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The lifestyle changes that can reverse Alzheimer’s disease

 

Last summer, a research group from the University of California, Los Angeles (UCLA) quietly published the results of a new approach in the treatment of Alzheimer’s disease. What they found was striking. Although the size of the study was small, every participant demonstrated such marked improvement that almost all were found to be in the normal range on testing for memory and cognition by the study’s end. Functionally, this amounts to a cure.

These are important findings, not only because Alzheimer’s disease is projected to become ever more common as the population ages, but because current treatment options offer minimal improvement at best. Last July, a large clinical trial found little benefit in patients receiving a major new drug called LMTX. And after that, another hopeful drug designed to target amyloid protein, one of the hallmarks of Alzheimer’s disease, failed its first large clinical trial as well.  Just two months ago, Merck announced the results of its trial of a drug called verubecestat, which is designed to inhibit formation of amyloid protein. It was found to be no better than placebo.

The results from UCLA aren’t due to an incredible new drug or medical breakthrough, though. Rather, the researchers used a protocol consisting of a variety of different lifestyle modifications to optimise metabolic parameters – such as inflammation and insulin resistance – that are associated with Alzheimer’s disease. Participants were counselled to change their diet (a lot of veggies), exercise, develop techniques for stress management, and improve their sleep, among other interventions. The most common ‘side effect’ was weight loss.

The study is notable not only for its remarkable outcomes, but also for the alternative paradigm it represents in the treatment of a complex, chronic disease. We’ve spent billions of dollars in an effort to understand the molecular basis of Alzheimer’s in the hope that it will lead to a cure, or at least to more effective therapies. And although we have greatly enlarged our knowledge of the disease, it has not yielded many successful treatments.

The situation is analogous in kind, if not quite degree, to the many other chronic diseases with which we now struggle, such as diabetes and cardiovascular disease. While we do have efficacious medications for these conditions, none work perfectly, and all have negative effects. Our understanding of the cellular processes at the root of these diseases is sophisticated, but technical mastery – the grail of a cure – has remained elusive.

Acknowledging these difficulties, the researchers at UCLA opted for a different approach. Beginning from the premise that Alzheimer’s disease is a particular manifestation of a highly complex system in disarray, they sought to optimise the system by changing the inputs. Put another way, the scientists chose to set aside the molecular box which has proven so vexing, and to focus instead on the context of the box itself. Although we cannot say precisely how the intervention worked, on a cellular level, the important thing is that it did work.

The method isn’t entirely novel. Researchers have already shown that multi-faceted, comprehensive lifestyle interventions can significantly improve outcomes in cardiovascular disease, diabetes and hypertension. But it’s difficult for these approaches to gain traction for two reasons. First, these protocols are more challenging than simply taking a pill at bedtime. Patients need ongoing education, counselling and support to effect meaningful change. And second, the pharmaceutical mode of treatment is deeply embedded within our current medical system. Insurance companies are set up to pay for medication, not lifestyle change; and physicians are taught pharmacology, not nutrition.

Despite these difficulties, it’s time to start taking these approaches much more seriously. The prevalence of Alzheimer’s disease is expected to triple over the next three decades, to nearly 14 million in the United States alone. Diabetes and other chronic diseases are expected to follow a similar trajectory. Trying to confront this epidemic with medication alone will raise a new host of problems, from prohibitive cost to adverse effects, without addressing any underlying cause. We know that comprehensive lifestyle modification can work for many chronic diseases, in some cases as well as medication. It deserves more than passing mention at the end of an annual check-up – it’s time to make it a cornerstone in the treatment not only of Alzheimer’s disease, but of all chronic disease.Aeon counter – do not remove

Dr Clayton Dalton is a medical resident at the Massachusetts General Hospital in Boston.

This article was originally published at Aeon and has been republished under Creative Commons.

The benefits of strength training: what the research tells us

Most of us probably know exercising is associated with a smaller risk of premature death, but a new study has found that doesn’t have to happen in a CrossFit box, a ninja warrior studio, or even a gym. Body weight-bearing exercises such as sit-ups and push-ups staved off death just as much as other forms of weight-bearing exercise.

Our study recruited just over 80,000 adults over 30 years living in England and Scotland between 1994 and 2008, who were followed up for an average of nine years. At the end of the followup period, we calculated their risk of death according to their strength-promoting exercise and how much they did.

