognitive and brain health outcomes in healthy aging and in individuals with or at risk for cognitive impairment and neurodegeneration. We also review neuroplastic adaptations in response to exercise and their potential neurobiological mechanisms. We conclude by highlighting goals for future studies, including addressing unexplored neurobiological mechanisms and the inclusion of under-represented populations.

Effects of chronic physical exercise on executive functions and episodic memory in clinical and healthy older adult populations: a systematic review and meta-analysis protocol

BACKGROUND

Executive functions (EFs) and episodic memory are fundamental components of cognition that deteriorate with age and are crucial for independent living. While numerous reviews have explored the effect of exercise on these components in old age, these reviews screened and analyzed selected older adult populations, or specific exercise modes, thus providing only limited answers to the fundamental question on the effect of exercise on cognition in old age. This article describes the protocol for a systematic review and multilevel meta-analytic study aiming at evaluating the effectiveness of different types of chronic exercise in improving and/or maintaining EFs and long-term episodic memory in older adults.

METHODS AND ANALYSIS

The study protocol was written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Several databases will be searched. Randomized controlled trials (RCTs) conducted in older adults aged ≥ 60 years providing any kind of planned, structured, and repetitive exercise interventions, and EFs and/or episodic memory measures as outcomes, published in English in peer-reviewed journals and doctoral dissertations will be included. Two independent reviewers will screen the selected articles, while a third reviewer will resolve possible conflicts. The Cochrane risk-of-bias tool will be used to assess the quality of the studies. Finally, data will be extracted from the selected articles, and the formal method of combining individual data from the selected studies will be applied using a random effect multilevel meta-analysis. The data analysis will be conducted with the metafor package in R.

DISCUSSION AND CONCLUSION

This review will synthesize the existing evidence and pinpoint gaps existing in the literature on the effects of exercise on EFs and episodic memory in healthy and unhealthy older adults. Findings from this meta-analysis will help to design effective exercise interventions for older adults to improve and/or maintain EFs and episodic memory. Its results will be useful for many researchers and professionals working with older adults and their families.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022367111.

Physical exercise and cognition in older adults, a scientific approach scanty reported in Latin America and Caribbean populations

The advancement of public services, including the increased accessibility of health services, has led to a rise in life expectancy globally. As a result, aging populations are becoming more prevalent, raising concerns about cognitive decline. Fortunately, non-pharmacological methods, such as physical exercise, have been shown to mitigate the effects of aging on the brain. In this perspective article, we examined meta-analyses on the impact of physical exercise on cognition in older adults. The results indicate that combined exercise (i.e., aerobic plus strength training), has a significant positive effect on overall cognition and executive function. However, we found a lack of scientific studies on this topic in Latin American and Caribbean countries. Therefore, there is a pressing need for research to identify the feasibility of physical exercise interventions to improve cognitive skills in older adults from these regions.

Effects of Multicomponent Exercise on Community-Dwelling Older Adults With Mild Cognitive Impairment

PURPOSE

To explore the effects of a group-based multicomponent exercise program on general cognitive functioning, depression, and social functioning in community-dwelling older adults with mild cognitive impairment (MCI) and whether the effects can be maintained.

METHOD

Fifty older adults with MCI were conveniently recruited from two communities in the study area and randomly assigned to the intervention group or control group. The intervention group received three sessions of 60-minute, multicomponent exercise per week for 3 months, plus MCI-related health education. The control group only received MCI-related health education. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Beijing Version (MoCA-BJ) were used to assess general cognitive function. The Functional Activities Questionnaire (FAQ) and Geriatric Depression Scale (GDS-30) were used to evaluate participants' social function and depression, respectively. Participants' exercise intensity was assessed using the Category Ratio Scale.

RESULTS

After the 3-month intervention, there were significant improvements in general cognitive function (p = 0.046), attention (p = 0.009), delayed recall (p = 0.015), and social function (p = 0.011) in the intervention group compared with the control group. However, after 3-month postintervention follow up, no significant differences in MMSE, MoCA-BJ, GDS-30, and FAQ scores were noted between groups.

