Aerobic Exercise Training Improves Cerebral Blood Flow and Executive Function: A Randomized, Controlled Cross-Over Trial in Sedentary Older Men

Optimal intensity and dose of exercise to improve university students' mental health: a systematic review and network meta-analysis of 48 randomized controlled trials

BACKGROUND

A systematic evaluation and network meta-analysis (NMA) using randomized controlled trials (RCTs) was conducted to investigate the effects of different exercise intensities and dosages on the mental health of college students.

METHODS

A systematic search of eight electronic databases of RCTs involving mental health exercise interventions for college students was conducted, which included data from the inception of the databases through July 2024. Two independent reviewers assessed the quality of the literature. Pairwise, network, and dose‒response meta-analyses were conducted via random-effects models to analyze the effects of exercise on college students' mental health.

RESULTS

A total of 48 RCTs (3951 patients) were included. Light, moderate, and vigorous exercise were all significantly effective at reducing symptoms of depression, anxiety and stress, whereas very light exercise was only effective at reducing symptoms of depression and stress. Surface under the cumulative ranking curve (SUCRA) probability ranking revealed that vigorous exercise had the highest probability of being the best intervention intensity to improve depression and stress symptoms, and the best exercise intensity to improve anxiety symptoms was moderate. The minimum threshold for overall exercise intervention for depressive symptoms was 150 METs-min per week, the benefits provided after doses above 1300 METs-min per week were less pronounced, and the predicted maximum significant response dose was 860 METs-min per week, which was the same as the predicted data for moderate exercise.

CONCLUSION

Very light, light, moderate, and vigorous exercise are all potentially effective exercise intensities for improving the mental health of college students, with no significant difference in effectiveness across the four exercise intensities. SUCRA rankings revealed that vigorous exercise is the most effective intervention for depression and stress and that moderate exercise is the most effective intervention for anxiety. Exercise interventions for depressive symptoms have a low dosage threshold, are simple and easy to administer, and are good treatments for psychological problems in college students.

The effects of stretching in Parkinson's disease: A systematic review of randomized controlled trials

INTRODUCTION

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterized by motor and non-motor symptoms. While incurable, exercise has shown therapeutic benefits. Stretching, an accessible and low-cost modality, may improve mobility, balance, and flexibility, warranting systematic evaluation for managing PD symptoms. This systematic review aimed to examine and critically analyze scientific evidence on the effects of stretching in people with Parkinson's disease.

METHODS

A search was conducted in four electronic databases (Scopus, Web of Science, PEDro, and MEDLINE/PubMed) from inception to November 2024. The methodological quality of included studies was assessed using the PEDro scale.

RESULTS

Twelve randomized controlled trials were analyzed. Stretching programs lasted 4 weeks to 6 months. Positive effects were observed in motor symptoms and functional mobility for people with PD, although these were generally less pronounced compared to interventions like Tai Chi or WuQinXi Qigong. In contrast, mixed results to no significant improvements were observed for balance, gait, strength, cardiorespiratory fitness, mental health, neurocognitive function, sleep quality, physical activity levels, and fatigue.

CONCLUSION

Stretching improves motor symptoms and mobility in people with PD, but its benefits for gait, motor function, and mental health are limited compared to other exercises. Further studies are needed to assess its impact on motor and neurocognitive functions.

Cardiac output-mediated regulation of cerebral blood flow during exercise: Clinical perspectives on the indirect impact of muscle metaboreflex

The muscle metaboreflex stimulates the elevation of arterial blood pressure, aiming to rectify the oxygen deficit by enhancing oxygen delivery to support muscle activity. Moreover, activating the muscle metaboreflex significantly increases cardiac output (CO) by increasing factors such as heart rate, ventricular contractility, preload, stroke volume and mobilization of central blood volume. Previous studies indicate that ageing and cardiovascular diseases modify the muscle metaboreflex during exercise, limiting the ability to increase CO during physical activity. Alongside reduced exercise capacity, the attenuated rise in CO due to abnormal muscle metaboreflex in these patients impedes the increase in cerebral blood flow during exercise. Considering that CO plays a pivotal role in regulating cerebral blood flow adequately during exercise, this occurrence might contribute to an elevated risk of cerebral diseases, and it could also, at least, reduce the effective role of exercise in preventing cerebral disease and dementia among elderly individuals and patients with cardiovascular conditions. Therefore, it is important to consider this phenomenon when optimizing the effectiveness of exercise rehabilitation in patients with cardiovascular disease to prevent cerebral diseases and dementia.

Carnitine supplementation improves insulin sensitivity and skeletal muscle acetylcarnitine formation in patients with type 2 diabetes

AIM/HYPOTHESIS

Recently, we reported that increasing free carnitine availability resulted in elevated skeletal muscle acetylcarnitine concentrations and restored metabolic flexibility in individuals who have impaired glucose tolerance. Metabolic flexibility is defined as the capacity to switch from predominantly fat oxidation while fasted to carbohydrate oxidation while insulin stimulated. Here we investigated if carnitine supplementation enhances the capacity of skeletal muscle to form acetylcarnitine and thereby improves insulin sensitivity and glucose homeostasis in patients with type 2 diabetes (T2DM).

METHODS

Thirty-two patients followed a 12-week L-carnitine treatment (2970 mg/day, orally). Insulin sensitivity was assessed by a two-step hyperinsulinemic-euglycemic clamp. In vivo skeletal muscle acetylcarnitine concentrations at rest and post-exercise (30 min, 70% Wmax) and intrahepatic lipid content (IHL) were determined by proton magnetic resonance spectroscopy (1H-MRS). All measurements were performed before and after 12 weeks of carnitine supplementation.

RESULTS

Compliance with the carnitine supplementation was good (as indicated by increased plasma-free carnitine levels (p < 0.01) and pill count (97.1 ± 0.7%)). Insulin-induced suppression of endogenous glucose production (31.9 ± 2.9 vs. 39.9 ± 3.2%, p = 0.020) and peripheral insulin sensitivity (Δ rate of glucose disappearance (ΔRd): 10.53 ± 1.85 vs. 13.83 ± 2.02 μmol/kg/min, p = 0.005) improved after supplementation. Resting (1.18 ± 0.13 vs. 1.54 ± 0.17 mmol/kgww, p = 0.008) and post-exercise (3.70 ± 0.22 vs. 4.53 ± 0.30 mmol/kgww, p < 0.001) skeletal muscle acetylcarnitine concentrations were both elevated after carnitine supplementation. Plasma glucose (p = 0.083) and IHL (p = 0.098) tended to be reduced after carnitine supplementation.

CONCLUSION

Carnitine supplementation improved insulin sensitivity and tended to lower IHL and fasting plasma glucose levels in patients with type 2 diabetes. Furthermore, carnitine supplementation increased acetylcarnitine concentration in muscle, which may underlie the beneficial effect on insulin sensitivity.

Effects of Tai Chi on executive function, single-leg dynamic balance, and brain functional connectivity in older adults

Although previous studies have confirmed the beneficial effects of Tai Chi Chuan (TCC) on improving balance ability and cognitive function in older adults, the synergistic regulatory mechanisms of TCC on bilateral lower limb muscle activation symmetry, brain functional connectivity(FC) strength, and dynamic balance ability remain unclear. This study aims to investigate the effects of a 9-week TCC training program on the executive function (EF), bilateral lower limb muscle activation symmetry, single-leg dynamic balance ability, and brain FC strength in elderly individuals. It provides valuable new insights into a field that has not been extensively explored before. After 9-week training intervention, (1) The TCC group showed significant improvements in the Y-balance Test (YBTs), with enhanced symmetry in single-leg dynamic balance between the bilateral lower limbs and a significant reduction in the laterality of lower limb muscle activation. (2) TCC training strengthened the FC of related brain regions during YBTs. When performing YBTs with the left and right legs separately, the laterality of the average brain FC strength between the two tasks was significantly reduced. (3) During EF tasks, the reaction time was significantly reduced, and the concentration of oxygenated hemoglobin in the prefrontal cortex increased. Studies have shown that TCC has significantly superior intervention effects compared to brisk walking in improving neuromuscular function in older adults. Through its multisensory integration training model, TCC simultaneously enhances neuromuscular coordination and brain network collaboration efficiency, promoting the adaptive reorganization of dynamic balance control.

Aerobic capacity moderates the association between cervical cord atrophy and clinical disability in mildly disabled multiple sclerosis patients

BACKGROUND

Spinal cord volume loss is associated with clinical disability in multiple sclerosis (MS). Aerobic capacity may mitigate the impact of central nervous system (CNS) damage accumulation, exerting beneficial effects on MS-related disability.

OBJECTIVES

We investigated whether aerobic capacity could moderate the association between spinal cord atrophy and clinical disability in MS.

