Effects of exercise and horticultural intervention on the brain and mental health in older adults with depressive symptoms and memory problems: study protocol for a randomized controlled trial [UMIN000018547]

Depressive symptoms and all-cause mortality among middle-aged and older people in China and associations with chronic diseases

Introduction

It remains unclear whether depressive symptoms are associated with increased all-cause mortality and to what extent depressive symptoms are associated with chronic disease and all-cause mortality. The study aims to explore the relationship between depressive symptoms and all-cause mortality, and how depressive symptoms may, in turn, affect all-cause mortality among Chinese middle-aged and older people through chronic diseases.

Methods

Data were collected from the China Health and Retirement Longitudinal Study (CHARLS). This cohort study involved 13,855 individuals from Wave 1 (2011) to Wave 6 (2020) of the CHARLS, which is a nationally representative survey that collects information from Chinese residents ages 45 and older to explore intrinsic mechanisms between depressive symptoms and all-cause mortality. The Center for Epidemiological Studies Depression Scale (CES-D-10) was validated through the CHARLS. Covariates included socioeconomic variables, living habits, and self-reported history of chronic diseases. Kaplan-Meier curves depicted mortality rates by depressive symptom levels, with Cox proportional hazards regression models estimating the hazard ratios (HRs) of all-cause mortality.

Results

Out of the total 13,855 participants included, the median (Q1, Q3) age was 58.00 (51.00, 63.00) years. Adjusted for all covariates, middle-aged and older adults with depressive symptoms had a higher all-cause mortality rate (HR = 1.20 [95% CI, 1.09-1.33]). An increased rate was observed for 55-64 years old (HR = 1.23 [95% CI, 1.03-1.47]) and more than 65 years old (HR = 1.32 [95% CI, 1.18-1.49]), agricultural Hukou (HR = 1.44, [95% CI, 1.30-1.59]), and nonagricultural workload (HR = 1.81 [95% CI, 1.61-2.03]). Depressive symptoms increased the risks of all-cause mortality among patients with hypertension (HR = 1.19 [95% CI, 1.00-1.40]), diabetes (HR = 1.41[95% CI, 1.02-1.95]), and arthritis (HR = 1.29 [95% CI, 1.09-1.51]).

Conclusion

Depressive symptoms raise all-cause mortality risk, particularly in those aged 55 and above, rural household registration (agricultural Hukou), nonagricultural workers, and middle-aged and older people with hypertension, diabetes, and arthritis. Our findings through the longitudinal data collected in this study offer valuable insights for interventions targeting depression, such as early detection, integrated chronic disease care management, and healthy lifestyles; and community support for depressive symptoms may help to reduce mortality in middle-aged and older people.

Effect of Physical Exercise on Executive Functions Using the Emotional Stroop Task in Perimenopausal Women: A Pilot Study

Exercise has beneficial effects on emotional cognitive control for the majority of the population. However, the impact of exercise on cognitive processes in perimenopausal women remains unclear. Therefore, this study investigated the effect of aerobic exercise on the cognitive processes of perimenopausal women using an emotional Stroop task (EST).

METHOD

A quasi-experimental pilot study was conducted involving 14 perimenopausal women (Peri-MG) and 13 healthy young women (YG) who completed an EST before and after an aerobic cycling exercise. Mixed-effects models for repeated measures were used to analyze reaction times (RTs) and error rates (ERs) during emotional word processing (positive, negative, and neutral) for both groups.

RESULTS

Compared with the YG, the Peri-MG showed significantly shortened RTs for positive and negative emotions (p < 0.05) post-exercise, but not for neutral words. In addition, the Peri-MG exhibited significantly increased ERs for negative words at baseline compared with the YG (p < 0.05), but this difference was not observed during the post-exercise test.

CONCLUSION

The findings suggest that aerobic exercise can enhance executive control performance in perimenopausal women. The Peri-MG exhibited marked behavioral plasticity in the form of reduced bias to salient cues that were significantly more sensitive to alterations due to exercise. This new evidence enhances the understanding of emotional vulnerability and beneficial susceptibility to exercise in perimenopausal women.

