Aerobic exercise has both short and long term effects on mood and emotional states by promotingpositive affect, inhibitingnegative affect, and decreasing the biological response to acutepsychological stress.[12] Aerobic exercise may affect both self-esteem and overall well-being (including sleep patterns) with consistent, long term participation.[15] Regular aerobic exercise may improve symptoms associated withcentral nervous system disorders and may be used asadjunct therapy for this disorders. There is some evidence of exercise treatment efficacy formajor depressive disorder.[9][16][17]
Somepreclinical evidence and emerging clinical evidence supports the use of exercise as an adjunct therapy for the treatment and prevention ofdrug addictions.[18][19][20][21]
Neuroplasticity is the process by whichneurons adapt to a disturbance over time, and most often occurs in response to repeated exposure to stimuli.[25] Aerobic exercise increases the production ofneurotrophic factors[note 1] (e.g.,BDNF,IGF-1,VEGF) which mediate improvements in cognitive functions and various forms of memory by promotingblood vessel formation in the brain,adult neurogenesis,[note 2] and other forms of neuroplasticity.[2][5][27][28] Consistent aerobic exercise over a period of several months inducesclinically significant improvements inexecutive functions and increasedgray matter volume in nearly all regions of the brain,[29] with the most marked increases occurring in brain regions that give rise to executive functions.[1][5][6] The brain structures that show the greatest improvements in gray matter volume in response to aerobic exercise are theprefrontal cortex,caudate nucleus, andhippocampus;[1][5] less significant increases in gray matter volume occur in theanterior cingulate cortex,parietal cortex,cerebellum, andnucleus accumbens.[5] The prefrontal cortex, caudate nucleus, and anterior cingulate cortex are among the most significant brain structures in thedopamine and norepinephrine systems that give rise to cognitive control.[30] Exercise-induced neurogenesis (i.e., the increases in gray matter volume) in the hippocampus is associated with measurable improvements inspatial memory.[31][32] Higherphysical fitness scores, as measured byVO2 max, are associated with better executive function, faster information processing speed, and greatergray matter volume of the hippocampus, caudate nucleus, and nucleus accumbens.[1]
Reviews of neuroimaging studies indicate that consistent aerobic exercise increasesgray matter volume in nearly all regions of the brain,[29] with more pronounced increases occurring in brain regions associated with memory processing, cognitive control,motor function, andreward;[1][5][29] the most prominent gains in gray matter volume are seen in the prefrontal cortex, caudate nucleus, and hippocampus, which support cognitive control and memory processing, among other cognitive functions.[1][6] Moreover, the left and right halves of the prefrontal cortex, the hippocampus, and thecingulate cortex appear to become morefunctionally interconnected in response to consistent aerobic exercise.[1] Three reviews indicate that marked improvements in prefrontal and hippocampal gray matter volume occur in healthy adults that regularly engage in medium intensity exercise for several months.[1][33] Other regions of the brain that demonstrate moderate or less significant gains in gray matter volume during neuroimaging include theanterior cingulate cortex,parietal cortex,cerebellum, andnucleus accumbens.[5][34]
Regular exercise has been shown to counter the shrinking of the hippocampus and memory impairment that naturally occurs in late adulthood.[5] Sedentary adults over age 55 show a 1–2% decline in hippocampal volume annually.[35] A neuroimaging study with a sample of 120 adults revealed that participating in regular aerobic exercise increased the volume of the left hippocampus by 2.12% and the right hippocampus by 1.97% over a one-year period.[35] Subjects in the low intensity stretching group who had higher fitness levels at baseline showed less hippocampal volume loss, providing evidence for exercise being protective against age-related cognitive decline.[35] In general, individuals that exercise more over a given period have greater hippocampal volumes and better memory function.[5] Aerobic exercise has also been shown to induce growth in thewhite matter tracts in the anteriorcorpus callosum, which normally shrink with age.[5][33]
The various functions of the brain structures that show exercise-induced increases in gray matter volume include:
Concordant with the functional roles of the brain structures that exhibit increased gray matter volumes, regular exercise over a period of several months has been shown to persistently improve numerous executive functions and several forms of memory.[5][6][42][43] In particular, consistent aerobic exercise has been shown to improveattentional control,[note 3]information processing speed,cognitive flexibility (e.g.,task switching),inhibitory control,[note 4]working memory updating and capacity,[note 5]declarative memory,[note 6] andspatial memory.[5][6][7][42] In healthy young and middle-aged adults, theeffect sizes of improvements in cognitive function are largest for indices of executive functions and small to moderate for aspects of memory and information processing speed.[1][7] It may be that in older adults, individuals benefit cognitively by taking part in both aerobic and resistance type exercise of at least moderate intensity.[45] Individuals who have a sedentary lifestyle tend to have impaired executive functions relative to other more physically active non-exercisers.[6] A reciprocal relationship between exercise and executive functions has also been noted: improvements in executive control processes, such as attentional control and inhibitory control, increase an individual's tendency to exercise.[6]
