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Pilot Quality Improvement Research Study:

 The Effect of Endurance Exercise and Patient Activation on Cognition and Mood in a Population of Seniors at Risk for Dementia

Awards: This research study abstract was selected for international publication and presentation at the Alzheimer's Association's 2017 International conference in London, England by the International Society to Advance Alzheimer's Research and Treatment.

ABSTRACT: Exercise significantly improves cognition/mood in a chronic behavioral-health senior cohort, high risk for developing dementia.

INTRODUCTION: Multi-domain lifestyle interventions are emerging as a leading strategy for preventing Alzheimer’s (AD) and other dementias, and as a treatment to restore, maintain, or improve memory, cognition and mood during early and middle phases of neurodegenerative illnesses.¹ While delivering promising outcomes in supervised research settings, community based applications of such protocols are complicated, hard to sustain, and proceed without knowing the therapeutic value of individual epigenomic components.² A core element of comprehensive brain improvement programs is endurance exercise, which by itself facilitates structural and functional neuroplasticity by enhancing brain operations at molecular and cellular levels.³ Habitual endurance exercise is associated with the production of additional synaptic connections, the growth of fresh cells in the hippocampus (brain’s learning and memory center), and the development of new O²/nutrient laden neuro-microvasculature.⁴ 

A critical process supporting both initial and long-term health related behavior change is patient motivation or activation, recently introduced as essential for engaging and sustaining newly learned neuro-protective/enhancing behavior routines.⁵ This is especially important for seniors with recurrent depression, schizophrenia, MCI, chronic anxiety and/or bipolar illnesses, who are much more more likely to develop dementia.⁶  This study investigates how two months of endurance exercise three times weekly, with psychiatrically impaired seniors coached for activation, impacts memory, cognition and mood.   

THE PREMISE: Consistent endurance exercise for 20-30 minutes produces Brain Derived Neurotrophic Factor, or BDNF, which changes gene expression to orchestrate: neurogenesis (creation of new brain cells), synaptogenesis (growth of the brain’s intercellular communication infrastructure), angiogenesis (growth of blood vessels supplying oxygen/nutrients to brain cells) and boosted neurotransmitter production.⁷ Decreased BDNF causes hippocampal deterioration, cognitive impairment, and depression, whereas increased BDNF mediates hippocampal atrophy, and improves memory, cognition and mood.⁸

It is hypothesized that BDNF-driven changes in gene expression triggered by 8 weeks of endurance exercise (precise threshold) produces neuroplasticity that improves cognition, memory and mood in a chronic psychiatric population of adults/seniors high risk for developing dementia. The likelihood of success will be enhanced by coaching that optimizes subject motivation via activation.  

PURPOSE: The urgent need for uncomplicated affordable non-medication solutions that improve or ameliorate memory, cognition, and mood, for patients at risk for, or experiencing mild cognitive impairment or dementia, is academic. The research thus-far on endurance exercise has not definitively answered key questions for those struggling with neurodegenerative challenges: what easily accessible endurance exercise works to improve memory, cognition and mood…and for how long per session, and how often per week, must one exercise to ensure best outcomes…and for how long over time must one exercise before measurable results can be documented…and how much does endurance exercise help?

Since many seniors have orthopedic/financial limitations, a low-cost, safe ‘all-season’ exercise was selected: recumbent cycling.    


METHODS: For this 8-week longitudinal research project 20 volunteers attending an adult behavioral health daycare were recruited to engage in endurance exercise recumbent cycling for 20-30 minutes 3 times per week. 17 subjects (10 men - 7 women) completed the study. Subjects were coached according to Brain In Play International’s Activation Science paradigm. Standard measures of memory/cognition (MMSE and St. Louis University Mental Status Examination for Detecting Mild Cognitive Impairment/Dementia - SLUMS), and mood (BECK Depression Inventory), were collected before, after 4 weeks, and following 8 weeks of cycling. This project was managed by a research assistant experienced with dementia.

RESULTS: At the study’s 8-week conclusion all subjects showed improved cognition and 15 of 17 exhibited mood improvement. Advanced statistical analysis found cognitive and mood improvements to be statistically significant. For cognition, 8 subjects increased scores from the MCI range to Normal – and 1 subject transitioned from dementia to MCI.  These results suggest 8 weeks of endurance exercise 3-times weekly for 20/30 minutes improves cognition and mood in a dementia- prone chronic psychiatric population when coached for activation. This research offers a new care standard and approach for seniors with MCI at risk for dementia.  To confirm these findings, controlled studies with larger samples are warranted.                

Authors: B.White MSN, APRN-BC / A.Ashare MD / K.White MSN, APRN-BC / J.Soscia / Erica Scioli, PhD                                                         

*[We are grateful for the help/support of leadership and staff at Living Well Adult Day Care.  This research study was funded by Brain In Play Nonprofit Foundation]                                                                                              

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