Effectiveness of traditional chinese medicine (TCM) exercise therapy intervention on the cognitive function in the elderly: A systematic review and meta-analysis

OBJECTIVES

There exists a deficiency in a distinct understanding of the intervention effects of Traditional Chinese Medicine (TCM) exercise therapies (Tai Chi, Yi Jin Jing, Ba Duan Jin, Liu Zi Jue, Qigong, Wu Qin Xi etc.) on cognitive function and its moderating variables in the elderly. This study aims to systematically evaluate the effects of TCM exercise therapies on the cognitive function of the elderly and further propose the best exercise intervention programme to delay the cognitive decline of the elderly.

METHODS

PubMed, EBSCO host, Web of Science, EMbase, China National Knowledge Infrastructure and Wan Fang databases were searched for the effects of TCM exercise therapies on the cognitive function in older adults until July 2022. A meta-analysis of the included literature was performed using Stata 12.0 software, with a subgroup analysis of seven moderating variables: subject type, intervention content, intervention duration, intervention frequency, intervention period, study type and sample size. A random effects model was used to combine the overall effect sizes and to test for heterogeneity and publication bias across studies.

RESULTS

A total of 20 publications with 1975 subjects were included. The TCM exercise therapies delayed cognitive decline in older adults (d = 0.83; 95 % CI [0.62-1.04]; P < 0.001). Subgroup analysis found that intervention content, intervention duration, intervention frequency, and intervention period were significant moderating variables influencing the effectiveness of the intervention. Among them, the Ba Duan Jin intervention (d = 0.85; 95 % CI [0.65-1.06]; P < 0.001), the duration of each exercise session of 60 min or more (d = 0.86; 95 % CI [0.71-1.00]; P < 0.001), the frequency of exercise of more than 5 times per week (d = 0.80; 95 % CI [0.64-0.96]; P < 0.001) and exercise cycles of 6-9 months (d = 0.96; 95 % CI [0.80-1.12]; P < 0.001) produced the largest effect sizes.

CONCLUSION

TCM exercise therapies can effectively improve the cognitive function of the elderly. The best effect on the cognitive function of the elderly was achieved by choosing Ba Duan Jin and exercising at least five times a week for at least 60 min each time for a total of 6-9 months. The effect size of the TCM exercise therapy interventions on the cognitive function in older adults may be overestimated because of publication bias. In addition, large-sample, multicenter, high-quality randomised controlled trials should be conducted to validate this result.

The effect of multi-component exercise on cognition function in patients with diabetes: A systematic review and meta-analysis

BACKGROUND

This meta-analysis investigated the influence of exercise on cognitive function in people living with diabetes.

METHODS

Stringent criteria for literature inclusion and exclusion were defined. Searches were conducted across four English databases to gather randomized controlled trials investigating exercise interventions for cognitive function in people living with diabetes. Outcome indicators from 1193 subjects across 12 articles were analyzed using RevMan 5.4 software.

RESULTS

Exercise intervention demonstrated the ability to mitigate cognitive decline in people living with diabetes, with a combined effect size (standardized mean difference) of 0.91, 95% CI: 0.28, 1.54, P < 0.00001. The intervention effect showed significant modulation by intervention content (I2 = 95%), intervention duration (I2 = 95%), intervention frequency (I2 = 95%), and intervention cycle (I2 = 96%). Among these factors, multi-component exercise, sessions >40 minutes, exercise frequency >4 times per week, and sustained exercise for >6 months were paramount, all with P < 0.05.

CONCLUSION

Exercise intervention emerges as a viable strategy for delaying cognitive decline in people living with diabetes. Its efficacy is subject to modulation by various variables. Optimal intervention includes multi-component exercise, individual sessions lasting 40-60 minutes, exercising >4 times a week, and continuous exercise for over 6 months.

Drug interactions of carbonic anhydrase inhibitors and activators

INTRODUCTION

Carbonic anhydrases (CAs, EC 4.2.1.1) have been established drug targets for decades, with their inhibitors and activators possessing relevant pharmacological activity and applications in various fields. At least 11 sulfonamides/sulfamates are clinically used as diuretics, antiglaucoma, antiepileptic, or antiobesity agents and one derivative, SLC-0111, is in clinical trials as antitumor/antimetastatic agent. The activators were less investigated with no clinically used agent.

AREAS COVERED

Drug interactions between CA inhibitors/activators and various other agents are reviewed in publications from the period March 2020 - January 2024.

EXPERT OPINION

Drug interactions involving these agents revealed several interesting findings. Acetazolamide plus loop diuretics is highy effective in acute decompensated heart failure, whereas ocular diseases such as X-linked retinoschisis and macular edema were treated by acetazolamide plus bevacizumab or topical NSAIDs. Potent anti-infective effects of acetazolamide and other CAIs, alone or in combination with other agents were demonstrated for the management of Neisseria gonorrhoea, vancomycin resistant enterococci, Acanthamoeba castellanii, Trichinella spiralis, and Cryptococcus neoformans infections. Topiramate, in combination with phentermine is incresingly used for the management of obesity, whereas zonisamide plus levodopa is highly effective for Parkinson's disease. Acetazolamide, methazolamide, ethoxzolamide, and SLC-0111 showed synergistic antitumor/antimetastatic action in combination with many other antitumor drugs.

