Exercise

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"Workout" redirects here. For other uses, see Exercise (disambiguation) and Workout
(disambiguation).

Running in water

Weight training

Exercise is any bodily activity that enhances or maintains physical fitness and overall health and
wellness.[1] It is performed for various reasons, including increasing growth and development,
preventing aging, strengthening musclesand the cardiovascular system, honing athletic skills, weight
loss or maintenance, and also for enjoyment. Many individuals choose to exercise publicly outdoors
where they can congregate in groups, socialize, and enhance well-being.[2]

Contents
[hide]

 1Classification
 2Health effects
 o 2.1Fitness
o 2.2Cardiovascular system
o 2.3Immune system
o 2.4Cancer
o 2.5Neurobiological
o 2.6Sleep
o 2.7Excessive exercise
 3Mechanism of effects
o 3.1Skeletal muscle
o 3.2Other peripheral organs
o 3.3Central nervous system
 4Public health measures
 5Exercise trends
o 5.1Social and cultural variation
 6Nutrition and recovery
 7History
 8Other animals
 9See also
 10Notes
 11References
 12External links

Classification[edit]

An astronaut, Daniel Tani, working out with a short bar to increase his upper body strength while in
a microgravity environment

Physical exercises are generally grouped into three types, depending on the overall effect they have
on the human body:[3]

 Aerobic exercise is any physical activity that uses large muscle groups and causes the body to
use more oxygen than it would while resting. [3] The goal of aerobic exercise is to
increase cardiovascular endurance.[4] Examples of aerobic exercise
include running, cycling, swimming, brisk walking, skipping rope, rowing, hiking,
playing tennis, continuous training, and long slow distance training.[3]
 Anaerobic exercise, which includes strength and resistance training, can firm, strengthen, and
tone muscles, as well as improve bone strength, balance, and coordination.[3] Examples of
strength moves are push-ups, pull-ups, lunges, and bicep curls using dumbbells.[3]Anaerobic
 exercise also include weight training, functional training, eccentric training, Interval
training, sprinting, and high-intensity interval training increase short-term muscle strength.[3][5]
 Flexibility exercises stretch and lengthen muscles.[3] Activities such as stretching help to
improve joint flexibility and keep muscles limber.[3]The goal is to improve the range of
motion which can reduce the chance of injury. [3][6]
Physical exercise can also include training that focuses on accuracy, agility, power, and speed.[7]
Sometimes the terms 'dynamic' and 'static' are used.[citation needed] 'Dynamic' exercises such as steady
running, tend to produce a lowering of the diastolic blood pressure during exercise, due to the
improved blood flow. Conversely, static exercise (such as weight-lifting) can cause
the systolic pressure to rise significantly (during the exercise). [8]

Health effects[edit]
Metabolic and musculoskeletal adaptations from endurance and strength training

Endurance Strength
Type of adaptation training training Sources
effects effects

Skeletal muscle morphology and exercise performance adaptations

Muscle hypertrophy ↔ ↑↑↑ [9]

Muscle strength and power ↔↓ ↑↑↑ [9]

Muscle fiber size ↔↑ ↑↑↑ [9]

Myofibrillar protein synthesis ↔↑ ↑↑↑ [9]

Neuromuscular adaptations ↔↑ ↑↑↑ [9]

Anaerobic capacity ↑ ↑↑ [9]

Lactate tolerance ↑↑ ↔↑ [9]

Endurance capacity ↑↑↑ ↔↑ [9]

Capillary growth (angiogenesis) ↑↑ ↔ [9]

Mitochondrial biogenesis ↑↑ ↔↑ [9]

Mitochondrial density and oxidative function ↑↑↑ ↔↑ [9]

Whole-body and metabolic adaptations

Bone mineral density ↑↑ ↑↑ [9]

Inflammatory markers ↓↓ ↓ [9]

Flexibility ↑ ↑ [9]

Posture ↔ ↑ [9]

Ability in activities of daily living ↔↑ ↑↑ [9]

Basal metabolic rate ↑ ↑↑ [9]

Body composition

Percent body fat ↓↓ ↓ [9]

Lean body mass ↔ ↑↑ [9]

Glucose metabolism
 Resting insulin levels ↓ ↓ [9]

Insulin sensitivity ↑↑ ↑↑ [9]

Insulin response to glucose challenge ↓↓ ↓↓ [9]

Cardiovascular adaptations

Resting heart rate ↓↓ ↔ [9]

Stroke volume (resting and maximal) ↑↑ ↔ [9]

Systolic blood pressure (resting) ↔↓ ↔ [9]

Diastolic blood pressure (resting) ↔↓ ↔↓ [9]

Cardiovascular risk profile ↓↓↓ ↓ [9]

