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P R E S E N T E D B Y
©2018IDEAHealth&FitnessAssociation.AllRightsReserved.
#ideapti
Fitness for the Brain at Any Age
Cody Sipe, PhD and Brett Klika
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Session 306E
Advances in neuroscience have proven that the brain can continue to grow
and get better as we get older. We are not destined to become senile or
suffer dementia if we take care of our bodies and our minds through good
nutrition and regular exercise. This session will take a look at optimal
brain development through movement and fitness from childhood to late
adulthood. We will explore how to activate and engage the primary
functions of the brain through programs such as SpiderFit Kids and
Ageless Grace. Learn fun, engaging and scientifically sound exercises
that will stimulate both the body and mind of your clients of all ages and
ability levels in as little as 10 minutes a day.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Ask yourself a very personal question:
What is your greatest concern about you and
your client’s health across your lifespan?
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Until recently, major health concerns were
heart disease and cancer.
Today one of the greatest health concerns on our planet is cognitive
decline as we age…
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
American School-Aged Children
• Rise in Behavioral Disorders
• CDC suggests nearly 7% of children ADHD
• Increased rates of depression amongst children and
teens
• Dramatic rise in sensory processing disorders
• Autism spectrum
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
People around the globe are concerned about
being diagnosed with:
• Alzheimer’s
• Dementia
• Parkinson’s
• or some other
form
of cognitive
decline.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Today
• Understand how movement plays a role in brain health
from the time we are born, all the way throughout our
lifespan.
• Understand some basic mechanisms behind how
movement creates a better brain.
• Identify key movement types that stimulate brain function
and growth.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
FAS Functional Domains
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Risk Factors for Cognitive Decline
• Age and Genetics
• CV disease
• Insulin resistance/DM
• High cholesterol
• HTN
• Obesity
• Smoking
• Amyloid plaque
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Neuroplasticity
Neuroplasticity: The brain's ability to reorganize and rebuild itself by
forming new neural connections.
• The more neural pathways you have, the more resilient your brain is:
Cognitive Reserve
Neurogenesis: the process of creating new neurons (brain cells).
• Contrary to popular belief, neurogenesis continuously
occurs in the adult brain under the right conditions
(i.e. EXERCISE).
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Specific Cognitive Functions
Executive Functions
• Organizational: Attentional control, working memory,
problem solving, planning, cognitive flexibility, abstract
thinking
• Regulatory: Self-control, initiation of action, emotional
regulation, inhibitory control, decision making
Memory Storage and Retrieval
• Explicit, semantic, episodic, short vs long-term
Motor Control and Coordination
Sensory Perception
Language
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Brain Games
"Claims promoting brain games are frequently
exaggerated and at times misleading. ... To date,
there is little evidence that playing brain games
improves underlying broad cognitive abilities, or that it
enables one to better navigate a complex realm of
everyday life.“
- Consensus statement (2014)
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
What’s Good for the
Heart…
Is Good for the Brain!
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Exercise and Cognition
Bamidis et al (2014)
Positive association between aerobic exercise or CV fitness and executive
functions is highly consistent but cannot determine causality.
Aerobic exercise (AE) has shown moderate to medium sized effects on
executive function and memory.
Resistance Training (RT) has improved executive function and memory.
Combined AE and RT has the biggest (potentially
synergistic) effect.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
What’s the difference?
CV Exercise
BDNF
Brain Derived Neurotrophic Factor
RT Exercise
IGF1
Immune-Globulin Factor 1
Neurogenesis
Synaptogenesis
Angiogenesis
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
The Importance of BDNF
• BDNF (Brain-Derived Neurotrophic Factor) is the key protein – a
hormone in your blood - that influences brain cell growth
• prevents death of existing brain cells,
• induces the growth of new brain cells (neurogenesis) and supports
cognitive functioning (thinking).
• Low levels of BDNF are linked to:
• Alzheimer’s and accelerated aging
• obesity, depression, and schizophrenia.
