Aerobic exercise improves quality of life, psychological well-being and systemic inflammation in subjects with Alzheimer's disease

Effects of physical fitness on mental health of Chinese college students: across-sectional study

BACKGROUND

The physical and mental health of college students is often mentioned, but there is limited research on a direct relationship between the mental health status of college students and their physical fitness level. This study mainly proves the relationship between Chinese college students' mental health and physical fitness indicators.

METHOD

This study collected SCL-90 Scale test results from 5262 students (4012 boys and 1250 girls) through a questionnaire survey and conducted a Sport Quality Test on these students. Statistical software SPSS was applied for differential analysis and logistic regression analysis. Specifically, the differences in sport quality indicators between normal and abnormal mean total scores of psychological tests were analyzed first. Then, the binary logistic regression model was used to explore the impacts of sports quality indicator scores on students' psychological fitness.

RESULTS

There are differences in the results of physical fitness tests between students with abnormal psychology and students with normal psychology. The four indexes of students' vital capacity, speed, explosive power of lower limbs, and endurance running are effective in improving students' psychologically abnormal state, and endurance running and improving vital capacity are the most effective methods to improve students' psychologically abnormal state. In the physical tests of Chinese college students, the risk of psychological abnormalities was reduced by 9% for every one-point increase in lung capacity and 10.4% for every one-point increase in endurance running performance.

CONCLUSIONS

Chinese college students' physical fitness and mental health are related. The best methods for treating psychological disorders are lung capacity improvement and endurance running. According to the physical test results of Chinese college students, for every 1-point increase in lung capacity and endurance running, the risk of psychological abnormalities decreased by 9% and 10.4%, respectively.

Exercise mimetics: a novel strategy to combat neuroinflammation and Alzheimer's disease

Neuroinflammation is a pathological hallmark of Alzheimer's disease (AD), characterized by the stimulation of resident immune cells of the brain and the penetration of peripheral immune cells. These inflammatory processes facilitate the deposition of amyloid-beta (Aβ) plaques and the abnormal hyperphosphorylation of tau protein. Managing neuroinflammation to restore immune homeostasis and decrease neuronal damage is a therapeutic approach for AD. One way to achieve this is through exercise, which can improve brain function and protect against neuroinflammation, oxidative stress, and synaptic dysfunction in AD models. The neuroprotective impact of exercise is regulated by various molecular factors that can be activated in the same way as exercise by the administration of their mimetics. Recent evidence has proven some exercise mimetics effective in alleviating neuroinflammation and AD, and, additionally, they are a helpful alternative option for patients who are unable to perform regular physical exercise to manage neurodegenerative disorders. This review focuses on the current state of knowledge on exercise mimetics, including their efficacy, regulatory mechanisms, progress, challenges, limitations, and future guidance for their application in AD therapy.

Prevalence and associations between occupational diseases, emotional exhaustion, and dust mask anxiety among coal miners in Northern China

This study examined the prevalence and associations between occupational-related diseases, emotional exhaustion, and dust mask anxiety among coal miners in Northern China. The study sampled 506 miners from two coal mines in Northern China. Descriptive (frequency, percentages, and chi-square tests) and inferential (complementary log-log logistic regression) analyses were carried out to assess prevalence and associations. The prevalence of coal mining-related pulmonary diseases was 94%, with 40% and 37% reporting pneumoconiosis and bronchitis respectively. Emphysema and tuberculosis were less prevalent with a total prevalence of 5% while 12% of the miners reported two, three, or four of these diseases. For cardiovascular diseases, 66% of the miners reported 3H (hypertension, hyperlipemia, and hyperglycemia) while heart disease and cerebral infarction were reported by 6% and 2% of the miners respectively. Also, 5% and 2% of the miners reported two or all three of 3H, heart condition, and cerebral infarction. The overall prevalence of cardiovascular diseases was 81% while 82% and 63% of the miners reported experiencing some frequency of emotional exhaustion and dust mask anxiety respectively. The study also identified associations between mining-related diseases, emotional exhaustion, dust mask anxiety, and other demographic, personal habits and work-related factors. Miners with pulmonary diseases were more likely to experience emotional exhaustion and dust mask anxiety. Contrariwise, miners with cardiovascular diseases were less likely to experience dust mask anxiety. Factors such as age, engaging in physical exercises, rhinitis, source of pressure and shift system were also associated with emotional exhaustion and dust mask anxiety. These findings highlight the prevalence of occupational diseases, emotional exhaustion, and dust mask anxiety among coal miners in China. The study emphasizes the need for interventions to address health risks, improve work conditions, and support miners' well-being in the coal mining industry.

Exercise therapy to prevent and treat Alzheimer's disease

Alzheimer's disease (AD) is a progressive neurodegenerative disease in the elderly with dementia, memory loss, and severe cognitive impairment that imposes high medical costs on individuals. The causes of AD include increased deposition of amyloid beta (Aβ) and phosphorylated tau, age, mitochondrial defects, increased neuroinflammation, decreased synaptic connections, and decreased nerve growth factors (NGF). While in animals moderate-intensity exercise restores hippocampal and amygdala memory through increased levels of p-AKT, p-TrkB, and p-PKC and decreased levels of Aβ, tau phosphorylation, and amyloid precursor proteins (APP) in AD. Aerobic exercise (with an intensity of 50-75% of VO2 max) prevents hippocampal volume reduction, spatial memory reduction, and learning reduction through increasing synaptic flexibility. Exercise training induces the binding of brain-derived neurotrophic factor (BDNF) to TrkB and the binding of NGF to TrkA to induce cell survival and neuronal plasticity. After aerobic training and high-intensity interval training, the increase of VEGF, angiopoietin 1 and 2, NO, tPA, and HCAR1 in cerebral vessels causes increased blood flow and angiogenesis in the cerebellum, motor cortex, striatum, and hippocampus. In the hippocampus, exercise training decreases mitochondrial fragmentation, DRP1, and FIS1, improving OPA1, MFN1, MFN2, and mitochondrial morphology. In humans, acute exercise as an anti-inflammatory condition causes an acute increase in IL-6 and an increase in anti-inflammatory factors such as IL-1RA and IL-10. Moderate-intensity exercise also inhibits inflammatory markers such as IFN-γ, IL-1β, IL-6, CRP, TNF-α, sTNFR1, COX-2, and NF-κB. Aerobic exercise significantly increases plasma levels of BDNF, nerve growth factor, synaptic plasticity, motor activity, spatial memory, and exploratory behavior in AD subjects. Irisin is a myokine released from skeletal muscle during exercise and protects the hippocampus by suppressing Aβ accumulation and promoting hippocampal proliferation through STAT3 signaling. Therefore, combined exercise training such as aerobic training, strength training, balance and coordination training, and cognitive and social activities seems to provide important benefits for people with AD.

The effects of strEngth aNd BaLance exercise on Executive function in people living with Dementia (ENABLED): Study protocol for a pilot randomized controlled trial

BACKGROUND

Exercise may improve executive function among people living with all-cause dementia (PWD), but more evidence is needed. The aim of this pilot randomized controlled trial (RCT) is to examine whether exercise plus usual care improves the primary outcome of executive function, and secondary physiological (inflammation, metabolic aging, epigenetics) and behavioral (cognition, psychological health, physical function, and falls) outcomes compared to usual care alone among PWD.