CONCLUSION

The 3-month multicomponent exercise program improved general cognitive function and social functioning in community-dwelling older adults with MCI. However, there was no evidence that these benefits lasted for another 3 months after stopping the exercise program. [Research in Gerontological Nursing, 17(2), 65-79.].

Effectiveness of a multicomponent exercise intervention in community-dwelling older Chinese people with cognitive frailty: protocol for a mixed-methods research

Aims

To evaluate the effectiveness of a multicomponent exercise intervention and to clarify the underlying mechanisms of the program in community-dwelling older adults with cognitive frailty. Additionally, the perception of participants in the program will be explored.

Design

A mixed-methods design, including a randomized controlled trial and an exploratory qualitative study, was used.

Methods

Each group consists of 41 participants. The experimental group will undergo a 12-week multicomponent exercise intervention, including warm-up, exergaming aerobic exercise, elastic-band resistance exercise, and cool-down. This intervention was developed based on the Health Belief Model (HBM) and Self-Efficacy Model (SEM). The control group will not receive any intervention. Physical frailty and cognitive function will be considered as primary outcomes. Data will be collected both at baseline and at the end of the intervention period. Fisher's exact test, analysis of covariance, and generalized linear models will be conducted to compare mean changes between the two groups. Additionally, the mediation models will be used to examine whether any intervention effects are mediated through exercise self-efficacy.

Discussion

The findings of this study are anticipated to provide valuable insights for healthcare providers, enabling them to learn about effective strategies to enhance exercise adherence and promote improved functionality, independence, and quality of life for older adults with cognitive frailty.Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2200058850].

Effects of physical activity and depressive symptoms on cognitive function in older adults: National Health and Nutrition Examination Survey

BACKGROUND & AIMS

Population aging is a growing phenomenon, with cognitive impairment becoming a prevalent issue among the elderly. This study aimed to investigate the impact of physical activity and depressive symptoms on cognitive function in older adults using a nationally representative data set of U.S. older adults aged ≥ 60 years.

METHODS

The study comprised 2713 participants aged ≥ 60 from the National Health and Nutrition Examination Survey 2011-2014. Participants were classified into two groups: Cognitive impairment and No-Cognitive impairment, determined by the results of the Digit Symbol Substitution Test (DSST). Physical activity (PA) was assessed using the Global Physical Activity questionnaire (GPAQ), while depressive symptoms were evaluated using the Patient Health Questionnaire (PHQ-9). Logistic regression analysis examined the relationship between physical activity, depressive symptoms and cognitive function.

RESULTS

Multifactorial logistic regression analysis showed that high levels of physical activity were found to be significantly associated with a lower risk of cognitive impairment compared to low levels of physical activity [OR = 0.789, 95% CI:0.632 ~ 0.986, P = 0.037]. On the other hand, the presence of major depressive symptoms was significantly associated with a higher risk of cognitive impairment compared to the absence of depressive symptoms [OR = 3.482, 95% CI: 2.278 ~ 5.324, P < 0.001]. Participants in the recreational physical activity group exhibited higher Cognitive scores (P < 0.001), indicating better cognitive functioning.

CONCLUSION

High levels of Physical activity were independently associated with a lower incident cognitive impairment. Additionally, the severity of depression was positively correlated with an increased risk of cognitive impairment.

Current perspectives on prevention of vascular cognitive impairment and promotion of vascular brain health

INTRODUCTION

The true global burden of vascular cognitive impairment (VCI) is unknown. Reducing risk factors for stroke and cardiovascular disease would inevitably curtail VCI.

AREAS COVERED

The authors review current diagnosis, epidemiology, and risk factors for VCI. VCI increases in older age and by inheritance of known genetic traits. They emphasize modifiable risk factors identified by the 2020 Lancet Dementia Commission. The most profound risks for VCI also include lower education, cardiometabolic factors, and compromised cognitive reserve. Finally, they discuss pharmacological and non-pharmacological interventions.

