Physical exercise and synaptic protection in human and pre-clinical models of multiple sclerosis

In multiple sclerosis,only immunomodulato ry and immunosuppressive drugs are recognized as disease-modifying therapies.Howeve r,in recent years,several data from pre-clinical and clinical studies suggested a possible role of physical exe rcise as disease-modifying therapy in multiple sclerosis.Current evidence is sparse and often conflicting,and the mechanisms underlying the neuroprotective and antinflammatory role of exercise in multiple sclerosis have not been fully elucidated.Data,mainly derived from pre-clinical studies,suggest that exe rcise could enhance longterm potentiation and thus neuroplasticity,could reduce neuroinflammation and synaptopathy,and dampen astrogliosis and microgliosis.In humans,most trials focused on direct clinical and MRI outcomes,as investigating synaptic,neuroinflammato ry,and pathological changes is not straightfo rward compared to animal models.The present review analyzed current evidence and limitations in research concerning the potential disease-modifying therapy effects of exercise in multiple sclerosis in animal models and human studies.

Physical exercise reverses immuno-cold tumor microenvironment via inhibiting SQLE in non-small cell lung cancer

Dear Editor,Physical exercise has been shown to be associated with reduced cancer incidence and cancer-associated mortality[1,2],but the underlying mechanisms are obscure.Immunometabolic regulation has emerged as one of the most prominent mechanisms explaining the effects of exercise on cancer[1,2].Physical exercise primarily lowers blood cholesterol and triglycerides,and protects against cardiovascular diseases[3].However,whether physical exercise can modulate cholesterol metabolism in tumor cells is currently unknown.

Study on the Influence of New Media on College Students’ Physical Exercise Behavior

New media is becoming an important method to promote physical exercise,and it is also an essential factor affecting the physical exercise behavior of college students.This study takes the influence of new media sports information on college students’physical exercise behavior as the research objective.By using a questionnaire survey and mathematical statistics,545 college students in Shandong Province of China are selected as research samples.Based on the theory of new media exposure,fitness behavior theory,and self-efficacy theory,this study systematically discusses the influence and mechanism of new media exposure on the physical exercise behavior of college students in Shandong Province,so as to help college students improve their physical exercise behavior.

Effects of personalized exercise prescriptions and social media delivered through mobile health on cancer survivors’physical activity and quality of life

Purpose This study aimed to examine the effects of a multi-component mobile health intervention(wearable,apps,and social media)on cancer survivors’(CS')physical activity(PA),quality of life,and PA determinants compared to exercise prescription only,social media only,and attention control conditions.Methods A total of 126 CS(age=60.37±7.41 years,mean±SD)were recruited from the United States.The study duration was 6 months and participants were randomly placed into 4 groups.All participants received a Fitbit tracker and were instructed to install its companion app to monitor their daily PA.They(1)received previously established weekly personalized exercise prescriptions via email,(2)received weekly Facebook health education and interacted with one another,(3)received both Conditions 1 and 2,or(4)were part of the control condition,meaning they adopted usual care.CS PA daily steps,quality of life(i.e.,physical health and mental health),and PA determinants(e.g.,self-efficacy,social support)were measured at baseline,3 months,and 6 months.Results The final sample size included 123 CS.The results revealed only the multi-component condition had greater improvements in PA daily steps than the control condition post-intervention(95%confidence interval(95%CI):368–2951;p<0.05).Similarly,those in the multi-component condition had significantly greater increased physical health than the control condition(95%CI:–0.41 to–0.01;p<0.05)over time.In addition,the social media condition had significantly greater increased perceived social support than the control condition(95%CI:0.01–0.93;p<0.05).No other significant differences on outcomes were identified.Conclusion The study findings suggest that the implementation of a multi-component mobile health intervention had positive effects on CS PA steps and physical health.Also,offering social media intervention has the potential to improve CS perceived social support.

