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Jasim N, Balakirishnan D, Zhang H, Steiner-Lim GZ, Karamacoska D, Yang GY. Effects and mechanisms of Tai Chi on mild cognitive impairment and early-stage dementia: a scoping review. Syst Rev 2023; 12:200. [PMID: 37891692 PMCID: PMC10612170 DOI: 10.1186/s13643-023-02358-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Dementia is associated with cognitive and functional decline that significantly impacts quality of life. There is currently no cure for dementia, thus, it is important to manage dementia in the early stages and delay deterioration. Previous studies have documented a range of health benefits of Tai Chi in people with early-stage dementia, however, none have systematically integrated these effects with their underlying mechanisms. The aims of this study were to (1) identify the neurocognitive, psychological, and physical health benefits of Tai Chi oi people with early-stage dementia, and (2) explore the underlying mechanisms of these effects. METHODS We searched systematic reviews (SRs) and randomised control trials (RCTs) on Tai Chi for adults aged 50 years and older with mild cognitive impairment (MCI) or early-stage dementia in MEDLINE, PubMed, Cochrane Library, EMBASE, and major Chinese databases. No language or publication restrictions were applied. Risk of bias was assessed. RESULTS Eight SRs with meta-analyses and 6 additional published RCTs revealed inconsistent findings of Tai Chi on improving global cognitive function, attention and executive function, memory and language, and perceptual-motor function. There was no significant between-group difference in depressive symptoms. The results from the RCTs showed that Tai Chi can reduce arthritis pain and slow the progress of dementia. No studies on MCI or early-stage dementia investigating the underlying mechanisms of Tai Chi were identified. Instead, nine mechanistic studies on healthy adults were included. These suggested that Tai Chi may improve memory and cognition via increased regional brain activity, large-scale network functional connectivity, and regional grey matter volume. CONCLUSION The effects of Tai Chi on neurocognitive outcomes in people with MCI and early-stage dementia are still inconclusive. Further high-quality clinical trials and mechanistic studies are needed to understand if and how Tai Chi may be applied as a successful intervention to delay deterioration and improve the quality of life in people with an increased risk of cognitive decline.
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Affiliation(s)
- Nibras Jasim
- School of Psychology, Western Sydney University, Penrith, NSW, 2751, Australia
| | | | - Han Zhang
- School of Acupuncture and Massage, Beijing University of Chinese Medicine, Beijing, 100029, China
| | | | - Diana Karamacoska
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Guo-Yan Yang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, 2751, Australia.
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2
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Han YMY, Chan MMY, Choi CXT, Law MCH, Ahorsu DK, Tsang HWH. The neurobiological effects of mind-body exercise: a systematic review and meta-analysis of neuroimaging studies. Sci Rep 2023; 13:10948. [PMID: 37415072 PMCID: PMC10326064 DOI: 10.1038/s41598-023-37309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023] Open
Abstract
The neurobiological effects of mind-body exercise on brain activation, functional neural connections and structural changes in the brain remain elusive. This systematic review and coordinate-based meta-analysis investigated the changes in resting-state and task-based brain activation, as well as structural brain changes before and after mind-body exercise compared to waitlist or active controls based on published structural or functional magnetic resonance imaging randomized controlled trials or cross-sectional studies. Electronic database search and manual search in relevant publications yielded 34 empirical studies with low-to-moderate risk of bias (assessed by Cochrane risk-of-bias tool for randomized trials or Joanna Briggs Institute's critical appraisal checklist for analytical cross-sectional studies) that fulfilled the inclusion criteria, with 26 studies included in the narrative synthesis and 8 studies included in the meta-analysis. Coordinate-based meta-analysis showed that, while mind-body exercise enhanced the activation of the left anterior cingulate cortex within the default mode network (DMN), it induced more deactivation in the left supramarginal gyrus within the ventral attention network (uncorrected ps < 0.05). Meta-regression with duration of mind-body practice as a factor showed that, the activation of right inferior parietal gyrus within the DMN showed a positive association with increasing years of practice (voxel-corrected p < 0.005). Although mind-body exercise is shown to selectively modulate brain functional networks supporting attentional control and self-awareness, the overall certainty of evidence is limited by small number of studies. Further investigations are needed to understand the effects of both short-term and long-term mind-body exercise on structural changes in the brain.PROSPERO registration number: CRD42021248984.
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Affiliation(s)
- Yvonne M Y Han
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China.
| | - Melody M Y Chan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Coco X T Choi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Maxwell C H Law
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Daniel Kwasi Ahorsu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Hector W H Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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3
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Xie Y, Cai K, Dai J, Wei G. Enhanced Integrity of White Matter Microstructure in Mind-Body Practitioners: A Whole-Brain Diffusion Tensor Imaging Study. Brain Sci 2023; 13:brainsci13040691. [PMID: 37190656 DOI: 10.3390/brainsci13040691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Tai Chi Chuan (TCC) is an increasingly popular multimodal mind-body practice with potential cognitive benefits, yet the neurobiological mechanisms underlying these effects, particularly in relation to brain white matter (WM) microstructure, remain largely unknown. In this study, we used diffusion tensor imaging (DTI) and the attention network test (ANT) to compare 22 TCC practitioners and 18 healthy controls. We found extensive differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) between the two groups. Specifically, TCC practitioners had significantly different diffusion metrics in the corticospinal tract (CST), fornix (FX)/stria terminalis (ST), and cerebral peduncle (CP). We also observed a significant correlation between increased FA values in the right CP and ANT performance in TCC practitioners. Our findings suggest that optimized regional WM microstructure may contribute to the complex information processing associated with TCC practice, providing insights for preventing cognitive decline and treating neurological disorders with cognitive impairment in clinical rehabilitation.
