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Erschienen in: Sports Medicine 10/2020

14.07.2020 | Current Opinion

Cognitive Fatigue Effects on Physical Performance: The Role of Interoception

verfasst von: Terry McMorris

Erschienen in: Sports Medicine | Ausgabe 10/2020

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Abstract

The consensus of opinion, with regard to the effect of cognitive fatigue on subsequent physical performance, is that there is a small, negative effect, but there is no consensus regarding the mechanisms involved. When glucose levels are normal, undertaking cognitive tasks does not induce energy or neurotransmitter depletion. The adenosine hypothesis is questioned as cognitively induced increases in adenosine release are phasic and transient, while persistent effects of adenosine are tonic. Thus, the most likely explanation for a negative effect of cognitive fatigue would appear to be changes in perceptions of effort, for which there is some evidence from subjective participant feedback, while interoceptive theory would suggest a role for motivation levels. Cognitive fatigue and physical fatigue are dependent on interoceptive mechanisms, in particular the interactions between top-down predictions of effort from the dorsolateral prefrontal cortex (PFC) to the insula cortex, anterior cingulate cortex, ventromedial and ventrolateral PFC, and bottom-up feedback from the lamina I spinothalamic pathway, and the vagal and glossopharyngeal medullothalamic pathway. The dopaminergic mesocorticolimbic and the locus coeruleus–noradrenaline pathways are also vital. It would appear that cognitive fatigue leads to different predictions of the expected sensory consequences of undertaking the exercise than in the control condition and there is some evidence that motivation can overcome this. Much more research, in which motivation levels are manipulated, is necessary as the effects are small and the reasons for cognitive fatigue causing changes in predictions of sensory consequences are not clear.
Literatur
1.
Zurück zum Zitat Van Cutsem J, Marcora S, De Pauw K, Bailey S, Meeusen R, Roelands B. The effects of mental fatigue on physical performance: a systematic review. Sports Med. 2017;47:1569–88.PubMed Van Cutsem J, Marcora S, De Pauw K, Bailey S, Meeusen R, Roelands B. The effects of mental fatigue on physical performance: a systematic review. Sports Med. 2017;47:1569–88.PubMed
2.
Zurück zum Zitat Pageaux B, Lepers R. The effects of mental fatigue on sport-related performance. Prog Brain Res. 2018;240:291–315.PubMed Pageaux B, Lepers R. The effects of mental fatigue on sport-related performance. Prog Brain Res. 2018;240:291–315.PubMed
3.
Zurück zum Zitat McMorris T, Barwood M, Hale BJ, Dicks M, Corbett J. Cognitive fatigue effects on physical performance. A systematic review and meta-analysis. Physiol Behav. 2018;188:103–7.PubMed McMorris T, Barwood M, Hale BJ, Dicks M, Corbett J. Cognitive fatigue effects on physical performance. A systematic review and meta-analysis. Physiol Behav. 2018;188:103–7.PubMed
4.
Zurück zum Zitat McMorris T, Barwood M, Hale BJ, Dicks M, Corbett J. Corrigendum to “Cognitive fatigue effects on physical performance: a systematic review and meta-analysis”. Physiol Behav. 2019;198:158 (Physiol Behav 2018; 188:103–107).PubMed McMorris T, Barwood M, Hale BJ, Dicks M, Corbett J. Corrigendum to “Cognitive fatigue effects on physical performance: a systematic review and meta-analysis”. Physiol Behav. 2019;198:158 (Physiol Behav 2018; 188:103–107).PubMed
5.
Zurück zum Zitat Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates; 1988.
6.
Zurück zum Zitat Brown DMY, Graham JD, Innes KI, Harris S, Flemington A, Bray SR. Cognitive exertion and physical performance: a systematic review and meta-analysis. Sports Med. 2020;50:497–529.PubMed Brown DMY, Graham JD, Innes KI, Harris S, Flemington A, Bray SR. Cognitive exertion and physical performance: a systematic review and meta-analysis. Sports Med. 2020;50:497–529.PubMed
7.