Theophylline for the management of respiratory disorders in adults in the 21st century: A scoping review from the American College of Clinical Pharmacy Pulmonary Practice and Research Network

Theophylline is an oral methylxanthine bronchodilator recommended as alternate therapy for the treatment of asthma and chronic obstructive pulmonary disease (COPD). However, it is not generally recommended for the treatment of other respiratory disorders such as obstructive sleep apnea (OSA) or hypoxia. Most clinical practice guidelines rely on evidence published prior to the year 2000 to make these recommendations. This scoping review aimed to gather and characterize evidence describing theophylline for the management of respiratory disorders in adults between January 1, 2000 and December 31, 2020. Databases searched included Ovid MEDLINE, Embase, CINAHL Complete, Scopus, and International Pharmaceutical Abstracts. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Studies were included if they were published in English, theophylline was used for any respiratory disorder, and the study outcomes were disease- or patient-oriented. After removal of duplicates, 841 studies were screened and 55 studies were included. Results aligned with current clinical guideline recommendations relegating theophylline as an alternative therapy for the treatment of respiratory disorders, in favor of inhaled corticosteroids and inhaled bronchodilators. This scoping review identified the need for future research including: theophylline versus other medications deemed alternative therapies for asthma and COPD, meta-analyses of low-dose theophylline, and studies evaluating evidence-based patient-oriented outcomes for OSA, hypoxia, ventilator-induced diaphragmatic dysfunction, and spinal cord injury-related pulmonary function.

Acute effects of different exercise forms on executive function and the mechanism of cerebral hemodynamics in hospitalized T2DM patients: a within-subject study

Objective

This study aimed to investigate the acute effects of aerobic exercise (AE), resistance exercise (RE), and integrated concurrent exercise (ICE; i.e., AE plus RE) on executive function among hospitalized type 2 diabetes mellitus (T2DM) inpatients, and the mechanism of cerebral hemodynamics.

Methods

A within-subject design was applied in 30 hospitalized patients with T2DM aged between 45 and 70 years in the Jiangsu Geriatric Hospital, China. The participants were asked to take AE, RE, and ICE for 3 days at 48-h intervals. Three executive function (EF) tests, namely, Stroop, More-odd shifting, and 2-back tests, were applied at baseline and after each exercise. The functional near-infrared spectroscopy brain function imaging system was used to collect cerebral hemodynamic data. The one-way repeated measurement ANOVA was used to explore training effects on each test indicator.

Results

Compared with the baseline data, the EF indicators have been improved after both ICE and RE (p < 0.05). Compared with the AE group, the ICE and RE groups have demonstrated significant improvements in inhibition (ICE: MD = - 162.92 ms; RE: MD = -106.86 ms) and conversion functions (ICE: MD = -111.79 ms; RE: MD = -86.95 ms). Based on the cerebral hemodynamic data, the beta values of brain activation in executive function related brain regions increased after three kinds of exercise, the EF improvements after the ICE showed synchronous activation of blood flow in the dorsolateral prefrontal cortex (DLPFC), the frontal polar (FPA) and orbitofrontal cortex (OFC), the improvement of inhibitory function after RE displayed synchronous activation of DLPFC and FPA, and AE mainly activates DLPFC. The HbO₂ concentration in the pars triangularis Broca's area increased significantly after AE, but the EF did not improve significantly.

Conclusion

The ICE is preferred for the improvements of executive function in T2DM patients, while AE is more conducive to the improvements of refresh function. Moreover, a synergistic mechanism exists between cognitive function and blood flow activation in specific brain regions.

The Impact of Acetazolamide and Methazolamide on Exercise Performance in Normoxia and Hypoxia

Doherty, Connor J., Jou-Chung Chang, Benjamin P. Thompson, Erik R. Swenson, Glen E. Foster, and Paolo B. Dominelli. The impact of acetazolamide and methazolamide on exercise performance in normoxia and hypoxia. High Alt Med Biol. 24:7-18, 2023.-Carbonic anhydrase (CA) inhibitors are commonly prescribed for acute mountain sickness (AMS). In this review, we sought to examine how two CA inhibitors, acetazolamide (AZ) and methazolamide (MZ), affect exercise performance in normoxia and hypoxia. First, we briefly describe the role of CA inhibition in facilitating the increase in ventilation and arterial oxygenation in preventing and treating AMS. Next, we detail how AZ affects exercise performance in normoxia and hypoxia and this is followed by a discussion on MZ. We emphasize that the overarching focus of the review is how the two drugs potentially affect exercise performance, rather than their ability to prevent/treat AMS per se, their interrelationship will be discussed. Overall, we suggest that AZ hinders exercise performance in normoxia, but may be beneficial in hypoxia. Based upon head-to-head studies of AZ and MZ in humans on diaphragmatic and locomotor strength in normoxia, MZ may be a better CA inhibitor when exercise performance is crucial at high altitude.