To assess the potential multi-domain benefits of exercise interventions on patients with Alzheimer’s disease (AD), as well as to determine the specific effects of different exercise modalities ...(aerobic, strength, or combined training).
A systematic search was conducted in PubMed and Web of Science until March 2021 for randomized controlled trials assessing the effect of exercise interventions (compared with no exercise) on patients with AD. Outcomes included cognitive function (mini-mental state examination MMSE test), physical function (e.g., 6-minute walking test 6MWT), functional independence (Barthel index), and neuropsychiatric symptoms (Neuropsychiatric Inventory NPI). A random-effects meta-analysis was conducted.
28 studies (total n = 1337 participants, average age 79–90 years) were included in the systematic review, of which 21 could be meta-analyzed. Although considerable heterogeneity was found, exercise interventions induced several significant benefits, including in Barthel index (n = 147 patients, mean difference MD=8.36 points, 95% confidence interval CI=0.63–16.09), 6MWT (n = 369, MD=84 m, 95% CI=44–133)), and NPI (n = 263, MD=−4.4 points, 95% CI=−8.42 to −0.38). Benefits were also found in the MMSE test, albeit significance was only reached for aerobic exercise (n = 187, MD=2.31 points, 95% CI 0.45–4.27).
Exercise interventions appear to exert multi-domain benefits in patients with AD.
•Exercise can be beneficial for Alzheimer’s disease (AD) but some questions still remain open.•Exercise improves AD patients’ functional independence and neuropsychiatric symptoms.•Evidence suggests that only aerobic exercise seems to significantly improve AD patients’ cognition.•More research is needed to identify the optimal type of exercise program (modality of exercise and dosage).
Nature-based solutions (NbS) can synergistically improve human well-being and biodiversity in urban areas by enhancing ecosystem functions and services. Scaling out NbS, understood as the widespread ...application of NbS in multiple contexts, is an important policy ambition to increase the number of people and regions benefiting from NbS. However, designing scaling-out strategies requires considering critical aspects of the nexus between NbS and ecosystem services (ES) supply to yield large-scale benefits effectively. The aim of the study is twofold: (i) to simulate the stepwise implementation of multiple NbS and (ii) to quantify their cumulative impacts on ES supply and beneficiaries. The NbS implementation was guided by a method that prioritizes different NbS types in multiple sites, by combining spatial information on ES demand and land suitability with a qualitative description of ES supply by NbS type. The cumulative impacts were computed stepwise using GIS modeling. The study was conducted in Las Palmas de Gran Canaria (Spain), focusing on five types of NbS (urban forests, urban parks, community gardens, infiltration ponds), and five ES (runoff mitigation, stormwater treatment, soil erosion control, recreation, and food supply). Overall, 179 NbS were simulated in 130 sites distributed in the city. The findings showed an improvement in all services, albeit significant increments occurred only for certain services. We observed a non-linear relationship between NbS and impacts, including constant, positive, and negative trends. We discussed several factors that were determinants of impacts, providing insights on how to design scaling-out strategies from the biophysical perspective. Moreover, we reflected on the role of multifunctionality, social preferences, and economic feasibility as prioritization criteria for NbS. Finally, we addressed the implementation of NbS scaling-out strategies from a broader perspective, deepening governance, economic and planning challenges, and potential actions for the case study.
•Scaling out urban NbS can contribute to the widespread distribution of co-benefits.•NbS were simulated stepwise and cumulative impacts on ecosystem services were assessed.•Land suitability, NbS multifunctionality and ES demand supported the prioritization.•A non-linear relationship was found between NbS implementation and impacts.•NbS location resulted in being as relevant as the total number and size of interventions.
The World Health Organization has introduced the term ‘intrinsic capacity’ (IC) as a marker of healthy ageing. However, controversy exists on the definition and assessment of IC. We aimed to review ...the definitions and methods used for the assessment of IC in older adults. In addition, we proposed a new IC scoring method.
A systematic search was performed in PubMed, Web of Science, Cochrane Library, Scopus and SPORTDiscus (up to February 10th, 2022) for studies assesing IC in older adults (>60 years).
Thirty-three studies were included. There is overall consensus on the definition of IC as well as on its different dimensions, that is: locomotion, vitality, sensory, cognition and psychological. However, the methods for assessing each of these five dimensions differ substantially across studies and there is no consensus on the best method to compute an eventual global compound score to evaluate IC taking into account all its different dimensions.
The IC represents a highly relevant clinical concept that has been unfortunately underutilized. We propose a standardization for the assessment of each dimension of IC, with a global 0 (worst) to 10 (highest) score.
