Healthy Body, Healthy Brain

1. Healthy Body, Healthy Brain Anthony R. Ellis, M.D. Medical Director – G.E.M.S. Unit Ingham Regional Medical Center

2. Normal Brain MRI

3. MRI of Alzheimer’s - Atrophy

4. Another Comparison

5. Why Exercise? • Vascular Health • Cardiac Health • Physical Health • Emotional Health

6. What is Vascular Health? • The relative absence of arteriolosclerosis and atherosclerosis = Vascular Health • What is arteriolosclerosis? • Arteriolosclerosis is any hardening (and loss of elasticity) of small arteries and arterioles. It is often associated with hypertension.. • Exercise reduces hypertension, and improves arterial elasticity, and reduces arteriosclerosis.

7. What is Atherosclerosis? • Hardening of an artery specifically due to atheromatous plaque. Atherosclerosis is the most common form of arteriosclerosis. Atherosclerosis is characterized by a thickening of the intima with plaques that can contain lipid-laden macrophages ("foam cells"). The plaques contain free lipid (cholesterol, etc.) and are prone to calcification and ulceration..

8. What does Atherosclerosis do? • Causes a chronic inflammatory response in the walls of arteries, in large part due to the accumulation of white blood cells promoted by low-density lipoproteins (plasma proteins that carry cholesterol and triglycerides) without adequate removal of fats and cholesterol from the macrophages by functional high density lipoproteins (HDL).

9. Atheromatous Carotid Arteries • Not good for your brain…

10. Why are these bad? • Arteriosclerosis and atherosclerosis decrease oxygen supply to vital organs. • Which organs need the most oxygen? The brain, the heart, and the kidneys. • The effects of reduced blood supply lead to progressive failure of these organs and to some common causes of human death: Stroke, MI, CHF, Dementia and Chronic Kidney Disease • A quarter of Americans will die of cardiovascular disease. It is the number one cause of death after age 65 and is number two from age 45 to 64.

11. What does exercise do to LDL and HDL? • Exercise reduces LDL and increases HDL • Lower LDL and higher HDL means less damage to blood vessels • HDL particles remove cholesterol from atheroma within arteries and transport it back to the liver for excretion or re-utilization. The cholesterol carried within HDL particles, termed HDL-C, is sometimes called "good cholesterol".

12. Vascular Link in A.D. • There is increasing focus on the importance of small vessel disease as a predictor of cognitive decline and dementia as it seems to amplify the effects of Alzheimer’s disease. • The problem however is, that white matter changes (seen on MRI of the brain) and tiny areas of damage are also frequently observed in the non-demented elderly and at some level can be regarded as normal aging.

13. So…Exercise. • To maintain vascular health, exercise. This reduces LDL, increases HDL, increases arteriole elasticity, improves blood and oxygen supply to vital organs, and by doing these things, reduces the risk of dementia, MI, stroke, CHF, and CRI. • A link has been shown between level of HDL and onset of dementia. Those with high HDL were less likely to have dementia. Low HDL-C in late-middle age has been associated with memory loss.

14. What is Cardiac Health? • Heart function adequate to perfuse the vital organs across the lifespan and support quality of life. • No MI, No CHF, No Angina, No HTN, No cardiac arrhythmias (rhythm problems) • No cardiac activity restrictions • Normal heart size, RHR (a sign of fitness) • High HDL, Low LDL

15. How do I get a healthy heart? • Don’t make your heart sick: • Eat a healthy diet • Aerobic Exercise • Maintain a healthy body weight • Don’t smoke • Don’t drink to excess • Good genetics help too…

16. What’s a Healthy Diet? WHO says: • Achieve an energy balance and a healthy weight (calories in equal calories burned) • Limit fat consumption, reduce saturated fats in favor of unsaturated fats, and move towards the elimination of trans-fatty acids • Increase consumption of fruits and vegetables, legumes, whole grains, and nuts • Limit the intake of simple sugar • Limit sodium consumption from all sources

17. Unhealthy Diet • Unhealthy diet is a major risk factor for a number of chronic diseases including: high blood pressure, diabetes, abnormal blood lipids, obesity, heart disease, and cancer. • The WHO estimates that 2.7 million deaths every year are attributable to a diet low in fruit and vegetables. Globally it is estimated to cause about 19% of GI cancer, 31% of ischemic heart disease, and 11% of strokes,making it one of the leading preventable causes of death worldwide.

18. What is Aerobic Exercise? • Aerobic activities "get the blood pumping." As the heart beats faster, the blood circulates more quickly, delivering extra oxygen to the muscles. This builds cardiovascular fitness. Some aerobic activities are walking, hiking, jogging, bicycling, swimming, jumping rope, dancing, rowing, and most sports.

19. Effects of Aerobic Exercise • Reduced blood pressure • Increases HDL, decreases LDL • Increases cardiac reserve • Helps maintain a healthy weight which reduces HTN, DM, Stroke, Cancer • Increase in VO2 max, increase RMR • Increased muscle strength and endurance

20. So…Exercise • Aerobic exercise is a necessary part of a health maintenance and brain maintenance program. • By staying lean, staying fit, eating well, and avoiding tobacco, you can support brain health and functional longevity.

21. Don’t Smoke • Smoking is the leading cause of preventable illness and death in the United States. • Smoking related-diseases kill one in 10 adults globally. By 2030, if current trends continue, smoking related illnesses will kill one in six people worldwide. • Among Americans, smoking rates shrunk by nearly half in three decades (mid-1960s to mid-1990s), falling to 23% of adults by 1997.

