The Effects of Appropriate Perioperative Exercise on Perioperative Neurocognitive Disorders: a Narrative Review

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  Fig. 1. Molecular mechanisms through which exercise may affect cognitive function. Surgical procedures can activate damage-associated molecular patterns (DAMPs), further activating macrophages. Activated macrophages can secrete cytokines through the damaged BBB, further leading to microglia activation in the hippocampus. After being activated, microglia can be divided into M1 and M2 phenotypes. M1-type microglia produce pro-inflammatory cytokines to damage neurons. M2-type microglia secrete anti-inflammatory cytokines participating in tissue repair and extracellular matrix reconstruction. Surgical trauma makes microglia develop M1 polarization, leading to a vicious circle of neuroinflammation progression. Exercise can promote microglia development in M2 polarization and inhibit the level of pro-inflammatory cytokines to promote neuronal recovery. Exercise can inhibit the production of valeric acid by altering the diversity of gut microbiota. Valeric acid produced by gut microbiota inhibited neurogenesis, reduced the dendritic branches and spine density, and increased the production of pro-inflammatory cytokines in the hippocampus. At the same time, exercise can also increase skeletal…

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  Fig. 2. Impact of different types of exercise on the brain. In animal studies, swimming and running have been shown to reduce pro-inflammatory cytokines and regulate gut microbiota, thereby improving post-operative cognitive function. In human studies, walking, multicomponent exercise, and resistance exercise can prevent cognitive decline. Rehabilitation exercise has a protective effect on post-operative cognitive function in elderly patients