Strength is Never a Weakness: June 2020

Monday 15 June 2020

Can Physical Activity Help Prevent & Combat Mild Cognitive Impairment’s and Dementia?

Hi Everyone

I hope all is well

This is a the next post of 2020. It is from my friend and colleague Tom Wing all around Dementia and Physical Activity.

Hope all my readers you find this useful :)

Enjoy!

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Hi Everyone,

Thank you for taking the time read this post!

I am currently studying MSc Physiotherapy (Pre-registration) at Teesside University, following graduating top of my class with 1st class honours in Sport’s Therapy and Rehabilitation. Since I have become a fully accredited member of the British Association of Sport Rehabilitators and Trainers (BASRaT) and was present with the GrayBrook award in 2019 for the highest academic degree classification for all Sports Rehabilitation courses in the United Kingdom. I would like to state I am NOT an expert on Dementia care but as a healthcare professional I am an advocate of Physical Activity and Exercise.

If anyone would like guidance on Physical Activity and Exercise, please contact me via my company’s (Teesside Athletic Academy) Facebook or Instagram page. The links are at the end of the article

Introduction

The word dementia originates from the Latin words – de and mens - translating as out of mind, leading to the development cultural stigma surrounding the illness (Mukadam, and Livingston 2012). Subsequently the loss of independence and autonomy experienced by patients with dementia (PwD) maybe due to the combination of cultural stigma and the illness (Mukadam, and Livingston, 2012; Yates et al., 2019). Dementia was referred historically to as a clinical syndrome affecting the brain and manifesting as a reduced cognitive status, typically within the elderly demographic (Breitner, 2006; Mukadam, and Livingston, 2012). This led some researchers to infer the pathology is a mental health disorder, adding to the aforementioned cultural stigma surrounding the disorder (Mukadam, and Livingston, 2012). The illness should now be recognized as a neurocognitive condition (Palm et al., 2016). Epidemiological data suggests the condition is the greatest international challenge to 21^st century health/social care and due to the ageing populace, prevalence is set to triple by 2050 (Mukadam, and Livingston, 2012; Livingston et al., 2017; Beydoun, and Kivimaki, 2019; World Health Organization, 2019). A systematic review by Suijkerbuijk et al., (2019), expresses the need to develop interventions promoting independence and well-being in PwD. The Lancet Commission for dementia care substantiates this, adding despite the underlying neurological condition remaining largely uncurable, the clinical manifestations may be modifiable with excellent care (Livingston et al., 2017). Physical Activity and Exercise maybe one such intervention.

Prevention of Mild Cognitive Impairment and Dementia

It is well documented increased exercise and physical activity in the older population positively impact upon falls, mood, function, mortality and combats risk factors of dementia - diabetes, hypertension, and obesity (Blake et al., 2009; Almeida et al., 2014; de Labra et al., 2015; Livingston et al., 2017; Blond et al., 2019; de Souto Barreto et al., 2019; Ekelund et al., 2019; García-Hermoso et al., 2020). A meta-analysis of prospective cohort studies (n=33,816) by Sofi et al., (2011) conducted high levels physical activity and exercise had a significant effect in mitigating cognitive decline in PwD. As explored throughout the Lancet Commission adults who perform regular physical activity and exercise display a greater prospect of maintaining cognitive function than those that do not, appearing to have an inverse relationship with rates of the cognitive decline or dementia (Livingston et al., 2017). The effectiveness of physical activity and exercise in combating cognitive decline is substantiated by a meta-analysis (n=163,797), suggesting that rates of dementia are lower in persons who perform high levels of physical activity and exercise (Hamer and Chida, 2009). Due to the lack of randomized controlled trials (RCT) within the meta-analyses both Hamer and Chida, (2009); Sofi et al., (2011) have low internal validity. Nevertheless, clinical relevance may still be taken from Hamer and Chida, (2009); Sofi et al., (2011) due to the large sample size within reducing the impact of within-subject variation, thus increasing the reliability of the results (Hopkins 2000; Hopkins 2019).

