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PRIME's Proof of Concept Research Study Abstract

 The Effect of Endurance Exercise and Patient Activation on Cognition and Mood in a Population of 55+ers at                                                                          Risk for Dementia [Date May 1, 2017; edited/updated January 31, 2024]

Awards: This research study abstract was selected for international publication and presentation at the Alzheimer's Association's 2017 International conference in London, England by the International Society to Advance Alzheimer's Research and Treatment.

ABSTRACT: Endurance Exercise, when facilitated by PRIME-BBM's Activation Science, significantly improves cognition and mood in a 55+er behavioral-health cohort at risk for developing moderate dementia.

INTRODUCTION: Multi-domain lifestyle interventions are emerging as a leading strategy for preventing Alzheimer’s (AD) and other dementias, and as a treatment to restore, maintain, or improve memory, cognition and mood during early and middle phases of neurodegenerative illnesses.¹ While delivering promising outcomes in supervised research settings, community based applications of such protocols are complicated, hard to sustain, and proceed without knowing the therapeutic value of individual epigenomic components.² A core element of comprehensive brain improvement programs is endurance exercise, which by itself facilitates structural and functional neuroplasticity by enhancing brain operations at molecular and cellular levels.³ Habitual endurance exercise is associated with the production of additional synaptic connections, the growth of fresh cells in the hippocampus (brain’s learning and memory center), and the development of new O²/nutrient laden neuro-microvasculature.⁴ A critical process supporting both initial and long-term health related behavior change is patient motivation or activation, recently introduced as essential for engaging and sustaining newly learned neuro-protective and neuro-enhancing behavior routines.⁵ This is especially important for 55+ers/seniors with recurrent depression, schizophrenia, MCI, chronic anxiety and/or bipolar illnesses, who are much more likely than others to develop dementia.⁶  This study investigates how 8 weeks of endurance exercise 3 times weekly for 20 minutes, combined with Activation Science(SM) facilitation, impacts memory, cognition and mood in 55+ers/Seniors who are at significant risk to develop dementia. 

THE PREMISE: Consistent endurance exercise for 20-30 minutes produces Brain Derived Neurotrophic Factor, or BDNF, which changes gene expression to orchestrate: neurogenesis (creation of new brain cells), synaptogenesis (growth of the brain’s intercellular communication infrastructure), angiogenesis (growth of blood vessels supplying oxygen/nutrients to brain cells) and boosted neurotransmitter production.⁷ Decreased BDNF causes hippocampal deterioration, cognitive impairment, and depression, whereas increased BDNF mediates hippocampal atrophy, and improves memory, cognition and mood.⁸

It is hypothesized that BDNF-driven changes in gene expression triggered by 8 weeks of endurance exercise and supported by 'Activation Science' will produce neuroplastic changes that improve cognition, memory and mood in a population of 55+ers/Seniors high risk for developing dementia. 

PURPOSE: The urgent need for accessible affordable non-medication solutions that improve or ameliorate memory, cognition, and mood, for patients at risk for, or already experiencing, mild cognitive impairment or moderate dementia is academic. The research thus-far on endurance exercise has not definitively answered key questions for those struggling with neurodegenerative challenges: what easily accessible endurance exercise works for elders to improve memory, cognition and mood…and for how long per exercise session and how often per week must one exercise to ensure best outcomes…and for how long over time must one exercise before measurable results can be documented…and how much does endurance exercise help when facilitated by Activation Science? Since many seniors have orthopedic/financial limitations, a low-cost, safe ‘all-season’ exercise was selected: recumbent stationary cycling.    


METHODS: For this 8-week longitudinal research project 20 volunteers attending an adult behavioral health daycare were recruited to engage in endurance exercise (recumbent cycling) for 20 minutes 3 times per week, facilitated by "Activation Science" support. 17 subjects (10 men - 7 women) completed the study. Subjects were coached according to PRIME-BBM's Activation Science paradigm. Standard measures of memory/cognition (MMSE and St. Louis University Mental Status Examination for Detecting Mild Cognitive Impairment/Dementia - SLUMS), and mood (BECK Depression Inventory), were collected before, after 4 weeks, and following 8 weeks of cycling. This project was managed by an 'outside' research assistant (to limit bias) experienced with dementia research protocols.

RESULTS: At the study’s 8-week conclusion all subjects showed improved cognition and 15 of 17 exhibited mood improvement. Advanced statistical analysis found both cognitive and mood improvements to be statistically significant. For cognition, 8 subjects increased scores from the Mild Cognitive Improvement (MCI) range to Normal, and 1 subject transitioned from moderate dementia to MCI.  These results suggest 8 weeks of endurance exercise 3-times weekly for 20 minutes improves cognition and mood in a dementia-prone psychiatric population of 55+ers/seniors when coached for activation. This research offers a new care standard and approach for 55+ers/seniors with MCI at risk for dementia.  To further confirm these findings, controlled studies with larger samples are warranted.                

Authors: B.White MSN, APRN-BC / A.Ashare MD / K.White MSN, APRN-BC / J.Soscia / Erica Scioli, PhD                                                         


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