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Yi J, Lee S, Lee SH. The effect of the Smart Health Continuous Feedback For Elderly Exercise (SHe CoFFEE) program on mobility: a randomized controlled pilot study. Front Public Health 2024; 12:1442064. [PMID: 39346580 PMCID: PMC11427408 DOI: 10.3389/fpubh.2024.1442064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 09/03/2024] [Indexed: 10/01/2024] Open
Abstract
Objectives This study determined the effectiveness of a comprehensive home-based online exercise program called "Smart Health Continuous Feedback for elderly exercise (SHe CoFFEE)" on mobility. Methods Sixty community-dwelling seniors were randomized in a 1:1 ratio to intervention or control group. Intervention was an 8-week "SHe CoFFEE" program, featuring continuous feedback, self-monitoring, and fall prevention exercises. The primary outcome was mobility, measured at 8 weeks with the Timed Up and Go (TUG) test. Secondary outcomes included TUG at 4 weeks, 10 m walking test, 30-s chair stand test, falls efficacy scale, activity-specific balance confidence, and Euro Quality of Life 5 Dimensions 5 Levels. Results At 8 weeks, the intervention group showed improved TUG scores compared with the control group (MD = -1.87, 95% CI, -2.60 to -1.14; ηp 2 = 0.326) in the adjusted intention-to-treat analysis. The per-protocol analysis data showed similar results. All secondary outcomes apart from quality of life improved with intervention to a greater degree than in control. Conclusion Smart healthcare and self-managed exercise programs may be viable for community-based health promotion and fall prevention in older adults unfamiliar with online technology.
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Affiliation(s)
- Jungeun Yi
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sunhee Lee
- College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seon Heui Lee
- College of Nursing, Gachon University, Incheon, Republic of Korea
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Xie S, Lu S, Lu J, Gong C, Chang C. Using mindfulness-based intervention to promote executive function in young children: a multivariable and multiscale sample entropy study. Cereb Cortex 2024; 34:bhae330. [PMID: 39235378 PMCID: PMC11375865 DOI: 10.1093/cercor/bhae330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 09/06/2024] Open
Abstract
Early childhood marks a pivotal period in the maturation of executive function, the cognitive ability to consciously regulate actions and thoughts. Mindfulness-based interventions have shown promise in bolstering executive function in children. This study used the functional near-infrared spectroscopy technique to explore the impact of mindfulness-based training on young children. Brain imaging data were collected from 68 children (41 boys, aged 61.8 ± 10.7 months) who were randomly assigned to either an intervention group (N = 37, aged 60.03 ± 11.14 months) or a control group (N = 31, aged 59.99 ± 10.89 months). Multivariate and multiscale sample entropy analyses were used. The results showed that: (1) brain complexity was reduced in the intervention group after receiving the mindfulness-based intervention in all three executive function tasks (ps < 0.05), indicating a more efficient neural processing mechanism after the intervention; (2) difference comparisons between the intervention and control groups showed significant differences in relevant brain regions during cognitive shifting (left dorsolateral prefrontal cortex and medial prefrontal cortex) and working memory tasks (left dorsolateral prefrontal cortex), which corroborates with improved behavioral results in the intervention group (Z = -3.674, P < 0.001 for cognitive shifting; Z = 2.594, P < 0.01 for working memory). These findings improve our understanding of early brain development in young children and highlight the neural mechanisms by which mindfulness-based interventions affect executive function. Implications for early intervention to promote young children's brain development are also addressed.
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Affiliation(s)
- Sha Xie
- Faculty of Education, Shenzhen University, Shenzhen 518055, China
| | - Shuqi Lu
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Lihu Campus, Shenzhen 518055, China
| | - Jiahao Lu
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Lihu Campus, Shenzhen 518055, China
| | - Chaohui Gong
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Lihu Campus, Shenzhen 518055, China
| | - Chunqi Chang
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Lihu Campus, Shenzhen 518055, China
- Peng Cheng Laboratory, Shenzhen 518055, China
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Bollimbala A, James PS. Impact of chronic physical activity on individuals' creativity. PSYCHOLOGICAL RESEARCH 2024; 88:684-694. [PMID: 37561201 DOI: 10.1007/s00426-023-01862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
There is growing evidence to suggest that physical activity positively influences cognitive processes. A similar trend is seen in the literature examining the relationship between acute physical activity and creativity. Nevertheless, certain questions persist: Does engaging in physical activity over an extended period (chronic) influence creativity? If it does, what is the duration of this impact? The present study uses Randomized Controlled Trials (RCT) to examine whether chronic physical activity for 6 weeks can improve individual creativity vis-à-vis a control group that performs regular class activity without any physical activity. It also assesses whether the effect of chronic physical activity on creativity endures after 2 weeks of ceasing the interventions. The study involves 49 school students who were randomly assigned to either the experimental or the control conditions. Their creativity, operationalized as divergent thinking is measured using the Alternate Uses Task. The measurements are taken before the intervention, again 6 weeks later, and once more, after 2 weeks of cessation of interventions. The results indicate that after 6 weeks of engaging in physical activity, the participants showed improvements in both the fluency and originality components of divergent thinking when compared to the control group. Furthermore, the results demonstrate a lingering effect of physical activity on the originality component of divergent thinking. The findings lend some support to the strength model of self-control. The implications for research and practice are further discussed in the study.
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Affiliation(s)
- Ashish Bollimbala
- School of Management, Indian Institute of Technology Mandi, Kamand, Himachal Pradesh, 175005, India.
| | - P S James
- School of Management, DC School of Management and Technology, Vagamon, Kerala, India
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Nguyen SA, Oughli HA, Lavretsky H. Use of Complementary and Integrative Medicine for Alzheimer's Disease and Cognitive Decline. J Alzheimers Dis 2024; 97:523-540. [PMID: 38073388 DOI: 10.3233/jad-230710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Integrative medicine takes a holistic approach because it considers multiple aspects of the individual. This includes a person's physical, emotional, interpersonal, behavioral, nutritional, environmental, and spiritual dimensions of wellbeing that contribute to the Whole Person Health. There is increasing interest and popularity of integrative approaches to treating cognitive decline and dementia because of the multifactorial nature of aging and the limited pharmacological interventions available in treating cognitive decline and dementia, particularly Alzheimer's disease, the most common type of dementia. This review summarizes the existing evidence using complementary and integrative medicine therapies in cognitive decline and Alzheimer's disease. This includes the use of mind-body therapies, lifestyle interventions (nutritional, physical exercise, stress reduction), and other integrative modalities. Unfortunately, there are still limited studies available to guide clinicians despite the increasing popularity of integrative treatments.
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Affiliation(s)
- Sarah A Nguyen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hanadi Ajam Oughli
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Helen Lavretsky
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Brown A, Bayley PJ. The Therapeutic Potential of Yoga for Alzheimer's Disease: A Critical Review. J Alzheimers Dis 2024; 101:S521-S535. [PMID: 39422963 DOI: 10.3233/jad-240719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2024]
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, memory impairment, and behavioral changes, significantly impacting the quality of life of affected individuals and their caregivers. While pharmacological treatments offer limited relief, nonpharmacological interventions, like yoga, have gained attention for their potential therapeutic benefits. This critical review synthesizes findings from various studies on the feasibility, adherence, physical function, cognitive improvements, inflammatory markers, neuroprotection, and mood and behavioral changes associated with yoga interventions for older adults with AD. Despite these promising results, further research with randomized controlled trials, larger sample sizes, control groups, longitudinal follow-ups, standardized protocols, and diverse populations is necessary to confirm these benefits and understand the long-term effects of yoga on AD progression. This critical review highlights yoga's potential as a valuable nonpharmacological intervention in the holistic management of AD.
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Affiliation(s)
- Adriel Brown
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Bayley
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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Ko KY, Kwok ZCM, Chan HYL. Effects of yoga on physical and psychological health among community-dwelling older adults: A systematic review and meta-analysis. Int J Older People Nurs 2023; 18:e12562. [PMID: 37577926 DOI: 10.1111/opn.12562] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/15/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES To synthesise and critically appraise the quality of existing evidence about the effects of yoga on physical and psychological outcomes among older adults. DESIGN A systematic review and meta-analysis. PARTICIPANTS Participants aged 60 and above. MEASUREMENTS Nine English and two Chinese electronic bibliographic databases, including MEDLINE OvidSP, PsycINFO, AMED, EMBASE, Global Health, PubMed, Scopus, CINAHL, Cochrane Library, Hyread and WanFang databases, were searched. Randomised controlled trials (RCT) of yoga on physical and psychological outcomes among older adults were included. Meta-analysis was conducted for outcomes studied in three or more studies, otherwise narrative synthesis was performed. RESULTS Fifteen studies were included for review. The results of meta-analysis after sensitivity analysis showed that yoga significantly improved balance (SMD = 0.81, 95% CI: 0.48-1.14, p < .001, II2 = 59%), flexibility (SMD = 0.38, 95% CI: 0.07-0.68, p = .020, II2 34%), muscle strength (SMD = 0.49, 95% CI: 0.18-0.79, p = .002, I2 43%) and depressive symptoms (SMD = 0.50, 95% CI = 0.09-0.91, p = .01, I2 0%). There was insufficient data for meta-analysis on gait and other psychological outcomes. Narrative synthesis suggested that yoga has positive effects on reducing anxiety, but its effects on improving gait and reducing stress among older adults were inconclusive. CONCLUSION The results of this review supported the beneficial effects of yoga on physical outcomes among older adults, but the heterogeneity across studies was relatively high. Evidence related to the effect on psychological outcomes was limited.
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Affiliation(s)
- Ka-Yan Ko
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zoe Ching Man Kwok
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Liu Z, Lemus J, Smirnova IV, Liu W. Rehabilitation for non-motor symptoms for patients with Parkinson's disease from an α-synuclein perspective: a narrative review. EXPLORATION OF NEUROPROTECTIVE THERAPY 2023; 3:235-257. [PMID: 37920444 PMCID: PMC10621781 DOI: 10.37349/ent.2023.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/22/2023] [Indexed: 11/04/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder affecting aged population around the world. PD is characterized by neuronal Lewy bodies present in the substantia nigra of the midbrain and the loss of dopaminergic neurons with various motor and non-motor symptoms associated with the disease. The protein α-synuclein has been extensively studied for its contribution to PD pathology, as α-synuclein aggregates form the major component of Lewy bodies, a hallmark of PD. In this narrative review, the authors first focus on a brief explanation of α-synuclein aggregation and circumstances under which aggregation can occur, then present a hypothesis for PD pathogenesis in the peripheral nervous system (PNS) and how PD can spread to the central nervous system from the PNS via the transport of α-synuclein aggregates. This article presents arguments both for and against this hypothesis. It also presents various non-pharmacological rehabilitation approaches and management techniques for both motor and non-motor symptoms of PD and the related pathology. This review seeks to examine a possible hypothesis of PD pathogenesis and points to a new research direction focus on rehabilitation therapy for patients with PD. As various non-motor symptoms of PD appear to occur earlier than motor symptoms, more focus on the treatment of non-motor symptoms as well as a better understanding of the biochemical mechanisms behind those non-motor symptoms may lead to better long-term outcomes for patients with PD.
