Keeping your eyes on the prize can help with exercise

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New research suggests the adage that encourages people to keep their "eyes on the prize" may be on target when it comes to exercise. When walking, staying focused on a specific target ahead can make the distance to it appear shorter and help people walk there faster, psychology researchers have found. Their study, which compares this technique to walking while looking around the environment naturally, offers a new strategy to improve the quality of exercise.

"People are less interested in exercise if physical activity seems daunting, which can happen when distances to be walked appear quite long," explains New York University's Emily Balcetis, an assistant professor in the Department of Psychology and one of the study's co-authors. "These findings indicate that narrowly focusing visual attention on a specific target, like a building a few blocks ahead, rather than looking around your surroundings, makes that distance appear shorter, helps you walk faster, and also makes exercising seem easier."

The study, which appears in the journal Motivation and Emotion, focused on "attentional narrowing," which affects perceptions of space. The researchers, who also included Shana Cole, an NYU doctoral student at the time of the study and now an assistant professor in the School of Arts and Sciences at Rutgers University, and Matthew Riccio, an undergraduate at NYU's College of Arts and Science, hypothesized that narrowing attention on a finish line would lead it to appear closer, increase walking speed, and reduce feelings of physical exertion.

Related research previously conducted in Balcetis' lab and published last year found that people who are overweight see distances as farther than those who are average weight, especially when they are not very motivated to exercise.

"People are gaining weight at alarming rates," Balcetis says. "More than 1.4 billion adults and 40 million kids under the age of five are overweight or obese worldwide. And in America, obesity rates have almost tripled in the last 30 years. Attentional narrowing might help people exercise more effectively because it makes physical activity look easier."

The new research found that attentional narrowing acts as an intervention, changing perceptions of distance, so that all people can see the distances in ways that fit people see it.

In the Motivation and Emotion paper, the researchers conducted two experiments.

In the first, the study's subjects—66 adults visiting a New York City park in the summer—stood 12 feet away from an open cooler, which contained cold beverages and ice. The experimenter explained to participants that they would estimate the distance to the cooler.

One set of subjects was randomly assigned to a narrowed attention condition in which they imagined that a spotlight was shining only on the cooler. They learned that to be effective at estimating distance, they should direct and focus their attention on the cooler and avoid looking around the environment. The second set of subjects was assigned to the natural attention condition and was instructed to allow their attention to move naturally and in whatever way they found to be most helpful for estimating distance.

Subjects who focused their attention only on the cooler perceived the cooler as closer than did those in the natural attention group.

In a second experiment, the researchers used this intervention to change perceptions of distance and improve the quality of exercise. Here, 73 participants walked 20 feet in a gymnasium while wearing ankle weights that added 15 percent to their body weight, thus making the task more challenging than unfettered walking.

As in the first experiment, one set of participants received the narrowed attention instructions (they were asked to focus on a traffic cone marking a finish line) and the other set received the natural attention condition (they were told to glance at the cone as well as look at their surroundings). Each group then completed the walking test while being timed by the experimenters.

The results confirmed the researchers' hypothesis that attentional narrowing changed perceptions of distance, speed of walking, and perceived effort.

Those in the narrowed attention group perceived the cones to be 28 percent closer than did those in the natural condition group. In addition, those in the narrowed attention group walked 23 percent faster than did those in the natural attention group. Finally, those in the narrowed attention group reported that the walk required less physical exertion than did those in the natural condition group—a finding that may serve as an incentive to exercise.

"Physical activity is an important component of a healthy lifestyle," Cole remarks. "Interventions that train people to keep their 'eyes on the prize' may play an important role in health and fitness. When goals appear within reach, and when people move faster and experience exercise as easier, they may be especially motivated to continue exercising.

"Given the alarming obesity epidemic in America, strategies that encourage or improve exercise may be particularly important for aiding the nationwide effort to combat obesity and promote healthier living."