METHODS AND STUDY DESIGN

The strEngth aNd BaLance exercise on Executive function in people living with Dementia (ENABLED) protocol is a pilot parallel, 6-month assessor-blinded RCT (1:1) in residential care facilities, including n = 21 receiving exercise plus usual care and n = 21 usual care alone [NCT05488951]. We will collect primary (Color-Word Stroop Test) and secondary physiological (inflammation, metabolic aging, epigenetics) and behavioral (cognition, psychological health, physical function, and falls) outcomes at baseline and 6 months. We will obtain falls monthly from medical charts. We will collect physical activity, sedentary behavior, and sleep via wrist-worn accelerometers over 7 days at baseline and 6 months. The physical therapist-led adapted Otago Exercise Program will involve 1-h of strength, balance and walking 3×/week for 6 months in groups of 5-7. We will use generalized linear mixed models to examine differences over time in primary and secondary outcomes between groups and examine potential interactions with sex and race.

DISCUSSION

This pilot RCT will examine the direct effects and potential underlying physiological mechanisms of exercise on executive function and other behavioral outcomes in PWD, which may have implications for clinical care management.

Exercise suppresses neuroinflammation for alleviating Alzheimer's disease

Alzheimer's disease (AD) is a chronic neurodegenerative disease, with the characteristics of neurofibrillary tangle (NFT) and senile plaque (SP) formation. Although great progresses have been made in clinical trials based on relevant hypotheses, these studies are also accompanied by the emergence of toxic and side effects, and it is an urgent task to explore the underlying mechanisms for the benefits to prevent and treat AD. Herein, based on animal experiments and a few clinical trials, neuroinflammation in AD is characterized by long-term activation of pro-inflammatory microglia and the NOD-, LRR- and pyrin domain-containing protein 3 (NLRP3) inflammasomes. Damaged signals from the periphery and within the brain continuously activate microglia, thus resulting in a constant source of inflammatory responses. The long-term chronic inflammatory response also exacerbates endoplasmic reticulum oxidative stress in microglia, which triggers microglia-dependent immune responses, ultimately leading to the occurrence and deterioration of AD. In this review, we systematically summarized and sorted out that exercise ameliorates AD by directly and indirectly regulating immune response of the central nervous system and promoting hippocampal neurogenesis to provide a new direction for exploring the neuroinflammation activity in AD.

A systematic review of exercise modalities that reduce pro-inflammatory cytokines in humans and animals' models with mild cognitive impairment or dementia

PURPOSE

To investigate which type, frequency, duration, intensity, and volume of chronic exercise might more strongly reduce pro-inflammatory cytokines and enhance anti-inflammatory cytokines in human and animal models with Mild Cognitive Impairment (MCI) or dementia.

DESIGN

A systematic review.

DATA SOURCE

English-language search of 13 electronic databases: Web of Science, PubMed/Medline, Sport Discus, Scopus, Cochrane, Psych Net, Springer, ScienceDirect, Pascal & Francis, Sage journals, Pedro, Google Scholar, and Sage.

INCLUSION CRITERIA

(i) human and animal studies that included exercise, physical activity, or fitness training as an experimental intervention, (ii) studies that addressed MCI, dementia, or AD, (iii) studies that focused on measuring cytokines and/or other inflammatory and/or neuroinflammatory immune markers, (iii) studies that examined inflammatory indicators in blood, CSF (Cerebrospinal Fluid), and brain tissue.

RESULTS

Of the 1290 human and animal studies found, 38 were included for qualitative analysis, 11 human articles, 27 animal articles, and two articles addressing both human and animal protocols. In the animal model, physical exercise decreased pro-inflammatory markers in 70.8 % of the articles and anti-inflammatory cytokines: IL -4, IL -10, IL-4β, IL -10β, and TGF-β in 26 % of articles. Treadmill running, resistance exercise, and swimming exercise reduce pro-inflammatory cytokines and increase anti-inflammatory cytokines. In the human model, 53.9 % of items reduced pro-inflammatory proteins and 23 % increased anti-inflammatory proteins. Cycling exercise, multimodal, and resistance training effectively decreased pro-inflammatory cytokines.

CONCLUSION

In rodent animal models with AD phenotype, treadmill, swimming, and resistance training remain good interventions that can delay various mechanisms of dementia progression. In the human model, aerobic, multimodal, and resistance training are beneficial in both MCI and AD. Multimodal training of moderate to high intensity multimodal exercise is effective for MCI. Voluntary cycling training, moderate- or high-intensity aerobic exercise is effective in mild AD patients.

Physical Exercise as a Nonpharmacological Intervention for the Treatment of Neuropsychiatric Symptoms in Persons With Dementia: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Neuropsychiatric symptoms (NPS) are prevalent in dementia and affect both patients and caregivers in multiple ways. Because of the complications of drug treatments, nonpharmacological interventions, such as exercise, are of particular value. This study aimed to investigate the effect of exercise on the NPS of dementia and draw recommendations for the disease management.

METHODS

Meta-analyses were conducted on the findings of randomized controlled trials identified during an initial systematic review of the literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies examined the effect of exercise interventions on patients with dementia or mild cognitive impairment using valid assessment tools. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation analysis.

RESULTS

The meta-analyses revealed that exercise significantly limits NPS [mean difference: -5.28, (95% CI, -9.46, -1.11), P = 0.01] and symptoms of depression [standardized mean difference: -0.16, (95% CI, -0.29, -0.02), P = 0.02], and has a beneficial effect on agitation symptoms. The Grading of Recommendations, Assessment, Development, and Evaluation analysis results showed that exercise has a moderate and high confidence positive effect on NPS and depression, respectively.

CONCLUSIONS

Exercise could be an alternative approach for nonpharmacological treatment of NPS in dementia. Therefore, exercise could be utilized as a treatment of choice or to support existing treatment regimens.

Neurodegenerative Diseases: Implications of Environmental and Climatic Influences on Neurotransmitters and Neuronal Hormones Activities

Neurodegenerative and neuronal-related diseases are major public health concerns. Human vulnerability to neurodegenerative diseases (NDDs) increases with age. Neuronal hormones and neurotransmitters are major determinant factors regulating brain structure and functions. The implications of environmental and climatic changes emerged recently as influence factors on numerous diseases. However, the complex interaction of neurotransmitters and neuronal hormones and their depletion under environmental and climatic influences on NDDs are not well established in the literature. In this review, we aim to explore the connection between the environmental and climatic factors to NDDs and to highlight the available and potential therapeutic interventions that could use to improve the quality of life and reduce susceptibility to NDDs.

Modulation of Inflammatory Mediators and Microglial Activation Through Physical Exercise in Alzheimer's and Parkinson's Diseases

Neuroinflammation is an inflammatory process in the central nervous system (CNS), in addition to being one of the main features of Alzheimer's disease (AD) and Parkinson's disease (PD). Microglia are known for their immune functions and have multiple reactive phenotypes related to the types of stages involving neurodegenerative diseases. Depending on the state of activation of microglia in the CNS, it can be neuroprotective or neurotoxic. In this context, AD is a neurodegenerative and neuroinflammatory disease characterized by the deposition of beta-amyloid plaques, formation of fibrillar tangles of tau protein, and loss of neurons due to neurotoxic activation of microglia. However, PD is characterized by the loss of dopaminergic neurons in the substantia nigra and accumulation of alpha-synuclein in the cortical regions, spinal cord, and brain stem, which occurs by microglial activation, contributing to the neuroinflammatory process. In this aspect, the activation of microglia in both pathologies triggers high levels of inflammatory markers, such as interleukins, and causes the neuroinflammatory process of the diseases. Thus, physical exercise is pointed out as neuroprotective, as it can act to strengthen neurogenesis and reduce the inflammatory process. Therefore, the present review addresses the neuroprotective effect of microglia after different types of physical exercise protocols and evaluates the activity and effects of inflammatory and anti-inflammatory parameters and mechanisms of AD and PD. This review will discuss the anti-inflammatory effects of physical exercise through microglia activation with neuroprotective activity and the role of pro-and anti-inflammatory cytokines in AD and PD.