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Affiliation(s)
- Yingrong Xie
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
| | - Kelong Cai
- College of Physical Education, Yangzhou University, Yangzhou 225127, China
| | - Jingang Dai
- Experimental Research Center, China Academy of Chinese Medical Sciences, National Chinese Medicine Experts Inheritance Office of Song Jun, Beijing 100700, China
| | - Gaoxia Wei
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing 100101, China
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4
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Wu K, Li Y, Zou Y, Ren Y, Wang Y, Hu X, Wang Y, Chen C, Lu M, Xu L, Wu L, Li K. Tai Chi increases functional connectivity and decreases chronic fatigue syndrome: A pilot intervention study with machine learning and fMRI analysis. PLoS One 2022; 17:e0278415. [PMID: 36454926 PMCID: PMC9714925 DOI: 10.1371/journal.pone.0278415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The latest guidance on chronic fatigue syndrome (CFS) recommends exercise therapy. Tai Chi, an exercise method in traditional Chinese medicine, is reportedly helpful for CFS. However, the mechanism remains unclear. The present longitudinal study aimed to detect the influence of Tai Chi on functional brain connectivity in CFS. METHODS The study recruited 20 CFS patients and 20 healthy controls to receive eight sessions of Tai Chi exercise over a period of one month. Before the Tai Chi exercise, an abnormal functional brain connectivity for recognizing CFS was generated by a linear support vector model. The prediction ability of the structure was validated with a random forest classification under a permutation test. Then, the functional connections (FCs) of the structure were analyzed in the large-scale brain network after Tai Chi exercise while taking the changes in the Fatigue Scale-14, Pittsburgh Sleep Quality Index (PSQI), and the 36-item short-form health survey (SF-36) as clinical effectiveness evaluation. The registration number is ChiCTR2000032577 in the Chinese Clinical Trial Registry. RESULTS 1) The score of the Fatigue Scale-14 decreased significantly in the CFS patients, and the scores of the PSQI and SF-36 changed significantly both in CFS patients and healthy controls. 2) Sixty FCs were considered significant to discriminate CFS (P = 0.000, best accuracy 90%), with 80.5% ± 9% average accuracy. 3) The FCs that were majorly related to the left frontoparietal network (FPN) and default mode network (DMN) significantly increased (P = 0.0032 and P = 0.001) in CFS patients after Tai Chi exercise. 4) The change of FCs in the left FPN and DMN were positively correlated (r = 0.40, P = 0.012). CONCLUSION These results demonstrated that the 60 FCs we found using machine learning could be neural biomarkers to discriminate between CFS patients and healthy controls. Tai Chi exercise may improve CFS patients' fatigue syndrome, sleep quality, and body health statement by strengthening the functional connectivity of the left FPN and DMN under these FCs. The findings promote our understanding of Tai Chi exercise's value in treating CFS.
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Affiliation(s)
- Kang Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Xinhua Hospital, Tongzhou District, Beijing, China
| | - Yuanyuan Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yihuai Zou
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Ren
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yahui Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaojie Hu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yue Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Chen
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mengxin Lu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Lingling Xu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Linlu Wu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kuangshi Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- * E-mail:
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5
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Wang S, Lu S. Brain Functional Connectivity in the Resting State and the Exercise State in Elite Tai Chi Chuan Athletes: An fNIRS Study. Front Hum Neurosci 2022; 16:913108. [PMID: 35782040 PMCID: PMC9243259 DOI: 10.3389/fnhum.2022.913108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
This study aimed to reveal the characteristics of multi-circuit brain synergy between elite tai chi chuan athletes in resting and exercise states and to provide neuroimaging evidence of improvements in brain function by motor skill training. Functional near-infrared spectroscopy (fNIRS) was used to compare the brain activity of professional tai chi chuan athletes (expert group) and beginners (novice group) in resting and exercise states, and to assess functional connectivity (FC) between the prefrontal lobe and the sensorimotor zone. In the resting state, the FC between the left prefrontal lobe and the right sensorimotor area in the expert group was significantly lower than that in the novice group (P < 0.05). In the exercise state, the patterns of FC between the left prefrontal lobe and right sensorimotor area, the right prefrontal lobe and left sensorimotor area, and the left and right sensorimotor areas in the expert group were significantly lower than that in the novice group (P < 0.05). From the resting state to the locomotor state, the expert group experienced a greater absolute value of functional connection increment between the left prefrontal cortex and right sensorimotor area, and between the left sensorimotor area and right sensorimotor area (P < 0.05). This was positively correlated with the self-evaluation results of motor performance behavior. Under sports conditions, professional athletes’ multi-circuit brain FC strength is significantly reduced, and their elite motor skill performance supports the neural efficiency hypothesis. This may be related to the high adaptation of the brain to specific tasks and the improvement of the integration of somatic perception processing and motor function.
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Affiliation(s)
- Shilong Wang
- Wushu School of China, Beijing Sports University, Beijing, China
| | - Shengnan Lu
- College of Dance and Martial Arts, Capital University of Physical Education and Sport, Beijing, China
- *Correspondence: Shengnan Lu
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Li Y, Wu K, Hu X, Xu T, Li Z, Zhang Y, Li K. Altered Effective Connectivity of Resting-State Networks by Tai Chi Chuan in Chronic Fatigue Syndrome Patients: A Multivariate Granger Causality Study. Front Neurol 2022; 13:858833. [PMID: 35720086 PMCID: PMC9203735 DOI: 10.3389/fneur.2022.858833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 12/05/2022] Open
Abstract
Numerous evidence has shown that patients with chronic fatigue syndrome (CFS) have changes in resting brain functional connectivity, but there is no study on the brain network effect of Tai Chi Chuan intervention in CFS. To explore the influence of Tai Chi Chuan exercise on the causal relationship between brain functional networks in patients with CFS, 21 patients with CFS and 19 healthy controls were recruited for resting-state functional magnetic resonance imaging (rs-fMRI) scanning and 36-item Short-Form Health Survey (SF-36) scale assessment before and after 1month-long training in Tai Chi Chuan. We extracted the resting brain networks using the independent component analysis (ICA) method, analyzed the changes of FC in these networks, conducted Granger causality analysis (GCA) on it, and analyzed the correlation between the difference causality value and the SF-36 scale. Compared to the healthy control group, the SF-36 scale scores of patients with CFS were lower at baseline. Meanwhile, the causal relationship between sensorimotor network (SMN) and default mode network (DMN) was weakened. The above abnormalities could be improved by Tai Chi Chuan training for 1 month. In addition, the correlation analyses showed that the causal relationship between SMN and DMN was positively correlated with the scores of Role Physical (RP) and Bodily Pain (BP) in CFS patients, and the change of causal relationship between SMN and DMN before and after training was positively correlated with the change of BP score. The findings suggest that Tai Chi Chuan is helpful to improve the quality of life for patients with CFS. The change of Granger causality between SMN and DMN may be a readout parameter of CFS. Tai Chi Chuan may promote the functional plasticity of brain networks in patients with CFS by regulating the information transmission between them.
