Exercise-Induced Neuroplasticity: A Mechanistic Model and Prospects for Promoting Plasticity

Exploring the impact of exercise-induced BDNF on neuroplasticity in neurodegenerative and neuropsychiatric conditions

This review investigates the intricate relationship between exercise, brain-derived neurotrophic factor (BDNF), neuroplasticity, and cognitive function, with a focus on implications for neuropsychiatric and neurodegenerative disorders. A systematic review was conducted by searching various databases for relevant studies that explored the connections between exercise, BDNF, neuroplasticity, and cognitive health. The analysis of eligible studies revealed that exercise increases BDNF levels in the brain, promoting neuroplasticity and enhancing cognitive functions. Furthermore, we discuss the protective effects of exercise against cognitive decline and neurological disorders, suggesting that BDNF plays a critical role in mediating these effects. Regular physical activity not only elevates BDNF levels but also fosters memory and learning, offering important implications for the prevention and treatment of neuropsychiatric and neurodegenerative conditions. Our findings underscore the necessity of incorporating exercise into a healthy lifestyle to optimize brain health. Future research is essential to elucidate the underlying mechanisms of this relationship and to refine exercise interventions for improved cognitive outcomes.

Improving reading competence in aphasia with combined aerobic exercise and phono-motor treatment: Protocol for a randomized controlled trial

Aphasia, a communication disorder caused primarily by left-hemisphere stroke, affects millions of individuals worldwide, with up to 70% experiencing significant reading impairments. These deficits negatively impact independence and quality of life, highlighting the need for effective treatments that target the cognitive and neural processes essential to reading recovery. This Randomized Clinical Trial (RCT) aims to test the efficacy of a combined intervention incorporating aerobic exercise training (AET) and phono-motor treatment (PMT) to enhance reading recovery in individuals with post-stroke aphasia. AET, known for its positive impact on cerebral blood flow (CBF) and oxygenation, is hypothesized to facilitate neuroplasticity when administered before PMT, an intensive therapy aimed at strengthening phonological processing. While most existing treatments focus on spoken language production, this study builds on evidence that PMT can also improve reading skills. The study is structured as a Phase I/II clinical trial and compares the effects of AET plus PMT to a control condition of stretching plus PMT on reading and other language outcomes including naming, auditory comprehension, and spontaneous speech. Additionally, it investigates the immediate and sustained impacts of the intervention on CBF, functional connectivity, and task-evoked brain activity. The central hypothesis posits that AET will increase CBF and, when combined with PMT, will lead to enhanced reading recovery, supporting treatment-induced plasticity. This trial represents one of the first large-scale interventions targeting post-stroke reading impairments and provides critical insights into the potential of combining AET with cognitive rehabilitation to improve language recovery in aphasia.

The impact of aerobic exercise on depression in young people: A meta regression and meta-analysis

OBJECTIVE

This systematic review aimed to 1) update the existing evidence on the antidepressant effects of aerobic exercise (AE) in youth. 2) Investigate any potential dose‒response relationships between AE interventions and depressive symptom reduction. 3) Provide evidence-based insights to inform future research and clinical depression treatment.

METHODS

Employing the PRISMA and PERSiST guidelines, a comprehensive search across nine databases (Web of Science, PubMed, Scopus, PsycINFO, SportDiscus, CINAHL, Medline, Embase, and CNKI) yielded a total of 782 relevant studies. Following rigorous selection criteria, 26 eligible studies (comprising 22 different samples) were included in the analysis, featuring a combined sample size of 1308 participants. The meta-analysis was conducted via R.

RESULTS

AE notably decreased depressive symptoms among youth [g = -0.92; 95% CI (-1.16, -0.69); p < 0.01]. Significant dose‒response relationships were observed across age groups [β = -0.06; 95% CI (-0.12, 0.00), p < 0.05], the intensity [β = -0.03; 95% CI (-0.06, 0.00); p < 0.05], and the duration ^ 2 [β = 0.001, 95% CI (0.001, 0.002), p < 0.05] of the AE intervention.

CONCLUSIONS

Aerobic exercise interventions can effectively alleviate depressive symptoms in youth. A moderate-intensity AE program, lasting 25-40 min and conducted three times a week for 9-15 weeks, can increase alleviation of depression.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Molecular biomarkers of dysphagia targeted exercise induced neuroplasticity: A review of mechanistic processes and preliminary data on detraining effects

While molecular adaptations accompanying neuroplasticity during physical exercises are well-established, little is known about adaptations during dysphagia-targeted exercises. This research article has two primary purposes. First, we aim to review the existing literature on the intersection between resistance (strength) training, molecular markers of neuroplasticity, and dysphagia rehabilitation. Specifically, we discuss the molecular mechanisms of two potential molecular markers: brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1) in exercise-induced neuroplasticity. Second, we present preliminary data on the effects of two weeks of detraining on circulating serum BDNF, IGF-1 levels, and expiratory muscle strength. This subset is a part of our more extensive studies related to dysphagia-targeted resistance exercise and neuroplasticity. Five young adult males underwent four weeks of expiratory muscle strength training, followed by two weeks of detraining. We measured expiratory strength, circulating levels of BDNF, and IGF-1 at post-training and detraining conditions. Our results show that expiratory muscle strength, serum BDNF, and IGF-1 levels decreased after detraining; however, this effect was statistically significant only for serum BDNF levels. Oropharyngeal and upper airway musculature involved in swallowing undergoes similar adaptation patterns to skeletal muscles during physical exercise. To fully comprehend the mechanisms underlying the potential neuroplastic benefits of targeted exercise on swallowing functions, mechanistic studies (models) investigating neuroplasticity induced by exercises addressing dysphagia are critical. Such models would ensure that interventions effectively and efficiently achieve neuroplastic benefits and improve patient outcomes, ultimately advancing our understanding of dysphagia-targeted exercise-induced neuroplasticity.

Use of Transcranial Magnetic Stimulation to Probe Neuroplasticity and Predict Gait Performance After Treadmill Training in Parkinson's Disease

BACKGROUND

Reduced step length is a hallmark of gait disturbance in people with Parkinson's disease (PD). Although treadmill training is effective for improving step length, the associated neural mechanisms have not been fully investigated. Moreover, exploring the baseline neurophysiological predictors for step length improvement after training could facilitate personalized gait rehabilitation for PD.

OBJECTIVE

The aim of this study was to investigate the neuroplastic changes in corticomotor excitability after treadmill training and to explore whether baseline neurophysiological measures could predict step length improvement in PD.

METHODS

Data from 61 participants with idiopathic PD who completed 12 treadmill training sessions were included. Gait performances and corticomotor excitability measured by transcranial magnetic stimulation (TMS) were obtained at baseline, postintervention, and 1-month follow-up. TMS outcomes included motor-evoked potentials, cortical silent period (CSP), intracortical facilitation (ICF), and short-interval intracortical inhibition (SICI). General estimating equation analysis and principal-component analyses were used to determine the neuroplastic changes induced by training, and multiple linear regression analysis was performed to explore the baseline TMS predictors for step length improvement at 1-month follow-up.

RESULTS

After treadmill training, SICI and CSP significantly increased and shared an emerging relationship. Regression analysis showed that female sex and greater baseline ICF and SICI were significant predictors of step length improvement at the follow-up.

CONCLUSIONS

This study advanced the understanding of neuroplastic changes induced by treadmill training in PD and showed that preserved SICI and ICF were predictors for lasting step length improvement after training. Future studies could investigate other influential factors for treadmill training in PD. © 2024 International Parkinson and Movement Disorder Society.

Optimizing antidepressant benefits: Effect of theta burst stimulation treatment in physically active people with treatment-resistant depression

Theta burst stimulation (TBS) is a promising therapy for treatment-resistant major depressive disorder (MDD), but a significant proportion of individuals do not respond adequately, necessitating alternative approaches. This study explores whether individuals meeting minimum recommended physical activity levels demonstrate better responses to TBS compared to physically inactive individuals. Using data from a randomized controlled trial (n = 43), participants were categorized as physically active or inactive based on baseline International Physical Activity Questionnaire (IPAQ) scores. Depression scores (Hamilton Rating Scale for Depression, 17-item; HRSD-17) were assessed at baseline, 4, and 6 weeks of TBS treatment. A significant Time X Group effect adjusted for age and baseline depression was observed. Physically active individuals consistently exhibited lower depression scores across time points. At 4 and 6 weeks, there was a significant increase in between-group differences, indicating that the physically active group derived greater benefits from treatment. At 6 weeks, a significantly higher proportion of responders (≥50 % HRSD-17 reduction) were observed in the physically active compared to inactive group. Physical activity significantly contributed to regression and logistic models predicting treatment response. These findings support the potential role of baseline physical activity in enhancing TBS therapy for MDD.

