Exercise

How physical exercise and fitness improves your brain function

Exercise reduces Alzheimer's damage in brain

August, 2012

A mouse study provides more support for the value of exercise in preventing Alzheimer’s disease, and shows one of the ways in which it does so.

A study designed to compare the relative benefits of exercise and diet control on Alzheimer’s pathology and cognitive performance has revealed that while both are beneficial, exercise is of greater benefit in reducing Alzheimer’s pathology and cognitive impairment.

The study involved mice genetically engineered with a mutation in the APP gene (a familial risk factor for Alzheimer’s), who were given either a standard diet or a high-fat diet (60% fat, 20% carbohydrate, 20% protein vs 10% fat, 70% carbohydrate, 20% protein) for 20 weeks (from 2-3 to 7-8 months of age). Some of the mice on the high-fat diet spent the second half of that 20 weeks in an environmentally enriched cage (more than twice as large as the standard cage, and supplied with a running wheel and other objects). Others on the high-fat diet were put back on a standard diet in the second 10 weeks. Yet another group were put on a standard diet and given an enriched cage in the second 10 weeks.

Unsurprisingly, those on the high-fat diet gained significantly more weight than those on the standard diet, and exercise reduced that gain — but not as much as diet control (i.e., returning to a standard diet) did. Interestingly, this was not the result of changes in food intake, which either stayed the same or slightly increased.

More importantly, exercise and diet control were roughly equal in reversing glucose intolerance, but exercise was more effective than diet control in ameliorating cognitive impairment. Similarly, while amyloid-beta pathology was significantly reduced in both exercise and diet-control conditions, exercise produced the greater reduction in amyloid-beta deposits and level of amyloid-beta oligomers.

It seems that diet control improves metabolic disorders induced by a high-fat diet — conditions such as obesity, hyperinsulinemia and hypercholesterolemia — which affects the production of amyloid-beta. However exercise is more effective in tackling brain pathology directly implicated in dementia and cognitive decline, because it strengthens the activity of an enzyme that decreases the level of amyloid-beta.

Interestingly, and somewhat surprisingly, the combination of exercise and diet control did not have a significantly better effect than exercise alone.

The finding adds to the growing pile of evidence for the value of exercise in maintaining a healthy brain in later life, and helps explain why. Of course, as I’ve discussed on several occasions, we already know other mechanisms by which exercise improves cognition, such as boosting neurogenesis.

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Computer use and exercise combo reduce odds of MCI

June, 2012

Engaging in both moderate exercise and cognitively stimulating activities has an additive effect in reducing your risk of becoming cognitively impaired.

More findings from the long-running Mayo Clinic Study of Aging reveal that using a computer plus taking moderate exercise reduces your risk of mild cognitive impairment significantly more than you would expect from simply adding together these two beneficial activities.

The study involved 926 older adults (70-93), of whom 109 (12%) were diagnosed with MCI. Participants completed questionnaires on physical exercise and mental stimulation within the previous year. Computer use was targeted in this analysis because of its popularity as a cognitive activity, and because it was particularly associated with reduced odds of having MCI.

Among the cognitively healthy, only 20.1% neither exercised moderately nor used a computer, compared to 37.6% of those with MCI. On the other hand, 36% of the cognitively healthy both exercised and used a computer, compared to only 18.3% of those with MCI. There was little difference between the two groups as regards exercise but no computer use, or computer use but no exercise.

The analysis took into account calorie intake, as well as education, depression, and other health factors. Daily calorie intake was significantly higher in those with MCI compared to those without (respective group medians of 2100 calories vs 1802) — note that the median BMI was the same for the two groups.

Moderate physical exercise was defined as brisk walking, hiking, aerobics, strength training, golfing without a golf cart, swimming, doubles tennis, yoga, martial arts, using exercise machines and weightlifting. Light exercise included activities such as bowling, leisurely walking, stretching, slow dancing, and golfing with a cart. Mentally stimulating activities included reading, crafts, computer use, playing games, playing music, group and social and artistic activities and watching less television.