• Aerobic exercise: 60-75% HRmax for 30min several times per week
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
The Child’s Brain
• Pristine
• Newly forming
• Extremely plastic
• Pre-wired “primitive” reflexes
• Development follows a critical timeline
• Forming patterns of processing
• Myelination
Forms both naturally and by the environmental demands
placed upon it
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Myelination
• Nueromuscular milestone occuring at about age 8
• Insulation of neurons
• Increases speed and efficiency of processing
• Essentially “seals in” neural firing patterns
• Interaction with a sensory rich environment is critical prior to
myelination
• Detriment in the quantity and quality of movement can lead to detriments in:
• Cognitive capacity
• Skill acquisition
• Behavior
Current data suggests children’s level of activity begins decreasing by age 6
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Sensory or “Perceptual-Motor” Skills
Also known as the “Learning Readiness Skills”
Essential link between movement, brain development, learning,
and behavior
• Body Awareness
• Directional Awareness
• Spatial Awareness
• Temporal Awareness
• Tactile Awareness
• Vestibular Awareness
• Proprioceptive Awareness
• Visual Awareness
• Auditory Awareness
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
A Sensory Rich Environment
• Aerobic exercise appears to increase BDNF significantly in the
hippocampus, improving:
• Memory
• Retention
• Comprehension
• Sensory-rich, high coordinative demand exercise may increase
BDNF in the Cerebellum in addition to creating a demand for
greater processing speeds across the corpus callosum.
• Improved behavior
• Improved emotional control
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Sensory or “Perceptual-Motor” Skills
• Directional Awareness
• Crossing the midline
• Increases neural speed and processing
between hemisphere.
• Body Name Spelling
• Temporal Awareness
• Rhythm (*Irregular Rhythm)
• Improves grammar and reading aptitude
• 3-Way Rhythm
• Proprioceptive Awareness
• Sense of body in space
• Impacts behavior
• Blind tag
Visual Awareness
Visual tracking
Associated with reading comprehension
Partner tracking tag
Vestibular Awareness
Hyper and hypo vestibular
Impacts behavior
Balance
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Cognitive Activity + Physical Activity
“We assume, that physical
exercise increases the potential
for neurogenesis and
synaptogenesis while cognitive
exercise guides it to induce
positive plastic change.”
Bamidis et al, 2014
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Combine Physical & Cognitive
“To maximize cognitive improvement combine
physical exercise with cognitive challenges in a
rich sensorimotor environment that includes
social interaction and a heaping dose of fun.”
- Cody Sipe, PhD
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Recommended Strategies
Bamidis et al, 2014
1.Tai Chi
2.Sports
3.Dance
4.Coordination/Motor Fitness
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Recommended Youth Activities
1. Soccer
2. Swimming
3. Dance
4. Martial Arts
5. Gymnastics
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Cutting Edge Brain-Body Fitness Based on Neuroscience and Play!
CREATOR & FOUNDER, Denise Medved
Brain Health Fitness
It’s Never too late to begin. It’s Never too early to start!
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Spelling “B” for Body
• Instead of using a pen or pencil, spell with your body
(hands, elbows, knees, belly-button, back, nose, feet)
• Any language
• Any word
• Print or cursive
• Letter by letter
• Complete word
• Forward or
backward
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Body Math
Tap hand and foot
Count aloud
Clap on random numbers
• RESPOND
• REACT
• RECOVER
Mitigates falls, accidents, unexpected surprises
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Gentle Geometry
Circles, lines and triangles
• Different shapes
• Sizes
• Speeds
• Different body parts, simultaneously
Stimulates neuroplasticity by doing something you
don’t know how to do.
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Front Row Orchestra
Pretending to play different musical instruments and
tapping your feet
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Power Tools
– imagining you are
using various tools to
build a house or
landscape a yard
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Dive In
Acting as if you are swimming in your chair, using
various strokes and dives
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Daily Life Choices
• Knit or sew and change hands
• Play tennis and serve on the other side
• Learn to juggle
• Drive or walk a different route
• Take up a new sport
Taxi Drivers in London
have higher than average
cognitive function
© 2018 IDEA Health & Fitness Association. All Rights Reserved.
Contacts:
Brett Klika CSCS
www.spiderfitkids.com
Brett@spiderfitkids.com
Spiderfit Kids on Facebook!
