Remediation of cognitive and motor functions in Tunisian elderly patients with mild Alzheimer's disease: implications of music therapy and/or physical rehabilitation.

The purpose of this study was to compare the effects of music therapy (MT) and/or physical rehabilitation (PR) on cognitive and motor function in elderly Tunisian male and female patients with mild Alzheimer's disease (AD). Male patients (N: 16; age: 74.19 ± 4.27 years; weight: 76.71 ± 5.22 kg) and female patients (N: 12; age: 71.46 ± 3.36 years; weight: 67.47 ± 4.31 kg) with mild AD were randomly assigned into 4 groups including control group (Co), PR group participated in physical rehabilitation, MT group received music therapy and MT + PR received both music therapy and physical rehabilitation. Participants were required to engage in the study for four months with three 60-min sessions per week. We found all scores of cognitive (MMSE, ADAS-Cog Total and the ADAS-Cog Memory subscale) and motor functions (step length, walking speed, 6MVT and BBS score) evaluated were the greatest in MT + PR compared to the other groups. Our study also demonstrated that MT has a greater effect on cognitive function, while PR has a more pronounced effect on motor function. Changes in MMSE scores were significantly positively correlated in the PR, MT and MT + PR groups with improvements in all motor functions including step length (r = 0.77), walking speed (r = 0.73), 6MVT (r = 0.75) and BBS scores (r = 0.78) in AD patients. In conclusion, the combination of MT and PR seems to be an appropriate intervention approach that needs consideration as a treatment strategy for elderly male and female patients with mild AD.

Salivary Testosterone and Cortisol Levels in Tunisian Elderly Male Patients With Mild Alzheimer's Disease. Implications of Musical Therapy And/Or Physical Rehabilitation.

Changes in salivary testosterone (T) and cortisol (C) levels were assessed in elderly Tunisian male patients with mild Alzheimer's disease (AD) subjected to music therapy and/or physical rehabilitation. Male patients with mild AD (N = 26; age = 76.23 ± 4.27 years; weight: 74.76 ± 5.36 kg) were randomly assigned into four groups for three 60-min sessions per week for 4 months; including Group1 or control group (Co) (n = 6); Group2 (n = 6), participated in physical rehabilitation (PR); Group3 (n = 7), subjected to music therapy (MT) and Group4 (n = 7), participated simultaneously in music therapy and physical rehabilitation (MT + PR). Salivary T levels increased (ηp2 = 0.7) and C levels decreased (ηp2 = 0.69), significantly (p < 0.001) in the PR, MT and MT + PR groups compared to the Co group respectively. Also, increases in salivary T levels and decreases in C levels in MT + PR group were greater compared to the other groups. MT increased T levels (p < 0.001) and decreased C levels (p < 0.05) to a greater extent than the PR group respectively. Changes in salivary T levels were positively (r = 0.83; p < 0.001) and C levels were negatively (r = -0.86; p < 0.001) correlated in the PR, MT and MT + PR groups with changes in MMSE in AD patients. This study highlights that combination of MT and PR holds potential to treat AD.

Mimicking Gene-Environment Interaction of Higher Altitude Dwellers by Intermittent Hypoxia Training: COVID-19 Preventive Strategies.

Cyclooxygenase 2 (COX2) inhibitors have been demonstrated to protect against hypoxia pathogenesis in several investigations. It has also been utilized as an adjuvant therapy in the treatment of COVID-19. COX inhibitors, which have previously been shown to be effective in treating previous viral and malarial infections are strong candidates for improving the COVID-19 therapeutic doctrine. However, another COX inhibitor, ibuprofen, is linked to an increase in the angiotensin-converting enzyme 2 (ACE2), which could increase virus susceptibility. Hence, inhibiting COX2 via therapeutics might not always be protective and we need to investigate the downstream molecules that may be involved in hypoxia environment adaptation. Research has discovered that people who are accustomed to reduced oxygen levels at altitude may be protected against the harmful effects of COVID-19. It is important to highlight that the study's conclusions only applied to those who regularly lived at high altitudes; they did not apply to those who occasionally moved to higher altitudes but still lived at lower altitudes. COVID-19 appears to be more dangerous to individuals residing at lower altitudes. The downstream molecules in the (COX2) pathway have been shown to adapt in high-altitude dwellers, which may partially explain why these individuals have a lower prevalence of COVID-19 infection. More research is needed, however, to directly address COX2 expression in people living at higher altitudes. It is possible to mimic the gene-environment interaction of higher altitude people by intermittent hypoxia training. COX-2 adaptation resulting from hypoxic exposure at altitude or intermittent hypoxia exercise training (IHT) seems to have an important therapeutic function. Swimming, a type of IHT, was found to lower COX-2 protein production, a pro-inflammatory milieu transcription factor, while increasing the anti-inflammatory microenvironment. Furthermore, Intermittent Hypoxia Preconditioning (IHP) has been demonstrated in numerous clinical investigations to enhance patients' cardiopulmonary function, raise cardiorespiratory fitness, and increase tissues' and organs' tolerance to ischemia. Biochemical activities of IHP have also been reported as a feasible application strategy for IHP for the rehabilitation of COVID-19 patients. In this paper, we aim to highlight some of the most relevant shared genes implicated with COVID-19 pathogenesis and hypoxia. We hypothesize that COVID-19 pathogenesis and hypoxia share a similar mechanism that affects apoptosis, proliferation, the immune system, and metabolism. We also highlight the necessity of studying individuals who live at higher altitudes to emulate their gene-environment interactions and compare the findings with IHT. Finally, we propose COX2 as an upstream target for testing the effectiveness of IHT in preventing or minimizing the effects of COVID-19 and other oxygen-related pathological conditions in the future.

Dose-Response Relationship between Endurance Training Prescription Variables and Increases in Aerobic Performance of Healthy and Unhealthy Middle and Very Old Individuals Aged 70 Years and Older: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: The objectives of this systematic review and meta-analysis were to quantify the effectiveness of endurance training (ET) on aerobic performance (i.e., peak oxygen uptake (VO2peak)) in healthy and unhealthy middle and very old adults aged 70 years and older, and to provide dose-response relationships of training prescription variables (in terms of frequency, and volume). METHODS: Several scholarly databases (i.e., PubMed/MEDLINE, SpringerLink, ScienceDirect Journals, and Taylor & Francis Online-Journals) were searched, identifying randomized controlled studies that investigated the effectiveness of ET on VO2peak in older adults. Standardized mean differences (SMD) were calculated. RESULTS: In terms of changes differences between experimental and control group, ET produced significant large effects on VO2peak performance (SMD = 2.64 (95%CI 0.97-4.31)). The moderator analysis revealed that "health status" variable moderated ET effect onVO2peak performance. More specifically, ET produced larger SMD magnitudes on VO2peak performance in healthy compared with unhealthy individuals. With regard to the dose-response relationships, findings from the meta-regression showed that none of the included training prescription variables predicted ET effects on VO2peak performance. CONCLUSIONS: ET is an effective mean for improving aerobic performance in healthy older adults when compared with their unhealthy counterparts.