Chinese Journal of Tissue Engineering Research ›› 2021, Vol. 25 ›› Issue (20): 3252-3258.doi: 10.3969/j.issn.2095-4344.3164
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Lu Yi, Deng Wenchong
Received:
2020-04-11
Revised:
2020-04-21
Accepted:
2020-08-11
Online:
2021-07-18
Published:
2021-01-18
About author:
Lu Yi, Master, Lecturer, Department of Physical Education, Chongqing University of Technology, Chongqing 400054, China
CLC Number:
Lu Yi, Deng Wenchong. Regulation and difference of different exercise styles on brain structure and cognitive function[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(20): 3252-3258.
2.1 健身运动介入与大脑结构的关系 健身运动介入对于个体生理的改善效益可通过科学仪器进行测定。早期研究中主要利用脑波仪,通过事件关联电位对大脑功能进行判断。随着脑神经结构及功能影像学的发展,利用MRI和CT等技术可侦测大脑额叶、基底节、胼胝体及海马等结构和功能等变化[17] ;利用单光子发射计算机断层成像术、正电子发射计算机断层显像及功能性MRI等技术可探测大脑纹状体、听觉区、感觉运动区及双侧枕区的血流和额叶皮质、扣带回、丘脑、尾状核及海马回糖代谢率。 2.1.1 健身运动介入与海马回 海马回位于大脑颞叶区,左右脑区各有1个,其体积可能受到不同经验的影响。海马回与个体空间记忆有关[18],在失智老年人中海马体每年以1%-2%的速度缩减;而心血管、高血压及老化相关的慢性疾病会加速海马回的萎缩[19]。抑郁症也与大脑结构异常有关,其中包括海马回体积减少。故如何减缓海马回的体积萎缩和防止记忆退化,已成为公共健康的一个重要课题[20]。 已有研究报道,相较于低体适能水平者,体适能水平较高者的海马回体积萎缩速度较慢且体积更大,信息处理速度、执行功能效果以及空间记忆表现更佳[21–23]。进一步研究发现,持续1年以上的有氧健身运动可使海马回体积增加约2%;并且每周健身运动总时间与海马回内部灰质体积呈正相关,但每周运动次数及每次运动时间对海马回的影响无统计学意义[24]。抑郁症患者的海马回体积会发生明显改变[20],并与抑郁相关的过程关系紧密,例如情绪处理、压力调节[25]。健身活动一直被报道为具有抗抑郁作用[26],最近对纳入183 779 4人的49项前瞻性队列研究的Meta分析显示,高体力活动水平者患抑郁症的概率比低体力活动者低17%[27];另有研究发现,运动可至少在中等程度上减少抑郁症的症状,并且可以作为药物治疗和心理治疗的有效补充[28]。纵向数据显示,低心肺适能抑郁症患者的心肺适能改善与抑郁症状和脑形态学改善相关。健身运动刺激了神经形成机制,并与老年人、抑郁症患者海马回、前额叶等脑区的生长有关[29];它还能刺激脑血流量增加,从而帮助萎缩和受损脑区恢复[30]。