show

Table legend

Physical exercise is important for maintaining physical fitness and can contribute to maintaining a
healthy weight, regulating digestive health, building and maintaining healthy bone density, muscle
strength, and joint mobility, promoting physiological well-being, reducing surgical risks, and
strengthening the immune system. Some studies indicate that exercise may increase life expectancy
and the overall quality of life.[10]People who participate in moderate to high levels of physical exercise
have a lower mortality rate compared to individuals who by comparison are not physically
active.[11]Moderate levels of exercise have been correlated with preventing aging by reducing
inflammatory potential.[12] The majority of the benefits from exercise are achieved with around
3500 metabolic equivalent (MET) minutes per week.[13] For example, climbing stairs 10 minutes,
vacuuming 15 minutes, gardening 20 minutes, running 20 minutes, and walking or bicycling for
transportation 25 minutes on a daily basis would togetherachieve about 3000 MET minutes a
week.[13] A lack of physical activity causes approximately 6% of the burden of disease from coronary
heart disease, 7% of type 2 diabetes, 10% of breast cancer and 10% of colon cancer
worldwide.[14] Overall, physical inactivity causes 9% of premature mortality worldwide. [14]
Fitness[edit]
Individuals can increase fitness following increases in physical activity levels. [15]Increases in muscle
size from resistance training is primarily determined by diet and testosterone. [16] This genetic
variation in improvement from training is one of the key physiological differences between elite
athletes and the larger population.[17][18] Studies have shown that exercising in middle age leads to
better physical ability later in life.[19]
Early motor skills and development have also shown to be related to physical activity and
performance later in life. Children who have more proficient motor skills early on are more inclined to
being physically active, and thus tend to perform well in sports and have better fitness levels. Early
motor proficiency has a positive correlation to childhood physical activity and fitness levels, while
less proficiency in motor skills results in a tendency to partake in a more sedentary lifestyle.[20]
A 2015 meta-analysis demonstrated that high intensity training improved stamina more than lower
intensity endurance training.[21]
Cardiovascular system[edit]
The beneficial effect of exercise on the cardiovascular system is well documented. There is a direct
correlation between physical inactivity and cardiovascular mortality, and physical inactivity is an
independent risk factor for the development of coronary artery disease. Low levels of physical
exercise increase the risk of cardiovascular diseases mortality. [22]
Children who participate in physical exercise experience greater loss of body fat and increased
cardiovascular fitness.[23] Studies have shown that academic stress in youth increases the risk of
cardiovascular disease in later years; however, these risks can be greatly decreased with regular
physical exercise.[24] There is a dose-response relation between the amount of exercise performed
from approximately 700–2000 kcal of energy expenditure per week and all-cause mortality and
cardiovascular disease mortality in middle-aged and elderly populations. The greatest potential for
reduced mortality is in the sedentary who become moderately active. Studies have shown that since
heart disease is the leading cause of death in women, regular exercise in aging women leads to
healthier cardiovascular profiles. Most beneficial effects of physical activity on cardiovascular
disease mortality can be attained through moderate-intensity activity (40–60% of maximal oxygen
uptake, depending on age). Persons who modify their behavior after myocardial infarction to include
regular exercise have improved rates of survival. Persons who remain sedentary have the highest
risk for all-cause and cardiovascular disease mortality. [25] According to the American Heart
Association, exercise reduces the risk of cardiovascular diseases, including heart
attack and stroke.[22]
Immune system[edit]
Although there have been hundreds of studies on physical exercise and the immune system, there is
little direct evidence on its connection to illness. Epidemiological evidence suggests that moderate
exercise has a beneficial effect on the human immune system; an effect which is modeled in a J
curve. Moderate exercise has been associated with a 29% decreased incidence of upper respiratory
tract infections (URTI), but studies of marathon runners found that their prolonged high-intensity
exercise was associated with an increased risk of infection occurrence. However, another study did
not find the effect. Immune cell functions are impaired following acute sessions of prolonged, high-
intensity exercise, and some studies have found that athletes are at a higher risk for infections.
Studies have shown that strenuous stress for long durations, such as training for a marathon, can
suppress the immune system by decreasing the concentration of lymphocytes. [26] The immune
systems of athletes and nonathletes are generally similar. Athletes may have slightly
elevated natural killer cell count and cytolytic action, but these are unlikely to be clinically
significant.[27]
Vitamin C supplementation has been associated with lower incidence of upper respiratory tract
infections in marathon runners.[27]
Biomarkers of inflammation such as C-reactive protein, which are associated with chronic diseases,
are reduced in active individuals relative to sedentary individuals, and the positive effects of exercise
may be due to its anti-inflammatory effects. In individuals with heart disease, exercise interventions
lower blood levels of fibrinogen and C-reactive protein, an important cardiovascular risk
marker.[28] The depression in the immune system following acute bouts of exercise may be one of the
mechanisms for this anti-inflammatory effect.[27]
Cancer[edit]
A systematic review evaluated 45 studies that examined the relationship between physical activity
and cancer survivorship. According to the study results "There was consistent evidence from 27
observational studies that physical activity is associated with reduced all-cause, breast cancer–
specific, and colon cancer–specific mortality".[29]
Epigenetic effects[edit]
Physical exercise was correlated with a lower methylation frequency of two tumor suppressor
genes, CACNA2D3 and L3MBTL.[30][31] Hypermethylation of CACNA2D3 is associated with gastric
cancer, while hypermethylation of L3MBTL is associated with breast cancer, brain
tumors and hematological malignancies.[30][31][32][33] A recent study indicates that exercise results in
reduced DNA methylation at CpG sites on genes associated with breast cancer.[34]
Cancer cachexia[edit]
Physical exercise is becoming a widely accepted non-pharmacological intervention for the
prevention and attenuation of cancer cachexia.[35] "Cachexia is a multiorganic syndrome associated
with cancer, characterized by inflammation, body weight loss (at least 5%) and muscle and adipose
tissue wasting".[36] Exercise triggers the activation of the transcriptional coactivator peroxisome
proliferator-activated receptor gamma coactivator-1α (PGC-1α), which suppresses FoxO- and NF-
κB-dependent gene transcription during muscle atrophy that is induced by fasting or denervation;
thus, PGC-1α may be a key intermediate responsible for the beneficial antiatrophic effects of
physical exercise on cancer cachexia.[37][38] The exercise-induced isoform PGC-1α4, which can
repress myostatin and induce IGF1 and hypertrophy, is a potential drug target for treatment
of cancer cachexia.[39] Other factors, such as JUNB and SIRT1, that maintain skeletal muscle mass
and promote hypertrophy are also induced with regular physical exercise. [40][41]
Neurobiological[edit]
This section is transcluded from Neurobiological effects of physical exercise. (edit | history)
The neurobiological effects of physical exercise are numerous and involve a wide range of
interrelated effects on brain structure, brain function, and cognition.[42][43][44][45] A large body of research
in humans has demonstrated that consistent aerobic exercise (e.g., 30 minutes every day) induces
persistent improvements in certain cognitive functions, healthy alterations in gene expression in the
brain, and beneficial forms of neuroplasticity and behavioral plasticity; some of these long-term
effects include: increased neuron growth, increased neurological activity (e.g., c-
Fos and BDNF signaling), improved stress coping, enhanced cognitive control of behavior,
improved declarative, spatial, and working memory, and structural and functional improvements in
brain structures and pathways associated with cognitive control and
memory.[42][43][44][45][46][47][48][49][50][51] The effects of exercise on cognition have important implications for
improving academic performance in children and college students, improving adult productivity,
preserving cognitive function in old age, preventing or treating certain neurological disorders, and
improving overall quality of life.[42][52][53]
In healthy adults, aerobic exercise has been shown to induce transient effects on cognition after a
single exercise session and persistent effects on cognition following regular exercise over the course
of several months.[42][51][54] People who regularly perform aerobic exercise (e.g., running, jogging, brisk
walking, swimming, and cycling) have greater scores on neuropsychological function and
performance tests that measure certain cognitive functions, such as attentional control, inhibitory
control, cognitive flexibility, working memory updating and capacity, declarative memory, spatial
memory, and information processing speed.[42][46][48][50][51][54] The transient effects of exercise on
cognition include improvements in most executive functions (e.g., attention, working memory,
cognitive flexibility, inhibitory control, problem solving, and decision making) and information
processing speed for a period of up to 2 hours after exercising.[54]
Aerobic exercise induces short- and long-term effects on mood and emotional states by
promoting positive affect, inhibiting negative affect, and decreasing the biological response to
acute psychological stress.[54] Over the short-term, aerobic exercise functions as both
an antidepressant and euphoriant,[55][56][57][58] whereas consistent exercise produces general
improvements in mood and self-esteem.[59][60]
Regular aerobic exercise improves symptoms associated with a variety of central nervous system
disorders and may be used as an adjunct therapy for these disorders. There is clear evidence of
exercise treatment efficacy for major depressive disorder and attention deficit hyperactivity
disorder.[52][57][61][62][63][64] The American Academy of Neurology's clinical practice guideline for mild
cognitive impairment indicates that clinicians should recommend regular exercise (two times per
week) to individuals who have been diagnosed with this condition. [65] Reviews of clinical evidence
also support the use of exercise as an adjunct therapy for certain neurodegenerative disorders,
particularly Alzheimer’s diseaseand Parkinson's disease.[66][67][68][69][70][71] Regular exercise is also
associated with a lower risk of developing neurodegenerative disorders. [69][72] A large body
of preclinicalevidence and emerging clinical evidence supports the use of exercise therapy for
treating and preventing the development of drug addictions.[73][74][75][76][77] Regular exercise has also
been proposed as an adjunct therapy for brain cancers.[78]
Depression[edit]
Part of this section is transcluded from Neurobiological effects of physical exercise. (edit | history)
A number of medical reviews have indicated that exercise has a marked and
persistent antidepressant effect in humans,[46][57][58][61][79][80] an effect believed to be mediated through
enhanced BDNF signaling in the brain.[49][61] Several systematic reviews have analyzed the potential
for physical exercise in the treatment of depressive disorders. The 2013 Cochrane
Collaboration review on physical exercise for depression noted that, based upon limited evidence, it
is more effective than a control intervention and comparable to psychological or antidepressant drug
therapies.[79] Three subsequent 2014 systematic reviews that included the Cochrane review in their
analysis concluded with similar findings: one indicated that physical exercise is effective as
an adjunct treatment (i.e., treatments that are used together) with antidepressant medication; [61] the
other two indicated that physical exercise has marked antidepressant effects and recommended the
inclusion of physical activity as an adjunct treatment for mild–moderate depression and mental
illness in general.[57][58] One systematic review noted that yoga may be effective in alleviating
symptoms of prenatal depression.[81] Another review asserted that evidence from clinical
trialssupports the efficacy of physical exercise as a treatment for depression over a 2–4 month
period.[46]
A 2015 review of clinical evidence which included a medical guideline for the treatment of
depression with exercise noted that the available evidence on the effectiveness of exercise therapy
for depression suffers from some limitations; [62] nonetheless, it stated that there is clear evidence of
efficacy for reducing symptoms of depression. [62] The review also noted that patient characteristics,
the type of depressive disorder, and the nature of the exercise program all affect the antidepressant
properties of exercise therapy.[62] A meta-analysisfrom July 2016 concluded that physical exercise
improves overall quality of life in individuals with depression relative to controls. [52]
Continuous aerobic exercise can induce a transient state of euphoria, colloquially known as a
"runner's high" in distance running or a "rower's high" in crew, through the increased biosynthesis of
at least three euphoriant neurochemicals: anandamide (an endocannabinoid),[82] β-
endorphin (an endogenous opioid),[83] and phenethylamine (a trace
amine and amphetamine analog).[84][85][86]
Sleep[edit]
A 2010 review of published scientific research suggested that exercise generally improves sleep for
most people, and helps sleep disorders such as insomnia. The optimum time to exercise may be 4
to 8 hours before bedtime, though exercise at any time of day is beneficial, with the possible
exception of heavy exercise taken shortly before bedtime, which may disturb sleep. There is, in any
case, insufficient evidence to draw detailed conclusions about the relationship between exercise and
sleep.[87]
According to a 2005 study, exercise is the most recommended alternative to sleeping pills for
resolving insomnia. Sleeping pills are more costly than to make time for a daily routine of staying fit,
and may have dangerous side effects in the long run. Exercise can be a healthy, safe and
inexpensive way to achieve more and better sleep. [88]
Excessive exercise[edit]
Too much exercise can be harmful. Without proper rest, the chance of stroke or
other circulation problems increases,[89] and muscle tissue may develop slowly. Extremely intense,
long-term cardiovascular exercise, as can be seen in athletes who train for multiple marathons, has
been associated with scarring of the heart and heart rhythm abnormalities. [90][91][92] Specifically, high
cardiac output has been shown to cause enlargement of the left and right ventricle volumes,
increased ventricle wall thickness, and greater cardiac mass. These changes further result in
myocardial cell damage in the lining of the heart, leading to scar tissue and thickened walls. During
these processes, the protein troponin increases in the bloodstream, indicating cardiac muscle cell
death and increased stress on the heart itself. [93]
Inappropriate exercise can do more harm than good, with the definition of “inappropriate” varying
according to the individual. For many activities, especially running and cycling, there are significant
injuries that occur with poorly regimented exercise schedules. Injuries from accidents also remain a
major concern,[94] whereas the effects of increased exposure to air pollution seem only a minor
concern.[95][96]
In extreme instances, over-exercising induces serious performance loss. Unaccustomed
overexertion of muscles leads to rhabdomyolysis (damage to muscle) most often seen in new army
recruits.[97] Another danger is overtraining, in which the intensity or volume of training exceeds the
body's capacity to recover between bouts. One sign of Overtraining Syndrome (OTS) is suppressed
immune function, with an increased incidence of upper respiratory tract infection (URTI). An
increased incidence of URTIs is also associated with high volume/intensity training, as well as with
excessive exercise (EE), such as in a marathon. [98] Marathon training requires the runner to build
their intensity week to week which makes them more susceptible to injury the more they increase
their mileage. A study shows that in the last 10–15 years up to 90% of marathon runners have
suffered a physical injury from their training.[99]
Stopping excessive exercise suddenly may create a change in mood. Exercise should be controlled
by each body's inherent limitations. While one set of joints and muscles may have the tolerance to
withstand multiple marathons, another body may be damaged by 20 minutes of light jogging. This
must be determined for each individual.
Too much exercise may cause a woman to miss her periods, a symptom known
as amenorrhea.[100] This is a very serious condition which indicates a woman is pushing her body
beyond its natural boundaries.[101]
Not only can excessive exercise cause physical damage, it can also cause psychological damage.
Every athlete strives for perfection in their sport. This is what may begin their excessive exercising
regime. If an athlete fails in this quest for perfection, this could result in anxiety, depression and low-
self esteem. A study of 179 athletes, all of whom were Olympians or potential Olympians, was
carried out in 2002 to find a relationship between perfectionism and sport-related competitive
anxiety. It was found that athletes with lower self—esteem had higher personal standards and in
comparison, those with high self-esteem had little concern in making mistakes or doubting
themselves.[102]