Physiotherapist-led home-based physical activity program versus community group exercise for middle-aged adults: Quasi-experimental comparison

Objectives: Program method, program deliverer and participant preference may be important factors in increasing physical activity adherence and program effectiveness. To investigate this, we compared two physical activity interventions in middle-aged adults. Methods: Using a pragmatic quasi-experimental design, sedentary community dwelling 50 - 65 year olds (n = 2105) were recruited to a non-randomized 6-month community group exercise program (n = 93) or a physiotherapist-led home-based physical activity program (n = 65). The primary outcome was physical activity adherence derived from exercise diaries. Secondary outcomes included the Active Australia Survey, aerobic capacity (step- test), quality of life (SF-12v2), blood pressure, waist circumference, waist-to-hip ratio (WHR) and body mass index. Results: Home-based participants were more likely to be younger, working full-time and not in a relationship (p Thirty-three percent of the group participants attended ≥ 70% of group exercise sessions. Ninety percent of home-based participants received ≥ 4 of the planned 6 telephone support calls. Intention-to-treat analysis found adherence to the physical activity sessions prescribed was the same for both interventions (26% ± 28% vs. 28% ± 35%). Both interventions significantly increased the number of participants achieving self-reported “sufficient” physical activity (p ≤ 0.001) and significantly decreased waist circumference (p < 0.001) and WHR (p 0.05). Conclusion: The physiotherapist- led home-based physical activity program, requiring few resources, appears to have increased the adoption of physical activity and adherence to physical activity program requirements for sedentary middle-aged adults. The home-based program, providing equivalent health benefits to the group exercise program, may be particularly suitable for those not interested in or unable to attend a group exercise program. Clinical Trial Registration number Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN126 1000890932.

Physical exercise protects muscle from accelerated aging induced by high-salt intake and muscle CG2196(salt)gene overexpression in Drosophila

Aging decreases muscle mass,strength,and functional capacity.High-salt stress seems to promote muscle aging and decrease lifespan.However,exercise delays muscle aging and increases longevity,and it may protect muscle from rapid aging induced by high-salt intake(HSI),but the molecular mechanisms are poorly understood.In this study,the flies were fed a high-salt diet and trained to exercise.Muscle CG2196(salt)gene and dSir2 gene were over-expressed by building mef2-gal4/UAS system.The results showed that both physical exercise and muscle dSir2 gene overexpression prevented HSI-induced and muscle salt overexpression-induced accelerated age-related decline of climbing index,climbing endurance,muscle NAD^(+)level,SOD activity level,dSir2 expression,and dFOXO expression,and they also prevented HSI-induced and muscle salt overexpression-induced accelerated age-related increase in muscle ROS level,MDA level,and salt gene expression.Physical exercise improved lifespan decrease induced by HSI and muscle salt overexpression.Therefore,current results indicated that high-salt stress accelerated muscle aging by decreasing muscular NAD^(+)/dSir2/dFOXO pathway activity and increasing oxidative stress.Physical exercise protected muscle from accelerated aging induced by high-salt stress through activating muscle NAD^(+)/dSir2/dFOXO pathway and enhancing muscle oxidation resistance.The combination of exercise and muscle dSir2 overexpression had the best protective effect on muscle aging and lifespan in flies.

Who Benefits More from Physical Exercise?On the Relations between Personality,Physical Exercise,and Well-Being

Although employers believe that encouraging and supporting physical exercise activities by purchasing fitness equipment and building sports venues can improve employees’well-being,the utilization rate is rather low.Since most of the evidence of the well-being promotion in the workplace concentrated on the perspectives of organizational factors and psychosocial factors and focused on the reduction of the negative affect of well-being,it is still an open question whether physical exercise has benefits on both negative and positive affect of well-being and who benefits more from physical exercise.Thus,the purpose of this study is to investigate the impact of physical exercise on occupational well-being(job burnout and work engagement)and examine whether effectiveness depends on personality traits.Online questionnaires were distributed.The sample included 671 participants from different enterprises in China.Results showed that the effectiveness of physical exercise was also applicable to well-being in the workplace.Physical exercise was negatively correlated with job burnout and positively correlated with work engagement.The effectiveness was different among employees with different personality traits.Contrary to our expectation,individuals with neuroticism were more likely to improve their work engagement through physical exercise.Extroversion and conscientiousness weakened the benefits of physical exercise.Therefore,differences of effectiveness among different personality traits emphasize the need for a more personalized strategy in physical exercise interventions.