The mediating effect of psychosomatic symptoms between physical activity and cognitive function among breast cancer patients: A path analysis

PURPOSE

Psychosomatic symptoms are frequently observed side effects in breast cancer (BC) patients and significantly influence cognitive function. However, limited research has addressed the role of psychosomatic symptoms in the relationship between physical activity and cognitive function. This study aimed to examine the mediating effect of psychosomatic symptoms on the relationship between physical activity and cognitive function in BC patients.

METHODS

A cross-sectional study was conducted across 10 hospitals in China from April 2022 to February 2023. Cognitive function was assessed using the Functional Assessment of Cancer Therapy-Cognitive Function scale. Exercise frequency, sleep quality, fatigue, anxiety, and depression were measured using the Pittsburgh Sleep Quality Index questionnaire, Cancer Fatigue Scale, Generalized Anxiety Disorder Questionnaire-7, and Patient Health Questionnaire-9, respectively, among 741 BC patients. Correlation analysis and path analysis were performed to explore associations between variables.

RESULTS

The prevalence of cognitive impairment in BC patients was found to be 9.58%. The path model demonstrated the best fit when age was included as a moderating variable, and the association between age and sleep disorders was controlled. Physical activity showed a negative correlation with both psychosomatic symptoms and cognitive impairment (p < 0.05). It exerted a direct impact on cognitive impairment (20.3%, p < 0.001) and an indirect impact mediated through anxiety and depression (6.3%, p < 0.001). The total effect in the model was 38.6% (p < 0.001).

CONCLUSION

Physical activity has a pivotal role in improving cognitive function in BC patients, both through direct mechanisms and indirectly by reducing anxiety and depression. While enhancements in sleep quality and fatigue levels were observed, their influence on cognitive function did not reach statistical significance, indicating the need for further research. These findings underscore the importance of incorporating psychological symptom management into supportive care plans to aid cognitive recovery. A combination of physical activity and psychological interventions could provide synergistic benefits, potentially boosting cognitive improvement and enhancing the overall quality of life in BC patients.

High-intensity interval exercise is more efficient than medium intensity exercise at inducing neurogenesis

The neurogenic potential of the brain decreases during ageing, whereas the risk of neurodegenerative diseases and stroke rises. This creates a mismatch between the rate of neuron loss and the brain's capacity for replacement. Adult neurogenesis primarily occurs in the subgranular zone (SGZ) and the ventricular-subventricular zone (V-SVZ). Exercise enhances SGZ neurogenesis, and we previously showed that V-SVZ neurogenesis is induced by exercise via activation of the lactate receptor HCA1. Here, we investigated how high-intensity interval training (HIIT) and medium-intensity interval training (MIIT) affect neurogenesis in these niches. Wild-type (WT) and HCA1 knockout (KO) mice were randomized to sedentary, HIIT or MIIT (n = 5-8 per group) for 3 weeks. In the SGZ, HIIT increased the density of doublecortin (DCX)-positive cells in WT mice by 85% (5.77±1.76 vs. 3.12±1.54 cells/100 µm, P = 0.013) and KO mice (67% increase; 7.91±2.92 vs. 4.73±1.63 cells/100 µm, P = 0.004). MIIT did not alter the density of DCX-positive cells in either genotype. HIIT increased the density of Ki-67-positive cells only in KO mice (P = 0.038), whereas no differences in nestin-positive cells were observed. In the V-SVZ, HIIT increased the density of DCX-positive cells in WT mice by 155% (117.79±39.72 vs. 46.25±19.96 cells/100 µm, P < 0.001) and MIIT increased the density of DCX-positive cells by 80% (83.26±39.48 vs. 46.25±19.96 cells/100µm, P = 0.027). No exercise-induced changes were observed in KO mice. Similar patterns were noted for Ki-67 positive and DCX/Ki-67 double-positive cells in the V-SVZ. These findings suggest that HIIT enhances neurogenesis more robustly than MIIT in both niches, with HCA1 playing a crucial role in V-SVZ neurogenesis. KEY POINTS: The neurogenic potential of the brain decreases with age, whereas the risk of neurodegenerative diseases and stroke increases, highlighting a mismatch between neuronal loss and replacement capacity. Exercise enhances neurogenesis in both the subgranular zone and the ventricular-subventricular zone. High-intensity interval exercise is more effective than medium-intensity interval exercise at promoting neurogenesis in both the subgranular zone and the ventricular-subventricular zone of wild-type mice. The enhancement of neurogenesis in the ventricular-subventricular zone is dependent on the activation of the HCA1 receptor, as evidenced by the ability of medium- and high-intensity interval exercise to induce neurogenesis in wild-type mice and the lack of this effect in HCA1 knockout mice. By contrast, neurogenesis in the subgranular zone is independent on the activation of the HCA1 receptor, highlighting that neurogenesis in the two major neurogenic niches are regulated differently.

Comparison of the Acute Effects of Virtual Reality Exergames and Core Stability Exercises on Cognitive Factors, Pain, and Fear Avoidance Beliefs in People with Chronic Nonspecific Low Back Pain

Objective: In this study, we aimed to investigate and compare the acute effects of exergames (EXG) and core stability exercises (CSEs) on cognitive factors, pain, mood, and fear-avoidance beliefs (FAB) in individuals with chronic low back pain (CLBP). Materials and Methods: In a single-blinded clinical trial, 40 participants with CLBP were randomly assigned to either the EXG group or the CSEs group. The EXG group engaged in a single session of exergames using the Xbox Kinect device, while the CSEs group completed a single session of common core stability exercises. Measurements of attention, working memory, pain intensity, mood states, and FAB were taken before and after each intervention. Results: The results showed that a single session of EXG was significantly more effective than CSEs in improving cognitive reaction time, pain intensity, FAB, and positive mood states (P ≤ 0.05). Additionally, participants reported lower perceived exertion due to exercising following EXG compared with CSEs. Conclusion: EXG may have potential therapeutic advantages over traditional exercise interventions for CLBP.

A meta-analysis of the efficacy of physical exercise interventions on activities of daily living in patients with Alzheimer's disease

Objective

This study aimed to systematically review published randomized controlled trials on the effects of physical exercise on activities of daily living (ADL) in Alzheimer's patients through meta-analysis, thereby synthesizing existing evidence to provide scientific intervention recommendations for exercise prescriptions in Alzheimer's patients.

Methods

Based on strict literature inclusion and exclusion criteria, a systematic search was conducted in databases including PubMed and Web of Science from their inception to July 1, 2024. The Cochrane risk assessment tool was used to evaluate the design of randomized controlled trials. Studies reporting on physical exercise interventions for ADL in Alzheimer's patients were systematically identified. Subgroup analyses and meta-regression were performed to explore sources of heterogeneity.

Results

Nineteen articles, for analysis, providing 27 randomized controlled trials (RCTs). A random-effects model was used to calculate the effect size and 95% confidence interval for each independent study, and meta-analysis was performed using Stata 16.0 and RevMan 5.4 software. The results showed that physical exercise might significantly improve ADL in Alzheimer's patients (SMD = 0.33, 95% CI: 0.12-0.54, I 2 = 81.7%). Sensitivity analysis confirmed the robustness of the results (p > 0.05). Egger's test did not reveal significant publication bias (p = 0.145). Samples were divided into different subgroups based on intervention content, duration, frequency, and session length. Subgroup analysis based on intervention characteristics showed that resistance training or aerobic exercise (SMD = 0.83, 95% CI: 0.60-1.05), long-term interventions (>6 months, SMD = 0.31, 95% CI: 0.13-0.49), medium-frequency interventions (4-5 times per week, SMD=0.39, 95% CI: 0.23-0.55), and short-duration training ( ≤ 30 min, SMD = 0.96, 95% CI: 0.71-1.21) might be most effective in enhancing ADL in Alzheimer's patients. These improvements were not only statistically significant but also had substantial impact in clinical practice.

Conclusion

Resistance training or aerobic exercise lasting more than 6 months, 4-5 times per week, and lasting no more than 30 min per session may be most effective in improving ADLs in patients with Alzheimer's disease.

