|
EFFECT OF STRENGTH AND ENDURANCE TRAINING ON COGNITION IN OLDER
PEOPLE
|
1School
of Physical Education and Sports, Akdeniz University, Antalya, Turkey
2Department of Neurology, Medical Faculty, Akdeniz University, Antalya,
Turkey.
| Received |
|
12 April 2005 |
| Accepted |
|
18
July 2005 |
| Published |
|
01
September 2005 |
©
Journal of Sports Science and Medicine (2005) 4, 300 - 313
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| ABSTRACT |
| The
purpose of this study was to investigate the effect of moderate strength
and endurance training on cognition evaluated by event-related potentials
(ERP) in older people. Thirty-six adults, aged 60-85 years, were randomly
divided into three groups: sedentary control (C), strength training
(ST), and endurance training (ET). Participants performed functional
fitness tests and ERP data were recorded before and after nine weeks
of training. Training involved three sessions per week. Functional
fitness test performance improved significantly in the ST and ET groups.
The latencies of the N1, N2, and P2 components and the amplitudes
of the N1P2, P2N2, and N2P3 components differed significantly between
groups (p < 0.05). After training, the latencies of the P2 and
N2 components at the Fz and Cz sites, decreased significantly, and
the amplitudes of the N1P2, P2N2, and N2P3 components at the Fz site
and the N1P2 and N2P3 components at the Cz site, increased significantly
in the ST group compared with the ET group. After training, the latencies
of N1, N2, and P2 components shortened significantly, and the amplitudes
of the N1P2, P2N2, and N2P3 components increased significantly in
the ST group compared with the C group. The latencies of the N2 and
P2 components shortened significantly in the ET group compared with
the C group, although the amplitudes of the ERP recordings did not
differ significantly between groups. These data suggest that strength
training might facilitate early sensory processing and cognitive functioning
in older individuals.
KEY
WORDS:Exercise training, cognitive function, aging, event-related
potentials, functional fitness.
|
| INTRODUCTION |
|
Aging
is a natural phenomenon characterized by loss of neurons and decrements
in neurotransmitter release and physiological function (Dice, 1993;
Yu, 1994).
The aging process is accompanied by deterioration of cognitive functions
such as memory, attention, reaction time, and speed of information
processing (Van Boxtel et al., 1997).
The neurotransmitter systems play an important role in the process
of cognition, and deterioration of the transmitter systems causes
cognitive decrement in aging.
A growing body of evidence suggests that physical exercise may have
facilitating effects on general cognitive function during aging
(Chodzko-Zajko and Moore, 1994;
Hatta et al., 2005;
McDowell et al., 2003;
Polich and Lardon, 1997;
Yagi et al., 1999).
In the first well-controlled study of exercise training and cognition,
Dustman et al. (1984)
found that performance on some cognitive tasks is attenuated in
participants with low physical fitness. Despite the implications
of the finding that exercise can contribute to cognitive capability
(intellectual performance), it is unclear whether the type of physical
activity might influence cognition.
Recommendations have been published about the appropriate exercise
prescription to maintain musculoskeletal fitness and reduce the
risk of cardiovascular diseases such as atherosclerosis and coronary
artery disease, which might contribute to healthy aging (ACSM, 1995;
Brandon et al., 2000;
Kasch et al., 1999;
Pollock et al., 2000).
Although aerobic exercise is more frequently recommended to increase
cardiovascular fitness in older adults (Kasch et al., 1999),
strength training is also highly recommended as an important component
of the overall fitness program (Evans and Cyr-Campbell, 1997;
Feigenbaum and Pollock, 1999;
Hass et al., 2001;
Pollock et al., 2000).
Whereas previous studies have suggested that physical training affects
cognitive performance in older subjects (Dustman et al., 1984;
1990;
1993;
Polich and Lardon 1997),
the literature does not address the question of whether different
exercise regimens might contribute to the maintenance of cognitive
capability.
Event-related potentials (ERPs) provide a non-invasive method to
assess the function of the central nervous system (CNS) (Beck and
Dustman, 1975).
ERPs are electrical potentials elicited by a series of repeating
stimuli such as flashes of light, clicks, or tones that the subject
expects to fail. Because ERPs reflect processes that occur in the
CNS between the stimulus and the response, they can provide information
about the time course of cognitive processing in the brain. ERPs
comprise a group of components involved in human cognitive processing
that are usually identified by their polarity and sequence of occurrence
(e.g., P3 specifies the third positive component following the stimulus
onset) (Beck and Dustman, 1975).
ERPs can be evoked in various ways to study aging, including early-latency
visual evoked potentials (VEP), brain stem auditory evoked potentials
(BAEP), and somatosensory evoked potentials (SEP). ERP components
extend over only a few milliseconds and provide information about
the neural transmission of signals through the sensory relay stations
in brain stem structures. Middle-latency components occur between
20 and 80 ms following stimulus presentation and reflect the arrival
and initial processing of sensory input in the primary cortical
receiving areas (Beck and Dustman, 1975).
Long-latency components occur after about 80 ms and reflect characteristics
of the subject's psychological state, for example, the level of
arousal, attention, and habituation (Beck and Dustman, 1975;
Picton et al., 1984;
Regan, 1972).
