Cardiovascular fitness and structural brain integrity: an update on current evidence
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REVIEW
Cardiovascular fitness and structural brain integrity: an update on current evidence Tracy d’Arbeloff
Received: 1 June 2020 / Accepted: 29 July 2020 # American Aging Association 2020
Abstract An aging global population and accompanying increases in the prevalence of age-related disorders are leading to greater financial, social, and health burdens. Aging-related dementias are one such category of age-related disorders that are associated with progressive loss of physical and cognitive integrity. One proposed preventative measure against risk of aging-related dementia is improving cardiovascular fitness, which may help reverse or buffer age-related brain atrophy associated with worse aging-related outcomes and cognitive decline. However, research into the beneficial potential of cardiovascular fitness has suffered from extreme heterogeneity in study design methodology leading to a lack of cohesion in the field and undermining any potential causal evidence that may exist. In addition, cardiovascular fitness and exercise are often conflated, leading to a lack of clarity in results. Here, I review recent literature on cardiovascular fitness, brain structure, and aging with the following goals: (a) Highlights • Improving cardiovascular is a promising intervention against age-related brain decline. • Causal evidence for this association remains tenuous, despite high interest levels. • Lack of causal evidence may be due to high levels of methodological heterogeneity. • This heterogeneity is hindering progress towards viable clinical intervention. • The field should look to evaluate quality of current evidence before moving forward. T. d’Arbeloff (*) Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC 27708, USA e-mail: [email protected]
to disentangle and lay out recent findings specific to aging, cardiovascular fitness, and brain structure, and (b) to ascertain the extent to which causal evidence actually exists. I suggest that, while there is some preliminary evidence for a link between cardiovascular fitness and brain structure in older adults, more research is still needed before definitive causal conclusions can be drawn. I conclude with a discussion of existing gaps in the field and suggestions for how they may be addressed by future research. Keywords Dementia . Cardiovascular fitness . Cognitive decline . Brain structure
Introduction An aging global population is creating an unprecedented need to preserve and prolong both physical and mental health [1–6]. Increases in average population age, as well as in longevity, have put extreme stress on social welfare systems; the growing size of adult populations is one of the largest factors associated with the major increase in age-related social and financial burden between 1990 and 2017 [3]. As of 2017, over 92 diseases have been identified as age-related, accounting for 50% or more of global burden among adults [1, 3]. Agerelated diseases are defined as those with incidence rates that increase quadratical
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