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5-minute workout lowers blood pressure as much as exercise, drugs

The ultra-time-efficient maneuver known as High-Resistance Inspiratory Muscle Strength Training (IMST) could play a key role in helping aging adults fend off cardiovascular disease.

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Photo by Meghan Holmes from Unsplash.com

Working out just five minutes daily via a practice described as “strength training for your breathing muscles” lowers blood pressure and improves some measures of vascular health as well as, or even more than, aerobic exercise or medication, new CU Boulder research shows.

The study, published in the Journal of the American Heart Association, provides the strongest evidence yet that the ultra-time-efficient maneuver known as High-Resistance Inspiratory Muscle Strength Training (IMST) could play a key role in helping aging adults fend off cardiovascular disease.

In the United States alone, 65% of adults over age 50 have above-normal blood pressure – putting them at greater risk of heart attack or stroke. Yet fewer than 40% meet recommended aerobic exercise guidelines.

“There are a lot of lifestyle strategies that we know can help people maintain cardiovascular health as they age. But the reality is, they take a lot of time and effort and can be expensive and hard for some people to access,” said lead author Daniel Craighead, an assistant research professor in the Department of Integrative Physiology. “IMST can be done in five minutes in your own home while you watch TV.”

Developed in the 1980s as a way to help critically ill respiratory disease patients strengthen their diaphragm and other inspiratory (breathing) muscles, IMST involves inhaling vigorously through a hand-held device which provides resistance. Imagine sucking hard through a tube that sucks back.

Initially, when prescribing it for breathing disorders, doctors recommended a 30-minute-per-day regimen at low resistance. But in recent years, Craighead and colleagues have been testing whether a more time-efficient protocol–30 inhalations per day at high resistance, six days per week–could also reap cardiovascular, cognitive and sports performance improvements.

For the new study, they recruited 36 otherwise healthy adults ages 50 to 79 with above normal systolic blood pressure (120 millimeters of mercury or higher). Half did High-Resistance IMST for six weeks and half did a placebo protocol in which the resistance was much lower.

After six weeks, the IMST group saw their systolic blood pressure (the top number) dip nine points on average, a reduction which generally exceeds that achieved by walking 30 minutes a day five days a week. That decline is also equal to the effects of some blood pressure-lowering drug regimens.

Even six weeks after they quit doing IMST, the IMST group maintained most of that improvement.

“We found that not only is it more time-efficient than traditional exercise programs, the benefits may be longer lasting,” Craighead said.

The treatment group also saw a 45% improvement in vascular endothelial function, or the ability for arteries to expand upon stimulation, and a significant increase in levels of nitric oxide, a molecule key for dilating arteries and preventing plaque buildup. Nitric oxide levels naturally decline with age.

Markers of inflammation and oxidative stress, which can also boost heart attack risk, were significantly lower after people did IMST.

And, remarkably, those in the IMST group completed 95% of the sessions.

“We have identified a novel form of therapy that lowers blood pressure without giving people pharmacological compounds and with much higher adherence than aerobic exercise,” said senior author Doug Seals, a Distinguished Professor of Integrative Physiology. “That’s noteworthy.”

The practice may be particularly helpful for postmenopausal women.

In previous research, Seals’ lab showed that postmenopausal women who are not taking supplemental estrogen don’t reap as much benefit from aerobic exercise programs as men do when it comes to vascular endothelial function. IMST, the new study showed, improved it just as much in these women as in men.

“If aerobic exercise won’t improve this key measure of cardiovascular health for postmenopausal women, they need another lifestyle intervention that will,” said Craighead. “This could be it.”

Preliminary results suggest MST also improved some measures of brain function and physical fitness. And previous studies from other researchers have shown it can be useful for improving sports performance.

“If you’re running a marathon, your respiratory muscles get tired and begin to steal blood from your skeletal muscles,” said Craighead, who uses IMST in his own marathon training. “The idea is that if you build up endurance of those respiratory muscles, that won’t happen and your legs won’t get as fatigued.”

Seals said they’re uncertain exactly how a maneuver to strengthen breathing muscles ends up lowering blood pressure, but they suspect it prompts the cells lining blood vessels to produce more nitric oxide, enabling them to relax.

The National Institutes of Health recently awarded Seals $4 million to launch a larger follow-up study of about 100 people, comparing a 12-week IMST protocol head-to-head with an aerobic exercise program.

