Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function.

“This is exceptional research of 3,247 adults studied prospectively while studying Coronary Artery Risk Development in Young Adults. Get up and dance everybody!”  Bill Chesnut, MD.

Midlife thinking ability and exercise. “Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function”

Tina D. Hoang, MSPH1; Jared Reis, PhD2; Na Zhu, MD, MPH3; David R. Jacobs Jr, PhD3; Lenore J. Launer, PhD4; Rachel A. Whitmer, PhD5; Stephen Sidney, MD5; Kristine Yaffe, MD6,7

JAMA Psychiatry. Published online December 02, 2015. doi:10.1001/jamapsychiatry.2015.2468

Importance Sedentary behaviors and physical inactivity are not only increasing worldwide but also are critical risk factors for adverse health outcomes. Yet, few studies have examined the effects of sedentary behavior on cognition or the long-term role of either behavior in early to middle adulthood.

Objective To investigate the association between 25-year patterns of television viewing and physical activity and midlife cognition.

Design, Setting, and Participants Prospective study of 3247 adults (black and white races; aged 18-30 years) enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) Study (March 25, 1985, to August 31, 2011). Data analysis was performed June 1, 2014, through April 15, 2015.

Main Outcomes and Measures We assessed television viewing and physical activity at repeated visits (≥3 assessments) over 25 years using a validated questionnaire. A 25-year pattern of high television viewing was defined as watching TV above the upper baseline quartile (>3 hours/d) for more than two-thirds of the visits, and a 25-year pattern of low physical activity was defined as activity levels below the lower, sex-specific baseline quartile for more than two-thirds of the of the visits. We evaluated cognitive function at year 25 using the Digit Symbol Substitution Test (DSST), Stroop test, and Rey Auditory Verbal Learning Test.

Results  At baseline, the mean (SD) age of the 3247 study participants was 25.1 (3.6) years, 1836 (56.5%) were female, 1771 (54.5%) were white, and 3015 (92.9%) had completed at least high school. Compared with participants with low television viewing, those with high television viewing during 25 years (353 of 3247 [10.9%]) were more likely to have poor cognitive performance (<1 SD below the race-specific mean) on the DSST and Stroop test, with findings reported as adjusted odds ratio (95% CI): DSST, 1.64 (1.21-2.23) and Stroop test, 1.56 (1.13-2.14), but not the Rey Auditory Verbal Learning Test, adjusted for age, race, sex, educational level, smoking, alcohol use, body mass index, and hypertension. Low physical activity during 25 years in 528 of 3247 participants (16.3%) was significantly associated with poor performance on the DSST, 1.47 (1.14-1.90). Compared with participants with low television viewing and high physical activity, the odds of poor performance were almost 2 times higher for adults with both high television viewing and low physical activity in 107 of 3247 (3.3%) (DSST, 1.95 [1.19-3.22], and Stroop test, 2.20 [1.36-3.56]).

Conclusions and Relevance High television viewing and low physical activity in early adulthood were associated with worse midlife executive function and processing speed. This is one of the first studies to demonstrate that these risk behaviors may be critical targets for prevention of cognitive aging even before middle age.


Ten Ways to Start Exercising. You’ll be proud you did.

“To be what you want to be, start here and let it grow you.” Bill Chesnut, MD


10 Ways to Start Exercising

By Cleveland Clinic Wellness Editors 
Published 7/13/2011

Walking, strength training, running, swimming, biking, yoga, tai chi — the possibilities for exercise are endless. The good news is that it doesn’t matter which one you choose — it just matters that you do some form of exercise. “If you have a choice between not moving and moving — move,” says Heather Nettle, MA, coordinator of exercise physiology services for the Cleveland Clinic Sports Health and Orthopaedic Rehabilitation Center. “Ultimately it will help with overall health and well-being.” So go ahead, find an activity you love and get moving with these 10 do’s and don’ts for starting an exercise routine.