The Interplay of Sports and Nutrition in Neurological Health and Recovery

This comprehensive review explores the dynamic relationship between sports, nutrition, and neurological health. Focusing on recent clinical advancements, it examines how physical activity and dietary practices influence the prevention, treatment, and rehabilitation of various neurological conditions. The review highlights the role of neuroimaging in understanding these interactions, discusses emerging technologies in neurotherapeutic interventions, and evaluates the efficacy of sports and nutritional strategies in enhancing neurological recovery. This synthesis of current knowledge aims to provide a deeper understanding of how lifestyle factors can be integrated into clinical practices to improve neurological outcomes.

Relationship between physical activity and cerebral white matter hyperintensity volumes in older adults with depressive symptoms and mild memory impairment: a cross-sectional study

Introduction

Cerebral white matter hyperintensities (WMHs) are commonly found in the aging brain and have been implicated in the initiation and severity of many central nervous system diseases. Furthermore, an increased WMH volume indicates reduced brain health in older adults. This study investigated the association between WMH volume and physical activity in older adults with depressive symptoms (DS) and mild memory impairment (MMI). Factors associated with the WMH volume were also investigated.

Methods

A total of 57 individuals aged over 65 years with DS and MMI were included in this study. The participants underwent magnetic resonance imaging to quantify WMH volumes. After WMH volume was accumulated, normalized to the total intracranial volume (TIV), the percentage of WMH volume was calculated. In addition, all participants wore a triaxial accelerometer for 2 weeks, and the average daily physical activity and number of steps were measured. The levels of blood biomarkers including cortisol, interleukin-6 (IL-6), brain-derived insulin-like growth factor-1, and brain-derived neurotrophic factor were measured. Motor and cognitive functions were also assessed.

Results

Faster maximum walking speed and longer time spent engaged in moderate physical activity were associated with a smaller percent of WMH volume, whereas higher serum IL-6 levels were associated with a larger percent of WMH volume. The number of steps per day, time spent engaged in low levels of physical activity, cognitive function, and all other measured biomarkers were not significantly associated with percent of WMH volume.

Discussion

Higher blood inflammatory cytokine levels, shorter duration of moderate physical activity, and lower maximum walking speed were associated with a higher percent of WMH volume. Our results provide useful information for maintaining brain health in older adults at a high risk of developing dementia and may contribute to the development of preventive medicine for brain health.

Effects of horticultural therapy on health in the elderly: A review and meta-analysis

Aim

Given the current aging population, the demand on medical facilities, facilities for elderly care, and even their high prevalence, it is crucial to investigate the advantages of older people. The purpose of our study was to systematically review the existing literature on the health effects of horticultural therapy as a treatment option for the elderly.

Subject and methods

Article searches were conducted through five databases: Web of science, Science Direct, PubMed, EBSCO, and Google Scholar, according to the standard method of systematic evaluation and meta-analysis. Thirty-two published articles were included, and 27 relevant variables were meta-analyzed to assess the benefits of horticultural therapy in terms of physical and psychological functioning in the elderly.

Results

Results show that horticultural therapy may be helpful in helping seniors lose weight -0.195 (95% CI -0.507,0.117), reduce their waist circumference -0.327 (95% CI -0.637, -0.017), lower their stress -0.339 (95% CI -0.610, -0.069) and cortisol -0.902 (95% CI -0.728, -0.002) levels, improve their physical flexibility 0.302 (95% CI 0.036, 0.569), social interaction 0.370, (95% CI 0.115, 0.624), and daily vegetables and fruit consumption 0.688 (95% CI: 0.287, 1.089).

Conclusion

Horticultural therapy may be a useful tool for enhancing the physical, mental and social aspects of the elderly. However, there is substantial heterogeneity and wide variation in the quality of the included studies. Further high-quality studies, rigorous controls and adjustments for significant confounding variables, and larger populations are needed in the future to further our understanding of the link between horticultural therapy and elder health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01938-w.

Effectiveness of horticultural therapy in aged people with depression: A systematic review and meta-analysis

Background

Depression, an increasing global crisis, has affected many people's daily life, especially for older adults. Horticultural therapy has been widely used in non-pharmacological treatment for patients with depression, with a body of studies demonstrating its therapeutic effects. However, a lack of systematic reviews and meta-analyses makes it difficult to get a holistic picture of this research field.

Objectives

We aimed to evaluate the reliability of the previous studies and the effectiveness of horticultural therapy (including the intervention of environmental settings, activities, and duration) on older adults with depression.