Long Term Physical Activity Improves Quality of Life Perception, Healthy Nutrition, and Daily Life Management in Elderly: A Randomized Controlled Trial

Physical activity (PA) is a key element in the management of successful aging. The aim of this paper was to show the effects of PA on the quality of life perception, nutritional status, and daily life management of 178 older adults (aged 63.87 ± 8.17) randomly assigned to an Experimental Group (EG), which performed moderate-to-high intensity aerobic and strengthening training, and a Control Group (CG) which performed low-impact PA, assessed after 6, 12, and 24 months. The Short-Form Health Survey (SF-36), Mini Nutritional Assessment (MNA), and Physical Activity Scale for the Elderly (PASE) were used for the study. In the SF-36 assessment, EG showed a good quality of life perception maintained after 24 months, while CG showed a worsening in the same period (p = 0.018). The EG reported a significant better nutritional status as compared to pre-intervention assessment (p = 0.003) and to CG (p < 0.001). Regarding the PASE, the EG showed a higher level of weekly activities than the CG after 24 months (p = 0.011), while the CG showed a worsening after 12 months (p = 0.008). The prolonged engagement in moderate-to high-intensity PA allowed the maintenance of a good quality of life perception, a good level of nutritional status, and daily life activities.

Prehabilitative resistance exercise reduces neuroinflammation and improves mitochondrial health in aged mice with perioperative neurocognitive disorders

Background

Postoperative neurocognitive dysfunction remains a significant problem in vulnerable groups such as the elderly. While experimental data regarding its possible pathogenic mechanisms accumulate, therapeutic options for this disorder are limited. In this study, we evaluated the neuroprotective effect of a period of preconditioning resistant training on aged mice undergoing abdominal surgery. Further, we examined the underlying mechanisms from the perspective of neuroinflammatory state and synaptic plasticity in the hippocampus.

Methods

18-month-old C57BL/6N mice were trained for 5 weeks using a ladder-climbing protocol with progressively increasing weight loading. Preoperative baseline body parameters, cognitive performance and neuroinflammatory states were assessed and compared between sedentary and trained groups of 9-month-old and 18-month-old mice. To access the neuroprotective effect of resistance training on postoperative aged mice, both sedentary and trained mice were subjected to a laparotomy under 3% sevoflurane anesthesia. Cognitive performance on postoperative day 14, hippocampal neuroinflammation, mitochondrial dysfunction and synaptic plasticity were examined and compared during groups.

Results

18-month-old mice have increased body weight, higher peripheral and central inflammatory status, reduction in muscle strength and cognitive performance compared with middle-aged 9-month-old mice, which were improved by resistance exercise. In the laparotomy group, prehabilitative resistant exercise improved cognitive performance and synaptic plasticity, reduced inflammatory factors and glial cells activation after surgery. Furthermore, resistance exercise activated hippocampal PGC-1α/BDNF/Akt/GSK-3β signaling and improved mitochondrial biogenesis, as well as ameliorated mitochondrial dynamics in postoperative-aged mice.

Conclusions

Resistance exercise reduced risk factors for perioperative neurocognitive disorders such as increased body weight, elevated inflammatory markers, and pre-existing cognitive impairment. Accordantly, preoperative resistance exercise improved surgery-induced adverse effects including cognitive impairment, synaptic deficit and neuroinflammation, possibly by facilitate mitochondrial health through the PGC1-a/BDNF pathway.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12974-022-02483-1.

Physical Exercise, a Potential Non-Pharmacological Intervention for Attenuating Neuroinflammation and Cognitive Decline in Alzheimer's Disease Patients

This narrative review summarises the evidence for considering physical exercise (PE) as a non-pharmacological intervention for delaying cognitive decline in patients with Alzheimer’s disease (AD) not only by improving cardiovascular fitness but also by attenuating neuroinflammation. Ageing is the most important risk factor for AD. A hallmark of the ageing process is a systemic low-grade chronic inflammation that also contributes to neuroinflammation. Neuroinflammation is associated with AD, Parkinson’s disease, late-onset epilepsy, amyotrophic lateral sclerosis and anxiety disorders. Pharmacological treatment of AD is currently limited to mitigating the symptoms and attenuating progression of the disease. AD animal model studies and human studies on patients with a clinical diagnosis of different stages of AD have concluded that PE attenuates cognitive decline not only by improving cardiovascular fitness but possibly also by attenuating neuroinflammation. Therefore, low-grade chronic inflammation and neuroinflammation should be considered potential modifiable risk factors for AD that can be attenuated by PE. This opens the possibility for personalised attenuation of neuroinflammation that could also have important health benefits for patients with other inflammation associated brain disorders (i.e., Parkinson’s disease, late-onset epilepsy, amyotrophic lateral sclerosis and anxiety disorders). In summary, life-long, regular, structured PE should be considered as a supplemental intervention for attenuating the progression of AD in human. Further studies in human are necessary to develop optimal, personalised protocols, adapted to the progression of AD and the individual’s mental and physical limitations, to take full advantage of the beneficial effects of PE that include improved cardiovascular fitness, attenuated systemic inflammation and neuroinflammation, stimulated brain Aβ peptides brain catabolism and brain clearance.

The effectiveness of physical exercise interventions in the management of neuropsychiatric symptoms in dementia patients: a systematic review

BACKGROUND

The management of neuropsychiatric symptoms (NPS) in patients with dementia is a major challenge. Since no effective therapy has been found to date and drug treatments are associatedwith significant side effects, there seems to be a pressing need for alternative non-pharmacological interventions.

OBJECTIVES

The current study aims to investigate and compare the effect of different types of physical exercise on the NPS.

METHODS

A systematic review of the literature was conducted according to the PRISMA guidelines. Five databases (SCOPUS, PubMed, SPORT Discus, Web of science and ScienceDirect) were searched using the appropriate algorithm. What was sought out was randomized control trials (RCTs) that applied physical activity interventions with specific characteristics (type, frequency, intensity, and duration) in patients with dementia or mild cognitive impairment, studied the effect of exercise on their NPS and compared this effect with a control group that did not follow an exercise program.

RESULTS

From 512 articles, 13 studies were included in this review, involving a total of 1,925 patients. The results were analyzed and synthesized according to the type of exercise applied - aerobic exercise, multidimensional interventions and muscular strength training programs. In particular, the results showed that repetitive aerobic exercise three to five times a week had a positive effect on NPS, whereas multidimensional interventions combining different types of exercise did not appear to be as effective. Strength training programs have been found to significantly reduce depression symptoms and behavioral problems in demented patients with mobility problems.

CONCLUSIONS

There is clear evidence that physical activity and especially aerobic exercise may be effective in the management of NPS. However, it is necessary to apply specific practical recommendations and specially designed programs to incorporate physical exercise into the daily routine of these patients.

Physical Activity Improves Cognition and Activities of Daily Living in Adults with Alzheimer’s Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objective: The purpose of this meta-analysis was to examine the effects of physical activity (PA) on cognition and activities of daily living in adults with Alzheimer’s Disease (AD). Methods: Six electronic databases (MEDLINE, CINAHL, PsycArticles, SPORTDiscus, EMBASE and CNKI) were used to search for potential studies from inception until October 2021. Randomized controlled trials (RCTs) investigating the effect of physical activity (PA) on cognition and activities of daily living in AD patients compared to a control condition were included. The effect sizes were synthesized using a random effects model with a 95% confidence interval (CI). Results: Sixteen articles including 945 participants (aged 70 to 88 years, 34.6% male) met the inclusion criteria. The pooled effect sizes demonstrated that PA intervention was associated with significant improvements in global cognition (Standard Mean Difference (SMD) = 0.41, 95% CI [0.24, 0.58], p < 0.01) and activities of daily living (SMD = 0.56, 95% CI [0.32, 0.79], p < 0.01) in AD patients. Subgroup analyses suggested that PA for 3–4 times per week for 30–45 min for more than 12 weeks had a relatively strong effect on improving global cognition in AD patients. The sensitivity analysis showed robust results. Conclusions: The findings from the current meta-analysis suggested that AD patients can improve their global cognition and Activities of Daily Living (ADL) through engaging in aerobic and mixed exercise (aerobic and anaerobic exercise).