Mechanism of effects[edit]
Skeletal muscle[edit]
Resistance training and subsequent consumption of a protein-rich meal promotes muscle
hypertrophy and gains in muscle strength by stimulating myofibrillar muscle protein synthesis (MPS)
and inhibiting muscle protein breakdown (MPB).[103][104] The stimulation of muscle protein synthesis by
resistance training occurs via phosphorylation of the mechanistic target of rapamycin (mTOR) and
subsequent activation of mTORC1, which leads to protein biosynthesis in cellular ribosomes via
phosphorylation of mTORC1's immediate targets (the p70S6 kinase and the translation repressor
protein 4EBP1).[103][105] The suppression of muscle protein breakdown following food consumption
occurs primarily via increases in plasma insulin.[103][106][107] Similarly, increased muscle protein
synthesis (via activation of mTORC1) and suppressed muscle protein breakdown (via insulin-
independent mechanisms) has also been shown to occur following ingestion of β-hydroxy β-
methylbutyric acid.[103][106][107][108]
Aerobic exercise induces mitochondrial biogenesis and an increased capacity for oxidative
phosphorylation in the mitochondria of skeletal muscle, which is one mechanism by which aerobic
exercise enhances submaximal endurance performance. [109] [103][110] These effects occur via an
exercise-induced increase in the intracellular AMP:ATP ratio, thereby triggering the activation
of AMP-activated protein kinase (AMPK) which subsequently phosphorylates peroxisome
proliferator-activated receptor gamma coactivator-1α (PGC-1α), the master regulator of
mitochondrial biogenesis.[103][110][111]

Diagram of the molecular signaling cascades that are involved in myofibrillar muscle protein synthesis
and mitochondrial biogenesis in response to physical exercise and specific amino acids or their derivatives
(primarily L-leucine and HMB).[103] Many amino acids derived from food protein promote the activation
of mTORC1 and increase protein synthesis by signaling through Rag GTPases.[103][112]
show
Abbreviations and representations
Resistance training stimulates muscle protein synthesis (MPS) for a period of up to 48 hours following exercise
(shown by dotted line).[104]Ingestion of a protein-rich meal at any point during this period will augment the
exercise-induced increase in muscle protein synthesis (shown by solid lines).[104]
Other peripheral organs[edit]

Summary of long-term adaptations to regular aerobic and anaerobic exercise. Aerobic exercise can cause
several central cardiovascular adaptations, including an increase in stroke volume (SV)[113] and maximal aerobic
capacity (VO2 max),[113][114] as well as a decrease in resting heart rate (RHR).[115][116][117] Long-term adaptations to
resistance training, the most common form of anaerobic exercise, include muscular hypertrophy,[118][119] an
increase in the physiological cross-sectional area (PCSA) of muscle(s), and an increase in neural
drive,[120][121] both of which lead to increased muscular strength.[122]Neural adaptations begin more quickly and
plateau prior to the hypertrophic response.[123][124]

Developing research has demonstrated that many of the benefits of exercise are mediated through
the role of skeletal muscle as an endocrine organ. That is, contracting muscles release multiple
substances known as myokines which promote the growth of new tissue, tissue repair, and multiple
anti-inflammatory functions, which in turn reduce the risk of developing various inflammatory
diseases.[125] Exercise reduces levels of cortisol, which causes many health problems, both physical
and mental.[126] Endurance exercise before meals lowers blood glucose more than the same exercise
after meals.[127] There is evidence that vigorous exercise (90–95% of VO2 max) induces a greater
degree of physiological cardiac hypertrophy than moderate exercise (40 to 70% of VO2 max), but it is
unknown whether this has any effects on overall morbidity and/or mortality. [128] Both aerobic and
anaerobic exercise work to increase the mechanical efficiency of the heart by increasing cardiac
volume (aerobic exercise), or myocardial thickness (strength training). Ventricular hypertrophy, the
thickening of the ventricular walls, is generally beneficial and healthy if it occurs in response to
exercise.
Central nervous system[edit]
Further information: Neurobiological effects of physical exercise § Neuroplasticity
The effects of physical exercise on the central nervous system are mediated in part by
specific neurotrophic factor hormones that are released into the blood stream by muscles,
including BDNF, IGF-1, and VEGF.[43][59][129][130][131][132]

Public health measures[edit]

