Practical Considerations In Using Exercise to Treat ADHD

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An overview of how to use exercise as a treatment for attention-deficit/hyperactivity disorder, as presented at the international CHADD conference in San Francisco.

An overview of how to use exercise as a treatment for attention-deficit/hyperactivity disorder, as presented at the international CHADD conference in San Francisco.

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  • \n
  • For some of us, exercise become another form of distraction rather than a means to improve focus and concentration. \n
  • In order to move like our paleolithic ancestors, we need to:\n1. Move more frequently in natural settings\n2. Lift heavy things\n3. Sprint \n
  • In order to move like our paleolithic ancestors, we need to:\n1. Move more frequently in natural settings\n2. Lift heavy things\n3. Sprint \n
  • In order to move like our paleolithic ancestors, we need to:\n1. Move more frequently in natural settings\n2. Lift heavy things\n3. Sprint \n
  • 1. O'Keefe JH, Vogel R, Lavie CJ, Cordain L. Achieving Hunter-gatherer Fitness in the 21st Century: Back to the Future. AJM. 2012:1–5.\n\nAbstract: The systematic displacement from a very physically active lifestyle in our natural outdoor environment to a sedentary, indoor lifestyle is at the root of many of the ubiquitous chronic diseases that are endemic in our culture. The intuitive solution is to simulate the indigenous human activity pattern to the extent that this is possible and practically achievable. Suggestions for exercise mode, duration, intensity, and frequency are outlined with a focus on realigning our daily physical activities with the archetype that is encoded within our genome.\n\nWith the advent of TV and the computer, we are sitting an average of 9.3 hours/day. That’s even more time than we spend sleeping (7.7 hours/day). \n\nSitting for more than 6 hours/day makes you 40% likelier to die within 15 years than someone who sits less than 3 hours. Even if you exercise. Studies show that only reducing sitting time helps.\n\n
  • 1. O'Keefe JH, Vogel R, Lavie CJ, Cordain L. Achieving Hunter-gatherer Fitness in the 21st Century: Back to the Future. AJM. 2012:1–5.\n\n\n
  • 1. O'Keefe JH, Vogel R, Lavie CJ, Cordain L. Achieving Hunter-gatherer Fitness in the 21st Century: Back to the Future. AJM. 2012:1–5.\n\n\n
  • 1. O'Keefe JH, Vogel R, Lavie CJ, Cordain L. Achieving Hunter-gatherer Fitness in the 21st Century: Back to the Future. AJM. 2012:1–5.\n\n\n
  • Nature Deficit Disorder refers to a hypothesis by Richard Louv in his 2005 book Last Child in the Woods that human beings, especially children, are spending less time outdoors resulting in a wide range of behavioral problems\n\n Key references\n1. Taylor AF, Kuo FE, Sullivan WC: Coping with ADHD: The surprising connection to green play settings. Environ Behav 2001, 33:54-77.\n2. Kuo FE, Taylor AF: A potential natural treatment for attention-deficit/ hyperactivity disorder: evidence from a national study. Am J Public Health 2004, 94:1580-1586.\n3. van den Berg A, van den Berg C: A comparison of children with ADHD in a natural and built setting. Child Care Health Dev 2011, 37:430-439.\n 4. Faber-Taylor A, Kuo FE: Children with attention deficits concentrate better after walk in the park. J Atten Disord 2009, 12:402-409.\n\nAbstract for “Children with Attention deficits...” paper:\nObjective: In the general population, attention is reliably enhanced after exposure to certain physical environments, particularly natural environments. This study examined the impacts of environments on attention in children with ADHD. Method: In this within subjects design, each participant experienced each of three treatments (environments) in single blind controlled trials. Seventeen children 7 to12 years old professionally diagnosed with ADHD experienced each of three environments—a city park and two other well-kept urban settings—via individually guided 20-minute walks. Environments were experienced 1 week apart, with randomized assignment to treatment order. After each walk, concentration was measured using Digit Span Backwards. Results: Children with ADHD concentrated better after the walk in the park than after the downtown walk (p = .0229) or the neighborhood walk (p = .0072). Effect sizes were substantial (Cohen's d =.52 and .77, respectively) and comparable to those reported for recent formulations of methylphenidate. \n\nConclusion: Twenty minutes in a park setting was sufficient to elevate attention performance relative to the same amount of time in other settings. These findings indicate that environments can enhance attention not only in the general population but also in ADHD populations. “Doses of nature” might serve as a safe, inexpensive, widely accessible new tool in the tool kit for managing ADHD symptoms. (J. of Att. Dis. 2009; 12(5) 402-409)\n\n\n\n\n1. Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environ. Sci. Technol. 2010;44(10):3947–3955.