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Tsolaki

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Physical Activity

Physical Activity

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  • Physical activity, cognitive functioning, and aging. Both cross-sectional and prospective cohort studies have linked participation in regular physical activity with a reduced risk for dementia or cognitive decline in older adults. Examples include the Study of Osteoporotic Fractures (268), which reported that activity level was linked to changes in Mini-Mental Status Examination scores, and the Canadian Study of Health and Aging, which demonstrated that physical activity was associated with lower risk of cognitive impairment and dementia (138). It also seems that decreases in physical mobility are linked to cognitive decline (127). The InCHIANTI study reported an association between physical mobility, specifically walking speed and ability to walk 1 km, with signs of neurological disease (65). Similarly, the Oregon Brain Aging Study reported an association between walking speed and onset of cognitive impairment (147) Finally, the MacArthur Research Network on Successful Aging Community Study reported associations between declines in cognitive performance and routine physical tasks including measures of grip strength and mobility (i.e., walking speed, chair stands) (238). Experimental trials of exercise interventions in older adults demonstrate that acute exposure to a single bout of aerobic exercise can result in short-term improvements in memory, attention, and reaction time (39), but more importantly, participation in both AET and RET alone, and in combination, leads to sustained improvements in cognitive performance, particularly for executive control tasks (39). Several studies have compared the individual and combined effects of physical and mental exercise interventions (61,177). These studies found cognitive benefits to be larger with the combined cognitive and aerobic training paradigms. The mechanism for the relationship between physical activity and exercise and cognitive functioning is not well understood; however, several researchers have suggested that enhanced blood flow, increased brain volume, elevations in brain-derived neurotrophic factor, and improvements in neurotransmitter systems and IGF-1 function may occur in response to behavioral and aerobic training (40,134).
  • The battery of psychomotor measures included simple and complex tasks which assess flexibility, strength of upper limbs, agility, dynamic balance, eye-hand coordination, reaction time, orientation, dexterity, balance, hand rapid movements, neuromuscular coordination and attention (Mouzakidis, 1998)
  • In the main exercise period ( 45 minutes), were chosen exercise routines that improve flexibility, strength of upper and lower limbs, endurance, dexterity, balance, agility, speed, attention and accuracy, co-ordination, orientation, memory, self-control, and co-operation among the patients. The exercise routines were flexible. They could be modified to the needs and the abilities of a patient without causing any feelings of discomfort to the rest of the team. There was a combination of standing and sitting exercises with one or two sets and five repetitions, which they were increasing gradually to 8 or 10 according to the level of the patients. The instructions were simple and rhythmic. The physical educator was using the same words and the same presentation for a specific exercise routine. To those who faced some difficulties to follow an exercise routine it was given one-on-one help. Furthermore, accordingly to the difficulty of the exercise routine, the physical educator provided the patients with encouragement, feedback, and reinforcement.
  • Paired Samples t-tests revealed that the patients of the experimental group managed to maintain their cognitive abilities ( t (11) = 0.692, p = 0.504), while the patients of the control group deteriorated ( t (11) = 3.570, p = 0.004).
  • Paired samples t tests indicated that the participants improved their performance in 8 out of 16 psychomotor measures, ie., reaction time, repetitive arm and hand movements , handgrip strength, sequential arm and hand movements , reeling string on a stick , throwing a b all , static balance, and in sit and reach . Mean scores, standard deviations, p values, and within-group pre-test to post-test comparisons for all psychomotor measures appear in Table 4 .
  • Transcript

    • 1. Physical activities and Cognitive function Magda Tsolaki, MD, PhD Neuropsychiatrist Professor of Aristotle University of Thessaloniki Chair of Greek Alzheimer Federation www.alzheimer-hellas.gr
    • 2.  