METHODS

In this cross-sectional analysis, expanded disability status scale (EDSS), peak of oxygen consumption (VO2peak), brain volumetric measures, and the normalized mean upper cervical cord area (nMUCCA) were collected from 51 MS patients and 33 healthy controls (HCs). Low aerobic capacity was defined as having a VO2peak z-score less than -1.64 standard deviations. In MS patients, we explored whether the association between nMUCCA and EDSS is moderated by the level of aerobic capacity.

RESULTS

The relationship between nMUCCA and EDSS was moderated by aerobic capacity, with a significant nMUCCA × aerobic capacity interaction (β = -0.099, 95% bootstrapped confidence interval [CI] = [-0.172; -0.014], p = 0.012). Lower nMUCCA was significantly associated with higher EDSS score in MS patients with low aerobic capacity (β = -0.073, p < 0.001), but not in those with high aerobic capacity (β = 0.026, p = 0.417).

CONCLUSIONS

In MS patients with mild disability, higher aerobic capacity can potentially mitigate the negative impact of spinal cord damage on clinical disability.

Physical function, functional capacity, cognition, and brain structure and function in older adults with chronic kidney disease (CKD)

OBJECTIVE

To evaluate associations between brain structure/function with physical function and functional capacity in older adults with CKD and cognitive complaints.

METHODS

We evaluated associations between neuroimaging and cognitive function with functional capacity and physical function in older adults (60-80years) with CKD and cognitive complaints (n = 39; age 67.6 years).

RESULTS

In multivariable analysis, each standard deviation (SD) increase in 6-minute walk test (6MWT) distance (functional capacity) was associated with better attention/information processing (Trails Making Test-A (TMT-A) (ß -10.86, 95% Confidence Interval (CI) -16.67, -5.06); digit symbol test (ß 5.24, 95% CI 1.02, 9.46)), and each SD increase in short physical performance battery (SPPB)(physical function) was associated with better attention/information processing (TMT-A) (ß -10.99, 95% CI -16.59, -5.39). 6MWT distance and SPPB were associated with some indicators of brain structure/diffusivity.

CONCLUSION

In older adults with CKD and cognitive complaints, functional capacity and physical function may be associated with cognition and brain structure/function.

Association between physical activity and cognitive function in a multi-ethnic Asian older adult population

Physical activity (PA) is regarded as a non-pharmacological preventive strategy against cognitive decline. This study aimed to examine the relationship between PA and cognitive function in cognitively normal older Malaysian adults from a multi-ethnic, urban-dwelling community. Participants completed a questionnaire with questions on demographic details, socioeconomic status, health conditions, and short form of the International Physical Activity Questionnaire (IPAQ). Bivariate analyses and hierarchical linear regression were conducted to examine the relationship between IPAQ and Montreal Cognitive Assessment (MoCA) scores. Among the 382 participants (median age = 66 years), 51.6% were female. Median MoCA score was 24; and IPAQ levels were 28%, 39% and 33% 'Low', 'Moderate' and 'High' respectively. Bivariate analysis showed MoCA scores significantly differed across IPAQ levels (p-value < 0.001). Pairwise comparisons showed significant differences between MoCA scores and 'High' and 'Low' (p-value < 0.001) and 'Moderate' and 'Low' (p-value = 0.001) IPAQ levels. Hierarchical regression of potential confounding factors showed that while lower PA, being older, being Malay and hypertension were initially associated with lower MoCA scores, the association was explained by the greater influence of education and savings. Additional research is required to gain a more comprehensive understanding of these relationships.

Optimal dose and type of exercise improve walking velocity in adults with Parkinson's disease: a systematic review and Bayesian network meta-analysis

To examine the dose-response relationship between specific types of exercise for improving walking velocity in Parkinson's disease (PD). This systematic review and network meta-analysis included searches of PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 18th, 2024. Data analysis was performed using R software with the MBNMA and RJAGS packages. Outcome indicators were measured as mean standard deviation (SMD) along with 95% confidence intervals (95% CrI). The network's risk of bias was independently evaluated by two reviewers employing the ROB2 tool. Our review encompassed 54 studies with 2,828 PD patients, examining the dose-response effects of different exercises on walking velocity. Aerobic Exercise (AE) demonstrated the greatest improvement at an optimal dose of 1,400 METs-min/week (SMD:1.215, 95% Crl: 0.113 to 2.306). Both Multicomponent Exercise (Mul) (SMD: 1.202, 95% Crl: 0.193 to 2.231) and Sensory Exercise (SE) (SMD: 0.649, 95% Crl: 0.139 to 1.183) showed optimal outcomes at a dose of 1,000 METs-min/week. Resistance Training (RT) was most effective at 750 METs-min/week (SMD:0.778, 95% Crl: 0.062 to 1.549), while Mind-Body Exercise (MBE) yielded significant improvements at a lower optimal dose of 500 METs-min/week (SMD: 0.580, 95% Crl: 0.218 to 1.137), offering valuable insights for exercise prescription in PD management. Various types of exercise showed specific optimal benefits at corresponding doses, among which AE was the most effective in improving the walking speed of PD patients at 1,400 Mets*min/week.Trial registration: PROSPERO (CRD42024506919).

Neural mechanisms underlying cognitive impairment in depression and cognitive benefits of exercise intervention

Depression is associated with functional brain impairments, although comprehensive studies remain limited. This study reviews neural mechanisms underlying cognitive impairment in depression and identifies associated activation abnormalities in brain regions. The study also explores the underlying neural processes of cognitive benefits of exercise intervention for depression. Executive function impairments, including working memory, inhibitory control and cognitive flexibility are associated with frontal cortex and anterior cingulate areas, especially dorsolateral prefrontal cortex. Depression is associated with certain neural impairments of reward processing, especially orbitofrontal cortex, prefrontal cortex, nucleus accumbens and other striatal regions. Depressed patients exhibit decreased activity in the hippocampus during memory function. Physical exercise has been found to enhance memory function, executive function, and reward processing in depression patients by increasing functional brain regions and the brain-derived neurotrophic factor (BDNF) as a nutritional factor also plays a key role in exercise intervention. The study documents neurophysiological mechanisms behind exercise intervention's improved functions. In summary, the study provides insights into neural mechanisms underlying cognitive impairments in depression and the effectiveness of exercise as a treatment.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

Impacts of APOE-ε4 and exercise training on brain microvascular endothelial cell barrier function and metabolism

BACKGROUND

The APOE-ε4 genotype is the highest genetic risk factor for Alzheimer's disease (AD), and exercise training can reduce the risk of AD. Two early pathologies of AD are degradation of tight junctions between brain microvascular endothelial cells (BMEC) and brain glucose hypometabolism. Therefore, the objective of this work was to determine how the APOE-ε4 genotype and serum from exercise trained individuals impacts BMEC barrier function and metabolism.

METHODS

iPSC homozygous for the APOE-ε3 and APOE-ε4 alleles were differentiated to BMEC-like cells and used to measure barrier function and metabolism. To investigate exercise effects, serum was collected from older adults pre- and post- 6 months of exercise training (n = 9 participants per genotype). APOE-ε3 and APOE-ε4 BMEC were treated with genotype-matched serum, and then barrier function and metabolism were measured.

FINDINGS

APOE-ε4 genotype impaired BMEC barrier function and metabolism by reducing sirtuin 1 (SIRT1) levels by 27% (p = 0.0188) and baseline insulin signalling by 37% (p = 0.0186) compared to APOE-ε3 BMEC. Exercise-trained serum increased SIRT1 by 33% (p = 0.0043) in APOE-ε3 BMEC but decreased SIRT1 by 22% (p = 0.0004) in APOE ε4 BMEC.

INTERPRETATION

APOE-ε4 directly impairs glucose metabolism and barrier function. Serum from exercise trained individuals alters SIRT1 in a genotype-dependent manner but may require additional cues from exercise to decrease AD pathologies.

FUNDING

Brain and Behaviour Initiative at the University of Maryland through the Seed Grant Program, NSF-GRFP DGE 1840340, Fischell Fellowship in Biomedical Engineering, NSF CBET-2211966 and DGE-1632976, National Niemann-Pick Disease Foundation, University of Maryland ASPIRE Program, NIH R01HL165193, R01HL140239-01, and R01AG057552.

The efficacy of exercise interventions on depressive symptoms and cognitive function in adults with depression: An umbrella review

OBJECTIVE

This umbrella review aims to consolidate the evidence concerning the influence of exercise on depressive symptoms and cognitive performance in adults diagnosed with depression.

METHODS

An umbrella review of systematic reviews with meta-analyses investigating the effect of exercise on depression and cognition was performed. Databases (PubMed, Cochrane Library, Web of Science, Embase) were searched from inception until February 2024 for reviews of randomized controlled trials. Overlap within included reviews was assessed using the corrected covered area method (CCA). A random effects model was used to calculate overall pooled effect size with sub-analyses.

