Oxygen deficit (O2 deficit) and post-exercise oxygen uptake ( V̇ O2) recovery responses are clinical prognostic markers in cardiac patients but have not been studied after exercise training in patients with coronary heart disease (CHD). We aimed to compare the effects of different modalities of exercise training on O2 deficit and post-exercise V̇ O2 responses in CHD patients. From a pooled analysis of three randomised control trial, patients with CHD were trained with moderate-intensity continuous exercise training (MICET), low volume high-intensity interval training (LV-HIIT), or combined MICET/HIIT for 12 weeks. Cardiopulmonary exercise test (CPET) parameters were assessed, and key exercise variables were calculated during and after exercise. O2 deficit, CPET post-exercise kinetics time constant for oxygen uptake ( τV̇ O2), carbon dioxide ( τV̇ CO2), minute ventilation ( τV̇ E) and heart rate ( τ HR), O2 debt and V̇ O2 recovery delay (RD) were calculated before and after training. A significant training effect for τV̇ O2 (p < 0.05) was shown for all groups. Shorter τV̇ O2 values with small effect size (ES from 0.21 to 0.4) were noted for the combined MICET/HIIT and MICET groups. A significant training effect (p < 0.01) was noted for O2 debt that was increased after training (ES: 0.1 to 0.47). No significant statistical effect was shown for V̇ O2 RD and τV̇ CO2, τV̇ E, τ HR and O2 deficit in all groups. In patients with CHD, exercise training improved post-exercise V̇ O2 kinetic and the O2 debt, with a higher impact of exercise dose (combined MICET/HIIT). Exercise training did not improve the V̇ O2 RD or the recovery time constant value of other cardiorespiratory parameters in CHD patients. NCT03414996, NCT02048696, NCT03443193.

Abstract Introduction Coronary artery disease (CAD) increases the risk of cerebrovascular events, yet early brain injury in this population remains poorly characterized. White matter hyperintensities (WMHs), a biomarker of cerebrovascular lesions, are prevalent in CAD and are linked to risk of stroke. Beyond total burden, spatial distribution of WMHs carries pathological significance and is critical for understanding CAD-related injury. While clinical outcomes including coronary revascularization procedure and myocardial infarction influence CAD prognosis, their impact on WMH burden remains unclear. Methods This study investigated regional WMH burden in CAD and its relationship with clinical characteristics. 82 adults over 50 years participated, including 44 individuals with CAD and 38 controls. WMHs were segmented from fluid attenuated inversion recovery and T1-weighted MRI and categorized as total, periventricular, deep, and superficial regions. History of myocardial infarction and coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)), was obtained from medical files. Results Individuals with CAD exhibited higher total, periventricular, and deep WMH volumes than controls. Participants who underwent CABG had higher superficial WMH volumes than those with PCI, suggesting greater disease severity influences WMH burden. Conclusion CAD is characterized by a distinct pattern of cerebrovascular vulnerability, with revascularization procedures influencing WMH burden

Background:Multimodal exercise programs do not specifically target lumbar paraspinal musculature, but incorporate aspects of different exercises to have an overall benefit. Objective:To investigate the effect of a multimodal exercise program on paraspinal muscle volume and composition, and patient outcomes in individuals with chronic low back pain (CLBP). Methods:Thirty-four participants with CLBP either completed a 14-week high-intensity training program (n = 8) including cardiorespiratory and resistance exercises 3 sessions per week or were waitlisted (n = 26). Participants underwent magnetic resonance imaging at baseline and post-intervention to assess paraspinal muscle volume (cm3) and fatty infiltration (% FI) at L3-L4, L4-L5, and L5-S1. Pain, disability, quality of life, pain-related fear (catastrophizing and Kinesiophobia), and anxiety were assessed via validated self-reported questionnaires. Results:Mixed-design ANOVA revealed no significant time × group interactions for paraspinal muscle volume and %FI. An exploratory analysis revealed a significant increase in multifidus %FI in the control group at L3-L4, L4-L5, and L5-S1, with a concomitant increase in multifidus volume at L3-L4 and L5-S1. The exercise group had a significant increase in multifidus %FI and volume at L5-S1. Significant time × group interactions for pain, disability, catastrophizing and kinesiophobia, and a main effect of group in physical and mental health were found. Significant correlations were found between changes in patient-reported and functional outcomes with paraspinal muscle morphology. Conclusion:Multimodal exercise programs may help prevent LBP-related paraspinal muscle atrophy and %FI, and lead to concomitant improvements in pain, disability and pain-related fear in individuals with CLBP.