What we found

Those who reported participation in any strength-promoting exercise (including gym workouts) averaged about 60 minutes a week and those who reported any own body weight exercises averaged 50 minutes a week. Participation in either gym workouts or own body weight exercises reduced the risk of early death by about 20%. Cancer-related deaths also decreased by 24-27%, but there was little evidence more was better.

We also compared the risk of those who met the recommendation of two sessions of strength-promoting exercise per week, with those who met the recommendation of 150 minutes of aerobic physical activity such as walking (or 75 minutes more intense, such as running) per week.

Compared to being inactive, meeting either guideline was associated with a 16-18% reduction in risk of early death.

But the results on cancer death risk told us a very different story. Those who met only the strength-promoting guideline by doing body weight exercises had a 31% lower risk of death from cancer. Those who met only the aerobic exercise guideline had no reduction in risk of cancer death.

On the other hand, reducing the risk of death from heart disease was only associated with aerobic physical activity (21% reduction).

Gyms can be daunting for beginners.
from www.shutterstock.com

Interpreting the results

Given this research is observational, there’s always a chance the relationship between exercise and early death could be due to other causes. Perhaps the people who exercised more were also just generally healthier in other ways.

To reduce the possibility of alternative explanations, we adjusted our results for age, sex, health status, obesity, other lifestyle behaviours (smoking, alcohol, diet), education level, mental health, and participation in other physical activity such as domestic activities, walking and aerobic exercise.

People with chronic diseases are less likely to exercise, and more likely to die early. Therefore we excluded from the results all participants who had heart disease or cancer, as well as those who died in the first two years of the followup (because their death was most likely caused by something they had prior to the study commencing).

Other studies have examined the relationship between strength promoting exercise and early death. An American study found lifting weights or doing callisthenics was associated with a 31% decrease in risk of death from any cause, which is consistent with our results. But contrary to our results, the same study found no association with cancer death risk.

Another study among cancer survivors showed lifting weights, but not aerobic activities, was associated with a 33% lower risk of death from any cause.

What it all means

Our study suggests exercise that promotes muscular strength has unique health benefits and is at least as important for health as walking, cycling, and other aerobic activities.

We shouldn’t forget the most important principle for choosing an activity is being able to incorporate it into your routine and stick to it long term. The simplicity of body weight exercises makes them a very attractive option: they are inexpensive and require little skill and no equipment. Plus we now know they yield comparable benefits to similar gym-based activities. This is important given gyms can be daunting or unaffordable for many people.

So in addition to doing enough moderate to vigorous intensity aerobic activity, good old fashioned push-ups or chin-ups at home, in the park, in the yard, or even in the office could be an excellent option. For most people two to three sessions a week would be sufficient for general health.

The ConversationThe American College of Sports Medicine recommends 2-4 sets of 8-15 repetitions of each strength promoting exercise with 2-3 minutes rest between sets. As with any physical activity, the most important principle here is a little is better than nothing, and gradually build up from little to enough.

Emmanuel Stamatakis, Associate Professor; Physical Activity, Lifestyle, and Health Behaviours, University of Sydney

This article was originally published on The Conversation. Read the original article.

We all have to die of something, so why bother being healthy?

It’s 6:45 on a cold and rainy Tuesday morning. The alarm blares. As you begin to wake and wonder how it could possibly be morning already, your good intentions dawn on you. It’s run morning – and it’s the last thing you want to do. As you roll over to hit the snooze button, your mind scrambles for a valid excuse.

Why bother trying to be healthy? We all have to die of something, right?

In part this is true. Regardless of our discomfort with death, we all have to die sometime, and we all have to die from something. However, this is where the truth ends.

Today in Australia, the leading causes of death are mostly preventable – or at least can be significantly delayed. Factors like poor diet and tobacco drive ailments including heart disease, stroke, diabetes (type 2), lung disease and cancers. And when you look more deeply at what ill-health brings, it’s not just death that makes the strongest case for getting out of bed.

 

You’ll die later

Sure you have to die of something, but you may not have to die so soon. Science suggests having a healthier lifestyle even at age 50 is associated with a four to seven year longer life expectancy.

Even at older age, improving lifestyle factors can benefit longevity. Avoiding an unhealthy weight, not smoking, maintaining a social network and engaging in leisure activities around age 75 sees a whopping five years added to a woman’s and six years added to a man’s life span.