  1. Do Anything — It’s Better Than Nothing
    Experts are quite clear on this point: Get 30 to 60 minutes of exercise three to five days a week for improved energy, as well as to help prevent heart disease, diabetes and certain types of cancer. But if you can’t hit that target for whatever reason, just do something. “One of the biggest mistakes I see people make is having an all-or-nothing mentality,” says Caroline Dawson, MBA, a certified fitness trainer and instructor at Town Sports International in New York City. “If you can realistically only commit to working out three days a week, remember that three is better than zero! Even if you can devote only 10 or 20 minutes to exercise, you’ll always feel better afterward.” To widen your activity horizons, keep a pair of walking shoes in your car or at your desk, and drive or walk to a scenic locale for your walks. On rainy days, the mall makes a great indoor track.
  2. Do Keep Track
    Tracking your steps with a pedometer is one key to success if you like to walk, says Michael F. Roizen, MD, chief wellness officer at the Cleveland Clinic. Another is recording some basic health information before starting a new routine. “Keeping track of how your body changes inside and out over the weeks and months gives you proof of the healthy changes you’re making,” he says. A few ways to do it:
  • Before your first workout, check your blood pressure at your local pharmacy. Then recheck once a month.
    • Time yourself at a track or on a treadmill. See how many minutes it takes you to walk or run one mile. Retest yourself after one month of consistent exercise.
    • Measure your waist circumference and your weight. Take these measurements once a week.
    • Schedule a visit with your physician and request these tests: lipid panel, vitamin D and C-reactive protein. Check these levels again after six months of consistent exercise.
  1. Do Weight-Train
    There’s no question: You’ll shed pounds faster if you lift weights. That’s because strength training builds muscle, and the more muscle you have, the faster your metabolism will be. And women, hear this: You will not bulk up! What you’re doing by lifting weights is preventing muscle loss. Strength training also improves overall body composition, giving you more lean muscle tissue in relation to fat, so you look toned and trim. To experience the most benefit, lift more weight than you think you can. Dashing through your repetitions doesn’t take as much effort because it allows your muscles to rely on momentum. Instead, focus on your form by practicing slow and steady movements on both the contraction and the release. This will help you strengthen every muscle fiber.
  2. Do Head for the Hills
    Do you follow the same flat path day in and day out when you go for your walk or run? Look for hills along your route that you can slip into your routine. If it’s too much for you to tackle all at once, start by going only halfway up. Walking or running up inclines boosts the intensity of your workout: It burns more calories and helps build muscle strength and cardiovascular endurance. Switching between flat surfaces and hills is a form of interval training, a type of workout that involves short bursts of high-intensity exercise in between moderate activity. This kind of exercise, practiced by elite athletes, can supercharge your workout. It can also help keep boredom at bay. If you have joint problems, go easy on the downhill — slow your pace and shorten your stride.
  3. Do Think Outside the Box
    Even if you can’t engage in rigorous, high-intensity sweat sessions, there are plenty of other ways to improve your physical health. According to a review in the American Journal of Health Promotion, mind-body practices like tai chi and qigong may help promote bone health, cardiorespiratory fitness, physical function, balance, quality of life, fall prevention and emotional well-being. Described as “meditation in motion,” tai chi and qigong involve a series of flowing, gentle movements — similar to but much slower than yoga. Interested? Get the Gaiam tai chi for beginners DVDin our clevelandclinicwellness.com wellness store.