\n\nGreen exercise is activity in the presence of nature. Evidence shows it leads to positive short and long-term health outcomes. This multistudy analysis assessed the best regime of dose(s) of acute exposure to green exercise required to improve self-esteem and mood (indicators of mental health). The research used meta-analysis methodology to analyze 10 UK studies involving 1252 participants. Outcomes were identified through a priori subgroup analyses, and dose-responses were assessed for exercise intensity and exposure duration. Other subgroup analyses included gender, age group, starting health status, and type of habitat. The overall effect size for improved self-esteem was d ) 0.46 (CI 0.34-0.59, p < 0.00001) and for mood d ) 0.54 (CI 0.38-0.69, p < 0.00001). Dose responses for both intensity and duration showed large benefits from short engagements in green exercise, and then diminishing but\nstill positive returns. Every green environment improved both self- esteem and mood; the presence of water generated greater effects. Both men and women had similar improvements in self- esteem after green exercise, though men showed a difference for mood. Age groups: for self-esteem, the greatest change was in the youngest, with diminishing effects with age; for mood, the least change was in the young and old. The mentally ill had one of the greatest self-esteem improvements. This study confirms that the environment provides an important health service.\n\n
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  • “What is Crossfit?”, available at crossfit.com \n\n“Fit by Nature” by John Colver\n
  • “What is Crossfit?”, available at crossfit.com \n\n“Fit by Nature” by John Colver\n
  • “What is Crossfit?”, available at crossfit.com \n\n“Fit by Nature” by John Colver\n
  • Mark Sisson. Primal Blueprint Fitness. \nWebsite: marksdailyapple.com \n
  • "An early-morning walk is a blessing for the whole day."\n~ Henry David Thoreau\n\n1. Barton J, Pretty J. What is the best dose of nature and green exercise for improving mental health? A multi-study analysis. Environ. Sci. Technol. 2010;44(10):3947–3955.\nGreen exercise is activity in the presence of nature. Evidence shows it leads to positive short and long-term health outcomes. This multistudy analysis assessed the best regime of dose(s) of acute exposure to green exercise required to improve self-esteem and mood (indicators of mental health). The research used meta-analysis methodology to analyze 10 UK studies involving 1252 participants. Outcomes were identified\nthrough a priori subgroup analyses, and dose-responses were assessed for exercise intensity and exposure duration. Other subgroup analyses included gender, age group, starting health\nstatus, and type of habitat. The overall effect size for improved self-esteem was d ) 0.46 (CI 0.34-0.59, p < 0.00001) and for mood d ) 0.54 (CI 0.38-0.69, p < 0.00001). Dose responses for both intensity and duration showed large benefits from short engagements in green exercise, and then diminishing but\nstill positive returns. Every green environment improved both self esteem and mood; the presence of water generated greater effects. Both men and women had similar improvements in self-esteem\nafter green exercise, though men showed a difference for mood. Age groups: for self-esteem, the greatest change was in the youngest, with diminishing effects with age; for mood, the least change was in the young and old. The mentally ill had one of the greatest self-esteem improvements. This study\nconfirms that the environment provides an important health service.\n\n\n
  • 1. Bledsoe J, Semrud-Clikeman M, Pliszka SR. A magnetic resonance imaging study of the cerebellar vermis in chronically treated and treatment-naive children with attention-deficit/hyperactivity disorder combined type. Biol. Psychiatry. 2009;65(7):620–624.\n\nAbstract\nBackground—Because of its dense connections to the prefrontal cortex and basal ganglia, the cerebellum is thought to play an important role in cognition. Numerous MRI studies have found abnormalities in the cerebellum in children with ADHD. While some studies in animal and human models suggest that the certain brain structures are affected by chronic stimulant medication, it is unclear whether the cerebellum is also affected. The purpose of the current study was to determine if cerebellar morphology was different in treatment-naïve vs. chronically-treated children with ADHD.\nMethods—There were 32 boys and 15 girls total (N = 47) that comprised three groups: ADHD-C children with no history of stimulant medication treatment (n = 14), ADHD-C children chronically treated with stimulant medication (n = 18), and typically developing control children (n = 15).\nResults—Treatment-naïve children with ADHD had significantly smaller area in the posterior inferior vermis (lobules VIII-X) than both chronically-treated children with ADHD (p = .004) and typically developing controls (p = .001). No differences were observed between chronically-treated children with ADHD and controls.\nConclusions—The results from this study suggest that chronic stimulant treatment may normalize the development of important areas of the cerebellar vermis in children with ADHD.\n\n
  • \nADHD prevalence: Boys to girls 3:1-8:1\n\nhttp://well.blogs.nytimes.com/2012/09/12/how-testosterone-may-alter-the-brain-after-exercise/: \n\nHow Testosterone May Alter the Brain After Exercise, Gretchen Reynolds\n\n“The only way to know for sure if the hormones were being synthesized in the brain would be to shut off production in the testes, to guarantee that hormones from that site wouldn’t migrate to the brain. So some of the rats in the experiment were surgically castrated. The rest underwent a sham operation, in which nothing was removed. That procedure ensures that stress from the operation won’t skew results; all animals will have had the same unpleasant experience.\nSeparately, some of the animals also were injected with a drug that blocks the ability of male sex hormones to bind to receptors in the brain. Those animals might be able to produce the hormones, but they wouldn’t have any effects on the brain.