RESULTS

This study included 27 reviews, encompassing 190 experiments. In patients with depression, compared to the control group, exercise demonstrated a moderate effect size in reducing depressive symptoms (SMD = -0.67; SE = 0.04; p < 0.0001), with a Number Needed to Treat (NNT) of 2.78. When analyses were limited to data from studies with a low risk of bias, the effect on depressive symptoms was smaller (SMD = -0.38; SE = 0.07; p < 0.0001; NNT = 4.72). Exercise had a small effect on cognitive functions (SMD = 0.12; SE = 0.03; p < 0.0001), with an NNT for cognitive function treatment of 14.79.

CONCLUSIONS

All forms of exercise benefit patients with depression. However, for optimal intervention outcomes, it is essential to customize the intensity and type of exercise according to the specific characteristics of the patient's depressive symptoms and cognitive functions. It is recommended to implement a phased treatment approach for patients based on the intensity of exercise.

Age and Sex-Related Differences in Neuroprotective Effects of Cardiovascular Endurance on Cortical Thickness and Brain Volume in Adults Across Age

BACKGROUND

Higher cardiorespiratory fitness and cardiovascular endurance (CE) have been shown to be neuroprotective in older adulthood, but the mechanisms underlying this neuroprotection across the adult lifespan are poorly understood. The current study sought to examine the neuroprotective effects of CRF on gray matter (GM) and white matter (WM) volumes, and mean cortical thickness (MCT), using a large sample across the adult lifespan. We also examined sex differences in these relationships.

METHODS

This cross-sectional study included data from 1691 adults across the adult lifespan (22-100 years) from the Human Connectome Project Young Adults and Aging data. 2-minute walk test performance was used as a proxy of CE. Structural MRI was used to assess total GM volume, WM volume, and MCT. Linear regression models were used to examine the interaction between age and CE on total GM volume, WM volume, and MCT after adjusting for sex, years of education, body mass index, systolic blood pressure, gait speed, and total intracranial volume. Whole-brain surface-based analysis was also performed to investigate regional effects. Finally, interactions between age, sex, and CE were examined to test sex differences. p < 0.05, two-sided test, was designed as statistically significant.

RESULTS

With greater CE, the associations between greater age and lower total and regional GM and WM volumes and MCT were attenuated in whole sample. In men, age was associated with lower total GM volume and MCT regardless of CE level. In women, attenuated negative associations between age and total GM volume and MCT were found in those with high CE.

CONCLUSION

Greater CE over the adult lifespan is associated with preservation of cortical thickness and brain volume, particularly in women.

Cerebral blood flow and arterial transit time responses to exercise training in older adults

Brain vascular health worsens with age, as is made evident by resting grey matter cerebral blood flow (CBFGM) reductions and lengthening arterial transit time (ATTGM). Exercise training can improve aspects of brain health in older adults, yet its effects on CBFGM and ATTGM remain unclear. This randomised controlled trial assessed responses of CBFGM and ATTGM to a 26 week exercise intervention in 65 healthy older adults (control: n = 33, exercise: n = 32, aged 60-81 years), including whether changes in CBFGM or ATTGM were associated with changes in cognitive functions. Multiple-delay pseudo-continuous arterial spin labelling data were used to estimate resting global and regional CBFGM and ATTGM. Results showed no between-group differences in CBFGM or ATTGM following the intervention. However, exercise participants with the greatest cardiorespiratory gains (n = 17; ∆V̇O2peak >2 mL/kg/min) experienced global CBFGM reductions (-4.0 [-7.3, -0.8] mL/100 g/min). Cognitive functions did not change in either group and changes were not associated with changes in CBFGM or ATTGM. Our findings indicate that exercise training in older adults may induce global CBFGM reductions when high cardiorespiratory fitness gains are induced, but this does not appear to affect cognitive functions.

Determinants of cerebral blood flow and arterial transit time in healthy older adults

Cerebral blood flow (CBF) and arterial transit time (ATT), markers of brain vascular health, worsen with age. The primary aim of this cross-sectional study was to identify modifiable determinants of CBF and ATT in healthy older adults (n = 78, aged 60-81 years). Associations between cardiorespiratory fitness and CBF or ATT were of particular interest because the impact of cardiorespiratory fitness is not clear within existing literature. Secondly, this study assessed whether CBF or ATT relate to cognitive function in older adults. Multiple post-labelling delay pseudo-continuous arterial spin labelling estimated resting CBF and ATT in grey matter. Results from multiple linear regressions found higher BMI was associated with lower global CBF (β = -0.35, P = 0.008) and a longer global ATT (β = 0.30, P = 0.017), global ATT lengthened with increasing age (β = 0.43, P = 0.004), and higher cardiorespiratory fitness was associated with longer ATT in parietal (β = 0.44, P = 0.004) and occipital (β = 0.45, P = 0.003) regions. Global or regional CBF or ATT were not associated with processing speed, working memory, or attention. In conclusion, preventing excessive weight gain may help attenuate age-related declines in brain vascular health. ATT may be more sensitive to age-related decline than CBF, and therefore useful for early detection and management of cerebrovascular impairment. Finally, cardiorespiratory fitness appears to have little effect on CBF but may induce longer ATT in specific regions.

Long-term effects of an egg-protein hydrolysate on cognitive performance and brain vascular function: a double-blind randomized controlled trial in adults with elevated subjective cognitive failures

PURPOSE

Short-term intake of the egg-protein hydrolysate Newtricious (NWT)-03 improved executive function, but underlying mechanisms and long-term effects, including other cognitive domains, are unknown.

METHODS

A 36-week randomized controlled trial involving 44 overweight/obese individuals experiencing elevated Subjective Cognitive Failures (SCF; aged 60-75 years) assessed the impact of daily consumption of 5.7 g of NWT-03 or placebo powders on cognitive performance (psychomotor speed, executive function, memory) and Cerebral Blood Flow (CBF), a marker of brain vascular function. Cognitive performance was evaluated using a neurophysiological test battery (CANTAB) and CBF was measured using magnetic resonance imaging perfusion method Arterial Spin Labeling (ASL). Serum samples were collected to determine brain-derived neurotrophic factor (BDNF) concentrations.

RESULTS

Anthropometrics, and energy and nutrient intakes remained stable throughout the trial. NWT-03 was well tolerated, and compliance was excellent (median: 99%; range: 87-103%). No overall intervention effects were observed on cognitive performance or CBF, but post-hoc analyses revealed significant improvements on executive function in women, but not men. Specifically, a reduction of 74 ms in reaction latency on the multitasking task (95% CI: -134 to -15; p = 0.02), a reduction of 9 between errors (95%CI: -14 to -3; p < 0.001), and a reduction of 9 total errors (95%CI: -15 to -3; p < 0.001) on the spatial working memory task were found in women. No intervention effects were observed on serum BDNF concentrations (p = 0.31).

CONCLUSION

Long-term consumption of NWT-03 improved multitasking abilities and working memory in women with elevated SCF. Brain vascular function remained unaffected. Sex differences in executive function require additional clarification.

A 10-min reduction in cerebral blood flow does not alter post-intervention executive function: evidence from lower-body negative pressure

A single bout of exercise as well as exposure to a hypercapnic environment increases cerebral blood flow (CBF) and is an adaptation linked to a post-intervention executive function (EF) benefit. In the present investigation we sought to determine whether a transient reduction in CBF impairs EF. Accordingly, we employed 10-min -30 mmHg and  -50 mmHg lower-body negative pressure (LBNP) interventions as well as a non-LBNP control condition. LBNP was employed because it sequesters blood in the lower legs and safely and reliably decreases CBF. Transcranial Doppler ultrasound was used to measure middle cerebral artery velocity (MCAv) to estimate CBF prior to and during LBNP conditions. As well, assessments of the inhibitory control component of EF (i.e., antipointing) were completed prior to (pre-) and immediately after (i.e., post-) each condition. Antipointing requires that an individual reach mirror-symmetrical to an exogenously presented target and is a task providing the resolution to detect subtle EF changes. Results showed that LBNP produced a 14% reduction in MCAv; however, null hypothesis, equivalence and Bayesian contrasts indicated that antipointing metrics did not vary from pre- to post-intervention, and LBNP-based changes in MCAv magnitude were not reliably correlated with antipointing planning times. Hence, a 10-min reduction in CBF did not impact the efficiency or effectiveness of an inhibitory control measure of EF.

