Exercise in moderation is a healthy choice. But what most people don’t realize is that exercise not only builds muscle but also builds brain and reduces Alzheimer’s disease risk.

Sarah McEwen, PhD, is a Cognitive Psychologist with 15 years of clinical research experience, specializing in the study of physical activity and cognitive enhancement interventions to investigate biological, behavioral and health-related outcomes in patients suffering from cognitively debilitating disorders.  Dr. McEwen graduated with a bachelor’s degree from the University of California, Davis and an MSc and PhD in Psychology from Trinity College, Dublin, Ireland.

She serves as Section Editor for the peer-reviewed journal NeuroReport, and Associate Editor for the Journal of Alzheimer’s Disease, and has published over 45 peer-reviewed journal articles. 

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Robert Lufkin 0:00
 Welcome to the health longevity secrets show and I’m your host, Dr. Robert Lufkin. Exercise in moderation is a healthy choice. But what most people don’t realize is that exercise not only builds muscle, but also builds brain and reduces Alzheimer’s disease risk. Sarah McEwen PhD is a cognitive psychologist with 15 years of clinical research experience specializing in the study of physical activity and cognitive enhancement interventions to investigate biological, behavioral and health related outcomes in patients suffering from cognitively debilitating disorders. Dr. McEwen graduated with a bachelor’s degree from the University of California Davis, and an MS and PhD in Psychology from Trinity College. Dr. McEwen serves as section editor for the peer review journal neuro report and Associate Editor for the Journal of Alzheimer’s disease. She has published over 45 peer reviewed scientific articles. And now please welcome Sarah McEwen. 

Sarah McEwen 1:10
 Hello, and thank you for joining me today for my lecture. I’m honored to be here to present at the 2021 virtual Alzheimer’s prevention conference. My name is Dr. Sarah McEwen, and I’m a cognitive psychologist and senior research scientist at the Pacific Brain Health Center in Santa Monica, California. I’ve spent the last 15 years of my research career trying to better understand brain function and risk for developing brain disorders using neuroimaging techniques. I’m excited to share with you today how exercise can improve brain health and boost neuroplasticity to ultimately reduce the risk of developing Alzheimer’s disease. I have no disclosures to share today. So I’d like to get started by showing this image of these amazing people who are part of the indigenous Tribe of Indians, known as the Tarahumara, roughly translated to the running people who live in the Copper Canyons of north central Mexico. Their incredible feats were made famous by Chris McDougall in his book Born to Run, he shared with the world how this unknown group of super humans thrive in their profoundly active lifestyle. Their active lifestyle has predominantly been because of their reclusive location, high in the rough mountain canyons, and having to run the distance between settlements between inter village communication and transportation and hunting, which led to this tradition of long distance running, some of them running even up to 200 miles in one session over a period of two days. Because of this, the Tarahumara runners are some of the best long distance runners in the world. However, running is not about hunting. And furthermore, not for the pursuit of physical reasons for through exercise for the Tarahumara. It’s a way of life and more importantly, a way of expressing joy and having fun. Researchers have been drawn to study these indigenous people. And some of the most impressive findings to come from these studies, is in this profoundly active community is the absence of chronic disease that plagues most of us living in modern society. The Tarahumara have almost non detectable rates of type two diabetes, cancer, and heart disease. I think, logical research attributes this low incidence of these chronic diseases to their physically active lifestyle. The CDC estimates that 75% of health care spending is on chronic diseases that could have been prevented. sedentary lifestyle alone is responsible for an estimated 24 billion in direct medical spending. It’s estimated that physical inactivity is responsible for almost 200,000, or one in 10 deaths each year. 