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Affiliation(s)
- Yuanyuan Li
- Department of Neurology and Stroke Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kang Wu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaojie Hu
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tianjiao Xu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zongheng Li
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Zhang
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Yong Zhang
| | - Kuangshi Li
- Department of Rehabilitation, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Kuangshi Li
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7
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Snyder AZ, Nishino T, Shimony JS, Lenze EJ, Wetherell JL, Voegtle M, Miller JP, Yingling MD, Marcus D, Gurney J, Rutlin J, Scott D, Eyler L, Barch D. Covariance and Correlation Analysis of Resting State Functional Magnetic Resonance Imaging Data Acquired in a Clinical Trial of Mindfulness-Based Stress Reduction and Exercise in Older Individuals. Front Neurosci 2022; 16:825547. [PMID: 35368291 PMCID: PMC8971902 DOI: 10.3389/fnins.2022.825547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
We describe and apply novel methodology for whole-brain analysis of resting state fMRI functional connectivity data, combining conventional multi-channel Pearson correlation with covariance analysis. Unlike correlation, covariance analysis preserves signal amplitude information, which feature of fMRI time series may carry physiological significance. Additionally, we demonstrate that dimensionality reduction of the fMRI data offers several computational advantages including projection onto a space of manageable dimension, enabling linear operations on functional connectivity measures and exclusion of variance unrelated to resting state network structure. We show that group-averaged, dimensionality reduced, covariance and correlation matrices are related, to reasonable approximation, by a single scalar factor. We apply this methodology to the analysis of a large, resting state fMRI data set acquired in a prospective, controlled study of mindfulness training and exercise in older, sedentary participants at risk for developing cognitive decline. Results show marginally significant effects of both mindfulness training and exercise in both covariance and correlation measures of functional connectivity.
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Affiliation(s)
- Abraham Z. Snyder
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Tomoyuki Nishino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Joshua S. Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Julie Loebach Wetherell
- VA San Diego Healthcare System, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Michelle Voegtle
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - J. Philip Miller
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Michael D. Yingling
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Daniel Marcus
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jenny Gurney
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jerrel Rutlin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Drew Scott
- Master of Social Welfare Program, University of California, Berkeley, Berkeley, CA, United States
| | - Lisa Eyler
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Deanna Barch
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Psychological and Brain Sciences, Washington University, St. Louis, MO, United States
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8
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Lehmann N, Villringer A, Taubert M. Priming cardiovascular exercise improves complex motor skill learning by affecting the trajectory of learning-related brain plasticity. Sci Rep 2022; 12:1107. [PMID: 35064175 PMCID: PMC8783021 DOI: 10.1038/s41598-022-05145-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
In recent years, mounting evidence from animal models and studies in humans has accumulated for the role of cardiovascular exercise (CE) in improving motor performance and learning. Both CE and motor learning may induce highly dynamic structural and functional brain changes, but how both processes interact to boost learning is presently unclear. Here, we hypothesized that subjects receiving CE would show a different pattern of learning-related brain plasticity compared to non-CE controls, which in turn associates with improved motor learning. To address this issue, we paired CE and motor learning sequentially in a randomized controlled trial with healthy human participants. Specifically, we compared the effects of a 2-week CE intervention against a non-CE control group on subsequent learning of a challenging dynamic balancing task (DBT) over 6 consecutive weeks. Structural and functional MRI measurements were conducted at regular 2-week time intervals to investigate dynamic brain changes during the experiment. The trajectory of learning-related changes in white matter microstructure beneath parieto-occipital and primary sensorimotor areas of the right hemisphere differed between the CE vs. non-CE groups, and these changes correlated with improved learning of the CE group. While group differences in sensorimotor white matter were already present immediately after CE and persisted during DBT learning, parieto-occipital effects gradually emerged during motor learning. Finally, we found that spontaneous neural activity at rest in gray matter spatially adjacent to white matter findings was also altered, therefore indicating a meaningful link between structural and functional plasticity. Collectively, these findings may lead to a better understanding of the neural mechanisms mediating the CE-learning link within the brain.
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Affiliation(s)
- Nico Lehmann
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103, Leipzig, Germany. .,Faculty of Humanities, Institute III, Department of Sport Science, Otto von Guericke University, Zschokkestraße 32, 39104, Magdeburg, Germany.
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103, Leipzig, Germany.,Mind and Brain Institute, Charité and Humboldt University, Luisenstraße 56, 10117, Berlin, Germany
| | - Marco Taubert
- Faculty of Humanities, Institute III, Department of Sport Science, Otto von Guericke University, Zschokkestraße 32, 39104, Magdeburg, Germany.,Center for Behavioral and Brain Science (CBBS), Otto von Guericke University, Universitätsplatz 2, 39106, Magdeburg, Germany
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9
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Shen QQ, Yin HC, Cui L, Zhang JY, Wang DL, Zhu LN, Wang Y, Li XJ. The Potential Advantages of Tai Chi Chuan in Promoting Inhibitory Control and Spontaneous Neural Activity in Young Adults. Front Behav Neurosci 2021; 15:747733. [PMID: 34803624 PMCID: PMC8600257 DOI: 10.3389/fnbeh.2021.747733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/06/2021] [Indexed: 01/18/2023] Open
Abstract
Tai Chi Chuan (TCC) is assumed to exert beneficial effects on functional brain activity and cognitive function in elders. Until now, empirical evidence of TCC induced intra-regional spontaneous neural activity and inhibitory control remains inconclusive. Whether the effect of TCC is better than that of other aerobic exercises is still unknown, and the role of TCC in younger adults is not yet fully understood. Here we used resting-state functional MRI (fMRI) to investigate the effects of 8-week TCC (n = 12) and brisk walking (BW, n = 12) on inhibitory control and fractional amplitude of low-frequency fluctuations (fALFF). The results found that TCC had significant effects on inhibitory control performance and spontaneous neural activity that were associated with significantly increased fALFF in the left medial superior frontal gyrus (Cohen's d = 1.533) and the right fusiform gyrus (Cohen's d = 1.436) and decreased fALFF in the right dorsolateral superior frontal gyrus (Cohen's d = 1.405) and the right paracentral lobule (Cohen's d = 1.132).TCC exhibited stronger effects on spontaneous neural activity than the BW condition, as reflected in significantly increased fALFF in the left medial superior frontal gyrus (Cohen's d = 0.862). There was a significant positive correlation between the increase in fALFF in the left medial superior frontal gyrus and the enhancement in inhibitory control performance. The change in fALFF in the left medial superior frontal gyrus was able to explain the change in inhibitory control performance induced by TCC. In conclusion, our results indicated that 8 weeks of TCC intervention could improve processing efficiency related to inhibitory control and alter spontaneous neural activity in young adults, and TCC had potential advantages over BW intervention for optimizing spontaneous neural activity.
