Facebook Live: All About Exercise for Cognition

Apollo Health’s Chief Science Officer Dr. Dale Bredesen and Chief Health Liaison Julie Gregory were joined by Ryan Glatt, a board-certified health coach and fitness professional with a Masters in Applied Neuroscience who specializes in the relationship between exercise and its benefits to brain health and neurological rehabilitation.

Dr. Bredesen, Julie, and Ryan discussed optimal exercise options and plans for those using the Bredesen Protocol™, taking into account their current level of physical fitness, subtype contributors, and much more.

We’ve included a complete recording of the session and a full transcript below for your convenience.

Watch here:

Transcript:

Dr. Bredesen: Hello, everyone, great to have you here, and I hope everyone is staying safe during this new spike in the pandemic unfortunately. Really fantastic here to have Ryan Glatt here today. Ryan, welcome.

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Julie Gregory: Thanks, I’m very excited about this one.

Dr. Bredesen: Yeah, and Julie actually suggested this, I think it was a fantastic idea. And Ryan is an expert in the area of exercise and its relationship to cognition. And Ryan give us a little background on how you got into this area and what you’re currently doing.

Ryan: Yeah, thanks Dr, Bredesen and Julie for having me, this is really exciting. I’m a huge fan of the work that you’re all doing. It’s been very impactful in the work that I do personally and professionally, so thank you. My background is in exercise science and neuroscience. I was overweight as a child, I was addicted to video games, I sustained a pretty severe concussion as a kid as well, which led to some social and cognitive issues, which probably led to my addictions and lack of healthy lifestyle behaviors. It was actually through video games, active video games, specifically like Dance, Dance Revolution, and then Nintendo Wii that allowed me to harness my addiction, lose weight, improve my permission, improve my social behavior. And that led me to help others make a change in their life through fitness as I joined the gym and started working out, lifting weights, doing more cardio, I became a personal trainer, simultaneously my mother had an issue with kidney disease, sustained a leg amputation. I saw her go through neuro rehabilitation and she was using the Nintendo Wii in her physical therapy clinic, to actually help.

Julie Gregory: Hmm.

Ryan Glatt: Yes, it helped with her rehab and weight transfers. And so I have this history of exercise and brain health and neuro rehab and orthopedic rehab, and also mental health issues in my family, sort of coalescing them to one, and lately what I’ve done is combined, and I say lately in the past five years is combined my training as a certified fitness professional. My work in physical therapy, I dropped out of physical therapy school to study neuroscience, so I got my master’s degree in Applied Neuroscience science from Kings College of London and I’m a board certified health coach. So now my interest is taking fitness, gaming and lifestyle guidance and gearing that towards brain health, and of course that intersects extremely well with your work, and I’m here at the Pacific Brain health Center in Santa Monica, California working alongside neurologists, neuropsychologists, and psychiatrists to help people enhance their brain health and prevent cognitive decline.

Dr. Bredesen: Fantastic, and of course, we’re all interested in seeing a reduction in the global burden of dementia. And obviously.

Ryan Glatt: Exactly.

Dr. Bredesen: We’re interested in understanding what’s working the best, what’s working the least and how it’s all working together as we build up and continue to improve the overall protocol. So maybe you could talk a little bit about an issue that you brought up just before we came on here, which is about the subtype. So we all recognize that there are people who have more of an inflammatory component to their cognitive decline. People who have more of an, atrophic component, a glycotoxic component, so common, various toxins, things like biotoxins and inorganics and organics, and then more of a vascular or even traumatic, and you mentioned the head injury. Of course, we’d all like to.

Ryan Glatt: Hmm.

Dr. Bredesen: Get to the point where we can all avoid cognitive decline. When you recommend exercises for people, could you talk a little bit about, are there differences for someone who’s got more of an inflammatory component versus say more of a vascular component?