Long-latency ERPs closely reflect cognitive functions such as stimulus-evaluation
time (P3 latency) and task relevance (P3 amplitude). The latency
of the P3 is acknowledged as a measure of information processing
speed for attention, working memory, and subjective probabilities
(Kügler et al., 1993).
Long-latency ERPs have been studied extensively in normal elderly
people and in individuals with brain pathology such as dementia,
Alzheimer's disease, and Parkinson's disease (Raudino et al., 1997;
Tandon and Majahan, 1999). Previous studies have shown that the P3 latency is influenced
only by the degree of stimulus discriminability but not by the degree
of difficulty in executing the motor responses. The factors that
might influence the P3 amplitude are sensitive to variations in
the sequence of the stimuli preceding the eliciting event, and are
inversely related to both subjective expectancy and objective overall
probability of event occurrence (Kügler et al., 1993).
Many studies have attempted to determine the effect of age on the
P3 component, and whether this has diagnostic utility (Kügler et
al., 1993;
Polich, 2004; Ozgocmen et al., 2003; Yamaguchi and Knight, 1991). For example, the latency of P3 progressively increases
in normal aging (Kügler et al., 1993). Men with a high VO2max demonstrate earlier
P3 latencies, greater P3 amplitude, and superior cognitive efficiency
than men with lower physical fitness (Dustman et al., 1993). The purpose of this study was to determine the effect
of different types of exercise training (moderate endurance and
strength training) on cognitive performance evaluated by ERP recordings
in older individuals.
|
| METHODS |
|
Participants
This study protocol was approved by the Akdeniz University Ethical
Committee (approval number 26.12.2002/08). All participants had
medical clearance to participate in the testing and training sessions.
One hundred and twenty elderly, sedentary participants who did not
engage in any physical training programs were assessed for eligibility
(Figure 1). All signed an informed
consent form before the testing and subsequent training. The participants
were volunteers, between 60 and 85 years of age, who were healthy,
living independently in a retirement home, performing daily living
activities without mobility aids, and had a Standardized Mini-Mental
State Examination (SMMSE) score > 24. Seventy-six people
were excluded: 21 because they had an SMMSE score < 24, and 55
because of a previous history of stroke, diabetes, depression, hypertension,
osteoarthritis, chronic obstructive lung disease, visual or auditory
impairment, and smoking habits. Forty-four of 120 individuals interviewed
initially were included in the study; an additional 25 individuals
did not wish to participate. The 44 adults (30 males, 14 females)
accepted into the study were stratified by their sex and were randomly
assigned to a control group (C), endurance training group (ET),
and strength training group (ST). Two of the women in ET and one
of the women in ST group preferred to stay in the C group, leaving
10 men and three women in the ET group, 10 men and three women in
the ST group, and 10 men and eight women in the C group. Participants
recruited as controls were asked not to participate in a formalized
exercise program or to change their physical activity routine during
the nine-week control period.
Clinical assessments included a thorough preventive medical evaluation
that covered a personal and family health history, a physical examination,
a questionnaire on demographic characteristics and health habits,
resting electrocardiography, lung radiography, blood chemistry,
and hematological tests followed by a consultation with a cardiologist
and neurologist. Older participants who did not repeat all measures
at the post-test assessment and who did not participate in three
consecutive training sessions were excluded. Thirty-six non-smoking
elderly adults completed the randomized trial.
Necessary information on functional ability, affective function,
and cognitive ability was collected at baseline.
Functional ability: Functional ability is an indicator of
physical function and reflects the level of an older adult's functioning
in activities of daily living, instrumental activities of daily
living, and mobility (DiPietro, 1996). Functional ability was assessed by self-evaluation,
using the Turkish version of the Composite Physical Function Questionnaire
(CPF) (Rikli and Jones, 1998). The test-re-test reliability of the Turkish version
of the questionnaire was 0.93. Functional ratings were based on
responses to a 12-item CPF scale asking participants to indicate
their ability to perform common everyday activities ranging from
personal care items such as bathing and dressing oneself (basic
activities of daily living), to various household, gardening, walking,
and lifting activities (activities needed to live independently
within the community), to advanced activities such as moving heavy
objects, sports, and aerobic dance activities (strenuous exercise).
The scoring protocol for the CPF questionnaire required that participants
check one of three responses: "can do" (score 2), "can
do with difficulty or with assistance" (score 1), or "cannot
do" (score 0) for each of the 12 items. Advanced functioning
was defined as being able to perform all 12 items with no difficulty,
moderate functioning as being able to perform seven of the 12 items
with no difficulty, and low functioning as being able to perform
six or fewer of the tasks with no difficulty or assistance (Rikli
and Jones, 2001).
Affective function: Depressive symptomatology was assessed
using the 30-item Geriatric Depression Scale (GDS) (Yesevage et
al., 1983). The GDS was dichotomized into depressed or not depressed
using the Standard cutoff > 11 and < 11, respectively.
However, we note that these cutoffs have not been validated fully
with Turkish older adults.
SMMSE: Cognitive function was measured using the modified Turkish
version of the SMMSE. The sensitivity of the scale was 92%, the
specificity was 93%, and the inter-rater reliability was 0.99 (Güngen
et al., 1999).