The Involvement of lncRNA HOTAIR/miR-130a-3p Axis in the Regulation of Voluntary Exercise on Cognition and Inflammation of Alzheimer's Disease

BACKGROUND

Alzheimer's disease (AD) is an age-related neurodegenerative disease and exercises might mitigate the progression of AD. This investigation aimed to manifest the potential mechanism of exercises in AD.

METHODS

Morris water maze (MWM) test was conducted to evaluate the cognitive function in APP/PS1 mice. Quantitative real-time PCR was performed to detect the expression of HOTAIR and miR-130a-3p. The enzyme-linked immunosorbent assay was applied to appraise the concentration of IL-1β, IL-6, and TNF-α. A luciferase report experiment was implemented to substantiate the relationship between miR-130a-3p and HOTAIR.

RESULTS

Exercises contributed to the elevated expression of HOTAIR. The findings of MWM implied HOTAIR inhibited the impacts of voluntary exercises on escape latency, distance moved, percentage of time spent in the target quadrant, platform crossing times, and inflammation. MiR-130a-3p mediated the function of HOTAIR on cognitive ability and inflammation.

CONCLUSION

HOTAIR participated in the regulation of exercises on AD by sponging miR-130a-3p.

Exercise improves mental health status of young adults via attenuating inflammation factors but modalities matter

INTRODUCTION

The mental health of young adults is a global public health challenge. Numerous studies have demonstrated that exercise benefits mental health. However, it is still unclear which exercise mode is optimal for protecting mental health and its association with the immune system. This study aimed to compare the intervention effect of high-intensity interval training (HIIT) and moderate-to-vigorous intensity continuous training (MVCT) on mental health and assess the underlying mechanism of exercise interventions to improve the immune system, which facilitated the mental health status.

METHODS

This is a double-blinded RCT study conducted from October 13, 2020 to January 25, 2021 (ClinicalTrials.gov identifier: NCT04830059). Ninety-three participants who met the inclusion criteria were randomized into the HIIT (N = 33), MVCT (N = 32), and control groups (N = 28) with a mean age of 25.26 (SD = 2.21), and 43% of males enrolled in the study. Professional coaches guided participants in HIIT and MVCT groups to perform 40 min of exercise training three times a week for 12-week while those in the control group received 1 h of health education twice a week. Questionnaires related to mental health status and blood samples of inflammatory factors, including immunoglobulin A (IgA), immunoglobulin M (IgM), albumin (Alb), globulin (GLO), lymphocytes (LYM), and lymphocyte percentage (LYM) were assessed before and after the intervention.

RESULTS

We found that blood inflammation factors increased significantly in the control group during 12 weeks (ΔIgA = 0.16 g/L, ΔIgM = 0.092 g/L, ΔAlb = 2.59 g/L, ΔGlo = 3.08 g/L, ΔLYM = 0.36, and ΔLYM% = 3.72%, p < 0.05), and both MVCT and HIIT intervention could effectively defend the increased inflammatory response compared with the control group (IgA: MVCT β = -0.14, p < 0.001, HIIT β = -0.096, p < 0.05; IgM: MVCT β = -0.12, p < 0.001; HIIT β = -0.068, p < 0.05; Alb: MVCT β = -1.64, p < 0.05, HIIT β = -1.14, p > 0.05; Glo: MVCT β = -3.17, p < 0.001, HIIT β = -2.07, p < 0.01; LYM: MVCT β = -0.34, p < 0.05, HIIT β = -0.35, p < 0.05). However, the MVCT intervention modality was more conducive to enhancing positive affect (β = 0.52, p = 0.018) and well-being (β = 1.08, p = 0.035) than HIIT. Furthermore, decreased IgA, Alb, and Glo were associated with improved mental health.

CONCLUSION

Both 12-week HIIT and MVCT are beneficial to the immune system. The MVCT intervention mode is recommended to prevent mental health problems and attenuate immune inflammation, and the immune system is a potential mechanism that exercises improving mental health.

CLINICAL TRIAL REGISTRATION

[ClinicalTrials.gov], identifier [NCT04830059].

Active Life for Brain Health: A Narrative Review of the Mechanism Underlying the Protective Effects of Physical Activity on the Brain

A growing body of evidence clearly indicates the beneficial effects of physical activity (PA) on cognition. The importance of PA is now being reevaluated due to the increase in sedentary behavior in older adults during the COVID-19 pandemic. Although many studies in humans have revealed that PA helps to preserve brain health, the underlying mechanisms have not yet been fully elucidated. In this review, which mainly focuses on studies in humans, we comprehensively summarize the mechanisms underlying the beneficial effects of PA or exercise on brain health, particularly cognition. The most intensively studied mechanisms of the beneficial effects of PA involve an increase in brain-derived neurotrophic factor (BDNF) and preservation of brain volume, especially that of the hippocampus. Nonetheless, the mutual associations between these two factors remain unclear. For example, although BDNF presumably affects brain volume by inhibiting neuronal death and/or increasing neurogenesis, human data on this issue are scarce. It also remains to be determined whether PA modulates amyloid and tau metabolism. However, recent advances in blood-based biomarkers are expected to help elucidate the beneficial effects of PA on the brain. Clinical data suggest that PA functionally modulates cognition independently of neurodegeneration, and the mechanisms involved include modulation of functional connectivity, neuronal compensation, neuronal resource allocation, and neuronal efficiency. However, these mechanisms are as yet not fully understood. A clear understanding of the mechanisms involved could help motivate inactive persons to change their behavior. More accumulation of evidence in this field is awaited.

The Beneficial Role of Exercise on Treating Alzheimer's Disease by Inhibiting β-Amyloid Peptide

Alzheimer's disease (AD) is associated with a very large burden on global healthcare systems. Thus, it is imperative to find effective treatments of the disease. One feature of AD is the accumulation of neurotoxic β-amyloid peptide (Aβ). Aβ induces multiple pathological processes that are deleterious to nerve cells. Despite the development of medications that target the reduction of Aβ to treat AD, none has proven to be effective to date. Non-pharmacological interventions, such as physical exercise, are also being studied. The benefits of exercise on AD are widely recognized. Experimental and clinical studies have been performed to verify the role that exercise plays in reducing Aβ deposition to alleviate AD. This paper reviewed the various mechanisms involved in the exercise-induced reduction of Aβ, including the regulation of amyloid precursor protein cleaved proteases, the glymphatic system, brain-blood transport proteins, degrading enzymes and autophagy, which is beneficial to promote exercise therapy as a means of prevention and treatment of AD and indicates that exercise may provide new therapeutic targets for the treatment of AD.

Physical Exercise Ameliorates the Cognitive Function and Attenuates the Neuroinflammation of Alzheimer's Disease via miR-129-5p

INTRODUCTION

Physical exercise has a significant neuroprotective role in Alzheimer's disease (AD), but the underlying mechanisms remain elusive.

OBJECTIVE

This study aimed to explore the molecular mechanisms of physical exercise by analyzing the role of microRNA-129-5p (miR-129-5p) in AD mice and patients.

METHODS

AD mice and patients were treated with 4-week and 3-month physical exercise, respectively. The expression of miR-129-5p was measured using quantitative real-time PCR. The Morris water-maze test was used for cognition evaluation, and enzyme-linked immunosorbent assay was used for inflammation analysis.

