# Exercise as it relates to Disease/Effects of aerobic exercise to help slow the process of cognitive impairment in healthy older adults

Article: White matter plasticity in healthy older adults: The effects of aerobic exercise
https://doi.org/10.1016/j.neuroimage.2021.118305

## What is the background to this research?[edit | edit source]

Cognitive impairment is associated with white matter deterioration in healthy older adults and this paper is identifying an intervention that can perhaps impede deterioration of brain health in the older population.
The topic of white matter deterioration and its risk factors have been extensively research, but there has been a lack of clinical trial studies on preventative treatments. It is important to identify preventative treatments as deterioration of brain health can cause a variety of poor health issues including dementia, cognitive impairment and increased risk of stroke.

## Where is the research from?[edit | edit source]

The group that is involved in this intervention are healthy older adults aged between 60 to 79 years old (68% female). White matter deterioration is practically an endemic in the elderly community with 50-98% of the population older than 60 years old being affected by the disease.
The study was written by nine authors, with majority of them being involved in writing at least 3 other research papers, they are all qualified in health and psychological sciences.
This paper was supported by the National Institute on Aging at the National Institutes of Health and their main objective is to support and conduct a variety of research on aging. The funding of the study was from Abbott nutrition through the centre for nutrition, learning and memory (University of Illinois) and from the Translational Medicine Institute, Translational Accelerated Program (Colorado State University). Both these organisations have a similar mission in advancing knowledge and improving health and wellbeing throughout life.

## What kind of research was this?[edit | edit source]

The study was a clinical trial that involved 180 community dwelling, low active healthy adults aged between 60-79 years. This type of research design is considered the gold standard for disease intervention research as its main objective is to find a safe and suitable intervention for different diseases.

## What did the research involve?[edit | edit source]

The 213 participants were split into 4 groups for a 6 month period. The 4 groups were labelled as the active control group (improve flexibility strength and balance with yoga mats and bands), walking group (walked for 20-40 minutes at 50-60% MHR (6 weeks) and increased to 40 minutes at 60-75% MHR (18 weeks)), walking and nutrition group (same conditions as walking group but with a nutritional supplement) and the dance group (learnt 4 social dances each session). Each participant went to 3, 1 hour sessions per week and all used progressive overload. To discover if the intervention was suitable all participants had to undertake multiple MRI imaging, cognitive and cardiorespiratory testing, before and after the 6 months.
The approach for this methodology is very controlled in how it was laid out and performed. Participants had to pass a 10 question inclusion criteria with one of the questions being: are you currently involved in another physical activity program? Along with this they had to pass another inclusion criteria but for completing a MRI, which involved 3 steps. These criteria allowed the trial to have participants that fit the criteria and saw 34 people not pass. To collect the important measures, they used the same approach before and after, to assess cardiovascular variables, MRI acquisition, T1w/T2w calculation, white matter signal abnormality volume estimation, region selection, cognitive assessment and finally statistical analysis.
A limitation that occurred when collecting data was that 180 participants instead of the total 213, had good quality MRI data before and after the intervention. Another one occurred in the dance intervention, performance gain was not measured and therefore an appropriate interpretation of dance effects on white matter was limited.

## What were the basic results?[edit | edit source]

Over the 6 month period, the results suggested that aerobic walking and dance helped impede white matter deterioration in older adults, as changes in vulnerable regions in the brain could be detected on a short-term scale.
Researchers interpreted these results from MRI scans as there were visible positive changes (myelination) in white matter regions in the walking and dance groups, whereas in the active control group there was a decline in those white matter regions.
The researchers may of over-emphasised the effect size of the results as changes were quite small, but they do state this and believe bigger changes will be seen with both longer studies and a larger group sample.

## What conclusions can we take from this research?[edit | edit source]

The study found that walking and dance reduces white matter deterioration through the use of T1-weighted images which is not the gold-standard way (FLAIR images) to calculate white matter hyperintensity volume. This information should be interpreted with caution and that more studies will need to be conducted with the use of the gold-standard approach as some areas of the brain were underestimated. This study was important to find evidence about white matter and its relationship to exercise but there is still plenty of uncertainty around the topic and, longer studies will need to commence to allow researchers to discover adaptations of the brain to exercise on episodic memory function.
Other recent studies all suggest the same conclusion, what aerobic exercise (acute, short or long term) is the most beneficial at protecting the aging brain against white matter deterioration. A studies findings from 2019, found no correlation between exercise and the cerebral white matter microstructure over a 6 month period. Another study from 2021, found that a week-long exercise intervention induced microstructural brain changes in a number of white matter pathways.

## Practical advice[edit | edit source]

Before any exercise can be performed, individuals need to take a pre exercise screening to identify if they have any conditions that could risk their health during exercise.
Exercise advice for healthy aging adults:
* Participate in social aerobic exercises (e.g. a walking group and/or a dance group)
* Implement progressive overload (every 2-4 weeks)
** Do this by increasing the amount of time exercising, the load and/or intensity.
* Monitor exercises through a fitness tracker (e.g. fitbit) and track progress
* To help motivate individuals, set realistic goals, do social exercises and create an exercise plan.
The aging population should know about the recommended physical activity for their age group and follow the recommendations as a guideline.