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Affiliation(s)
- Zhaoyang Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jessica Lemus
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Irina V. Smirnova
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Kaligal C, Kanthi A, Vidyashree M, Krishna D, Raghuram N, Hongasandra Ramarao N, Deepeshwar S. Prefrontal oxygenation and working memory in patients with type 2 diabetes mellitus following integrated yoga: a randomized controlled trial. Acta Diabetol 2023; 60:951-961. [PMID: 37014456 DOI: 10.1007/s00592-023-02085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/24/2023] [Indexed: 04/05/2023]
Abstract
AIMS Type 2 diabetes mellitus (T2DM) alters brain functional and structural connectivity leading to cognitive dysfunction. This study examined the effect of a 12-week yoga intervention on prefrontal cortex (PFC) oxygenation and working memory in patients with T2DM. METHODS Fifty participants were randomized into yoga and waitlist control groups. The yoga protocol specific to T2DM was followed. The pre- (day 1), mid- (6 weeks) and post-intervention (12 weeks) assessments included measurement of PFC oxygenation while performing working memory tasks (n-back) using functional near-infrared spectroscopy. RESULTS Following a 12-week intervention, the yoga group showed improved performance in working memory [accuracy (geometric mean difference of 3.15%, 95% CI [2.33,3.96], p = 0.001) and reaction time (mean difference of 100.8 milliseconds,95% CI [- 166.6, - 35.1], p = 0.002] in the high task load (2-back) associated with higher oxygenation in dorsolateral PFC (β coefficient mean difference of 95.6, 95% CI [0.23,191], p = 0.049) and ventrolateral PFC (β coefficient mean difference of 53.4, 95% CI [7.8,98.9], p = 0.018) regions. Higher oxygenation in dorsolateral PFC during 2-back task was positively correlated with accuracy (r(23) = 0.65, p < 0.001) and negatively correlated with reaction time (r(23) = - 0.47,p = 0.017). CONCLUSION Integrated yoga practice may improve working memory performance associated with higher PFC oxygenation in patients with T2DM. As 12 weeks of yoga intervention improved working memory performance, the regular practice of yoga may have the potential to prevent decline of cognitive functions in clinical conditions.
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Affiliation(s)
- Chidananda Kaligal
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana, Samsthana (S-VYASA), #19 Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore, 560019, India
| | - Amit Kanthi
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana, Samsthana (S-VYASA), #19 Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore, 560019, India
| | - M Vidyashree
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana, Samsthana (S-VYASA), #19 Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore, 560019, India
| | - Dwivedi Krishna
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana, Samsthana (S-VYASA), #19 Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore, 560019, India
| | - Nagarathna Raghuram
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana, Samsthana (S-VYASA), #19 Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore, 560019, India
| | - Nagendra Hongasandra Ramarao
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana, Samsthana (S-VYASA), #19 Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore, 560019, India
| | - Singh Deepeshwar
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhana, Samsthana (S-VYASA), #19 Eknath Bhavan, Gavipuram Circle, K.G. Nagar, Bangalore, 560019, India.
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Farhang M, Rojas G, Martínez P, Behrens MI, Langer ÁI, Diaz M, Miranda-Castillo C. The Impact of a Yoga-Based Mindfulness Intervention versus Psycho-Educational Session for Older Adults with Mild Cognitive Impairment: The Protocol of a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15374. [PMID: 36430097 PMCID: PMC9690706 DOI: 10.3390/ijerph192215374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is a global agreement in the medical community that a significant proportion of dementia cases could be prevented or postponed. One of the factors behind this agreement comes from scientific evidence showing that mind-body interventions such as mindfulness and yoga for the elderly have been related to a range of positive outcomes, including improved cognition performance in seniors with mild cognitive impairment (MCI). OBJECTIVE This study aims to evaluate the effectiveness of a yoga-based mindfulness intervention (YBM) versus psychoeducational sessions for older adults with MCI attending Hospital Clinic Universidad de Chile in Santiago. METHOD Two-arm, individually randomized controlled trial (RCT) will be carried out at Clinical Hospital Universidad de Chile in Santiago. Older people over 60 years with any type of MCI using a score < 21 in the Montreal Cognitive Assessment (MoCA) test and a score of 0.05 in the Clinical Dementia Rating (CDR) Scale; and with preserved activities of daily living will be randomly assigned with an allocation ratio of 1:1 in either the yoga-based mindfulness intervention or the active control group based on the psycho-educational program. People who have performed yoga and/or mindfulness in the last 6 months or/and people with a psychiatric clinical diagnosis will be excluded from the study. Montreal Cognitive Assessment, the Lawton Instrumental Activities of Daily Living Scale (IADL), the Barthel Index (BI), the Pemberton happiness index, the Geriatric Anxiety Inventory (GAI) as well as the Geriatric Depression Scale (GDS-5) will be administered by blinded outcomes assessors before random assignment (Pre-test), the week following the last session of the intervention (post-test), and then after 3- and 6-months follow-up. RESULTS The YBM intervention protocol based on a video recording has been adapted and designed. This is the first RCT to examine the effects of a yoga-based mindfulness intervention in improving cognitive and physical functions and mental health outcomes for Chilean elderly diagnosed with MCI. It is expected to be implemented as an acceptable and effective non-pharmacological option for older people with MCI. CONCLUSION Providing evidence-based programs such as preventive therapy for Alzheimer's disease has relevant implications for public mental health services in Chile.
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Affiliation(s)
- Maryam Farhang
- Escuela de Enfermería, Facultad de Salud y Ciencias Sociales, Universidad de Las Américas, Santiago 8370040, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Millennium Institute for Care Research (MICARE), Santiago 8370134, Chile
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago 8380455, Chile
| | - Graciela Rojas
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago 8380455, Chile
| | - Pablo Martínez
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 150, Place Charles-Le Moyne, Longueuil, QC J4K A08, Canada
| | - Maria Isabel Behrens
- Centro de Investigación Clínica Avanzada (CICA), Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago 8380456, Chile
- Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago 7800284, Chile
- Departamento de Neurología y Psiquiatría, Clínica Alemana Santiago, Universidad del Desarrollo, Santiago 7800284, Chile
| | - Álvaro I. Langer
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, Santiago 8380455, Chile
- Mind-Body Lab, Institute of Psychological Studies, Austral University, Valdivia 5110566, Chile
| | - Marcela Diaz
- Clínica Psiquiátrica Universitaria, Hospital Clínico, Universidad de Chile, Santiago 7800284, Chile
| | - Claudia Miranda-Castillo
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 8380453, Chile
- Millennium Institute for Care Research (MICARE), Santiago 8370134, Chile
- Faculty of Nursing, Universidad Andres Bello, Santiago 7550000, Chile
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Zhang T, Liu W, Gao S. Effects of mind-body exercises on cognitive impairment in people with Parkinson's disease: A mini-review. Front Neurol 2022; 13:931460. [PMID: 36119693 PMCID: PMC9474886 DOI: 10.3389/fneur.2022.931460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Parkinson's disease (PD) is an important health problem caused by the degeneration of brain neurons. Bradykinesia and lower balance ability seriously affect the quality of life of people with PD. Non-motor symptoms, such as cognitive impairment, accompany the course of the disease but still lack sufficient attention. In general, drugs combined with cognitive training are the most common ways to improve cognitive impairment in people with PD. However, long-term use of psychiatric drugs may lead to side effects such as brain death and movement disorders. Recently, mindfulness has been used by researchers in the treatment of cognitive impairment, because healthy older adults who engage in mind-body exercises for a long time have higher cognitive levels than normal aging populations. Mind-body exercise, as a therapy that combines concentration, breath control, and physical activity, is beneficial for improving practitioners' brain and mental health. Mind-body exercises such as Tai Chi, yoga, dance, and Pilates can improve cognitive performance in older adults with or without cognitive impairment. Therefore, mind-body exercise may be a feasible strategy for the treatment of cognitive impairment in people with PD. This study summarizes the latest evidence that mind-body exercises including Tai Chi, Qigong, yoga, and dance improve cognitive impairment associated with PD. We also explored the limitations of current mind-body exercise research, aiming to provide new ideas for improving mind-body exercise as a strategy to alleviate cognitive impairment in people with PD.
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Affiliation(s)
- Ting Zhang
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- University Hospital, Zhejiang Normal University, Jinhua, China
| | - Wei Liu
- Physical Education College, Guangxi University of Science and Technology, Liuzhou, China
| | - Song Gao
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- *Correspondence: Song Gao
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Zheng J, Su X, Xu C. Effects of exercise intervention on executive function of middle-aged and elderly people: A systematic review of randomized controlled trials. Front Aging Neurosci 2022; 14:960817. [PMID: 36034137 PMCID: PMC9413534 DOI: 10.3389/fnagi.2022.960817] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Jian Zheng
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xuan Su
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Chang Xu
- School of Psychology, Shanghai University of Sport, Shanghai, China
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12
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Baklouti S, Aloui A, Baklouti H, Souissi N, Jarraya M. Effects of Hatha yoga on cognitive functions in the elderly: a cross-sectional study. Libyan J Med 2022; 17:2080799. [PMID: 35657065 PMCID: PMC9176371 DOI: 10.1080/19932820.2022.2080799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study aimed to investigate the effects of Hatha yoga practice on cognitive functions in the elderly. Thirty healthy older men participated in this study. They belonged to 2 groups. The first group included 15 Hatha yoga practitioners for at least 2 years. The control group involved 15 male older adults who shared the same characteristics (age, years of formal education, and level of physical activity) as the Hatha yoga group but were naive to yoga, meditation, or any mind-body intervention. Neuropsychological tests were applied to measure selective attention, sustained attention, episodic memory, and processing speed. The following tests were administered: The French adaptation of the Victoria Stroop test, the Zazzo's Cancellation Task, the Five Word Test, and a battery of computerized tests to evaluate reaction time. Long-term Hatha yoga practice showed promising results related to executive functions and reaction time, but no significant difference was found between the two groups in episodic memory and sustained attention although a trend of improvement was observed in favor of Hatha yoga practitioners. In conclusion, long-term Hatha yoga practitioners have better cognitive abilities compared to the control group in certain aspects of cognitive functions. Further physiological and psychological variables need to be examined in order to highlight the correlation between yoga intervention and cognitive performance.
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Affiliation(s)
- Souad Baklouti
- Physical Activity, Sport and Health Research Unit (UR18JS01), National Sport Observatory, Tunis, Tunisia
| | - Asma Aloui
- Physical Activity, Sport and Health Research Unit (UR18JS01), National Sport Observatory, Tunis, Tunisia.,High Institute of Sport and Physical Education, University of Gafsa, Gafsa, Tunisia
| | - Hana Baklouti
- Physical Activity, Sport and Health Research Unit (UR18JS01), National Sport Observatory, Tunis, Tunisia
| | - Nizar Souissi
- Physical Activity, Sport and Health Research Unit (UR18JS01), National Sport Observatory, Tunis, Tunisia
| | - Mohamed Jarraya
- High Institute of Sport and Physical Education, University of Sfax, Sfax, Tunisia
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13
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Kim O, Heo N. Self-Management Support with Yoga on Psychological Health and Quality of Life for Breast Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074183. [PMID: 35409866 PMCID: PMC8999059 DOI: 10.3390/ijerph19074183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 12/15/2022]
Abstract
The purpose of this study was to identify whether the improvement of self-management support (SMS) combined with yoga can improve anxiety, depression, stress, and quality of life in female breast cancer survivors. The SMS combined with yoga group and control group (yoga only) were comprised of 21 and 20 participants, respectively. The SMS with yoga and yoga programs were provided to each group for 8 weeks. Data obtained from self-report questionnaires included details of anxiety, depression, stress, and quality of life. The levels of anxiety, depression, and stress significantly decreased in both the SMS with yoga and control groups (p < 0.05). Moreover, the quality of life improved significantly in the SMS with yoga group (p < 0.001). Among the five quality-of-life domains (physical, social/family, emotional and functional well-being, and breast cancer subscale), social/family well-being in the SMS with yoga group was significantly higher than that in the yoga-only group (p = 0.011). Conclusions: The results show that yoga is a beneficial activity for the psychological health of breast cancer survivors. Our findings suggest that SMS strategies can improve quality of life.
