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Exercise as an intervention across cognition and mood Joe Verghese, MBBS, MS Albert Einstein College of Medicine Bronx, NY Disclosure 1: Funding received.

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Presentation on theme: "Exercise as an intervention across cognition and mood Joe Verghese, MBBS, MS Albert Einstein College of Medicine Bronx, NY Disclosure 1: Funding received."— Presentation transcript:

1 Exercise as an intervention across cognition and mood Joe Verghese, MBBS, MS Albert Einstein College of Medicine Bronx, NY Disclosure 1: Funding received from National Institutes On Aging (grants PO1 AGO3949 and RO1 AGO25119)

2 Disclosure 2: The speaker has not received any funding from these companies (not even a cup of coffee!)

3 Exercise Good for the brain? Good for mood? Which activities? How much? How do they work?

4 Strength of evidence? Mental exercise Physical exercise Social activities Observational Vs. RCT

5 Fratiglioni, Lancet Neurol 2004

6 Bronx Aging Study Inception: volunteers Age Community living 90% Caucasian 65% women No dementia Katzman R, Ann Neurol 1989, Verghese J, NEJM 2003

7 469 nondemented subjects Clinical, neuropsychological evaluations at entry and at mo follow-up visits Study period: Dementia 30 Vascular dementia 25 Mixed dementia

8 Cognitive

9 Physical

10 7 : almost daily 4: several days 1: once weekly 0: < weekly or never Leisure activity scales Cognitive activity scale (0-42) Physical activity scale (0-77) XX X X XX XXXX X Activity days

11 Hazard ratio (95% CI) CognitivePhysical Dementia ( ) 1.00 ( ) Vascular ( ) 1.01 ( ) Mixed ( ) 0.90 ( ) aMCI ( ) 0.97 ( ) VCI830.94( ) 1.01 ( ) Verghese NEJM 2003, Neurology 2006

12 Honolulu-Asia study 2257 men 71-93y Vs. 2mi/day <0.25: HR to 1: HR 1.71 Abbott, et al. JAMA 2004 Nurses Health Study 18,766 women 70-81y Walking better baseline cognition Physical activity cognitive decline Weuve J, et al. JAMA 2004 Bronx Aging study Walking HR 0.67 ( )

13 Dancing and risk of dementia Adjusted Hazard Ratio 0.24 ( ) Verghese J, N Engl J Med 2003

14 DancersNon-dancers p (24)(84) Blessed test FCSRT Block design Digit span Digit Symbol Verbal Fluency Trail Making B Matched by age, sex, and education. Dancers have better gait but not cognition Verghese J, J Am Geriatr Soc 2006

15 Life-p Table c Cognitive tests at baseline and 12-mo in the entire cohort Baseline12 mo Cognitive Test Mea nSD Mea nSD DSST Rey Short Rey Long Rey Inference MS Stroop

16 Ball, K. JAMA 2002 Memory Mnemonics, list recall N =703 Reasoning Problem solving N = 699 Processing speed Visual search N = 702 Control N = 698 ACTIVE trial

17 Exercise and mood Two meta-analyses of RCT of exercise and depression. Lawlor & Hopker, BMJ 2001 Stathopoulou G., et al. Clinical Psychology 2006

18 Lawlor & Hopker. BMJ 2001;322:763

19 Lawlor & Hopker. BMJ 2001 RCT: PHYSICAL EXERCISE Vs. No INTERVENTION Pooled standardized mean difference in effect size: -1.1 (95% CI -1.5 to -0.6).

20 Pooled standardized mean difference in effect size: -0.3 (95% CI -0.7 to 0.1) Lawlor & Hopker. BMJ 2001 RCT: EFFECT OF PHYSICAL EXERCISE Vs. COGNITIVE THERAPY

21 Stathopoulou, G., et al. Clinical Psychology: Science and Practice 2006, 13, 179–193. RCT with non-active comparison (wait list, placebo, low level exercise, health education) Depression secondary to medical illness excluded

22 Mean overall effect size: 1.39 (95% 0.89 to 1.82)

23 NAgeInterventionEffectRef 3270 Resistance training 3/wk Health seminar 2/wk No Singh, et al Walk x 40 min - 3/wk Chat x 1h - 2/wk Wait list control Social: NO Wait list: YES McNeill, et al Weight lifting 10 wk followed by unsupervised exercise 10 wk Lectures x 10 wk Beck DI at 26 mo Singh, et al Exercise 3/wk x 16wk Antidepressant Combination No difference 20% drop out Blumenthal, et al Weight/stretch x 10wk Health Education p = 0.05 Mather, et al. 2002

24 All the world's a stage, And all the men and women merely players; They have their exits and their entrances; and one man in his time plays many parts, His acts being seven ages……………. Last scene of all, that ends this strange eventful history, Is second childishness and mere oblivion; Sans teeth, sans eyes, sans taste, sans everything." Shakespeare Wm. As you like it. Act II, Scene VII

25 How much?

26 Cognitive Activity Scale (0-42) Dementia Hazard ratio 0.93 (7% risk reduction) 1 4

27 Low levels of participation! 73 urban elderly Mean age 80.5 y 90% women Ambrose AF, Poster A77: AGS 2005 Mean activity scores

28 Mechanisms Cardiac fitness Neurobiological benefits of exercise: Serotonin, endorphin, neurotrophic factors Stress Improved sleep patterns Cognitive reserve

29 Brain effects 6 month RCT 59 sedentary elderly Aerobic exercise group vs. stretching/toning Colcombe et al. J Gerontol A Biol Sci Med Sci2006

30 11 subjects 33y (21-45) Aerobic 4/wk x 11 Pereira As, et a. PNAS 2007

31 Can leisure activities be bad for you? Daily TV viewing1.32 (1.08 – 2.62) Social activities 0.82 (0.68 – 0.98) Physical activities1.11 (0.89 – 1.38) Intellectual activities0.84 (0.72 – 0.98) Adjusted for age, gender, education, and income. Lindstrom, et al. Brain & Cognition, 2005

32 Exercise Challenges 1 Small studies, volunteer populations Brief follow-up. Effective short term but long term? Give up easily: 20% drop out rate Less active at baseline Poor maintenance behaviors: dyads

33 Exercise Challenges 2 Aerobic vs. Anaerobic Physical, Cognitive, Social, or all three? Cognitive domain specific Biomarkers (track effect and change)


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