Guilherme Moraes Balbim

Objective: To assess the effect of exercise training as a single intervention (ie, Exercise-Only ) and exercise combined with other lifestyle interventions (ie, Exercise-Plus ) on executive functions, memory and processing speed of older adults living without dementia. Design: We performed a systematic review with pairwise meta-analyses and network meta-analysis to examine the effects of: (1) Exercise-Only versus Control ; (2) Exercise-Plus versus Control ; and (3) Exercise-Plus versus Exercise-Only . Data sources: We searched four databases (Medline, Embase, PsycINFO and CINAHL) between database inception and March 2026. Eligibility criteria: We included randomised controlled trials that examined the effects of exercise training as a single domain or multidomain intervention on cognitive function of adults aged over 60 living without dementia. Results: We included 227 studies in the pairwise meta-analyses ( Exercise-Only =178, Exercise- Plus=67) and 105 studies in the subset for the network meta-analysis ( Exercise-Only =76, Exercise-Plus= 36). Cognitive training and cognitively engaging activities were the most common Plus component in the included studies. Exercise-Only produced statistically significant improvements across all three cognitive domains compared with Control. Exercise-Plus was only significantly better than Control for memory. Exercise-Plus was also significantly better than Exercise-Only for executive functions and processing speed but not for memory. Conclusion: We recommend the promotion of exercise training to improve cognitive outcomes of older adults. Further research is needed to determine the added benefit of multidomain exercise interventions. PROSPERO registration number: CRD42022322199.

Background: Physical activity, sedentary behaviour, and sleep are three behaviours which occupy the 24-h cycle and interact to influence a multitude of health outcomes. Different terms are currently used to describe these behaviours collectively (e.g., movement behaviours or physical behaviours ). The lack of clear and consistent terminology makes it hard to compare, interpret, and build on research findings. As a first step towards developing consensus on what terminology to use for discussing the 24-h cycle of physical activity, sedentary behaviour, and sleep, we conducted a scoping review to identify the breadth of terminology used to describe this phenomenon. Methods: All searches occurred between September 18th – 20th 2024. We searched nine databases: Medline, EMBASE, CINAHL, PsycInfo, Web of Science, Scopus, ERIC, Education Source, and Compendex from inception to September 18th 2024. The Journal of Activity, Sedentary and Sleep Behaviors and the International Network of Time-Use Epidemiologists (INTUE) publication lists were manually searched on September 19th – 20th 2024. Peer-reviewed articles were included if they 1) were published in English, Spanish, Portuguese, French, Chinese, Korean, or Japanese; 2) focused on humans; and 3) describe physical activity, sedentary behaviour, and sleep in an integrated manner. We identified different terminologies used for collectively discussing physical activity, sedentary behaviour, and sleep across the 24-h cycle. Results: Our search identified 10,749 articles of which 979 articles met our inclusion criteria. Across all articles, 199 different terms were used to describe physical activity, sedentary behaviour, and sleep collectively. The term movement behaviours was used in 673 articles, 24-h movement behaviours was used in 457 articles, physical behaviours was used in 58 articles, 24-h activity cycle was used in 36 articles, and time-use behaviours was used in 31 articles. Conclusions: The two most popular terms for describing the collective interaction of physical activity, sedentary behaviour, and sleep are movement behaviours and 24-h movement behaviours . However, there is not yet an internationally recognized and agreed-upon term for holistically describing the 24-h cycle of physical activity, sedentary behaviour, and sleep. Developing a homogeneous and widely accepted set of terminology and definitions is thus critical if we hope to ensure clarity, enhance reproducibility, and enable the translation of future research into coherent guidelines, policies, and practices for these behaviours.

Background: In 2024, the Supreme Court ruled in the City of Grants Pass vs Johnson that local towns and municipalities may ban people from sleeping in public places, overturning a lower-court precedent that previously deemed this cruel and unusual punishment. Purpose: This position paper sought to identify effective interventions for addressing homelessness and emphasize the implications of legislature on sleep and public health outcomes. Methods: As this is a policy position paper, the opinions listed in this report have been informed by existing evidence. We provide policy recommendations for research-supported approaches addressing homelessness. Results: Successful interventions for homelessness included those that focused on providing support and increasing resources, such as the development of Safe Sleeping Zones in California, or providing individuals with housing subsidies, income assistance, or support in finding rentals. Conclusion: We provide the following policy recommendations for legislators: increased federal funding/incentives for unsheltered homelessness programs, a greater allocation of the federal budget attributed to supportive services, and increased legislation for homelessness prevention. We suggest a shift in focus on implementing more empowerment and supportive-based approaches as opposed to punitive approaches. Investing in homelessness prevention efforts has yielded long-term societal-level financial and economic benefits.