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Affiliation(s)
- Oksoo Kim
- College of Nursing, Ewha Womans University, Seoul 03760, Korea;
| | - Narae Heo
- Department of Nursing, Hansei University, Gunpo-si 15852, Gyeonngi-do, Korea
- Correspondence: ; Tel.: +82-31-450-9875
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14
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Abstract
There is growing scientific evidence that yoga interventions have positive impacts on health in community-dwelling older adults. Older adults are an exponentially growing cohort; efforts to improve their health can also contribute to community health. The objective of the current integrative review was to examine quantitative evidence concerning effectiveness of yoga interventions related to the health of community-dwelling older adults. Six studies met inclusion criteria of community-dwelling older adults, randomized controlled trial (RCT) design, and yoga intervention in the past 10 years. Hatha yoga was most frequently used; interventions were well-received with high adherence rates. Benefits from participation in yoga included improvements in psychological and physical health, such as reductions in anger, anxiety, and fear of falling, and increases in well-being, self-efficacy, improved executive and immunological function, strength, and balance. Findings reveal that additional well-designed yoga RCTs are indicated with longer intervention and follow up to assess lifespan changes. [Journal of Gerontological Nursing, 48(2), 43-52.].
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15
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Qin S, Basak C. Comparing the Effects of Two Cardiovascular Health Factors on Working Memory Capacity in Healthy Aging: Separate and Combined Effects of Arterial Elasticity and Physical Fitness. J Gerontol B Psychol Sci Soc Sci 2022; 77:94-103. [PMID: 33914083 PMCID: PMC8755910 DOI: 10.1093/geronb/gbab071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Arterial elasticity and physical fitness are 2 important cardiovascular health factors that influence cognition in older adults. Working memory capacity (WMC), a core component underlying cognitive aging across many cognitive domains, may be affected by individual differences in cardiovascular health in older adults. This study aims to identify in older adults: (a) separate and combined effects of these 2 cardiovascular health factors on WMC and (b) which of the 2 factors is more critical in influencing WMC. METHODS WMC in 89 healthy older adults was assessed by 2 complex span tasks. Arterial elasticity was assessed by pulse pressure (PsP). Physical fitness was measured by an established proxy of VO2 max (MET). Effects of PsP and MET on WMC were evaluated via step-wise regressions. RESULTS After controlling for age, sex, and education, PsP and MET were separately predictive of WMC in older adults. Together, the combined effect of PsP and MET was more predictive of WMC than fitness alone, but not more than PsP alone. Mediation analysis indicates that the relationship between MET and WMC was completely mediated by PsP. DISCUSSION This study innovatively demonstrates that though arterial elasticity and physical fitness separately predict WMC, the former completely mediates the relationship between fitness and WMC. This suggests that biologically based cardiovascular health factors like arterial elasticity are crucial individual difference variables that should be measured and monitored in cognitive aging studies as well as in physical interventions that are designed to improve cognition in healthy aging.
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Affiliation(s)
- Shuo Qin
- Center for Vital Longevity, School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA
| | - Chandramallika Basak
- Center for Vital Longevity, School of Behavioral and Brain Sciences, The University of Texas at Dallas, USA
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16
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Silva DF, Santos MERA, Carmo TSD, Moura MEDC, Arruda IPDDEMA, Pereira SDC. Yoga implications for preventing accidental falls in older adults: a systematic review. FISIOTERAPIA EM MOVIMENTO 2022. [DOI: 10.1590/fm.2022.35201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract Introduction: Studies have shown the importance of healthy habits in older adults, emphasizing physical activity or mobility for a better quality of life and to delay physical degeneration in this population. Yoga is one of several exercises recommended for therapeutic purposes to reduce the risk of falls, a common occurrence in this age group. Objective: To synthesize the existing evidence regarding the effects of yoga on quality of life and physical-functional capacity and its contribution to fall prevention in older people. Methods: This systematic review was conducted in August 2020 on the Medline/Pubmed, LILACS, SCOPUS, Web of Science and PEDro databases, with no restrictions for language or year of publication. In line with the eligibility criteria, randomized or quasi-randomized clinical trials were included. Results: A total of 1,190 articles were found, 18 of which were included for data collection. The average sample size was between 16 and 120 participants, consisting of older individuals of both sexes ranging in age from 62 to 85 years. Conclusion: Regular yoga practice has a beneficial effect on the quality of life and physical-functional capacity of older adults, thereby contributing to fall prevention. However, evidence is still limited and further studies are suggested to better elucidate the scope of the effects of yoga as a therapeutic resource.
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17
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Zahedian-Nasab N, Jaberi A, Shirazi F, Kavousipor S. Effect of virtual reality exercises on balance and fall in elderly people with fall risk: a randomized controlled trial. BMC Geriatr 2021; 21:509. [PMID: 34563120 PMCID: PMC8465759 DOI: 10.1186/s12877-021-02462-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Deficient balance and fear of falling in elderly people can lead to disturbed daily activities, falling, and finally reduced quality of life. Therefore, evaluation of low-risk methods that might partially improve balance in this group of people is of utmost importance. The present study aimed to investigate the impact of Virtual Reality (VR) exercises based on Xbox Kinect on balance and fear of falling among elderly people. METHODS This clinical trial was performed on 60 elderly individuals living in nursing homes divided into two groups of control and Xbox. The participants in the intervention group received VR exercises based on Xbox Kinect in form of two 30-45-min sessions held on a weekly basis for 6 weeks. The individuals in the control group, on the other hand, received routine exercises of the nursing homes. The research tools used in this study included a demographic questionnaire, the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falling Efficacy Scale (FES). RESULTS The findings of the current study demonstrated that the scores of BBS and TUG test as the indices of balance among elderly people improved significantly in the Xbox group after the intervention (p < 0.001 for both BBS and TUG test). Moreover, the score of fear of falling diminished significantly in the intervention group compared to the control group (p < 0.001). CONCLUSION According to the results of the present investigation, 6 weeks of VR balance exercises could enhance balance and fear of falling among elderly people living in nursing homes. TRIAL REGISTRATION Code: IRCT20190727044347N1 , Date: 17-8-2019.
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Affiliation(s)
- Noorolla Zahedian-Nasab
- Student Resarch Committe, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Azita Jaberi
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Shirazi
- Community Based Psychiatric Care Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Somayyeh Kavousipor
- Occupational Therapy Department, School of Rehabilitation Sciences, Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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18
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Gothe NP. Examining the effects of light versus moderate to vigorous physical activity on cognitive function in African American adults. Aging Ment Health 2021; 25:1659-1665. [PMID: 32426993 DOI: 10.1080/13607863.2020.1768216] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Physical activity (PA) recommendations for older adults often endorse participation in moderate to vigorous intensity (MVPA). However, health disparities are evident such that African Americans engage in lower levels of MVPA, have a higher prevalence of chronic health and cognitive impairments. The purpose of this cross-sectional study was to examine the role of light PA in addition to MVPA and their associations with measures of executive function among African American older adults. METHODS One hundred and ten participants (mean age = 64.78 ± 5.7, males = 14) completed measures of cognitive functioning, including the Trail making, Flanker and the N-back tasks. Additionally, participants completed a 6-minute walk test to estimate their cardiovascular fitness and were given an Actigraph accelerometer for 7-days to objectively assess their light and MVPA. RESULTS Regression analyses controlling for age, fitness and education showed that higher levels of light PA but not MVPA predicted better cognitive performance on the incongruent flanker reaction time (β=-.24), trails B (β=-.24) and 1-back accuracy (β=.28). Both light PA and MVPA predicted faster reaction times on the 1-back and 2-back conditions of the n-back (light PA: β's=-.22-.23; MVPA: β's=-.28). CONCLUSIONS Light PA demonstrated similar or better associations than MVPA with cognitive functions which are known to decline with age. Designing and promoting light PA interventions in African American older adults maybe more feasible given the prevalence of disability and functional health disparities. Intervention studies testing the efficacy and effectiveness of light PA are needed and could have a significant public health impact among aging African Americans.
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Affiliation(s)
- Neha P Gothe
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Champaign, Illinois, USA
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19
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Feasibility of a yoga, aerobic and stretching-toning exercise program for adult cancer survivors: the STAYFit trial. J Cancer Surviv 2021; 16:1107-1116. [PMID: 34455545 PMCID: PMC8402960 DOI: 10.1007/s11764-021-01101-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/17/2021] [Indexed: 11/04/2022]
Abstract
Background The use of yoga as a mind–body practice has become increasingly popular among clinical populations and older adults who use this practice to manage age and chronic disease-related symptoms. Although yoga continues to gain popularity among practitioners and researchers, pilot studies that examine its feasibility and acceptability, especially among cancer survivors, are limited. Feasibility studies play a critical role in determining whether the target population is likely to engage with larger scale efficacy and effectiveness trials. In this paper we present feasibility and acceptability data from a 12-week randomized controlled trial (RCT) conducted with adult cancer survivors. Methods Participants n = 78 (Mean age: 55 years) were randomized to one of three groups: a Hatha yoga, aerobic exercise, or stretching-toning control group with group exercise classes held for 150 min/week for 12 weeks. Herein we report feasibility and acceptability, including enrollment rates, attendance, attrition and adverse events, and participant feedback and satisfaction data. Results Of the 233 adults screened, 109 were eligible and 78 randomized to one of the three intervention arms. Session attendance was high for all groups (75.5–89.5%) and 17 participants dropped out during the 12-week intervention. Program satisfaction was high (4.8 or higher out of 5) and no adverse events were reported. One cohort (n = 15) of the intervention transitioned to remote intervention delivery due to the COVID-19 pandemic. Feasibility data from these participants suggested that synchronized group exercise classes via Zoom with a live instructor were acceptable and enjoyable. Participant feedback regarding most and least helpful aspects of the program as well as suggestions for future yoga interventions are summarized. Conclusions Overall, the yoga intervention was highly feasible and acceptable. The feasibility parameters from this trial can aid researchers in estimating recruitment rates for desired sample sizes to successfully randomize and retain cancer survivors in short- and long-term yoga-based efficacy and effectiveness trials. The findings also provide evidence to clinicians who can recommend up to 150 min of a combination of exercises—aerobic, yoga, or stretching-toning to their cancer patients in order to improve health and wellbeing during cancer survivorship.
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20
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Bhattacharyya KK, Hueluer G, Meng H, Hyer K. Movement-based mind-body practices and cognitive function in middle-aged and older adults: Findings from the Midlife in the United States (MIDUS) study. Complement Ther Med 2021; 60:102751. [PMID: 34118391 DOI: 10.1016/j.ctim.2021.102751] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/28/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cognitive function is a key component of healthy aging. While conventional physical activities (walking, jogging, etc.) have been shown to support physical and cognitive health in late-life, it remains unclear whether traditional Eastern movement-based mind-body practices (MBP) have long-term cognitive benefits above and beyond conventional leisure physical activities. This study examines the relationship between movement-based MBP and cognitive function in middle-aged and older adults during a 10-year follow-up period. METHODS We used data from Waves 2 (2004-05) and 3 (2013-14) of the Midlife in the United States (MIDUS) study. MIDUS initially surveyed a national probability sample of community-living adults aged 24-75 years in 1995 (Wave 1). Tests of cognitive functioning measuring executive function and episodic memory were added in Wave 2 and repeated in Wave 3. We estimated multivariable linear regression models to examine the effect of MBP (Wave 2) on the episodic memory and executive function (Wave 3) while controlling for covariates (sociodemographic factors, health, and cognitive function at Wave 2). RESULTS A total of 2097 individuals aged 42-92 years (M = 64 ± 11, 56 % women) were included. After controlling for sociodemographic factors, health and functional status, and prior levels of cognitive function, engaging in MBP was independently associated with a smaller decline in episodic memory (b = 0.11, p = .03), but not executive function (b=0.03, p = .34). DISCUSSION The findings provide the first large population-based evidence supporting the cognitive benefits of MBP over a 10-year period among middle-aged and older adults. Future research should examine whether MBP are effective non-pharmacological intervention to attenuate age-related cognitive decline.