It should be noted that the assessment of computer activities was very basic. The researchers suggest that in future studies, both duration and frequency should be assessed. I would add type of activity, although that would be a little more difficult to assess.

Overall, the findings add yet more weight to the evidence for the value of physical exercise and mental stimulation in staving off cognitive impairment in old age, and add the twist that doing both is much better than doing either one alone.

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Nature walks improve cognition in people with depression

June, 2012

A small study provides more support for the idea that viewing nature can refresh your attention and improve short-term memory, and extends it to those with clinical depression.

I’ve talked before about Dr Berman’s research into Attention Restoration Theory, which proposes that people concentrate better after nature walks or even just looking at nature scenes. In his latest study, the findings have been extended to those with clinical depression.

The study involved 20 young adults (average age 26), all of whom had a diagnosis of major depressive disorder. Short-term memory and mood were assessed (using the backwards digit span task and the PANAS), and then participants were asked to think about an unresolved, painful autobiographical experience. They were then randomly assigned to go for a 50-minute walk along a prescribed route in either the Ann Arbor Arboretum (woodland park) or traffic heavy portions of downtown Ann Arbor. After the walk, mood and cognition were again assessed. A week later the participants repeated the entire procedure in the other location.

Participants exhibited a significant (16%) increase in attention and working memory after the nature walk compared to the urban walk. While participants felt more positive after both walks, there was no correlation with memory effects.

The finding is particularly interesting because depression is characterized by high levels of rumination and negative thinking. It seemed quite likely, then, that a solitary walk in the park might make depressed people feel worse, and worsen working memory. It’s intriguing that it didn’t.

It’s also worth emphasizing that, as in earlier studies, this effect of nature on cognition appears to be independent of mood (which is, of course, the basic tenet of Attention Restoration Theory).

Of course, this study is, like the others, small, and involves the same demographic. Hopefully future research will extend the sample groups, to middle-aged and older adults.

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How exercise affects the brain, and who it benefits

June, 2012

New research indicates that the cognitive benefits of exercise depend on the gene variant you carry.

I’ve mentioned before that, for some few people, exercise doesn’t seem to have a benefit, and the benefits of exercise for fighting age-related cognitive decline may not apply to those carrying the Alzheimer’s gene.

New research suggests there is another gene variant that may impact on exercise’s effects. The new study follows on from earlier research that found that physical exercise during adolescence had more durable effects on object memory and BDNF levels than exercise during adulthood. In this study, 54 healthy but sedentary young adults (aged 18-36) were given an object recognition test before participating in either (a) a 4-week exercise program, with exercise on the final test day, (b) a 4-week exercise program, without exercise on the final test day, (c) a single bout of exercise on the final test day, or (d) remaining sedentary between test days.

Exercise both improved object recognition memory and reduced perceived stress — but only in one group: those who exercised for 4 weeks including the final day of testing. In other words, both regular exercise and recent exercise was needed to produce a memory benefit.

But there is one more factor — and this is where it gets really interesting — the benefit in this group didn’t happen for every member of the group. Only those carrying a specific genotype benefited from regular and recent exercise. This genotype has to do with the brain protein BDNF, which is involved in neurogenesis and synaptic plasticity, and which is increased by exercise. The BDNF gene comes in two flavors: Val and Met. Previous research has linked the less common Met variant to poorer memory and greater age-related cognitive decline.

In other words, it seems that the Met allele affects how much BDNF is released as a result of exercise, and this in turn affects cognitive benefits.

The object recognition test involved participants seeing a series of 50 images (previously selected as being highly recognizable and nameable), followed by a 15 minute filler task, before seeing 100 images (the previous 50 and 50 new images) and indicating which had been seen previously. The filler task involved surveys for state anxiety, perceived stress, and mood. On the first (pre-program) visit, a survey for trait anxiety was also completed.

