This document discusses connections between movement, mood, and memory. It explores mood disorders like depression and Alzheimer's disease, and how exercise can positively impact both. Regular exercise is suggested to reduce risks of many chronic diseases, as well as depression and Alzheimer's. The benefits of exercise are explained from psychological, neurogenic, and neurochemical perspectives. Goals and strategies for starting an exercise routine are also outlined.

1. Movement, Mood and Memory:
Exploring connections, setting goals
Stephan Esser MD
www.esserhealth.com

4. Exercise?
Fingers, Feet and ForksFingers, Feet and Forks

5. I want you to……
• Be familiar with basic mood disorders
• Know what Alzheimer’s is
• Understand the basics of Exercise
• Prepare to apply the information to your
health

6. Mood Disorders
• A group of mental disorders involving a
disturbance of mood, along with either a full
or partial excessively happy (manic) or
extremely sad (depressive) syndrome not
caused by any other physical or mental
disorder. Mood refers to a prolonged emotion
• Depression
• Bipolar: Cyclic lows and highs
http://medical-dictionary.thefreedictionary.com/mood+disorder
The mind is its own
place, and in itself can
make a Heav'n of
Hell……a Hell of Heav'n.
JOHN MILTON (1608-1674)
The mind is its own
place, and in itself can
make a Heav'n of
Hell……a Hell of Heav'n.
JOHN MILTON (1608-1674)

8. Mood Disorders

9. Depression
• Epidemiology:
– about 121 million people worldwide.
– NIMH: In any given 1-year period, 9.5 percent of the population, or about 20.9
million American adults, suffer from a depressive illness
– 1 in 10 Adults
• Cost of Care:
– leading cause of disability as measured by YLDs
– By 2020, depression is projected to reach 2nd place in the ranking of DALYs
calculated for all ages, both sexes with more spending then on CV disease.
– Workplace: annual workplace cost of depression in America
at over $40 billion
– Personal: Incalculable
• Associated Factors:
-ass. with 850,000 suicides/yr
"Men are disturbed not by "Men are disturbed not by
things, but by the view things, but by the view
which they take of them.“which they take of them.“
EpicletusEpicletus -The Enchiridion--The Enchiridion-
"Men are disturbed not by "Men are disturbed not by
things, but by the view things, but by the view
which they take of them.“which they take of them.“
EpicletusEpicletus -The Enchiridion--The Enchiridion-

10. Depression
A: one of the criteria from category 1 and three of the
criteria from category 2 for most of the day nearly every
day for at least 2 weeks
– Category 1:
• Persistent depressed mood
• Anhedonia
– Category 2:
• SIGECAPS
B: symptoms do not meet criteria for mixed episode
C: symptoms cause significant impairment
D: symptoms not due to substance or GMC

11. Etiology
• Combination:
–Genetic
–Environmental
• Psychosocial
• Neurophysiologic
• Nutritional
• Pharmacologic
We can Nurture
Nature
We can Nurture
Nature

12. Risk Factors
• Gender: Women
• Family:
• Marital Status:
Divorced, widowed,
separated
• Social Class: Poverty
• Life Events/Traumas
• Medical Co-morbidities
• Obesity
• Gender: M=F
• Family:
• Marital Status:
Divorced, widowed,
separated
• Social Class: =
Exercise, Nutrition, Sleep, Sunlight (Vitamin D Status), Metabolic DysfunctionExercise, Nutrition, Sleep, Sunlight (Vitamin D Status), Metabolic Dysfunction

13. What we know about
Mood Disorders
• Common
• Many Risk Factors: Multifactorial etiology
• Expensive: $135 Billion SAMSHA 2012
• Debilitating
• Complex
• Prevention must be primary

14. TransitionTransition

15. Alzheimer’s
The most common form of Dementia

16. Definitions
• Dementia:
– Latin roots: De (absence) ment-(mind)
– loss of cognitive ability in a previously healthy
person, that is greater then what would be
expected from natural aging alone
– Frequent Deficits:
• Memory
• Attention
• Language
• Problem solving

17. Dementia
• Types:
– Alzheimer’s
– Vascular
– Fronto-Temporal
– Dementia with Lewy Bodies
– Mixed
– Other: Metabolic, Vitamin Deficiency’s, Syphillis,
HIV, Medication s/e’s, dementia pugilistica etc

