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Neuroscience of Exercise: From Neurobiology Mechanisms To Mental Health
Neuroscience of Exercise: From Neurobiology Mechanisms To Mental Health
Neuroscience of Exercise: From Neurobiology Mechanisms To Mental Health
Neuroscience of Exercise:
From Neurobiology Mechanisms
to Mental Health
Eduardo Matta Mello Portugal a–c Thais Cevada a, d Renato Sobral Monteiro-Junior a, b, e
a
Neuroscience Laboratory of Exercise, UGF, b Exercise and Sport Sciences Graduate Program, Gama Filho University, UGF,
c
Performance Research Group, UGF, d Institute of Psychiatry of the Federal University of Rio de Janeiro, IPUB/UFRJ,
e
Clinic School of Physiotherapy, UGF, f Federal University of Rio de Janeiro, UFRJ, g Biometry Laboratory, Federal University
of Rio de Janeiro, UFRJ, h Physical Education Course, University Estácio de Sá, and i Laboratory of Physical Activity and Health
Key Words mental health of athletes. Exercise is associated with the in-
Neurobiology of exercise · Depression · Adherence · creased synthesis and release of both neurotransmitters and
Physical training · Mood neurotrophic factors, and these increases may be associat-
ed with neurogenesis, angiogenesis and neuroplasticity.
This review is a call-to-action that urges researchers to con-
Abstract sider the importance of understanding the neuroscience of
The neuroscience of exercise is a growing research area physical exercise and its contributions to sports science.
that is dedicated to furthering our understanding of the ef- Copyright © 2013 S. Karger AG, Basel
fects that exercise has on mental health and athletic perfor-
mance. The present study examined three specific topics:
(1) the relationship between exercise and mental disorders Men ought to know that from nothing else
but the brain come joys, delights, laughter and
(e.g. major depressive disorder, dementia and Parkinson’s
sports, grief, despondency, and lamentation.
disease), (2) the effects of exercise on the mood and mental Hippocrates, 400 BC
health of athletes, and (3) the possible neurobiological
mechanisms that mediate the effects of exercise. Positive re-
sponses to regular physical exercise, such as enhanced func- Introduction
tional capacity, increased autonomy and improved self-es-
teem, are frequently described in the recent literature, and Neuroscience is a growing research area comprising a
these responses are all good reasons for recommending reg- variety of multidisciplinary investigations that seek to un-
ular exercise. In addition, physical exercise may improve derstand the relationship between the body and the brain.
both mood and adherence to an exercise program in healthy At the beginning of the previous century, our knowledge
individuals and might modulate both the performance and of the correlation between neuroscience and exercise was
DOI: 10.1159/000350946
subsequent development of a disability, and some diseas- understanding of this observation. In summary, more re-
es that have MDD as a comorbidity are associated with a search is necessary to better understand the effects of exer-
diminished Mean Health Score [18]. There is a relation- cise on the depressive symptoms of MDD patients.
ship among morbidity due to this disease, aging, the num-
ber of systemic illnesses and a lack of physical exercise [7]. Dementia
Several hypotheses regarding the mechanisms that un- Dementia is the most prevalent neurodegenerative
derlie the pathophysiology of MDD have been studied. disease worldwide. In a review study it was estimated that
The most popular theory involves the activity of mono- 24.3 million cases have been reported, and 4.6 million
amines, namely reductions in the activities of serotonin new cases are reported annually in the world [27]. Despite
and norepinephrine [19]. Another mechanism involved the heterogeneity of its symptoms, dementia is associated
in depression is the hyperactivity of the hypothalamic- with the progressive loss of various cognitive functions
pituitary-adrenal axis due to the increased release of cor- and the consequent impairment of an individual’s ability
tisol and corticotropin-releasing factor [20]. to perform daily life activities. Mental stimulation, prop-
The effect of exercise, as an adjunct to pharmacologi- er nutrition and exercise appear to exert both prophylac-
cal treatment, on depressive symptoms has been studied tic and therapeutic effects on the development and pro-
[5, 21]. Follow-up studies, clinical trials and randomized gression of neurodegenerative dementia [28–30]. Physi-
controlled trials have found evidence of a positive corre- cal activity alone is associated with a 28% reduction in an
lation between regular physical exercise and a reduction individual’s risk of developing the disease [31].