Outcome measures
The study was conducted between March 2003 and May 2003. The functional
fitness tests and ERP recordings were performed two weeks before
the start of the training program and repeated in the tenth week,
after the training program had ended. The tests were administered
by the same observers without reference to the baseline values.
The order of testing was identical before and after training: the
ERP recordings were performed first followed by the functional fitness
tests. All recording and testing was performed in the morning between
08:00 and 11:00 h.
ERP procedures
Recordings were made in a sound-attenuated chamber adjacent to the
computers, video monitors, amplifiers, and recorders. During electrophysiological
testing, the participants sat in a comfortable chair 1 m in front
of a monitor. Participants sat motionless and with eyes closed during
the recordings of P3. During ERP monitoring procedure, vigilance
was maintained at a constant level throughout the recording by alerting
participants at 2 min intervals. The participants were familiarized
with the two different tones and instructed to count the rare target
tones silently before the P3 was recorded.
ERP recordings
Ag-AgCl electrodes were placed at Fz and Cz actively according to
the international 10-20 system (Heinze et al., 1999), referenced to a linked earlobe electrode, and with a
forehead electrode as a ground electrode. Impedances were maintained
below 5 k and were measured from each lead at the beginning and
end of each session. P3 potentials were recorded with a Nihon-Kohden®
Neuropack® 8 EMG/evoked-response measuring system
MEB-4200K with a band-pass of 0.1-50 Hz. Recordings were made for
1000 ms, beginning at 100 ms prior to stimulus onset, with an amplification
of 50 V/unit sensitivity. P3 potentials were obtained from an auditory
oddball paradigm. The 2 kHz target tones were presented with a probability
of 20%, whereas the 1 kHz non-target tones were presented with a
probability of 80% binaurally over headphones at a sound level intensity
of 90 dB. Tone bursts were presented with an inter-stimulus interval
of 2 s with 10 ms rise-fall times. Rare tones were presented randomly
when the task was not presented more than three times consecutively.
Responses of targets and non-targets were averaged separately. At
the end of each session, each participant's count was compared with
the actual number of target tones given to assess the accuracy of
the task performance. All participants performed the tasks with
an error rate < 5% in all trials.
Principal peaks and their identification were made according to
the standard recommendations for long latency auditory event-related
potentials of The International Federation of Clinical Neurophysiology
and principal component analysis technique (Heinze et al., 1999). The N1, P2, N2, and P3 latencies and amplitudes were
measured from peak-to-peak points of the N2 and P3 waves at Cz and
Fz recordings. The P3 potentials obtained from target tones were
evaluated. Peak latencies of N1, P2, N2, and P3 were measured using
either the points at which the amplitude was highest or the extrapolated
points when necessary. The amplitude of the P3 wave was measured
as an absolute value between the peak points of N2 and P3 (N2P3).
The neurophysiological values were averaged across Cz and Fz electrode
positions in all participants.
Functional fitness
Functional fitness has been defined as having the physiological
capacity to perform normal everyday activities safely, independently,
and without undue fatigue. After a 10 min warm-up led by an exercise
instructor, the participants completed the Senior Fitness Test items
(Rikli and Jones, 2001),
which have been validated by Rikli and Jones (Rikli and Jones, 1999a). All tests were administered in a group setting of up
to 22 participants per group. To accommodate group testing, all
test stations except the 6 min walk were set up "circuit"
style in a gymnasium. Stations were arranged in the following order
around the periphery of the gymnasium: chair stand, arm curl, height
and weight, chair sit-and-reach, back scratch, and 8 ft (2.44 m)
up-and-go. Immediately after the 10 min warm-up exercises, participants
were evenly divided (four per group) and sent to one of the seven
testing stations to begin their tests. Tests were administered at
each station by one volunteer assistant, with the test coordinator
overseeing the procedures and rotating the groups in clockwise order
from one station to the next. The 6 min walk test was administered
after all other tests had been completed.
The Senior Fitness Test consists of seven different assessments:
1. The chair-stand test was used to assess lower body strength.
After a demonstration by the tester, participants completed a practice
trial of two repetitions, followed by one 30 s test trial. The score
was the total number of stands executed correctly within 30 s.
2. An arm-curl test was used to assess upper body strength.
After a demonstration by the tester, participants completed a practice
trial of two repetitions, followed by one 30 s test trial. The score
was the total number of hand-weight curls performed through the
full range of motion in 30 s.
3. Height was measured by using an ultrasonic height measure
(Soehnle 5001, Soehnle-Waagen GmbH, Murrhardt, Germany) and body
weight was measured with a Tanita Body Composition Analyzer (Model
TBF-300 TANITA, Tokyo, Japan); body mass index (BMI) was calculated
as weight in kilograms divided by the square of height in meters.
4. The chair sit-and-reach test was used to assess lower
body flexibility. After a demonstration by the tester, participants
performed two practice trials, followed by two test trials. The
score was the best distance achieved between the extended fingers
and the tip of the toe, measured to the nearest 1.3 cm.
5. A back-scratch test was used to assess upper body flexibility.
After a demonstration by the examiner, participants performed two
practice trials, followed by two test trials. The score was the
shortest distance achieved between the extended middle fingers,
measured to the nearest 1.3 cm.