Hemodynamics of short-duration light-intensity physical exercise in the prefrontal cortex of children: a functional near-infrared spectroscopy study

Identifying the types of exercise that enhance cerebral blood flow is crucial for developing exercise programs that enhance cognitive function. Nevertheless, few studies have explored the amount of light-intensity, short-duration exercises that individuals can easily perform on cerebral blood flow, particularly in children. We examined the effects of these exercises on the hemodynamics of the prefrontal cortex (PFC) using functional near-infrared spectroscopy. Participants comprised 41 children (aged 12.1 ± 1.5 years, 37% female) who engaged in seven light-intensity exercises, with each movement performed in two patterns lasting 10 or 20 s. Changes in oxygenated hemoglobin (oxy-Hb) levels at rest and during exercise were compared using analysis of covariance, with sex and age as covariates. Significant increases in oxy-Hb were observed in multiple regions of the PFC during all forms of exercise (including dynamic and twist stretching [66.6%, 8/12 regions, η2 = 0.07-0.27], hand and finger movements [75.0%, 9/12 regions, η2 = 0.07-0.16], and balance exercises (100.0%, 6/6 regions, η2 = 0.13-0.25]), except for static stretching with monotonic movements. This study implies that short-duration, light-intensity exercises, provided that they entail a certain degree of cognitive and/or physical demands, can activate the PFC and increase blood flow.

The effects of moderate-intensity aerobic exercise on cognitive function in individuals with stroke-induced mild cognitive impairment: a randomized controlled pilot study

OBJECTIVE

To assess the impact of moderate-intensity aerobic exercise on working memory in stroke-induced mild cognitive impairment (MCI).

DESIGN

Randomized, double-blind controlled study.

SUBJECTS AND METHODS

Twenty MCI patients from the Fifth Affiliated Hospital of Guangzhou Medical University (December 2021 to February 2023), aged 34-79, 2-12 months post-stroke, were divided into an experimental group (EG) and a control group (CG), each with 10 participants. The EG underwent standard rehabilitation plus 40 minutes of aerobic exercise, while the CG received only standard therapy, 5 times weekly for 2 weeks. Working memory was tested using the n-back task, and overall cognitive function was measured with the MOCA and MMSE Scales before and after the intervention.

RESULTS

The EG showed higher 3-back correctness (71.80 ± 14.53 vs 56.50 ± 13.66), MOCA scores (27.30 ± 1.57 vs 24.00 ± 3.13), and improved visuospatial/executive (4.60 ± 0.52 vs 3.30 ± 1.06) and delayed recall (4.30 ± 0.82 vs 3.00 ± 1.56) on the MOCA scale compared with the CG.

CONCLUSION

Moderate-intensity aerobic exercise may enhance working memory, visuospatial/executive, and delayed recall functions in stroke-induced MCI patients.

Physical Exercise and Executive Function in the Pediatric Overweight and Obesity Population: A Systematic Review Protocol

BACKGROUND

Executive function is often altered in overweight/obese children and adolescents, which has a negative impact on their learning and daily life. Furthermore, research has shown the benefits of physical exercise in improving cognitive performance. This protocol aims to define in a detailed and structured manner the procedures that will be conducted for the development of a systematic review of the literature aimed at evaluating the effects of physical exercise on the executive functions of children and adolescents (≤18 years) with overweight/obesity in comparison with peers in control groups.

METHODS

The Web of Science, PubMed, Scopus, and EBSCO databases will be searched for longitudinal studies that have at least one experimental and one control group using pre- and post-intervention measures of executive function, including working memory, inhibition, and cognitive flexibility in the pediatric population who are overweight or obese. The risk of bias and certainty of evidence will be assessed using Cochrane RoB2 and GRADE, respectively. Furthermore, Der Simonian-Laird's random effects model will be employed for meta-analyses. The effect sizes will be calculated with 95% confidence intervals, and p values < 0.05 indicate statistical significance for each dimension of executive function in the different groups before and after the intervention.

DISCUSSION

The results of this review may be useful for education and health professionals to design treatment plans for overweight/obese children and adolescents, offering potential benefits related to the learning and cognitive abilities of this population. PROSPERO registration number: CRD42023391420.

Effects of a brief HIIT intervention on cognitive performance in older women

Cardiorespiratory fitness (CRF) mitigates age-related decline in cognition and brain volume. Little is known, however, about the effects of high-intensity interval training (HIIT) on cognitive aging and the relationship between HIIT, cognition, hippocampal subfield volumes, and cerebral oxygen extraction fraction (OEF). Older sedentary women participated in an 8-week HIIT intervention. We conducted cognitive assessments, fitness assessments (VO2max), MRI scans: asymmetric spin echo oxygen extraction fraction (ASE-OEF), high-resolution multiple image co-registration and averaging (HR-MICRA) imaging, and transcranial Doppler ultrasonography before and after the intervention. VO2max increased from baseline (M = 19.36, SD = 2.84) to follow-up (M = 23.25, SD = 3.61), Z =  - 2.93, p < .001, r = 0.63. Composite cognitive (Z =  - 2.05, p = 0.041), language (Z =  - 2.19, p = 0.028), and visuospatial memory (Z =  - 2.22, p = 0.026), z-scores increased significantly. Hippocampal subfield volumes CA1 and CA3 dentate gyrus and subiculum decreased non-significantly (all p > 0.05); whereas a significant decrease in CA2 (Z =  - 2.045, p = 0.041, r = 0.436) from baseline (M = 29.51; SD = 24.50) to follow-up (M = 24.50; SD = 13.38) was observed. Right hemisphere gray matter was correlated with language z-scores (p = 0.025; r = 0.679). The subiculum was correlated with attention (p = 0.047; r = 0.618) and verbal memory (p = 0.020; r = 0.700). The OEF and CBF were unchanged at follow-up (all p > .05). Although we observed cognitive improvements following 8 weeks of our HIIT intervention, they were not explained by hippocampal, OEF, or CBF changes.

Exercise and Protection from Age-Related Cognitive Decline

In this chapter, we review the cross-sectional evidence in healthy human subjects for physical activity and cardiorespiratory fitness to offer neuroprotection and moderate cognitive decline in older age. The role of exercise training on cognition in healthy older adults and those diagnosed with mild cognitive impairment (MCI) is also discussed, including the evidence from neuroimaging studies that document changes to brain structure and function after a period of exercise training and improved fitness. Finally, in reference to animal models, the potential neurophysiological mechanisms for physical activity and exercise to impact human brain health are highlighted.

Effect of physio-cognitive dual-task training on cognition in pre-ageing and older adults with neurocognitive disorders: A meta-analysis and meta-regression of randomized controlled trial

Declines in cognitive performance, such as those seen in neurocognitive disorders (NCDs) are often associated with ageing. Both physical activity and cognitive training are common interventional strategies that can mitigate the decline in cognitive and physical performance. This review aims to (1) to evaluate the effects of Physio-Cognitive Dual-task Training (PCDT) intervention on cognition, physical performance, activities of daily living (ADL) and health-related quality of life (HRQoL) in pre-ageing and older adults with neurocognitive disorders, (2) explore the effects of covariates on intervention outcomes. A systematic search was conducted in eight databases. Cochrane's Risk of Bias Tool version 1 and GRADE criteria were used to assess risk of bias and certainty of evidence, respectively. Meta-analysis and meta-regression analyses were conducted using R software. Twenty-six randomized controlled trials involving 1,949 pre-ageing and older adults with NCDs were included in the meta-analysis. PCDT interventions had small-to-medium effect size on all cognition outcomes (g = 0.40-0.52) and instrumental ADL (g == 0.42), and a large effect size on HRQoL (g = 0.72). The quality of evidence was rated moderate to low for the outcome measures in pre-ageing and older adults with NCDs. These findings highlight the importance of PCDT interventions in preventing and slowing down cognitive impairment in pre-ageing and older adults. Registration: PROSPERO Number (CRD42020213962).

Cerebral blood flow and cerebrovascular reactivity are modified by maturational stage and exercise training status during youth

NEW FINDINGS

What is the central question of this study? Gonadal hormones modulate cerebrovascular function while insulin-like growth factor 1 (IGF-1) facilitates exercise-mediated cerebral angiogenesis; puberty is a critical period of neurodevelopment alongside elevated gonadal hormone and IGF-1 activity: but whether exercise training across puberty enhances cerebrovascular function is unkown. What is the main finding and its importance? Cerebral blood flow is elevated in endurance trained adolescent males when compared to untrained counterparts. However, cerebrovascular reactivity to hypercapnia is faster in trained vs. untrained children, but not adolescents. Exercise-induced improvements in cerebrovascular function are attainable as early as the first decade of life.