Of the 54 participants, 31 carried two copies of the Val allele, and 23 had at least one Met allele (19 Val/Met; 4 Met/Met). The population frequency for carrying at least one Met allele is 50% for Asians, 30% in Caucasians, and 4% in African-Americans.

Although exercise decreased stress and increased positive mood, the cognitive benefits of exercise were not associated with mood or anxiety. Neither was genotype associated with mood or anxiety. However, some studies have found an association between depression and the Met variant, and this study is of course quite small.

A final note: this study is part of research looking at the benefits of exercise for children with ADHD. The findings suggest that genotyping would enable us to predict whether an individual — a child with ADHD or an older adult at risk of cognitive decline or impairment — would benefit from this treatment strategy.

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Why exercise helps memory and learning

May, 2012

A mouse study suggests exercise increases neurogenesis through muscles’ release of an enzyme that affects energy and metabolism — an enzyme whose production lessens with age.

A number of studies, principally involving rodents, have established that physical exercise stimulates the creation of new brain cells in the hippocampus. A recent study attempted to uncover more about the mechanism.

Using two drugs that work directly on muscles, producing the physical effects of exercise, the researchers compared the effects on the brain. One drug (Aicar) improves the fitness of even sedentary animals. The other drug increases the effects of exercise on animals that exercise, but has little effect on sedentary animals.

After a week of receiving one of the drugs, sedentary mice performed better on tests of memory and learning, and showed more new brain cells. These effects were significantly greater for those taking Aicar.

Because the drugs have very little ability to cross into the brain, this demonstrates that the neurogenesis results from exercise-type reactions in the muscles, not to brain responses to the drugs. Indeed, previous research has found that direct infusion of Aicar into the brain impaired learning and memory.

Aicar increases the muscles’ output of AMPK, an enzyme that affects cellular energy and metabolism. It’s speculated that some of this enzyme may enter the bloodstream and travel to the brain. Interestingly, as with neurogenesis, AMPK activity in muscles appears to decline with age. It may be that AMPK production could serve as a biomarker for neurogenesis, as well as being a target for improving neurogenesis.

These findings add weight to evidence for the value of aerobic exercise over other types of exercise (given that the mice exercise by running). However, I see that human research has found that resistance training (which is difficult to study in mice!) also increases AMPK activity.

Do note — if you are hopeful that drugs will relieve you of the need to exercise — that the benefits were not only smaller than those achieved from exercise, but also didn’t last. In those mice taking Aicar for a second week, their brains not only stopped deriving any benefit, but actually deteriorated.

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Resistance training benefits seniors with MCI

May, 2012

Six months of resistance training has improved executive function and associative memory in older women with mild cognitive impairment.

A study involving 86 older women (aged 70-80) with probable MCI has compared the effectiveness of resistance and aerobic training in improving executive function. The women were randomly allocated either to resistance training, aerobic training, or balance and tone training (control group). The programs all ran twice weekly for six months.

The 60-minute classes involved lifting weights (resistance training), outdoor walking (aerobic training), or stretching, balancing, and relaxation exercises (control).

Executive function was primarily assessed by the Stroop Test (measuring selective attention/conflict resolution), and also by Trail Making Tests (set-shifting) and Verbal Digits Tests (working memory). Associative memory (face-scene pairs) and problem-solving ability (Everyday Problems Test) were also assessed.

The study found that resistance training significantly improved performance on the Stroop Test and also the associative memory task. These improvements were associated with changes in some brain regions. In contrast to previous studies in healthy older adults, aerobic training didn’t produce any significant cognitive improvement, although it did produce significantly better balance and mobility, and cardiovascular capacity, compared to the control.

Interestingly, a previous study from these researchers demonstrated that it took a year of resistance training to achieve such results in cognitively healthy women aged 65-75. This suggests that the benefits may be greater for those at greater risk.

It may be that the greater benefits of resistance training over aerobic training are not be solely due to physical differences in the exercise. The researchers point out that resistance training required more cognitive engagement (“If you’re lifting weights you have to monitor your sets, your reps, you use weight machines and you have to adjust the seat, etc.”) compared to walking.