NIEMANN等[9]采用横断式研究探讨了不同运动类型对大脑结构的影响,包括有氧运动、无氧训练运动与精细协调的动作训练,经12个月的运动介入后海马回体积发生了明显增大。总之,体适能水平和是否长期健身运动在健康人群和抑郁症等特殊人群中均与海马回体积间存在正相关关系。 2.1.2 健身运动介入与前额叶皮质 前额叶位于大脑的前半部,位于额叶运动区和辅助运动区之间。前额叶又可再细分为内侧前额叶皮质、背外侧前额叶及眼眶前额叶皮质。前额叶体积占大脑中最大的部分,具有掌控执行功能的作用[31]。 COLCOMBE等[32]将59位身心健康的老年人随机分成实验组与对照组,进行为期6个月的有氧健身运动介入及无活动,结果显示从事长期健身运动老年人的颞叶与前额叶皮质的白质与灰质体积增加。GORDON等[33]将20位年轻人与具有高、低体适能的老年人各20人进行比较,结果发现尽管老年人前额叶皮质区的灰质,顶叶、颞叶以及前内侧区的白质密度皆显著低于年轻人,但具有高体适能老年人的前顶区、中颞区与内额区的灰质密度则显著优于低体适能者。WEINSTEIN等[34]招募了142位老年人并直接测试其心肺适能水平,结果显示体适能水平与背外侧前额叶的灰质体积呈正相关。ALOSCO等[35]考察了心脏疾病患者的心肺适能与灰白质的关系,结果发现体适能水平与灰质体积存在正向相关。GUJRAL等[29]在11例患有抑郁症的年轻人和老年人中进行了一项为期12周的运动计划,发现心肺功能的改善与背外侧前额叶皮质和前扣带皮质体积的增加有关。SCHLAFFKE等[36]在横断式研究中将精英运动员分为有氧运动组、无氧代谢组及对照组,结果发现2个运动组相较于对照组在辅助动作区域的背侧运动前皮质具有较大的灰质体积;此外,长期进行高强度有氧训练的耐力运动员在额前叶呈现出灰质体积显著增大的现象。总之,不论是本身具有高心肺适能者亦或是从事健身运动介入者皆表明,运动对其前额叶皮质有正向效益,而在健康或罹患心脏疾病、抑郁症的群体中皆呈现此种正向关联,其中高强度有氧运动可能对前额叶体积影响较大。 2.1.3 健身运动介入与基底核 基底核也被称为基底神经节,位于大脑深处并可再区分为视丘下核、纹状体、苍白球、尾状核及黑质等结构。基底核与前额叶位置接近,且与该结构形成了一条皮质回路系统。基底核主要负责自主运动控制的功能,而帕金森症、手足徐动症、肌张力障碍、芭蕾舞症及舞蹈症等肢体障碍有关的疾病均可能与基底核损伤或病变有关[37]。基底核亦与认知控制 (准备、启动、抑制、转换的反应)有关 [38]。 研究发现体适能状况与基底核体积具有正相关关系,其中又以与尾状核及伏隔核的相关性最显著;而中老年人心肺功能水平与基底神经节体积及大脑执行功能的相关性较高[39]。但对于健身运动对基底核体积的改善,目前研究结论不一,CHADDOCK-HEYMAN等[40]发现有氧健身运动介入组的海马回体积显著改善,但尾状核以及丘脑方面无明显影响。LIU-AMBROSE等[41]的研究认为长期有氧健身运动介入对运动能力的改变与基底核体积的变化之间的关系有调节作用。但有氧运动没有导致基底核的体积增大,而没有健身运动介入且运动水平下降的人的基底核体积显著下降。NIEMANN等[9]的研究结果显示长期协调性健身运动介入能够增加尾状核与伏隔核体积。总之,体适能状况与基底核体积具有正相关关系,但直接探究基底核与健身运动的研究尚少,且结果存在差异,健身运动介入对基底核的改善作用需要进一步探究。 2.2 健身运动介入对大脑执行功能的影响 大脑执行功能是指对低级认知过程协调,从而使个体能在不熟悉的环境中完成非自动化任务(解决问题、计划等)的高级认知功能,主要包括抑制控制、工作记忆和认知灵活性三部分,其主要受大脑前额叶皮质控制[42]。