By Paul R. Burghardt, PhD

A couple of recent articles in the journal Clinical Practice and Epidemiology in Mental Health, reported exercise as an effective adjunctive treatment for individuals suffering from Major Depressive Disorder (MDD).

An Italian research group [Pilu et al, 2007] reported that individuals receiving antidepressant drugs along with cardiovascular (aerobic) exercise for eight months had decreased severity of depression compared to individuals receiving drugs but not exercise. A follow up analyses of the study determined that these individuals’ perception of their quality of life was also improved [Carta et al, 2008].

One of the interesting things about this study is that the researchers specifically chose women who were not responding to drug treatment. But when drug treatment was coupled with exercise they felt better! Pretty cool.

Lack of response to antidepressant drug treatment is a pretty sizeable problem. Many times individuals will be placed on different drugs, sometimes combinations of drugs, or varying doses of drug, until something seems to work. This can be unpleasant due to the side effects of antidepressant drugs, and relative amount of time it may take to find the appropriate drug and dose.

So the potential for exercise to increase the effectiveness of antidepressant drugs is an important finding that will hopefully be incorporated at the clinical level.

There are a couple of limitations to the study that the authors acknowledge. First, only a small number of participants were included. Generally, results from studies with larger numbers of participants have more statistical power. That means that researchers can more confidently attribute the results to the treatment, and not just random chance.

Second, the study only included women within in a specific age range (40-60 years old). The problem here is that the findings might not apply to a different demographic, say 18-25 year old males. On the positive side, it does suggest a benefit in that age group of women which is of interest since the rates of depression our about twice as high in women compared to men.

Third, they didn’t have the full set of control groups. Since the exercise sessions were conducted as a group, it may be that the social interaction among the participants during the exercise period is what caused the improvements in depressive symptoms. However, several prior studies also suggest anti-depressive effects of exercise. Still, the authors can’t say for sure that these effects were due to exercise, and not the social aspects of coming together to exercise in a group.

But if we step back and look at the big picture, it doesn’t really matter if it is “just” the exercise that reduces depressive symptoms. These women felt less depressed and that they had a better life! So if we feel the need to be scientifically cautious about these findings….. for now, get together with some other people to exercise.

Again, this was a small study that didn’t have the full array of scientific comparison groups, but this is another option for people suffering from depression who are not responsive to their medications. You may be wondering, did these women even need the drugs? Great question! We’ll talk about that in an upcoming post.

By Paul R. Burghardt, PhD

A recent issue of Nature Reviews Drug Discovery (volume 7, 2008) painted an interesting portrait of the current state of drug approval by the FDA. The editorial, responding to an article by Bethan Hughes in the same issue, reported that in 2007 a total of 19 requests (17 new drugs and 2 license applications for existing drugs) were approved by the FDA; making it the LOWEST year for novel drug approvals since 1983.

There are several potential arguments to why this has happened, which the editorial and article touch upon. These include lack of novel science, insufficient funding, overregulation, understaffing, and bureaucracy. But aside from the intricacies of why there were only 19 approvals issued by the FDA in 2007, the fact remains that there were only 19 approvals issued by the FDA in 2007.

So with the veritable trickle of drug approval over the past couple years (hence the “drip”) a couple questions immediately come to mind. Should you wait for the new drug to treat your ailment? If so, what drug is it that you are waiting for?

Here’s what I think. Whatever the cause of declining numbers of approved drugs, it graphically illustrates the delicacy of a system. A very important system set in place to protect the public by both producing novel therapies while ensuring that those therapies are not harmful. This process that takes time. First, to find a treatment that is effective. Second, to ensure that said treatment doesn’t screw up the rest of our biology. Not a trivial task! But ultimately, this is a system that profoundly affects individuals’ health (for better or worse) as well as the well-being of their loved ones.

Can you afford to wait?

Making smart lifestyle choices that promote overall health is something that is completely within your control. Not only on what you choose to do, but when you choose to start.

The take home message is that there has never been a good reason to wait around for a drug to improve our health. For one, a drug that effectively treats your problem may not be developed for some time, if ever. If there is a drug that looks promising for you, it still takes time to get through the approval process (for good reason . . . safety). There are many choices we can make on a daily basis to improve our health. And although it is never too late to start, the sooner you start the better your odds of avoiding a problem in the long run.

This is particularly important to keep in mind when thinking about brain health. The complexity of our brains has been said to rival, and probably surpass, the complexity of the Universe. Remember that we’re talking about an organ that can think about, how it (the brain) is thinking about how complex the Universe is. So it’s a bit of a stretch to assume that any drug will be able to solve all the problems related to mental or cognitive disorder. A drug may help alleviate a specific problem/symptom, but it won’t fix the underlying cause.

