#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”

Oscar Wilde, The Picture of Dorian Gray

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.

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