Clinical applications of exercise in Parkinson's disease: what we need to know?

INTRODUCTION: Exploring the potential of exercise in the rehabilitation process of patients with Parkinson's (PD) may be an interesting treatment perspective. Exercise-induced responses derived from neurotrophic elements appear to ameliorate the decline in neurodegeneration. Despite this understanding, the literature needs to be updated. AREAS COVERED: Our review focuses on: a) the key mechanisms of exercise on PD, highlighting mainly the responses related to neuroplasticity; b) the effects induced by different traditional types of exercise, also highlighting the effects of complementary therapies related to movement; c) the volume of exercise required to support efficient results are explored in the context of PD. Additionally, the proposition of new clinical application strategies in the context of PD will also be determined. EXPERT OPINION: It is suggested that different intensities of aerobic exercise be explored for the treatment of PD. The results associated with high intensity seem promising for performance, physiological and clinical parameters, such as BDNF production and cognition. On the other hand, the diversification of tasks and repetition of motor gestures appear as consistent arguments to exercise prescription. Finally, for future investigations, the neuromodulation strategy in association with aerobic exercise appears as a potential inducer of benefits on gait and cognitive function.

Juvenile cannabidiol chronic treatments produce robust changes in metabolic markers in adult male Wistar rats.

The use of cannabidiol (CBD), the non-psychotropic compound derived from Cannabis sativa, for therapeutic purposes is growing exponentially by targeting the management of multiple medical disorders, including metabolic-related diseases. Nevertheless, substantial questions have emerged in concerning the potential metabolic disturbances in adulthood as consequence of the long-term uses of CBD during early years of life. Therefore, we studied whether chronic CBD injections (5, 10 or 30 mg/kg; i.p.) given to juvenile rats (from post-natal day [PND] 30) for 14 days might influence in adulthood the activity of metabolic markers, such as glucose, total cholesterol, triglycerides as well as activity of antioxidants (DPPH) from plasma, white adipose tissue (WAT), brown adipose tissue (BAT), liver, and hypothalamus. Our results showed that adult rats treated during juvenile ages with CBD (5, 10 or 30 mg/kg) for two weeks increased the contents of glucose whereas with no changes on total cholesterol in adulthood were observed. Additionally, a significant decrease in the levels of triglycerides were found in plasma, WAT, BAT, and liver in adult rats treated with chronic injections of CBD during the adolescence. However, unexpectedly, the contents of triglycerides in hypothalamus were found enhanced. Finally, the DPPH assay showed a significant enhancement in triglycerides analyzed from WAT and liver whereas opposite findings were observed in BAT and no significant changes were found in hypothalamus in adult rats that received during the adolescence chronic injections of CBD. In conclusion, repeated CBD administration to juvenile rats induced significant alterations in multiple metabolic markers analyzed in the adulthood. Our findings highlight the relevance of chronic CBD treatment in disturbed metabolic activity and remark the need for studying the underlying mechanisms involved.

The synthetic CB1 cannabinoid receptor selective agonists: Putative medical uses and their legalization.

More than 500 molecules have been identified as components of Cannabis sativa (C. sativa), of which the most studied is Δ9-tetrahydrocannabinol (Δ9-THC). Several studies have suggested that Δ9-THC exerts diverse biological effects, ranging from fragmentation of DNA to behavioral disruptions. Currently, it is accepted that most of the pharmacological properties of Δ9-THC engage the activation of the cannabinoid receptors, named CB1 and CB2. Interestingly, multiple pieces of evidence have suggested that the cannabinoid receptors play an active role in the modulation of several diseases leading to the design of synthetic cannabinoid-like compounds. Advances in the development of synthetic CB1 cannabinoid receptor selective agonists as therapeutical approaches are, however, limited. This review focuses on available evidence searched in PubMed regarding the synthetic CB1 cannabinoid receptor selective agonists such as AM-1235, arachidonyl-2' chloroethylamide (ACEA), CP 50,556-1 (Levonantradol), CP-55,940, HU-210, JWH-007, JWH-018, JWH-200 (WIN 55,225), methanandamide, nabilone, O-1812, UR-144, WIN 55,212-2, nabiximols, and dronabinol. Indeed, it would be ambitious to describe all available evidence related to the synthetic CB1 cannabinoid receptor selective agonists. However, and despite the positive evidence on the positive results of using these compounds in experimental models of health disturbances and preclinical trials, we discuss evidence in regards some concerns due to side effects.

Feedback-Based Treatments for Eating Disorders and Related Symptoms: A Systematic Review of the Literature.

The effectiveness of biofeedback and neurofeedback has been investigated in a range of psychiatric disorders. However, to date, there are few studies on the clinical usefulness of feedback-based techniques for eating disorders (EDs) and EDs-related symptoms (e.g., food craving). A systematic search of PubMed, Scopus and PsychINFO identified 162 articles. Among these, thirteen studies exploring the therapeutic use of biofeedback and neurofeedback in EDs or EDs-related symptoms were included. Biofeedback and neurofeedback were implemented respectively in five and eight of all reviewed articles. No studies incorporated different feedback modalities or both biofeedback and neurofeedback. The considered studies provide preliminary data of the usefulness of feedback-based techniques in the treatment of several dysfunctional eating behaviors (e.g., food craving, rumination). Although no significant effect has been reported for other important EDs-related symptoms (i.e., body image disturbance), feedback-based techniques are also associated with significant modifications of both sympathetic reaction to food-related stimuli and brain activity in several regions of the reward system (e.g., insula). Taken together the results of the present review suggest that feedback-based treatments may be useful in the treatment of several dysfunctional eating behaviors operating both on top-down and bottom-up individual coping strategies. Methodological and clinical issues are also discussed.