However, as a modern society, we’re wholly inactive. Only one in three adults receives the recommended amount of exercise per week, and less than 5% of adults participate in exercise 30 minutes per day, and more than 80% of adults do not meet the guidelines for both aerobic and muscle strengthening activities. But I don’t just want to talk all gloom and doom today. I want to talk about the scientific basis and think of this as a motivational primer if you will, for why exercise can lead to reducing the risk for Alzheimer’s disease, and also what types of exercise are most efficacious for brain health? I’ll start by talking about exercise for Alzheimer’s risk reduction. Go into some of the scientific basis of the neurobiological mechanisms of exercise induced neuroplasticity. Talk about different types of exercise and the effect on the brain. also discuss the female advantage of engaging An exercise for Alzheimer’s risk reduction. Since we know that Alzheimer’s is much more prominent in females than males, we need to make a concerted effort to reduce the risk in women. I also want to talk about a new idea of combining exercise with cognitive training and some new ways of being able to do that and how that could better boosts brain health. And then I’ll give some exercise recommendations for brain health, and then close by talking about future directions and exercise, Alzheimer’s prevention research. 

So I don’t think I have to waste too much time with this audience. To talk about the dearth of treatments available for Alzheimer’s patients. The failure rate of Alzheimer’s drugs is 99.6%. And is actually worse than cancer drugs whose failure rate is around 81%. We all know this is likely because of the inaccurate neurobiological target for these drugs, which is in beta amyloid plaques, which is actually a long term consequence of the disease and certainly not an appropriate target for preventing the onset or progression progression of the disease. Currently, there are no disease modifying therapies for Alzheimer’s. The for currently FDA approved medications for Alzheimer’s patients only treat the symptoms of the disorder and are no way considered a cure. There are also no approved pharmacological drugs available, available to present prevent the onset of this devastating disease. Well, much of the last 50 years has been devoted to medication discovery, and they’ve been highly unsuccessful unfortunately, now there’s been a shift towards talking about modifiable lifestyle factors which drive experience dependent neuroplasticity in the brain. This neuroplasticity has been shown to have substantial impacts on cognition. Such the current neurological guidelines recommend exercise and cognitive stimulation now as the first line of treatment for the diagnosis of mild cognitive impairment. The lack of medical treatments available to stop or slow down development of age related cognitive decline has shifted the research focus toward the urgent need to develop preventative non pharmacological approaches and lifestyle interventions for at risk populations. At the moment, endorsed by WHO and the Lancet Commission are preventative interventions. The preventative intervention with some of the strongest data for increasing physical is for increasing physical activity through exercise. So I can’t really think of another intervention that could be deemed as a panacea for the brain. And the great thing about physical exercise is that it’s one of the best ways you can improve cognitive functioning and stave off brain aging. considerable evidence suggests that engaging in regular physical activity, this could prevent cognitive decline, and also dementia. active individuals have lower metabolic and vascular risk factors. And these 

risk factors may explain the propensity for healthy brain aging. Even short term exercise acute bouts of exercise has been shown to increase cognition and improve hippocampal atrophy in older adults, and also improve brain connectivity. There was a study from 2017 that actually showed engaging in physical activity could delay the risk of Alzheimer’s by 20 years. This review from 2017 looked at the effects of physical activity and risk for Alzheimer’s disease and found consistent evidence for the benefits of reducing Alzheimer’s risk. They concluded that physical activity over the lifespan contributes to cognitive reserve, or you can think of it as a savings account for your brain as you age, and and your brain starts to deteriorate due to age related neurodegenerative neurodegenerative conditions. They also found in this review that increasing brain volumes in the prefrontal cortex and the hippocampus is part of what is driving the increases in cognitive function, and cognitive reserve. They also found that leisure time physical activity is more protective against Alzheimer’s disease than work related physical activity. Engaging in regular physical exercise, as they concluded could stave off the development of Alzheimer’s by 20 years. That’s a lot of good extra years. 