ABSTRACT

Global cerebral blood flow (gCBF) and cerebrovascular reactivity to hypercapnia (CV R C O 2 ${\mathrm{CV}}{{\mathrm{R}}_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ ) are modulated by gonadal hormone activity, while insulin-like growth factor 1 facilitates exercise-mediated cerebral angiogenesis in adults. Whether critical periods of heightened hormonal and neural development during puberty represent an opportunity to further enhance gCBF andCV R C O 2 ${\mathrm{CV}}{{\mathrm{R}}_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ is currently unknown. Therefore, we used duplex ultrasound to assess gCBF andCV R C O 2 ${\mathrm{CV}}{{\mathrm{R}}_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ in n = 128 adolescents characterised as endurance-exercise trained (males: n = 30, females: n = 36) or untrained (males: n = 29, females: n = 33). Participants were further categorised as pre- (males: n = 35, females: n = 33) or post- (males: n = 24, females: n = 36) peak height velocity (PHV) to determine pubertal or 'maturity' status. Three-factor ANOVA was used to identify main and interaction effects of maturity status, biological sex and training status on gCBF andCV R C O 2 ${\mathrm{CV}}{{\mathrm{R}}_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ . Data are reported as group means (SD). Pre-PHV youth demonstrated elevated gCBF and slowerCV R C O 2 ${\mathrm{CV}}{{\mathrm{R}}_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ mean response times than post-PHV counterparts (both: P ≤ 0.001). gCBF was only elevated in post-PHV trained males when compared to untrained counterparts (634 (43) vs. 578 (46) ml min-1 ; P = 0.007). However,CV R C O 2 ${\mathrm{CV}}{{\mathrm{R}}_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ mean response time was faster in pre- (72 (20) vs. 95 (29) s; P ≤ 0.001), but not post-PHV (P = 0.721) trained youth when compared to untrained counterparts. Cardiorespiratory fitness was associated with gCBF in post-PHV youth (r2  = 0.19; P ≤ 0.001) andCV R C O 2 ${\mathrm{CV}}{{\mathrm{R}}_{{\mathrm{C}}{{\mathrm{O}}_{\mathrm{2}}}}}$ mean response time in pre-PHV youth (r2  = 0.13; P = 0.014). Higher cardiorespiratory fitness during adolescence can elevate gCBF while exercise training during childhood primes the development of cerebrovascular function, highlighting the importance of exercise training during the early stages of life in shaping the cerebrovascular phenotype.

Examining sex differences in the association between sedentary behavior and cognitive function in bariatric surgery patients

BACKGROUND

Obesity is associated with cognitive impairment. A potential contributor to these deficits is sedentary behavior (SB), which is linked to poorer cognitive functioning in other populations. Little is known about the association between SB and cognitive function in bariatric surgery populations.

OBJECTIVES

This cross-sectional study examined the association between SB and cognitive function in preoperative bariatric surgery patients, as well as possible sex differences in this relationship.

SETTING

Data were collected at 2 health centers in the United States.

METHODS

A total of 121 participants (43.2 ± 10.3 yr of age) scheduled for Roux-en-Y gastric bypass or sleeve gastrectomy completed the National Institute of Health (NIH) Toolbox for the Assessment of Neurological and Behavioral Function Cognition Domain, a computerized neuropsychological assessment battery. Participants wore a waist-mounted accelerometer for 7 consecutive days to measure SB and light-intensity physical activity (LPA).

RESULTS

Pearson and partial correlations found no significant relationships between cognitive function and SB or LPA in the full sample. However, partial correlations controlling for LPA found that greater SB was associated with poorer performance on List Sorting Working Memory Test in women (r = -.28; P = .006), whereas there was a positive relationship between SB and Dimensional Change Card Sort for men (r = .51; P = .015; 95% CI [.25, .73]).

CONCLUSIONS

These results showed that greater SB, independent of LPA, is associated with poorer working memory in women and better set shifting ability in men. Future studies should examine the possibility of domain-specific cognitive effects associated with SB in bariatric surgery samples and clarify possible sex differences.

Exercise Reshapes the Brain: Molecular, Cellular, and Structural Changes Associated with Cognitive Improvements

Physical exercise is well known as a non-pharmacological and holistic therapy believed to prevent and mitigate numerous neurological conditions and alleviate ageing-related cognitive decline. To do so, exercise affects the central nervous system (CNS) at different levels. It changes brain physiology and structure, promoting cognitive improvements, which ultimately improves quality of life. Most of these effects are mediated by neurotrophins release, enhanced adult hippocampal neurogenesis, attenuation of neuroinflammation, modulation of cerebral blood flow, and structural reorganisation, besides to promote social interaction with beneficial cognitive outcomes. In this review, we discuss, based on experimental and human research, how exercise impacts the brain structure and function and how these changes contribute to cognitive improvements. Understanding the mechanisms by which exercise affects the brain is essential to understand the brain plasticity following exercise, guiding therapeutic approaches to improve the quality of life, especially in obesity, ageing, neurodegenerative disorders, and following traumatic brain injury.

Effortful and effortless training of executive functions improve brain multiple demand system activities differently: an activation likelihood estimation meta-analysis of functional neuroimaging studies

Both effortful and effortless training have been shown to be effective in enhancing individuals' executive functions. Effortful training improves domain-specific EFs, while effortless training improves domain-general EFs. Furthermore, effortful training has significantly higher training effects on EFs than effortless training. The neural mechanism underlying these different effects remained unclear. The present study conducted meta-analysis on neuroimaging studies to explore the changes of brain activations induced by effortful and effortless training. The results showed that effortful training induced greater activation in superior frontal gyrus, while effortless training induced greater activation in middle frontal gyrus, precuneus and cuneus. The brain regions of MD system enhanced by effortful training were more associated with core cognitive functions underlying EFs, while those enhanced by effortless training were more correlated with language functions. In addition, the significant clusters induced by effortful training had more overlaps with the MD system than effortless training. These results provided us with possibility to discuss the different behavioral results brought by effortful and effortless training.

Greater accelerometer-measured physical activity is associated with better cognition and cerebrovascular health in older adults

OBJECTIVES

Physical activity (PA) may help maintain brain structure and function in aging. Since the intensity of PA needed to effect cognition and cerebrovascular health remains unknown, we examined associations between PA and cognition, regional white matter hyperintensities (WMH), and regional cerebral blood flow (CBF) in older adults.

METHOD

Forty-three older adults without cognitive impairment underwent magnetic resonance imaging (MRI) and comprehensive neuropsychological assessment. Waist-worn accelerometers objectively measured PA for approximately one week.

RESULTS

Higher time spent in moderate to vigorous PA (MVPA) was uniquely associated with better memory and executive functioning after adjusting for all light PA. Higher MVPA was also uniquely associated with lower frontal WMH volume although the finding was no longer significant after additionally adjusting for age and accelerometer wear time. MVPA was not associated with CBF. Higher time spent in all light PA was uniquely associated with higher CBF but not with cognitive performance or WMH volume.

CONCLUSIONS

Engaging in PA may be beneficial for cerebrovascular health, and MVPA in particular may help preserve memory and executive function in otherwise cognitively healthy older adults. There may be differential effects of engaging in lighter PA and MVPA on MRI markers of cerebrovascular health although this needs to be confirmed in future studies with larger samples. Future randomized controlled trials that increase PA are needed to elucidate cause-effect associations between PA and cerebrovascular health.

Feasibility of performing a multi-arm clinical trial examining the novel combination of repetitive transcranial magnetic stimulation and aerobic exercise for post-stroke depression

BACKGROUND

Post-stroke depression (PSD) occurs in approximately one-third of chronic stroke survivors. Although pharmacotherapy reduces depressive symptoms, side effects are common and stroke survivors have increased likelihood of multimorbidity and subsequent polypharmacy. Thus, alternative non-pharmacological treatments are needed. Combining two non-pharmacological anti-depressant treatments, aerobic exercise (AEx) and repetitive transcranial magnetic stimulation (rTMS), has been demonstrated to be feasible and well-tolerated in chronic stroke survivors.

OBJECTIVES

The purpose of this trial was to determine the feasibility of conducting a multi-arm combinatorial trial of rTMS and AEx and to provide an estimate of effect size of rTMS+AEx on PSD symptoms.

METHODS

Twenty-four participants were allocated to one of four treatment arms AEx, rTMS, rTMS+AEx, or non-depressed Control receiving AEx. All participants received a total of 24 treatment sessions. Participant adherence was the primary outcome measure for feasibility and within group effect sizes in Patient Health Questionnaire-9 (PHQ-9) score was the primary outcome for preliminary efficacy.

RESULTS

Mean adherence rates to the exercise intervention for AEx, rTMS+AEx, and Control subjects were 83%, 98%, and 95%, respectively. Mean adherence rates for rTMS and rTMS+AEx subjects were 97% and 99%, respectively. The rTMS and rTMS+AEx treatment groups demonstrated clinically significant reductions of 10.5 and 6.2 points in PHQ-9 scores, respectively.

CONCLUSION

Performing a multi-arm combinatorial trial examining the effect of rTMS+AEx on PSD appears feasible. All treatment arms demonstrated strong adherence to their respective interventions and were well received. rTMS and the combination of AEx with rTMS may be alternative treatments for PSD.

