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Exercise improves brain function, possibly reducing dementia risk

Insulin, which is produced by the pancreas and travels to the brain to perform its functions, plays a central role in promoting brain blood flow and neuronal functioning for cognition.

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A study led by scientists at Rutgers University-New Brunswick has shown that specialized cells involved in how the body responds to insulin are activated in the brain after exercise, suggesting that physical activity may directly improve brain function.

study, published in Aging Cell, a journal focused on the biology of aging, indicates that therapies targeting this insulin action may be developed to offset or even prevent dementia progression.

“We believe this work is important because it suggests exercise may work to improve cognition and memory by improving the abilities of insulin to act on the brain,” said Steven Malin, an associate professor in the Department of Kinesiology and Health in the Rutgers School of Arts and Sciences and lead author of the study.

Conducted in collaboration with the National Institutes of Health’s National Institute on Aging, the researchers focused on the role of neuronal extracellular vesicles, specialized cells released by the brain.

Extracellular vesicles, once dismissed by researchers as “cell dust,” have in the past 15 years grown exponentially in recognition as important players in the microscopic world of the human body, facilitating transport of key molecules such as proteins between cells. For this study, the scientists targeted vesicles produced in the brain that ferry several proteins involved in insulin sensitivity – one of which is called Akt.

Insulin sensitivity is a measure of how well the body responds to insulin, a hormone that controls blood sugar levels. People with high insulin sensitivity can use blood glucose more effectively in the body, such as in its muscles, which reduces blood sugar. People with diabetes, with its key symptom of low insulin sensitivity or insulin resistance, have brain cells that are less responsive to insulin. This can have negative impacts on cognition.

Researchers were able to study the vesicles by isolating them in the blood of participants in an experimental study. The trial, conducted over two weeks, included a group of 21 volunteers who had an average age of 60 and had prediabetes. Over the course of the study, they engaged in 12 individual, supervised, 60-minute exercise sessions of moderate to high intensity. The participants ingested a glucose drink before and after training. Researchers then collected blood samples before and during the drink from the participants at the start and end of exercise training.

The blood samples showed that the number of neuronal vesicles carrying proteins involved in insulin sensitivity increased after each training, with Akt being most notable.

“We showed for the first time that exercise impacts insulin signaling from neuronal extracellular vesicles in relation to clinical improvements in blood sugar,” Malin said. “And we use these neuronal extracellular vesicles as an indicator of brain insulin sensitivity.” 

Exercise, therefore, is potentially able to improve the brain’s capacity to respond to insulin for neuronal function, he said.

Insulin is a hormone increasingly recognized to regulate cognition, the mental process of acquiring knowledge through thought, experience and the senses. Prediabetes is a serious health condition that occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as Type 2 diabetes. Those with prediabetes run the risk of having insufficient levels of insulin in their bodies, particularly the brain, which increases the chances of developing diseases of dementia such as Alzheimer’s, Malin said. 

Insulin also plays a crucial role in memory formation, recall, processing speed and the functioning of synapses, structures that allow brain cells to communicate with one another. 

“If insulin is insufficient in the brain, that means not only will brain cells become potentially dysfunctional, but also they may fail to interact with each other properly,” Malin said. “It’s like playing the game telephone with a friend. At some point the message gets lost when the brain becomes insulin resistant.”

Exercise has long been believed to improve cognition, but the mechanisms involved have been unclear. Past studies have uncovered evidence that high blood sugar contributes to a decrease in the brain’s ability to recall information and learn new information.

Malin said that insulin, which is produced by the pancreas and travels to the brain to perform its functions, plays a central role in promoting brain blood flow and neuronal functioning for cognition.

“Our work suggests that therapies that target brain insulin action may be able to ward off dementia,” Malin said.

In a new study, Malin and his colleagues are examining whether a single bout of exercise can enhance the ability of intranasal insulin to support cognitive health in aging adults with obesity by measuring brain blood flow and neuronal extracellular vesicles. Their future plans are to conduct a long-term exercise training study that assesses brain insulin sensitivity improvements in relation to cognition in older adults. 

Other Rutgers scientists on the study included Michal Beeri, director of the Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center at Rutgers
Robert Wood Johnson Medical School; and Daniel Battillo, a doctoral candidate in the kinesiology and applied physiology graduate program. Scientists from the National Institute of Health’s National Institute on Aging involved in the study included Dimitrios Kapogiannis, Maja Mustapic and Francheska Delgado-Peraza.

Wellness

Keeping fit and building muscle could increase survival rates in cancer patients

Anyone can benefit from higher muscle strength and cardiorespiratory fitness to have reduced mortality. But there are especially positive findings for those patients living with lung cancer and digestive cancer.