Multiple component community-wide campaigns are frequently used in an attempt to increase a
population's level of physical activity. A 2015 Cochrane review, however, did not find evidence
supporting a benefit.[133] The quality of the underlying evidence was also poor. [133] However, there is
some evidence that school-based interventions can increase activity levels and fitness in
children.[15] Another Cochrane review found some evidence that certain types of exercise
programmes, such as those involving gait, balance, co-ordination and functional tasks, can improve
balance in older adults.[134] Following progressive resistance training, older adults also respond with
improved physical function.[135] Survey of brief interventions promoting physical activity found that
they are cost-effective, although there are variations between studies. [136]
Environmental approaches appear promising: signs that encourage the use of stairs, as well as
community campaigns, may increase exercise levels.[137] The city of Bogotá, Colombia, for example,
blocks off 113 kilometers (70 mi) of roads on Sundays and holidays to make it easier for its citizens
to get exercise. These pedestrian zones are part of an effort to combat chronic diseases. [138]
To identify which public health strategies are effective, a Cochrane overview of reviews is in
preparation.[139]
Physical exercise was said to decrease healthcare costs, increase the rate of job attendance, as well
as increase the amount of effort women put into their jobs. [140] There is some level of concern about
additional exposure to air pollution when exercising outdoors, especially near traffic. [141]
Children will mimic the behavior of their parents in relation to physical exercise. Parents can thus
promote physical activity and limit the amount of time children spend in front of screens. [142]
Overweight children who participate in physical exercise experience greater loss of body fat and
increased cardiovascular fitness. According to the Centers for Disease Control and Prevention in the
United States, both children and adults should do 60 minutes or more of physical activity each
day.[143] Implementing physical exercise in the school system and ensuring an environment in which
children can reduce barriers to maintain a healthy lifestyle is essential.
The European Commission - DG EAC - Directorate General for Education and Culture - has
dedicated programs and funds for HEPA - Health Enhancing Physical Activityprojects[144] within
its Horizon 2020 and Erasmus+ program, as research showed that too many Europeans are not
physically active enough. Financing is available for increased collaboration between players active in
this field across the EU and around the world, the promotion of HEPA in the EU and its partner
countries and the European Sports Week. The DG EAC regularly publishes a Eurobarometer on
sport and physical activity.
Exercise trends[edit]

Running has become a popular form of exercise.

Main article: Exercise trends

Worldwide there has been a large shift towards less physically demanding work. [145] This has been
accompanied by increasing use of mechanized transportation, a greater prevalence of labor saving
technology in the home, and fewer active recreational pursuits.[145] Personal lifestyle
changes however can correct the lack of physical exercise.
Research in 2015 indicates integrating mindfulness to physical exercise interventions increases
exercise adherence, self-efficacy and also has positive effects both psychologically and
physiologically.[146]
Social and cultural variation[edit]
Exercising looks different in every country, as do the motivations behind exercising. [2] In some
countries, people exercise primarily indoors, and in others, people exercise primarily outdoors.
People may exercise for personal enjoyment, health and well-being, social interactions, competition
or training, etc. These differences could potentially be attributed to geographic location, social
tendencies, or otherwise.
In Colombia, citizens value and celebrate the outdoor environments of their country. In many
instances, they utilize outdoor activities as social gatherings to enjoy nature and their communities.
In Bogotá, Colombia, a 70-mile stretch of road known as the Ciclovía is shut down each Sunday for
bicyclists, runners, rollerbladers, skateboarders and other exercisers to work out and enjoy their
surroundings.[147]
Similarly to Colombia, citizens of Cambodia tend to exercise socially outside. In this country, public
gyms have become quite popular. People will congregate at these outdoor gyms not only to utilize
the public facilities, but also to organize aerobics and dance sessions, which are open to the
public.[148]
Sweden has also begun developing outdoor gyms, called utegym. These gyms are free to the public
and are often placed in beautiful, picturesque environments. People will swim in rivers, use boats,
and run through forests to stay healthy and enjoy the natural world around them. This is especially
possible in Sweden due to its geographical location. [149]
Chinese exercise, particularly in the retired community, seems to be socially grounded. In the
mornings, dances are held in public parks; these gatherings may include Latin dancing, ballroom
dancing, tango, or even the jitterbug. Dancing in public allows people to interact with those with
whom they would not normally interact, allowing for both health benefits and social benefits. [150]
These sociocultural variations in physical exercise show how people in different geographic locations
and social climates have varying motivations and methods of exercising. Physical exercise can
improve health and well-being, as well as enhance community ties and appreciation of natural
beauty.[2]

Nutrition and recovery[edit]

Proper nutrition is as important to health as exercise. When exercising, it becomes even more
important to have a good diet to ensure that the body has the correct ratio of macronutrients while
providing ample micronutrients, in order to aid the body with the recovery process following
strenuous exercise.[151]
Active recovery is recommended after participating in physical exercise because it
removes lactate from the blood more quickly than inactive recovery. Removing lactate from
circulation allows for an easy decline in body temperature, which can also benefit the immune
system, as an individual may be vulnerable to minor illnesses if the body temperature drops too
abruptly after physical exercise.[152]

History[edit]
The benefits of exercise have been known since antiquity. Dating back to 65 BCE, it was Marcus
Cicero, Roman politician and lawyer, who stated: "It is exercise alone that supports the spirits, and
keeps the mind in vigor."[153] Exercise was also seen to be valued later in history during the Early
Middle Ages as a means of survival by the Germanic peoples of Northern Europe.[154]
More recently, exercise was regarded as a beneficial force in the 19th century. After 1860, Archibald
MacLaren opened a gymnasium at the University of Oxford and instituted a training regimen for 12
military officials at the university. This regimen was later assimilated into the training of the British
Army.[155] Several mass exercise movements were started in the early twentieth century as well. The
first and most significant of these in the UK was the Women's League of Health and Beauty, founded
in 1930 by Mary Bagot Stack, that had 166,000 members in 1937.[156]
The link between physical health and exercise (or lack of it) was further established in 1949 and
reported in 1953 by a team led by Jerry Morris.[157][158] Dr. Morris noted that men of similar social class
and occupation (bus conductors versus bus drivers) had markedly different rates of heart attacks,
depending on the level of exercise they got: bus drivers had a sedentary occupation and a higher
incidence of heart disease, while bus conductors were forced to move continually and had a lower
incidence of heart disease.[158]

Other animals[edit]
Studies of animals indicate that physical activity may be more adaptable than changes in food intake
to regulate energy balance.[159]
Mice having access to activity wheels engaged in voluntary exercise and increased their propensity
to run as adults.[160] Artificial selection of mice exhibited significant heritability in voluntary exercise
levels,[161] with "high-runner" breeds having enhanced aerobic
capacity,[162] hippocampal neurogenesis,[163] and skeletal muscle morphology.[164]
The effects of exercise training appear to be heterogeneous across non-mammalian species. As
examples, exercise training of salmon showed minor improvements of endurance, [165] and a forced
 swimming regimen of yellowtail amberjack and rainbow trout accelerated their growth rates and
altered muscle morphology favorable for sustained swimming.[166][167] Crocodiles, alligators,
and ducks showed elevated aerobic capacity following exercise training. [168][169][170] No effect of
endurance training was found in most studies of lizards,[168][171] although one study did report a
training effect.[172] In lizards, sprint training had no effect on maximal exercise capacity,[172] and
muscular damage from over-training occurred following weeks of forced treadmill exercise. [171]

See also[edit]

 Health and fitness portal

 Medicine portal

 Society portal

 Sports portal
Main article: Outline of exercise

 Active living
 Behavioural change theories
 Bodybuilding
 Exercise hypertension
 Exercise-induced nausea
 Exercise intensity
 Exercise intolerance
 Exercise-induced anaphylaxis
 Exercise-induced asthma
 Kinesiology
 Metabolic equivalent
 Physical fitness
 Supercompensation
 Warming up

