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Personalising exercise recommendations for healthy cognition and mobility in ageing: time to consider one’s pre-existing function and genotype (Part 2)
  1. Cindy K Barha1,
  2. Ryan S Falck1,
  3. Søren T Skou2,3,
  4. Teresa Liu-Ambrose1
  1. 1 Physical Therapy, Facutly of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2 Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
  3. 3 Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
  1. Correspondence to Dr Teresa Liu-Ambrose, Faculty of Medicine, University of British Columbia, Vancouver, Canada; teresa.ambrose{at}

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As we outlined in Part 1, precise exercise recommendations remain elusive and effects of current recommendations are small to moderate. Increased precision of exercise prescriptions may greatly promote adoption, adherence and maximise benefits. Current scientific efforts seek to delineate what (e.g., type, duration, frequency and intensity) exercise should be recommended, when (e.g., midlife vs late life) it is most effective for cognition and for whom and how does exercise benefit cognition and mobility. Identifying moderators (e.g., who, when)—factors that either attenuate or amplify the effects of exercise—will enable precise recommendations for individuals with similar characteristics (i.e., subgroups).

In this two-part editorial series, we focus on for whom factors that may moderate the effect of exercise on cognitive function and mobility (figure 1). In Part 1, we discussed biological sex and gender. Here in Part 2, we focus on the impact of pre-existing physical and cognitive health as well as genetic polymorphisms.

Figure 1

Proposed moderators of exercise for brain health. Key moderators of the relationship between different types of exercise (e.g., resistance training, aerobic exercise) and brain health are genetics, sex and gender, frailty and lifestage. Please refer to Parts 1 and 2 commentary for more details.

Physical and cognitive health of the individual

Pre-existing (i.e., baseline) physical function impacts the efficacy of exercise interventions on health outcomes. Exercise prevents a greater number of falls in older adults with a previous fall than those with no such history.1 Among older adults with limited mobility, increasing physical activity of moderate intensity by at least 43 min per week—or ~6 min per day—had significant and clinically meaningful effects on mobility and the risk of major mobility disability,2 highlighting that ‘a little can do a lot’ for those at risk for functional decline.

In a 24-month randomised controlled trial (RCT) that compared a home-based and centre-based exercise programme …

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  • Twitter @dr_cindy_b, @STSkou

  • Contributors All authors contributed to the conception and design of this paper. TL-A, CKB and RSF drafted the work and STS provided substantial feedback on content. All authors approve the final version.

  • Funding Canadian Institutes of Health Research to (MOP-142206 and PJT-148902) Teresa Liu-Ambrose. Søren T Skou is currently funded by a grant from Region Zealand (Exercise First) and a grant from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation program (grant agreement No 801790).

  • Competing interests STS is associate editor of Journal of Orthopaedic & Sports Physical Therapy, he has received grants from The Lundbeck Foundation, personal fees from Munksgaard, all outside the submitted work. He is cofounder of Good Life with Osteoarthritis in Denmark (GLA:D), a not-for profit initiative hosted by the University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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