Methods

This systematic review was conducted under the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. We searched relevant studies in multiple databases, and the original search was finished on 25 September 2022. We included studies using randomized controlled trials (RCTs) or quasi-experimental designs.

Results

We yielded a total of 7,366 studies and finally included 13 which involved 698 aged people with depression. Results from meta-analysis indicated significant effects of horticultural therapy on reducing depressive symptoms for the older adults. Besides, we found different outcomes among various horticultural interventions (such as environmental setting, activities, and duration). Depression reduction was more effective in care-providing settings than in community settings; participatory activities were more effective in reducing depression than observational activities; intervention of 4–8 weeks might represent the optimal course of treatment compared to interventions more than 8 weeks in duration.

Conclusion

We came up with a comprehensive set of recommendations based on the meta-analysis: aged people in care-providing settings with depression could get the most benefit from horticultural therapy by participating in participatory activities for 4–8 weeks.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022363134, identifier CRD42022363134.

The effectiveness of group-based gardening interventions for improving wellbeing and reducing symptoms of mental ill-health in adults: a systematic review and meta-analysis

BACKGROUND

There is increasing interest in the association between nature, health and wellbeing. Gardening is a popular way in which interaction with nature occurs and numerous gardening projects aim to facilitate wellbeing among participants. More research is needed to determine their effectiveness.

AIM

To systematically evaluate the effectiveness of group-based gardening interventions for increasing wellbeing and reducing symptoms of mental ill-health in adults.

METHODS

A systematic review of Randomised Controlled Trials was conducted following the protocol submitted to PROSPERO (CRD42020162187). Studies reporting quantitative validated health and wellbeing outcomes of the community residing, adult populations (18+) were eligible for inclusion.

RESULTS

24 studies met inclusion criteria: 20 completed and four ongoing trials. Meta-analyses suggest these interventions may increase wellbeing and may reduce symptoms of depression, however, there was uncertainty in the pooled effects due to heterogeneity and unclear risk of bias for many studies. There were mixed results for other outcomes.

RESEARCH LIMITATIONS/IMPLICATIONS

Heterogeneity and small sample sizes limited the results. Poor reporting precluded meta-analysis for some studies. Initial findings for wellbeing and depression are promising and should be corroborated in further studies. The research area is active, and the results of the ongoing trials identified will add to the evidence base.

Exercise in Aging: Be Balanced

The beneficial effects of exercise are recognized for preventing physical and cognitive decline during the aging process. However, there is still a gap concerning recommended intensity, volume, frequency and mode of exercise especially for older people. The aim of this study was to investigate an appropriate type of physical activity (PA) model for healthy aging. A commentary of the influence of PA and exercise on healthy aging through an online search of the databases Web of Science, PubMed and Google Scholar. Two living groups can be considered as potential references: modern hunter-gatherer small-scale population and master athletes. Greater physical activity is proposed for healthy aging than that recommended by WHO. Additionally, mindfulness meditation techniques during exercise are recommended especially for persons practicing long-duration exercises. Complex and compound exercise and workouts should include challenging exercises adjusted and balanced to provide clients, especially older people, with noticeable changes and progress.

Measuring the Feasibility and Effectiveness of an Individualized Exercise Program Delivered Virtually to Cancer Survivors

ABSTRACT

In the spring of 2020, we faced a global pandemic that resulted in social distancing limitations not previously experienced, forcing practitioners to adapt exercise programming to a virtual model. The purpose of this investigation was to measure the effectiveness of a virtual exercise oncology program in 491 participants undergoing antineoplastic therapy between March and June 2020. Each session was completed virtually with a certified exercise oncology trainer. Fitness and psychological parameters were measured preexercise and postexercise intervention. Overall, participants completed 4949 of 5892 prescribed exercise sessions. Patients saw increases in cardiovascular endurance (15.2%, P < 0.05), muscular endurance (18.2%, P < 0.05), flexibility (31.9%, P < 0.05), feelings of support (58.7%, P < 0.05), and quality of life (32.2%, P < 0.05), as well as decreases in loneliness (54%, P < 0.05) and fatigue (48.7%, P < 0.05). In light of our findings, we assert that virtual exercise training is a viable option in circumstances where in-person, individualized exercise training is not possible.

