Hindawi Journal of Aging Research Volume 2021, Article ID 9912339, 10 pages https://doi.org/10.1155/2021/9912339 Research Article Acute Effects of Low- and High-Speed Resistance Exercise on Cognitive Function in Frail Older Nursing-Home Residents: A Randomized Crossover Study 1,2,3 4,5 6 He ´ lio J. Coelho-Ju ´ nior , Samuel da Silva Aguiar , Riccardo Calvani , 6 2 2 Anna Picca , Denise de Azevedo Carvalho, Juliana da Costa Zwarg-Sa ´ , 7 3,6 1 Michel Audiﬀren , Emanuele Marzetti , and Marco Carlos Uchida Laboratory of Applied Kinesiology, School of Physical Education, University of Campinas, Campinas, São Paulo, Brazil Rehabilitation Unit, Mãe Mariana Nursing Home, Poa´, Brazil Universita` Cattolica Del Sacro Cuore, Rome, Italy School of Physical Education, Catholic University of Bras´ılia, Campus I—QS 07—Lote 01—EPCT—Aguas Claras—Bras´ılia—DF CEP: 71966-700, Bras´ılia, Brazil Physical Education Department, University Center UDF, Bras´ılia-DF, Brazil Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy Research Centre on Cognition and Learning, UMR CNRS 7295, University of Poitiers, Poitiers, France Correspondence should be addressed to He´lio J. Coelho-Ju´nior; firstname.lastname@example.org Received 10 March 2021; Revised 30 June 2021; Accepted 22 July 2021; Published 3 August 2021 Academic Editor: Carmela R. Balistreri Copyright © 2021 He´lio J. Coelho-Ju´nior et al. (is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. (e present study investigated the acute eﬀects of low- and high-speed resistance exercise on the cognitive function of frail older women living in nursing home. Materials and Methods. Ten institutionalized frail older women were recruited. Rey Auditory Verbal Learning Test and Stroop test were performed before, immediately after, 1 h after, and 24 h after the end of the ex- perimental session. Participants randomly performed low- and high-speed resistance exercise and a control session. Exercise sessions were composed of 4 resistance exercises with 4–8 sets of 4–10 repetitions at moderate intensity. Results. Results indicated that the performance of Rey Auditory Verbal Learning Test was similarly increased immediately after both low- and high-speed resistance exercises. However, only improvements elicited by low-speed resistance exercise remained signiﬁcant 1 h after the end of the exercise session. No acute eﬀects of resistance exercise were observed on Stroop performance. Conclusion. Our ﬁndings indicated that both low- and high-speed resistance exercises acutely increased episodic memory in frail older women, whereas no changes on Stroop were observed. Findings from cross-sectional studies suggest that cog- 1. Introduction nitive function declines across frailty statuses in non- Frailty refers to a reversible state of increased vulnerability to demented older adults [2–4]. In addition, frail older people stressful agents, which occurs as a result of multisystem have been shown to be at a higher risk of developing de- derangements and poor social support . (e progression of mentia compared with nonfrail individuals [5–7]. (is frailty is marked by increased occurrence of negative events, scenario is especially concerning, since reduced physical such as falls and fractures, disability, and loss of independence performance and declining cognitive function depict the . Furthermore, a signiﬁcant association between frailty and paradigm of unsuccessfully aging  and are therefore cognitive decline has also been documented [2–7]. recognized as major public health problems . 