\nAfter recovery, most of the rats ran for two weeks on treadmills set at a leisurely jogging pace. Some remained sedentary.\nThen the scientists examined all of the animals’ brains. They found that, compared with the sedentary animals, the running rats had significantly more of a potent testosterone derivative called dihydrotestosterone, or DHT, in their brains. Even the brains of rats that had been castrated sloshed with DHT.\nSo the exercise had prompted increased production of the hormone.\nMost of the animals also had a plethora of new neurons in the hippocampus, a portion of the brain associated with learning and memory. Unexpectedly, however, the animals in this experiment that could not use the DHT in their brains did not experience enhanced neurogenesis. They exercised just as the other animals did, but their brains did not benefit in the same way.\nThis tells us that the uptake of DHT in the brain after exercise “appears to be a necessary step in achieving adult hippocampal neurogenesis,” Dr. McEwen says.\nIn essence, exercise prompts the production of more DHT. And more DHT helps to create more new brain cells.”\n\n\n\n\n1. Van Dam PS, Aleman A, De Vries WR, et al. Growth hormone, insulin-like growthfactor I and cognitive function in adults. Growth Hormone & IGF Research. 2000;10:S69–S73.\n
  • 1. O'Connor DB, Archer J, Hair WM, Wu FCW. Activational effects of testosterone on cognitive function in men. Neuropsychologia. 2001;39(13):1385–1394.\n\nAbstract\nObjecties: The effect of testosterone (T) on sexual function in men is well established. However, less is known about its effects\non cognitive function. The aim of this study is to investigate the relationship between T levels and sex-typed cognitive abilities in\nboth eugonadal and hypogonadal men. Design: A single-blind placebo-controlled design was employed in this study. Methods:\nThirty healthy eugonadal men and seven hypogonadal men participated in the study. Eugonadal men were randomised into one\nof two treatment regimens: (1) active group – receiving 200 mg of T enanthate i.m. weekly for 8 weeks (raising T levels into the\nsupraphysiological range) or (2) placebo group – receiving 200 mg of sodium chloride i.m. weekly for 8 weeks. The hypogonadal\ngroup received the physiological replacement dose of 200 mg T enanthate i.m. bi-weekly for 8 weeks. All groups underwent a\nbattery of neuropsychological tests and had circulating T measured at baseline, and at weeks 4 and 8 during treatment. Results:\nA significant time by group interaction effect was found in the measure of spatial ability (i.e., block design test) indicating that\nthe active group’s performance declined significantly at week 4, compared to placebo group (F(4,64)=3.78, P0.01). Conversely,\nthe active group performed significantly better than the placebo group in the measure of verbal fluency (i.e., the Controlled Oral\nWord Association Test) at week 4 (F(4,64)=2.54, P0.05). No significant changes were found on any of the other tests.\nGenerally, the hypogonadal group performed less well than the eugonadal groups on all tests.\n Conclusions: These results offer support to the notion that increased T has a differential effect on cognitive function, inhibiting spatial abilities while improving verbal fluency in eugonadal men.\n
  • “Convict Conditioning” by Paul Wade. \n
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  • High impact running improves learning.\nWinter B, Breitenstein C, Mooren FC, Voelker K, Fobker M, Lechtermann A, Krueger K, Fromme A, Korsukewitz C, Floel A, Knecht S.\nSource: Department of Neurology, University of Muenster, Muenster, Germany. bwinter@uni-muenster.de\nAbstract\nRegular physical exercise improves cognitive functions and lowers the risk for age-related cognitive decline. Since little is known about the nature and the timing of the underlying mechanisms, we probed whether exercise also has immediate beneficial effects on cognition. Learning performance was assessed directly after high impact anaerobic sprints, low impact aerobic running, or a period of rest in 27 healthy subjects in a randomized cross-over design. Dependent variables comprised learning speed as well as immediate (1 week) and long-term (>8 months) overall success in acquiring a novel vocabulary. Peripheral levels of brain-derived neurotrophic factor (BDNF) and catecholamines (dopamine, epinephrine, norepinephrine) were assessed prior to and after the interventions as well as after learning. We found that vocabulary learning was 20 percent faster after intense physical exercise as compared to the other two conditions. This condition also elicited the strongest increases in BDNF and catecholamine levels. More sustained BDNF levels during learning after intense exercise were related to better short-term learning success, whereas absolute dopamine and epinephrine levels were related to better intermediate (dopamine) and long-term (epinephrine) retentions of the novel vocabulary. Thus, BDNF and two of the catecholamines seem to be mediators by which physical exercise improves learning.\n\nGretchen Reynolds NYT Article “How Exercise Fuels the Brain” \n“In the first of their new experiments, published last year in The Journal of Physiology, scientists at the Laboratory of Biochemistry and Neuroscience at the University of Tsukuba gathered two groups of adult male rats and had one group start a treadmill running program, while the other group sat for the same period of time each day on unmoving treadmills. The researchers’ aim was to determine how much the level of brain glycogen changed during and after exercise.