Impact of Exercise Interventions on Sustained Brain Health Outcomes in Frail Older Individuals: A Comprehensive Review of Systematic Reviews

Several systematic review studies highlight exercise's positive impact on brain health outcomes for frail individuals. This study adopts a Comprehensive Review of reviews (CRs) approach to amalgamate data from existing reviews, focusing on exercise's influence on brain health outcomes in older frail and pre-frail adults. The methodology involves a thorough search of Portuguese, Spanish, and English-indexed databases (i.e., Ebsco Health, Scielo, ERIC, LILACS, Medline, Web of Science, SportDiscus) from 1990 to 2022, with the AMSTAR-2 tool assessing evidence robustness. The search terms "physical exercise", "elderly frail", and "systematic review" were employed. Results: Out of 12 systematically reviewed studies, four presented high-quality (with metanalyses), while eight exhibit critically low quality. Positive trends emerge in specific cognitive and neuromotor aspects, yet challenges persist in psychosocial domains, complex cognitive tasks, and ADL outcomes. This study yields reasonable and promising evidence regarding exercise's influence on quality of life and depression in frail older individuals. However, the impact on biochemical markers remains inconclusive, emphasizing the need for standardized methodologies. Conclusions: The findings highlight the importance of acknowledging methodological nuances for clinicians and policymakers when translating these results into impactful interventions for aging populations. This emphasizes the necessity for a comprehensive and customized approach to exercise interventions aimed at fostering the sustainability of overall well-being in older individuals, aligning with United Nations Sustainable Development Goal 3.

Prevalence of associations among sarcopenia, obesity, and metabolic syndrome in Brazilian older adults

Background

Although aging is a process associated with the development of obesity, metabolic syndrome (MetS), and sarcopenia, the prevalence of these conditions in older adults from São Paulo, Brazil, is unclear.

Methods

Therefore, the current study aimed to investigate the prevalence of obesity, sarcopenia, and MetS, both separately and together, in a community-based sample of older adults from São Paulo, Brazil. Data from the medical records of 418 older adults of both genders, aged 60  years or older (mean age 69.3 ± 6.5  years), who were not physically active, were used to conduct this retrospective cross-sectional study. Anthropometric variables were used to determine both body mass index (BMI) and Conicity index (C index). Sarcopenia and MetS were defined according to the criteria of the European Working Group on Sarcopenia in Older People and by the Brazilian Society of Endocrinology and Metabolism, respectively.

Results

Based on BMI, the group of older men (n = 91) showed a predominance of adequate weight (n = 49) and the group of older women (n = 327) showed a predominance of obesity (n = 181). In association with obesity, while only the group of older women presented with sarcopenia (n = 5), 52 older women and 9 older men presented with MetS, and two older women presented with sarcopenia + MetS [prevalence ratio = 0.0385, 95% CI (0.007;0.1924)]. Based on the C index, 58 older women and 11 older men presented with MetS, while the occurrence of sarcopenia or MetS + sarcopenia was found in 32 and 5 older women, respectively [prevalence ratio = 0.0910, 95% CI (0.037;0.2241)].

Discussion

Our results suggest that obesity, as measured by BMI or the C Index, was more closely associated with the occurrence of MetS than sarcopenia, regardless of gender, and also that sarcopenic obesity was only found in the group of older women. Additionally, the prevalence ratio of obesity, sarcopenia, and MetS evidenced using the C index was 2.3 times higher than the values found using the BMI classification.

Effect of exercise training on HDL subclasses and cholesterol transfers to HDL in elderly individuals

Introduction

Lifestyle habits play a crucial role on coronary artery disease (CAD) prevention. Exercise training promotes increase of HDL-C and decrease of plasma triglycerides is an important tool against atherogenesis. HDL-C determination evaluates only partially the HDL status and anti-atherosclerotic potential. A number of other parameters also relates HDL metabolism and function with CAD, such as HDL subclass distribution and cholesterol transfer to HDL, that have been reported as impaired in CAD. It is known that exercise training can improve those parameters in young individuals, but it has not been explored whether this effect can also be obtained in elderly subjects undergoing moderate training.

Purpose

Investigate the effects of regular practice of moderate exercise training on cholesterol transfer to HDL and HDL subclasses distribution in elderly compared to young subjects.

