The BDNF-Interactive Model for Sustainable Hippocampal Neurogenesis in Humans: Synergistic Effects of Environmentally-Mediated Physical Activity, Cognitive Stimulation, and Mindfulness

From Synaptic Plasticity to Neurodegeneration: BDNF as a Transformative Target in Medicine

The brain-derived neurotrophic factor (BDNF) has become one of the cornerstones of neuropathology, influencing synaptic plasticity, cognitive resilience, and neuronal survival. Apart from its molecular biology, BDNF is a powerful target for transformative benefit in precision medicine, leading to innovative therapeutic approaches for neurodegenerative and psychiatric diseases like Alzheimer's disease (AD), Parkinson's disease (PD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Nevertheless, clinical applicability is obstructed by hurdles in delivery, patient-specific diversity, and pleiotropic signaling. Here, we summarize findings in BDNF research, including its regulatory pathways and diagnostic/prognostic biomarkers and integrative therapeutic approaches. We describe innovative delivery systems, such as lipid nanoparticle-based mRNA therapies and CRISPR-dCas9-based epigenetic editing that bypass obstacles such as BBB (blood-brain barrier) and enzymatic degradation. The recent implementation of multiplex panels combining BDNF biodynamic indicators with tau and amyloid-β signaling markers showcases novel levels of specificity for both early detection and potential therapeutic monitoring. Humanized preclinical models like iPSC-derived neurons and organoids point to the key role of BDNF in neurodeveloping and neurodegenerative processes, paralleling advances in bridging preclinical observation and clinical environments. Moreover, novel therapeutic tools delivering TrkB activators or the implementation of AI-based dynamic care platforms enable tailored and scalable treatments. This review also aims to extend a framework used in the understanding of BDNF's relevance to traditional neurodegenerative models by situating more recent work detailing BDNF's actions in ischemic tissues and the gut-brain axis in the context of systemic health. Finally, we outline a roadmap for the incorporation of BDNF-centered therapies into worldwide healthcare, highlighting ethical issues, equity, and interdisciplinary decomposition. The therapeutic potential of BDNF heralds a new era in neuroscience and medicine, revolutionizing brain health and paving the way for the advancement of precision medicine.

Effects of Mindfulness and Exercise on Growth Factors, Inflammation, and Stress Markers in Chronic Stroke: The MindFit Project Randomized Clinical Trial

Background/Objectives: Stroke often leads to persistent cognitive and emotional impairments, which rehabilitation may mitigate. However, the biological mechanisms underlying such improvements remain unclear. This study investigated whether supplementing computerized cognitive training (CCT) with mindfulness-based stress reduction (MBSR) or physical exercise (PE) modulated biomarkers of neuroplasticity, inflammation, and stress in patients with chronic stroke compared to CCT alone. We also explored whether biomarker changes mediated or correlated with behavioral improvements. Methods: In a three-arm, single-blind, randomized controlled trial (NCT04759950), 141 patients with chronic stroke were randomized (1:1:1) to MBSR+CCT, PE+CCT, or CCT-only for 12 weeks. Plasma levels of brain-derived neurotrophic factor (BDNF), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF), C-reactive protein (CRP), interleukin-6 (IL-6), and cortisol were measured at baseline and post-intervention. Cognitive, mental health, mindfulness, and fitness outcomes were also assessed. Between- and within-group changes were analyzed using ANCOVA and paired t-tests. Per-protocol and complete-case analyses were conducted. Results: Among the 109 participants with ≥80% adherence, the only significant between-group difference was for VEGF: it remained stable in the MBSR+CCT group but declined in PE+CCT and CCT-only. Within-group analyses showed significant decreases in cortisol in MBSR+CCT and PE+CCT, while IGF-1 levels declined across all groups. In contrast, BDNF, IL-6, and CRP did not show significant changes, and biomarker changes were not significantly associated with behavioral improvements. Complete-case analysis (n = 126) yielded similar findings. Conclusions: Our findings suggest that combining MBSR or PE with CCT may modulate certain biological processes relevant to stroke recovery. MBSR may help maintain VEGF levels, which could support vascular health, while MBSR and PE may contribute to lowering cortisol levels. However, since no clear association with behavioral improvements was found, further research is needed to determine the clinical relevance of these biomarker changes in stroke recovery.

The Impact of Walking on BDNF as a Biomarker of Neuroplasticity: A Systematic Review

BACKGROUND/OBJECTIVES

The brain-derived neurotrophic factor (BDNF) is a critical exercise-induced modulator of various neuroplasticity processes, including adult hippocampal neurogenesis. Environmental affordance for physical activity is a novel theory that aims to increase the BDNF through walking or climbing stairs, stimulated by the urban and interior environment. In a systematic review, this paper explores the association between walking, as a structured or free-living form of physical activity, and changes in the BDNF in humans with healthy locomotion.

METHOD

A systematic review with a registered protocol, INPLASY2024110093, and following the PRISMA guidelines, includes English-language original research articles on adult and older adult human subjects who are locomotor-healthy, studies on walking as a structured exercise or free-living physical activity that is presented in a non-combined intervention, and must report changes in the BDNF as a dependent variable. The search was conducted using three databases: PubMed, Web of Science, and Scopus, resulting in 21 eligible studies.