    • 3. Age is #1 Dementia Risk Factor
    • 4. Numbers in Greece
      • 1. Prevalence , 9% in subjects more than 70 in Pylea, Thessaloniki
        • 2. In Great Alexander municipality 3,6% >65
          • Tsolaki M. et al, AJAD, 1999
          • Tsolaki M. et al, ADI2010
      • Family
      • Ε4 (11% vs 32% )
      • Olive oil
      06/01/11
    • 5. Alzheimer's disease
    • 6.  
    • 7.  
    • 8.  
    • 9.  
    • 10.  
    • 11.  
    • 12.
      • MIND
      • YOUR BODY
      • and YOUR BRAIN
    • 13. Alzheimer Disease Progression Deterioration Time in years From S GAUTHIER 1996  Clinical Phase ? Mood disturbances Cognitive impairments Impaired activities of daily living ADL Behavioural disturbances Motor disorders
    • 14.
      • LITERATURE
      • P articipation in both aerobic and resistance training exercises alone, and in combination, leads to sustained improvements in cognitive performance, particularly for executive control tasks
      • ( MEDICINE & SCIENCE IN SPORTS & EXERCISE , 2009 ; 1510-1530)
    • 15. Guidelines for Physical Activities
    • 16. Physical Exercise: Mechanisms of action
      • 1.CNS neuronal apoptosis is a consequence of exercise in the adult rat and suggests that this process is a potential mediator of rapid exercise-induced plasticity. Exercise in mouse models causes neurogenesis in the dentate gyrus.
      • Alzheimers Res
      • Ther. 2011 Feb
    • 17. Physical Exercise: Mechanisms of action
      • 2.Exercise engages arousal mechanisms in the reticular-activating system, which involves a big number of neurotransmitter systems.
      • 3. Exercise, also, disengages the higher-order functions of the prefrontal cortex.
      • 4. Improvement of blood circulation and brain oxygen supply J. Am Geriatr. Soc., 38, 123-128, 1990.
    • 18. Possible effect of interventions which delay the onset of dementia Prevalence in USA Delay (years)
    • 19. ANIMAL MODELS ( Combination of physical and cognitive exercise )
    • 20. NBBMBNMBNMBSSS
    • 21.  
    • 22. Other MECHANISMS
      • The current experiment assessed levels of apoptosis , angiogenesis , and neurogenesis during the first week of an exercise regimen in the adult rat. The results indicate that exercise rapidly induces these processes in the hippocampus and cerebellum
      • Behav Neurosci. 2011 Feb
    • 23. TRIALS IN HUMANS ( ONLY PHYSICAL EXERCISE )
    • 24. ACSM (American College of Sports Medicine), 2009
      • At least 3 times a week for two weeks
      • ~ 1 hour
      • Warm-up period 5-10 min.
      • Main Part 40-50 min.
        • Stretching 8-10 min.
        • Strength (upper body) 10-15 min
        • Flexibility - Aerobic 8-10 min.
        • Balance – Strength (lower body) 15 min.
      • Cool down period 5 min
    • 25. FFA, Scientific issues
      • Organized interventions of Increased difficulty
      • Assessment
      • Subjective criteria : Heart rate and blood pressure
      • Subjective criteria : Borg Scal e
      Borg Scale
    • 26. Physical exercise and cognitive function
      • Multiple results of physical exercise on cognitive function
      • 3 reviews -meta-analysis and 7 studies
      • Principles
      • Scientific model of improvement of cognitive functions – clear methodology and target
      • Severity of exercise according the abilities of participants. – step by step changes of exercises
      • Every patient can do different activities
      • Balance between duration of exercise and frequency
    • 27. Physical exercise and Cognitive function
      • Principles of body exercise
      • Medical follow up
      • Organization of the program according abilities
      • Use of experience
      • Encourage of independence
      • Characteristics of exercise :
      • Simple ,
      • preparation – main part - relaxation
      • Socialization
    • 28. Physical exercise and Cognitive function
      • Suggestions
      • Duration (31 – 45 mins )
      • Bigger improvement ( more than 6 months) .