The question you should have been asking yourself about any drug is “do the benefits outweigh the side-effects?” Now, that question comes along with the caveats “when will it be developed,” and “what if it’s never developed?”

If you want control of your health, take it.

By Simon J. Evans, PhD

A recent article in the New York Times highlighted new studies directed at figuring out how long-time married couples can keep their romance alive. The answer was very simple. Do something different.

In one ten-week study, researchers worked with 53 couples. They instructed one third of them to spend 90 minutes per week doing familiar but enjoyable activities, like going to dinner or a movie. Researchers instructed another third to spend 90 minutes doing something exciting that they both enjoyed. This group spent time doing new things or things they didn’t do very often. The final group received no specific instructions.

After the study was over, researchers interviewed the couples to rate the quality of their relationships. The couples that spent time doing new things scored higher than the other two groups.

This may all be common sense. The more exciting stuff you do together, the stronger your relationship can get. But it’s interesting to look at the underlying brain science, because it has implications for your overall brain fitness as well.

The brain enjoys new things. New experiences crank up the brain’s reward system, driven largely by the ‘pleasure’ signal, dopamine. This same circuit is very active early in the intensely romantic part of a relationship. So, the theory goes that doing new, exciting stuff together, may literally help rekindle the brain circuits that drive romance.

We have been promoting interjecting variety into your daily routines, as good for your brain fitness, for some time now. Beyond variety improving your relationships, it also helps you make new brain connections that are good for all kinds of brain functions.

Your brain is a web of about 100 trillion connections between 100 billion neurons. When we do new things and learn new stuff, the level of connectivity increases, and not just in your pleasure circuits but in other parts of your brain as well.

Increasing the connectivity between neurons in parts of the brain responsible for memory, decision making and creative thinking, is very beneficial to your long-term brain fitness. The more connectivity you create, the more defenses you have against cognitive decline as you age.

Think of an old tree with many branches. This is sort of what neurons look like. The more you learn by experiencing new things, the bushier the neuron gets and the more connections it can make. In fact, neuroscientists use the term ‘arborization’, meaning a tree-like appearance, to define the amount of branches a neuron has.

The degree of arborization is an indicator of a neurons health, especially in brain regions associated with learning and memory. Although we can’t directly measure arborization in people, studies in rodents show that those exposed to new environments on a regular basis have more arborization in neurons involved in memory.

What we can do in people is use new brain scanning technology to determine the level of activity in brain regions, which has some correlation with the level of connectivity and neuronal arborization in animal studies.

These brain-scanning technologies show that people in long-term, high quality relationships have greater brain activity in their pleasure centers when shown a picture of their spouse. Researchers believe that interjecting new experiences into marriage is one thing that helps maintain these connections.

So this Valentine’s Day, instead of visiting your favorite restaurant, try a new one. Or get out and do something you both enjoy but don’t get the opportunity to do very often. It will be good for parts of your brain that will help keep your mind and your relationship young.

Written by Simon J. Evans, PhD

We have are fortunate enough today to expect to live about 20 years longer than our grandparents did. Since the 1950s, we have enjoyed a two-decade increase in lifespan. The downside is there is a big difference between lifespan and healthspan, which is the number of years that you remain healthy.

A new editorial in Archives of Internal Medicine looks at the health of people reaching 100 years of age. Today there are 55,000 centenarians in the US. The people that make it that far today generally fare pretty well. That’s because it’s still difficult to reach that status without some strong genes and a healthy lifestyle.

But modern medicine is pushing more and more people to a ripe old age. In fact, conservative estimates predict 800,000 centenarians by 2050. That’s a lot of people reaching 100 so the issue of healthspan becomes a very important consideration.

A specific component of healthspan that most people care deeply about is their brainspan, or the number of years you maintain a healthy brain. Alzheimer’s disease and other types of dementia are probably the most feared diseases we have. The vast majority of people rate brain health at the top of their list for quality of life indicators. The more fit your brain, the better you feel.

Unfortunately, increases in brainspan have not yet paralleled increases in lifespan. Over the age of 65, there is still a 5% chance of having Alzheimer’s disease. Over the age of 85, those odds jump to 50%. But frankly, those statistics are much scarier than they need to be. When people hear statistics like that, they tend to feel helpless, as if they are rolling the dice. However, when it comes to your brainspan you can weight the dice in your favor.