Effects of physical activities on dementia-related biomarkers: A systematic review of randomized controlled trials

INTRODUCTION

Physical activities (PA) may lead to improved cognition in mild cognitive impairment (MCI), Alzheimer's disease (AD), and dementia. The mechanisms mediating potential PA effects are unknown. Assessment of PA effects on relevant biomarkers may provide insights into mechanisms underlying potential PA effects on cognition.

METHODS

We systematically reviewed randomized controlled trials (RCTs) that studied PA effects on biomarkers in MCI, AD, and dementia populations. We examined whether biological mechanisms were hypothesized to explain associations among PA, biomarkers, and cognitive functions. We used the PubMed database and searched for RCTs with PA until October 31, 2019.

RESULTS

Of 653 studies examining changes in biomarkers in PA trials, 18 studies met inclusion criteria for the present review. Some studies found favorable effects of PA on neurotrophic and inflammatory biomarkers. AD pathological markers were rarely investigated, with inconclusive results. Most studies were relatively small in sample size, of limited duration, and not all studies compared the changes in biomarkers between the control and experimental groups.

DISCUSSION

There is only limited use of potentially informative biomarkers in PA trials for MCI, AD, and dementia. Most studies did not examine the role of biomarkers to study associations between PA and cognitive functions in their analyses. Several potential biomarkers remain uninvestigated. Careful use of biomarkers may clarify mechanisms underlying PA effects on cognition. Our review serves as a useful resource for developing future PA RCTs aimed at improving cognitive functions in MCI, AD, and dementias.

Meta-analysis of controlled trials testing horticultural therapy for the improvement of cognitive function

Improving cognitive function is one of the most challenging global issues in cognitive impairment population. Horticultural therapy involves the expertise of a horticultural therapist who establishes a treatment plan for horticultural activities that aim to achieve cognitive changes, and thereby improve health-related quality of life. However, more convincing evidence demonstrating the effect of horticultural therapy on cognitive function is essential. The purpose of this study was to conduct a meta-analysis of controlled trials testing the effect of horticultural therapy on cognitive function and the findings indicate that horticultural therapy programs significantly improved cognitive function. The effect size of the horticultural therapy program was large. Findings of this meta-analysis have important implications for practice and policies. Contemporary healthcare systems should consider horticultural therapy as an important intervention for improving patients’ cognitive function. Governments and policy-makers should consider horticultural therapy as an important tool to prevent the decline of cognitive function in cognitive impairment population.

The Effect of Mindfulness-Based Stress Reduction (MBSR) on Depression, Cognition, and Immunity in Mild Cognitive Impairment: A Pilot Feasibility Study

BACKGROUND

Mindfulness-based programs have shown a promising effect on several health factors associated with increased risk of dementia and the conversion from mild cognitive impairment (MCI) to dementia such as depression, stress, cognitive decline, immune system and brain structural and functional changes. Studies on mindfulness in MCI subjects are sparse and frequently lack control intervention groups.

OBJECTIVE

To determine the feasibility and the effect of mindfulness-based stress reduction (MBSR) practice on depression, cognition and immunity in MCI compared to cognitive training.

METHODS

Twenty-eight MCI subjects were randomly assigned to two groups. MBSR group underwent 8-week MBSR program. Control group underwent 8-week cognitive training. Their cognitive and immunological profiles and level of depressive symptoms were examined at baseline, after each 8-week intervention (visit 2, V2) and six months after each intervention (visit 3, V3). MBSR participants completed feasibility questionnaire at V2.

RESULTS

Twenty MCI patients completed the study (MBSR group n=12, control group n=8). MBSR group showed significant reduction in depressive symptoms at both V2 (p=0.03) and V3 (p=0.0461) compared to the baseline. There was a minimal effect on cognition - a group comparison analysis showed better psychomotor speed in the MBSR group compared to the control group at V2 (p=0.0493) but not at V3. There was a detectable change in immunological profiles in both groups, more pronounced in the MBSR group. Participants checked only positive/neutral answers concerning the attractivity/length of MBSR intervention. More severe cognitive decline (PVLT≤36) was associated with the lower adherence to home practice.

CONCLUSION

MBSR is well-accepted potentially promising intervention with positive effect on cognition, depressive symptoms and immunological profile.

