The Effect of Twelve Weeks of Physical Exercise with Ginkgo Biloba Supplementation on the Serum Levels of Brain-Derived Neurotrophic Factor and Inactive Elderly Lifestyle in Tehran

Aging is a process that Based on slow and progressive changes with age, it covers the whole human being. Today, 31 countries in the world have more than 2 million elderly people over the age of 60, and the number of these countries is increasing day by day (1). The need to care for the elderly living at home will increase significantly in the coming years due to population growth and lack of physical activity (2). Most older people get older at home, and most have one or more chronic disorders (3). What is certain is that with age, the risk of acute and chronic diseases increases and people's functional abilities as well as their power of senses and perception decrease. These changes in the biological, psychological and social spheres threaten the quality of life of the elderly, to the extent that they prevent them from carrying out daily activities (4). One of the factors observed due to increasing aging is cognitive dysfunction, i.e. a decrease in BDNF levels and in line with this issue, a decrease in quality of life (5). Neurotrophin is a substance that enhances the survival and regeneration of nerve cells and strengthens, stimulates and grows neurons and is essential for memory.Neurotrophic factors support and grow a variety of brain neurons (6).BDNF is a protein encoded by a gene called BDN.This factor belongs to the family of neurotrophies that causes the expansion of the neural network.Brain-derived neurogenic factor is one of the most important members of this family and by binding to specific kinase tyrosine receptors, it triggers intracellular cascades and ultimately produces and differentiates new neurons (7,8).This factor acts as a mediator for synaptic effects, neural connections and plasticity in the brain.One study found that lowering BDNF levels in the elderly could reduce learning and functional impairment (9).On the other hand, increased BDNF and neurogenesis in the body can prevent nerve and muscle coordination in the elderly.Exactly the decrease in nerve and muscle coordination is one of the reasons that occurs with a decrease in BDNF levels in the elderly and will affect the quality of life of these people.In recent years, the possibility of using exogenous BDNF as a therapeutic approach against neurological diseases has been estimated (9).However, the role of exercise and nutrition in increasing BDNF and quality of life still has many challenges.Exercise and nutrition itself are an exogenous factor in increasing BDNF.Research has shown that exercise in young rats increases the number of new cells in the hippocampus and improves brain function.Physiological studies have also shown that physical activity increases the electrical activity of the hippocampus, which can be caused by altered neuronal activity and neurotransmitters (10). The effect of aerobic exercise in young rats shows that exercise increases spatial learning and neuronal density of the hippocampus in the dentate gyrus and other parts of the hippocampus without changing the rate of apoptosisand improves short-term memory. Researchers believe that exercise may strengthen the hippocampus in humans.In the meantime, resistance training has been able to have a significant impact on changes in the hippocampus (11). Doing resistance training can also make a positive difference in BDNF levels (12). On the other hand, nutrition can also help increase BDNF levels.ginkgo biloba has been shown to be used for brain-related issues, including memory enhancement or even the treatment of Alzheimer's patients (13).ginkgo biloba is well known for its antioxidant components and has the ability to scavenge free radicals and lipid peroxidation.ginkgo biloba contains more than 60 bioactive compounds, the most important of which are terpene lactones and flavonoids (14).Recent research has also highlighted the importance of the effect of ginkgo biloba supplementation on cognitive function.In this regard, it has been found that ginkgo supplementation has neuroprotective effects and improves cognitive function capacity, and it performs these actions by reducing oxidative stress and increasing BDNF concentration (15). Therefore, due to the importance of increasing old age and lack of physical activity and the existence of conflicting studies regarding the importance of supplementation and combination with exercise in the elderly, the present study decided to fill the scientific gap of the present study as the effect of twelve weeks of exercise. Check serum BDNF levels and quality of life of inactive elderly with ginkgo biloba supplementation.

The statistical sample of the present study consisted of 40 elderly men and women (75-60 years), who were selected in a targeted and accessible manner.And were randomly divided into 4 groups of exercise (n=10), supplement (n=10), exercise + supplement (n=10) and placebo or control (n=10).Criteria for inclusion in the present study of the subjects according to the callBeing over 60 years old, having Iranian nationality, ability to speak Persian, not having a known mental illness (psychosis), having full consciousness while studying, ability to communicate, ability to answer study questions and living in Tehran.Exclusion criteria from the present study included refraining from answering the questionnaire during work and interviews, as well as refusing to perform the desired training program or supplement, as well as unwanted events.After selecting the participants during an introductory session, the steps, process and purpose of the research were fully explained to them and a informed consent form was obtained.This study was also registered in the Clinical Trial Center with the code IR.SSRC.REC.1398.116. The training sessions were supervised by trained personnel and will last for 20 minutes 5 times a week for 12 weeks. Each training session included 5 minutes of warm-up, 5 minutes of resistance training, 5 minutes of balance and walking training, and 5 minutes of cooling. Subjects were randomly assigned to receive 240 mg (once daily and in the morning) of EGb761 or placebo (cellulose). To do the chair exercise, get on your toes, get on your heels, lift your knees, open your knees, and do other movements while standing behind the chair to maintain more balance. To strengthen the ankle weight bearing exercise, to strengthen the legs, a fixed weight was placed on the ankle and strengthening exercises were performed.

The results of one-way analysis of variance showed that there was a significant difference between serum levels of neurotrophic factor derived from the brain of the elderly in the study groups after twelve weeks of aerobic exercise with ginkgo biloba supplementation (P = 0.05).The results of one-way analysis of variance showed that there was a significant difference between the quality of life of the elderly in the study groups after twelve weeks of exercise with ginkgo biloba supplementation (P = 0.05).

The aim of this study was to evaluate the effect of 12 weeks of physical activity with ginkgo biloba on serum BDNF levels and quality of life in the elderly in Tehran.The results of this study showed that there was a significant difference between BDNF levels in the elderly and quality of life (QoL) in the study groups after twelve weeks of aerobic exercise with ginkgo biloba supplementation (P <0.05). The intergroup results also showed that there was a significant difference in serum BDNF levels between all groups (P <0.05).Also, the results of Tukey test for comparison between QoL index showed that there was a significant difference between all groups (P <0.05) but there was no significant difference between the complementary and control groups (P> 0.05). In general, the results of the present study show thatExercising and taking ginkgo biloba supplements at the same time for 12 weeks will improve serum BDNF levels and quality of life in the elderly, thereby reducing aging mortality and improving the living conditions and independence of the elderly.