Results of yoga and cardio train on verbal fluency | CIA

Digital-based nursing interventions for reducing Stress | JMDH

Paul Welford,1 Josefine sth,1 Sara Hoy,2 Susan L Rossell,3 Michaela Pascoe,4 Vinod Diwan,1 Mats Hallgren1

1Division of International Public Well being, Karolinska Institutet, Solna, Sweden; 2Swedish Faculty of Sport and Well being Sciences (GIH), Stockholm, Sweden; 3Centre for Psychological Well being, Faculty of Well being Sciences, Swinburne College, Melbourne, Victoria, Australia; 4Institute for Well being and Sport, Victoria College, Melbourne, Victoria, Australia

Correspondence: Mats Hallgren, Division of International Public Well being, Karolinska Institutet, Degree 6, 1e Solnavgen, Solna, 11365, Sweden, Tel +46852480000, E-mail [email protected]

Objective: To check the consequences on verbal fluency of a supported yoga-based train intervention to an cardio train intervention and a wait-list management group.
Contributors and Strategies: Eighty-two physically-inactive however in any other case wholesome adults (imply age 72.5 years, vary 65 85, 77% feminine) have been recruited right into a 12-week, three-group, parallel randomized managed trial. Contributors have been supported to finish 3 Hatha yoga lessons per/week or 3 structured cardio train periods/week. A wait-list management group continued ordinary every day actions solely. Verbal fluency, together with total-FAS, animals, and verbs, was assessed earlier than and after interventions. Group results have been assessed utilizing evaluation of covariance (ANCOVA).
Outcomes: Twenty-seven individuals have been randomized to yoga, 29 to cardio train and 26 to a waitlist. At 12-week follow-up, in comparison with baseline, there have been will increase in imply total-FAS within the yoga (+5.0 phrases, p=0.002) and cardio train teams (+6.6 phrases, p=0.004). Imply total-FAS within the wait-list management group remained secure ( 0.5 phrases, p=0.838). There have been medium-magnitude estimated therapy results on total-FAS for yoga versus wait-list management and cardio train versus wait-list management: Hedges g=0.51 (p=0.213) and 0.57 (p=0.098) respectively. As well as, small-to-medium magnitude estimated therapy results have been seen on animals and verbs for yoga versus wait-list management and cardio train versus wait-list management: g=0.28 (p=0.155), 0.19 (p=0.766) and 0.50 (p=0.085), 0.59 (p=0.233) respectively.
Conclusion: Participation in yoga or cardio train was related to estimated enhancements in verbal fluency in comparison with a non-active management group. Yoga and cardio train could also be promising approaches by which to advertise cognitive perform amongst older adults.
Trial Registration: DRKS00015093, U1111-1217-4248.

Key phrases: bodily exercise, verbal fluency check, government perform, cognitive growing older, wholesome growing older


Getting older is related to a gradual decline in cognitive capabilities, together with poorer reminiscence, consideration, and verbal fluency.1,2 These modifications are sometimes not extreme sufficient to warrant a medical prognosis (eg, dementia), however could also be noticeable to others and negatively impression vanity, autonomy, and life high quality.3 Language is among the most complicated capabilities in people and is important for communication and autonomy. Research on regular growing older have proven that some language expertise are resilient to age-related declines; comprehension, semantic skills, and vocabulary stay secure and even enhance with age.4,5 In contrast, verbal fluency and naming are among the many most susceptible cognitive capabilities to growing older.6

Cardio train has nicely established psychological well being advantages,7 together with improved cognitive functioning, and is beneficial for older adults.8,9 Regardless of this, bodily inactivity (ie, partaking in <150 minutes of moderate-to-vigorous bodily exercise/week) is prevalent amongst older adults, starting from 5% (Sweden) to 29% (Portugal) within the European Union.10

Musculoskeletal accidents are frequent impediments to participation in some types of cardio train (eg, operating) and have a tendency to extend with age.11 Yoga is a type of structured bodily exercise that mixes bodily postures with respiratory and meditative workouts and is proven to be appropriate for older adults, together with these with mobility issues.12–15 This mix of bodily and “conscious” components distinguishes yoga from standard cardio coaching, and will confer extra psychological well being advantages.16 Participation in yoga-based train is rising,17 alongside yoga associated analysis.18–20 The reported advantages of yoga embody improved psychological well being (decreased despair and nervousness), sleep, and life high quality.21–23 Enhancements in cardiovascular health, physique composition, and blood strain have additionally been reported.24–26