执行功能异常与阿尔茨海默症、儿童注意缺陷多动障碍、抑郁症等疾病有关。有效改善执行功能的方法已成为脑科学和神经科学领域的研究热点。 2.2.1 有氧运动与执行功能 多项研究指出长期进行有氧健身运动的少年儿童,其心肺适能、记忆储存、健康心智、大脑执行功能均可获得显著提高,并发现心肺适能较好的儿童其心智健康、大脑执行功能表现也较好[43-45]。中等强度有氧健身运动能改善注意缺陷多动障碍儿童的执行功能,且改善效果优于正常儿童,这可能与干预前正常儿童和注意缺陷多动障碍儿童间的发育差异有关 [46-48]。另有研究发现,中等强度有氧运动对青年人认知控制能力带来的促进效益主要表现在反应执行能力的保持和抑制能力的提高两个方面[49]。众多研究表明,长期有氧健身运动能够有效预防健康老年人抑制控制、工作记忆、认知转换的衰退[5,16]。也有研究认为,有氧健身运动能够改善阿尔茨海默症、脑卒中、认知障碍老年人的执行功能、记忆能力和语言表达能力[16,50-51]。高海拔环境中进行有氧健身运动,对非高原原著居民的执行功能有积极影响。有氧健身运动改善执行功能脑机制,可能是长期有氧运动后人体心肺适能提升,血液循环加强,从而增强执行功能相关脑区血流水平,促进脑源性神经营养因子的产生以及激活神经内分泌通路促进前额叶、枕叶、前扣带回等功能连接的增强,进而提升执行功能神经网络的整体效率。 2.2.2 无氧运动与执行功能 VERSCHUREN等[52]研究发现脑性麻痹患儿在接受长期无氧运动介入后,体质量指数、敏捷性、肌力、自我概念、工作记忆和抑制控制方面皆有显著改善。中老年女性在接受无氧阈强度以上的无氧抗组训练后,在简单反应时间、口语流畅、河内塔、联机测验-B等大脑执行功能检测中表现均有提升。中老年人接受急性高强度抗阻运动后其认知转换和刷新表现有显著提高[53],并且高速抗阻训练比低速抗阻训练对老年人轻度认知损害有更大的改善效益[54]。LIU-AMBROSE等[41] 针对65-75岁的88名妇女进行12个月的无氧抗阻训练介入,发现能够增加对反应抑制过程参与的同时将响应抑制准备默认状态的趋势降低。由此可知,运动对于认知表现的效益或许不仅局限于单一形式的有氧运动,无氧运动提供不同生理系统的运动模式亦对执行功能有正面影响。 2.2.3 协调性运动与执行功能 柔韧协调训练可以有效促进老年人在叫色测验的执行控制表现,其效果在运动介入前期特别显著[55]。太极拳和舞蹈等协调性要求较高的运动,对认知功能完整或受损的老年人的认知能力、认知灵活性、工作记忆能力、语言流畅性以及学习能力均有促进作用,并且中等强度下效果最佳[14]。与有氧健身运动相比,协调性健身运动介入在对老年人视觉表现、工作记忆、认知灵活相关能力的改善效果更加显著[56]。儿童在协调素质敏感期接受身体协调性健身运动可显著改善其协调动作表现、视觉空间工作记忆、注意力、计划及抑制能力[57]。若需要改善儿童的转换功能,可利用短时中等强度、协调灵敏性运动进行干预。总之,协调性运动亦可增进儿童至老年族群的抑制能力与选择性注意力表现,甚至在视觉、听觉任务表现上有显著效益,除了具备有氧运动的好处,更促进身体的动作协调能力与大脑认知功能。 2.3 健身运动介入对内分泌的影响 胰岛素样生长因子1、生长激素、脑源性神经营养因子在血管形成、神经生长、突触可塑性和细胞增殖等过程中发挥着重要作用[11] 。研究显示生长激素和胰岛素样生长因子1是运动诱导新生神经元的重要中介物质,阻断脑源性神经营养因子、胰岛素样生长因子1后,运动对于增加海马新生神经元的促进效益和学习记忆任务优越表现也被同时抑制。