Pumped: How to Build A Better Brain Through Exercise and Movement

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Exercise is one of the most effective, non-pharmacologic methods to elevate mood, improve memory and enhance overall wellbeing. Learn how to develop a personalized program and maintain the exercise habit in this 6-hour seminar by Dr. Michael Lara, a board-certified psychiatrist and fitness enthusiast.
Learn how sedentary behaviors contribute to mood disorders and cognitive decline.
Learn how key neurotransmitters such as serotonin, norepinephrine and brain opiates are influenced by exercise.
Learn how exercise induces anatomical changes in the brain through brain-derived neurtrophic factor, vascular endothelial growth factor, and other chemical messengers.
Learn how different forms of exercise such as cardiovascular training and resistance training affect mood and cognition.

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  • Bassett DR JR.,Wyatt HR, Thompson H, Peters JC, Hill JO. Pedometer-measured physical activity and health behaviors in United States adults. Med Sci Sports Exerc. 2010;42(10):1819.Basset (et. al.) tracked the steps of 1,136 adults around the United States who wore pedometers for two days in 2003. The study showed that American men, with an average daily step count of 5,340, are moving more than women, who averaged only 4,912 steps a day. Being single was associated with taking more steps. Single people averaged 6,076 daily steps, compared with 4,793 steps for married people. Widowed participants moved the least, averaging 3,394 daily steps.
  • Tremblay MSTM, Colley RCCR, Saunders TJST, Healy GNHG, Owen NON. Physiological and health implications of a sedentary lifestyle. Applied Physiology, Nutrition, and Metabolism. 2010;35(6):725–740.The physiologic changes associated with sedentary behavior include: increase in plasma triglyceride levels, decreased levels of high-density lipoprotein, and decreased insulin sensitivity. These changes are mediated though lipoprotein lipase activity. Lipoprotein lipase is the enzyme that facilitates the update of free fatty acids into muscle and adipose tissue. LPL activity appears to be reduced in response to both acute and chronic sedentary behavior.
  • Pedersen BK. The diseasome of physical inactivity - and the role of myokines in muscle-fat cross talk. The Journal of Physiology. 2009;587(23):5559–5568. doi:10.1113/jphysiol.2009.179515.The finding that muscles produce and release myokines provides a conceptual basis to understand the mechanisms whereby exercise influences metabolism and exerts anti-inflammatory effects. According to our theory, contracting skeletal muscles release myokines, which work in a hormone-like fashion, exerting specific endocrine effects on visceral fat. Other myokines work locally within the muscle via paracrine mechanisms, exerting their effects on signalling pathways involved in fat oxidation.
  • Fischer CP, Berntsen A, Perstrup LB, Eskildsen P, Pedersen BK. Plasma levels of interleukin-6 and C-reactive protein are associated with physical inactivity independent of obesity. Scand J Med Sci Sports. 2006.It is recognized that the path from physical inactivity and obesity to lifestyle-related diseases involves low-grade inflammation, indicated by elevated plasma levels of inflammatory markers. Interestingly, contracting skeletal muscle is a major source of circulating interleukin-6 (IL-6) in response to acute exercise, but with a markedly lower response in trained subjects. As C-reactive protein (CRP) is induced by IL-6, we hypothesized that basal levels of IL-6 and CRP reflect the degree of regular physical activity when compared with other markers of inflammation associated with lifestyle-related morbidity. Fasting plasma/serum levels of IL-6, IL-18, CRP, tumur necrosis factor-α (TNF-α), soluble TNF receptor II (sTNF-RII), and adiponectin were measured in healthy non-diabetic men and women (n=84). The amount of leisure-time physical activity (LTPA) was assessed by interview. Obesity was associated with elevated insulin, C-peptide, triglycerides, low-density lipoprotein, IL-6, CRP, and adiponectin (all P<0.05). Importantly, physical inactivity was associated with elevated C-peptide (P=0.036), IL-6 (P=0.014), and CRP (P=0.007) independent of obesity, age, gender, and smoking. Furthermore, the LTPA score was inversely associated with IL-6 (P=0.017) and CRP (P=0.005), but with neither of the other markers. The results indicate that low levels of IL-6 and CRP – not IL-18, TNF-α, sTNF-RII, or adiponectin – reflect regular physical activity.
  • Effect of physical activity on serum C-reactive protein ☆Michelle A. Albert, MD, MPHa, , , Robert J. Glynn, PhDa, Paul M. Ridker, MD, MPHa, *a Center for Cardiovascular Disease Prevention and the Leducq Center for Cardiovascular Research, Divisions of Cardiovascular Diseases and Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USAhttp://dx.doi.org/10.1016/j.amjcard.2003.09.046, How to Cite or Link Using DOI
  • Pedersen BK. The diseasome of physical inactivity - and the role of myokines in muscle-fat cross talk. The Journal of Physiology. 2009;587(23):5559–5568.
  • Duvivier BMFM, Schaper NC, Bremers MA, et al. Minimal intensity physical activity (standing and walking) of longer duration improves insulin action and plasma lipids more than shorter periods of moderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable. PLoS ONE. 2013;8(2):e55542. Background: Epidemiological studies suggest that excessive sitting time is associated with increased health risk, independent of the performance of exercise. We hypothesized that a daily bout of exercise cannot compensate the negative effects of inactivity during the rest of the day on insulin sensitivity and plasma lipids.Methodology/Principal Findings: Eighteen healthy subjects, age 2162 year, BMI 22.662.6 kgm22 followed randomly three physical activity regimes for four days. Participants were instructed to sit 14 hr/day (sitting regime); to sit 13 hr/day and to substitute 1 hr of sitting with vigorous exercise 1 hr (exercise regime); to substitute 6 hrs sitting with 4 hr walking and 2 hr standing (minimal intensity physical activity (PA) regime). The sitting and exercise regime had comparable numbers of sitting hours; the exercise and minimal intensity PA regime had the same daily energy expenditure. In the sitting regime, daily energy expenditure was about 500 kcal lower than in both other regimes. Triglycerides, non-HDL cholesterol and apolipoprotein B plasma levels improved significantly in the minimal intensity PA regime compared to sitting and showed non-significant trends for improvement compared to exercise.Conclusions: One hour of daily physical exercise cannot compensate the negative effects of inactivity on insulin level and plasma lipids if the rest of the day is spent sitting. Reducing inactivity by increasing the time spent walking/standing is more effective than one hour of physical exercise, when energy expenditure is kept constant.
  • Americans are spending more time indooors than ever. Screen time has replaced green time.
  • Coon JT, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ. Sci. Technol. 2011;45(5):1761–1772.1. Scragg R, Camargo CA. Frequency of Leisure-Time Physical Activity and Serum 25-Hydroxyvitamin D Levels in the US Population: Results from the Third National Health and Nutrition Examination Survey. American Journal of Epidemiology. 2008;168(6):577–586. doi:10.1093/aje/kwn163.
  • Uchida S, Shioda K, Morita Y, Kubota C, Ganeko M, Takeda N. Exercise Effects on Sleep Physiology. Frontiers in Neurology. 2012;3. 1. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Arch Intern Med. 2006;166(16):1756.
  • Sleep is made up of two physiologic states: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. NREM sleep consists of stages 1 though 4 and is characterized by low physiological activity. Slow wave sleep (SWS), the deepest, most restorative form of sleep, occurs during stage 3 and 4. REM sleep, by contrast, is characterized by high levels of brain and physiological activity and is most often associated with the dreaming state. A REM period occurs about every 90-120 minutes during sleep.
  • The National Sleep Foundation recently published a comprehensive report on Exercise and Sleep 2013. The report polled 1,000 Americans about their activity and sleep patternsThe report can be accessed at:http://www.sleepfoundation.org/sites/default/files/RPT336%20Summary%20of%20Findings%2002%2020%202013.pdfAmong the key findings of the report:People who identify as exercisers reported better sleep than those who consider themselves non-exercisers, even when both groups get the same amount of sleep.Vigorous exercisers reported the best sleep, with just 17 percent saying their overall sleep quality was fairly or very bad. Nearly half of the non-exercisers reported fairly or very bad sleep.Non-exercisers were more than twice as likely to take sleep medication than those who exercised. Non-exercisers reported worse overall health and more disability than those who exercise. Time spent sitting was associated with poorer sleep quality. Only 12% of people who sit for 10 hours/day reported very good sleep.