Daily use of omega-3 and B Vitamins can decrease health-care expenditures

Use of specific dietary supplements can have a positive effect on health care costs through avoided hospitalizations related to Coronary Heart Disease (CHD), according to a new article published in the Journal of Dietary Supplements(1). The article, "From Science to Finance—A Tool for Deriving Economic Implications from the Results of Dietary Supplement Clinical Studies," published by Christopher Shanahan and Robert de Lorimier, Ph.D., explores a potential cost-benefit analysis tool that, when applied to a high-risk population (U.S. adults over 55 with CHD) who take dietary supplements, specifically omega-3 fatty acid or B vitamin dietary supplements, can result in the reduction of the individuals' odds of experiencing a costly medical event.

 Hospitalizations for all U.S. adults over the age of 55 with CHD cost the United States over $64 billion in 2012(2), and the amount spent on the treatment of CHD, rather than the prevention, is burdensome on both the societal and individual levels—and only expected to increase, according to the article. 

"One way to control the burden of CHD costs is to minimize the number of costly inpatient procedures," the authors said. "Many dietary supplement products are available in the market today that have been shown to have positive effects on heart health through associated clinical studies...Thus, the potential decrease of total health care expenditures in the United States is a strong argument for the daily use of dietary supplements."

According to the authors' analysis of all U.S. adults over the age of 55 diagnosed with CHD:

•  If every high-risk person in the target population were to take omega-3 supplements at preventive intake levels daily, there would be an average of $2.1 billion in avoided expenditures per year and a cumulative of $16.5 billion in avoided expenditures between 2013 – 2020

•  If every high-risk person in the target population were to take B vitamins at preventive intake levels daily, there would be an average of $1.5 billion in avoided expenditures per year and a cumulative of $12.1 billion in avoided expenditures between 2013 – 2020

"This is a relatively low-technology, yet smart, approach that can be used by consumers, physicians, employers, and policymakers as a means to reduce personal and societal health care costs," the authors concluded.

The cost-savings model presented in this article was first presented in a report, "Smart Prevention—Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements," in which Frost & Sullivan conducted a systematic review of scientific research in peer-reviewed, published studies that looked separately at relationships between omega-3 supplement intake and the risk of a CHD-attributed event, and B vitamins intake and the risk of a CHD-attributed event. 

The firm then projected the rates of CHD-attributed medical events across U.S. men and women over the age of 55 with CHD and applied a cost benefit analysis to determine the cost savings if people in this targeted population took omega-3 supplements or B vitamin supplements at preventive intake levels.

Omega-3 fatty acids in fish oil supplements fight depression

Patients with increased inflammation, including those receiving cytokines for medical treatment, have a greatly increased risk of depression. For example, a 6-month treatment course of interferon-alpha therapy for chronic hepatitis C virus infection causes depression in approximately 30% of patients.

Omega-3 fatty acids, more commonly known as fish oil, have a long list of health benefits, including lowering the risk of heart disease and reducing triglyceride levels. These nutritional compounds are also known to have anti-depressant and anti-inflammatory properties.

Despite some recent negative findings, as their tendency to increase the risk for prostate cancer was proven and some of the putative health benefits were not replicated in large trials, omega-3's remain of high interest to the depression field, where several studies have suggested benefits for depression and other psychiatric disorders.

This led a group of international researchers, led by senior author Dr. Carmine Pariante, to conduct a randomized, double-blind, placebo-controlled study in order to carefully evaluate the effects of omega-3 fatty acids on inflammation-induced depression.

They recruited 152 patients with hepatitis C to participate, each of whom was randomized to receive two weeks of treatment with EPA, DHA, or placebo. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are the two main omega-3 fatty acids in fish oil supplements.

Following the two-week treatment, the patients received a 24-week course of interferon-alpha treatment and were evaluated repeatedly for depression.

The researchers found that treatment with EPA, but not DHA or placebo, decreased the incidence of interferon-alpha-induced depression in patients being treated for hepatitis C.

Pariante, a Professor at the Institute of Psychiatry, Psychology & Neuroscience at King's College London, added, "The study shows that even a short course (two weeks) of a nutritional supplement containing one such omega-3 polyunsaturated fatty acid (EPA) reduced the rates of new-onset depression to 10%."

In addition, both EPA and DHA delayed the onset of depression, and both treatments were well tolerated, with no serious side effects.