胰岛素样生长因子1、生长激素和脑源性神经营养因子在体力活动对于认知能力作用中发挥重要生理作用[58]。胰岛素样生长因子1、生长激素和脑源性神经营养因子的结构与胰岛素类似,可调整体内激素的平衡,其浓度随幼儿时期逐渐增加,在青春时期达到浓度的高峰,约40岁后才逐渐下降[59]。胰岛素样生长因子1、生长激素是体内重要的代谢调整激素,对于合成代谢有重要作用。 2.3.1 有氧运动与脑源性神经营养因子、胰岛素样生长因子1及生长激素 在青年人群中,不论是急性有氧运动或是长期有氧运动,在运动后20-30 min 生长激素的分泌量达到峰值,而脑源性神经营养因子分泌量在运动后60-90 min内显著增加[60],并且该时段认知表现提升显著。老年人急性有氧运动后,血清脑源性神经营养因子水平也会显著提升,进一步研究发现中强度有氧运动对老年人外周脑源性神经营养因子水平刺激最为明显[61]。但是有氧运动对阿尔茨海默症患者的影响效果尚无定论,有试验发现,高强度有氧训练后女性患者除大脑执行功能显著改善外,胰岛素水平、皮质醇水平、脑源性神经营养因子水平均降低;男性患者则出现胰岛素样生长因子1水平提升、脑源性神经营养因子水平降低的现象[62]。另有多项研究显示,有氧运动可显著提升抑郁症和阿尔茨海默症患者血浆脑源性神经营养因子水平[59,63-64]。关于运动是否提高抑郁症患者血清脑源性神经营养因子水平的Meta分析结果好坏参半;但是动物实验结果一致表明,运动可以提升大脑脑源性神经营养因子水平。运动还会引起其他一些有助于神经可塑性的细胞和分子发生变化,例如突触可塑性、胰岛素样生长因子1、生长激素;通过释放神经营养因子,使包括海马回在内的几个脑区的结构和功能发生变 化[58-59,65]。有氧运动介入能促进血液中的脑源性神经营养因子流进海马回,进而让海马回中的神经元得到养分,使得神经元及突触增长、滋生,最终强化认知表现。 2.3.2 无氧运动与脑源性神经营养因子、胰岛素样生长因子1及生长激素 有氧运动和无氧运动的生长激素值在运动后20-30 min后达到峰值,而无氧运动在20,30,40 min的分泌量显著高于有氧运动;在胰岛素样生长因子1方面,运动后20 min无氧运动显著高于有氧运动,说明无氧运动比有氧运动对生长激素、胰岛素样生长因子1的刺激分泌作用更大。有研究证实,单次的大质量抗阻训练可以刺激人体生长激素与胰岛素样生长因子1的分泌增加[66];甚至有学者认为无氧抗阻运动后会增加人体胰岛素样生长因子1分泌量,但在有氧训练后则会减少[67]。生长激素、胰岛素样生长因子1与认知功能关系密切,当走路时的步伐频率较慢时,生长激素、胰岛素样生长因子1的分泌量较少,因此在路径描绘测验、符号数字模块测验、形状选择任务、单词回忆、故事记忆等认知表现显著较差[68]。总之,无氧运动有利于刺激血管内皮生长因子与脑下垂体分泌生长激素、胰岛素样生长因子1,并促进肝脏分泌生长激素递质,进而有利于认知功能的提升。 2.3.3 协调性运动与脑源性神经营养因子、胰岛素样生长因子1及生长激素 协调性运动可使聚集在神经元细胞突触囊泡中的脑源性神经营养因子释放,使突触更有弹性并产生新的神经元,使神经元网络重新建构及增加神经传递物质系统的可塑性[69],而在穿越绳索、穿越障碍物等复杂动作技巧的协调运动上,也可促进突触生长及结构调整[70]。总之,协调性运动属于较复杂或综合了多项运动的运动模式[71],其强度因动作速度的要求,可以设计成低、中、高不同运动强度,目前针对人体从事协调性运动后所产生的内分泌物质与认知功能关系的研究较为缺乏,主要以动物研究作为基础来说明其效益。 