RESULTS

This systematic review finds that the impact of walking on the BDNF is evidenced, but subject to moderate to high intensities in single bouts. At the same time, the long-term effects are yet to be fully understood, potentially due to the uptake of the BDNF for functional brain improvements, neuroplasticity processes, or muscle repair, instead of an accumulation of the BDNF itself, yet still confirm the important role of the BDNF for neurosustainability. Age and environmental factors such as heat are also found to affect the increase in the BDNF. The narrative synthesis provides elaborate explanations for understanding those complex dynamics before reaching future conclusions on the impact of walking or environmental affordance for physical activity on the changes in the BDNF concentrations.

CONCLUSIONS

This systematic review highlights the potential role played by moderate- and high-intensity walking as a lifestyle intervention that can be utilised through the built environment to promote adaptive brain changes, through the sustainable regulation of the BDNF.

Architecturally Mediated Allostasis and Neurosustainability: A Proposed Theoretical Framework for the Impact of the Built Environment on Neurocognitive Health

The global rise in mental health-related disorders represents a significant health and wellbeing challenge, imposing a substantial social and economic burden on individuals, communities, and healthcare systems. According to the World Health Organization, one in four people globally will be affected by mental or neurological disorders at some point in their lives, highlighting a significant global health concern that warrants carefully considered and innovative responses. While mental health challenges arise from complex, multifaceted factors, emerging research indicates that the built environment-the architecture of our homes, workplaces, and public spaces-may exert a critical but underappreciated influence on mental health outcomes. This paper outlines a novel theoretical framework for how visual stressors in the built environment might trigger neurophysiological stress responses via the HPA and SAM axes, potentially contributing over time to allostatic load. In this paper, it is proposed that chronic physiological strain can alter neuroplastic processes and neurogenesis in key brain regions-such as the hippocampus, prefrontal cortex (PFC), anterior cingulate cortex (ACC), and amygdala-thereby affecting cognitive health, emotional regulation, and overall mental wellbeing. Drawing on the principle of neurosustainability, this paper suggests that long-term exposure to stress-inducing environments may create feedback loops, particularly involving the amygdala, that have downstream effects on other brain areas and may be linked to adverse mental health outcomes such as depression. By presenting this framework, this paper aims to inspire further inquiry and applied experimental research into the intersection of neurophysiology, mental health, and the built environment, with a particular emphasis on rigorous testing and validation of the proposed mechanisms, that may then be translated into practical architectural design strategies for supporting health and wellbeing. In doing so, it is hoped that this work may contribute to a more holistic approach to improving mental health that integrates the creation of nurturing, resilient spaces into the broader public health agenda.

Home Environment as a Therapeutic Target for Prevention and Treatment of Chronic Diseases: Delivering Restorative Living Spaces, Patient Education and Self-Care by Bridging Biophilic Design, E-Commerce and Digital Health Technologies

A high prevalence of chronic diseases exposes diverse healthcare pain points due to the limited effectiveness of pharmaceutical drugs and biologics, sedentary lifestyles, insufficient health literacy, chronic stress, unsatisfactory patient experience, environmental pollution and competition with commercial determinants of health. To improve patient care and long-term outcomes, the impact of the home environment is overlooked and underutilized by healthcare. This cross-disciplinary work describes perspectives on (1) the home environment as a therapeutic target for the prevention and treatment of chronic diseases and (2) transforming health-centric household goods e-commerce platforms into digital health interventions. We provide a rationale for creating therapeutic home environments grounded in biophilic design (multisensory, environmental enrichment) and supporting physical activities, quality sleep, nutrition, music, stress reduction, self-efficacy, social support and health education, hence providing clinical benefits through the modulation of the autonomic nervous system, neuroplasticity and behavior change. These pleiotropic "active non-pharmacological ingredients" can be personalized for people living with depression, anxiety, migraine, chronic pain, cancer, cardiovascular and other conditions. We discuss prospects for integrating e-commerce with digital health platforms to create "therapeutic home environment" interventions delivered through digital therapeutics and their combinations with prescription drugs. This multimodal approach can enhance patient engagement while bridging consumer spending with healthcare outcomes.

Walking and Hippocampal Formation Volume Changes: A Systematic Review

BACKGROUND/OBJECTIVES

Sustaining the human brain's hippocampus from atrophy throughout ageing is critical. Exercise is proven to be effective in promoting adaptive hippocampal plasticity, and the hippocampus has a bidirectional relationship with the physical environment. Therefore, this systematic review explores the effects of walking, a simple physical activity in the environment, on hippocampal formation volume changes for lifelong brain and cognitive health.

METHOD

PubMed, Scopus, and Web of Science were searched for studies on humans published up to November 2022 examining hippocampal volume changes and walking. Twelve studies met the inclusion criteria. Study quality was assessed using the PEDro scale and ROBINS-I tool. A narrative synthesis explored walking factors associated with total, subregional, and hemisphere-specific hippocampal volume changes.

RESULTS

Overall, walking had positive effects on hippocampal volumes. Several studies found benefits of higher-intensity and greater amounts of walking for total hippocampal volume. The subiculum increased after low-intensity walking and nature exposure, while the parahippocampal gyrus benefited from vigorous intensity. The right hippocampus increased with spatial navigation during walking. No studies examined the effect of walking on the dentate gyrus.

CONCLUSIONS

This systematic review highlights walking as a multifaceted variable that can lead to manifold adaptive hippocampal volume changes. These findings support the promotion of walking as a simple, effective strategy to enhance brain health and prevent cognitive decline, suggesting the design of physical environments with natural and biophilic characteristics and layouts with greater walkability and cognitive stimulation. Future research is encouraged to explore the hippocampal subregional changes instead of focusing on total hippocampal volume, since the hippocampal formation is multicompartmental and subfields respond differently to different walking-related variables.