Dr. Cody Sipe, Co-founder,
Functional Aging Institute
www.functionalaginginstitute.com
srfitsolutions@yahoo.com

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Idea pt 2018 fitness for the brain at any age

  • 1. P R E S E N T E D B Y ©2018IDEAHealth&FitnessAssociation.AllRightsReserved. #ideapti Fitness for the Brain at Any Age Cody Sipe, PhD and Brett Klika
  • 2. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Session 306E Advances in neuroscience have proven that the brain can continue to grow and get better as we get older. We are not destined to become senile or suffer dementia if we take care of our bodies and our minds through good nutrition and regular exercise. This session will take a look at optimal brain development through movement and fitness from childhood to late adulthood. We will explore how to activate and engage the primary functions of the brain through programs such as SpiderFit Kids and Ageless Grace. Learn fun, engaging and scientifically sound exercises that will stimulate both the body and mind of your clients of all ages and ability levels in as little as 10 minutes a day.
  • 3. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Ask yourself a very personal question: What is your greatest concern about you and your client’s health across your lifespan?
  • 4. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Until recently, major health concerns were heart disease and cancer. Today one of the greatest health concerns on our planet is cognitive decline as we age…
  • 5. © 2018 IDEA Health & Fitness Association. All Rights Reserved. American School-Aged Children • Rise in Behavioral Disorders • CDC suggests nearly 7% of children ADHD • Increased rates of depression amongst children and teens • Dramatic rise in sensory processing disorders • Autism spectrum
  • 6. © 2018 IDEA Health & Fitness Association. All Rights Reserved. People around the globe are concerned about being diagnosed with: • Alzheimer’s • Dementia • Parkinson’s • or some other form of cognitive decline.
  • 7. © 2018 IDEA Health & Fitness Association. All Rights Reserved.
  • 8. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Today • Understand how movement plays a role in brain health from the time we are born, all the way throughout our lifespan. • Understand some basic mechanisms behind how movement creates a better brain. • Identify key movement types that stimulate brain function and growth.
  • 9. © 2018 IDEA Health & Fitness Association. All Rights Reserved.
  • 10. © 2018 IDEA Health & Fitness Association. All Rights Reserved. FAS Functional Domains
  • 11. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Risk Factors for Cognitive Decline • Age and Genetics • CV disease • Insulin resistance/DM • High cholesterol • HTN • Obesity • Smoking • Amyloid plaque
  • 12. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Neuroplasticity Neuroplasticity: The brain's ability to reorganize and rebuild itself by forming new neural connections. • The more neural pathways you have, the more resilient your brain is: Cognitive Reserve Neurogenesis: the process of creating new neurons (brain cells). • Contrary to popular belief, neurogenesis continuously occurs in the adult brain under the right conditions (i.e. EXERCISE).
  • 13. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Specific Cognitive Functions Executive Functions • Organizational: Attentional control, working memory, problem solving, planning, cognitive flexibility, abstract thinking • Regulatory: Self-control, initiation of action, emotional regulation, inhibitory control, decision making Memory Storage and Retrieval • Explicit, semantic, episodic, short vs long-term Motor Control and Coordination Sensory Perception Language
  • 14. © 2018 IDEA Health & Fitness Association. All Rights Reserved.
  • 15. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Brain Games "Claims promoting brain games are frequently exaggerated and at times misleading. ... To date, there is little evidence that playing brain games improves underlying broad cognitive abilities, or that it enables one to better navigate a complex realm of everyday life.“ - Consensus statement (2014)
  • 16. © 2018 IDEA Health & Fitness Association. All Rights Reserved.
  • 17. © 2018 IDEA Health & Fitness Association. All Rights Reserved. What’s Good for the Heart… Is Good for the Brain!
  • 18. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Exercise and Cognition Bamidis et al (2014) Positive association between aerobic exercise or CV fitness and executive functions is highly consistent but cannot determine causality. Aerobic exercise (AE) has shown moderate to medium sized effects on executive function and memory. Resistance Training (RT) has improved executive function and memory. Combined AE and RT has the biggest (potentially synergistic) effect.