      • Moderate aerobic exercise
    • 29. Authors Year Participants Intervention Results Molloy et al 1988 N= 15, MMSE: 24 1 st group : mild aerobic exercise 45΄/ once a week for two weeks 2 nd group : no intervention Improvement in verbal fluency Mulrow et al 1994 N= 194, MMSE: 21 1 st group ασκήσεις ενδυνάμωσης, ισορροπίας, κινητικότητας. 2 η ομάδα: φιλικές επισκέψεις. 45΄/ 3 φορές την εβδομάδα/ 16 εβδομάδες Moderate motor improvement Baum et al 2003 N= 20 MMSE: 21 1 η ομάδα: εύρος κινητικότητας καθισμένου 2 η ομάδα: ψυχαγωγικές δραστηριότητες 60΄/ 3 φορές την εβδομάδα/ 6 μήνες Improvement in physical status and MMSE Stevens et al 2006 N= 75 MMSE: 9 - 23 1 η ομάδα: σωματική άσκηση 2 η ομάδα: κοινωνικές επισκέψεις 30΄/ 3 φορές την εβδομάδα/ 12 εβδομάδες 2 η ομάδα: καμία παρέμβαση Delay of cognitive and physical deterioration
    • 30.  
    • 31. Physical Exercise Proximal F/U Hillman et al. Nature Reviews Neuroscience (2008)
    • 32. RCT of PE x in MCI with Longitudinal FU
    • 33. RCT of PE x in MCI with Longitudinal FU Lautenschlager et al. 2008
    • 34. RCT of PE x in MCI with Longitudinal FU
    • 35. RCT of PE x in MCI with Longitudinal FU
    • 36. PEx Reorganises Hippocampal Synaptic Connectivity Joyce Siette In preparation
    • 37. What about combining cBT and PEx?
    • 38.  
    • 39. TRIALS IN HUMAN (PROTECTIVE)
    • 40. Can Physical Exercise Prevent Cognitive Decline?
    • 41. PHYSICAL EXERCISE AND DEMENTIA
      • P hysical activity or exercise can prevent or delay the onset of age-related cognitive impairment or dementia ( Middleton K.R., 2007)
      • P ositive effects of physical activity on
      • attention,
      • memory,
      • communication,
      • executive functions and
      • global mental functioning, in older people with dementia. ( Eggermont L., Swaab D., et al, 2005; Fang Yu, Kolanowski A. M., 2006)
    • 42.  
    • 43. TRIALS IN HUMAN (THERAPEUTIC)
    • 44.  
    • 45.  
    • 46.  
    • 47. OUR EXPERIENCE
      • RHEA, a non pharmacological cognitive training intervention in patients with Mild Cognitive Impairment ( MCI): A Pilot Study
      •  
      • Kounti F, 1, 2 Bakoglidou E, 1, 2 Agogiatou C, 1, 2 Emerson Lombardo NB, 5 Serper LL, 4 Tsolaki M 1, 2, 3
    • 48. PARTICIPANTS
      • 58 MCI patients with MMSE= 27.69 , assigned to 2 groups of 29 each (experimental, 20-weekly RHEA sessions, and no-therapy control), matched for age, gender, education, cholinesterase inhibitors, cognitive abilities.
    • 49. NEUROPSYCHOLOGICAL TESTS
      • MMSE [ Mini Mental State Examination - MMSE ( Roth , Huppert , Tum , & Mouthjoy , 1988)]
      • TEA [ Test of Every Day Attention( Robertson et al., 1989)]
      • RBMT [Rivermead Behavioural Memory Test ( Wilson et al., 1989) ]
      • ROCFT [Rey Osterreith Complex Figure Test (Rey, 1941) ]
    • 50. NEUROPSYCHOLOGICAL TESTS
      • FUCAS [ Functional Cognitive Assessment Scale - FUCAS ( Kounti , Efklides, Tsolaki , & Kiosseoglou , 200 6 )]
      • WCST [Wisconsin Card Sorting Test ( Berg , 1948) ]
      • ΧΣΑ [Verbal fluency (Kosmidis , Vlachou , Panagiotaki , & Kiosseoglou , 2004) ]
      • FRSSD [ Functional Rating Scale of Symptoms of Dementia - FRSSD ( Hutton , 1990) ]
    • 51. RHEA Intervention Design and Rationale
      • The RHEA intervention was 90 minutes duration, once a week, for 20 weeks.