Rising proof means that yoga-based train may additionally enhance cognitive functioning in older adults.19,27–29 Three systematic evaluations30–32 and a meta-analysis33 every concluded that yoga-based interventions improved government capabilities in older adults. A scientific evaluation evaluating the consequences of three various kinds of train on government functioning within the aged confirmed that yoga-based train had stronger results (g = 0.38) than each resistance coaching (g = 0.22) and cardio train (g = 0.14), respectively.34 A notable limitation of those evaluations is that they included individuals with identified psychological problems and/or cognitive deficits, together with despair and dementia and due to this fact will not be generalizable to bodily inactive however in any other case wholesome older adults. A latest systematic evaluation of randomized managed trials by Hoy, Osth, Pascoe, Kandola and Hallgren32 examined the consequences of yoga on cognition in older adults with out recognized psychological or bodily comorbidities. Participation in yoga was related to improved cognitive functioning, together with gross reminiscence and government capabilities. Nonetheless, the evaluation was restricted to solely 5 trials, every with a excessive total danger of bias, and not one of the included research in contrast yoga to cardio train.35,36 Such direct comparisons are wanted to tell clinicians who could advise sufferers on the potential results of various train regimes.

We performed a 12-week randomized managed trial to match the consequences of a supported yoga-based train intervention to an cardio train intervention and a wait-list management group (ordinary actions) on verbal fluency, in bodily inactive however in any other case wholesome older adults. We hypothesized that participation in yoga and cardio train could be related to equal magnitude enhancements in verbal fluency in comparison with management situations.

Supplies and Strategies

Design and Setting

We performed a twelve-week, three-group, single-blinded, parallel randomized managed trial (RCT) in accordance with the CONSORT assertion (Desk S1, Supplementary Supplies) and the Helsinki Declaration for analysis involving people.37 This examine was performed on the Karolinska Institute (KI) in central Stockholm and authorised by the Regional Ethics Committee in Stockholm (2017/1862-31/2, modification quantity 2018/2156-32). The trial was prospectively registered with German Scientific Trials (DRKS 00015093). A examine protocol is publicly out there.38


A complete of 82 community-dwelling individuals have been recruited by way of three separate ads in a newspaper distributed all through central Stockholm (“Mitt-I”, April 2019–January 2020). Inclusion standards: Age 65–85 years, resident of Stockholm County and fluent in Swedish. Knowledgeable consent was obtained previous to enrollment. Exclusion standards: (a) Participation in common, structured train ≥ two days/week, moderate-to-vigorous actions ≥ 75 min/week, or light-to-moderate actions ≥150min/week throughout the earlier three months; (b) Bodily incapacity, harm or extreme cognitive deficit (identified dementia); (c) Main surgical procedure throughout the previous 12 months (or deliberate the approaching 12 months) that will impair bodily exercise or motion; (d) Insulin-dependent diabetes, irregular pulse, uncontrolled blood glucose or blood strain; (e) Suggested in opposition to average train by a medical skilled; (f) Latest prognosis of significant psychological sickness (main depressive dysfunction, bipolar dysfunction, or schizophrenia spectrum problems) or acutely suicidal; (g) Unable to attend the yoga studio or a health centre used within the examine. A extra detailed description of the inclusion standards is offered within the examine protocol.38


People who have been within the trial have been suggested to contact (by cellphone or e mail) a analysis assistant who performed a 20-minute phone screening interview to find out eligibility (part 2.2). These eligible have been invited to a baseline evaluation (~1.5 hours) between one and three weeks later, throughout which demographic, questionnaire and anthropometric information have been collected by a analysis assistant. Contributors have been referred to have baseline blood samples taken on the Karolinska College Hospital laboratory (in collaboration with Karolinska Trial Alliance). Observe-up appointments have been booked at 6 weeks (midpoint) and 12 weeks (endpoint). Midpoint assessments concerned a short (~quarter-hour) evaluation for adversarial occasions and aimed to resolve adherence points (eg, accessing train lessons). Observe-up assessments have been equivalent to baseline assessments however have been performed by a distinct analysis assistant.