EXPERT OPINION

By virtue of the high frequencies of stroke and cardiovascular disease the global prevalence of VCI is expectedly higher than prevalent neurodegenerative disorders causing dementia. Since ~ 90% of the global burden of stroke can be attributed to modifiable risk factors, a formidable opportunity arises to reduce the burden of not only stroke but VCI outcomes including progression from mild to the major in form of vascular dementia. Strict control of vascular risk factors and secondary prevention of cerebrovascular disease via pharmacological interventions will impact on burden of VCI. Non-pharmacological measures by adopting healthy diets and encouraging physical and cognitive activities and urging multidomain approaches are important for prevention of VCI and preservation of vascular brain health.

Topical Cellular/Tissue and Molecular Aspects Regarding Nonpharmacological Interventions in Alzheimer's Disease-A Systematic Review

One of the most complex and challenging developments at the beginning of the third millennium is the alarming increase in demographic aging, mainly-but not exclusively-affecting developed countries. This reality results in one of the harsh medical, social, and economic consequences: the continuously increasing number of people with dementia, including Alzheimer's disease (AD), which accounts for up to 80% of all such types of pathology. Its large and progressive disabling potential, which eventually leads to death, therefore represents an important public health matter, especially because there is no known cure for this disease. Consequently, periodic reappraisals of different therapeutic possibilities are necessary. For this purpose, we conducted this systematic literature review investigating nonpharmacological interventions for AD, including their currently known cellular and molecular action bases. This endeavor was based on the PRISMA method, by which we selected 116 eligible articles published during the last year. Because of the unfortunate lack of effective treatments for AD, it is necessary to enhance efforts toward identifying and improving various therapeutic and rehabilitative approaches, as well as related prophylactic measures.

The effect of short daytime napping on cognitive function, sleep quality, and quality of life in mild cognitive impairment patients

Mild cognitive impairment (MCI) is a neurological disorder that can increase the risk of Alzheimer's disease (AD) by three to five times more than those with normal cognition. To better understand the effects of daytime napping on MCI patients, a study was conducted to measure the effects of short naps on cognitive function, sleep quality, and quality of life. In total, 38 participants were asked to take 20-minute naps between 1:00p.m. and 3:00p.m. three times a week for eight weeks. The cognitive function of the participants was measured using the Thai version of the Montreal Cognitive Assessment (Thai-MoCA), their sleep quality was measured using the Thai version of the Pittsburgh Sleep Quality Index (Thai-PSQI), and their quality of life was measured using the Thai version of the Quality of Life (Thai-QoL) questionnaire. After the 8-week period, the participants' scores for the Thai-MoCA and the Thai-QoL questionnaire showed a significant improvement (p < 0.001 for both), while the Thai-PSQI decreased significantly (p = 0.012). This suggests that taking short daytime naps can help to improve the cognitive function, sleep quality, and quality of life of MCI patients.

Mechanisms of the Beneficial Effects of Exercise on Brain-Derived Neurotrophic Factor Expression in Alzheimer's Disease

Brain-derived neurotrophic factor (BDNF) is a key molecule in promoting neurogenesis, dendritic and synaptic health, neuronal survival, plasticity, and excitability, all of which are disrupted in neurological and cognitive disorders such as Alzheimer's disease (AD). Extracellular aggregates of amyloid-β (Aβ) in the form of plaques and intracellular aggregates of hyperphosphorylated tau protein have been identified as major pathological insults in the AD brain, along with immune dysfunction, oxidative stress, and other toxic stressors. Although aggregated Aβ and tau lead to decreased brain BDNF expression, early losses in BDNF prior to plaque and tangle formation may be due to other insults such as oxidative stress and contribute to early synaptic dysfunction. Physical exercise, on the other hand, protects synaptic and neuronal structure and function, with increased BDNF as a major mediator of exercise-induced enhancements in cognitive function. Here, we review recent literature on the mechanisms behind exercise-induced BDNF upregulation and its effects on improving learning and memory and on Alzheimer's disease pathology. Exercise releases into the circulation a host of hormones and factors from a variety of peripheral tissues. Mechanisms of BDNF induction discussed here are osteocalcin, FNDC5/irisin, and lactate. The fundamental mechanisms of how exercise impacts BDNF and cognition are not yet fully understood but are a prerequisite to developing new biomarkers and therapies to delay or prevent cognitive decline.

