Build Strength. Protect Your Brain.

An evidence-based coaching program to help prevent and slow cognitive decline — integrating neuroscience, lifestyle medicine, and cutting-edge research into one personalized plan

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Research coverage only — not an endorsement of E4 STRENGTH.
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Founded by Johns Hopkins-trained exercise physiologist and cognitive neuroscientist Dr. Alfonso Alfini, PhD, MS, CSCS

Dementia Is a Global Crisis - But Not an Inevitable One.

Every 3 seconds someone develops dementia - yet up to 45% of cases may be preventable.

Science shows that by addressing 14 key risk factors, we can prevent and slow cognitive decline.

Lifestyle choices—especially around muscle health and daily rhythms—can dramatically shift risk.

E4 STRENGTH gives you practical, science-backed tools to protect your brain and body.

See The 14 Key Risk Factors (Lancet 2024)
  1. Less education
  2. Hearing loss
  3. Vision loss
  4. Hypertension
  5. High LDL cholesterol
  6. Obesity
  7. Physical inactivity
  8. Diabetes
  9. Depression
  10. Smoking
  11. Excess alcohol
  12. Air pollution
  13. Traumatic brain injury (TBI)
  14. Social isolation

Reference: Livingston, G., Huntley, J., Liu, K. Y., et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet Standing Commission. Lancet, 404(10452), 572–628. PubMed

The number of people living with dementia is expected to nearly triple by 2050.

E4 STRENGTH

Skeletal muscle is increasingly recognized as a powerful organ for brain health. Beyond movement, contracting muscle releases signaling molecules—known as myokines—that modulate inflammation and metabolism and stimulate factors like BDNF that support learning and memory. This muscle–brain connection helps explain why maintaining strength is linked with slower cognitive decline and reduced dementia risk.

Sleep and nutrition amplify these benefits. The body’s circadian rhythms, which are partly regulated by skeletal muscle, play a critical role in brain recovery and cognitive performance. At the same time, adequate protein and balanced nutrition provide the raw materials for muscle repair and function, sustaining the flow of protective signals. Together, muscle quality, restorative sleep, and proper nutrition form a foundation for resilience against dementia.

Staying active also supports social stimulation and cognitive engagement; when physical capacity declines, people often move less, reducing social and cognitive stimulation, and accelerating impairment.

  • Muscle → Brain Signals Exercise releases protective myokines that support learning and memory.
  • Strength Matters Maintaining muscle mass and strength is associated with lower dementia risk.
  • Sleep & Nutrition Amplify Circadian alignment and balanced, MIND-style energy sustain muscle’s brain-protective signaling.
  • Connection & Cognitive Engagement Remaining active helps maintain social stimulation and cognitive engagement—key buffers against decline.

At E4 STRENGTH, we operationalize this science across four pillars—Exercise, Sleep, Nutrition, and Connection.

Reference
  1. McNeish, B. L., Miljkovic, I., Liu-Ambrose, T., et al. (2025). Muscle–brain crosstalk as a driver of brain health in aging. Geroscience. Online ahead of print. PubMed
Midlife adult performing a kettlebell goblet squat; spherical signals flow from muscles toward a brain within a circadian ring.

The Future of Brain Health Begins with Muscle

The Four Pillars of Cognitive Resilience

Figure with cool mist background gradients

Exercise

Progressive resistance, aerobic, and mobility training—calibrated to your baseline.

Sleep

Consistent routines, light exposure, and timing to drive tissue repair and memory consolidation.

Nutrition

MIND-style, whole-food, balanced energy to build muscle and stabilize metabolism.

Connection

Cognitive training, mindfulness skills, and social support—anchored by regular health monitoring.

The E4 STRENGTH framework is built on four evidence-based pillars that support muscle-driven brain health and protect long-term cognitive performance.

A precision training system for neurocognitive resilience and longevity
E4 STRENGTH
Muscle-Driven Brain Health
S
Structured
Systematic
T
Targeted
Goal-Specific
R
Relevant
Person-Centered
E
Evidence-Based
Data-Backed
N
Numerical
Measurable
G
Growth-Driven
Progressive
T
Time-Locked
Circadian-Aligned
H
Habit-Forming
Sustainable
  • Exercise icon
  • Sleep icon
  • Nutrition icon
  • Connection icon

PROPRIETARY FRAMEWORK

The S.T.R.E.N.G.T.H.™ Method

Why E4 STRENGTH

Dr. Alfonso Alfini, Founder & Scientific Director at E4 Strength
Meet Dr. Alfonso Alfini
Founder & Scientific Director

I founded E4 STRENGTH because I believe building muscle health is one of the most powerful ways to protect your brain. My mission is to translate science into strength — helping people optimize cognitive function, enhance physical performance, and live longer, healthier lives.