Saying that people over 85 have a 50% chance of having Alzheimer’s disease is a little misleading. The real statement is that by the age of 85, 50% of people have Alzheimer’s disease. That may seem like the same thing, but it’s really a very different statement. Putting it the first way, it seems that everyone has a 50-50 chance of getting the disease, but that’s not really true. Some folks have a very high chance, while others are completely safe. Your chance of developing Alzheimer’s by the age of 85 is not necessarily 50% – so what is it?

The new editorial cites a 2004 study that looked at correlations between metabolic syndrome and cognitive decline. Metabolic syndrome is a collection of problems, including abdominal obesity, high cholesterol, high blood pressure and difficulty controlling blood sugar (usually insulin resistance).

About 1 in 5 (23%) adults have metabolic syndrome in the US today, but almost 1 in 2 (43%) of folks over 75 find themselves in this state, curiously similar to the number of people with Alzheimer’s disease at that age.

In fact, researchers found that those with metabolic syndrome had a much greater chance of experiencing cognitive decline. The good news is that metabolic syndrome is highly preventable by simply eating better and exercising. It just takes a little investment of effort to dramatically shift the odds in your favor.

Now, this study was only observational, meaning researchers can’t conclude that metabolic syndrome causes Alzheimer’s. However, many other studies show that similar risk factors are involved in both diseases and it’s not a stretch to think that if you take care of your body you will also be taking care of your brain.

We understand perfectly well the relationship between saving and investing money throughout your career to enable a comfortable retirement. If you choose not to save anything, you aren’t surprised when you retire broke.

Yet, this association of investing in the health of your body and brain doesn’t seem to be as obvious to many folks. Perhaps it’s because we don’t get monthly balance statements to watch our ‘health accounts’ grow or shrink. Yet, the relationship between lifestyle and late-life brain health is clear.

This is more important today than ever. Since modern medicine will likely help you stretch your lifespan by many years, wouldn’t it be nice to do the same for your brainspan?

Written by Simon J. Evans, PhD

This is a short post on the incredible efforts of a local elementary school principal in my hometown. Nancy Tetens is the principal at my 5^th grader’s school (Symon’s Elementary) who is putting herself on the national stage in order to be a good example for her students.

Ms. Tetens, admittedly struggles with her weight, and felt like she wanted to show her students that adults can step up and take responsibility to improve their health. For the past couple of years Ms. Tetens has been doing just that. She is actively involved in promoting healthy behavior in her school and, more importantly, practicing what she preaches.

Recently, Ms. Tetens joined a national contest called, Clean Start Challenge, sponsored by Lifetime (the TV channel). And guess what…she was chosen as a finalist. Now she is ‘competing’ as one of only ten contestants over the next three months, to transform her life. You can check out Ms. Tetens story and cast your vote for her by clicking here.

More important than winning the prize is the chance to show hundreds of students how to turn their health around. It’s no surprise that kids today are not as healthy as they were decades ago. In fact, child obesity rates have risen dramatically over the past 30 years. In the 1970s the percentage of overweight kids was only a couple of percent. Today, nearly 1 in 5 fit into that category. On top of that, the center for disease control expects about one third of today’s kids to become diabetic.

There are all kinds of reasons for this, mostly boiling down to poor nutrition and less (way less) physical activity. One issue that has received serious national attention is the disappearance of daily P.E. in our schools.

Forced by current political policy and budget crunches, schools have reduced physical education programs in favor of more classroom instruction in order to meet the imposed national standards (some call it ‘no child left without a big behind’). Ironically, the more we learn about how the brain works the more we realize these kids would do better in school if they received more PE, not less.

Study after study has shown that kids boost their math, science and language performance with regular physical activity. But it goes way beyond grades. Physically active kids also have greater self-esteem and lower incidence of mood problems. Given that about 2 million American kids are on anti-depressants or anti-psychotics, this alone should be a strong reason to reintroduce more PE.

This is why Ms. Tetens’ story is such an inspiration. She is swimming against the tide to promote good health in kids. And the kids are taking notice. They are getting behind her and cheering her on all the way. This effort has the real potential to change lives. I strongly encourage you to take 30 seconds right now to cast your vote for Nancy to help promote this movement.

Written by Paul R. Burghardt, PhD

Why is it such a pain to exercise?

