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Week 6

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Reason 6

Exercise Reduces the Efects of Alzheimer’s Disease (AD) and Combats Depression

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Alzheimer’s

Alzheimer’s is the most common type of memory loss, accounting for 60-80% of cases [1]. It starts as a mild cognitive impairment. However, in more than half of the cases, it develops into Alzheimer’s disease (AD) within five years [1]. Alzheimer’s progressively destroys memory and thinking skills, including executive function. Executive function refers to a set of mental skills that consist of working memory, self-control, and mental flexibility. These skills are essential in life and are used in many daily tasks. Hence, their destruction as a result of Alzheimer’s disease can significantly reduce a person’s quality of life. Furthermore, patients with Alzheimer’s often experience agitation, anxiety, depression and injury. Drug treatment can help, but the benefits can be limited [1].

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Aerobic exercises seem to decrease the onset of mild cognitive impairment and Alzheimer’s disease. It also reduces the rate of deterioration once the disease process has commenced. Exercise has shown to improve attention, executive function, memory, processing speed and blood flow.

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A small part of the brain called the hippocampus is involved in memory. There is a decay of the hippocampus in patients with Alzheimer’s disease. Exercise seems to increase the blood supply and decrease the decay in the hippocampus. MRI scans have verified this.

Another effect of exercise on Alzheimer’s disease is through nerve factors. Brain-derived neurotrophic factor is one of the proteins that maintain brain function. This is decreased in Alzheimer’s disease. Exercise seems to maintain levels of this nerve factor which then prevents reduction in the volume of the brain.

Want to test yourself / someone for signs of dementia?

The following test [2] is used across the UK to help investigate cognitive decline in a primary care setting (for example at the GP). It would be best to do this test with someone else guiding you through, so that they can check the accuracy of your answers. If you do complete this test with any mistakes, do not worry – you can go and talk to your GP if you have any further questions about this.

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There are 6 questions as part of this assessment – with each question weighted differently.
The scoring is detailed below.

To complete this assessment, ask the individual the following questions:

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1. What year is it? (Correct = 0 points. Incorrect = 4 points)

2. What month is it? (Correct = 0 points. Incorrect = 3 points)

3. Give the person an address phrase to remember with 5 components – e.g. John, Smith, 42, High St, Bedford

4. About what time is it (within one hour)? (Correct = 0 points. Incorrect = 3 points)

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5. Count backwards from 20 to 1. (Correct = 0 points. 1 error = 2 points. More than one error = 4 points)

6. Say the months of the year in reverse. (Correct = 0 points. 1 error = 2 points. More than one error = 4 points)

7. Repeat address phrase. (Correct = 0 points. 1 error = 2 points. 2 errors = 4 points. 3 errors – 6 points. 4 errors = 8 points. All wrong = 10 points)

To score the individual, add all the scores together to cumulate a total 6CIT score out of 28. Scores of 0-7 are considered normal, with a score of 8 or more being significant.

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Depression

Depression is a growing health concern, affecting 264 million people globally [3]. It can be common in older adults and may increase their risk of death from other illnesses, including diabetes and cardiovascular disease. Additionally, depression can sadly result in suicide, causing the loss of valuable lives [3]. Currently, traditional treatments for depression do not yield satisfactory outcomes [3]. Fortunately, there is an abundance of evidence supporting exercise as an effective intervention [3]. For example, a review by researchers Zemberi and colleagues analysed the results of 13 previous studies. Each of these studies had investigated the efficacy of exercise as the primary intervention for depression [3].

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Exercise also seems to enhance the effect of anti-depressants. The combined effect of exercise with anti-depressants is greater than the sum total of the individual effects [3].

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Metaphor 6 – “Credit Limit” is Like “Activity Limit”

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What is the story?

Patrick’s business had a downturn, and he became bankrupt. He needed a credit card but found it challenging to find one due to his poor financial status. In the end, one bank manager gave him a credit card with only a £200 credit limit.

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Patrick knew that he would be fined if he went over this limit. Patrick was careful to spend only £190 of the available £200 to be well under the limit.

After remaining well under his limit for a few months, the bank manager increased the credit limit to £250. For the next few months, Patrick spent up to £240 to make sure he was well under the new limit. Over time, Patrick slowly but surely built up his business and increased his credit limit, becoming very successful. If he had gone over the limit, then he would have been fined and the credit facility would have been removed.

So, what went wrong?

Well, nothing went wrong in this story. Patrick respected the limits put on him by his bank manager. He remained well under these limits and as a result, over time, his limits were increased, and he was able to build up his credit and business.

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Do not break/fight the pain barrier

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How can we relate this story to our health?

When we have chronic pain, our brain gives us an “activity limit”. The “activity limit” is the “pain barrier”. This “activity limit” is similar to the “credit limit” given to Patrick. If we go beyond the “activity limit”, the inner brain will cause pain, just as the bank manager would have fined Patrick if he had gone over the “credit limit”.

Patrick stayed well within the “credit limit” and found that the “credit limit” was increased automatically with time. Similarly, when we exercise following injury, we need to stay within the “activity limit” determined by our inner brain. Note that Patrick never spent beyond £190 of the £200 limit or £240 of his £250 limit. Similarly, it is best to keep well within the “activity limit”. If we respect the limits given to us by our brain and stick to the traffic light system described in the introduction of this book, then, over time, we can do more and more.

Moral of the story

In chronic pain (or following injury) – don’t fight the pain barrier.

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Exercise Notes For Week 1

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“Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.”

“At vero eos et accusamus et iusto odio dignissimos ducimus qui blanditiis praesentium voluptatum deleniti atque corrupti quos dolores et quas molestias excepturi sint occaecati cupiditate non provident, similique sunt in culpa qui officia deserunt mollitia animi, id est laborum et dolorum fuga. Et harum quidem rerum facilis est et expedita distinctio. Nam libero tempore, cum soluta nobis est eligendi optio cumque nihil impedit quo minus id quod maxime placeat facere possimus, omnis voluptas assumenda est, omnis dolor repellendus. Temporibus autem quibusdam et aut officiis debitis aut rerum necessitatibus saepe eveniet ut et voluptates repudiandae sint et molestiae non recusandae. Itaque earum rerum hic tenetur a sapiente delectus, ut aut reiciendis voluptatibus maiores alias consequatur aut perferendis doloribus asperiores repellat.”

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Remember the traffic light system should be used when you exercise.
Please do not go through the red light or break the pain barrier!

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Short intro of encouragement to compliment the notes above.

Please now go to the video page and begin you exercise plan for the week.

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Head and Neck

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Lower Back

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Otago

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References

Meng Q, Lin MS, Tzeng IS. Relationship Between Exercise and Alzheimer’s Disease: A Narrative Literature Review. Front Neurosci. 2020;14:131. Published 2020 Mar 26.
Velayudhan L, Ryu SH, Raczek M, Philpot M, Lindesay J, Critchfield M, Livingston G. Review of brief cognitive tests for patients with suspected dementia. Int Psychogeriatr. 2014 Aug;26(8):1247-62. .
Md Zemberi NFN, Ismail MM, Abdullah MFIL. Exercise Interventions as the Primary Treatment for Depression: Evidence from a Narrative Review. Malays J Med Sci. 2020;27(5):5

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