For the past 20 years, I’ve studied how exercise, sleep, and daily rhythms impact brain health — work rooted in my PhD in exercise physiology and cognitive neuroscience. My experience at Johns Hopkins and the NIH helped shape my evidence-based approach to performance and resilience.

Before my scientific career, I was a teacher, coach, and NCAA athlete; a background that taught me the best science only matters if it can be applied in real life. At E4 STRENGTH, I combine high-level research with practical coaching to translate evidence into meaningful results for the people I work with.

“Targeting muscle with effective lifestyle strategies supports brain health and cognition across the lifespan.”
Academic & Professional Credentials
  • Program Director, Sleep Disorders Medicine — National Institutes of Health
  • Faculty, Neurology — Johns Hopkins School of Medicine
  • Postdoctoral Fellow, Aging & Dementia — Johns Hopkins School of Medicine
  • PhD, Exercise Physiology & Cognitive Neuroscience — University of Maryland
  • Predoctoral Fellow, Sleep & Circadian Science — University of British Columbia
  • MS, Strength & Conditioning — George Washington University
  • CSCS — National Strength & Conditioning Association
Select Publications
  1. Aggarwal, B., Gao, Y., Alfini, A., et al. (2025). Sleep and circadian rhythms in cardiovascular resilience: mechanisms, implications, and a roadmap for research and interventions. Nature Reviews Cardiology. Online ahead of print. PubMed
  2. Guida, J. L., Alfini, A. J., Lee, K. C., et al. (2023). Integrating sleep health into resilience research. Stress & Health, 39(S1), 22–27. PubMed
  3. Alfini, A. J., Won, J., Weiss, L. R., et al. (2022). Cardiorespiratory fitness as a moderator of sleep-related associations with hippocampal volume and cognition. Brain Sciences, 12(10), 1360. PubMed
  4. Alfini, A. J., Albert, M., Faria, A. V., et al. (2021). Associations of actigraphic sleep and circadian rest/activity rhythms with cognition in the early phase of Alzheimer’s disease. SLEEP Advances, 2(1), zpab007. PubMed
  5. Won, J., Alfini, A. J., Weiss, L. R., et al. (2019). Semantic memory activation after acute exercise in healthy older adults. Journal of the International Neuropsychological Society, 25(6), 557–568. PubMed
  6. Alfini, A. J., Weiss, L. R., Nielson, K. A., et al. (2019). Resting cerebral blood flow after exercise training in mild cognitive impairment. Journal of Alzheimer’s Disease, 67(2), 671–684. PubMed
Media Appearances
  1. The New York Times (2019). How Exercise Affects Our Memory. Link
  2. Psychology Today (2019). 30 Minutes of Aerobic Exercise Supercharges Semantic Memory. Link
  3. ScienceDaily (2019). Exercise Benefits Brains, Changes Blood Flow in Older Adults, Study Finds. Link
  4. The New York Times (2016). Brain Benefits of Exercise Diminish After Short Rest. Link
  5. Men’s Health (2016). 4 Ways Your Brain Suffers When You Stop Working Out. Link

Grounded in Science

Our approach is built on evidence-based habits shown to strengthen both brain structure and performance—woven into a personalized, muscle-driven plan.

These habits not only address the 14 dementia risk factors but also influence brain health directly.

  • Brain Volume & Thickness

    • Regular aerobic exercise increases hippocampal volume and improves memory.
    • Greater adherence to a MIND-like diet is linked with greater overall brain volume.
    References
    1. Erickson, K. I., Voss, M. W., Prakash, R. S., et al. (2011). Exercise training increases size of hippocampus and improves memory. Proceedings of the National Academy of Sciences, 108(7), 3017–3022. PubMed
    2. Gu, Y., Brickman, A. M., Stern, Y., et al. (2015). Mediterranean diet and brain structure in a multiethnic elderly cohort. Neurology, 85(20), 1744–1751. PubMed