in depressive symptoms [21–25]. Both strength training Given the possible adverse effects related to pharma-
and aerobic training have positive effects in the treatment cological treatment, the quality of life and the general
of depression [25]. Furthermore, high-intensity strength well-being of individuals who suffer from dementia can
training (80% of one maximum workload lifted (1 repeti- be compromised [32]. Thus, it is important to investigate
tion maximum (RM)) [23], moderate aerobic training alternative, non-pharmacological treatment strategies
(17 kcal/kg/min) [22] and supervised moderate-intensity such as exercise [33]. A meta-analysis conducted by Hein
training (70–80% HRR) [21] were all shown to induce et al. [32] found that regular exercise performed with the
positive responses in an investigation of the effect of ex- mean training duration from all studies of 23 weeks, with
ercise on depressive symptoms. In contrast, Krogh et al. a range of 2–112 weeks, had positive effects on both cog-
[26] have observed the opposite pattern of results in a re- nitive and behavioral improvement. There was an aver-
cent meta-analysis. They concluded that exercise has age of 3.6 sessions per week, ranging from 1 to 6 sessions,
small short-term effects on the severity of depressive with each session lasting an average of 45 min (mean) and
symptoms but that the existing data regarding the long- ranging from 20 to 150 min. However, Forbes et al. [34]
term effects of exercise are inconclusive. The lack of in- conclude that there is not sufficient evidence to deter-
clusion criteria, even for studies of good quality, can ex- mine whether participation in a regular exercise program
plain these results. Using rigorous inclusion criteria, our actually benefits people with dementia. The inconclusive
group performed a meta-analysis [25] that showed that results of their study may have been obtained because
both aerobic exercise and strength training have positive these authors chose criteria for assessing the methodolog-
effects on depressive symptoms. These effects are sub- ical quality of existing studies that resulted in the inclu-
stantial in elderly individuals and individuals who have sion of only two studies in their meta-analysis.
mild depressive symptoms [25]. There is some evidence that exercise can improve cog-
It appears that the efficacy of using exercise to reduce nitive function, the ability to perform daily life activities
the severity of depressive symptoms depends on the level and the ability to walk in dementia patients, but both the
of adherence to an optimal exercise regimen; a combina- low intensities of the prescribed exercise regimens that
tion of moderate-intensity aerobic training and high-inten- were used in the studies that Forbes et al. [34] reviewed and
sity strength training may provide more positive benefits the methodological qualities of those studies can be criti-
than other exercise programs. Neurobiological mecha- cized. For example, a recent study examined 62 dementia
nisms can explain these positive effects (see the Neurobiol- patients who underwent 3 months of progressive resis-
ogy of Exercise section). However, there are both method- tance and functional group training. The resistance train-
ological limitations (i.e. lack of statistically significant ing targeted functionally relevant muscle groups at a sub-
results, poor sample selection criterion and MDD diagnos- maximal intensity (70–80% of 1RM) and was performed in
tics, no adequate control of exercise regimen) that limit our groups of 4–6 participants for 3 months (2 h, twice a week).
DOI: 10.1159/000350946
period during which a PD patient does not participate in According to Ekkekakis and Petruzzello [50], there
regular training. These improvements may be related to may be a U-shaped relationship between aerobic exercise
neurobiological changes that occur as a result of physical intensity and affective state. This theory suggests that the
exercise, particularly neurogenesis [47], an increase in mi- optimal intensity, the one that produces the most positive
tochondrial activity and an increase in the synthesis of cer- affective response, would be a moderate intensity that is
tain neurotransmitters, such as dopamine [48]. The neu- near the ventilatory threshold (∼65% VO2max [51]). It
robiological mechanisms of the effects of exercise are dis- may be that intensities above the ventilatory threshold
cussed in detail in the Neurobiology of Exercise section. are perceived as threatening by most individuals and,
Currently, there are several practical considerations therefore, tend to generate a negative affective state [52].
