The impact of dietary intervention & physical-cognitive exercise on cognitive function in postmenopausal women – a March 2024 study

Peri-menopause, menopause and post-menopause bring a host of challenges for women, including increased risks of obesity, cardiovascular disease, and cognitive decline. These risks are compounded by the hormonal changes that occur during this period, which can lead to both physical and cognitive health issues.

Oestrogen, in particular, plays a critical role in brain function, including supporting neurotransmitter activity, promoting blood flow to the brain, and protecting neurons from damage. Interestingly, oestrogen’s role in modulating amyloid-beta production (a protein that accumulates in Alzheimer’s disease) and tau phosphorylation (a process that leads to neurofibrillary tangles) suggests that it may help delay or prevent the onset of Alzheimer’s in women. Studies have shown that women are more likely than men to develop Alzheimer’s, and the loss of oestrogen during menopause is believed to be a contributing factor.

This very cool 2024 study (which I absolutely love!) explored the effectiveness of combined dietary intervention and physical-cognitive exercise on improving cognitive function and cardiometabolic health in postmenopausal women with obesity. The findings offer really valuable insights into how lifestyle modifications can significantly benefit women in this phase of life. Although the study included obese women only, I really believe this can be a powerful intervention across the board. So, I have gone into a lot of detail regarding the method and findings of this report.

Study Overview

The randomized controlled trial (RCT) included 92 postmenopausal women with obesity, who were divided into four groups:

1. Diet-Only Group
2. Exercise-Only Group
3. Combined Diet and Exercise Group
4. Control Group

The intervention lasted three months, during which participants in the intervention groups followed specific protocols designed to enhance cognitive function and cardiometabolic health. The primary focus was on the effects of intermittent fasting (IF) as the dietary intervention, coupled with physical and cognitive exercises aimed at improving overall health outcomes.

Detailed information on the 5:2 Intermittent Fasting Protocol

Fasting Days:

• Participants consumed approximately 500–600 calories per day on fasting days – The meals were structured to be nutrient-dense despite the low-calorie content.
• The caloric intake was divided into two small meals:
  • First meal (200–250 calories): Consumed around midday.
  • Second meal (300–350 calories): Consumed in the evening.
  • Macros as follows:
    • Protein: Approximately 30-35% of total calories to promote satiety and preserve lean muscle mass.
    • Carbohydrates: Around 40-45% of total calories, focusing on complex carbohydrates with a low glycaemic index.
    • Fats: Comprised about 20-25% of total calories, mainly from healthy sources such as nuts, seeds, and olive oil.

Non-Fasting Days:

• Participants were advised to eat normally without specific calorie restrictions, focusing on maintaining their usual diet while avoiding overeating.
• Emphasis was placed on consuming a balanced diet rich in whole grains, lean proteins, healthy fats, fruits, and vegetables.
  • Macros as follows:
    • Carbohydrates: 45-55%
    • Proteins: 20-25%
    • Fats: 20-30%

Physical and Cognitive Exercise Intervention

• Physical Exercise: The exercise regimen focused on aerobic activities combined with resistance training, tailored to each participant’s fitness level (love how individualised it was!). This included activities such as walking, cycling, and strength training exercises.
• Cognitive Exercise: Participants engaged in cognitive training exercises designed to improve memory, executive function, and mental agility. These exercises included puzzles, memory games, and problem-solving tasks.

Key Findings of the Study

1. Cognitive Function Improvement:

• • Combined Intervention Group: Participants in the combined diet and exercise group showed significant improvements in both memory and executive function compared to the control group. These cognitive gains were more pronounced than in the groups that only followed either the diet or exercise intervention.
  • Exercise-Only Group: The exercise-only group also demonstrated improvements in memory, although to a lesser extent than the combined group.
  • Diet-Only Group: Surprisingly, the diet-only group did not show significant cognitive improvements, suggesting that while intermittent fasting has metabolic benefits, its cognitive effects may be limited when not combined with physical and cognitive exercise.

2. Cardiometabolic Health Benefits:

• • The combined intervention group experienced significant improvements in cardiometabolic health markers, including increased insulin sensitivity, higher plasma adiponectin levels (a hormone associated with reduced inflammation and improved glucose regulation), and reductions in total cholesterol, fat mass, and body weight.
  • These changes were more substantial when diet and exercise were combined, emphasizing the synergistic effects of these interventions on cardiometabolic health.

3. Biomarkers of Brain Health:

• • All intervention groups showed increased levels of brain-derived neurotrophic factor (BDNF), a protein that plays a key role in supporting neuron survival, growth, and cognitive function. The combined intervention group achieved the greatest increase in BDNF levels, indicating a strong link between comprehensive lifestyle changes and improved brain health.

Potential implications of this study

What is great about this study is that it highlights the importance of a holistic approach to health for women as we enter this phase of our lives. By addressing both diet and exercise (physical and cognitive) simultaneously, women can achieve greater improvements in cognitive function and cardiometabolic health than by focusing on one aspect alone. Supporting cognitive function is crucial and to be able to do so in such an uncomplicated way is really encouraging. I can’t wait to work with women in this way.