Studies point to exercise as possible way to help prevent dementia

Host Amber Smith: 纽约州锡拉丘兹上州医科大学邀请您成为“知情患者”，收听由纽约中部唯一的学术医疗中心的专家组成的播客. I'm your host, Amber Smith. Several research studies have shown that vigorous exercise, walking, even household chores, can have positive effects on the brain. Can this reduce our risk of developing dementia as we age? I'm talking about this with Upstate exercise physiologist, Carol Sames. Welcome back to The Informed Patient, Dr. Sames.

Carol Sames, PhD: Thank you so much, Amber. Glad to be here.

Host Amber Smith: We've talked before about the benefits of exercise, not only to the whole body, but specifically to the brain. 但现在我知道有三个主要的长期研究，涉及数十万人，历时数年, that get fairly specific about the types of exercise, the intensity, duration, that provide protection against dementia. Can you tell us about them?

Carol Sames, PhD: Absolutely. So the first study is coming out of the U.K. and they had about 500,000 individuals. And what they did was they recruited them between like 2006, 2010, 他们在招募一年后开始跟踪他们，然后一直跟踪到2019年底. So, you're looking at between eight and 12 years. 他们最初做的基本上是收集他们活动的信息. They used questionnaires, what type of activity, what type of more vigorous activities, so more sports type activities - hiking, running, biking, more vigorous types of activities. But they also included household activities, job-related activities, if anybody was using biking or walking to work, or were they doing any type of transportation for others.

They also collected some what we call mental activity, so looking at social contacts, uses of electronic devices. They also wanted to look at educational levels. And what made this study kind of unique is that they had data, blood data, and they were able to look at some genetic markers of dementia. And, they also asked about family history, 因为我们知道某些类型的痴呆确实有遗传成分. 他们发现从事更剧烈的体育活动的人患全因痴呆的风险降低了, Alzheimer's, dementia, and vascular dementia by 35% compared to the lowest level of physical activity. 但他们也发现，从事家务活动的人患病风险降低了21%. And generally household is more of a moderate level of exercise intensity. So it doesn't have to be things that are highly vigorous.

Host Amber Smith: So vacuuming, dusting, those sorts of just movement?

Carol Sames, PhD: Exactly. Mowing the lawn, probably all the things that we don't necessarily enjoy doing. But the point is, the body is moving. They are physical activity. They don't require us to become out of breath and to be sweating profusely. And so I think that's a big, really important finding in this study because I think many people, when they think of physical activity, they think it has to be something that is arduous. And then, how many people want to do arduous activity?

Host Amber Smith: That was a study out of the United Kingdom, correct?

Carol Sames, PhD: Yes. Mm-hmm.

Host Amber Smith: So what else has been found since then?

Carol Sames, PhD: So another study, 2022年8月刚刚发表的是我们所说的系统回顾和荟萃分析. And so what they did was they took 38 articles, and when you add articles together like that, you really increase your sample size. And, so what they had was 2 million people that were in these 38 studies. They followed them for three years. And these individuals started without dementia, and then they followed them for three years to see, like, a combination of all of these studies. They also looked at leisure activities, things that spanned from what we would call more vigorous to less vigorous activity. They also looked at cognitive outcomes, things like reading books, magazines, newspapers, watching television, writing, playing cards or checkers or board games. And then they also include listening to music or painting. And then they also include what they called social activities. 所以，你知道，和朋友或家人在一起，或者做志愿者，或者参加任何类型的社交俱乐部. and so the results were that when you controlled for age, education, and gender, 与那些不运动的人相比，这种种类繁多的体育活动使患痴呆症的风险降低了17%. So again, we're getting these results from large sample sizes following people, 观察那些患有痴呆症的人，发现他们往往有更高的体育活动水平. 在我刚才在元分析中给出的例子中，他们也有更多的社交活动. But here's the conundrum. 有更多社交活动的人往往更多地参与认知活动和体育活动. So, you know, that's a little tough to tease out.