Note that impaired associative memory is one of the earliest cognitive functions affected in Alzheimer’s.

It’s also worth noting that exercise compliance was low (55-60%), suggesting that benefits might have been greater if the participants had been more motivated — or found the programs more enjoyable! The failure of aerobic exercise to improve cognition is somewhat surprising, and perhaps it, too, may be attributed to insufficient engagement — in terms of intensity as well as amount.

The researchers have put up a YouTube video of the resistance training exercises used in the study.

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Being active reduces Alzheimer's risk

May, 2012
  • A large study provides evidence that higher levels of everyday activity help prevent Alzheimer’s, although more intense activity is even better.

A four-year study involving 716 elderly (average age 82) has revealed that those who were most physically active were significantly less likely to develop Alzheimer’s than those least active. The study is unique in that, in addition to self-reports of physical and social activity, activity was objectively measured (for up to 10 days) through a device worn on the wrist. This device (an actigraph) enabled everyday activity, such as cooking, washing the dishes, playing cards and even moving a wheelchair with a person's arms, to be included in the analysis.

Cognitive performance was assessed annually. Over the study period, 71 participants (10%) developed Alzheimer’s.

The study found that those in the bottom 10% of daily physical activity were more than twice as likely (2.3 times) to develop Alzheimer's disease as those in the top 10%. Those in the bottom 10% of intensity of physical activity were almost three times (2.8 times) as likely to develop Alzheimer's disease as people in the top 10%.

Moreover, the level of activity was associated with the rate of cognitive decline.

The association remained after motor function, depression, chronic health conditions, and APOE gene status were taken into account.

The findings should encourage anyone who feels that physical exercise is beyond them to nevertheless engage in milder forms of daily activity.

 

Addendum:

Another recent study, involving 331 cognitively healthy elderly, has also found that higher levels of physical activity were associated with better cognitive performance (specifically, a shorter time to complete the Trail-making test, and higher levels of verbal fluency) and less brain atrophy. Activity levels were based on the number of self-reported light and hard activities for at least 30 minutes per week. Participants were assessed in terms of MMSE score, verbal fluency, and visuospatial ability.

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Walking speed and grip strength may predict dementia, stroke risk

March, 2012

More evidence comes for a link between lower physical fitness and increased risk of dementia in a large study that extends earlier findings to middle-aged and younger-old.

Following on from research showing an association between lower walking speed and increased risk of dementia, and weaker hand grip strength and increased dementia risk, a large study has explored whether this association extends to middle-aged and younger-old adults.

Part of the long-running Framingham study, the study involved 2,410 men and women with an average age of 62, who underwent brain scans and tests for walking speed, hand grip strength and cognitive function. During the follow-up period of up to 11 years, 34 people (1.4%) developed dementia (28 Alzheimer’s) and 79 people (3.3%) had a stroke.

Those who had a slower walking speed at the start of the study were one-and-a-half times more likely to develop dementia compared to people with faster walking speed, while stronger hand grip strength was associated with a 42% lower risk of stroke or transient ischemic attack in people over age 65.

Slower walking speed and weaker hand grip strength were also associated with lower brain volume and poorer cognitive performance. Specifically, those with slower walking speed scored significantly worse on tests of visual reproduction, paired associate learning, executive function, visual organization, and language (Boston Naming test). Higher hand grip strength was associated with higher scores on tests of visual reproduction, executive function, visual organization, language and abstraction (similarities test).

While the nature of the association is not yet understood, the findings do seem to support the benefits of physical fitness. At the least, these physical attributes can serve as pointers to the need for more investigation of an older person’s brain health. But they might also serve as a warning to improve physical fitness.

Reference: 

Camargo, E.C., Beiser, A., Tan, Z.S., Au, R., DeCarli, C., Pikula, A., Kelly-Hayes, M., Kase, C., Wolf, P. & Seshadri, S. 2012. Walking Speed, Handgrip Strength and Risk of Dementia and Stroke: The Framingham Offspring Study. To be presented April 25 at the American Academy of Neurology's 64th Annual Meeting in New Orleans.