This sectionneeds expansion with: an introduction about myokines and how this concept relates to BDNF, IGF-1, VEGF, and other neuroactive biomolecules that penetrate the blood–brain or blood–CSF barriers. General references:[46][47]. You can help byadding to it.(March 2019)
One of the most significant effects of exercise on the brain is increased synthesis and expression ofBDNF, aneuropeptide andhormone, resulting in increased signaling through itsreceptor tyrosine kinase,tropomyosin receptor kinase B (TrkB).[4][48][49] Since BDNF is capable of crossing theblood–brain barrier, higher peripheral BDNF synthesis also increases BDNF signaling in the brain.[28] Exercise-induced increases in BDNF signaling are associated with improved cognitive function, improved mood, and improved memory.[27][48] Furthermore, research has provided a great deal of support for the role of BDNF in hippocampal neurogenesis, synaptic plasticity, and neural repair.[5][48] Engaging in moderate-high intensity aerobic exercise such as running, swimming, and cycling increases BDNFbiosynthesis throughmyokine signaling, resulting in up to a threefold increase inblood plasma and BDNF levels;[4][48][49] exercise intensity is positively correlated with the magnitude of increased BDNF biosynthesis and expression.[4][48][49] A meta-analysis of studies involving the effect of exercise on BDNF levels found that consistent exercise modestly increases resting BDNF levels as well.[27] This has important implications for exercise as a mechanism to reduce stress since stress is closely linked with decreased levels of BDNF in the hippocampus. In fact, studies suggest that BDNF contributes to the anxiety-reducing effects of antidepressants. The increase in BDNF levels caused by exercise helps reverse the stress-induced decrease in BDNF which mediates stress in the short term and buffers against stress-related diseases in the long term.[50]
Cytokines are smallproteins andpeptides released by muscle cells during exercise or contraction that are emitted during power and resistance training, signaling theimmune system.[51][52] They are secreted by various cell types, including immune cells, such asmacrophages, T cells, anddendritic cells,endothelial cells, andfibroblasts. Cytokines facilitate the communication between cells, coordinating varieties of immune responses such as inflammation, cell activation, proliferation, differentiation, andapoptosis, (the death of a cell). Cytokines can act in anautocrine,paracrine, orendocrine manner, depending on the target cells they influence. Cytokine signaling is a must to maintaining immunehomeostasis, defense against pathogens, and resolution of inflammation.[53][54][55][56]
In addition to the persistent effects on cognition that result from several months of daily exercise, acute exercise (i.e., a single bout of exercise) has been shown to transiently improve a number of cognitive functions.[12][62][63] Reviews and meta-analyses of research on the effects of acute exercise on cognition in healthy young and middle-aged adults have concluded that information processing speed and a number of executive functions – including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision making, and inhibitory control – all improve for a period of up to 2 hours post-exercise.[12][62][63] A systematic review of studies conducted on children also suggested that some of the exercise-induced improvements in executive function are apparent after single bouts of exercise, while other aspects (e.g., attentional control) only improve following consistent exercise on a regular basis.[42] Other research has suggested immediate performative enhancements during exercise, such as exercise-concurrent improvements in processing speed and accuracy during both visual attention and working memory tasks.[64][65]
Continuous exercise can produce a transient state ofeuphoria – an emotional state involving the experience ofpleasure and feelings of profound contentment, elation, and well-being – which is colloquially known as a "runner's high" indistance running or a "rower's high" inrowing.[66][67][68][69] Not everyone experiences this.[70]
