1. Exercise and the Brain Karen Lindgren, Ph.D.

2. 2 By 2014 our distinct ability to deliver high quality individualized services in modern living, learning and working environments will exceed stakeholder expectations and secure Bancroft as the region’s elite provider of services to people with intellectual and developmental disabilities and brain injuries. Our Core Values To ensure that every person is given opportunities for lifelong learning and fulfillment. We do this by altering perceptions, and by supporting those with intellectual and developmental challenges and acquired brain injuries in achieving their life goals as valued and respected members of our world. Responsible Empathetic Supportive Passionate Empowered Committed Trustworthy R E S P E C T Our Vision Our Mission

3. 3 Strength of mind is exercise, not rest -Alexander Pope It is exercise alone that supports the spirits, and keeps the mind in vigor - Marcus Tullius Cicero

4. 4 Goals How does exercise benefit general health? How does exercise benefit neurological health? What are specific cognitive benefits of exercise? What is neuroplasticity? How does exercise benefit neuroplasticity?

5. 5 Format GEOGRAPHY OF THE BRAIN WHAT IS NEUROPLASTICITY EXERCISE o What it is o Physiology EXERCISE AND THE BRAIN o Simple connections o Complex connections

6. 6 The link should be clear Our brain is a physical organ Our brain is a thinking organ

7. 7 The link should be clear Exercise helps us physically strengthens: hearts, bones, lungs, blood vessels physical changes should be related to thinking changes Like our other organs, our brain is a constantly changing organ

8. 8 The brain: physical organ Geography of the brain Brain basics Neurons Blood vessels Neurotransmitters

9. 9 The brain: a thinking organ What is thinking? Cognition refers to any mental process

10. 10 What is cognition? Areas of cognition include: Attention Concentration Sensory skills Motor skills

11. 11 What is cognition? Areas of cognition include: Language Visual Skills Memory Problem solving/judgment moral reasoning

12. 12 Brain Geography

13. 13 Neuroplasticity What is neuroplasticity? Refers to the ability of the brain to shape itself according to experience Refers to physical change on a neuronal level

14. 14 Neuroplasticity What changes when we learn? Neurons connect with other neurons Synapses strength changes with learning More synapses form between neurons

15. 15 What is exercise? Types Cardiovascular Weight training (resistance training) Intensity Active lifestyle Light Vigorous

16. 16 What happens when we exercise? Heart rate increases Hormones respond Pituitary gland releases human growth hormone to increase production of bone, muscle, or connective tissue cells. Pituitary gland regulates Thyroid Adrenal

17. 17 Pituitary Gland Located in brain, limbic system Influences: o Thyroid: neck o Adrenal: kidneys

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19. 19 What happens when we exercise? Hormones respond Pituitary gland regulates thyroid gland Thyroid: releases hormones Increase heart rate and blood pressure Regulate body temperature Elevate “alertness” in brain to increase concentration and reaction time

20. 20 What happens when we exercise? Hormones respond Pituitary gland regulates o Adrenal glands: In response to the ACTH (adrenocorticotropin) from the pituitary, release o 1. cortisol: causes blood pressure to rise, triggers increase in glucose, acts as anti-inflammatory agent (repairs tissues) Curbs non-critical functions (e.g., thirst, urine, hunger). Effects immune system.

21. 21 What happens when we exercise? Hormones respond Pituitary gland regulates o Adrenal glands: In response to the ACTH (adrenocorticotropin) from the pituitary, release o 2. aldosterone: bodily response to anticipate dehydration through impact on kidney function.

22. 22 What happens when we exercise? Hormones respond Pituitary gland regulates o Adrenal glands: In response to the ACTH (adrenocorticotropin) from the pituitary, release o 3. adrenaline (fight or flight) mechanism. A stimulant, increases strength and frequency of heart contractions. Speeds breakdown of stored carbs into glucose for muscle energy.

23. 23 Section Break GEOGRAPHY OF THE BRAIN WHAT IS NEUROPLASTICITY EXERCISE o What it is o Physiology EXERCISE AND THE BRAIN o Simple connections o Complex connections

24. 24 Exercise and the Brain: How do we know they are linked Studies vary greatly (meta-analysis, Kramer et al) Ages vary Length of time looked at varies Exercise type varies Method of reporting varies (often self-report) Method of reporting cognitive skill varies (e.g., MMSE screen, neuropsych, presence of dementia)

25. 25 What is the link? Simple links Increased blood flow to the brain is good for us Simple mind/body benefits: mindfulness training, yoga Complex links Neuroplasticity Preventing problems Improved mood--- improved thinking

26. 26 Simple connections Exercise improves blood flow to the brain Is increased blood flow related to improved cognition?