Ryan Glatt: That’s a great question and I’d have to answer it, maybe. It really does depend on the individual, and when I was recovering from a concussion, I have also worked with a lot of people who have sustained traumatic brain injuries or concussions, there’s this concept of metabolic capacity, whereby if you were to engage in exercise and if get a concussion you would start to have symptoms, just dizziness, fatigue, nausea, in that regard, you’ve probably met or exceeded your metabolic capacity. And I would say we could use that framework of thinking for individuals with high levels of inflammation or high levels of toxicity in which they might experience fatigue or things of that regard. And so we don’t want to exceed or surpass that capacity, whatever that is. And there’s fitness tests that allow us to measure that individual person’s level of fitness or cardiovascular endurance, which could contribute to this concept of metabolic capacity, and for individuals struggling with inflammation, it’s challenging to say, you know, which type of exercise would target each inflammatory biomarker, I did my master’s thesis just on this concept. And because exercise is such a panacea, it has this sort of global effect, but it’s interesting that certain variables of exercise like frequency, intensity, time and type might play a role in this. And so there was a small study on college students showing that high intensity interval training created more CRP in their blood profile, which it was elevated after baseline in a way that was outside the recommended ranges. And so for someone struggling with a high level of inflammation, they may want to avoid high intensity for now until they’re able to curb that, start with low to moderate and kind of work their way up, keeping that metabolic capacity metaphor in mind. Same thing with people with high levels of toxicity, they might need to work on exercise modalities that don’t exceed moderate intensity, maybe focus on low intensity, maybe combining it with things like saunas and the other detoxification protocols and behaviors you already know about and speak about. And so I hope that’s sort of a nice little peak into that window. More research is needed, but it really depends on what you can tolerate at that point in time, but just like when doing resistance training, you want to keep this principle progressive overload in mind, almost like exposure therapy, because exercise is an acute inflammatory process, we want to be mindful of that as we’re prescribing an exercise to individuals and it can be confusing because you hear about research saying, oh, the benefits of high intensity interval training, and especially here in Santa Monica, we have a sort of a high intensity obsessed fitness culture. So we do have to be careful. I’m not saying that’s a bad thing, but there could be some different considerations of frequency, intensity and duration based on your subtype.

Dr. Bredesen: Great. Okay. So let’s talk about a typical person, let’s say that someone comes to you who has a relatively early mild cognitive impairment, there are somewhere between five and 10 million Americans that have had this exact issue. So they come in and let’s say, you know, they have a MoCA score in them, you know, mid 20s, but that we already know scientifically they’ve had the biochemical changes going on for at that point more than 10 years, because SCI typically lasts about 10 years or so. So you’re faced with, okay. how do you turn things around that had been going on for quite a while? But yet the person is still functional, still able to drive and still able to do many things, but clearly now scoring suboptimally on their cognitive testing, they know that something is wrong. And let’s say for example, they’re heterozygous for APOE4 which is again, very, very common.

Ryan Glatt: Hmm.

Dr. Bredesen: We know about 75 million Americans are heterozygous for APOE4. So what sort of exercise approach would you recommend for a person in that group?

Ryan Glatt: Yeah, so what I would do is I would say, I would take that person as they are, and as they show up and understand what they’re currently doing. And most of the time, I’m going to generalize, but most of the time people say they’re walking about three to five days a week on average, let’s categorize that at a low intensity for 20 to 30 minutes on average. And that’s the norm for the people here in Santa Monica, which is, you know, we have great weather here in Santa Monica, we’re probably already pretty active. The socioeconomics are a little different here and so we want to consider those variables as well. But let’s say they’re walking and they’re saying, I already exercise, I heard exercise was good for my brain. My neurologist told me that exercise is good for my brain and I already walk. Check. I say, well, hold on, let’s back up, let’s look at the physical activity guidelines for second Americans, which is very general, but also includes research on benefits for brain health as does the World Health Organization when it comes to exercise, which is great. And so while these are very general recommendations, it’s a great place to start. Can we get to those general recommendations, which are, and we’ve all heard this before probably, 150 to 300 minutes a week of moderate to vigorous physical activity. We hear it all the time. But when we hear that, it’s sort of this arbitrary number of minutes, nobody thinks about that. What happens?

Dr. Bredesen: Right.