\nUsing their glycogen detection method, they discovered that prolonged exercise significantly lowered the brain’s stores of energy, and that the losses were especially noticeable in certain areas of the brain, like the frontal cortex and the hippocampus, that are involved in thinking and memory, as well as in the mechanics of moving.\nThe findings of their subsequent follow-up experiment, however, were even more intriguing and consequential. In that study, which appears in this month’s issue of The Journal of Physiology, the researchers studied animals after a single bout of exercise and also after four weeks of regular, moderate-intensity running.\nAfter the single session on the treadmill, the animals were allowed to rest and feed, and then their brain glycogen levels were studied. The food, it appeared, had gone directly to their heads; their brain levels of glycogen not only had been restored to what they had been before the workout, but had soared past that point, increasing by as much as a 60 percent in the frontal cortex and hippocampus and slightly less in other parts of the brain. The astrocytes had “overcompensated,” resulting in a kind of brain carbo-loading.\nThe levels, however, had dropped back to normal within about 24 hours”\n\n\n\n\n
  • Tabata I, Nishimura K, Kouzaki M, et al. (1996). "Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max".Med Sci Sports Exerc 28 (10): 1327–30.\n\nAbstract: This study consists of two training experiments using a mechanically braked cycle ergometer. First, the effect of 6 wk of moderate-intensity endurance training (intensity: 70% of maximal oxygen uptake (VO2max), 60 min.d-1, 5 d.wk-1) on the anaerobic capacity (the maximal accumulated oxygen deficit) and VO2max was evaluated. After the training, the anaerobic capacity did not increase significantly (P > 0.10), while VO2max increased from 53 +/- 5 ml.kg-1 min-1 to 58 +/- 3 ml.kg-1.min-1 (P < 0.01) (mean +/- SD). Second, to quantify the effect of high-intensity intermittent training on energy release, seven subjects performed an intermittent training exercise 5 d.wk-1 for 6 wk. The exhaustive intermittent training consisted of seven to eight sets of 20-s exercise at an intensity of about 170% of VO2max with a 10-s rest between each bout. After the training period, VO2max increased by 7 ml.kg-1.min-1, while the anaerobic capacity increased by 28%. In conclusion, this study showed that moderate-intensity aerobic training that improves the maximal aerobic power does not change anaerobic capacity and that adequate high-intensity intermittent training may improve both anaerobic and aerobic energy supplying systems significantly, probably through imposing intensive stimuli on both systems. \n
  • Tabata I, Nishimura K, Kouzaki M, et al. (1996). "Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max".Med Sci Sports Exerc 28 (10): 1327–30.\n\nAbstract: This study consists of two training experiments using a mechanically braked cycle ergometer. First, the effect of 6 wk of moderate-intensity endurance training (intensity: 70% of maximal oxygen uptake (VO2max), 60 min.d-1, 5 d.wk-1) on the anaerobic capacity (the maximal accumulated oxygen deficit) and VO2max was evaluated. After the training, the anaerobic capacity did not increase significantly (P > 0.10), while VO2max increased from 53 +/- 5 ml.kg-1 min-1 to 58 +/- 3 ml.kg-1.min-1 (P < 0.01) (mean +/- SD). Second, to quantify the effect of high-intensity intermittent training on energy release, seven subjects performed an intermittent training exercise 5 d.wk-1 for 6 wk. The exhaustive intermittent training consisted of seven to eight sets of 20-s exercise at an intensity of about 170% of VO2max with a 10-s rest between each bout. After the training period, VO2max increased by 7 ml.kg-1.min-1, while the anaerobic capacity increased by 28%. In conclusion, this study showed that moderate-intensity aerobic training that improves the maximal aerobic power does not change anaerobic capacity and that adequate high-intensity intermittent training may improve both anaerobic and aerobic energy supplying systems significantly, probably through imposing intensive stimuli on both systems. \n
  • Tabata I, Nishimura K, Kouzaki M, et al. (1996). "Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max".Med Sci Sports Exerc 28 (10): 1327–30.\n\nAbstract: This study consists of two training experiments using a mechanically braked cycle ergometer. First, the effect of 6 wk of moderate-intensity endurance training (intensity: 70% of maximal oxygen uptake (VO2max), 60 min.d-1, 5 d.wk-1) on the anaerobic capacity (the maximal accumulated oxygen deficit) and VO2max was evaluated. After the training, the anaerobic capacity did not increase significantly (P > 0.10), while VO2max increased from 53 +/- 5 ml.kg-1 min-1 to 58 +/- 3 ml.kg-1.min-1 (P < 0.01) (mean +/- SD). Second, to quantify the effect of high-intensity intermittent training on energy release, seven subjects performed an intermittent training exercise 5 d.wk-1 for 6 wk. The exhaustive intermittent training consisted of seven to eight sets of 20-s exercise at an intensity of about 170% of VO2max with a 10-s rest between each bout. After the training period, VO2max increased by 7 ml.kg-1.min-1, while the anaerobic capacity increased by 28%. In conclusion, this study showed that moderate-intensity aerobic training that improves the maximal aerobic power does not change anaerobic capacity and that adequate high-intensity intermittent training may improve both anaerobic and aerobic energy supplying systems significantly, probably through imposing intensive stimuli on both systems. \n