β-Phenylethylamine, commonly referred to asphenethylamine, is a humantrace amine and potentcatecholaminergic andglutamatergicneuromodulator that has similarpsychostimulant andeuphoriant effects and a similarchemical structure toamphetamine.[74] Thirty minutes of moderate to high intensity physical exercise has been shown to induce an enormous increase in urinaryβ-phenylacetic acid, the primary metabolite of phenethylamine.[75][76][77] Two reviews noted a study where the average 24 hour urinaryβ-phenylacetic acid concentration among participants following just 30 minutes of intense exercise increased by 77% relative to baseline concentrations in resting control subjects;[75][76][77] the reviews suggest that phenethylamine synthesis sharply increases while an individual is exercising, during which time it is rapidly metabolized due to its short half-life of roughly 30 seconds.[75][76][77][78] In a resting state, phenethylamine is synthesized incatecholamine neurons fromL-phenylalanine byaromatic amino acid decarboxylase (AADC) at approximately the same rate at whichdopamine is produced.[78]
In light of this observation, the original paper and both reviews suggest that phenethylamine plays a prominent role in mediating the mood-enhancingeuphoric effects of a runner's high, as both phenethylamine and amphetamine are potent euphoriants.[75][76][77]
β-Endorphin (contracted from "endogenous morphine") is an endogenousopioidneuropeptide that binds toμ-opioid receptors, in turn producingeuphoria andpain relief.[79] Ameta-analytic review found that exercise significantly increases the secretion ofβ-endorphin and that this secretion is correlated with improved mood states.[79] Moderate intensity exercise produces the greatest increase inβ-endorphin synthesis, while higher and lower intensity forms of exercise are associated with smaller increases inβ-endorphin synthesis.[79] A review onβ-endorphin and exercise noted that an individual's mood improves for the remainder of the day following physical exercise and that one's mood is positively correlated with overall daily physical activity level.[79]
However, human studies showed that pharmacological blockade of endogenous endorphins does not inhibit a runner's high, while blockade of endocannabinoids may have such an effect.[80]
Anandamide is anendogenous cannabinoid andretrograde neurotransmitter that binds tocannabinoid receptors (primarilyCB1), in turn producing euphoria.[68][81] It has been shown that aerobic exercise causes an increase in plasma anandamide levels, where the magnitude of this increase is highest at moderate exercise intensity (i.e., exercising at ~70–80% maximum heart rate).[81] Increases in plasma anandamide levels are associated withpsychoactive effects because anandamide is able to cross theblood–brain barrier and act within the central nervous system.[81] Thus, because anandamide is a euphoriant and aerobic exercise is associated with euphoric effects, it has been proposed that anandamide partly mediates the short-term mood-lifting effects of exercise (e.g., the euphoria of a runner's high) via exercise-induced increases in its synthesis.[68][81]
This sectionneeds expansion with:[12]. You can help byadding to it.(June 2017)
Glutamate, one of the most common neurochemicals in the brain, is anexcitatory neurotransmitter involved in many aspects of brain function, including learning and memory.[86] Based upon animal models, exercise appears to normalize the excessive levels of glutamate neurotransmission into thenucleus accumbens that occurs in drug addiction.[19] A review of the effects of exercise on neurocardiac function in preclinical models noted that exercise-induced neuroplasticity of therostral ventrolateral medulla (RVLM) has an inhibitory effect on glutamatergic neurotransmission in this region, in turn reducingsympathetic activity;[87] the review hypothesized that this neuroplasticity in the RVLM is a mechanism by which regular exercise prevents inactivity-relatedcardiovascular disease.[87]
Exercise-induced increases in irisin and BDNF synthesis enhancehippocampalneurogenesis, synaptic plasticity, and neuronal survival, all processes closely linked to improved memory and cognitive performance.[91][92][93] Similarly, circulating lactate andBAIBA from skeletal muscle andβ-hydroxybutyrate from the liver directly influence mitochondrial metabolism in the central nervous system, a mechanism that helps facilitate neuronal energetics and cognitive resilience.[89][93] Additional exerkines such as clusterin and CXCL4 appear to reduce hippocampal inflammation and promote neuralcell proliferation, which may mitigate age-related impairments in cognitive function.[93] While aerobic and resistance exercise induce partially overlapping profiles of circulating exerkines, one review found that they each elicit distinct exerkine profiles and may differentially influence cognitive adaptions to exercise as a consequence.[88]
Engaging in active physical pursuits has demonstrated positive effects on the mental health of children and adolescents,[94] enhances their academic performance,[95] boosts cognitive function,[96] and diminishes the likelihood of obesity and cardiovascular diseases among this demographic.[97] Establishing consistent exercise routines with regular frequency and duration is pivotal.[98][99][100] Cultivating beneficial exercise habits and sustaining adequate physical activity may support the overall physical and mental well-being of young individuals. Therefore, identifying factors that either impede or encourage exercise behaviors could be a significant strategy in promoting the development of healthy exercise habits among children and adolescents.