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Physical fitness and increasing muscle strength could reduce the mortality rate for cancer patients by between 31% to 46%, new research from Edith Cowan University (ECU) has found.

Around 20 million new cancer cases were reported in 2022, with 9.7 million cancer deaths reported world-wide during the same period, with experts expecting the trend to increase in the coming decades.

ECU PhD student Mr Francesco Bettariga noted that in healthy adults, physical fitness and muscle strength has been associated with a 21% reduction in all-cause mortality, as well as a 15% reduction for cardiovascular disease mortality, and a 27% reduction for chronic obstructive pulmonary disease mortality.

Mr Bettariga’s research has found that both muscle strength and cardiorespiratory fitness had a significant impact to lower the risk of all-cause and cancer-specific mortality in patients with any form of cancer and stage.

“Our research found that anyone can benefit from higher muscle strength and cardiorespiratory fitness to have reduced mortality. But when we did our sub-group analysis, we found especially positive findings for those patients living with lung cancer and digestive cancer,” Mr Bettariga said.

“Increased muscle strength and cardiorespiratory fitness had also significant potential to extend the lives of people living with advanced stage of cancer.”

Mr Bettariga said that while physical fitness was beneficial to everyone, increased muscle strength and cardiorespiratory fitness after a cancer diagnosis would still deliver results.

“In practical terms, if a person is diagnosed with cancer and only starts exercising to increase their muscle strength or cardiorespiratory fitness levels after that diagnosis, they will potentially extend their survival and reduce their mortality risk.”

He noted that cardiorespiratory fitness could be particularly increased by aerobic exercises like brisk walking, running, swimming or cycling, while muscle strength could be enhanced by the adoption of resistance exercise programs, including the use of dumbbells, barbell and weight-machine.

“The guidelines are that people should be exercising at least three to five days per week. They can do between 75 minutes and 150 minutes of vigorous-intensity exercise a week, or around 300 minutes of moderate-intensity exercise.

“Resistance exercise training can be done at least twice a week, and would need to incorporate at least two or three sets of each resistance exercise, consisting of around 8 to 15 repetitions each at moderate intensity at least.”

Mr Bettariga said the results from his research underscored the importance of clinical practitioners assessing the physical fitness of cancer patients as part of the process of predicting survival.

“Moreover, from a practical perspective, implementing tailored exercise prescriptions to enhance muscle strength and cardiorespiratory fitness throughout the cancer continuum may contribute to reducing cancer-related mortality.”

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Wellness

Physical activity boosts mental health in women with chronic pelvic pain disorders

By using innovative data modeling techniques, we can better understand how lifestyle factors like physical activity interact with health conditions and pave the way for more personalized treatment approaches.

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A Mount Sinai study provides compelling evidence that exercise can significantly help the mental well-being of millions of women living with chronic pelvic pain disorders (CPPDs), such as endometriosis and uterine fibroids.

The researchers at the Icahn School of Medicine at Mount Sinai found that activities like brisk walking or aerobic exercise can lead to measurable improvements in mental well-being, regardless of pain levels or history of anxiety or depressive disorders. Their findings were reported in the February 26 online issue of the Journal of Pain Research.

CPPDs affect millions of women worldwide, leading to increased health care costs, reduced quality of life, and a higher risk of anxiety and depression, yet effective management strategies remain limited. This study highlights the potential of physical activity as a simple and accessible way to enhance mental well-being, say the investigators.

“Chronic pelvic pain disorders are incredibly complex and burdensome for those affected, yet we still have very few effective treatment strategies,” says lead corresponding author Ipek Ensari, PhD, an Assistant Professor in the Windreich Department of Artificial Intelligence and Human Health at the Icahn School of Medicine and a member of the Hasso Plattner Institute of Digital Health at Mount Sinai. “Our research suggests that physical activity could be an important tool for improving mental health in these patients, offering them a proactive way to enhance their well-being.”

The study tracked 76 women with CPPDs over 14 weeks using mobile health technology, collecting more than 4,200 days’ worth of data. Participants reported their mental health, physical functioning, and pain levels weekly via an app (ehive), while Fitbit devices recorded their daily physical activity. The researchers used advanced statistical modeling to analyze how movement patterns influenced mental health outcomes over time.

One key finding was that the benefits appear to accumulate over time rather than provide immediate relief. “We were particularly intrigued to find that the positive effects of exercise seem to lag by a few days, meaning the mental health benefits may build up gradually,” says Dr. Ensari. “This insight is vital for both patients and health care providers, as it underscores the importance of consistency in physical activity.”

Beyond its implications for patient care, the study also highlights the growing role of artificial intelligence and mobile health technologies in chronic disease management.