2 Journal of Aging Research Cognitive impairment  and frailty  are highly considered to be eligible for inclusion if they satisﬁed the prevalent among nursing-home residents, in whom they following criteria: (a) ≥60 years of age; (b) frail according to contribute to the occurrence of many negative events Fried’s criteria ; (c) possessed suﬃcient physical and [11, 12]. Hence, strategies to maintain, or even improve, cognitive abilities to perform all measurements required by cognitive function and homeostatic reserves are crucial to the protocol; and (d) received physician approval to par- foster independence, autonomy, quality of life, and dignity ticipate. Candidates were excluded if they had participated in in institutionalized older people [13, 14]. a structured physical exercise program in the previous six (e practice of physical exercise is recommended for months, had uncorrected visual deﬁcit or color blindness, nursing-home residents  and frail older adults . were prescribed with hormone replacement therapy and/or Among the available exercise training protocols, particular psychotropic drugs, had experienced any cardiovascular attention has been given to low-speed resistance exercise event (e.g., myocardial infarction) or complication in the (LSRE), a training modality in which muscles work to hold past six months, or suﬀered from dementia according to or against an applied force at low-to-moderate velocity . Mini Mental State Examination (MMSE) scores adjusted by education level . LSRE elicits substantial improvements in muscle strength, power, and functional outcomes in older adults with dif- Participants performed three experimental sessions: ferent conditions [18–20] and causes larger increases in the LSRE, HSRE, or control session (CS), each separated by neuromuscular function of frail older people . seven days. (e order of experimental sessions was deﬁned Notably, some neuromuscular aspects seem to be more randomly using a computer-generated list of random dependent on high-speed muscle actions than on those per- numbers based on a 1 :1 :1 ratio. All experiments were formed at low speed [22, 23]. For this reason, a recent performed in the rehabilitation unit of the nursing home. statement from the National Strength and Conditioning As- Food consumption was maintained constant during the sociation has recommended including high-speed resistance previous 48 h and participants consumed a standard exercise (HSRE) in exercise programs for older adults . breakfast 60–90 min before the beginning of the experi- (e acute eﬀects of LSRE and HSRE on cognitive mental session. function in older adults are still poorly investigated. A recent systematic review and meta-analysis found that LSRE could 2.2. Ten-Repetition Maximum (10RM) Test. Participants elicit transitory improvements in global cognitive function, were familiarized with resistance exercises prior to a 10- inhibitory control, and cognitive ﬂexibility but not working repetition maximum (10RM) test. 10RM tests were per- memory and attention in 447 adults between 20.4 and 72.3 formed for the three following exercises: squat on the chair years old . However, these results were not conﬁrmed in (until 90 knee ﬂexion), seated unilateral hip ﬂexion, and subsequent studies . Studies examining older adults are seated unilateral knee extension. Before the tests, partici- still scarce, but the few available results are encouraging pants performed a brief speciﬁc warm-up using light loads. [27, 28]. However, studies have examined “healthy” com- Afterward, the 10RM load was determined in up to ﬁve munity-dwelling older adults [25, 27, 28] and, to the best of attempts, with a 3 min interval among trials. (e resistance our knowledge, no trials have investigated the eﬀects of was increased according to participants’ capacity to perform HSRE and/or institutionalized frail older people. more than one successful repetition maximum with the To ﬁll this gap in knowledge, the present study explored proper move and full range of motion. (e test was com- and compared the acute eﬀects of LSRE and HSRE on pleted when participants were unable to perform more than cognitive function in a sample of frail, nondemented older 10 repetitions using proper technique . Subsequently, women living in nursing homes. the 1-repetition maximum (1RM) was calculated according to the following formula : 2. Materials and Methods 10RM 1RM � . (1) [1.0278(0.0278 × 10)] (is was a single-center, randomized crossover study that examined the acute eﬀects of two types of resistance exercise on the cognitive performance of frail older