The effects of acute exercise intensity on memory: Controlling for state-dependence

The present experiment evaluated the effects of varying intensities of acute exercise on free-recall memory performance while controlling for potential state-dependent effects. Forty-eight young adults completed a within-subject experiment involving seven primary laboratory visits. The encoding and retrieval phases were matched or mismatched by taking place either during rest or during a less than 5-min bout of acute exercise, and at moderate or vigorous intensity. We did not find evidence that the effects of acute exercise on memory were state-dependent but instead demonstrated that memory recall was greater when memory retrieval occurred during vigorous-intensity exercise compared to rest. These findings have important implications for the strategic placement of exercise during the phases of memory (e.g., acquisition, storage, retrieval) to optimize memory performance and suggest boundary conditions of state-dependent learning. We discuss various theoretical accounts (e.g., shift in metabolic resources across brain regions) to explain these findings.

Executive Functions Rehabilitation in Premature Children Using an Adaptive Motion-Interaction Videogame Platform: A Randomized Controlled Trial

Background: Premature children are at increased risk of executive functions (EF) deficits and these difficulties persist into adolescence and adulthood, potentially undermining their development and academic achievements. The aim of the present randomized controlled trial (RCT) is to evaluate the efficacy of the Intendu trainer, an adaptive virtual reality platform, at ameliorating EF in preterm children. Methods: A single-center, RCT was conducted. The intervention group was exposed to game session with the Intendu software in addition to the standard of care in use in our center. The main outcome was the proportion of children with a 10-point increase in the processing speed quotient as measured by WPPSI-III after 4 weeks from the baseline assessment. Results: Forty-seven children born before 36 + 5 weeks were randomized to the experimental (n = 24) or control arm (n = 23). Five children were lost to follow-up. Thirteen of 23 children (56%) reached the main outcome in the experimental group and 5 of 19 (26%) in the control group (P = 0.049, per-protocol analysis) with an absolute benefit increase (ABI) of 30% reconfirmed by the intention-to-treat analysis (P = 0.022, ABI of 32%). Conclusion: Intendu brain-trainer showed promising short-term results on EF in pre-term children, however, larger studies with longer periods of follow-up are warranted to better investigate the role of this or similar technology in promoting better EF in preterm children.

Electrical stimulation: a potential alternative to positively impact cerebral health?

An increasing body of evidence confirms the effectiveness of physical exercise (PE) in promoting brain health by preventing age-related cognitive decline and reducing the risk of neurodegenerative diseases. The benefits of PE are attributed to neuroplasticity processes which have been reported to enhance cerebral health. However, moderate to high-intensity PE is necessary to induce these responses and these intensities cannot always be achieved especially by people with physical limitations. As a countermeasure, electrical stimulation (ES) offers several benefits, particularly for improving physical functions, for various neurological diseases. This review aims to provide an overview of key mechanisms that could contribute to the enhancement in brain health in response to ES-induced exercise, including increases in cerebral blood flow, neuronal activity, and humoral pathways. This narrative review also focuses on the effects of ES protocols, applied to both humans and animals, on cognition. Despite a certain paucity of research when compared to the more classical aerobic exercise, it seems that ES could be of interest for improving cerebral health, particularly in people who have difficulty engaging in voluntary exercise.

Simulating space walking: a systematic review on anti-gravity technology in neurorehabilitation

Neurological disorders, such as Parkinson's disease (PD), multiple sclerosis (MS), cerebral palsy (CP) and stroke are well-known causes of gait and balance alterations. Innovative devices (i.e., robotics) are often used to promote motor recovery. As an alternative, anti-gravity treadmills, which were developed by NASA, allow early mobilization, walking with less effort to reduce gait energy costs and fatigue. A systematic search, according to PRISMA guidelines, was conducted for all peer-reviewed articles published from January 2010 through September 2023, using the following databases: PubMed, Scopus, PEDro and IEEE Xplore. After an accurate screening, we selected only 16 articles (e.g., 5 RCTs, 2 clinical trials, 7 pilot studies, 1 prospective study and 1 exploratory study). The evidence collected in this systematic review reported promising results in the field of anti-gravity technology for neurological patients, in terms of improvement in gait and balance outcomes. However, we are not able to provide any clinical recommendation about the dose and parameters of anti-gravity treadmill training, because of the lack of robust high-quality RCT studies and large samples. Registration number CRD42023459665.

The effect of physical exercise on cognitive function in schizophrenia patients: A GRADE assessed systematic review and meta-analysis of controlled clinical trials

BACKGROUND

Physical exercise has demonstrated the potential to improve cognitive impairment in schizophrenia, although the results are limited. The objective of this meta-analysis is to synthesize the existing evidence on the impact of physical exercise on cognitive functions in schizophrenia.

METHODS

A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted. The study included controlled clinical trials on patients with schizophrenia that received physical exercise as the intervention for improving cognition. A meta-analysis was conducted using a random-effects model, and the outcomes were reported using the standardized mean difference (SMD) and a 95 % confidence interval (95 % CI).

RESULTS

A total of 22 articles, including 1066 patients (565 in the intervention group and 501 in the control group), were included in the final analysis. Physical exercises significantly improved global cognition (SMD: 0.73, 95 % CI (0.46-1.00), P < 0.001), and aerobic exercise was found to have a more significant effect than resistance and mindfulness exercise (SMD: 0.76, 95 % CI (0.45-1.07), P < 0.001). The speed of processing [SMD: 0.88, 95 % CI (0.37-1.38), P = 0.001], attention [SMD: 0.61, 95 % CI (0.20-1.02), P = 0.004], and visual learning memory [SMD: 1.42, 95 % CI (0.14-2.71), P = 0.03] demonstrated significant improvement after physical exercise, while no significant effects were observed on working memory, verbal learning memory, reasoning and problem-solving, and social cognition.

CONCLUSIONS

Exercise can improve overall cognitive function in people with Schizophrenia. However, it is unclear whether this improvement is significant in specific cognitive domains.

MRS-assessed brain GABA modulation in response to task performance and learning

Gamma-aminobutyric acid (GABA), the most important inhibitory neurotransmitter in the human brain, has long been considered essential in human behavior in general and learning in particular. GABA concentration can be quantified using magnetic resonance spectroscopy (MRS). Using this technique, numerous studies have reported associations between baseline GABA levels and various human behaviors. However, regional GABA concentration is not fixed and may exhibit rapid modulation as a function of environmental factors. Hence, quantification of GABA levels at several time points during the performance of tasks can provide insights into the dynamics of GABA levels in distinct brain regions. This review reports on findings from studies using repeated measures (n = 41) examining the dynamic modulation of GABA levels in humans in response to various interventions in the perceptual, motor, and cognitive domains to explore associations between GABA modulation and human behavior. GABA levels in a specific brain area may increase or decrease during task performance or as a function of learning, depending on its precise involvement in the process under investigation. Here, we summarize the available evidence and derive two overarching hypotheses regarding the role of GABA modulation in performance and learning. Firstly, training-induced increases in GABA levels appear to be associated with an improved ability to differentiate minor perceptual differences during perceptual learning. This observation gives rise to the 'GABA increase for better neural distinctiveness hypothesis'. Secondly, converging evidence suggests that reducing GABA levels may play a beneficial role in effectively filtering perceptual noise, enhancing motor learning, and improving performance in visuomotor tasks. Additionally, some studies suggest that the reduction of GABA levels is related to better working memory and successful reinforcement learning. These observations inspire the 'GABA decrease to boost learning hypothesis', which states that decreasing neural inhibition through a reduction of GABA in dedicated brain areas facilitates human learning. Additionally, modulation of GABA levels is also observed after short-term physical exercise. Future work should elucidate which specific circumstances induce robust GABA modulation to enhance neuroplasticity and boost performance.

Physical exercise for brain plasticity promotion an overview of the underlying oscillatory mechanism

The global recognition of the importance of physical exercise (PE) for human health has resulted in increased research on its effects on cortical activity. Neural oscillations, which are prominent features of brain activity, serve as crucial indicators for studying the effects of PE on brain function. Existing studies support the idea that PE modifies various types of neural oscillations. While EEG-related literature in exercise science exists, a comprehensive review of the effects of exercise specifically in healthy populations has not yet been conducted. Given the demonstrated influence of exercise on neural plasticity, particularly cortical oscillatory activity, it is imperative to consolidate research on this phenomenon. Therefore, this review aims to summarize numerous PE studies on neuromodulatory mechanisms in the brain over the past decade, covering (1) effects of resistance and aerobic training on brain health via neural oscillations; (2) how mind-body exercise affects human neural activity and cognitive functioning; (3) age-Related effects of PE on brain health and neurodegenerative disease rehabilitation via neural oscillation mechanisms; and (4) conclusion and future direction. In conclusion, the effect of PE on cortical activity is a multifaceted process, and this review seeks to comprehensively examine and summarize existing studies' understanding of how PE regulates neural activity in the brain, providing a more scientific theoretical foundation for the development of personalized PE programs and further research.