Exercise and Horticultural Programs for Older Adults with Depressive Symptoms and Memory Problems: A Randomized Controlled Trial

Depressive symptoms and memory problems are risk factors for dementia. Exercise can reduce these in older people, and horticultural activity can benefit people with dementia. This study assessed the efficacy of exercise and horticultural interventions for community-dwelling older adults with depressive symptoms and mild memory decline. In this randomized controlled trial, older adults (n = 89) were assigned to exercise, horticultural, or control groups. Exercise and horticultural programs included 20 weekly 90-minute sessions. The control group attended two 90-minute classes. Outcomes were assessed at baseline, and then 6- and 12-months post-intervention. Primary outcome measures were the Geriatric Depression Scale-15 (GDS-15) and Wechsler Memory Scale-Revised. Walking speed, two-minute walking test scores, social network, life space, and subjective daily physical activity were secondary outcome measures. Compared with the control group, the exercise group obtained higher immediate and delayed recall logical memory scores, and the increase in immediate recall scores remained 12-months post-intervention. Two-minute walking performance improved in the exercise group, but not after 12 months. GDS-15 scores showed no significant improvements. The horticultural and control groups showed no differences. Exercise may improve memory, while horticultural activity may not. The effects of exercise and horticultural interventions on depressive symptoms remain unclear.

Can a Green Care Informal Learning Program Foster Active Aging in Older Adults? Results From a Qualitative Pilot Study in Central Italy

Due to population aging worldwide, it is important for Health Care Systems to design new services fostering Active Aging dimensions (e.g., physical health, psychological well-being, social engagement, and lifelong learning). The aim of this pilot study was to develop new services fostering Active Aging dimensions by means of a 12-month green care informal learning program targeting 112 individuals among community-dwelling older people and day care center users. The impact of the intervention was assessed through three rounds of focus groups. Individuals' perception of the training benefits depended on their health and social condition at baseline. The program improved the social participation and learning attitudes of community-dwelling older people and the perceived well-being and health of day care center users. Green care activities triggered an Active Aging virtuous spiral where learning new practical and relational competencies helped older people recognize their value. Thus, it is recommendable to include green care therapy within the practice of services for older people, especially day care centers.

Effects of Combined Physical and Cognitive Exercises on Cognition and Mobility in Patients With Mild Cognitive Impairment: A Randomized Clinical Trial

IMPORTANCE

Although participation in physical and cognitive activities is encouraged to reduce the risk of dementia, the preventive efficacy of these activities for patients with mild cognitive impairment is unestablished.

OBJECTIVE

To compare the cognitive and mobility effects of a 40-week program of combined cognitive and physical activity with those of a health education program.

DESIGN

A randomized, parallel, single-blind controlled trial.

SETTING

A population-based study of participants recruited from Obu, a residential suburb of Nagoya, Japan.

PARTICIPANTS

Between August 2011 and February 2012, we evaluated 945 adults 65 years or older with mild cognitive impairment, enrolled 308, and randomly assigned them to the combined activity group (n = 154) or the health education control group (n = 154).

INTERVENTIONS

The combined activity program involved weekly 90-minute sessions for 40 weeks focused on physical and cognitive activities. The control group attended 90-minute health promotion classes thrice during the 40-week trial period.

MEASUREMENT

The outcome measures were assessed at the study's beginning and end by personnel blinded to mild cognitive impairment subtype and group. The primary endpoints were postintervention changes in scores on (1) the Mini-Mental State Examination as a measure of general cognitive status and memory, (2) the Wechsler Memory Scale-Revised-Logical Memory II, and (3) the Rey Auditory Verbal Learning Test. We applied mobility assessments and assessed brain atrophy with magnetic resonance imaging.

RESULTS

Compared with the control group, the combined activity group showed significantly greater scores on the Mini-Mental State Examination (difference = 0.8 points, P = .012) and Wechsler Memory Scale-Revised-Logical Memory II (difference = 1.0, P = .004), significant improvements in mobility and the nonmemory domains and reduced left medial temporal lobe atrophy in amnestic mild cognitive impairment (Z-score difference = -31.3, P < .05).

CONCLUSION

Combined physical and cognitive activity improves or maintains cognitive and physical performance in older adults with mild cognitive impairment, especially the amnestic type.