•The World Health Organization defined the ‘intrinsic capacity’ (IC) as a marker of healthy ageing.•There is overall consensus on the definition of IC, although the methods for assessing it differ substantially across studies.•There is a need for validating a global capacity score that takes into account all its different dimensions.
Introduction
During the last decade, physical activity (PA) (or “exercise”) has been identified as one of the main modifiable factors that influence the development of Alzheimer’s disease (AD) ...pathophysiology. We performed an umbrella review to summarize the evidence on the association between PA/exercise and the risk of developing AD risk, and the effect of exercise interventions on the progression of AD.
Methods
A systematic search was performed in PubMed, SportDiscus, Cochrane Library and Web of Science (March 2022) to identify meta-analyses assessing the association between PA and the incidence of AD, and assessing the effect of exercise interventions on patients with AD.
Results
Twenty-one studies were included. The results with strongest evidence revealed the positive effects of PA on AD risk. Specifically, meeting the WHO recommendations for PA was associated with a lower risk of AD. They also revealed positive effects of exercise on cognitive function, physical performance, and functional independence.
Conclusions
There is strong evidence of a protective effect of regular PA against AD risk; however, the dose–response association remains unclear. Physical exercise seems to improve several dimensions in patients with AD, although research is warranted to elucidate the exercise characteristics that promote the greatest benefits.
Alzheimer's disease (AD), the most common form of neurodegenerative dementia in adults worldwide, is a multifactorial and heterogeneous disorder characterized by the interaction of genetic and ...epigenetic factors and the dysregulation of numerous intracellular signaling and cellular/molecular pathways. The introduction of the systems biology framework is revolutionizing the study of complex diseases by allowing the identification and integration of cellular/molecular pathways and networks of interaction. Here, we reviewed the relationship between physical activity and the next pathophysiological processes involved in the risk of developing AD, based on some crucial molecular pathways and biological process dysregulated in AD: (1) Immune system and inflammation; (2) Endothelial function and cerebrovascular insufficiency; (3) Apoptosis and cell death; (4) Intercellular communication; (5) Metabolism, oxidative stress and neurotoxicity; (6) DNA damage and repair; (7) Cytoskeleton and membrane proteins; (8) Synaptic plasticity. Moreover, we highlighted the increasingly relevant role played by advanced neuroimaging technologies, including structural/functional magnetic resonance imaging, diffusion tensor imaging, and arterial spin labelling, in exploring the link between AD and physical exercise. Regular physical exercise seems to have a protective effect against AD by inhibiting different pathophysiological molecular pathways implicated in AD.
Historically, aging research has largely centered on disease pathology rather than promoting healthy aging. The World Health Organization’s (WHO) policy framework (2015–2030) underscores the ...significance of fostering the contributions of older individuals to their families, communities, and economies. The WHO has introduced the concept of intrinsic capacity (IC) as a key metric for healthy aging, encompassing five primary domains: locomotion, vitality, sensory, cognitive, and psychological. Past AD research, constrained by methodological limitations, has focused on single outcome measures, sidelining the complexity of the disease. Our current scientific milieu, however, is primed to adopt the IC concept. This is due to three critical considerations: (I) the decline in IC is linked to neurocognitive disorders, including AD, (II) cognition, a key component of IC, is deeply affected in AD, and (III) the cognitive decline associated with AD involves multiple factors and pathophysiological pathways. Our study explores the application of the IC concept to AD patients, offering a comprehensive model that could revolutionize the disease’s diagnosis and prognosis. There is a dearth of information on the biological characteristics of IC, which are a result of complex interactions within biological systems. Employing a systems biology approach, integrating omics technologies, could aid in unraveling these interactions and understanding IC from a holistic viewpoint. This comprehensive analysis of IC could be leveraged in clinical settings, equipping healthcare providers to assess AD patients’ health status more effectively and devise personalized therapeutic interventions in accordance with the precision medicine paradigm. We aimed to determine whether the IC concept could be extended from older individuals to patients with AD, thereby presenting a model that could significantly enhance the diagnosis and prognosis of this disease.
•The IC concept could be extended from older individuals to patients with AD.•IC is believed to consist of intricately interconnected biological pathways.•Systems biology, employing integrative omics approaches, helps understand IC.•Omics biomarkers and clinicians’ assessments of AD patients’ helps characterize IC.•IC examination can support healthcare providers to develop tailored therapies.
Lichen sclerosus is a debilitating and chronic disease that typically affects the anogenital area, although it can also be found on extragenital locations such as the shoulders, neck, trunk, breasts, ...and arms. Facial involvement is rare, but there have been a few reported cases of extragenital lichen sclerosus affecting the infraorbital area. To our knowledge, there are 7 documented cases of extragenital lichen sclerosus affecting the eyelid in medical literature. This is a novel case and documented report of a patient with extragenital lichen sclerosus located on the eyelid with eyelash margin involvement.