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Affiliation(s)
- Qi-Qi Shen
- College of P. E. and Sports, Beijing Normal University, Beijing, China
| | - Heng-Chan Yin
- College of P. E. and Sports, Beijing Normal University, Beijing, China
| | - Lei Cui
- College of P. E. and Sports, Beijing Normal University, Beijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Jing-Yi Zhang
- College of P. E. and Sports, Beijing Normal University, Beijing, China
| | - Dong-Ling Wang
- College of P. E. and Sports, Beijing Normal University, Beijing, China
| | - Li-Na Zhu
- College of P. E. and Sports, Beijing Normal University, Beijing, China
| | - Yuan Wang
- College of P. E. and Sports, Beijing Normal University, Beijing, China
| | - Xiu-Juan Li
- PE Department, Renmin University of China, Beijing, China
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10
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Cui L, Tao S, Yin HC, Shen QQ, Wang Y, Zhu LN, Li XJ. Tai Chi Chuan Alters Brain Functional Network Plasticity and Promotes Cognitive Flexibility. Front Psychol 2021; 12:665419. [PMID: 34267705 PMCID: PMC8275936 DOI: 10.3389/fpsyg.2021.665419] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/01/2021] [Indexed: 01/17/2023] Open
Abstract
Objective: This study used resting-state functional magnetic resonance imaging to investigate the effects of 8 weeks of Tai Chi Chuan and general aerobic exercise on the topological parameters of brain functional networks, explored the advantages of Tai Chi Chuan for improving functional network plasticity and cognitive flexibility, and examined how changes in topological attributes of brain functional networks relate to cognitive flexibility. Methods: Thirty-six healthy adults were grouped into Tai Chi Chuan (Bafa Wubu of Tai Chi), general aerobic exercise (brisk walking), and control groups. All of the subjects underwent fMRI and behavioral assessment before and after the exercise intervention. Results: Tai Chi Chuan exercise significantly enhanced the clustering coefficient and local efficiency compared with general aerobic exercise. Regarding the nodal properties, Tai Chi Chuan significantly enhanced the nodal clustering coefficient of the bilateral olfactory cortex and left thalamus, significantly reduced the nodal clustering coefficient of the left inferior temporal gyrus, significantly improved the nodal efficiency of the right precuneus and bilateral posterior cingulate gyrus, and significantly improved the nodal local efficiency of the left thalamus and right olfactory cortex. Furthermore, the behavioral performance results demonstrated that cognitive flexibility was enhanced by Tai Chi Chuan. The change in the nodal clustering coefficient in the left thalamus induced by Tai Chi Chuan was a significant predictor of cognitive flexibility. Conclusion: These findings demonstrated that Tai Chi Chuan could promote brain functional specialization. Brain functional specialization enhanced by Tai Chi Chuan exercise was a predictor of greater cognitive flexibility.
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Affiliation(s)
- Lei Cui
- College of P.E. and Sports, Beijing Normal University, Beijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Sha Tao
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Heng-Chan Yin
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Qi-Qi Shen
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Yuan Wang
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Li-Na Zhu
- College of P.E. and Sports, Beijing Normal University, Beijing, China
| | - Xiu-Juan Li
- PE Department, Renmin University of China, Beijing, China
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11
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The Effect of Tai Chi Chuan on Emotional Health: Potential Mechanisms and Prefrontal Cortex Hypothesis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5549006. [PMID: 34007290 PMCID: PMC8110391 DOI: 10.1155/2021/5549006] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/25/2021] [Accepted: 04/22/2021] [Indexed: 12/31/2022]
Abstract
Deep involvement in the negative mood over long periods of time likely results in emotional disturbances/disorders and poor mental health. Tai Chi Chuan (TCC) is regarded as a typical mind-body practice combining aerobic exercise and meditation to prevent and treat negative mood. Although there are an increasing number of TCC studies examining anxiety, depression, and mental stress, the mechanisms underlying these negative emotions are not fully understood. This review study examined TCC studies related to emotional health from both clinical patients and healthy individuals. Next, several potential mechanisms from physiological, psychological, and neurological perspectives were evaluated based on direct and indirect research evidence. We reviewed recent functional magnetic resonance imaging studies, which demonstrated changes in brain anatomy and function, mainly in the prefrontal cortex, following TCC practice. Finally, the effects of TCC on emotion/mental health is depicted with a prefrontal cortex hypothesis that proposed “an immune system of the mind” indicating the role of the prefrontal cortex as a flexible hub in regulating an individual's mental health. The prefrontal cortex is likely a key biomarker among the multiple complex neural correlates to help an individual manage negative emotions/mental health. Future research is needed to examine TCC effects on mental health by examining the relationship between the executive control system (mainly prefrontal cortex) and limbic network (including amygdala, insula, and hippocampal gyrus).
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12
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Effects of Mind-Body Exercise on Brain Structure and Function: A Systematic Review on MRI Studies. Brain Sci 2021; 11:brainsci11020205. [PMID: 33562412 PMCID: PMC7915202 DOI: 10.3390/brainsci11020205] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
Mind–body exercise has been proposed to confer both physical and mental health benefits. However, there is no clear consensus on the neural mechanisms underlying the improvements in health. Herein, we conducted a systematic review to reveal which brain region or network is regulated by mind–body exercise. PubMed, Web of Science, PsycINFO, SPORTDiscus, and China National Knowledge Infrastructure databases were systematically searched to identify cross-sectional and intervention studies using magnetic resonance imaging (MRI) to explore the effect of mind–body exercise on brain structure and function, from their inception to June 2020. The risk of bias for cross-sectional studies was assessed using the Joanna Briggs Institute (JBI) checklist, whereas that of interventional studies was analyzed using the Physiotherapy Evidence Database (PEDro) scale. A total of 15 studies met the inclusion criteria. Our analysis revealed that mind–body exercise modulated brain structure, brain neural activity, and functional connectivity, mainly in the prefrontal cortex, hippocampus/medial temporal lobe, lateral temporal lobe, insula, and the cingulate cortex, as well as the cognitive control and default mode networks, which might underlie the beneficial effects of such exercises on health. However, due to the heterogeneity of included studies, more randomized controlled trials with rigorous designs, similar measured outcomes, and whole-brain analyses are warranted.