Methods

111 healthy subjects were enrolled in this study, as divided in four groups paired by sex: active elderly (AE, n=25), inactive elderly (IE, n=21), active young (AY, n=40) and inactive young (IY, n=25). All subjects performed cardiopulmonary test to determine VO2 peak and answered a questionnaire about exercise practice; only subjects practicing regular training for at least one year were selected to the 2 “active” groups. Blood samples were collected to determine lipid and apolipoprotein profile. Lipid subfractions were measured using the Lipoprint system. Cholesterol transfer to HDL was performed by incubating plasma with a donor lipoprotein-like nanoparticle containing radioactively labeled unesterified (UC) and esterified cholesterol (EC), followed by chemical precipitation and radioactive count.

Results

Data are shown on Table 1. Higher VO2 peak in both active groups confirmed the effectiveness of the training. HDL-C was higher in AE and AY than in IE and IY; apo A-I was higher in AY than in IY, but AE and IE were equal. UC transfer was higher in AE and AY than in IE and IY, but EC was higher AY than in IY, AE and IE were equal. Large HDL subfraction was higher in AY than in IY, but AE and IE were equal. The intermediate HDL subfraction was higher in AE than in IE. Comparing AE with AY, no differences in UC and EC, as well as HDL subfractions were observed.

Conclusion

Training had the ability to improve parameters of HDL metabolism not only in young but also in elderly subjects and it is remarkable that, despite their lower VO2 peak, in the AE group the cholesterol transfers and the HDL subfraction profile were similar to those of the AY group. Those results confirm the effectiveness of training to improve HDL anti-atherosclerotic features in the elderly.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo à Pesquisa do Estado de São Paulo

The advantages of physical exercise as a preventive strategy against NAFLD in postmenopausal women

BACKGROUND

The prevalence and severity of nonalcoholic fatty liver disease (NAFLD) increase in women after menopause. This narrative review discusses the causes and consequences of NAFLD in postmenopausal women and describes how physical activity can contribute to its prevention.

METHODS

The authors followed the narrative review method to perform a critical and objective analysis of the current knowledge on the topic. The Medical Subject Heading keywords 'physical exercise', 'menopause', 'hormone replacement therapy', 'estradiol' and 'NAFLD' were used to establish a conceptual framework. The databases used to collect relevant references included Medline and specialized high-impact journals.

RESULTS

Higher visceral adiposity, higher rate of lipolysis in adipose tissue after oestrogen drop and changes in the expression of housekeeping proteins involved in hepatic lipid management are observed in women after menopause, contributing to NAFLD. Excessive liver steatosis leads to hepatic insulin resistance, oxidative stress and inflammation, accelerating NAFLD progression. Physical activity brings beneficial effects against several postmenopausal-associated complications, including NAFLD progression. Aerobic and resistance exercises partially counteract alterations induced by metabolic syndrome in sedentary postmenopausal women, impacting NAFLD progression and severity.

CONCLUSIONS

With the increased global obesity epidemic in developing countries, NAFLD is becoming a severe problem with increased prevalence in women after menopause. Evidence shows that physical activity may delay NAFLD development and severity in postmenopausal women, although the prescription of age-appropriate physical activity programmes is advisable to assure the health benefits.

The poorly conducted orchestra of steroid hormones, oxidative stress and inflammation in frailty needs a maestro: Regular physical exercise

This review outlines the various factors associated with unhealthy aging which includes becoming frail and dependent. With many people not engaging in recommended exercise, facilitators and barriers to engage with exercise must be investigated to promote exercise uptake and adherence over the lifespan for different demographics, including the old, less affluent, women, and those with different cultural-ethnic backgrounds. Governmental and locally funded public health messages and environmental facilitation (gyms, parks etc.) can play an important role. Studies have shown that exercise can act as a conductor to balance oxidative stress, immune and endocrine functions together to promote healthy aging and reduce the risk for age-related morbidities, such as cardiovascular disease and atherosclerosis, and promote cognition and mood over the lifespan. Like a classic symphony orchestra, consisting of four groups of related musical instruments - the woodwinds, brass, percussion, and strings - the aging process should also perform in harmony, with compassion, avoiding the aggrandizement of any of its individual parts during the presentation. This review discusses the wide variety of molecular, cellular and endocrine mechanisms (focusing on the steroid balance) underlying this process and their interrelationships.

Fire simulator exposure alters the innate epithelial response and inflammatory status in the airways of firefighters

BACKGROUND

Firefighters are often exposed to high temperatures and by-products of combustion, which can compromise their health. We aimed to evaluate the effect of fire exposure in fire simulators on the airways of firefighters at different time-points.

METHODOLOGY

Thirty-seven male firefighters exposed to fire simulators were evaluated in three phases: pre-exposure, at the end of the first week, and 4 weeks after. Pulmonary function by spirometry, nasal mucociliary clearance; peripheral oxygen saturation, inflammatory markers in the nasal lavage and CC16 in the sputum, nasal obstruction, and quality of life (using the questionnaires NOSE and SNOT-22) were assessed.