“This study showcases the power of wearable technology and AI-driven analysis to uncover valuable insights about health and behavior in real time,” says Girish N. Nadkarni, MD, Chair of the Windreich Department of Artificial Intelligence and Human Healthat the Icahn School of Medicine, Director of the Hasso Plattner Institute for Digital Health, Irene and Dr. Arthur M. Fishberg Professor of Medicine, and Director of The Charles Bronfman Institute for Personalized Medicine. Dr. Nadkarni is also the inaugural System Chief of the Division of Data-Driven and Digital Medicine within Mount Sinai’s Department of Medicine and Co-Director of the Mount Sinai Clinical Intelligence Center. “By using innovative data modeling techniques, we can better understand how lifestyle factors like physical activity interact with health conditions and pave the way for more personalized treatment approaches.”

While the findings are encouraging, the researchers emphasize that physical activity should not be viewed as a replacement for medical treatment but rather as a complementary strategy. Future research will explore how different types and intensities of exercise impact mental health, pain, and fatigue, with the ultimate goal of developing personalized interventions using wearable technology and mobile apps.

The paper is titled “Trajectories of mHealth-tracked mental health and their predictors in female chronic pelvic pain disorders.”

The remaining authors, all with the Icahn School of Medicine except where indicated, are Emily L. Leventhal, BA: Nivedita Nukavarapu, PhD; Noemie Elhadad, PhD (Columbia University Irving Medical Center); Suzanne R. Bakken, PhD, RN, FAAN, FACMI, FIAHSI (Columbia University School of Nursing);  Michal A. Elovitz, MD;  Robert P. Hirten, MD;  Jovita Rodrigues, MS;  Matteo Danieletto, PhD; and Kyle Landell, BA.

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Wellness

Move more, age well: Prescribing physical activity for older adults as a recipe for healthy aging

150 minutes of moderate physical activity every week reduced risk of death from all causes by 31%. Physical activity is essential for aging well and can help prevent or reduce disease in more than 30 chronic conditions, such as coronary artery disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, depression, dementia, and cancer.

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Can physical activity extend the lifespans of older adults? A review article published in CMAJ (Canadian Medical Association Journal) summarizes the considerable evidence supporting the important role physical activity plays in preventing or reducing the effects of diseases and discusses how to prescribe effective exercise for older adults.

Canada’s population is aging, with at least 1 in 5 people aged 65 years or older in 2025, and the number of people older than age 85 years is expected to triple in the next 20 years. However, for many people, these added years do not mean healthy years. More than 80% of adults do not meet the recommendations for physical activity from the Canadian Physical Activity Guidelines.

“Physical activity is one of the most important ways to preserve or improve functional independence, including among older adults who are frail or deemed to be at increased risk of falling,” writes Dr. Jane Thornton, associate professor at Schulich School of Medicine & Dentistry, Western University, London, Ontario, and director of health, medicine and science at the International Olympic Committee. “Higher levels of physical activity in older age are associated with improvements in cognition, mental health, and quality of life.”

A 2023 meta-analysis of several large studies found that 150 minutes of moderate physical activity every week reduced risk of death from all causes by 31%. Physical activity is essential for aging well and can help prevent or reduce disease in more than 30 chronic conditions, such as coronary artery disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, depression, dementia, and cancer.

Benefits of activity include the following:

  • Protection against risk of death from any cause
  • Falls prevention through increased muscle strength and better balance
  • Bone and joint health, including improved bone density and alleviation of some osteoarthritis symptoms
  • Improved cognitive function, and better mood and mental health
  • Ability to engage in daily activities and improved quality of life

The World Health Organization (WHO) recommends 150–300 minutes weekly of moderate-to-intense physical activity for adults, including older adults.

How can clinicians prescribe physical activity?

“As many older adults live with chronic health conditions or reduced mobility, clinicians should tailor and encourage them to take a gradual approach to increasing their physical activity, which should include resistance training (muscle strengthening) as an essential component,” said Dr. Samir Sinha, professor of medicine at the University of Toronto and director of health policy research, National Institute on Ageing.

The WHO 5-step framework — called the “5As” — can provide clinicians with a roadmap to promote activity in their patients. The authors also suggest inputting physical activity in patient records as a vital sign to follow over time. 

“Physical activity is underused as a health intervention both in the community and in the delivery of health care for older adults. Age, frailty, or existing functional impairments should not be viewed as absolute contraindications to physical activity but rather key reasons to prescribe it, considering the benefits of physical activity interventions for older adults. Older adults who become more physically active can potentially add years to their lives as well as higher quality of life to those years,” the authors conclude.

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