  • “Food For Thought: How Nutrients Affect the Brain” by Michael Lara, MD\nA 6-hour DVD available at the Institute for Brain Potential’s website: www.ibpceu/catalog\n\n
  • “Food For Thought: How Nutrients Affect the Brain” by Michael Lara, MD\nA 6-hour DVD available at the Institute for Brain Potential’s website: www.ibpceu/catalog\n\n
  • 1. Martin B, Mattson MP, Maudsley S. Caloric restriction and intermittent fasting: Two potential diets for successful brain aging. Ageing Research Reviews. 2006;5(3):332–353.\n\nAbstract\nThe vulnerability of the nervous system to advancing age is all too often manifest in neurodegenerative disorders such as Alzheimer's and Parkinson's diseases. In this review article we describe evidence suggesting that two dietary interventions, caloric restriction (CR) and intermittent fasting (IF), can prolong the health-span of the nervous system by impinging upon fundamental metabolic and cellular signaling pathways that regulate life-span. CR and IF affect energy and oxygen radical metabolism, and cellular stress response systems, in ways that protect neurons against genetic and environmental factors to which they would otherwise succumb during aging. There are multiple interactive pathways and molecular mechanisms by which CR and IF benefit neurons including those involving insulin-like signaling, FoxO transcription factors, sirtuins and peroxisome proliferator- activated receptors. These pathways stimulate the production of protein chaperones, neurotrophic factors and antioxidant enzymes, all of which help cells cope with stress and resist disease. A better understanding of the impact of CR and IF on the aging nervous system will likely lead to novel approaches for preventing and treating neurodegenerative disorders.\n\n1. Gomez-Pinilla F. The influences of diet and exercise on mental health through hormesis. Ageing Research Reviews. 2008;7(1):49–62.\n\nAbstract\nIt is likely that the capacity of the brain to remain healthy during ageing depends upon its ability to adapt and nurture in response to environmental challenges. In these terms, main principles involved in hormesis can be also applied to understand relationships at a higher level of complexity such as those existing between the CNS and the environment. This review emphasizes the ability of diet, exercise, and other lifestyle adaptations to modulate brain function. Exercise and diet are discussed in relationship to their aptitude to impact systems that sustain synaptic plasticity and mental health, and are therefore important for combating the effects of aging. Mechanisms that interface energy metabolism and synaptic plasticity are discussed, as these are the frameworks for the actions of cellular stress on cognitive function. In particular, neurotrophins are emerging as main factors in the equation that may connect lifestyle factors and mental health.\n\n\n
  • 1. Martin B, Mattson MP, Maudsley S. Caloric restriction and intermittent fasting: Two potential diets for successful brain aging. Ageing Research Reviews. 2006;5(3):332–353.\n\nAbstract\nThe vulnerability of the nervous system to advancing age is all too often manifest in neurodegenerative disorders such as Alzheimer's and Parkinson's diseases. In this review article we describe evidence suggesting that two dietary interventions, caloric restriction (CR) and intermittent fasting (IF), can prolong the health-span of the nervous system by impinging upon fundamental metabolic and cellular signaling pathways that regulate life-span. CR and IF affect energy and oxygen radical metabolism, and cellular stress response systems, in ways that protect neurons against genetic and environmental factors to which they would otherwise succumb during aging. There are multiple interactive pathways and molecular mechanisms by which CR and IF benefit neurons including those involving insulin-like signaling, FoxO transcription factors, sirtuins and peroxisome proliferator- activated receptors. These pathways stimulate the production of protein chaperones, neurotrophic factors and antioxidant enzymes, all of which help cells cope with stress and resist disease. A better understanding of the impact of CR and IF on the aging nervous system will likely lead to novel approaches for preventing and treating neurodegenerative disorders.\n\n1. Gomez-Pinilla F. The influences of diet and exercise on mental health through hormesis. Ageing Research Reviews. 2008;7(1):49–62.\n\nAbstract\nIt is likely that the capacity of the brain to remain healthy during ageing depends upon its ability to adapt and nurture in response to environmental challenges. In these terms, main principles involved in hormesis can be also applied to understand relationships at a higher level of complexity such as those existing between the CNS and the environment. This review emphasizes the ability of diet, exercise, and other lifestyle adaptations to modulate brain function. Exercise and diet are discussed in relationship to their aptitude to impact systems that sustain synaptic plasticity and mental health, and are therefore important for combating the effects of aging. Mechanisms that interface energy metabolism and synaptic plasticity are discussed, as these are the frameworks for the actions of cellular stress on cognitive function. In particular, neurotrophins are emerging as main factors in the equation that may connect lifestyle factors and mental health.\n\n\n