Ryan Glatt: What that actually mean? Well, if you’re going to just walk and not add any other types of exercise but meet those minimum recommendations to get the brain health benefits associated with that, we could say, okay, you’re already walking three to five times a week, you can do three times a week for 45 to 60 minutes to hit that 150, or you could do five times a week for 30 minutes to hit that 150. And we want to increase your pace, so you get a little bit out of breath, and I use the one to ten scale, the rate of perceived exertion, where ten is the most physically possible intense and one is the least possible intense physically. And we say, we want about a six to an eight, or we could use the talk test. We could use the talk test to say, you should be a little out of breath like this while you’re walking.

Dr. Bredesen: Yeah.

Ryan Glatt: You could use singing and other ways of categorizing it, people say, oh, that’s an easy change, I can make that change. And if the person’s willing to do more, then we can add more, and this is more of a behavior change conversation. The 150 minutes of moderate to vigorous is great, but it’s the minimum that we have to hit if we’re going to not guarantee brain health benefits, but according to the literature, that’s almost the minimum we need to elicit those brain health benefits significantly. I’m sure we could do less, some researchers showing 75 minutes of higher intensity may be equivalent to that 150 minutes, but we want to try to get everyone to adhere to that at the minimum. If we can add two to four days a week of resistance training or strength training, ideally using external load and not just body weight, which a lot of people think about when they hear that and we can get into the reason, the mechanistic reasons why we might want to do that, that would be great as well. And if they can introduce some sort of activities that are cognitively stimulating or coordinatively demanding, which I don’t know if coordinatively demanding is a word, but something that makes your body coordinate and move and think and move at the same time, such as a dance, a sport like tennis or ping pong, a martial art of some kind, or a mind-body exercise as like Tai Chi, Qigong, yoga, Pilates. If we can have those three elements, which is coordinated, also referred to as neuromotor in the physical activity guidelines. Resistance, and aerobic, then that’s what we call a multimodal exercise program for brain health and research has shown that a multimodal program will slow cognitive decline and reduce the risk of dementia more than a single modality program. So this my issue with saying one exercise is best, but with that case study you gave me, I would start them by just progressing them to that 150 minutes at the minimum, and if they’re willing or able, or if they’re willing to get a trainer to help implement that resistance training protocol, fantastic. And if they’re ready to add a leisure time activity that’s coordinatively or cognitively demanding, or do something like Zumba, which they be checking off the neuro motor category and the aerobic category simultaneously, because if it gets your heart rate up, it counts towards those minutes, fantastic. So really depends on that individual and the family caregiver or care partner is at behaviorally, what they’re willing to do, what their affordances are, of course, during COVID, it’s been very interesting recommending virtual resources and at-home resources. I see so many people, I’m sure you have as well, that had a great system where they went to the YMCA, they had a trainer, they had a physical therapist and that all went away.

Dr. Bredesen: Yeah.

Ryan Glatt: And they didn’t reactivate it. And sometimes we need to engage in that behavioral reactivation. So that would start that individual. If we can hit that the multimodal framework a little bit, then I think that would be the best possible intervention for that individual. If they’re unwilling to do more than just walking, we want to hit that 150 minutes, but maybe they’re kind of, they think walking’s boring, they’re afraid to walk outside because of COVID, the weather isn’t permitting and let’s say they love dance, well, there’s plenty of research, systematic reviews showing the benefits cognitively and physically and on balance in individuals with MCI and dementia with dance. And so I might recommend that as a way to check off both aerobic and neuro motor simultaneously. So it’s sort of this behavioral negotiation with that individual based on their preferences and affordances. But certainly, we never think it’s too late. There’s some contradictory research saying that individuals with dementia may or may not benefit from exercise, although I’m seeing more research saying that it would, I think, you know, the cross-sectional study I’m talking about saying that people with dementia who exercise got worse, but I have some issues with that paper, but for someone with MCI, certainly incorporating a multimodal exercise program is sort of setting a strong defense against that progression of cognitive decline. And we’re trying to get all the unique benefits mechanically and neuro biologically from those different modalities of exercise.

Dr. Bredesen: Yeah, great point. So you’ve talked about the three different ones, the strength, the aerobics and the coordination. And of course, way back when, when I was training, the usual claim was, well, the coordination is good for your cerebellum, but it doesn’t do much for your cerebrum. Obviously that’s changed a lot.

Ryan Glatt: Mm-hmm.