You’ll be healthier, longer

Trying to be as healthy as you can is not just about adding more years to your life, but adding healthy years, or even decades. Populations who follow healthy forms of behaviour show a 60% decline in dementia, in addition to a 70% reduction in type 2 diabetes, heart disease and stroke when compared with unhealthier peers. Studies also find healthier 50 year-olds live longer without disability than those who are overweight or smoke.

Yes, we all have to die eventually, but we want to be happy, well, independent and pain-free leading up to our deaths.
from www.shutterstock.com

A significant proportion of octogenarians are also living healthier, more active lives. This is seen in measures of mobility, self-care, levels of pain and discomfort, and absence of anxiety and depression. But rather than being related just to age, variations in health-related quality of life are also linked to factors such as exercise, nutrition and social engagement.

So being active and eating well could mean a healthier, more independent life for longer.

You’ll feel better in the meantime

Eating healthier and exercising have also been shown to have benefits on your day-to-day wellbeing. Exercise can improve and protect mental health. As a strategy to manage mild to moderate depression, exercise can provide comparable benefits to some antidepressants, and can complement medications to improve symptoms further. Similarly, exercise can play a role in treating anxiety, obsessive-compulsive disorder, and post-traumatic stress disorder. It can also improve your sleep quality and even benefit self-esteem and confidence.

It’s thought exercise does this by reducing your sensitivity to the symptoms of anxiety, building resilience to stressful mood states, positively altering the neurotransmitters in the brain, and disrupting or distracting you from social isolation.

Getting active can also allay general body aches and pains. An Australian study recently suggested jogging improves the composition of the cushion-like discs in your spine, reducing wear and tear. Exercise not only fortifies the discs but is also generally effective in preventing and treating pain. This is particularly important given 67% of Australians experience pain at least monthly, with inactivity being a major risk factor.

Exercise has benefits for most aspects of our physical and mental well-being.
from www.shutterstock.com

A healthy diet combined with exercise can also strengthen your bones, reducing the risk of fractures if you do have a serious injury.

You’ll save more and spend less

There’s good evidence, including from Australia, that eating healthy food is actually more affordable than an unhealthy diet. And smoking one pack of cigarettes per day, when combined with the health costs that result, is estimated to cost a staggering US$638,750 (A$812,556) to you and society over 50 years.

Type 2 diabetes, often associated with obesity, is estimated to result in A$4,025 per year per person in total costs without medical complications, or in excess of A$9,645 once complications develop. These costs are incurred not only through the need for treatment, but also in job discrimination, higher health insurance costs, lost productivity with sick days and poor physical function.

While no similar analysis exists for Australia, evidence from the US estimates lifetime social and public health costs of obesity at US$92,235 (A$117,332) per person, when combining medical expenditure and reduced productivity.

The direct medical costs to individuals in Australia may be lower due to our universal health system, but the costs from obesity still add up to A$873 million each year. A A$719 million per annum slice of the Australian budget is spent on the complications of physical inactivity alone, through heart disease, stroke, type 2 diabetes, breast cancer, colon cancer, depression and falls.

This isn’t noted to shame anyone or to recommend reducing care, it’s about realising policy and health inaction comes at a huge economic and social cost.

Your kids will be healthier, and maybe even their kids

Poor diet, smoking, alcohol use and a lack of physical activity can also affect your kids’ health – and maybe even the health of their kids.

Firstly, through role modelling. The kids of parents who smoke are significantly more likely to smoke themselves, and likewise with unhealthy drinking and eating. These kids are also more likely to be obese. Some of these effects could also be from socioeconomic factors.

Second, through a mechanism called epigenetics, our own health can influence the health of subsequent generations. This results from alterations in the expression of genes and not through changes in the genes themselves.

Altered epigenetics from physical inactivity, diet and environmental factors are now thought to be passed down through generations. They influence the subsequent risk of metabolic diseases such as obesity and diabetes.

Finally, being overweight, a lack of exercise and even consuming sugary drinks could actually reduce your chances of having kids in the first place. In women, being overweight increases the risk of polycystic ovarian syndrome, which causes irregular ovulation and can occasionally render women infertile.

While in men, excess weight contributes to infertility by reducing the quality of semen, as well as increasing the risks of sexual dysfunction.