Effects of Physical Exercise and Music Therapy on Cognitive Aspects in Tunisian Patients with Mild Alzheimer’s Type Dementia

Aim: The objective of this research is to highlight the effectiveness of physical exercise and music therapy in older patients with Alzheimer’s disease (AD). Methods: Patients with a mild level of AD were included in this study, divided into the therapy group (TG;N = 30, aged 68 ± 3.2 years) and the control group (CG;N=30, aged 65 ± 2.6 years). The therapy group was enrolled in an exercise-training program (walking, resistance and balance exercises) combined with musical therapy for 10 weeks (three sessions of 60 minutes per week). The Control group was instructed to follow their daily rhythm of life (e.g., rest, reading) under the same conditions. The intervention program was enrolled under the supervision of;one psychologist;a neurologist;two music therapists, and two physiotherapists, all belonging to the same hospital unit. After 10 weeks of participation in the combined program, cognitive parameters were improved in the therapy group measured with the Behavior Pathology in Alzheimer Disease (BEHAVE-AD), (p < 0.05) for activity disturbance, diurnal rhythm disturbances, anxieties and phobias, affective disturbance. The percentage range of improvements is 1.07% to 2.96%. Results: Our results demonstrate that physical exercise combined with music therapy improves cognitive function in patients with Alzheimer’s disease. Conclusions: Physical exercise and music therapy are beneficial combined treatments for improving life quality in older patients. This approach may be useful to help patients with a mild level of Alzheimer’s disease improve their behavioral and psychological parameters.

The Positive Effects of Physical Exercise on Mental Health Among Chinese Students Under Great Competitive Pressure

Under an environment full of competitive stress,students tend to form negative emotions,and the time for them to engage in physical exercise is greatly limited due to overwhelming academic tasks.Therefore,in this paper,we focus on acknowledging the purpose of physical exercise,and how physical exercise affects the mental health of students under stressful circumstances but not in the context of leisure.Questionnaire was distributed to participants with an average age of 20,to investigate their preference,frequency,and reason for exercising,and their attitude towards it.Our results showed that participants think that exercise can strengthen the body,relieve stress,improve fitness and interpersonal relationship regardless of their purpose such as interests,emotional necessity and even out of non-subjective ideas.In conclusion,physical exercise helped to improve students’mental health especially under great pressure and ultimately,it will enhance their academics and bring about the unity of mind and body.

2024 Adult Compendium of Physical Activities:A third update of the energy costs of human activities

Background:The Compendium of Physical Activities was published in 1993 to improve the comparability of energy expenditure values assigned to self-reported physical activity(PA)across studies.The original version was updated in 2000,and again in 2011,and has been widely used to support PA research,practice,and public health guidelines.Methods:This 2024 update was tailored for adults 19-59 years of age by removing data from those≥60 years.Using a systematic review and supplementary searches,we identified new activities and their associated measured metabolic equivalent(MET)values(using indirect calorimetry)published since 2011.We replaced estimated METs with measured values when possible.Results:We screened 32,173 abstracts and 1507 full-text papers and extracted 2356 PA energy expenditure values from 701 papers.We added303 new PAs and adjusted 176 existing MET values and descriptions to reflect the addition of new data and removal of METs for older adults.We added a Major Heading(Video Games).The 2024 Adult Compendium includes 1114 PAs(912 with measured and 202 with estimated values)across 22 Major Headings.Conclusion:This comprehensive update and refinement led to the creation of The 2024 Adult Compendium,which has utility across research,public health,education,and healthcare domains,as well as in the development of consumer health technologies.The new website with the complete lists of PAs and supporting resources is available at https://pacompendium.com.