Notes[edit]
References[edit]
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37. Jump up^ Sandri M, et al. (2006). "PGC-1α protects skeletal muscle from atrophy by suppressing
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40. Jump up^ Vissing K, et al. (2013). "Effect of resistance exercise contraction mode and protein
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41. Jump up^ Ferrara N, et al. (2008). "Exercise training promotes SIRT1 activity in aged rats". Rejuven.
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42. ^ Jump up to:a b c d e Erickson KI, Hillman CH, Kramer AF (August 2015). "Physical activity, brain, and
cognition". Current Opinion in Behavioral Sciences. 4: 27–32. doi:10.1016/j.cobeha.2015.01.005.
43. ^ Jump up to:a b c Paillard T, Rolland Y, de Souto Barreto P (July 2015). "Protective Effects of Physical
Exercise in Alzheimer's Disease and Parkinson's Disease: A Narrative Review". J Clin Neurol. 11 (3):
212–219. doi:10.3988/jcn.2015.11.3.212. PMC 4507374  . PMID 26174783. Aerobic physical
exercise (PE) activates the release of neurotrophic factors and promotes angiogenesis, thereby
facilitating neurogenesis and synaptogenesis, which in turn improve memory and cognitive
functions. ... Exercise limits the alteration in dopaminergic neurons in the substantia nigra and
contributes to optimal functioning of the basal ganglia involved in motor commands and control by
adaptive mechanisms involving dopamine and glutamate neurotransmission.
44. ^ Jump up to:a b McKee AC, Daneshvar DH, Alvarez VE, Stein TD (January 2014). "The
neuropathology of sport". Acta Neuropathol. 127 (1): 29–51. doi:10.1007/s00401-013-1230-
6. PMC 4255282  . PMID 24366527. The benefits of regular exercise, physical fitness and sports
participation on cardiovascular and brain health are undeniable ... Exercise also enhances
psychological health, reduces age-related loss of brain volume, improves cognition, reduces the risk
of developing dementia, and impedes neurodegeneration.
45. ^ Jump up to:a b Denham J, Marques FZ, O'Brien BJ, Charchar FJ (February 2014). "Exercise: putting
action into our epigenome". Sports Med. 44 (2): 189–209. doi:10.1007/s40279-013-0114-
1. PMID 24163284. Aerobic physical exercise produces numerous health benefits in the brain.
Regular engagement in physical exercise enhances cognitive functioning, increases brain
neurotrophic proteins, such as brain-derived neurotrophic factor (BDNF), and prevents cognitive
diseases [76–78]. Recent findings highlight a role for aerobic exercise in modulating chromatin
remodelers [21, 79–82]. ... These results were the first to demonstrate that acute and relatively short
aerobic exercise modulates epigenetic modifications. The transient epigenetic modifications observed
due to chronic running training have also been associated with improved learning and stress-coping
strategies, epigenetic changes and increased c-Fos-positive neurons ... Nonetheless, these studies
demonstrate the existence of epigenetic changes after acute and chronic exercise and show they are
associated with improved cognitive function and elevated markers of neurotrophic factors and
neuronal activity (BDNF and c-Fos). ... The aerobic exercise training-induced changes to miRNA
profile in the brain seem to be intensity-dependent [164]. These few studies provide a basis for further
exploration into potential miRNAs involved in brain and neuronal development and recovery via
aerobic exercise.
46. ^ Jump up to:a b c d Gomez-Pinilla F, Hillman C (January 2013). "The influence of exercise on cognitive
abilities". Compr. Physiol. 3 (1): 403–428. doi:10.1002/cphy.c110063. PMC 3951958 
. PMID 23720292.
47. Jump up^ Erickson KI, Leckie RL, Weinstein AM (September 2014). "Physical activity, fitness, and
gray matter volume". Neurobiol. Aging. 35 Suppl 2: S20–
528. doi:10.1016/j.neurobiolaging.2014.03.034. PMC 4094356  . PMID 24952993. Retrieved 9
December 2014.
48. ^ Jump up to:a b Guiney H, Machado L (February 2013). "Benefits of regular aerobic exercise for
executive functioning in healthy populations". Psychon Bull Rev. 20 (1): 73–86. doi:10.3758/s13423-
012-0345-4. PMID 23229442.
49. ^ Jump up to:a b Erickson KI, Miller DL, Roecklein KA (2012). "The aging hippocampus: interactions
between exercise, depression, and BDNF". Neuroscientist. 18 (1): 82–
97. doi:10.1177/1073858410397054. PMC 3575139  . PMID 21531985.
50. ^ Jump up to:a b Buckley J, Cohen JD, Kramer AF, McAuley E, Mullen SP (2014). "Cognitive control in
the self-regulation of physical activity and sedentary behavior". Front Hum Neurosci. 8:
747. doi:10.3389/fnhum.2014.00747. PMC 4179677  . PMID 25324754.
51. ^ Jump up to:a b c Cox EP, O'Dwyer N, Cook R, Vetter M, Cheng HL, Rooney K, O'Connor H (August
2016). "Relationship between physical activity and cognitive function in apparently healthy young to
middle-aged adults: A systematic review". J. Sci. Med. Sport. 19 (8): 616–
628. doi:10.1016/j.jsams.2015.09.003. PMID 26552574. A range of validated platforms assessed CF
across three domains: executive function (12 studies), memory (four studies) and processing speed
(seven studies). ... In studies of executive function, five found a significant ES in favour of higher PA,
ranging from small to large. Although three of four studies in the memory domain reported a significant
 benefit of higher PA, there was only one significant ES, which favoured low PA. Only one study
examining processing speed had a significant ES, favouring higher PA.
CONCLUSIONS: A limited body of evidence supports a positive effect of PA on CF in young to
middle-aged adults. Further research into this relationship at this age stage is warranted. ...
Significant positive effects of PA on cognitive function were found in 12 of the 14 included
manuscripts, the relationship being most consistent for executive function, intermediate for memory
and weak for processing speed.
52. ^ Jump up to:a b c Schuch FB, Vancampfort D, Rosenbaum S, Richards J, Ward PB, Stubbs B (July
2016). "Exercise improves physical and psychological quality of life in people with depression: A meta-
analysis including the evaluation of control group response". Psychiatry Res. 241: 47–
54. doi:10.1016/j.psychres.2016.04.054. PMID 27155287. Exercise has established efficacy as an
antidepressant in people with depression. ... Exercise significantly improved physical and
psychological domains and overall QoL. ... The lack of improvement among control groups reinforces
the role of exercise as a treatment for depression with benefits to QoL.
53. Jump up^ Pratali L, Mastorci F, Vitiello N, Sironi A, Gastaldelli A, Gemignani A (November
2014). "Motor Activity in Aging: An Integrated Approach for Better Quality of Life". Int. Sch. Res.
Notices. 2014: 257248. doi:10.1155/2014/257248. PMC 4897547  . PMID 27351018. Research
investigating the effects of exercise on older adults has primarily focused on brain structural and
functional changes with relation to cognitive improvement. In particular, several cross-sectional and
intervention studies have shown a positive association between physical activity and cognition in older
persons [86] and an inverse correlation with cognitive decline and dementia [87]. Older adults enrolled
in a 6-month aerobic fitness intervention increased brain volume in both gray matter (anterior
cingulate cortex, supplementary motor area, posterior middle frontal gyrus, and left superior temporal
lobe) and white matter (anterior third of corpus callosum) [88]. In addition, Colcombe and colleagues
showed that older adults with higher cardiovascular fitness levels are better at activating attentional
resources, including decreased activation of the anterior cingulated cortex. One of the possible
mechanisms by which physical activity may benefit cognition is that physical activity maintains brain
plasticity, increases brain volume, stimulates neurogenesis and synaptogenesis, and increases
neurotrophic factors in different areas of the brain, possibly providing reserve against later cognitive
decline and dementia [89, 90].
54. ^ Jump up to:a b c d Basso JC, Suzuki WA (March 2017). "The Effects of Acute Exercise on Mood,
Cognition, Neurophysiology, and Neurochemical Pathways: A Review". Brain Plasticity. 2(2): 127–
152. doi:10.3233/BPL-160040  . Lay summary – Can A Single Exercise Session Benefit Your
Brain? (12 June 2017). A large collection of research in humans has shown that a single bout of
