The Impact of Exercise on Cognitive Functioning

this ucsd-tv program is presented by university of california television like what you learn visit our website or follow us on Facebook and Twitter to keep up with the latest programs the Sam Andros Stein Institute for research on Aging is committed to advancing lifelong health and well-being through research professional training patient care and community service as a nonprofit organization at the University of California San Diego School of Medicine our research and educational outreach activities are made possible by the generosity of private donors it is our vision that successful aging will be an achievable goal for everyone to learn more please visit our website at aging UCSD edu hi everybody and welcome to the Stein Institute for Research on Aging's monthly public lecture so my name is Luz Pinto I am the events and marketing manager at the Stein Institute for Research on Aging as well as the Center for healthy aging so our group strives to advance health and well-being and we do this through research training and outreach and this here is an example of our outreach we've been doing these public lectures for I think it's almost 30 years and we do this because we want to update you our community on all the advances that are happening on research so today it's my privilege to introduce our speaker dr. Amy Jack so let me tell you a little bit about her dr. jack is a clinical neuropsychologist with extensive clinical and research related expertise with older adults normal cognitive aging mild cognitive impairment and dementia she is an associate professor of psychiatry at UC San Diego as well as a staff neuropsychologist and director of the TBI cognitive rehabilitation clinic at the VA San Diego healthcare system she is a fellow of the Society for clinical neuropsychology of the American Psychological Association and serves on the Editorial Board of the Journal of clinical and experimental neuropsychology she has conducted numerous research studies and has published over 60 research articles and these are peer reviewed articles in fact dr. jack is currently the principal investigator of a study investigating whether incorporating walking or a computer-based cognitive training can positively impact cognitive functioning in those with mild cognitive impairment so please join me in welcoming dr. Amy jack thank you thank you everyone for coming this evening as Luz mentioned I'm a clinical neuropsychologist so really what that means is that my focus and really what what I emphasize and what I do in my day-to-day work is look at people's cognitive functioning so memory attention problem solving those sorts of things and try to determine what's going on with it if it's not working so well what if anything can we do about it and of particular interest in the salient topic for this evening is of course things like behavioral interventions so exercise can that be useful in in promoting good cognitive functioning and restoring cognitive functioning if you've had any declines and that's really going to be the topic for this evening so just to lay some of the foundation about why we might care about these sorts of things maybe you already know which is why you're here but but we have an aging population as a whole so the percentage of Americans over the age of 65 has tripled more than tripled actually in the last century and even in addition to just the general aging of the population we have more kind of the oldest old group than we've really ever had before so about 70 thousand folks 100 or older right now and by 2015 that's expected to increase somewhere to over 800,000 so this is the you know this is sort of the the picture of what's coming and and the positive things have come out of how we're better able to treat illnesses and again keep folks living longer along with that though I think we'd also like to make sure that folks are also living well as they're living longer and one of the unfortunate than downsides of an aging population is that age is actually one of the largest risk factors for dementia and for Alzheimer's in particular and also MERS disease is the most common dementia so if you're in the folks in the age range of 65 state to 70 the prevalence of Alzheimer's disease is about one in a hundred but again if we think about that demographic I showed before as the population continues to get older and have a higher proportion in that oldest old group over 85 years the prevalence of Alzheimer's disease is somewhere between 20 and 50 percent and the prevalence does unfortunately continue to rise as as folks age so so it's going to get more positive I promise this is the this is the the unfortunate statistics right now but truly the concern that a lot of us doing this research have is that if these current trends continue with no other effective interventions or preventative treatments that by about 2050 this is the anticipation that 14 million older adults older Americans are expected to have Alzheimer's disease and this is what we're all interested in in trying to prevent and avoid so here's the kind of a schematic of very simplified schematic of the cognitive aging process so what we're we're really trying to intervene at this point or think about what can we do is if you follow that yellow line you can see that's really where we want everybody to stay you see that it there's a little drop-off it's kind of the end of the yellow line so there are some normal cognitive changes as people age but it's not terribly dramatic what we're really trying to avoid is kind of that blue path and certainly down into that red path and so one of the things that has been a huge focus of research certainly our medication trials or pharmacologic trials to find drugs that work to prevent or stall or delay the onset of Alzheimer's disease unfortunately they have not been as successful as we had hoped and so 99 percent of those really have not proven to be effective in the way that we wanted them to be so this is then the reason that a lot of a lot of folks are particularly turning their attention two other Behavioral Interventions still certainly looking for medications that will work that's not been abandoned but also putting some additional emphasis on other things beside medication trials and so one of those things certainly has been to look at exercise