Build Strength Protect Your Brain
An evidence-based coaching program to help prevent, slow, and mitigate cognitive decline — integrating neuroscience, lifestyle medicine, and cutting-edge research into one personalized plan.
Founded by Johns Hopkins-trained exercise physiologist and cognitive neuroscientist Dr. Alfonso Alfini, PhD, MS, CSCS
Dementia Is a Global Crisis — But Its Not Inevitable.
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, slow, and mitigate cognitive decline.
The number of people living with dementia is expected
to triple by 2050.
The Future of Brain Health Starts with Muscle
E4 STRENGTH
E4 STRENGTH is the first muscle-driven brain health program, turning cutting edge neuroscience into a structured, personalized plan to help prevent, slow, and mitigate cognitive decline.
Your brain and body are connected — and your muscle strength is one of the most powerful predictors of long-term cognitive resilience. E4 STRENGTH integrates exercise, sleep, nutrition, and connection into a precision lifestyle framework designed to maximize both performance and protection.
E4 STRENGTH
EXERCISE ● SLEEP ● NUTRITION ● CONNECTION
The Four Pillars of Cognitive Resilience
Exercise
Build and maintain muscle strength, power, and endurance through personalized resistance and aerobic training. Optimizing muscle quality protects brain health, improves metabolism, and slows cognitive decline.
Sleep
Improve memory, focus, and recovery by optimizing sleep quality and circadian alignment. Restorative sleep clears brain toxins, consolidates memory, and stabilizes metabolic and hormonal balance.
Nutrition
Fuel your brain and body with a MIND-inspired approach, targeted protein, hydration, and evidence-based supplementation. The goal is to optimize metabolic health and reduce inflammation to support long-term cognitive resilience.
Connection
Stay mentally sharp and socially engaged while proactively monitoring key brain and body health factors. Cognitive training, meaningful relationships, and medical engagement strengthen cognitive reserve and reduce dementia risk.
The E4 STRENGTH framework is built on four scientifically validated pillars that support muscle-driven brain health and protect long-term cognitive performance.
PROPRIETARY FRAMEWORK
The S.T.R.E.N.G.T.H.™ Method
| Exercise | Sleep | Nutrition | Connection |
Why E4 STRENGTH
I founded E4 STRENGTH because I believe building muscle health is one of the most powerful ways to protect your brain as you age. 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 shape brain health — work rooted in my PhD in exercise physiology and cognitive neuroscience. My research and leadership roles at Johns Hopkins and the NIH gave me deep insight into the science of performance and resilience.
Before my scientific career, I was a teacher, coach, and NCAA athlete. Those experiences taught me that 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.”
- 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
View list
- Mechanisms, Implications, and Applications of Sleep and Circadian Rhythms in Cardiovascular Resilience: Developing a Roadmap. 2024 (In Press). Nature Reviews Cardiology
- Integrating Sleep Health into Resilience Research. 2023. Stress & Health
- Cardiorespiratory Fitness as a Moderator of Sleep-Related Associations with Hippocampal Volume and Cognition. 2022. Brain Sciences
- Associations of Actigraphic Sleep and Circadian Rest/Activity Rhythms with Cognition in the Early Phase of Alzheimer’s Disease. 2021. Sleep Advances
- Resting Cerebral Blood Flow After Exercise Training in Mild Cognitive Impairment. 2019. Journal of Alzheimer’s Disease
View links
- Psychology Today: 30 Minutes of Aerobic Exercise Supercharges Semantic Memory (2019)
- New York Times: How Exercise Affects Our Memory (2019)
- Science Daily: Exercise Benefits Brains, Changes Blood Flow in Older Adults, Study Finds (2019)
- New York Times: Brain Benefits of Exercise Diminish After Short Rest (2016)
- Men’s Health: 4 Ways Your Brain Suffers When You Stop Working Out (2016)
Grounded in Science
Evidence-based habits that preserve brain structure and improve functional efficiency—translated into your muscle-driven plan.
“Up to ~40–45% of dementia cases may be preventable by addressing modifiable risks.” — Lancet Commission
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Brain Volume & Thickness
Aerobic training and a Mediterranean/MIND-style diet are linked with larger hippocampal and cortical volumes in aging.
