Causes and Consequences of Interindividual Response Variability: A Call to Apply a More Rigorous Research Design in Acute Exercise-Cognition Studies.

The different responses of humans to an apparently equivalent stimulus are called interindividual response variability. This phenomenon has gained more and more attention in research in recent years. The research field of exercise-cognition has also taken up this topic, as shown by a growing number of studies published in the past decade. In this perspective article, we aim to prompt the progress of this research field by (i) discussing the causes and consequences of interindividual variability, (ii) critically examining published studies that have investigated interindividual variability of neurocognitive outcome parameters in response to acute physical exercises, and (iii) providing recommendations for future studies, based on our critical examination. The provided recommendations, which advocate for a more rigorous study design, are intended to help researchers in the field to design studies allowing them to draw robust conclusions. This, in turn, is very likely to foster the development of this research field and the practical application of the findings.

Cortical hemodynamics as a function of handgrip strength and cognitive performance: a cross-sectional fNIRS study in younger adults.

BACKGROUND: There is growing evidence for a positive correlation between measures of muscular strength and cognitive abilities. However, the neurophysiological correlates of this relationship are not well understood so far. The aim of this study was to investigate cortical hemodynamics [i.e., changes in concentrations of oxygenated (oxyHb) and deoxygenated hemoglobin (deoxyHb)] as a possible link between measures of muscular strength and cognitive performance. METHODS: In a cohort of younger adults (n = 39, 18-30 years), we assessed (i) handgrip strength by a handhold dynamometer, (ii) short-term working memory performance by using error rates and reaction times in the Sternberg task, and (iii) cortical hemodynamics of the prefrontal cortex (PFC) via functional near-infrared spectroscopy (fNIRS). RESULTS: We observed low to moderate negative correlations (rp = ~ - 0.38 to - 0.51; p < 0.05) between reaction time and levels of oxyHb in specific parts of the PFC. Furthermore, we noticed low to moderate positive correlations (rp = ~ 0.34 to 0.45; p < 0.05) between reaction times and levels of deoxyHb in distinct parts of the PFC. Additionally, higher levels of oxyHb (rp (35) = 0.401; p = 0.014) and lower levels of deoxyHb (rp (34) = - 0.338; p = 0.043) in specific parts of the PFC were linked to higher percentage of correct answers. We also found low to moderate correlations (p < 0.05) between measures of handgrip strength and levels of oxyHb (rp = ~ 0.35; p < 0.05) and levels of deoxyHb (rp = ~ - 0.25 to - 0.49; p < 0.05) in specific parts of the PFC. However, there was neither a correlation between cognitive performance and handgrip strength nor did cortical hemodynamics in the PFC mediate the relationship between handgrip strength and cognitive performance (p > 0.05). CONCLUSION: The present study provides evidence for a positive neurobehavioral relationship between cortical hemodynamics and cognitive performance. Our findings further imply that in younger adults higher levels of handgrip strength positively influence cortical hemodynamics although the latter did not necessarily culminate in better cognitive performance. Future research should examine whether the present findings can be generalized to other cohorts (e.g., older adults).

A Discussion on Different Approaches for Prescribing Physical Interventions - Four Roads Lead to Rome, but Which One Should We Choose?

It is well recognized that regular physical exercise has positive effects on physical and mental health. To use the beneficial health effects of physical exercise, there are worldwide movements encouraging health care providers to include physical exercise in their care and treatments strategies. However, a crucial point in administering the "exercise polypill" is the dosing and, in turn, the prescription of the physical intervention (PI). In this perspective article, we discuss the advantages and disadvantages of different approaches to prescribe PI. In this context, we also highlight outstanding questions and potential areas of opportunity for further investigations.

Effect of Resistance Training Under Normobaric Hypoxia on Physical Performance, Hematological Parameters, and Body Composition in Young and Older People.