Effect of a multicomponent programme based on reality orientation therapy on the physical performance and cognitive function of elderly community-dwellers: a quasi-experimental study

BACKGROUND

Effects of a multicomponent exercise programme have an impact on the physical, cognitive, and psychological domains in elderly community-dwellers. However, some individuals aged 65 years or more have not shown positive effects after the intervention as reported in similar research. The objective of this quasi-experimental study was to clarify the effectiveness of a multicomponent programme based on reality orientation therapy (ROT) on the physical performance, cognitive ability, and psychological state in the elderly.

METHOD

Participants were recruited from the general public in 20 areas of Akita Prefecture, Japan, and they took part in each exercise programme for 90 min a day, once every 2 weeks, for 3 months, according to the group classification using cluster randomization into 20 cohorts in Akita. Physical, cognitive, and geriatric depression assessments were performed at baseline and after the 3-month intervention in both the ROT-based intervention group and the control group.

RESULT

The final samples for analysis consisted of 31 participants in the control group and 30 participants in the intervention group. The results of the statistical analysis comparing the two groups showed that the 5-repetition sit-to-stand test was performed significantly faster (P < 0.05) and that the results of the word list memory (WM) test and the Symbol Digit Substitution Task also had significantly improved (P < 0.05) after the intervention in both groups. The WM score did not show an interactive effect between the group and time factors, but it had a significant main effect on time in both groups (P < 0.05).

CONCLUSION

The results of our quasi-experimental study indicated that the multicomponent programme based on the ROT would be as effective as the original multicomponent programme combined with aerobic exercise and cognitive tasks, as highlighted in the WM.

The interaction between instrumental activities of daily living and dual sensory function on cognition among the elderly in China: A cross-sectional survey

To explore the interaction of instrumental activities of daily living (IADLs) and dual sensory function on cognition in the elderly. A cross-sectional survey was conducted in six general hospitals in China, from October 2022 to December 2022. Data collection included general information, IADLs scale, self-reported sensory function questionnaire, and mini-mental state examination (MMSE). Binary logistic regression was used to examine the association between factors and cognition. The interactive effect was evaluated by synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (AP). The odds ratio (OR) of IADLs decline in cognition is 4.412 (95% confidence interval [CI]: 3.633-5.358, p < 0.001); the OR of dual sensory difficulty on cognition is 2.502 (95% CI: 1.272-4.921, p = 0.008). The OR of interaction between IADLs decline and dual sensory difficulty on cognition is 13.737 (95% CI: 9.726-19.400, p < 0.001). RERI (95% CI) = 7.823 (3.230-12.417), AP (95% CI) = 0.570 (0.392-0.747), S (95% CI) = 2.593 (1.616-4.160). IADLs decline and dual sensory difficulty are associated with cognitive decline. IADLs decline and dual sensory difficulty have interaction with cognitive decline; the interaction is greater than the sum effect of those two on cognitive decline independently. Sensory and IADLs assessment can be used as early screening items for cognition among the elderly. In addition, protecting sensory function and maintaining IADLs in the elderly can help protect their cognition.

Effects of physical activity interventions on executive function in older adults with dementia: A meta-analysis of randomized controlled trials

BACKGROUND

To date quantitative meta-analysis with large samples to investigate the effects and potential moderators of physical activity (PA) on executive function (EF) in older adults with dementia is insufficient. Therefore, we conducted this meta-analysis.

DESIGN

Meta-analysis of randomized controlled trials (RCTs).

PARTICIPANTS

Old people with Alzheimer's disease (AD) or related dementia of varying types and severity as the primary diagnosis.

METHODS

PubMed, Web of Science, the Cochrane Library and Embase databases were searched for relevant studies published from 01 January, 2010 to 01 March, 2022. The results of executive function were reported in all RCTs. Random-effects meta-analysis was used to calculate the size of effects. Subgroup analyses of three moderators (including the specific sub-domains of EF, exercise prescription variables, and sample characteristics) were performed.