Objective: To assess the potential for preventing or reversing the cognitive decline associated with prediabetes and coronary heart disease. Methods: In the DIABEPIC-1 feasibility study, participants with coronary heart disease and prediabetes (HbA1c of 5.7% to 6.4%) underwent a 6-month multidisciplinary enhanced cardiac rehabilitation intervention in Canada in 2023. Cognitive performance was assessed at baseline and six months with the Montreal Cognitive Assessment (MoCA), Rey Auditory Learning Verbal Test (RAVLT), Digit Symbol Substitution Test (DSST), Trail Making Test (TMT), Stroop test, and Verbal Fluency (VFT) test. To account for practice effects in the absence of a control group, standardized regression-based (SRB) formulas and reliable change indexes (RCI) were applied. Results: Thirty participants completed the protocol. Significant improvements were observed in global cognition (MoCA), memory (RAVLT total learning and delayed recall), processing speed (DSST), and executive function (TMT–B, Stroop inhibition and switching, semantic VFT). SRB and RCI analyses showed some participants exceeded expected practice effects in certain cognitive domains. Weight loss was associated with improved processing speed, and reductions in HbA1c were linked to gains in processing speed. Participants achieving prediabetes remission showed greater cognitive improvement. Conclusions: These findings suggest potential cognitive benefits of prediabetes remission and support further investigation.

Cognitive impairment can affect up to 50% of patients with chronic heart failure (CHF) and is associated with reduced treatment adherence, high mortality rates, and poor quality of life. Nonpharmacologic strategies, including cognitive intervention and physical exercise training, may help enhance cognition in patients with CHF. Recent studies in dementia prevention have shown that combining cognitive and exercise interventions could have synergistic effects on cognition, but scientific evidence for the benefits in CHF patients is lacking. Moreover, how men and women with heart failure may differ in their response to nonpharmacologic interventions is also unknown. This randomized controlled trial will investigate the effects of combining cognitive and exercise training, on cognition and cerebral blood flow regulation in men and women with CHF. To achieve this, 216 participants (50% female) with stable CHF regardless of etiology and left ventricular ejection fraction will be randomized to 1 of the 3 following arms: 1. combined cognitive and exercise training; 2. exercise training alone; 3. usual medical care with standard cardiovascular rehabilitation. The first 2 groups will engage in a 6-month intervention, whereas those in group 3 will take part in a standard 3-month cardiac rehabilitation program. The primary endpoint will be changes in cognitive performance from baseline to 6 months based on 4 cognitive composite scores (global cognitive functioning, memory, executive functions, processing speed). Secondary outcomes will include changes in cerebral blood flow regulation (neurovascular coupling, pulsatility, and autoregulation). Tertiary outcomes will include cardiorespiratory fitness, physical functioning, and quality of life. Clinical Trial Registration:NCT04970888.