Randomization and Blinding

A sex-stratified randomization record was generated by an unbiased statistician utilizing a random quantity pc program. The allocation sequence was then transferred into sealed, opaque envelopes by an unbiased analysis assistant. Contributors opened envelopes instantly after the baseline evaluation. Group allocation was recorded on separate types that weren’t available to follow-up assessors and individuals have been requested to keep away from revealing group allocation. Analysis assistants have been due to this fact blinded to group allocation at follow-up.


Verbal fluency was examined at baseline and at 12-week follow-up. To evaluate phonological fluency, individuals have been required to recall as many distinctive phrases as attainable starting with the letters F, A and S, inside 60 a second interval for every letter (total-FAS). Contributors have been then requested to call as many animals and verbs as they might, in 60 seconds for every class, with the intention to check semantic fluency. All assessments have been audio recorded, and the variety of distinctive phrases (total-FAS, animals and verbs) have been calculated by the analysis assistant following every check. Verbal fluency assessments are extensively reported as legitimate, dependable measures of government functioning and language in older adults; phonological fluency, specifically, is taken into account to rely closely on government capabilities.39–41

Baseline assessments concerned accumulating demographic information together with age, gender and schooling), together with indicators of somatic well being, reminiscent of self-reported details about comorbidities, drugs, smoking, alcohol consumption and bodily exercise behaviours (Worldwide Bodily Exercise Questionnaire) have been collected at baseline.42 We assessed blood strain and resting coronary heart fee utilizing the Omron M3 Consolation monitor. Physique mass index was calculated from goal measurements, waist circumference was measured, and stability examined utilizing the Berg Stability Scale.43 Grip power for the dominant hand was assessed with an digital hand-held dynamometer. Blood samples have been analysed for whole ldl cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). Contributors recorded their train adherence utilizing a coaching calendar which indicated when a scheduled yoga or cardio train session was accomplished. Contributors have been requested to goal to finish at the least three lessons/week for a interval of 12 weeks and in addition to document any extra, casual periods of moderate-vigorous bodily exercise. Train depth was estimated at six-weeks by way of Borg’s Score of Perceived Exertion scale (RPE); scored from six (no exertion) to twenty (maximal exertion).44 Mid-ranges on the RPE (the goal of this intervention) are as follows: 11 = pretty mild, 13 = considerably exhausting, 15 = exhausting. Scores between these values haven’t any narrative values. The imply RPE reported for 3 train periods throughout the earlier week was calculated. Hostile occasions have been assessed at weeks six and 12 by asking individuals if they’d skilled any accidents brought on by taking part within the trial. All individuals who reported adversarial occasions have been referred to see their physician (common practitioner).



Every yoga group participant acquired a free 12-week membership to a centrally situated yoga studio. Lessons have been one hour in size, designed for older adults and freshmen and in addition out there to adults not taking part within the examine. Lessons have been provided at the least thrice/week. Yoga individuals have been additionally supplied with entry to “Yogobe”, a web-based platform with yoga lessons tailored for seniors. These might be used for house yoga apply. The intervention was primarily based on Hatha yoga which includes mild bodily postures (asanas) plus respiratory workouts and is suitable for older adults.45 Opening postures included: Cat/Cow pose, Mountain pose and Partial Solar Salute. Basic Hatha yoga postures have been then instructed, together with Chair pose, Plank, Tree pose, Warrior I and II, Downward going through canine, Aspect stretch, Backbone twist, Cobra pose and Bridge pose. The ending collection included rest workouts reminiscent of Useless man’s pose. An in depth description of those actions has been reported beforehand.45 Round 50 minutes was dedicated to bodily postures and 10 to respiratory workouts and rest. Between two and 10 folks participated in every class.

Cardio Train

The cardio train group acquired a free 12-week membership with ‘Friskis & Svettis’, allowing entry to health centres throughout Stockholm. Contributors have been requested to finish three 60-minute supervised group cardio train lessons/week. All lessons have been appropriate for older adults. To optimize adherence, individuals got the choice of three various kinds of cardio train: biking/spinning, dance-based train, and light-to-moderate depth aerobics (synchronized motion to music). Contributors met a private coach (~half-hour) for an introduction to the web-based reserving system and to assist them select lessons. Contributors additionally acquired a DVD produced by the health centre that contained a number of seated cardio train exercises appropriate for older adults, and will additionally entry on-line lessons as a part of their health centre membership. Contributors have been inspired to extend steadily to a subjectively “average” train depth. All lessons have been delivered by certified health instructors and have been out there to adults not collaborating within the examine. Sometimes, lessons have been attended by 10–25 folks.