A 2003 meta-analysis found a positive effect of exercise in children on perceptual skills, intelligence quotient, achievement, verbal tests, mathematic tests, and academic readiness.[101] The correlation was strongest for the age ranges of 4–7 and 11–13 years.[101]
A 2010 meta-analysis of the effect of activity on children's executive function found that aerobic exercise may briefly aid children's executive function and also influence more lasting improvements to executive function.[102] Other studies suggested that exercise is unrelated to academic performance, perhaps due to the parameters used to determine exactly what academic achievement is.[103] This area of study has been a focus for education boards that make decisions on whether physical education should be implemented in the school curriculum, how much time should be dedicated to physical education, and its impact on other academic subjects.[101]
Another study found that sixth-graders who participated in vigorous physical activity at least three times a week had the highest scores compared to those who participated in moderate or no physical activity at all. Children who participated in vigorous physical activity scored three points higher, on average, on their academic test, which consisted of math, science, English, and world studies.[104]
Neuroimaging studies indicate that exercise may influence changes in brain structure and function.[103] Some investigations have linked low levels of aerobic fitness in children with impaired executive function when older as adults, but lack of selective attention, response inhibition, and interference control may also explain this outcome.[105]
Clinical and preclinical evidence indicate that consistent aerobic exercise, especially endurance exercise (e.g.,marathon running), actually prevents the development of certaindrug addictions and is an effective adjunct treatment for drug addiction, and psychostimulant addiction in particular.[18][19][20][21] Consistent aerobic exercise magnitude-dependently (i.e., by duration and intensity) may reduce drug addiction risk, which appears to occur through the reversal of drug-induced, addiction-related neuroplasticity.[19][20] Moreover, aerobic exercise decreases psychostimulant self-administration, reduces thereinstatement (i.e., relapse) of drug-seeking, and induces opposite effects onstriataldopamine receptor D2 (DRD2) signaling (increased DRD2 density) to those induced by pathological stimulant use (decreased DRD2 density).[19][20] Consequently, consistent aerobic exercise may lead to better treatment outcomes when used as an adjunct treatment for drug addiction.[19][21] As of 2016[update], more clinical research is still needed to understand the mechanisms and confirm the efficacy of exercise in drug addiction treatment and prevention.[18]
Exercise does not reduce the symptoms of ADHD.[106] The conclusion by the International Consensus Statement is based on two meta-analyses: one of 10 studies with 300 children and the other of 15 studies and 668 participants, which showed that exercise yields no statistically significant reductions on ADHD symptoms. A 2024 systematic review and meta analysis commissioned by the Patient-Centered Outcomes Research Institute (PCORI) identified seven studies on the effectiveness of physical exercise for treating ADHD symptoms.[107] The type and amount of exercise varied widely across studies from martial arts interventions to treadmill training, to table tennis or aerobic exercise. Effects reported were not replicated, causing the authors to conclude that there is insufficient evidence that exercise intervention is an effective form of treatment for ADHD symptoms.[107][106][107]
Numeroussystematic reviews andmeta-analyses have indicated that exercise has a marked and persistentantidepressant effect in humans,[108][16][109][17][110] an effect believed to be mediated through enhancedBDNF signaling in the brain.[17] Several systematic reviews have analyzed the potential for physical exercise in the treatment ofdepressive disorders. The 2013Cochrane Collaboration review onphysical exercise for depression noted that, based upon limited evidence, it is more effective than a control intervention and comparable to psychological or antidepressant drug therapies.[110] Three subsequent 2014 systematic reviews that included the Cochrane review in their analysis concluded with similar findings: one indicated that physical exercise is effective as anadjunct treatment (i.e., treatments that are used together) with antidepressant medication;[17] the other two indicated that physical exercise has marked antidepressant effects and recommended the inclusion of physical activity as an adjunct treatment for mild–moderate depression and mental illness in general.[16][109] A 2016 meta-analysis concluded that physical exercise improves overall quality of life in individuals with depression relative to controls. One systematic review noted thatyoga may be effective in alleviating symptoms ofprenatal depression.[111] Another review asserted that evidence fromclinical trials supports the efficacy of physical exercise as a treatment for depression over a 2–4 month period.[5] These benefits have also been noted inold age, with a review conducted in 2019 finding that exercise is an effective treatment for clinically diagnosed depression in older adults.[112]