"These new data provide promising support for omega-3 fatty acids to prevent depression, complementing other studies where omega-3's were found to enhance antidepressant treatment," said Dr. John Krystal, Editor of Biological Psychiatry.

EPA is considered an "endogenous" anti-inflammatory, and in previous work, also published in Biological Psychiatry, these same authors found that subjects with low levels of endogenous EPA in the blood were at higher risk of developing depression. Therefore, the authors speculate that this nutritional intervention restores the natural protective anti-inflammatory capabilities of the body, and thus protects patients from new-onset depression when inflammation occurs.

Although further work is still necessary and the findings must be replicated, these data indicate that omega-3 polyunsaturated fatty acids may be effective in preventing depression in a group of patients at high-risk of depression because of increased inflammation.

The article is "Omega-3 Fatty Acids in the Prevention of Interferon-Alpha-Induced Depression: Results from a Randomized, Controlled Trial" by Kuan-Pin Su, Hsueh-Chou Lai, Hui-Ting Yang, Wen-Pang Su, Cheng-Yuan Peng, Jane Pei-Chen Chang, Hui-Chih Chang, and Carmine M. Pariante (doi: 10.1016/j.biopsych.2014.01.008). The article appears in Biological Psychiatry, Volume 76, Issue 7 (October 1, 2014), published by Elsevier.

Lift weights, improve your memory

Study finds that one short bout of resistance exercise can enhance episodic memory

Posted September 30, 2014 | Atlanta, GA

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Here’s another reason why it’s a good idea to hit the gym: it can improve memory. A new Georgia Institute of Technology study shows that an intense workout of as little as 20 minutes can enhance episodic memory, also known as long-term memory for previous events, by about 10 percent in healthy young adults.

Another reason why it’s a good idea to hit the gym: it can improve memory. A new Georgia Institute of Technology study shows that an intense workout of as little as 20 minutes can enhance episodic memory, also known as long-term memory for previous events, by about 10 percent in healthy young adults.

The Georgia Tech research isn’t the first to find that exercise can improve memory. But the study, which was just published in the journal Acta Psychologica, took a few new approaches. While many existing studies have demonstrated that months of aerobic exercises such as running can improve memory, the current study had participants lift weights just once two days before testing them. The Georgia Tech researchers also had participants study events just before the exercise rather than after workout. They did this because of extensive animal research suggesting that the period after learning (or consolidation) is when the arousal or stress caused by exercise is most likely to benefit memory.

The study began with everyone looking at a series of 90 photos on a computer screen. The images were evenly split between positive (i.e. kids on a waterslide), negative (mutilated bodies) and neutral (clocks) pictures. Participants weren’t asked to try and remember the photos. Everyone then sat at a leg extension resistance exercise machine. Half of them extended and contracted each leg at their personal maximum effort 50 times. The control group simply sat in the chair and allowed the machine and the experimenter to move their legs. Throughout the process, each participant’s blood pressure and heart rate were monitored. Every person also contributed saliva samples so the team could detect levels of neurotransmitter markers linked to stress.

The participants returned to the lab 48 hours later and saw a series of 180 pictures – the 90 originals were mixed in with 90 new photos. The control group recalled about 50 percent of the photos from the first session. Those who exercised remembered about 60 percent.

“Our study indicates that people don’t have to dedicate large amounts of time to give their brain a boost,” said Lisa Weinberg, the Georgia Tech graduate student who led the project.

Although the study used weight exercises, Weinberg notes that resistance activities such as squats or knee bends would likely produce the same results. In other words, exercises that don’t require the person to be in good enough to shape to bike, run or participate in prolonged aerobic exercises.

While all participants remembered the positive and negative images better than the neutral images, this pattern was greatest in the exercise participants, who showed the highest physiological responses. The team expected that result, as existing research on memory indicates that people are more likely to remember emotional experiences especially after acute (short-term) stress.

But why does it work? Existing, non-Georgia Tech human research has linked memory enhancements to acute stress responses, usually from psychological stressors such as public speaking. Other studies have also tied specific hormonal and norepinephrine releases in rodent brains to better memory. Interestingly, the current study found that exercise participants had increased saliva measures of alpha amylase, a marker of central norepinephrine.