RESULTS

In both AD mice and patients, the expression of miR-129-5p was elevated by physical exercise. By in vivoregulation of miR-129-5p, we found that the improved cognitive function and reduced inflammatory responses were reversed by the knockdown of miR-129-5p. In patients with AD, the serum expression of miR-129-5p was further found to be correlated with the serum levels of cognitive function markers and proinflammatory cytokines.

CONCLUSION

All data indicated that the expression of miR-129-5p in AD mice and patients is significantly upregulated by physical exercise. The knockdown of miR-129-5p can abrogate the neuroprotective effect of exercise on cognition and neuroinflammation in AD mice. This study provides a novel insight into the molecular mechanisms underlying the neuroprotective effect of physical exercise in AD, and miR-129-5p may provide a novel therapeutic target for AD treatment.

Biomarkers for evaluating the effects of exercise interventions in patients with MCI or dementia: A systematic review and meta-analysis

OBJECTIVES

To summarize the biomarkers for evaluating the effects of exercise interventions in patients with cognitive impairment associated with aging, as well as their responses to exercise interventions.

DESIGN

A systematic review and meta-analysis METHODS: We systematically searched different electronic database, including PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, PsycINFO, SPORTDiscus up to April 2020. Clinical controlled trials with exercise interventions in patients with cognitive impairment were included. The main outcomes included all the biomarkers used to evaluate the effects of exercise interventions. If data for certain biomarkers was enough (more than 2 studies), meta-analyses would be performed to estimate the effect sizes by calculating the standard mean differences (SMDs) and 95% confidence intervals (CIs).

RESULTS

Finally, we included 33 articles from 26 trials. The biomarkers included neurotrophic factors, inflammatory factors, oxidative stress markers, neuropathological hallmarks, metabolic biomarkers and genotypes. The meta-analyses indicated that exercise significantly decreased the levels of IL-6 (SMD = -0.45; 95% CI: -0.72, -0.18) and low-density lipoprotein (SMD = -0.26; 95% CI: -0.50, -0.01). Subgroup analyses showed that aerobic exercise also could decrease the levels of TNF-α (SMD = -1.21; 95% CI: -2.29, -0.14). There were some important cognition-related biomarkers which were rarely measured, such as Aβ, tau and IGF-1.

CONCLUSION

Regular exercise showed positive effects on reducing inflammation and regulating lipid metabolism. But the available evidence is limited and more studies with different exercise interventions should be conducted to test the effects of exercise on other important cognition-related biomarkers in patients with cognitive dysfunction.

Comparative efficacy of interventions for reducing symptoms of depression in people with dementia: systematic review and network meta-analysis

OBJECTIVE

To describe the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia who experience depression as a neuropsychiatric symptom of dementia or have a diagnosis of a major depressive disorder.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Medline, Embase, the Cochrane Library, CINAHL, PsycINFO, and grey literature between inception and 15 October 2020.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Randomised trials comparing drug or non-drug interventions with usual care or any other intervention targeting symptoms of depression in people with dementia.

MAIN OUTCOME MEASURES

Pairs of reviewers screened studies, abstracted aggregate level data, and appraised risk of bias with the Cochrane risk of bias tool, which facilitated the derivation of standardised mean differences and back transformed mean differences (on the Cornell scale for depression in dementia) from bayesian random effects network meta-analyses and pairwise meta-analyses.

RESULTS

Of 22 138 citations screened, 256 studies (28 483 people with dementia) were included. Missing data posed the greatest risk to review findings. In the network meta-analysis of studies including people with dementia without a diagnosis of a major depressive disorder who were experiencing symptoms of depression (213 studies; 25 177 people with dementia; between study variance 0.23), seven interventions were associated with a greater reduction in symptoms of depression compared with usual care: cognitive stimulation (mean difference -2.93, 95% credible interval -4.35 to -1.52), cognitive stimulation combined with a cholinesterase inhibitor (-11.39, -18.38 to -3.93), massage and touch therapy (-9.03, -12.28 to -5.88), multidisciplinary care (-1.98, -3.80 to -0.16), occupational therapy (-2.59, -4.70 to -0.40), exercise combined with social interaction and cognitive stimulation (-12.37, -19.01 to -5.36), and reminiscence therapy (-2.30, -3.68 to -0.93). Except for massage and touch therapy, cognitive stimulation combined with a cholinesterase inhibitor, and cognitive stimulation combined with exercise and social interaction, which were more efficacious than some drug interventions, no statistically significant difference was found in the comparative efficacy of drug and non-drug interventions for reducing symptoms of depression in people with dementia without a diagnosis of a major depressive disorder. Clinical and methodological heterogeneity precluded network meta-analysis of studies comparing the efficacy of interventions specifically for reducing symptoms of depression in people with dementia and a major depressive disorder (22 studies; 1829 patients).

CONCLUSIONS

In this systematic review, non-drug interventions were found to be more efficacious than drug interventions for reducing symptoms of depression in people with dementia without a major depressive disorder.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017050130.

Pain-Reducing Effects of Physical Therapist-Delivered Interventions: A Systematic Review of Randomized Trials Among Older Adults With Dementia

BACKGROUND AND PURPOSE

Pain is common among older adults with dementia. There are nonpharmacological options for managing pain in this population. However, the effects of physical therapist-delivered interventions have not been summarized. The purpose of this systematic review was to summarize the literature on physical therapist-delivered interventions in randomized trials for reducing pain among older adults with dementia.

METHODS

A systematic search of MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science was conducted for randomized trials of pain management in individuals 60 years or older with medically diagnosed dementia of any severity. Included studies addressed the effects of nonpharmacological physical therapist-delivered interventions on pain outcomes. Pain outcomes included patient or caregiver self-report, observational or interactive measures. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale.

RESULTS AND DISCUSSION

Three studies (total = 222 participants; mean age range = 82.2-84.0 years; 178 [80.2%] females) met inclusion criteria. PEDro scores ranged from 4 to 8/10. Interventions included passive movement and massage. Pain outcomes included the observational measures Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), Pain in Advanced Dementia (PAINAD), and Doloplus-2 Scale. Passive movement did not show better results when compared with no treatment, while massage showed pain-reducing effects in 1 study compared with no treatment.

CONCLUSIONS

The evidence supporting pain-reducing physical therapy interventions for patients with dementia is limited. There is a clear gap in knowledge related to evidence-based physical therapy for managing pain in this population. Future studies should examine active physical therapist-delivered interventions and utilize interactive pain measures.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

DISCUSSION

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

Physical Activity for Executive Function and Activities of Daily Living in AD Patients: A Systematic Review and Meta-Analysis

Objectives: The present study aimed to systematically analyze the effects of physical activity on executive function, working memory, cognitive flexibility, and activities of daily living (ADLs) in Alzheimer's disease (AD) patients and to provide a scientific evidence-based exercise prescription.

Methods: Both Chinese and English databases (PubMed, Web of Science, the Cochrane Library, EMBASE, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were used as sources of data to search for randomized controlled trials (RCTs) published between January 1980 and December 2019 relating to the effects of physical activity on executive function, working memory, cognitive flexibility, and ADL issues in AD patients. Sixteen eligible RCTs were ultimately included in the meta-analysis.

Results: Physical activity had significant benefits on executive function [standard mean difference (SMD) = 0.42, 95% confidence interval (CI) 0.22–0.62, p < 0.05], working memory (SMD = 0.28, 95% CI 0.11–0.45, p < 0.05), cognitive flexibility (SMD = 0.23, 95% CI −0.02 to 0.47, p < 0.01), and ADLs (SMD = 0.68, 95% CI 0.19–1.16, p < 0.05) among AD patients. Subgroup analysis indicated that, for executive function issues, more than 60 min per session for 16 weeks of moderate-to-high-intensity dual-task exercises or multimodal exercise had a greater effect on AD patients. For working memory and cognitive flexibility issues, 60–90 min of moderate-intensity dual-task exercises 1–4 times/week was more effective. For ADL issues, 30–90 min of multimodal exercise at 60–79% of maximal heart rate (MHR) 3–4 times/week had a greater effect on AD patients.

