Effect of Multicomponent Exercise and Nutrition Support on the Cognitive Function of Older Adults: A Randomized Controlled Trial

Multidomain interventions for sarcopenia and cognitive flexibility in older adults for promoting healthy aging: a systematic review and meta-analysis of randomized controlled trials

The global population is undergoing rapid aging, making physical activity a crucial element in preventing mortality and lowering the risk of Alzheimer's disease. Age-related declines in muscle mass and cognitive abilities significantly contribute to frailty and dependency. Thus, this study focuses on a meticulous analysis of the protective effects of multidomain interventions, an emerging resource combating age-related declines. It seeks to underscore their profound impact on cognitive flexibility and sarcopenia, highlighting their pivotal role in mitigating the adverse effects of aging. To identify relevant randomized controlled trials up to November 2023, we reviewed eight online academic databases, following PERSiST guidelines, PRISMA reporting system, and PICOs criteria. Meta-analyses on selected functional outcomes utilized a random-effects model, including the Timed Up and Go Test, Sit to Stand Test, Victoria Stroop Test, and Trail Making Test. Out of 2082 scrutinized articles, 17 were included in the systematic review, and 8 in the meta-analysis. Positive effects (p = 0.05, I2 = 57%; 95% CI - 0.63 to - 0.05) were observed in cognitive flexibility for certain interventions. Similarly, interventions addressing muscle strength demonstrated improvements in the Sit to Stand Test for the exercise group compared to the control group (p = 0.02, I2 = 0%; 95% CI - 0.63 to - 0.05). These findings underscore the importance of incorporating physical activity as a primary component of public health interventions for promoting healthy aging and reducing the burden of age-related diseases. Future interventions may explore more homogeneous approaches and evaluate the impact of thrice multidomain weekly sessions.

Effects of Plant-Based Protein Interventions, with and without an Exercise Component, on Body Composition, Strength and Physical Function in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Maintaining muscle mass, strength, and function is crucial for our aging population. Exercise and dietary protein intake are recommended strategies; however, animal proteins have been the most studied. Plant-based protein sources have lower digestibility and incomplete amino acid profiles. However new innovative plant-based proteins and products may have overcome these issues. Therefore, this systematic review aimed to synthesize the current research and evaluate the effects of plant-based protein interventions compared to placebo on body composition, strength, and physical function in older adults (≥60 years old). The secondary aim was whether exercise improved the effectiveness of plant-based protein on these outcomes. Randomized controlled trials up to January 2023 were identified through Medline, EMBASE, CINAHL, and Cochrane Library databases. Studies contained a plant-protein intervention, and assessed body composition, strength, and/or physical function. Thirteen articles were included, all using soy protein (0.6-60 g daily), from 12 weeks to 1 year. Narrative summary reported positive effects on muscle mass over time, with no significant differences compared to controls (no intervention, exercise only, animal protein, or exercise + animal protein interventions). There was limited impact on strength and function. Meta-analysis showed that plant-protein interventions were comparable to controls, in all outcomes. In conclusion, plant-protein interventions improved muscle mass over time, and were comparable to other interventions, warranting further investigation as an anabolic stimulus in this vulnerable population.

Association of depressive symptoms with Geriatric Locomotive Function Scale score in community-dwelling older adults living in the state of emergency

BACKGROUND

Under the state of emergency, it has been reported that the amount of physical activity among community-dwelling older adults has decreased significantly due to refraining from going out, and there are strong concerns about the Geriatric Locomotive Function Scale and deterioration of mental health. Therefore, this study aimed to investigate whether the depressive state before the coronavirus disease 2019 (COVID-19) pandemic affected the 25-Geriatric Locomotive (GLFS) score during the COVID-19 pandemic among community-dwelling older adults.

METHODS

The participants were 194 community-dwelling older adults (45 men, 149 women) with an average age of 75.5 ± 5.5 years who responded to a self-administered survey conducted three times (preliminary, second, and third) from before the 2018 COVID-19 pandemic to March 2021. Individuals with a score of ≥ 10 on the Geriatric Depression Scale 15 (GDS 15) were excluded. The survey items included the 25-question Geriatric Locomotive Function Scale (GLFS25), GDS 15, and other basic attributes. Those with scores of 5 to 9 on the GDS 15 and those with scores of 0 to 4 were assigned to the depressive symptoms (DS) group and the non-DS group, respectively. Statistical analysis was performed using two-way analysis of variance. The Mann-Whitney U test was used for comparisons between the groups.