BACKGROUND: Resistance training (RT) under hypoxic conditions has been used to increase muscular performance under normoxic conditions in young people. However, the effects of RT and thus of RT under hypoxia (RTH) could also be valuable for parameters of physical capacity and body composition across the lifespan. Therefore, we compared the effects of low- to moderate-load RTH with matched designed RT on muscular strength capacity, cardiopulmonary capacity, hematological adaptation, and body composition in young and older people. METHODS: In a pre-post randomized, blinded, and controlled experiment, 42 young (18 to 30 year) and 42 older (60 to 75 year) participants were randomly assigned to RTH or RT (RTH young, RT young, RTH old, RT old). Both groups performed eight resistance exercises (25-40% of 1RM, 3 × 15 repetitions) four times a week over 5 weeks. The intensity of hypoxic air for the RTH was administered individually in regards to the oxygen saturation of the blood (SpO2): ∼80-85%. Changes and differences in maximal isokinetic strength, cardiopulmonary capacity, total hemoglobin mass (tHb), blood volume (BV), fat free mass (FFM), and fat mass (FM) were determined pre-post, and the acute reaction of erythropoietin (EPO) was tested during the intervention. RESULTS: In all parameters, no significant pre-post differences in mean changes (time × group effects p = 0.120 to 1.000) were found between RTH and RT within the age groups. However, within the four groups, isolated significant improvements (p < 0.050) of the single groups were observed regarding the muscular strength of the legs and the cardiopulmonary capacity. DISCUSSION: Although the hypoxic dose and the exercise variables of the resistance training in this study were based on the current recommendations of RTH, the RTH design used had no superior effect on the tested parameters in young and older people in comparison to the matched designed RT under normoxia after a 5-week intervention period. Based on previous RTH-studies as well as the knowledge about RT in general, it can be assumed that the expected higher effects of RTH can may be achieved by changing exercise variables (e.g., longer intervention period, higher loads).

Does squatting need attention?-A dual-task study on cognitive resources in resistance exercise.

INTRODUCTION: Accumulating evidence shows that acute resistance exercises and long-term resistance training positively influence cognitive functions, but the underlying mechanisms have been rarely investigated. One explanatory approach assumes that the execution of resistance exercises requires higher cognitive processes which, in turn, lead to an 'indirect' training of higher cognitive functions. However, current knowledge on the engagement of higher cognitive functions during the execution of resistance exercises is relatively sparse. Hence, the purpose of this study was to examine to what extent cognitive resources are needed to perform a resistance exercise in the form of barbell back squatting. METHODS: Twenty-four young adults performed a cognitive task (serial subtraction of 7's) during standing and during barbell back squatting on a Smith machine. The total number and the number of correct responses were analyzed and taken as indicators of the cognitive load imposed by the experimental condition (squatting) and the control condition (standing). Additionally, participants' perceived exertion, mean heart rate, and the number of squats they were able to perform were assessed. RESULTS: While accuracy scores were found not to be significantly different between conditions, the numbers of total and of correct responses were significantly lower during squatting than during standing. Additionally, during squatting a higher number of total answers was given in the fifth set compared to the first set. We attribute this phenomenon to a learning effect. Furthermore, there was no statistically significant correlation between cognitive measures and perceived exertion. CONCLUSION: Results suggest that perceived exertion cannot explain the higher dual-task costs observed during squatting. They rather reflect that more cognitive resources are needed to perform low-load barbell back squats than during standing. However, further research is necessary to confirm and generalize these findings.

Perspective of Dose and Response for Individualized Physical Exercise and Training Prescription.

Physical interventions are used to increase physical (sports) performance and considered as effective low-cost strategies in the fields of healthcare, disease or injury prevention, and medical treatment. In general, a considerable amount of evidence buttress the application of physical interventions in various fields as it has been demonstrated to contribute to the maintenance and recovery of physical performance, cognitive function, and overall state of health. To implement physical interventions effectively, it is essential to provide an appropriate exercise and training prescription. Exercise and training prescription are key for "dose" specification and for the individualization (personalizing) of physical exercise and training, precisely adjusted and controlled like medication. Since the physiological response to physical interventions is demonstrably individual and dependent on many influencing factors, individualization is an emerging approach aiming to maximize the efficiency of an intervention by accounting for the interindividual heterogeneity. The present brief viewpoint article aims to distinguish and to redefine between the terms dose and response in order to improve the understanding of practitioners, the methodology of study protocols, and to relate future findings to the actual biological (interindividual) variability of acute and chronic responses.