Dr. Bredesen: Could you talk a little bit about for each of those three, whether you think are there specific things that in terms of, do you tend to get a different positive outcomes from each one? And do you tend to start with one? So let’s say go back to the MCI patient.

Ryan Glatt: Hmm.

Dr. Bredesen: Would you start them with one of those three or do you try to get them to start all three?

Ryan Glatt: It’s a great question, it’s another behavioral negotiation. What behavior are they closest to achieving?

Dr. Bredesen: Yeah.

Ryan Glatt: Which would they enjoy the most? And this would just ensure more sustainable behavior change. But if I could probably pick one of the modalities to start with that most people are missing that research is starting to show, especially for MCI with certainly benefit cognition. I think it would depend on the type of MCI, is it multi-domain? Is it more fun executive?

Dr. Bredesen: Right.

Ryan Glatt: Is it amnestic? Are we not sure what kind of MCI it is? What’s these process at that point in time? I would probably go with resistance training, but not just any resistance training, if we can have resistance training set up in a format that is aerobically demanding, sort of a circuit training sort of format.

Dr. Bredesen: Mm-hmm.

Ryan Glatt: To you to check off this, and within that resistance training routine, if we’re learning new movements, especially with the guidance of a fitness or movement professional, like a physical therapist and occupational therapist, a personal trainer, exercise physiologist, group fitness instructor, we’re also learning new things, right?

Dr. Bredesen: Mm-hmm.

Ryan Glatt: There’s some researchers who have had positive resistance training as a form of a cognitively demanding activity, which it is.

Dr. Bredesen: Yeah.

Ryan Glatt: If you think of your form, sets, reps, there’s a lot to keep track of there. So there’s a systematic review that came out showing that resistance training had one of the most positive effects on global cognition for individuals with MCI. And since this was a systematic review, this look mostly looking at MoCA scores, which I think is relevant to your question or your case study there, followed by extra gaming, which is the stuff that I did to lose weight as a kid, like Nintendo Wii, X-Box Connect Dance, Dance Revolution. Currently what’s available is virtual reality which we can talk about followed by aerobic exercise. They all have beneficial effects.

Dr. Bredesen: Hmm.

Ryan Glatt: But we probably start with resistance training, for other reasons as well that there’s great contributors to improvements in balance, improvements in strength, preventing sarcopenia, preventing osteopenia or osteoporosis, both of those referring to lessen muscle mass or lessen bone mass over time, it would help with the hormone profile of the individual.

Dr. Bredesen: Hmm.

Ryan Glatt: And what we’re finding with resistance training is there’s another systematic review showing that it has really profound effects on the frontal lobe and executive functions, whereas something like aerobic exercise, what’s most of the neuroimaging outcomes on, it’s the temporal lobes, the hippocampus, sometimes global gray matter volume, often frontal lobe volume as well. So there’s these global, but sometimes specific effects with these different modalities. And depending on that, if that individual gave me, had a volumetric MRI, I might be able to tweak that a little bit more.

Dr. Bredesen: Hmm.

Ryan Glatt: You know, if they had lower temporal lobe or hippocampal atrophy, I might emphasize the aerobic a little bit more, if they had more frontal lobe atrophy and reduced executive functioning based on the MoCA or additional neuropsych, maybe push the resistance training a little bit more.

Dr. Bredesen: Yeah. Thank you, yes. So we often think of just very general biochemical terms of the people who have insulin resistance issues, we really want to get them more on the strength training because that helps so much with their insulin resistance and the people who have vascular issues, we really want to get them more on the aerobics. And let me come to Julie in just a moment, but last question before I asked Julie about her exercise regimen, let me just ask you about ketosis. So let’s say you’ve got two different people, one who’s really trying to get into ketosis, and the other one who’s really not focusing on that and is just burning glucose, is there a different recommendation for those people based on ketosis.

Ryan Glatt: Oh.

Dr. Bredesen: And non-ketosis?

Ryan Glatt: That’s a great question. To be honest with you. I need to look into that more.

Dr. Bredesen: Mm-hmm.

Ryan Glatt: What I’ve come across is issues with energy levels and ketosis during exercise.