A 2024 systematic review and network meta-analysis of 218randomized controlled trials involving over 14,000 participants found that various forms of exercise, including walking orjogging, yoga,resistance training, and mixedaerobic activities, were associated with reductions in depressive symptoms. The review observed that the effects of exercise were comparable to those ofpsychotherapy andpharmacotherapy, with more intensive exercise yielding greater benefits. Resistance training was identified as particularly effective for younger individuals, while yoga appeared to be more beneficial for older adults. While confidence in the findings was limited by methodological concerns in the included studies, the review noted that exercise produced significant improvements in symptoms across a wide range of participants and treatment contexts.[108]
Physical exercise plays a significant role in the prevention and management ofstroke. It is well established that physical activity decrease the risk of ischemic stroke andintracerebral haemorrhage.[113][114][115] Engaging in physical activity before experiencing a stroke has been found to have a positive impact on the severity and outcomes of stroke.[116] Exercise has the potential to increase the expression of VEGF,caveolin, andangiopoietin in the brain. These changes may promoteangiogenesis andneovascularization that contribute to improved blood supply to the stroke affected areas of the brain.[117][118][119] Exercise may affect the activation ofendothelial nitric oxide synthase (eNOS) and subsequent production ofnitric oxide (NO).[120][121][122] The increase in NO production may lead to improved post-stroke cerebral blood flow, ensuring a sufficient oxygen and nutrient supply to the brain. Physical activity has been associated with increased expression and activation ofhypoxia-inducible factor 1 alpha (HIF-1α),heat shock proteins, andbrain-derived neurotrophic factor (BDNF).[123][124][125] These factors play crucial roles in promoting cellular survival, neuroprotection, and repair processes in the brain following a stroke. Exercise also inhibitglutamate andcaspase activities, which are involved in neuronal death pathways.[126][127][128][129] Additionally, it may promoteneurogenesis in the brain. These effects collectively contribute to the reduction of brain infarction and edema, leading to potential improvements in neurological and functional outcomes. The neuroprotective properties of physical activity in relation to haemorrhagic strokes are less studied. Pre-stroke physical activity has been associated with improved outcomes after intracerebral haemorrhages.[130] Furthermore, physical activity may reduce the volume of intracerebral haemorrhages.[131][132] Being physically active after stroke also enhance the functional recovery.[133][134][135]
Alzheimer's disease is a cortical neurodegenerative disorder and the most prevalent form ofdementia, representing approximately 65% of all cases of dementia; it is characterized by impaired cognitive function, behavioral abnormalities, and a reduced capacity to performbasic activities of daily life.[22] Two reviews found evidence for possible positive effects of physical exercise on cognitive function, the rate of cognitive decline, and the ability to perform activities of daily living in individuals with Alzheimer's disease.[22] A subsequent review found higher levels of physical activity may be associated with reduced risk of dementia and cognitive decline.[24]
Parkinson's disease symptoms reflect various functional impairments and limitations, such aspostural instability,gait disturbance, immobility, and frequent falls. Some evidence suggests that physical exercise may lower the risk of Parkinson's disease.[136] A 2017 study found that strength and endurance training in people with Parkinson's disease had positive effects lasting for several weeks.[137] A 2023 Cochrane review on the effects of physical exercise in people with Parkinson's disease indicated thataquatic exercise might reduce severity of motor symptoms and improve quality of life.[138] Furthermore,endurance training,functional training, and multi-domain training (i.e., engaging in several types of exercise) may provide improvements.[138]
^Neurotrophic factors arepeptides or other small proteins that promote the growth, survival, anddifferentiation of neurons by binding to and activating their associatedtyrosine kinases.[26]
^Adult neurogenesis is the postnatal (after-birth) growth of new neurons, a beneficial form of neuroplasticity.[25]
^Attentional control allows an individual to focus their attention on a specific source and ignore other stimuli that compete for one's attention,[30] such as in thecocktail party effect.
^ Inhibitory control is the process of altering one's learned behavioral responses, sometimes called "prepotent responses", in a way that makes it easier to complete a particular goal.[36][44] Inhibitory control allows individuals to control their impulses and habits when necessary or desired,[36][44] e.g., to overcomeprocrastination.
^Working memory is the form of memory used by an individual at any given moment for active information processing,[30] such as when reading or writing an encyclopedia article. Working memory has a limited capacity and functions as an information buffer, analogous to a computer'sdata buffer, that permits the manipulation of information for comprehension, decision-making, and guidance of behavior.[36]
^Declarative memory, also known asexplicit memory, is the form of memory that pertains to facts and events.[37]
^In healthy individuals, this energy deficit resolves simply from eating and drinking a sufficient amount of food and beverage after exercising.
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