Physical Exercise as Disease-Modifying Alternative against Alzheimer's Disease: A Gut-Muscle-Brain Partnership

Alzheimer's disease (AD) is a common cause of dementia characterized by neurodegenerative dysregulations, cognitive impairments, and neuropsychiatric symptoms. Physical exercise (PE) has emerged as a powerful tool for reducing chronic inflammation, improving overall health, and preventing cognitive decline. The connection between the immune system, gut microbiota (GM), and neuroinflammation highlights the role of the gut-brain axis in maintaining brain health and preventing neurodegenerative diseases. Neglected so far, PE has beneficial effects on microbial composition and diversity, thus providing the potential to alleviate neurological symptoms. There is bidirectional communication between the gut and muscle, with GM diversity modulation and short-chain fatty acid (SCFA) production affecting muscle metabolism and preservation, and muscle activity/exercise in turn inducing significant changes in GM composition, functionality, diversity, and SCFA production. This gut-muscle and muscle-gut interplay can then modulate cognition. For instance, irisin, an exercise-induced myokine, promotes neuroplasticity and cognitive function through BDNF signaling. Irisin and muscle-generated BDNF may mediate the positive effects of physical activity against some aspects of AD pathophysiology through the interaction of exercise with the gut microbial ecosystem, neural plasticity, anti-inflammatory signaling pathways, and neurogenesis. Understanding gut-muscle-brain interconnections hold promise for developing strategies to promote brain health, fight age-associated cognitive decline, and improve muscle health and longevity.

A framework of transient hypercapnia to achieve an increased cerebral blood flow induced by nasal breathing during aerobic exercise

During exercise, cerebral blood flow (CBF) is expected to only increase to a maximal volume up to a moderate intensity aerobic effort, suggesting that CBF is expected to decline past 70 % of a maximal aerobic effort. Increasing CBF during exercise permits an increased cerebral metabolic activity that stimulates neuroplasticity and other key processes of cerebral adaptations that ultimately improve cognitive health. Recent work has focused on utilizing gas-induced exposure to intermittent hypoxia during aerobic exercise to maximize the improvements in cognitive function compared to those seen under normoxic conditions. However, it is postulated that exercising by isolating breathing only to the nasal route may provide a similar effect by stimulating a transient hypercapnic condition that is non-gas dependent. Because nasal breathing prevents hyperventilation during exercise, it promotes an increase in the partial arterial pressure of CO2. The rise in systemic CO2 stimulates hypercapnia and permits the upregulation of hypoxia-related genes. In addition, the rise in systemic CO2 stimulates cerebral vasodilation, promoting a greater increase in CBF than seen during normoxic conditions. While more research is warranted, nasal breathing might also promote benefits related to improved sleep, greater immunity, and body fat loss. Altogether, this narrative review presents a theoretical framework by which exercise-induced hypercapnia by utilizing nasal breathing during moderate-intensity aerobic exercise may promote greater health adaptations and cognitive improvements than utilizing oronasal breathing.

The Physiological and Molecular Links Between Physical Activity and Brain Health: A Review

There is currently an epidemic of sedentary behavior throughout the world, leading to negative impacts on physical health and contributing to both mortality and burden of disease. The consequences of this also impact the brain, where increased levels of cognitive decline are observed in individuals who are more sedentary. This review explores the physiological and molecular responses to our sedentary propensity, its contribution to several medical conditions and cognitive deficits, and the benefits of moderate levels of physical activity and exercise. Also presented is the recommended level of activity for overall physical health improvement.

Nonpharmacological modulation of cortical spreading depolarization

AIMS

Cortical spreading depolarization (CSD) is a wave of pathologic neuronal dysfunction that spreads through cerebral gray matter, causing neurologic disturbance in migraine and promoting lesion development in acute brain injury. Pharmacologic interventions have been found to be effective in migraine with aura, but their efficacy in acutely injured brains may be limited. This necessitates the assessment of possible adjunctive treatments, such as nonpharmacologic methods. This review aims to summarize currently available nonpharmacological techniques for modulating CSDs, present their mechanisms of action, and provide insight and future directions for CSD treatment.

MAIN METHODS

A systematic literature review was performed, generating 22 articles across 3 decades. Relevant data is broken down according to method of treatment.

KEY FINDINGS

Both pharmacologic and nonpharmacologic interventions can mitigate the pathological impact of CSDs via shared molecular mechanisms, including modulating K⁺/Ca²⁺/Na⁺/Cl^- ion channels and NMDA, GABA_A, serotonin, and CGRP ligand-based receptors and decreasing microglial activation. Preclinical evidence suggests that nonpharmacologic interventions, including neuromodulation, physical exercise, therapeutic hypothermia, and lifestyle changes can also target unique mechanisms, such as increasing adrenergic tone and myelination and modulating membrane fluidity, which may lend broader modulatory effects. Collectively, these mechanisms increase the electrical initiation threshold, increase CSD latency, slow CSD velocity, and decrease CSD amplitude and duration.

SIGNIFICANCE

Given the harmful consequences of CSDs, limitations of current pharmacological interventions to inhibit CSDs in acutely injured brains, and translational potentials of nonpharmacologic interventions to modulate CSDs, further assessment of nonpharmacologic modalities and their mechanisms to mitigate CSD-related neurologic dysfunction is warranted.

Valuing embodiment: insights from dance practice among people living with dementia

There is a growing appreciation for the ability of person-centered arts-based approaches to extend multiple domains of brain health of people living with dementia. Dance is a multi-modal artistic engagement which has positive impacts on cognition, mobility and the emotional and social aspects of brain health. Although research into multiple domains of brain health among older adults and people living with dementia is promising, several gaps remain, specifically in understanding the benefits of co-creative and improvisational dance practices. Collaborative research between dancers, researchers, people living with dementia and care partners is needed to design and evaluate future research on dance and to determine relevance and usability. Furthermore, the respective praxes and experience of researchers, dance artists and people living with dementia contribute distinctly and uniquely to the identification and the assignment of value to dance in the context of the lives of people living with dementia. In this manuscript the author, a community-based dance artist, creative aging advocate and Atlantic Fellow for Equity in Brain Health, discusses current challenges and gaps in the understanding of the value of dance for and with people living with dementia and how transdisciplinary collaboration between neuroscientists, dance artists and people living with dementia can advance collective comprehension and implementation of dance practice.

Train Smart Study: protocol for a randomised trial investigating the role of exercise training dose on markers of brain health in sedentary middle-aged adults

INTRODUCTION

Regular aerobic exercise is associated with improved cognitive function, implicating it as a strategy to reduce dementia risk. This is reinforced by the association between greater cardiorespiratory fitness and larger brain volume, superior cognitive performance and lower dementia risk. However, the optimal aerobic exercise dose, namely the intensity and mode of delivery, to improve brain health and lower dementia risk has received less attention. We aim to determine the effect of different doses of aerobic exercise training on markers of brain health in sedentary middle-aged adults, hypothesising that high-intensity interval training (HIIT) will be more beneficial than moderate-intensity continuous training (MICT).

METHODS AND ANALYSIS

In this two-group parallel, open-label blinded endpoint randomised trial, 70 sedentary middle-aged (45-65 years) adults will be randomly allocated to one of two 12-week aerobic exercise training interventions matched for total exercise training volume: (1) MICT (n=35) or HIIT (n=35). Participants will perform ~50 min exercise training sessions, 3 days per week, for 12 weeks. The primary outcome will be measured as between-group difference in cardiorespiratory fitness (peak oxygen uptake) change from baseline to the end of training. Secondary outcomes include between-group differences in cognitive function and ultra-high field MRI (7T) measured markers of brain health (brain blood flow, cerebrovascular function, brain volume, white matter microstructural integrity and resting state functional brain activity) changes from baseline to the end of training.

ETHICS AND DISSEMINATION

The Victoria University Human Research Ethics Committee (VUHREC) has approved this study (HRE20178), and all protocol modifications will be communicated to the relevant parties (eg, VUHREC, trial registry). Findings from this study will be disseminated via peer-review publications, conference presentations, clinical communications and both mainstream and social media.

TRIAL REGISTRATION NUMBER

ANZCTR12621000144819.

Associations between everyday activities and arterial spin labeling-derived cerebral blood flow: A longitudinal study in community-dwelling elderly volunteers

Cerebral blood flow (CBF) is critical for brain metabolism and function. Age-related changes in CBF are associated with increased risk of neurocognitive disorders and vascular events such as stroke. Identifying correlates and positive modifiers of age-related changes in CBF before the emergence of incipient clinical decline may inform public health advice and clinical practice. Former research has been inconclusive regarding the association between regular physical activity and CBF, and there is a lack of studies on the association between level of everyday activities and CBF, in older adults. To investigate these relationships, 118 healthy community-dwelling adults (65-89 years) underwent pseudo-continuous arterial spin labeling (ASL) MRI, neurocognitive, physical, and activity assessments at baseline. Eighty-six participants completed a follow-up ASL MRI, on average 506 (SD = 113) days after the baseline scan. Cross-sectional analysis revealed credible evidence for positive associations between time spent on low intensity physical activity and CBF in multiple cortical and subcortical regions, time spent on moderate to vigorous intensity physical activity and accumbens CBF, participation in social activity and CBF in multiple cortical regions, and between reading and thalamic CBF, indicating higher regional CBF in more active adults. Longitudinal analysis revealed anecdotal evidence for an interaction between time and baseline level of gardening on occipital and parietal CBF, and baseline reading on pallidum CBF, indicating more change in CBF in adults with lower level of activity. The findings support that malleable lifestyle factors contribute to healthy brain aging, with relevance for public health guidelines.