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Affiliation(s)
- Kallol Kumar Bhattacharyya
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA.
| | - Gizem Hueluer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Hongdao Meng
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
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Ye M, Wang L, Xiong J, Zheng G. The effect of mind-body exercise on memory in older adults: a systematic review and meta-analysis. Aging Clin Exp Res 2021; 33:1163-1173. [PMID: 32329024 DOI: 10.1007/s40520-020-01557-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The current systematic review aims to examine the effect of mind-body exercise on different memory types in the elderly population. METHODS Four literature databases (Pubmed, Cochrane library, Embase and Sinomed) were searched from inception to March 19, 2019. Randomized controlled trials (RCTs) examining the effect of mind-body exercise on memory in older adults were included. The assessment of risk of bias for the included studies and data synthesis were conducted using the software of review manager 5.3 based on the Cochrane handbook. RESULTS Twelve eligible RCTs with a total 1051 participants were identified that met the inclusion criteria for the systematic review. Meta-analysis in elderly adults without known neurological diseases showed mind-body exercise intervention had a large effect on general memory (SMD = 1.24, p = 0.005), a moderate effect on short-term memory (SMD = 0.51, p = 0.02) and long-term memory (SMD = 0.78, p < 0.001), a small effect on working memory (SMD = 0.28, p = 0.009), and a moderate effect on episodic memory (SMD = 0.74, p < 0.001) and semantic memory (SMD = 0.59, p = 0.003) compared to no specific exercise intervention. Similar results were also found in elderly adults with known neurological diseases, showing a moderate effect on general memory (SMD = 0.56, p < 0.001), short-term memory (SMD = 0.68, p = 0.01), and long-term memory (SMD = 0.80, p = 0.003); a small effect on working memory (SMD = 0.46, p < 0.001); and a large effect on episodic memory (SMD = 0.91, p < 0.001). CONCLUSION Compared with no specific exercise, mind-body exercise enhances memory in older adults. However, larger, more robust trials with longer follow-up periods and standardized neuropsychological outcome measures are needed before more definitive conclusions can be drawn.
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Affiliation(s)
- Mingzhu Ye
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Lecong Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jian Xiong
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Guohua Zheng
- Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- College of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
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22
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Lang AJ, Malaktaris A, Maluf KS, Kangas J, Sindel S, Herbert M, Bomyea J, Simmons AN, Weaver J, Velez D, Liu L. A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery. Contemp Clin Trials Commun 2021; 21:100719. [PMID: 33604485 PMCID: PMC7875811 DOI: 10.1016/j.conctc.2021.100719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/07/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Posttraumatic stress disorder (PTSD) is a chronic, disabling, and prevalent mental health disorder among Veterans. Despite the availability of empirically supported psychotherapies, many Veterans remain symptomatic after treatment and/or prefer to seek complementary and integrative health approaches, including yoga, to manage PTSD. The randomized controlled trial (RCT) described herein will evaluate the efficacy of a manualized yoga program as compared to nonaerobic exercise in reducing PTSD severity among Veterans. A secondary aim of this study is to better understand the mechanisms of change. METHODS Veterans (N = 192) with PTSD will be randomized to hatha yoga or nonaerobic physical activity control; both groups consist of 12 weekly, 60-min group or online training sessions with 15-20 min of daily at-home practice. Outcome measures will be administered at baseline, mid-treatment, posttreatment, and 12-week follow-up. PROJECTED OUTCOMES This study will evaluate changes in PTSD severity (primary outcome) as well as depression, anxiety, anger, sleep problems, and psychosocial disability (secondary outcomes). We will also use multiple mediation to examine two potential models of the mechanisms of clinical effect: the Attention Model (i.e., yoga increases attentional control, which reduces PTSD symptoms), the Coping Model (i.e., yoga increases distress tolerance, which improves coping, which reduces PTSD symptoms), and the combination of these models. This aspect of the study is innovative and important given the absence of an existing, comprehensive model for understanding yoga's impact on PTSD. Ultimately, we hope to develop guidelines for application of yoga to PTSD recovery.
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Affiliation(s)
- Ariel J. Lang
- VA San Diego Center of Excellence for Stress and Mental Health, UCSD Departments of Psychiatry and Family Medicine and Public Health, 3350 La Jolla Village Dr. (MC 111N1), San Diego, CA, 92161, USA
| | - Anne Malaktaris
- VA San Diego Healthcare System/Center of Excellence for Stress and Mental Health, UCSD Department of Psychiatry, 3350 La Jolla Village Dr., San Diego, CA, 92161, USA
| | - Katrina S. Maluf
- San Diego State University, School of Exercise and Nutritional Sciences, Doctor of Physical Therapy Program, 5500 Campanile Dr., San Diego, CA, 92182, USA
| | - Julie Kangas
- VA San Diego Healthcare System, UCSD Department of Psychiatry, 8810 Rio San Diego Dr., San Diego, CA, 92108, USA
| | - Selin Sindel
- University of California San Diego, Department of Cognitive Science, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Matthew Herbert
- VA San Diego Center of Excellence for Stress and Mental Health, UCSD Department of Psychiatry, 9500 Gilman Dr. MC 0855, La Jolla, CA, 92037, USA
| | - Jessica Bomyea
- VA San Diego Center of Excellence for Stress and Mental Health, UCSD Department of Psychiatry, 9500 Gilman Dr. MC 0855, La Jolla, CA, 92037, USA
| | - Alan N. Simmons
- VA San Diego Center of Excellence for Stress and Mental Health, UCSD Department of Psychiatry, 9500 Gilman Dr. MC 0855, La Jolla, CA, 92037, USA
| | - Judy Weaver
- Connected Warriors, 4950 Communication Ave, Ste 115, Boca Raton, FL, 33431, USA
| | - Deborah Velez
- Veteran's Medical Research Foundation, 3350 La Jolla Village Dr, San Diego, CA, 92037, USA
| | - Lin Liu
- VA San Diego Healthcare System, UCSD Department of Preventive Medicine and Public Health, 9500 Gilman Dr., MC0725, La Jolla, CA, 92093-0725, USA
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Hoy S, Östh J, Pascoe M, Kandola A, Hallgren M. Effects of yoga-based interventions on cognitive function in healthy older adults: A systematic review of randomized controlled trials. Complement Ther Med 2021; 58:102690. [PMID: 33618011 DOI: 10.1016/j.ctim.2021.102690] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The world's elderly population is growing. Physical activity has positive effects on health and cognition, but is decreasing among the elderly. Interest in yoga-based exercises has increased in this population, especially as an intervention targeting balance, flexibility, strength, and well-being. Recent interest has arisen regarding yoga's potential benefits for cognition. OBJECTIVE To systematically review evidence from randomized controlled trials (RCTs) examining the effects of yoga-based interventions on cognitive functioning in healthy adults aged ≥60. A secondary aim was to describe intervention characteristics and, where possible, the extent to which these influenced study outcomes. METHOD The review was conducted in accordance with PRISMA guidelines. Searches were performed from inception to June 2020 using the following electronic databases: (1) PubMed (NLM); (2) Embase (Elsevier); (3) Cochrane Central (Wiley); (4) PsycINFO (EBSCOhost); and (5) Cinahl (EbscoHost). INCLUSION CRITERIA RCTs of yoga-based interventions assessing cognition in healthy adults ≥60 years. Risk of bias was assessed using the revised Cochrane risk of bias tool. RESULTS A total of 1466 records were initially identified; six studies (5 unique trials) were included in the review. Four of the six articles reported significant positive effects of yoga-based interventions on cognition, including gross memory functioning and executive functions. Intervention characteristics and assessment methods varied between studies, with a high overall risk of bias in all studies. CONCLUSION Yoga-based interventions are associated with improvements in cognition in healthy older adults. Adequately powered RCTs with robust study designs and long-term follow-ups are required. Future studies should explicitly report the intervention characteristics associated with changes in cognitive function.
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Affiliation(s)
- Sara Hoy
- The Swedish School of Sport and Health Sciences (GIH), Stockholm 114 33, Sweden.
| | - Josefine Östh
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Michaela Pascoe
- Institute for Health and Sport, Victoria University, Melbourne VIC 3011, Australia
| | - Aaron Kandola
- Division of Psychiatry, University, College London, London W1T 7BN, United Kingdom
| | - Mats Hallgren
- Department of Global Public Health, Karolinska Institutet, Stockholm 171 77, Sweden
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Kora P, Meenakshi K, Swaraja K, Rajani A, Raju MS. EEG based interpretation of human brain activity during yoga and meditation using machine learning: A systematic review. Complement Ther Clin Pract 2021; 43:101329. [PMID: 33618287 DOI: 10.1016/j.ctcp.2021.101329] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The present investigation is to study the impact of yoga and meditation on Brain waves concerning physical and mental health. There are mainly three stages (steps) in the brain wave classification:(i) preprocessing, ii) feature extraction, and iii) classification. This work provides a review of interpretation methods of Brain signals (Electroencephalogram (EEG)) EEG during yoga and meditation. Past research has revealed significant mental and physical advantages with yoga and meditation. METHODS The research topic reviewed focused on the machine learning strategies applied for the interpretation of brain waves. In addressing the research questions highlighted earlier in the general introduction, we conducted a systematic search of articles from targeted scientific and journal online databases that included PubMed, Web of Science, IEEE Xplore Digital Library (IEEE), and Arxiv databases based on their relevance to the research questions and domain topic. The survey topic is relatively nascent, and therefore, the scope of the search period was limited to the 20-year timeline that was deemed representative of the research topic under investigation. The literature search was based on the keywords "EEG", "yoga*" and "meditation*". The key phrases were concatenated using Boolean expressions and applied to search through the selected online databases yielding a total of 120 articles. The online databases were selected based on the relevancy of content with the research title, research questions, and the domain application. The literature review search, process, and classification were carefully conducted guided by two defined measures; 1.) Inclusion criteria; and 2.) Exclusion criteria. These measures define the criteria for searching and extracting relevant articles relating to the research title and domain of interest. RESULTS Our literature search and review indicate a broad spectrum of neural mechanics under a variety of meditation styles have been investigated. A detailed analysis of various mental states using Zen, CHAN, mindfulness, TM, Rajayoga, Kundalini, Yoga, and other meditation styles have been described by means of EEG bands. Classification of mental states using KNN, SVM, Random forest, Fuzzy logic, neural networks, Convolutional Neural Networks has been described. Superior research is still required to classify the EEG signatures corresponding to different mental states. CONCLUSIONS Yoga practice may be an effective adjunctive treatment for a clinical and aging population. Advanced research can examine the effects of specific branches of yoga on a designated clinical grouping. Yoga and meditation increased overall healthy brain activity.
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Bhattacharyya KK, Andel R, Small BJ. Effects of yoga-related mind-body therapies on cognitive function in older adults: A systematic review with meta-analysis. Arch Gerontol Geriatr 2020; 93:104319. [PMID: 33338831 DOI: 10.1016/j.archger.2020.104319] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/24/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Considering dementia has no definite curative intervention available through modern medical management, alternative therapeutic symptomatic interventions are needed urgently. This systematic review with meta-analysis evaluated whether yoga-related practices, as a preventive mind-body therapy, is effective for the management of cognitive decline in older adults. METHODS Seven electronic databases (Abstracts in Social Gerontology, Age Line, CINAHL, PsycINFO, PubMed, Scopus, and Web of Science) were searched using specified inclusion criteria to identify original studies that investigated the effects of yoga-related mind-body therapies on cognitive function, in the context of aging. A meta-analysis was also carried out calculating the overall effect sizes, expressed as standardized mean differences (i.e., d). RESULTS Twelve studies, including 912 participants (73.9% female; 239 with and 673 without cognitive impairment) were selected for this review; eleven were randomized controlled trials. One study had a high risk of bias and was excluded from the meta-analysis. Studies involved a wide variety of yoga practices with a common focus on meditative postural exercises. Results revealed significant beneficial effects on memory (Cohen's d = 0.38), executive function (Cohen's d = 0.40), and attention and processing speed (Cohen's d = 0.33). No adverse effects were reported. DISCUSSION Yoga-related mind-body interventions for older adults appear to be safe, feasible, and effective alternative practice for maintenance of cognitive functions both in age- and disease-related cognitive decline. Practicing yoga can be a useful part of daily routine to maintain cognitive function in older adulthood. Suggestions for further research were discussed.
