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INTRODUCTION
It has already been established that physical exercise is having a beneficial effect on
mental performance (1,2). This effect of exercise has been studied in a wide range of
population covering pre-school age to older adults considering various disease conditions,
gender differences etc. Within this broad spectrum, there is a vast variability regarding the
selection of physical exercise, duration of performance, type of cognitive test performed and
type of measurement techniques applied (1). Like improvement in cardio-respiratory fitness,
physical exercise is also associated with the improved mental performance (3,4,5). Exercise
has been implicated in many different tests of brain function. It has been observed that by
performing a moderate intensity aerobic exercise (defined by 70-80% of maximal heart rate)
there is an improvement in working memory (6). The majority of studies have focused on the
chronic effects of exercise, while studies on acute effect of exercise on cognition have started
to gain attention (7). Some studies suggest that acute exercise increases cognitive function
(8,9), while others suggest that it may either decrease or does not alter cognitive function
(10,11).Yanagisawa (12) observed among a group of young Japanese adults that there was
improved cognitive flexibility on the Stroop task performance established by increased activity
level at the dorsolateral and prefrontal area of cortex. Previous studies (13-16) have also shown
that short duration of submaximal exercise can cause improvement in cognitive function.
However, it still needs to be examined that for how long this improvement is sustained and
what is the appropriate level of submaximal exercise that is required to improve cognitive
function.
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REVIEW OF LITERATURE
Besides the old adult population, studies have been conducted on pre-adolescent
children aged between 7-12 yrs and it was found that aerobic fitness was related to better
cognitive performance (29). Earlier studies conducted to examine the associations between
daily physical activity and executive functioning among school going children (aged 8-12
years) found that childrens physical activity is associated with their better planning ability
(30). In view of previous findings, present study was planned to explore whether application of
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short duration, submaximal exercise is an effective tool to improve cognitive performance of
young adults and if there is an improvement, then for how long this improvement sustains.
Since very few studies have looked at the effects of acute exercise on cognitive function in
young adults. As a best alternative to conventional practice, we are planning to develop
protocol of short duration exercise which can be conducted anytime, anywhere to improve
cognitive performance.
Identified short duration exercise will be an effective exercise tool in terms of its
simplicity and less time consuming for improving cognitive performance with special
reference to the speed of processing and selective attention in young adults.
AIM
The aim of the study is to explore whether short duration sub-maximal exercise confers
improvement in cognitive performance and if yes, then for how long this improvement sustains
and what is the appropriate level of exercise. To achieve this aim, following will be the
objectives of this study.
OBJECTIVES
2) To measure and compare various physiological and cognitive responses before and
after submaximal exercise performance.
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MATERIALS AND METHODS
The study will be conducted at V. P. Chest Institute. It will be carried out after approval
from the Institutional Human Ethics Committee (IEC). Written, informed consent will be
obtained from all subjects prior to induction in the study. Duration of the study will be for two
years. Present study will be supported by available resources in the laboratory and no extra-
mural funding will be required.
Subjects selection
Thirty five subjects will be enrolled into the study and will comprise of healthy subjects
of similar age group i.e. those without known medical disorders and illnesses such as
respiratory, cardiovascular or musculoskeletal disease or on medications that could
significantly confound the results.
Inclusion Criteria:
1. Subjects with sedentary life style and age range between 18 to 30 years of either
gender.
2. All subjects must have quit smoking at least eight weeks before inclusion into the
study.
3. No known concomitant illnesses that would significantly affect pulmonary function,
exercise capacity, autonomic function and general health status.
4. Subjects willing to undertake the study regimens
Exclusion Criteria:
1. Physically active subjects, defined as those who are actively involved in any kind of
exercise training, yoga, active sports such as cycling, swimming or gymnasium.
2. Subjects having co-morbidities precluding the safe and convenient administration of
study regimens.
3. Subjects having medical history of cardiovascular, respiratory, metabolic and
musculoskeletal diseases and current smokers.
4. Subjects having episode of acute infectionin the month preceding induction into the
study or during the study.
5. Pregnant and lactating women.
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STUDY DESIGN
Procedure:
Subjects will be screened as per inclusion and exclusion criteria.
All outcome parameters (as detailed below) will be assessed at inclusion in the
study (Day 0).
After baseline assessment, subjects will be asked to come on three alternate days to
perform submaximal exercise according to their maximum heart rate (HRmax) on
cycle ergometer as below mentioned protocol.