not to really I guess give away the the final ending of my talk but there really is quite strong evidence to support using exercise for lowering risk for cognitive decline and dementia and that's really what I'm going to talk about is give you some of the details about what we know and the evidence that supports that and why and why we think there's that there is this really strong research base to suggest that you should be exercising not only for your physical health but for your cognitive health so one of the places that really this all originated from was if we look at the animal literature and and people have quite widely so at a pretty basic level the idea was was such that if you use rodents and put put them in a sort of plain old cage with nothing much in there but their food and water versus put them in an enriched environment which is really giving them things to do something that would simulate maybe their natural everyday environment if they were still in the wild and lo and behold the animals that have these enriched environments do much better on tasks of learning in memory their neuronal growth is more robust and so that enriched environment that cognitively enriching environment was good for their cognition so along those same lines then different groups have looked at exercise particularly in in rodent populations and also found that if they're allowed to exercise in case you're wondering because I was wondering when I first started this research I was like really how do you get the mice to you know you put the wheel in there and how do you get him to run it's a natural behavior for them so they do it sort of spontaneously and I was also then thinking to myself how how nice it would be if if that was the case for humans so if we had you know you have that treadmill that's sitting in your garage that you hang laundry on and if we were also so motivated like the the mice were to actually be on the treadmill just sort of naturally but um so so but what we found was that if you allow the the mouse or the rat to have this access to the running wheel they will use it and those then that are allowed to exercise have way healthier hippocampus and in fact one of the more exciting things was not only that they have larger hippocampus which is the structure in the brain really important for memory but they actually have hippocampal neurogenesis once they start exercising so some some kind of generation of hippocampi hippocampal cells from the link to the exercise so that was particularly exciting and so that inspired a lot of different research groups to say wow we have really solid evidence from the animal literature let's see what this looks like in humans and so I have a summary multiple summaries to try to give you kind of the the gamut so we have as a starting point a lot of epidemiological research so large population-based studies which you get a lot of information about people's history and then try to make some connections between the things they've endorsed that they did over their lifetime to how they're functioning now which is how we understand some of the information that I put up here so people that endorse being particularly physically active when they were young or in their middle adulthood actually go on to have a lower risk of cognitive impairment as older adults and multiple studies have shown that if you move into midlife say you weren't much of a sporty person when you were young but you were doing more physical activity at midlife this also is associated with a decreased risk of dementia or cognitive decline later in life so in general this regular physical activity can reduce the risk or delay the onset of dementia and why this is important so again the take-home message won't really be that exercise will completely prevent dementia in every single person but that it does reduce risk levels rather substantially and in those that might go on to develop dementia that onset for those that have exercised is often delayed and that delay can really be huge for quality of life for financial reasons to the system of care things like that exercise actually has also been shown to be particularly valuable for anybody that is at genetic risk for cognitive decline so there are some some genetic factors that place people at higher risk for cognitive decline and if you have one of those factors in our an exerciser it seems to help modulate that risk level a little bit moderate exercise done either in mid or now getting into later life also has reduced the likelihood of mild cognitive impairment so if you think back to that schematic where we had the yellow kind of normal cognitive aging line and then that blue line that was starting to have some cognitive decline that's that's that area of mild cognitive impairment so that's a space where we wouldn't yet consider somebody to have dementia or Alzheimer's disease the impairment is not significant enough but again their cognition is not what we'd expect for normal aging it's kind of in that border zone and it's a risk factor for future cognitive decline and so again moderate exercise either in mid or late life then seems to reduce the risk for kind of traveling down that blue path and staying more on the yellow path so for any of you out there thinking okay well it didn't really exercise much as a youngster and I didn't do that great about exercising when I was in middle age so you know is there any is there any hope for me and I would say certainly there is much hope that a lot of the evidence also then supports that it's really never too late to begin some sort of physical activity program so starting later in life there was some evidence that at least four hours of exercise per week and still protect against cognitive impairment even in that oldest old group and particularly in females kind of if you take all of this put together that exercise seems to result in about a 20% reduction in risk for future cognitive impairment or the equivalent of taking about three years off of your age so again there's there's quite good evidence to support the benefits of exercise again not just only your physical self but but for your cognitive health as well so so I often have questions as well about so this is nice as a potential preventive strategy but what about for anybody who has already progressed to a place with cognitive impairment