RESULTS

Eighteen RCTs were included with a combined sample size of 1366. Overall, PA interventions improved overall EF (standardized mean difference [SMD]=0.23, 95% confidence interval [CI] 0.05 to 0.41, p<0.05). The EF sub-domain "planning" was significant moderator (SMD=0.31, 95%CI 0.11 to 1.51, p<0.01), but inhibitory control, working memory and cognitive flexibility were not significant. Regarding exercise prescription variables, type of resistance training; moderate intensity; total duration ≤24 weeks and short (once or twice a week) frequency improved overall EF performance. Session length may be a moderator. Regarding sample characteristics, old-old, AD and both dementia and AD had significant benefits.

CONCLUSIONS AND IMPLICATIONS

EF in older adults with AD or related dementia benefited from physical activity, and the benefit was affected by the type, intensity, total duration, frequency of exercise. Physical activity can be an alternative intervention in aging patients with dementia, to improve EF performance or prevent or EF decline.

Does Multicomponent Training Improve Cognitive Function in Older Adults Without Cognitive Impairment? A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVES

To carry out a systematic review and meta-analysis to verify the effects of multicomponent training on the cognitive function of older adults without cognitive impairment.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults aged 60 years and older.

METHODS

The searches were accomplished through MEDLINE (via PubMed), EMBASE, Cochrane Library, Web of Science, SCOPUS, LILACS, and Google Scholar databases. We performed the searches up to November 18, 2022. The study included only randomized controlled trials and older adults without any cognitive impairment (dementia, Alzheimer's, mild cognitive impairment, neurologic diseases). Risk of Bias 2 tool and PEDro scale was performed.

RESULTS

Ten randomized controlled trials were included in the systematic review, of which 6 (involving 166 participants) were compiled in the meta-analysis of random effects models. The Mini-Mental State Examination and Montreal Cognitive Assessment were used to assess global cognitive function. The Trail-Making Test (TMT) (A and B domains) was performed by 4 studies. Compared with the control group, multicomponent training increases the global cognitive function (standardized mean difference = 0.58, 95% CI: 0.34-0.81, I² = 11%; P < .001). Regarding TMT-A and TMT-B, multicomponent training decreases the time performed in the tests (TMT-A: mean difference = -6.70, 95% CI: -10.19 to -3.21; I² = 51%; P = .0002) (TMT-B: mean difference = -8.80, 95% CI: -17.59 to -0.01; I² = 69%; P = .05). The PEDro scale for the studies in our review ranged from 7 to 8 (mean = 7.4 ± 0.5), meaning good methodologic quality, and most studies were judged as at least low in terms of risk of bias.

CONCLUSION AND IMPLICATIONS

Multicomponent training improves cognitive function in older adults without cognitive impairment. Therefore, a possible protective effect of multicomponent training for cognitive function in older adults is suggested.

Relationship Between Physical Exercise and Cognitive Impairment Among Older Adults with Type 2 Diabetes: Chain Mediating Roles of Sleep Quality and Depression

Objective

Although physical exercise has been shown to boost physical, psychological, and psychiatric conditions in older adults, there is a relative lack of research on the mechanisms involved in this process for older adults with type 2 diabetes mellitus (T2DM). We thus evaluated whether sleep quality and depression mediated the relationship between physical exercise and cognitive impairment in older adults with T2DM by focusing on the exercise-physiology-psychology and psychiatry connection.

Methods

Self-reported data were collected from 2646 older adults with T2DM in Weifang, Shandong, China. Regression and bootstrap analyses were conducted to explore the chain mediator model including physical exercise, cognitive impairment, sleep quality, and depression.

Results

Engaging in physical exercise (coefficient = -0.6858, p < 0.001), high levels of sleep quality (coefficient = -0.3397, p = 0.015), and low levels of depression (coefficient = 0.3866, p < 0.001) were significantly associated with a low level of cognitive impairment. Sleep quality and depression mediated the chain effect between physical exercise and cognitive impairment (total effect = -1.0732, 95% CI [-1.3652, -0.7862]; direct effect = -0.6858, 95% CI [-0.9702, -0.3974]; indirect effect = -0.3875, 95% CI [-0.5369, -0.2521]).

Conclusion

Physical exercise may improve sleep quality in older adults with T2DM, alleviating depression and delaying the development of cognitive impairment. Physical exercise can enhance patients' ability to resist depression and cognitive impairment, and creating comfortable sleep environments can also reinforce the effects of this process. These findings have important implications for promoting healthy aging in older adults with T2DM.

Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis

Background

Physical exercise has been recommended as an important nonpharmacological therapeutic strategy for managing attention deficit hyperactivity disorder (ADHD). We conducted a network meta-analysis (NMA) to assess the comparative impact of different physical exercise modalities on enhancing executive functions (EFs) and alleviating symptoms in children and adolescents with ADHD.

Methods

We searched Web of Science, PubMed, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, PsycINFO, CNKI, and clinical trials databases from inception to October 20, 2022. Randomized controlled trials (RCTs) and quasi-experimental studies investigating physical exercise for ADHD-related symptoms of hyperactivity/impulsivity and inattention, and executive functions were included. The frequentist random-effect NMA method was applied to pool the results.

Results

A total of 59 studies (including 39 RCTs, 5 quasi-RCTs, and 15 self-controlled trials) published between 1983 and 2022 were incorporated into the systematic review, of which 44 studies with 1757 participants were eligible for meta-analysis. All types of physical exercise were effective in improving EFs (SMD = 1.15, 95% CI: 0.83 to 1.46), and open-skill activities which require participants to react in a dynamically changing and externally paced environment induced the most incredible benefits for executive functions (SUCRA = 98.0%, SMD = 1.96, and 95% CI: 1.15 to 2.77). Subgroup analyses for EFs revealed varied findings that open-skill activities were the most promising physical exercise type for improving inhibitory control (SUCRA = 99.1%, SMD = 1.94, and 95% CI: 1.24 to 2.64), and closed-skill activities dominated by aerobic exercises had a slightly higher probability of being the most promising physical exercise intervention for working memory (SUCRA = 75.9%, SMD = 1.21, and 95% CI: -0.22 to 2.65), and multicomponent physical exercise tended to be the most effective in cognitive flexibility (SUCRA = 70.3%, SMD = 1.44, and 95% CI: -0.19 to 3.07). Regarding ADHD-related symptoms, closed-skill activities dominated by aerobic exercises might be more advantageous for hyperactivity/impulsivity (SUCRA = 72.5%, SMD = -1.60, and 95% CI: -3.02 to -0.19) and inattention (SUCRA = 96.3%, SMD = -1.51, and 95% CI: -2.33 to -0.69) improvement.

Conclusion

Physical exercise can significantly help to alleviate the symptoms of ADHD and improve executive functions in children and adolescents with ADHD. Most of all, to promote adherence to treatment, they should be encouraged to perform the physical exercises that they enjoy most.

Effects of a 12-week Vivifrail exercise program on intrinsic capacity among frail cognitively impaired community-dwelling older adults: secondary analysis of a multicentre randomised clinical trial

INTRODUCTION

The World Health Organisation recently defined the construct of intrinsic capacity (IC), a function-based marker of older adult's health encompassing all mental and physical capacities of the individual. Multicomponent physical exercise (MCE) is a potential intervention capable to maintain/increase IC at older age; however, evidence is scarce on the effects of MCE on IC in cognitively impaired pre-frail/frail older adults.

METHODS

Secondary analyses of a randomised clinical trial. One hundred and eighty-eight older outpatients (age = 84.06 ± 4.77, 70.2% women) presenting with pre-frailty/frailty (according to Fried Criteria) and mild cognitive impairment (MCI)/mild dementia were recruited in the Geriatric clinics of three tertiary hospitals in Spain. Subjects were randomised to participate in the 12-week home-based individualised Vivifrail MCE or usual care. An IC index was created based on the z-score of the locomotion (Short Physical Performance Battery), cognitive (Montreal Cognitive Assessment), psychology (15-item Geriatric Depression Scale Yesavage) and vitality (handgrip strength) domains.

RESULTS

After the 3-month intervention, linear mixed models showed significant between-group differences in the evolution of the IC composite score (β=0.48; 95% confidence interval [CI] = 0.24, 0.74; P < 0.001), IC Locomotion (β = 0.42; 95% CI = 0.10, 0.74; P < 0.001), IC Cognition (β = 0.45; 95% CI = 0.03, 0.87; P < 0.05) and IC Vitality domains (β = 0.50; 95% CI = 0.25, 0.74 at 3-month) favouring the MCE group.

