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Evidence Based

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Exercise and Brain Health — Why It Matters

Written by Dr. Michael Ruscio, DC on October 3, 2022

Written by Dr. Michael Ruscio, DC on October 3, 2022 — Reviewed by Dr. Hannah Hamlin

Exercise Can Prevent and Slow Cognitive Decline, Including Alzheimer’s Disease

• Ways Exercise Can Improve Brain Health|
• Effects of Exercise on Brain Health|
• Best Type of Exercise for Brain Health|
• Exercise as Prevention|
• Exercise and Brain Health Are Linked|

Maybe you’re familiar with the rush of endorphins (happy hormones) you get after a difficult workout, or the “runner’s high” many people feel after a multiple-mile run around town. 

Or maybe you’ve experienced the opposite effect: after a few hours of sedentary work (or sitting on the couch watching TV), you might feel like your ability to think and solve problems has slowed down considerably, and you may even feel demotivated or anxious. 

Either way, it’s not hard to see that there’s a significant connection between exercise and brain health in our everyday lives, and the research supports this theory. 

In fact, the connection between exercise and brain health may be far stronger than we thought, especially when we look at the research on exercise slowing and potentially reversing cognitive decline, even for conditions like Alzheimer’s disease and dementia. 

In this article, we’ll explore all of the ways exercise affects brain health, including cognitive performance, memory, executive function, mood, focus and attention, neuroplasticity, and sleep quality. 

Ways Exercise Can Improve Brain Health and Cognition

There are several ways that exercise can improve brain health.

In the short term, exercise increases blood flow to the brain, bringing fresh oxygen. Oxygen keeps your brain cells (neurons) healthy, alive, and functioning optimally. We know that this positive effect occurs with just one bout of exercise [1].

Recurring bouts of exercise also lead to the development of new blood vessels (angiogenesis), synapses (synaptogenesis), and nerves (neurogenesis), all of which are good for brain health [1]. More blood vessels means more nutrients and oxygen delivered to your brain, which are important for enhancing cognition. 

Furthermore, exercise increases a substance called brain-derived neurotrophic factor (BDNF) and other brain-protective chemicals that promote neuroplasticity (the ability of the brain to change and heal) [2, 3, 4, 5]. Brain plasticity is essential for improving cognitive abilities and preventing cognitive decline.

Another substance stimulated by exercise is insulin-like growth factor or IGF-1, a hormone that helps the brain develop and repairs damage to the central nervous system [5]. Finally, exercise reduces inflammatory markers like tumor necrosis factor-alpha (TNFα) and C-reactive protein in areas of the brain [5]. Exercise can also suppress inflammation in the gut, which as we know from the mechanism of the gut-brain axis, can eventually spread to the brain if left unchecked [6].

An inflamed brain (neuroinflammation) leads to symptoms like brain fog, inability to focus, and poor memory. Over the long term, neuroinflammation contributes to disorders of the central nervous system, including Alzheimer’s disease, Parkinson’s, schizophrenia, anxiety, depression, stroke, and others [7]. Keeping neuroinflammation to a minimum is definitely a good thing.

To sum it up — regular physical activity keeps your nervous system healthy and your brain functioning optimally.

Effects of Exercise on Brain Health

Now that we’re familiar with the ways exercise may improve brain health, let’s translate that to the actual effects you’ll notice with consistent exercise. 

Exercise for Academic Performance

A systematic review and meta-analysis of adolescents and young adults found that even just one bout of acute exercise improved processing speed and attention and reduced procrastination related to academic performance. This is likely due to its beneficial effects on the prefrontal cortex (the part of the brain involved in decision-making and planning).

The same study found that recurring exercise (occurring over several days) significantly improved processing speed, attention, cognitive flexibility (the ability to adapt one’s thinking to a new environment or situation), working memory, and language skills related to academic performance in teens and young adults [1].