or with Alzheimer's disease what does exercise do at that point and I will say that it's probably that the evidence is not quite as optimistic once somebody's progressed to Alzheimer's disease as it is is a preventive strategy but there are some benefits to continued physical activity even if somebody has has declined to the point of dementia so it increases sort of physical health and increases survival rates but doesn't tend to change cognitive functioning or rates of functional decline which is unfortunate because I know that's that's been sort of what what we've all been hoping that it would do physical activity with with folks with Alzheimer's disease can improve things though like their nutritional status the MMSE is a mini Mental Status exam so kind of a quick cognitive screen they may get a little bit of bump in that score again not maybe enough to truly have a significant increase in their cognition but some some kind of bumps in that in some of the basic questions that we might ask somebody reduce things like fall risks and improve some behavioral problems or some psychiatric problems that can also emerge in Alzheimer's disease so those are some benefits a much more recent study took kind of another look and really engaged in a small trial people in much more moderate to significant kind of high intensity physical activity that also had Alzheimer's disease now again they didn't find that there were dramatic cognitive improvements as a whole but what they did find was that there was again some improvement in psychiatric and behavioral symptoms for the group that was exercising but if they kind of drilled down and looked at the people who were particularly adherent to the program we're really coming three times a week and this was all monitored and supervised of course but that they were really coming they were really kind of working to the level of intensity that was being requested of them that that subgroup actually did have a little bit better maintenance of cognitive functioning meaning maybe not improvement but not not quite the same level of decline now again this was a smaller study and again kind of structured and monitored with this moderate to high intensity activity but again kind of fits with this bigger picture that you get a lot of other benefits from exercise in Alzheimer's disease even if it's the evidence is a little bit equivocal about what it might do for your actual cognitive functioning so these are the the outward behavioral things that we have found to happen with exercise related to your cognitive functioning but a lot of us are really interested to like great that's the behavioral but but are we really making brain changes are we following what we saw in the animal literature and are there really kind of actual changes in the brain that might be linked to these outward behavioral changes and certainly at a very global level if you rate people's cognitive and cardiovascular fitness they do have less age-related volume loss in most areas of the brain so in the frontal cortices parietal and temporal lobes we're particularly interested in the frontal lobe because this is the air riah that impacts planning kind of volitional action multitasking kind of our higher-level thinking center and the temporal lobe in particularly because these are memory centers so having kind of a less age-related volume loss in those areas in particular is very encouraging those that are exercising regularly also have larger gray matter and white matter volumes again and no specific brain regions just look at the brain as a whole and we're particularly interested in in both of those components of the brain but white matter because it helps us do things quickly and sort of process information in an efficient manner and so then if you're looking at a kind of 50 to 80 year old age range those that had higher rates of exercise just over the last 10 years right so not looking so much epidemiologically but just over the last 10 years also had larger frontal lobes and reduced rate of temporal lobe atrophy so maintaining better brain health for those that are exercising in older adults particularly focused on than the hippocampus which is the structure in your temporal lobe that's essential for memory it's one of the first structures that that show some sign of atrophy when there is cognitive decline or in dementia so we're particularly interested in trying to maintain the health of the hippocampus and those that have higher levels of aerobic fitness so these are measured kind of think about if anybody's done a stress test so it's a vo2 max the amount of kind of capabilities that that your body has for aerobic activity people that had higher levels of aerobic fitness had larger hippocampal volumes on both sides of their brain so that was kind of looking back and saying okay we've measured your physical fitness and it seems to correspond to how big your hippocampus is and then they followed that study up really kind of replicating what had been done in rodents and prospective Lea assigned individuals to an aerobic exercise group or or a control group and found that those that began the exercise program in experienced hippocampal volume increases by about two percent so advert I poke ample volume loss per year over the age of say 65 is about one to two percent a year in normal healthy people it may be a little bit more in folks that are declining rapidly so really then this was the equivalent of reversing that age-related lost by one to two years by engaging in this aerobic activity so that was particularly exciting news so I'm going to talk a little bit more about kind of everyday activity and walking in particular but I also wanted to add that the the studies that I had just talked about these were exercise studies so engaging in a guided program for the for the purpose of raising your heart rate right aerobic ly driven activity but the most popular activity that anybody does older adults or not is walking for the most part and so there's been some interest in saying well what about that what about sort of that level of activity and lo and behold that walking also increases functional connectivity in the brain so kind of the connections that the brain has between different areas as well as than the corresponding cognitive outward cognitive skills and even walking increased average hippocampal