Meanwhile, the research group is developing a smartphone app to enable people to do the protocol at home using already commercially available devices.

Those considering IMST should consult with their doctor first. But thus far, IMST has proven remarkably safe, they said.

“It’s easy to do, it doesn’t take long, and we think it has a lot of potential to help a lot of people,” said Craighead.

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Wellness

Exercise improves brain function, possibly reducing dementia risk

Exercise is potentially able to improve the brain’s capacity to respond to insulin for neuronal function.

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A study led by scientists at Rutgers University-New Brunswick has shown that specialized cells involved in how the body responds to insulin are activated in the brain after exercise, suggesting that physical activity may directly improve brain function.

The study, published in Aging Cell, a journal focused on the biology of aging, indicates that therapies targeting this insulin action may be developed to offset or even prevent dementia progression.

“We believe this work is important because it suggests exercise may work to improve cognition and memory by improving the abilities of insulin to act on the brain,” said Steven Malin, an associate professor in the Department of Kinesiology and Health in the Rutgers School of Arts and Sciences and lead author of the study.

Conducted in collaboration with the National Institutes of Health’s National Institute on Aging, the researchers focused on the role of neuronal extracellular vesicles, specialized cells released by the brain.

Extracellular vesicles, once dismissed by researchers as “cell dust,” have in the past 15 years grown exponentially in recognition as important players in the microscopic world of the human body, facilitating transport of key molecules such as proteins between cells. For this study, the scientists targeted vesicles produced in the brain that ferry several proteins involved in insulin sensitivity – one of which is called Akt.

Insulin sensitivity is a measure of how well the body responds to insulin, a hormone that controls blood sugar levels. People with high insulin sensitivity can use blood glucose more effectively in the body, such as in its muscles, which reduces blood sugar. People with diabetes, with its key symptom of low insulin sensitivity or insulin resistance, have brain cells that are less responsive to insulin. This can have negative impacts on cognition.

Researchers were able to study the vesicles by isolating them in the blood of participants in an experimental study. The trial, conducted over two weeks, included a group of 21 volunteers who had an average age of 60 and had prediabetes. Over the course of the study, they engaged in 12 individual, supervised, 60-minute exercise sessions of moderate to high intensity. The participants ingested a glucose drink before and after training. Researchers then collected blood samples before and during the drink from the participants at the start and end of exercise training.

The blood samples showed that the number of neuronal vesicles carrying proteins involved in insulin sensitivity increased after each training, with Akt being most notable.

“We showed for the first time that exercise impacts insulin signaling from neuronal extracellular vesicles in relation to clinical improvements in blood sugar,” Malin said. “And we use these neuronal extracellular vesicles as an indicator of brain insulin sensitivity.” 

Exercise, therefore, is potentially able to improve the brain’s capacity to respond to insulin for neuronal function, he said.

Insulin is a hormone increasingly recognized to regulate cognition, the mental process of acquiring knowledge through thought, experience and the senses. Prediabetes is a serious health condition that occurs when blood sugar levels are higher than normal but not high enough to be diagnosed as Type 2 diabetes. Those with prediabetes run the risk of having insufficient levels of insulin in their bodies, particularly the brain, which increases the chances of developing diseases of dementia such as Alzheimer’s, Malin said. 

Insulin also plays a crucial role in memory formation, recall, processing speed and the functioning of synapses, structures that allow brain cells to communicate with one another. 

“If insulin is insufficient in the brain, that means not only will brain cells become potentially dysfunctional, but also they may fail to interact with each other properly,” Malin said. “It’s like playing the game telephone with a friend. At some point the message gets lost when the brain becomes insulin resistant.”

Exercise has long been believed to improve cognition, but the mechanisms involved have been unclear. Past studies have uncovered evidence that high blood sugar contributes to a decrease in the brain’s ability to recall information and learn new information.

Malin said that insulin, which is produced by the pancreas and travels to the brain to perform its functions, plays a central role in promoting brain blood flow and neuronal functioning for cognition.

“Our work suggests that therapies that target brain insulin action may be able to ward off dementia,” Malin said.