      • The tasks are ecological. The stimuli that are used are shapes, colours, sizes, and numbers. The technical materials include wreath, boards with letters, cards with colours, shapes and numbers, corridors with numbers, balls, wands, rings, and cones.
    • 52. RHEA Intervention Design and Rationale
      • Each session includes 5 exercises lasting approximately 15 minutes each.
      • The program has tasks with an increasing degree of difficulty varying according to the cognitive and kinetic performance of the participants
    • 53. 1 st Exercise (Free movements)
    • 54. 1 st Exercise (Free movements)
    • 55. 2 nd Exercise: Walking
    • 56. 2 nd Exercise (Walking)
    • 57. 3 rd Exercise (Balance)
    • 58. 3 rd Exercise (Balance)
    • 59. 4 th Exercise (mild movement abilities)
    • 60. 4 th Exercise (mild movement abilities)
    • 61. 5 th Exercise (Free voluntary movements)
    • 62. 5 th Exercise (Free voluntary movements)
    • 63. Results (MCI)
      • The benefit of the experimental group was in Attention (p=0.002),
      • Language(p=0.015),
      • Visual-spatial (p=0.013),
      • MMSE (p=0.047),
      • ADL(p=0.009).
      • Experimental participants improved cognitive and functional performances while control participants remained stable.
    • 64. OUR EXPERIENCE EFFECTS OF AN EXERCISE INTERVENTION ON COGNITIVE FUNCTION OF ALZHEIMER’S DISEASE PATIENTS C.A. Mouzakidis, M.Tsolaki
    • 65. METHODS
      • 2 4 AD patients
      • Exercise Group (n=1 2 ). Mean Age = 65 . 70 , SD = 7 . 73,
      • Education = 9 . 33 , SD = 2 . 90.
      • Control Group (n=1 2 ). Mean Age = 6 8.5 0 , SD = 3.8 7,
      • Education = 8.92, SD = 4.72 .
      • Assessment
      • Cognitive Functions (MMSE)
      • Psychomotor Measures
    • 66.
      • Equipment
      • Colored easy controlled balls, sticks, hoops of different sizes, plastic bottles, soda cans, tennis balls, chairs, dumbbells.
      • Duration
      • 36 weeks (3 times/week)
      • 90 minutes/time
      • Description of Exercise Program
      • Warm up Period (30’). Aerobic & range of motion exercises
      • Main Exercise Period (50’). flexibility, strength of upper and lower limbs, endurance, dexterity, balance, agility, speed, attention and accuracy, co-ordination, orientation, memory, self-control, and co-operation
      • Cool down Period (10’). Main purpose to allow the heart rate to return to normal and the body to relax.
    • 67. RESULTS
      • The patients of the exercise group managed to maintain their cognitive and functional abilities, while the patients of the control group deteriorated.