Zurück zum Zitat Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3:655–66.PubMed Craig AD. How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci. 2002;3:655–66.PubMed
8.
Zurück zum Zitat Gailliot MT, Baumeister RF, DeWall CN, Maner JK, Plant EA, Tice DM, et al. Self-control relies on glucose as a limited energy source: willpower is more than a metaphor. J Pers Soc Psychol. 2007;92:325–36.PubMed Gailliot MT, Baumeister RF, DeWall CN, Maner JK, Plant EA, Tice DM, et al. Self-control relies on glucose as a limited energy source: willpower is more than a metaphor. J Pers Soc Psychol. 2007;92:325–36.PubMed
9.
Zurück zum Zitat Zijlstra FRH. Efficiency in work behavior: a design approach for modern tools. Delft: Delft University Press; 1993. Zijlstra FRH. Efficiency in work behavior: a design approach for modern tools. Delft: Delft University Press; 1993.
12.
Zurück zum Zitat Martin K, Meeusen R, Thompson KG, Keegan R, Rattray B. Mental fatigue impairs endurance performance: a physiological explanation. Sports Med. 2018;48:2041–51.PubMed Martin K, Meeusen R, Thompson KG, Keegan R, Rattray B. Mental fatigue impairs endurance performance: a physiological explanation. Sports Med. 2018;48:2041–51.PubMed
13.
Zurück zum Zitat Raichle ME. Behind the scenes of functional brain imaging: a historical and physiological perspective. Proc Natl Acad Sci USA. 1998;95:765–72.PubMedPubMedCentral Raichle ME. Behind the scenes of functional brain imaging: a historical and physiological perspective. Proc Natl Acad Sci USA. 1998;95:765–72.PubMedPubMedCentral
14.
Zurück zum Zitat Raichle ME. The neural correlates of consciousness: an analysis of cognitive skill learning. Phil Trans R Soc Lond B. 1998;353:1889–901. Raichle ME. The neural correlates of consciousness: an analysis of cognitive skill learning. Phil Trans R Soc Lond B. 1998;353:1889–901.
15.
16.
Zurück zum Zitat Buckner RL, Andrews-Hanna JR, Schacter DL. The brain's default network: anatomy, function, and relevance to disease. Ann NY Acad Sci. 2008;2008(1124):1–38. Buckner RL, Andrews-Hanna JR, Schacter DL. The brain's default network: anatomy, function, and relevance to disease. Ann NY Acad Sci. 2008;2008(1124):1–38.
17.
Zurück zum Zitat McKenna MC, Dienel GA, Sonnewald U, Waagepetersen HS, Schousboe A. Energy metabolism of the brain. In: Brady ST, Siegel GJ, Albers RW, Proce DL, editors. Basic neurochemistry. New York: Academic; 2012. p. 200–231. McKenna MC, Dienel GA, Sonnewald U, Waagepetersen HS, Schousboe A. Energy metabolism of the brain. In: Brady ST, Siegel GJ, Albers RW, Proce DL, editors. Basic neurochemistry. New York: Academic; 2012. p. 200–231.
18.
Zurück zum Zitat Arnsten AFT. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009;10:410–22.PubMedPubMedCentral Arnsten AFT. Stress signalling pathways that impair prefrontal cortex structure and function. Nat Rev Neurosci. 2009;10:410–22.PubMedPubMedCentral
19.
Zurück zum Zitat Matsumoto M, Hikosaka O. Two types of dopamine neuron distinctly convey positive and negative motivational signals. Nature. 2009;459:837–41.PubMedPubMedCentral Matsumoto M, Hikosaka O. Two types of dopamine neuron distinctly convey positive and negative motivational signals. Nature. 2009;459:837–41.PubMedPubMedCentral
20.