RESULTS

In total, 187 patients were included in the analysis, excluding 7 patients. GLFS 25 showed a significant increase in scores at the second and third time points compared with baseline, and a main effect was confirmed in both groups, with no interaction effect. The second time, the score was 10.0 ± 8.5 and 13.7 ± 10.5 in the non-DS and DS groups, respectively. The third time, the non-DS and DS groups scored 10.8 ± 10.5 and 14.9 ± 10.1 points, respectively, indicating a significant difference.

CONCLUSIONS

Our results revealed that the increase in the GLFS 25 score in community-dwelling older adults during the COVID-19 pandemic was related to their DS during normal times before the pandemic. Evaluating such individuals and providing social support may effectively reduce the deterioration of the GLFS 25 score.

The Therapeutic Impact of Plant-Based and Nutritional Supplements on Anxiety, Depressive Symptoms and Sleep Quality among Adults and Elderly: A Systematic Review of the Literature

BACKGROUND

The emerging research in the literature continues to forecast a drastic and alarming increase in negative mental health and sleep health outcomes among populations, especially after the COVID-19 pandemic, which significantly influenced people's way of life. With mental health pharmaceutical interventions continuing to be stigmatized and inaccessible among populations, natural supplements provide an opportunity for intervention.

OBJECTIVE

This study sought to conduct a systematic review of the literature on the most recent comprehensive evidence for which nutritional supplements have the greatest therapeutic impact on symptoms of anxiety, depression, and insomnia.

METHODS

A systematic search of the literature, utilizing several databases, including PubMed and Web of Science, was conducted on 29 April 2022. We used developed keywords and MeSH terms for the search. The study eligibility criteria included (1) a randomized control trial; (2) investigating a plant-based therapeutic or natural supplement as the intervention; (3) measuring at least one health outcome of the following: anxiety symptoms, depressive symptoms, or sleep health outcomes; (4) utilizing validated measurement tools to measure the outcome of interest; (5) written in the English language; (6) peer reviewed; and (7) focused on adults and elderly populations.

MAIN RESULTS

Following the PRISMA guidelines, 76 studies were included in this review. We used the revised Risk of Bias tool (RoB2) to assess the quality of all included randomized control trials. A qualitative data synthesis was conducted. Overall, we found several valuable insights from the evidence in the literature, including evidence that demonstrates the benefits of probiotics and vitamin B complexes on anxiety symptoms, depressive symptoms, and sleep quality. Implication of Key Findings: This review provides the most updated findings in the literature on the topic, including an abundance of research that was published in the past 5 years. Given the expected rise in negative mental and sleep health outcomes following the pandemic, the supplements and therapeutics identified in this study should be the target of intervention measures to increase their accessibility and affordability and allow them to be incorporated into clinical guidelines of treatment. PROSPERO registration number: CRD42022361130.

Which intervention is more effective in improving sarcopenia in older adults? A systematic review with meta-analysis of randomized controlled trials

This systematic review aims, however, to determine which intervention is more effective. The skeletal muscle index (SMI), handgrip, and gait speed were used as indicators of improvement, and these effects were compared across six subgroups: combined intervention versus exercise; nutrition or control group; exercise versus nutrition; and exercise or nutrition versus control group. Out of 1596 articles, 32 studies (3063 older adults) were selected and meta-analyzed. Comparing the combined intervention with a control group, the WMD was 0.20 kg/m², 1.56 kg, and 0.08 m/s for SMI, handgrip, and gait speed, respectively, all of which showed a statistically significant improvement. When a combined intervention was compared with exercise and nutrition, the former resulted in improvements in handgrip (WMD 0.38 kg) and gait speed (WMD 0.12 m/s). On comparing exercise and nutrition, there was an improvement in gait speed (0.12 m/s) with exercise alone. On comparing exercise with a control group, only handgrip (WMD 1.74 kg) and gait speed (WMD 0.11 m/s) showed improvement, whereas in the nutrition versus the control group, only the handgrip (WMD 0.90 kg) improved. Although exercise and nutritional therapy together demonstrated improved muscle strength, exercise is recommended for the improvement of physical performance.

