Myokines as mediators of exercise-induced cognitive changes in older adults: protocol for a comprehensive living systematic review and meta-analysis.

Background: The world's population is aging, but life expectancy has risen more than healthy life expectancy (HALE). With respect to brain and cognition, the prevalence of neurodegenerative disorders increases with age, affecting health and quality of life, and imposing significant healthcare costs. Although the effects of physical exercise on cognition in advanced age have been widely explored, in-depth fundamental knowledge of the underlying mechanisms of the exercise-induced cognitive improvements is lacking. Recent research suggests that myokines, factors released into the blood circulation by contracting skeletal muscle, may play a role in mediating the beneficial effect of exercise on cognition. Our goal in this ongoing (living) review is to continuously map the rapidly accumulating knowledge on pathways between acute or chronic exercise-induced myokines and cognitive domains enhanced by exercise. Method: Randomized controlled studies will be systematically collected at baseline and every 6 months for at least 5 years. Literature search will be performed online in PubMed, EMBASE, PsycINFO, Web of Science, SportDiscus, LILACS, IBECS, CINAHL, SCOPUS, ICTRP, and ClinicalTrials.gov. Risk of bias will be assessed using the Revised Cochrane Risk of Bias tool (ROB 2). A random effects meta-analysis with mediation analysis using meta-analytic structural equation modeling (MASEM) will be performed. The primary research question is to what extent exercise-induced myokines serve as mediators of cognitive function. Secondarily, the pooled effect size of specific exercise characteristics (e.g., mode of exercise) or specific older adults' populations (e.g., cognitively impaired) on the relationship between exercise, myokines, and cognition will be assessed. The review protocol was registered in PROSPERO (CRD42023416996). Discussion: Understanding the triad relationship between exercise, myokines and cognition will expand the knowledge on multiple integrated network systems communicating between skeletal muscles and other organs such as the brain, thus mediating the beneficial effects of exercise on health and performance. It may also have practical implications, e.g., if a certain myokine is found to be a mediator between exercise and cognition, the optimal exercise characteristics for inducing this myokine can be prescribed. The living review is expected to improve our state of knowledge and refine exercise regimes for enhancing cognitive functioning in diverse older adults' populations. Registration: Systematic review and meta-analysis protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on the 24th of April 2023 (registration number CRD42023416996).

A randomized controlled trial concerning the implementation of the postural Mézières treatment in elite athletes with low back pain.

OBJECTIVE: This study aimed to evaluate the impact of adding the Mézières Method (MM) to the standard rehabilitation protocol for the elite athletes with low back pain (LBP) in reducing lumbar pain rather than only using the traditional rehabilitation protocol treatment. The disciplines considered in this study were soccer, rhythmic gymnastics, and basketball. DESIGN: Randomized controlled trial. SETTING: Training Camp. PARTICIPANTS: One hundred and thirty-nine elite athletes with low back pain of whom 69 were assigned to the experimental group. INTERVENTION: The intervention consists of treatment with three lying postures in a 40-minute-long session twice a week. The session's goal was to focus on breathing exercises, spine mobility, and stretching of the back muscles, with particular attention to the diaphragmatic, paravertebral, and latissimus dorsi muscles. OUTCOME MEASURES: Assessments such as Visual Analogue Scale (VAS), Sit and Reach flexibility test, Roland-Morris Questionnaire, and health status questionnaire (SF12) were used. RESULTS: The evaluation of all outcomes in four measurement periods of the study (baseline, 4, 12, and 24 weeks) showed a significant difference between the groups. Also, at the 6 months of the intervention, a significant difference in the means (SD) was observed in pain (VAS), back flexibility (Sit & Reach) and back disability (QRM) outcomes in favor of the experimental group with a medium-large effect size compared with the control group. CONCLUSION: The MM approach can also be applied to established conventional protocols to alleviate pain and functionality. The obtained results include improving the quality of life of the athletes and their physical and emotional states.