The relevance of BDNF for neuroprotection and neuroplasticity in multiple sclerosis

Background

Neuroplasticity as a mechanism to overcome central nervous system injury resulting from different neurological diseases has gained increasing attention in recent years. However, deficiency of these repair mechanisms leads to the accumulation of neuronal damage and therefore long-term disability. To date, the mechanisms by which remyelination occurs and why the extent of remyelination differs interindividually between multiple sclerosis patients regardless of the disease course are unclear. A member of the neurotrophins family, the brain-derived neurotrophic factor (BDNF) has received particular attention in this context as it is thought to play a central role in remyelination and thus neuroplasticity, neuroprotection, and memory.

Objective

To analyse the current literature regarding BDNF in different areas of multiple sclerosis and to provide an overview of the current state of knowledge in this field.

Conclusion

To date, studies assessing the role of BDNF in patients with multiple sclerosis remain inconclusive. However, there is emerging evidence for a beneficial effect of BDNF in multiple sclerosis, as studies reporting positive effects on clinical as well as MRI characteristics outweighed studies assuming detrimental effects of BDNF. Furthermore, studies regarding the Val66Met polymorphism have not conclusively determined whether this is a protective or harmful factor in multiple sclerosis, but again most studies hypothesized a protective effect through modulation of BDNF secretion and anti-inflammatory effects with different effects in healthy controls and patients with multiple sclerosis, possibly due to the pro-inflammatory milieu in patients with multiple sclerosis. Further studies with larger cohorts and longitudinal follow-ups are needed to improve our understanding of the effects of BDNF in the central nervous system, especially in the context of multiple sclerosis.

Factors associated with perceived cognitive function in breast cancer patients treated with chemotherapy: A multicenter cross-sectional study

PURPOSE

This study aimed to investigate the factors associated with perceived cognitive function among breast cancer patients treated with chemotherapy in China.

METHODS

The study was a multicenter cross-sectional design. Data were collected from 10 public hospitals in China between April 2022 and February 2023. A total of 741 participants completed questionnaires assessing sociodemographic and medical characteristics, perceived cognitive function, sleep quality, fatigue, anxiety, and depression. Hierarchical multiple regression analysis was used to assess the determinants of cognitive function.

RESULTS

The hierarchical multiple regression model accounted for 31.5% of variation in perceived cognitive function (sociodemographic 4.5%; medical 6.6%; exercise frequency 6.6%; sleep quality 2.1%; fatigue 2.8%; anxiety combined with depression 9.0%). Education level, chemotherapy type, number of chemotherapy cycles, and cyclophosphamide drug use were significant predisposing factors of perceived cognitive function (p < 0.001). Exercising ≥3 times/week (p < 0.001) was a significant factor positively influencing perceived cognitive function, meanwhile, anxiety (p < 0.001) and depression (p < 0 0.001) were negative factors.

CONCLUSION

Our findings suggest that patients with low education levels, postoperative chemotherapy, cyclophosphamide treatment, and a greater number of chemotherapy cycles need more assessment. Sedentary patients, those who have never exercised, and those with anxiety or depression all showed greater cognitive decline. By identifying susceptible populations, encouraging regular exercise, and addressing anxiety and depression, healthcare professionals can contribute significantly to prevent patients' cognitive decline throughout chemotherapy.

An acute bout of high-intensity exercise affects nocturnal sleep and sleep-dependent memory consolidation

Acute exercise has been shown to affect long-term memory and sleep. However, it is unclear whether exercise-induced changes in sleep architecture are associated with enhanced memory. Recently, it has been shown that exercise followed by a nap improved declarative memory. Whether these effects transfer to night sleep and other memory domains has not yet been studied. Here, we investigate the influence of exercise on nocturnal sleep architecture and associations with sleep-dependent procedural and declarative memory consolidation. Nineteen subjects (23.68 ± 3.97 years) were tested in a balanced cross-over design. In two evening sessions, participants either exercised (high-intensity interval training) or rested immediately after encoding two memory tasks: (1) a finger tapping task and (2) a paired-associate learning task. Subsequent nocturnal sleep was recorded by polysomnography. Retrieval was conducted the following morning. High-intensity interval training lead to an increased declarative memory retention (p = 0.047, d = 0.40) along with a decrease in REM sleep (p = 0.012, d = 0.75). Neither procedural memory nor NREM sleep were significantly affected. Exercise-induced changes in N2 showed a positive correlation with procedural memory retention which did not withstand multiple comparison correction. Exploratory analyses on sleep spindles and slow wave activity did not reveal significant effects. The present findings suggest an exercise-induced enhancement of declarative memory which aligns with changes in nocturnal sleep architecture. This gives additional support for the idea of a potential link between exercise-induced sleep modifications and memory formation which requires further investigation in larger scaled studies.

The Effect of Omega-3 Fatty Acid Supplementation and Exercise on Locomotor Activity, Exploratory Activity, and Anxiety-Like Behavior in Adult and Aged Rats

Aging is an inevitable and complex biological process that is associated with a gradual decline in physiological functions and a higher disease susceptibility. Omega-3 fatty acids, particularly docosahexaenoic acid, play a crucial role in maintaining brain health and their deficiency is linked to age-related cognitive decline. Combining omega-3-rich diets with exercise may enhance cognitive function more effectively, as both share overlapping neurobiological and physiological effects. This study aimed to evaluate the effect of exercise and omega-3 fatty acid (FA) supplementation in two different doses (160 mg/kg and 320 mg/kg) on anxiety-like behavior and cognitive abilities in both adult and aged rats. Male Wistar rats (4-5- and 23-24-month-old) were randomly divided into seven groups: 3-week control supplemented with placebo without exercise, low-dose omega-3 FAs, high-dose omega-3 FAs, 7-week control supplemented with placebo without exercise, exercise-only, low-dose omega-3 FAs with exercise, and high-dose omega-3 FAs with exercise. The administered oil contained omega-3 FAs with DHA:EPA in a ratio of 1.5:1. Our results indicate that aging negatively impacts the locomotor and exploratory activity of rats. In adult rats, a low dose of omega-3 FAs reduces locomotor activity when combined with exercise while high dose of omega-3 FAs reduces anxiety-like behavior and improves recognition memory when combined with exercise. The combination of omega-3 FAs and exercise had varying impacts on behavior, suggesting a need for further research in this area to fully understand their therapeutic efficacy in the context of cognitive changes associated with aging.

Volleyball training improves working memory in children aged 7 to 12 years old: an fNIRS study

This study aimed to investigate the effect of a 12-wk extracurricular volleyball training on working memory from both behavioral and cerebral aspects. A total of 80 children were randomized assigned to (i) the experimental group, who engaged in extracurricular volleyball training for 60 min, thrice a week for 12 wk, and (ii) the control group, who maintained their regular daily routine. Working memory was evaluated in both groups using the N-back task before and after the intervention. Furthermore, functional near-infrared spectroscopy was employed to monitor the level of oxygenated hemoglobin in the prefrontal cortex. The experimental group performed better in the behavioral task than the control group, as evidenced by a shorter response time and a higher correct rate. The functional near-infrared spectroscopy results suggested that the activation of the left dorsolateral prefrontal cortex was significantly higher in the experimental group than in the control group. In addition, correlation analyses showed that the enhancement of left dorsolateral prefrontal cortex activation was significantly correlated with decreasing response time and improving response accuracy in the N-back task. These findings suggest that the left dorsolateral prefrontal cortex is likely the neural substrate for improved working memory performance elicited by 12-wk open skill exercise.

PEAK Mood, Mind, and Marks: a pilot study of an intervention to support university students' mental and cognitive health through physical exercise

Introduction

Regular exercise has the potential to enhance university students' mental and cognitive health. The PEAK Mood, Mind and Marks program (i.e., PEAK) is a neuroscience-informed intervention developed using the Behaviour Change Wheel to support students to exercise three or more times per week to benefit their mental and cognitive health. This pilot study assessed the impact of PEAK on exercise, mental and cognitive health, and implementation outcomes.

