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Exercise is medicine, for the body and the brain
  1. Lindsay S Nagamatsu1,
  2. Leon Flicker2,
  3. Arthur F Kramer3,
  4. Michelle W Voss4,
  5. Kirk I Erickson5,
  6. Chun Liang Hsu6,
  7. Teresa Liu-Ambrose6,7,8
  1. 1 Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Centre for Medical Research, University of Western Australia, Perth, Australia
  3. 3 Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana-Champaign, Illinois, USA
  4. 4 Department of Psychology, University of Iowa, Iowa City, Iowa, USA
  5. 5 Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  6. 6 Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7 Brain Research Centre, Vancouver, British Columbia, Canada
  8. 8 Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Teresa Liu-Ambrose, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada V6T 1Z3; tlambrose{at}exchange.ubc.ca

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Cognitive decline is one of the most pressing healthcare issues of the 21st century. Worldwide, one new case of major cognitive decline (ie, dementia) is detected every 4 s.1 Given that no effective pharmacological treatment to alter the progress of cognitive decline exists, there is much interest in lifestyle approaches for preventing or treating dementia. Ideally, such strategies should be cost-efficient and widely accessible at a societal level to have the largest benefit for older adults with varying income and functional status levels.

One attractive solution that aligns with the above criteria is exercise. However, despite a large and consistent pool of evidence generated over the past five decades linking exercise to improved cognitive functions in older adults,2 there is a reluctance among academics, healthcare practitioners and the public alike to embrace exercise as a prevention and treatment strategy for cognitive decline. For example, the National Institutes of Health (NIH) consensus statement from 20103 concedes that there appears to be preliminary data to support the efficacy of exercise in improving cognitive function. However, they caution that there is currently no strong evidence to suggest that modifiable lifestyle factors can alter the trajectory of cognitive decline. Adding fuel to the fire are publications such as a 2013 systematic review of randomised controlled trials (RCTs) (prior to 31 October 2011) reporting ‘weak’ evidence for the effects of exercise on cognition.4 We must highlight that the search strategy used in that systematic review failed to capture many pertinent papers providing evidence from RCTs that exercise promotes cognitive and brain plasticity not only in healthy older adults but also in those with cognitive impairment. Furthermore, there are a number of animal studies that provide insight into the molecular and cellular mechanisms by which exercise promotes neuroplasticity.5

In a previous commentary, …

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