The Effect of Physical Activity and Exercise on Mild Cognitive Impairment

As discussed through the Lancet Commission there is a developing body of research suggesting exercise and physical activity may be beneficial for suffers of the mild cognitive impairment (Livingston et al., 2017). Despite this, there is conflicting evidence documenting the effectiveness of exercise and physical activity as an intervention to improve cognition in an older demographic. Furthermore, the National Institute for Health and Care Excellence (NICE) Guidelines, (2018) only recommended exercise for dementia patients with disturbed sleep. A Cochrane review of 12 studies (n=754) reported that there is no evidence to supporting the utilization of aerobic exercise as an intervention to improve cognition in healthy elderly adults (Young et al., 2015). A meta-analysis by Kelly et al., (2014), of 25 RCT’s corroborate findings of the Cochrane review, suggesting the evidence surrounding aerobic exercise to improve cognition to be inconclusive. As the meta-analysis has a high number of RCT’s the meta-analysis has an exceptionally high internal validity as RCT’s are considered to be level 1 evidence for evidence-based practice (Hshieh et al., 2015). Despite this, aerobic exercise may be an effective intervention for elderly adults suffering with cognition impairments such as dementia. A meta-analysis of 11 papers by Zheng et al., (2016) found aerobic interventions were effective in improving global cognition in the elderly populace with cognitive impairment. This is validated by a recent meta-analysis of 5 RCT’s by Zhu et al., (2020) discovered aerobic dance had positive effects on global cognition (Mean difference=1.43; 95% CI: [0.59, 2.27]; p=0.0009). Due to all the studies within the meta-analysis being RTC’s, Zhu et al., (2020) has a high internal validity. Despite this, as aerobic dance is an emerging intervention to improve cognition there is a limited number of studies available for analysis, reducing external validly. Further research is needed to verify finding by Zhu et al., (2020) before aerobic dance can be utilized as intervention. Nonetheless, this adds to the expanding body of research supporting the use of aerobic activity by healthcare professionals to improve cognition in elderly patients suffering with cognitive deficiency.

The Effect of Physical Activity and Exercise on Dementia

A Cochrane review of 17 trials studies (n=1067) found no evidence exercise improved cognitive function in PwD and deemed the evidence to be very low quality (Forbes et al., 2015). Studies within the review are dated pre 2013, more contemporary evidence endorses the utilization of exercise and physical activity to enhance cognition. Subsequent systematic-reviews/meta-analyse investigating physical actively and exercise as an intervention in patients living with Alzheimer’s disease and dementia, thus disputing the findings of Cochrane review (Groot et al., 2016; Karssemeijer et al., 2017; Du et al., 2018; Jia et al., 2019; Law et al., 2020). The Lancet Commission concluded, exercise programs for PwD suffering mild to moderate dementia is well accepted with high-intensity exercise groups well evidenced among-st Alzheimer’s suffers (Livingston et al., 2017). A systematic review of 50 papers (n=5099) by Law et al., (2020), uphold findings by the Lancet Commission, inferring there is moderate evidence supporting the use of aerobic exercise at moderate to high intensity to improve global cognition in PwD. Nevertheless, Egger’s regression asymmetry test discovered publication bias to be present among-st studies within the review, hence impacting upon the validity of the results (Hussain et al., 2011). Healthcare professionals may still take clinical relevance from the Lancet Commission and Law et al., (2020) as it highlights the importance of reaching aerobic threshold during high intensity exercise sessions to facilitate hippocampal neurogenesis (Erickson et al., 2011; Erickson, Gildengers and Butters, 2013; Livingston et al., 2017).