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13
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Kong J, Huang Y, Liu J, Yu S, Ming C, Chen H, Wilson G, Harvey WF, Li W, Wang C. Altered functional connectivity between hypothalamus and limbic system in fibromyalgia. Mol Brain 2021; 14:17. [PMID: 33472674 PMCID: PMC7816461 DOI: 10.1186/s13041-020-00705-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/23/2020] [Indexed: 12/14/2022] Open
Abstract
The hypothalamus links the nervous system to the endocrine system and plays a crucial role in maintaining the human body's homeostasis. This study aims to investigate the resting state functional connectivity (rsFC) changes of the hypothalamus in fibromyalgia patients. 24 Fibromyalgia patients and 24 matched healthy controls (HCs) were recruited. Resting state fMRI data were collected from the fibromyalgia patients and HC's. Fibromyalgia patients went through a second scan after 12 weeks of Tai Chi mind-body intervention. Data analysis showed that fibromyalgia patients displayed less medial hypothalamus (MH) rsFC with the thalamus and amygdala when compared to the functional connectivity in the HCs. After the Tai Chi mind-body intervention, fibromyalgia patients showed increased MH rsFC with the thalamus and amygdala accompanied by clinical improvement. Effective connectivity analysis showed disrupted MH and thalamus interaction in the fibromyalgia patients, which was altered by mind-body exercise. Our findings suggest that fibromyalgia is associated with altered functional connectivity within the diencephalon and limbic system. Elucidating the roles of the diencephalon and limbic system in the pathophysiology and development of fibromyalgia may facilitate the development of a new biomarker and effective treatment methods for this prevalent disorder.Trial Registration ClinicalTrials.gov, NCT02407665. Registered: 3 April 2015, https://clinicaltrials.gov/ct2/show/NCT02407665?term=NCT02407665&draw=2&rank=1.
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Affiliation(s)
- Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA.
| | - Yiting Huang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Jiao Liu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Siyi Yu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Cheng Ming
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Helen Chen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, 02129, USA
| | - William F Harvey
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center / Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Wen Li
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Chenchen Wang
- Center for Complementary and Integrative Medicine, Division of Rheumatology, Tufts Medical Center / Tufts University School of Medicine, Boston, MA, 02111, USA.
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14
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Huang N, Li W, Rong X, Champ M, Wei L, Li M, Mu H, Hu Y, Ma Z, Lyu J. Effects of a Modified Tai Chi Program on Older People with Mild Dementia: A Randomized Controlled Trial. J Alzheimers Dis 2020; 72:947-956. [PMID: 31743998 DOI: 10.3233/jad-190487] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tai Chi exercise is a non-pharmacological therapy that has received increased attention in recent years. A Tai Chi program has been specifically modified for older people with cognitive impairments by the research team. OBJECTIVE We aim to assess the effects of this Tai Chi program on mild dementia. METHODS Eighty older people with mild dementia were recruited and randomly assigned to a Tai Chi group or a control group. The Tai Chi group practiced the Tai Chi program three times a week for 10 months, while the control group continued receiving routine treatments. All participants were assessed for cognitive function, behavior/mood, and activities of daily living at baseline, 5 months, and 10 months. RESULTS The Tai Chi group performed better than the control group. Repeated measures ANOVA revealed a significant group×time interaction in the Montreal Cognitive Assessment (MoCA). Further analysis of sub-items of the MoCA showed a significant time effect in naming and abstraction. It was statistically significant in both main effect of time and group×time interaction in the Neuropsychiatric Inventory (NPI) and Geriatric Depression Scale (GDS). Paired sample t test showed the Tai Chi group scored lower at 5 and 10 months in the NPI and at 10 months in the GDS compared with baseline. The Tai Chi group scored lower than the control group at 10 months in the NPI and GDS. CONCLUSION The results suggest this Tai Chi program may help improve cognitive function and mental well-being for older adults with mild dementia.
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Affiliation(s)
- Nayan Huang
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China.,Center for Brain Disorders Research, Capital Medical University; Beijing Institute of Brain Disorders, Beijing, China
| | - Wenjie Li
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Xiangjiang Rong
- School of Kinesiology and Health, Capital University of Physical Education and Sport, Beijing, China
| | - Mei Champ
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Lian Wei
- Graduate School, Capital University of Physical Education and Sport, Beijing, China
| | - Mo Li
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Haiyan Mu
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Yueqing Hu
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Zongjuan Ma
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China
| | - Jihui Lyu
- Center for Cognitive Disorders, Beijing Geriatric Hospital, Beijing, China.,Center for Brain Disorders Research, Capital Medical University; Beijing Institute of Brain Disorders, Beijing, China
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15
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Zhang L, Li W, Wang L, Bai T, Ji GJ, Wang K, Tian Y. Altered functional connectivity of right inferior frontal gyrus subregions in bipolar disorder: a resting state fMRI study. J Affect Disord 2020; 272:58-65. [PMID: 32379621 DOI: 10.1016/j.jad.2020.03.122] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/04/2020] [Accepted: 03/29/2020] [Indexed: 11/26/2022]
Abstract
The right inferior frontal gyrus (rIFG) is a key cortical node in the circuits of emotion and cognitive control, and it has been frequently associated with bipolar disorder (BP); however, a reliable pattern of aberrant rIFG activation and connectivity in bipolar disorder has yet to be established. To further elucidate rIFG abnormalities in different states of bipolar disorder, we examined activation and functional connectivity (FC) in five subregions of rIFG in bipolar disorder. A total of 83 participants, including those with bipolar depression (BPD; n = 25) and bipolar mania (BPM; n = 37) along with healthy control (HC) subjects (n = 26), were examined by resting state functional magnetic resonance imaging (rs-fMRI). Both BPD and BPM groups showed higher values of amplitude of low-frequency fluctuations (ALFF) than healthy control in four of the five rIFG subregions except cluster 2(posterior-ventral rIFG). Using five subregions of rIFG as seeds, the decreased FC in bipolar disorder was mainly between posterior-ventral rIFG(cluster 2) and multiple brain regions including the postcentral gyrus, the precentral gyrus, paracentral lobule, lingual Gyrus, fusiform and cerebellum posterior lobe. These results indicated that local activity and FC were altered within specific subregions of the rIFG in BP. These findings may provide the distinct functional connectivity of rIFG subregions in BP and suggest that the cluster2 (posterior-ventral rIFG) circuitry plays a crucial role in BP. Also, such abnormalities might help define a more precise intervention targets.