6. An 8 ft up-and-go test was used to assess agility or dynamic
balance. After a demonstration, participants performed one practice
trial, followed by two test trials. The score was the shortest time
to rise from a seated position, walk 0.31 m, turn, and return to
the seated position, measured to the nearest 0.1 s.
7. A 6 min walk test was used to assess aerobic endurance.
Participants performed one practice trial before the actual test,
with a break of two days between the practice and test trials. The
score was the total distance walked in 6 min along a 45.72 m rectangular
course, which was marked every 4.57 m.
Exercise protocol
Participants participated in a nine-week exercise program that included
training sessions three times per week. Training sessions began
with a 10 min warm-up and ended with a 10 min cool-down period,
which both included a slow walk followed by slow, static stretching.
The ET group performed aerobic training on a running track, the
ST group performed strength training, and the C group did not train.
Each session was led by trained fitness instructors and supervised
by the researchers.
Aerobic training: The training heart rate was established
using the Karvonen method (Wilmore and Costill, 1994).
The parameters used for the training were intensity (70% of heart
rate reserve), and frequency (3 d·wk-1). The duration
on day 1 was 20 min, which increased by 5 min each session until
participants were walking for 50 min in wk 3. The training heart
rate was monitored by determining the heart rate at the midpoint
and end of each training session via a heart-rate monitor (Sport
Tester PE 300, Helsinki, Finland).
Strength training: The participants performed one set of
12 repetitions of seven exercise stations in the first week, and
three sets in the second week. The exercises included hip extension,
knee flexion, seated lower-leg lift, chair squat, arm raise, biceps
curl, and abdominal crunch. Familiarization sessions and one-repetition
maximum (1RM) determination were performed before the first week
of the training. 1RM was determined for each exercise as suggested
by Rogers et al. (2003).
After formal instruction in the use of weight-training equipment,
participants performed each exercise several times at a low resistance
to ensure proper warm-up and familiarization (free self-selected
weights such as dumbbell, sand bags, and weighted belt). Beginning
weights ranged from 0.5 to 1.5 kg and weight increments were in
the range of 0.5-7 kg, depending on the exercise, until the subject
was unable to lift the additional weight with acceptable form despite
verbal encouragement. Failure was defined as an inability of the
subject to lift the weight through the entire range of motion on
at least two attempts spaced 45-60 s apart. Lifts were discounted
if the participant used momentum or changed body position in a manner
not directly related to the movement of the weight during the exercise
motion to minimize fatigue resulting from repetition, each test
began at a weight near a predicted maximum, and the 1RM was identified
with four to six repetitions. Two minutes of rest was allowed between
trials to prevent premature fatigue. The order in which the 1RMs
were performed was: hip extension, abdominal crunch, biceps curl,
knee flexion, seated lower-leg lift, arm raise, and chair squat.
Weight training began at 60% of 1RM and was gradually adjusted by
5% every 2 wk until participants lifted 80% of 1RM.
Statistical
analysis
Data are expressed as means ± S.E.M. Data were analyzed using SPSS
software (SPSS V. 10.0). P < 0.05 was considered significant.
The absolute changes (postintervention-preintervention) on the Senior
Fitness Test values, and the latencies and amplitudes of the ERP
recordings were calculated for each subject. Analysis of variance
(ANOVA) was used to compare the groups on baseline characteristics,
functional fitness test scores, and ERP recording scores, and to
compare changes between preintervention and postintervention. When
the ANOVA was significant, Tukey post hoc tests were used to locate
the significant differences. A paired t test was used to compare
the mean preintervention and postintervention values from the ERP
recordings for each group.
|
| RESULTS |
|
The
primary aim of this study was to compare the effects of different
types of training (moderate endurance and strength training) on
cognitive performance in elderly participants.
The groups did not differ significantly at baseline for age (p =
0.443), cognitive function (p = 0.289), education (p = 0.553), BMI
(p = 0.725), CPF (p = 0.101), or GDS (p = 0.541). The groups differed
significantly at baseline on the arm-curl test [F(2,33) = 4.596,
p = 0.021] (Table 1 and Table
2). Post hoc comparison of the arm-curl test score revealed
higher scores in the C group than in the ET group (p = 0.017), while
there were no differences between C and ST groups (p = 0.578) and
also ST and ET groups (p = 0.154). The groups did not differ at
baseline on scores for the chair sit-and-reach test (p = 0.713),
back-scratch test (p = 0.256), chair-stand test (p = 0.873), 8 ft
up-and-go test (p = 0.069), 6 min walk test (p = 0.087). The groups
also did not differ significantly at baseline for the latencies
of the N1 (p = 0.992), P2 (p = 0.097), N2 (p = 0.771), and P3 (p
= 0.555) components at the Fz site, and the N1 (p = 0.836), P2 (p
= 0.053), N2 (p = 0.174), and P3 (p = 0.912) components at the Cz
site (Table 3). The groups
did not differ significantly at the Fz site in the amplitudes of
the N1P2 (p = 0.301), P2N2 (p = 0.442), and N2P3 (p = 0.577) components,
and at the Cz site in the amplitudes of the N1P2 (p = 0.525), P2N2
(p = 0.058), and N2P3 (p = 0.156) components (Table
4). All participants were classified as having moderate functional
ability. No accidents or medical complications related to directly
to the training were observed.