18. Alzheimer’s
• 1906: Described by German psychiatrist Alois
Alzheimer MD
• “Alzheimer’s disease is an irreversible,
progressive brain disease that slowly destroys
memory and thinking skills and, eventually
even the ability to carry out the simplest tasks
of daily living.” National Institute of Aging, NIH 2012

19. Mortality Statistics

20. Statistics
• 5.4 mill. Americans have Alzheimer’s
• 1 in 8 adults over 65 y/o
• Spending:
– 300% higher Medicare costs if pt has dementia
– Projected thru 2050 a 500% increase in combined
Medicare and Medicaid spending

21. Cause
?

22. Outcomes
Beta-amyloid plaquesBeta-amyloid plaques
Neurofibrilary TanglesNeurofibrilary Tangles

23. Cause
?

24. Risk Factors
Non-Modifiable
• Age >65
– 5 yrs = double risk
• Gender ?
• Family History
• Ethnicity
• Genetics
–  risk
– Apo-E
Modifiable
• HBP/HLD/CAD
• Homocysteine
• Obesity 78%
• Diabetes
• Smoking 200%
• Head Trauma
• Exercise
• Nutrition
• Education

26. 2 of 32 of 3

27. The Problem
• High Blood Pressure:
– 1 in 3 adults
1:3 adults1:3 adults

28. 1:6 adults1:6 adults

29. The Problem
1:9 adults1:9 adults

30. Exercise
• Achieve recommended levels of Exercise:
– 20% of all adults >20 y/o
– 13% of those age 65-74 y/o
– 6% of those >75 y/o

31. Nutrition
Consume Recommended Servings of Fruits and
Vegetables:
-Adolescents: 0.9%
-Men: 2.2%
-Women: 3.5%
Consume Recommended Servings of Fruits and
Vegetables:
-Adolescents: 0.9%
-Men: 2.2%
-Women: 3.5%

32. What we know
• Basics of Alzheimer’s
• Foundational Statistics
• Risk Factors
We “Ain’t doing so good”

33. Treatment
• No Proven Universal Cure
• Medications:
– Delay institutionalization
• Symptom Focused
– Behavior, incontinence, depression
• Environmental

34. To Maintain Mood and Memory
Prevention is Essential

35. Risk Factors
•Gender: Women
•Family
•Marital Status
•Social Class
•Events/Traumas
•Medical Co-morbidities
•Obesity

36. Exercise

38. Definitions
• Exercise:
–movement of the body resulting in the
enhancement of health and improvement
of function

39. Categories
• Leisure time Exercise: organized sports,
running, gym activities, rehabilitation etc.
• Lifestyle Exercise: activity incorporated into our
daily pattern of life
– eg: parking in the distant portion of the parking lot rather then the first
bumper, taking the stairs instead of the elevator, mowing your own lawn,
sweeping the house etc.

40. Exercise
• Flexibility: 2-3 x’s/wk
• Balance: 2-3 x’s/wk
• Strength: 2-3 days/wk
• Cardiovascular: 150 min/wk

41. How could we hypothesize
exercise might reduce
Alzheimer’s risk?

42. Risk Factors
Non-Modifiable
• Age >65
– 5 yrs = double risk
• Gender ?
• Family History
• Ethnicity
• Genetics
–  risk
– Apo-E
Modifiable
• HBP/HLD/CAD
• Homocysteine
• Obesity 78%
• Diabetes
• Smoking 200%
• Head Trauma
• Exercise
• Nutrition
• Education

43. Benefits of Exercise
•  risk of HBP/Hchol/CAD
•  risk of Obesity
•  risk of Type 2 Diabetes
• Less likely to smoke
• More likely to eat health promoting foods

44. Exercise and Physical Health
• Reduces risk of
– Heart Disease ≈ 40%
– Obesity: ≈ 30-100%
– Stroke ≈ 50%
– Type 2 Diabetes ≈ 50%
– Hypertension ≈ 50%
– Disability delayed ≈15 years
– Colon Cancer ≈ 25-40%
– Breast Cancer ≈ 20%-44%
– Osteoporosis ≈ 20+%
• As many as 250,000 deaths per year in the United
States areattributable to a lack of regular
physical activity

45. Benefits of Exercise
• Obvious physiologic benefits
• Cognitive value
• Multi-system
– Cognitive, balance, coordination, strength, CV etc
– Executive, purpose, intention, goal-setting etc

46. Exercise and Alzheimers
• Delays the onset and reduces incidence
• Those who are in the top 10% of exercisers
have a 250% lower risk of alzheimers