Functional and/or structural brain changes in response to resistance exercises and resistance training lead to cognitive improvements - a systematic review.

BACKGROUND: During the aging process, physical capabilities (e.g., muscular strength) and cognitive functions (e.g., memory) gradually decrease. Regarding cognitive functions, substantial functional (e.g., compensatory brain activity) and structural changes (e.g., shrinking of the hippocampus) in the brain cause this decline. Notably, growing evidence points towards a relationship between cognition and measures of muscular strength and muscle mass. Based on this emerging evidence, resistance exercises and/or resistance training, which contributes to the preservation and augmentation of muscular strength and muscle mass, may trigger beneficial neurobiological processes and could be crucial for healthy aging that includes preservation of the brain and cognition. Compared with the multitude of studies that have investigated the influence of endurance exercises and/or endurance training on cognitive performance and brain structure, considerably less work has focused on the effects of resistance exercises and/or resistance training. While the available evidence regarding resistance exercise-induced changes in cognitive functions is pooled, the underlying neurobiological processes, such as functional and structural brain changes, have yet to be summarized. Hence, the purpose of this systematic review is to provide an overview of resistance exercise-induced functional and/or structural brain changes that are related to cognitive functions. METHODS AND RESULTS: A systematic literature search was conducted by two independent researchers across six electronic databases; 5957 records were returned, of which 18 were considered relevant and were analyzed. SHORT CONCLUSION: Based on our analyses, resistance exercises and resistance training evoked substantial functional brain changes, especially in the frontal lobe, which were accompanied by improvements in executive functions. Furthermore, resistance training led to lower white matter atrophy and smaller white matter lesion volumes. However, based on the relatively small number of studies available, the findings should be interpreted cautiously. Hence, future studies are required to investigate the underlying neurobiological mechanisms and to verify whether the positive findings can be confirmed and transferred to other needy cohorts, such as older adults with dementia, sarcopenia and/or dynapenia.

Dose-response relationship of intermittent normobaric hypoxia to stimulate erythropoietin in the context of health promotion in young and old people.

PURPOSE: Erythropoietin (EPO) has multifactorial positive effects on health and can be increased by intermittent normobaric hypoxia (IH). Recommendations about the intensity and duration of IH to increase EPO exist, but only for young people. Therefore, the aim of the study was to investigate the dose-response relationship regarding the duration of hypoxia until an EPO expression and the amount of EPO expression in old vs. young cohorts. METHODS: 56 young and 67 old people were assigned to two separate investigations with identical study designs (3-h hypoxic exposure) but with different approaches to adjust the intensity of hypoxia: (i) the fraction of inspired oxygen (FiO2) was 13.5%; (ii) the FiO2 was individually adjusted to an oxygen saturation of the blood of 80%. Age groups were randomly assigned to a hypoxia or control group (normoxic exposure). EPO was assessed before, during (90 and 180 min), and 30 min after the hypoxia. RESULTS: EPO increased significantly after 180 min in both cohorts and in both investigations [old: (i) + 16%, p = 0.007 and (ii) + 14%, p < 0.001; young: (i) + 27%, p < 0.001 and (ii) + 45%, p = 0.007]. In investigation (i), EPO expression was significantly higher in young than in old people after 180 min of hypoxic exposure (p = 0.024) and 30 min afterwards (p = 0.001). CONCLUSION: The results indicate that after a normobaric hypoxia of 180 min, EPO increases significantly in both age cohorts. The amount of EPO expression is significantly higher in young people during the same internal intensity of hypoxia than in old people.