2.4 健身运动介入与神经电生理变化 事件关联电位是认知神经科学相关的测量方式,也被称为认知电位,可以借此了解大脑认知和加工过程。事件关联电位是对刺激呈现在脑电形式上的一种反应,主要成分有P1,N1,P2,N2,P3,其中P代表正向波,N代表负向波;而不同成分存在差异,N1与P2被视为选择性注意力的指标;N2与P3则反映了注意力资源分配与抑制能力。先前研究发现,P3振幅指示了对刺激的注意力资源投入程度,而P3潜伏期则指示了对刺激分类的信息处理速度;健身运动研究者可根据振幅与潜伏期来了解大脑内的认知信息处理过程。 2.4.1 有氧运动与神经电生理变化 有研究指出有氧适能高的年轻人及9-10岁孩童,在接受认知测验时有较大的P3振幅,即体适能较佳个体的注意力、抑制控制能力或是大脑运作速度皆优于体适能差者[71]。CHANG等[72]研究发现,与低身体活动量相比,身体活动量大的老年人记忆反应时间更短、P3与N1振幅更高、有较短的P3潜伏期。AMJAD等[73]研究表明,随着年龄增加使得反应时间变慢,运动控制变得更依赖认知控制机制,如前额叶皮质的活化,这可能是对年龄相关感觉运动下降的补偿,前额叶皮质的活化是反映感觉运动下降的敏感指标,经过长期有氧健身运动可以降低前额叶皮质的活化,即减少与年龄相关的对额外认知控制的依赖。总之,有氧适能水平较高者在认知测验中有较佳的表现,甚至在事件关联电位上显示出较大的P3振幅与较短的P3潜伏期,即规律运动人群在应对认知相关任务时有较佳的反应时间,以及可运用较多的注意力投入至该项测验模式中,而在脑电图研究也发现体适能水平较高者,会产生较大的前额叶皮质活化。 2.4.2 无氧运动与神经电生理变化 DUZOVA等[74]考察了无氧运动介入对事件关联电位中多个脑区N2、P3的影响,结果发现高身体活动量组在无氧运动后N2振幅显著降低,表明无氧运动对听觉任务的抑制功能有显著增强的作用,且同时增大P3振幅亦代表有更多的注意力资源投入在该项任务中。也有学者探讨了为期4周的无氧运动介入对年轻成人觉醒、注意力、神经生理学标记物的影响,结果发现个体α峰值频率在衰竭性运动后的休息期有显著增加,但稳定状态下的休息期个体α峰值频率则有下降趋势,可见个体α峰值频率与运动强度增加有关,证明外在输入的刺激强度越高,越能够提升觉醒水平[62]。GUTMNN等[75]研究发现,在渐增力竭运动中从50%最大摄氧量至最大摄氧量峰值的运动过程中,前额叶皮质与运动皮质上脑电图活化增加,而运动结束后脑电图活化则会下降,这表示运动强度升高时,前额叶皮质、运动皮质也会随之活化。总之,无氧运动介入不仅对于认知行为有正面影响,更对于其脑电图有显著正向效益[76]。 2.4.3 协调性运动与神经电生理变化 已有学者尝试探讨协调性运动干预对儿童执行功能和事件关联电位的影响[77]。参与者在运动介入前、后接受flanker task的认知测验,并以2次/周、35 min/次的低或中等运动强度进行介入,结果发现无论是低或中等强度的运动介入,在认知测验一致、不一致情境的行为表现上均显示出较短的反应时间及较高的准确性;并且与一致情境相比,运动介入后在不一致情境上有更大的效益。此外,在神经电生理方面,表现出更大的P3振幅和较短的P3潜伏期。总之,协调性运动可以让幼儿园儿童未成熟的大脑在前额依赖性任务中,特别增加注意资源的分配和提高神经认知处理的效率。但目前这方面研究报道极少,而且协调性运动对于成年人及高龄人群的神经生理变化目前鲜见学者进行探讨。 "
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