“Even without doing expensive fMRI scans, our results give us an idea of what areas of the brain might be supporting these exercise-induced memory benefits,” said Audrey Duarte, an associate professor in the School of Psychology. “The findings are encouraging because they are consistent with rodent literature that pinpoints exactly the parts of the brain that play a role in stress-induced memory benefits caused by exercise.”

The collaborative team of psychology and applied physiology faculty and students plans to expand the study in the future, now that the researchers know resistance exercise can enhance episodic memory in healthy young adults.

“We can now try to determine its applicability to other types of memories and the optimal type and amount of resistance exercise in various populations,” said Minoru Shinohara, an associate professor in the School of Applied Physiology. “This includes older adults and individuals with memory impairment.” 

Memory loss associated with Alzheimer's reversed using systems approach

Patient one had two years of progressive memory loss. She was considering quitting her job, which involved analyzing data and writing reports, she got disoriented driving, and mixed up the names of her pets. Patient two kept forgetting once familiar faces at work, forgot his gym locker combination, and had to have his assistants constantly remind him of his work schedule. Patient three's memory was so bad she used an iPad to record everything, then forgot her password. Her children noticed she commonly lost her train of thought in mid-sentence, and often asked them if they had carried out the tasks that she mistakenly thought she had asked them to do.

Since its first description over 100 years ago, Alzheimer's disease has been without effective treatment. That may finally be about to change: in the first, small study of a novel, personalized and comprehensive program to reverse memory loss, nine of 10 participants, including the ones above, displayed subjective or objective improvement in their memories beginning within three to six months after the program's start. Of the six patients who had to discontinue working or were struggling with their jobs at the time they joined the study, all were able to return to work or continue working with improved performance. Improvements have been sustained, and as of this writing the longest patient follow-up is two and one-half years from initial treatment. These first ten included patients with memory loss associated with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), or subjective cognitive impairment (SCI; when a patient reports cognitive problems). One patient, diagnosed with late stage Alzheimer's, did not improve.

The study, which comes jointly from the UCLA Mary S. Easton Center for Alzheimer's Disease Research and the Buck Institute for Research on Aging, is the first to suggest that memory loss in patients may be reversed, and improvement sustained, using a complex, 36-point therapeutic program that involves comprehensive changes in diet, brain stimulation, exercise, optimization of sleep, specific pharmaceuticals and vitamins, and multiple additional steps that affect brain chemistry.

The findings, published in the current online edition of the journal Aging, "are very encouraging. However, at the current time the results are anecdotal, and therefore a more extensive, controlled clinical trial is warranted," said Dale Bredesen, the Augustus Rose Professor of Neurology and Director of the Easton Center at UCLA, a professor at the Buck Institute, and the author of the paper.

In the case of Alzheimer's disease, Bredesen notes, there is not one drug that has been developed that stops or even slows the disease's progression, and drugs have only had modest effects on symptoms. "In the past decade alone, hundreds of clinical trials have been conducted for Alzheimer's at an aggregate cost of over a billion dollars, without success," he said.

Other chronic illnesses such as cardiovascular disease, cancer, and HIV, have been improved through the use of combination therapies, he noted. Yet in the case of Alzheimer's and other memory disorders, comprehensive combination therapies have not been explored. Yet over the past few decades, genetic and biochemical research has revealed an extensive network of molecular interactions involved in AD pathogenesis. "That suggested that a broader-based therapeutics approach, rather than a single drug that aims at a single target, may be feasible and potentially more effective for the treatment of cognitive decline due to Alzheimer's," said Bredesen.

While extensive preclinical studies from numerous laboratories have identified single pathogenetic targets for potential intervention, in human studies, such single target therapeutic approaches have not borne out. But, said Bredesen, it's possible addressing multiple targets within the network underlying AD may be successful even when each target is affected in a relatively modest way. "In other words," he said, "the effects of the various targets may be additive, or even synergistic."