So let’s talk a little bit about the mechanisms behind why exercise reduces the risk for Alzheimer’s disease. The predominant theory is that exercise induces neuroplasticity in the brain. Neuroplasticity is the brain’s ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons in the brain to compensate for brain injury and disease by adjusting their activities and forming new connections. Decades of research has shown that exercise radically stimulates and enriches the brain’s neurochemical environment, research shown the profound effects of exercise on biological, neurobiological, and behaviors in both animals and humans. One of the first studies to do this was done by Henry and Yvonne frog, and Rusty Gage at the Salk Institute back in 1999. And what they found was in the earliest animal study of exercise, they looked in vivo, which is directly within the brain to look at what exercise does. And what they found was that the animals who did daily aerobic exercise, they actually grew twice as many new neurons in the hippocampus as animals that were sedentary that did not exercise. In addition to neurogenesis, there’s a host of other neuro chemical environmental enrichment factors that happen through exercise, such as neurogenesis, which is the growth of new neurons, cell proliferation in the brain, angiogenesis, which is the growth of new blood vessels in the brain, synaptic protein release such as synapses, which is usually happens with doing resistance exercise, increased cerebral blood flow, increased growth factors and nutrients such as brain derived neurotrophic factor, VEGF IGF, all these growth factors helped to give nutrients to the brain to help it survive. It also reduces inflammation and getting increases anti inflammatory cytokines, it reduces oxidative stress, it also increases neurotransmitters that are important for healthy brain function. And these all contribute to different changes in plasticity in the larger brain structures in the brain. The human studies that have been done have actually looked at how exercise can increase the gray matter, or the cortical volume within the brain. And they find predominantly, it’s in the prefrontal cortex, which is in the front of the brain responsible for our higher order thinking skills, and also in the hippocampus, which is our learning and memory part of the brain, which we know is a main area to deteriorate in Alzheimer’s disease. So the protection of these 

two brain areas is critical. And it’s been shown that exercise can actually increase the size of those brain structures and their function. This is a recent paper that shows all of the physical activity kinds of interventions, aerobic resistance neuro motor, and looked at how they affect different structures in the brain. And what they found is that exercise actually has the ability to impact about 82% of the entire gray matter in the brain, which can be impacted through just physical exercise. So this shows the extent of physical activity and how it can impact almost all of the brain structures. So from new neuronal growth, to reducing inflammation, improving neurotransmitters, which improve mood and quality of life, and preventing dementia, you can see why exercises become a profound intervention that can be used for those looking to have neuronal repair and reduce cognitive decline. Next, I’d like to talk about the difference, different types of exercise and how they affect the brain. So I think most commonly, people think of exercise as aerobic exercise, cycling and running, walking those types of things. So a robic exercise or cardiovascular exercise is a system of conditioning in the body aimed at enhancing circulatory and respiratory efficiency that improves the body’s use of oxygen through sustained exercise. And it’s usually mostly matric in automated when you do it, so there’s actually different neuro physiological effects that are specific to aerobic exercise, which at the cellular level, which you can think is the lowest level of impact in the brain. This is where we see the neurogenesis in the the formation of the new neurons in the brain. And also angiogenesis, the formation of new blood vessels, which is important for carrying more oxygen and nutrients. At the next level up you can see the impact on brain structures such as in the medial temporal lobe, which is where the hippocampus is that area I talked about that is responsible for learning and memory. And in the behavioral level, you see this present as increasing bottom up cognitive functions, which we can think of as processing speed, and learning and memory. 

On the flip side of that are motor skill based exercise, which are more goal oriented movements in the temporal or spatial accuracy, which is important for achieving predetermined activities, mostly novel activities. And these types of exercises are classified as neuro motor exercises by the American College of Sports Medicine, and recommended to be done two times a week. You can think of such activities like Tai Chi, dancing and boxing are all commonly employed which involve complex training of motor sequencing to attach specific practice. And they’ve seen in a lot of studies in Parkinson’s disease to show that these kinds of interventions improve gait and balance and range of motion. on a physiological level, there’s much, much bigger differences you can see at the cellular level for synaptogenesis, which is the formation of new neurons, the formation of new synapses between the neurons. And at the structural level, you actually see larger gray matter volume in the prefrontal cortex, anterior cingulate cerebellum in Visio spatial network within the brain, which are different from what you see with aerobic exercise. And how these are related the behavioral level is that they predominantly increase executive functions or top down cognitive control functions like attention, coordination, reasoning and problem solving. So there’s exercises that require greater physical motor skill, like the goal directed behaviors that relate to recruiting more frontal parietal cognitive control regions in the brain, to help with executive processing. And then aerobic exercise helps to engage these broader changes in blood flow, and 