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Support for link between physical activity & academic success

March, 2012

A review supports the benefits of physical activity for children’s and adolescent’s scholastic performance, but points to the need for better studies. A recent study looks at the effects on attention of different types of physical activity.

A review of 10 observational and four intervention studies as said to provide strong evidence for a positive relationship between physical activity and academic performance in young people (6-18). While only three of the four intervention studies and three of the 10 observational studies found a positive correlation, that included the two studies (one intervention and one observational) that researchers described as “high-quality”.

An important feature of the high-quality studies was that they used objective measures of physical activity, rather than students' or teachers' reports. More high-quality studies are clearly needed. Note that the quality score of the 14 studies ranged from 22%! to 75%.

Interestingly, a recent media report (NOT, I hasten to add, a peer-reviewed study appearing in an academic journal) spoke of data from public schools in Lincoln, Nebraska, which apparently has a district-wide physical-fitness test, which found that those were passed the fitness test were significantly more likely to also pass state reading and math tests.

Specifically, data from the last two years apparently shows that 80% of the students who passed the fitness test either met or exceeded state standards in math, compared to 66% of those who didn't pass the fitness test, and 84% of those who passed the fitness test met or exceeded state standards in reading, compared to 71% of those who failed the fitness test.

Another recent study looks at a different aspect of this association between physical exercise and academic performance.

The Italian study involved138 normally-developing children aged 8-11, whose attention was tested before and after three different types of class: a normal academic class; a PE class focused on cardiovascular endurance and involving continuous aerobic circuit training followed by a shuttle run exercise; a PE class combining both physical and mental activity by involving novel use of basketballs in varying mini-games that were designed to develop coordination and movement-based problem-solving. These two types of physical activity offered the same exercise intensity, but very different skill demands.

The attention test was a short (5-minute) paper-and-pencil task in which the children had to mark each occurrence of “d” with double quotation marks either above or below in 14 lines of randomly mixed p and d letters with one to four single and/or double quotation marks either over and/or under each letter.

Processing speed increased 9% after mental exercise (normal academic class) and 10% after physical exercise. These were both significantly better than the increase of 4% found after the combined physical and mental exertion.

Similarly, scores on the test improved 13% after the academic class, 10% after the standard physical exercise, and only 2% after the class combining physical and mental exertion.

Now it’s important to note is that this is of course an investigation of the immediate arousal benefits of exercise, rather than an investigation of the long-term benefits of being fit, which is a completely different question.

But the findings do bear on the use of PE classes in the school setting, and the different effects that different types of exercise might have.

First of all, there’s the somewhat surprising finding that attention was at least as great, if not better, after an academic class than the PE class. It would not have been surprising if attention had flagged. It seems likely that what we are seeing here is a reflection of being in the right head-space — that is, the advantage of continuing with the same sort of activity.

But the main finding is the, also somewhat unexpected, relative drop in attention after the PE class that combined mental and physical exertion.

It seems plausible that the reason for this lies in the cognitive demands of the novel activity, which is, I think, the main message we should take away from this study, rather than any comparison between physical and mental activity. However, it would not be surprising if novel activities that combine physical and mental skills tend to be more demanding than skills that are “purely” (few things are truly pure I know) one or the other.

Of course, it shouldn’t be overlooked that attention wasn’t hampered by any of these activities!

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'Exergames' may provide greater cognitive benefit for older adults

February, 2012

An intriguing pilot study finds that regular exercise on a stationary bike enhanced with a computer game-type environment improves executive function in older adults more than ordinary exercise on a stationary bike.

We know that physical exercise greatly helps you prevent cognitive decline with aging. We know that mental stimulation also helps you prevent age-related cognitive decline. So it was only a matter of time before someone came up with a way of combining the two. A new study found that older adults improved executive function more by participating in virtual reality-enhanced exercise ("exergames") that combine physical exercise with computer-simulated environments and interactive videogame features, compared to the same exercise without the enhancements.