BackgroundMultitasking, such as listening while balancing, relies on integrated processing in the sensory, cognitive, and motor systems; systems that often decline with age. Hearing loss is linked to increased risks of both falls and cognitive decline. Improving cognitive processing through executive function (EF) training may support balance, especially in older adults with hearing loss. This randomized controlled study conducted across age groups and hearing abilities, examined the effects of a 12-week EF training program on postural outcomes (center of pressure (COP)) using an auditory-cognitive-postural dual-task paradigm.MethodsSixty-five participants including middle-aged adults with normal hearing (MA; n = 19), older adults with normal hearing (OA; n = 23), and older adults with hearing loss who used hearing aids (OAHL; n = 23) were randomly assigned within each age group to an EF training condition or a control condition. Primary outcome measures were auditory-cognitive reaction time on an auditory 2-back working memory task and postural measures (COP path length variability), which were collected in single- and dual-task conditions. Secondary analyses examined whether sensory, cognitive, and mobility performance, as evaluated by baseline standardized assessments, predicted training-related outcomes.ResultsAcross MA, OA, and OAHL groups, cognitive performance generally improved following EF training and transfer of these training effects were observed during experimental postural tasks and auditory-cognitive tasks, but differed depending on age, pure-tone hearing thresholds, and cognitive abilities. Specifically, for postural outcomes, performance improved after training, but only for older adults with better hearing, while those with poorer hearing at any age did not improve. For auditory-cognitive task performance, older adults with the poorest hearing and cognition benefited the most from training.ConclusionsEF training may support balance and cognition in older adults, although its benefits for balance may be limited by severe hearing loss, underscoring the value of early intervention.Trial registrationRegistry Name: ClinicalTrials.gov. Registration/Trial number: NCT05418998. Trial URL: https://clinicaltrials.gov/ct2/show/NCT05418998.

Background Life’s Essential 8 provides a comprehensive framework linking modifiable behavioral and biological factors to cardiovascular risk. This study evaluated a multimediation model to explain how low income is associated with cardiovascular risk indexed by blood pressure. Methods National Health and Nutrition Examination Survey (2021–2023) data were analyzed among community‐dwelling US adults (n=3345). A multimediation path analysis tested a behavioral‐to‐biological pathway from income through health behaviors (moderate‐to‐vigorous physical activity [MVPA], sleep, nutrition, and smoking) to biological measures (body mass index, low‐density lipoprotein cholesterol, and fasting glucose), with systolic blood pressure as the end point. Results Low income was associated with lower MVPA (β=0.11, P<0.001), lower nutrition (β=0.11, P<0.001), and increase in smoking (β=0.40, P<0.001). Total indirect effects indicated that low income was associated with higher fasting glucose (β=−0.10 [95% CI, −0.128 to −0.066]; P=0.010), body mass index (β=−0.10, [95% CI, −0.134 to −0.069]; P=0.006), and systolic blood pressure (β=−0.12 [95% CI, −0.146 to −0.088]; P=0.006). Low MVPA was associated with higher systolic blood pressure (β=−0.03 [95% CI, −0.056 to 0.000]; P=0.048), fasting glucose (β=−0.07, P<0.001), and body mass index (β=−0.08, P<0.001). Conclusions Low income was associated with unhealthy behaviors and indirect associations with adverse biological outcomes and elevated systolic blood pressure. MVPA demonstrated the strongest behavioral association, suggesting that promoting MVPA may mitigate income‐related cardiovascular risk and inform community‐based trials among low‐income individuals.

Background:Hearing loss is one of the largest potentially modifiable risk factors for dementia and is linked with poor cognitive-motor dual-task performance (e.g., walking while performing a cognitive task). Hearing loss is more prevalent and severe in males, whereas dementia is more prevalent in females. Physical exercise and cognitive interventions appear promising in improving dual-tasking in older adults; however, it is currently unclear whether hearing ability affects training efficacy on dual-task outcomes in older adults with mild cognitive impairment (MCI), and whether sex influences this effect. Objective:The primary aim of this study was to examine whether hearing ability affects dual-task performance at baseline and after training in individuals with MCI, and whether sex further influences these relationships, irrespective of intervention arm. Methods:Secondary data was analysed from 75 participants with MCI (Mage  = 73.66 ± 6.67) enrolled in the SYNERGIC trial. Hearing ability was assessed using self-report and behavioral measures. Participants completed a 20-week intervention: (1) Exercise (aerobic-resistance exercise + sham cognitive training; n = 31), (2) Multi-Domain Training (aerobic-resistance exercise + cognitive training; n = 32), or (3) Placebo Training (balance and toning exercises + sham cognitive training; n = 12). Primary outcomes included dual-task gait and cognitive performance. Results:At baseline, poorer hearing predicted worse dual-task performance, particularly in males. Dual-task gait variability significantly improved following Multi-Domain Training in participants with a greater degree of self-reported hearing complaints. Sex-stratified analyses revealed that females with more hearing complaints improved more across all interventions, while in the Multi-Domain group, males with poorer objective hearing and females with better hearing showed the greatest gains. Additionally, in those with poorer hearing, lower cognitive scores (MoCA) predicted greater improvements after Multi-Domain Training, but a decline after Placebo Training. Conclusion:Hearing ability, sex, and cognitive status appear to interact to influence the effects of exercise and cognitive training on dual-task performance in older adults with MCI. Multi-Domain Training appears particularly beneficial for those with hearing loss (who are male and/or have lower cognitive status), highlighting the need for personalized interventions to preserve function and slow decline in this at-risk population. Clinical trial registration:https://www.clinicaltrials.gov/ct2/show/NCT02808676, NCT02808676.