Zurück zum Zitat Gnegy ME. Catecholamines. In: Brady ST, Siegel GJ, Albers RW, Proce DL, editors. Basic neurochemistry. New York: Academic; 2012. p. 283–299. Gnegy ME. Catecholamines. In: Brady ST, Siegel GJ, Albers RW, Proce DL, editors. Basic neurochemistry. New York: Academic; 2012. p. 283–299.
21.
Zurück zum Zitat Hawkins RA, O’Kane RL, Simpson IA, Viña JR. Structure of the blood-brain barrier and its role in the transport of amino acids. J Nutr. 2006;136:218S–S226226.PubMed Hawkins RA, O’Kane RL, Simpson IA, Viña JR. Structure of the blood-brain barrier and its role in the transport of amino acids. J Nutr. 2006;136:218S–S226226.PubMed
22.
Zurück zum Zitat Fernstrom JD, Fernstrom MH. Tyrosine, phenylalanine, and catecholamine synthesis and function on the brain. J Nutr. 1539S;137:1539S–S15471547.PubMed Fernstrom JD, Fernstrom MH. Tyrosine, phenylalanine, and catecholamine synthesis and function on the brain. J Nutr. 1539S;137:1539S–S15471547.PubMed
25.
Zurück zum Zitat Pageaux B, Lepers R, Dietz KC, Marcora SM. Response inhibition impairs subsequent self-paced endurance performance. Eur J Appl Physiol. 2014;114:1095–105.PubMed Pageaux B, Lepers R, Dietz KC, Marcora SM. Response inhibition impairs subsequent self-paced endurance performance. Eur J Appl Physiol. 2014;114:1095–105.PubMed
28.
Zurück zum Zitat Grace AG. Dysregulation of the dopamine system in the pathophysiology of depression and schizophrenia. Nat Rev Neurosci. 2016;17:524–32.PubMedPubMedCentral Grace AG. Dysregulation of the dopamine system in the pathophysiology of depression and schizophrenia. Nat Rev Neurosci. 2016;17:524–32.PubMedPubMedCentral
29.
Zurück zum Zitat Haydon PG. Purinergic signaling. In: Brady ST, Siegel GJ, Albers RW, Proce DL, editors. Basic neurochemistry. New York: Academic; 2012. p. 377–389. Haydon PG. Purinergic signaling. In: Brady ST, Siegel GJ, Albers RW, Proce DL, editors. Basic neurochemistry. New York: Academic; 2012. p. 377–389.
30.
Zurück zum Zitat Porkka-Heiskanen T, Alanko L, Kalinchuk A, Stenberg D. Adenosine and sleep. Sleep Med Rev. 2002;6:321–32.PubMed Porkka-Heiskanen T, Alanko L, Kalinchuk A, Stenberg D. Adenosine and sleep. Sleep Med Rev. 2002;6:321–32.PubMed
31.
Zurück zum Zitat Lovatt D, Xu Q, Liu W, Takano T, Smith NA, Schermann J, Tieu K, Nedergaard M. Neuronal adenosine release, and not astrocytic ATP release, mediates feedback inhibition of excitatory activity. Proc Natl Acad Sci USA. 2012;109:6265–70.PubMedPubMedCentral Lovatt D, Xu Q, Liu W, Takano T, Smith NA, Schermann J, Tieu K, Nedergaard M. Neuronal adenosine release, and not astrocytic ATP release, mediates feedback inhibition of excitatory activity. Proc Natl Acad Sci USA. 2012;109:6265–70.PubMedPubMedCentral
32.
Zurück zum Zitat Grieder TE, George O, Tan H, George SR, Le Foll B, Laviolette SR, van der Kooy D. Phasic D1 and tonic D2 dopamine receptor signaling double dissociate the motivational effects of acute nicotine and chronic nicotine withdrawal. Proc Natl Acad Sci USA. 2012;109:3101–6.PubMedPubMedCentral Grieder TE, George O, Tan H, George SR, Le Foll B, Laviolette SR, van der Kooy D. Phasic D1 and tonic D2 dopamine receptor signaling double dissociate the motivational effects of acute nicotine and chronic nicotine withdrawal. Proc Natl Acad Sci USA. 2012;109:3101–6.PubMedPubMedCentral
33.