  • Medina JA, Netto T, Muszkat M. Exercise impact on sustained attention of ADHD children, methylphenidate effects. ADHD Attention Deficit …. 2010.Mattson MP, Maudsley S, Martin B. BDNF and 5-HT: a dynamic duo in age-related neuronal plasticity and neurodegenerative disorders. Trends in Neurosciences. 2004;27(10):589–594.3. Xu Q, Park Y, Huang X, et al. Physical activities and future risk of Parkinson disease. Neurology. 2010;75(4):341–348.
  • Wigal SB, Nemet D, Swanson JM, et al. Catecholamine Response to Exercise in Children with Attention Deficit Hyperactivity Disorder. Pediatr. Res. 2003;53(5):756–761. The objective of this study was to examine differences in catecholamine (CA) response to exercise between children who had received a diagnosis of attention-deficit/hyperactivity disorder (ADHD) and age- and gender-matched controls. On the basis of the notion of a CA dysfunction in ADHD, we reasoned that the normal robust increase in circulating CA seen in response to exercise would be blunted in children with ADHD. To test this, we recruited 10 treatment-naïve children with newly diagnosed ADHD and 8 age-matched controls (all male) and measured CA response to an exercise test in which the work was scaled to each subject's physical capability. After exercise, epinephrine and norepinephrine increased in both control and ADHD subjects (p = 0.006 and p = 0.002, respectively), but the responses were substantially blunted in the ADHD group (p = 0.018) even though the work performed did not differ from controls. Circulating dopamine increased significantly in the control subjects (p < 0.016), but no increase was noted in the subjects with ADHD. Finally, a significant attenuation in the lactate response to exercise was found in ADHD (between groups, p < 0.005). Our data suggest that CA excretion after exercise challenges in children with ADHD is deficient. This deficiency can be detected using a minimally invasive, nonpharmacologic challenge.An interval training exercise protocol was used in this study. The session consisted of a series of 10, 2-min bouts of constant-work rate cycle ergometry with 1-min resting intervals between each exercise bout for a total of 30 minutes. HR was 152.1 =/- 4.6 during exericise.
  • Janal MN, Colt EWD, Clark WC, Glusman M. Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: Effects of naloxone. Pain. 1984;19(1):13–25. doi:10.1016/0304-3959(84)90061-7.1. Boecker H, Sprenger T, Spilker ME, et al. The runner's high: opioidergic mechanisms in the human brain. Cerebral Cortex. 2008;18(11):2523–2531.
  • Boecker H, Sprenger T, Spilker ME, et al. The runner's high: opioidergic mechanisms in the human brain. Cerebral Cortex. 2008;18(11):2523–2531.This slide demonstrates the correlation of opioidergic binding in runners with VAS ratings of euphoria. Scatter plots of opioid receptor binding (DV) with individual VAS euphoria ratings (VAS post run) are shown from 3 regions (top row: right anterior cingulate cortex, ACC; middle row: right orbitofrontal cortex, OFC; bottom row: right insula, INS). The [18F]FDPN binding in the respective areas is plotted in relation to perceived euphoria (abscissa: VAS rating from 0–100, ordinate: SPM-scaled DV values). The SPMs are overlaid in color on axial, coronal, and transversal sections of a stereotactically normalized brain (Montreal Neurological Institute single subject brain as provided by SPM2). For display purposes, the statistical analysis is thresholded at an uncorrected height threshold of P < 0.001.
  • Wheeler GD. Reduced Serum Testosterone and Prolactin Levels in Male Distance Runners. JAMA. 1984;252(4):514. 2. Safarinejad MR, Azma K, Kolahi AA. The effects of intensive, long-term treadmill running on reproductive hormones, hypothalamus-pituitary-testis axis, and semen quality: a randomized controlled study. Journal of Endocrinology. 2008;200(3):259–271. doi:10.1677/JOE-08-0477.
  • Safarinejad MR, Azma K, Kolahi AA. The effects of intensive, long-term treadmill running on reproductive hormones, hypothalamus-pituitary-testis axis, and semen quality: a randomized controlled study. Journal of Endocrinology. 2008;200(3):259–271. Effects of intensive exercise on hypothalamus–pituitary–testis (HPT) axis remain controversial. Our aim was to determine the effects of intensive, long-term treadmill running on reproductive hormones, HPT axis, and semen quality. A total of 286 subjects were randomly assigned to moderate-intensity exercise (60% maximal oxygen uptake (VO2max); group 1, nZ143) and high-intensity exercise (80% VO2max; group 2, nZ143) groups. The two groups exercised for 60 weeks in five sessions per week, each session lasting 120 min. This was followed by a 36-week low-intensity exercise recovery period. After 24 weeks of exercise, the subjects exercising with high intensity demonstrated significantly declined semen parameters compared with those exercising with moderate intensity. These parameters improved to their pre-exercise level during the recovery period. Long-term strenuous treadmill exercises (overtraining syndrome) have a deleterious effect on reproduction.
  • McTiernan A, Tworoger SS, Ulrich CM, et al. Effect of Exercise on Serum Estrogens in Postmenopausal Women A 12-Month Randomized Clinical Trial. Cancer Research. 2004;64(8):2923–2928.Elevated circulating estrogens and a sedentary lifestyle increase risk for breast cancer. The effect of exercise on circulating estrogens in sedentary postmenopausal women is unknown. The objective of this study was to examine the effects of a 12-month moderate-intensity exercise intervention on serum estrogens. We randomly assigned 173 sedentary, overweight (body mass index > 24.0 kg/m2, body fat > 33%), postmenopausal women, ages 50 –75 years to exercise and control groups. The exercise intervention included facility and home-based exercise (45 min, 5 days/ week moderate intensity sports/recreational exercise). A total of 170 (98.3%) women completed the study with exercisers averaging 171 min/ week of exercise. After 3 months, exercisers experienced declines in estrone, estradiol, and free estradiol of 3.8, 7.7, and 8.2%, respectively, versus no change or increased concentrations in controls.At 12 months, the direction of effect remained the same, although the differences were no longer statistically significant. The effect was limited to women who lost body fat: women whose percentage of body fat [by dual energy x-ray absortiometry (DEXA)] decreased by >2% had statistically significant (comparing exercisers versus controls) decreases at 12 months of 11.9, 13.7, and 16.7% for serum estrone, estradiol, and free estradiol, respectively. We concluded that a 12-month moderate-intensity exercise intervention in postmenopausal women resulted in significant decreases in serum estrogens. The association between increased physical activity and reduced risk for postmenopausal breast cancer may be partly explained by effects on serum estrogens.
  • 1. Videbech P, Ravnkilde B. Hippocampal Volume and Depression: A Meta-Analysis of MRI Studies. Am J Psychiatry. 2004;161(11):1957–1966. doi:10.1176/appi.ajp.161.11.1957.
  • Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc. Natl. Acad. Sci. U.S.A. 2011;108(7):3017–3022.Summary: The hippocampus shrinks in late adulthood, leading to impaired memory and increased risk for dementia. Hippocampal and medial temporal lobe volumes are larger in higher-fit adults, and physical activity training increases hippocampal perfusion, but the extent to which aerobic exercise training can modify hippocampal volume in late adulthood remains unknown. Here we show, in a randomized controlled trial with 120 older adults, that aerobic exercise training increases the size of the anterior hippocampus, leading to improvements in spatial memory. Exercise training increased hippocampal volume by 2%, effectively reversing age-related loss in volume by 1 to 2 y. We also demonstrate that increased hippocampal volume is associated with greater serum levels of BDNF, a mediator of neurogenesis in the dentate gyrus. Hippocampal volume declined in the control group, but higher preintervention fitness partially attenuated the decline, suggesting that fitness protects against volume loss. Caudate nucleus and thalamus volumes were unaffected by the intervention. These theoretically important findings indicate that aerobic exercise training is effective at reversing hippocampal volume loss in late adulthood, which is accompanied by improved memory function.
  • Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc. Natl. Acad. Sci. U.S.A. 2011;108(7):3017–3022.Summary: The hippocampus shrinks in late adulthood, leading to impairedmemory and increased risk for dementia. Hippocampal and medialtemporal lobe volumes are larger in higher-fit adults, and physicalactivity training increases hippocampal perfusion, but the extent towhich aerobic exercise training can modify hippocampal volume in late adulthood remains unknown. Here we show, in a randomizedcontrolled trial with 120 older adults, that aerobic exercise trainingincreases the size of the anterior hippocampus, leading to improvements in spatial memory. Exercise training increased hippocampalvolume by 2%, effectively reversing age-related loss in volume by1 to 2 y. We also demonstrate that increased hippocampal volumeis associated with greater serum levels of BDNF, a mediator ofneurogenesis in the dentate gyrus. Hippocampal volume declined inthe control group, but higher preintervention fitness partiallyattenuated the decline, suggesting that fitness protects againstvolume loss. Caudate nucleus and thalamus volumes were unaffected by the intervention. These theoretically important findingsindicate that aerobic exercise training is effective at reversing hippocampal volume loss in late adulthood, which is accompanied byimproved memory function.
  • 1. Colcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise training increases brain volume in aging humans. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2006;61(11):1166–1170.Background. The present study examined whether aerobic fitness training of older humans can increase brain volume in regions associated with age-related decline in both brain structure and cognition.Methods. Fifty-nine healthy but sedentary community-dwelling volunteers, aged 60–79 years, participated in the 6- month randomized clinical trial. Half of the older adults served in the aerobic training group, the other half of the older adults participated in the toning and stretching control group. Twenty young adults served as controls for the magnetic resonance imaging (MRI), and did not participate in the exercise intervention. High spatial resolution estimates of gray and white matter volume, derived from 3D spoiled gradient recalled acquisition MRI images, were collected before and after the 6-month fitness intervention. Estimates of maximal oxygen uptake (VO2) were also obtained.Results. Significant increases in brain volume, in both gray and white matter regions, were found as a function of fitness training for the older adults who participated in the aerobic fitness training but not for the older adults who participated in the stretching and toning (nonaerobic) control group. As predicted, no significant changes in either gray or white matter volume were detected for our younger participants.Conclusions. These results suggest that cardiovascular fitness is associated with the sparing of brain tissue in aging humans. Furthermore, these results suggest a strong biological basis for the role of aerobic fitness in maintaining and enhancing central nervous system health and cognitive functioning in older adults.
  • Blumenthal JA, Babyak MA, Doraiswamy PM, et al. Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder. Psychosomatic Medicine. 2007;69(7):587–596. doi:10.1097/PSY.0b013e318148c19a.Objective: To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls. Methods: Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50–200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D). Results: After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of 8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise 45%; home-based exercise 40%; medication 47%; placebo 31% (p .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p .23). Conclusions: The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, ongoing symptom monitoring, attention, and other nonspecific factors.
  • Blumenthal JA, Babyak MA, Doraiswamy PM, et al. Exercise and Pharmacotherapy in the Treatment of Major Depressive Disorder. Psychosomatic Medicine. 2007;69(7):587–596. doi:10.1097/PSY.0b013e318148c19a.Objective: To assess whether patients receiving aerobic exercise training performed either at home or in a supervised group setting achieve reductions in depression comparable to standard antidepressant medication (sertraline) and greater reductions in depression compared to placebo controls. Methods: Between October 2000 and November 2005, we performed a prospective, randomized controlled trial (SMILE study) with allocation concealment and blinded outcome assessment in a tertiary care teaching hospital. A total of 202 adults (153 women; 49 men) diagnosed with major depression were assigned randomly to one of four conditions: supervised exercise in a group setting; home-based exercise; antidepressant medication (sertraline, 50–200 mg daily); or placebo pill for 16 weeks. Patients underwent the structured clinical interview for depression and completed the Hamilton Depression Rating Scale (HAM-D). Results: After 4 months of treatment, 41% of the participants achieved remission, defined as no longer meeting the criteria for major depressive disorder (MDD) and a HAM-D score of 8. Patients receiving active treatments tended to have higher remission rates than the placebo controls: supervised exercise 45%; home-based exercise 40%; medication 47%; placebo 31% (p .057). All treatment groups had lower HAM-D scores after treatment; scores for the active treatment groups were not significantly different from the placebo group (p .23). Conclusions: The efficacy of exercise in patients seems generally comparable with patients receiving antidepressant medication and both tend to be better than the placebo in patients with MDD. Placebo response rates were high, suggesting that a considerable portion of the therapeutic response is determined by patient expectations, on going symptom monitoring, attention, and other nonspecific factors.
  • 1. Broocks A, Bandelow B, Pekrun G, et al. Comparison of Aerobic Exercise, Clomipramine, and Placebo in the Treatment of Panic Disorder. Am J Psychiatry. 1998;155(5):603–609.OBJECTIVE: The purpose of this study was to compare the therapeutic effect of exercise for patients with panic disorder to a drug treatment of proven efficacy and to placebo. METHOD: Forty-six outpatients suffering from moderate to severe panic disorder with or without agoraphobia (DSM-III-R criteria) were randomly assigned to a 10-week treatment protocol of regular aerobic exercise (running), clomipramine (112.5 mg/day), or placebo pills. RESULTS: The dropout rate was 31% for the exercise group, 27% for the placebo group, and 0% for the clomipramine group. In comparison with placebo, both exercise and clomipramine led to a significant decrease in symptoms according to all main efficacy measures (analysis of variance, last-observation-carried-forward method and completer analysis). A direct comparison of exercise and clomipramine revealed that the drug treatment improved anxiety symptoms significantly earlier and more effectively. Depressive symptoms were also significantly improved by exercise and clomipramine treatment. CONCLUSIONS: These results suggest that regular aerobic exercise alone, in comparison with placebo, is associated with significant clinical improvement in patients suffering from panic disorder, but that it is less effective than treatment with clomipramine.
  • 1. Hötting K, Schauenburg G, Röder B. Long-Term Effects of Physical Exercise on Verbal Learning and Memory in Middle-Aged Adults: Results of a One-Year Follow-Up Study. Brain Sciences. 2012;2(4):332–346. doi:10.3390/brainsci2030332.
  • Driemeyer J, Boyke J, Gaser C, Büchel C, May A. Changes in Gray Matter Induced by Learning—Revisited. PLoS ONE. 2008;3(7):e2669. Background:Recently, activation-dependant structural brain plasticity in humans has been demonstrated in adults after three months of training a visio-motor skill. Learning three-ball cascade juggling was associated with a transient and highly selective increase in brain gray matter in the occipito-temporal cortex comprising the motion sensitive area hMT/V5 bilaterally. Principal Findings:Using a 3 Tesla scanner and monitoring whole brain structure we repeated and extended our original study in 20 healthy adult volunteers, focusing on the temporal aspects of the structural changes and investigated whether these changes are performance or exercise dependant. The data confirmed our earlier observation using a mean effects analysis and in addition showed that learning to juggle can alter gray matter in the occipito-temporal cortex as early as after 7 days of training. Neither performance nor exercise alone could explain these changes.Conclusion:We suggest that the qualitative change (i.e. learning of a new task) is more critical for the brain to change its structure than continued training of an already-learned task.
  • Melov S, Tarnopolsky MA, Beckman K, Felkey K, Hubbard A. Resistance Exercise Reverses Aging in Human Skeletal Muscle. PLoS ONE. 2007;2(5):e465. Abstract: Human aging is associated with skeletal muscle atrophy and functional impairment (sarcopenia). Multiple lines of evidence suggest that mitochondrial dysfunction is a major contributor to sarcopenia. We evaluated whether healthy aging was associated with a transcriptional profile reflecting mitochondrial impairment and whether resistance exercise could reverse this signature to that approximating a younger physiological age. Skeletal muscle biopsies from healthy older (N = 25) and younger (N = 26) adult men and women were compared using gene expression profiling, and a subset of these were related to measurements of muscle strength. 14 of the older adults had muscle samples taken before and after a six-month resistance exercise-training program. Before exercise training, older adults were 59% weaker than younger, but after six months of training in older adults, strength improved significantly (P<0.001) such that they were only 38% lower than young adults. As a consequence of age, we found 596 genes differentially expressed using a false discovery rate cut-off of 5%. Prior to the exercise training, the transcriptome profile showed a dramatic enrichment of genes associated with mitochondrial function with age. However, following exercise training the transcriptional signature of aging was markedly reversed back to that of younger levels for most genes that were affected by both age and exercise. We conclude that healthy older adults show evidence of mitochondrial impairment and muscle weakness, but that this can be partially reversed at the phenotypic level, and substantially reversed at the transcriptome level, following six months of resistance exercise training.
  • Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance Training and Executive Functions: A 12-Month Randomized Controlled Trial. Arch Intern Med. 2010;170(2):170–178. Background:Cognitive decline among seniors is a pressing health care issue. Specific exercise training may combat cognitive decline. We compared the effect of once-weekly and twice-weekly resistance training with that of twice-weekly balance and tone exercise training on the performance of executive cognitive functions in senior women.Methods: In this single-blinded randomized trial, 155 community-dwelling women aged 65 to 75 years living in Vancouver were randomly allocated to once-weekly (n = 54) or twice-weekly (n = 52) resistance training or twice-weekly balance and tone training (control group) (n = 49). The primary outcome measure was performance on the Stroop test, an executive cognitive test of selective attention and conflict resolution. Secondary outcomes of executive cognitive functions included set shifting as measured by the Trail Making Tests (parts A and B) and working memory as assessed by verbal digit span forward and backward tests. Gait speed, muscular function, and whole-brain volume were also secondary outcome measures.Results: Both resistance training groups significantly improved their performance on the Stroop test compared with those in the balance and tone group (P ≤ .03). Task performance improved by 12.6% and 10.9% in the once-weekly and twice-weekly resistance training groups, respectively; it deteriorated by 0.5% in the balance and tone group. Enhanced selective attention and conflict resolution was significantly associated with increased gait speed. Both resistance training groups demonstrated reductions in whole-brain volume compared with the balance and tone group at the end of the study (P ≤ .03).Conclusion:Twelve months of once-weekly or twice-weekly resistance training benefited the executive cognitive function of selective attention and conflict resolution among senior women.
  • 1. de Brito LBB, Ricardo DR, de Araújo DSMS, Ramos PS, Myers J, de Araújo CGS. Ability to sit and rise from the floor as a predictor of all-cause mortality. Eur J PrevCardiol. 2012.
  • de Brito L, Ricardo DR. Ability to sit and rise from the floor as a predictor of all-cause mortality. European journal of …. 2012.Background: While cardiorespiratory fitness is strongly related to survival, there are limited data regarding musculoskeletal fitness indicators. Our aim was to evaluate the association between the ability to sit and rise from the floor and all-cause mortality.Design: Retrospective cohort.Methods: 2002 adults aged 51–80 years (68% men) performed a sitting-rising test (SRT) to and from the floor, which was scored from 0 to 5, with one point being subtracted from 5 for each support used (hand/knee). Final SRT score, varying from 0 to 10, was obtained by adding sitting and rising scores and stratified in four categories for analysis: 0–3; 3.5–5.5, 6–7.5, and 8–10.Results: Median follow up was 6.3 years and there were 159 deaths (7.9%). Lower SRT scores were associated with higher mortality (p < 0.001). A continuous trend for longer survival was reflected by multivariate-adjusted (age, sex, body mass index) hazard ratios of 5.44 (95% CI 3.1–9.5), 3.44 (95% CI 2.0–5.9), and 1.84 (95% CI 1.1–3.0) (p < 0.001) from lower to higher SRT scores. Each unit increase in SRT score conferred a 21% improvement in survival.Conclusions: Musculoskeletal fitness, as assessed by SRT, was a significant predictor of mortality in 51–80-year-old subjects. Application of a simple and safe assessment tool such as SRT, which is influenced by muscular strength and flexibility, in general health examinations could add relevant information regarding functional capabilities and outcomes in non-hospitalized adults.
  • Kaplan-Maier survival analysis for four ranges of SRT scoring in subjects aged 51–80 years.
  • 1. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: a systematic review. The Journal of the American Board of Family Practice. 2005;18(6):491–519.
  • Streeter CC, Whitfield TH, Owen L, et al. Effects of Yoga Versus Walking on Mood, Anxiety, and Brain GABA Levels: A Randomized Controlled MRS Study. The Journal of Alternative and Complementary Medicine. 2010;16(11):1145–1152. Objectives: Yoga and exercise have beneficial effects on mood and anxiety. γ-Aminobutyric acid (GABA)-ergic activity is reduced in mood and anxiety disorders. The practice of yoga postures is associated with increased brain GABA levels. This study addresses the question of whether changes in mood, anxiety, and GABA levels are specific to yoga or related to physical activity.Methods: Healthy subjects with no significant medical/psychiatric disorders were randomized to yoga or a metabolically matched walking intervention for 60 minutes 3 times a week for 12 weeks. Mood and anxiety scales were taken at weeks 0, 4, 8, 12, and before each magnetic resonance spectroscopy scan. Scan 1 was at baseline. Scan 2, obtained after the 12-week intervention, was followed by a 60-minute yoga or walking intervention, which was immediately followed by Scan 3.Results: The yoga subjects (n = 19) reported greater improvement in mood and greater decreases in anxiety than the walking group (n = 15). There were positive correlations between improved mood and decreased anxiety and thalamic GABA levels. The yoga group had positive correlations between changes in mood scales and changes in GABA levels.Conclusions: The 12-week yoga intervention was associated with greater improvements in mood and anxiety than a metabolically matched walking exercise. This is the first study to demonstrate that increased thalamic GABA levels are associated with improved mood and decreased anxiety. It is also the first time that a behavioral intervention (i.e., yoga postures) has been associated with a positive correlation between acute increases in thalamic GABA levels and improvements in mood and anxiety scales. Given that pharmacologic agents that increase the activity of the GABA system are prescribed to improve mood and decrease anxiety, the reported correlations are in the expected direction. The possible role of GABA in mediating the beneficial effects of yoga on mood and anxiety warrants further study.
  • 1. Nguyen MH, Kruse A. A randomized controlled trial of Tai chi for balance, sleep quality and cognitive performance in elderly Vietnamese. ClinInterv Aging. 2012:185.
  • 1. Nguyen MH, Kruse A. A randomized controlled trial of Tai chi for balance, sleep quality and cognitive performance in elderly Vietnamese. ClinInterv Aging. 2012:185.
  • 1. Nguyen MH, Kruse A. A randomized controlled trial of Tai chi for balance, sleep quality and cognitive performance in elderly Vietnamese. ClinInterv Aging. 2012:185.
  • Earhart GM. Dance as therapy for individuals with Parkinson disease. European journal of physical and rehabilitation medicine. 2009;45(2):231.A comparison of tango, waltz/foxtrot, Tai Chi, and no intervention suggests that all three interventions were superior to no exercise.36,37 With both forms of dance and Tai Chi there were significant improvements on the Berg Balance Scale (Figure 1). Average improvement in each dance group was 4 points with effect sizes >0.9 and in the Tai Chi group was 3 points with an effect size of 0.8. All three interventions also resulted in significant improvements of 40 meters or more in six minute walk distance (6MWD), with effect sizes of 0.63, 0.50, and 0.36 for tango, waltz/foxtrot, and Tai Chi, respectively (Figure 1). Backward walking velocity and backward stride length also improved significantly in all 3 interventions, with effect sizes ranging from 0.3 to 0.6. Differences between the interventions emerged for the Timed Up & Go and for forward walking. Although no significant changes in these measures were noted with any of the interventions, the largest improvements were noted in the tango group. The tango group decreased TUG time by 2 seconds with an effect size of 0.45, while waltz/foxtrot showed no change in TUG time and Tai Chi improved by only one second with an effect size of 0.23. The tango group also demonstrated an increase in forward walking velocity of 0.08 m/s, with an effect size of 0.36, while the other interventions showed changes of 0.02 m/s or less.
  • 1. Graybiel AM. Habits, rituals, and the evaluative brain. Annu. Rev. Neurosci. 2008;31:359–387.
  • 1. Yin HH, Knowlton BJ. The role of the basal ganglia in habit formation. Nat Rev Neurosci. 2006;7(6):464–476.
  • Drugs of abuse, despite diverse initial actions, produce some common effects on the ventral tegmental area (VTA) and nucleus accumbens (NAc). Stimulants directly increase dopaminergic transmission in the NAc. Opiates do the same indirectly: they inhibit GABA-ergic interneurons in the VTA, which disinhibits VTA dopamine neurons. Opiates also directly act on opioid receptors on NAc neurons, and opioid receptors, such as D2 dopamine (DA) receptors, signal via Gi; hence, the two mechanisms converge within some NAc neurons. The actions of the other drugs remain more conjectural. Nicotine appears to activate VTA dopamine neurons directly via stimulation of nicotinic cholinergic receptors on those neurons and indirectly via stimulation of its receptors on glutamatergic nerve terminals that innervate the dopamine cells. Alcohol, by promoting GABAA receptor function, may inhibit GABA-ergic terminals in the VTA and disinhibit VTA dopamine neurons. It may similarly inhibit glutamatergic terminals that innervate NAc neurons. Many additional mechanisms (not shown) are proposed for alcohol. Cannabinoid mechanisms are complex and involve the activation of cannabinoid CB1 receptors (which, similar to D2 and opioid receptors, are Gi-linked) on glutamatergic and GABA-ergic nerve terminals in the NAc and on NAc neurons themselves. Phencyclidine (PCP) may act by inhibiting postsynaptic NMDA glutamate receptors in the NAc. Finally, evidence shows that nicotine and alcohol may activate endogenous opioid pathways and that these and other drugs of abuse (such as opiates) may activate endogenous cannabinoid pathways (not shown). PPT/LDT, peduncularpontinetegmentum/lateral dorsal tegmentum.