CONCLUSIONS

The 12-week Vivifrail multicomponent exercise program is an effective strategy to enhance IC, especially in terms of locomotion, cognition and vitality IC domains in community-dwelling older adults with pre-frailty/frailty and MCI/mild dementia, compared to usual care.

Baduanjin exercise modulates the hippocampal subregion structure in community-dwelling older adults with cognitive frailty

Background

Regular Baduanjin exercise intervention was proven to be beneficial in improving the cognitive ability and physical performance of older adults with different health conditions but was unclear to influence the structural plasticity of the hippocampus. This study aimed to explore the modulation of hippocampal subregions as a mechanism by which Baduanjin exercise improves cognitive frailty in older adults.

Methods

A total of 102 community-dwelling older adults with cognitive frailty were recruited and randomly allocated to the Baduanjin exercise training group and usual physical activity control group. The participants in the Baduanjin exercise training group participated in a 24-week Baduanjin exercise intervention program with an exercise frequency of 60 min per day, 3 days per week. Cognitive ability and physical frailty were assessed, and MRI scans were performed on all participants at baseline and after 24 weeks of intervention. The structural MRI data were processed with MRIConvert (version 2.0 Rev. 235) and FreeSurfer (version 6.0.0) software. Data analyses were performed using the independent sample t tests/Mann-Whitney U tests with the Bonferroni correction, mixed linear model, correlation, or mediation analysis by the SPSS 24.0 software (IBM Corp, Armonk, NY, United States).

Results

After 24 weeks of intervention, a statistically significant increase was found for the Montreal Cognitive Assessment (MoCA) scores (p = 0.002) with a large effect size (Cohen's d = 0.94) and the significant interaction effect (P _{goup × time} < 0.05), Memory Quotient (MQ) scores (p = 0.019) with a medium effect size (Cohen's d = 0.688) and the significant interaction effect (P _{goup × time} < 0.05), and other parameters of WMS-RC test including pictures (p = 0.042), recognition (p = 0.017), and association (p = 0.045) test with a medium effect size (Cohens' d = 0.592, 0.703, and 0.581) for the Baduanjin training group, while significant decrease for the Edmonton Frailty Scale (EFS) score (p = 0.022), with a medium effect size (Cohen's d = -0.659) and the significant interaction effect (P _{goup × time} < 0.05) for the Baduanjin training group. The differences in the left parasubiculum, Hippocampal Amygdala Transition Area (HATA), right Cornu Ammonis Subfield 1 (CA1) and presubiculum volumes from baseline to 24 weeks after intervention in the Baduanjin training group were significantly greater than those in the control group (p < 0.05/12). Further analysis showed that the changes in right CA1 volume were positively correlated with the changes in MoCA and MQ scores (r = 0.510, p = 0.015; r = 0.484, p = 0.022;), the changes in right presubiculum and left parasubiculum volumes were positively correlated with the changes in MQ (r = 0.435, p = 0.043) and picture test scores (r = 0.509, p = 0.016), respectively, and the changes in left parasubiculum and HATA volumes were negatively correlated with the changes in EFS scores (r = -0.534, p = 0.011; r = -0.575, p = 0.005) in the Baduanjin training group, even after adjusting for age, sex, years of education and marital status; furthermore, the volume changes in left parasubiculum and left HATA significantly mediated the Baduanjin exercise training-induced decrease in the EFS scores (β = 0.376, 95% CI 0.024 ~ 0.947; β = 0.484, 95% CI 0.091 ~ 0.995); the changes of left parasubiculum and right CA1 significantly mediated the Baduanjin exercise training-induced increase in the picture and MO scores (β = -0.83, 95% CI-1.95 ~ -0.002; β = -2.44, 95% CI-5.99 ~ -0.32).

Conclusion

A 24-week Baduanjin exercise intervention effectively improved cognitive ability and reduced physical frailty in community-dwelling older adults with cognitive frailty, and the mechanism might be associated with modulating the structural plasticity of the hippocampal subregion.

