Apr 19, 2018

TRANSCRIPT

Dr. Jones: Ladies, if there was a pill that you could take that would decrease your risk of Alzheimer's disease and dementia by 80%, would you take it? What if it wasn't a pill but was an activity? This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health, and this is "The Seven Domains of Women's Health" on The Scope.

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Most of us in midlife have friends and family members struggling with dementia, and the future looks a little bleak for them. Women attending a midlife women's health clinic expressed their concerns about their memory even when it's just forgetting where they put their keys. Forgetting where you put your keys isn't necessarily a sign of future dementia, and young women forget their keys too. However, for women in midlife, they're fearful that their memory lapses might mean a future of serious cognitive decline.

As clinicians, we're left with a few tools to reassure them. We certainly can measure cognitive function. And some very simple tests are done, and some very extensive tests can be done, but we don't have any specific therapy yet. We do have some recommendations based on long-term studies of women as they age and that includes: one, eat a healthy diet of fruits and vegetables and not much; two, maintain a healthy weight; three, control your blood sugar; four, control your blood pressure; and five, exercise. It's this last one, exercise, that is catching the attention of neurologists.

Although the positive effect of exercise on memory works for both and women, a study published last week in ";The Journal of Neurology" looks specifically at women. In 1958, Swedish researchers studied women, 38 to 60, by looking at their cardiovascular fitness. Many studies on fitness look at overall activity by patient's personal reports.

But in this study, they put women on a bicycle and had them pedal as hard as they could, something called a step-wise increased maximal ergometer cycling test. It sounds like torture, personally. You get on a bike. They make you cycle harder and harder until you can't do it anymore. They measure fitness by how hard you can cycle. Some women had to stop the test before they really got going because they were so unfit. Some superwomen were so fit the test was stopped because they exceeded the measurements of the test.

A hundred and ninety-one women of a larger group of 1,400 women ages 38 to 60 were willing and able to get on a bike and ride, and they were followed for the next 40 years. The researchers tried to control for blood pressure, cholesterol, body weight, smoking, drinking, and other risk factors for dementia so they could try to see what the effect of cardiovascular fitness was by itself, not just the association of being unfit with other risk factors.

The overall rate of dementia as these women aged, both in the larger group who didn't get on the bike test and the bike test group was about 23%, a frightening number to think that one-quarter of these women developed dementia before they died. The incidence of dementia was 32% in the low fitness group, 25% for the medium fitness group, and 5% for those with the high fitness level. The average age of dementia was 11 years older in the high fitness group than in the medium fitness group. Compared with medium fitness, high fitness decreased the risk of dementia by 88%.

So this isn't the first study to show that cardiovascular fitness, the ability to exercise really hard, decreases the development of dementia. People who have a fitness level to exercise hard live longer in many studies, and they have lower risks of dementia. A study with Swedish men at age 18 who took this bicycle test show that they developed lower rate of dementia later in life. People with a low level of fitness in midlife have smaller brains later in life, particularly in the area most associated with Alzheimer's.

Now, this was not a randomized study. Women were not randomized to a high-intensity exercise or couch-sitting for 40 years. That study won't get done. However, some recent studies for men and women that are randomized show that high-intensity interval training, working out as hard as you can for short periods of time can improve cardiovascular fitness more than moderate exercise or strength training. And, of course, it's been done in rats and shown that high-intensity exercise improves rat memory. The randomized high-intensity fitness study show clearly that in midlife, increasing cardiovascular fitness is good for the heart, and what's good for the heart is good for the brain.

So ladies of a certain age, what to do? Unfortunately, this isn't a pill that is free and easy to take with your morning juice or coffee. It's free, but it's hard. You don't need a gym to climb the stairs at work as fast as you can for five minutes several times a day. You don't need a gym to walk up a steep slope as fast as you can for 10 minutes every day. If you have a gym, it's easy to get on the bike or the treadmill or the stair climber or the rowing machine, but then you have to do the hard stuff. But you don't have to do it for long. There's a lot of information about high-intensity interval training on the internet. And the research suggests that even a minute done several times over an hour can be helpful for a start.

If you already have high blood pressure, diabetes, or heart disease, you should talk with your doctor first. But most of us can just get started. Get your brain around it and your brain will probably be with you in your life for longer, and you'll feel better for the years that you have. Thanks for joining us on The Scope.

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