Fisioterapia

The Adaptive Neuroplasticity Hypothesis of
Behavioral Maintenance

1. Introduction

Physical activity is a seemingly simple, clinically potent and costeffective approach to reduce morbidity and mortality, particularly in highrisk chronic disease populations, such as those with coronary heart disease (CHD). For example, people with CHD who are physically active have a 26– 47% reduction in2–5-year all-cause mortality and a 28– 30% reduction in cardiac mortality [1–5]. Nonetheless, long- term maintenance of physical activity remains a frustratingly elusive goal for patients and practitioners alike. In this paper, we hypothesize that recidivism after the initiation of physical activity may represent maladaptive neuroplastic changes in malleable neural processes in older adults with CHD whodo not possess the neuronal networks necessary to support maintenance of physical activity. It has previously been established that physical activity promotes adaptive neuroplastic changes in older human beings and thus, based on animal studies, this likely represents neurogenesis,

enhanced synaptic plasticity and dendritic branching. We further hypothesize that behavioral interventions thatsuc- cessfully promote physical activity may also enhance adaptive neuroplasticity and play a key role in the maintenance of physical activity through the development of new neuronal pathways that enhance functional ability in older adults. Conversely, without such adaptive neuroplastic changes, ingrained maladaptive neuroplasticity will prevail and long- term maintenance of physical activity willfail. State-of-the-art behavioral science research that is
designed to motivate the initiation and maintenance of physical activity usually incorporates three core elements: (1) education; (2) behavioral modification (e.g., exercise instruction; and (3) cognitive-behavioral approaches (e.g., self-monitoring, behavioral goal setting) [6]. In combi- nation, these approaches can effectively promotephysical activity, and thus enhance adaptive neuroplasticity, in healthy community-dwelling older adults [7, 8]. However, previ- ous efforts to motivate long-term maintenance of physical

Neural Plasticity

activity in older adults with chronic disease have been disappointing, particularly among people with CHD [6, 9, 10]. Behavioral science has not normally employed the concepts and dynamics ofadaptive neuroplasticity when designing studies to promote behavioral change. Given the enormous potential for physical activity to yield improved health outcomes in people with CHD, it is imperative that investigators apply modern constructs of neurobiology to the development of more effective and enduring behavioral science treatment approaches. Translation of successes from basic behavioralscience to high-risk, clinically ill patient groups has not traditionally been employed and holds great potential to motivate ini- tiation and maintenance of behavior change and, in turn, improve long-term health outcomes. For example, induction of positive affect has demonstrated the ability to motivate both increased physical activity and improved medication adherence in two studies of chronicdisease [11, 12]. Given their potential potency, the application of such approaches to motivate physical activity may also stimulate adaptive neuroplastic changes that can support long-term physical activity maintenance. One barrier to translational behavioral science has been the absence of a standardized approach to translate basic behavioral and social science research to the study and treatment ofpatients with chronic disease. To this end, we have recently developed EVOLVE, which is a mixed methods and staged approach for this purpose [13]. While generalizing from animal models to humans is always complicated, this new frontier of behavioral medicine holds great promise because it begins to adopt the neurobiologic concepts of adaptive neuroplasticity in its application to behavioral...