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Affiliation(s)
| | - Ross Andel
- School of Aging Studies, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33620, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, 4202 E Fowler Avenue, Tampa, FL 33620, USA
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Chobe S, Patra SK, Chobe M, Metri K. Effect of integrated Yoga and Ayurveda Rasayana on cognitive functions in elderly with mild cognitive impairment. J Ayurveda Integr Med 2020; 13:100373. [PMID: 33349568 PMCID: PMC9034459 DOI: 10.1016/j.jaim.2020.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
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Zimmer P, Javelle F, Lampit A. Comment on: "Effects of Exercise Training Interventions on Executive Function in Older Adults: A Systematic Review and Meta‑analysis". Sports Med 2020; 51:593-595. [PMID: 33128735 PMCID: PMC7900026 DOI: 10.1007/s40279-020-01369-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Philipp Zimmer
- Institute for Sport and Sport Science, Division of Performance and Health (Sports Medicine), TU Dortmund University, Otto-Hahn-Straße 3, 44227, Dortmund, Germany.
| | - Florian Javelle
- Institute for Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Amit Lampit
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Neurology, CHARITÉ-Universitätsmedizin Berlin, Berlin, Germany
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Xiong J, Ye M, Wang L, Zheng G. Effects of physical exercise on executive function in cognitively healthy older adults: A systematic review and meta-analysis of randomized controlled trials: Physical exercise for executive function. Int J Nurs Stud 2020; 114:103810. [PMID: 33248291 DOI: 10.1016/j.ijnurstu.2020.103810] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/08/2020] [Accepted: 10/17/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the effect of physical exercise interventions on executive function in cognitively healthy adults aged 60 years and older. METHODS Four electronic databases, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science and Embase, were comprehensively searched from their inception to November 25, 2019. Randomized controlled trials (RCTs) examining the effect of physical exercise on executive function in cognitively healthy older adults were included. RESULTS Twenty-five eligible trials with fair methodological quality were identified. Compared to a no-exercise intervention, physical exercise had positive effect on working memory (Hedge's g=0.127, p<0.01, I2= 0%), cognitive flexibility (Hedge's g=0.511; p=0.007, I2=89.08%), and inhibitory control (Hedge's g=0.136; p=0.001, I2=0%) in cognitively healthy older adults. The moderator analysis indicated that more than 13 weeks of aerobic exercise significantly improved working memory and cognitive flexibility, and intervention lasting more than 26 weeks significantly improved inhibition; mind-body exercise significantly improved working memory. No significant effect on planning or semantic verbal fluency (SVF) was found. CONCLUSION Regular physical exercise training, especially aerobic exercise and mind-body exercise, had positive benefit for improving working memory, cognitive flexibility and inhibitory control of executive function in cognively healthy older adults. Further well-designed RCTs should focus on the impact of specific exercise forms with a standardized exercise scheme on executive function in cognitively healthy older adults.
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Affiliation(s)
- Jian Xiong
- College of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, China; No.1 People's Hospital of Zhangjiagang, JiangSu, China
| | - Mingzhu Ye
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lecong Wang
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guohua Zheng
- College of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, China; Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Shields GS, Skwara AC, King BG, Zanesco AP, Dhabhar FS, Saron CD. Deconstructing the effects of concentration meditation practice on interference control: The roles of controlled attention and inflammatory activity. Brain Behav Immun 2020; 89:256-267. [PMID: 32640286 DOI: 10.1016/j.bbi.2020.06.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/11/2022] Open
Abstract
Prior work has linked meditation practice to improvements in interference control. However, the mechanisms underlying these improvements are relatively unknown. In the context of meditation training, improvements in interference control could result eitherfrom increases in controlled attention to goal-relevant stimuli, or from reductions in automatic capture by goal-irrelevant stimuli. Moreover, few studies have linked training-related changes in attention to physiological processes, such as inflammatory activity, that are thought to influence cognitive function. This study addresses these gaps by examining associations between cognitive performance and cytokines in the context of an intensive meditation retreat. Participants were randomly assigned to complete 3 months of meditation training first, or to serve as waitlist controls. The waitlist-control participants then later completed a separate 3-month training intervention. We assessed participants' interference control with a flanker task and used computational modeling to derive component processes of controlled and automatic attention. We also collected blood samples at the beginning, middle, and end of training to quantify changes in cytokine activity. Participants who completed training evidenced better controlled attention than waitlist controls during the first retreat intervention, and controls showed significant improvements in controlled attention when they completed their own, second retreat. Importantly, inflammatory activity was inversely associated with controlled attention during both interventions. Our results suggest that practice of concentration meditation influences interference control by enhancing controlled attention to goal-relevant task elements, and that inflammatory activity relates to individual differences in controlled attention.
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Affiliation(s)
- Grant S Shields
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA.
| | - Alea C Skwara
- Center for Mind and Brain, University of California, Davis, CA, USA; Department of Psychology, University of California, Davis, CA, USA
| | - Brandon G King
- Center for Mind and Brain, University of California, Davis, CA, USA
| | - Anthony P Zanesco
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Firdaus S Dhabhar
- Department of Psychiatry & Behavioral Sciences, Department of Microbiology & Immunology, and The Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Clifford D Saron
- Center for Mind and Brain, University of California, Davis, CA, USA.
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Wu J, Ma Y, Ren Z. Rehabilitative Effects of Virtual Reality Technology for Mild Cognitive Impairment: A Systematic Review With Meta-Analysis. Front Psychol 2020; 11:1811. [PMID: 33101098 PMCID: PMC7545425 DOI: 10.3389/fpsyg.2020.01811] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/01/2020] [Indexed: 12/19/2022] Open
Abstract
Objective: To evaluate the impact of virtual reality (VR) technology on the cognitive functions (overall cognitive ability, executive function, short-term memory, and long-term memory) of people with mild cognitive impairment (MCI). Methods: All major databases, including Web of Science, PubMed, Scopus, Proquest, WanFang, and CNKI, were searched to identify all relevant studies published in English or Chinese since October 28th, 2019. Two researchers independently conducted document retrieval, study selection, data extraction, and methodological quality evaluation. Result: 15 randomized controlled trials were analyzed (N = 612 people with MCI), with the methodological quality evaluation score ranging from 5 to 7 points. A random effects model was selected to combine effect sizes. The result of the meta-analysis indicates that VR significantly enhanced MCI patients' overall cognitive ability (SMD = 0.869, 95% confidence interval [CI] = 0.330–1.407, P = 0.002, I2 = 86.822, n = 537) and executive function (SMD = 1.083, 95%, 95%CI = 00.134–2.031, P = 0.025, I2 = 93.748, n = 220). The meta-analysis indicated that after VR training, effects on short-term memory (SMD = 0.488, 95%CI = −0.108–1.084, P = 0.109, I2 = 62.354, n = 131) and long-term memory (SMD = 0.335, 95%CI = −1.194–0.863, P = 0.0.214, I2 = 58.868, n = 152) were not statistically significant. Conclusions: The present meta-analysis verifies the potential rehabilitative effects of VR technology for mild cognitive impairment.
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Affiliation(s)
- Jinlong Wu
- Department of Physical Education, Shenzhen University, Shenzhen, China
| | - Yudan Ma
- Jilin Institute of Sport Science, Changchun, China
| | - Zhanbing Ren
- Department of Physical Education, Shenzhen University, Shenzhen, China
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Gothe NP, Erlenbach ED, Streeter SL, Lehovec L. Effects of yoga, aerobic, and stretching and toning exercises on cognition in adult cancer survivors: protocol of the STAY Fit pilot randomized controlled trial. Trials 2020; 21:792. [PMID: 32933561 PMCID: PMC7493165 DOI: 10.1186/s13063-020-04723-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 09/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background Cancer survivors experience compromised quality of life due to impaired cognitive function as a result of cancer diagnosis and treatment. Although exercise has proven to be effective in improving cognitive function across the lifespan, interventions comprehensively testing the effectiveness for cancer survivors are limited. The STAY Fit Trial is a three-armed pilot randomized controlled trial designed to compare the effects of a 12-week yoga, aerobic walking, and stretch and tone intervention on cognitive function among adult cancer survivors. Methods This pilot study aims to recruit 75 adult cancer survivors who will complete assessments of cognitive function, cardiovascular fitness, physical activity, and psychosocial measures at baseline and after the 12-week intervention. The aims of STAY Fit are (1) to assess the efficacy of yoga to improve cognitive function among cancer survivors, compared to aerobic exercise and an active control group; (2) to examine changes in cardiovascular fitness as a result of the interventions; and (3) to assess changes in quality of life among our population as a result of the exercise interventions. Discussion The STAY Fit Trial will test the effectiveness of yoga, aerobic exercise, and stretching and toning exercises in improving cognitive function and fitness among adult cancer survivors. The results of this pilot study will enable us to understand the most effective physical activity modality to improve cognitive function in this population and potentially combat cancer-related cognitive impairment. Trial registration ClinicalTrials.gov NCT03650322. Registered on 28 August 2018.
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Affiliation(s)
- Neha P Gothe
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA.
| | - Emily D Erlenbach
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Samuel L Streeter
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - Linda Lehovec
- Department of Dance, University of Illinois at Urbana-Champaign, Urbana, 61801, USA
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Bollimbala A, James P, Ganguli S. The effect of Hatha yoga intervention on students' creative ability. Acta Psychol (Amst) 2020; 209:103121. [PMID: 32731011 DOI: 10.1016/j.actpsy.2020.103121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022] Open
Abstract
There is increasing demand for individual creativity as organizations seek innovative ways to remain relevant. Higher education institutions, particularly business schools, are sensitive to this demand and are constantly in search for innovative ways to enhance the creative ability of their students. Prior studies have shown encouraging results for physical activity-oriented interventions. Building on this research, this study uses Randomized Controlled Trial (RCT) to understand if an acute combinatory intervention, involving both physical and mental exercises embodied in Hatha yoga can improve individual creativity. This study uses 92 MBA student participants to investigate the impact of a 20-minute Hatha yoga session intervention against a short 20-minute case study session for the control group. Creative ability of the participants is operationalized through divergent and convergent thinking, which are then assessed through counter-balanced forms of Guilford Alternate Uses tasks and Remote Associate Test, respectively. The results show that while Hatha yoga significantly improves divergent thinking, the control group shows deterioration in divergent thinking. There is no effect on convergent thinking. These findings lend some support to the executive function hypothesis. The study also finds that prodding a person to be more creative on a routine academic task may not enhance their creative ability.