Aerobic exercise training promotes cardiovascular, brain and cognitive health. Regular exercise is associated with higher cardiorespiratory fitness, commonly assessed by peak oxygen uptake (VO2peak) during maximal effort testing. Higher cardiorespiratory fitness has been linked to preserved brain health, particularly higher gray matter volume and perfusion. The brain relies heavily on oxidative metabolism, yet the relationship between cardiorespiratory fitness and brain oxidative metabolism remains underexplored. This study investigated the association between VO2peak and two key cerebral metabolic parameters: the cerebral metabolic rate of oxygen consumption (CMRO2) and oxygen extraction fraction (OEF), which represents the balance between cerebral blood flow (CBF) and CMRO2. Thirty-seven healthy adults aged ⩾50 underwent maximal cardiopulmonary exercise testing for VO2peak assessment. Neuroimaging included dual calibrated functional MRI (dc-fMRI) and quantitative susceptibility mapping (QSM). Higher VO2peak correlated positively with higher CBF across whole-brain gray matter but showed no relationship with CMRO2. Conversely, higher VO2peak negatively correlated with lower OEF from both dc-fMRI and QSM. These findings suggest that greater cardiorespiratory fitness enhances cerebral perfusion without changing resting metabolic rate in healthy older adults, resulting in a reduced oxygen extraction. These results are consistent with exercise yielding improved vascular-metabolic coupling, which would reduce the likelihood of transient hypoxic episodes.

PURPOSE:This study aimed to compare heart rate variability-guided (HRV-G) exercise training versus standard exercise training (SET) on peak oxygen uptake (V̇O₂ peak ) in patients experiencing an acute coronary syndrome event. METHODS:This randomized controlled trial included 48 patients randomized to HRV-G or SET. Both groups consisted of 3 aerobic exercise sessions per week for 3 months. For the HRV-G group, daily exercise was based on a 5-minute morning heart rate recording and the root mean square of successive differences between normal heartbeats (RMSSD). If RMSSD was within ±0.5 SD from baseline, a high-intensity interval training session was performed; if beyond ±0.5 SD , an active recovery session was prescribed. The SET group did 2 sessions of moderate-intensity continuous exercise and 1 session of high-intensity interval training per week, irrespective of HRV status. RESULTS:The V̇O₂ peak increased significantly in both groups (+1.9 mL·kg -1 ·min -1 , P = .002 for SET and +2.1 mL·kg -1 ·min -1 , P < .001 for HRV-G) with no significant group-by-time interaction ( P = .794). Fifty percent of patients were considered responders (ΔV̇O₂ peak change post-pre >5%) in the SET group versus 75% in the HRV-G group ( P = .111). There was a significant time-by-group interaction for V̇O 2 at the first ventilatory threshold, adjusted for lean body mass, showing greater improvement in the HRV-G group compared with the SET group ( P = .043). The training load was significantly lower in HRV-G. CONCLUSIONS:In patients with coronary artery disease, HRV-G exercise training led to similar V̇O₂ peak improvements and prevalence of responders but a larger improvement in V̇O 2 at the first ventilatory threshold adjusted for lean body mass compared with SET, despite a lower training load.

