Exercise to maintain brain and cognitive health in the later stages of life with Dr. Teresa-Liu Ambrose

The Masters in Exercise podcast features Dr. Teresa Liu Ambrose, a UBC professor, discussing her research on exercise's impact on cognition, particularly in older adults. Her work highlights exercise's potential to slow cognitive decline, with a focus on the effects of aerobic and resistance training on brain health. She explores factors like genetics and biological sex that may influence cognitive responses to exercise. Dr. Liu Ambrose emphasizes the importance of personalized exercise prescriptions and the need for supportive environments to encourage participation, especially in older populations with varying physical and cognitive abilities.

• Dr. Liu-Ambrose's career path was shaped by her personal experiences with physical therapy during her youth, which inspired her to pursue a career in the field.
• Her transition from clinical practice to academia was gradual and driven by a desire for structured learning and further exploration in research.
• Her research interests evolved from rehabilitation post-ACL reconstruction to cognitive neuroscience, influenced by her educational journey and experiences.

"I was always pretty active as a kid, loved playing sports... And as a teenager I did sustain a number of injuries that basically resulted in me seeing a physio on a pretty regular basis."

• Personal experiences with physical therapy as a teenager sparked her interest in the field.

"I needed time to learn and have some structure around that learning... I kind of made this honestly, very last minute decision to apply for a master's."

• Her decision to pursue further education was driven by a personal need for structured learning.

"It just, I guess over time it was a good fit. And that's why I stayed and I guess switched from clinical to academia."

• The transition from clinical practice to academia was an organic process influenced by her research interests and experiences.

• Dr. Liu-Ambrose's interest in exercise and cognition developed over time, influenced by her research in related areas such as bone health and fall risk.
• Her work focuses on understanding the relationship between exercise and cognitive health, particularly in older populations.

"It was more really as a faculty member I started the whole pursuit of exercise and cognition."

• Her focus on exercise and cognition began during her tenure as a faculty member, driven by a growing interest in the topic.

"I realized I didn't want to go further in terms of the bone health perspective... But I still wanted to stay in exercise."

• Her shift from bone health to cognition was a result of exploring her interests and understanding what she wanted to pursue.

• Regular physical activity is associated with a reduced risk of dementia, as supported by large population studies and cohort studies.
• Targeted exercise training has been shown to benefit brain function and structure, though more research is needed to refine exercise prescriptions.

"The Global Council on Brain Health... came up with this overall conclusion that regular physical activity does have an effect on one's dementia risk."

• The Global Council on Brain Health supports the notion that regular physical activity can reduce dementia risk.

"Targeted exercise does have benefits for both brain function and structure."

• Evidence from randomized controlled trials indicates that targeted exercise benefits brain health.

• Cognitive reserve refers to the brain's ability to cope with damage and maintain function, potentially influenced by lifestyle factors like exercise.
• Starting exercise earlier in life may contribute to building cognitive reserve, though benefits can still be gained from starting later.

"Lifestyle factors such as exercise seem to promote your reserve... Even if you start to exercise later in life, there is benefit."

• Exercise is believed to enhance cognitive reserve, with benefits observed even when started later in life.

"The earlier you start, the more reserve you're building... Even if it's small deposits you make over time, you do end up with a greater sum at the end."

• The analogy of planning for retirement illustrates the benefits of starting exercise early to build cognitive reserve.

• There is interest in identifying critical windows or periods when exercise may have the most significant impact on cognitive health.
• Understanding these windows could help optimize exercise recommendations for cognitive health benefits.

"There is also now a lot of interest in looking at windows of opportunity or critical windows."

• Research is focused on identifying specific periods when exercise may be most beneficial for cognitive health.

• Midlife is a critical period for cognitive health, where many risk factors for dementia are present.
• Prevention of dementia is easier than treatment; focus on managing chronic conditions like high blood pressure and diabetes.
• Hormonal changes, particularly in women, such as fluctuations in estrogen, can impact brain health.
• Estrogen is beneficial for the brain, and midlife is a crucial time to maintain cognitive health for later life.

"Midlife is a time where most of us do incur a lot of the risk factors for dementia. So chronic conditions such as high blood pressure, diabetes, type 2 diabetes, but I think there's also that recognition of just even hormonal changes."

• Midlife presents significant risk factors for dementia, including chronic diseases and hormonal changes.

"There is a notion that midlife might be that critical window where, if you haven't been taking care of yourself, is that critical window where you really should start to really preserve yourself later in life."

• Midlife is a pivotal time to start preserving cognitive health to ensure better outcomes in later life.

• Both aerobic and resistance training offer similar cognitive benefits, particularly for executive functions and memory.
• Executive functions involve higher-order processes like planning, strategizing, and problem-solving.
• Tai Chi and other functional exercises may also provide cognitive benefits and merit further study.
• Combining different types of exercises might be the most beneficial approach.