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Chen FT, Etnier JL, Chan KH, Chiu PK, Hung TM, Chang YK. Effects of Exercise Training Interventions on Executive Function in Older Adults: A Systematic Review and Meta-Analysis. Sports Med 2020; 50:1451-1467. [PMID: 32447717 PMCID: PMC7376513 DOI: 10.1007/s40279-020-01292-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Chronic exercise training has been shown be to positively associated with executive function (EF) in older adults. However, whether the exercise training effect on EF is affected by moderators including the specific sub-domain of EF, exercise prescription variables, and sample characteristics remains unknown. OBJECTIVES This systematic and meta-analytic review of randomized controlled trials (RCTs) investigated the effects of exercise training on EF in older adults and explored potential moderators underlying the effects of exercise training on EF. METHODS In accordance with the PRISMA guidelines, the electronic databases MEDLINE (PubMed) and EMBASE (Scopus) were searched from January 2003 to November 2019. All studies identified for inclusion were peer-reviewed and published in English. To be included, studies had to report findings from older (> 55 years old), cognitively normal adults or adults with mild cognitive impairment (MCI) randomized to an exercise training or a control group. The risk of bias in each study was appraised using the Cochrane risk-of-bias tool. Fixed-effects models were used to compare the effects of exercise training and control conditions on EF assessed at baseline and post-intervention. In addition, subgroup analyses were performed for three moderators (i.e., the specific sub-domain of EF, exercise prescription variables, and sample characteristics). RESULTS Thirty-three RCTs were included. Overall, exercise training was associated with a significant small improvement in EF [Q(106) = 260.09, Hedges' g = 0.21; p < 0.01]. The EF sub-domain moderator was not significant [Q(2) = 4.33, p > 0.05], showing that the EF improvement in response to exercise is evident for measures of inhibition, updating, and shifting. Regarding exercise prescription variables, results were significantly moderated by frequency of exercise training [Q(1) = 10.86, p < 0.05], revealing that effect sizes (ESs) were larger for moderate frequency (g = 0.31) as compared to low frequency exercise (g = 0.15). The results also showed type of exercise training moderated the ESs [Q(4) = 26.18, p < 0.05], revealing that ESs were largest for other forms of exercise (g = 0.44), followed by Tai Chi and yoga (g = 0.38), resistance exercise (g = 0.22), aerobic exercise (g = 0.14), and combined exercise (g = 0.10). In addition, The results showed moderated length of training the ESs [Q(2) = 16.64, p < 0.05], revealing that ESs were largest for short length (g = 0.32), followed by mid length (g = 0.26) and long length (g = 0.09). No significant difference in effects was observed as a function of exercise intensity [Q(1) = 2.87 p > 0.05] and session time [Q(2) = 0.21, p > 0.05]. Regarding sample characteristics, the results were significantly moderated by age [Q(2) = 20.64, p < 0.05], with significant benefits for young-old (55-65 years old) (g = 0.30) and mid-old (66-75 years old) (g = 0.25), but no effect on EF for old-old (more than 75 years old). The results were also significantly moderated by physical fitness levels [Q(1) = 10.80, p < 0.05], revealing that ESs were larger for sedentary participants (g = 0.33) as compared to physically fit participants (g = 0.16). In addition, results were also significantly moderated by cognitive status [Q(1) = 11.44, p < 0.05], revealing that ESs were larger for participants with cognitively normal (g = 0.26) as compared to those with mild cognitive impairment (g = 0.08). No significant differences in effects were observed as a function of sex [Q(2) = 5.38, p > 0.05]. CONCLUSIONS Exercise training showed a small beneficial effect on EF in older adults and the magnitude of the effect was different across some moderators.
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Affiliation(s)
- Feng-Tzu Chen
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Jennifer L Etnier
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Kuei-Hui Chan
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan, ROC
| | - Ping-Kun Chiu
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan, ROC
| | - Tsung-Ming Hung
- Department of Physical Education, National Taiwan Normal University, 162, Section 1, Heping E. Rd., Taipei, Taiwan, ROC
- Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan, ROC
| | - Yu-Kai Chang
- Department of Physical Education, National Taiwan Normal University, 162, Section 1, Heping E. Rd., Taipei, Taiwan, ROC.
- Institute for Research Excellence in Learning Science, National Taiwan Normal University, Taipei, Taiwan, ROC.
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Okhomina VI, Seals SR, Anugu P, Adu-Boateng G, Sims M, Marshall GD. Adherence and retention of African Americans in a randomized controlled trial with a yoga-based intervention: the effects of health promoting programs on cardiovascular disease risk study. ETHNICITY & HEALTH 2020; 25:812-824. [PMID: 29609480 DOI: 10.1080/13557858.2018.1458073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
Objectives: Sedentary lifestyle is a risk factor for cardiovascular disease (CVD). Few alternative lifestyle interventions, such as yoga practice, focus on African Americans (AA), the population most vulnerable to CVD. Our objective is to compare the retention and adherence rates between yoga, walking, and health education interventions while providing information about the acceptance of various yoga regimens. Design: Three hundred seventy-five AA participants were recruited exclusively from an active cohort study and randomized into a 48-week study (24 weeks intervention, 24 weeks follow-up) with 5 health promotion interventions: high frequency yoga, moderate frequency yoga, low frequency yoga, guided walking, and health education. In addition to examining the separate yoga interventions, a pooled yoga intervention is considered for comparison to guided walking and health education. Participant retention, adherence, and vitals were monitored at each intervention session. Participants were also scheduled for four clinic visits throughout the study where blood panels, health behavior, and medication surveys were administered. Results: Of the 375 participants recruited, 31.7% did not complete the study. At baseline, in both the guided walking group and the high frequency yoga group, there were significant differences between those who completed the study and those who did not. Although intervention retention in the pooled yoga program (78.3%) was higher compared to the walking (60%) and education programs (74.3%) (p = 0.007), differences in post-intervention retention was not significant. Median adherence rates for the pooled yoga program exceeded rates for guided walking and education with moderate frequency yoga out performing high and low frequency yoga. Conclusion: Study-defined retention success rates were not reached by all health promotion programs. However, retention and adherence rates for the pooled yoga program show that older African Americans are receptive to participating in yoga-based health promotion practices.
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Affiliation(s)
- Victoria I Okhomina
- Department of Data Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, USA
| | - Samantha R Seals
- Department of Mathematics and Statistics, Hal Marcus College of Science and Engineering, University of West Florida, Pensacola, FL, USA
| | - Pramod Anugu
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Godwin Adu-Boateng
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mario Sims
- Department of Medicine, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gailen D Marshall
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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A 10-week yoga practice has no effect on cognition, but improves balance and motor learning by attenuating brain-derived neurotrophic factor levels in older adults. Exp Gerontol 2020; 138:110998. [PMID: 32544572 DOI: 10.1016/j.exger.2020.110998] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/23/2022]
Abstract
Despite studies investigating the effect of yoga on cognitive and motor functioning in older adults, the effect on dual-task performance and motor learning and the specific mechanisms underlying the positive effect of yoga remain unclear. Thus, the aim of this study was to investigate the effects of yoga on cognition, balance under single- and dual-task conditions, and motor learning. The potential role of brain-derived neurotrophic factor (BDNF) in induced improvement was also explored. Participants aged 60-79 years were randomized to either a control group (n = 15) or a yoga group (n = 18) for a 10-week period. The yoga group received 90-min duration yoga classes two times per week. Changes in cognition, balance under single- and dual-task conditions, and learning fast and accurate reaching movements were assessed. Yoga practice decreased (P < 0.05) the velocity vector of the center of pressure under single- and dual-task conditions, whereas no changes in cognitive performance were observed. Although reaction and movement times during learning were decreased in both groups (P < 0.05), a faster reaction time (P < 0.05) and shorter movement time (P < 0.05) were observed in the yoga group than in the control group. Significant moderate relationships (P < 0.05) between changes in BDNF levels and functional improvements were observed. Thus, 10 weeks of yoga practice resulted in improved balance and learning in the speed-accuracy motor task that were mediated by increased BDNF levels, but had no impact on cognition in older adults.
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Krejčí M, Psotta R, Hill M, Kajzar J, Jandová D, Hošek V. A short-term yoga-based intervention improves balance control, body composition, and some aspects of mental health in the elderly men. ACTA GYMNICA 2020. [DOI: 10.5507/ag.2020.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chobe S, Chobe M, Metri K, Patra SK, Nagaratna R. Impact of Yoga on cognition and mental health among elderly: A systematic review. Complement Ther Med 2020; 52:102421. [PMID: 32951703 DOI: 10.1016/j.ctim.2020.102421] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cognitive decline and psychological health problems are the most frequently observed and under-treated issues among the elderly. Many studies have assessed the efficacy of Yoga on cognitive and mental health parameters among the elderly. However, up to date, there is no systematic review done to evaluate the role of Yoga-based interventions on cognition and mental health in the elderly. OBJECTIVE This review evaluates the beneficial effect of Yoga in improving cognitive and mental health in the elderly. METHODOLOGY A comprehensive search has performed on Medline, Google Scholar, PubMed, and PsycINFO electronic database from their inception to January 2019. The literature search was constructed around search term for "mental health", "cognition", "yoga" and "elderly". Out of 3388 records, we were considered only Randomized control trials (RCTs) with Yoga-based interventions on the older people for this review. Risk of bias was assessed using Delphi list and PEDro criteria. RESULTS After filtering out irrelevant studies, in our search, we come across 13 RCTs, and they included in this systematic review. Of 13 RCTs, four studies assessed only cognitive parameters and five studies assessed only psychological parameters, and four studies evaluated both. Study quality was fair to moderate of included RCTs on the Delphi list and PEDro criteria. Maximum studied variables in cognition were executive functions, memory, attention, and language while in mental health depression, anxiety, stress, and mood. Yoga-based interventions have some beneficial effects on attention, executive functions among cognitive variables, and depression among mental health parameters among the elderly. CONCLUSION The present review indicates that Yoga-based interventions have some positive evidence in improving attention, executive functions and memory of cognition, while depression in mental health compared to active control among the elderly. However, methodological limitations and small number of studies preclude confirming the potential benefits of Yoga-based interventions on cognition and mental health among the elderly. Further, this review strongly recommends more randomized control trials with standard study methodology, use of validated modules of Yoga intervention, and long term follow up to have definite conclusions.
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Affiliation(s)
- Shivaji Chobe
- Department of Yoga, Central University of Rajasthan, Ajmer, India; Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhan Samsthana (SVYASA University), Bengaluru, India.
| | - Meenakshi Chobe
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhan Samsthana (SVYASA University), Bengaluru, India.
| | - Kashinath Metri
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhan Samsthana (SVYASA University), Bengaluru, India.
| | - Sanjib Kumar Patra
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhan Samsthana (SVYASA University), Bengaluru, India.
| | - R Nagaratna
- Division of Yoga and Life Sciences, Swami Vivekananda Yoga Anusandhan Samsthana (SVYASA University), Bengaluru, India.
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Santhanam Kumar SS, Kamath A, Poojary S. Effect of Unilateral Left Nostril Breathing (Chandra Anga Pranayama) on Cognitive Function in Healthy Yoga-Naïve Individuals: A Randomized, Controlled, Pilot Study. Complement Med Res 2020; 27:319-327. [PMID: 32344403 DOI: 10.1159/000506972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/28/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Breathing modulates cortical neuronal activity. Various breathing exercises are purported to have specific effects on emotional and cognitive functions. OBJECTIVE To determine the effect of unilateral left nostril breathing (ULNB) on nonlateralized, overall cognitive functions using computerized psychometric tests. METHODS A randomized, controlled, pilot study was conducted among 20 healthy yoga-naïve medical students. ULNB was performed for 15 min by the test group (n = 10) and breath awareness by the control group (n = 10). Attention and processing speed, memory, and executive function were assessed using the Letter-Digit Substitution Test, Sternberg Memory Task, and Victoria Stroop Test, respectively. Baseline, pre- and postintervention scores were recorded. RESULTS There was no significant difference between the groups in baseline scores. In the Sternberg Memory Task, a statistically significant decrease in response time was seen in the test (t(9) = 3.855, p = 0.004) as well as the control group (t(9) = 3.120, p = 0.012); there was no significant difference between the groups. No significant effect of UNLB was seen in the Letter-Digit Substitution Test and Stroop Test. CONCLUSIONS Our study showed no difference in the effects of 15-min practice of ULNB and breath awareness on cognitive functions; both improved memory but not attention or executive function.