In a new study, Malin and his colleagues are examining whether a single bout of exercise can enhance the ability of intranasal insulin to support cognitive health in aging adults with obesity by measuring brain blood flow and neuronal extracellular vesicles. Their future plans are to conduct a long-term exercise training study that assesses brain insulin sensitivity improvements in relation to cognition in older adults. 

Other Rutgers scientists on the study included Michal Beeri, director of the Herbert and Jacqueline Krieger Klein Alzheimer’s Research Center at Rutgers Robert Wood Johnson Medical School; and Daniel Battillo, a doctoral candidate in the kinesiology and applied physiology graduate program. Scientists from the National Institute of Health’s National Institute on Aging involved in the study included Dimitrios Kapogiannis, Maja Mustapic and Francheska Delgado-Peraza.

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Wellness

Mental well-being and physical activity can form a positive cycle

The study found no connection between experiencing negative affectivity and physical activity when depressive feelings were considered. The experience of depressive feelings can include other symptoms besides negative affectivity, such as insomnia and loss of appetite. Therefore, depressive feelings may be a more comprehensive risk factor for low physical activity than negative affectivity alone.

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In a study conducted at the Gerontology Research Center and the Faculty of Sport and Health Sciences at the University of Jyväskylä, Finland, it was found that most men and women aged 60 to 88 either maintained or even increased their level of physical activity during the restrictions imposed by the COVID-19 pandemic. Participants who experienced more positive affectivity had higher physical activity levels and were more likely to increase their activity during the restrictions. 

“It was interesting to observe that the link between positive affectivity and physical activity was more consistent in individuals around the age of 60 than in those over 70,” says postdoctoral researcher Tiina Savikangas. 

“In Finland, no curfew was declared but the older participants faced stricter restrictions compared to working-age individuals, which may have reduced the role of positive mental well-being on physical activity.” 

Previous research evidence has shown that physical activity contributes to mental well-being. However, recent findings suggest that mental well-being can also help maintain a physically active lifestyle. Mental well-being and physical activity may thus form a positive cycle. 

“Mental well-being is an important resource for physical activity.” 

“Those who have such resources are more likely to stay active, even during exceptional circumstances”, Savikangas notes.  

The study also found that experiencing depressive feelings during the COVID-19 pandemic was associated with lower levels of physical activity and a higher likelihood of reducing activity. The link between depressive feelings and lower physical activity was particularly pronounced among participants over 70. The findings suggest that different aspects of mental well-being may have varying significance for physical activity at different ages. 

“Supporting mental well-being is crucial for promoting a physically active lifestyle, even in societal emergencies,” Savikangas explains. 

“However, the focus should not only be on preventing depressive feelings but also on strengthening the positive side of mental well-being.”  

The study found no connection between experiencing negative affectivity and physical activity when depressive feelings were considered. The experience of depressive feelings can include other symptoms besides negative affectivity, such as insomnia and loss of appetite. Therefore, depressive feelings may be a more comprehensive risk factor for low physical activity than negative affectivity alone. 

The research publication is based on the Jyväskylä Longitudinal Study of Personality and Social Development (JYLS), especially its latest data collection phase Developmental Psychological Perspectives on Transitions at Age 60: Individuals Navigating Across the Lifespan (TRAILS) and Promoting Safe Walking Among Older Adults (PASSWORD), both conducted at the Faculty of Sport and Health Sciences and the Gerontology Research Center, University of Jyväskylä, Finland. A total of 162 men and women aged 60 to 61 from TRAILS participated in this study by responding to a survey on physical activity during the COVID-19 pandemic between April 2020 and July 2021. From PASSWORD, 272 men and women aged 72 to 88 participated by responding to a postal survey conducted between April and June 2020. The amount of physical activity during the COVID-19 pandemic and changes in it were assessed using a questionnaire specifically developed for this purpose by the Faculty of Sport and Health Sciences. Positive and negative affectivity, as well as depressive feelings, were measured using self-reports. Additionally, factors such as participants’ gender, marital status, education level, employment status, perceived health, usual physical activity and, in the older cohort, age, were taken into account. The JYLS study is led by research director Katja Kokko, and the PASSWORD study by Professor of Sport Gerontology Sarianna Sipilä. Both studies were funded by the Academy of Finland. 

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Wellness

Short-term cognitive boost from exercise may last for 24 hours

On average, people aged 50 to 83 who did more moderate to vigorous physical activity than usual on a given day did better in memory tests the day after.