Absolute changes in the senior fitness tests (postintervention-preintervention)
The absolute changes in the senior fitness tests are presented in
Table 2. Training resulted
in a significant difference in performance between the groups in
the chair sit-and-reach [F(2,33) = 6.663, p = 0.005]; back scratch
[F(2,33) = 9.819, p = 0.001]; arm curl [F(2,33) = 27.854, p <
0.001]; chair stand [F(2,33) = 10.583, p = 0.001]; 8 ft up-and-go
[F(2,33) = 5.740, p = 0.010] and 6 min walk [F(2,33) = 4.561, p
= 0.022]. The groups did not differ significantly for BMI [F(2,33)
= 0.082, p = 0.922]. Post hoc analysis showed no significant differences
between ET and ST in the chair sit-and-reach (p = 0.899), back scratch
(p = 0.765), arm curl (p = 0.896), chair stand (p = 0.650), 8 ft
up-and-go (p = 0.310), and 6 min walk (p = 0.937). In the ET group,
training produced a significant improvement in performance in the
chair sit-and-reach (p = 0.023), back scratch (p = 0.007), arm curl
(p < 0.001), chair stand (p = 0.007), and 8 ft up-and-go (p =
0.007). Similarly, in the ST group, training improved performance
in the chair sit-and-reach (p = 0.008), back scratch (p = 0.001),
arm curl (p < 0.001), chair stand (p = 0.001) and 6 min walk
(p = 0.030). 8 ft up-and-go performance did not differ between the
ST and C groups (p = 0.182) and 6 min walk performance did not differ
between the ET and C groups (p = 0.063). The C group showed no significant
change in any variable.
Intraclass evaluation of ERP latencies
The latencies of the ERP components for all groups are presented
in Table 3. The latency of
the N1 component at the Fz and Cz sites was reduced in the ST group,
(p = 0.016 and p = 0.005, respectively), and in the ET group (p
= 0.03 and p = 0.003, respectively). The latencies of the P2, N2,
and P3 components at the Fz and Cz sites did not change significantly
in the ST and ET groups (p > 0.05). In the C group, the mean
latencies of the N1, P2, N2, and P3 components did not change significantly
at either the Fz or Cz site (p > 0.05).
Absolute
changes of ERP latencies (postintervention-preintervention)
The absolute changes of the latencies of the ERP components are
presented in Table 5. The groups
differed significantly at the Fz site in the latencies of the N1
component [F(2,33) = 3.335, p = 0.041], P2 component [F(2,33) =
8.111, p = 0.004], and N2 component [F(2,33) = 9.260, p = 0.002].
The groups also differed significantly at the Cz site in the latencies
of the P2 component [F(2,33) = 9.756, p = 0.001] and N2 component
[F(2,33) = 9.787, p = 0.001]. The groups did not differ significantly
at the Fz site in the latency of the P3 component [F(2,33) = 0.020,
p = 0.981]. The groups also did not differ significantly at the
Cz site in the latencies of the P3 component [F(2,33) = 1.145, p
= 0.112] and N1 component [F(2,33) = 2.582, p = 0.0.091].
Post hoc analysis showed significant differences between the ST
and ET groups at the Fz site in the latencies of the P2 component
(p = 0.032) and N2 component (p = 0.011), and at the Cz site in
the latencies of the P2 component (p = 0.007) and N2 component (p
= 0.002). The ST and ET groups did not differ significantly at the
Fz site in the latency of the N1 component (p = 0.292).
In the ST group compared with the C group, training produced significant
improvement in the latencies of the N2 and P2 components at the
Fz site (p = 0.013 and p = 0.003, respectively) and at the Cz site
(p = 0.027 and p = 0.034, respectively) The N1 latency at the Fz
site was shortened in the ST group compared with the C group (p
= 0.002).
The ET and C groups differed significantly in the latencies of the
N2 component at the Fz site (p = 0.013) and the Cz site (p = 0.027),
and the latency of the P2 component at the Fz site (p = 0.003).
The groups did not differ significantly in the latencies of the
N1 component at the Fz site (p = 0.061), and the P2 component at
the Cz site (p = 0.066).
Intraclass
evaluation of the ERP amplitudes
The amplitudes of the ERP components for all groups are presented
in Table 4. In the ST group,
the peak-to-peak amplitudes of N1P2 (p < 0.001), P2N2 (p = 0.027),
N2P3 (p = 0.020) at the Fz site and N1P2 (p = 0.012) at the Cz site
were significantly higher at postintervention than at baseline,
while there were no differences in the peak-to-peak amplitudes of
P2N2 and N2P3 at the Cz site (p > 0.05).
In the ET group, the peak-to-peak amplitude of N1P2 and N2P3 components
at both the Fz and Cz sites were non-significantly higher and peak-to-peak
amplitude of P2N2 at both the Fz and Cz sites were non-significantly
lower at postintervention than at baseline levels (p > 0.05).