References
- Erickson, K. I., Voss, M. W., Prakash, R. S., et al. (2011). Exercise training increases size of hippocampus and improves memory. PNAS, 108(7), 3017–3022. doi:10.1073/pnas.1015950108
- 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. doi:10.1212/WNL.0000000000002121
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White Matter Integrity
Resistance training can slow white-matter lesion progression, and Mediterranean-pattern nutrients relate to healthier WM microstructure.
References
- Bolandzadeh, N., Tam, R., Handy, T. C., et al. (2015). Resistance training and white matter lesion progression in older women: A 12-month RCT. J Am Geriatr Soc, 63(10), 2052–2060. doi:10.1111/jgs.13644
- Gu, Y., Zang, C., Tierney, M. C., et al. (2016). White matter integrity mediates links between dietary nutrients and cognition in the elderly. Ann Neurol, 79(6), 1014–1025. doi:10.1002/ana.24674
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Cerebral Blood Flow
A single bout of moderate aerobic exercise increases hippocampal blood flow, whereas sleep loss reduces regional cerebral perfusion.
References
- Palmer, J. A., Morris, J. K., Billinger, S. A., et al. (2023). Hippocampal blood flow rapidly increases after moderate-intensity exercise in older adults. Cereb Cortex, 33(9), 5297–5306. PMC
- Zhou, F., Huang, M., Gu, L., et al. (2019). Regional cerebral hypoperfusion after acute sleep deprivation: ASL-fMRI study. Medicine (Baltimore), 98(2), e14008. doi:10.1097/MD.0000000000014008
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Functional Connectivity
Sleep deprivation weakens default-mode connectivity, while richer social networks relate to stronger resting-state FC.
References
- De Havas, J. A., Parimal, S., Soon, C. S., & Chee, M. W. L. (2012). Sleep deprivation reduces DMN connectivity and anti-correlation. NeuroImage, 59(2), 1745–1751. doi:10.1016/j.neuroimage.2011.08.026
- Pillemer, S., Holtzer, R., & Blumen, H. M. (2017). Functional connectivity associated with social networks in older adults. Social Neuroscience, 12(3), 242–252. PMC
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Neural Efficiency
Cognitive training and resistance training can reduce the activation needed for equal or better performance—i.e., more efficient processing.
References
- Heinzel, S., Lorenz, R. C., Duong, Q. L., et al. (2016). Neural correlates of training and transfer in working memory (older adults). NeuroImage, 134, 236–249. doi:10.1016/j/neuroimage.2016.03.068
- 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: 12-month RCT. Neurobiol Aging, 33(8), 1690–1698. PubMed
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Amyloid-Beta & Tau Pathology
Better circadian alignment of rest-activity predicts lower future amyloid burden, while loneliness/social isolation relates to higher cortical amyloid.
References
- Ho, P. T. N., Neitzel, J., et al. (2024). Sleep, 24-hour activity rhythms, and subsequent amyloid-β pathology. JAMA Neurology. Article | PMC
- Donovan, N. J., Okereke, O. I., Vannini, P., et al. (2016). Higher cortical amyloid burden associated with loneliness in cognitively normal older adults. JAMA Psychiatry, 73(12), 1230–1237. PDF
E4 Strength operationalizes this research across four pillars—Exercise, Nutrition, Sleep, and Connection—with a personalized, muscle-driven plan.
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Prevention potential
≈40–45%
of dementia cases may be preventable by addressing modifiable risk factors (midlife action matters).
References
- The Lancet Commission on Dementia (overview). Commission page
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Nutrition (MIND)
Up to 53% ↓ risk
Higher MIND diet adherence is associated with lower Alzheimer’s incidence in prospective cohorts.
References
- Morris, M. C., et al. (2015). MIND diet and AD incidence. Alzheimer’s & Dementia. Article
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Muscle strength
Grip → risk
Lower handgrip strength is associated with higher dementia incidence in large cohort data (e.g., UK Biobank).
References
- Alzheimer’s Research & Therapy (UK Biobank analysis). Article
What’s Included
A Precision, Muscle-Driven Coaching Experience Delivered in Three Clear Steps.
Assess
Precision Baseline & Risk Analysis
Establish the data that drives your plan.
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Personalize
Tailored Coaching Across Four Pillars
A plan matched to your biology and lifestyle.
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Transform
Build Strength, Protect Your Brain
Convert habits into measurable outcomes.
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Your Brain’s Future Starts Today
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