  • 1. Martin B, Mattson MP, Maudsley S. Caloric restriction and intermittent fasting: Two potential diets for successful brain aging. Ageing Research Reviews. 2006;5(3):332–353.\n\nAbstract\nThe vulnerability of the nervous system to advancing age is all too often manifest in neurodegenerative disorders such as Alzheimer's and Parkinson's diseases. In this review article we describe evidence suggesting that two dietary interventions, caloric restriction (CR) and intermittent fasting (IF), can prolong the health-span of the nervous system by impinging upon fundamental metabolic and cellular signaling pathways that regulate life-span. CR and IF affect energy and oxygen radical metabolism, and cellular stress response systems, in ways that protect neurons against genetic and environmental factors to which they would otherwise succumb during aging. There are multiple interactive pathways and molecular mechanisms by which CR and IF benefit neurons including those involving insulin-like signaling, FoxO transcription factors, sirtuins and peroxisome proliferator- activated receptors. These pathways stimulate the production of protein chaperones, neurotrophic factors and antioxidant enzymes, all of which help cells cope with stress and resist disease. A better understanding of the impact of CR and IF on the aging nervous system will likely lead to novel approaches for preventing and treating neurodegenerative disorders.\n\n1. Gomez-Pinilla F. The influences of diet and exercise on mental health through hormesis. Ageing Research Reviews. 2008;7(1):49–62.\n\nAbstract\nIt is likely that the capacity of the brain to remain healthy during ageing depends upon its ability to adapt and nurture in response to environmental challenges. In these terms, main principles involved in hormesis can be also applied to understand relationships at a higher level of complexity such as those existing between the CNS and the environment. This review emphasizes the ability of diet, exercise, and other lifestyle adaptations to modulate brain function. Exercise and diet are discussed in relationship to their aptitude to impact systems that sustain synaptic plasticity and mental health, and are therefore important for combating the effects of aging. Mechanisms that interface energy metabolism and synaptic plasticity are discussed, as these are the frameworks for the actions of cellular stress on cognitive function. In particular, neurotrophins are emerging as main factors in the equation that may connect lifestyle factors and mental health.\n\n\n
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  • 1. Bloch MH, Qawasmi A. Omega-3 Fatty Acid Supplementation for the Treatment of Children With Attention-Deficit/Hyperactivity Disorder Symptomatology: Systematic Review and Meta-Analysis. Journal of the American Academy of Child & Adolescent Psychiatry. 2011;50(10):991–1000.\n\nObjective\nSeveral studies have demonstrated differences in omega-3 fatty acid composition in plasma and in erythrocyte membranes in patients with attention-deficit/hyperactivity disorder (ADHD) compared with unaffected controls. Omega-3 fatty acids have anti-inflammatory properties and can alter central nervous system cell membrane fluidity and phospholipid composition. Cell membrane fluidity can alter serotonin and dopamine neurotransmission. The goal of this meta-analysis was to examine the efficacy of omega-3 fatty acid supplementation in children with ADHD.\nMethod\nPubMed was searched for randomized placebo-controlled trials examining omega-3 fatty acid supplementation in children with ADHD symptomatology. The primary outcome measurement was standardized mean difference in rating scales of ADHD severity. Secondary analyses were conducted to determine the effects of dosing of different omega-3 fatty acids in supplements.\nResults\nTen trials involving 699 children were included in this meta-analysis. Omega-3 fatty acid supplementation demonstrated a small but significant effect in improving ADHD symptoms. Eicosapentaenoic acid dose within supplements was significantly correlated with supplement efficacy. No evidence of publication bias or heterogeneity between trials was found.\nConclusion\nOmega-3 fatty acid supplementation, particularly with higher doses of eicosapentaenoic acid, was modestly effective in the treatment of ADHD. The relative efficacy of omega-3 fatty acid supplementation was modest compared with currently available pharmacotherapies for ADHD such as psychostimulants, atomoxetine, or α2 agonists. However, given its relatively benign side-effect profile and evidence of modest efficacy, it may be reasonable to use omega-3 fatty supplementation to augment traditional pharmacologic interventions or for families who decline other psychopharmacologic options.\n
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  • Dr. Charles E. Schaefer is a world-renowned American psychologist considered by many to be the "Father of Play Therapy"\n
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Transcript

  • 1. Practical Considerations in UsingExercise As Treatment for ADHDMichael Lara, MDDiplomate, American Board of Psychiatry and NeurologyPrivate Practice Psychiatry, Belmont CA 1
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  • 7. Evolutionary MilestonesHumans evolved primarily as hunter gatherer species ‣ 84,000 Generations • From emergence of Homo species 2.4 million years ago, humans have survived primarily as hunter gatherer species ‣ 350 Generations Ago • Agricultural Revolution ‣ 75 Generations Ago • Industrial Revolution ‣ 2 Generations • Digital Age 4
  • 8. Typical Activities of Hunter-GathererPhysical activities of our paleolithic ancestors have correlates inmodern day forms of exercise 5