The Cybercycle Study involved 79 older adults (aged 58-99) from independent living facilities with indoor access to a stationary exercise bike. Of the 79, 63 participants completed the three-month study, meaning that they achieved at least 25 rides during the three months.

Unfortunately, randomization was not as good as it should have been — although the researchers planned to randomize on an individual basis, various technical problems led them to randomize on a site basis (there were eight sites), with the result that the cybercycle group and the control bike group were significantly different in age and education. Although the researchers took this into account in the analysis, that is not the same as having groups that match in these all-important variables. However, at least the variables went in opposite directions: while the cybercycle group was significantly younger (average 75.7 vs 81.6 years), it was significantly less educated (average 12.6 vs 14.8 years).

Perhaps also partly off-setting the age advantage, the cybercycle group was in poorer shape than the control group (higher BMI, glucose levels, lower physical activity level, etc), although these differences weren’t statistically significant. IQ was also lower for the cybercycle group, if not significantly so (but note the high averages for both groups: 117.6 vs 120.6). One of the three tests of executive function, Color Trails, also showed a marked group difference, but the large variability in scores meant that this difference was not statistically significant.

Although participants were screened for disorders such as Alzheimer’s and Parkinson’s, and functional disability, many of both groups were assessed as having MCI — 16 of the 38 in the cybercycle group and 14 of the 41 in the control bike group.

Participants were given cognitive tests at enrolment, one month later (before the intervention began), and after the intervention ended. The stationary bikes were identical for both groups, except the experimental bike was equipped with a virtual reality display. Cybercycle participants experienced 3D tours and raced against a "ghost rider," an avatar based on their last best ride.

The hypothesis was that cybercycling would particularly benefit executive function, and this was borne out. Executive function (measured by the Color Trails, Stroop test, and Digits Backward) improved significantly more in the cybercycle condition, and indeed was the only cognitive task to do so (other cognitive tests included verbal fluency, verbal memory, visuospatial skill, motor function). Indeed, the control group, despite getting the same amount of exercise, got worse at the Digits Backward test, and failed to show any improvement on the Stroop test.

Moreover, significantly fewer cybercyclists progressed to MCI compared to the control group (three vs nine).

There were no differences in exercise quantity or quality between the two groups — which does argue against the idea that cyber-enhanced physical activity would be more motivating. However, the cybercycling group did tend to comment on their enjoyment of the exercise. While the enjoyment may not have translated into increased activity in this situation, it may well do so in a longer, less directed intervention — i.e. real life.

It should also be remembered that the intervention was relatively short, and that other cognitive tasks might take longer to show improvement than the more sensitive executive function. This is supported by the fact that levels of the brain growth factor BDNF, assessed in 30 participants, showed a significantly greater increase of BDNF in cybercyclists.

I should also emphasize that the level of physical exercise really wasn't that great, but nevertheless the size of the cybercycle's effect on executive function was greater than usually produced by aerobic exercise (a medium effect rather than a small one).

The idea that activities that combine physical and mental exercise are of greater cognitive benefit than the sum of benefits from each type of exercise on its own is not inconsistent with previous research, and in keeping with evidence from animal studies that physical exercise and mental stimulation help the brain via different mechanisms. Moreover, I have an idea that enjoyment (in itself, not as a proxy for motivation) may be a factor in the cognitive benefits derived from activities, whether physical or mental. Mere speculation, derived from two quite separate areas of research: the idea of “flow” / “being in the zone”, and the idea that humor has physiological benefits.

Of course, as discussed, this study has a number of methodological issues that limit its findings, but hopefully it will be the beginning of an interesting line of research.  

Reference: 

[2724] Anderson-Hanley, C., Arciero P. J., Brickman A. M., Nimon J. P., Okuma N., Westen S. C., et al.
(2012).  Exergaming and Older Adult Cognition.
American Journal of Preventive Medicine. 42(2), 109 - 119.

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