volumes this was a study on women you know up to kind of one ish percent which again might not sound like a lot except if you remember what I said about average annual decline in hippocampal volumes is about one to two percent an increase from walking by one percent is pretty notable it makes a big difference in in that particular trajectory so in thinking about about exercise there's also all sorts of other activities that folks might participate in that that we have begun to try to get a handle on and determine whether they're useful for enhancing cognitive functioning and yoga's one of those actually get a lot of questions about hey what about what about yoga so yoga is a little bit more equivocal so it's pretty clear that folks that participate in do yoga have lots of quality of life benefits have lots of kind of mental health benefits but like I said the cognitive benefits are a little bit more equivocal one recent study found some cognitive benefits but a study from a few years ago really just hands-down didn't find any cognitive gains so again there's lots of other benefits from yoga but probably doesn't it rise quite to the level of aerobic activity in thinking about that for cognitive benefit and then there's also been a lot of interest in resistance or strength training which also clearly has lots of other health benefits particularly for women and maintaining strength and bone health and things like that but whether doing strength or resistance training again would have any cognitive benefit and the answer seems to be leaning towards yes again some of the older information was a little bit more equivocal where it wasn't looking quite as favorable but some of the more recent prospective studies that are actually randomised trials of strengthened resistance training how be going to demonstrate some positive impact on things like working memory so kind of holding information in your in your brain and doing something with it an executive functioning that's just our overarching term for that frontal lobe functioning so the problem-solving the planning the higher-level thinking and then if you use a meta analytic approach which is really just gathering all the studies that that that fit into your subject matter and kind of pooling the data to get to get bigger statistical power that you do see that really then combining aerobic activity and something like strength or resistance training really might actually give you the most benefit of all that putting them together may be particularly beneficial for your cognitive functioning I felt like I would be remiss I didn't talk about the kind of the opposite end of the spectrum and talk just for a minute about sedentary behavior so I have to say when you know when I started some of this work I sort of envisioned sedentary behavior sort of just the the inverse of a physical activity and and the research isn't isn't exactly supportive of that meaning that that you know kind of doing your your thirty minutes of physical activity a day is great but if you're sedentary kind of the remainder of the time that has its own detrimental effects that perhaps that kind of exercise time that you did and should be applauded for isn't maybe going to really kind of balance out the negatives of that much sedentary behavior so you know as I said here meeting those physical activity guidelines doesn't exactly eliminate the negative consequences of prolonged periods of sitting it can you know kind of at a health level compromise metabolic health increases mortality risk and so people have been begun to actually try to systematically study this and just a couple of the more interesting results that I pulled that older adults that have primarily sedentary past times have poor executive functioning so again that higher level thinking so and those then in this this last study was a very large study and those with a lifetime history kind of higher lifetime history of television viewing so a lot of TV watching had lower cognitive functioning particularly in executive functioning than those who had kind of less history of overall of watching TV so again I like TV I don't want to say that you shouldn't you know watch your shows and you know the news and some things that we watch are quite cognitively stimulating but it's sort of that balance about engaging sort of predominantly in sedentary pastimes and trying to balance that out with some kind of movement and other physical activity so I kind of hinted at a lot of the research that has been done to date has been good solid research that's done in the laboratory so we bring people in and we monitor how long say they're on a treadmill or they're in a group exercise class so we know how long they were participating in whatever the physical activity we we were hoping that they would engage in right where they're being well monitored and while that's very useful from a scientific perspective again to make sure that we kind of have a handle on that level of detail and we know what the input is it's not really how we operate in the everyday world I'm not saying people don't go to a gym but sort of coming into a laboratory to exercise three times a week is probably not a sustainable approach for most people and so um a lot of us myself included have been particularly interested in trying to kind of see what does this look like I guess more in the real world and doing it prospectively so again I mentioned that we have a lot of epidemiological data or retrospective data where we're kind of looking back and asking people to say hey how much you know did you exercise in the last year how much did you exercise when you were a teenager to get that level of data but from a scientific rigor perspective asking people to engage and sort of here's your exercise program let's see what happens moving forward gives us a lot of really good information as well and those studies have been less common a lot of studies have also been done with healthy aging and so again really valuable information to have to understand how people that are aging well are in fact aging well but but we also have a lot of interest in seeing how and to what degree we can apply this to to mild cognitive impairment or some of the studies that have been done in Alzheimer's disease and most studies of exercise have been done in healthy aging certainly not all that many