increase hippocampal volume, and also motor coordination within the cerebellum. So all of these aspects of nervous neuro energetics facilitate the angiogenesis within the brain. So you can see here how the two different types of exercise can actually have profoundly different effects on the brain and why they’re both need to be completed. So now I want to talk about the advantages of exercises specifically in women. So we know that Alzheimer’s disease is more common in females. Unfortunately, two thirds of Alzheimer’s disease patients are female, women in their 60s are twice as likely to develop Alzheimer’s disease over the rest of their lives as they are developing breast cancer. Some theories have pointed to the role of hormones for increasing risk since estrogen protects the brain against neurodegeneration is reduced in late life years. Therefore, there needs to be a concerted effort to encouraging risk reduction in females. Some of the research I want to highlight is around middle aged females show greater improvements in executive functioning than males whose abilities declined when they engaged in different kinds of exercise training. estradiol actually helps dendritic spine density in hippocampal neurons respond to higher levels of estradiol and females, not in males. And also, chronic hormone replacement therapy of greater than 10 years can cause executive executive functioning deficits and atrophy within the prefrontal cortex. But when those women are doing aerobic exercise, and it’s quite high, and they’re on the hormone replacement therapy, it doesn’t affect the prefrontal cortex and the cognitive loss in the same way. Also, there seems to be a dose response in females. So the more exercise they do, the larger their hippocampus gets, but not in males. So actually, for females, it’s more important to be more active than it even is for males for increasing hippocampal volume. Some other things I wanted to highlight from the research is the amount of physical activity affects brain metabolism. So we know that glucose hypometabolism is something that’s incredibly common, and part of the diagnostics of Alzheimer’s disease. Women normally have higher metabolism in the brain than men, which is related to higher memory abilities, which is a good thing. 

Physical activity levels so low or moderate, which is five days of 30 minutes with the American College recommends for aerobic exercise, and high amounts in middle age when they look at these three different levels of physical activity in participation in middle aged women that were at high genetic risk for Alzheimer’s disease but didn’t have any symptoms. And they found that the glucose metabolism in Alzheimer’s disease affected all of the brain regions, but only in the moderate activity level did increase brain metabolism was found in other regions. So this moderate level seems to be really important in terms of how often to exercise and for how long so that moderate level of five days a week for 30 minutes is really important. In fitness levels and dementia risk. There was a study that followed up women for 44 years from midlife to when they were elderly and they tested for those that had transitioned to getting dementia. And what they found was the risk was 88% lower for developing dementia and those that had higher cardio fitness levels. Then moderate fitness levels, the high fitness delayed age and dementia onset by 9.5 years in time to dementia onset by five years, compared to the median fitness level. So this is actually pointing to trying to get moderate to higher levels of physical activity throughout the Middle aged years to be prevented for Alzheimer’s disease. 