The bigger picture

Living a healthier lifestyle is about making small, possible, simple and sustainable changes like taking the stairs instead of the lift – not totally rethinking the way you live.

Being healthy is about small, incremental, sustainable changes over many years.
Flickr / TYFVMP

But while there are many compelling reasons to be healthy, personal discipline alone will never solve our chronic disease and obesity epidemics. If neighbourhoods lack safe spaces for kids to run, or fresh food is inaccessible and unaffordable, good intentions will not get you very far. Government policies need to make health easier, even preferred.

The ConversationIn the meantime, look to friends for motivation; your family to share and support a healthy diet; apps that map and commend the exercise you do; and your GP and important services like Quitline for assistance with alcohol reduction and smoking cessation.

Alessandro R Demaio, Australian Medical Doctor; Fellow in Global Health & NCDs, University of Copenhagen

This article was originally published on The Conversation. Read the original article.

Dementia study debunks exercise theory

 

Look at any of the multitude of articles of the past few years on how to avoid dementia and you’ll almost certainly read that exercise delays onset. Not so, according to the most recent research, published this week in the BMJ.

The 28-year study followed over 10,000 middle-aged British civil servants, noting at seven-year intervals whether participants were doing the “recommended” amount of exercise, defined as moderate or vigorous physical activity for 2.5 or more hours per week.

Surprisingly, the researchers found no correlation between how much exercise a patient did and whether they experienced cognitive decline over the study period, identified through a battery of cognitive tests, along with dementia diagnoses from hospital and mental health services.

The finding runs counter to several recent meta-analyses of observational studies which concluded that physical activity is neuroprotective in cognitive decline and dementia risk.

What the researchers did find was that in participants who eventually developed dementia, a decline in physical activity started around nine years before diagnosis.

This finding could be key to why previous observational studies have found a correlation between exercise and dementia risk, say the French researchers from the Centre for Research in Epidemiology and Population Health in Paris.

It’s now well known that brain changes start happening many years before dementia symptoms become apparent, and a decrease in physical activity is probably part of the cascade of changes in this preclinical phase of dementia, the researchers say.

The upshot is that findings of a lower risk of dementia with exercise may be attributable to reverse causation – in other words, decline in physical activity is due to the dementia, and not the other way around.

The researchers say that two problems with some of the earlier observational studies were that their duration was too short and their participants were too old. This made them more liable to be confounded by participants with preclinical dementia, who for that reason had lower levels of physical exercise.

They also point out a difference between observational and randomised trials, with the latter less likely to find a protective effect with exercise.

The recommendation of exercise for the prevention of dementia has already become enshrined in a number of international guidelines, including in Australia.

You can access the study here.

The one thing that helps in chronic disease

Exercise, exercise and more exercise should be recommended to people with non-communicable chronic diseases, say Finnish researchers.

And it doesn’t necessarily matter what kind of exercise, or even what kind of chronic disease the patient has, according to a new umbrella review of 85 meta-analyses.

Aerobic exercise, resistance training, or a combination of both all improved functional capacity in roughly equal measure across 22 common chronic diseases, in randomised trials comparing exercise therapy with no treatment or usual care.

Chronic diseases in the review included osteoarthritis, rheumatoid arthritis, coronary artery disease, heart failure, type 2 diabetes, various cancers and Alzheimer’s disease.

The review encompassed 146 physical and functional capacity indicators, such as the six-minute walking test, maximal lower body muscle strength, balance tests and self-assessed ability to carry out everyday functions. Around 85% of these indicators were improved with exercise, with 20% showing large improvement.

These improvements were similar in both objective performance measurements and patients’ own assessment of their function.

At the same time, reported adverse events were no greater in exercise versus control groups.

The study authors from the University of Jvaskyla say research into exercise in chronic conditions has generally been more focused on risk factors, prevention and risk of death, and has often overlooked the importance of physical functioning.

Better function improves coping with daily living and may lessen pain and even disease progression, the researchers say. On a societal level, there are also economic benefits in reducing care needs of people with chronic conditions and improving their ability to live at home.

The authors suggest exercise therapy should be recommended to all patients with non-communicable chronic diseases, although training programs should be progressive and include follow-ups to monitor adherence, effectiveness or any adverse effects.

You can read the study here.