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Affiliation(s)
- Li Zhang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Wenfei Li
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Long Wang
- Anhui Mental Health Center, Hefei, Anhui Province, China
| | - Tongjian Bai
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China
| | - Gong-Jun Ji
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230022, China;; Department of Medical Psychology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Kai Wang
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei 230022, China;; Department of Medical Psychology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
| | - Yanghua Tian
- Department of Neurology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China;; Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei 230022, China; Department of Medical Psychology, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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16
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Xu A, Zimmerman CS, Lazar SW, Ma Y, Kerr CE, Yeung A. Distinct Insular Functional Connectivity Changes Related to Mood and Fatigue Improvements in Major Depressive Disorder Following Tai Chi Training: A Pilot Study. Front Integr Neurosci 2020; 14:25. [PMID: 32581734 PMCID: PMC7295154 DOI: 10.3389/fnint.2020.00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/15/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: Tai chi (TC), a contemplative practice combining slow movements and deep breathing, has been shown to be clinically effective in alleviating depressive symptoms. Feelings of fatigue or low vitality often accompany major depressive disorder (MDD) though they are commonly overlooked and not well understood neurologically. By using resting state functional connectivity (rs-FC) using the insula as the seed, this study examines the relationship between mood and vitality symptoms in MDD and how they are impacted by TC training. Methods: Patients (N = 16) with MDD participated in a 10-week TC intervention. Self-report scores of vitality (using the SF-36 scale) and depressed mood (using the Beck Depression Inventory) as well as rs-fMRI were collected pre- and post-intervention. A seed-to-voxel approach was used to test whether changes in insular rs-FC were related to therapeutic improvement in MDD-related symptoms resulting from TC practice. Results: We found decreased self-reported depressed mood and increased vitality following the TC intervention. Furthermore, decreases in depressed mood were associated with increased rs-FC between the right anterior insula (AIC) and superior temporal gyrus and caudate (cluster-corrected p < 0.05). Increased vitality was associated with increased rs-FC between the right posterior insula (PIC) and regions associated with sensorimotor processes (cluster-corrected p < 0.05). Conclusion: These results provide support for differential changes in insula connectivity as neural correlates of symptom improvement in MDD.
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Affiliation(s)
- Anna Xu
- Department of Cognitive, Linguistic, and Psychological Sciences, Brown University, Providence, RI, United States
| | - Chloe S Zimmerman
- Department of Neuroscience, Brown University, Providence, RI, United States.,Alpert Medical School, Brown University, Providence, RI, United States
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Yan Ma
- Harvard Medical School, Boston, MA, United States.,Center for Dynamical Biomarkers, Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Catherine E Kerr
- Alpert Medical School, Brown University, Providence, RI, United States
| | - Albert Yeung
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Benson Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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17
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Brain Functional Specialization Is Enhanced Among Tai Chi Chuan Practitioners. Arch Phys Med Rehabil 2020; 101:1176-1182. [PMID: 32109436 DOI: 10.1016/j.apmr.2020.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/31/2020] [Accepted: 02/07/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To investigate the effect of long-term Tai Chi Chuan (TCC) practice on practitioners' brain functional specialization compare with the TCC novices. DESIGN A cross-sectional study. SETTING A psychology Institute. PARTICIPANTS TCC practitioners (N=22) (52.4±6.8y; 7 men; educated years: 12.18±3.03y) and 18 healthy adults (54.8±6.8y; 8 men; education years: 11.78±2.90y) matched by age, sex, and education were enrolled. MAIN OUTCOME MEASURES Participants underwent functional magnetic resonance imaging scanning and cognitive test to measure the differences in functional specialization and cognitive function. Functional specialization was evaluated by voxel-mirrored homotopic connectivity (VMHC) method. RESULTS Lower middle frontal gyrus VMHC in TCC practitioners compared to controls. For TCC practitioners, the longer they practice, the lower their VMHC in precentral and precuneus. TCC practitioners showed better cognition performance. CONCLUSIONS Changed VMHC indicated that TCC practice could enhance functional specialization in the middle frontal cortex of practitioners, which may be associated with higher-order cognitive ability.
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18
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Cui L, Yin H, Lyu S, Shen Q, Wang Y, Li X, Li J, Li Y, Zhu L. Tai Chi Chuan vs General Aerobic Exercise in Brain Plasticity: A Multimodal MRI Study. Sci Rep 2019; 9:17264. [PMID: 31754170 PMCID: PMC6872722 DOI: 10.1038/s41598-019-53731-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022] Open
Abstract
This study contrasted the impact of Tai Chi Chuan and general aerobic exercise on brain plasticity in terms of an increased grey matter volume and functional connectivity during structural magnetic resonance imaging (sMRI) and resting-state functional magnetic resonance imaging (rs-fMRI), explored the advantages of Tai Chi Chuan in improving brain structure and function. Thirty-six college students were grouped into Tai Chi Chuan (Bafa Wubu of Tai Chi), general aerobic exercise (brisk walking) and control groups. Individuals were assessed with a sMRI and rs-fMRI scan before and after an 8-week training period. The VBM toolbox was used to conduct grey matter volume analyses. The CONN toolbox was used to conduct several seed-to-voxel functional connectivity analyses. We can conclude that compared with general aerobic exercise, eight weeks of Tai Chi Chuan exercise has a stronger effect on brain plasticity, which is embodied in the increase of grey matter volume in left middle occipital gyrus, left superior temporal gyrus and right middle temporal gyrus and the enhancement of functional connectivity between the left middle frontal gyrus and left superior parietal lobule. These findings demonstrate the potential and advantages of Tai Chi Chuan exercises in eliciting brain plasticity.