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Affiliation(s)
| | - Ashwin Kamath
- Department of Pharmacology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India,
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Schmid AA, Fruhauf CA, Sharp JL, Van Puymbroeck M, Bair MJ, Portz JD. Yoga for People With Chronic Pain in a Community-Based Setting: A Feasibility and Pilot RCT. J Evid Based Integr Med 2020; 24:2515690X19863763. [PMID: 31394910 PMCID: PMC6689911 DOI: 10.1177/2515690x19863763] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The purpose of this feasibility pilot study was to assess benefits of 8 weeks of yoga in people with chronic pain. Participants completed baseline assessments and were randomized to yoga or usual care. Yoga was offered twice a week for 8 weeks. We assessed feasibility and the Brief Pain Inventory (BPI) was the primary outcome, assessing pain-severity and pain interference on daily activities. Eighty-three people were recruited; 67 people completed the study and were included in the analyses. Average age of participants was 50.78 ± 10.43 years and most participants had pain >10 years. The intervention appeared feasible and there were significant improvements (P < .05) in multiple measures for the yoga group, including a decrease in BPI interference scores from 7.15 ± 1.70 to 6.14 ± 2.21 (P = .007). There was a significant difference in body responsiveness and pain management scores between groups at 8 weeks. It appears that yoga was feasible and positively influenced multiple outcome measures for people with chronic pain.
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Affiliation(s)
| | | | | | | | - Matthew J Bair
- 3 Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jennifer Dickman Portz
- 1 Colorado State University, Fort Collins, CO, USA.,4 University of Colorado, Aurora, CO, USA
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Hartman SJ, Weiner LS, Nelson SH, Natarajan L, Patterson RE, Palmer BW, Parker BA, Sears DD. Mediators of a Physical Activity Intervention on Cognition in Breast Cancer Survivors: Evidence From a Randomized Controlled Trial. JMIR Cancer 2019; 5:e13150. [PMID: 31605514 PMCID: PMC6914286 DOI: 10.2196/13150] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/11/2019] [Accepted: 08/14/2019] [Indexed: 12/13/2022] Open
Abstract
Background Emerging research suggests that increasing physical activity can help improve cognition among breast cancer survivors. However, little is known about the mechanism through which physical activity impacts cancer survivors’ cognition. Objective The objective of this secondary analysis examined physical and psychological function potentially linking physical activity with changes in cognition among breast cancer survivors in a randomized controlled trial where the exercise arm had greater improvements in cognition than the control arm. Methods A total of 87 sedentary breast cancer survivors were randomized to a 12-week physical activity intervention (n=43) or control condition (n=44). Objectively measured processing speed (National Institutes of Health Toolbox Oral Symbol Digit), self-reported cognition (patient-reported outcomes measurement information system [PROMIS] cognitive abilities), PROMIS measures of physical and psychological function (depression, anxiety, fatigue, and physical functioning), and plasma biomarkers (brain-derived neurotrophic factor, homeostatic model assessment 2 of insulin resistance, and C-reactive protein [CRP]) were collected at baseline and 12 weeks. Linear mixed-effects models tested intervention effects on changes in physical and psychological function variables and biomarkers. Bootstrapping was used to assess mediation. Exploratory analyses examined self-reported cognitive abilities and processing speed as mediators of the intervention effect on physical functioning. Results Participants in the exercise arm had significantly greater improvements in physical functioning (beta=1.23; 95% CI 2.42 to 0.03; P=.049) and reductions in anxiety (beta=−1.50; 95% CI −0.07 to −2.94; P=.04) than those in the control arm. Anxiety significantly mediated the intervention effect on cognitive abilities (bootstrap 95% CI −1.96 to −0.06), whereas physical functioning did not (bootstrap 95% CI −1.12 to 0.10). Neither anxiety (bootstrap 95% CI −1.18 to 0.74) nor physical functioning (bootstrap 95% CI −2.34 to 0.15) mediated the intervention effect on processing speed. Of the biomarkers, only CRP had greater changes in the exercise arm than the control arm (beta=.253; 95% CI −0.04 to 0.57; P=.09), but CRP was not associated with cognition; therefore, none of the biomarker measures mediated the intervention effect on cognition. Neither cognitive abilities (bootstrap 95% CI −0.06 to 0.68) nor processing speed (bootstrap 95% CI −0.15 to 0.63) mediated the intervention effect on physical function. Conclusions Physical activity interventions may improve self-reported cognition by decreasing anxiety. If supported by larger studies, reducing anxiety may be an important target for improving self-reported cognition among cancer survivors. Trial Registration ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876
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Affiliation(s)
- Sheri J Hartman
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Lauren S Weiner
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Sandahl H Nelson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Loki Natarajan
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Ruth E Patterson
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States
| | - Barton W Palmer
- Veterans Affairs San Diego Healthcare System, San Diego, CA, United States.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Barbara A Parker
- UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States.,Department of Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Dorothy D Sears
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, United States.,UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, CA, United States.,Department of Medicine, University of California, San Diego, La Jolla, CA, United States.,College of Health Solutions, Arizona State University, Phoenix, AZ, United States
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Hishikawa N, Takahashi Y, Fukui Y, Tokuchi R, Furusawa J, Takemoto M, Sato K, Yamashita T, Ohta Y, Abe K. Yoga-plus exercise mix promotes cognitive, affective, and physical functions in elderly people. Neurol Res 2019; 41:1001-1007. [PMID: 31588880 DOI: 10.1080/01616412.2019.1672380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: Increased attention is being paid to Asian medicine in balanced total health care. We investigated the effects of mixed exercise including yoga ('Yoga-plus') among elderly individuals. Methods: A total of 385 subjects (72 males and 313 females, 75.5 ± 8.7 years old) participated in a 12-month (M) exercise program at a health and welfare center, a day service center, and a nursing home. Cognitive, affective, and physical functions, and activities of daily living (ADL), were compared at baseline (0M), 6M and 12M of exercise intervention. Results: Mean scores on the frontal assessment battery, clock drawing test, cube copying test, letter fluency, and category fluency significantly improved after the Yoga-plus intervention, while mini-mental state examination, Hasegawa dementia score-revised, and trail-making test performance were relatively stable. Affective scores on the geriatric depression scale (GDS), apathy scale (AS) and Abe's behavioral and psychological symptoms of dementia were not significantly affected by exercise therapy, but subgroups with higher baseline GDS (GDS ≥ 5) and AS (AS ≥ 16) scores showed a significant improvement after intervention. One-leg standing time and 3-m timed up and go test performance significantly improved after 12M intervention. Discussion: Yoga-plus improved cognitive, affective, ADL, and physical functions in a local elderly population, particularly among below-baseline individuals, indicating the benefits of dementia prevention among elderly individuals.
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Affiliation(s)
- Nozomi Hishikawa
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | | | - Yusuke Fukui
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Ryo Tokuchi
- Department of Occupational Therapy, Okayama Institute for Medical and Technical Sciences , Okayama , Japan
| | - Junichi Furusawa
- Department of Occupational Therapy, Mizunaga Rehabilitation Hospital , Okayama , Japan
| | - Mami Takemoto
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Kota Sato
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Toru Yamashita
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Yasuyuki Ohta
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
| | - Koji Abe
- Department of Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences , Okayama , Japan
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Zwilling CE, Daugherty AM, Hillman CH, Kramer AF, Cohen NJ, Barbey AK. Enhanced decision-making through multimodal training. NPJ SCIENCE OF LEARNING 2019; 4:11. [PMID: 31396398 PMCID: PMC6683193 DOI: 10.1038/s41539-019-0049-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 06/03/2019] [Indexed: 05/04/2023]
Abstract
A central aim of research in the psychological and decision sciences is to establish interventions that enhance performance, investigating the efficacy of modern approaches to improve human inference and decision-making. Whereas the decision sciences have established interventions to reduce decision biases by promoting strategies for critical thought and reasoning, methods from psychology have instead focused on enhancing cognition through skill-based training of executive functions. Contemporary research in psychology has engaged these operations through multi-modal interventions designed to enhance cognition and physical health through training of executive functions, mindfulness meditation, and physical fitness. Despite the comparable aims of research in the psychological and decision sciences, the efficacy of multi-modal interventions to enhance decision-making remain to be established. We therefore conducted a comprehensive, 16-week, randomized controlled trial (RCT) to investigate this issue, enrolling 160 healthy adults in one of four interventions: (1) high-intensity cardioresistance fitness training (HICRT); (2) HICRT and cognitive training of core executive functions; (3) HICRT and cognitive training, along with mindfulness meditation training; or (4) active control training. The results of our RCT demonstrate that HICRT training and multi-modal interventions that also incorporate cognitive training and mindfulness meditation have beneficial effects on decision-making competence. The observed pattern of findings motivate the application of modern interventions from psychology and cognitive neuroscience to enhance human judgment and decision-making in complex, real-world environments.
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Affiliation(s)
- Christopher E. Zwilling
- Decision Neuroscience Laboratory, University of Illinois, Urbana, IL USA
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL USA
| | - Ana M. Daugherty
- Decision Neuroscience Laboratory, University of Illinois, Urbana, IL USA
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL USA
- Department of Psychology, Wayne State University, Detroit, MI USA
| | | | - Arthur F. Kramer
- Department of Psychology, Northeastern University, Boston, MA USA
| | - Neal J. Cohen
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL USA
- Center for Brain Plasticity, University of Illinois, Urbana, IL USA
- Department of Psychology, University of Illinois, Urbana, IL USA
- Neuroscience Program, University of Illinois, Urbana, IL USA
| | - Aron K. Barbey
- Decision Neuroscience Laboratory, University of Illinois, Urbana, IL USA
- Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, IL USA
- Center for Brain Plasticity, University of Illinois, Urbana, IL USA
- Department of Psychology, University of Illinois, Urbana, IL USA
- Neuroscience Program, University of Illinois, Urbana, IL USA
- Department of Bioengineering, University of Illinois, Urbana, IL USA
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Esmail A, Vrinceanu T, Lussier M, Predovan D, Berryman N, Houle J, Karelis A, Grenier S, Minh Vu TT, Villalpando JM, Bherer L. Effects of Dance/Movement Training vs. Aerobic Exercise Training on cognition, physical fitness and quality of life in older adults: A randomized controlled trial. J Bodyw Mov Ther 2019; 24:212-220. [PMID: 31987547 DOI: 10.1016/j.jbmt.2019.05.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/04/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION It is generally accepted that physical activity promotes healthy aging. Recent studies suggest dance could also benefit cognition and physical health in seniors, but many styles and approaches of dance exist and rigorous designs for intervention studies are still scarce. The aim of this study was to compare the effects of Dance/Movement Training (DMT) to Aerobic Exercise Training (AET) on cognition, physical fitness and health-related quality of life in healthy inactive elderly. METHODS A single-center, randomized, parallel assignment, open label trial was conducted with 62 older adults (mean age = 67.48 ± 5.37 years) recruited from the community. Participants were randomly assigned to a 12-week (3x/week, 1hr/session) DMT program, AET program or control group. Cognitive functioning, physical fitness and health-related quality of life were assessed at baseline (T-0), and post-training (T-12 weeks). RESULTS 41 participants completed the study. Executive and non-executive composite scores showed a significant increase post-training (F(1,37) = 4.35, p = .04; F(1,37) = 7.01, p = .01). Cardiovascular fitness improvements were specific to the AET group (F(2,38) = 16.40, p < .001) while mobility improvements were not group-dependent (10 m walk: F(1,38) = 11.67, p = .002; Timed up and go: F(1,38) = 22.07, p < .001). CONCLUSIONS Results suggest that DMT may have a positive impact on cognition and physical functioning in older adults however further research is needed. This study could serve as a model for designing future RCTs with dance-related interventions. REGISTRATION: clinicaltrials. gov Identifier NCT02455258.
