Aging and Exercise

[Diane]

Mindblog always seems to have some useful item (http://mindblog.dericbownds.net/2007/11/exercise-on-brain.html) that is of interest to PT.. This time it has to do with a linked piece (http://dericbownds.net/uploaded_images/Exercise_Brain.htm) about how vigorous daily exercise keeps executive function intact.

[Jon Newman]

More from Deric Bownds: Staying a step ahead of aging (http://mindblog.dericbownds.net/2008/02/staying-step-ahead-of-aging.html)

[Jon Newman]

Cochrane Database Syst Rev. (javascript:AL_get(this, 'jour', 'Cochrane Database Syst Rev.');) 2008 Jul 16;(3):CD005381.http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--www3.interscience.wiley.com-aboutus-images-wiley_interscience_150x34.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3058&itool=AbstractPlus-def&uid=18646126&db=pubmed&url=http://dx.doi.org/10.1002/14651858.CD005381.pub3) Links (javascript:PopUpMenu2_Set(Menu18646126);)
Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment.

Angevaren M (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Angevaren%20M%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPane l.Pubmed_RVAbstractPlus), Aufdemkampe G (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Aufdemkampe%20G%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPane l.Pubmed_RVAbstractPlus), Verhaar H (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Verhaar%20H%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPane l.Pubmed_RVAbstractPlus), Aleman A (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Aleman%20A%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPane l.Pubmed_RVAbstractPlus), Vanhees L (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Vanhees%20L%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPane l.Pubmed_RVAbstractPlus).
Research Group Lifestyle and Health, University of Applied Sciences, Bolognalaan 101, Utrecht, Netherlands, 3584 CJ.
BACKGROUND: Physical activity is beneficial for healthy ageing. It may also help maintain good cognitive function in older age. Aerobic activity improves cardiovascular fitness, but it is not known whether this sort of fitness is necessary for improved cognitive function. Studies in which activity, fitness and cognition are reported in the same individuals could help to resolve this question. OBJECTIVES: To assess the effectiveness of physical activity, aimed at improving cardiorespiratory fitness, on cognitive function in older people without known cognitive impairment. SEARCH STRATEGY: We searched MEDLINE, EMBASE, PEDro, SPORTDiscus, PsycINFO, CINAHL, Cochrane Controlled Trials Register (CENTRAL), Dissertation abstracts international and ongoing trials registers on 15 December 2005 with no language restrictions. SELECTION CRITERIA: All published randomised controlled trials comparing aerobic physical activity programmes with any other intervention or no intervention with participants older than 55 years of age were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Eleven RCTs fulfilling the inclusion criteria are included in this review. Two reviewers independently extracted the data from these included studies. MAIN RESULTS: Eight out of 11 studies reported that aerobic exercise interventions resulted in increased cardiorespiratory fitness of the intervention group (an improvement on the maximum oxygen uptake test which is considered to be the single best indicator of the cardiorespiratory system) of approximately 14% and this improvement coincided with improvements in cognitive capacity. The largest effects on cognitive function were found on motor function and auditory attention (effect sizes of 1.17 and 0.50 respectively). Moderate effects were observed for cognitive speed (speed at which information is processed; effect size 0.26) and visual attention (effect size 0.26). AUTHORS' CONCLUSIONS: There is evidence that aerobic physical activities which improve cardiorespiratory fitness are beneficial for cognitive function in healthy older adults, with effects observed for motor function, cognitive speed, auditory and visual attention. However, the majority of comparisons yielded no significant results.The data are insufficient to show that the improvements in cognitive function which can be attributed to physical exercise are due to improvements in cardiovascular fitness, although the temporal association suggests that this might be the case. Larger studies are still required to confirm whether the aerobic training component is necessary, or whether the same can be achieved with any type of physical exercise. At the same time, it would be informative to understand why some cognitive functions seem to improve with (aerobic) physical exercise while other functions seem to be insensitive to physical exercise.Clinicians and scientists in the field of neuropsychology should seek mutual agreement on a smaller battery of cognitive tests to use, in order to render research on cognition clinically relevant and transparent and heighten the reproducibility of results for future research.

[JasonE]

One of my clients has suffered from MS for over 20 years. In the year or so that I've been training her, she has showed marked improvement both in various physical attributes and overall cognitive function. Here's a short blurb she wrote some months ago: http://cstminnesota.com/5.html#susan

In the 6+ months since she wrote that piece, Susan has resumed creative writing and done public readings, taken on household tasks requiring greater manual dexterity, and increased overall activity levels. Significantly, her friends, family, and physicians have also been telling her that she no longer seems depressed. Her training is designed to stimulate neurological function and improve overall movement efficiency... performance improvements and changes in physical attributes are predictable side effects rather than intended goals.

I take great pleasure in working with older and/or impaired clients that are committed to the process. Older folks are able to accomplish incredible things, and if properly stimulated they tend to "wake up" to what's going on and become very engaged.