Strengthening the Brain-Is Resistance Training with Blood Flow Restriction an Effective Strategy for Cognitive Improvement?

Aging is accompanied by a decrease in physical capabilities (e.g., strength loss) and cognitive decline. The observed bidirectional relationship between physical activity and brain health suggests that physical activities could be beneficial to maintain and improve brain functioning (e.g., cognitive performance). However, the exercise type (e.g., resistance training, endurance training) and their exercise variables (e.g., load, duration, frequency) for an effective physical activity that optimally enhance cognitive performance are still unknown. There is growing evidence that resistance training induces substantial brain changes which contribute to improved cognitive functions. A relative new method in the field of resistance training is blood flow restriction training (BFR). While resistance training with BFR is widely studied in the context of muscular performance, this training strategy also induces an activation of signaling pathways associated with neuroplasticity and cognitive functions. Based on this, it seems reasonable to hypothesize that resistance training with BFR is a promising new strategy to boost the effectiveness of resistance training interventions regarding cognitive performance. To support our hypothesis, we provide rationales of possible adaptation processes induced by resistance training with BFR. Furthermore, we outline recommendations for future studies planning to investigate the effects of resistance training with BFR on cognition.

Motor-cognitive dual-tasking under hypoxia.

Hypoxic conditions diminish motor performance and cognitive functions, especially when the motor task and the cognitive task are conducted simultaneously. Hypoxia does further increase prefrontal cortex activity which provokes a reduced capability of efficient resource utilisation. This, again, might evoke that the capacity of the limited mental resources of a dual task will be reached at an earlier stage of task complexity. The purpose of our study was to examine whether a cognitive task would increase gait variability to a higher extent under hypoxic as compared to normoxic conditions. 18 young subjects walked on a treadmill with and without performing a cognitive task under normoxic vs. normobar hypoxic conditions. The variability of stride times was calculated and a two-way ANOVA with repeated measurements was performed to compare single-task walking with a dual task under both environmental conditions. Furthermore, we compared the cognitive performance while walking in different conditions with Wilcoxon tests. An interaction effect (F 1,34 = 6.178; p = 0.018; η p2  = 0.154) was observed indicating that in the dual-task condition, there was a greater increase in gait variability in hypoxic conditions as compared to normoxic conditions. We further observed that under hypoxic conditions, each participant performed worse in the cognitive task while walking (p < 0.001). Hypoxia might decrease the ability of performing a motor-cognitive dual task. We speculate that performing a dual task under hypoxia requires a shift of resources away from prefrontal regions. However, future research should verify this assumption examining prefrontal cortex activity while dual-task walking under normoxic conditions to analyse the haemodynamic responses of the brain.

Intersession Reliability of Isokinetic Strength Testing in Knee and Elbow Extension and Flexion Using the BTE PrimusRS.

CONTEXT: The use of isokinetic dynamometers playing an important role in different settings of sports and medicine. Therefore, a high reliability of these devices is required. OBJECTIVE: The aim of this study was to examine the intersession reliability of the dynamometer BTE PrimusRS regarding to the isolated single-joint exercises extension/flexion of the knee and elbow for isokinetic testing DESIGN: Intersession reliability. SETTING: Clinical settings and sports science. PARTICIPANTS: 16 young male students. INTERVENTION: The testing protocol includes 5 consecutive repetitions (concentric/concentric) at a velocity of 60°/s for the exercises. MAIN OUTCOME MEASURES: Raw data of torque curves were used to determine the peak torque. Reliability was evaluated with the intraclass correlation coefficient (ICC), the limits of agreement (LoA), and the bias and the variability of measurements (V). RESULTS: High ICC values (.954-.991) were found for the used exercises. However, the LoAs yielded up to over 16 Nm and the V yielded up to nearly 9 % in several testing exercises, indicating poor absolute reliability. CONCLUSION: The BTE PrimusRS shows good to excellent reliability. However, regarding the absolute measures of reliability, the users must decide as experts in their fields whether this reliability is sufficient for their purposes.