Manipulation of Training Variables

The manipulation of other training variables - such as frequency, session duration and length of intervention may also have beneficial impacts on cognition as well as intensity. A meta-analysis of 13 studies by Jia et al., (2019) reports lower frequency (≤3 sessions a week) and sessions duration (≤30-minute) of moderate to high intensity sessions to have the greatest impact on cognition in patients suffering from Alzheimer’s. Furthermore, interventions longer than 16 weeks appear to have more beneficial impacts on cognition. This is substantiated by Law et al., (2020), concluding if the total training duration is greater than 24-hours the effectiveness of intervention may increase. Nonetheless, Jia et al., (2019) suggests due to the variation in exercise interventions, more high-quality RCT’s are needed to corroborate these findings. Healthcare professionals therefore maybe able improve patient’s global cognition through the use of ≤30-minute high intensity aerobic exercises ≤3 sessions per week for ≥16 weeks (Groot et al., 2016; Zheng et al., 2016; Karssemeijer et al., 2017; Livingston et al., 2017; Du et al., 2018; Jia et al., 2019; Law et al., 2020; Zhu et al., 2020).

Conclusion

It remains controversial whether physical activity and exercise can prevent mild cognitive impairments and dementia or whether physical activity and exercise can be utilized to treat the conditions. Nevertheless, there is a growing body of evidence supporting this hypothesis that an increased physical activity and exercise level in the general population and the use of 30-minute high intensity aerobic exercises, 3 sessions per week for 16+ weeks, will decrease rate of cognitive impairments and dementia. It is important to note healthcare professionals or people considering this somewhat aggressive approach must first address patient safety. Therefore, considerations should be made for the patients current physical actively level, aerobic capacity, blood pressure, oxygen saturation levels etc. In addition, the patient should be closely monitored Pre, During and Post any exercise intervention.

Authors Information

Thomas Wing BSc (hons), G.S.R, BASRaT-reg
Facebook Page- Teesside Athletic Academy
Instagram- @teessideathleticacademy

Reference List

Hamer, M. and Chida, Y., (2009). “Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence”. Psychological medicine, 39(1), pp.3-11.
Hopkins, W. G. (2019). Sportscience. [online] Sportsci.org. Available at: https://sportsci.org/ [Accessed 11 Apr. 2019].
Hopkins, W.G. (2000). ‘Measure of Reliability in Sports Medicine and Science.’ Sports Medicine. 30, (1), 1-15.
Sofi, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G.F., Casini, A. and Macchi, C., (2011). “Physical activity and risk of cognitive decline: a meta‐analysis of prospective studies”. Journal of internal medicine, 269(1), pp.107-117.

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Thank you Tom for this insightful post!

I am sure the readers have enjoyed this topic and given them plenty food for thought.

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University.

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019.

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications:

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning.

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering.

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness.

I had my own business for providing training plans for teams and athletes.

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships,

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge.

Contact details below;

Facebook: Andrew Richardson (search for)

Facebook Page: @StrengthisNeveraWeakness

Twitter: @arichie17

Instagram: @arichiepowerlifting

Snapchat: @andypowerlifter

Email: a.s.richardson@tees.ac.uk

Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278

Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7

Tuesday 9 June 2020

Career Transitions for the Elite Athlete by Callum Wilkinson

Image by David Marcu/@davidmarcu

Hi Everyone

I hope all is well

This is a the next post of 2020, is by my good friend Callum Wilkinson. It is all about career transitions for the elite athlete.

Hope all my readers you find this useful :)

Enjoy!

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This is my first time writing a blog for Andrew so thought I would just introduce myself and the topic I’m going to discuss.

I’m Callum and I cycled at an elite and professional level for three years before commencing my BSc in Sport Science at Teesside University. Whilst at university I’d never really managed to reconcile with my time as a cyclist and I began to struggle with feelings of regret and anger at myself for not fully capitalising on my time as an athlete. What I mean by that is I always felt I should have done things differently, from communicating more with teammates, sponsors, attending networking events and just generally having a more of a wider perspective on things. As an athlete I was very driven and determined but that really went against me as I could only see one path and was usually blinkered to what was going on around me.