The Mézières Method as a Novel Treatment for Elite Spanish Second-Division Soccer League Players With Low Back Pain: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the efficacy of 24 weeks of treatment with Mézières method in a Spanish elite second-division soccer team with low back pain (LBP), analyzing their state of back health, flexibility, pain, and steps speed. DESIGN: Double-blind randomized controlled trial. METHODS: A total of 20 players with LBP from the second soccer division league were allocated equally to the experimental and control groups (n = 10) as per selection criteria and participated in 2 different rehabilitation programs. The postural Mézières method was implemented in the experimental group, whereas the standard European treatment protocol for LBP was implemented in the control group. Both treatments had a twice weekly session of 40 minutes duration for 24 weeks consecutively with a follow-up in the fourth, 12th, and 24th weeks. RESULTS: Multivariate analysis of covariance with the baseline assessment as a covariance showed a significant difference between groups at the 12th and 24th weeks of the treatment for pain and back functionality. A relevant difference between the experimental and control groups was shown only at the 24th week of the treatment (P < .05) for back flexibility. A significant difference between groups was reported for the quality of life scale and steps speed at the 24th week of the treatment (P > .05). CONCLUSION: The Mézières method showed a positive effect in the elite soccer athletes with nonspecific chronic LBP and can be used as an alternative treatment.

Does the Global Postural Re-Education Affect the Psychological and Postural Aspects of Alzheimer Disease Patients? A Six Months Quasi-Experimental Study.

OBJECTIVE: To study the implementation of Global Postural Re-education as a rehabilitative alternative in residence facilities for seniors with Alzheimer, and to verify its effect on psychological and cognitive symptoms. METHODS: A quasi-experimental design was employed using month-follow-up assessments at 1,3, and 6 months respectively. Ninety elderly people participated in the composition of the study sample: 69 women and 21 men aged from 67 to 89 years (80.2 ±5.5), grouped in two phases: mild and moderate, according to Alzheimer severity. Patients in both groups received the same treatment twice a week for consecutively 24 weeks. Three follow-up medium-long term assessments were performed at intervals of 1, 3, and 6 months. Outcome measures included Mini-Mental State Examination, Geriatric Depression Scale, Quality of Life in Alzheimer Disease, Barthel Index, and Tinetti Scale. RESULTS: The severity of groups therapy interaction showed significant changes in four outcome measures as cognition [F(1,88)=60.26; p=.000; partial η2= 0.406], depression [F(1,88)=8.24; p=.005; partial η2= 0.086], life quality [F(1,88)= 10.45; p=.002; partial η2= 0.106] and equilibrium [F(1,88)= 6.96; p=.010; partial η2= 0.073]. No changes were found for autonomy [F(1,88)= 1.10; p=.297; partial η2= 0.012]. These changes between the two groups were observed at the sixth month follow-up assessment. CONCLUSION: Global postural reeducation could be useful as a complementary rehabilitation treatment in Alzheimer patients.

An Experimental Pilot Study of Global Postural Reeducation Concerning the Cognitive Approach of Patients With Alzheimer's Disease.

BACKGROUND: Several recent studies have examined the positive effects of physical exercise and equilibrium on individuals with neurodegenerative diseases. OBJECTIVES: In this sense, this study based on an experimental design, tested whether global postural reeducation (GPR) can affect equilibrium and cognition, life quality, and psychological symptoms of patients with Alzheimer's disease (AD). METHODS: One hundred thirty-five participants with mild and moderate AD diagnosis were assigned to 2 groups: experimental group (EG, n = 90) and control group (CG, n = 45). The GPR therapy was implemented in the EG for 6 months, while both groups underwent neuropsychological assessments prior and after the 6-month period. RESULTS: According to the repeated measures of analysis of variance, significant differences between groups were found at the 6-month follow-up period, in benefit of the EG such as Mini-Mental State Examination (P = .000), Geriatric Depression Scale (P = .000), Neuropsychiatric Inventory (P = .000), quality of life in AD/patient (P = .000), quality of life in AD/caregivers (P = .000), Barthel index (P = .000), and Tinetti Scale (P = .000), while the CG showed a low performance in the neuropsychological tests. CONCLUSIONS: We suggest that GPR is a therapeutic option, which can improve the psychological, physical, and cognitive aspects of patients with AD.