So the next type of Alzheimer’s prevention strategy I want to talk about is cognitive training. And you can think of cognitive training as being complementary to exercise physical exercise. And so how exactly to stay in cognitively or intellectually engaged help prevent Alzheimer’s disease? Well, the theory behind this is that cognitively stimulated or enriched environments as they call them in the animal literature, is a way to help newly born neurons stay alive in our brains, especially those that are in the hippocampus, which is where that adult neurogenesis happens. And those neurons need to be activated and integrated into the brain network quickly, or they’ll die. And what happens is, once those die off, it reduces functioning to that part of the brain, and atrophy follows. So that’s why we see the the atrophy happening and Alzheimer’s disease in the hippocampus as being one of the most predominant parts of the brain, but also one of those parts of the brain, that could be the most receptive to doing exercise in cognitive stimulation to help improve it. So the idea behind this is that cognitive training helps new neurons to survive and strengthens the connections with other neurons in that network. So this whole idea of neurons that fire together wire together, is that those neurons are co activated and strengthened through the use of doing cognitive stimulus targeted cognitive stimulation exercises. And in the famous words of Albert Einstein, once you start, once you stop learning, you start dying, and the same would go for the neurons in your brain. So what types of cognitive training are the most effective for reducing Alzheimer’s risk? Well, there was a recent review that was done that looked at dozens of cognitive training studies in older adults. And what they found was that multi component cognitive training is better for treating cognitive deficits. So what do I mean when I say multi component training, I’m talking about three different kinds of cognitive training that you could do. So there’s computerized cognitive training. So these are adaptive computerized exercises that you can do that are made specifically to target memory, attention, speed, executive functioning, and you do those sitting at a computer. And these studies have suggested doing those about five times a week for 30 minutes, for at least a period of three months. And in another way that you can train cognitive skills through compensatory training. So the idea with this is once people have severe cognitive impairments, it’s hard to do standard cognitive exercises. So instead, we provide people with strategies and skills and tools to help them better remember things like directions to somewhere where they need to go or somebody’s name, things like that, and giving them the skill, the skills and tools to do that, even if they have impairments with learning and memory. And the last category, there is novel skill learning. So there was a recent paper that was published that followed 800 women from midlife to old age, they followed them for a period of 44 years. And what they found is that those that were most cognitively active in the midlife years in their 40s and 50s, they had a 60% Reduced risk for developing Alzheimer’s disease. 60% 60% reduce risk by just staying cognitively stimulated through the midlife years. And some of the things to do that some of the specific activities are things like reading and writing, learning a new language, playing an instrument, engaging in acting classes or learning some sort of a new new skill like photography, and also being active in clubs or other social groups. Those are the kinds of things that were cognitively stimulating activities. So intellectual, artistic, active memberships, in groups and organizations, all of those things are really 

important for trying to preserve our brains as we age. And so let’s talk a little bit about how we can combine exercise in cognitive stimulation and what that looks like at at the neural level. So there’s this theory of the guided plasticity Phillip facilitation framework. 

And what that is a model that’s been developed recently to depict how different modalities of cognitive motor training, be in sequential or simultaneous lead to increased neuroplasticity and improve cognitive performance. So if you look at the image on the left there, you can see the two different kinds of temporal ordering of exercise. So you can do them separately where you do the exercise and then do cognitively stimulating exercises, or you can do them simultaneously. And this idea of the facilitation effect happens with the physical exercise which triggers this cascade of neuro physiological mechanisms which promote neuroplasticity. But they’re transient and time constrained. But with the cognitive exercises, this does the guidance effective cognitive training, which is thought to guide the targeted neural networks, the neurons that fire together wire together and those cognitive processes is the guidance effects of the cognitive exercises are positive to be distinct survival mechanisms for those newborn cells in the image on the right there conveys that. So if you look to the far right column, that the mental and physical exercise training actually shows the most, not only restoration, but growth and proliferation of newborn cells within the hippocampus by doing the combined exercise. So we are interested at the brain health center and thinking of new and novel ways to try to combine exercise and cognitive training. And the way I started thinking about this was a few years back when I was at UCLA, and I conducted a study there with some of my colleagues from the brain health center, where we were interested in this exact idea of trying to look at how could we combine exercise and cognitive training in the most effective way to try to improve memory in older adults. So we did a randomized control trial, where we had two arms in this study, it was a two arm single blind study. And they were either doing the simultaneous intervention where they did exercise and compensatory memory training at the same time, or they did sequential training while they were doing the exercise, and then stopping the exercise and then doing the compensatory memory training. So one of the biggest things with this study, as we were trying to find out if this was even feasible to do in older adults, could they do the cycling while they were doing the the compensatory memory training program, and we found that the compensatory memory training program we use was developed at UCLA by Dr. Karen Miller and her associates. And we adapted that curriculum to be used on the bikes. And again, we were looking at patients that had subjective memory complaints. So these were not MCI or Alzheimer’s patients, but middle aged adults that were suffering from memory lapses. And all of the participants in the study were given two weeks to get ramped up to do exercise. So they can maintain 40 minutes of continuous cycling at a target heart rate zone, which was 65% of their max heart rate. And the design of the study was this was a four week intervention. And the simultaneous group, as I said, they did the 60 minutes of stretching tone. So this was just a control for time of the for the sequential group with the simultaneous group, but then they did 20 minutes of non non aerobic memory training. And then they got on the bike, and they did 40 minutes where they were doing instructor led memory training program, while doing the rubric exercise at the same time, sequential group did 60 minutes of 