Factors affecting chronic low back pain among high school baseball players in Japan: A pilot study

The prevalence of chronic lower back pain (CLBP) among baseball players is high. CLBP is associated with reduced participation in practice and games. This pilot study examined the factors associated with CLBP among high school baseball players in Fukui, Japan. The participants underwent two health examinations in high school: (1) as first-grade baseball players (baseline) and (2) as second-grade baseball players (follow-up); a total of 59 players who could be followed-up a year later were included in the study. Players were divided into three groups based on whether they had no lower back pain (LBP) (n = 30), improved LBP (n = 17), or CLBP (n = 12) after 1 year of follow-up. Players were evaluated on the physical and cognitive aspects of pain. The Number Rating System, Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Central Sensitization Inventory (CSI), body characteristics (age, height, weight, body mass index, and skeletal mass index), and a medical history questionnaire regarding spondylolysis and baseball loads were used to evaluate the players. Inventory scores were highest in the CLBP group, which indicated that this group had significant pain that affected their willingness to engage in baseball-related activities. The TSK scores in the CLBP group were worse on follow-up. High school baseball players with CLBP were more likely to have lumbar spondylolysis and kinesiophobia, which are also factors related to pain chronicity. Kinesiophobia and the presence of lumbar spondylolysis should be considered when creating an exercise program for high school baseball players with CLBP.

Improvement of memory function via a combination of exercise and soy peptide supplementation in community-dwelling older adults: A randomized controlled trial

Background

Soy peptide, when consumed as a functional food, has been reported to improve cognitive function. This study aimed to verify the combined effect of soy peptide supplementation and exercise on cognitive function among community-dwelling older adults in Japan.

Methods

In this population-based, non-blinded randomized controlled trial, 72 community-dwelling older adults who were independent in activities of daily living were randomly assigned to an "exercise plus nutrition" program (Ex + Nt group, n = 36) or an exercise program (Ex group, n = 36). For 3 months, both groups participated in an exercise and cognitive training regimen once per week, with the Ex + Nt group receiving soy supplementation once per week. Pre- and post-intervention measurements included grip strength, gait speed, skeletal muscle mass index, and scores on Addenbrooke's Cognitive Examination-Revised, trail-making test A, and the Geriatric Depression Scale. Participant enrollment for this study started in January 2019 and ended in April 2019.

Results

Exercise training increased the skeletal muscle mass index by 2.0% and 3.0% in the Ex + Nt and Ex groups, respectively. The Ex + Nt group exhibited a significant 0.3-point increase in the memory score.

Conclusion

A 3-month exercise program combined with soy peptide supplementation may be effective in improving both motor and memory function in community-dwelling older adults.

The Effects of Multi-Domain Interventions on Cognition: A Systematic Review

This review aimed to evaluate the effects of multi-domain interventions on cognition among individuals without dementia. Multi-domain interventions refer to those combining any single preventive measure such as physical activity, cognitive training, and/or nutrition to prevent dementia. Seventeen studies were included (n = 10,056 total participants; mean age = 73 years), eight of which were rated as strong in quality while the other nine showed moderate quality. The standardized mean difference (SMD; d) was used to calculate the effect size for each included study. Multi-domain interventions consisting of physical activity, cognitive training, cardioprotective nutrition, and/or cardiovascular health education exerted beneficial effects on global cognition, episodic memory, and/or executive function with very small to moderate effect sizes (0.16-0.77). Nurses may consider combining these components to potentially stave off dementia. Future research is warranted to identify the optimal multi-domain intervention components that can induce clinically significant beneficial effects on cognition.