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Affiliation(s)
- Lei Cui
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China
| | - HengChan Yin
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China.
| | - ShaoJun Lyu
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China.
| | - QiQi Shen
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China
| | - Yuan Wang
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China
| | - XiuJuan Li
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China
| | - Jing Li
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China
| | - YunFei Li
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China
| | - LiNa Zhu
- College of P. E. and Sports, Beijing Normal University, Beijing, 100875, China
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19
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Li L, Zhang S, Cui J, Chen LZ, Wang X, Fan M, Wei GX. Fitness-Dependent Effect of Acute Aerobic Exercise on Executive Function. Front Physiol 2019; 10:902. [PMID: 31354533 PMCID: PMC6636661 DOI: 10.3389/fphys.2019.00902] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 12/15/2022] Open
Abstract
Cognitive gains are reported to be induced by acute aerobic exercise, but the role of fitness in the effect of acute aerobic exercise on executive function remains unknown. Therefore, we aimed to examine the effect of fitness on acute exercise-induced changes in executive function from neural mechanism approach. Twenty-four female college students were assigned to high-fitness or low-fitness groups based on their cardiovascular fitness level, and then underwent functional magnetic resonance imaging while performing N-back tasks before and after 30 min of acute exercise. The behavioral results revealed significant interaction effects of group by time in the 0-back and 1-back tasks, but not in the 2-back task. The accuracy was significantly higher in the high-fitness group than in the low-fitness group before exercise in the 1-back and 2-back tasks. At the neural level, significant interaction effects of group by time were observed in all tasks. The 0-back and 1-back tasks activated the right cerebellum while the 2-back task activated subcortical regions. Our findings suggest that fitness moderates the effect of aerobic exercise on cognitive function, and provide the first neural evidence to support the influence of fitness on exercise-induced cognitive performance.
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Affiliation(s)
- Lin Li
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,School of Physical Education and Health Care, East China Normal University, Shanghai, China
| | - Shu Zhang
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jie Cui
- Key Laboratory of Adolescent Health Assessment and Exercise Intervention of Ministry of Education, East China Normal University, Shanghai, China.,School of Physical Education and Health Care, East China Normal University, Shanghai, China
| | - Li-Zhen Chen
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiaoyan Wang
- School of Teacher Education and Psychology, Sichuan Normal University, Chengdu, China
| | - Mingxia Fan
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Gao-Xia Wei
- Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
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20
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Tao J, Liu J, Chen X, Xia R, Li M, Huang M, Li S, Park J, Wilson G, Lang C, Xie G, Zhang B, Zheng G, Chen L, Kong J. Mind-body exercise improves cognitive function and modulates the function and structure of the hippocampus and anterior cingulate cortex in patients with mild cognitive impairment. Neuroimage Clin 2019; 23:101834. [PMID: 31128522 PMCID: PMC6535682 DOI: 10.1016/j.nicl.2019.101834] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022]
Abstract
Mild cognitive impairment (MCI) is a common neurological disorder. This study aims to investigate the modulation effect of Baduanjin (a popular mind-body exercise) on MCI. 69 patients were randomized to Baduanjin, brisk walking, or an education control group for 24 weeks. The Montreal Cognitive Assessment (MoCA) and Magnetic Resonance Imaging scans were applied at baseline and at the end of the experiment. Compared to the brisk walking and control groups, the Baduanjin group experienced significantly increased MoCA scores. Amplitude of low-frequency fluctuations (ALFF) analysis showed significantly decreased ALFF values in the right hippocampus (classic low-freqency band, 0.01-0.08 Hz) in the Baduanjin group compared to the brisk walking group and increased ALFF values in the bilateral anterior cingulate cortex (ACC, slow-5 band, 0.01-0.027 Hz) in the Baduanjin group compared to the control group. Further, ALFF value changes in the right hippocampus and bilateral ACC were significantly associated with corresponding MoCA score changes across all groups. We also found increased gray matter volume in the Baduanjin group in the right hippocampus compared to the brisk walking group and in the bilateral ACC compared to the control group. In addition, there was an increased resting state functional connectivity between the hippocampus and right angular gyrus in the Baduanjin group compared to the control group. Our results demonstrate the potential of Baduanjin for the treatment of MCI.
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Affiliation(s)
- Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China; Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Jiao Liu
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China; National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Xiangli Chen
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin, Madison 53706, United States of America
| | - Rui Xia
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Moyi Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Maomao Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Shuzhen Li
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Joel Park
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Georgia Wilson
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Courtney Lang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Guanli Xie
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China
| | - Binlong Zhang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States of America
| | - Guohua Zheng
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China.
| | - Lidian Chen
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350122, China.
| | - Jian Kong
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, United States of America.
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21
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Kong J, Wilson G, Park J, Pereira K, Walpole C, Yeung A. Treating Depression With Tai Chi: State of the Art and Future Perspectives. Front Psychiatry 2019; 10:237. [PMID: 31031663 PMCID: PMC6474282 DOI: 10.3389/fpsyt.2019.00237] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/28/2019] [Indexed: 01/05/2023] Open
Abstract
Major depressive disorder (MDD) is one of the most prevalent mental illnesses in America. Current treatments for MDD are unsatisfactory given high non-response rates, high relapse rates, and undesirable side effects. Accumulating evidence suggests that Tai Chi, a popular mind-body intervention that originated as a martial art, can significantly regulate emotion and relieve the symptoms of mood disorders. In addition, the availability of instructional videos and the development of more simplified and less structured Tai Chi has made it a promising low-intensity mind-body exercise. In this article, we first examine a number of clinical trials that implemented Tai Chi as a treatment for depression. Then, we explore several mechanisms by which Tai Chi may alleviate depressive symptoms, hypothesizing that the intervention may modulate the activity and connectivity of key brain regions involved in mood regulation, reduce neuro-inflammatory sensitization, modulate the autonomic nervous system, and regulate hippocampal neurogenesis. Finally, we discuss common challenges of the intervention and possible ways to address them. Specifically, we pose developing a simplified and tailored Tai Chi protocol for patients with depression, comparatively investigating Tai Chi with other mind-body interventions such as yoga and Baduanjin, and developing new mind-body interventions that merge the advantages of multiple mind-body exercises.