so you know that I said that that guided but ultimately independently done physical activity kind of in your own home on your own time has been less systematically studied like and how does this exercise happen in the real world there's some benefits certainly to that it's lower resources that are required that for the people to participate in it can expand accessibility so individuals that may not really be able to come into the into your lab or to the specific place that they can do the exercise where they're at and again kind of just to get a better handle on we know what it looks like in a very clean setting within a laboratory but what does it kind of look like in everyday life so we have a little bit of information about that this was a particularly well done study that they looked at actigraphy so this is sort of a usually it's a kind of like a wristwatch sort of apparatus that that people wear that track their activity often as well as some other things and basically just looked at people how they how much activity they had in their every day life now certainly if they were doing purposeful aerobic activity it would pick that up as well but what was really interesting is that particularly in women those that had this highest just general daytime activity did have significantly better cognitive functioning and those tests that I listed our tests of executive functioning then individuals who had lower levels of daily activity and so you know one of the questions I had when I was reading this study which then they also answered kind of through their statistical methods was okay but so maybe these people that are moving a lot throughout the day right always on their feet always going are also the people who happen to be doing a lot of aerobic exercise so they really statistically were able to control for that particular variable and kind of take that off the table and they still found then that there was a bump in cognitive functioning from people who were just moving more so increased daily basic daily activity so so this was a particular interest to me and a few years ago the the Stein Institute actually has pilot grants and I was awarded one of those pilot grants and we did a study to look at just that so now a walking intervention that people did in kind of in their own daily life we gave them a structured program to follow to see if increasing that level of daily activity would help their cognitive functioning so it was a 12-week study we had 15 healthy older adults who healthy sedentary but otherwise healthy 65 to 80 they all wore a pedometer which again is pretty low-tech device this was even kind of a for like fitbit's and all the wearable technology took off so this is a really low-tech step count that they that they used to track their daily steps activity now they did receive weekly calls from the study coordinator to say here's your next step goal and to follow up and see if they had met their their goal for the past week and they were split so seven increased their their daily steps over the course of the 12 weeks and eight just participated in their activity as usual still wore the pedometer we still track their activity and we tested them cognitive test before and after their participation so just to give you the flavor of when I say could have progressively increased their step count so again these were reasonably sedentary individuals so baseline step counts were somewhere usually between say 2 or 3,000 steps today to give you a little bit of a framework of where that lies the general kind of Surgeon General's recommendation is usually for about 10,000 steps a day so they were falling well short of that and so we very slowly up their step counts so say in the first week they were only asked to increase about 300 steps a day but the next week then it was 400 steps today and then 600 steps today right so you can kind of see the progression but it really was very slow and very gradual but by the end of the intervention if they were following the protocol which they did for the most part they they up there step counts close to sort of four to five thousand steps so they were ending in kind of the seven to eight thousand step range which again is maybe below that 10,000 step mark but if you think about where they started that was a pretty dramatic increase in their daily activity and then this is what happens to their cognitive functioning so these are tests of executive functioning and across the board really every executive functioning measure that we gave them showed some significant increases in the walking group compared to the control group so certainly the control group had some bump often that's from a practice effect that they both have by taking the test once and then taking the test again twelve weeks later but you can see that then the walking group had a had improvements kind of above and beyond what we would expect just from practice more executive functioning tests not all of them are significant changes but the vast majority of executive functioning measures showed a positive increase in response to this increase in in daily walking we did not see though the same significant increases in memory or other health variables so that the first couple of columns there GDS is the geriatric depression scale so this was in there because one of the ideas about why does exercise really help is because maybe it improves your mood and that's giving you some of that cognitive boost that you're kind of stripping off some mood changes and so there was a little bit of a positive change in depressive symptoms but not different between the groups and not enough to kind of be a significant difference the the walking group actually slept a little bit better not significantly so but that was another kind of hypothesis or one thing about maybe exercise actually for most people does do positive things for your sleep and so if you're getting a better night's rest maybe your cognitive functioning is is improved because of that so it didn't seem like sleep was you know the biggest component here they lost a few pounds the walking group although not significantly more than the other group they did lose a few pounds and that last column is a word list learning test and like I said we didn't find significant differences in memory performance but we did an executive functioning so in this