Coronary artery disease is associated with white matter alterations. However, the biological basis of these changes remains unclear, specifically in normal-appearing white matter. Myelin and iron content are crucial measures of white matter health and can be measured with quantitative MRI. This study investigated whether myelin and iron alterations occur in coronary artery disease, and their relationship with cognition. In this cross-sectional study, 46 individuals with coronary artery disease and 40 healthy controls aged > 50 years, with normal cognition underwent 3T MRI and cognitive assessments. Quantitative MRI metrics (susceptibility, magnetization transfer saturation (MTsat), R2* and R1 relaxation rates) were calculated in the border zones between adjacent arterial territories (watershed regions) and in the areas outside these borders (non-watershed regions) in normal-appearing white matter. Relative to controls, the coronary artery disease group showed lower myelin and higher iron content, as measured by lower MTsat and R1, and higher susceptibility specifically in watershed regions. Importantly, these microstructural alterations were associated with poorer cognitive performance in the coronary artery disease group with lower MTsat and R1 related to poorer global cognition and with higher magnetic susceptibility with poorer verbal memory. These findings suggest that coronary artery disease is associated with demyelination and iron deposition in normal-appearing white matter, most prominently in watershed regions, which are known for their susceptibility to stroke. The association of these microstructural alterations with cognition highlights the role of normal-appearing white matter as a key vulnerable region and a promising focus for future mechanistic and therapeutic studies.

PURPOSE: Oxygen deficit (O2 deficit) and post-exercise oxygen uptake ([Formula: see text]O2) recovery responses are clinical prognostic markers in cardiac patients but have not been studied after exercise training in patients with coronary heart disease (CHD). We aimed to compare the effects of different modalities of exercise training on O2 deficit and post-exercise [Formula: see text]O2 responses in CHD patients. METHODS: From a pooled analysis of three randomised control trial, patients with CHD were trained with moderate-intensity continuous exercise training (MICET), low volume high-intensity interval training (LV-HIIT), or combined MICET/HIIT for 12 weeks. Cardiopulmonary exercise test (CPET) parameters were assessed, and key exercise variables were calculated during and after exercise. O2 deficit, CPET post-exercise kinetics time constant for oxygen uptake ([Formula: see text]O2), carbon dioxide ([Formula: see text]CO2), minute ventilation ([Formula: see text]E) and heart rate (τHR), O2 debt and [Formula: see text]O2 recovery delay (RD) were calculated before and after training. RESULTS: A significant training effect for [Formula: see text]O2 (p < 0.05) was shown for all groups. Shorter [Formula: see text]O2 values with small effect size (ES from 0.21 to 0.4) were noted for the combined MICET/HIIT and MICET groups. A significant training effect (p < 0.01) was noted for O2 debt that was increased after training (ES: 0.1 to 0.47). No significant statistical effect was shown for [Formula: see text]O2 RD and [Formula: see text]CO2, [Formula: see text]E, τHR and O2 deficit in all groups. CONCLUSIONS: In patients with CHD, exercise training improved post-exercise [Formula: see text]O2 kinetic and the O2 debt, with a higher impact of exercise dose (combined MICET/HIIT). Exercise training did not improve the [Formula: see text]O2 RD or the recovery time constant value of other cardiorespiratory parameters in CHD patients. TRIAL REGISTRATION: NCT03414996, NCT02048696, NCT03443193.

It has been demonstrated that cognitive training can improve working memory task performance in older adults; however, less is known about the associated brain changes. This study examines how brain activation changes in older adults as a function of working memory training improvement and how this relationship is influenced by task load and training phase. Participants were 58 cognitively healthy older and 28 younger adults from the Attentional Control Training for Older People (ACTOP) study. Older participants completed either working memory training or an active control condition (inhibition training) and received fMRI scans while completing an N-back task at low (1-back) and high (2-back) load before training (PRE), after 6 (MID) and 12 (POST) training sessions. Younger participants served as an age comparison for brain activation. Working memory training improvement was associated with an early (PRE to MID) decrease in activity in frontoparietal regions during the 1-back condition, followed by a late-phase (MID to POST) increase in activity in the frontal lobe during the 2-back condition. There were no significant associations in the control group. Furthermore, there was a significant difference in load-related activation (2>1 back) between older and younger adults at PRE, which was no longer observed at POST within the medial and left hemisphere, suggesting that training restores older adults' load-related modulation of activation to more youthlike levels. These results suggest that working memory training gain in older adults is associated with more efficient brain activation for low-load tasks and a greater ability to recruit neural resources as tasks become more demanding.