27. 27 Simple connections Physical effects of exercise Increased blood flow to the brain o Blood volume increases o Blood flow is more “predictable” o Small vessels grow – increase in number Study of 16 women aged 60 and older, walking briskly 3-4 times per week, improved blood flow up to 15 %

28. 28 Simple connections Physical effects of exercise Brings O2, glucose, nutrients to brain cells, vital for cell health Cell growth: supports new connections, particularly in hippocampus- memory Blood washes away “metabolic wastes” such as “amyloid beta protein” (implicated in development of Alzheimers)

29. 29 Simple connections Walking: Increases blood circulation Increased oxygen and glucose to the brain Not strenuous- muscles do not use extra oxygen and glucose as in more strenuous exercise In sum, you oxygenate your brain “Clear your head”

30. 30 Complex Links Complex links Prevents primary neurologic disease Promotes healthy normal aging Neuroplasticity Improved mood--- improved thinking

31. 31 Exercise prevents primary neurologic disease Primary Neurologic Disease Vascular disease o Cholesterol lowering effects of exercise o Exercise lowers blood pressure:  High blood pressure is related to stroke and mild cognitive impairment o Increased blood flow o Increased vessels

32. 32 Exercise promotes healthy aging Normal Aging Ameliorates decline: Canadian researchers 1 examined active lifestyle for “elderly” individuals over 2-5 years, showed stability in cognitive functioning for individuals who were active, greater change if sedentary. 90% of individuals with greatest daily energy scored consistently on tests each year Activities included walking, cooking, cleaning 1. Archives of Internal Medicine, 2011

33. 33 Exercise promotes healthy aging Normal Aging More specifically, women in 70’s with vascular disease showed a slower rate of cognitive decline than the active group. Editorial (Dr. Eric Larson) noted the goal was to slow the onset of dementia.

34. 34 Exercise promotes healthy aging Normal Aging A second study 2 showed that light duty weight training has neurological effects. After one year, older women who lifted 2x per week showed changes on both functional MRIs and cognitive tests. 2. Neurobiology of Aging, 2011

35. 35 Exercise promotes healthy aging Normal Aging: start early! Mayo clinic study of 1,126 individuals with “normal cognition” (as opposed to Mild cognitive impairment) 3 Individuals with Moderate exercise during midlife were less likely to develop impairment in later life 3. Archives of Neurology, 2011

36. 36 Exercise promotes healthy aging Exercise prevents onset of dementia Meta analysis of 1600 research papers examining role of exercise in perserving cognitive abilities Conclusion: Important therapy against dementia

37. 37 Exercise promotes healthy aging “…you can make a very compelling argument for exercise as a disease-modifying strategy to prevent dementia and mild cognitive impairment, and for favorably modifying these processes once they have developed.” -- J. Eric Ahlskog, M.D., Ph.D., neurologist, Mayo Clinic

38. 38 Exercise promotes healthy aging Other Neurologic Disease Parkinson’s Disease o Researchers 4 followed 140,000 people with avg. age of 63 for 10 years. o Moderate to vigorous activity levels were related to a 40% less chance to develop Parkinsons than those with light or no activity levels. o Not clear if the relationship is focused on short term or long term (i.e., do you need to start exercising at 40?) 4. American Academy of Neurology, 2007

39. 39 Exercise promotes healthy aging Other Neurologic Disease Mild cognitive impairment (MCI): each year, 10-15% of individuals with mild cognitive impairment will develop dementia 5. Study: 33 adults with MCI. 23 assigned randomly to aerobic group and exercised at high intensity levels for 45-60 minutes per day, 4 days per week, with a trainer. Control group: 10 individuals performed supervised stretching with low heart rate. 5. Archives of Neurology, 2011

40. 40 Exercise promotes healthy aging Other Neurologic Disease Found improved fitness (body fat analysis, metabolic markers) and improved cognition. Cognitive improvements were more marked in women than men. This may be related to body’s use of insulin, glucose, and cortisol, which differed between the sexes.

41. 41 Exercise and Stress Chronic cortisol release leads to detrimental effects: o Chronically high cortisol reduces dopamine Exercise initially mimics this effect Regular exercise training helps to reduce cortisol levels (e.g., a 20 minute walk ceases to be “stressful” to the body).

42. 42 Mood Benefits Exercise improves stress tolerance: Exercise causes a drop in stress hormones Improves “resilience” to stress Brain-derived neurotrophic factors (BDNF) o “fertilizer” of the brain’s neurons o Grow more quickly, develop stronger connections o Associated with improved cognition, mood

43. 43 Mood Benefits Exercise improves stress tolerance: Rats assigned to 4 groups 6 : o Engaged in “voluntary running” o Given antidepressants o Both o Neither Rats then underwent a 2-day “forced swimming” procedure 6. California State University, 2001

44. 44 Mood Benefits Exercise improves stress tolerance: Results: o BDNF levels in untreated animals were depressed o Animals that were given physical training or antidepressants had BDNF restored to baseline o Animals with both showed increase in hippocampal BDNF well above baseline.