again it's a small pilot trial but it really was fitting and in line with some of the data that was emerging that even after this three-month you know congratulate Greece there was a positive changes in their executive functioning although not not the same level of changes in memory attention mood or health variables we did follow up with these individuals and three months later they they still had maintained these these improvements in their executive functioning and not all of them had maintained that particularly loved walking but some of them had so really what this led us to conclude was that even small increases in physical activity does lead to improvements in executive functioning in older adults so that was very encouraging and where we're going with that information now through some funding through the Alzheimer's Association is really to take that walking program and apply it to individuals that have mild cognitive impairment again so translating from normal kind of healthy aging to mild cognitive impairment and can they follow the walking program at home can they do it semi independently again with guidance but but at about their leisure in their own environment and we're also comparing it to some computer-based cognitive training and then combining them both together but this study just started a little over a year ago so I don't have any data to present just kind of wanted to give you some of the future directions that we're heading so hopefully I've given you a reasonable body of evidence that that physical activity is beneficial to your cognitive functioning a lot of us are just very curious and say that's great but why what is it what's really going on why is why is something that seems like oh it should help your heart it should help your vascular system it's helping your brain so there's many hypothesis and I will say that this list is probably not a pick one and that's the definitive it's probably going to be a combination ultimately of many of these things so you get some general health gains from exercise so if you lower your vascular burden right if you lower your blood pressure if you you know kind of lower some of your metabolic risk factors from exercise you get healthy brain benefits from those things as well you do get some increased ability of the heart to deliver oxygen the brain really likes oxygen and glucose you can increase the rubra blood flow so kind of increasing the metabolic resources to the brain might be piece of it there's certainly some evidence that it becomes a bit neuroprotective so that if something else might happen to your brain you're a little bit better buffered against some of those other things that might go wrong because you had some of this additional protection there there's some interesting information about it as a stress reducing technique so I don't want to go too far afield but certainly with things like post traumatic stress disorder there's been some emerging information about long term risk for cognitive decline for individuals that have PTSD and one of the hypothesis is because it's sort of a chronic stress reaction that does negative things to your cognitive functioning over time and exercise is an excellent way to reduce stress and to reduce that level of cortisol to the brain so again kind of can reduce some of those physiological components of stress as well as just truly improve your mood so that there's clearer thinking so that some of those even mental health comorbidities aren't impacting cognitive functioning to the same degree it it does facilitate learning by the process of long term potentiation in the brain so it really facilitates that actual process in the brain there's some information that inflammation may be one of the mechanisms by which exercise helps in that ex helps reduce inflammation and therefore enhances cognitive functioning as I mentioned in the animal literature as well as in the human literature that there there has been evidence of neuro generous neurogenesis rather in the hippocampus so actually kind of you know having new cells in an area relevant to memory may be a component of the benefit to cognition and exercise also up regulates some growth factors that we have in our system so brain derived neurotrophic factor maybe one in particular that exercise sort of stimulates that particular growth factor which then has a positive impact on the rest of your cognitive functioning and as I said I don't think that it's sort of oh it's it's just going to be the inflammation or it's just going to be the neurogenesis it's probably some combination of many of these these ideas but this is where we are with thinking about how exercise impacts cognition as we understand it now okay so then usually people say that's all great we love the science you know but really what am I supposed to do so here's hopefully some more practical recommendations gleaned from from that research literature about about what what's what is we're really asking people to do to enhancer or maintain their cognitive health so exercise at least as intense as walking a minimum of about three times a week now again the recommendations for physical health or cardiovascular health might be different from this but for cognitive health this is this is sort of the minimum marker any variety that you can do in your exercise is also welcome but again something even as simple as increased walking would do it as I mentioned there there is some evidence to suggest that if you combine aerobic activity with strength or resistance training that you may get even more cognitive benefit than one of the alone as I kind of showed from just that brief trial of of walking short interventions have have some cognitive benefit but three to six months kind of or longer seem to be really the minimum suggestion to recog 'native benefits so like I said because they can really accrue over a relatively short period of time let's sort of just to be sure three to six months or more is probably the best recommendation there there's some information about if you've been actually exercising and that you're able to maintain that level kind of the duration and an approximate intensity that you're used to exercising at that that's particularly beneficial because I mentioned yoga definite improvements in other factors a little bit equivocal about whether it improves cognitive