Wait-Record Management

The wait-list management group was instructed to proceed ordinary every day actions with out rising bodily exercise ranges or commencing a brand new train regime. To enhance adherence, a free cinema ticket and a 12-week membership (to start after the examine ended) to both the yoga studio or the cardio train facility was provided to those that adhered to the wait-list situation and accomplished a follow-up evaluation.

Results of COVID-19 on Recruitment, Train Adherence and Evaluation

Trial recruitment commenced in April 2019 and concluded in March 2020 attributable to COVID-19 restrictions, which mandated closure of the yoga and cardio train amenities. There was, nevertheless, no formal lockdown or restriction of unsupervised, outside bodily exercise. Previous to restrictions, 82 trial individuals have been enrolled; 41 had accomplished a 12-week intervention and 41 have been in numerous levels of completion. To facilitate intervention continuation, we supplied enrolled individuals with verbal and written directions on find out how to proceed their train regimes. Yoga individuals acquired a leaflet produced by the trial’s yoga instructor with directions and diagrams illustrating the postures and sequences used on the studio. Contributors have been requested to proceed yoga periods at house thrice/week utilizing the booklet or on-line supplies as a information. Equally, these randomized to cardio train have been instructed to proceed their most popular kind(s) of cardio train from house and, the place attainable, to duplicate the workouts provided throughout the trial. All follow-up assessments that occurred after restrictions have been launched have been performed by way of phone. Thus, post-COVID-19 observe up assessments didn’t embody bodily examinations reminiscent of blood strain and coronary heart fee.

Information Evaluation Plan

Pattern Dimension

A pattern dimension calculation is described within the revealed protocol.38 Based mostly on a earlier associated examine46 and a predicted small impact dimension (0.2) – favouring yoga in comparison with cardio train – a complete pattern of 180 individuals was estimated. Resulting from COVID-19 restrictions this goal couldn’t be met; the trial is thus underpowered to detect statistically important variations. As an alternative, our analyses deal with the magnitude of group variations (estimated impact sizes).

Statistical Strategies

Descriptive statistics have been stratified in keeping with intervention group. Major analyses adopted intention-to-treat (ITT) principals. Between-group variations in verbal fluency have been assessed utilizing Evaluation of Covariance (ANCOVA) with baseline rating included because the covariate. Inside-group modifications in imply verbal fluency check scores (baseline to 12-weeks) are reported with 95% confidence intervals (CIs). Impartial samples t-tests with Bonferroni corrections have been used to discover contrasts between variations within the three teams at follow-up (yoga versus cardio train; yoga versus wait-list management; cardio train versus wait-list management). Estimated impact sizes (Hedges’ g) with p-values are reported for the three teams and interpreted utilizing the next standards; 0.2, small, 0.5, medium and 0.8 or greater, a big impact dimension.47 Assumptions have been examined utilizing the Shapiro–Wilk check for normality and Levene’s homogeneity of variance check. Patterns in lacking follow-up information have been assessed utilizing Little’s lacking utterly at random (MCAR) check. Pre-planned sensitivity analyses consisted of repeating the strategies described above after imputing lacking follow-up information (final statement carried ahead (LOCF) methodology).38 As no interim analyses have been carried out, outcomes weren’t recognized on the level of ceasing recruitment into the trial. Analyses have been performed utilizing SPSS v27.



As this trial stopped early attributable to COVID-19, remaining follow-up came about in Might 2020. The move of individuals’ progress by the trial is reported in Determine 1.

Determine 1 Move diagram of individuals’ progress by the trial.