Non-coding RNAs in exercise immunology:A systematic review

Regular physical exercise has been recognized as a potent modulator of immune function,with its effects including enhanced immune surveillance,reduced inflammation,and improved overall health.While strong evidence exists that physical exercise affects the specific expression and activity of non-coding RNAs(ncRNAs)also involved in immune system regulation,heterogeneity in individual study designs and analyzed exercise protocols exists,and a condensed list of functional,exercise-dependent ncRNAs with known targets in the immune system is missing from the literature.A systematic review and qualitative analysis was used to identify and categorize ncRNAs participating in immune modulation by physical exercise.Two combined approaches were used:(a)a systematic literature search for“ncRNA and exercise immunology”,(b)and a database search for microRNAs(miRNAs)(miRTarBase and DIANA-Tarbase v8)aligned with known target genes in the immune system based on the Reactome database,combined with a systematic literature search for“ncRNA and exercise”.Literature searches were based on PubMed,Web of Science,and SPORTDiscus;and miRNA databases were filtered for targets validated by in vitro experimental data.Studies were eligible if they reported on exercise-based interventions in healthy humans.After duplicate removal,95 studies were included reporting on 164 miRNAs,which were used for the qualitative synthesis.Six studies reporting on long-noncoding RNAs(lncRNAs)or circular RNAs were also identified.Results were analyzed using ordering tables that included exercise modality(endurance/resistance exercise),acute or chronic interventions,as well as the consistency in reported change between studies.Evaluation criteria were defined as“validated”with 100%of≥3 independent studies showing identical direction of regulation,“plausible”(≥80%),or“suggestive”(≥70%).For resistance exercise,upregulation of miR-206 was validated while downregulation of miR-133a appeared plausible.For endurance exercise,15 miRNAs were categorized as validated,with 12 miRNAs being consistently elevated and 3 miRNAs being downregulated,most of them after acute exercise training.In conclusion,our approach provides evidence that miRNAs play a major role in exercise-induced effects on the innate and adaptive immune system by targeting different pathways affecting immune cell distribution,function,and trafficking as well as production of(anti-)inflammatory cytokines.miRNAs miR-15,miR-29c,miR-30a,miR-142/3,miR-181a,and miR-338 emerged as key players in mediating the immunomodulatory effects of exercise predominantly after acute bouts of endurance exercise.

Impacts of Nutlin-3a and exercise on murine double minute 2-enriched glioma treatment

Recent research has demonstrated the impact of physical activity on the prognosis of glioma patients,with evidence suggesting exercise may reduce mortality risks and aid neural regeneration.The role of the small ubiquitin-like modifier(SUMO)protein,especially post-exercise,in cancer progression,is gaining attention,as are the potential anti-cancer effects of SUMOylation.We used machine learning to create the exercise and SUMO-related gene signature(ESLRS).This signature shows how physical activity might help improve the outlook for low-grade glioma and other cancers.We demonstrated the prognostic and immunotherapeutic significance of ESLRS markers,specifically highlighting how murine double minute 2(MDM2),a component of the ESLRS,can be targeted by nutlin-3.This underscores the intricate relationship between natural compounds such as nutlin-3 and immune regulation.Using comprehensive CRISPR screening,we validated the effects of specific ESLRS genes on low-grade glioma progression.We also revealed insights into the effectiveness of Nutlin-3a as a potent MDM2 inhibitor through molecular docking and dynamic simulation.Nutlin-3a inhibited glioma cell proliferation and activated the p53 pathway.Its efficacy decreased with MDM2 overexpression,and this was reversed by Nutlin-3a or exercise.Experiments using a low-grade glioma mouse model highlighted the effect of physical activity on oxidative stress and molecular pathway regulation.Notably,both physical exercise and Nutlin-3a administration improved physical function in mice bearing tumors derived from MDM2-overexpressing cells.These results suggest the potential for Nutlin-3a,an MDM2 inhibitor,with physical exercise as a therapeutic approach for glioma management.Our research also supports the use of natural products for therapy and sheds light on the interaction of exercise,natural products,and immune regulation in cancer treatment.

“Active Feedback” Fitbit-Based Physical Activity and Sleep Hygiene Intervention for Memory Assessment Service (MAS) Patients with Cognitive Deficits: Feasibility, Acceptability, Sleep Quality, Stress, and Wellbeing Outcomes

Research Background: Compared to the general population, people experiencing age-related cognitive decline are more likely to have low levels of physical activity and sleep problems. Sufficient physical activity and quality sleep are protective factors against cognitive decline and poor health and can improve coping with stressors. The “Active Feedback” intervention comprises a wearable activity and sleep tracker (Fitbit), access to Fitbit software healthy lifestyle software apps;one session with Memory Assessment Service (MAS) staff providing physical activity and sleep hygiene advice and two further engagement, discussion, and feedback sessions. Purpose/Aim: This study investigates the acceptability and feasibility of Active Feedback and the effect on stress, mental wellbeing, and sleep quality, and the links between these factors. Methods: An open-label patient cohort design with no control group was used. Pre-intervention, 4-week and 8-week intervention assessments were performed using participant self-report measures: Perceived Stress Scale (PSS), Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), and Sleep Conditioning Index (SCI). Twenty-five participants completed an eight-week three-session intervention (18 males and 7 females), with the age range of 66 - 84 years old, and average age of 73.8 years (SD = 5.09). Fifteen participants had a diagnosis of MCI, ten participants did not. Results: There were non-significant improvements in SCI scores from 21.0 (SD = 8.84) to 21.6 (SD = 6.20) at 8 weeks, PSS scores from 17.5 (SD = 5.89) to 17.0 (SD = 6.20) at 8 weeks, and WEMWBS scores from 46.9 (SD = 9.23) to 48.8 (SD = 9.69) at 8 weeks. There were negative correlations between WEMWBS and PSS. Conclusion: Active Feedback intervention was found to be feasible and acceptable. Active Feedback could be enhanced to include motivational interviewing and goal setting.