Another review of nine clinical trials found that exercise seemed to improve math performance and attention in kids [8]. A longer exercise intervention created by trained specialists as opposed to short “active breaks” appeared to further improve cognitive performance, but both interventions were helpful to some extent.

Exercise for Traumatic Brain Injury (TBI, Concussions)

A high-quality review looked at 23 controlled clinical trials to understand the role of physical activity in managing concussions (traumatic brain injuries). Researchers found that physical activity had a large positive effect on concussion recovery. 

Overall, single-type subthreshold aerobic exercise had the largest positive effect on concussion recovery, whereas mixed interventions had a more moderate effect [9]. 

NOTE: Subthreshold aerobic exercise consists of exercises (for example, 20 minutes on a treadmill or stationary bicycle) that keep the heart rate at 80% of that which causes post-concussive symptoms. Some of these symptoms may include headaches, dizziness, fatigue, loss of concentration, anxiety, and irritability. 

This study indicates that the ability of exercise to put the body in a state of eustress (good stress) — where exertion is just enough to stimulate the brain and body but not enough to flip it into a state of negative stress — may promote better healing and overall well-being. 

Exercise for Cognitive Impairment

A 2022 systematic review and meta-analysis evaluated 15 controlled clinical trials to understand the effects of physical activity on mental health in kids and teens with intellectual disabilities. 

Overall, physical activity, especially more than 120 minutes of aerobic exercise per week, had medium positive effects on psychological health and large positive effects on cognitive function in kids and teens with intellectual disabilities [10]. 

Another study assessed five randomized controlled trials to find out how effective combined brain games and physical exercise are at improving cognitive impairment in adults who have had a stroke. 

They found that combining brain games and physical activity significantly improved cognitive impairment (global cognition, reasoning, logical thinking, and visual-spatial memory) after a stroke [11].

Exercise for Mental Health and Psychological Conditions

There are many studies on the effects of exercise on a wide range of mental health and psychological conditions, from generalized anxiety to PTSD. 

One research review involving patients with coronary heart disease and anxiety or depression found that those who participated in regular exercise therapy had a significant improvement in anxiety and depression [12]. The study authors concluded that exercise is a powerful non-pharmacologic (non-drug) therapy for anxiety and depression.

This isn’t to say that starting an exercise habit is easy, especially with anxiety or depression, but it is worth pursuing. If you need support from a therapist, personal trainer, or an encouraging accountability partner, reach out for help. Those around you want to support you even more when you are trying to instill a new healthy habit to feel better.  

A 2022 review compared 15 controlled clinical trials to find out how different aerobic exercises affect cognition in people with schizophrenia. 

Compared with controls, all aerobic exercise yielded significant small effects on:

• Global cognition
• Attention/vigilance
• Working memory
• Verbal learning 

The best results were achieved with at least 90 minutes of group or professionally monitored exercise per week for at least 12 weeks to improve cognition in people with schizophrenia [13].

Another systematic review evaluated 11 randomized controlled trials to understand the effects of exercise on PTSD symptoms. Researchers found that yoga and other types of exercise significantly improved depression, sleep, substance use, and quality of life in PTSD patients [14].

In addition to these specific conditions, exercise reduces stress, which may have a negative impact on cognitive function and mental health. It seems that exercise can improve mental health through many different channels. 

Is There a Best Type of Exercise for Brain Health?

The cardio vs. strength training debate seems nearly as old as the chicken and the egg, but the research points to benefits for both types of exercise depending on your life stage, with a slight advantage towards strength training overall. 

According to two recent research reviews, moderate- and high-intensity exercises such as HIIT workouts raise BDNF levels in younger people but not always in older healthy people or patients with multiple sclerosis (MS), Parkinson’s, or stroke [3, 15]. 

In older people with and without cognitive decline, moderate intensity mind-body exercises such as Tai Chi, Baduanjin, dance, or handball, and especially resistance training, appear to have the greatest cognitive benefits [2, 16, 16, 17, 18, 19]. 