RESULTS

Higher levels of IL-8, IL-10, and exhaled carbon monoxide were found more in phase 2 than in phase 1. Higher CC16 levels and lower peripheral oxygen saturation were observed in phase 3 as compared to phase 1. Lower levels of IL-2 and peripheral oxygen saturation were found in phase 3 than in phase 2. Higher nasal mucociliary clearance, as well as the worst quality of life and nasal obstruction, were observed in phases 2 and 3 as compared to phase 1.

CONCLUSIONS

The firefighters’ exposures to high temperatures and by-products of combustion in the fire simulators elicit an inflammatory process in the airways with impairment in the innate epithelial response of the upper airway lining. Furthermore, changes in O2 transport affected the professionals’ quality of life negatively.

Lipid transfer to high-density lipoprotein is greater in elderly individuals with higher predictive cardiorespiratory fitness for age

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): FAPESP and CNPq

Background

Elderly individuals have higher coronary artery disease (CAD) risk. Triggering factors include diminished peak of oxygen consumption (VO2peak), commonly referred as cardiorespiratory fitness (CF), and increase in atherogenic lipid profile: non high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). The effect of aging on HDL-C is yet not clear, however, evaluating only the concentrations do not represent all HDL anti-atherosclerosis potential, aspects related to HDL metabolism and function can be more accurate to understand atherosclerosis process. Beyond that, elderly individuals also show reduced lipid transfer to HDL, an important assessment of HDL metabolism and function reported to be lower in CAD patients. Additionally, higher CF level is associated with longevity and lower hospitalizations rates and higher lipid transfer, independently of HDL-C. Data about different ages and absolute values of CF on lipids transfer are nonexistent. Purpose: To analyze the effect of paired CF absolute values and BMI in a healthy population of different ages on lipid transfer to HDL. Methods: 61 healthy individuals, enrolled in two groups: 30 young (27 ± 4 years, 21 females, BMI: 24.6 ± 2.6 kg/m², VO2peak: 33.9 ± 5.0 ml/kg/min) and 31 elderly (67 ± 5 years, 15 females, BMI: 23.9 ± 3.3 kg/m², VO2peak: 33.2 ± 4.5 ml/kg/min) that do not use any medication for chronic disease. Anthropometric data were collected. All participants performed treadmill cardiopulmonary test and the CF predictive value for age was calculated, according to each sex. Plasma lipids and cholesterol ester transfer protein (CETP) concentrations were determined. Lipid transfer was performed by incubating plasma with a donor lipoprotein-like nanoparticle containing radioactively labeled unesterified cholesterol (UC) and esterified cholesterol (EC), followed by chemical precipitation and radioactive count.  Cholesterol transfers from the donor nanoparticle to HDL are expressed as %. For the statistical analysis Student"s t and Mann-Whitney tests were used according to data distribution. Results: Waist circumference (p = 0.0291) and waist-hip ratio (p < 0.0001) were higher in elderly. LDL-C (p = 0.0005) and non HDL-C (p = 0.0003) were higher in elderly, as well apolipoprotein A-I, B, and CETP concentration. HDL-C and triglycerides were equal between groups. EC (p = 0.0268) and UC (p = 0.0348) transfers to HDL were higher in elderly. VO2peak predictive by age expressed in percentage was higher in elderly (90 ± 13 vs. 120 ±18; p < 0.0001). Conclusion: Elderly individuals show higher anthropometric data and concentrations of atherogenic cholesterol lipoproteins; however, HDL-C was equal. When paired by absolute CF values and BMI with young adults, elderly subjects with high CF predicted by age, have higher cholesterol transfer to HDL which demonstrates greater HDL metabolism.

Sustaining efficient immune functions with regular physical exercise in the COVID-19 era and beyond

The new coronavirus (SARS-CoV-2) appearance in Wuhan, China, did rise the new virus disease (COVID-19), which spread globally in a short time, leading the World Health Organization to declare a new global pandemic. To contain and mitigate the spread of SARS-CoV-2, specific public health procedures were implemented in virtually all countries, with a significant impact on society, making it difficult to keep the regular practice of physical activity. It is widely accepted that an active lifestyle contributes to the improvement of general health and preservation of cardiovascular, respiratory, osteo-muscular and immune system capacities. The positive effects of regular physical activity on the immune system have emerged as a pivotal trigger of general health, underlying the beneficial effects of physical activity on multiple physiological systems. Accordingly, recent studies have already pointed out the negative impact of physical inactivity caused by the social isolation imposed by the public sanitary authorities due to COVID-19. Nevertheless, there are still no current narrative reviews evaluating the real impact of COVID-19 on active lifestyle or even discussing the possible beneficial effects of exercise-promoted immune upgrade against the severity or progression of COVID-19. Based on the consensus in the scientific literature, in this review, we discuss how an exercise adherence could adequately improve immune responses in times of the 'COVID-19 Era and beyond'.