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The short-term boost our brains get after we do exercise persists throughout the following day, suggests a new study led by UCL (University College London) researchers.

Previous research in a laboratory setting has shown that people’s cognitive performance improves in the hours after exercise, but how long this benefit lasts is unknown.

The new study, published in the International Journal of Behavioral Nutrition and Physical Activity, found that, on average, people aged 50 to 83 who did more moderate to vigorous physical activity than usual on a given day did better in memory tests the day after.

Less time spent sitting and six hours or more of sleep were also linked to better scores in memory tests the next day.

More deep (slow-wave*) sleep also contributed to memory function, and the research team found this accounted for a small portion of the link between exercise and better next-day memory.

The research team looked at data from 76 men and women who wore activity trackers for eight days and took cognitive tests each day.

Lead author Dr Mikaela Bloomberg (UCL Institute of Epidemiology & Health Care) said: “Our findings suggest that the short-term memory benefits of physical activity may last longer than previously thought, possibly to the next day instead of just the few hours after exercise. Getting more sleep, particularly deep sleep, seems to add to this memory improvement.

“Moderate or vigorous activity means anything that gets your heart rate up – this could be brisk walking, dancing or walking up a few flights of stairs. It doesn’t have to be structured exercise.

“This was a small study and so it needs to be replicated with a larger sample of participants before we can be certain about the results.”

In the short term, exercise increases blood flow to the brain and stimulates the release of neurotransmitters such as norepinephrine and dopamine which help a range of cognitive functions.

These neurochemical changes are understood to last up to a few hours after exercise. However, the researchers noted that other brain states linked to exercise were more long-lasting. For instance, evidence suggests exercise can enhance mood for up to 24 hours.

A previous study, published by a separate research team in 2016, also found more synchronised activity in the hippocampus (a marker of increased hippocampal function, which facilitates memory function) for 48 hours after high-intensity interval training (HIIT) cycling.  

Co-author Professor Andrew Steptoe (UCL Institute of Epidemiology & Health Care) said: “Among older adults, maintaining cognitive function is important for good quality of life, wellbeing, and independence. It’s therefore helpful to identify factors that can affect cognitive health on a day-to-day basis.

“This study provides evidence that the immediate cognitive benefits of exercise may last longer than we thought. It also suggests good sleep quality separately contributes to cognitive performance.

“However, we can’t establish from this study whether these short-term boosts to cognitive performance contribute to longer term cognitive health and though there is plenty of evidence to suggest physical activity might slow cognitive decline and reduce dementia risk, it’s still a matter of some debate.”

For the new study, the researchers looked at data from wrist-worn activity trackers to determine how much time participants spent being sedentary, doing light physical activity, and doing moderate or vigorous physical activity. They also quantified sleep duration and time spent in lighter (rapid eye movement, or REM) sleep and deeper, slow-wave sleep.

In looking at the links between different types of activity and next-day cognitive performance, the research team adjusted for a wide variety of factors that might have distorted the results, including the amount of moderate or vigorous physical activity that participants did on the day of the tests.

They also accounted for participants’ average levels of activity and sleep quality across the eight days they were tracked, as participants who are habitually more active and typically have higher-quality sleep perform better in cognitive tests.

The team found that more moderate or vigorous physical activity compared to a person’s average was linked to better working memory and episodic memory (memory of events) the next day. More sleep overall was linked to improved episodic and working memory and psychomotor speed (a measure of how quickly a person detects and responds to the environment). More slow-wave sleep was linked to better episodic memory.

Conversely, more time spent being sedentary than usual was linked to worse working memory the next day.

The study is among the first to evaluate next-day cognitive performance using a “micro-longitudinal” study design where participants were tracked going about their normal lives rather than having to stay in a lab.

Among the study limitations, the researchers noted that the participants were a cognitively healthy group, meaning the results might not be true for people who have neurocognitive disorders.

The study involved researchers from the UCL Institute of Epidemiology & Health Care, UCL Division of Surgery & Interventional Science and the University of Oxford, and received funding from the UK’s Economic and Social Research Council (ESRC).

*Slow-wave sleep was given its name based on the characteristic brain waves that can be observed during this stage of sleep. It is deep, restorative sleep, where a person’s heart rate slows and blood pressure decreases.

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