exercise alters behavior at the level of affective state and cognitive functioning in several key ways. In
terms of affective state, acute exercise decreases negative affect, increases positive affect, and
decreases the psychological and physiological response to acute stress [28]. These effects have been
reported to persist for up to 24 hours after exercise cessation [28, 29, 53]. In terms of cognitive
functioning, acute exercise primarily enhances executive functions dependent on the prefrontal cortex
including attention, working memory, problem solving, cognitive flexibility, verbal fluency, decision
making, and inhibitory control [9]. These positive changes have been demonstrated to occur with very
low to very high exercise intensities [9], with effects lasting for up to two hours after the end of the
exercise bout (Fig. 1A) [27]. Moreover, many of these neuropsychological assessments measure
several aspects of behavior including both accuracy of performance and speed of processing.
McMorris and Hale performed a meta-analysis examining the effects of acute exercise on both
accuracy and speed of processing, revealing that speed significantly improved post-exercise, with
minimal or no effect on accuracy [17]. These authors concluded that increasing task difficulty or
complexity may help to augment the effect of acute exercise on accuracy. ... However, in a
comprehensive meta-analysis, Chang and colleagues found that exercise intensities ranging from
very light (<50% MHR) to very hard (>93% MHR) have all been reported to improve cognitive
functioning [9].
55. Jump up^ Cunha GS, Ribeiro JL, Oliveira AR (June 2008). "[Levels of beta-endorphin in response to
exercise and overtraining]". Arq Bras Endocrinol Metabol (in Portuguese). 52 (4): 589–
598. PMID 18604371. Interestingly, some symptoms of OT are related to beta-endorphin (beta-end(1-
31)) effects. Some of its effects, such as analgesia, increasing lactate tolerance, and exercise-induced
euphoria, are important for training.
56. Jump up^ Boecker H, Sprenger T, Spilker ME, Henriksen G, Koppenhoefer M, Wagner KJ, Valet M,
Berthele A, Tolle TR (2008). "The runner's high: opioidergic mechanisms in the human brain". Cereb.
 Cortex. 18 (11): 2523–2531. doi:10.1093/cercor/bhn013. PMID 18296435. The runner's high
describes a euphoric state resulting from long-distance running.
57. ^ Jump up to:a b c d Josefsson T, Lindwall M, Archer T (2014). "Physical exercise intervention in
depressive disorders: meta-analysis and systematic review". Scand J Med Sci Sports. 24(2): 259–
272. doi:10.1111/sms.12050. PMID 23362828.
58. ^ Jump up to:a b c Rosenbaum S, Tiedemann A, Sherrington C, Curtis J, Ward PB (2014). "Physical
activity interventions for people with mental illness: a systematic review and meta-analysis". J Clin
Psychiatry. 75 (9): 964–974. doi:10.4088/JCP.13r08765. PMID 24813261. This systematic review and
meta-analysis found that physical activity reduced depressive symptoms among people with a
psychiatric illness. The current meta-analysis differs from previous studies, as it included participants
with depressive symptoms with a variety of psychiatric diagnoses (except dysthymia and eating
disorders). ... This review provides strong evidence for the antidepressant effect of physical activity;
however, the optimal exercise modality, volume, and intensity remain to be determined. ...
Conclusion
Few interventions exist whereby patients can hope to achieve improvements in both psychiatric
symptoms and physical health simultaneously without significant risks of adverse effects. Physical
activity offers substantial promise for improving outcomes for people living with mental illness, and the
inclusion of physical activity and exercise programs within treatment facilities is warranted given the
results of this review.
59. ^ Jump up to:a b Szuhany KL, Bugatti M, Otto MW (October 2014). "A meta-analytic review of the
effects of exercise on brain-derived neurotrophic factor". J Psychiatr Res. 60C: 56–
64. doi:10.1016/j.jpsychires.2014.10.003. PMC 4314337  . PMID 25455510. Consistent evidence
indicates that exercise improves cognition and mood, with preliminary evidence suggesting that brain-
derived neurotrophic factor (BDNF) may mediate these effects. The aim of the current meta-analysis
was to provide an estimate of the strength of the association between exercise and increased BDNF
levels in humans across multiple exercise paradigms. We conducted a meta-analysis of 29 studies (N
= 1111 participants) examining the effect of exercise on BDNF levels in three exercise paradigms: (1)
a single session of exercise, (2) a session of exercise following a program of regular exercise, and (3)
resting BDNF levels following a program of regular exercise. Moderators of this effect were also
examined. Results demonstrated a moderate effect size for increases in BDNF following a single
session of exercise (Hedges' g = 0.46, p < 0.001). Further, regular exercise intensified the effect of a
session of exercise on BDNF levels (Hedges' g = 0.59, p = 0.02). Finally, results indicated a small
effect of regular exercise on resting BDNF levels (Hedges' g = 0.27, p = 0.005). ... Effect size analysis
supports the role of exercise as a strategy for enhancing BDNF activity in humans.
60. Jump up^ Lees C, Hopkins J (2013). "Effect of aerobic exercise on cognition, academic achievement,
and psychosocial function in children: a systematic review of randomized control trials". Prev Chronic
Dis. 10: E174. doi:10.5888/pcd10.130010. PMC 3809922  . PMID 24157077. This omission is
relevant, given the evidence that aerobic-based physical activity generates structural changes in the
brain, such as neurogenesis, angiogenesis, increased hippocampal volume, and connectivity (12,13).
In children, a positive relationship between aerobic fitness, hippocampal volume, and memory has
been found (12,13). ... Mental health outcomes included reduced depression and increased self-
esteem, although no change was found in anxiety levels (18). ... This systematic review of the
literature found that [aerobic physical activity (APA)] is positively associated with cognition, academic
achievement, behavior, and psychosocial functioning outcomes. Importantly, Shephard also showed
that curriculum time reassigned to APA still results in a measurable, albeit small, improvement in
academic performance (24). ... The actual aerobic-based activity does not appear to be a major
factor; interventions used many different types of APA and found similar associations. In positive
association studies, intensity of the aerobic activity was moderate to vigorous. The amount of time
spent in APA varied significantly between studies; however, even as little as 45 minutes per week
appeared to have a benefit.
61. ^ Jump up to:a b c d Mura G, Moro MF, Patten SB, Carta MG (2014). "Exercise as an add-on strategy
for the treatment of major depressive disorder: a systematic review". CNS Spectr. 19 (6): 496–
508. doi:10.1017/S1092852913000953. PMID 24589012. Considered overall, the studies included in
the present review showed a strong effectiveness of exercise combined with antidepressants. ...
Conclusions
This is the first review to have focused on exercise as an add-on strategy in the treatment of MDD.
Our findings corroborate some previous observations that were based on few studies and which were
difficult to generalize.41,51,73,92,93 Given the results of the present article, it seems that exercise might be
 an effective strategy to enhance the antidepressant effect of medication treatments. Moreover, we
hypothesize that the main role of exercise on treatment-resistant depression is in inducing
neurogenesis by increasing BDNF expression, as was demonstrated by several recent studies.
62. ^ Jump up to:a b c d Ranjbar E, Memari AH, Hafizi S, Shayestehfar M, Mirfazeli FS, Eshghi MA (June
2015). "Depression and Exercise: A Clinical Review and Management Guideline". Asian J. Sports
Med. 6 (2): e24055. doi:10.5812/asjsm.6(2)2015.24055. PMC 4592762  . PMID 26448838. Keeping
in mind that exercise shows no medication side effects such as withdrawal symptoms (20), weight
gain, dry mouth or insomnia (21), but shows potential health benefits such as weight reduction, it is
highly recommended to use exercise as an adjunctive treatment for depression (22). New findings
confirm that exercise can be recommended as a first-line treatment for mild to moderate depression;