Chemobrain in rats: Behavioral, morphological, oxidative and inflammatory effects of doxorubicin administration

Doxorubicin (DOX) is known to cause cognitive impairments in patients submitted to long-term chemotherapy (deficits also known as chemobrain). The present study investigated whether DOX administration could affect behavior and brain morphology, as well as oxidative and inflammatory status in rats. Male Wistar rats were injected with DOX (2.5 mg/kg/week, 4 weeks, i.p.) or saline. Behavioral analyses were performed. Brains were collected and analyzed by hematoxylin-eosin and luxol fast blue staining techniques and by immunohistochemistry (for glial fibrillary acidic protein expression in astrocytes; GFAP). Serum and brain levels of TNF-α, IL-1β, IL-6, IL-8, IL-10 and CXCL-1 were determined. Oxidative parameters, such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), nitric oxide (NO•), brain iron and ferritin levels, as well as reduced and oxidized glutathione (GSH and GSSG, respectively) and thiobarbituric acid reactive substances (TBARS) were also assessed in brain. DOX-injected rats presented cognitive/memory impairments, increased GFAP expression, increased levels of TBARS, NO and GR, but decreased GSSG and ferritin levels in brain homogenate. In addition, increased serum and brain levels of IL-6, IL-8 and CXCL1 were noted in the DOX group, although IL-10 decreased. As DOX has a poor penetration across the blood-brain barrier (BBB), it is proposed that this drug elicits a systemic proinflammatory response with increase of proinflammatory cytokines which cross the BBB and can be involved in the induction of oxidative molecules and proinflammatory cytokines that altogether induce astrogliosis all over the brain. These events may be responsable for chemotherapy-induced cognitive/memory deficits.

Immune responses induced by Pelargonium sidoides extract in serum and nasal mucosa of athletes after exhaustive exercise: modulation of secretory IgA, IL-6 and IL-15

The evidence that exhaustive exercise may compromise the immune response is mainly confirmed by upper respiratory tract infections which are probably related to the decrease in secretory immunoglobulin A in the upper airway mucosa and/or profile changes of systemic cytokines as well as local cytokines of the upper respiratory tract. An extract from Pelargonium sidoides roots is currently used to treat infections in the upper airways. The aim of the present study was to evaluate the action of this herbal medicine on the immune response of athletes submitted to an intense running session by analyzing the production of immunoglobulin A in their saliva and of cytokines both locally and systemically, using a placebo as control. The results show that Pelargonium sidoides extract modulates the production of secretory immunoglobulin A in saliva, both interleukin-15 and interleukin-6 in serum, and interleukin-15 in the nasal mucosa. Secretory immunoglobulin A levels were increased, while levels of IL-15 and IL-6 were decreased. Based on this evidence, we suggest that this herbal medicine can exert a strong modulating influence on the immune response associated with the upper airway mucosa in athletes submitted to intense physical activity.

B-1 cells modulate the kinetics of wound-healing process in mice

Wound healing is a complex phenomenon whose mechanisms are not fully understood. Although inflammatory cells are recruited to the site of the lesion there are no reports concerning the participation of B lymphocytes in tissue repair. As demonstrated in our laboratory, B-1 cells migrate to a non-specific inflammatory focus and differentiate into a phagocyte. It has been reported that BALB/Xid mice are deficient in B-1 cells. Using this model, here we report that BALB/Xid mice have an increased inflammatory response, a delayed wound-healing process, a prominent neutrophilic infiltration of the lesion, and an increased neovascularization of the lesion as compared with BALB/c and BALB/Xid reconstituted with B-1 cells. The infiltration of B-1 cells into the wound was demonstrated. As B-1 cells secret and use interleukin 10 (IL-10) as an autocrine growth factor, the possible participation of this interleukin in the kinetics of wound healing was investigated. Results show that C57/BL6 IL-10 KO mice had an increased inflammatory response when compared with C57/BL6 and C57/BL6 IL-10 KO mice reconstituted with B-1 cells, thus suggesting that the observed effects of B-1 cells in the healing process is mediated by this interleukin. However, the mechanisms by which IL-10 influence these phenomena remain to be uncovered.