Exercise Training to Improve Brain Health in Older People Living With HIV: Study Protocol for a Randomized Controlled Trial

BACKGROUND

With the advent of antiretrovirals, people living with HIV are living near-normal lifespans. However, people living with HIV are at greater risk of experiencing cognitive impairment and reduced brain integrity despite well-controlled viremia. A robust literature supports exercise interventions as a method of improving cognition and structural brain integrity in older individuals without HIV. The effects of exercise on cardiometabolic, neurocognitive, and neural structures in middle-aged to older people living with HIV are less well known, with few prospective studies examining these measures.

OBJECTIVE

This prospective randomized clinical trial will examine the effects of a 6-month exercise training intervention compared to a 6-month stretching intervention (control) on cardiorespiratory fitness, physical function and strength, cognition, and neuroimaging measures of brain volumes and cerebral blood flow in people living with HIV.

METHODS

Sedentary middle-aged to older people living with HIV (ages≥40; n=150) with undetectable HIV viral load (<20 copies/mL) will be enrolled in the study. At the baseline and final visit, fasting plasma lipid, insulin, glucose, and brain neurotrophic factor concentrations; cardiorespiratory fitness; cognitive performance; brain volumes; and cerebral blood flow via a magnetic resonance imaging scan will be measured. Participants will be randomized in a 2:1 ratio to either the exercise or control stretching intervention. All participants will complete their assigned programs at a community fitness center 3 times a week for 6 months. A professional fitness trainer will provide personal training guidance at all sessions for individuals enrolled in both arms. Individuals randomized to the exercise intervention will perform endurance and strength training exercises, while those randomized to the control intervention will perform stretches to increase flexibility. A midpoint visit (at 3 months) will assess cognitive performance, and at the end point visit, subjects will undergo cardiorespiratory fitness and cognition testing, and a magnetic resonance imaging scan. Physical activity throughout the duration of the trial will be recorded using an actigraph.

RESULTS

Recruitment and data collection are complete as of December 2020. Data processing, cleaning, and organization are complete as of December 2021. Data analysis began in January 2022, with the publication of study results for primary aims 1 and 2 expected by early 2023.

CONCLUSIONS

This study will investigate the effects of a 6-month aerobic and resistance exercise training intervention to improve cardiometabolic risk factors, cognitive performance, cerebral structure, and blood flow in sedentary people living with HIV. Results will inform clinicians and patients of the potential benefits of a structured aerobic exercise training program on the cognitive, functional, and cardiometabolic health status of older people living with HIV. Assessment of compliance will inform the development and implementation of future exercise programs for people living with HIV.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02663934; https://clinicaltrials.gov/ct2/show/NCT02663934.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41421.

Effects of Physical Exercise Training on Cerebral Blood Flow Measurements: A Systematic Review of Human Intervention Studies

The aim of this systematic review was to examine the effects of physical exercise training on cerebral blood flow (CBF), which is a physiological marker of cerebrovascular function. Relationships between training-induced effects on CBF with changes in cognitive performance were also discussed. A systematic search was performed up to July 2022. Forty-five intervention studies with experimental, quasi-experimental, or pre-post designs were included. Sixteen studies (median duration: 14 weeks) investigated effects of physical exercise training on CBF markers using magnetic resonance imaging, 20 studies (median duration: 14 weeks) used transcranial Doppler ultrasound, and eight studies (median duration: 8 weeks) used near-infrared spectroscopy. Studies using magnetic resonance imaging observed consistent increases in CBF in the anterior cingulate cortex and hippocampus, but not in whole-brain CBF. Effects on resting CBF-measured with transcranial Doppler ultrasound and near-infrared spectroscopy-were variable, while middle cerebral artery blood flow velocity increased in some studies following exercise or hypercapnic stimuli. Interestingly, concomitant changes in physical fitness and regional CBF were observed, while a relation between training-induced effects on CBF and cognitive performance was evident. In conclusion, exercise training improved cerebrovascular function because regional CBF was changed. Studies are however still needed to establish whether exercise-induced improvements in CBF are sustained over longer periods of time and underlie the observed beneficial effects on cognitive performance.

Randomized controlled trial of early aerobic exercise following sport-related concussion: Progressive percentage of age-predicted maximal heart rate versus usual care

OBJECTIVE

To examine the effect of a readily accessible, structured aerobic exercise intervention on days to asymptomatic status and days to medical clearance compared to usual care exercise prescription in a cohort of adolescents and young adults following sport-related concussion (SRC).

METHODS

A longitudinal, randomized, non-blinded clinical trial consisting of a structured aerobic exercise protocol (SAEP) group and a usual care exercise prescription (UCEP) group. Participants in the SAEP group underwent an exercise protocol including 8 sessions over 11 days progressing in duration and intensity stepwise based on participants' age-predicted maximal heart rate. Symptom follow-ups were on days 7, 14, 21, and 28. The primary outcome measures of the study were days to asymptomatic status and days to medical clearance, while the secondary outcome measure was symptom severity on days 7, 14, 21, and 28.

RESULTS

38 participants (SAEP, n = 20; UCEP, n = 19) were recruited and completed all follow-up appointments. Compared to the UCEP group, the SAEP had a faster time to asymptomatic status with 96% posterior probability. In addition, the SAEP group displayed an earlier time to medical clearance with 93% posterior probability. While symptom severity scores did not differ between groups at enrolment (SAEP symptom severity, 30; UCEP, 29), they were subsequently lower in the SAEP group at all assessments throughout the trial with 100% posterior probability.

CONCLUSIONS

An aerobic exercise protocol based on percentages of age-predicted maximum heart rate is a safe and effective treatment for reducing symptoms and can be initiated during the first week following SRC.

TRIAL REGISTRATION

ClinicalTrials.gov, no. NCT02969824.

The effects of an exercise intervention on executive function among overweight adults with obstructive sleep apnea

PURPOSE

Obstructive sleep apnea (OSA) is associated with poorer executive function. This study examined the effects of a comprehensive exercise intervention on executive function in overweight adults with mild and moderate-to-severe OSA.

METHODS

Participants aged between 30 and 65 years, with a body mass index (BMI) ranging from 27 to 42 kg/m^2, participated in a 6-week exercise program. Standardized polysomnographic recording methods provided total Apnea-Hypopnea Index (AHI) and level of hypoxemia. Executive function was assessed using the NIH Toolbox Flanker Inhibitory Control Test. A submaximal treadmill exercise test evaluated cardiorespiratory fitness. Participants with baseline total AHI between 5 and 14.9 events/h were classified as mild OSA and participants with baseline total AHI 15 ≥ events/h were classified as moderate-to-severe OSA.

RESULTS

Fifteen participants completed 18 exercise sessions. Significant differences between OSA categories at baseline were observed for sleep characteristics, but not for fitness or executive function. Wilcoxon Signed Rank Tests showed significant increases in median values for the Flanker Test in the moderate-to-severe category only, z = 2.429, p < .015, η² = .737.

CONCLUSION

Six weeks of exercise improved executive function in overweight individuals with moderate-to-severe OSA, but not in those with mild OSA.

Normal pace walking is beneficial to young participants’ executive abilities

Background

Exercise can improve cognitive function. The impact of acute exercise on cognition is related to exercise intensity. This study aimed to explore whether normal walking had a beneficial effect on cognition.

Methods

Compared with standing still, thirty healthy young men walked on a treadmill at a normal pace, and completed the Stroop test. Near-infrared spectroscopy was used to monitor the hemodynamic changes of the prefrontal cortex during the entire experiment.

Results

Studies showed that normal walking did not stimulate higher average cerebral oxygen in the PFC, but the peak cerebral oxygen in cognitive tests during walking was higher (Stroop Word: 2.56 ± 0.43 and 3.80 ± 0.50, P < 0.01, Stroop Color: 2.50 ± 0.37 and 3.66 ± 0.59, P < 0.05, Stroop Color-Word: 4.13 ± 0.55 and 5.25 ± 0.66, P < 0.01, respectively), and better results were achieved in the Stroop Color-Word test, which was reflected in faster reaction times (49.18 ± 1.68 s, 56.92 ± 2.29 s, respectively, P < 0.001) and higher accuracies (46.19 ± 0.69, 44.15 ± 0.91, respectively, P = 0.018).

Conclusion

For healthy young people, even a normal walk is therefore good for cognition.

