ABSTRACT: Exercise improves memory/cognition and mood in an older disabled population at risk for dementia.
INTRODUCTION: Multi-domain lifestyle interventions are becoming a leading strategy for preventing Alzheimer’s (AD) and other dementias, and for top clinicians treating patients to restore or maintain memory, cognition and mood during early-middle phases of neurodegenerative illnesses. ¹ While delivering promising outcomes in research settings, the community based application of such programs can be complicated, expensive, and often proceed without knowing the relative therapeutic value of their many individual epigenomic components. ²A core element of all comprehensive cognitive improvement programs is endurance exercise, which by itself facilitates neuroplasticity and enhances brain functions at molecular and cellular levels. This includes the development of enhanced synaptic ‘superhighways’, and the growth of new cells in the hippocampus, the brain’s learning and memory center, and a nexus for AD’s clinical toxicity. ³
Patients with major psychiatric diseases have long been considered a population at risk to develop dementias, with some experts even suggesting recurrent/refractory major depression, schizophrenia and bipolar illness may for some, be a prodromic stage of AD. ⁴ This pilot research study investigates how two months of endurance stationary bicycling three times weekly impacts memory, cognition and mood in a chronically disabled behavioral health population.
THE PREMISE: Consistent endurance exercise for 20-30 minutes three times weekly produces Brain Derived Neurotrophic Factor, or BDNF, which changes gene expression to facilitate: neurogenesis (creation of new brain cells), synaptogenesis (new development of the brain’s intercellular communication infrastructure), angiogenesis (growth of blood vessels supplying oxygen/nutrients to brain cells and synapses), and boosted neurotransmitter production. ⁵ ⁶ Decreased BDNF is associated with age-related hippocampal deterioration, memory impairment, and depression, whereas increased BDNF via aerobic exercise mediates hippocampal atrophy, improves memory, and enhances mood. ⁷ It is hypothesized that the BDNF-driven neuroplasticities bolded above are stimulated by neuroepigenetic changes in gene expression triggered by endurance exercise at threshold, thus operationalizing brain conditions for improved cognition, memory and mood.
PURPOSE: The need for uncomplicated affordable solutions that improve or ameliorate memory/cognitive symptoms, and mood, for patients at risk for, or experiencing dementia, is academic. The research thus-far on endurance exercise has not answered the essential question(s) for individuals/families struggling with mild cognitive impairment (MCI) or dementia: What easily accessible endurance exercise works to improve memory, cognition and mood…and for how often, and for how long must one exercise to ensure best outcomes…and how much does endurance exercise help? Since many in this target population are seniors with orthopedic limitations, a low-cost, safe exercise was selected that might offer neuroprotection, cognitive enrichment, and antidepressant effects, as hypothesized - stationary recumbent bicycling.
METHODS: For this 8-week prospective pilot research 20 volunteers attending an adult behavioral health daycare were recruited to engage in endurance exercise recumbent cycling for 20-30 minutes 3 times per week. 17 subjects (10 men and 7 women) completed the study. Standard measures of memory/cognition (MMSE and St. Louis University Mental Status Examination for Detecting Mild Cognitive Impairment/Dementia - SLUMS), and mood (BECK Depression Inventory), were collected before, at 4 weeks, and after 8 weeks of cycling. This project was coordinated by a prospective medical student with research assistant experience at two of the nation’s leading Alzheimer’s/Dementia Research Centers.
RESULTS: At the study’s 8-week conclusion all subjects showed improved cognitive functioning scores, and 15 of 17 exhibited mood improvement. Most importantly, advanced bio-statistical analysis determined these findings to be statistically significant. Regarding memory/cognition, 8 subjects had their scores increase from the MCI range to Normal Cognition – and 1 subject progressed from dementia to MCI respectively. At the 4-week mark this was not the case. These research results indicate that recumbent cycling endurance exercise 3-times a week for a 20/30-minute threshold improves memory, cognition and mood in a chronically disabled population at risk for AD – suggesting a new care standard. To further confirm these breakthrough findings, controlled studies with larger samples are warranted.
*[The authors are grateful for the help and support of staff and volunteers at Living Well Adult Day Care. This pilot research study was funded by the founders of Brain In Play Nonprofit Foundation]