Conclusions: Physical activity was found to lead to significant improvements in executive function, working memory, cognitive flexibility, and ADLs in AD patients and can be used as an effective method for clinical exercise intervention in these patients. However, more objective, scientific, and effective RCTs are needed to confirm this conclusion.

Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years.

Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 ^th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups.

Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’ g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’ g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’ g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges’ g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment.

Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults.

Registration: PROSPERO CRD42018115866 (23/11/2018).

Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials

Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018).

Treadmill exercise ameliorates memory deficits and hippocampal inflammation in ovalbumin-sensitized juvenile rats

The behavioral changes, including spatial learning and memory impairment as well as depressive- and anxiety-like behaviors in an animal model of asthma were demonstrated previously. On the other hand, there is increasing evidence that the anti-inflammatory actions of exercise are related to their neuroprotective properties against different insults in the brain. This study was aimed to explore the effects of moderate treadmill exercise on cognitive deficits and possible anti-inflammatory mechanisms in ovalbumin (OVA)-sensitized rats. The exercise groups were trained to run on the treadmill 30 min/day with an intensity of 12 m/min, 5 days/week for 4 weeks. Animals in the OVA groups were sensitized by two intraperitoneal (i.p.) injections of OVA (10 μg/injection) and challenged with OVA by inhalation during the treadmill running exercise period. Passive avoidance (PA) memory, levels of interleukin (IL)-10 and tumor necrosis factor (TNF)-α in the hippocampus, total and differential white blood cell (WBC) count in the blood as well as pathological changes of the lung were then evaluated. OVA-sensitization was resulted in cognitive deficits in the PA task, along with increased total and differential WBC in blood and TNF-α in the hippocampus. However, exercise ameliorated these changes and increased the IL-10 level in the hippocampus, suggesting that moderate treadmill exercise can improve memory impairment in OVA-sensitized rats due to its anti-inflammatory properties.

The Importance of Exercise in Alzheimer's Disease and the Minds in Motion® Program: An Editorial

Alzheimer's Disease (AD) and other dementias are prevalent neurodegenerative diseases characterized by decreased cognition, physical function, and quality of life. Currently, millions of people are living with AD and other dementias. With no cure, research has examined the use of non-pharmacological treatment options including exercise. Many high-quality studies demonstrate that physical activity slows the progression of AD's many outcomes, and is beneficial to overall quality of life in those living with AD. However, creating exercise interventions at the community level that individuals will adhere to is often a challenge. The Alzheimer's Society of Canada developed a unique program that combines physical activity with cognitive stimulation in a social atmosphere: The Minds in Motion® program. Minds in Motion® addresses many of the barriers often linked to poor physical activity participation in chronic diseases (such as inclusion of the care partner), to ensure the best program uptake. The Minds in Motion® program has anecdotally been successful in helping to increase physical function and social skills in those living with dementia. However, it is important to connect community-driven programs with the academic research community, to create an opportunity for high quality evaluation metrics that can be disseminated at multiple levels: to research audiences, clinical audiences, and to those in the community. With ongoing collaborations between research and community programs, there is a greater opportunity to understand the positive impact of a program, which ultimately increases the chance of funding for the program. In this editorial, we highlight that community-integrated research is an important priority for future collaborations.

Relations between subjective well-being and Alzheimer's disease: A systematic review

Subjective Well-Being (SWB) is determined by the degree of satisfaction with one's own life and the intensity/frequency with which we experience negative and positive emotions. Current studies indicate that SWB is beneficial for health.

Objective

The aim of this systematic review was to analyze the methodological quality of published articles on SWB in people with Alzheimer's disease (AD).

Methods

The keywords "Well-Being" and "Alzheimer" were used. Inclusion criteria were a) articles with a sample of the elderly population; b) empirical articles; c) articles published between 2014 and 2019. Analysis of the selected articles was performed using the Downs and Black Checklist.

Results

13 articles were selected for further analysis. The results showed that only one of the articles reached a high methodological quality level. The other articles had an average level, ranging from 46% to 67%, of total protocol compliance.

Conclusion

The studies analyzed had a medium level of methodological quality. It is important to improve the methodological quality of studies on SWB in people with AD.

Web-Based Intervention Effects on Mild Cognitive Impairment Based on Apolipoprotein E Genotype: Quasi-Experimental Study

BACKGROUND

Apolipoprotein E (APOE) ε4 allele is a major genetic risk factor for Alzheimer disease and mild cognitive impairment (MCI). Computer-based training programs can improve cognitive performance in elderly populations. However, the effects of computer-based interventions on MCI APOE ε4 carriers have never been studied before.

OBJECTIVE

The effects of different web-based interventions and the APOE isoform-specific differences in training outcomes are investigated.

METHODS

Using a quasi-experimental study design, 202 participants with MCI aged 60 years and older took part in three different intervention programs (physical and cognitive [Long-Lasting Memories, or LLM], cognitive [Active Control, or AC], or physical intervention [Physical Training Control, or PTC]) via an innovative information and communication technologies exergaming platform. Participants in each interventional group were subdivided into APOE ε4 carriers and non-APOE ε4 carriers. All participants underwent an extensive neuropsychological evaluation before and after the training, blood tests, and brain imaging.

RESULTS

All interventions resulted in multiple statistically significant cognitive benefits after the intervention. Verbal learning (California Verbal Learning Test: immediate recall test score-LLM: P=.04; AC: P<.001), working memory (digit span forward and backward test scores-AC: P=.03; PTC: P=.02 and P=.006, respectively), and long-term memory (California Verbal Learning Test: delayed recall test score-LLM: P=.02; AC: P=.002; and PTC: P=.02) were improved. There was no statistically significant difference among the intervention effects. APOE ε4 presence moderates intervention effects as the LLM intervention improved only their task-switching processing speed (Trail Making Test, Part B: P=.03) and the PTC intervention improved only the working memory (digit span backward: P=.03). No significant performance alteration was noted for the APOE ε4+ cognitive AC training group.

CONCLUSIONS

None of the applied interventions could be identified as the optimal one; it is suggested, however, that combined cognitive and physical training and physical training via exergaming may be more effective for the high-risk MCI ΑPOE ε4+ subgroup.

Lifestyle Medicine Interventions in Patients With Advanced Disease Receiving Palliative or Hospice Care

Background: Lifestyle medicine interventions have the potential to improve symptom management, daily function, and quality of life (QOL) in patients with advanced or terminal disease receiving palliative or hospice care. The goal of this review is to summarize the current state of the literature on this subject. Methods: The authors used a broad search strategy to identify relevant studies, reviews, and expert opinions, followed by narrative summary of available information. Results: Four main categories of lifestyle interventions feature prominently in the palliative care literature: exercise, nutrition, stress management, and substance use. High-quality studies in this vulnerable population are relatively sparse. Some interventions show promise. However, most show mixed results or inadequate evidence. For some interventions, risks in this generally frail population outweigh the benefits. Clinical decision making involves balancing research findings, including the risks and benefits of interventions, with a clear understanding of patients' prognosis, goals of care, and current physical, emotional, and spiritual state. Achieving optimum QOL, safety, and ethical care are emphasized. Conclusions: The use of lifestyle interventions in patients receiving palliative or hospice care is a complex undertaking, requiring tailoring recommendations to individual patients. There is potential for considerable benefits; however, more research is needed.