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Affiliation(s)
- Jian Kong
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Georgia Wilson
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Joel Park
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Kaycie Pereira
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Courtney Walpole
- Psychiatry Department, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, United States
| | - Albert Yeung
- Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
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22
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Kong J, Wolcott E, Wang Z, Jorgenson K, Harvey WF, Tao J, Rones R, Wang C. Altered resting state functional connectivity of the cognitive control network in fibromyalgia and the modulation effect of mind-body intervention. Brain Imaging Behav 2019; 13:482-492. [PMID: 29721768 PMCID: PMC6214794 DOI: 10.1007/s11682-018-9875-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This study examines altered resting state functional connectivity (rsFC) of the cognitive control network (CCN) in fibromyalgia patients as compared to healthy controls, as well as how an effective mind-body intervention, Tai Chi, can modulate the altered rsFC of the CCN. Patients with fibromyalgia and matched healthy subjects were recruited in this study. Fibromyalgia patients were scanned 12 weeks before and after intervention. The bilateral dorsolateral prefrontal cortex (DLPFC) was used as a seed to explore the rsFC of the CCN. Data analysis was conducted with 21 patients and 20 healthy subjects. Compared to healthy subjects, fibromyalgia patients exhibited increased rsFC between the DLPFC and the bilateral rostral anterior cingulate cortex (rACC) and medial prefrontal cortex (MPFC) at baseline. The rsFC between the CCN and rACC/MPFC further increased after Tai Chi intervention, and this increase was accompanied by clinical improvements. This rsFC change was also significantly associated with corresponding changes in the Overall Impact domain of the Revised Fibromyalgia Impact Questionnaire (FIQR). Further analysis showed that the rACC/MPFC rsFC with both the PAG and hippocampus significantly decreased following Tai Chi intervention. Our study suggests that fibromyalgia is associated with altered CCN rsFC and that effective mind-body treatment may elicit clinical improvements by further increasing this altered rsFC. Elucidating this mechanism of enhancing the allostasis process will deepen our understanding of the mechanisms underlying mind-body interventions in fibromyalgia patients and facilitate the development of new pain management methods.
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Affiliation(s)
- Jian Kong
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.
| | - Emily Wolcott
- Center For Complementary And Integrative Medicine, Department of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Zengjian Wang
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Kristen Jorgenson
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - William F Harvey
- Center For Complementary And Integrative Medicine, Department of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 02111, USA
| | - Jing Tao
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Ramel Rones
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Chenchen Wang
- Center For Complementary And Integrative Medicine, Department of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, 02111, USA.
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23
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Wu MT, Tang PF, Goh JOS, Chou TL, Chang YK, Hsu YC, Chen YJ, Chen NC, Tseng WYI, Gau SSF, Chiu MJ, Lan C. Task-Switching Performance Improvements After Tai Chi Chuan Training Are Associated With Greater Prefrontal Activation in Older Adults. Front Aging Neurosci 2018; 10:280. [PMID: 30319391 PMCID: PMC6165861 DOI: 10.3389/fnagi.2018.00280] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 08/28/2018] [Indexed: 12/19/2022] Open
Abstract
Studies have shown that Tai Chi Chuan (TCC) training has benefits on task-switching ability. However, the neural correlates underlying the effects of TCC training on task-switching ability remain unclear. Using task-related functional magnetic resonance imaging (fMRI) with a numerical Stroop paradigm, we investigated changes of prefrontal brain activation and behavioral performance during task-switching before and after TCC training and examined the relationships between changes in brain activation and task-switching behavioral performance. Cognitively normal older adults were randomly assigned to either the TCC or control (CON) group. Over a 12-week period, the TCC group received three 60-min sessions of Yang-style TCC training weekly, whereas the CON group only received one telephone consultation biweekly and did not alter their life style. All participants underwent assessments of physical functions and neuropsychological functions of task-switching, and fMRI scans, before and after the intervention. Twenty-six (TCC, N = 16; CON, N = 10) participants completed the entire experimental procedure. We found significant group by time interaction effects on behavioral and brain activation measures. Specifically, the TCC group showed improved physical function, decreased errors on task-switching performance, and increased left superior frontal activation for Switch > Non-switch contrast from pre- to post-intervention, that were not seen in the CON group. Intriguingly, TCC participants with greater prefrontal activation increases in the switch condition from pre- to post-intervention presented greater reductions in task-switching errors. These findings suggest that TCC training could potentially provide benefits to some, although not all, older adults to enhance the function of their prefrontal activations during task-switching.
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Affiliation(s)
- Meng-Tien Wu
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Yonghe Cardinal Tien Hospital, Taipei, Taiwan
| | - Pei-Fang Tang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Center for Artificial Intelligence and Robotics, National Taiwan University, Taipei, Taiwan
| | - Joshua O. S. Goh
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Center for Artificial Intelligence and Robotics, National Taiwan University, Taipei, Taiwan
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Tai-Li Chou
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
| | - Yu-Kai Chang
- Department of Physical Education, National Taiwan Normal University, Taipei, Taiwan
| | - Yung-Chin Hsu
- Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Jen Chen
- Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Chi Chen
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wen-Yih Isaac Tseng
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Institute of Medical Device and Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Jang Chiu
- Graduate Institute of Brain and Mind Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Department of Psychology, College of Science, National Taiwan University, Taipei, Taiwan
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching Lan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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24
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Yu AP, Tam BT, Lai CW, Yu DS, Woo J, Chung KF, Hui SS, Liu JY, Wei GX, Siu PM. Revealing the Neural Mechanisms Underlying the Beneficial Effects of Tai Chi: A Neuroimaging Perspective. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2018. [PMID: 29542330 DOI: 10.1142/s0192415x18500131] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Tai Chi Chuan (TCC), a traditional Chinese martial art, is well-documented to result in beneficial consequences in physical and mental health. TCC is regarded as a mind-body exercise that is comprised of physical exercise and meditation. Favorable effects of TCC on body balance, gait, bone mineral density, metabolic parameters, anxiety, depression, cognitive function, and sleep have been previously reported. However, the underlying mechanisms explaining the effects of TCC remain largely unclear. Recently, advances in neuroimaging technology have offered new investigative opportunities to reveal the effects of TCC on anatomical morphologies and neurological activities in different regions of the brain. These neuroimaging findings have provided new clues for revealing the mechanisms behind the observed effects of TCC. In this review paper, we discussed the possible effects of TCC-induced modulation of brain morphology, functional homogeneity and connectivity, regional activity and macro-scale network activity on health. Moreover, we identified possible links between the alterations in brain and beneficial effects of TCC, such as improved motor functions, pain perception, metabolic profile, cognitive functions, mental health and sleep quality. This paper aimed to stimulate further mechanistic neuroimaging studies in TCC and its effects on brain morphology, functional homogeneity and connectivity, regional activity and macro-scale network activity, which ultimately lead to a better understanding of the mechanisms responsible for the beneficial effects of TCC on human health.
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Affiliation(s)
- Angus P Yu
- * School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Bjorn T Tam
- ‡ Department of Cell Biology and Physiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Christopher W Lai
- § Department of Health Technology and Informatics, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Doris S Yu
- ∥ The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Jean Woo
- ** Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ka-Fai Chung
- † Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Stanley S Hui
- †† Department of Sports Science and Physical Education, Faculty of Education, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Justina Y Liu
- ¶ School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Gao X Wei
- ‡‡ Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Parco M Siu
- * School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
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