Dr. Bredesen: Yeah.

Ryan Glatt: I think we really have to weigh the scales of justice here. We consider both to be important, right? We have to kind of weigh the scales and see, well, is the ketosis really getting in the way of an exercise program for you?

Dr. Bredesen: Right, right.

Ryan Glatt: And if so, you just need to back off a little bit there, maybe down-regulate the emphasis on ketosis, get you into this exercise program and make that more of a steady exposure process if you will, and go a little bit slower with it perhaps. That’s mostly where ketosis comes into play. If they’re already in ketosis and tolerating it very well, and they’re already active to some degree, and we’re just slowly up-regulating either the frequency, intensity duration and, or type of exercise, once again, it’s a lot of experimentation just like it can be with nutrition to see if we can make sure we can avoid suboptimal symptoms and respond.

Dr. Bredesen: Hmm.

Ryan Glatt: And make sure we can get that person to be successful and feel good, because not only can it be psychologically overwhelming for these people to take on all these behaviors at once, but it can also be biologically overwhelming.

Dr. Bredesen: Yeah.

Ryan Glatt: And so with ketosis and exercise, they kind of come with a biological punch and there’s pros and cons to that. And so we just gotta.
,
Dr. Bredesen: Right.

Ryan Glatt: Just trust the process, it depends.

Dr. Bredesen: Yeah. So Julie, let me come to you for a moment here. You have been.

Julie Gregory: okay.

Dr Bredesen. You really have a gift with looking at when you add or subtract something, what is the effect on your cognition on your overall feeling, which I think has been tremendously helpful in continuing to improve, improve, improve. So if you were there, could you tell us then what sort of exercise if any, what were the ones that really gave you the feeling of, you know, this has really given me a boost, this has really helped me the most, this is something I want to continue to do?

Julie Gregory: You know, it’s funny, all different kinds of exercise benefit me in different ways.

Dr. Bredesen: Yeah.

Julie Gregory: One thing that I find so healing is spending time in nature.

Dr. Bredesen: Mm-hmm.

Julie Gregory: So, I do an hour walk every day, I do about four miles. And when I say walk, I’m doing some HIIT work in there. So I’m running when I feel like it, and I’m walking, you know. I just find that incredibly healing, just spending that time in nature, because as you know, I spend the rest of my day behind a desk inside. So getting outdoors I think is just amazing. When I pick up the high intensity, I notice a difference.

Dr. Bredesen: Yeah.

Julie Gregory: Like if I do a little exercise trick sometimes, I’ll do 100 steps of walking, 100 steps of jogging and then 100 steps of running. And I do that for the whole four miles. That is amazing, when I get home, my brain’s on fire. The other thing that I love to do is strength training. With strength training, I feel very different afterwards. And as you know, I began doing strength training with Kaatsu ever since COVID, I got kicked him out of my gym, essentially, which I miss very much, but I’ve kind of upped my game by using the Kaatsu bands. And that’s been really remarkable. I feel very different afterwards. And so that’s something I try to do about three or four days a week.

Dr. Bredesen: Yeah.

Julie Gregory: I also like to do rebounding. I have a little mini trampoline in my office.

Dr. Bredesen: Hmm.

Julie Gregory: It gets the lymphatic system going. So it’s something I can do literally between meetings, you know, I mean jump for 15 minutes or so. But I think we all sit too much, so I just try to walk around for ten minutes out of every hour, whether it’s doing.

Dr. Bredesen: yeah.

Julie Gregory: House chores or jumping on my rebound or whatever.

Dr. Bredesen: Yeah.

Julie Gregory: I also do yoga. I love the mind body connection …

Dr. Bredesen: Yeah.

Julie Gregory: Pilates I adore, I don’t have a good instructor at the moment, if you know of a good virtual resource, Ryan, let me know.

Ryan Glatt: Sure, well, I know I was just reading that Apple Fitness Plus is now coming out with Pilates classes.

Julie Gregory: Oh, good.

Dr. Bredesen: That’s interesting.

Julie Gregory: I miss that …

Dr. Bredesen: Yeah.

Ryan Glatt: Yeah.

Julie Gregory: Yeah, it’s been hard since COVID, I think a lot of us, had to completely change what we were doing.