as an adjunct to medications (23); as an alternative to cognitive behavioral therapy (11); and in
preventing depression in clinical as well as healthy populations (24–26). ... Although recent findings
have shown that exercise can decrease depressive symptoms, there are still many questions and
limitations to wider application of exercise in depression. For instance, there are deficiencies in
methodological planning such as uncontrolled nonrandomized trials, small sample sizes, inadequate
allocation concealment, lack of intention-to-treat analyses, non-blinded outcome assessments, and
inclusion of subjects without clinical diagnosis that limit the interpretability of research outcomes (53).
Box 1: Patients with Depression Who May Particularly Benefit From Exercise Programs
Box 2: Depressive Disorders Other Than Major Depression That May Benefit From Exercise
Programs
Box 3: The Characteristics of an Exercise Program that will Maximize the Anti-depressive Properties
63. Jump up^ Den Heijer AE, Groen Y, Tucha L, Fuermaier AB, Koerts J, Lange KW, Thome J, Tucha O
(July 2016). "Sweat it out? The effects of physical exercise on cognition and behavior in children and
adults with ADHD: a systematic literature review". J. Neural. Transm. (Vienna). doi:10.1007/s00702-
016-1593-7. PMID 27400928.
64. Jump up^ Kamp CF, Sperlich B, Holmberg HC (July 2014). "Exercise reduces the symptoms of
attention-deficit/hyperactivity disorder and improves social behaviour, motor skills, strength and
neuropsychological parameters". Acta Paediatr. 103 (7): 709–
14. doi:10.1111/apa.12628. PMID 24612421. The present review summarises the impact of exercise
interventions (1–10 weeks in duration with at least two sessions each week) on parameters related to
ADHD in 7-to 13-year-old children. We may conclude that all different types of exercise (here yoga,
active games with and without the involvement of balls, walking and athletic training) attenuate the
characteristic symptoms of ADHD and improve social behaviour, motor skills, strength and
neuropsychological parameters without any undesirable side effects. Available reports do not reveal
which type, intensity, duration and frequency of exercise is most effective in this respect and future
research focusing on this question with randomised and controlled long-term interventions is
warranted.
65. Jump up^ Petersen RC, Lopez O, Armstrong MJ, Getchius T, Ganguli M, Gloss D, Gronseth GS,
Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A (January 2018). "Practice
guideline update summary: Mild cognitive impairment – Report of the Guideline Development,
Dissemination, and Implementation Subcommittee of the American Academy of
Neurology". Neurology. Special article. 90 (3): 1–
10. doi:10.1212/WNL.0000000000004826. PMID 29282327. Lay summary – Exercise may improve
thinking ability and memory (27 December 2017). In patients with MCI, exercise training (6 months) is
likely to improve cognitive measures and cognitive training may improve cognitive measures. ...
Clinicians should recommend regular exercise (Level B). ... Recommendation
For patients diagnosed with MCI, clinicians should recommend regular exercise (twice/week) as part
of an overall approach to management (Level B).
66. Jump up^ Farina N, Rusted J, Tabet N (January 2014). "The effect of exercise interventions on
cognitive outcome in Alzheimer's disease: a systematic review". Int Psychogeriatr. 26 (1): 9–
18. doi:10.1017/S1041610213001385. PMID 23962667. Six RCTs were identified that exclusively
considered the effect of exercise in AD patients. Exercise generally had a positive effect on rate of
cognitive decline in AD. A meta-analysis found that exercise interventions have a positive effect on
global cognitive function, 0.75 (95% CI = 0.32–1.17). ... The most prevalent subtype of dementia is
Alzheimer’s disease (AD), accounting for up to 65.0% of all dementia cases ... Cognitive decline in AD
is attributable at least in part to the buildup of amyloid and tau proteins, which promote neuronal
dysfunction and death (Hardy and Selkoe, 2002; Karran et al., 2011). Evidence in transgenic mouse
models of AD, in which the mice have artificially elevated amyloid load, suggests that exercise
 programs are able to improve cognitive function (Adlard et al., 2005; Nichol et al., 2007). Adlard and
colleagues also determined that the improvement in cognitive performance occurred in conjunction
with a reduced amyloid load. Research that includes direct indices of change in such biomarkers will
help to determine the mechanisms by which exercise may act on cognition in AD.
67. Jump up^ Rao AK, Chou A, Bursley B, Smulofsky J, Jezequel J (January 2014). "Systematic review
of the effects of exercise on activities of daily living in people with Alzheimer's disease". Am J Occup
Ther. 68 (1): 50–56. doi:10.5014/ajot.2014.009035. PMC 5360200  . PMID 24367955. Alzheimer’s
disease (AD) is a progressive neurological disorder characterized by loss in cognitive function,
abnormal behavior, and decreased ability to perform basic activities of daily living [(ADLs)] ... All
studies included people with AD who completed an exercise program consisting of aerobic, strength,
or balance training or any combination of the three. The length of the exercise programs varied from
12 weeks to 12 months. ... Six studies involving 446 participants tested the effect of exercise on ADL
performance ... exercise had a large and significant effect on ADL performance (z = 4.07, p < .0001;
average effect size = 0.80). ... These positive effects were apparent with programs ranging in length
from 12 wk (Santana-Sosa et al., 2008; Teri et al., 2003) and intermediate length of 16 wk (Roach et
al., 2011; Vreugdenhil et al., 2012) to 6 mo (Venturelli et al., 2011) and 12 mo (Rolland et al., 2007).
Furthermore, the positive effects of a 3-mo intervention lasted 24 mo (Teri et al., 2003). ... No adverse
effects of exercise on ADL performance were noted. ... The study with the largest effect size
implemented a walking and aerobic program of only 30 min four times a week (Venturelli et al., 2011).
68. Jump up^ Mattson MP (2014). "Interventions that improve body and brain bioenergetics for
Parkinson's disease risk reduction and therapy". J Parkinsons Dis. 4 (1): 1–13. doi:10.3233/JPD-
130335. PMID 24473219.
69. ^ Jump up to:a b Grazina R, Massano J (2013). "Physical exercise and Parkinson's disease: influence
on symptoms, disease course and prevention". Rev Neurosci. 24 (2): 139–152. doi:10.1515/revneuro-
2012-0087. PMID 23492553.
70. Jump up^ van der Kolk NM, King LA (September 2013). "Effects of exercise on mobility in people
with Parkinson's disease". Mov. Disord. 28 (11): 1587–
1596. doi:10.1002/mds.25658. PMID 24132847.
71. Jump up^ Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE, Stowe R, et al. (September 2013).
"Physiotherapy versus placebo or no intervention in Parkinson's disease". Cochrane Database Syst
Rev. 9: CD002817. doi:10.1002/14651858.CD002817.pub4. PMID 24018704.
72. Jump up^ Blondell SJ, Hammersley-Mather R, Veerman JL (May 2014). "Does physical activity
prevent cognitive decline and dementia?: A systematic review and meta-analysis of longitudinal
studies". BMC Public Health. 14: 510. doi:10.1186/1471-2458-14-510. PMC 4064273 
. PMID 24885250. Longitudinal observational studies show an association between higher levels of
physical activity and a reduced risk of cognitive decline and dementia. A case can be made for a
causal interpretation. Future research should use objective measures of physical activity, adjust for
the full range of confounders and have adequate follow-up length. Ideally, randomised controlled trials
will be conducted. ... On the whole the results do, however, lend support to the notion of a causal
relationship between physical activity, cognitive decline and dementia, according to the established
criteria for causal inference.
73. Jump up^ Carroll ME, Smethells JR (February 2016). "Sex Differences in Behavioral Dyscontrol:
Role in Drug Addiction and Novel Treatments". Front. Psychiatry. 6:
175. doi:10.3389/fpsyt.2015.00175. PMC 4745113  . PMID 26903885. There is accelerating
evidence that physical exercise is a useful treatment for preventing and reducing drug addiction ... In
some individuals, exercise has its own rewarding effects, and a behavioral economic interaction may
occur, such that physical and social rewards of exercise can substitute for the rewarding effects of
drug abuse. ... The value of this form of treatment for drug addiction in laboratory animals and humans
