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The Neurocognitive Connection Between Physical Activity And obesity reviews doi: 10.1111/j.1467-789X.2011.00893.x Etiology and Pathophysiology The neurocognitive connection between physical activity and eating behaviourobr_893 800..812 R. J. Joseph1, M. Alonso-Alonso2, D. S. Bond3, A. Pascual-Leone2,4 and G. L. Blackburn1 1Center for the Study of Nutrition Medicine, Summary Beth Israel Deaconess Medical Center, As obesity rates increase worldwide, healthcare providers require methods to Boston, MA, USA; 2Berenson Allen Center for instill the lifestyle behaviours necessary for sustainable weight loss. Designing Noninvasive Brain Stimulation, Beth Israel effective weight-loss interventions requires an understanding of how these behav- Deaconess Medical Center, Boston, MA, USA; iours are elicited, how they relate to each other and whether they are supported by 3Weight Control and Diabetes Research common neurocognitive mechanisms. This may provide valuable insights to opti- Center, The Miriam Hospital, Providence, RI, mize existing interventions and develop novel approaches to weight control. USA; 4Institut Universitari de Researchers have begun to investigate the neurocognitive underpinnings of eating Neurorehabilitació Guttmann, Universidad behaviour and the impact of physical activity on cognition and the brain. This Autónoma de Barcelona, Badalona, Spain review attempts to bring these somewhat disparate, yet interrelated lines of literature together in order to examine a hypothesis that eating behaviour and Received 18 February 2011; revised 22 April physical activity share a common neurocognitive link. The link pertains to execu- 2011; accepted 1 May 2011 tive functions, which rely on brain circuits located in the prefrontal cortex. These advanced cognitive processes are of limited capacity and undergo relentless strain Address for correspondence: Dr GL in the current obesogenic environment. The increased demand on these neurocog- Blackburn, Beth Israel Deaconess Medical nitive resources as well as their overuse and/or impairment may facilitate impulses Center, Department of Surgery, Center for the to over-eat, contributing to weight gain and obesity. This impulsive eating drive Study of Nutrition Medicine, Feldberg 880, may be counteracted by physical activity due to its enhancement of neurocognitive East Campus, 330 Brookline Avenue, Boston, resources for executive functions and goal-oriented behaviour. By enhancing the MA 02215, USA. E-mail: resources that facilitate ‘top-down’ inhibitory control, increased physical activity [email protected] may help compensate and suppress the hedonic drive to over-eat. Understanding how physical activity and eating behaviours interact on a neurocognitive level may help to maintain a healthy lifestyle in an obesogenic environment. Keywords: Eating behaviour, neurocognition, obesity, physical activity. obesity reviews (2011) 12, 800–812 relapse of weight gain (6) are common. The limited long- Introduction term success of such interventions may be attributable in Despite increased awareness, public health campaigns and part to a failure to fully understand and exploit the con- novel therapies, obesity rates remain at alarming levels in nection between the two therapeutic cornerstones, physi- the USA (1) and are increasing worldwide (2). Lifestyle- cal activity and eating behaviours. Indeed, while much based weight-loss interventions consistently produce a emphasis is placed on modifying both behaviours to 7–10% decline in initial body weight (3), but the condi- promote an immediate energy deficit, there has been less tion is refractory, and poor retention rates (4,5) and emphasis on understanding how a change in one of these behaviours may support the longer-term maintenance of The authors do not report any financial support in the research or in the change in the other. A clearer understanding of the inter- writing of this manuscript. action between physical activity and eating behaviours 800 © 2011 The Authors obesity reviews © 2011 International Association for the Study of Obesity 12, 800–812 obesity reviews Physical activity restrains over-eating R. J. Joseph et al. 801 based on underlying neurocognitive processes and adap- dietary self-report and mixed samples of normal and tations may help to optimize the implementation, adop- overweight/obese individuals may undermine the reliability tion and combined effect of each for healthy, sustainable of the data. Such epidemiologic studies can, at best, identify weight loss (7,8). potential associations and help formulate hypothesis that The analysis of behaviour change via neurocognitive warrant follow-up testing. The extent and direction of cau- modelling holds promise as one of this decade’s most ben- sality and underlying mechanisms of this behavioural