The peak-to-peak amplitudes of all components at both sites did
not change significantly in the C group (p > 0.05).
Absolute
changes of ERP amplitudes (postintervention-preintervention)
The absolute changes of the amplitudes of the ERP components are
presented in Table 6. The groups
differed significantly at the Fz site in the amplitudes of the N1P2
component [F(2,33) = 8.601, p = 0.005], P2N2 component [F(2,33)
= 3.979, p = 0.013], and N2P3 component [F(2,33) = 6.497, p = 0.021].
The groups also differed significantly at the Cz site in the amplitudes
of the N1P2 component [F(2,33) = 9.240, p = 0.003] and N2P3 component
[F(2,33) = 4.572, p = 0.010]. The groups did not differ significantly
at the Cz site in the amplitude of the P2N2 component [F(2,33) =
0.743, p = 0.494].
At the Fz site, the absolute changes in the amplitudes of the N1P2
(p = 0.002), P2N2 (p = 0.038), and N2P3 (p = 0.044) components were
greater in the ST than in the ET group. At the Cz site, the absolute
changes in the amplitudes of the N1P2 (p = 0.007) and N2P3 (p =
0.024) components were greater in the ST than in the ET group.
At the Fz site, the absolute changes in the amplitudes of N1P2 (p
= 0.011), P2N2 (p = 0.041), and N2P3 (p = 0.004) components were
greater in the ST than in the C group. At the Cz site, the absolute
changes in the amplitudes of the N1P2 (p = 0.003) and N2P3 (p =
0.010) components were greater in the ST than in the C group. The
ET and C groups did not differ significantly at the Fz site in the
amplitudes of the N1P2 (p = 0.206), P2N2 (p = 0.368), and N2P3 (p
= 0.879) components, and at the Cz site in the amplitudes of the
N1P2 (p = 0.638) and N2P3 (p = 0.057) components.
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| DISCUSSION |
|
The
aim of this study was to determine whether two types of exercise
training would improve cognition or have different effects on cognitive
processing in older people. The functional fitness tests showed
significant improvements after training in the two trained groups,
suggesting that the training programs were sufficient to cause an
improvement in functional fitness in these participants.
Senior
fitness tests
The absolute changes in performance in the functional fitness tests
did not differ between the two training groups. The performance
of both training groups improved significantly in the chair sit-and-reach,
back-scratch, arm-curl, and chair-stand tests compared with the
control group. The absolute change in performance on the 6 min walk
test was greater in the ST than in the C group, and the absolute
change in the 8 ft up-and-go test was higher in the ET than in the
C group.
A high proportion of participants in all groups performed below
the age- and gender-based population norms for these functional
fitness tests (Rikli and Jones, 1999b). In the ET group, 50% were below the relevant norm on
the arm curl and 8 ft up-and-go tests, 58% on the chair-stand and
chair sit-and-reach tests, 33% on the back-scratch test, and 75%
on the 6 min walk test. In the ST group, 42% were below the relevant
norm on the arm-curl test, 67% on the chair-stand and 8 ft up-and-go
tests, 75% on the back-scratch test, and 83% on the 6 min walk and
chair sit-and-reach tests. In the C group, 33% were below the relevant
norm on the arm-curl test, 58% on the chair-stand test, 92% on the
8 ft up-and-go test, 83% on the back-scratch test, 67% on the chair
sit-and-reach test, and 100% on the 6 min walk test. The lower performance
on all tests suggests that these participants were unfit, so the
differences from the published norms probably resulted from the
participants' poor fitness.
Although the participants in the two exercise groups exercised in
a supervised and controlled setting, the improvements in all functional
fitness tests were small, especially for the chair-stand and arm-curl
tests. The improvements in the arm-curl test and chair-stand test
in the ST group were much lower than should be expected with nine
weeks of training. Surprisingly, the ET group improved slightly
more on the arm-curl test than the ST group. Although age did not
differ significantly between the groups, a visual inspection of
the data shows that the ST group was older than the ET group: 42%
of participants in the ST group were 75 years or older. In a previous
study we did not find significant difference between the training
responses of young-old and older participants (Toraman and Şahin,
2004), although another study has reported that adults over
75 years of age had lower rates of restoration of function than
participants in the 65-74 years age range (Beland and Zunzunegui,
1999).
The strength training protocol was adjusted by increasing resistance
by 5% every two weeks and included a familiarization session in
the previous week of training. Another possible reason for the small
improvement in arm strength in the ST group is that the familiarization
sessions before the study began might have caused motor learning-neural
adaptations. Neural factors affect the maximal force output of a
muscle by determining which and how many motor units generate force
in a muscle contraction and the rate at which the motor units fire.
Much of the improvement in strength in the first few weeks of resistance
training is attributable to neural adaptations, as the brain learns
how to generate more force from a given amount of contractile tissue
(Harman, 2000). It is also possible that poor muscle and joint flexibility
of the lower and upper extremities may have limited the extent of
improvement in the arm-curl and chair-stand tests in the ST group.
However, it is unclear how strength training affects the gains in
strength in older people with a poor range of motion. Although we
found no significant difference between the ST and ET groups, arm-curl
performance was better at baseline in the ST group than in ET group.