There are likely several factors that make it difficult to maintain exercise programs. A substantial hurtle, in my opinion, is that it takes time. Obvious statement, I know. But, think about how much you have to do in a given day. We’re busier than ever! We’re doing more in our day-to-day lives because a lot of things have been made easier and more efficient as ‘technology’ has plowed forward. Since we can do so much more, dedicating a chunk of time away from our technological vices, to run around the neighborhood in shorts, may seem like a period of lost productivity. Or a time better spent relaxing.

I know what you’re thinking…‘Here we go, he’s leading us down some techno-phobic rant that will culminate in the demise of the world as we know it’…but, I’d like to pose that technological innovations are starting to provide us with some great options for multi-tasking physical activity into our daily grind. And always remember that maintaining or increasing physical activity levels (exercising is one option) is very productive.

If you work at a desk job, how much walking do you THINK you do in a day? Here’s an easy, and disturbing, little experiment you can run to find out. If you’re so inclined, go out and buy a pedometer…if you haven’t heard of them they are a little beeper-looking device that will count the number of steps you take when it is clipped to your belt; you can find several options for less than $10. Estimate how many steps you think you take during the course of a normal workday. Then, strap that little bugger on your hip and wear it around for a week. Record your steps at the end of each day (try doing it for a full workweek and calculating your average daily steps), and chances are you will be appalled by what you see.

This is an important people experiment for people to run on themselves. In most cases, I don’t think people know how little physical activity they are engaging in on a day-to-day basis…I know I was shocked when I tried it on myself.

Now that you know the awful truth, how do we go about increasing our physical activity levels?

One option is setting aside a dedicated chunk of time to exercise. It’s a good idea, and I work to make it a priority in my life. But this approach doesn’t work for everyone, and exercise is often one of the first things to be dropped when we start to get overwhelmed with our “to-do” lists.

The other tried and true option is to make things a little more difficult. For example, park out at the end of the parking lot, take the stairs not the elevator, shovel the snow instead of using the snow-blower, and so-on. This is good advice, but again, it will end up requiring more of your time, and if we’re in a time-crunch, we’re more likely to cheat.

So how do we get it in? Well….what if we incorporated it into something we have to do everyday. Something that is a necessity and that we can’t cheat on time.

Two recent products could provide the opportunity for people to increase their levels of physical activity while simultaneously accomplishing at least other daily task. One could be used during your commute and the other while you are at your “desk.”

You can incorporate some physical activity into your commute with little need for technological assistance. Walking, or riding a bike are options. Now, this may only be an option for people who live close enough and in an area amenable to walking or biking. But for those who live in these types of areas why wouldn’t they? One reason is that no one wants to get all sweaty before they walk into work for the day, right?

Well, the RevoPower bike tire may offer a solution to this problem. This bike tire has a motor and you can easily mount it onto your existing bike. It runs at speeds of approximately 20 mph (so it isn’t considered a motor vehicle) and can reportedly get up to 100 miles on a gallon of gas. That’s pretty cool. If you didn’t want to end up all sweaty you could rely on the motor during your commute into work, and pedal your way home at the end of the day. It may also be economically beneficial if you end up saving on gas and not needing to pay for parking.

Another option comes from a research group at the Mayo Clinic in Minnesota. What they have developed is a workstation designed around a treadmill, referred to as the Walk-and-Work desk. It’s not a treadmill you can run on, it only operates at low speeds… walking at a pace of 1 mph is pretty slow (typical walking pace is about 3 mph). The interesting thing is if you were able to walk during the course of a normal working day you would burn an extra 500-700 calories depending on your individual physiology. That’s 2500-3500 extra for a 5-day work week (equal to one pound of fat), with a potential loss of up to 52 pounds a year; assuming you don’t do anything else and your diet stays the same.

Not only do these provide advantages for weight management, but mental, and therefore job, performance may be enhanced. Now this would need to be tested to determine how much of a benefit would provided, but there’s a lot of science that already shows exercise increases awareness, attention, vigilance and cognitive function. Those factors alone would probably benefit a number of people around the 3pm lull when there’s no coffee left in the break room.

One of the obvious concerns is, of course safety. But if people are able to incorporate these products safely and maintain or improve performance, think of the multitasking capabilities. Plus, this could provide your physical activity without having to make a dedicated trip to the gym freeing up time for other activities.

I want to make it clear that we have no affiliation with RevoPower or the Walk-and-Work desk, nor do we endorse (or not endorse for that matter) these products. But they provide very interesting and in my, opinion, exciting pieces of technology that might help some people work more physical activity into their daily lifestyle. Hopefully, we’ll start to see more inventions that parallel this type of ingenuity.

While these options may not be for everyone, they are two examples of what’s coming around the corner.