functioning or not so kind of maybe improves cognitive functioning they to be sure to break up periods of sedentary activity with periods of activities so again that idea of sort of sit less move more even if it's not all aerobic activity just interspersed those periods of of sedentary with activity and certainly then think about that level of everyday activity so it doesn't although it's great if you go to the gym regularly and do kind of purposeful aerobic activity but even if it's been a really long time since you've been to the gym and that feels a little overwhelming daily increases in just walking or sort of everyday activity also seem to have some potential to have cognitive benefits as with sort of everything you know we like to study these things in isolation because it makes it nice and clean for us as researchers but in the real world most of this stuff goes on together meaning you're probably not just doing whatever your exercise is and not trying to maintain a healthy diet or you might have social engagement with other people family members or friends or you might be doing things that are cognitively stimulating computer games crossword puzzles reading new books whatever so ultimately a lot of these kind of combinations of things matter too so exercise matters and I have and could do a whole nother talk on kind of cognitive stimulation or other other behavioral factors that also play positively into your cognitive functioning and ultimately those sorts of combinations may may also be particularly beneficial so a couple of those studies that are listed there even things like there was a study of using an exercise bike just kind of a regular old exercise bike versus being on an exercise bike with a screen and kind of playing a video game so kind of cognitively stimulated while you're doing physical activity and that group got way more cognitive benefit than just riding the exercise bike alone so this is this is kind of the idea of combining some of those cognitive physical social support dietary things like that less work has been done and really more work is needed on combining and cognitive training with some of the medications that we do often think of and use for dementia or Alzheimer's disease so there have been a couple of trials for the drugs that are on the market and have shown some efficacy for Alzheimer's disease to partner them with some plant physical activity and you do seem to get more of a boost from that kind of combo package than from either in isolation as I mentioned you know from our animal literature as well as from other human literature that those enriched environments right doing things that are cognitively engaging as well as physically engaging are particularly useful for your cognitive functioning and the idea for that is that potentially that physical activity kind of sets the stage for for the neurogenesis that then gets even further enhanced by say cognitive tivity or cognitively stimulating information that's coming in so just a few things that seem to come up a lot certainly there's a ton of future directions and questions that we don't have the answer to yet but one of the things that that people ask me frequently and really is still an area somewhat wide open is this idea about okay so but you know we know that walking is a good activity but what's the best physical activity like what's really going to give me the best cognitive functioning and we don't really know is you know swimming better than walking or do you need to play tennis or is it dancing and for the most part different physical activities haven't been pitted against one another to see besides sort of walking versus they like strength training so that's kind of an open question my current answer to that about what's the best activity to do is usually if whatever activity you'll do is the one that you should do so even if I came in here like next time and said they've done the study and they said swimming swimming is the best cognitive activity and you're like I'm not getting in the pool I don't have a swimsuit or whatever right if you're not going to swim it's not you're not going to it's not the best activity for you so enzyme think kind of about time so most studies have looked somewhere in the 30 to 60-minute range because that's been the recommendation for physical health but we don't really 100% know if that's what you need for cognitive health so thinking about the time and the frequency we don't have definitive data on that as I mentioned we have a lot of epidemiological data that says hey if you were you know kind of a exercise a lot of the teenager and kept up your physical activity into midlife that you reap some benefits from that but we don't really know what kind of what's the latest point at which you could say begin an exercise program if you are generally not very physically active throughout your life to still gain some of those benefits it's looking like late in life will still be effective but we don't have kind of that that pinned down quite as well as we might like and then certainly as I mentioned some of those kind combo studies so what about some of the medications that maybe didn't fare 100% well in their clinical drug trial but there was some subset of people that seem to have some benefit what if you added exercise to that again what if you put kind of medication and behavioral interventions together would they work better than if you kept them separate so final conclusions no known study has really found that exercise makes cognition worse so so so there's you know little little risk you know my disclosure should be that you should clear anything you do with your physician first but in general there's no negative cognitive consequences to physical activity and for most people inquiry at least increase in kind of daily activity has has low risk for most individuals and so really as I kind of started out and I know I already gave you the the final punchline of my talk but yes exercise is really good for your cognitive functioning it's highly recommended if you're physically able to participate so in just a few acknowledgments of the places that have funded the work that I have done and I thank you very much for your attention so so it sounds like the question is is really can-can exercise or physical activity counteract any negative side effects from