Randomised controlled trials for the prevention of cognitive decline or dementia: A systematic review

Dementia prevention research has progressed rapidly in recent years, with publication of several large lifestyle intervention trials, and renewed interest in pharmacological interventions, notably for individuals with Alzheimer's disease biomarkers, warranting an updated review of results and methodology. We identified 112 completed trials testing the efficacy of single-domain pharmacological (n = 33, 29%), nutritional (n = 27, 24%), physical activity (n = 18, 16%) and cognitive stimulation (n = 13, 12%), or multidomain (n = 22, 20%) interventions on incident dementia, or a relevant intermediate marker (e.g. cognitive function, biomarkers or dementia risk scores) in people without dementia. The earliest trials tested pharmacological interventions or nutritional supplements, but lifestyle interventions predominated in the last decade. In total, 21 (19%) trials demonstrated a clear beneficial effect on the pre-specified primary outcome (or all co-primary outcomes), but only two (10%) were large-scale (testing blood pressure lowering (Syst-Eur) or multidomain (FINGER) interventions on incident dementia and cognitive change in cognitive function, respectively). Of the 116 ongoing trials, 40% (n = 46) are testing multidomain interventions. Recent methodological shifts concern target populations, primary outcome measures, and intervention design, but study design remains constant (parallel group randomised controlled trial). Future trials may consider using adaptive trials or interventions, and more targeted approaches, since certain interventions may be more effective in certain subgroups of the population, and at specific times in the life-course. Efforts should also be made to increase the representativeness and diversity of prevention trial populations.

Association between grip strength and cognitive impairment in older American adults

BACKGROUND AND AIMS

Exponential population aging has led to an increased prevalence of cognitive impairment worldwide. Hand grip strength, which may be associated with physical activity, could be a useful predictor of cognitive impairment. However, few studies have reported the association, if any, between hand grip strength and cognitive function.

METHODS

We used data obtained from the National Health and Nutrition Examination Survey between 2011-2012 and 2013-2014 to investigate the association between hand grip strength and cognitive impairment. Cognitive impairment was assessed using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD), animal fluency (AF), and digit symbol substitution test (DSST) scores. Cutoff values of CERAD < 5, AF < 14, and DSST < 34 were used to define cognitive impairment. In this cross-sectional study, we used odds ratios to determine the potential usefulness of hand grip strength for the prediction of cognitive impairment.

RESULTS

This study included 2,623 participants aged ≥60 years. The DSST results showed that hand grip strength was associated with a low risk of cognitive impairment and that subgroup analysis showed that male sex, 60-69 years of age, and the Non-Hispanic (NH)-White, NH Black, and Asian were associated with a significantly low risk of cognitive impairment. The CERAD test results showed that 70-79 years of age and the NH White were significantly associated with a low risk of cognitive impairment. By following full adjustment, we did not observe statistically significant differences between hand grip strength and cognitive impairment based on the CERAD test. The AF test results showed that >80 years of age, female sex, and the NH White were associated with a significantly low risk of cognitive impairment. The most important finding is that a linear association lies between grip strength and cognitive impairment, as well as a sex-based linear association. Machine learning of the XGBoost model suggests that grip strength is one of the top two most important negative predictor variables.

CONCLUSION

We observed an inverse relationship between hand grip strength and cognitive impairment, which might suggest a shared underlying mechanism that needs to be further investigated using a large-scale prospective clinical trial to validate our findings.

Interdisciplinary Approaches to Deal with Alzheimer's Disease-From Bench to Bedside: What Feasible Options Do Already Exist Today?

Alzheimer's disease is one of the most common neurodegenerative diseases in the western population. The incidence of this disease increases with age. Rising life expectancy and the resulting increase in the ratio of elderly in the population are likely to exacerbate socioeconomic problems. Alzheimer's disease is a multifactorial disease. In addition to amyloidogenic processing leading to plaques, and tau pathology, but also other molecular causes such as oxidative stress or inflammation play a crucial role. We summarize the molecular mechanisms leading to Alzheimer's disease and which potential interventions are known to interfere with these mechanisms, focusing on nutritional approaches and physical activity but also the beneficial effects of cognition-oriented treatments with a focus on language and communication. Interestingly, recent findings also suggest a causal link between oral conditions, such as periodontitis or edentulism, and Alzheimer's disease, raising the question of whether dental intervention in Alzheimer's patients can be beneficial as well. Unfortunately, all previous single-domain interventions have been shown to have limited benefit to patients. However, the latest studies indicate that combining these efforts into multidomain approaches may have increased preventive or therapeutic potential. Therefore, as another emphasis in this review, we provide an overview of current literature dealing with studies combining the above-mentioned approaches and discuss potential advantages compared to monotherapies. Considering current literature and intervention options, we also propose a multidomain interdisciplinary approach for the treatment of Alzheimer's disease patients that synergistically links the individual approaches. In conclusion, this review highlights the need to combine different approaches in an interdisciplinary manner, to address the future challenges of Alzheimer's disease.