  • 19. © 2018 IDEA Health & Fitness Association. All Rights Reserved. What’s the difference? CV Exercise BDNF Brain Derived Neurotrophic Factor RT Exercise IGF1 Immune-Globulin Factor 1 Neurogenesis Synaptogenesis Angiogenesis
  • 20. © 2018 IDEA Health & Fitness Association. All Rights Reserved. The Importance of BDNF • BDNF (Brain-Derived Neurotrophic Factor) is the key protein – a hormone in your blood - that influences brain cell growth • prevents death of existing brain cells, • induces the growth of new brain cells (neurogenesis) and supports cognitive functioning (thinking). • Low levels of BDNF are linked to: • Alzheimer’s and accelerated aging • obesity, depression, and schizophrenia. • Aerobic exercise: 60-75% HRmax for 30min several times per week
  • 21. © 2018 IDEA Health & Fitness Association. All Rights Reserved. The Child’s Brain • Pristine • Newly forming • Extremely plastic • Pre-wired “primitive” reflexes • Development follows a critical timeline • Forming patterns of processing • Myelination Forms both naturally and by the environmental demands placed upon it
  • 22. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Myelination • Nueromuscular milestone occuring at about age 8 • Insulation of neurons • Increases speed and efficiency of processing • Essentially “seals in” neural firing patterns • Interaction with a sensory rich environment is critical prior to myelination • Detriment in the quantity and quality of movement can lead to detriments in: • Cognitive capacity • Skill acquisition • Behavior Current data suggests children’s level of activity begins decreasing by age 6
  • 23. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Sensory or “Perceptual-Motor” Skills Also known as the “Learning Readiness Skills” Essential link between movement, brain development, learning, and behavior • Body Awareness • Directional Awareness • Spatial Awareness • Temporal Awareness • Tactile Awareness • Vestibular Awareness • Proprioceptive Awareness • Visual Awareness • Auditory Awareness
  • 24. © 2018 IDEA Health & Fitness Association. All Rights Reserved. A Sensory Rich Environment • Aerobic exercise appears to increase BDNF significantly in the hippocampus, improving: • Memory • Retention • Comprehension • Sensory-rich, high coordinative demand exercise may increase BDNF in the Cerebellum in addition to creating a demand for greater processing speeds across the corpus callosum. • Improved behavior • Improved emotional control
  • 25. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Sensory or “Perceptual-Motor” Skills • Directional Awareness • Crossing the midline • Increases neural speed and processing between hemisphere. • Body Name Spelling • Temporal Awareness • Rhythm (*Irregular Rhythm) • Improves grammar and reading aptitude • 3-Way Rhythm • Proprioceptive Awareness • Sense of body in space • Impacts behavior • Blind tag Visual Awareness Visual tracking Associated with reading comprehension Partner tracking tag Vestibular Awareness Hyper and hypo vestibular Impacts behavior Balance
  • 26. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Cognitive Activity + Physical Activity “We assume, that physical exercise increases the potential for neurogenesis and synaptogenesis while cognitive exercise guides it to induce positive plastic change.” Bamidis et al, 2014
  • 27. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Combine Physical & Cognitive “To maximize cognitive improvement combine physical exercise with cognitive challenges in a rich sensorimotor environment that includes social interaction and a heaping dose of fun.” - Cody Sipe, PhD
  • 28. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Recommended Strategies Bamidis et al, 2014 1.Tai Chi 2.Sports 3.Dance 4.Coordination/Motor Fitness
  • 29. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Recommended Youth Activities 1. Soccer 2. Swimming 3. Dance 4. Martial Arts 5. Gymnastics
  • 30. © 2018 IDEA Health & Fitness Association. All Rights Reserved.
  • 31. Cutting Edge Brain-Body Fitness Based on Neuroscience and Play! CREATOR & FOUNDER, Denise Medved Brain Health Fitness It’s Never too late to begin. It’s Never too early to start!
  • 32. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Spelling “B” for Body • Instead of using a pen or pencil, spell with your body (hands, elbows, knees, belly-button, back, nose, feet) • Any language • Any word • Print or cursive • Letter by letter • Complete word • Forward or backward
  • 33. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Body Math Tap hand and foot Count aloud Clap on random numbers • RESPOND • REACT • RECOVER Mitigates falls, accidents, unexpected surprises
  • 34. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Gentle Geometry Circles, lines and triangles • Different shapes • Sizes • Speeds • Different body parts, simultaneously Stimulates neuroplasticity by doing something you don’t know how to do.