other medications or something along those lines do certain medications guaranteed to affect your ability to exercise and your cognition hmm so so there's really not been so much of that research done as far as thinking about kind of medication side effects specifically in cog and exercises ability to maybe counteract some of those it's not exactly your question but certainly that's been has been investigated at least with certain other risk factors so again genetic risk factors exercise seems to try to counterbalance that again it doesn't eliminate or erase them entirely but there's some you know kind of added benefit to be being active to counterbalance some of that but but i but I don't have probably the information that that you're thinking I don't think it exists yet for the medication side effect piece Yeah right behind you okay so I'm gonna start with your your first couple of questions and the question really was I think trying to gauge what's the right then if exercise is good for me that's kind of the take-home message from today but but what like what's an okay level for me when you you know when I'm saying aerobic or whatever like what what does that really mean and that that to some degree is a is an individual question that's probably honestly best answered by your physician or somebody that's actually kind of prescribing the the physical activity that knows what a decent aerobic range is right what kind of elevates your heart rate to a place that you're in an aerobic zone but yeah you're right nobody wants you to be you know kind of exercise to the point that you're you you kind of collapse right that's not the spirit of it either so in that light I would say you know it's a legitimate question I would definitely ask your physician sort of what might say a target heart range be for somebody of your age and your health status and so that you can find that place like you said that feels comfortable look you know like you know you're working a little bit hard but not not working too too hard and probably the same thing with weights you know what is kind of legitimate for where everybody is and again it's because everybody's going to be pretty individual about where their starting point is depending on you know your health status your level of physical activity that you've already participated in that sort of thing as far as the sleep medication goes that's unfortunately probably a little outside my scope to be able to answer I was thinking at least at some point I know there was a sleep flexure that that was part of the series and I'm wishing they were here right now to answer your question I'm sorry I'm not going to be able to probably answer the the ambien question well and and but what I would say to that too is a ask your physician but also kind of keep in mind maybe some of the points of the data that I showed that just upping kind of general everyday activity so without the pain just move more has some cognitive benefit as well but to find that kind of healthy place for aerobic activity definitely you know consult consult your your physician about that so the question was really about the interaction of diet with with exercise and you kind of mentioned you know the benefits of eating things like fish or things that along those lines so there certainly are some studies looking at at diet one of the big ones looked at the Mediterranean style diet right so kind of healthy fats fish vegetables again some of that it's a less familiar literature to me but what I know of it is a little bit still equivocal that there are some again kind of general health benefits and maybe some hints of cognitive benefits but it's not quite as clear cut but but that's another question right then if you kind of enhance those two together with exercise so that was sort of the idea about doing more work to study these combo studies of these sorts of things there was another flyer out on the out on the table as well and I wasn't looking at diet but it was another kind of combination study about looking at about combining different of these kind of cognitive and and health factors together to yeah to try to get that picture of yeah what does it really look like because most people aren't doing these behaviors in isolation in the real world anyway the question was about any existing research that I know about ongoing to participate in that combines kind of nutrition and an exercise and I don't actually have to top my head but you can always our UC SDS all surfers disease Research Center is often a good resource for ongoing studies again don't necessarily have to have Alzheimer's disease they're looking for healthy participants for mild cognitive impairment etc as well as you can always look at clinical trials.gov they all have a again it's across the country everything might not be local but you can always get kind of a nice view about any clinical trials that are going on particularly with a keyword like you know nutrition and aging or nutrition and exercise to try and see if there's something going on but I can't think right now off the top of my head that that's focusing on their nutrition piece yeah yeah sure so the comment was if you notice cognitive changes in yourself or in a loved one or a friend have it checked out immediately and you're right because sometimes they're they're very reversible things yeah so having it checked out is a healthy thing to do yes sir the question was about what do I mean when I say computer cognitive training and so you know usually what I'm thinking of and referring to are these computer based programs that have you know kind of cognitive games and things but they're in a set yep it's a set program however there is definitely lots of evidence to suggest that participating in cognitively stimulating activities learning a new language I think was one of your examples you know learning something off the computer does have cognitive benefit as well with or without the computer absolutely just doing something that's new and novel for your brain I don't see any other hands for questions so thank you if you do please come see me after thank you you

Channel: University of California Television (UCTV)

Views: 73,652

Rating: 4.847012 out of 5

Keywords: aging, cognition, activity level, Exercise

Id: gfL7bxPAarY

Length: 58min 20sec (3500 seconds)

Published: Wed Apr 06 2016