Effect of intermittent normobaric hypoxia on aerobic capacity and cognitive function in older people.

OBJECTIVES: Physical exercise, especially aerobic training, improves physical performance and cognitive function of older people. Furthermore, it has been speculated that age-associated deteriorations in physical performance and cognitive function could be counteracted through exposures to passive intermittent normobaric hypoxia (IH). Thus, the present investigation aimed at investigating the effect of passive IH combined with subsequent aerobic training on hematological parameters and aerobic physical performance (V˙O2max) as well as peripheral levels of the neurotrophin brain-derived neurotrophic factor (BDNF) and cognitive function. DESIGN: Randomized controlled trial in a repeated measure design. METHODS: 34 older participants were randomly assigned to an intervention group (IG) or control group (CG). While IG was supplied with passive IH for 90min, CG breathed ambient air. Subsequently, both groups underwent 30min of aerobic training three times per week for four consecutive weeks. Aerobic physical performance and cognitive function was tested with spiroergometry and the Stroop test. Blood samples were taken to measure hematological parameters and the peripheral serum BDNF-level. RESULTS: We found increases in the values of hematological parameters, the time to exhaustion in the load test and an augmented and sustainable improvement in cognitive function within the IG of the older people only. However, in both groups, the V˙O2max and serum BDNF-level did not increase. CONCLUSIONS: Based on these results, hypoxic training seems to be beneficial to enhance hematological parameters, physical performance and cognitive function in older people. The current hypoxic-dose was not able to enhance the serum BDNF-level or V˙O2max.

The effect of physical exhaustion on gait stability in young and older individuals.

Fatigue directly affects key features of the sensorimotor system which disorganizes voluntary control of movement accuracy. Local dynamic stability of walking is considered a sensitive measure for neuromuscular performance. To gain greater insight in the role of fatigue in motor behaviour in older and young adults during walking, the current experiment analyses gait patterns of healthy young but maximal fatigued individuals and gait patterns in submaximal fatigued older adults. Ten young and 18 older subjects performed a bicycle incremental exercise test on a cycle ergometer. In young subjects, the incremental test was performed until total physical exhaustion. In older subjects, the test was performed until submaximal fatigue. Prior to and after the test, the participants walked for 2.5min on a treadmill. Based on linear acceleration data of the trunk, local dynamic stability was assessed. Student's t-test was used to check if differences are statistically significant. In young individuals, we found a significant decrease in the finite-time maximal Lyapunov exponents between unfatigued walking and maximal fatigued walking. In older participants, significant increases in the finite-time maximal Lyapunov between unfatigued walking and submaximal fatigued walking were observed. The results indicate that (1) young and sporty subjects become more stable after having passed a maximum cardiopulmonary exercise test on a cycle ergometer while (2) older individuals walk less locally stable in a submaximal fatigued condition. Older cohorts might show a higher fall risk when they are physically fatigued.

The reliability of local dynamic stability in walking while texting and performing an arithmetical problem.

In the recent years, local dynamic stability of walking was frequently used to quantify motor control. Particularly, dual-task paradigms are used to assess a shift in gait control strategy to test walking in real life situations. Texting short messages while walking is a common motor-cognitive dual task of daily living. To able to monitor possible intervention effects on motor-cognitive dual-task performance, the test-retest reliability of the measure has to be evaluated. Since the reliability of the effects of cognitive tasks including texting while walking on local dynamic gait stability has not been assessed yet, this will be evaluated in the current study. Eleven young individuals were included. Gait data was registered twice (test-retest interval: seven days) using an inertial sensor fixed on the subjects' trunks in three conditions: normal walking, walking while texting a message and walking while reciting serials of 7. Short-term finite maximum Lyapunov Exponents were quantified to assess local dynamic stability. The test-retest reliability was calculated using intra-class correlation coefficients and Bland and Altman Plots (bias and limits of agreement). ICC values of the current study show that in normal walking and walking while texting, outcomes are comparable and indicate mostly good to excellent reliability. The reliability values were almost always the lowest in walking while reciting serials of 7. Local dynamic stability derived from kinematic data of walking while cell phone texting can be reliably collected and, in turn, be used as an outcome measure in clinical trials with repeated measures design.