Effects of Exercise Training on Neurotrophic Factors and Blood-Brain Barrier Permeability in Young-Old and Old-Old Women

Aging and regular exercise may have opposite effects on brain health, and although oxidative stress and sirtuins may be involved in these effects, studies on this topic are limited. Accordingly, the present study aimed to verify the effect of exercise training on oxidant-antioxidant balance, neurotrophic factors, blood-brain barrier permeability, and sirtuins in young-old and old-old women. The study participants were 12 women aged 65-74 years (Young-Old group) and 12 women aged 75-84 years (Old-Old group). All of the selected participants performed exercise training consisting of treadmill walking and resistance band exercise three times a week for 12 weeks. Blood samples were collected before and after exercise training to analyze serum oxidant-antioxidant markers (reactive oxygen species [ROS], superoxide dismutase [SOD]), neurotrophic factor (brain-derived neurotrophic factor [BDNF], vascular endothelial growth factor [VEGF]) levels, and blood-brain barrier permeability marker (S100 calcium-binding protein β [S100β], matrix metalloproteinase-9 [MMP-9]) levels, and sirtuin (SIRT-1, SIRT-2, SIRT-3) levels. The Young-Old group showed significantly increased SOD, BDNF, VEGF, SIRT-1, and SIRT-3 levels after training in comparison with the levels before training (p < 0.05), and a significantly higher BDNF level than the Old-Old group after training (p < 0.05). On the other hand, the Old-Old group showed significantly higher SIRT-1 levels after training in comparison with the levels before training (p < 0.05). Thus, exercise training may be effective in increasing the levels of neurotropic factors and reducing blood-brain barrier permeability in the elderly women, and increased antioxidant capacity and elevated levels of sirtuins are believed to play a major role in these effects. The positive effect of exercise may be greater in participants of relatively young age.

Effectiveness of a multicomponent exercise training program for the management of delirium in hospitalized older adults using near-infrared spectroscopy as a biomarker of brain perfusion: Study protocol for a randomized controlled trial

Delirium is an important cause of morbidity and mortality in older adults admitted to hospital. Multicomponent interventions targeting delirium risk factors, including physical exercise and mobilization, have been shown to reduce delirium incidence by 30-40% in acute care settings. However, little is known about its role in the evolution of delirium, once established. This study is a randomized clinical trial conducted in the Acute Geriatric Unit of Hospital Universitario de Navarra (Pamplona, Spain). Hospitalized patients with delirium who meet the inclusion criteria will be randomly assigned to the intervention or the control group. The intervention will consist of a multicomponent exercise training program, which will be composed of supervised progressive resistance and strength exercise over 3 consecutive days. Functional Near-Infrared Spectroscopy (NIRS) will be used for assessing cerebral and muscle tissue blood flow. The objective is to assess the effectiveness of this intervention in modifying the following primary outcomes: duration and severity of delirium and functional status. This study will contribute to determine the effectiveness of physical exercise in the management of delirium. It will be the first study to evaluate the impact of a multicomponent intervention based on physical exercise in the evolution of delirium.

Clinical trial registration

ClinicalTrials.gov. identifier: NCT05442892 (date of registration June 26, 2022).

A Systematic Study into the Effects of Long-Term Multicomponent Training on the Cognitive Abilities of Older Adults with Neurodegenerative Disorders

Cognition includes all processes through which a person becomes aware of their situation, needs, goals, and necessary actions. Regular specialized cognitive and neuromotor simulation exercises have improved various cognitive processes, including memory, speed of reasoning, and problem-solving skills. This review focuses on understanding the efficacy of long-term multicomponent exercise interventions to mitigate and delay the effects on cognitive abilities in older adults with neurodegenerative disorders. The main criteria for final studies were randomised controlled trials with a minimum of a 24-week intervention. The Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS, B-On, Sport Discus, Scielo, APA PsycINFO, Psychology and Behavioural Sciences, Academic Search Complete, Medline (PubMed), ERIC, and Google Scholar databases were checked. The search occurred between April 2022 and July 2022. A total of 19 studies were used in this review. The initial search identified 6.835 studies. In the first screening, a total of 6474 studies were excluded. After this, 361 studies were analysed by co-authors and did not meet the specific final criteria and were excluded. In total, 19 studies were included in the final analysis, and 14 papers met all requirements previously defined.