Zurück zum Zitat Ross AE, Venton BJ. Adenosine transiently modulates stimulated dopamine release in the caudate-putamen via A1 receptors. J Neurochem. 2015;132:51–60.PubMed Ross AE, Venton BJ. Adenosine transiently modulates stimulated dopamine release in the caudate-putamen via A1 receptors. J Neurochem. 2015;132:51–60.PubMed
34.
Zurück zum Zitat Cechova S, Venton BJ. Transient adenosine efflux in the rat caudate–putamen. J Neurochem. 2008;105:1253–63.PubMed Cechova S, Venton BJ. Transient adenosine efflux in the rat caudate–putamen. J Neurochem. 2008;105:1253–63.PubMed
36.
Zurück zum Zitat McLellan TM, Caldwell JA, Lieberman HR. A review of caffeine;s effect on cognitive, physical and occupational performance. Neurosci Biobehav Rev. 2016;71:294–312.PubMed McLellan TM, Caldwell JA, Lieberman HR. A review of caffeine;s effect on cognitive, physical and occupational performance. Neurosci Biobehav Rev. 2016;71:294–312.PubMed
37.
Zurück zum Zitat Boat R, Cooper SB. Self-control and exercise: a review of the bi-directional relationship. Brain Plast. 2019;6:97–104. Boat R, Cooper SB. Self-control and exercise: a review of the bi-directional relationship. Brain Plast. 2019;6:97–104.
38.
Zurück zum Zitat Meeusen R, Roelands B, Spriet LL. Caffeine, exercise and the brain. In: van Loon LJC, Meeusen R, editors. Nestlé Nutr Inst Workshop Ser, vol. 76. Basel: Vevey/S.Karger; 2013. p. 1–12. Meeusen R, Roelands B, Spriet LL. Caffeine, exercise and the brain. In: van Loon LJC, Meeusen R, editors. Nestlé Nutr Inst Workshop Ser, vol. 76. Basel: Vevey/S.Karger; 2013. p. 1–12.
39.
Zurück zum Zitat McMorris T, Barwood M, Corbett J. Central fatigue theory and endurance exercise: toward an interoceptive model. Neurosci Biobehav Rev. 2018;93:193–7. McMorris T, Barwood M, Corbett J. Central fatigue theory and endurance exercise: toward an interoceptive model. Neurosci Biobehav Rev. 2018;93:193–7.
40.
Zurück zum Zitat Craig AD. Distribution of trigeminothalamic and spinothalamic lamina I terminations in the macaque monkey. J Comp Neurol. 2004;477:119–48.PubMed Craig AD. Distribution of trigeminothalamic and spinothalamic lamina I terminations in the macaque monkey. J Comp Neurol. 2004;477:119–48.PubMed
41.
Zurück zum Zitat Gu X, Hof PR, Friston KJ, Fan J. Anterior insular cortex and emotional awareness. J Comp Neurol. 2013;2013(521):3371–88. Gu X, Hof PR, Friston KJ, Fan J. Anterior insular cortex and emotional awareness. J Comp Neurol. 2013;2013(521):3371–88.
42.
Zurück zum Zitat Singer T, Critchley HD, Preuschoff K. A common role of insula in feelings, empathy and uncertainty. Trends Cogn Sci. 2009;13:334–40.PubMed Singer T, Critchley HD, Preuschoff K. A common role of insula in feelings, empathy and uncertainty. Trends Cogn Sci. 2009;13:334–40.PubMed
43.