Evaluation of a supervised multi-modal physical exercise program for prostate cancer survivors in the rehabilitation phase: Rationale and study protocol of the ProCaLife study.

BACKGROUND: After treatment for localized prostate cancer, many survivors experience severe physical and psychological/psychosocial impairments, such as urinary incontinence, erectile dysfunction, fatigue, depressive symptoms and decreased physical functioning. Physical activity and exercise can positively influence such side effects and improve quality of life. However, the majority of prostate cancer survivors are not physically active. Thus, supportive interventions, such as supervised exercise programs, are necessary. But particularly in the post-treatment phase, infrastructure and resources are limited and specific exercise recommendations for prostate cancer survivors do not yet exist. METHODS/DESIGN: The ProCaLife study is a quasi-randomized controlled intervention trial evaluating a specific 26-week physical exercise program for prostate cancer survivors in the rehabilitation phase following medical treatment. Participants are assigned to one of two intervention groups (supervised multi-modal physical exercise including or not including further behavior-oriented techniques) or a control group (not receiving any supervised intervention). Exercise sessions are performed twice weekly and contain specific aerobic, strengthening, flexibility, balance, relaxation and pelvic floor/sphincter exercises as well as mixed games. Behavior-oriented techniques include physical activity-related knowledge transfer and barriers management. The primary endpoint quality of life and secondary psychological/psychosocial, urological, physical fitness and physical activity outcomes are assessed at pre-intervention, post-intervention and follow-up time points. DISCUSSION/CONCLUSION: By evaluating a specific supervised multi-modal physical exercise program, the ProCaLife study contributes to identify effective forms of physical exercise for prostate cancer survivors in the rehabilitation phase. This is of great importance for establishing specific exercise recommendations which are missing so far.

Effects of intermittent hypoxia on cognitive performance and quality of life in elderly adults: a pilot study.

BACKGROUND: Physical exercise has a positive effect on cognitive performance and quality of life (QoL). One reason for this is the upregulation of brain-derived neurotrophic factor, which improves brain plasticity. Intermittent hypoxia promotes first the proliferation of endogenous neuroprogenitors which leads to an increased number of newborn neurons and second the expression of brain-derived neurotrophic factor in the adult hippocampus. Intermittent hypoxia may, therefore, support synaptic plasticity, the process of learning and provoke antidepressant-like effects. Hence, intermittent hypoxia might also lead to improved cognitive functioning and QoL. OBJECTIVE: This study aims to evaluate to what extent physical activity with preceded intermittent hypoxic training is more effective than solely strength-endurance training on cognitive performance and QoL. METHODS: 34 retired people aged between 60 and 70 years were randomly assigned to a control group or intervention group. Contrarily to the control group, which was supplied with a placebo air mixture, the intervention group was supplied with an intermittent hypoxic training prior to a strength-endurance exercise program. The cognitive performance of individuals was examined using the d2 test and the Number Combination Test (ZVT) both before and after the exercise program. We assessed QoL with the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-12) and Pittsburgh Sleep Quality Index (PSQI) and the strength-endurance capacity using the Spring test. RESULTS: Regarding the d2 test, a time × group effect was observed. Speed of cognitive performance in seconds was measured using ZVT. Here, no interaction effect was discovered. An interaction effect was not found in the Physical Component Summary scores (SF-12). Regarding the Mental Component Summary, an interaction effect just failed to become statistically significant. Furthermore, we determined sleep quality with the PSQI. Here, an interaction effect was observed. The analysis of the strength-endurance test revealed no interaction effects. CONCLUSION: The data of the current study suggest that an additional intermittent hypoxic training combined with physical exercise augments the positive effects of exercise on cognitive performance and QoL in elderly humans.