  • Pumped: How to Build A Better Brain Through Exercise and Movement

    1. 1. Pumped: How To Build ABetter Brain Through Exerciseand MovementMichael Lara, MDDiplomate, American Board of Psychiatry and NeurologySan Francisco, CAwww.drmikelara.com
    2. 2. The Pumped e-book will teach youeverything you need to know to getstarted• The physical and mental health benefitsof intermittent fasting• How to begin an intermittent fast• Best timing schedules forfasting/nonfasting• What type of results to expect• What supplements to use to maximizegains• An overview of exercise strategies• The single best interval strategy formaximal fat loss
    3. 3. $19.9530 Day Money-Back Guarantee!Download yourcopy atwww.drmikelara.com$9.95Facebook.com/BrainMD MichaelLaraMD
    4. 4. Born To MoveWhy Our Brains Were Designed To Move andHow Our Sedentary Habits are Killing Us
    5. 5. The Human Brain EvolvedThrough MovementThe human brain evolved over 4 million years from 400grams in earliest hominids to 1.4 kilograms (3 lbs).Complex movement sequences such as long-distancerunning and throwing projectiles were essential todevelopment of neocortical structures and pathwaysThe brain exists, according to some neuroscientists, forone reason and one reason only: not to think or feel, butto produce adaptable and complex movements.Wolpert, D. The Real Reasons for Brains. TedTalks.http://www.ted.com/talks/daniel_wolpert_the_real_reason_for_brains.html. Accessed March 18, 2013
    6. 6. Physical activities of our paleolithic ancestors havecorrelates in modern day forms of exerciseTypical Activities of Hunter-Gatherer• Slow Cardio: 5-10 miles/day of low intensity walking• Hunter gatherers cover 5-15 miles per days. Persistence hunterscover in excess of 30 miles/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 ofpreyOKeefe JH, Vogel R, Lavie CJ, Cordain L. Achieving Hunter-gatherer Fitness in the 21st Century:Back to the Future. AJM. 2012:1–5.
    7. 7. The Primary Motor Cortex
    8. 8. Cerebellum and Movement• Cerebellum (Latin for ―little brain‖) isresponsible for coordination, precisionand accurate timing of movement• Contains 50-80% of total neurons inbrain• Cerebellum is dysfunctional inmovements of attention (ADHD) andmovement (Parkinson Disease)• Moving to rhythm or cadence is anestablished treatment for both ADHDand PDBledsoe J, Semrud-Clikeman M, Pliszka SR. A magnetic resonance imaging study of the cerebellarvermis in chronically treated and treatment-naive children with attention-deficit/hyperactivity disordercombined type. Biol. Psychiatry. 2009;65(7):620–624.
    9. 9. Americans Move Less0 2000 4000 6000 8000 10000 12000AmericansAustraliansSwissJapaneseSteps/day; 1 mile=2,000 stepsBassett DR JR.,Wyatt HR, Thompson H, Peters JC, Hill JO. Pedometer-measured physical activity andhealth behaviors in United States adults. Med Sci Sports Exerc. 2010;42(10):1819.
    10. 10. Too Much Sitting: An ImportantPredictor of Chronic Disease?• Increased participation in physical activity is a central tenet ofstrategies for preventing major chronic diseases (type 2diabetes, cardiovascular disease, breast and colon cancer).• Recent findings also suggest that physical activity, in the context ofotherwise sedentary lifestyles, is unlikely to be sufficient to preventincreasing rates of chronic disease.• We spend an average of 9.3 hours/day sitting--even more timethan we spend sleeping (7.7 hours)Owen N, Bauman A, Brown W. Too much sitting: a novel and important predictor of chronic diseaserisk? British Journal of Sports Medicine. 2009;43 (2):81–83.
    11. 11. Sedentary Physiology• Though conceptualized as the low end of the physicalactivity continuum, sedentary behavior has independentand qualitatively different effects on humanmetabolism, physical function and brain function.• Individuals can achieve high levels of moderate tovigorous physical activity and still exhibit high levelsof sedentary behavior — one behavior does notnecessarily displace the otherTremblay MSTM, Colley RCCR, Saunders TJST, Healy GNHG, Owen NON. Physiological and healthimplications of a sedentary lifestyle. Applied Physiology, Nutrition, and Metabolism. 2010;35(6):725–
    12. 12. TheConsequences ofa SedentaryLifestyle• Type 2diabetes, cardiovasculardiseases, coloncancer, breastcancer, dementia anddepression constitute acluster of diseases, whichare mediated byinflammation.• Chronic inflammation isinvolved in thepathogenesis of insulinresistance, atherosclerosis,neurodegeneration andtumor growth.• Evidence suggests that theprotective effect of exercisemay due to the anti-inflammatory effect ofregular exercisePedersen BK. The diseasome of physical inactivity - and the role of myokines in muscle-fat cross talk.Journal of Physiology. 2009;587(23):5559–5568.
    13. 13. Plasma Levels of Interleukin-6 and C-Reactive Protein are Associated withPhysical Inactivity Independent of Obesity• Inflammatory cytokines are released in response to acuteexercise, but trained subjects have a markedly lowerlevels of C-reactive protein (CRP) and interleukin-6 (IL.)• CRP and IL-6 reflect the degree of regular physical activitywhen compared with other markers of inflammation.• Obesity is associated with elevated insulin, C-peptide, triglycerides, low-density lipoprotein, IL-6, CRP, and adiponectin.• Physical inactivity was associated with elevated C-peptide, IL-6, and CRP independent ofobesity, age, gender, and smoking.Fischer CP, Berntsen A, Perstrup LB, Eskildsen P, Pedersen BK. Plasma levels of interleukin-6 and C-reactive protein are associated with physical inactivity independent of obesity. Scand J Med Sci Sports.2006.
    14. 14. Myokines and InflammationPedersen BK. The diseasome of physical inactivity - and the role of myokines in muscle-fat cross talk.The Journal of Physiology. 2009;587(23):5559–5568. doi:10.1113/jphysiol.2009.179515.
    15. 15. Longer Periods of Standing or Walking ImproveInsulin Action More Than Acute Bouts ofModerate to Vigorous ActivityOne hour of daily physical exercise cannot compensate the negative effects of inactivity on insulinlevel and plasma lipids if the rest of the day is spent sitting.Duvivier BMFM, Schaper NC, Bremers MA, et al. Minimal intensity physical activity (standing andwalking) of longer duration improves insulin action and plasma lipids more than shorter periods ofmoderate to vigorous exercise (cycling) in sedentary subjects when energy expenditure is comparable.PLoS ONE. 2013;8(2):e55542.
    16. 16. Benefits of Outdoor Exercise• Exposure to natural settings has restorative health effects• Japanese practice of shinrin-yoku, or forest bathing• Exercising in natural environments associated with greaterfeelings of revitalization and positiveengagement, decreases in tension, confusion, anger, anddepression, and increased energy.• Exercising outdoor increases body levels of vitamin Dlevels.• Persons aged >60 yrs who participated in daily outdooractivities had vitamin D concentrations similar to that ofpersons aged 20-39 yrs.Coon JT, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity inoutdoor natural environments have a greater effect on physical and mental wellbeing than physicalactivity indoors? A systematic review. Environ. Sci. Technol. 2011;45(5):1761–1772.
    17. 17. Exercise Improves Sleep• Exercise improves sleep quality and normalizes circadianrhythms.• Acute and chronic exercise increases slow wave sleep andtotal rest time. Exercise also decreases the amount of time tofall asleep and decreases the amount of time spent in non-restorative REM sleep.• Lack of restorative sleep increases inflammatory cytokinesand is associated with chronic disease• A single night of sleep deprivation results in higher levels ofinterleukin-6 and tumor necrosis factorUchida S, Shioda K, Morita Y, Kubota C, Ganeko M, Takeda N. Exercise Effects on SleepPhysiology. Frontiers in Neurology. 2012;3.