"For both aerobic and resistance training, they do have fairly similar benefits. And within our own research, that's what we found too, is that similar to aerobic training, resistance training seems to have benefits for both executive functions and memory."

• Aerobic and resistance training both enhance executive functions and memory, showing similar cognitive benefits.

"In that meta analysis, it also shows that perhaps other types of training such as Tai Chi, may also really have good benefits and should be considered and perhaps studied more."

• Tai Chi and similar exercises may offer cognitive benefits and should be further explored in research.

• Different exercises may have distinct molecular pathways but lead to similar behavioral outcomes.
• Animal models show that aerobic and resistance training have different mechanistic pathways.
• Clinical applications should consider individual needs and capabilities when prescribing exercise.

"They seem to have slightly different mechanistic pathways, but then they converge on the behavior. So different pathways to the same behavioral outcome."

• Different exercises may use various molecular mechanisms but achieve similar cognitive outcomes.

"If that's the outcome we want for individuals, we have different tools to reach that. It's a great option for us."

• Having multiple exercise options allows for tailored approaches to achieve desired cognitive outcomes.

• Current evidence suggests combining exercise types may offer the most benefits.
• Research is ongoing to determine the best exercise combinations for cognitive health.
• Exercise is particularly effective for improving executive functions compared to other cognitive domains.

"Based on the current evidence, it does seem like multimodal or like combining the two might be the most beneficial."

• Combining different exercise types may provide the most cognitive benefits.

"Executive functioning is one of the cognitive domains that is most impacted by age."

• Exercise significantly benefits executive functions, which are highly affected by aging.

• Exercise can positively impact brain structures like the hippocampus and prefrontal cortex.
• The hippocampus, crucial for memory, can maintain or increase in volume with exercise.
• Cortical thickness, related to cognitive abilities, may also be preserved or increased through exercise.
• Measuring brain function is complex and can be assessed through various methods like task-based fMRI.

"Studies have shown that with exercise, both with aerobic and with resistance training, that you can potentially see changes in the hippocampal volume, which is perceived to be a good thing."

• Exercise can lead to beneficial changes in hippocampal volume, supporting memory.

"Cortical thickness is often related to your general cognitive abilities and certainly does seem to thin out with age and with disease."

• Exercise may help maintain or increase cortical thickness, which is linked to cognitive abilities.

• Brain function can be studied through task-based or resting state functional MRI.
• Task-based studies focus on brain activation during specific tasks, while resting state studies focus on brain connectivity at rest.
• Interpretation of brain function data is complex and influenced by factors such as age and population studied.
• Younger individuals typically show specific brain region activation during tasks, while older adults may show widespread activation, potentially as a compensatory mechanism.

"The other way is looking at your brain during rest. So it's resting state functional MRI where we're more interested in looking at how different regions of your brain are kind of almost connected to each other, not structurally, but kind of temporarily in terms of the signals during rest."

• Resting state functional MRI examines how brain regions connect temporally, not structurally, during rest.

"Generally with younger individuals, when we scan a younger individual and they're doing a cognitive task, we typically would expect the activation to be pretty specific to brain regions."

• Younger individuals typically show specific brain region activation during cognitive tasks.

"With older adults, there is the phenomena whereby we see more widespread activation of the brain, but then their behavior or how they're performing the task might be equally the same."

• Older adults may show widespread brain activation, interpreted as a compensatory mechanism, to maintain task performance.

• Interpretation of increased or decreased brain activation in studies can be challenging.
• Activation patterns need context, such as comparison to younger individuals or those with cognitive decline.
• Behavioral performance should be reported alongside brain scans for accurate interpretation.

"It always needs to relate to A, the population and two, always check the behavior in the sense that I always do advise my own grad students. When you're reading like a functional MRI study, they should always be reporting how the person's actually behaving."

• Context, population, and behavioral performance are crucial for interpreting brain activation studies.

• Bias exists as volunteers in studies are often more motivated.
• Positive environment and supportive interactions are crucial for encouraging exercise.
• Social interactions among participants and clear communication are important.
• Tailoring exercise programs to individual needs and ensuring team communication are essential.

"Creating a positive environment in the sense that it is really important who is teaching them the exercises and how the interactions are."

• A positive environment and supportive interactions are crucial for exercise motivation.

"Allowing time for social interactions among themselves. Again, I think most of us know this, but it is actually quite critical even in research."

• Social interactions are critical for encouraging exercise participation.

"Clear communication. So again, we work with older adults who do have some degree of cognitive impairment."

• Clear communication is essential for older adults with cognitive impairments.