Effective roles of exercise and diet adherence in non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease(NAFLD)is characterized by symptoms of excessive fat accumulation and steatosis in the liver without alcohol intake in patients.The associated pathogenic mechanism is not completely understood and there are no specific drugs for patients with NAFLD.Exercise and diet adherence are the best options for the management of NAFLD patients.Questionnaire associated analysis models of adherence to these interventions are used to assess their effectiveness in the management of NAFLD patients using specificity,sensitivity,and so on.Studies have indicated that the relative ratio of NAFLD can be reduced by physical activity with diet control.In the future,the pathogenesis of NAFLD should be clarified with stratified efforts to develop appropriate drugs,and both exercise and diet adherence should be optimized using better questionnaire design and evaluation models for patients with NAFLD.

An Innovative Approach towards Selecting Aerobic and Coordinative Exercises in Clinical Practice for Children and Young People with ADHD

A growing body of studies and systematic reviews show evidence of the beneficial effects of physical exercise on core symptoms of ADHD. Furthermore, studies indicate that physical exercise as an adjuvant can enhance the effects of medication in the treatment of ADHD. Aerobic and coordinative exercises improve executive functioning through their effect on neurocognitive domains that are implicated in ADHD. It is postulated that through their specific modus operandi, aerobic exercise, by raising cortical arousal levels, improves impaired alerting functions whereas coordinative exercises improve the regulation of inhibitory control through the involvement of a higher variety of frontal-dependent cognitive processes. The increasing use of routine neurocognitive testing with continuous performance tests (CPT), such as the QbTest, at clinical assessments for ADHD allows for an innovative approach to identify the assessment impairments in alerting function and inhibition control that are related to ADHD and accordingly choose aerobic or coordinative physical exercise in a more targeted fashion.

Exercise-induced modulation of miR-149-5p and MMP9 in LPS-triggered diabetic myoblast ER stress: licorice glycoside E as a potential therapeutic target

Background:This study explores the relationship between endoplasmic reticulum(ER)stress and diabetes,particularly focusing on the impact of physical exercise on ER stress mechanisms and identifying potential therapeutic drugs and targets for diabetes-related sepsis.The research also incorporates traditional physical therapy perspectives,emphasizing the genomic insights gained from exercise therapy in disease management and prevention.Methods:Gene analysis was conducted on the GSE168796 and GSE94717 datasets to identify ER stress-related genes.Gene interactions and immune cell correlations were mapped using GeneCard and STRING databases.A screening of 2,456 compounds from the TCMSP database was performed to identify potential therapeutic agents,with a focus on their docking potential.Techniques such as luciferase reporter gene assay and RNA interference were used to examine the interactions between microRNA-149-5p and MMP9.Results:The study identified 2,006 differentially expressed genes and 616 miRNAs.Key genes like MMP9,TNF-α,and IL1B were linked to an immunosuppressive state.Licorice glycoside E demonstrated high affinity for MMP9,suggesting its potential effectiveness in treating diabetes.The constructed miRNA network highlighted the regulatory roles of MMP9,IL1B,IFNG,and TNF-α.Experimental evidence confirmed the binding of microRNA-149-5p to MMP9,impacting apoptosis in diabetic cells.Conclusion:The findings highlight the regulatory role of microRNA-149-5p in managing MMP9,a crucial gene in diabetes pathophysiology.Licorice glycoside E emerges as a promising treatment option for diabetes,especially targeting MMP9 affected by ER stress.The study also underscores the significance of physical exercise in modulating ER stress pathways in diabetes management,bridging traditional physical therapy and modern scientific understanding.Our study has limitations.It focuses on the microRNA-149-5p-MMP9 network in sepsis,using cell-based methods without animal or clinical trials.Despite strong in vitro findings,in vivo studies are needed to confirm licorice glycoside E’s therapeutic potential and understand the microRNA-149-5p-MMP9 dynamics in real conditions.