## Further information/resources[edit | edit source]

The National Institue on Aging provide a variety of helpful information and articles for both patients and allied health professionals on all topics relating to aging health issues.
Further readings about brain health and interventions:
* https://www.nia.nih.gov/health/cognitive-health-and-older-adults
* https://www.nia.nih.gov/health/preventing-alzheimers-disease-what-do-we-know

## References[edit | edit source]

* Colmenares A, Voss M, Fanning J, Salerno E, Gothe N, Thomas M, Mcauley E, Kramer A, Burzynska A. White matter plasticity in healthy older adults: The effects of aerobic exercise. Neuroimage. 2021 Oct 1.
* File: Alzheimer's disease brain comparison. jpg
* Xiong Y and Mok V. Age-related white matter changes. J Aging Res. 2011 Aug 23.
* Launer L.J., Berger K.c, Breteler M.M.B.b, Dufouil C.d, Fuhrer R.e, Giampaoli S.f, Nilsson L.-G.g, Pajak A.h, de Ridder M.b, van Dijk E.J.b, Sans S.i, Schmidt R.j, Hofman A.b. Regional variability in the prevalence of cerebral white matter lesions: an MRI study in 9 European countries (CASCADE). Neuroepidemiology. 2006.
* National Institute of Aging. nia.nih.gov/about/mission. Accessed September 4, 2022. https://www.nia.nih.gov/about/mission
* Moulton C, Wee E, Kuchan M , Garleb K, Cohen N. The Center for Nutrition, Learning, & Memory: Together Addressing a Grand Challenge. The FASEB journal. 2015 April 1.
* Translational Research Acceleration Program (TRAP) Award. fightingblindness.org. Accessed September 4, 2022. https://www.fightingblindness.org/translational-research-acceleration-program
* Chidambaram A, Josephson M. Clinical research study designs: The essentials. Pediatric Investigation. 2019 Dec 21.
* File: Walking (61716) - The Noun Project. jpg
* File: USMC-100529-M-3740P-406.jpg
* File: Social-dancing-stevens-and0emma-under-arm-turn.jpg
* J. J. Steventon, H. L. Chandler, C. Foster, H. Dingsdale, M. Germuska, T. Massey, G. Parker, R. G. Wise & K. Murphy. Changes in white matter microstructure and MRI-derived cerebral blood flow after 1-week of exercise training. Sci Rep. 2021 Nov 11.
* Clark C, Guadagni V, Mazerolle E, Hill M, Hogan D, Pike G, Poulin M. Effect of aerobic exercise on white matter microstructure in the aging brain. Sci Direct. 2019 Nov 5.
* Launch of latest Adult Pre-Exercise Screening System for health and fitness industry. hsma.org.au. Accessed September 6, 2022. https://sma.org.au/launch-of-latest-adult-pre-exercise-screening-system-for-health-and-fitness-industry/
* What Is Progressive Overload Training? healthline.com Accessed September 6. https://www.healthline.com/health/progressive-overload
* Promoting Wellness in Older Patients. nia.nih.gov. Accessed September 6 2022. https://www.nia.nih.gov/health/promoting-wellness-older-patients
* Physical activity and exercise guidelines for all Australians. health.gov.au. Accessed September 6 2022. https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians
* National Institute on Aging.nia.nih.gov. Accessed September 7 2022. https://www.nia.nih.gov/health
* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 https://doi.org/10.1016/j.neuroimage.2021.118305
* ↑ File:Alzheimer's disease brain comparison.jpg
* 1 2 3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3163144/
* ↑ https://doi.org/10.1159/000089233
* ↑ https://www.nia.nih.gov/about/mission
* ↑ https://faseb.onlinelibrary.wiley.com/doi/abs/10.1096/fasebj.29.1_supplement.741.11?cited-by=yes&legid=fasebj%3B29%2F1_Supplement%2F741.11
* ↑ https://www.fightingblindness.org/translational-research-acceleration-program
* ↑ https://onlinelibrary.wiley.com/doi/10.1002/ped4.12166
* ↑ File:Walking (61716) - The Noun Project.svg
* ↑ File:USMC-100529-M-3740P-406.jpg
* ↑ File:Social-Dancing-Stevens-and-Emma-Under-Arm-Turn-1080x720.jpg
* 1 2 https://doi.org/10.1038/s41598-021-01630-7
* 1 2 https://doi.org/10.1016/j.bbr.2019.112042
* ↑ https://sma.org.au/launch-of-latest-adult-pre-exercise-screening-system-for-health-and-fitness-industry/
* ↑ https://www.healthline.com/health/progressive-overload
* ↑ https://www.nia.nih.gov/health/promoting-wellness-older-patients
* ↑ https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians
* ↑ https://www.nia.nih.gov/health