women living in a 2.3. Experimental Sessions. Exercise sessions were per- nursing home. (e Research Ethics Committee of the formed in the mornings (07:30 am–10:00 am) under the University of Campinas approved the protocol. All study supervision of at least two ﬁtness instructors. After a brief procedures were conducted in compliance with the Decla- warm-up, participants performed the following exercises ration of Helsinki and the Resolution 196/96 of the National using an adjustable weight vest and ankle weights Health Council. All participants gave their written informed st (DOMYOS , Shanghai, China): (1 ) squat on the chair consent prior to participation. (is study complies with the nd (until 90 knee ﬂexion), (2 ) seated unilateral hip ﬂexion, criteria of the CONSORT Statement . rd th (3 ) seated unilateral knee extension, and (4 ) bilateral calf raise. (e total volume (sets × repetitions × load �∼800 kg) 2.1. Participants. Older women were recruited by conve- was equalized among exercise sessions. nience between August and December 2019 from a private LSRE and HSRE were designed according to the pecu- nursing home located in the eastern region of São Paulo liarities of each type of resistance exercise . During LSRE, State, southern Brazil. Nursing-home residents were participants performed 4 sets of 8–10 repetitions at 70–75% Journal of Aging Research 3 of 1RM. (e concentric and eccentric phases were carried red. Two possible responses, corresponding or not to the out for 2 s. For HSRE, exercises were performed 8 times color of the rectangle, were shown at the lower corners of the (sets) with 3–5 repetitions at 70–75% of 1RM. (e concentric monitor, and participants were requested to tell the color phase was performed as fast as possible, and the eccentric corresponding to the rectangle. In the congruent condition, phase was carried out for 2 s. Bilateral calf raise was per- the stimulus was the name of a color (e.g., red written in formed with the load of unilateral knee extension. A re- white). Two possible responses (i.e., name of two colors searcher was responsible for monitoring and ensuring that written in white, one corresponding to the stimulus and the the velocity of muscle contraction was performed according other not) were presented at the lower corners of the to the protocol. Particularly, verbal encouragement was monitor and participants had to read the color word. In the provided in the HSRE. During CS, participants remained incongruent condition, the stimulus is a color name seated on a comfortable chair for approximately 30 min. exhibited in a nonmatching color (e.g., red written in blue). Two possible responses, the name of the color word (red in the example) and the color of the ink (blue in the example), 2.4. Cognitive Function. All cognitive tests were performed were presented at the lower corners of the monitor. Par- before (rest), immediately after (IA), 1 h after, and 24 h after ticipants were requested to name the color of the ink and the end of the exercise session. Cognitive assessments were inhibit the reading of the word. A total of 36 stimuli (12 trials conducted face to face by a trained researcher in a private for each condition) were randomly provided, and reaction silent room. Shorter and simpliﬁed versions of cognitive time was recorded in ms. After the participant vocal response, tests were used to familiarize participants before actual a researcher was responsible for immediately pressing the testing. corresponding key (← or ⟶). (is protocol was established after a pilot study in which we observed that participants of the present study took too long or were unable to return the 2.4.1. Rey Auditory Verbal Learning Test (RAVLT). RAVLT is a neuropsychological tool widely used for testing hand to the initial position, if they had to take it oﬀ, even if the keyboard was composed by only two keys. episodic memory . (e test consists in read aloud two lists (A and B) of 15 substantives each with a 1 s interval between each two words. At the beginning of the test, list A 2.5. Statistical