Baseline traits for the 82 individuals are introduced in Desk 1. The imply age was 72.5 years (65–85, normal deviation (SD) 5.3). Regardless of a preponderance of females (77%), the distribution of sexes was comparable between teams. About 78% of individuals have been retired and 65% have been college educated. Contributors reported having, on common, one (0—4) pre-existing medical situation (eg, managed hypertension) and taking one (0–4) treatment. The vast majority of individuals have been ex-smokers (55%), adopted by non-smokers (40%) and solely a minority have been present people who smoke (5%). Alcohol consumption was usually under hazardous ranges;48 Roughly 7% reported consuming 9 items/week or extra (the place one unit = 12g of pure ethanol). Participant bodily exercise ranges have been decrease than these beneficial by WHO (ie, ≥150 minutes of moderate-to-vigorous bodily exercise/week);49 The imply self-reported period of time spent endeavor moderate-to-vigorous bodily exercise was about 44 minutes/week. Ldl cholesterol, grip power and cognition (verbal fluency) scores have been comparable among the many three teams at baseline. Physique mass index and waist circumference measurements indicated that, on common, individuals have been obese at baseline.

Desk 1 Baseline Demographic, Scientific and Bodily Traits of Contributors (N = 82)

Completeness of Observe-Up and Adherence

Baseline verbal fluency check scores have been out there for 80/82 individuals; baseline information was lacking for one wait-list management group participant and one other wait-list participant was excluded from analyses attributable to problem following directions throughout verbal fluency testing. Twelve-week follow-up was accomplished for 74/80 included individuals (25/27 randomized to yoga, 27/29 to cardio train and 23/26 to wait-list management). Contributors within the yoga group reported finishing a median of 28 (0–54) yoga periods, versus 16 train periods (0–51) within the cardio train group (t = 2.569, p = 0.013). Yoga individuals additionally reported finishing a median of eight (0–36) casual periods of moderate-to-vigorous bodily exercise, versus 17 (0–66) within the cardio train group and 17 (0–90) amongst wait-list management group individuals. On common (imply), Borg’s RPE was 14.5 (SD 1.4) per cardio train session, barely greater than a imply of 12.9 (SD 1.8) per yoga session (t = 3.17, p = 0.003).

Intervention Results on Verbal Fluency

Desk 2 exhibits within-group modifications in imply verbal fluency at 12-week follow-up, with between-group comparisons and estimated impact sizes. Determine 2 illustrates these modifications over time. Over the examine length, there have been within-group will increase (ie, enhancements) in imply total-FAS amongst yoga individuals (+5.0 phrases, p = 0.002) and cardio train individuals (+6.6 phrases, p = 0.004). Imply total-FAS within the wait-list management group, then again, remained secure (−0.5 phrases, p = 0.838). Small will increase in imply verbal fluency for animals in all three teams; yoga (+2.1 phrases, p = 0.071), cardio train (+1.5 phrases, p = 0.127) and wait-list management (+1.1 phrases, p = 0.671) weren’t statistically important. There have been comparable, non-significant will increase in imply verbal fluency check scores for verbs within the yoga (+2.0 phrases, p = 0.194) and cardio train (+1.4 phrases, p = 0.114) teams, and a slight lower within the wait-list management group (−1.1 phrases, p = 0.195). There have been medium-magnitude, constructive estimated therapy results on total-FAS for yoga versus wait-list management and cardio train versus wait-list management: Hedges’ g = 0.51 (p = 0.213) and 0.57 (p = 0.098) respectively). Nonetheless, no important between-group variations have been detected on the examine endpoint (p = 0.075). Related, medium-sized therapy results have been estimated for verbs (yoga vs wait-list management, g = 0.50, p = 0.085; cardio train vs wait-list management, g = 0.59, p = 0.233), together with small therapy results for animals (yoga vs wait-list management, g = 0.28, p = 0.155; cardio train vs wait-list management, g = 0.19, p = 0.766).

Desk 2 Inside- and Between-Group Therapy Results on Cognition (Verbal Fluency), Intention-to-Deal with Analyses (N = 74)

Determine 2 Modifications in verbal fluency check over time (N = 74): (a): Will increase in imply total-FAS for yoga (+5.0 phrases, p=0.002) and cardio train teams (+6.6 phrases, p=0.004) over time. (b): Imply animals for yoga (+2.1 phrases, p=0.071), cardio train (+1.5 phrases, p=0.127) and wait-list management (+1.1 phrases, p=0.671) teams over time. (c): Imply verbs for yoga (+2.0 phrases, p=0.194), cardio train (+1.4 phrases, p=0.114), and wait-list management teams (−1.1 phrases, p=0.195) over time.