Methods

PEAK was delivered to 115 undergraduate university students throughout a 12-week university semester. The primary outcome was weekly exercise frequency. Secondary outcomes were: time spent engaged in moderate-vigorous exercise, sedentary behaviour and perceived mental health and cognitive health. All were measured via online self-report questionnaires. Qualitative interviews with 15 students investigated influences on engagement, the acceptability and appropriateness of PEAK, and its mechanisms of behaviour change. Paired t-tests, Wilcoxon Signed-Rank tests and template analysis were used to analyse quantitative and qualitative data, respectively.

Results

On average, 48.4% of students engaged in the recommended frequency of three or more exercise sessions per week. This proportion decreased towards the end of PEAK. Sedentary behaviour significantly decreased from baseline to end-point, and moderate-vigorous exercise significantly increased among students' who were non-exercisers. Mental wellbeing, stress, loneliness, and sense of belonging to the university significantly improved. There were no significant changes in psychological distress. Concentration, memory, and productivity significantly improved. Sixty-eight percent of students remained engaged in one or more components of PEAK at end-point. Qualitative data indicated students found PEAK to be acceptable and appropriate, and that it improved aspects of their capability, opportunity, and motivation to exercise.

Conclusions

Students are receptive to an exercise-based program to support their mental and cognitive health. Students exercise frequency decreased; however, these figures are likely a conservative estimate of students exercise engagement. Students valued the neuroscience-informed approach to motivational and educational content and that the program's goals aligned with their academic goals. Students identified numerous areas PEAK's content and implementation can be optimised, including use of a single digital delivery platform, more opportunities to connect with peers and to expand the content's cultural inclusivity.

Exercise-induced neuroplasticity: a new perspective on rehabilitation for chronic low back pain

Chronic low back pain patients often experience recurrent episodes due to various peripheral and central factors, leading to physical and mental impairments, affecting their daily life and work, and increasing the healthcare burden. With the continuous advancement of neuropathological research, changes in brain structure and function in chronic low back pain patients have been revealed. Neuroplasticity is an important mechanism of self-regulation in the brain and plays a key role in neural injury repair. Targeting neuroplasticity and regulating the central nervous system to improve functional impairments has become a research focus in rehabilitation medicine. Recent studies have shown that exercise can have beneficial effects on the body, such as improving cognition, combating depression, and enhancing athletic performance. Exercise-induced neuroplasticity may be a potential mechanism through which exercise affects the brain. This article systematically introduces the theory of exercise-induced neuroplasticity, explores the central effects mechanism of exercise on patients with chronic low back pain, and further looks forward to new directions in targeted neuroplasticity-based rehabilitation treatment for chronic low back pain.

Comparative efficacy of different interventions on executive function in adolescents with internet use disorder

BACKGROUND

The formation and relapse of Internet use disorder (IUD) are related to the decline in executive function. Previous studies have indicated that exercise intervention and high-definition transcranial direct current stimulation (HD-tDCS) can improve the cognitive abilities of adolescents with IUD. However, the combined intervention's impact on executive function in these adolescents remains unclear. Therefore, this study aims to explore the effects and differences of multimodal exercise, HD-tDCS intervention, and combined intervention on the executive function of adolescents with IUD.

METHODS

Forty-eight adolescents with IUD were randomly assigned to the multimodal exercise group, HD-tDCS intervention group, combined intervention group, and control group. The intervention groups received 4 weeks of moderate-intensity multimodal exercise, HD-tDCS intervention (2 mA, 20min/session, 3 times/week), or combined multimodal exercise with HD-tDCS intervention. The control group received conventional educational learning. Executive function measurements were taken before intervention, after intervention, and 2 weeks post-intervention.

RESULTS

Compared to pre-intervention, different interventions effectively improved the behavioral performance of adolescents with IUD in executive function tasks. In comparison to single interventions, the combined intervention significantly outperformed multimodal exercise and HD-tDCS intervention in influencing the executive function (especially inhibitory control and working memory) in adolescents with IUD.

CONCLUSION

Combined multimodal exercise with HD-tDCS intervention proves to be an effective means of enhancing executive function in adolescents with IUD, particularly contributing to the improvement of explicit behavioral performance related to executive function.

Maintaining a Dynamic Brain: A Review of Empirical Findings Describing the Roles of Exercise, Learning, and Environmental Enrichment in Neuroplasticity from 2017-2023

Brain plasticity, also termed neuroplasticity, refers to the brain's life-long ability to reorganize itself in response to various changes in the environment, experiences, and learning. The brain is a dynamic organ capable of responding to stimulating or depriving environments, activities, and circumstances from changes in gene expression, release of neurotransmitters and neurotrophic factors, to cellular reorganization and reprogrammed functional connectivity. The rate of neuroplastic alteration varies across the lifespan, creating further challenges for understanding and manipulating these processes to benefit motor control, learning, memory, and neural remodeling after injury. Neuroplasticity-related research spans several decades, and hundreds of reviews have been written and published since its inception. Here we present an overview of the empirical papers published between 2017 and 2023 that address the unique effects of exercise, plasticity-stimulating activities, and the depriving effect of social isolation on brain plasticity and behavior.

Comparative electroencephalography analysis: Marathon runners during tapering versus sedentary controls reveals no significant differences

INTRODUCTION

Previous studies described various adaptive neuroplastic brain changes associated with physical activity (PA). EEG studies focused mostly on effects during or shortly after short bouts of exercise. This is the first study to investigate the capability of EEG to display PA-induced long-lasting plasticity in runners compared to a sedentary control group.

METHODS

Thirty trained runners and 30 age- and sex-matched sedentary controls (SC) were included as a subpopulation of the ReCaP (Running effects on Cognition and Plasticity) study. PA was measured with the International Physical Activity Questionnaire (IPAQ). Resting-state EEG of the runners was recorded in the tapering phase of the training for the Munich marathon 2017. Power spectrum analyses were conducted using standardized low-resolution electromagnetic tomography (sLORETA) and included the following frequency bands: delta: 1.5-6 Hz, theta: 6.5-8.0 Hz, alpha1: 8.5-10 Hz, alpha2: 10.5-12.0 Hz, beta1: 12.5-18.0 Hz, beta2: 18.5-21.0 Hz, beta3: 21.5-30.0 Hz, and total power (1.5-30 Hz).

RESULTS

PA (IPAQ) and BMI differed significantly between the groups. The other included demographic parameters were comparable. Statistical nonparametric mapping showed no significant power differences in EEG between the groups.

DISCUSSION

Heterogeneity in study protocols, especially in time intervals between exercise cessation and EEG recordings and juxtaposition of acute exercise-induced effects on EEG in previous studies, could be possible reasons for the differences in results. Future studies should record EEG at different time points after exercise cessation and in a broader spectrum of exercise intensities and forms to further explore the capability of EEG in displaying long-term exercise-induced plasticity.

Integrating Cardiac Rehabilitation in Stroke Recovery

Stroke remains a top contributor to long-term disability in the United States and substantially limits a person's physical activity. Decreased cardiovascular capacity is a major contributing factor to activity limitations and is a significant health concern. Addressing the cardiovascular capacity of stroke survivors as part of poststroke management results in significant improvements in their endurance, functional recovery, and medical outcomes such as all-cause rehospitalization and mortality. Incorporation of a structured approach similar to the cardiac rehabilitation program, including aerobic exercise and risk factor education, can lead to improved cardiovascular function, health benefits, and quality of life in stroke survivors.

Physical training improves inhibitory control in children aged 7-12 years: An fNIRS study

Physical exercise plays a crucial role in the development of cognition and brain functions in children. Inhibitory control is an advanced cognition that affects children's life and learning. In the current study, the relationship between physical training and inhibitory control was explored. In total, 80 children were randomly but equally assigned to the experimental and control groups. The experimental group underwent physical training (volleyball) for 60 min, thrice a week for 12 weeks. In contrast, the control group did not undergo any training and continued with their daily routines. The flanker task and functional near-infrared spectroscopy (fNIRS) were employed to investigate the effects of 12-week physical training on inhibitory control and changes in the oxy-Hb concentration in the prefrontal cortex (PFC) during the task. The behavioral results revealed that the experimental group performed better on the flanker task (e.g., shorter response time [F(1,74) = 18.420, p < 0.001, ηp2 = 0.199] and higher accuracy [F(1,74) = 15.00, p < 0.001, ηp2 = 0.169] than the control group. The oxy-Hb concentration in the right dorsolateral PFC (R-DLPFC) was higher and the activation level of this region was higher during the flanker task [F(1,74) = 6.216, p < 0.05, ηp2 = 0.077]. Moreover, the McNemar test revealed improved cognitive performance in response time or accuracy and R-DLPFC activation induced by physical exercise coincided significantly (χ2 = 5.49, p < 0.05; χ2 = 6.081, p < 0.05). These findings suggest that the R-DLPFC is likely the neural substrate for improved cognitive performance elicited by 12-week physical training.