Analysis. Normality of data was tested using was read ﬁve consecutive times by a researcher. (en, the Kolmogorov-Smirnov test. Intragroup and intergroup participants were requested to recall as many words as comparisons at diﬀerent timepoints for RAVLT and Stroop possible after each trial (A1–A5). List B (interference list) variables were performed using two-way analysis of variance with 15 new substantives was read after A5 and words had to (ANOVA) followed by Dunnett’s post hoc test. Greenhouse- be retrieved (B1). Finally, participants were asked to recall Geisser corrections were applied for data that violated the words from list A immediately after the interference list sphericity assumptions. (e level of signiﬁcance was set at (A6, immediate recall) and following a delay of 20 min (A7, 5% (p< 0.05), and all analyses were run using GraphPad delayed recall), without listening to list A again . Eight Prism software (GraphPad Software, Inc., San Diego, CA, diﬀerent lists (for lists A and for lists B) with similar fre- USA). quency of words of the same semantic category were pre- sented at each session to avoid learning eﬀects. Five summary scores were used to assess episodic memory, 3. Results delayed memory, verbal learning, and susceptibility to in- terference : Eighteen nursing-home residents were recruited for the present study and ﬁfteen accepted to be evaluated for in- Verbal learning (VL) curve � A1, A2, A3, A4, A5, clusion. Of these, four had dementia according to MMSE Verbal learning (VL) score � A1 − A5 − (5 ∗ A1), scores and one left the study after the 10-RM test, leaving a total of 10 older women. (e main characteristics of the Forgetting speed (FS) � A7 − A6, study sample are shown in Table 1. Immediate recall (IR) � The sum of correct wordsretrieved in A6, (e acute eﬀects of resistance exercise on RAVLT are Delayed recall (DR) � The sum of correct words retrieved in A7. shown in Figures 1 and 2. Signiﬁcant time and interaction (2) eﬀects were observed. (e point-by-point analysis indicated that VL increased linearly IA from A1 to A5 in HSRE (Figure 1; p< 0.001). A signiﬁcantly higher A5 was observed 2.4.2. Stroop Test. A computerized version of the Stroop test at rest (p � 0.01), IA (p � 0.001), and 1 h after exercise (TESTINPACS )  was used to measure the reaction (p � 0.001) in LSRE. A4 was only improved 1 h after LSRE time (ms) and the number of correct responses for each (p< 0.001; Figure 1). Figure 2(a) shows overall VL scores. A stimulus (control, congruent, and incongruent) . For the signiﬁcant interaction eﬀect was observed. Higher VL scores test, participants remained seated in front of a 17ʺ color were observed IA in both HSRE (p � 0.001) and LSRE monitor. (e distance from the monitor was set according to (p � 0.01) compared with CS but remained greater at 1 h participant vision needs. (e Stroop test involves three only in LSRE (p � 0.01). At 24 h, VL was signiﬁcantly higher experimental conditions. In the control condition, the in CS relative to baseline (p � 0.001) and HSRE (p � 0.01). stimulus was a rectangle painted in green, yellow, blue, or No changes were observed in FS, IR, and DR in response to 4 Journal of Aging Research Table 1: Main characteristics of study participants. Variables n � 10 Age, years 86.2± 10.2 BMI, kg/m 23.5± 1.3 Period of institutionalization, years 1.0± 0.0 MMSE, points 16.4± 4.4 Comorbidities (n) Hypertension 8 Osteoarthritis 6 Stroke 2 Diabetes 2 Data are presented as mean± SD. BMI � body mass index; MMSE � Mini Mental State Examination. 