The ET group was taught the proper walking technique of keeping
the elbows flexed firmly at a 90-degree angle, and swinging the
arms from the shoulder so that the hands end their forward swing
at the level of the sternum, and on the backswing end with the upper
arm nearly parallel to the ground. Although aerobic exercise usually
has little effect on muscular strength, this may have improved arm-curl
performance in the ET group.
Latencies of the ERP components
There is evidence that aerobic exercise produces its effect on P3
by increasing arousal. Exercise helps to contribute to decreased
peak latency (Polich and Lardon, 1997). Yagi et al. (1999) examined the auditory and visual P3 and reaction times
in young volunteers before and after exercise on a cycle ergometer.
They found that the facilitation of reaction times and P3 latency
during exercise was accompanied by decreased accuracy on the oddball
tasks. Bulut et al. (2003)
reported that acute and regular exercise shortens the latency of
sensory-evoked potentials.
We used ERP measurements to investigate the effects of the two exercise
training modes on cognitive processing in older people. After nine
weeks of training, the participants in the ET and ST groups had
earlier N1 latencies, but unchanged P2, N2, and P3 latencies. However,
the absolute decreases in the latencies of the P2 and N2 components
at the Fz site and at the Cz site were greater in the ST group than
in ET group. The absolute changes in the latencies of the N1, P2,
and N2 components at the Fz site, and in the latencies of the P2
and N2 components at the Cz site were shorter in the ST group than
in the C group. The changes in latencies of the P2 and N2 components
at the Fz site and the N2 component at the Cz site were greater
in the ET group than in the C group. Among the physiological factors
involved in ERP variations, little attention has focused on the
influence of exercise type. The P1, N1, P2 components of the ERP
is attributed to early sensory processing (Emmerson-Hanover et al.,
1994; Kayser et al., 2003; Pekkonen et al., 2005; Yagi et al., 1999; Yordanova et al., 2004). The role of exercise on selective VEP and BAEP components
has been extensively studied in young and older participants (Delpont
et al., 1991; Dustman et al., 1990) and in animal studies (Ozkaya et al., 2003). Shorter VEP and BAEP latencies and shorter reaction
times have been reported in physically fit individuals compared
with their sedentary peers (Chodzko-Zajko and Moore, 1994; Dustman et al., 1993; McDowell et al., 2003). In our previous study, we found that shortened VEP latencies
after aerobic exercise were independent of changes in body temperature
(Ozkaya et al., 2003). In our current study, recordings of the ERP components
were made while the participants rested. Chmura et al. (1994)
found that auditory and visual reaction times were immediately preceded
by increases in the plasma concentrations of norepinephrine and
epinephrine in exercising participants.
Amplitudes
of ERP components
Although it is known that exercise helps to contribute to increased
P300 amplitude (Polich and Lardon, 1997), McDowell et al. (2003)
reported that the analysis of amplitude revealed no main effect
for physical activity history.
The amplitudes of the ERP components corresponded with the latency
values of the ERP components, except for the P3 latency and the
N2P3 amplitude in the ST group. In the ST group, the amplitudes
of the N1P2, P2N2, and N2P3 components at the Fz site and the N1P2
component at the Cz site increased, whereas these components did
not change after training in the ET and C groups. The absolute changes
in the amplitudes of the N1P2, P2N2, and N2P3 components at the
Fz site and the N1P2 component at the Cz site were higher in the
ST group than in the ET and C groups. These data suggest that participants
in the ST group had shorter ERP latencies and superior N1P2 values
at both sites. The higher N2P3 amplitude at both sites in the ST
group compared with the ET and C groups suggests that strength training
might improve cognitive function. Although greater amplitudes were
observed in the ET group compared with the C group, these differences
did not reach significance. To our knowledge, no study has investigated
the effects of the different types of exercise training on cognitive
function evaluated by ERP recordings.
The scalp distributions of the early ERP components P1, N1, and
P2 were evidently modality specific, and within each modality, these
early components were nearly identical for new and old items. These
observations are consistent with other studies that used auditory
(Wolpaw and Penry, 1975) and visual stimuli (Kayser et al., 1999). We presume that this pattern reflects the activation
of different neural generators associated with an early, low-level
analysis of auditory and visual stimuli (Kayser et al., 2003). The larger P1 and N1 amplitudes may reflect increased
attention to external stimuli (Hillyard and Anllo-Vento, 1998). It is also possible that, when an older adult performs
a more complex sensorimotor task, the motor responses need to be
guided by, or executed with a stronger reference to, external stimuli,
so that more attention is focused on these stimuli to support the
movement excitation. If so, our data suggest that strength training
may be a more complex sensorimotor task than endurance training.
In a recent study, Yordanova et al. (2004) found that functional dysregulation of motor cortex excitability
during sensorimotor processing occurs with advanced age. In contrast,
several cholinergic (Pekkonen et al., 2005) and non-cholinergic (Raudino et al., 1997;
Tandon and Majahan, 1999)
synaptic mechanisms are relevant to mediating the synaptic mechanisms
involved in early sensory processing and cognition. In our study
design, it is difficult to clarify by which synaptic mechanisms
exercise might affect the sensorimotor cortex. However, our results
suggest that strength training facilitates information processing.