that must be considered when determining the appropri- Moreover, although intensities below the ventilatory
ate exercise regimen for PD patients. Data from the recent threshold have a high individual variability, these lower
literature recommend aerobic activities using a cycle er- intensities are perceived as pleasurable by most individu-
gometer and body support that are performed 3–5 times als [52, 53]. A meta-analysis conducted by Reed and Ones
per week at a level of intensity (low, moderate or high) [54] showed that low-intensity exercises that had a dura-
determined on the basis of the trainability and disease tion of 35 min or less also induced a strong activation of
stage of each patient. The levels of intensity are character- positive affect. In contrast, recent research has shown that
ized as follows: an intensity <40% of the heart rate reserve an exercise protocol that included intervals of high-inten-
(HRR) or VO2 reserve (VO2R) is considered low; an in- sity generated more pleasure than a program that used a
tensity <60% of the HRR or VO2R is considered moder- continuous moderate intensity [55]. There is also evi-
ate, and an intensity >60% HRR or VO2R is considered dence that suggests that positive behavioral outcomes
high. The recommendations for strength training for PD tend to occur after exercising at a self-selected intensity
patients prioritize strengthening the lower limbs and sug- [56].
gest strength training 2–3 times per week at an intensity It appears that moderate-intensity exercise programs
of 40–50% 1RM (light) or 60–80% 1RM (moderate/high) result in improved behavioral, affective, mood or anxiety
depending on the aforementioned conditions regarding responses [53]. The response to this type of exercise regi-
the disease stage and trainability of each patient. The lit- men represents a common point between two classical
erature also suggests that both aerobic and strength train- models of exercise efficacy that have been proposed in the
ing should be accompanied by functional exercises, espe- literature (the inverted U-shaped curve and circumplex
cially exercises involving gait (fig. 1) [49]. models of affect), both of which are presented in figure 2.
The circumplex model consists of a two-dimensional
structure in which combinations of arousal and affective
Mood and Anxiety: Acute Effects of Exercise, valence are represented in quadrants [for a review, see 57].
Adherence to an Exercise Program, and Athletic The substantial variation in the findings of studies of
Performance exercise efficacy may be attributed to the use of different
methods of measuring behavior and to the failure to stan-
Effects of Aerobic Exercise dardize the pretest scores in addition to the effects that
There are many scientific studies that provide evidence depend on an individual’s level of physical fitness. For
of the beneficial effects of exercise on disease prevention example, affective state, mood and anxiety are often treat-
and overall health. However, promoting adherence to ed as synonyms, but there are differences in the opera-
programs of regular physical activity is one of the greatest tional definitions of these terms that could theoretically
challenges in the field of sports science. The affective re- result in differing interpretations when comparing the re-
sponse that a single exercise session provokes has been sults. Thus, it appears that the variable that is termed ad-
shown to predict the level of engagement of a participant herence to an exercise program is the most consistently
over the course of the subsequent 6–12 months [13]. The applied measure of affective state in this context [13].
link between affective responses and adherence has been
explained by Williams using an integrative model [for a Effects of Strength Training
review, see 6]. Thus, it is likely that improving our under- Despite the increasing interest in the acute effects of
standing of the effects that different types of exercise have exercise on affect, mood and anxiety, few studies have at-
on human behavior may also improve our ability to in- tempted to investigate the differential influences of vari-
crease the rates of adherence to exercise programs. ous types of exercise. For example, the effects of strength
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Fig. 1. Effects of exercise on neurodegenerative diseases and men- and MDD, respectively. Exercise training could be beneficial be-
tal disorders. The reductions in dopamine and mitochondrial cause neurotransmitters and neurotrophic factors are synthesized
function, the generation of β-amyloid plaques and hippocampal in response to physical exertion. These factors could delay of the
atrophy and the decreases in the serotonin and noradrenaline lev- progression of neurodegenerative diseases and mental disorders.
els (in the hippocampus, hypothalamus, amygdala, cortex and oth- Moreover, exercise improves physical function and functional au-
er parts of brain) are the primary alterations that result in PD, AD tonomy. ADLs = Activities of daily living.