If you are new to consistent exercise, try doing a combination of low-moderate intensity cardio and low-moderate intensity strength training three times per week until you become more comfortable with exercise. Then you can increase the difficulty and intensity over time. 

Here are some examples of exercises that can easily be done from home, with minimal or no equipment, and can be modified to your ability level: 

• Stationary bike
• Treadmill/sprints
• Dumbbells/kettlebells
• Bodyweight exercises
• Boxing/martial arts
• Jumping rope
• Pilates
• Yoga
• Dance

You can find video tutorials for most of these exercises on YouTube that are easy and fun to follow along. There are also plenty of great apps you can use that provide fresh content or allow for personalization. 

The Down Dog app offers great options for yoga, running, HIIT, barre, and even prenatal yoga where you can customize your workout based on your goals. Apps like Steezy let you learn different types of dance. And there are even apps directed toward those on a time crunch, like Seven, which offers no-equipment seven-minute long exercises. There are tons of resources to find what works best for you.

I also want to emphasize that there is no “best” exercise for brain health, as long as it combines some form of cardio and strength training. What’s most important is consistency over the longterm and continuing to challenge your muscles. You can also integrate shorter exercise breaks into your daily routine if you find it challenging to carve out an hour or more for a workout during the day. 

As one 2022 research review found, adding in these short exercise breaks is a good way to incorporate physical activity into your day without compromising your work performance or cognition (though the exercise breaks didn’t offer a significant improvement in cognitive tasks either) [20]. 

For a more in-depth perspective on strength training and fitness performance, I’d recommend my recent conversation with Eric Hinman, an endurance athlete and 5x Ironman. For more of a clinician perspective on muscle, exercise, and health, you can check out my conversation with Dr. Gabrielle Lyon. Dr. Lyon practices muscle-centric medicine to improve metabolic health, reduce the risk of chronic disease, and maintain overall long-term wellness.

Exercise as Prevention: Neurodegenerative Conditions and Cognitive Decline

Exercise has excellent cognitive benefits for neurodegenerative conditions like Alzheimer’s disease, multiple sclerosis, Parkinson’s, etc. 

In fact, a research review conducted by my colleague Dr. Peter Attia and his team found that regular exercise (especially strength training) is the best researched among the top four non-drug treatments for reducing systemic inflammation and the risk of Alzheimer’s. Diet, sleep, and stress reduction also made the list, so (even if you’re exercising) it’s important not to neglect other aspects of your lifestyle.

Another systematic review and meta-analysis looked at 18 RCTs to determine how exercise affects BDNF levels in people with neurodegenerative disorders, including MS, Parkinson’s, mild cognitive impairment, and Alzheimer’s disease [2]. BDNF levels increased with exercise, and the most effective forms of exercise were: 

1. Resistance exercise (strength training) 
2. Aerobic exercise 
3. Combined exercise

Exercise is also essential to maintain cognitive health and prevent decline with aging. Research has found that exercise is related to better cognitive health in older adults and may be good for preventing dementia, even when adopted later in life. Combining exercise with cognitive training may also have added benefits [21]. 

Overall, staying active as you age is extremely important to maintain cognitive function and brain health, as well as prevent degenerative neurological disease. 

Exercise and Brain Health Are Closely Linked

Looking at the research on exercise and brain health, several points stand out: 

1. Exercise has significant benefits for general cognition, focus, memory, mood regulation, and prevention of cognitive decline.
2. It’s never too late (or too early!) to start an exercise habit to support brain health.
3. Some exercise is always better than none, even if it’s only a handful of minutes between work tasks doing basic bodyweight exercises. The important thing is just to start and get some consistency going. 

Exercise is excellent for brain health and slowing cognitive decline. However, you don’t have to be experiencing cognitive decline to benefit from the brain health benefits of exercise, and it’s never too early to prevent dementia and Alzheimer’s. So get moving!

If you want to learn more about how we can support your brain health on a one-to-one basis, schedule a consultation with us at the Ruscio Institute for Functional Medicine.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.