aerobic cycling, and then they got off of the bike and then did 60 minutes of the compensatory memory training. 

And the groups were we were pulling groups from UCLA and the motion picture Television Foundation site in Woodland Hills. And we ended up with 55 patients in the study with subjective memory impairments, they were between 60 and 75 years old, have a mocha around 27. And again, none of these patients had MCI or Alzheimer’s disease. So we had them engaged in the intervention at UCLA for four weeks. And we tested their memory at baseline and then at four week follow up after they finished the intervention. And what we found was quite striking, we found you can see the green line there no increases in a composite standardized battery of memory tests in the sequential group. But we did find a significant increase of about eight points on this particular measure in the simultaneous group which is that dotted blue line you see there. So we found significant of a P equals point o one in the simultaneous combination group, which was quite striking. So since then, we’ve received an NIH Funded award from the National Institute of Aging to conduct a randomized, controlled trial of this type of intervention. But we developed a mobile application where MCI patients can do self directed compensatory memory training on a tablet at home on a stationary bike for 12 weeks. And we’re comparing that to a physical activity monitoring only group. And we’re looking at putative mechanisms for cognitive engagement by asking BDNF, norepinephrine, and also looking at some brain imaging biomarkers. So we hope to have that RCT wrapped up by the end of the year and some results for you next year. So now let’s talk about the practical things. What are some good exercise recommendations? Based on what we’ve talked about today? Well, the most well studied exercise intervention is aerobic exercise. There’s the most literature on that and the most evidence for that that enhances cognition, brain function, and neuroplasticity through the induction of these neuro chemicals, you know, trophic factors, reduction of pro inflammatory cytokines, immune factors, all of those things. And the prescription for that is five days a week for 30 minutes at a moderate intensity. So at that intensity between about 60 to 80%, of your max heart rate. So using a heart rate monitor for aerobic exercise is really important, because you want to make sure that you’re getting to that intensity level. And the next type of exercise I want to talk about is resistance exercise. So this is strength training exercise. So this is muscle building exercises, which does more to promote blood flow, and also increased growth, different kinds of growth factors to help with neuroplasticity in the brain. And the American College of Sports Medicine recommends two times a week doing resistance exercises, and doing about eight to 10 muscle groups. So and you know, about 10 to 15 repetitions per set is what I’m doing three sets. And the next type of exercise I recommend is that neuro motor or neuro skill based exercise. So learning a new goal directed physical skill, like golf or tennis, something that you really aren’t too familiar with and isn’t an automatic type of exercise for you is really important for brain health as well. So doing that two times a week, which can improve those top down neural networks. So remember, there’s more prefrontal networks in the brain that are in charge of executive functioning, like reasoning and problem solving. And then I want to talk about high intensity interval training. This is something I haven’t talked about in this lecture. But there’s been studies that have found 

that 28 minutes of exercise is more effective than one hour of exercise of doing like steady state cardio. And also for women, it seems to be more helpful for cognitive functioning, glucose metabolism, cardio, respiratory fitness, body composition, a whole host of things HIIT training seems to be more impactful for so the standard protocol recommended is what they call the four by four, which is four times of four minute max sprint intervals with three minute recovery and doing that three times a week. And that’s a pretty 