training are rarely compared with the effects of aerobic ticipant is evaluated appears to influence the observa-
exercise [58]. tions that are obtained. It appears that a minimum recov-
The results of studies of the acute effects of strength ery time of 20 min must elapse before a decrease in the
training on mood have been contradictory, and studies anxiety level of a participant can be observed, and par-
that have focused on low- and high-intensity strength ticipants require a 40-min recovery period before a re-
training programs have had divergent results [58]. Fur- duction in their levels of physical exertion can be dis-
thermore, the time between the conclusion of an exercise cerned [59, 60]. When different types of physical exercise
session and the time at which the mental state of the par- are compared, both strength training and aerobic exer-
DOI: 10.1159/000350946
specific exercise-related physical and mental stresses that
6.0
favor the emergence of mood and anxiety disorders [16].
Although sports psychiatry has been poorly studied to
HI date, investigations in this field should be emphasized be-
5.0
cause exercise-induced changes in an athlete’s behavior
(–) Activation (FAS) (+)
DOI: 10.1159/000350946
ing in perturbations to multiple body systems (neurolog- In summary, the need for a comprehensive and inte-
ical, endocrine and immune systems) coupled with mood grated multidisciplinary approach to understanding the
changes [86]. The symptoms of overtraining include de- effects of central changes on athletic performance and the
pressed mood, general apathy, decreased self-esteem, mental health of athletes is evident from the results pre-
emotional instability, impaired performance, restless- sented in the existing literature.
ness, irritability, disturbed sleep, weight loss, loss of ap-
petite, increased resting heart rate, increased vulnerabil-
ity to injuries, hormonal changes and a lack of supercom- Neurobiology of Exercise
pensation [87]. Armstrong and VanHeest [14] showed
that 60% of long-distance runners experienced symptoms Acute Exercise Mechanisms
of overtraining at some point during their careers, 50% of There is evidence that physical exercise promotes
professional soccer players experienced these symptoms changes in the human brain due to increases in metabo-
during a single competitive season (5 months), and 33% lism, oxygenation and blood flow in the brain. Unfortu-
of basketball players experienced these symptoms during nately, our knowledge of how the human brain is affected
their 6-week training period. For most athletes, the rela- by physical exercise interventions is limited, and the avail-
tionship between psychological stress, anxiety and ath- able evidence is predominantly from animal studies [5, 10].
letic performance is best understood via a self-regulation Studies with animals have shown that physical exercise
model that consists in training regulation by emotional modulates the major CNS neurotransmitters that are as-
status [88]. sociated with an individual’s state of alertness (norepi-
In sports, factors such as concentration, emotional nephrine), the pleasure and reward system (dopamine)
control and coping strategies are linked to better perfor- and the level of anxiety (serotonin). Moreover, changes in
mance [63, 88]. The relationship between psychological the levels of these neurotransmitters may have different
stress, anxiety and performance in sports is better demon- consequences depending on the type(s) of receptors and
strated by the individual zones of optimal functioning the cortical areas that are activated [96]. Other neurochem-
(IZOF) as proposed by Hanin [89], providing a function- ical factors that may be released during physical activities
al explanation for the dynamics of the emotion-perfor- include opioids and endocannabinoids, which promote a
mance relationship based on a detailed description of ath- sense of euphoria and well-being, anxiolytic effects, seda-
letes’ idiosyncratic subjective experiences [90]. In addi- tion and decreased sensitivity to pain in humans [97].