6 a b HSRE LSRE CS Figure 1: Point-by-point analysis of Rey Auditory Verbal Learning Test (RAVLT). CS � control session; LSRE � low-speed resistance a b exercise; HSRE � high-speed resistance exercise. p< 0.05 versus A1 in HSRE; p< 0.05 versus A1 in LSRE. 10 2.0 a a 1.5 1.0 0.5 –5 Rest I A 1 h 24 h 0.0 –10 Rest I A 1 h 24 h CS CS LSRE LSRE HSRE HSRE (a) (b) 1.0 0.6 0.8 0.4 0.6 0.4 0.2 0.2 0.0 0.0 Rest I A 1 h 24 h Rest I A 1 h 24 h CS CS LSRE LSRE HSRE HSRE (c) (d) Figure 2: Continued. Verbal learning (n) Verbal learning Retroactive interference Rest-A1 Rest-A2 Rest-A3 Rest-A4 Rest-A5 IA-A1 IA-A2 IA-A3 IA-A4 IA-A5 Forgetting speed Proactive interference 1h-A1 1h-A2 1h-A3 1h-A4 1h-A5 24 h-A1 24 h-A2 24 h-A3 24 h-A4 24 h-A5 Journal of Aging Research 5 4 2.5 2.0 1.5 1.0 0.5 0.0 Rest I A 1 h 24 h Rest I A 1 h 24 h CS LSRE CS LSRE HSRE HSRE (e) (f) Figure 2: Rey Auditory Verbal Learning Test (RAVLT) scores at diﬀerent timepoints according to group allocation. CS � control session; ∗ a LSRE � low-speed resistance exercise; HSRE � high-speed resistance exercise; IA � immediately after. p< 0.05 versus rest; p< 0.05 versus CS. any session and no other between-group diﬀerences were greater IA HSRE compared to LSRE. (e possible mecha- found. nisms underlying such eﬀects were not investigated in the current study. (e total exercise volume was equalized (e acute eﬀects of resistance exercise on Stroop per- formance are shown in Figures 3 and 4. Neither LSRE nor among groups, thereby allowing discarding the hypothesis that our ﬁndings could be explained by diﬀerent workloads. HSRE aﬀected the number of correct answers (Figures 3(b) and 3(c)), which was signiﬁcantly reduced at 1 h during the On the other hand, diﬀerences in the duration of muscle incongruent stimulus in CS (Figure 3(a)). No changes were contraction between training modalities could oﬀer a observed in reaction time (Figure 4) and no between-group plausible explanation for our results, given that muscle diﬀerences were observed. contractions occurred at low velocity during LSRE and at high velocity during HSRE. Indeed, muscle contraction velocity might aﬀect neuroendocrine responses to exercise 4. Discussion . For instance, insulin-like growth factor-1 (IGF-1) is acutely increased in response to LSRE in older adults  (e ﬁndings of the present study indicate that, in frail older and systemic IGF-1 levels are signiﬁcantly associated with women living in nursing home, both LSRE and HSRE verbal memory and hippocampal perfusion and volume acutely increased VL, an indicator of episodic memory. . In addition, acute increases in IGF-1 levels have been Diﬀerent patterns of cognitive changes were observed observed in brain areas associated with memory formation among experimental conditions, so that VL remained higher (e.g., hippocampus and cortex) , which seems to be during 1 h following LSRE, while it was only increased IA critically involved in exercise-induced improvements in HSRE. Notably, VL was signiﬁcantly reduced in HSRE 24 h neuronal activation and cell proliferation . after the exercise session. No acute eﬀects of exercise were Serum testosterone, sex hormone binding globulin observed on Stroop performance, but the number of correct (SHBG), and cortisol levels tend to be lower IA HSRE in answers was signiﬁcantly lower in CS during the incon- comparison to LSRE with an equivalent total volume , gruent stimulus. suggesting that other mechanisms may be associated with Acute eﬀects of resistance exercise on cognitive function acute HSRE-induced transitory cognitive gains. Nitric oxide in older adults have been sparsely investigated. Furthermore, (NO) is a possible candidate to explain improved verbal the few available studies were conducted on “healthy” memory after HSRE . Indeed, infusion of the NO community-dwelling older adults [25, 27, 28]. Hsieh et al. precursor L-arginine ameliorated learning and memory and  found improved working memory 10 min following an LSRE session in nondemented older men. Similarly, Naderi increased the length of cortical capillaries in rats . (ese beneﬁts were abrogated by the administration of the NO et al.  observed improved working memory in older synthase inhibitor N -nitro-L-arginine methyl ester (L- adults who performed LSRE at 40% and 70% 1RM. In a NAME) . Remarkably, NO concentrations were found to recent systematic review and meta-analysis, Wilke et al.  be increased in saliva after an acute session of HSRE in older reported that an acute session of resistance exercise could women . However, these speculations cover only few of improve inhibitory control and cognitive