The Effectiveness of the Mézières Method in Elite Rhythmic Gymnastics Athletes With Low Back Pain: A Randomized Controlled Trial.

CONTEXT: One of the main reasons why athletes with a high physical condition suffer from low back pain disease is because they often participate in sports that involve disc compression movements during flexion, lifting loads, or torsion movement. OBJECTIVES: This study aims to examine the effectiveness of the postural treatment of the Mézières method on elite rhythmic gymnastics athletes with low back pain. DESIGN: Double-blind, randomized, controlled trial. SETTING: The sports hall of "Puente Tocinos," Murcia, Spain. PARTICIPANTS: Ninety gymnastics athletes were randomized into 2 parallel groups (intervention: n = 39; control: n = 51), of whom 98.9% were women (women = 89; man = 1). INTERVENTION: The Mézières method postural therapy was implemented. It lasted about 60 minutes in repeated sessions of 2 to 3 meetings per week by counting in overall 60 sessions during a 24-week period. MAIN OUTCOME MEASURES: Visual analog scale of pain, sit and reach flexibility test, Runtastic (pedometer performance android application), Roland-Morris Questionnaire for the physical disability, and the Health Status Questionnaire were used. RESULTS: The univariate analysis of variance and independent sample t test revealed a significant improvement in the intervention group concerning the visual analog scale pain assessment scale (P < .05, ηp2=.625), and, also, the between-groups effect size was high during the 24 sessions of treatment (d > 0.8) compared with the control one. The same situation persists even for Roland-Morris Questionnaire (P < .05, ηp2=.802), physical score (P < .05, ηp2=.613), mental score (P < .05, ηp2=.736), sit and reach flexibility test (P < .05, ηp2=.666), and Runtastic performance (P < .05, ηp2=.790), where the between-groups effect size was high during the 24 sessions of treatment (d > 0.8). CONCLUSION: The Mézières method treatment performed on athletes with low back pain has caused positive effects on all the outcomes analyzed compared with the ones of control group.

Why Not a Global Postural Reeducation as an Alternative Therapy Applied to Alzheimer's Patients in Nursing Homes? A Pioneer Randomized Controlled Trial.

INTRODUCTION: The classical gymnastics has always given great importance to exercises of -rachis extension and abduction of the arms during deep inhalation to acquire a greater -thoracic capacity. OBJECTIVE: The aim of this study is to organize the concentration and the self-limited capacity of patients with Alzheimer's disease (AD) thanks to the physical and -respiratory exercise modalities of global postural reeducation. DESIGN: A randomized controlled trial was conducted. SETTING: Nursing homes. PARTICIPANTS: Patients with probable AD diagnosis. INTERVENTION: The global postural reeducation method (GPR) was implemented for a total of 72 treatment sessionswith a frequency of 3 times a week, for 24 weeks consecutively. MAIN OUTCOME MEASURES: The Neuropsychiatric Inventory, Mini Mental State Examination, Geriatric Depression Scale, Quality of Life in Alzheimer's Disease and Tinetti Scale and respiratory rate frequency (RSP/F) were applied. RESULTS: Ninety elderly people participated in this study, precisely 50 women and 40 men aged 67-92 years (mean age = 81.17, SD = 5.24). The therapy had a significant effect on the difference between groups in all the outcomes (p < 0.05 in all cases) with a large effect size with exception of the RSP/F (p > 0.05). CONCLUSION: This study demonstrated a very good tolerance rate on behalf of the significant results achieved.