    18. 18. Exercise increasestime spent in deepsleep
    19. 19. Source: National Sleep Foundation. Exercise and Sleep 2013 .www.sleepfoundation.org
    20. 20. The Molecules of MovementNeurotransmitters, Hormones, and Neurotrophins
    21. 21. Norepinephrine SerotoninDopamineAlertnessConcentrationEnergyObsessionsCompulsionsMemoryPleasureRewardMotivationHigh-Intensity Interval TrainingSprint TrainingWalkingSwimmingJoggingYogaTai ChiDancing
    22. 22. Exercise IncreasesNeurotransmitters• Exercise has both short and long-term effects on neurotransmittersthat regulate attention, mood, and movement• Norepinephrine (NE) increases abruptly at exercise intensities thatexceed 50% of VO2 max• NE turnover is increased in the frontal cortex and is helpful in alleviatedsymptoms of ADHD• Serotonin (5-HT) is modulated by exercise in specific brain regionsand is also affected by intensity and duration of exercise.• High-intensity interval training increases 5-HT synthesis in thehippocampus via interaction with brain derived neurotrophic factor(BDNF).• Dopamine (DA) is also increased in pathways involved in regulationand control of movement• Higher levels of moderate to vigorous activities are associated with alower risk of developing Parkinson diseaseMattson MP, Maudsley S, Martin B. BDNF and 5-HT: a dynamic duo in age-related neuronalplasticity and neurodegenerative disorders. Trends in Neurosciences. 2004;27(10):589–594.
    23. 23. Catecholamine Response to Exercise
    24. 24. Beta-Endorphin and TheRunner’s High• Exercise, a form of voluntary stress, activates thehypothalamic-pituitary-adrenal axis• Beta-endorphin is released from anterior pituitary• Subjective feelings of euphoria are mediated by risinglevels of beta-endorphin• Naloxone, an opioid antagonist, attenuates the subjectivefeelings of joy and euphoria associated with running• Beta-endorphin increases in prefrontal and limbic regions ofthe brain after 2 hours of endurance running and levelscorrelate with euphoria ratings.Janal MN, Colt EWD, Clark WC, Glusman M. Pain sensitivity, mood and plasma endocrinelevels in man following long-distance running: Effects of naloxone. Pain. 1984;19(1):13–25.
    25. 25. Boecker H, Sprenger T, Spilker ME, et al. The runners high: opioidergic mechanisms in thehuman brain. Cerebral Cortex. 2008;18(11):2523–2531.ACC: Errordetection, modulationof emotional responsesOFC: signals expectedreward/punishment ofan actionINS: interoceptiveawareness of bodystate
    26. 26. Effects of Chronic EnduranceExercise on Testosterone• Gonadal steroid hormones, testosterone andestrogen, are affected by exercise mode and intensity.• In general, chronic endurance training depressesreproductive hormone responses in both men and women• Endurance-trained men have lower levels of testosteronecompared with sedentary controls.• Decreases in testosterone, sperm motility and correlatewith exercise intensity.Wheeler GD. Reduced Serum Testosterone and Prolactin Levels in Male Distance Runners.JAMA. 1984;252(4):514.
    27. 27. Effects of Intensive, Long-TermRunning on Reproductive HormonesTestosterone levels were lowerin the group of runners whoexercised more intensely andwere restored after 36 weeks ofrecoveryTotal sperm count, spermmotility, and sperm morphologywere all lower in the high-intensity exercise group v. themedium-intensity exercise groupSafarinejad MR, Azma K, Kolahi AA. The effects of intensive, long-term treadmill running on reproductive hormones, hypothalamus-pituitary-testis axis, and semen quality: a randomized controlledstudy. Journal of Endocrinology. 2008;200(3):259–271.
    28. 28. Effect of Exercise on Estrogen inPostmenopausal Women• Elevated circulating estrogens and a sedentary lifestyleincrease risk for breast cancer.• Objective: examine effects of 12-month moderate-intensityexercise intervention on serum estrogens.• Method: 173 sedentary, overweight women, ages 50-75, assigned to exercise (45 min, 5days/week) and controlgroup.• Results: After 3 months, exercisers experienced declinesin estrone, estradiol, and free estradiol versus no changeor increased concentrations in controls. After12, months, the direction of effect remained the same. Theeffect was limited to women who lost body fat.McTiernan A, Tworoger SS, Ulrich CM, et al. Effect of Exercise on Serum Estrogens inPostmenopausal Women A 12-Month Randomized Clinical Trial. Cancer Research. 2004;64(8):2923–
    29. 29. Andreasen, Brave New Brain: Conquering Mental Illness in the Era of the Genome, 2001Effects of Cortisol onHippocampus
    30. 30. Cortisol and The Hippocampus• Chronic exposure to elevated levels of cortisol is known toreduce hippocampal volume• Reductions in hippocampal volume are seen across manyneurocognitive and neurodegenerative diseases includingmajor depressive disorder, dementia, and schizophrenia• Exercise-trained individuals tend to display attenuatedHPA axis responses to exercise and mental stress.Hippocampal volumes are larger in high fit adults.Videbech P, Ravnkilde B. Hippocampal Volume and Depression: A Meta-Analysis of MRI Studies. AmJ Psychiatry. 2004;161(11):1957–1966.
    31. 31. Exercise Reverses HippocampalVolume Loss in Late Adulthood• Hippocampus shrinks in late adulthood, leading toimpaired memory and risk for dementia• Randomized controlled trial with 120 older adultsdemonstrated an increased size of anteriorhippocampus, leading to improvements in spatial memory.• Exercise training increased hippocampal volume by2%, effectively reversing age-related loss in volume by 1to 2 years.• Hippocampal volume declined in the control groupErickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus andimproves memory. PNAS. 2011;108(7):3017–3022.
    32. 32. Aerobic Exercise Training IncreasesBrain Volume In Aging AdultsBlue regions: Gray matter volume was increased for aerobic exercisersYellow regions: White matter was increased for aerobic exercisersColcombe SJ, Erickson KI, Scalf PE, et al. Aerobic exercise training increases brain volume in aginghumans. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences.2006;61(11):1166–1170.
    33. 33. Cardio or Weights?The Cognitive Benefits of Aerobics, Resistance Training, andOther Forms of Mindful Movement
    34. 34. Pumped will teach you everything youneed to know to get started• The physical and mental health benefitsof intermittent fasting• How to begin an intermittent fast• Best timing schedules forfasting/nonfasting• What type of results to expect• What supplements to use to maximizegains• An overview of exercise strategies• The single best interval strategy formaximal fat loss
    35. 35. $19.9530 Day Money-Back Guarantee!Download yourcopy atwww.drmikelara.com$9.95Facebook.com/BrainMD MichaelLaraMD
    36. 36. Exercise and Pharmacotherapy inthe Treatment of Major Depression• Objective: to assess whether patients receiving aerobicexercise achieve reductions in depression compared tostandard antidepressant medication.• Methods: RCT of 202 adults diagnosed with MDDassigned to one of four conditions: supervisedexercise, home-based exercise, antidepressantmedication, or placebo for 16 weeks.• Results: after 4 months of treatment, exercising groupshad response rates comparable to group takingmedication.Blumenthal JA, Babyak MA, Doraiswamy PM, et al. Exercise and Pharmacotherapy in theTreatment of Major Depressive Disorder. Psychosomatic Medicine. 2007;69(7):587–596.
    37. 37. Exercise v. Sertraline in MDDHamilton Depression Rating Scale (HAM-D) scores after 16 weeks of treatmentusing intention-to-treat analysisPatients in the Home andSupervisedexercise groups had comparableresults to group taking medication
    38. 38. Exercise v. Clomipramine in PanicDisorderObjective: To compare the therapeutic effect of exercise for patients with panic disorderto a drug treatment..Method: 46 outpatients suffering from panic disorder were randomly assigned to a 10-week treatment protocol of regular aerobic exercise, clomipramine, or placebo pills.Results: Both exercise and clomipramine led to a significant decrease in symptoms.Clomipramine treatment improved anxiety symptoms significantly earlier and moreeffectively.Conclusions: Regular aerobic exercise alone is associated with significant clinicalimprovement, but it is less effective than treatment with clomipramine.Broocks A, Bandelow B, Pekrun G, et al. Comparison of Aerobic Exercise, Clomipramine, and Placebo in the Treatment ofPanic Disorder. Am J Psychiatry. 1998;155(5):603–609.