  4. Don’t Do It If You Don’t Love It
    The perfect exercise is something you enjoy, according to Gordon Blackburn, MD, director of the Cardiac Rehabilitation Program at the Cleveland Clinic. He recommends doing something you can fit in on a daily basis and something you can continue doing. Walk briskly, run, bike, use a program like Wii Fit. As the saying goes, it’s all good. Once you find what you love, aim to gradually increase the duration and intensity of your activity. As you get more fit, your functional capacity increases, so you really can do more. If you love your daily walk, add distance and build up speed. If you love bicycling, add another few miles or tackle that big hill. It all adds up, and getting going today will keep your heart going in the long run.
  5. Don’t Stretch Too Soon
    You probably learned to stretch before exercise in elementary school PE. But science has determined that holding stretches for 20 to 30 seconds prior to the start of a workout actually makes it more difficult for your muscles to perform. A University of Nevada study found that athletes who performed traditional hamstring stretches before working out generated less power from those muscles than athletes who did no stretching at all. For a good-for-you warm-up, do moves that raise your heart rate and promote flexibility, such as a straight-legged march: Kick your right leg straight out in front of you, keeping your toes pointed up. As you kick, reach your left fingertips to touch (or nearly touch) your right toes. Step your weight forward onto your right leg, then repeat on the left side, bringing your right hand to touch your left toes as you kick. Keep going for eight to 10 steps. As for those static stretches from your school days, there’s still a time and a place for them — after you’re done with your workout.
  6. Don’t Forget Your Core
    It’s no coincidence that core training and balance training are often grouped together. A strong core — which consists of your abdominal, back and pelvic muscles — can function like an insurance policy against balance-related injuries. “When your core is strong, then your protective stabilizing muscles kick in and protect you,” explains Dallas-based Pilates expert Karon Karter, author of Balance Training: Stability Workouts for Core Strength and a Sculpted Body. Studies have shown that taking a holistic view of balance training is probably the most effective route. That means changing up your exercise routine to challenge both strength and balance, and pairing it with core training. Use balance exercises to warm up for things like walking, running or biking. After establishing your balance on one foot (just holding still is a good first step), try raising and lowering your body on one leg, keeping your torso erect while bending at the knee and waist. As you get more confident, add repetitions, go lower, or move your free leg into different positions.
  7. Don’t Walk With Weights (Amen) 
    Though it may feel like you’re working harder, strapping on hand or ankle weights while you walk won’t give you the extra burn you’re looking for. And it may just increase your risk of joint problems or injuries. To burn extra calories, you would need to carry at least three- to five-pound weights — and that’s a definite no-no. When you swing the weights, it exponentially increases the force on your shoulder and elbow joints if using hand weights, or knee and hip joints if using ankle weights. For people with heart disease or high blood pressure, using weights can also cause a temporary spike in blood pressure. Leave the weights at home and boost your burn by walking up hills instead.
  8. Don’t Focus on Appearance
    If you can’t seem to muster the motivation to hit the gym, it may be time to rethink your reasons for going. Working out for the sake of how you look can actually discourage you from exercise. Instead of viewing physical activity as a means to a better-looking body, think of it as a way to stay healthy and feel great. Though you will burn calories, melt fat and build muscle, regular physical activity can also reduce stress, banish bad moods, ramp up energy levels and boost self-esteem.