Analysis of current status of and barriers to exercise participation among patients on maintenance hemodialysis

Objective:The objective of this study was to analyze the current status of barriers to exercise participation(EP)among patients on maintenance hemodialysis(MHD).Materials and Methods:A cross-sectional study was conducted on 277 outpatients undergoing MHD in 2 tertiary first-class hospitals in Beijing from February 2023 to June 2023 who were selected using convenience sampling method.The data of patients on MHD were collected using the general information questionnaire,Physical Activity Rating Scale,Exercise Benefits/Barriers Scale(EBBS),and Exercise Self-Efficacy Scale(ESES).The relationship between EP and barriers to EP was analyzed through univariate and multivariate linear regression models.Results:Patients on MHD had a low exercise volume score of 13.71±0.68 points and a medium EBBS score of 63.36±0.40 points.Multivariate logistic analysis showed that exercise volume was significantly related to the following four aspects,including low monthly household income per capita(odds ratio[OR]=86.741,95%confidence interval[CI][1.164-6.465],P=0.042),primary underlying disease of diabetic nephropathy(OR=45.993,95%CI[1.353-1.564],P=0.033),the belief that“fatigue in lower extremities hinders exercise”(OR=4.697,95%CI[1.127-19.585],P=0.034),and the belief that“physical exercise bringing optimistic and positive life attitude”(OR=0.074,95%CI[0.007-0.830],P=0.035).Conclusions:Since patients on MHD had low physical exercise volume,the health-care provider should pay more attention on the controllable factors that affect the EP of patients on MHD.Therefore,feasible and effective intervention measures can be formulated based on ESES in clinical nursing.

A Bibliometric Analysis of Global Research Trends of Exercise in Oncology During the Past Three Decades

Recently, studies have found that exercise can promote recovery in cancer patients. Based on bibliometric analysis, this paper discusses the trends and hot spots of exercise oncology research in the past 30 years. The Science Citation Index Expanded of the Web of Science Core Collection (WoSCC) was searched to obtain information on publications and records published between 1993 to 2023.VOSviewer and CiteSpace were used to conduct bibliometric and visual analyanalysis on the overall distribution of keywords and highly cited papers, and a total of 1775 articles were retrieved. Harvard University was the institution with the highest number of publications and Fearon ranked first in 2013 with a total of 605 citations.

Fat cell-secreted adiponectin mediates physical exercise-induced hippocampal neurogenesis: an alternative anti-depressive treatment?

Psychological depression is drawing accumulating attention nowadays, due to the skyrocketing incidence worldwide and the enormous burdens it incurs. Physical exercise has been long recog- nized for its therapeutic effects on depressive disorders, although knowledge of the underlying mechanisms remains limited. Suppressed hippocampal neurogenesis in adult brains has been regarded, at least partly, contributive to depression, whereas physical exercise that restores neuro- genesis accordingly exerts the anti-depressive action. Several recent publications have suggested the potential role of adiponectin, a protein hormone secreted by peripheral mature adipocytes, in mediating physical exercise-triggered enhancement of hippocampal neurogenesis and alleviation of depression. Here, we briefly review these novel findings and discuss the possibility of counter- acting depression by modulating adiponectin signaling in the hippocampus with interventions including physical exercise and administration of pharmacological agents.

Combined effect of repetitive transcranial magnetic stimulation and physical exercise on cortical plasticity

Physical exercise can minimize dysfunction and optimize functional motor recovery after stroke by modulating cortical plasticity.However,the limitation of physical exercise is that large amounts of time and effort are necessary to significantly improve motor function,and even then,substantial exercise may not be sufficient to normalize the observed improvements.Thus,interventions that could be used to strengthen physical exercise-induced neuroplasticity may be valuable in treating hemiplegia after stroke.Repetitive transcranial magnetic stimulation seems to be a viable strategy for enhancing such plasticity.As a non-invasive cortical stimulation technique,repetitive transcranial magnetic stimulation is able to induce longterm plastic changes in the motor system.Recently,repetitive transcranial magnetic stimulation was found to optimize the plastic changes caused by motor training,thereby enhancing the long-term effects of physical exercise in stroke patients.Therefore,it is believed that the combination of repetitive transcranial magnetic stimulation and physical exercise may represent a superior method for restoring motor function after stroke.