Effect of flavonoids on skeletal muscle mass, strength and physical performance in middle-aged and older adults with or without Sarcopenia: A meta-analysis of randomized controlled trials

The role of flavonoids in regulating the synthesis and function of skeletal muscles is increasingly recognized. However, randomized controlled trials have yielded inconsistent results on the influence of flavonoids on human muscular parameters. Therefore, we performed a meta-analysis to evaluate the possible effects of flavonoids on sarcopenia-related parameters in middle-aged and elderly people. Eligible literature and randomized controlled trials reports have been extensively searched from PubMed, Cochrane Library, Web of Science, and EMBASE databases until April 2022. A total of 20 articles involving 796 participants were available for the meta-analysis. There were significant benefits for participants in appendicular muscle mass gain (SMD = 0.29; 95% CI: 0.07, 0.52; P = 0.01) and 6-min walk distance (SMD = 0.37; 95% CI: 0.01, 0.73; P = 0.05). A subgroup analysis indicated that flavonoid significantly improves appendicular muscle mass (SMD = 0.50; 95% CI: 0.21, 0.80; P < 0.01) and Timed-Up and Go test (SMD = −0.47; 95% CI: −0.85, −0.09; P = 0.02) in Sarcopenia population. Our results provide insight into the effects of flavonoids on skeletal muscle mass and gait speed for those without exercise. However, there was no significant improvement in the subjects' muscle strength.

Modifiable Innate Biology within the Gut–Brain Axis for Alzheimer’s Disease

Alzheimer’s disease (AD) is a prototypical inflammation-associated loss of cognitive function, with approximately 90% of the AD burden associated with invading myeloid cells controlling the function of the resident microglia. This indicates that the immune microenvironment has a pivotal role in the pathogenesis of the disease. Multiple peripheral stimuli, conditioned by complex and varied interactions between signals that stem at the intestinal level and neuroimmune processes, are involved in the progression and severity of AD. Conceivably, the targeting of critical innate immune signals and cells is achievable, influencing immune and metabolic health within the gut–brain axis. Considerable progress has been made, modulating many different metabolic and immune alterations that can drive AD development. However, non-pharmacological strategies targeting immunometabolic processes affecting neuroinflammation in AD treatment remain general and, at this point, are applied to all patients regardless of disease features. Despite these possibilities, improved knowledge of the relative contribution of the different innate immune cells and molecules comprising the chronically inflamed brain network to AD pathogenesis, and elucidation of the network hierarchy, are needed for planning potent preventive and/or therapeutic interventions. Moreover, an integrative perspective addressing transdisciplinary fields can significantly contribute to molecular pathological epidemiology, improving the health and quality of life of AD patients. This review is intended to gather modifiable immunometabolic processes based on their importance in the prevention and management of AD.

Nutritional supplementation to enhance the efficacy of exercise training in older adults: what is the evidence from the latest randomized controlled trials?

PURPOSE OF REVIEW

This review summarizes recent studies that assessed whether nutritional supplementation enhances the efficacy of exercise training in older adults, focusing on the benefits for physical/functional performance of protein, vitamin D, or multi-ingredient supplementation.

RECENT FINDINGS

Studies applying long-term exercise training strongly support the benefits of different exercise regimens for muscle strength and function but most studies do not provide direct evidence for protein, vitamin D, or multi-ingredient supplementation to further augment such improvements in older adults. Several methodological limitations are addressed that likely limited the reliability to convincingly establish or refute any additive effects of supplementation. Only when specifically tailored to the population under study, ensuring proper intensity, duration, and adherence to exercise, and aiming for a daily intake of ∼1.5 g protein per kg body mass, and ∼800 IU of vitamin D supplementation, there appears to be some potential to augment the efficacy of long-term exercise training in older adults, with potentially greater benefits in compromised older subpopulations.

