Saturday, 14 January 2017

#BrainHealth & #ClinicSpeak: is the couch potato effect the chicken or the egg?

How good are you at sticking to your New Year's resolutions? #BrainHealth #ClinicSpeak




“There is a fatality about good resolutions – that they are always made too late”


How are you feeling this morning? Tired, lethargic, hungover, depressed? To much red wine last night? Full of self-loathing for having eaten too much and for missing your exercise routine this week? Lifestyle optimisation is one of the hardest things to achieve in life. How do we, HCPs, prescribe a healthy lifestyle and get people to adhere to it? 

The study below, although small, links sedentary behaviour to brain volume loss in pwMS. The less active you are the smaller your brain. This is an important observation and needs to be confirmed. It is important because brain size, or neuronal reserve, and cognitive reserve (education) protects you against age-related and MS-related cognitive impairment. The issue that needs to be established is this observation simply an association or is it causal. 

It would be associative if MS caused people to exercise less; in other words the more severe your MS, the more brain volume you lose. It is easy to understand that the more severe your MS, the more neurological impairments you will have, the less likely you are to exercise. Please note these neurological impairments could be physical, for example leg weakness that may make it harder to exercise, or hidden, for example MS-related anxiety and depression may reduce your motivation to exercise. 

The observation would be causal if we could show that exercise could maintain brain volume independent of other factors associated with preservation of brain reserve in MS, e.g. DMTs, diet, lack of or treatment of comorbidities, not smoking, low alcohol intake, etc. 

Finding out whether this observation is causal is very difficult and it will require a large randomised-controlled trial, which for an exercise intervention is very difficult and some would say impossible to achieve. The other approach is simple, there is enough evidence that exercise is good for you regardless of whether, or not, it is maintaining your brain volume. Exercise improves sleep, fatigue, mood and anxiety. Exercise helps maintain you metabolically, i.e. your weight, glucose levels, blood pressure, etc. Exercise outside of the MS space protects, or delays, you from developing age-related cognitive impairment. So why wouldn't you want to exercise? The problem is that if you have disabilities exercising may be difficult. This is why you may need to see a physio, or physical, therapist to help. Our physiotherapists tell us that regardless of disability there are exercise programmes that can be designed specifically for you. I know that the above is easier said than done, but unless you try you won't know. 

If you are a healthcare professional you need to practice what you preach. You can't be recommending healthy lifestyle interventions to your patients unless you are trying to adopt them yourself. You have to walk the talk. This is why we launched the Barts-MS Brain Health Challenge last year; to motivate you to improve your health and wellness so that when you advise your patients you sound more credible and you have the moral high ground. To quote one of my favourite clichés 'Just Do It'


Klaren et al. Objectively measured sedentary behavior and brain volumetric measurements in multiple sclerosis. Neurodegener Dis Manag. 2017 Jan 11. doi: 10.2217/nmt-2016-0036.

AIM: This study examined the association between sedentary behavior patterns and whole brain gray matter (GM), white matter (WM) and subcortical GM structures in persons with multiple sclerosis (MS).

METHODS: 36 persons with MS wore an accelerometer and underwent a brain MRI. Whole brain GM and WM and deep GM structures were calculated from 3D T1-weighted structural brain images.

RESULTS: There were statistically significant (p < 0.01) and moderate or large associations between number of sedentary bouts/day and brain volume measures. The primary result was a consistent negative association between number of sedentary bouts/day and whole brain GM and WM, and deep GM structures.

CONCLUSION: We provide novel evidence for decreased brain volume as a correlate of a sedentary behavior pattern in persons with MS.

19 comments:

  1. Thanks ProfG for taking the time on Saturday morning to post this reminder to us all. Hope you're still enjoying your running :-)

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  2. Prof G how is your fitness regimen going? Are you still active?

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    1. Re: "Prof G how is your fitness regimen going? Are you still active?"

      Yes, I run may be twice a week and row another 2 times a week. The problem is my hip remains a problem and I can't run further than say 10km; so marathons are out. I am considering taking up cycling and it is a low-impact sport, provide you don't have accidents.

      My sleep pattern is very poor and all over the place. I don't sleep enough.

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    2. Join the legions of injured runners who are now cyclists ;-)

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    3. "And DrK? Is he sleeping more?"

      Sorry negative. But I have some excuses. Small children being #1 + #2. Then a perhaps too idealistic outlook when it comes to grant submissions my peers keep turning down, which means you've worked your a** off for months with shorter than (brain-) healthy nights, only to find you've been prescribed more of the same medicine for the upcoming months. Also affects time for exercise, so it's a double whammy. No complaints, just matter of fact.

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    4. Prof G start cycling 🚴 and wear knee and elbow
      Pads, and helmet. And you'l feal saver +camera in case of accident.

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  3. Potato/potatoes.