  • White Matter Integrity

    • Regular resistance training reduces white-matter lesion progression.
    • Greater adherence to a MIND-like diet is tied to preserved white matter integrity and connectivity.
    References
    1. Bolandzadeh, N., Tam, R., Handy, T. C., et al. (2015). Resistance training and white matter lesion progression in older women: A 12-month randomized controlled trial. Journal of the American Geriatrics Society, 63(10), 2052–2060. PubMed
    2. Rodrigues, B., Coelho, A., Portugal-Nunes, C., et al. (2020). Higher adherence to the Mediterranean diet is associated with preserved white matter integrity and altered structural connectivity. Frontiers in Neuroscience, 14, 786. PubMed

  • Cerebral Blood Flow

    • Regular aerobic exercise increases frontal lobe blood flow and improves executive function.
    • A single night of sleep deprivation reduces prefrontal and parahippocampal blood flow.
    References
    1. Kleinloog, J. P. D., Mensink, R. P., Ivanov, D., et al. (2019). Aerobic exercise training improves cerebral blood flow and executive function: A randomized controlled cross-over trial in sedentary older men. Frontiers in Aging Neuroscience, 11, 333. PubMed
    2. Zhou, F., Huang, M., Gu, L., et al. (2019). Regional cerebral hypoperfusion after acute sleep deprivation: An ASL-fMRI study. Medicine, 98(2), e14008. PubMed

  • Functional Connectivity

    • Circadian misalignment is linked with lower default mode network connectivity and worse attention.
    • Greater social connections are associated with greater central executive network connectivity.
    References
    1. Facer-Childs, E. R., Campos, B. M., Middleton, B., Skene, D. J., & Bagshaw, A. P. (2019). Circadian phenotype impacts the brain’s resting-state functional connectivity, attentional performance, and sleepiness. Sleep, 42(5), zsz033. PubMed
    2. Pillemer, S., Holtzer, R., & Blumen, H. M. (2017). Functional connectivity associated with social networks in older adults. Social Neuroscience, 12(3), 242–252. PubMed

  • Neural Efficiency

    • Consistent cognitive training improves working memory while reducing neural activation.
    • Regular resistance training improves executive function and modulates the neural response.
    References
    1. Heinzel, S., Lorenz, R. C., Duong, Q. L., et al. (2016). Neural correlates of training and transfer in working memory in older adults. NeuroImage, 134, 236–249. PubMed
    2. Liu-Ambrose, T., Nagamatsu, L. S., Voss, M. W., Khan, K. M., & Handy, T. C. (2012). Resistance training and functional plasticity of the aging brain: A 12-month randomized controlled trial. Neurobiology of Aging, 33(8), 1690–1698. PubMed

  • Amyloid-β & Tau Pathology

    • Shorter sleep duration and worse quality sleep are linked with higher levels of cortical amyloid-β.
    • Greater loneliness is associated with greater hippocampal tau deposition.
    References
    1. Spira, A. P., Gamaldo, A. A., An, Y., et al. (2013). Self-reported sleep and β-amyloid deposition in community-dwelling older adults. JAMA Neurology, 70(12), 1537–1543. PubMed
    2. d’Oleire Uquillas, F., Jacobs, H. I. L., Biddle, K. D., et al. (2018). Regional tau pathology and loneliness in cognitively normal older adults. Translational Psychiatry, 8(1), 282. PubMed

E4 STRENGTH translates research into action through four pillars—Exercise, Nutrition, Sleep, and Connection.

  • Prevention potential

    ≈45% Avoidable

    Nearly half of all dementia cases may be preventable by addressing modifiable risk factors (midlife action matters).

    Reference
    1. Livingston, G., Huntley, J., Liu, K. Y., et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet, 404(10452), 572–628. PubMed

  • Muscle strength

    Brain Gains

    Greater muscle strength is linked to lower dementia risk, sharper cognition, and healthier brain structure.

    Reference
    1. Duchowny, K. A., Ackley, S. F., Brenowitz, W. D., et al. (2022). Associations between handgrip strength and dementia risk, cognition, and neuroimaging outcomes in the UK Biobank cohort study. JAMA Network Open, 5(6), e2218314. PubMed

  • Age-related muscle loss

    ≈2x Risk

    Losing muscle with age is associated with nearly double the dementia risk (preserving muscle protects the brain).

    Reference
    1. Ling, Y., Yuan, S., Huang, X., et al. (2024). Association between probable sarcopenia and dementia risk: A prospective cohort study with mediation analysis. Translational Psychiatry, 14(1), 398. PubMed

  • Multidomain intervention

    Proven Benefits

    Structured programs combining exercise, nutrition, and brain training improve global cognitive function.