I don't really know what exercise protocols are usually used in research studies, but a brief review of some literature indicates the training is usually pretty generic (treadmills, basic weight training, etc) and not terribly mentally stimulating. That's great for minimizing variables, but I feel that such basic protocols necessarily fall far short of showing the true potential of intelligent exercise as a contributor to improving mental function.

[nari]

Jason,

I agree entirely! Physical workouts are helpful, but they must be stimulating and creative as well, rather than mind-numbing.
Learning a new language, even just the basic phrases and sentences is reported to be favourable for neurogenesis, as are cryptic crosswords and stimulating discussions. We have an organisation called University of the Third Age (UTA) designed for the over-60s which is very popular; subjects range from geology to studying medieval poetry.

Nari

[JasonE]

Fascinating, Nari! Sounds like a blast! :)

On the flip side of stimulation, I have one training client with whom I have mainly focused on reducing excess stimulation/innervation. Due to an MVA in infancy, she has severe brain hemisphericity. This has resulted in a lifetime of frequent, baffling health concerns and combinations of signs and symptoms that seemed to make no sense. She was referred to me for training by her primary bodyworker and the chiropractic neurologist that finally diagnosed her condition and established effective treatment protocols.

Because one hemisphere of her brain is so dominant, I have to modify my body position, speech patterns and volume, and the way I teach movements to avoid overstimulation of the one side and/or understimulation of the other. This includes using physical contact in ways that I would not with other clients. She is a professional musician, and I also must often tap into my own musical background to explain the purposed of an exercise and/or how to perform it.

The bulk of our work together has focused on training more efficient and effective body movement, increasing full-body ROM, and improving her breathing habits to facilitate relaxation and performance of ADLs and her music. At first, she needed to wear a blood O2 monitor so we could observe how it changed during training. I was in frequent touch with her health care team. Now we meet weekly to review her progress and seek to either increase the challenge of her "homework" and/or to overcome challenges that have popped up.

Since I started working with her, we've seen many improvements in her health and functionality. She is nearly off her meds, and professionally she is performing at a higher level than she has in years. I doubt there will ever be a study done on the type of training I am doing with this client, but it's great anecdotal experience!

[nari]

Jason, do you remember any figures from the SaO2 monitoring? This has always interested me, from previous days in acute ambulatory care, where nothing short of 90-95% SaO2 was enough, according to the nurses, and we, as PTs, were always disagreeing with them to no avail.

Nari

[Jon Newman]

Jason,

Please do expand on this

She was referred to me for training by her primary bodyworker and the chiropractic neurologist that finally diagnosed her condition and established effective treatment protocols.What was the diagnosis and can you point us toward the "effective treatment protocols"?

Actually, consider starting a new thread unless what you're about to post is within the theme of exercise and aging as this thread is only 8 posts old and the intended topic hasn't received much consideration yet.

[JasonE]

Jason, do you remember any figures from the SaO2 monitoring? This has always interested me, from previous days in acute ambulatory care, where nothing short of 90-95% SaO2 was enough, according to the nurses, and we, as PTs, were always disagreeing with them to no avail.

Nari

Her health pros advised me that they preferred her to have a SaO2 level of 95% or higher when doing manual therapy or therapeutic exercises. When she and I began training, we saw extremely rapid fluctuations from 98% to 79% and back again within the span of a minute or two, all at extremely low levels of exertion and complexity. Her ability to function was retained at lower levels, but she would experience various types of discomfort symptoms until her SaO2 levels went up again. Within a few weeks, we were able to keep her levels at 95% or higher regardless of intensity/complexity, partly due to improved breathing habits. We have been training without the SaO2 monitor for 9 months now, so I don't have recent numbers for you.

[JasonE]

Jason,

Please do expand on this

What was the diagnosis and can you point us toward the "effective treatment protocols"?

Actually, consider starting a new thread unless what you're about to post is within the theme of exercise and aging as this thread is only 8 posts old and the intended topic hasn't received much consideration yet.

John - I don't fully understand the formal diagnosis and won't try to pretend otherwise. The man that made the diagnosis told me it's the most complex case he's ever seen, whatever that means. Regarding "effective treatment protocols" - I know the gamut of therapies has included manual therapies, nutrition, neurological therapies (mental exercises, eye exercises, etc), and so forth. My client has often stated that it's the first time in her life that things seem to be improving consistently, and she is certainly much improved from what I've seen and heard.

I don't believe my knowledge is sufficient to justify starting a new thread on this, so... let's get back to "Aging and Exercise" !

The gym I am at is near several senior living centers, and we have many older members. One gentleman is 91 and going strong, coming in several days each week. He's been a member for 25+ years, and knows most of the regulars that come in each morning. Aside from the benefits of exercise, he obviously gets a lot of stimulation from talking to the other members, flirting with the young ladies, and joking around. Sharp as a tack, he drives and seems to be doing just fine. On the other hand, some older folks that just joined often seem to be a bit lost, almost perpetually confused. It's impossible to know how much of it is the new environment and how much is... something else. The new members that stayed active throughout adulthood seem to be more "with it" than those who did not.