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Exercise as an intervention across cognition and mood Joe Verghese, MBBS, MS

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).

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Exercise as an intervention across cognition and mood Joe Verghese, MBBS, MS

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  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: 1980-1983 488 volunteers Age 75-85 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 12-18 mo follow-up visits Study period: 1980-2001 • 124 Dementia • Vascular dementia • 25 Mixed dementia

  8. Cognitive

  9. Physical

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

  11. Hazard ratio (95% CI) Cognitive Physical Dementia 124 0.93 (0.90-0.97) 1.00 (0.98-1.03) Vascular 30 0.92 (0.86-0.99) 1.01 (0.97-1.04) Mixed25 0.87 (0.78-0.93) 0.90 (0.83-1.03) aMCI 58 0.95 (0.91-0.99) 0.97 (0.93-1.00) VCI83 0.94 (0.91-0.98) 1.01 (0.98-1.04) Verghese NEJM 2003, Neurology 2006

  12. Honolulu-Asia study 2257 men 71-93y Vs. 2mi/day <0.25: HR 1.77 0.25 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 (0.45-1.05)

  13. Dancing and risk of dementia Adjusted Hazard Ratio 0.24 (0.06-0.99) Verghese J, N Engl J Med 2003

  14. Dancers Non-dancers p (24) (84) ------------------------------------------------------------ ------ Blessed test 2.0 2.0 .92 FCSRT 47.9 47.9 .79 Block design 23.1 23.1 .97 Digit span 14.5 14.9 .52 Digit Symbol 45.3 46.1 .75 Verbal Fluency 39.1 37.8 .67 Trail Making B 146.5 165.4 .95 Matched by age, sex, and education. Dancers have better gait but not cognition Verghese J, J Am Geriatr Soc 2006

  15. Life-p

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

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

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

  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. 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

  24. How much?

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

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

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

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

  29. 11 subjects 33y (21-45) Aerobic 4/wk x 11 Pereira As, et a. PNAS 2007

  30. Can leisure activities be bad for you? Daily TV viewing 1.32 (1.08 – 2.62) Social activities 0.82 (0.68 – 0.98) Physical activities 1.11 (0.89 – 1.38) Intellectual activities 0.84 (0.72 – 0.98) Adjusted for age, gender, education, and income. Lindstrom, et al. Brain & Cognition, 2005

  31. 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

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

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