    39. 39. Benefits of Aerobic Training• The majority of scientific literature supports a generalbenefit of aerobic fitness on childhood cognitiveperformance.• Interventional studies in adults suggest that previouslysedentary older adults improve in executivefunctioning, attention, and memory after as little as 5-6months of regular aerobic exercise.• Aerobic training associated with increases in brain-derivedneurotrophic factor (BDNF) and vascular endothelialgrowth factor (VEGF).Voss MW, Nagamatsu LS, Liu-Ambrose T, Kramer AF. Exercise, brain, and cognition acrossthe life span. Journal of Applied Physiology. 2011;111(5):1505–1513.
    40. 40. Juggling Increases Gray Matter in theCortex• Learning to juggle can alter graymatter in the occipito-temporalcortex as early as after 7 days oftraining.• Learning a new task is more criticalfor the brain to change thancontinued training of an already-learned task.Driemeyer J, Boyke J, Gaser C, Büchel C, May A. Changes in Gray Matter Induced by Learning—Revisited.PLoS ONE. 2008;3(7):e2669
    41. 41. Benefits of Resistance- Training• In addition to increasing strength, resistance training (RT)increases growth hormone, improves glycemiccontrol, and increases lean body mass (LBM).• RT increases LBM by approx. 2.2 lbs in older adults. Thisis in contrast to the 0.4 lb annual decline that occursthrough sedentary lifestyle after age 50.• RT reverses aging in skeletal muscle. Gene expressionchanges associated with aging are reversed to youthfullevels after only 6 months of resistance training.Melov S, Tarnopolsky MA, Beckman K, Felkey K, Hubbard A. Resistance Exercise ReversesAging in Human Skeletal Muscle. PLoS ONE. 2007;2(5):e465.
    42. 42. Resistance-Training andExecutive Function• Background: We compared the effect of once-weekly and twice-weekly resistance training with that of twice-weekly balance andtone exercise training on the performance of executive cognitivefunctions in senior women.• Methods: Single-blinded randomized trial, 155 women aged 65to 75 years were randomly allocated to once-weekly (n = 54) ortwice-weekly (n = 52) resistance training or twice-weeklybalance and tone training (control group) (n = 49). The primaryoutcome measure was performance on the Stroop test, anexecutive cognitive test of selective attention and conflictresolution. Gait speed, muscular function, and whole-brainvolume were also secondary outcome measures.Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance Training andExecutive Functions: A 12-Month Randomized Controlled Trial. Arch Intern Med. 2010;170(2):170–178.
    43. 43. Resistance-Training andExecutive FunctionResults: Both resistance training groups significantly improvedtheir performance on the Stroop test compared with those in thebalance and tone group (P ≤ .03). Enhanced selective attentionand conflict resolution was significantly associated withincreased gait speed. Both resistance training groupsdemonstrated reductions in whole-brain volume compared withthe balance and tone group at the end of the study (P ≤ .03).Conclusion: Twelve months of once-weekly or twice-weeklyresistance training benefited the executive cognitive function ofselective attention and conflict resolution among senior women.Liu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance Training andExecutive Functions: A 12-Month Randomized Controlled Trial. Arch Intern Med. 2010;170(2):170–178.
    44. 44. The CONSORT (Consolidated Standards of Reporting Trials) flowchart. BAT indicates twice-weekly balance and tone exercisetraining; 1× RT, once-weekly resistance training; and 2× RT, twice-weekly RT.Figure Legend:Resistance Training Improves Executive FunctionLiu-Ambrose T, Nagamatsu LS, Graf P, Beattie BL, Ashe MC, Handy TC. Resistance Training andExecutive Functions: A 12-Month Randomized Controlled Trial. Arch Intern Med. 2010;170(2):170–178.
    45. 45. Ability to Sit and Rise from FloorPredicts Mortality• Background: While cardiorespiratory fitness is stronglyrelated to survival, there are limited data regardingmusculoskeletal fitness indicators. Our aim was toevaluate the association between the ability to sit and risefrom the floor and all-cause mortality.• Methods: 2002 adults aged 51–80 years (68% men)performed a sitting-rising test (SRT) to and from thefloor, which was scored from 0 to 5, with one point beingsubtracted from 5 for each support used (hand/knee).Final SRT score, varying from 0 to 10, was obtained byadding sitting and rising scores and stratified in fourcategories for analysis: 0–3; 3.5–5.5, 6–7.5, and 8–10.de Brito LBB, Ricardo DR, de Araújo DSMS, Ramos PS, Myers J, de Araújo CGS. Ability tosit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2012.
    46. 46. Ability to Sit and Rise from FloorPredicts Mortality• Results: Median follow up was 6.3 years and there were 159deaths (7.9%). Lower SRT scores were associated with highermortality. Each unit increase in SRT score conferred a 21%improvement in survival.• Conclusions: Musculoskeletal fitness, as assessed by SRT, wasa significant predictor of mortality in 51–80-year-old subjects.de Brito LBB, Ricardo DR, de Araújo DSMS, Ramos PS, Myers J, de Araújo CGS. Ability tosit and rise from the floor as a predictor of all-cause mortality. Eur J Prev Cardiol. 2012.
    47. 47. Yoga as Health Intervention for ChronicDiseaseInnes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistancesyndrome, cardiovascular disease, and possible protection with yoga: a systematic review. The Journal ofthe American Board of Family Practice. 2005;18(6):491–519.
    48. 48. Effects of Yoga Versus Walking onMood, Anxiety, and Brain GABA Levels• Objectives: Yoga and exercise have beneficial effects onmood and anxiety. GABA activity is reduced in mood andanxiety disorders. The practice of yoga postures isassociated with increased brain GABA levels. This studyaddresses the question of whether changes inmood, anxiety, and GABA levels are specific to yoga orrelated to physical activity.• Methods: Healthy subjects with no significantmedical/psychiatric disorders were randomized to yoga ora metabolically matched walking intervention for 60minutes 3 times a week for 12 weeks.Streeter CC, Whitfield TH, Owen L, et al. Effects of Yoga Versus Walking on Mood, Anxiety, andBrain GABA Levels: A Randomized Controlled MRS Study. The Journal of Alternative andComplementary Medicine. 2010;16(11):1145–1152.
    49. 49. Effects of Yoga Versus Walking onMood, Anxiety, and Brain GABA Levels• Results: The yoga subjects (n = 19) reportedgreater improvement in mood and greaterdecreases in anxiety than the walking group(n = 15). There were positive correlations betweenimproved mood and decreased anxiety andthalamic GABA levels.• Conclusions: The 12-week yoga intervention wasassociated with greater improvements in mood andanxiety than a metabolically matched walking exercise.This is the first study to demonstrate that increasedthalamic GABA levels are associated with improved moodand decreased anxiety.Streeter CC, Whitfield TH, Owen L, et al. Effects of Yoga Versus Walking on Mood, Anxiety, andBrain GABA Levels: A Randomized Controlled MRS Study. The Journal of Alternative andComplementary Medicine. 2010;16(11):1145–1152.
    50. 50. Streeter CC, Whitfield TH, Owen L, et al. Effects of Yoga Versus Walking on Mood, Anxiety, andBrain GABA Levels: A Randomized Controlled MRS Study. The Journal of Alternative andComplementary Medicine. 2010;16(11):1145–1152.
    51. 51. Tai Chi Improves Balance, SleepQuality and Cognitive Performance• Objective: To evaluate the effects of Tai chi exercise onbalance, sleep quality, and cognitive performance.• Design: A randomized controlled trial.• Participants: One hundred two subjects were recruited.• Intervention: Subjects were divided randomly into twogroups. The Tai chi group was assigned 6 months’ Tai chitraining. The control group was instructed to maintain theirroutine daily activities.Nguyen MH, Kruse A. A randomized controlled trial of Tai chi for balance, sleep quality andcognitive performance in elderly Vietnamese. Clin Interv Aging. 2012:185.