cova- eficial developments in the treatment of obesity. Behaviour riance remains largely unexplored given the observational change implies a critical switch whereby an externally nature of these studies. imposed intervention transits into self-regulated actions Studies also indicate that physical activity and dietary that facilitate a desired outcome. Adapted cognitive pro- behaviours comprise a constellation of similar lifestyle cesses and resultant behaviour patterns underlie these behaviours that cluster together (17,18). A review article by so-called ‘goal-oriented’ actions, such as resisting high- Blair et al. indicates that physical activity may indirectly calorie foods and increasing physical activity to align with influence health behaviours like smoking, substance abuse, a weight-loss goal. On a neurocognitive level, these behav- risk taking, over-eating and stress management (19). Con- iour changes involve the alteration of the brain’s neurobio- versely, sedentary behaviour and unhealthy eating habits fit logical substrates and plastic processing pathways that are into the cluster of behaviours that are adverse to health. cemented over time (9). Identifying these pathways and One study, which documented the prevalence and cluster determining how to modify the neurocognitive processes patterns of lifestyle factors among a random sample of involved in adopting healthy lifestyle behaviours is essential adolescents, adults and seniors from a large Midwestern to achieving sustained weight loss. By linking two emerging health plan, found that overall, 14.5% of the health plan lines of neuroscience literature, we posit that increased members met recommended guidelines for four healthy physical activity and consumption of a healthy diet share a lifestyle factors – physical activity, non-smoking, high- common neurocognitive underpinning. This may help to quality diet and healthy weight (20). An investigation into explain the observational association and behavioural the prevalence and clustering of lifestyle risk factors such as interplay between these lifestyle factors and may be useful sedentary behaviour, smoking, low fruit and vegetable con- in developing more effective weight-loss interventions. sumption and excessive alcohol consumption among Dutch men and women found significant clustering, with about 20% of the participants having three risk factors simulta- The associative link between physical neously (21). Analysis of data from the Cardiovascular activity and diet: observations and Risk in Young Finns Study reported similar grouping (22). theoretical foundations Specifically, physical inactivity has been associated with Whereas the effect of physical activity and dietary habits on smoking (23) and increased dietary fat consumption (24), disease has been established (10,11), the ability of these and those who smoke and drink regularly tend to consume two behaviours to indirectly modify each other has been less fruits and vegetables (25). In one study that specifically sparsely documented. The few studies that examined the examined the patterns of adolescent physical activity and interaction between habitual physical activity and healthy dietary behaviours, the most prevalent cluster of related diet suggest an interactive and reinforcing relationship health behaviours was formed by not meeting the physical (12,13). A study by Brodney et al. found that higher car- activity and fruit and vegetable recommendations (26). diorespiratory fitness levels were associated with lower per- These studies imply that physical activity and dietary centage of energy from fat, higher dietary fibre intake, behaviours do not occur in isolation. The synchronized reduced cholesterol intake and closer adherence to dietary tracking of lifestyle factors suggests that these are complex, recommendations (14). Findings from a study of 2004 New multidimensional behaviours that coexist, occur collec- England households suggested that moderately to very tively in distinct patterns and perhaps reinforce each other. active individuals tend to consume more fibre, less total fat For decades, health psychologists, who examine how and less saturated fat than sedentary participants (15). In biological, behavioural and psychological factors influence one of the few prospective studies in this area, men and health and illness, have laid the groundwork to explain women who reported increases in their activity levels from the connection between lifestyle behaviours through obser- age 33 to 42 also reported improvement in the overall vation, theories and tested psychological constructs. A quality of their diet (16). Taken together, these studies variety of social cognitive models (27), each of which pro- suggest a link between physical activity and diet, opening vides a slightly
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