intensive protocol. So I would start, start easy with yourself and just start trying to mix in some interval training into your steady state cardio, either walk, run or jog, and trying to make setup for some intervals three times a week. And also, as I’ve talked about, is this idea of cognitive stimulation or dual task training while you’re doing physical exercise. So this training has been shown in enriched environments, and it leads to cognitive improvements, higher BDNF and hippocampal. neurogenesis in the survival of those neurons, within the hippocampus to so things like dancing are a way of trying to do cognitive training and exercise at the same time. Team sports are also another way to do that. And in anything you can think of where you can try to do more of an automatic physical activity that has a higher cognitive load on it. So that’s why I say things like team sports, because there’s a lot of uncertainty in them. And then there’s also a lot of factors that you can’t replicate, doing cognitive training programs. So trying something new with a sports team is a really good idea as well. And I haven’t talked about this either, but the idea of just taking a nature walk is really important. There’s been some studies showing that just 15 minutes a week, three times a week has been shown to reduce stress and stress hormones like cortisol, along with improving cognition and improving well being. So being outside is really important. So whenever you have the opportunity to exercise outside, it’s much more impactful for you then then inside exercise and mindful movement. It’s also really important to exercising and flexibility really go hand in hand. So you can train balance, flexibility, attention and promote well being through exercises like yoga and tai chi, which have some more social emotional benefits as well too, in addition to just standard exercise training, and lastly, change it up, our bodies and minds adapt pretty quickly to new environments. So you want to make sure that you’re trying something new all the time. More novelty equals more neuroplasticity. So just to summarize today, we all have this innate ability to increase neuroplasticity in our brains through our activities, neuro plasticity, it’s a fundamental theory that supports the scientific basis for how we can improve our brain functions as we age and how we can prevent cognitive decline in Alzheimer’s disease exercises, just about the most important thing we have, as clinicians, researchers and individuals to keep our brains healthy and, and operating in an optimal level. And also, the synergistic combination of exercise and cognitive training to improve cognition is really, really exciting area of research right now, and how this can have more of a synergistic impact on brain plasticity. So we know that the cognitive training or the exercise alone can’t achieve the same benefits as doing them combined together. So doing more exercises that are combined simultaneously with cognitive stimulation is is a really exciting thing to do now, and some future directions. So this whole idea of doing translational research, so using what we’ve learned in animal models to show the effects of exercise on neuroplasticity, in vivo, but 

how those can impact human populations. And doing so through the use of different kinds of non invasive neuroimaging is really important, and we need to start looking at more of the neurobiological mechanisms. So we’re still at the very very frontiers of trying to understand what’s going on in the brain in in humans and risk reduction with with complex diseases like Alzheimer’s, so there’s still a lot more questions to be answered. Specifically looking at cellular mechanisms of exercise in cognitive training, which has never been looked at before looking at inflammatory markers, gene expression, and also a host of cellular metabolism, metabolism factors that could be looked at as mediators of driving these neuroplasticity changes. 

And also looking at precision exercise interventions. Not everybody responds to exercise in the same way. So we need to consider different physical differences, genetic markers, biological differences, like red blood cell levels, and different glucose metabolism and oxygen expenditure at the individual patient level to think how we could better prescribe these exercise interventions. And I’ll just close with this quote, nothing happens until something moves, the future of your brain is in your hands. So please, I implore you get moving today. And you can actually help change the way your brain ages. Thank you for listening to my presentation today. If you want to learn more about the Pacific Brain Health Center and our clinical research, you can go to Pacific brain health.org Thank you for listening. 

Unknown Speaker 38:33
 Know, this is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have. Never disregard professional medical advice or delay seeking of it because of something you’ve seen here. If you find this to be a value of you, please hit that like button and subscribe and support the work we do on this channel. Also, we take your suggestions and advice very seriously. Please note us know what you’d like to see on this channel. Thanks for watching and hope to see you next time.