Motor unit firing rates increase as a result of strength training
in older individuals (Roth et al., 2000).
In older individuals, strength training induces neurogenic adaptations,
which contribute to improvements in muscular strength, although
the specific neural adaptations resulting from strength training
are often difficult to determine. To our knowledge, no study has
investigated the effects of strength training on the CNS.
Extensive data show that aerobic exercise is associated with enhanced
cognitive performance in older individuals (Dustman et al., 1990;
Polich and Lardon, 1997).
Two basic mechanisms have been suggested to explain the effect of
aerobic fitness on cognitive processes: the cerebral circulation
hypothesis and the neurotrophic-stimulation hypothesis, which predicts
a beneficial effect of neuromuscular activity on higher brain centers;
both mechanisms may contribute simultaneously (Dustman et al., 1993;
Yagi et al., 1999).
Our data showing shorter N1 latencies after training in both the
ST and ET groups are consistent with these mechanisms.
However, we did not find any facilitating effect of moderate endurance
training, which improved oxidative capacity in the ET group, on
selective ERP components. One possible explanation is the higher
aerobic capacity measured by the 6 min walk test in the ST group.
The duration of the endurance training might have been inadequate
for the slight change in oxidative capacity to contribute to improve
cognition.
It is interesting that only small improvements in functional fitness
affected cognitive performance. To our knowledge, no study has investigated
the relation between the amount of the improvement in physical fitness
and the amount of the improvement in cognitive function. It is likely
that simple participation in group activities, which required sharing
and following the instructors' orders, contributed to the improved
cognitive function despite only small improvements in functional
fitness. Chodzko-Zajko and Moore, (1994)
conclude that the relationship between physical fitness and cognition
is highly task dependent. Physical fitness effects are most likely
to be observed with tasks that require rapid or effortful cognitive
processing and are less likely to occur with automatic processing
tasks (Chodzko-Zajko and Moore, 1994).
|
| CONCLUSIONS |
| In
conclusion, although there were no differences in functional fitness
tests between the ST and ET groups, our results suggest that strength
training may have facilitating effects on early information processing
and cognition. The mechanism of the ERP changes induced by the strength
training is not yet known. After strength training, neurobiological
changes, such as changes in cerebral blood flow, neurotransmitter
functioning, or increased cell complexity, might occur in different
brain regions and contribute to CNS integrity. More research is needed
to determine how the different exercise regimens contribute to discrete
changes in CNS functioning and how such changes affect the P3 component
of the ERP. These preliminary findings await replication using a larger
sample size, which may provide a positive motivational force for the
encouragement of multicomponent exercise programs that include aerobic,
muscular strength, and flexibility components for older adults. |
| ACKNOWLEDGMENTS |
| This
study was supported by a grant from Akdeniz University Research Foundation
(number 2005.01. 0122.001) and by Akdeniz University Sports Sciences
Research and Application Center. The authors are grateful to Nihat
Ayceman, Gülsah Sahin, and Burak Aglamis for their motivational leadership
in the testing and exercise training of our dedicated participants. |
| KEY
POINTS |
- Strength
training may have facilitating effects on early information processing
and cognition in older people.
- It
is interesting that only small improvements in functional fitness
affected cognitive performance.
- More
research is needed to determine how the different exercise regimens
contribute to discrete changes in CNS functioning and how such
changes affect the P3 component of the ERP.
|
| AUTHORS
BIOGRAPHY |
Gül Y. ÖZKAYA
Employment: Ass. Prof., Akdeniz University, School of PE
and Sports, Antalya, Turkey.
Degree: MD.
Research interests: Exercise physiology and neurophysiology.
E-mail: ozkayag@akdeniz.edu.tr |
|
Hülya AYDIN
Employment: Ass. Prof., Akdeniz University Medical Faculty,
Department of Neurology, Antalya,,Turkey.
Degree: MD Assistant Professor
Research Interests: Neurophysiology
E-mail: haydingungor@akdeniz.edu.tr
|
|
Füsun N. TORAMAN
Employment: Dean Assistant, Assoc. Prof., Akdeniz Univ.
School of PE and Sports, Director, Akdeniz Univ. Sport Sciences
Research and Application Center, Antalya, Turkey.
Degree: MD
Research Interests: Geriatrics and gerontology
E-mail: ftoraman@akdeniz.edu.tr |
|
Ferah KIZILAY
Employment: Akdeniz University Medical Faculty, Department
of Neurology, Antalya,Turkey.
Degree: MD, Instructor
Research Interests: Neurophysiology
E-mail: ferah@akdeniz.edu.tr
|
|
Özgür ÖZDEMİR
Employment: PhD student in Physıcal Education and Sports
Teaching in School of Physical Education and Sports at Akdeniz
University, Antalya,Turkey.
Degree: BS
Research Interests: Health of athletes.
E-mail: oozdemir@akdeniz.edu.tr
|
|
Vedat CETİNKAYA
Employment: Department
of Athletic Training, Akdeniz University School of Physical
Education and Sports, Antalya, Turkey.
Degree: MSC, Instructor
Research Interests: Coaching, soccer.
E-mail: cetinkaya@akdeniz.edu.tr
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