Anyway, fast forward onto my final year at uni and it was time to decide on a dissertation topic. I decided on investigating the struggles elite athletes face when transitioning out of sport and into a more ‘normal’ life. The findings all confirmed what I suspected- athletes struggled with a loss of identity, loss of purpose in life, feelings of deep regret and in some cases falling into a very depressed state of mind. These were all very familiar, but I decided for my MSc thesis to flip it on its head and look into what can be done to support young athletes who are transitioning into elite sport. If we catch them at young age and guide them then hopefully, they won’t have to experience any of this when their athletic career is coming to a close…

The athletic career transition has received widespread research attention over the years (Wylleman and Lavalee, Stambulova, Alferman, Statler to name just some) but strangely there has been less focus devoted on how we can support young athletes making a difficult transition into professional sport. I think Bloom (1985) was one of the first to explore the transition into elite sport at a conceptual level, describing the entry into elite sport as a critical developmental phase in which athletes become more dedicated to their sport and where the amount of training and level of specialisation increases. That was over 30 years ago now though and there’s really only been dribs and drabs since then into this specific topic.

What makes this a particularly difficult time for youngsters is a compound effect of not only coping with the normal demands associated with adolescence but also encountering events and issues (e.g., injury, burnout) that may increase the pressures of the development process. I could go on and on listing the potential challenges faced at this stage, but I thought I would bullet point below some of the key things I’ve learnt from my research and also my time spent as an athlete. Hopefully these can provide some guidance to young athletes, coaches, parents and even schoolteachers who may be supporting in the transition:

1. Communicate. Don’t be afraid to open up with teammates, friends, family etc. Having a strong support network has been found to be a critical factor to youth athlete success, especially during the entry transition into elite sport.

2. Don’t put lots of pressure on yourself. You will have down days and performances but focus on the bigger picture and don’t compare yourself to others. This is something coaches and parents need to be aware of to remind the athlete to remain task focused and the importance of competing against themselves.

3. Enjoy your sport and have fun. Rigid training structures have their place, especially as an athlete matures and becomes more specialised but having fun with your training and competing is a must in order to get the best out of yourself. Plenty of evidence has shown that to much emphasis on results and performance, especially at a young age, can lead to injury, disengagement and reduced performance.

4. In relation to the above point, don’t put all your eggs into one basket. Make sure your studies at school or college are a priority. Your education will last a lifetime and gives you something to fall back on if your athletic career doesn’t work out. Good coaches should be able to advise and effectively manage an athlete’s time commitments to education and sport.

5. Network. You may already be part of a team that has a wide range of sponsors, so reach out to them. You could start the conversation with telling them about your recent performances or what your plans are for the competitive season. It gets your name and face known which could lead to opportunities in the future.

6. Leading on from that last point- use social media platforms to showcase what you’re doing. Fully utilise it to make career connections and get your name out there. You can then begin to self-market, build a personal brand, and promote yourself.

7. Lastly, Set some goals. Working towards something is a great way to stay motivated, so set yourself some targets of what you would like to achieve. I don’t mean these ‘where do you see yourself in 2, 5 or 10 years’ type goals as they are pointless and just put unnecessary pressure on you. Instead look at outcome goals which deal with your results in competition and analyse elements you could improve upon and Performance goals which will help you breakdown areas you need to work on in order to improve in your next competition.

This is by no means an exhaustive list but it’s what I have found to be stand out elements which can help an athlete make a much smoother transition into elite sport. It’s all about taking a holistic approach to life and never putting too much pressure on yourself or trying to live up to someone else’s expectations.

Thanks for reading,

Callum.

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Thank you Callum for this splendid article. I am sure the readers will find this very useful.

If you want to speak to Callum his LinkedIn is here: https://www.linkedin.com/in/callum-wilkinson01