SUMMARY

There is some support for the efficacy of nutritional supplementation to further augment the beneficial effects of prolonged exercise training in older adults but any intervention needs tailoring of both the exercise and the nutritional intervention towards the intended (sub)population.

Correlation of medial longitudinal arch morphology with body characteristics and locomotive function in community-dwelling older women: A cross-sectional study

PURPOSE

This cross-sectional study aimed to investigate the effects of foot arch deformities on physical characteristics, muscular strength, and motor function in older women depending on the presence or absence of pain.

METHODS

Overall, 145 community-dwelling women aged 65 to 90 years were included in this study. We measured the foot arch height ratio (AHR, dorsal height/truncated foot length) and classified participants with AHR values above, below, or within 1.5 standard deviations into the high-arched group (HAG), Low-Arched Group (LAG), or normal-arched group (NAG), respectively. We also compared body characteristics (age, height, weight, body mass index (BMI), and skeletal mass index), muscle strength (handgrip strength and intrinsic foot strength (IFS)), and locomotive function (two-step value and gait speed) among the three groups.

RESULTS

Locomotive examination and muscle strength showed significant differences among the three groups only in the presence of pain; in the two-step test, HAG, NAG, and LAG values were 0.98 cm/cm, 1.19 cm/cm, and 1.18 cm/cm, respectively. The IFS measured 19.2 N, 24.2 N, 31.0 N, respectively, in the HAG, NAG, and LAG.

CONCLUSION

This study suggests that decreased IFS affects the mobility function of high-arched feet in older women. Although there was no significant difference in the evaluation of pain, HAG showed the highest average value, which is considered to contribute to the decreased two-step value. It has been suggested that a high-arched foot in the presence of pain is associated with IFS weakness and may affect the decline of mobility function in older women.

Effects of a Multicomponent Exercise Program on Groups of Community-Dwelling Older Adults with Low Schooling: A Pilot Study

The aim of this study was to analyze the effects of a multicomponent exercise program on the physical and hemodynamic functions of community-dwelling older adults with low schooling levels in relation to simple multicomponent group exercises. Twenty-one older people were randomly assigned to two groups: G1 (n = 11) and G2 (n = 10); sixteen of whom completed the sixteen sessions over a six-week period, three times a week. During eight sessions, G1 performed adapted dual-task multicomponent exercises (strengthening, balance, and cognition) and G2 simple multicomponent exercises (strengthening and balance), and both groups engaged in eight additional sessions of simple multicomponent exercises. The dual-task multicomponent exercises exhibited similar effects to those of their simple multicomponent counterparts. The older adults from both groups improved mobility, frailty, static postural control, balance, and hemodynamic stability. The adapted program was beneficial to the community-dwelling older people with low schooling in the group intervention.

Effects of Moderate Intensity Exercise on the Cortical Thickness and Subcortical Volumes of Preclinical Alzheimer's Disease Patients: A Pilot Study

OBJECTIVE

We aimed to explore the impact of moderate intensity exercise on the cortical thickness and subcortical volumes of preclinical Alzheimer's disease (AD) patients.

METHODS

Sixty-three preclinical AD patients with magnetic resonance imaging (MRI) and 18-florbetaben positron emission tomography (PET) data were enrolled in the study. Information on demographic characteristics, cognitive battery scores, self-reported exercise habits were attained. Structural magnetic resonance images were analyzed and processed using Freesurfer v6.0.

RESULTS

Compared to Exercise group, Non-Exercise group demonstrated reduced cortical thickness in left parstriangularis, rostral middle frontal, entorhinal, superior frontal, lingual, superior parietal, lateral occipital, inferior parietal gyrus, temporal pole, precuneus, insula, fusiform gyrus, right precuneus, superiorparietal, lateral orbitofrontal, rostral middle frontal, medial orbitofrontal, superior frontal, lingual, middle temporal gyrus, insula, supramarginal, parahippocampal, paracentral gyrus. Volumes of right thalamus, caudate, putamen, pallidum, hippocampus, amygdala were also reduced in Non-Exercise group.

CONCLUSION

Moderate intensity exercise affects cortical and subcortical structures in preclinical AD patients. Thus, physical exercise has a potential to be an effective intervention to prevent future cognitive decline in those at high risk of AD.