Acute Effects of Augmented Reality Exergames versus Cycle Ergometer on Reaction Time, Visual Attention, and Verbal Fluency in Community Older Adults

BACKGROUND

This study aims to investigate the acute effects of an augmented reality session and a cycle ergometer session compared to no exercise on the reaction times, cognitive flexibility, and verbal fluency of older adults.

METHODS

Each participant did a familiarization with cognitive tests and the following three sessions: cycle ergometer, no exercise (control group), and augmented reality exergame (Portable Exergame Platform for Elderly) sessions. The participants were randomized in a within-group design into one of six possible combinations. Each moment had a 30 min duration, and after the session, the participants performed a Trail Making Test, a verbal fluency test, and a Deary-Liewald reaction time task. The data were analyzed with a one-way ANOVA with a Bonferroni adjustment.

RESULTS

The analysis between the no exercise, cycle ergometer, and augmented reality sessions showed no significant differences in the cognitive measurements.

CONCLUSIONS

One session of the cycle ergometer exercise or the augmented reality exergames does not acutely improve the reaction times, cognitive flexibility, or verbal fluency in the elderly.

Association of military-specific reaction time performance with physical fitness and visual skills

Background

The aim of the present study was to explore whether military-specific reaction time (RT) test performance is affected by individuals' physical and visual skills.

Method

In a single testing session, the military-specific Simple and Go, No-Go RT, aerobic power (20-m Multistage Shuttle Run test), maximal upper- and lower-body mechanical capacities (bench press and squat against different loads), and visual skills (multiple object tracking and dynamic visual acuity) of 30 young men (15 active-duty military personnel and 15 sport science students) were evaluated.

Results

The main findings revealed that the Simple RT and Go, No-Go RT presented (1) with aerobic power non-significant small correlations in military personnel (r = -0.39 and -0.35, respectively) and non-significant negligible correlations in sport science students (r = -0.10 and 0.06, respectively), (2) inconsistent and generally non-significant correlations with the maximal mechanical capacities of the upper- and lower-body muscles (r range = -0.10, 0.67 and -0.27, 0.48, respectively), (3) non-significant correlations with visual skills (r magnitude ≥ 0.58) with the only exception of the Go, No-Go RT that was significantly correlated to all visual variables in the group of students (i.e., students who achieved better results during visual tests had shorter RT; r magnitude ≥ 0.58), and (4) none of the physical and visual variables significantly predicted the Simple RT or Go, No-Go RT.

Conclusion

Altogether, these results indicate that military-specific RT performance is generally independent of physical and visual skills in both military personnel and active university students.

Acute inorganic nitrate intake increases regional insulin action in the brain: Results of a double-blind, randomized, controlled cross-over trial with abdominally obese men

AIMS

Improving brain insulin sensitivity may be a promising approach in the prevention and treatment of metabolic and cognitive diseases. Our aim was to investigate acute effects of inorganic nitrate on regional cerebral blood flow (CBF) responses to intranasal insulin in abdominally obese men.

METHODS

Eighteen apparently healthy men, aged 18-60 years and with a waist circumference ≥ 102 cm, participated in a randomized, double-blind, placebo-controlled cross-over trial. The study consisted of two test days separated by at least one week. Men received in random order a drink providing 10 mmol (i.e., 625 mg nitrate) potassium nitrate or an isomolar placebo drink with potassium chloride. Brain insulin action was assessed 120-150 min after the drinks by quantifying acute effects of nasal insulin on regional CBF using arterial spin labeling Magnetic Resonance Imaging. Glucose and insulin concentrations were measured at regular intervals, while blood pressure was determined fasted and at 240 min.

RESULTS

Inorganic nitrate intake increased regional insulin action in five brain clusters. The two largest clusters were located in the right temporal lobe (ΔCBF: 7.0 ± 3.8 mL/100 g/min, volume: 5296 mm³, P < 0.001; and ΔCBF: 6.5 ± 4.3 mL/100 g/min, volume: 3592 mm³, P < 0.001), while two other cortical clusters were part of the right frontal (ΔCBF: 9.0 ± 6.0 mL/100 g/min, volume: 1096 mm³, P = 0.007) and the left parietal lobe (ΔCBF: 6.1 ± 4.3 mL/100 g/min, volume: 1024 mm³, P = 0.012). One subcortical cluster was located in the striatum (ΔCBF: 5.9 ± 3.2 mL/100 g/min, volume: 1792 mm³, P < 0.001). No effects of nitrate were observed on CBF before administration. Following nitrate intake, circulating nitrate plus nitrite concentrations increased over time (P = 0.003), but insulin and glucose concentrations and blood pressure did not change.

CONCLUSION

Acute inorganic nitrate intake may improve regional brain insulin action in abdominally obese men. These regions are involved in the regulation of different metabolic and cognitive processes. The trial was registered on January 6th, 2021 at ClinicalTrials.gov as NCT04700241.

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 exercise intervention on executive function of middle-aged and elderly people: A systematic review of randomized controlled trials

Background

Executive function will gradually decline with the increase of age, which will have a negative impact on the quality of life and general health. Exercise intervention can improve executive function and prevent its deterioration, but the evidence from randomized controlled trials is not consistent.

Aim

To assess the effect of exercise intervention on executive function of healthy middle-aged and elderly people, and briefly describe its mechanism.

Methods

A search was conducted using PubMed, Web of science and EBSCO. The searches were limited to English articles published from January 2010 to January 2022. The information is extracted from searched articles included or excluded based on certain criteria.

Results

The search returned 2,746 records, of which 11 articles were included in the systematic review, and 8 articles were supplemented according to the references included and related reviews. The results show that different types of exercise intervention have positive effects on the executive function of the middle-aged and elderly people. The intervention prescriptions in most studies are executed in medium to low frequency, medium intensity and medium duration, while only 11% of the studies were followed up.

Conclusions

The intervention, which was executed twice a week with 30-60 min single intervention time and over 12 weeks total duration, showed a good intervention effect. Exercise intervention is to improve executive function by affecting the activation of brain network and the synthesis of neurotransmitters.

Regional cortical perfusion increases induced by a 6-month endurance training in young sedentary adults

Physical inactivity is documented as a health risk factor for chronic diseases, accelerated aging, and cognitive impairment. Physical exercise, on the other hand, plays an important role in healthy aging by promoting positive muscular, cardiovascular, and central nervous system adaptions. Prior studies on the effects of exercise training on cerebral perfusion have focused largely on elderly cohorts or patient cohorts, while perfusion effects of exercise training in young sedentary adults have not yet been fully assessed. Therefore, the present study examined the physiological consequence of a 6-month endurance exercise training on brain perfusion in 28 young sedentary adults randomly assigned to an intervention group (IG; regular physical exercise) or a control group (CG; without physical exercise). The IG performed an extensive running interval training three times per week over 6 months. Performance diagnostics and MRI were performed every 2 months, and training intensity was adapted individually. Brain perfusion measurements with pseudo-continuous arterial spin labeling were analyzed using the standard Oxford ASL pipeline. A significant interaction effect between group and time was found for right superior temporal gyrus (STG) perfusion, driven by an increase in the IG and a decrease in the CG. Furthermore, a significant time effect was observed in the right middle occipital region in the IG only. Perfusion increases in the right STG, in the ventral striatum, and in primary motor areas were significantly associated with increases in maximum oxygen uptake (VO_2max). Overall, this study identified region-specific increases in local perfusion in a cohort of young adults that partly correlated with individual performance increases, hence, suggesting exercise dose dependency. Respective adaptations in brain perfusion are discussed in the context of physical exercise-induced vascular plasticity.

Effect of Physical Activity/Exercise on Oxidative Stress and Inflammation in Muscle and Vascular Aging

Functional status is considered the main determinant of healthy aging. Impairment in skeletal muscle and the cardiovascular system, two interrelated systems, results in compromised functional status in aging. Increased oxidative stress and inflammation in older subjects constitute the background for skeletal muscle and cardiovascular system alterations. Aged skeletal muscle mass and strength impairment is related to anabolic resistance, mitochondrial dysfunction, increased oxidative stress and inflammation as well as a reduced antioxidant response and myokine profile. Arterial stiffness and endothelial function stand out as the main cardiovascular alterations related to aging, where increased systemic and vascular oxidative stress and inflammation play a key role. Physical activity and exercise training arise as modifiable determinants of functional outcomes in older persons. Exercise enhances antioxidant response, decreases age-related oxidative stress and pro-inflammatory signals, and promotes the activation of anabolic and mitochondrial biogenesis pathways in skeletal muscle. Additionally, exercise improves endothelial function and arterial stiffness by reducing inflammatory and oxidative damage signaling in vascular tissue together with an increase in antioxidant enzymes and nitric oxide availability, globally promoting functional performance and healthy aging. This review focuses on the role of oxidative stress and inflammation in aged musculoskeletal and vascular systems and how physical activity/exercise influences functional status in the elderly.