The document discusses the relationship between exercise, mood disorders like depression, and Alzheimer's disease. It provides information on the basics of mood disorders and Alzheimer's, statistics on prevalence, and modifiable risk factors like exercise. Regular exercise is associated with reduced risk of depression by impacting psychology, neurogenesis, and neurochemistry. Exercise also delays the onset and reduces the risk of Alzheimer's possibly by influencing conditions like hypertension, obesity, and diabetes that are themselves risk factors.
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
The mind is its own
place, and in itself can
make a Heav'n of
make a Heav'n of
Hell……a Hell of Heav'n.
JOHN MILTON (1608-1674)
Hell……a Hell of Heav'n.
JOHN MILTON (1608-1674)
9. Depression
• Epidemiology:
""MMeenn aarree ddiissttuurrbbeedd nnoott bbyy
tthhiinnggss,, bbuutt bbyy tthhee vviieeww
wwhhiicchh tthheeyy ttaakkee ooff tthheemm..““
EEppiicclleettuuss --TThhee EEnncchhiirriiddiioonn--
– 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 aarree ddiissttuurrbbeedd nnoott bbyy
tthhiinnggss,, bbuutt bbyy tthhee vviieeww
wwhhiicchh tthheeyy ttaakkee ooff tthheemm..““
EEppiicclleettuuss --TThhee EEnncchhiirriiddiioonn--
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
We can Nurture
Nature
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), Exercise, Nutrition, Sleep, Sunlight (Vitamin D Status), M Meettaabboolilcic D Dyyssfufunnccttioionn
13. What we know about
Mood Disorders
• Common
• Many Risk Factors: Multifactorial etiology
• Expensive: $135 Billion SAMSHA 2012
• Debilitating
• Complex
• Prevention must be primary
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
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
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
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.
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 are attributable to a lack of regular
physical activity
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. Exercise training for depressed older adults with
Alzheimer's disease 2008
“…with severe AD evidenced a clear benefit to
“A simple exercise program, 1 hour twice
a week, led to significantly slower decline
“A simple exercise program, 1 hour twice
a week, led to significantly slower decline
in ADL score inpatients with
in ADL score inpatients with
AD living in a nursing home than routine
AD living in a nursing home than routine
medical care.” 2007
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 “
participants in this study “
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
53.
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
55.
56.
57. Neuro-Chemistry
• Exercise results in increased production of
– Norepinephrine
– Serotonin
– B-Endorphins
60. My Reasons to Exercise
• Feel good in my skin
• Increase energy, Reduce stress
• Increase my confidence, discipline
• Be Reduce a role model, my risk socialize, of Alzheimer’s
family time
• It’s fun, I love and to Depression
sweat and work hard
• I love challenges
• Reduce disease risk
• Lower disability risk
• Maintain independence
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
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 -
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
http://i.i.com.com/cnwk.1d/i/tim2/2013/05/16/militarystock_620x350.jpg
http://www.thegatewaypundit.com/wp-content/uploads/2012/12/adam-lanza.jpg
Adam lanza
http://www.nimh.nih.gov/statistics/1anymooddis_adult.shtml
Estimated $147 billion in costs
YLD’s years lived with disability
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidailty
The Substance Abuse and Mental Health Services Administration ...
OF 8million on disability, nearly 2million for “ mood disorder” 2nd largest diagnostic cause for disability 2nd to MSK disorders (ie: back pain etc)
Cogito ergo sum…………rene decartes challenges our sense of personhood…our sense of identity….
Cadaveric study on a woman with an unusual mental illness…..with memory loss, language problems and odd behavior….found some off things in the brain we will talk about..
Approx. 1,300,000 new cases per year
www.cdc.gov/.../mmwrhtml/ figures/m846qsf.gif
www.ncbi.nlm.nih.gov/ bookshelf/picrender.fcgi..
http://www.ctahr.hawaii.edu/CS/blogs/sustainable_agriculture/cdc_logo(2).jpg
http://www.heart.org/idc/groups/heart-public/@wcm/@sop/@smd/documents/downloadable/ucm_319587.pdf
The prevalence of hypertension (defined as high blood pressure or taking antihypertensive medication) increases with age. In 2005–2008, 33%–34% of men and women 45–54 years of age had hypertension, compared with 67% of men and 80% of women 75 years of age and over (Table 67).
In 2005-2008 11% of adults 20 years of age or older had diabetes. In 2005-2008 the percentage of adults with dm increased with age from 4% of persons 20-44 to 27% of adults 65 years of age or older
http://meps.ahrq.gov/mepsweb/
Medical Expenditure Panel survey
http://www.cdc.gov/nchs/fastats/exercise.htm
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2654704/
2003-2004 NHANS Data set……
National Health and Nutrition Examination Survey (NHANES)
Cholinesterase Inhibitors……….. Razadyne® (galantamine), Exelon® (rivastigmine), and Aricept® (donepezil). Another drug, Cognex® (tacrine)
Namenda® (memantine), an N-methyl D-aspartate (NMDA) antagonistAmantadine,
Obesity inc by 78% Smoking inc by 200%.....Cognitive reserves……
Smoking:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(97)07541-7/fulltext
http://www.neurology.org/content/52/7/1408.short
Obesity:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC558283/?rendertype=abstract
Diabetes:
http://aje.oxfordjournals.org/content/145/4/301.short
http://aje.oxfordjournals.org/content/154/7/635.short
http://www.alz.org/alzheimers_disease_causes_risk_factors.asp
(Journal of the American Medical AssociationJAMA: 2000, Vol. 283. No. 22, pp. 2961-2967)
http://www.news.harvard.edu/gazette/1999/10.21/diabetes.html
http://www.reuters.com/article/healthNews/idUSTRE53E71N20090415?feedType=RSS&feedName=healthNews
http://www.nature.com/bjc/index.html
http://www.ncbi.nlm.nih.gov/pubmed/18599492?ordinalpos=18&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Exercise Program for Nursing Home Residents with Alzheimer’s
Disease: A 1-Year Randomized, Controlled TrialJ Am Geriatr Soc 55:158–165, 2007.
Example…if you take up running for the first time…success should not be running a marathon in 2 hours……rather 15 minutes without running may be a legitimate goal etc
SpecificWell definedClear to anyone that has a basic knowledge of the project
MeasurableKnow if the goal is obtainable and how far away completion is
Know when it has been achievedAgreed UponAgreement with all the stakeholders what the goals should be
RealisticWithin the availability of resources, knowledge and time
Time BasedEnough time to achieve the goalNot too much time, which can affect project performance
I hope you moved one step down the path of change…from thinking to doing, or from doing to embracing….
Frequqncy: How often? Intensity……..start slowly…build up gradually…….