INTRODUCTION: The 24‐hour activity cycle (24‐HAC) includes physical activity (PA), sedentary behavior (SB), and sleep. The 24‐HAC composition and brain health relationship in adults with mild cognitive impairment (MCI) remains underexplored. We examined associations between 24‐HAC composition and gray matter (GM) volume. METHODS: Cross‐sectional study in 110 adults with MCI. Actigraphy assessed 24‐HAC behaviors. FreeSurfer quantified GM. Compositional linear regressions and isotemporal substitution determined 24‐HAC composition and GM volume associations. RESULTS: Higher moderate‐to‐vigorous physical activity (MVPA) relative to remaining behaviors was associated with greater right inferior temporal gyrus volume (ß = 0.30, false‐discovery rate (FDR)‐corrected‐ p =  0.030). Higher SB relative to remaining behaviors was associated with lower volume in the same region (ß = −0.45, FDR‐corrected ‐p =  0.015). Reallocating 30 min from SB to MVPA predicted 2.1% greater (ß = 0.06, p  < 0.001) and from MVPA to SB predicted 2.8% lower volume (ß = −0.08, p  < 0.001). DISCUSSION: Increasing MVPA at the expense of SB may protect GM in regions prone to Alzheimer's disease‐related atrophy. TRIAL REGISTRATIONS: ClinicalTrials.gov, NCT02926157, NCT02737878, and NCT02669394. Highlights: The 24‐hour behaviors are associated to inferior temporal volume in older adults with mild cognitive impairment (MCI). More moderate‐to‐vigorous physical activity (MVPA) is linked with greater inferior temporal volume in older adults with MCI. Allocation from sedentary time to MVPA predicts greater inferior temporal volume.

Background: People with mild cognitive impairment are at greater risk of Alzheimer’s disease. Physical activity (PA), sedentary behaviour, and sleep are movement behaviours constituting the 24‐hour activity cycle (24‐HAC) and are interactively associated with cognitive and brain health. However, the relationship between 24‐HAC compositions (i.e., time in one behaviour relative to remaining) and brain volume in this population remains underexplored. We aimed to investigate the associations between 24‐HAC compositions and time reallocation of 24‐HAC movement behaviours with brain volume.Method: A cross‐sectional study in 110 community‐dwelling adults (55+ years) with mild cognitive impairment (Montreal Cognitive Assessment 0.05). Reallocating 30 minutes from sedentary behaviour to moderate‐to‐vigorous PA was associated with 2.1% greater volume in the TE2a region (ß = 0.06, 95% CI = 0.02; 0.10, pp<0.001).Conclusion: Greater light PA composition may happen at the expense of lower moderate‐to‐vigorous PA composition, which could explain its associations with lower cortical volume. Greater moderate‐to‐vigorous PA composition and reallocating time from sedentary behaviour to moderate‐to‐vigorous PA may counteract cortical atrophy in an Alzheimer’s disease signature region in people with mild cognitive impairment.

Objective To examine the effects of strength training on patient-important outcomes of stroke recovery and to quantify the influence of the exercise prescription on treatment effects. Design Systematic review and meta-analysis. Data sources Eight electronic databases (MEDLINE, EMBASE, EMCARE, AMED, PsycINFO, CINAHL, SPORTDiscus, and Web of Science) and two clinical trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) were searched from inception to 19 June 2024. Eligibility criteria Randomised controlled trials were eligible if they examined the effects of strength training compared with no exercise or usual care and reported at least one exercise prescription parameter. An advisory group of community members with lived experience of stroke helped inform outcomes most relevant to stroke recovery. Results Forty-two randomised trials (N=2204) were included. Overall risk of bias was high across most outcomes. Strength training improved outcomes rated as ‘critical for decision-making’ by the advisory group, including walking capacity (standardised mean difference (SMD)=0.95 (95% CI 0.34–1.56)), balance (SMD=1.13 (0.51–1.75)), functional ability and mobility (SMD=0.61 (0.09–1.14)), and habitual (mean difference (MD)=0.05 m/s (0.02–0.09)) and fast-paced walking speed (MD=0.09 m/s (0.01–0.17)), with very low to moderate certainty of evidence, mainly due to risk of bias and inconsistency. More frequent strength training, traditional strength training programmes and power-focused intensities (ie, emphasis on movement velocity) were positively associated with walking capacity, health-related quality of life and fast-paced walking speed. Conclusion Strength training alone or combined with usual care improves stroke recovery outcomes that are important for decision-making. More frequent strength training, power-focused intensities and traditional programme designs may best support stroke recovery. PROSPERO registration number CRD42023414077.

Background: The relationship of cognition and the 24-h activity cycle (24-HAC), encompassing physical activity, sedentary behavior, and sleep, in older adults with mild cognitive impairment (MCI) remains uncertain. Distinct combinations of 24-HAC behaviors can characterize unique activity profiles and influence cognition. We aimed to characterize 24-HAC activity profiles in older adults with MCI and assess whether differences in cognition exist across profiles. Methods: We conducted a cross-sectional analysis utilizing baseline data from 3 randomized controlled trials involving 253 community-dwelling older adults (55 + years) with MCI (no functional impairment, dementia diagnosis, and Montreal Cognitive Assessment score .05). Conclusions: Older adults with MCI exhibited four 24-HAC activity profiles conforming to recommended physical activity and sleep guidelines. Nonetheless, cognition was similar across these profiles.