22. Don’t Smoke • Cigarettes cause more than one in five American deaths. Evidence shows that around 50% of those who start smoking in adolescent years go on to smoke for 15 to 20 years. • Smoking is the single largest preventable cause of disease and premature death. It is a factor in heart disease, stroke, and chronic lung disease. It can cause cancer of the lungs, larynx, esophagus, mouth, and bladder, and contributes to cancer of the cervix, pancreas, and kidneys.

23. Remember…the WHO says: • Chronic diseases, such as heart disease, stroke, cancer, chronic lung disease, and diabetes are the leading causes of mortality in the world, representing 60% of all deaths. • Overall, 2.7 million deaths are attributable to low fruit and vegetable intake. • Overall, 1.9 million deaths are attributable to physical inactivity.

24. Brain Health and Exercise • One study has used brain imaging to look at the effect of fitness on the human brain. In 2006, Colcombe and colleagues randomly assigned 59 older adults to either a cardiovascular exercise group, or a non­aerobic exercise control group (stretching and toning exercise). Participants exercised 3h per week for 6 months. Colcombe et al. scanned the participants’ brains before and after the training period.

25. Cont. • After 6 months, the brain volume of the aerobic exercise group increased in several areas compared to the other group. Volume increase was principally in frontal and temporal areas of the brain involved in executive and memory processes. Based on animal research, these changes may be due to an increased number of blood vessels and an increased number of connections between neurons.

26. More Studies… • People in their 40s and 50s who get a half hour of exercise at least twice a week may reduce their risk of dementia later in life by about 50 percent, says a Swedish study in the journal Lancet Neurology. The study of nearly 1,500 men and women also found that this kind of physical activity could reduce the risk of Alzheimer's disease by about 60 percent in people who are genetically prone to the disease. The study has been published in Lancet Neurology October 2005. Miia Kivipelto Aging Research Center, Karolinska Institutet, Sweden.

27. Exercise Helps “Fluid Intelligence” • In an experiment at the Department of Sport/Exercise Psychology at Texas Tech University, fluid intelligence, which involves short-term memory, abstract thinking, and reaction time, was evaluated under stressful conditions. • College-aged participants who led active lifestyles had significantly greater performance on the fluid intelligence tasks compared to those who were typically inactive • The same result was found in moderately active adults in their sixties and seventies, who fared nearly as well as people in their twenties and thirties who were not exercising

28. And another study… • Exercise Reduces Risk of Dementia in Women:In a 2-year follow-up of 18,766 nurses ages 70-81, those who had been the least active showed more mental decline even though the exercise data came from 10 years earlier, presumable before any impairment due to incipient dementia was occurring. Even walking 1.5 hours per week added 1.5 years of cognitive ability over those with little exercise. Robert P Friedland et al. Case Western, JAMA 9/22/04.

29. BMJ Study • Prospective analysis of 10,276 men and women who had undergone detailed, multiphase health evaluations between 1964 and 1973, when they were age 40 to 45, and who were still members of the Kaiser health plan in 1994, nearly 30 years later. Examination revealed that from 1994 to 2003, 713 of the 10,000-plus participants (6.9%) had been diagnosed with dementia. Mean age at initial recorded diagnosis was 74.3 years (range 66 to 82).

30. The Skinny… • Compared to those whose weight was normal at midlife, obese participants had a 74% greater risk of dementia • Those who were overweight had a 35% greater risk of dementia compared to those whose weight was normal. • Compared to men in the lowest fifth of the distribution of triceps skin-fold thickness, men in the highest fifth had a 72% greater risk of dementia • Women in the highest fifth in the distribution of skin-fold thickness were at 60% greater risk than women in the lowest fifth

31. Inactivity and Smoking - Deadly • There are an estimated 400,000 deaths in the United States each yearattributed to lack of adequate exercise, comparable to the 435,000 annual deaths attributable to smoking.

32. Emotional Health – Hard to Define • A feeling of security and status within society • Self-confidence and self-esteem • A sense of contentment with life • A zest for life and a wide range of emotional responses, both positive as well as negative • Eagerness to participate in meaningful activities and develop positive relationships • Ability to laugh, to socialize and to have fun • Flexibility of mind to adapt to changes in life's circumstances

33. EH, cont. • Resilience in dealing with stress • Balance in all areas of life: work and play, rest and exercise, and in private life and social life • Ability to care for own self and for others • An ability to fantasize, enabling hope and creativity to flourish

34. Exercise and Emotional Health • Exercise builds confidence and provides a feeling of empowerment and freedom that comes with knowing that your legs and body are strong and capable. • Exercise has also been proven to improve attitude • Exercise can treat mild depression and reduce harmful addictive behaviors. • the benefit of a community and culture all its own creates an atmosphere of friendliness and the group support can get you over the new exercise “hump” • training with other people is a surefire way to meet fellow exercisers and make friends.

35. Stress is Bad for Your Brain • You tend to withdraw from or not ask for help? • You have difficulty delegating to others? • You externalize instead of problem solve? • You overload yourself and have a difficult time saying no to committees, new projects, etc.? • You have asymmetrical work relationships in which you give more than you get?

36. Balance Family, Work, Self-Care • Working 50+ hours per week • Always running late, driving too fast • Beeper and cell phone always going off • Get home after the kids have gone to bed • No breakfast, fast food lunch, late for dinner again, “I’ll be late, I have a meeting” • Forgetting important dates, missing family events, neglecting to take care of yourself

37. Take Care of Yourself • Strong sense of self esteem and purpose • Good social support system • Use humor as a coping skill • Take good care of yourself • Know when to say no • Don’t take yourself or life too seriously • Develop a broad group of activities and interests outside of work