Host Amber Smith: Well, when we talk about a risk reduction of 17% or 21%, or even, I think you said 33% on the high end, those sound like small numbers, but the, those are really huge differences, right?

Carol Sames, PhD: They really are. Because think about, this is the sample size we're looking at. So we're not talking about looking at 20 people, right? 第一个研究中有50万人，第二个研究中有200万人. That's an impressive risk reduction, understanding that when we talk about the human body, there's not one factor that impacts an outcome. There's multiple risk factors. So, 很明显，我认为这项研究表明，体育活动是降低风险因素的有力手段, and there's other, also, 除了身体活动，认知活动和社会活动之外.

Host Amber Smith: Now, 2022年8月发表在《推荐最近最火的赌博软件》上的第三项研究主要针对儿童. Can you tell us about that?

Carol Sames, PhD: Super unique study. So they had children that were between the ages of seven and 15 years old in 1985. And it just so happens they were participating in a study, and they collected data on their cardiovascular fitness, their muscle strength, their muscle power, and then their waist to hip ratio. And then they followed up from 2017 to 2019 these same children, which were clearly now middle adults, they were now 39 to 50 years old, and they wanted to see, were there any differences?

Not surprising, the adults when they were children, if they had higher levels of fitness strength and lower waist hip ratios, they had a reduced risk of developing dementia than the adults who, when they were children, had poor fitness, poor strength, and greater waist to hip ratios.

Host Amber Smith: So someone who as a child was not very active, or wasn't very active their whole life, is it too late to get benefit from becoming active?

Carol Sames, PhD: No, it's not. A study that came out of the Cooper Institute in 2013 actually looked at midlife, so around the age of 50. They looked at cardiorespiratory fitness. Then they followed people until either they died or they developed dementia. And what they found is that they divided fitness levels into five different levels. 最高水平和第二高水平的个体患全因痴呆的风险明显较低. So that's midlife impacting later life. Again, really highlighting the impact we get from being active.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast with your host, Amber Smith. My guest is Dr. Carol Sames. She's an exercise physiologist at Upstate, 我们正在谈论体育活动如何保护人们免受痴呆症的影响.

So let's get a bit more firm definition of what counts as vigorous exercise. Is this another word for aerobic?

Carol Sames, PhD: 所以当我们谈论有氧运动或心血管运动时，我们有一个连续的强度. So we can have intensity that's moderate. Moderate level intensity is being able to carry on a conversation. So if I go out and walk with my friend, you know at a nice easy pace, doing some household activity, generally that's moderate. 强度，剧烈强度是指那些你注意到呼吸加快的运动. You're really not carrying on a conversation, maybe saying yes or no. You'll really notice that your heart is elevated. 你可以看出，你正在做的事情肯定比中等强度的运动更具挑战性.

But here's what we know, in terms of the guidelines, 有氧运动或心血管运动的指导方针是每周150分钟中等强度的运动, or 75 minutes a week of what we call more vigorous activity. Or a combination of both. So, if you think about 150 minutes -- and that's the goal; people might not start there. People might start with 10 minutes in a week, 这很好，因为新的指导方针强调了减少久坐行为的重要性, so that even if I get my 150 minutes of moderate activity in, in a week, but I sit for long portions of the day, I actually negate some of the benefits that you get from cardiovascular activity. So we want to move more, sit less, and aim for that 150 or 75 minutes a week of either moderate or vigorous activity.

Host Amber Smith: And of course the 150 minutes isn't done in one session. 你把它分散开来，每天10分钟或20分钟，或者30分钟，对吧?

Carol Sames, PhD: Absolutely. And for people that maybe they haven't been very active, right? They maybe have a sedentary job. You're just starting with a few minutes. Maybe what I do is, I walk a few minutes every hour, and those minutes add up. They don't have to be done in a chunk. So again, the research is really suggesting the power of movement. So maybe I walk for five minutes here, five minutes there, and the next thing you know, I've walked for 15 minutes. 我以此为基础，因为这15分钟比没有时间好得多.