    Sitting on my moral high ground! ;-)

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  4. I bought a book about diet and ms, read it from cover to cover, fascinating, enjoyable and inspiring read. I tried to implement what I had learned but couldn't get organised with it and failed repeatedly and I realised I just wasn't capable and abandoned the idea.

    When my cogfog improved, pain levels dropped and energy increased after stopping GA I went back to the book and read it again. I am doing very well with the diet now and although weight loss is painfully slow and disappointing, energy and clarity of mind have further improved and I feel better for it.

    Next step is to move more. I need a hip replacement so pain is a problem as is stability, weakness and fatigue but as you say there are still things I could do. But, there is absolutely nothing you can say to make me exercise more. I know the benefits of doing it and I know the risks of not, so it is not a lack of knowledge. I have noticed however that I forget to do it and I find it difficult to organise my time efficiently. I need to work out a way to sort that. (I think people use smart phones for that sort of thing but they are outside of my budget.)

    I am sorry to say that this whole idea of having the moral highground over patients smacks of arrogance and ignorance. If you had said that doctors should keep fit to set a good example and to encourage, that would have come across better. Please remember that people are all different, with different priorities and different capabilities and as you say anxiety and depression can play a big part. If you are well and able to eat healthily and exercise regularly and don't have the difficult task of shedding weight and getting fit whilst also being in pain and very unwell, then great, but try not to think that that makes you a better person. Sometimes people's lifestyle habits are a reaction, perhaps a continuation of childhood fear and anxiety resulting from abuse, and that takes a lot more to turn around than a doctor chirping from their moral high ground.

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  5. One of the few upsides to getting MS is that I now do cruises. Please recommend them to MSers who have mobility and balance issues. A ship has acres of flat, carpeted spaces with handrails - perfect for extensive safe walking (plus: doctor on board, plentiful helpful staff, numerous diversionary activities). My mobility improves exponentially and I come back energised and more confident. Prices have come down in recent years - it needn't cost the earth.

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  6. I have never been into exercise for the sake of it. It has to be enjoyable, "make sense". Used to be very into cycling, hiking; now one thing I particularly enjoy - think it's a dirty word on here now? - gardening. Wonderful. Yoga, Pilates, etc. are boring necessities I do whilst listening to music. I think - if you don't enjoy it, you won't keep it up.

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  7. Its wet, freezing cold, blowing a gale and not a lot of daylight. Then I read an article from ProfG who says that I need to take exercise. Yup I'm disabled and cannot walk without a rollator (SPMS, EDSS about 6.25) and possibly neurologically impaired. I know exercise is good for me, I keep on reading about it and here is another attempt to get me outside taking some exercise.

    It takes me at least 20 minutes to walk 600 metres on a level road using a rollator. Add to that 5 minutes at each end to get to and from the house. I do that at least twice a week, would 3 times a week be enough?

    I think I will listen to something on my phone in future, might make it more enjoyable - thanks Waldkauz

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    1. You can also vary the music to fit your mood! Just have to be careful of traffic etc. if you're outdoors!

      I use a rollator too. Whilst I won't be doing Munros with it, it carries binoculars and a picnic in the bag, and I can have a seat whenever...

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  8. I have always practiced intensely exercises.
    Even after the EM, I put as a goal in my life that I would exercise as far as I could, and I go from 4x to 6x a week to the gym and I am currently in the exercise program H.I.I.T.

    And yes, I had problems with mobility (loss of strength in the left leg) in my 1st releapse, but I think that I have been acting fast in order to recover the mobility and to return to practice exercises were central, fundamental to take me where I'm today.

    I just have to improve my sleep, if I could switch from morning to night, and it hurts me.

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    1. Cinara, what ypur ms like r/r or secondary?
      Do you use the gym like weights.
      Because I used go to Gym and walking 20 mile + a day.
      But when I got ms 16 year go, I was told not to do excercise any more.

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    2. Yes I go to the gym, I work with weights yet. I have EMRR, in fact everything is the same as EM, mine just is not yet "aggressive", which I still do not have spasticity. I do both strength work (with even weights) and aerobic, I'm actually doing a 01 hour H.I.I.T exercise program, aiming at strength, definition, and decrease in body fat.

      You already have 16 years of road with EM, I am completing 03 years, I hope to reach the 16 years still active.
      In fact I hope that by then they will find "definitive solutions" to the disease.

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    3. Oops, I wrote a "EM" of multiple sclerosis in portuguese, sorry.

      Sometimes talking in two languages ​​at the same time confuses the already compromised neurons |o|

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  9. I have PPMS and am very disabled. I still go to the gym and lift weights twice every week for 90 minutes. I got the gym to make it accessible for me. They refused at fist but I hired a solicitor on pro bono to fight my case in county court on equality grounds.

    Exercise is very important to me.

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    1. Good for you! My physio says you use it or lose it with MS ;-)

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