Need a New Year’s Resolution? Try Exercise!

By Ahmed Raza Khan, MD, MPH
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Child and Adolescent Psychiatry Physician at Stanford University School of Medicine

Most people know that exercise is beneficial for cardiac health and is prescribed by physicians for the prevention and alleviation of various medical complications. But what if I told you exercise can also significantly benefit your mental health in more ways than one? Let’s take a look at some of the ways exercise can improve mental health and how to incorporate this into your new year’s resolution list!

Exercise and Depression Prevention:More than 350 million people in the world suffer from depression and it is the leading cause of disability worldwide.  Exercise has often been considered as a supplemental tool in treating depression, but recent evidence points to exercise playing a role in the prevention of future depressive episodes. These recent findings show that even low levels of physical activity (e.g., walking less than 150 minutes a week) can prevent future depression. There has been significant research in the last few years that links cardiovascular health’s role in the origin of depression. This would certainly be a plausible explanation for why exercise may prevent depression.

Alzheimer’s Disease Prevention:Alzheimer’s disease is a chronic, degenerative disease of the brain that affects over 25 million people in the world. This illness leads to a progressive mental decline, steering its victims to dependence on caregivers and, eventually, death. Amyloid plaques are abnormal clusters of protein fragments that are found in the brains of patients with Alzheimer’s disease and are thought to play a major role in its progression. Recent studies have found that people who exercised at or above the levels recommended by the American Heart Association had significantly lower numbers of amyloid plaques than those who exercised less. This was the case for even those who carried the APOE-e4 gene variant, which is an established risk factor for Alzheimer’s disease. When people with the APOE-e4 gene variant were compared, those with higher levels of exercise had lower levels of amyloid plaques.

Improving Cognitive Functioning:Exercise has been shown to increase cognitive functioning in rats. As rats get older, their memory tends to diminish and this appears to be due to a drop of nerve synapses in the hippocampus, the memory center of the brain. But after 12 weeks of voluntary running, both memory and hippocampus nerve synapses were restored in these rats.

Consistency in Exercise:Recent neuroscientific studies have shown that the cognitive benefit of exercise may have a window of time. In fact, rats that improved their cognitive functioning by exercise, had this improvement dissipate in 3-6 weeks of inactivity. This is similar to what is seen with muscle mass or heart rate when exercise is withdrawn. This evidence intimates that exercise is beneficial for the brain and should be performed consistently.

The American Heart Association is a great resource for planning the amount and type of exercise one needs. They recommend at least 30 minutes of moderate-intensity aerobic activity at least 5 days a week for a total of 150 minutes or at least 25 minutes of vigorous aerobic activity 3 days a week for a total of 75 minutes. An easy target to remember: 30 minutes a day, 5 days a week.

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National Caregivers Month: Alzheimer's Disease

By Felicia Wong, MD

Alzheimer’s Disease is a progressive, irreversible brain disease. The cause is poorly understood, and there is no known cure. Symptoms of Alzheimer’s include memory loss, confusion, impaired judgment, personality changes, disorientation and loss of language skills. It is the most common form of irreversible dementia.

Watching someone you love slowly lose their memory, thinking and reasoning skills can be heartbreaking. Caring for a person with Alzheimer’s Disease is a difficult task and can become overwhelming at times. As Alzheimer’s patients gradually lose their memory and their skills , each day brings new challenges to the caregiver. This is why I wanted to recognize caregivers for Alzheimer's patients in November, which is National Family Caregivers Month and Alzheimer's Disease Awareness Month.

Over time, communication diminishes, rewards decrease, and without strong support from family, friends and the community, caregivers of Alzheimer's patients face challenges to their very own well-being. Maintaining emotional and physical fitness while providing care for a loved one with Alzheimer’s Disease is crucial. Preparing and protecting yourself, understanding your loved one’s experience, and accepting help from others can reduce the stress associated with care-giving, and maximize the joys of being there for a loved one.

Here is a link to tips to help caregivers of loved ones with Alzheimer’s cope.

Additional support for Alzheimer’s and Dementia Caregivers, including warning signs of caregiver burnout, and tips on how to plan your own self care can be found on Helpguide.

Find additional information on Alzheimer's and other issues affecting mental health in seniors on the American Psychiatric Association's Healthy Minds website.
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Caregiving and Youth

By R. Scott Benson, M.D.

I met a remarkable young woman last week. Sarah (not her real name) was only 15 years old so she couldn’t get a summer job, so she offered to help with her grandmother who had recently returned home from a brief hospital stay. Sarah was pretty excited about the opportunity since she always felt that she was her grandmother’s favorite.

After a few weeks Sarah had what she described as a pretty typical panic attack. Her parents weren’t particularly surprised since Sarah had had some problems with anxiety when she started middle school. Those problems resolved with brief therapy. They quickly arranged for a reevaluation aware that she was at risk for a recurrence of her anxiety problems.

Before she came for the visit she had experienced a couple more panics and was having trouble settling for sleep at night. She couldn’t identify any new stressors. She was positive about her family and peer relationships. She told me her time with her grandmother was going well and she enjoyed the responsibility. She did tell me that her grandmother needed someone with her and the family didn’t have any other easy options.

We reviewed the tools she learned in the sixth grade for control of her anxiety symptoms. Her schedule was a little cramped and she had dropped her regular exercise (she is a runner). We got that going again, talked about her sleep and agreed on a follow-up appointment.

That week Sarah continued having panic attacks and some crying spells. I asked her to tell me a little more about the time she spent with her grandmother. At first she was hesitant since she didn’t want to complain – “Sometimes it’s hard, but it’s okay.” I pressed for more, and she began to cry. It was turning out to be harder than she thought it would be. Her grandmother had gotten mean and complaintful. Nothing Sarah did was right.

She could tell her grandmother was getting forgetful, but she wasn’t prepared for the repeated accusations that it was Sarah who was misplacing, even hiding things from her. Sarah, ever dutiful, would retrace her steps, offer reassurances to her grandmother, only to hear the same accusing questions a few minutes later. The worst for Sarah was her grandmother’s angry name calling, accusing Sarah of stealing, questioning her behavior with her boyfriend, claiming sexual behaviors that never happened.

Sarah had kept all this to herself even questioning if some of these hurtful accusations could be true, thinking her parents would disbelieve that her grandmother would say such things, worried what would happen to her grandmother if Sarah didn’t “tough it out” and help the family keep her grandmother in the family home.

Sarah was relieved to get these problems out in the open. She agreed that we should share these problems with her mother. Her mother was concerned that Sarah was having such a struggle with the grandmother; she knew there were some memory problems but had not seen these behaviors. Both were relieved to hear that these were not unusual behaviors in elderly persons with early dementia.

Sarah’s mother agreed to talk with their family physician about an evaluation for her mother. I talked with Sarah and her mother a little about strategies they could use to help Sarah with some of the stress of this caretaking responsibility. I suggested they look at the information available through the Alzheimer’s Association and the AARP site on caregiving.

Families will be challenged by increased demands for caregiving as the baby boom generation ages. A lot of this caretaking will fall on mature children and adolescents. Currently, there are estimated to be 1 to 1.3 million teens who have caretaking responsibilities. A lot is written about the demands on adults put in a caregiving role realizing that they are subject to depression, anxiety, and burnout. Teens in caregiving roles face the same risks and we need to be prepared to provide the support they need. Some communities have recognized this problem and started programs to provide these young people with the support they need. One program, the American Association of Caregiving Youth in Boca Raton, FL, is bringing national attention.

There is also information about Alzheimer's and the mental health of seniors at HealthyMinds.org.
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