  • 9. Typical Activities of Hunter-GathererPhysical activities of our paleolithic ancestors have correlates inmodern day forms of exercise ‣ Slow Cardio: 5-10 miles/day of low intensity walking • Hunter gatherers cover 5-15 miles per day 5
  • 10. Typical Activities of Hunter-GathererPhysical activities of our paleolithic ancestors have correlates inmodern day forms of exercise ‣ Slow Cardio: 5-10 miles/day of low intensity walking • Hunter gatherers cover 5-15 miles per day ‣ Resistance Training: Lifting, Throwing, and Carrying Objects • Encompass functional movements such as pushing, pulling, sprinting, and jumping 5
  • 11. Typical Activities of Hunter-GathererPhysical activities of our paleolithic ancestors have correlates inmodern day forms of exercise ‣ Slow Cardio: 5-10 miles/day of low intensity walking • Hunter gatherers cover 5-15 miles per day ‣ Resistance Training: Lifting, Throwing, and Carrying Objects • Encompass functional movements such as pushing, pulling, sprinting, and jumping ‣ Interval Training: Periodic bursts of high-intensity activity • Brief bouts of sprinting alternating with walking or jogging in pursuit of prey 5
  • 12. Nature Deficit DisorderDiminished use of senses and attentionaldifficulties due to alienation from nature 6
  • 13. Nature Deficit DisorderDiminished use of senses and attentionaldifficulties due to alienation from nature 6
  • 14. Exercising to Improve ADHD SymptomsCharacteristics of an ideal exercise program for ADHD ADHD Exercise ADHD Symptoms Program Often has difficulty organizing tasks Structured workouts that are part Structure and activities of a comprehensive program Incorporate constantly varied Often avoids, dislikes, or is functional movements: squatting, Variety reluctant to engage in tasks that require sustained mental effort pushing, pulling, sprinting, throwing Often has difficulty sustaining Learning and acquisition of new Novelty attention in tasks or play activities skills in natural environments Is often easily distracted by Exercise outdoors with active and Monitoring extraneous stimuli passive attention 7
  • 15. Exercise Programs for ADHDPrograms that include cross-training outdoors 8
  • 16. Exercise Programs for ADHDPrograms that include cross-training outdoors “constantly varied, high-intensity functional Crossfit movements with goal of increasing work capacity across broad time and modal domains” crossfit.com 8
  • 17. Exercise Programs for ADHDPrograms that include cross-training outdoors “constantly varied, high-intensity functional Crossfit movements with goal of increasing work capacity across broad time and modal domains” crossfit.com Outdoor fitness program incorporating cross- Fit by Nature training and body weight exercises across different terrains. Adventx.com 8
  • 18. Exercise Programs for ADHDPrograms that include cross-training outdoors “constantly varied, high-intensity functional Crossfit movements with goal of increasing work capacity across broad time and modal domains” crossfit.com Outdoor fitness program incorporating cross- Fit by Nature training and body weight exercises across different terrains. Adventx.com Primal Moving frequently at a slow pace, lift heavy things, Fitness and sprint. marksdailyapple.com 8
  • 19. Primal Fitness“The Primal Blueprint” by Mark Sisson Sprint “All Out” efforts once every 7-10 days, for <10 minutes Lift Heavy Brief, intense sessions of full-body functional movements for up to 30 Things minutes 1-3x/week Move Frequently at Walk, hike or jog at 55-75% maximum heart a Slow Pace rate for 2-5 hours/week 9
  • 20. Move Frequently at a Slow PaceLeisurely walks in nature at least five times/week ‣ Exercise in green environments reduces stress and improves focus ‣ Leisurely walks improve fat metabolism and insulin sensitivity ‣ Engages passive attention 10
  • 21. ADD and the Cerebellum‣ Cerebellum is responsible for coordination, precision and accurate timing of movement‣ Contains 50-80% of total neurons in brain‣ Cerebellum is dysfunctional in ADD‣ Moving to rhythm or cadence may improve symptoms of ADD‣ Cadence beats: podrunner.com 11
  • 22. Lift Heavy ThingsPushing, pulling, squatting, and throwing ‣ Heavy resistance training increases growth hormone (GH) and testosterone ‣ Low levels of GH/IGF-1 associated with cognitive decline ‣ Testosterone may improve some domains of cognitive function 12
  • 23. 13
  • 24. Body-Weight Resistance TrainingThe Big 5 of Body Weight Resistance Training1 Upper Body Push-ups, pull-ups, chin-ups, rows2 Lower Body Squats, lunges, jumps3 Core Sit-ups, hanging leg-raises, planks4 Back Good Mornings, bridging5 Total Body Squats, dead lifts, bear crawls, burpees 14
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  • 28. SprintRunning at maximal intensity for no more than 30 seconds ‣ Exercise intensity correlates with rise of catecholamines and brain-derived neurotrophic factor (BDNF) ‣ High-intensity interval training (HIIT) may increase glycogen storage in astrocytes cells ‣ Carb loading for the brain 18
  • 29. High-Intensity Interval TrainingHIIT involves “all out” efforts with fixed work:rest ratios 19
  • 30. High-Intensity Interval Training HIIT involves “all out” efforts with fixed work:rest ratios30:30Total time: 10 min 30 seconds of work 30 seconds of rest 19
  • 31. High-Intensity Interval Training HIIT involves “all out” efforts with fixed work:rest ratios15:45 15 seconds ofTotal time: 10 min 45 seconds of rest work30:30Total time: 10 min 30 seconds of work 30 seconds of rest 19