    Reference
    1. Baker, L. D., Espeland, M. A., Whitmer, R. A., et al. (2025). Structured vs self-guided multidomain lifestyle interventions for global cognitive function: The US POINTER randomized clinical trial. JAMA, 334(8), 681–691. PubMed

What’s Included

A Precision, Muscle-Driven Coaching Experience in Three Steps.

1

Step 1

Assess

Establish current health profile.

Health Screening Recommendation & Review Fitness & Functional Testing Sleep & Circadian Assessments Nutrition Evaluation Learning & Memory Assessments
2

Step 2

Personalize

Implement strategies across pillars.

Regular Health Monitoring Progressive Exercise Plan Sleep & Circadian Hygiene Strategies MIND-Diet Principles & Macronutrient Plan Brain Training
3

Step 3

Re-Assess & Adapt

Measure change. Adapt the plan.

Repeat Baseline Testing Evaluate Progress Goal & Habit Review Barrier & Facilitator Review Plan Recalibration

Tiered programing options available to fit your unique needs and schedule.

Frequently Asked Questions

What is E4 Strength?

E4 is a precision, lifestyle program focused on four pillars—Exercise, Sleep, Nutrition, and Connection—to build muscle health that supports brain function and longevity.

Who is it for (and can my partner join)?

High-performing adults (often age 30+, but all are welcome), people proactive about brain health, and athletes/executives optimizing longevity and cognition. New to training is welcome, too. Yes—partners or family members can join; social support improves adherence and outcomes.

Is “E4” related to the APOE ε4 gene?

No. Here, E (ε) stands for precision; “4” refers to the four pillars. The program is lifestyle-based and not a genetics service.

How is the plan personalized—and how much time/equipment will I need?

We start with a review of health history and status, lifestyle-based assessments, and goals. Then we adjust training cycles, sleep timing, meal targets, and recovery to fit you. Most members do 3–5 sessions of 30–45 minutes plus simple daily habits. Bodyweight, dumbbells, or bands are enough; a gym is optional.

What assessments are included—and is this medical care?

We recommend health screenings and use that data (e.g., blood pressure trends, sleep/circadian, strength/mobility, cognition snapshots). They’re for coaching—not diagnosis. We don’t order labs or prescribe medications, but we can share a concise summary and coordinate with your clinician, and we’re happy to collaborate with your existing coach or physical therapist.

How does E4 Strength address the 14 dementia risk factors?

We map your baseline to the 14 modifiable factors, then build habits and training blocks that target the highest-impact areas for you (e.g., blood pressure, activity, sleep, nutrition, connection). You can see the full list in the “See The 14 Key Risk Factors” toggle above.

How is progress measured?

Clear checkpoints: strength & mobility milestones, aerobic capacity estimates, sleep monitoring, cognition training/assessments, body composition trends, adherence streaks, and periodic reviews of BP/LDL/A1c via your clinician.

Do you support wearables, shift work, or heavy travel?

Absolutely. We can work with the devices and apps you prefer (or none at all). We use sleep and circadian hygiene strategies, travel playbooks, and portable training plans to maintain progress on the road or across time zones.

Is nutrition “one size fits all”?

No. We anchor on MIND-style principles and tailor protein, calories, and macros to your goals, preferences, and cultural patterns—without rigid rules.

Is my data private?

Yes. We only collect what’s needed for coaching (training logs, brief screens, optional wearable data). You control what you share, and you can request deletion at any time. We don’t sell personal data.

What is the MIND diet—and how does it work?

MIND stands for Mediterranean–DASH Intervention for Neurodegenerative Delay. It blends the Mediterranean and DASH patterns to emphasize brain-supportive foods and limit items linked with worse vascular/metabolic health.

Emphasize: leafy greens and other vegetables, berries, nuts, olive oil, beans, whole grains, fish, and poultry. Limit: red/processed meats, butter/solid fats, pastries/sweets, fried/fast foods, and excess cheese.

Evidence in brief: Higher adherence to MIND is associated with slower cognitive decline and lower dementia risk in observational studies. Trial evidence is growing but still developing. We personalize these principles to your preferences, culture, and protein goals.

Note: If you have a medical condition (e.g., diabetes, kidney disease, food allergies), follow guidance from your clinician as we tailor your plan.

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