45. 45 Mood Benefits Improved mood improves cognition: Exercise has an “antidepressant effect” Antidepressant effect of running was associate with more cell growth in hippocampus 9 9. Proceedings of the Academy of Natural Sciences, 2010

46. 46 Does exercise foster neuroplasticity? Exercise increased growth factors in brain making it easier to grow new connections 10 Mice that ran on a wheel had twice as many new brain cells as mice housed in standard cages 11. As a comparison, provided mice with other “enriched” environments (e.g., “free swim”)- only running produced the effect. o Growth was in the hippocampus (learning and memory) 10. UCLA, 2011 11. Nature Neuroscience, 1999

47. 47 Does exercise foster neuroplasticity? Illinois researchers scanned brains of 55 individuals aged 55-79, measured maximal O2 during exercise 12 Used MRIs and functional imaging to examine age- related brain shrinkage Results: fit subjects had less shrinkage in temporal, parietal, and frontal areas- crucial for learning and memory 12. Journal of Gerontology, 2003

48. 48 Does exercise foster neuroplasticity? Meta-analysis of 18 controlled studies of cognitive function and aerobic fitness for individuals aged 55-80 13 13. Psychological Sciences, 2003

49. 49 Does exercise foster neuroplasticity? Results: Exercise had clear, selective cognitive benefits for attention, organization, planning Frontal skills Strength training combined with aerobic fitness was most effective Exercise sessions of less than 30 minutes per session had little impact

50. 50 Does exercise foster neuroplasticity? Brain-derived neurotrophic factors (BDNF) “fertilizer” of the brain’s neurons o Grow more quickly, develop stronger connections Associated with improved cognition, mood

51. 51 Does exercise foster neuroplasticity? Brain-derived neurotrophic factors (BDNF) produced in the brain during endurance training produced peripherally in resistance training, circulates to the brain University of Florida study: 20 college aged men 14 o Increased neurotrophic factors at 1, 30 and 60 minutes after endurance training 14. American College of Sports Medicine, 2010

52. 52 Cognitive exercise Cognitive exercise has similar effects Two together have strongest effects Visualizing exercise improves neuroplasticity as well Best exercise is novel tasks: at any level

53. 53 Yoga is cognitive and physical Yoga, mind/body connection is good for us Yoga decreases depression, anxiety, hypertension, stress

54. 54 Yoga is cognitive and physical Yoga: the research Enhanced effects of meditation alone Study of novice participants in a 12-week yoga training program 15 15. Journal of Alternative and Complementary Medicine, 2009

55. 55 Yoga is cognitive and physical Results: EEG changes were greater in left hemisphere Participants experienced greater ability to activate their brain, particularly right hemisphere, through yoga Increased blood flow in right pre-frontal cortex Changes in amygdala, sensorimotor cortex consistent with changes in processing emotions and sensory phenomena

56. 56 Conclusions Cognition is complex MIND-MOOD-BRAIN all connected to health

57. 57 Conclusions Exercise is shown to positively affect cognition in the following ways: Improving blood circulation Increased availability of oxygen and nutrients Clears metabolic waste

58. 58 Conclusions Exercise prevents disease: Cardiovascular effects decrease risk of stroke Shown to prevent Alzheimers, Parkinsons, mild cognitive impairment onset

59. 59 Conclusions Regular exercise decreases our symptoms of stress (e.g., lowers cortisol) Improves resiliency Improves mood- acts as an antidepressant Increases growth of neurons in key areas: o Frontal lobes, hippocampus

60. 60 Practical Advice The Basics: Do something Stick with what you stick with Every bit counts: even 20 minutes of exercise facilitates brain function

61. 61 Practical Advice The Details: Exercise has short term effects of mood, concentration, memory and stress that last for several hours after exercise Moderate exercise for a six month time frame is beneficial to begin to see long term benefits

62. 62 Practical Advice The Details: Exercise should continue with age Exercise that encourages cognitive focus has additional benefits : find something that challenges you (ballroom dancing, a new class, yoga, etc.) Exercise that is interesting is also good (vary your walk!)

63. 63 Special Information: Brain Injury Exercise after concussion is not recommended: REST IS RECOMMENDED

64. 64 Special Information: Brain Injury For all these reasons, exercise is important for long term recovery from a brain injury Promotes mood Promotes stable sleep patterns Promotes physical health Promotes self-efficacy, improved views of health Promotes neurogenesis in animal models Increased blood flow in hippocampus

65. 65 Special Information: Brain Injury For all these reasons, exercise is important for long term recovery from a brain injury Promotes mood Promotes stable sleep patterns Promotes physical health Promotes self-efficacy, improved views of health Promotes neurogenesis in animal models Increased blood flow in hippocampus

66. 66 Questions?

67. 67 Thank you for joining us!