Keep your brain sharp on the road ahead by moving your body now

“Going to the gymnasium every day has surprising benefits.  Your metabolism rate is higher, you have more energy, your balance improves and you may retain more IQ points in the coming years.” Bill Chesnut, MD 

This is from the Cleveland Clinic Wellness Newsletter January 25, 2016.

Keep your brain sharp on the road ahead by moving your body now.
“Use it or lose it” may have more than just one meaning. Staying physically fit doesn’t keep only your body strong, flexible and resilient. It may do the same thing for your brain. Research has linked cardiovascular fitness to both long-term memory and executive function — your inner CEO, the part of your brain that helps you reason, plan and prioritize. Scientists recently mapped brain activity in older men engaged in tests of attention and quick decision-making, and they found that the brains of the most aerobically fit functioned most like the brains of younger men. You don’t have to run marathons to reach the mental fountain of youth. Pick your favorite moderate-intensity activity — walking, swimming, dancing or biking — and do it for half an hour on most days of the week. It looks like we need to schedule exercise the way we plan for any important gathering, celebration or meeting. It‘s an investment in your future health, below the shoulders and above! Visit our Healthy Brains Initiative to learn more about how to stay sharp as you age.

Cleveland Clinic 1.25.16

Have you heard of the Bird Dog Plank? It is great for your core!

I love  this quick energy-generating exercise.  The plank is part of my daily routine.  Have you heard of the Bird Dog Plank?  Do the plank exercises on your wrists and toes while holding one straight leg up higher than your back. You look like a Bird Dog! https://www.youtube.com/watch?v=hHkBmfwTjN8 ” Bill Chesnut, MD    
Brrrr! When it’s cold outside, keep your inner fire burning with plank pose.
The yoga posture known as plank pose proves that exertion comes in many forms — not just running distances and pumping iron. Plank pose builds strength and vitality year-round, and, at this time of year, it can serve as an efficient “winter warmer,” says Judi Bar, Cleveland Clinic’s yoga program manager. Here’s how it’s done: Get down on the ground, face down, and come up onto your hands and knees. (If you feel pain or strain in your wrists, rest your weight on your entire forearms, with your elbows directly under your shoulders for support.) As you exhale, stretch one leg back so the knee is almost straight. On your next exhale, stretch and place the other leg beside the first, hip distance apart, with your toes curled under. Engage your torso muscles, from belly to spine, and allow your head, shoulders, hips and heels to form a straight line, like a plank. Hold the pose for three to five breaths, or more. Come out of plank pose by bending your knees to the ground and then sitting comfortably. Repeat this pose up to three times. Are you warm yet?


Hitting the slopes? Just “beet” altitude sickness!

“Beet juice is handy to know about if you live in Albuquerque, Santa Fe or even higher than 5000 or 7200 feet.  Help protect your low attitude guests so they enjoy their visit.” Bill Chesnut, MD
January 12, 2016
Hitting the slopes? Just “beet” altitude sickness!
Hitting the ski slopes or another high-altitude terrain this winter? Channel your inner mountain goat all you like, but you may want to pack some beet juice for good measure. Altitude sickness — which affects about half of all travelers to elevations above 8,000 feet, regardless of fitness level — can seriously cramp your vacation style with several days of light-headedness, nausea, and other unpleasant symptoms. Your blood vessels, which deliver oxygen throughout your body, depend on the oxygen in the air to do their job. It normally takes several days for your blood vessels to adjust to the decreased oxygen levels — a process called acclimatization — but researchers have found that drinking beet juice can speed up the process. The magic ingredient in this jewel-colored root vegetable? Nitrate. Your body converts this compound to nitric oxide, which helps to normalize blood vessel function. (That same mechanism may explain why beet juice has been shown to benefit athletes and people with heart failure.) More time enjoying the mountains? This idea just can’t be “beet”!


Run for your mind, stay smart longer.

“Run for your mind, stay smart longer. We all underestimate the ability of our mind to grow especially if it has years to accumulate experience.” Bill Chesnut, MD
Think on this: Running improves learning and memory, among many other benefits.
We love how researchers keep learning more about why exercise needs to be a priority for everyone. Take the latest news about running, for example. You may already know that running has a host of health benefits: It reduces your risk of certain cancers and protects against heart disease; increases bone mass and helps slow age-related bone loss; helps prevent obesity and type 2 diabetes; adds years to your life; and improves mood, focus and clarity. Well, new research shows that running also enhances the development of new brain cells in the adult brain, resulting in improved learning and memory. Pretty impressive for an exercise that requires just a comfortable pair of sneakers and some motivation! Before you lace up your shoes and head out to log some miles, though, be sure your body is ready. If you think you may be at risk for heart disease, or if you have been having chest pains, light-headedness or shortness of breath, please be evaluated by your primary care provider or cardiologist before you hit the track.

Cleveland Clinic Wellness Newsletter, February 3, 2016.