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Affiliation(s)
- Alida Esmail
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada; Institut Universitaire sur La Réadaptation en Déficience Physique de Montréal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Tudor Vrinceanu
- Research Centre, Montreal Heart Institute, Montreal, Canada; Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada; Department of Medicine, Université de Montréal, Montreal, Canada
| | - Maxime Lussier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Canada; Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - David Predovan
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada; Department of Psychology, Université Du Québec à Montréal, Montreal, Canada
| | - Nicolas Berryman
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada; Department of Sports Studies, Bishop's University, Sherbrooke, Canada
| | - Janie Houle
- Department of Psychology, Université Du Québec à Montréal, Montreal, Canada; Research Centre, Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
| | - Antony Karelis
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada; Department of Exercise Science, Université Du Québec à Montréal, Montreal, Canada
| | - Sébastien Grenier
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada; Department of Psychology, Université de Montréal, Montreal, Canada
| | - Thien Tuong Minh Vu
- Department of Medicine, Université de Montréal, Montreal, Canada; Centre Hospitalier de L'Université de Montréal, Montreal, Canada
| | | | - Louis Bherer
- Research Centre, Montreal Heart Institute, Montreal, Canada; Research Centre, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada; Department of Medicine, Université de Montréal, Montreal, Canada; PERFORM Centre and Department of Psychology, Concordia University, Montreal, Canada.
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Abstract
UNLABELLED ABSTRACTBackground:Mind-body interventions have been associated with a range of positive outcomes in older adults with mild cognitive impairment (MCI). The aim of the present study was to review the impact of different non-pharmacological programs based on mind-body intervention for older adults with MCI. METHODS A comprehensive search method as required by the Cochrane Collaboration has been performed through the following databases: Google Scholar, Science Direct, PubMed, PsycINFO, MEDLINE, EMBASE, CINHAL, Cochrane, Ebsco. We included the studies that evaluated the impact of mind-body interventions such as mindfulness or meditation, yoga, Tai Chi and Qigong on cognitive function and everyday functionality of non-hospitalized adults aged 55 years or over with MCI. RESULTS Nine studies met the inclusion criteria. Results indicated that mind-body interventions improved cognitive function, everyday activities functioning, and mindfulness, as well as resulting in a moderate reduction in fall risk, depression and stress and lower risk of dementia at one year. CONCLUSION Several mind-body interventions focused broadly on mindfulness, yoga and Tai Chi training have been studied. This review shows that mind-body interventions improved cognitive function and everyday activities functioning, memory, resilience and mindfulness in older adults with MCI. However, the conclusions faced limitations, such as small sample size, heterogeneity of outcome measures, lack of an active control group and absence of long-term follow up. Further high-quality evidence is needed in order to determine whether mind-body interventions are cost-effective for improving cognitive decline in older adults with MCI and for delaying the rapid progression from MCI to Alzheimer or other types of dementia.
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Choi W, Lee S. The Effects of Virtual Kayak Paddling Exercise on Postural Balance, Muscle Performance, and Cognitive Function in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial. J Aging Phys Act 2019; 27:861–870. [PMID: 31034303 DOI: 10.1123/japa.2018-0020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Deterioration of physical and psychological health is an important issue in older adults aged 65 years or more. This study aimed to determine whether a virtual kayak paddling (VKP) exercise could improve postural balance, muscle performance, and cognitive function in older adults with mild cognitive impairment. Sixty participants were randomly assigned to the VKP (n = 30) or control group (n = 30). Participants in the VKP group performed the paddling exercise in a virtual environment for 60 min twice a week for 6 weeks, while those in the control group performed home exercises. Postural balance (p < .05), muscle performance (p < .05), and cognitive function (p < .05) were significantly improved in the VKP group and were superior to those in the control group (p < .05). Thus, our findings indicate that VKP exercise improves postural balance, muscle performance, and cognitive function in older adults with mild cognitive impairment.
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Affiliation(s)
- Wonjae Choi
- 1 Institute of SMART Rehabilitation, Sahmyook University, Seoul 01795, Republic of Korea
| | - Seungwon Lee
- 1 Institute of SMART Rehabilitation, Sahmyook University, Seoul 01795, Republic of Korea
- 2 Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
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Follador L, Alves RC, Ferreira SDS, Silva AC, Silva SGD. Perceived Exertion and Affect From Tai Chi, Yoga, and Stretching Classes for Elderly Women. Percept Mot Skills 2019; 126:223-240. [PMID: 30638426 DOI: 10.1177/0031512518823661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tai Chi, yoga, and stretching regimens are gaining popularity as alternatives to more traditional exercise, but there is scant research regarding participants' perceived exertion and affective responses to these practices. We compared experienced states of perceived exertion, feelings of pleasure/displeasure, and arousal in 70 elderly women enrolled in groups of Tai Chi ( n = 26), yoga ( n = 25), or stretching ( n = 19) classes. Mean rates of perceived exertion, feelings of pleasure, and arousal responses were significantly higher over the time course of all three groups, while the overall mean perceived exertion ( Somewhat Hard on the Borg CR-10 scale) and pleasure responses (∼ Very Good on the Feeling Scale) were similar between them. The circumplex model of affect showed that changes occurred in the high-activation pleasure quadrant (energy on the Felt Arousal Scale). From a practical perspective, the exercise intensity and affective responses elicited during these classes made participants feel good and infused with energy, likely creating a positive memory and reinforcing continued physical activity participation.
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Affiliation(s)
- Lucio Follador
- 1 Department of Physical Education, Federal University of Parana, Brazil
| | - Ragami C Alves
- 1 Department of Physical Education, Federal University of Parana, Brazil
| | | | - Aldo C Silva
- 1 Department of Physical Education, Federal University of Parana, Brazil
| | - Sergio G da Silva
- 1 Department of Physical Education, Federal University of Parana, Brazil
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Agbangla NF, Audiffren M, Pylouster J, Albinet CT. Working Memory, Cognitive Load andCardiorespiratory Fitness: Testing the CRUNCHModel with Near-Infrared Spectroscopy. Brain Sci 2019; 9:brainsci9020038. [PMID: 30744137 PMCID: PMC6406418 DOI: 10.3390/brainsci9020038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 01/07/2023] Open
Abstract
The present study aimed to examine the effects of chronological age and cardiorespiratory fitness (CRF) on cognitive performance and prefrontal cortex activity, and to test the compensation-related utilization of neural circuits hypothesis (CRUNCH). A total of 19 young adults (18–22 years) and 37 older ones (60–77 years) with a high or low CRF level were recruited to perform a working memory updating task under three different cognitive load conditions. Prefrontal cortex hemodynamic responses were continuously recorded using functional near-infrared spectroscopy, and behavioral performances and perceived difficulty were measured. Results showed that chronological age had deleterious effects on both cognitive performance and prefrontal cortex activation under a higher cognitive load. In older adults, however, higher levels of CRF were related to increased bilateral prefrontal cortex activation patterns that allowed them to sustain better cognitive performances, especially under the highest cognitive load. These results are discussed in the light of the neurocognitive CRUNCH model.
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Affiliation(s)
- Nounagnon Frutueux Agbangla
- Centre de Recherches sur la Cognition et l'Apprentissage (UMR 7295), Université de Poitiers and Université François-Rabelais de Tours, 86073 Poitiers CEDEX 9, France.
- Atelier SHERPAS - Unité de Recherche Pluridisciplinaire Sport Santé Société (EA 7369), Université d'Artois, 62800 Liévin, France.
| | - Michel Audiffren
- Centre de Recherches sur la Cognition et l'Apprentissage (UMR 7295), Université de Poitiers and Université François-Rabelais de Tours, 86073 Poitiers CEDEX 9, France.
| | - Jean Pylouster
- Centre de Recherches sur la Cognition et l'Apprentissage (UMR 7295), Université de Poitiers and Université François-Rabelais de Tours, 86073 Poitiers CEDEX 9, France.
| | - Cédric T Albinet
- Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCoTE ⁻ EA 7420), Université de Toulouse, INU Champollion, 81012 Albi, France.
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Sorbie GG, Low C, Richardson AK. Effect of a 6-week yoga intervention on swing mechanics during the golf swing: a feasibility study. INT J PERF ANAL SPOR 2019. [DOI: 10.1080/24748668.2019.1566845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Graeme G. Sorbie
- School of Social & Health Sciences, Sport and Exercise, Abertay University, Dundee, UK
| | - Chris. Low
- School of Social & Health Sciences, Sport and Exercise, Abertay University, Dundee, UK
| | - Ashley K. Richardson
- School of Social & Health Sciences, Sport and Exercise, Abertay University, Dundee, UK
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Htut TZC, Hiengkaew V, Jalayondeja C, Vongsirinavarat M. Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial. Eur Rev Aging Phys Act 2018; 15:10. [PMID: 30305852 PMCID: PMC6169073 DOI: 10.1186/s11556-018-0199-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 09/24/2018] [Indexed: 12/25/2022] Open
Abstract
Background Physical exercise (PE), virtual reality-based exercise (VRE), and brain exercise (BE) can influence physical and cognitive conditions in older persons. However, it is not known which of the three types of exercises provide the best effects on physical and cognitive status, and which exercise is preferred by older persons. This study compared the effects of PE, VRE, and BE on balance, muscle strength, cognition, and fall concern. In addition, exercise effort perception and contentment in older persons was evaluated. Methods Eighty-four older persons (n = 84) were randomly selected for PE, VRE, BE, and control groups. The exercise groups received 8-week training, whereas the control group did not. Balance was assessed by Berg Balance Scale (BBS) and Timed Up and Go test (TUG), muscle strength by 5 Times Sit to Stand (5TSTS) and left and right hand grip strength (HGS), cognition by Montreal Cognitive Assessment (MoCA) and Timed Up and Go test Cognition (TUG-cog), fall concern by Fall Efficacy Scale International (FES-I), exercise effort perception by Borg category ratio scale (Borg CR-10), and exercise contentment by a questionnaire. Results After exercise, PE significantly enhanced TUG and 5TSTS to a greater extent than VRE (TUG; p = 0.004, 5TSTS; p = 0.027) and BE (TUG; p = 0,012, 5TSTS; p < 0.001). VRE significantly improved MoCA (p < 0.001) and FES-I (p = 0.036) compared to PE, and 5TSTS (p < 0.001) and FES-I (p = 0.011) were improved relative to BE. MoCA was significantly enhanced by BE compared to PE (p < 0.001) and both MoCA and TUG-cog were improved compared to VRE (p = 0.04). PE and VRE significantly (p < 0.001) increased Borg CR-10 in all exercise sessions, whereas BE showed a significant improvement (p < 0.001) in the first 4 sessions. Participants had a significantly greater satisfaction with BE than controls (p = 0.006), and enjoyed VRE and BE more than PE (p < 0.001). Subjects in all exercise groups exhibited benefits compared to the control group (p < 0.001). Conclusions PE provided the best results in physical tests, VRE produced measurable improvements in physical and cognition scores, while BE enhanced cognition ability in older persons. Older persons preferred VRE and BE compared to PE. Both exercises are suggested to older persons to improve physical and cognitive conditions.
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Affiliation(s)
- Thwe Zar Chi Htut
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Chutima Jalayondeja
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
| | - Mantana Vongsirinavarat
- Faculty of Physical Therapy, Mahidol University, 999 Phutthamonthon 4 Rd., Salaya, Phutthamonthon, Nakhon Pathom, 73170 Thailand
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50
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Pandya SP. Yoga Education Program for Improving Memory in Older Adults: A Multicity 5-Year Follow-Up Study. J Appl Gerontol 2018; 39:576-587. [DOI: 10.1177/0733464818794153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This article reports a multicity study on the effect of a yoga education program (YEP) in improving memory and cognitive functions of a nonclinical sample of community-dwelling older adults. Specifically, the intervening personal resources that bolster or hinder YEP effectiveness were examined. Of the original cohort of 918 older adults randomized into intervention and waitlist control groups, 792 remained with the study 5 years later. Results indicated that weekly YEP lessons and self-practice improved participants’ scores on the Mini-Mental State Examination (MMSE) and Rivermead Behavioral Memory Test–Third Edition (RBMT-3). Participants from Asian cities, women, Hindus and Buddhists, middle class, highly educated, retired, ever single or widowed, living alone or with children and kin, were more responsive to the YEP. Regular attendance and self-practice were strong moderators of YEP effectiveness, with self-practice having the strongest predictor effect. Some cultural variations and improvisations would lend the YEP a wider application.
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