Zurück zum Zitat Schoenbaum G, Roesch MR, Stalnaker TA, Takahashi YK. A new perspective on the role of the orbitofrontal cortex in adaptive behaviour. Nat Rev Neurosci. 2009;10:885–92.PubMedPubMedCentral Schoenbaum G, Roesch MR, Stalnaker TA, Takahashi YK. A new perspective on the role of the orbitofrontal cortex in adaptive behaviour. Nat Rev Neurosci. 2009;10:885–92.PubMedPubMedCentral
44.
Zurück zum Zitat Cole MW, Reynolds JR, Power JD, Repovs G, Anticevic A, Braver TS. Multi-task connectivity reveals flexible hubs for adaptive task control. Nat Neurosci. 2013;16:1348–55.PubMedPubMedCentral Cole MW, Reynolds JR, Power JD, Repovs G, Anticevic A, Braver TS. Multi-task connectivity reveals flexible hubs for adaptive task control. Nat Neurosci. 2013;16:1348–55.PubMedPubMedCentral
45.
Zurück zum Zitat Koechlin E, Hyafil A. Anterior prefrontal function and the limits of human decision-making. Science. 2007;318:594–8.PubMed Koechlin E, Hyafil A. Anterior prefrontal function and the limits of human decision-making. Science. 2007;318:594–8.PubMed
46.
Zurück zum Zitat Bromberg-Martin ES, Matsumoto O, Hikosaka K. Coding of task reward value in the dorsal raphe nucleus. J Neurosci. 2010;30:6262–72.PubMedPubMedCentral Bromberg-Martin ES, Matsumoto O, Hikosaka K. Coding of task reward value in the dorsal raphe nucleus. J Neurosci. 2010;30:6262–72.PubMedPubMedCentral
47.
Zurück zum Zitat Rinaman L. Hindbrain noradrenergic A2 neurons: diverse roles in autonomic, endocrine, cognitive, and behavioral functions. Am J Physiol Regul Integr Comp Physiol. 2011;300:R222–R23535.PubMed Rinaman L. Hindbrain noradrenergic A2 neurons: diverse roles in autonomic, endocrine, cognitive, and behavioral functions. Am J Physiol Regul Integr Comp Physiol. 2011;300:R222–R23535.PubMed
48.
Zurück zum Zitat Ohiwa N, Saito T, Chang H, Omoria T, Fujikawa T, Asada T, Soya H. Activation of A1 and A2 noradrenergic neurons in response to running in the rat. Neurosci Lett. 2006;395:46–50.PubMed Ohiwa N, Saito T, Chang H, Omoria T, Fujikawa T, Asada T, Soya H. Activation of A1 and A2 noradrenergic neurons in response to running in the rat. Neurosci Lett. 2006;395:46–50.PubMed
49.
Zurück zum Zitat Soya H, Mukai A, Deocaris CC, Ohiwa N, Chang H, Nishijima T, et al. Threshold-like pattern of neuronal activation in the hypothalamus during treadmill running: Establishment of a minimum running stress (MRS) rat model. Neurosci Res. 2007;58:341–8.PubMed Soya H, Mukai A, Deocaris CC, Ohiwa N, Chang H, Nishijima T, et al. Threshold-like pattern of neuronal activation in the hypothalamus during treadmill running: Establishment of a minimum running stress (MRS) rat model. Neurosci Res. 2007;58:341–8.PubMed
50.
Zurück zum Zitat Grenhoff J, Nisell M, Ferré S, Aston-Jones G, Svensson TH. Noradrenergic modulation of dopamine cell firing elicited by stimulation of the locus coeruleus in the rat. J Neural Transm Gen. 1993;93:11–25. Grenhoff J, Nisell M, Ferré S, Aston-Jones G, Svensson TH. Noradrenergic modulation of dopamine cell firing elicited by stimulation of the locus coeruleus in the rat. J Neural Transm Gen. 1993;93:11–25.
51.