is that exercise, if it can substitute for the rewarding effects of drugs, could be self-maintained over an
extended period of time. Work to date in [laboratory animals and humans] regarding exercise as a
treatment for drug addiction supports this hypothesis. ... However, a RTC study was recently reported
by Rawson et al. (226), whereby they used 8 weeks of exercise as a post-residential treatment for
METH addiction, showed a significant reduction in use (confirmed by urine screens) in participants
who had been using meth 18 days or less a month. ... Animal and human research on physical
exercise as a treatment for stimulant addiction indicates that this is one of the most promising
treatments on the horizon.[emphasis added]
74. Jump up^ Lynch WJ, Peterson AB, Sanchez V, Abel J, Smith MA (September 2013). "Exercise as a
novel treatment for drug addiction: a neurobiological and stage-dependent hypothesis". Neurosci
 Biobehav Rev. 37 (8): 1622–1644. doi:10.1016/j.neubiorev.2013.06.011. PMC 3788047 
. PMID 23806439.
75. Jump up^ Olsen CM (December 2011). "Natural rewards, neuroplasticity, and non-drug
addictions". Neuropharmacology. 61 (7): 1109–
1122. doi:10.1016/j.neuropharm.2011.03.010. PMC 3139704  . PMID 21459101. Similar to
environmental enrichment, studies have found that exercise reduces self-administration and relapse
to drugs of abuse (Cosgrove et al., 2002; Zlebnik et al., 2010). There is also some evidence that these
preclinical findings translate to human populations, as exercise reduces withdrawal symptoms and
relapse in abstinent smokers (Daniel et al., 2006; Prochaska et al., 2008), and one drug recovery
program has seen success in participants that train for and compete in a marathon as part of the
program (Butler, 2005). ... In humans, the role of dopamine signaling in incentive-sensitization
processes has recently been highlighted by the observation of a dopamine dysregulation syndrome in
some patients taking dopaminergic drugs. This syndrome is characterized by a medication-induced
increase in (or compulsive) engagement in non-drug rewards such as gambling, shopping, or sex
(Evans et al., 2006; Aiken, 2007; Lader, 2008).
76. Jump up^ Linke SE, Ussher M (2015). "Exercise-based treatments for substance use disorders:
evidence, theory, and practicality". Am J Drug Alcohol Abuse. 41 (1): 7–
15. doi:10.3109/00952990.2014.976708. PMC 4831948  . PMID 25397661. The limited research
conducted suggests that exercise may be an effective adjunctive treatment for SUDs. In contrast to
the scarce intervention trials to date, a relative abundance of literature on the theoretical and practical
reasons supporting the investigation of this topic has been published. ... numerous theoretical and
practical reasons support exercise-based treatments for SUDs, including psychological, behavioral,
neurobiological, nearly universal safety profile, and overall positive health effects.
77. Jump up^ Zhou Y, Zhao M, Zhou C, Li R (July 2015). "Sex differences in drug addiction and
response to exercise intervention: From human to animal studies". Front. Neuroendocrinol. 40: 24–
41. doi:10.1016/j.yfrne.2015.07.001. PMC 4712120  . PMID 26182835. Collectively, these findings
demonstrate that exercise may serve as a substitute or competition for drug abuse by changing
ΔFosB or cFos immunoreactivity in the reward system to protect against later or previous drug use. ...
As briefly reviewed above, a large number of human and rodent studies clearly show that there are
sex differences in drug addiction and exercise. The sex differences are also found in the effectiveness
of exercise on drug addiction prevention and treatment, as well as underlying neurobiological
mechanisms. The postulate that exercise serves as an ideal intervention for drug addiction has been
widely recognized and used in human and animal rehabilitation. ... In particular, more studies on the
neurobiological mechanism of exercise and its roles in preventing and treating drug addiction are
needed.
78. Jump up^ Cormie P, Nowak AK, Chambers SK, Galvão DA, Newton RU (April 2015). "The potential
role of exercise in neuro-oncology". Front. Oncol. 5: 85. doi:10.3389/fonc.2015.00085. PMC 4389372 
. PMID 25905043.
79. ^ Jump up to:a b Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead
GE (September 2013). "Exercise for depression". Cochrane Database Syst. Rev. 9 (9):
CD004366. doi:10.1002/14651858.CD004366.pub6. PMID 24026850. Exercise is moderately more
effective than a control intervention for reducing symptoms of depression, but analysis of
methodologically robust trials only shows a smaller effect in favour of exercise. When compared to
psychological or pharmacological therapies, exercise appears to be no more effective, though this
conclusion is based on a few small trials.
80. Jump up^ Brené S, Bjørnebekk A, Aberg E, Mathé AA, Olson L, Werme M (2007). "Running is
rewarding and antidepressive". Physiol. Behav. 92 (1–2): 136–
140. doi:10.1016/j.physbeh.2007.05.015. PMC 2040025  . PMID 17561174.
81. Jump up^ Gong H, Ni C, Shen X, Wu T, Jiang C (February 2015). "Yoga for prenatal depression: a
systematic review and meta-analysis". BMC Psychiatry. 15: 14. doi:10.1186/s12888-015-0393-
1. PMC 4323231  . PMID 25652267.
82. Jump up^ Tantimonaco M, Ceci R, Sabatini S, Catani MV, Rossi A, Gasperi V, Maccarrone M (2014).
"Physical activity and the endocannabinoid system: an overview". Cell. Mol. Life Sci. 71 (14): 2681–
2698. doi:10.1007/s00018-014-1575-6. PMID 24526057.
83. Jump up^ Dinas PC, Koutedakis Y, Flouris AD (2011). "Effects of exercise and physical activity on
depression". Ir J Med Sci. 180 (2): 319–325. doi:10.1007/s11845-010-0633-9. PMID 21076975.
84. Jump up^ Szabo A, Billett E, Turner J (2001). "Phenylethylamine, a possible link to the
antidepressant effects of exercise?". Br J Sports Med. 35 (5): 342–
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85. Jump up^ Lindemann L, Hoener MC (2005). "A renaissance in trace amines inspired by a novel
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neurological and psychiatric diseases". Rev Recent Clin Trials. 2 (1): 3–
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87. Jump up^ Buman, M.P., King, A.C. (2010). "Exercise as a Treatment to Enhance Sleep". American
Journal of Lifestyle Medicine. 31 (5): 514. doi:10.1177/1559827610375532.
88. Jump up^ Youngstedt, S.D. (April 2005). "Effects of exercise on sleep" (PDF). Clin Sports Med. 24(2):
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Budde T, Mann K, Barkhausen J, Heusch G, Jöckel KH, Erbel R (200). "Running: the risk of coronary
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107. ^ Jump up to:a b Wilkinson DJ, Hossain T, Limb MC, Phillips BE, Lund J, Williams JP, Brook
MS, Cegielski J, Philp A, Ashcroft S, Rathmacher JA, Szewczyk NJ, Smith K, Atherton PJ (October
2017). "Impact of the calcium form of β-hydroxy-β-methylbutyrate upon human skeletal muscle protein
metabolism". Clinical Nutrition (Edinburgh,
Scotland). doi:10.1016/j.clnu.2017.09.024. PMID 29097038. Ca-HMB led a significant and rapid
(<60 min) peak in plasma HMB concentrations (483.6 ± 14.2 μM, p < 0.0001). This rise in plasma
HMB was accompanied by increases in MPS (PA: 0.046 ± 0.004%/h, CaHMB: 0.072 ± 0.004%/h, p <
[0.001]) and suppressions in MPB (PA: 7.6 ± 1.2 μmol Phe per leg min−1, Ca-HMB: 5.2 ± 0.8 μmol Phe
per leg min−1, p < 0.01). ... During the first 2.5 h period we gathered postabsorptive/fasted
measurements, the volunteers then consumed 3.42 g of Ca-HMB (equivalent to 2.74 g of FA-HMB) ...
It may seem difficult for one to reconcile that acute provision of CaHMB, in the absence of exogenous
nutrition (i.e. EAA's) and following an overnight fast, is still able to elicit a robust, perhaps near
maximal stimulation of MPS, i.e. raising the question as to where the additional AA's substrates
required for supporting this MPS response are coming from. It would appear that the AA's to support
this response are derived from endogenous intracellular/plasma pools and/or protein breakdown
(which will increase in fasted periods). ... To conclude, a large single oral dose (~3 g) of Ca-HMB
robustly (near maximally) stimulates skeletal muscle anabolism, in the absence of additional nutrient
intake; the anabolic effects of Ca-HMB are equivalent to FA-HMB, despite purported differences in
bioavailability (Fig. 4).
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