我还必须说，针对成年人和老年人的指导方针是力量训练，我们肯定会强调力量训练的重要性. 事实上，对于老年人来说，力量训练和我们所说的力量训练更为重要. So why is strength important for adults and older adults? Well, simply put, you need muscle to move. And if you don't have muscle, you're not moving, you're not going to complete that cardiovascular activity. We need muscle functionally, just to do all the functional things that we need to exist in our world, whether it be going up and down stairs, whether it be making a bed, doing a wash, just all of those activities. We need strength.

随着年龄的增长，我们开始失去所谓的快肌纤维. They're our power fibers. And a lot of times people say, "well, who cares? Older adults don't need power. 这是更年轻的成年人或运动人群，”我们说，“绝对不是. You need power to get outta your chair. You need power to take the first step. If you have stairs, that's all about power." We need power as we get older. And so power training with older adults, sometimes that's our first line. We won't even start cardiovascular activity if people are really weak. We'll start with strength training and power training first.

Host Amber Smith: So these recommendations for physical activity, if we also want to keep our brains healthy, are the exercises for our brain health on top of the physical recommendations, 还是说，我们在锻炼身体的同时，还能从大脑健康中获益?

Carol Sames, PhD: Well, certainly there probably is some carryover there, right? That it's difficult to tease those out. But the research is still suggesting that we need to be engaged cognitively. And that is just such a wide spectrum of activities. You know how people say I don't really like to read? And it's like, fine, you don't need to read to be engaged. Do you enjoy listening to music? Do you enjoy looking at art? I don't do crossword puzzles because I'm terrible at them, but do you enjoy something along the lines of that? There's some question about television. 因此，研究表明，这不仅仅是像电视一样在背景中播放, but that I am engaged with whatever is on the TV, so that there's an actual engagement. Carrying on a conversation, that is cognitive. 你可以选择不同层次的认知，就像活动一样. 没有最好的体育活动，也没有最好的认知活动.

Host Amber Smith: 体育锻炼对那些有痴呆症家族史的人是否有认知保护作用? 或者我们刚刚谈到的研究，它们更适用于平均风险的人?

Carol Sames, PhD: No. So here's what's impressive is that even in individuals that have a family history, being active is reducing the risk. 所以我的意思是，当我们谈到运动的影响时，这真的很强大. Certainly, as I usually tell my students, you can't choose your parents, right? We don't know how to do that yet. So, I'm born with these genetics, and so what can I do? So I have a mother who has very severe dementia, and hopefully my lifetime of activity, and my lifetime of enjoyment of reading can help to reduce my risk. It doesn't mean it's going to be eliminated. Genetics is genetics, but we know study after study when you control for family history, or in the example of that U.K. article, they actually controlled for the biomarkers and the family history. There still was protection with physical activity.

Host Amber Smith: Gosh, it sounds like if you are at higher risk, maybe that's all the more reason to make sure that you get the activity.

Carol Sames, PhD: And also, it's like when people say I want to lose weight; that's why I want to be active. Remember, you're getting a plethora of other benefits of being active. So we're just talking about dementia here. There are all the other benefits that come with being active, you know, just reduction in cardiovascular disease risk, being able to maintain appropriate weight, reduce weight gain, having better muscle quality. So what happens as we get older, we start to see more fat infiltrate muscle, and so our muscle quality goes down. So the whole reduce the risk of depression and anxiety, bone health, I mean the list goes on, and on, and on, seven different types of cancers. So you're getting all of those benefits whether you want them or not. You're active, you get all the benefits.

Host Amber Smith: Well, Dr. Sames, I appreciate you making time for this interview.

My pleasure.

My guest has been Dr. Carol Sames. She's an exercise physiologist at Upstate. "The Informed Patient" is a podcast covering health, science, and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/Informed. This is your host, Amber Smith, thanking you for listening.