1. Laura Baker, PhD
Internal Medicine, Neurology, & Public Health Sciences
Wake Forest School of Medicine
Winston-Salem, NC USA

2. Sedentary is the new SMOKING !

3. Why Exercise for the Brain?
I’m going to tell you about a study we just completed here at Wake Forest
We wanted to test whether aerobic exercise might serve as ‘medicine’ to protect brain health in adults who are at high risk for developing Alzheimer’s
Why exercise? Most medications target a specific deficient chemical in the brain (stress hormones), or a specific system (circulation).
Exercise, on the other hand, has the potential to restore health to multiple chemicals and multiple systems

4. Aerobic Exercise – TherapY to Prevent AD?
Clinical studies:
Growing support for positive effects on memory & thinking abilities in healthy older adults and in those who are at high risk for developing dementia
Animal studies:
Numerous positive effects on the brain: more connections between brain cells, reduced inflammation, improved health of blood vessels, increased resistance to stress, reduced Alzheimer pathology

5. Aerobic Exercise and Brain Function in Older Adults
In healthy adults, brain volume increased with 6 months of aerobic exercise (colors=areas showing an increase) (Colcombe 2006)
In adults at increased risk for Alzheimer’s dementia (e.g., with mild cognitive impairment), exercise increased brain metabolic activity in regions that are first affected by the disease (Porto 2016)

6. Results of Small Randomized Controlled Studies of Exercise
Results from our prior studies (3 completed so far) indicate that EXERCISE may serve as ‘MEDICINE’ for the brain in adults with mild cognitive impairment:
Positive results on memory & thinking tests
Positive results showing increased blood flow in the brain
Positive results on brain volume
Positive results on a hallmark Alzheimer protein in the cerebrospinal fluid

7. A new national 18-month clinical trial of exercise to test whether exercise is ‘medicine’ to slow progression of a memory impairment and Alzheimer’s disease

8. is funded by the NIH’s National Institute on Aging and is managed by the Alzheimer’s Disease Cooperative Study at the University of California, San Diego.
Major EXERT partners include the Y-USA, Wake Forest University, the University of California at Irvine, and philanthropic organizations.

9. Study Design Medical & Cognitive Screeningf
Medical & Cognitive Screening
Aerobic vs. Stretching/Balance/Range of Motion Exercise
Supervised
Unsupervised 6
Month 12
Month 18
Blood
Cog Testing
Blood
Cog Testing
Walk Test
Walk Test
Brain MRI
Cerebrospinal Fluid Collection
Walk Test
Brain MRI
Cerebrospinal Fluid Collection
N = 300 older adults with preclinical Alzheimer’s Disease; 1 in 5 minority

10. Participants Experiencing mild memory loss
Eligible study participants include those who meet the following criteria:
Experiencing mild memory loss
Age is between 65 and 89 years old
Willing to be assigned to either exercise group, and to complete the assigned exercise program for the duration of the 18-month study
Willing and able to travel to the designated YMCA four times per week for the duration of the study
Willing and able to travel to a participating clinic for physical exams, specimen collection, cognitive testing, and brain imaging
In overall good general health with no planned surgeries over the next 18 months that could interfere with study participation
Not taking insulin for diabetes
Not currently exercising
Have a close friend or family member with whom the participant has regular weekly contact, who can serve as a study partner and accompany the participant to most of the clinic visits

11. Intervention & Measures
Intervention: Using a participating YMCA, exercise 45 minutes per session, 4 times per week; supervision twice per week for 12 months, and graduating to independent exercise for the last 6 months of the study (through Month 18)
Aerobic exercise: 70-80% of maximum heart rate for minutes of each 45 minute session
Stretching, Balance, Range of Motion exercise: 30% of maximum heart rate for 45 minutes per session
Measures of Interest: Cognition, daily function abilities, markers of Alzheimer pathology in the brain obtained through brain imaging, and fluid collection)

12. To find out more about EXERT or to inquire about other Alzheimer’s clinical trials, contact the Alzheimer’s Disease Education and Referral Center (ADEAR), a service of the National Institute on Aging at ;
Or, go to