Insufficient sleep impairs cognition, particularly hippocampal-dependent memory. However, effective strategies for addressing these effects in humans remain limited. Physical exercise enhances slow-wave sleep (SWS) and improves memory performance, suggesting it may provide a physiologically grounded buffer against sleep-loss-related memory deficits. Here, we tested whether a single session of moderate-intensity exercise may protect long-term declarative memory following sleep restriction, and whether SWS mediates this effect. Eighty-eight healthy young adults (52% female; 24.0 ± 3.8 years) were randomly assigned to one of four groups based on exercise and sleep opportunity: average sleep (S8: 8.5 hours/night), sleep restriction (S5: 4.5 hours/night), exercise before average sleep (ExS8), and exercise before sleep restriction (ExS5). Participants completed either a 30-min evening moderate-intensity cycling (7:00 p.m.; 55-60% VO₂max) or seated rest prior to learning 80 face-name pairs (10:00 p.m.), followed by immediate and delayed recall (120 face-name pairs: 80 studied, 40 novel) after polysomnography-recorded sleep. We found a significant exercise × sleep interaction for delayed recall performance (discriminability index, d'; p = 0.033, partial η2 = 0.056). The delayed recall d' of the ExS5 was significantly higher than the S5 (p = 0.028), but was comparable to S8 and ExS8 groups (ps > 0.05). The proportion of SWS mediated the association between exercise and delayed recall d' (B = 0.105, SE = 0.091, 95% bootstrap CI (0.073, 0.924)). These findings indicate that acute moderate-intensity exercise is associated with offsetting the negative impact of sleep restriction on long-term declarative memory in sleep restriction, an effect statistically mediated by SWS percentage.

Cognitive deficits are common but underrecognized complications of type 2 diabetes (T2D), which may be mitigated by lifestyle factors. The DIABEPIC-2 pilot trial evaluated a 6-month lifestyle intervention targeting T2D remission. We aimed to assess post-intervention changes in cognitive performance and identify associations with metabolic, anthropometric and intervention-related parameters. . This secondary analysis included thirty adults with T2D (mean age 63.0 years, 60

Home-based physical exercise is an accessible strategy to help maintain physical functioning in adults over 50, but mobility gains may be limited without direct supervision. By improving cognitive processes involved in motor control, cognitive training may help enhance the effectiveness of home-based physical exercise in preventing age-related decline in mobility. This study compares the effects of a six-month home-based physical exercise, with or without cognitive training, on gait speed and balance. 127 community-dwelling adults aged 50–87 years (mean 65.20 ± 7.93; 76

Cognitive training can help improve cognition and build cognitive reserve in seniors, but the extent to which cognitive training leads to improvement in untrained tasks, the so called transfer effect, is still debated, and age-related difference in this matter remain understudied. This study investigated the effect of two executive function training tasks, the dual-task and the n-back task, on their analogous untrained tasks in 35 younger adults and 49 older adults. Performance was assessed before and after each group had completed 6 h of their respective training program spread over four weeks. Results show improvement in the dual-task transfer task after dual-task training in both younger and older adults, and that dual-task performances also improved after n-back training but only in older adults. Improvement in performance on the n-back transfer task was also observed after both trainings for the moderate task load (2-back), while for the higher load (3-back) the improvement was only observed in the n-back training group, with equivalent training effects in older and younger adults. These results suggest that executive function training can lead to near transfer to a non-trained task tapping the same attentional control process, in addition to showing age-related difference in transfer effect across tasks. This suggests that, while performing executive control tasks, older adults may engage different attentional control processes from the one targeted by the task. Indeed, improvement in dual-task performance after n-back training in older adults implies that improved working memory capacity can help older adults to better manage dual-task situations.