Outcome parameters:
1. Six minute walk test
2. Body Composition Analysis
3. Heart Rate Variability & Heart Rate Recovery
4. Cognitive performance assessment
a. Letter Cancellation Test (LCT)
b. Digit Substitution Test (DST)
c. Visual and Auditory Reaction Time
d. Arithmetic Mental Task
e. Stroop Test
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2. Body composition analysis
Body Fat Percentage and Fat Free Mass will be assessed by bio-impedance
method using InBody 230 (Biospace, Korea) as per standard guidelines.
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c. Visual and Auditory Reaction Time
This is a customized protocol designed in java platform and subjects will be
seated in front of a computer screen.
In Visual reaction time, participants will be asked to respond as quickly as
possible on flashing of green lights by clicking the right button of the mouse in
a column of three lights respectively as red, yellow, green from top to bottom.
An average value of five trials will be considered for analysis.
In Auditory reaction time, the subjects will be asked to click the mouse on a
designated area on hearing a particular sound. An average value of five trials
will be considered for analysis.
e. Stroop Test33
Subjects will be asked to read the power point slides and respond as quickly as
possible without committing any error. They will have to read either the name
of the word (ST-I, Modified Stroop Task Sub Task-I), or name the color in
which the words are written (ST-II), or read the words and name the colors in
which the words are written (ST-III). Time duration from first response till the
last response will be recorded as performance time.
Analysis of data:
Repeated measures ANOVA (Analysis of Variance) will be used with
Bonferroni / Tukeys post hoc test for multiple, between-group comparisons.
Correlation analysis of different sub-maximal exercise and cognitive
performance will be carried out by Pearson test. P value of < 0.05 will be
considered statistically significant.
Confidentiality of Data:
All information about your health status and results of the test will be kept confidential
and retained in the institute as required under rules. Results may be presented at conferences
and published without any disclosure of your identity directly or in directly.
Conflicts of interest:
None of the investigators has any conflict of interests of any kind whatsoever with
research and its outcome.
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REFERENCES
1. Radak Z, Kaneko T, Tahara S et al. Regular exercise improves cognitive function and
decreases oxidative damage in rat brain. Neurochem Int 2001; 38 (1):17-23.
2. Lambourne K, Tomporowski PD. The effect of exercise-induced arousal on cognitive task
performance: a meta-regression analysis. Brain Res 2010; 1341:1224.
3. Ploughman M. Exercise is brain food: The effects of physical activity on cognitive
function. Dev Neurorehabil 2008; 11:236-40.
4. Hillman CH, Erickson KI, Kramer AF. Be smart, exercise your heart: exercise effects on
brain and cognition. Nat Rev Neuroscience 2008; 9 (1): 5865.
5. Winter B, Breitenstein C, Mooren FC et al. High impact running improves learning.
Neurobiol Learn Mem 2007; 87 (4): 597- 609.
6. Kavussanu M, Martins AQ, Ring C. Moderate intensity exercise facilitates working
memory. Psychol Sport Exerc 2013; 14 (3): 323-8.
7. Tomporowski P.D. Effects of acute bouts of exercise on cognition. Acta Psychol. (Amst)
2013; 112 (3): 297 324.
8. Pesce C, Audiffren M. Does acute exercise switch off switch costs? A study with younger
and older athletes. J. Sport Exerc. Psychol. 2011; 33: 609-26.
9. Pesce CR, Tessitore A, Casella R et al. Focusing of visual attention at rest and during
physical exercise in soccer players. J. Sports Sci 2007; 25:1259-70.
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18. Brisswalter J, Collardeau M, and Rene A. Effects of acute physical exercise characteristics
on cognitive performance. Sports Med 2002; 32:55566
19. McMorris T, Sproule J, Turner A et al. Acute, intermediate intensity exercise, and speed
and accuracy in working memory tasks: a meta-analytical comparison of effects. Physiol.
Behav 2011; 102: 4218.
20. Lucas S J, Ainslie PN, Murrell CJ et al. Effect of age on exercise-induced alterations in
cognitive executive function: relationship to cerebral perfusion. Exp. Gerontol 2012; 47:
541-51.
21. Mekari S, Fraser S, Bosquet L et al. The relationship between exercise intensity, cerebral
oxygenation and cognitive performance in young adults. Eur J Appl Physiol. 2015; 115
(10): 2189-97.
22. Grego F, Vallier JM, Collardeau M et al. Influence of exercise duration and hydration
status on cognitive function during prolonged cycling exercise. Int J Sports Med 2005;
26 (1): 27-33.
23. Ogoh S, Dalsgaard MK, Yoshiga CC et al. Dynamic cerebral autoregulation during
exhaustive exercise in humans. Am J Physiol Heart Circ Physiol. 2005; 288 (3): H1461-7.
24. Colcombe S & Kramer AF. Fitness effects on the cognitive function of older adults: A
meta analytic study. Psychol Sci. 2003; 14 (2), 125-130.