Hostile Occasions

Of 82 individuals, 17 (21%) reported minor adversarial occasions, together with 6/27 (22%) within the yoga group, 10/27 (37%) within the cardio train group reported adversarial occasions and 1/25 (4%) within the wait-list management group. Widespread adversarial occasions included minor strains and sprains.

Sensitivity Analyses

Sensitivity analyses are introduced in Supplementary Desk S2 (Supplementary Supplies). Normally, the outcomes following imputations have been according to these of the primary analyses, however with barely attenuated impact sizes.


Verbal fluency is among the government capabilities central to wholesome growing older, and whereas train seems to have constructive results on cognition, bodily exercise ranges amongst older adults are reducing.50,51 This 12-week RCT in contrast the consequences of yoga, cardio train, and ordinary actions on verbal fluency in 82 bodily inactive, however in any other case wholesome adults aged 65–85 years. Contributors in each the yoga and cardio train teams confirmed enhancements in imply verbal fluency check scores (total-FAS). In comparison with a wait-list management group, yoga and cardio train interventions have been estimated to have small-to-medium magnitude, constructive results on verbal fluency.

The findings of this examine are according to a rising physique of proof suggesting that bodily exercise interventions, together with yoga programmes, could enhance cognitive perform in wholesome older adults.30–32,34,52 A 2021 systematic evaluation of RCTs by Hoy et al, for instance, reported helpful results of yoga-based interventions on cognition amongst wholesome older adults.32 4 of the six research included in that evaluation reported constructive results on numerous facets of cognition, together with government perform, though a excessive danger of bias was recognized in all research. A 2020 systematic evaluation and meta-analysis of 33 RCTs indicated that results on government perform could range in keeping with the frequency, length and kind of train, however not the depth degree.34 The authors reported a mixed impact dimension for yoga and Tai Chi (g = 0.38, p <0.05), evaluating favourably to that for cardio train (g = 0.14, p <0.05). The estimated impact sizes in our examine, by comparability, have been considerably bigger than these reported by Chen et al, notably within the case of cardio train. We additionally word that yoga and cardio train had comparable estimated results on verbal fluency, regardless of greater adherence within the yoga group and marginally greater RPE within the cardio train group. Our findings, nevertheless, are in line with these of the biggest trial (N = 792) on this discipline to this point, which reported that once-weekly supervised yoga lessons, with unbiased house apply, resulted in improved Mini-Psychological State Examination (MMSE) and Rivermead Behavioural Reminiscence Check (third version) scores in older adults (imply age = 67.1 years, SD 3.2), when in comparison with a wait-list management group (yoga intervention versus wait-list, d = 0.43, p = 0.04; yoga intervention follow-up versus baseline, d = 0.46, p = 0.02).53 That is the primary examine to look at the consequences of yoga on verbal fluency in older adults. One examine54 confirmed that introducing an cardio train routine (spin biking) in beforehand sedentary older adults (n=20) improves semantic fluency over a interval of 12 weeks, which is according to the present findings.

Inside-group modifications in verbal fluency within the yoga and cardio train teams within the present examine could counsel the presence of intervention results. Baseline scores for total-FAS, animals and verbs have been equal to, or higher than present normative imply values for Swedish adults aged 65–89 (total-FAS 36.6–45.2, animals 17.8–20.6 and verbs 14.9–19.4, depending on instructional degree),55 noticed modifications are due to this fact unlikely to be defined by regression to the imply. Verbal fluency scores additionally remained secure for the wait-list management group, suggesting that enhancements within the yoga and cardio teams are usually not adequately defined by check apply results. Sadly, attributable to unforeseeable train facility closures that occurred attributable to COVID-19, this trial was insufficiently powered to detect between-group variations. We speculate that, had our supposed pattern dimension been reached and supervised coaching proceeded as deliberate, group variations – favouring yoga and cardio train – could have reached statistical significance. It’s unclear whether or not the within-group increments in verbal fluency that occurred among the many yoga and cardio train group individuals mirror significant modifications in government perform. Earlier longitudinal work has tended to deal with the decline in verbal fluency that accompanies the development of cognitive impairment, fairly that will increase in verbal fluency amongst wholesome older adults.2 It’s extensively acknowledged, nevertheless, that government capabilities are very important for participation in every day actions even amongst older adults with out cognitive impairment.56