Effect of electrical muscle stimulation on cerebrovascular function and cognitive performance

It is known that electrical muscle stimulation (EMS) can enhance physical function, but its impact on cognition and cerebral hemodynamics is not well understood. Thus, the purpose of this study was to investigate the effects of one EMS session on cerebrovascular function and cognitive performance. The 17 recruited young healthy participants undertook a 25-min session of EMS and a resting control session (Ctrl group) in a random order. Cerebral blood flow velocity (CBFv) in the middle and posterior cerebral arteries (right MCAv and left PCAv, respectively), cerebral oxygenation, cardiac output, and heart rate were measured throughout the sessions, whereas cognitive function was assessed before and after each experimental condition. MCAv, cardiac output, heart rate, and cerebral oxygenation were increased throughout the EMS session, whereas PCAv remained unchanged. In addition, EMS led to improved scores at the Rey auditory verbal learning test-part B and congruent Stroop task versus Ctrl. The present study demonstrates that a single session of EMS may improve cognitive performance and concomitantly increase CBFv and cerebral oxygenation. Therefore, EMS appears to be a valuable surrogate for voluntary exercise and could therefore be advantageously used in populations with severe physical limitations who would not be able to perform physical exercise otherwise.NEW & NOTEWORTHY This study is the first to demonstrate that one session of EMS applied to the quadriceps increases cerebral blood flow velocity and cerebral oxygenation, which are pivotal factors for brain health. Thus, EMS has the potential to be used as an interesting option in rehabilitation to increase cerebral perfusion and defend if not improve cognitive function sustainably for people with severe physical limitations who would not be able to perform physical exercise voluntarily.

Effects of power training in older patients with multiple sclerosis on neurodegeneration, neuromuscular function, and physical function. A study protocol for the "power training in older multiple sclerosis patients (PoTOMS) randomized control trial

Introduction

Approximately one-third of all persons with multiple sclerosis (pwMS) are older, i.e., having an age ≥60 years. Whilst ageing and MS separately elicit deteriorating effects on brain morphology, neuromuscular function, and physical function, the combination of ageing and MS may pose a particular challenge. To counteract such detrimental changes, power training (i.e., a type of resistance exercise focusing on moderate-to-high loading at maximal intended movement velocity) presents itself as a viable and highly effective solution. Power training is known to positively impact physical function, neuromuscular function, as well as brain morphology. Existing evidence is promising but limited to young and middle-aged pwMS, with the effects of power training remaining to be elucidated in older pwMS.

Methods

The presented 'Power Training in Older MS patients (PoTOMS)' trial is a national, multi-center, parallel-group, randomized controlled trial. The trial compares 24 weeks of usual care(n = 30) to 24 weeks of usual care and power training (n = 30). The primary outcome is whole brain atrophy rate. The secondary outcomes include changes in brain micro and macro structures, neuromuscular function, physical function, cognitive function, bone health, and patient-reported outcomes.

Ethics and dissemination

The presented study is approved by The Regional Ethics Committee (reference number 1-10-72-222-20) and registered at the Danish Data Protection Agency (reference number 2016-051-000001). All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences independent of the results. The www.clinicaltrials.gov identifier is NCT04762342.

Lack of effects of acute exercise intensity on mnemonic discrimination

The hippocampus is thought to support episodic memory by pattern separation, thereby supporting the ability to discriminate high similarity items. Past research evaluating whether acute exercise can improve mnemonic discrimination of high similarity items is mixed. The present experiment attempts to extend these prior mixed findings by evaluating the effects of multiple exercise intensities on hippocampal-dependent, mnemonic discrimination and memory performance. Fifty-seven young adults completed a three-condition (control, moderate-intensity, and vigorous-intensity), within-subjects crossover pretest-posttest comparison. We observed no effects of acute exercise on recognition memory or mnemonic discrimination. We discuss the implications of these null findings with the broader literature by discussing the complexity of this potential exercise-mnemonic discrimination relationship, including the unique role of exercise intensity, differences in the level of processing (e.g., conceptual vs. perceptual), and unique brain regions involved in mnemonic discrimination.

Intranasal insulin intake and exercise improve memory function in amyloid-β induced Alzheimer's-like disease in rats: Involvement of hippocampal BDNF-TrkB receptor

The most prevalent type of dementia, Alzheimer's disease (AD), is a compelling illustration of the link between cognitive deficits and neurophysiological anomalies. We investigated the possible protective effect of intranasal insulin intake with exercise on amyloid-β (Aβ)-induced neuronal damage. The level of hippocampal brain-derived neurotrophic factor (BDNF) and tropomyosin-related kinase B (TrkB) were analyzed to understand the involvement of BDNF-TrkB pathway in this modulation. In this study, we induced AD-like pathology by amyloid-β (Aβ) administration. Then, we examined the impact of a 4-week pretreatment of moderate treadmill exercise and intranasal intake of insulin on working and spatial memory in male Wistar rats. We also analyzed the mechanisms of improved memory and anxiety through changes in the protein level of BDNF and TrkB. Results showed that animals received Aβ had impaired working memory, increased anxiety which were accompanied by lower protein levels of BDNF and TrkB in the hippocampus. The exercise training and intranasal insulin improved working memory deficits, decreased anxiety, and increased BDNF, and TrkB levels in the hippocampus of animals received Aβ. Our finding of improved memory performance after intranasal intake of insulin and exercise may be of significance for the treatment of memory impairments and anxiety-like behavior in AD.

From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome

BACKGROUND

As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed.

MAIN BODY

This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions.

CONCLUSION

PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.

Clinical and neuroimaging correlates in a pilot randomized trial of aerobic exercise for major depression

BACKGROUND

Aerobic exercise (AE) combined with pharmacotherapy is known to reduce depressive symptoms; however, studies have not focused on long-term AE for volumetric changes of brain regions (amygdala, thalamus, and nucleus accumbens [NAcc]) linked to the control of affective responses and hopelessness in individuals with major depression (MD). In addition, AE with motor complexity (AEMC) would be more effective than AE in causing brain plasticity. We compared the effects of 24 weeks of AE and AEMC combined with pharmacotherapy on clinical and volumetric outcomes in individuals with MD.

METHODS

Forty medicated individuals with MD were randomly assigned to nonexercising control (C), AE, and AEMC groups. The training groups exercised for 60 min, twice a week for 24 weeks. Clinical and volumetric outcomes were assessed before and after the 24 weeks. Effect size (ES) and confidence interval (CI) were calculated for within-group and between-groups changes.

RESULTS

AE and AEMC reduced hopelessness (ES = -0.73 and ES = -0.62, respectively) and increased affective responses (ES = 1.24 and ES = 1.56, respectively). Only AE increased amygdala (ES = 0.27 left and ES = 0.34 right), thalamus (ES = 0.33 left and ES = 0.26 right) and left NAcc (ES = 0.54) volumes. AE was more effective than the C group in reducing hopelessness and causing brain plasticity. The changes in the right amygdala volume showed a strong trend in explaining 72 % of the changes in affective responses following AE (p = 0.06).

LIMITATION

Lack of posttraining follow-up and small sample size.

CONCLUSION

These preliminary data indicate that AE combined with pharmacotherapy can cause clinical improvement and brain plasticity in individuals with MD.

Cognitive and physical age gaps in relation to mild cognitive impairment and behavioral phenotypes

We can study how fast our biological aging clocks tick by calculating the difference (i.e., age gaps) between machine learning estimations of biological age and chronological age. While this approach has been increasingly used to study various aspects of aging, few had applied this approach to study cognitive and physical age gaps; not much is known about the behavioral and neurocognitive factors associated with these age gaps. In the present study, we examined these age gaps in relation to behavioral phenotypes and mild cognitive impairment (MCI) among community-dwelling older adults. Participants (N = 822, Agemean = 67.6) were partitioned into equally-sized training and testing samples. Cognitive and physical age-prediction models were fitted using nine cognitive and eight physical fitness test scores, respectively, within the training samples, and subsequently used to estimate cognitive and physical age gaps for each subject in the testing sample. These age gaps were then compared among those with and without MCI and correlated with 17 behavioral phenotypes in the domains of lifestyle, well-being, and attitudes. Across 5000 random train-test split iterations, we showed that older cognitive age gaps were significantly associated with MCI (versus cognitively normal) and worse outcomes across several well-being and attitude-related measures. Both age gaps were also significantly correlated with each other. These results suggest accelerated cognitive and physical aging were linked to worse well-being and more negative attitudes about the self and others and reinforce the link between cognitive and physical aging. Importantly, we have also validated the use of cognitive age gaps in the diagnosis of MCI.