• Biological sex and genotype may influence response to exercise interventions.
• Differences between males and females exist in exercise physiology, such as lung capacity and fatigue.
• The BDNF polymorphism may interact with biological sex, affecting the cognitive response to exercise.
• Research is ongoing to explore these interactions and their implications.

"There is some interesting data to suggest that there are biological underpinnings as to why females and males may respond differently to exercise."

• Biological sex differences may influence exercise response.

"We're also quite interested in genotypes specifically related to the BDNF polymorphism, just because we do know with the polymorphism, it does impact how one would respond in terms of the BDNF cascade in response to at least aerobic exercise."

• BDNF polymorphism interacts with biological sex, affecting exercise response.

"The evidence is really contradictory. You don't have, especially in interventional papers, the sample size is very small, so very difficult to say."

• Contradictory evidence and small sample sizes challenge conclusions about BDNF and exercise response.

• The field of BDNF (Brain-Derived Neurotrophic Factor) research is currently filled with more questions than answers.
• There is an interest in exploring the interaction between BDNF response and biological sex, particularly in women.
• The hypothesis is that women might respond better to exercise due to a lower BDNF response threshold.

"Certainly I would say for Dr. Aparha, she does really think some of the conflicting data on the BDNF piece is related to the fact that people haven't considered as an interaction with biological sex."

• This highlights the potential role of biological sex in influencing BDNF response, which might explain some of the conflicting data in current research.

"When you say that with women generally have a lower BDNF response, and that's actually one of the reasons we wonder if that's why perhaps women respond better than to exercise."

• Suggests that the lower BDNF response in women might lead to better improvements through exercise, due to a greater room for improvement.

• Genotype can provide insights but should not be the sole basis for medical prescriptions or interventions.
• Precision medicine involves a combination of genetic information and individual preferences and abilities.
• The approach is similar to physical therapy, where evidence is combined with client-specific factors.

"I think it would be faulty to consider that, you know, just gaining a better understanding potentially of how genotype may impact response that you'll be. You would rely only on genotype information to prescribe."

• Emphasizes that relying solely on genotype for medical prescriptions is inadequate and potentially misleading.

"Part of the precision medicine movement is also about, you know, what works best for the individual in terms of their preferences and abilities."

• Highlights the importance of considering individual preferences and abilities alongside genetic information in precision medicine.

• Individuals with stroke often have poorer sleep quality compared to non-stroke individuals.
• There is a hypothesis that exercise might improve sleep quality in stroke patients, but current evidence is insufficient.
• Poor sleep quality in stroke patients could increase adverse cardiovascular outcomes, including the risk of a second stroke.

"We a first show that individuals with stroke do have poor sleep quality as compared to non stroke individuals and then we also show that poor sleep quality, again assessed subjectively in this case is related to relevant outcomes such as physical function, etc."

• Indicates the established link between stroke and poor sleep quality, which affects physical function and other outcomes.

"Could physical or could physical exercise improve sleep in individuals with stroke? The answer is I don't know. I assume so that's my hypothesis."

• Acknowledges the hypothesis that exercise might improve sleep quality in stroke patients, but current evidence is lacking.

• There is limited literature on the relationship between sleep quality and recovery in stroke patients, especially in the subacute and chronic phases.
• Methodological challenges exist in quantifying sleep quality and its impact on recovery using tools like actigraphy and polysomnography.
• Subjective and objective measures of sleep quality often do not concur, complicating research findings.

"We do know that sleep is critical for brain health and that a good sleep is not only good for neuroplasticity, but it's also to remove all the toxic waste that you accumulate throughout the day."

• Underlines the critical role of sleep in brain health and neuroplasticity, emphasizing the need for quality sleep.

"From a methods perspective, there was really no established cutoffs as to what is a good sleeper versus a bad slide sleeper."

• Highlights the methodological difficulties in defining and measuring sleep quality in stroke research.

• It is important for individuals, especially women, to speak up for themselves and ensure their voices are heard.
• Career paths do not need to be planned; following one's passion and making courageous choices is vital.
• Pursuing what one loves is essential for personal and professional fulfillment.

"I think it is really important. I think just in general, like, it doesn't matter what you are doing. I think it is important to speak up for yourself."

• Encourages self-advocacy and the importance of speaking up in professional settings.

"I think just being courageous enough to making choices that, you know, fundamentally sits right with yourself when it comes to the financial piece and all the rest of that stuff."

• Advocates for making career choices that align with personal values and passions, even if they seem unconventional.

• The speaker's lab has a Twitter account where they post the latest research papers.
• Individuals can contact the speaker directly via email for specific questions.

"We have a lab Twitter account, so I don't have my own. We just have one for the lab and it's just bccogmoblab."

• Provides information on where to find the lab's research updates and how to contact the speaker.