ﬂexibility but not the myriad of mechanisms that can be responsible for the working memory in healthy adults. acute eﬀects of resistance exercise on cognition and future Our results provide a prima facie case for the diﬀerential studies are required to better explore the matter. eﬀects of LSRE and HSRE on verbal memory in frail older women. Notably, LSRE elicited longer learning improve- Noticeably, VL performance was signiﬁcantly reduced at 24 h in HSRE. (ese results go against the inverted-U shaped ments in comparison to HSRE, even if results seem to be Immediate recall Delayed recall 6 Journal of Aging Research 8 8 4 6 6 3 4 2 2 2 0 0 Rest I A 1 h 24 h Rest IA 1 h 24 h Rest I A 1 h 24 h Congruent stimuli Control stimuli Incongruent stimuli CS CS CS LSRE LSRE LSRE HSRE HSRE HSRE (a) (b) (c) 8 8 4 6 3 4 2 2 2 0 0 0 Rest I A 1 h 24 h Rest I A 1 h 24 h Rest IA 1 h 24 h Congruent stimuli Control stimuli Incongruent stimuli CS CS CS LSRE LSRE LSRE HSRE HSRE HSRE (d) (e) (f) 8 8 4 6 3 4 2 2 1 Rest IA 1 h 24 h Rest I A 1 h 24 h Rest IA 1 h 24 h Control stimuli Congruent stimuli Incongruent stimuli CS CS CS LSRE LSRE LSRE HSRE HSRE HSRE (g) (h) (i) Figure 3: Correct answers in the Stroop test. CS � control session; LSRE � low-speed resistance exercise; HSRE � high-speed resistance exercise; IA � immediately after. p< 0.05 versus rest. curve proposed by Audiﬀren , in which low- and high- Another possible explanation resides in the fact that intensity exercise sessions are expected to induce small tran- explosive muscle contractions require more attention than sitory cognitive improvements, while greater changes may be those performed at lower speed . Accordingly, sustained observed after moderate-intensity exercise. One possible ex- attention during HSRE might lead to a transient state of planation for this phenomenon may be that frail older adults mental fatigue, thereby reducing motivation  and cog- have high baseline cortisol levels . Although HSRE was nitive performance . (is can be particularly true in frail performed at moderate intensity, frail older women may have older people  and in nursing-home residents , whose reduced resiliency to physical stress , resulting in exag- homeostatic reserve is typically reduced. gerated hypercortisolemia during recovery with consequent (e eﬀects of resistance exercise on Stroop performance transient deterioration of memory performance . remain equivocal. In keeping with our ﬁndings, numerous Correct answers Correct answers Correct answers Correct answers Correct answers Correct answers Correct answers Correct answers Correct answers Journal of Aging Research 7 4000 4000 5000 0 0 Rest IA 1h 24 h Rest IA 1 h 24 h Rest IA 1 h 24 h Control stimuli Congruent stimuli Incongruent stimuli CS CS CS LSRE LSRE LSRE HSRE HSRE HSRE (a) (b) (c) 4000 4000 5000 0 0 Rest IA 1 h 24 h Rest IA 1h 24 h Rest IA 1h 24 h Control stimuli Congruent stimuli Incongruent stimuli CS CS CS LSRE LSRE LSRE HSRE HSRE HSRE (d) (e) (f) 4000 4000 5000 3000 3000 2000 2000 1000 1000 0 0 Rest IA 1 h 24 h Rest IA 1 h 24 h Rest I A 1 h 24 h Control stimuli Congruent stimuli Incongruent stimuli CS CS CS LSRE LSRE LSRE HSRE HSRE HSRE (g) (h) (i) Figure 4: Reaction time in the Stroop test. CS � control session; LSRE � low-speed resistance exercise; HSRE � high-speed resistance exercise; IA � immediately after. studies did not report improvements in Stroop performance (e above-mentioned ﬁndings are hard to reconcile. A following LSRE in middle-aged and older adults with mild possible explanation for the divergent results may be that cognitive impairment . On the other hand, Johnson et al. Johnson et al.  used a circuit-based resistance exercise,  found increased performance on the incongruent which has a high aerobic component . Diﬀerences in age stimulus up to 1 h after resistance exercise. (ese ﬁndings and health status of participants across studies may oﬀer an are supported by a recent systematic review and meta- additional explanation for these discrepancies. Indeed, healthy analysis showing that a single LSRE session