[Brain-derived neurotrophic factor in the acute and early recovery period of ischemic stroke: the role of nocturnal hypoxemia]

OBJECTIVE

To study the relationship between brain-derived neurotrophic factor (BDNF) and the severity of nocturnal hypoxemia in patients in the acute and early recovery period of ischemic stroke (IS).

MATERIAL AND METHODS

We enrolled 44 patients (27 men, 17 women), aged 18-85 years, in the acute phase of IS. At 3-month follow-up, 35 people were examined (21 men and 14 women). In the acute period, in addition to routine diagnostic procedures, respiratory monitoring was carried out, and the serum level of BDNF was measured by enzyme-linked immunosorbent assay. BDNF level was also evaluated at 3-month follow-up visit. Neurological status and its dynamics in the acute period of stroke were assessed as part of the clinical routine according to the National Institutes of Health Stroke Scale (NIHSS) at admission and discharge.

RESULTS

We found a direct correlation between the duration of hypoxemia with SpO2 less than 90% (r=0.327, p=0.035) and less than 85% (r=0.461, p=0.003) and BDNF level in the acute phase of IS. BDNF level in the acute period of IS was negatively correlated with the minimum saturation value (r=-0.328, p=0.034). There was a direct relationship between BDNF level in the early recovery period and the duration of hypoxemia with SpO2 less than 85% (r=-0.389, p=0.028). A regression model showed that BDNF level was associated with the minimum SpO2 level. No significant associations were found with indicators of sleep-disordered breathing severity, such as the apnea-hypopnea index and the oxygen desaturation index.

CONCLUSION

The severity of nocturnal hypoxemia is associated with the increase in BDNF levels both in the acute and recovery periods of IS, regardless of the presence of concomitant breathing disorders during sleep.

Cognitive Performance following Single- or Multi-Session Exercise Intervention in Middle Age: A Systematic Review

BACKGROUND

Research in modifiable behaviors, like exercise, on risk for dementia is increasing. Although many studies focus on older adults, brain pathology for Alzheimer's Disease can begin in middle age, suggesting an ideal target for intervention.

METHODS

We conducted a systematic review from exercise intervention studies on cognitive function among healthy, middle-aged participants (45-65). We searched multiple databases (PubMed, PsycINFO, MEDLINE, Cochrane Central Register of Controlled Trials, Google Scholar) for studies using standard, validated, neuropsychological measures following either single- or multi-session interventions in cognitively-unimpaired, middle-aged adults.

RESULTS

We identified 13 eligible studies. There was notable heterogeneity across studies, with varying design, measures, interventions, and results. Results from single-session studies showed improvement in response inhibition, while results for cognitive flexibility were mixed. No significant changes were found on measures of attention, working memory, or processing speed. Results from multi-session studies were more varied. Verbal memory was found to improve while performance on tests of attention and working memory, processing speed, and executive function were mixed.

CONCLUSION

Importantly, for both single-session and multi-session studies, there was no standard set of neuropsychological tests administered, making it more difficult to synthesize the findings into a single narrative. We end with a discussion on future directions and implementation.

Exercise and Acute Cognitive Enhancement

Substantial research has explored the effects of a single session of exercise on cognitive performance. Meta-analytic reviews provide summary statistics relative to these effects when the cognitive task is performed while exercising and when performed after exercise. When performed concomitantly the effects of exercise are typically small or negative with the exception of moderate effects for speed of cognitive performance during moderate intensity exercise. When cognitive performance is assessed following the cessation of exercise, the effects are typically positive. When considering the effects following exercise, most studies have focused on executive function and episodic memory as the cognitive outcomes of interest with meta-analyses supporting small-to-moderate benefits. When potential moderators related to exercise parameters or participants characteristics are examined, results suggest that 20 minutes of moderate to vigorous intensity exercise consistently benefits performance with larger effects evident for executive function tasks with higher cognitive demands, for long-term memory tasks when exercise is performed prior to information encoding, and when considering individuals with lower initial cognitive performance levels. These observed benefits are likely due to the impacts acute exercise can have on physiological arousal, brain function, and brain neurotrophic factors. Advancements in our understanding of the potential of a single session of exercise to benefit cognitive performance are important for exercise prescription and to inform chronic exercise programs designed to benefit cognition.

Molecular origin and biological effects of exercise mimetics

With the rapid development of sports science and molecular biology technology, academia refers to molecules or microorganisms that mimic or enhance the beneficial effects of exercise on the body, called "exercise mimetics." This review aims to clarify the concept and development history of exercise mimetics, and to define the concept of exercise mimetics by summarizing its characteristics and functions. Candidate molecules and drug targets for exercise mimetics are summarized, and the relationship between exercise mimetics and exercise is explained, as well as the targeting system and function of exercise mimetics. The main targeting systems for exercise mimetics are the exercise system, circulatory system, endocrine system, endocrine system, and nervous system, while the immune system is potential targeting systems. Finally, future research directions for exercise mimetics are discussed.

Effects of an app-based sensorimotor training in promoting neuroplasticity and neuropsychological functioning in frailty: A randomized controlled trial

BACKGROUND

Loss of sensorimotor stimulation and maladaptive plastic changes of the brain may play a major role in problematic aging phenomena such as frailty. However, it is not clear if interventions specifically targeting neuroplasticity can reverse or slow the development of frailty.

OBJECTIVES

We compared the effect of a tablet-based neuroplasticity-oriented sensorimotor training (experimental group, EG) and a tablet-based relaxation training (control group, CG) on frailty and sensorimotor brain function.

METHODS

Interventions consisted of daily 30 min sessions distributed over 90 days. Assessments took place at baseline, after 60 days, and after 90 days. A total of N = 48 frail older adults (EG: n = 24; CG: n = 24) were assigned to the two groups and reassessed after 60 days. Primary outcomes included frailty phenotype (FP) and frailty index (FI). Sensorimotor brain activity was evaluated using functional magnetic resonance imaging and single-pulse transcranial magnetic stimulation.

RESULTS

After 60 days of training, both groups showed a reduction in the number of FP criteria (p < 0.001) with a trend towards a significant time-by-group interaction (p = 0.058) indicating a stronger reduction of frailty in the EG (p < 0.001) compared to the CG (p = 0.039). In addition, pain was significantly reduced in the EG but not the CG. No significant effects were found for measures of brain function.

DISCUSSION

We provided initial evidence that a neuroplasticity-oriented sensorimotor training could be beneficial in counteracting frailty as well as chronic pain. Further studies are needed to determine the potentially underlying neuroplastic mechanisms and the influence of plasticity-related biomarkers as well as their clinical significance.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03666039 (registered 11 September 2018).

Running from depression: the antidepressant-like potential of prenatal and pre-pubertal exercise in adolescent FSL rats exposed to an early-life stressor

OBJECTIVE

We aimed to answer the questions of whether early-life (perinatal and/or juvenile) exercise can induce antidepressant-like effects in a validated rodent model of depression, and whether such early-life intervention could prevent or reverse the adverse effects of early-life stress in their offspring.

METHODS

Male and female Flinders sensitive line rats born to a dam that exercised during gestation, or not, were either maternally separated between PND02 and 16 and weaned on PND17 or not. Half of these animals then underwent a fourteen-day low-intensity exercise regimen from PND22. Baseline depressive-like behaviour was assessed on PND21 and then reassessed on PND36, whereafter hippocampal monoamine levels, redox state markers and metabolic markers relevant to mitochondrial function were measured.

RESULTS

Pre-pubertal exercise was identified as the largest contributing factor to the observed effects, where it decreased immobility time in the FST by 6%, increased time spent in the open arms of the EPM by 9%. Hippocampal serotonin and norepinephrine levels were also increased by 35% and 26%, respectively, whilst nicotinic acid was significantly decreased.

CONCLUSION

These findings suggest that pre-pubertal low-intensity exercise induces beneficial biological alterations that could translate into antidepressant behaviour in genetically susceptible individuals.