25. Taylor CB, Sallis JF & Needle R. The relation of physical activity and exercise to mental
health. Public Health Rep. 1985; 100 (2): 195-202.
26. Van Uffelen JG, Chin A, Paw MJ et al. The effects of exercise on cognition in older adults
with and without cognitive decline: a systematic review. Clin. J. Sports Med 2008; 18: 486-
500.
27. Predovan D, Fraser SA, Renauld M et al. The effect of three months of aerobic training on
stroop performance in older adults. J Aging Res 2012; Article ID-269811:1-7, DOI-
10.1155/2012/269815.
28. David FJ, Robichaud JA, Leurgans SE et al. Exercise improves cognition in Parkinsons
Disease: The PRET-PD Randomized Clinical Trial. Mov Disord. 2015; 30 (12): 1657-63.
29. Buck SM, Hillman CH and Castelli DM. The Relation of Aerobic Fitness to Stroop Task
Performance in Preadolescent Children. Med. Sci. Sports Exerc. 2008; 166-172 Book
chapter.
30. Van der Niet AG, Smith J, Schrder EJ et al. Effects of a cognitively demanding aerobic
intervention during recess on childrens physical fitness and executive functioning. Pediatr
Exerc Sci. 2016; 28 (1): 64-70.
31. ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med
2002; 166: 1117.
32. Task Force of the European Society of Cardiology and the North American Society of
Pacing and Electrophysiology. Heart rate variability: standards of measurement,
physiological interpretation and clinical use. Circulation 1996; 93:1043-65.
33. Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol; 18 (6): 643-62.
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Annexure-I
VALLABHBHAI PATEL CHEST INSTITUTE
UNIVERSITY OF DELHI, DELHI 110007
11
will be later analyzed for measuring heart rate variability. Body composition analysis will be
done by bio-impedance method for assessing Body Fat Percentage and Fat Free Mass.
For Heart rate recovery assessment, you will be asked to pedal on leg ergometer at
selected pedal frequencies between 50-55 cycles/min. After a 3-minute warm-up period of
unloaded pedaling, the workload will be set according to your functional exercise capacity as
derived from the 6MWT. Standard encouragements will be provided during exercise. You will
be required to cycle till the point of volitional fatigue or till the achievement of 85% of the
target heart rate (pre-calculated training HR). At this point, you will be asked to continue to
pedal for at least 15 seconds to ensure the maintenance of the heart rate at the same level.
Ergometer will be unloaded at this time and the recovery phase will commence, you will
continue pedaling to cool down with unloaded pedaling for another 3-minute. Heart rate will
be recorded before and after the warm-up, during ergometry, at 1 min into recovery period and
at end of cool-down period till recovery to the baseline. Heart rate will be recorded using
continuous finger plethysmograph during the entire process.
Further you will be assessed for Cognitive performance which includes following tests:
1. Letter Cancellation Test (LCT)
2. Digit Substitution Test (DST)
3. Visual and Auditory Reaction Time
4. Arithmetic Mental Task
5. Stroop Test
In these tests you will be assessed for certain mental tasks which include specific letter
cancellation in a string of letters, Digit Substitution, simple arithmetic computations, reading
name of a color (e.g., "blue", "green", or "red") which is printed in a color that is not denoted
by the name (e.g., the word "red" printed in blue ink instead of red ink).
Benefits of the Study
There is no immediate benefit to you from this study; however this study will help us to
establish whether different levels of sub-maximal exercises improves cognitive performance
and help us in formulating cognition enhancing modalities.
Risk of the study
There are no risks involved in the study. All the tests will be performed under trained
medical person and continuous monitoring of vital parameters.
Voluntary participation
Your participation in this study is voluntary. You are free to enroll yourself in this
study or decide not to. You may opt out from the study anytime.
Number of Visits
A total number of four visits will be required for assessment and exercise sessions.
Charges:
There will be no charge for participation in the research work. All the assessments will
be conducted free of cost.
Conflicts of interest:
None of the investigators has any conflict of interests of any kind whatsoever with
research and its outcome.
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Confidentiality of Data:
All information about your illness or health status and results of the test will be kept
confidential and retained in the institute as required under rules. Results may be presented at
conferences and published without any disclosure of your identity directly or in directly.
CONSENT FORM
I, S/o/D/o resident of
exercising
my free power of choice hereby give my consent to be included as a subject in the study
Cognitive performance after short duration submaximal exercise in young adults.
I have been explained the purpose, risks, benefits and methodology of the study, by the
investigator in the language, I can understand.
I am also aware of my right to go out of the study at any time during its course without having
to give reason for doing so.
13
Annexure II
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