Effects of Exercise on Inflammatory, Oxidative, and Neurotrophic Biomarkers on Cognitively Impaired Individuals Diagnosed With Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

Although the effects of physical exercise (PE) on cognitive function in dementia and mild cognitive impairment (MCI) have been largely studied, its biochemical effect is still poorly explored. The aim of this systematic review was to investigate the effects of PE on inflammatory, oxidative, and neurotrophic biomarkers of participants with MCI or dementia. Six electronic databases, (PubMed, Cochrane Central, Embase, PEDro, PsycINFO, and SportDiscus) were searched for randomized controlled trials assessing the effects of PE on serum and/or plasma biomarkers of elderly participants with MCI or dementia. After selection process, eight studies were included. Meta-analysis was performed by comparison of changes from baseline, using the random effects method. Meta-analysis showed a significant effect of aerobic exercise on interleukin-6 and tumor necrosis factor alpha decrease and positive effects on brain-derived neurotrophic factor expression. As only one study was included with oxidative biomarker assessment, the effects of PE on oxidative process remain unclear. Finally, even though it was possible to observe positive effects of PE on some biomarkers of MCI and dementia individuals, current evidence does not allow drawing specific practical recommendations such as type, frequency, intensity, or duration of PE in these population. Further researches aiming to estimate the PE effectiveness on biomarkers of MCI and Alzheimer's disease are needed.

Strength exercise suppresses STZ-induced spatial memory impairment and modulates BDNF/ERK-CAMKII/CREB signalling pathway in the hippocampus of mice

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that has generated scientific interest because of its prevalence in the population. Studies indicate that physical exercise promotes neuroplasticity and improves cognitive function in animal models and in human beings. The aim of the present study was to investigate the effects of strength exercise on the hippocampal protein contents and memory performance in mice subjected to a model of sporadic AD induced by streptozotocin (STZ). Swiss mice received two injections of STZ (3 mg/kg, intracerebroventricular). After 21 days, they began physical training using a ladde. Mice performed this protocol for 4 weeks. After the last exercise training session, mice performed the Morris Water Maze test. The samples of hippocampus were excised and used to determine protein contents of brain-derived neurotrophic factor (BDNF), extracellular signal-regulated kinase-Ca²⁺ (ERK), calmodulin-dependent protein kinase (CAMKII) and cAMP-response element-binding protein (CREB) signalling pathway. Strength exercise was effective against the decrease in the time spent and distance travelled in the target quadrant by STZ-injected mice. Strength exercise was also effective against the reduction of mature BDNF, tropomyosin receptor kinase B and neuronal nuclear antigen (NeuN) hippocampal protein levels in STZ mice. The decrease in the hippocampal ratio of pERK/ERK, pCAMKII/CAMKII and pCREB/CREB induced by STZ was reversed by strength exercise. Strength exercise decreased Bax/Bcl2 ratio in the hippocampus of STZ-injected mice. The present study demonstrates that strength exercise modulated the hippocampal BDNF/ERK-CAMKII/CREB signalling pathway and suppressed STZ-induced spatial memory impairment in mice.

Effect of 9 weeks continuous vs. interval aerobic training on plasma BDNF levels, aerobic fitness, cognitive capacity and quality of life among seniors with mild to moderate Alzheimer's disease: a randomized controlled trial

Background

Evidence suggests that aerobic-type training confers physical benefits and appears to contribute positively to brain health. This study aims to compare the effect of 9-weeks continuous (CAT) to interval aerobic training (IAT) on brain derived neurotrophic factor (BDNF) plasma level, aerobic fitness, cognitive performance, and quality of life among senior with Alzheimer's disease (AD).

Methods

52 participants were randomly allocated into three groups (CAT n = 14; IAT n = 17; and Controls n = 21). CAT and IAT consisted of 18 sessions of 30-min cycling, twice a week, over 9 weeks. During the same period, controls were engaged in interactive information sessions. Plasma BDNF level; aerobic fitness parameters (Metabolic equivalent task - METs; Maximal Tolerated Power - MTP); functional capacities (6-Minute Walk Test - 6MWT); cognitive performance (Mini Mental State Examination; Rey auditory verbal learning test; and digit span test) and quality of life (Quality Of Life of Alzheimer's Disease scale - QoL-AD) were measured in all participants at baseline and 9 weeks later. A third plasma BDNF level was quantified following a 4 weeks detraining.

Results

No significant change was measured in terms of plasma BDNF level and cognitive performance after interventions, in all groups compared to baseline. After 9 weeks, CAT and IAT significantly improved aerobic fitness parameters compared to controls (METs: + 0.6 and + 1.0 vs. + 0.4; MTP: + 16 watts and + 20 watts vs. + 10 watts; and functional capacities (6MWT: + 22 m and + 31 m vs. -40 m). Compared to controls, QoL-AD after CAT was improved (+ 2 points; p = 0.02).

Conclusions

Neither aerobic exercise modalities significantly modified plasma BDNF levels and cognitive performances. CAT and IAT enhanced aerobic fitness and functional capacities in AD patients and CAT their QoL.

Trial registration

ClinicalTrials.gov website (NCT02968875); registration date: 7 September 2016. "Retrospectively registered".

Molecular Signature of the Immune Response to Yoga Therapy in Stress-related Chronic Disease Conditions: An Insight

The world Health Organization defines health as complete well-being in terms of physical, mental and social, and not merely the absence of disease. To attain this, individual should adapt and self-mange the social, physical and emotional challenges of life. Exposure to chronic stress due to urbanization, work stress, nuclear family, pollution, unhealthy food habits, lifestyle, accidental death in the family, and natural calamities are the triggering factors, leading to hormonal imbalance and inflammation in the tissue. The relationship between stress and illness is complex; all chronic illnesses such as cardiovascular disease and asthma have their root in chronic stress attributed by inflammation. In recent times, yoga therapy has emerged as an important complementary alternative medicine for many human diseases. Yoga therapy has a positive impact on mind and body; it acts by incorporating appropriate breathing techniques and mindfulness to attain conscious direction of our awareness of the present moment by meditation, which helps achieve harmony between the body and mind. Studies have also demonstrated the important regulatory effects of yoga therapy on brain structure and functions. Despite these advances, the cellular and molecular mechanisms by which yoga therapy renders its beneficial effects are inadequately known. A growing body of evidence suggests that yoga therapy has immunomodulatory effects. However, the precise mechanistic basis has not been addressed empirically. In this review, we have attempted to highlight the effect of yoga therapy on immune system functioning with an aim to identify important immunological signatures that index the effect of yoga therapy. Toward this, we have summarized the available scientific evidence showing positive impacts of yoga therapy. Finally, we have emphasized the efficacy of yoga in improving physical and mental well-being. Yoga has been a part of Indian culture and tradition for long; now, the time has come to scientifically validate this and implement this as an alternative treatment method for stress-related chronic disease.

Path analysis from physical activity to quality of life among dementia patients: A dual-path mediating model

AIMS

To clarify the specific impact paths among physical activity, activity of daily living, depression and quality of life among dementia patients.

DESIGN

A descriptive, cross-sectional design.

METHODS

Dementia patients and their caregivers from five tertiary general hospitals and one dementia patients' club were recruited. A total of 216 valid questionnaires were collected from November 2018 - March 2019. Path analysis was performed by Mplus 7.0 to test the casual relationship among physical activity, activity of daily living, depression and quality of life.

RESULTS

Most patients with dementia presented a low level of physical activity and suffered from impaired quality of life. The modified model presented a good model fit and revealed that physical activity had indirect positive effects on quality of life mediated by activity of daily living and depression.

CONCLUSION

The results showed that physical activity was a promising non-pharmacological method to improve the performance of activity of daily living and reduce depressive symptoms and then enhance the quality of life among dementia patients.

IMPACT

The findings were beneficial to elevate the awareness of physical activity among patients and professionals. This study was helpful to understand how physical activity exerted effects on life quality of dementia patients. This study provided a new perspective for researchers to elucidate the causal relationship of variables among dementia patients.