The uniform failure of drug trials in Alzheimer's influenced Bredesen's research to get a better understanding of the fundamental nature of the disease. His laboratory has found evidence that Alzheimer's disease stems from an imbalance in nerve cell signaling: in the normal brain, specific signals foster nerve connections and memory making, while balancing signals support memory loss, allowing irrelevant information to be forgotten. But in Alzheimer's disease, the balance of these opposing signals is disturbed, nerve connections are suppressed, and memories are lost.

The model of multiple targets and an imbalance in signaling runs contrary to the popular dogma that Alzheimer's is a disease of toxicity, caused by the accumulation of sticky plaques in the brain. Bredesen believes the amyloid beta peptide, the source of the plaques, has a normal function in the brain -- as part of a larger set of molecules that promotes signals that cause nerve connections to lapse. Thus the increase in the peptide that occurs in Alzheimer's disease shifts the memory-making vs. memory-breaking balance in favor of memory loss.

Given all this, Bredesen thought that rather than a single targeted agent, the solution might be a systems type approach, the kind that is in line with the approach taken with other chronic illnesses -- a multiple-component system.

"The existing Alzheimer's drugs affect a single target, but Alzheimer's disease is more complex. Imagine having a roof with 36 holes in it, and your drug patched one hole very well -- the drug may have worked, a single "hole" may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much."

Bredesen's approach is personalized to the patient, based on extensive testing to determine what is affecting the plasticity signaling network of the brain. As one example, in the case of the patient with the demanding job who was forgetting her way home, her therapeutic program consisted of some, but not all of the components involved with Bredesen's therapeutic program, and included:

(1) eliminating all simple carbohydrates, leading to a weight loss of 20 pounds;

(2) eliminating gluten and processed food from her diet, with increased vegetables, fruits, and non-farmed fish;

(3) to reduce stress, she began yoga;

(4) as a second measure to reduce the stress of her job, she began to meditate for 20 minutes twice per day;

(5) she took melatonin each night;

(6) she increased her sleep from 4-5 hours per night to 7-8 hours per night;

(7) she took methylcobalamin each day;

(8) she took vitamin D3 each day;

(9) fish oil each day;

(10) CoQ10 each day;

(11) she optimized her oral hygiene using an electric flosser and electric toothbrush;

(12) following discussion with her primary care provider, she reinstated hormone replacement therapy that had been discontinued;

(13) she fasted for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime;

(14) she exercised for a minimum of 30 minutes, 4-6 days per week.

The results for nine of the 10 patients reported in the paper suggest that memory loss may be reversed, and improvement sustained with this therapeutic program, said Bredesen. "This is the first successful demonstration," he noted, but he cautioned that the results are anecdotal, and therefore a more extensive, controlled clinical trial is needed.

The downside to this program is its complexity. It is not easy to follow, with the burden falling on the patients and caregivers, and none of the patients were able to stick to the entire protocol. The significant diet and lifestyle changes, and multiple pills required each day, were the two most common complaints. The good news, though, said Bredesen, are the side effects: "It is noteworthy that the major side effect of this therapeutic system is improved health and an optimal body mass index, a stark contrast to the side effects of many drugs."

The results for nine of the 10 patients reported in the paper suggest that memory loss may be reversed, and improvement sustained with this therapeutic program, said Bredesen. "This is the first successful demonstration," he noted, but he cautioned that the results need to be replicated. "The current, anecdotal results require a larger trial, not only to confirm or refute the results reported here, but also to address key questions raised, such as the degree of improvement that can be achieved routinely, how late in the course of cognitive decline reversal can be effected, whether such an approach may be effective in patients with familial Alzheimer's disease, and last, how long improvement can be sustained," he said.

Cognitive decline is a major concern of the aging population. Already, Alzheimer's disease affects approximately 5.4 million Americans and 30 million people globally. Without effective prevention and treatment, the prospects for the future are bleak. By 2050, it's estimated that 160 million people globally will have the disease, including 13 million Americans, leading to potential bankruptcy of the Medicare system. Unlike several other chronic illnesses, Alzheimer's disease is on the rise--recent estimates suggest that AD has become the third leading cause of death in the United States behind cardiovascular disease and cancer.