may induce adults were investigated by Johnson et al.  and Wilke et al. moderate improvements on inhibitory control . , while frail older women were enrolled in our study. Reaction time (ms) Reaction time (ms) Reaction time (ms) Reaction time (ms) Reaction time (ms) Reaction time (ms) Reaction time (ms) Reaction time (ms) Reaction time (ms) 8 Journal of Aging Research Our ﬁndings may have important practical implications. only during 1 h after LSRE. Remarkably, the performance on Acute hemodynamic responses to resistance exercise have the RAVLT was reduced 24 h after HSRE. While no been shown to predict long-term cardiovascular adaptations mechanistic explanation may be provided for this ﬁnding, it  and contribute to lower cardiac risk during the activities might be hypothesized that the sustained attention required of daily living . (ere exists the possibility that the same by HSRE could induce a transient state of mental fatigue, scenario might occur in relation to cognitive function. resulting in reduced cognitive performance. (erefore, frail Hence, acute cognitive responses to resistance exercise could older persons engaged in HSRE programs may need rest serve as a metric to identify responders and nonresponders intervals longer than 24 h to avoid cognitive overload. Fi- . (is information, in turn, may be used to design nally, we did not observe any acute eﬀects of either LSRE or personalized training programs as well as to interpret results HSRE on Stroop test. Yet, the number of correct answers was of clinical trials testing long-term LSRE and HSRE protocols lower in CS during the incongruent stimulus. in frail older adults. Of particular interest is the reduced RAVLT perfor- Data Availability mance observed 24 h after HSRE. (is ﬁnding suggests that the frail older people should be closely monitored after (e data are available from the ﬁrst author upon request. performing HSRE, as they may develop memory deﬁcits following training. Such eﬀects are transitory and should Disclosure return to regular levels within 48 hours. However, health professionals responsible for exercise prescription must be (is study was part of the PhD thesis of H elio ´ Jose´ Coelho- aware of this scenario and be on the lookout for signs of Junior. ´ (e funders had no role in study design, data col- mental fatigue. Hence, rest intervals longer than 24 h might lection and analysis, decision to publish, or preparation of be necessary after HSRE for avoiding cognitive overloading. the manuscript. Our analysis also revealed two unexpected results. No- tably, A5 was signiﬁcantly increased at rest in LSRE but not Conflicts of Interest in the other two situations, whereas exclusive increases in VL were observed 24 hours after the CS. (ese observations (e authors declare no conﬂicts of interest. might be attributed to within-person ﬂuctuations in frailty status. In fact, Stolz et al.  noted that frail very old Acknowledgments women with low educational levels were more susceptible to show unstable health, characterized according to frequent (is work was supported by Innovative Medicines Initiative- oscillations in a multidomain frailty index. Joint Undertaking (IMI-JU #115621), by the Nonproﬁt Another possible explanation for our results is the Research Foundation “Centro Studi Achille e Linda Lor- presence of learning eﬀect, despite our attempts to reduce it enzon” and by a scholarship to H.J.C.-J. from Coordenação using randomization and eight diﬀerent RAVLT lists. de Aperfeiçoamento de Pessoal de N´ıvel Superior (CAPES; According to Scharfen et al. , retest eﬀects in memory Finance Code 001). capacity tests increased up to the fourth test administration until they reached a plateau and are highly inﬂuenced by the References length of the test-retest interval. Hence, future studies  E. O. Hoogendijk, J. Aﬁlalo, K. E. Ensrud, P. Kowal, G. Onder, proving larger intervals between sessions are still necessary and L. P. 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Journal of Aging Research – Hindawi Publishing Corporation
Published: Aug 3, 2021