“It is exercise alone that supports the spirits, and keeps the mind in vigor.” The great Roman statesman and orator Cicero (106 BC-43 BC) uttered these timeless words over two millennia ago, words that remain relevant today for anesthesiologists concerned about our older patients' brain health following anesthesia and surgery. Today, modern biology can explain the molecular and cellular mechanisms by which physical exercise benefits the brain – increases in trophic factors that support neuronal health, the birth of new neurons (i.e., neurogenesis), altered connectivity within specific brain networks, etc. Further, we now know that physical exercise provides highly specific mental benefits such as reduction in anxiety, depression, and stress and prevention of age-related memory loss. Partly for these reasons, in addition to the well-known benefits of physical exercise on cardiovascular health, current guidelines call for older adults to...

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