Whereas we didn’t examine the potential mechanism underlying enhancements in verbal fluency within the present examine, we speculate that findings could also be defined by neurobiological, psychological, and social processes. Train seems to control the hypothalamo-pituitary-adrenal (HPA) axis, resulting in reductions in glucocorticoid stress hormones.57 Lowering the degrees of circulating stress hormones could, in flip, ameliorate the detrimental results of continual stress on cognition.58 Equally, decreased psychological stress and improved cognitive effectivity have been instructed to elucidate the consequences of yoga on cognition.28,59 Whereas the first focus of interventions in our examine was bodily exercise, fairly than meditation, earlier work means that the meditative side of yoga could improve resting-state exercise in a number of cortico-striatal circuits;60 providing a putative rationalization for enhancements in government perform.29 The psychological results of accelerating bodily exercise may additionally be necessary; train can act as a distraction from demanding life occasions, enhance vanity, and will cut back adverse attentional biases.61 The well-documented helpful results of train on temper could in itself result in improved government capabilities.62 Lastly, social isolation is usually recommended to be detrimental for cognition in later life and has lately been amplified by the consequences of COVID-19.63,64 We recommend that, within the present examine, social interactions that occurred when attending yoga or cardio train lessons could have supplied an extra stimulus for enhancements in verbal fluency.

Strengths and Limitations

Strengths of this examine embody the randomized design with blinded follow-up assessments, the comparability of two types of community-based bodily exercise and the inclusion of a non-active management group. Bodily inactive, however in any other case wholesome older adults signify a rising however understudied inhabitants group. Verbal fluency testing included each phonological and semantic variations, offering a sound and dependable estimation of government management processes.41 Adherence and Borg’s RPE have been assessed, permitting the intervention dose to be thought-about, though compliance with allotted interventions and train depth weren’t measured objectively.

As famous beforehand, this trial was underpowered attributable to COVID-19 restrictions and half of the individuals have been affected by mandatory modifications to the examine protocol. We recognise that conducting some follow-up assessments of verbal fluency by way of phone could have deprived sure individuals, such these with hearing-impairments. Our rationale for reporting pre- and post-COVID-19 individuals collectively was as follows. Firstly, all three teams have been affected equally by restrictions, aside from the termination of supervised workouts lessons. We contemplate that, whereas this may occasionally have attenuated therapy results, it’s unlikely that important bias was launched. Secondly, as COVID-19 coverage in Sweden didn’t embody a proper lockdown, or curfews, individuals have been in a position to proceed non-supervised bodily exercise and a level of social contact, according to the unique examine protocol. Thirdly, we felt that reporting separate analyses would have launched an pointless lack of statistical energy, provided that measures reminiscent of on-line supplies have been put in place to permit individuals to proceed deliberate interventions as intently as attainable.

Research generalizability is more likely to be restricted by a wholesome entrant impact, the place individuals have been at a stage of readiness to vary their bodily exercise habits, in addition to by the predominance of feminine individuals. The restricted follow-up interval additionally prevents any inference of longer-term cognitive advantages.


Participation in both a 12-week yoga-based intervention or a 12-week cardio train intervention was related to a rise in phonological (total-FAS) verbal fluency. When in comparison with a wait-list management group, small-to-medium magnitude estimated therapy results have been seen for participation in both yoga or cardio train. General, these findings help the advice of each yoga and cardio train to advertise wholesome growing older in bodily inactive older adults. The outcomes could inform the design of an appropriately powered RCT. Such work must also goal to judge the consequences of yoga and cardio train on different domains of cognitive perform, in addition to on mind construction, to higher perceive the mechanisms underlying potential cognitive modifications.

Ethics Approval and Knowledgeable Consent

This examine was performed in accordance with the Helsinki Declaration and authorised by the Regional Ethics Committee in Stockholm (2017/1862-31/2, modification quantity 2018/2156-32).


The authors wish to acknowledge Hugo Sjöqvist for help with randomization, blinding and statistical recommendation and Patricia Eustachio Colombo for conducting assessments.


This examine is supported by Swedish Analysis Council for Well being, Working Life and Welfare (FORTE), grant quantity 2017-00024. The funding physique had no involvement within the assortment, evaluation or interpretation of knowledge, the writing of the manuscript or the choice to submit the manuscript for publication.


The authors report no conflicts of curiosity on this work.


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