tion, the model suggests that self-emotional regulation by Other neuromodulators that are activated by acute ex-
athletes is an important tool during competitions [88]. ercise are trophic factors. Studies in animals have shown
Another physiological mechanism widely discussed is the that the expression levels of brain-derived neurotrophic
central governor model (CGM) proposed by Noakes et al. factor (BDNF), insulin-like growth factor (IGF-1), vascu-
[91]. The CGM shows that all types of exercise are regu- lar endothelial growth factor (VEGF), neurotrophin-3
lated by the CNS. The CNS is subconsciously capable of (NT3), fibroblast growth factor (FGF-2), glial cell line-
managing neuromuscular recruitment and calculating the derived neurotrophic factor (GDNF), epidermal growth
metabolic cost to execute a task and succeed. Therefore, factor (EGF) and nerve growth factor (NGF) appear to
the CNS’s anticipatory control should prevent the cata- increase in conjunction with exercise interventions, and
strophic failure of the human body [91]. The implementa- these trophic factors act as survival, proliferation and
tion of a new approach to exercise science, after this para- maturation factors in specific cells in the brain [98]. Upon
digm shift between peripheral control and central control binding to their specific receptors, these factors can pro-
proposed by Noakes [92], is highly criticized [93–95]. mote the activation of signaling pathways by activating
However, according to Pires [3], the science community the Ras/Raf proteins, P13K (protein 13 kinase)/Akt (pro-
has almost accepted this theory. This author suggests that tein kinase B) and cAMP response element-binding
these old concepts have new interpretations and that oth- (CREB) protein, which is a protein that is associated with
er aspects, such as the number of citations and the increas- transcription. The aforementioned neurotrophic factors
ing debate related to CGM, should be considered evidence can even inhibit signals in the caspase-mediated apop-
of the acceptance of this new theory in exercise science. totic pathway. In the CNS, these trophic factors can both
From these new ideas arise the crises that promote scien- act as modulators and be modulated by neurotransmit-
tific revolutions, and the exercise science follows a pattern ters, which may play a substantial role in determining an
similar to the kuhnian model of scientific discovery [3]. individual’s level of cognition and behaviors. Sex hor-
DOI: 10.1159/000350946
Neurobiology of exercise-the cell
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Fig. 3. Neurobiology of exercise = Endocannab = endocannabi- enosine monophosphate; PKC = protein kinase C; PKA = protein
noids; NE = norepinephrine; Dopa = dopamine; 5HT = serotonin; kinase A; NO = nitric oxide; PI3K = phosphoinositide 3-kinase;
Ca+ = calcium ion; Na+ = sodium ion; K+ = potassium ion; GPi = mTOR = mammalian target of rapamycin; S6K1/2 = S6 kinase 1;
G protein inhibitors; GPe = G protein excitors; Adenyl Cyclase = MEK = methyl ethyl ketone; ERK = extracellular signal-regulated
adenylate cyclase; CaMKII = calcium calmodulin-dependent pro- kinases; BAD = Bcl-2-associated death promoter; AMPK = AMP-
tein kinase II; ATP = adenosine triphosphate; cAMP = cyclic ad- activated protein kinase.
Individuals who practice moderate physical activity explaining exercise-related reductions in the depressive
appear to have longer telomeres than sedentary individuals symptoms of MDD subjects and overall improvements
and those who practice exercise that is either higher or in mental health [5]. Furthermore, evidence from an ani-
lower in intensity. The reported results regarding wheth- mal study showed that a combination of regular exercise
er physical exercise enhances telomerase activity are still and pharmacological treatment contributed to a greater
inconclusive [111]. observed increase in the expression of BDNF mRNA in
the dentate gyrus than either intervention alone [112].
Chronic Diseases The production of BDNF, IGF-1 and VEGF is impor-
For individuals with depression, several biochemical, tant not only for neurogenesis but also for the mainte-
physiological and neurophysiological analyses of exer- nance of neurons [113] and the prevention of PD. These
cise-related effects on the brain have shown positive ef- neurotrophic factors and others can be induced by mus-
fects with regard to the alleviation of depressive symp- cle contraction and can cross the blood-brain barrier.
toms. Moreover, the exercise-induced release of neu- Therefore, BDNF, IGF-1 and VEGF act directly on brain
rotransmitters and the elevation in neurotrophin activity structures. Moreover, ROS produced by exercise requires
contribute to both neuroplasticity [5] and normal (un- greater antioxidant activity, which improves signaling re-
suppressed) cortical activity [24] and may play a role in lated to deoxyribonucleic acid (DNA) repair and induces
Conclusion Acknowledgment
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DOI: 10.1159/000350946