47. “A simple exercise program, 1 hour twice
a week, led to significantly slower decline
in ADL score inpatients with
AD living in a nursing home than routine
medical care.” 2007
“A simple exercise program, 1 hour twice
a week, led to significantly slower decline
in ADL score inpatients with
AD living in a nursing home than routine
medical care.” 2007
Exercise training for depressed older adults with
Alzheimer's disease 2008
“…with severe AD evidenced a clear benefit to
participants in this study “
Exercise training for depressed older adults with
Alzheimer's disease 2008
“…with severe AD evidenced a clear benefit to
participants in this study “

48. Depression

49. Exercise and Depression
• The Antidepressive Effects of Exercise CJSM 2009
– Meta Analysis of 58 randomized studies (n = 2982)
– Participants in the exercise treatment had
significantly lower depression scores
– In many studies, similar outcomes to medication
– Dropout rates for the exercise treatment were
similar to those found in psychotherapeutic and
drug interventions.

50. How could we hypothesize
exercise might influence
Depression?

51. How does it Work?
• Psychology
• Neurogenesis
• Neuro-Biochemistry

52. Psychology
• Exercise and clinical depression: examining
two psychological mechanisms Psych. of Sport and Exercise 2005
– 2 Groups: Exercise vs Control
– 9 wk program
– Exercisers:
• Dec. Depression Scores
• Inc. Coping and Self Efficacy
• Less Rumination
• Less evidence that increased distraction was etiology

54. Neurogenesis
• Antidepressant effects of exercise: Evidence
for an adult-neurogenesis hypothesis? Journal of
Psychiatry and Neuroscience 2006
– Exercise increases synthesis of new neurons in the adult
brain
– Up to 2-3 x’s growth in Hippocampus
– Facilitates improved memory, completion of functional tasks,
learning of new tasks/materials
– Opposite effect seen with excessive stress

57. Neuro-Chemistry
• Exercise results in increased production of
– Norepinephrine
– Serotonin
– B-Endorphins

58. Transition

59. Stages of Change (Prochaska and DiClemente)
1: Pre-contemplation
2: Contemplation
3: Preparation/planning
4: Action
5: Maintenance
6: Permanent Maintenance
(Termination)

60. My Reasons to Exercise
• Feel good in my skin
• Increase energy, Reduce stress
• Increase my confidence, discipline
• Be a role model, socialize, family time
• It’s fun, I love to sweat and work hard
• I love challenges
• Reduce disease risk
• Lower disability risk
• Maintain independence
Reduce my risk of Alzheimer’s
and Depression
Reduce my risk of Alzheimer’s
and Depression

61. What are your reasons?

62. My Reasons NOT to Exercise
• Time
• I’m tired or lazy
• Inconvenience (I forgot my clothes etc…)
• Money (shoes, travel, racquets)
• Other priorities
• Hate Change
• Don’t know what to do
• I’m Injured

63. What are your reasons
NOT
to Exercise?

64. “Physical fitness can neither be
achieved by wishful thinking nor
outright
purchase.”
Joseph Pilates

65. You are never too old to set another goal or
to dream a new dream
C.S. Lewis

66. Defining Success
• What is success for you?
• Are such goals achievable, legitimate?
• What will you do if you fail to “succeed”?

67. Setting Goals
•Specific
•Measureable
•Achievable
•Realistic
•Timely

68. • “You have to work at living, period. You’ve got
to train like you are training for an athletic
event. Most older people just give up. They
think, “I’m too old for that,” because they
have an ache here or a pain there. Life is a
pain in the butt; you’ve got to work at it.”
- Jack LaLanne -

69. Establishing Priorities
• Potential responsibilities, limitations
• Discover balance
• Be dynamic, flexible

70. If you have decided
to start or increase
your activity level…….now what?

71. FITT
• Frequency
• Intensity
• Time
• Type

72. Lasting Change
• Track your efforts and progress
• Re-visit your goals regularly
• Adjust to meet your needs
• Thrive!

73. “Eating alone will not keep a man well; he must
also take exercise. For food and exercise……
work together to produce health.”
Hippocrates
Regimen 400 BC

74. “Exercise is just as essential as a rational diet”
Dr. William Esser N.D. DC.

75. “First say to yourself what you would be; and
then do what you have to do”
Epictectus
Greek Stoic Philosopher AD 55–AD 135

76. Thank You!
Stephan Esser MD
www.esserhealth.com