Acute exercise performed before and after motor practice enhances the positive effects on motor memory consolidation

Performing a single bout of exercise can enhance motor learning and long-term retention of motor skills. Parameters such as the intensity and when the exercise bout is performed in relation to skill practice (i.e., timing) likely influence the effectiveness. However, it is still not fully understood how exercise should be administered to maximize its effects and how exercise interacts with distinct components of skill learning. Here, we expand this knowledge by investigating the potential synergistic effects of performing acute exercise both prior to and following motor practice. Sixty-four, able-bodied, young adult male participants practiced a sequential visuomotor accuracy tracking (SVAT) task requiring rapid and accurate force modulation and high levels of precision control using intrinsic hand muscles. The task also contained a repeated pattern of targets that allowed sequence-specific skill improvements. Sequential and non-sequential motor performance was assessed at baseline, immediately after motor practice, and again seven days later. One group performed moderate-intensity exercise before practice (PREMO), a second group performed high-intensity exercise after practice (POSTHI), a third group exercised both before and after practice (PREMO + POSTHI), and a fourth group did not exercise during these periods (CON). Regardless of the exercise condition, acute exercise improved long-term retention of the skill by countering performance decay between experimental sessions (i.e., a 7-day interval). Furthermore, exercising both before and after motor practice led to the greatest improvements in skilled performance over time. We found that the effects of exercise were not specific to the practiced sequence. Namely, the effects of exercise generalized across sequential and non-sequential target positions and orders. This suggests that acute exercise works through mechanisms that promote general aspects of motor memory (e.g., lasting improvements in fast and accurate motor execution). The results demonstrate that various exercise protocols can promote the stabilization and long-term retention of motor skills. This effect can be enhanced when exercise is performed both before and after practice.

The joint effect and hemodynamic mechanism of PA and PM2.5 exposure on cognitive function: A randomized controlled trial study

BACKGROUND

While PM2.5 has been shown to impair cognitive function, physical activity (PA) is known to enhance it. Nonetheless, considering the increased inhalation of PM2.5 during exercise, the potential of PA to counteract the detrimental effects of PM2.5, along with the underlying hemodynamic mechanisms, remains uncertain.

METHODS

We conducted a double-blinded, randomized controlled trial among healthy young adults in Beijing, China. Ninety-three participants were randomly allocated to groups experiencing different intensities of PA interventions, and either subjected to purified or unpurified air conditions. Cognitive function was measured by the Color-Word Matching Stroop task, and the hemodynamic response was measured using functional near-infrared spectroscopy during participants performed the Stroop task both before and after the intervention. Linear mixed-effect models were used to estimate the impact of PA and PM2.5 on cognitive function and hemodynamic response.

RESULTS

The reaction time for congruent and incongruent Stroop tasks improved by - 80.714 (95% CI: -136.733, -24.695) and - 105.843 (95% CI: -188.6, -23.085) milliseconds after high-intensity interval training (HIIT) intervention. PM2.5 and HIIT had interaction effects on cognition, such that every 1 μg/m3 increase in PM2.5 attenuated the benefits of HIIT on reaction time by 2.231 (95% CI: 0.523, 3.938) and 3.305 (95% CI: 0.791, 5.819) milliseconds for congruent and incongruent Stroop tasks. Moreover, we divided participants into high and low PM2.5 exposure groups based on average PM2.5 concentration (32.980 μg/m3), and found that HIIT intervention in high PM2.5 concentration led to 69.897 (95% CI: 9.317, 130.476) and 99.269 (95% CI: 10.054, 188.485) milliseconds increased in the reaction time of congruent and incongruent Stroop, compared with the control group among low PM2.5. Furthermore, we found a significant interaction effects of PM2.5 and moderate-intensity continuous training (MICT) on the middle frontal gyrus (MFG) and dorsolateral superior frontal gyrus (DLPFC). PM2.5 and HIIT had a significant interaction effect on the DLPFC.

CONCLUSIONS

HIIT improved cognitive function, but the cognitive benefits of HIIT were attenuated or even reversed under high PM2.5 exposure. The activation of the DLPFC and MFG could serve as hemodynamic mechanisms to explain the joint effect of PA and PM2.5.

Acute cycling exercise and hippocampal subfield function and microstructure in healthy older adults

Aging is associated with deterioration in dentate gyrus (DG) and CA3, both crucial hippocampal subfields for age susceptible memory processes such as mnemonic discrimination (MD). Meanwhile, a single aerobic exercise session alters DG/CA3 function and neural activity in both rats and younger adults and can elicit short-term microstructural alterations in the hippocampus of older adults. However, our understanding of the effects of acute exercise on hippocampal subfield integrity via function and microstructure in older adults is limited. Thus, a within subject-design was employed to determine if 20-min of moderate to vigorous aerobic exercise alters bilateral hippocampal subfield function and microstructure using high-resolution functional magnetic resonance imaging (fMRI) during an MD task (n = 35) and high angular resolution multi-shell diffusion imaging (n = 31), in healthy older adults, compared to seated rest. Following the exercise condition, participants exhibited poorer MD performance, particularly when their perception of effort was higher. Exercise was also related to lower MD-related activity within the DG/CA3 but not CA1 subfield. Finally, after controlling for whole brain gray matter diffusion, exercise was associated with lower neurite density index (NDI) within the DG/CA3. However, exercise-related differences in DG/CA3 activity and NDI were not associated with differences in MD performance. Our results suggest moderate to vigorous aerobic exercise may temporarily inhibit MD performance, and suppress DG/CA3 MD-related activity and NDI, potentially through neuroinflammatory/glial processes. However, additional studies are needed to confirm whether these short-term changes in behavior and hippocampal subfield neurophysiology are beneficial and how they might relate to long-term exercise habits.

Task-Based and Resting-State Cortical Functional Differences After Spinal Cord Injury: A Pilot Functional Near-Infrared Spectroscopy Study

Brain reorganization following spinal cord injury (SCI) has been well-established using animal and human studies. Yet, much is unknown regarding functional recovery and adverse secondary outcomes after SCI. Functional near-infrared spectroscopy (fNIRS) is a neuroimaging technique that offers methodological flexibility in a real-world setting. We used fNIRS to examine the cortical functional differences between 12 males with thoracolumbar SCI (46.41 ± 11.09 years of age) and 12 healthy males (47.61 ± 11.94 years of age) during resting state and task conditions-bilateral finger tapping (FT), mental imagery of bilateral FT with action observation (FTI+AO), and bilateral ankle tapping (AT). We found an overall decrease in hemodynamic response of the SCI group during all three task conditions. Task modulated functional connectivity (FC) computed using beta series correlation technique was compared using independent sample t-tests at α = 0.05. Connectivity between the right mediolateral sensorimotor network (SMN) and the right medial SMN was reduced during the FT task in SCI. A mixed analysis of variance revealed that the FC within the right mediolateral SMN was reduced during FT but preserved during FTI+AO (i.e., comparable to controls) in the SCI group. Lower FC of these regions was associated with longer injury durations. Additionally, we found a general decrease in resting state FC of the SCI group, specifically in the Slow-3 frequency range (0.073 to 0.1 Hz). These results, though preliminary, are consistent with past studies and highlight the potential of fNIRS in SCI and rehabilitative research.

Supervised machine learning: A new method to predict the outcomes following exercise intervention in children with autism spectrum disorder

The individual differences among children with autism spectrum disorder (ASD) may make it challenging to achieve comparable benefits from a specific exercise intervention program. A new method for predicting the possible outcomes and maximizing the benefits of exercise intervention for children with ASD needs further exploration. Using the mini-basketball training program (MBTP) studies to improve the symptom performance of children with ASD as an example, we used the supervised machine learning method to predict the possible intervention outcomes based on the individual differences of children with ASD, investigated and validated the efficacy of this method. In a long-term study, we included 41 ASD children who received the MBTP. Before the intervention, we collected their clinical information, behavioral factors, and brain structural indicators as candidate factors. To perform the regression and classification tasks, the random forest algorithm from the supervised machine learning method was selected, and the cross validation method was used to determine the reliability of the prediction results. The regression task was used to predict the social communication impairment outcome following the MBTP in children with ASD, and explainable variance was used to evaluate the predictive performance. The classification task was used to distinguish the core symptom outcome groups of ASD children, and predictive performance was assessed based on accuracy. We discovered that random forest models could predict the outcome of social communication impairment (average explained variance was 30.58%) and core symptom (average accuracy was 66.12%) following the MBTP, confirming that the supervised machine learning method can predict exercise intervention outcomes for children with ASD. Our findings provide a novel and reliable method for identifying ASD children most likely to benefit from a specific exercise intervention program in advance and a solid foundation for establishing a personalized exercise intervention program recommendation system for ASD children.

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

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