  • 32. High-Intensity Interval Training HIIT involves “all out” efforts with fixed work:rest ratiosTabata20:10 10 seconds 20 seconds of workTotal time: 4 min of rest15:45 15 seconds ofTotal time: 10 min 45 seconds of rest work30:30Total time: 10 min 30 seconds of work 30 seconds of rest 19
  • 33. Exercise, Nutrition and The BrainFood For Thought:How Nutrients Affect the Brain www.ibpceu/catalog 20
  • 34. Exercise, Nutrition and The BrainFood For Thought:How Nutrients Affect the Brain Exercise www.ibpceu/catalog 20
  • 35. Exercise, Nutrition and The BrainFood For Thought:How Nutrients Affect the Brain Exercise Nutrition www.ibpceu/catalog 20
  • 36. Intermittent FastingNutritional strategy that alternates brief periods of fasting withnon-fasting 21
  • 37. Intermittent FastingNutritional strategy that alternates brief periods of fasting withnon-fasting ‣ Fasting raises catecholamine levels • Norepinephrine and dopamine levels rise in the first 8 hours of fasting 21
  • 38. Intermittent FastingNutritional strategy that alternates brief periods of fasting withnon-fasting ‣ Fasting raises catecholamine levels • Norepinephrine and dopamine levels rise in the first 8 hours of fasting ‣ Fasting reduces markers of chronic inflammation • Reductions of inflammatory markers (IL-1, IL-6) observed in the first 12 hours of fasting 21
  • 39. Intermittent FastingNutritional strategy that alternates brief periods of fasting withnon-fasting ‣ Fasting raises catecholamine levels • Norepinephrine and dopamine levels rise in the first 8 hours of fasting ‣ Fasting reduces markers of chronic inflammation • Reductions of inflammatory markers (IL-1, IL-6) observed in the first 12 hours of fasting ‣ Fasting increases BDNF levels • Intermittent fasting increases brain-derived neurotrophic factor 21
  • 40. How to Succeed with Intermittent FastingAlternate periods of fasting with non-fasting for 1-3 non-consecutive days/week For more information: www.brainwebinar.com 22
  • 41. How to Succeed with Intermittent FastingAlternate periods of fasting with non-fasting for 1-3 non-consecutive days/week 6:00 PM 10:00 AM Modified Fast: 16 hours For more information: www.brainwebinar.com 22
  • 42. How to Succeed with Intermittent FastingAlternate periods of fasting with non-fasting for 1-3 non-consecutive days/week 6:00 PM 10:00 AM Modified Fast: 16 hours Allowed Foods •Green tea •Omega-3 fatty acids (fish oil) •Medium chain triglycerides (coconut oil) For more information: www.brainwebinar.com 22
  • 43. How to Succeed with Intermittent FastingAlternate periods of fasting with non-fasting for 1-3 non-consecutive days/week 6:00 PM 10:00 AM 6:00 PM Modified Fast: 16 hours Feed: 8 hours Allowed Foods •Green tea •Omega-3 fatty acids (fish oil) •Medium chain triglycerides (coconut oil) For more information: www.brainwebinar.com 22
  • 44. How to Succeed with Intermittent FastingAlternate periods of fasting with non-fasting for 1-3 non-consecutive days/week 6:00 PM 10:00 AM 6:00 PM Modified Fast: 16 hours Feed: 8 hours Allowed Foods Recommended Diets •Green tea •Mediterranean Diet •Omega-3 fatty acids (fish oil) •Zone Diet •Medium chain triglycerides (coconut oil) •Paleo Diet For more information: www.brainwebinar.com 22
  • 45. How to Succeed with Intermittent FastingAlternate periods of fasting with non-fasting for 1-3 non-consecutive days/week 6:00 PM 10:00 AM 6:00 PM Modified Fast: 16 hours Feed: 8 hours Leisurely walk Allowed Foods Recommended Diets •Green tea •Mediterranean Diet •Omega-3 fatty acids (fish oil) •Zone Diet •Medium chain triglycerides (coconut oil) •Paleo Diet For more information: www.brainwebinar.com 22
  • 46. How to Succeed with Intermittent FastingAlternate periods of fasting with non-fasting for 1-3 non-consecutive days/week 6:00 PM 10:00 AM 6:00 PM Modified Fast: 16 hours Feed: 8 hours Sprint Leisurely walk Lift Allowed Foods Recommended Diets •Green tea •Mediterranean Diet •Omega-3 fatty acids (fish oil) •Zone Diet •Medium chain triglycerides (coconut oil) •Paleo Diet For more information: www.brainwebinar.com 22
  • 47. Omega-3 Fatty AcidsMaintain fluidity of cell membranes and reduce inflammation ‣ “Modestly” effective in the treatment of ADHD • Small but significant effect in improving symptoms of ADHD ‣ Improve glucose utilization in brain and muscle tissue • Sensitizes insulin receptors ‣ Reduce markers of chronic inflammation ‣ Recommended Dose: 2 grams (EPA+DHA), twice daily 23
  • 48. Power Program for ADHDA comprehensive program for exercising to improve mood andcognition Sprint 1x/week ; “all out” efforts for less than 10 min Lift 2x/week: body weight resistance training Heavy Intermittent 3x/week: fast for 12-18 hours Fasting Omega-3 Fatty Acids 4 grams of EPA+DHA daily Leisurely Walks in Nature 5 hours/week in outdoor activities 24
  • 49. Primal Fitness In ActionThe results of exercising in nature and intermittent fasting December 2010 March 2012 25
  • 50. Primal Fitness In ActionThe results of exercising in nature and intermittent fasting December 2010 March 2012 25
  • 51. Primal Fitness In ActionThe results of exercising in nature and intermittent fasting December 2010 March 2012 25
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  • 54. “We are never more fully alive, morecompletely ourselves, or more deeplyengrossed in anything, than when we are atplay.” Charles Schaefer 28
  • 55. “We are never more fully alive, morecompletely ourselves, or more deeplyengrossed in anything, than when we are atplay.” Charles Schaefer 28
  • 56. For More InformationFor more information about online coaching and other services Michael Lara, MD 650-592-1229 mlaramd@gmail.com www.mlaramd.com 29