    52. 52. Tai Chi Improves Balance, SleepQuality and Cognitive Performance• Outcome measures: The Falls Efficacy Scale(FES), Pittsburgh Sleep Quality Index (PSQI), and TrailMaking Test (TMT) were used as primary outcomemeasures.• Results: Participants in the Tai chi group reportedsignificant improvement in TMT in comparison with thecontrol group. Tai chi participants also reported betterscores in PSQI and FES than the control group.• Conclusion: Tai chi is beneficial to improve balance, sleepquality, and cognitive performance of the elderly.Nguyen MH, Kruse A. A randomized controlled trial of Tai chi for balance, sleep quality andcognitive performance in elderly Vietnamese. Clin Interv Aging. 2012:185.
    53. 53. Tai Chi Improves Balance, SleepQuality and Cognitive PerformanceNguyen MH, Kruse A. A randomized controlled trial of Tai chi for balance, sleep quality andcognitive performance in elderly Vietnamese. Clin Interv Aging. 2012:185.
    54. 54. Dance as Therapy for Individuals withParkinson DiseaseA comparison oftango, waltz/foxtrot, Tai Chi, and nointervention suggests that all threeinterventions were superior to noexercise.With both forms of dance and Tai Chithere were significant improvements onthe Berg Balance Scale.All three interventions also resulted insignificant improvements of 40 metersor more in six minute walk distanceEarhart GM. Dance as therapy for individuals with Parkinson disease. European journal ofphysical and rehabilitation medicine. 2009;45(2):231.
    55. 55. Establishing the ExerciseHabitHow to Form Healthy Habits and Avoid Unhealthy Habits
    56. 56. Habits DefinedHabits (mannerisms, customs, rituals) are largely learned; theyare acquired via experience-dependent plasticity.Habitual behaviors occur repeatedly over the course of days oryears, and they can become remarkably fixed.Habits are performed almost automatically, virtually non-consciously, allowing attention to be focused elsewhere.Habits tend to involve an ordered, structured action sequencethat is prone to being elicited by a particular context or stimulus.Habits can comprise cognitive expressions of routine (habits ofthought) as well as motor expressions of routine.Graybiel AM. Habits, rituals, and the evaluative brain. Annu. Rev. Neurosci. 2008;31:359–387.
    57. 57. Habit Formation and the BasalGangliaYin HH, Knowlton BJ. The role of the basal ganglia in habit formation. Nat Rev Neurosci.2006;7(6):464–476.
    58. 58. Neurobiology of Addiction
    59. 59. Tools to Start and MaintainHealthy Habits• StickK.com: uses a ―commitment contracts‖ to publiclydeclare stated goal. Progress is monitored via referee.• Place a financial wager on yourself. If you accomplish yourgoal, you get your money back; if not, your money goes tocharity.• HabitForge.com: identify one simple goal and receivedaily emails for tracking progress. Goals can be public orprivate.• Dietbet.com: Uses commitment contracts and wagers withfocus on weight loss. Bet against others or yourself.• 21Habit.com: Identify one goal and deposit $21. Each dayyou succeed you get $1; each day you fail, you lose $1.
    60. 60. Tracking Tools• Fitbit is an accelerometer that tracks movements andsleep patterns. Data is sent wirelessly to fitbit.com, wheredata is parsed and visualized according to variables youspecify.• Withings WiFi body scale tracks weight, BMI, and LBM.Data is sent wirelessly to your mobile devices, where it isanalyzed. Reminders to weight in are sent via email andtext messages.• RunKeeper and Digifit are websites and mobile apps thatintegrate with fitbit and the Withings WiFi scale. Both takedata from multiple sources and represent it in graphicformat.
    61. 61. Just Do It!An Overview of Exercise Types and Program Design
    62. 62. How Intense? In aerobic studies examined, participants exercised at60%-70% of maximum heart rate. This is equivalent to aleisurely walk for a sedentary individual.Karvonen Formula:220 – age = Maximum HR (MHR)Max HR – Resting HR = Heart Rate Reserve (HRR)HRR x Training Intensity % + Resting HR = Training HR Studies on resistance training began with weight that was50% of 1 repetition max (1 RM) and increased 3-5%/weekuntil 80% 1RM weight was used.Estimated 1RM :Weight x Reps x .0333 + Weight
    63. 63. How Often? In aerobic studies examined, participants exercised anaverage of 3 days/week. Exercise sessions lasted 45 minor less. Participants in resistance training programs exercised 3days/week. Exercise sessions lasted 30 min or less. The average drop-out rates for the aerobic and exercisegroups was less than 10%.
    64. 64. Exercise Programs for a Better BrainPrograms that include cross-training outdoors―constantly varied, high-intensity functionalmovements with goal of increasing workcapacity across broad time and modaldomains‖ crossfit.comFit byNatureOutdoor fitness program incorporatingcross-training and body weight exercisesacross different terrains. Adventx.comPrimalFitnessMoving frequently at a slow pace, lift heavythings, and sprint. marksdailyapple.comCrossfit
    65. 65. 77Lift Heavy ThingsMove Frequently at aSlow Pace―The Primal Blueprint‖ by Mark SissonPrimal FitnessSprintWalk, hike or jog at 55-75% maximum heartrate for 2-5 hours/weekBrief, intense sessions of full-body functional movements forup to 30 minutes 1-3x/week―All Out‖ efforts once every 7-10days, for <10 minutes
    66. 66. 78Leisurely walks in nature at least five times/weekMove Frequently at a Slow PaceExercise in green environmentsreduces stress and improves focusLeisurely walks improve fatmetabolism and insulin sensitivityEngages passive attention
    67. 67. 79Pushing, pulling, squatting, and throwingLift Heavy Things‣ Heavy resistance trainingincreases growth hormone (GH)and testosterone‣ Low levels of GH/IGF-1associated with cognitive decline‣ Testosterone may improvesome domains of cognitivefunction‣ Activates myokines, muscle-derived cytokines that protectagainst inflammation
    68. 68. Body-Weight Resistance TrainingThe Big 5 of Body Weight Resistance TrainingUpper Body Push-ups, pull-ups, chin-ups, rowsLower Body Squats, lunges, jumpsCore Sit-ups, hanging leg-raises, planksBack Good Mornings, bridgingTotal Body Squats, dead lifts, bear crawls, burpees12345
    69. 69. 81Nutritional strategy that alternates brief periods of fasting with non-fastingIntermittent 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 first12 hours of fasting• Fasting increases BDNF levels• Intermittent fasting increases brain-derived neurotrophic factor
    70. 70. 82Alternate periods of fasting with non-fasting for 1-3 non-consecutive days/weekHow to Succeed with IntermittentFasting6:00 PM 10:00 AMModified Fast: 16 hours Feed: 8 hours6:00 PMOptional Nutrients•Green tea•Omega-3 fatty acids (fish oil)•Medium chain triglycerides (coconutoil)Recommended Diets•Mediterranean Diet•Zone Diet•Paleo DietLeisurely walk SprintLiftFor more information: www.drmikelara.com
    71. 71. May’s StoryDecember 2010 March 2012To Watch the Free 1-hour Webinar:www. Brain Webinar. com
    72. 72. 84
    73. 73. Running at maximal intensity for no more than 30secondsSprint Training• Exercise intensity correlates withrise of catecholamines and brain-derived neurotrophic factor (BDNF)• High-intensity interval training (HIIT)increases glycogen storage inastrocytes cells• Carb loading for the brain
    74. 74. 88HIIT involves ―all out‖ efforts with fixed work:rest ratiosHigh-Intensity Interval Training30:30Total time: 10 min30 seconds of work 30 seconds of rest15:45Total time: 10 min15 seconds ofwork45 seconds of restTabata20:10Total time: 4 min20 seconds ofwork10secondsof rest
    75. 75. Power Program for a Better BrainA comprehensive program for exercising to improve mood andcognitionLeisurely Walks in Nature5 hours/week in outdooractivitiesOmega-3 Fatty Acids 4 grams of EPA+DHA dailyIntermittentFasting 3x/week: fast for 12-18 hoursSprint 1x/week ; ―all out‖ efforts for less than 10 minLift Heavy 2x/week: body weight resistance training
    76. 76. Pumped will teach you everything youneed to know to get started• The physical and mental health benefitsof intermittent fasting• How to begin an intermittent fast• Best timing schedules forfasting/nonfasting• What type of results to expect• What supplements to use to maximizegains• An overview of exercise strategies• The single best interval strategy formaximal fat loss
    77. 77. $19.9530 Day Money-Back Guarantee!Download yourcopy atwww.drmikelara.com$9.95Facebook.com/BrainMD MichaelLaraMD
    78. 78. Get Pumped!

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