Alpha/Theta Neurofeedback Increases Mentalization and Default Mode Network Connectivity in a Non-Clinical Sample.

Several studies showed the effectiveness of alpha/theta (A/T) neurofeedback training in treating some psychiatric conditions. Despite the evidence of A/T effectiveness, the psychological and neurobiological bases of its effects is still unclear. The aim of the present study was to explore the usefulness of the A/T training in increasing mentalization in a non-clinical sample. The modifications of electroencephalographic (EEG) functional connectivity in Default Mode Network (DMN) associated with A/T training were also investigated. Forty-four subjects were enrolled in the study and randomly assigned to receive ten sessions of A/T training [neurofeedback group (NFG) = 22], or to act as controls [waiting list group (WLG) = 22]. All participants were administered the mentalization questionnaire (MZQ) and the Symptom Checklist-90-Revised (SCL-90-R). In the post training assessment, compared to WLG, NFG showed a significant increase of MZQ total scores (3.94 ± 0.73 vs. 3.53 ± 0.77; F1;43 = 8.19; p = 0.007; d = 0.863). Furthermore, A/T training was also associated with a significant increase of EEG functional connectivity in several DMN brain areas (e.g. Posterior Cingulate Cortex). Taken together our results support the usefulness of the A/T training in enhancing mentalization and DMN connectivity.

Coping food craving with neurofeedback. Evaluation of the usefulness of alpha/theta training in a non-clinical sample.

The aim of the present study was to explore the usefulness of the alpha/theta (A/T) training in reducing Food Craving (FC) in a non-clinical sample. The modifications of electroencephalographic (EEG) power spectra associated with A/T training was also investigated. Fifty subjects were enrolled in the study and randomly assigned to receive ten sessions of A/T training [neurofeedback group (NFG)=25], or to act as controls [waiting list group (WLG)=25]. All participants were administered the Food Cravings Questionnaire-Trait, the Eating Disorder Examination Questionnaire and the Symptom Checklist-90-Revised. In the post training assessment, compared to the WLG, the NFG showed a significant reduction of intentions and plans to consume food (F1; 49=4.90; p=.033; d=0.626) and of craving as a physiological state (F1; 49=8.09; p=.007; d=803). In NFG, changes in FC persisted after 4months follow-up. Furthermore, A/T training was associated with significant a increase of resting EEG alpha power in several brain areas involved in FC (e.g., insula) and food cue reactivity (e.g., parahippocampal gyrus, inferior and superior temporal gyrus). Taken together, our results showed that ten sessions of A/T training are associated with a decrease of self-reported FC in a non-clinical sample. These findings suggest that this brain-directed intervention may be useful in the treatment of dysfunctional eating behaviors characterized by FC.

Adverse Psychiatric Effects Associated with Herbal Weight-Loss Products.

Obesity and overeating are among the most prevalent health concerns worldwide and individuals are increasingly using performance and image-enhancing drugs (PIEDs) as an easy and fast way to control their weight. Among these, herbal weight-loss products (HWLPs) often attract users due to their health claims, assumed safety, easy availability, affordable price, extensive marketing, and the perceived lack of need for professional oversight. Reports suggest that certain HWLPs may lead to onset or exacerbation of psychiatric disturbances. Here we review the available evidence on psychiatric adverse effects of HWLPs due to their intrinsic toxicity and potential for interaction with psychiatric medications.

Neurophysiological correlates of eye movement desensitization and reprocessing sessions: preliminary evidence for traumatic memories integration.

We have investigated the potential role of eye movement desensitization and reprocessing (EMDR) in enhancing the integration of traumatic memories by measuring EEG coherence, power spectra and autonomic variables before (pre-EMDR) and after (post-EMDR) EMDR sessions during the recall of patient's traumatic memory. Thirteen EMDR sessions of six patients with post-traumatic stress disorder were recorded. EEG analyses were conducted by means of the standardized Low Resolution Electric Tomography (sLORETA) software. Power spectra, EEG coherence and heart rate variability (HRV) were compared between pre- and post-EMDR sessions. After EMDR, we observed a significant increase of alpha power in the left inferior temporal gyrus (T = 3.879; P = 0.041) and an increased EEG coherence in beta band between C3 and T5 electrodes (T = 6.358; P < 0.001). Furthermore, a significant increase of HRV in the post-EMDR sessions was also observed (pre-EMDR: 6.38 ± 6.83; post-EMDR: 2.46 ± 2.95; U-Test = 45, P = 0.043). Finally, the values of lagged coherence were negatively associated with subjective units of disturbance (r(24) = -0.44, P < 0.05) and positively associated with parasympathetic activity (r(24) = 0.40, P < 0.05). Our results suggest that EMDR leads to an integration of dissociated aspects of traumatic memories and, consequently, a decrease of hyperarousal symptoms [Correction made here after initial publication].