Lichen sclerosus is a debilitating and chronic disease that typically affects the anogenital area, although it can also be found on extragenital locations such as the shoulders, neck, trunk, breasts, and arms. Facial involvement is rare, but there have been a few reported cases of extragenital lichen sclerosus affecting the infraorbital area. To our knowledge, there are 7 documented cases of extragenital lichen sclerosus affecting the eyelid in medical literature. This is a novel case and documented report of a patient with extragenital lichen sclerosus located on the eyelid with eyelash margin involvement.
This systematic review aims to evaluate and summarize findings from published meta-analyses on the effects of regular exercise in patients with peripheral arterial disease (PAD). The review will ...assess the impact of exercise on functional parameters, health-related quality of life, haemodynamic parameters, physical activity levels, adverse events, and mortality.
A systematic search was performed in PubMed, Web of Science, Scopus, and Cochrane Library databases (up to May 2023) to identify meta-analyses including randomized controlled trials that examined the effects of regular exercise in patients with PAD. Sixteen studies, with a total of 198 meta-analyses, were identified. Results revealed with strong evidence that patients with PAD who exercised improved functional and health-related quality of life parameters. Specifically, supervised aerobic exercise (i.e. walking to moderate-maximum claudication pain) improves maximum walking distance mean difference (MD): 177.94 m, 95% confidence interval (CI) 142.29-213.60; P < 0.00001; I2: 65%, pain-free walking distance (fixed MD: 68.78 m, 95% CI 54.35-83.21; P < 0.00001; I2: 67%), self-reported walking ability i.e. distance score (MD: 9.22 points, 95% CI 5.74-12.70; P < 0.00001; I2: 0%), speed score (MD: 8.71 points, 95% CI 5.64-11.77; P < 0.00001, I2: 0%), stair-climbing score (MD: 8.02 points, 95% CI 4.84-11.21; P < 0.00001, I2: 0%), and combined score (MD: 8.76 points, 95% CI 2.78-14.74; P < 0.0001, I2: 0%), aerobic capacity (fixed MD: 0.62 mL/kg/min, 95% CI 0.47-0.77, P < 0.00001, I2: 64%), and pain score (MD: 7.65, 95% CI 3.15-12.15; P = 0.0009; I2: 0%), while resistance exercise improves lower limb strength (standardized mean difference: 0.71, 95% CI 0.29-1.13, P = 0.0009; I2: 0%. Regarding other outcomes, such as haemodynamic parameters, no significant evidence was found, while physical activity levels, adverse events, and mortality require further investigation.
Synthesis of the currently available meta-analyses suggests that regular exercise may be beneficial for a broad range of functional tasks improving health-related quality of life in patients with PAD. Supervised aerobic exercise is the best type of exercise to improve walking-related outcomes and pain, while resistance exercise is more effective to improve lower limb strength.
Alzheimer’s disease (AD) is determined by various pathophysiological mechanisms starting 10–25 years before the onset of clinical symptoms. As multiple functionally interconnected molecular/cellular ...pathways appear disrupted in AD, the exploitation of high-throughput unbiased omics sciences is critical to elucidating the precise pathogenesis of AD. Among different omics, metabolomics is a fast-growing discipline allowing for the simultaneous detection and quantification of hundreds/thousands of perturbed metabolites in tissues or biofluids, reproducing the fluctuations of multiple networks affected by a disease. Here, we seek to critically depict the main metabolomics methodologies with the aim of identifying new potential AD biomarkers and further elucidating AD pathophysiological mechanisms. From a systems biology perspective, as metabolic alterations can occur before the development of clinical signs, metabolomics – coupled with existing accessible biomarkers used for AD screening and diagnosis – can support early disease diagnosis and help develop individualized treatment plans. Presently, the majority of metabolomic analyses emphasized that lipid metabolism is the most consistently altered pathway in AD pathogenesis. The possibility that metabolomics may reveal crucial steps in AD pathogenesis is undermined by the difficulty in discriminating between the causal or epiphenomenal or compensatory nature of metabolic findings.
•Exploring metabolomic biomarker profiles shows the complexity of AD pathophysiology.•Metabolomics helps disclose candidate blood-based biomarker signatures.•Lipid metabolism is the most consistently dysregulated pathway in AD pathogenesis.•Metabolomics aids to optimize AD diagnosis, prognosis, and targeted therapies.•Metabolomics/lipidomics data can provide a holistic depiction of AD pathophysiology.
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