  • 35. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Front Row Orchestra Pretending to play different musical instruments and tapping your feet
  • 36. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Power Tools – imagining you are using various tools to build a house or landscape a yard
  • 37. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Dive In Acting as if you are swimming in your chair, using various strokes and dives
  • 38. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Daily Life Choices • Knit or sew and change hands • Play tennis and serve on the other side • Learn to juggle • Drive or walk a different route • Take up a new sport Taxi Drivers in London have higher than average cognitive function
  • 39. © 2018 IDEA Health & Fitness Association. All Rights Reserved. Contacts: Brett Klika CSCS www.spiderfitkids.com Brett@spiderfitkids.com Spiderfit Kids on Facebook! Dr. Cody Sipe, Co-founder, Functional Aging Institute www.functionalaginginstitute.com srfitsolutions@yahoo.com

Editor's Notes

  1. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective Matthew Baumgart, Heather M. Snyder, Maria C. Carrillo, Sam Fazio, Hye Kim, Harry Johns An estimated 47 million people worldwide are living with dementia in 2015, and this number is projected to triple by 2050. In the absence of a disease-modifying treatment or cure, reducing the risk of developing dementia takes on added importance. In 2014, the World Dementia Council (WDC) requested the Alzheimer's Association evaluate and report on the state of the evidence on modifiable risk factors for cognitive decline and dementia. This report is a summary of the Association's evaluation, which was presented at the October 2014 WDC meeting. The Association believes there is sufficient evidence to support the link between several modifiable risk factors and a reduced risk for cognitive decline, and sufficient evidence to suggest that some modifiable risk factors may be associated with reduced risk of dementia. Specifically, the Association believes there is sufficiently strong evidence, from a population-based perspective, to conclude that regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension) reduce the risk of cognitive decline and may reduce the risk of dementia. The Association also believes there is sufficiently strong evidence to conclude that a healthy diet and lifelong learning/cognitive training may also reduce the risk of cognitive decline.
  2. Cognitive training interventions based on repetitive practice on cognitive processes have been effective in improving the trained process but not so much for other untrained cognitive functions (Ball et al., 2002, 2007; Hampstead et al., 2012; Mozolic et al., 2011). Some clinical trials, however, have shown transfer to other domains different than that of the trained exercises (Cheng et al., 2012; Mahncke et al., 2006; Oswald et al., 2006; Richmond et al., 2011; Willis et al., 2006). Computerized training is the preferred option in most of the intervention studies as the program can automatically adapt to the trainee’s daily performance. The intervention could be useful depending on the extent of the improvement to abilities not directly trained during the intervention. The degree to which a learned skill is shown in proximal (near transfer) or more distant (far transfer) tasks and contexts is central regarding cognitive training interventions. Near transfer effects are found after training in tasks close to the trained task (e.g., improvements on a verbal WM task after training on a spatial WM task). Far transfer effects are shown in tasks very different from those of trained tasks (e.g., improvements on intelligence tests scores, attention, arithmetic, language abilities, or everyday activities). Unfortunately, evidence for the effective transfer of cognitive training to untrained tasks is mixed (Tidwell et al., 2014) with some studies suggesting positive results, while others showing none or only a limited improvement In summary, computerized cognitive training has shown small to moderate improvements in certain cognitive domains with no significant effects in executive functions. Unsupervised training at home was not effective compared to group-based supervised training at a center or laboratory. Moreover, training regimes of more than 3-sessions per week seem ineffective. Working memory and executive functions do not improve after training and may require perhaps multi-modal interventions. Review Maintaining older brain functionality: A targeted review Soledad Ballesteros a,∗, Eduard Kraft b, Silvina Santanac, Chariklia Tziraki d
  3. In 2014, the Stanford University Center on Longevity and Germany's Max Planck Institute for Human Development convened international cognitive psychologists and neuroscientists to hash out a consensus on the state of evidence on brain training, which was blunt: "Claims promoting brain games are frequently exaggerated and at times misleading. ... To date, there is little evidence that playing brain games improves underlying broad cognitive abilities, or that it enables one to better navigate a complex realm of everyday life."
  4. Bamidis 2014 It has been proposed that the physical and cognitive exercise might interact to induce larger functional benefits (Hötting andRöder, 2013; Kempermann et al., 2010; Kraft, 2012; Lustig et al.,2009). Several interventional studies yielded consistent results inline with this hypothesis by demonstrating larger benefits on cogni-tive test performance for combined physical and cognitive activitythan for each activity alone (Anderson-Hanley et al., 2012; Maillotet al., 2012; Mortimer et al., 2012). Those studies comprise anobservational cross-sectional (Eskes et al., 2010), a longitudinal(Karp et al., 2006), as well as two controlled interventional designs(Fabre et al., 2002; Oswald et al., 2006).
  5. Ballesteros 2015