Zurück zum Zitat Grenhoff J, Svensson TH. Prazosin modulates the firing pattern of dopamine neurons in rat ventral tegmental area. Eur J Pharmacol. 1993;233:79–84.PubMed Grenhoff J, Svensson TH. Prazosin modulates the firing pattern of dopamine neurons in rat ventral tegmental area. Eur J Pharmacol. 1993;233:79–84.PubMed
52.
Zurück zum Zitat Grace AA, Bunney BS. Intracellular and extracellular electrophysiology of nigral dopaminergic neurons–1 Identification and characterization. Neuroscience. 1983;10:301–15.PubMed Grace AA, Bunney BS. Intracellular and extracellular electrophysiology of nigral dopaminergic neurons–1 Identification and characterization. Neuroscience. 1983;10:301–15.PubMed
53.
Zurück zum Zitat Schulz W. Predictive reward signal of dopamine neurons. J Neurophysiol. 1998;80:1–27. Schulz W. Predictive reward signal of dopamine neurons. J Neurophysiol. 1998;80:1–27.
54.
Zurück zum Zitat Aston-Jones G, Cohen JD. An integrative theory of locus coeruleus-norepinephrine function: adaptive gain and optimal performance. Annu Rev Neurosci. 2005;28:403–50.PubMed Aston-Jones G, Cohen JD. An integrative theory of locus coeruleus-norepinephrine function: adaptive gain and optimal performance. Annu Rev Neurosci. 2005;28:403–50.PubMed
55.
Zurück zum Zitat Ettenhofer ML, Hambrick DZ, Abeles N. Reliability and stability of executive functioning in older adults. Neuropsychol. 2006;20:607–13. Ettenhofer ML, Hambrick DZ, Abeles N. Reliability and stability of executive functioning in older adults. Neuropsychol. 2006;20:607–13.
57.
Zurück zum Zitat Brown DMY, Bray SR. Effects of mental fatigue on physical endurance performance and muscle activation are attenuated by monetary incentives. J Sport Exerc Psychol. 2017;39:385–96.PubMed Brown DMY, Bray SR. Effects of mental fatigue on physical endurance performance and muscle activation are attenuated by monetary incentives. J Sport Exerc Psychol. 2017;39:385–96.PubMed
58.
Zurück zum Zitat Müller T, Apps MAJ. Motivational fatigue: a neurocognitive framework form the impact of effortful exertion on subsequent motivation. Neuropsychologia. 2019;123:141–51.PubMed Müller T, Apps MAJ. Motivational fatigue: a neurocognitive framework form the impact of effortful exertion on subsequent motivation. Neuropsychologia. 2019;123:141–51.PubMed
59.
Zurück zum Zitat Marcora SM, Staiano W, Manning V. Mental fatigue impairs physical performance in humans. J Appl Physiol. 2009;106:857–64.PubMed Marcora SM, Staiano W, Manning V. Mental fatigue impairs physical performance in humans. J Appl Physiol. 2009;106:857–64.PubMed
61.
Zurück zum Zitat Wascher E, Rasch B, Sänger J, Hoffmann S, Schneider D, Rinkenauer G, Heuer H, Gutberlet I. Frontal theta activity reflects distinct aspects of mental fatigue. Biol Psychol. 2014;96:57–655.PubMed Wascher E, Rasch B, Sänger J, Hoffmann S, Schneider D, Rinkenauer G, Heuer H, Gutberlet I. Frontal theta activity reflects distinct aspects of mental fatigue. Biol Psychol. 2014;96:57–655.PubMed
Metadaten
Titel
Cognitive Fatigue Effects on Physical Performance: The Role of Interoception
verfasst von
Terry McMorris
Publikationsdatum
14.07.2020
Verlag
Springer International Publishing
Erschienen in
Sports Medicine / Ausgabe 10/2020
Print ISSN: 0112-1642
Elektronische ISSN: 1179-2035
DOI
https://doi.org/10.1007/s40279-020-01320-w

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