Efficacy of path-oriented psychological self-help interventions to improve mental health of empty-nest older adults in the Community of China

BACKGROUND

China has the world's largest aging population and the number of empty-nest older adults is on the rise. In comparison to the aging population in general, empty-nest older adults have a lower level of subjective well-being and poorer mental health status due to a lack of emotional support from their children. The aim of this study is to conduct an empirical study to evaluate the efficacy of the 'Path-oriented Psychological Self-help Intervention' (P-oPSI) led by nurses on the mental health of empty-nest older adults in the community, to provide a scientific foundation for improving their quality of life.

METHODS

A Quasi-Experimental controlled intervention study was conducted from 2015 to 2017. A total of 76 empty-nest older adults from 2 districts were recruited using a convenience sampling and assigned to 2 groups based on their residential communities in the city of Chifeng in the Inner Mongolia Autonomous Region, China. The wait list control group participated in a mental health lecture to gain knowledge and learn techniques of mental health promotion. The intervention group additionally received 1 month of training in a nurse-led 'P-oPSI' for a month. Both groups were followed-up for 3 months. Mental health status, coping styles, and psychological self-help ability of the participating empty nest older adults were assessed at the baseline, 1 month, and 3-months follow up, respectively. Two-way analysis of variance and a simple effect test were used to analyse the differences of the two groups.

RESULTS

The P-oPSI yielded a greater benefit for the mental health status, coping styles, and psychological self-help ability of the participants in the intervention group. Combined with a simple effect test, the scores of the mental health status, positive coping style, and psychological self-help ability of those in the intervention group significantly increased at 1 month after the baseline (F _{mental health status} = 7.59, F _{positive coping style} = 7.24, F _{psychological self-help ability} = 7.07); and the sustainable effect of this program lasted for 3 months after the intervention (F _{mental health status} = 13.24, F _{positive coping style} = 10.42, F _{psychological self-help ability} = 10.45), which reached statistical significance (P < 0.01).

CONCLUSIONS

The P-oPSI program significantly improved the level of mental health of empty-nest older adults in China. This intervention provides a new approach of self-management to improve mental health of older adults in community settings.

TRIAL REGISTRATION

chictr.org.cn: ChiCTR1900025552. Retrospectively registered 1 September 2019.

Effects of Exergaming in People with Dementia: Results of a Systematic Literature Review

Background:

Physical exercise benefits functioning, health, and well-being. However, people living with dementia in particular hardly engage in exercise. Exergaming (exercise and gaming) is an innovative, fun, and relatively safe way of exercising in a virtual reality or gaming environment. It may help people living with dementia overcome barriers they can experience regarding regular exercise activities.

Objective:

This systematic literature review aims to provide an overview of the cost-effectiveness of exergaming and its effects on physical, cognitive, emotional, and social functioning, as well as the quality of life in people living with dementia.

Methods:

PubMed, Embase, Cinahl, PsycINFO, the Cochrane Library, and the Web of Science Core Collection were searched. Selection of studies was carried out by at least two independent researchers.

Results:

Three studies were found to be eligible and were included in this review. Two of these showed some statistically significant effects of exergaming on physical, cognitive, and emotional functioning in people living with dementia, although based on a very small sample. No articles were found about the cost-effectiveness of exergaming.

Conclusions:

Only a few controlled studies have been conducted into the effectiveness of exergaming, and these show very little significant benefits. More well-designed studies are necessary to examine the effects of exergaming.

Longitudinal association of PTSD symptoms and self-reported physical functioning among Veterans

BACKGROUND

Few longitudinal studies have investigated the potentially dynamic relationship between Posttraumatic Stress Disorder (PTSD) and physical functioning, and the number of follow-up timepoints have been limited. We evaluated whether PTSD symptoms predicted future physical functioning and vice versa using five assessments over four years.

METHODS

Data was used from a longitudinal cohort of 695 participants recruited from Veteran Affairs medical outpatient clinics who experienced a traumatic event. PTSD symptom severity was assessed annually with the PTSD Checklist (PCL). Physical functioning was measured with the 10-item subscale of the SF-36. An autoregressive cross-lagged panel model was used to determine the temporal associations between PTSD and physical functioning, adjusting for age, sex, ethnicity, education and employment. Comorbidities and health behaviors were added to assess their roles in the relationship.

RESULTS

Greater PTSD symptom severity predicted worse physical functioning the following year (average β = -0.10, P <0.001), where a 10-point increase in PCL score predicted a 0.3-point decline in physical function score over one year. Similarly, better physical functioning also predicted reduced PTSD severity the following year, but to a smaller magnitude (average β = -0.04, P = .003). The pattern of effects was similar after controlling for comorbidities and health behaviors.

LIMITATIONS

Both primary variables relied on self-report, and generalizability may be limited by the mostly male Veteran sample.

CONCLUSIONS

Our results support a bidirectional, but unequal, relationship between PTSD and physical functioning over time. They also highlight the importance of long-term control of PTSD symptoms in preventing functional decline.

The (cost-) effectiveness of exergaming in people living with dementia and their informal caregivers: protocol for a randomized controlled trial

Background

Physical activity is linked to benefits such as increased physical fitness, cognition, emotional and social functioning, general health and well-being in older people. Some evidence suggests that this also applies to people living with dementia. However, it can be harder for them to perform physical activities, due to several barriers, such as issues with orientation and balance problems. A relatively new type of physical activity called exergaming may help them overcome these barriers. Exergaming is “physical exercise interactively combined with cognitive stimulation in a gaming environment”. The aim of our study is to evaluate the effectiveness and cost-effectiveness of exergaming compared to regular activities in people living with dementia, who attend day-care centres. Additionally, we want to investigate whether the exergaming activity for the person living with dementia, also (indirectly) affects the informal caregiver, as well as which facilitators and barriers to implementation of exergames for this target group exist.

Methods

A cluster Randomized Controlled Trial (RCT), with economic and process evaluations alongside will be carried out. In the Netherlands, 24 day-care centres are randomized in the experimental or control group. The study group will consist of 224 dyads (community-dwelling participants with dementia and their informal caregivers), who are interviewed at baseline, and at 3 and 6 months of follow-up. The participant with dementia has to visit the day-care centre for at least two days per week, have a diagnosis of mild to moderate dementia and have an informal caregiver present, who is willing to participate. Societal cost data will be collected during interviews, using healthcare utilization diaries, and from day-care centres. The process evaluation will only involve the experimental group, and will include an online survey, qualitative interviews and focus groups.

Discussion

This study will contribute to the evidence base that more effective exercise among people with dementia will result in positive effects on their wellbeing and quality of life. This will motivate people with dementia to be physically active. We also envision that there might be a positive effect on the burden of care experienced by their informal caregivers.

Trial registration

This trial was registered at the Netherlands Trial Register (NTR) on December 10, 2015 (number: NTR5537), this publication is based on protocol amendment number 01, issue date 28 December 2018. This includes all items from the World Health Organization Trial Registration Data Set [see Additional file 1].

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1062-x) contains supplementary material, which is available to authorized users.

Exercise and mental health

There is a growing body of literature that recognizes the positive effects of exercise on mood states such as anxiety, stress and depression, through physiological and biochemical mechanisms, including endorphins, mitochondria, mammalian target of rapamycin, neurotransmitters and the hypothalamic-pituitary-adrenal axis, and via the thermogenic hypothesis. In addition, psychological mechanisms influence the effects of exercise on mood states, as suggested by both the distraction hypothesis and the self-efficacy hypothesis. Exercise has also been shown to reduce inflammation via several different processes (inflammation, cytokines, toll-like receptors, adipose tissue and via the vagal tone), which can contribute to better health outcomes in people suffering from mood disorders.