      * p < 0.05 Exercise Group ( n = 12) Control Group ( n = 12) Before Mean ( SD ) After Μ ean ( SD ) Before Μ ean ( SD ) After Μ ean ( SD ) MMSE 18,50 (8,85) 18,33 (9,02) 16,25 (5,64) 12,83 (5,57)*
    • 68. NS = non-significant Soda Pop Test 12 16.50 ( ± 11.79) 13.20 ( ± 11.20) NS Finger Dexterity 12 29.75 ( ± 31.00) 25.85 ( ± 23.26) NS Hand Tapping 12 62.00 ( ± 19.00) 70.00 ( ± 11.67) NS Reaction Time (cm) 12 38.50 (±15.51) 29.70 (±13.75) p = 0.001 Repetitive Arm and Hand Movements Right Hand 12 3.21 (±0.97) 2.75 (±0.74) p = 0.001 Left Hand 12 3.44(±0.97) 3.00 (±0.78) p = 0.010 Grip Test (kg) Right Hand 12 27.58 (±6.37) 30.00 (±7.29) p = 0.007 Left Hand 12 24.33 (±7.40) 26.50 (±8.10) p = 0.007 Sequential Arm and Hand Movements 12 1.75 (±2.05) 0.83 (±2.00) p = 0.050 Reeling String on a Stick 11 17.17 (±11.93) 15.22 (±11.00) p = 0.001 Bounce a Ball 12 2.17 ( ± 2.21) 1.08 ( ± 2.06) NS Throw a B all to a target 12 2.08 (±1.24) 0.92 (±1.24) p = 0.004 Bowling 12 2.17 ( ± 2.33) 3.50 ( ± 2.71) NS Gait Control 11 0.45 ( ± 1.21) 0.09 ( ± 0.30) NS Static Balance 12 25.17 (±22.61) 33.81 (±23.57) p = 0.008 Step Into and Out of a Hoop 12 0.83 ( ± 1.64) 1.58 ( ± 2.35) NS Sit and Reach Test 12 49.25 (±13.50) 52.17 (±15.35) p = 0.006 Agility 12 7.00 ( ± 4.26) 8.25 ( ± 5.67) NS
    • 69.  
    • 70. OUR EXPERIENCE (MCI)
      • Tsolaki M , Kounti F , Agogiatou C , Poptsi E , Bakoglidou E , Zafeiropoulou M , Soumbourou A , Nikolaidou E , Batsila G , Siambani A , Nakou S , Mouzakidis C , Tsiakiri A , Zafeiropoulos S , Karagiozi K , Messini C , Diamantidou A , Vasiloglou M .
      • Effectiveness of Nonpharmacological Approaches in Patients with Mild Cognitive Impairment . Neurodegener Dis. 2010 Dec 3
    • 71. ΝΟΣΟΣ ALZHEIMER Μάγδα Τσολάκη, MD, PhD Νευρολόγος-Ψυχίατρος, Θεολόγος, Αναπληρώτρια Καθηγήτρια, Α.Π.Θ. Πρόεδρος της Ελληνικής Ομοσπονδίας Νόσου Alzheimer
    • 72.  
    • 73. CLINICAL TRIALS ( Combination of physical and cognitive exercise )
    • 74.  
    • 75. What is LLM ?
      • Long Lasting Memories (LLM) is an integrated ICT platform which:
        • combines state-of-the-art cognitive exercises
        • with physical activity
        • in the framework of an
        • advanced ambient assisted living environment.
      2011
    • 76. Component 1: Effects of Physical Exercise in the Elderly
      • Regular physical exercise, significantly improves physical functioning of individuals at any age
      • Engagement of elderly individuals in regular physical exercise programs has demonstrated improvement in
        • aerobic capacity, muscular strength, muscular endurance, flexibility, balance,
        • motor control and performance,
        • skill acquisition,
        • coordination,
        • cognition and psychological well being
        • ( www.who.int/hpr/ageing/heidelberg_eng.pdf )
      2011
    • 77. LLM Design Idea 2011
    • 78. The Pilots
      • Pilots in 5 countries
        • Austria
        • Spain
        • France
        • Greece
        • Cyprus
      2011
    • 79. Expected Results pre post Cognitive Function Theory Expected Results Results from Konstanz: 10 weeks physical training 2 x 45 min/week Hertzog et al., 2009 LLM Control 2011
    • 80. ΓΙΑΤΙ ΟΧΙ AKOMH ΣΤΟ ΑΙΜΑ;
    • 81.  
    • 82. Σας ευχαριστώ Thank you very much for your attention

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