Dr. Bredesen: Yeah, we suffered with that, the last third of the clinical trial was during the pandemic, and so all these people.

Julie Gregory: Mm-hmm.

Dr. Bredesen: Who were doing so well, you know, no longer went to the gym, they really changed.

Julie Gregory: Yeah.

Dr. Bredesen: So definitely we could see that in the analysis. But this brings up so many interesting questions. So Ryan, let me come back to you for a minute, what about people when they say, well, look, I want to do the exercise you recommend me, but I’d really like to include creatine or ALCAR, you know, Acetyl-L-carnitine or other sorts of things that will support. Of course, some people like to take exogenous ketones as another way to go. Do you have favorite ones? Do you have things that you like to see people on or things that you would like to see people not be on?

Ryan Glatt: You know, I wouldn’t say I have any favorites, I’m following the literature, and I say, well, wow, look at the cognitive benefits that creatine is having.

Dr. Bredesen: Yeah.

Ryan Glatt: And for women, especially older adults, I guess that’s a great thing and people could consider taking that. It’s not necessarily within my scope of practice to recommend or prescribe it.

Dr. Bredesen: Sure.

Ryan Glatt: But really whatever the doctor is going to prescribe and whatever the nutritionist would like to do, I’m going to be in favor of. I think any of these ergogenic aids or compounds in addition to exercise are fantastic. Anything we can do to create more trophic support is going to be great. Anything we can do to have that person feel more energy to enhance recovery. I have seen some people where sometimes those compounds can get in the way of recovery.

Dr. Bredesen: Yeah.

Ryan Glatt: Maybe extended muscle soreness, which we really got to troubleshoot and triage with the medical team there. But certainly things like caffeine, creatine, of course having your omega’s, having some of the compounds that help with inflammatory control. I’d like to think that could be incredibly helpful.

Dr. Bredesen: Yeah.

Ryan Glatt: And I’m talking about exercise in isolation. We don’t need to dive into diet, I think you do that much better than I and quite well, and quite comprehensively. We of course know that sleep is very important so any compounds that help with sleep and recovery, but also, I believe helped with the cognitive benefits and then the recovery as the result of exercise.

Dr. Bredesen: Thank you. So we often tell people, great to get outdoors for one thing, you’re away for many mycotoxins, which are so incredibly common indoors unfortunately. You’re out there, you’re getting your vitamin D and you’re getting your sun exposure, but at some point now, especially for those of us who were in the California fires and Northwest fires for that matter and so many other areas where there can be pollution, do you have a cutoff? You know, I always check every day and typically we’re running, you know, 50 60 here, today it happens to be 115. So it’s actually a relatively polluted, air polluted day here in Northern California. Do you have a point where you say, you know, what do your exercise inside if it’s above X in terms of the pollution outside?

Ryan Glatt: Yeah. I don’t have a specific number cut-off, but I’d say anything in the moderate range, I’d be weary of.

Dr. Bredesen: Yeah.

Ryan Glatt: I’m attracted and relate to the benefits of exercising outdoors. I actually haven’t seen any studies that compare the cognitive benefits of exercising indoors versus outdoors either. So I wouldn’t be too attached to it. I think exercising outdoors certainly has its pros and cons. I wouldn’t say that exercising outdoors and then risking the, consuming some sort of pollutants just because they’re outside is worthwhile. Of course we want tp consider healthy skin, we don’t want anyone to get melanoma because they only exercise outdoors. There’s also a greater fall risk associated with exercising outdoors, depending on the individual. If the person has more significant cognitive decline and they have wandering behaviors, that might not be a good idea.

Dr. Bredesen: Right.

Ryan Glatt: Or they have a issue splitting their attention with Parkinson’s or dementia and their data’s also affected, there’s various considerations there.

Dr. Bredesen: Right.

Ryan Glatt: So, it really does depend, I always say if there’s issues or risks with pollutants or the sun or the environment, go ahead and stay inside and always have sort of modality of exercise as a backup, as a plan B inside. And so this.

Dr. Bredesen: right.

Ryan Glatt: Is like common sense, but common sense is not always common practice and that there’s plenty of people who stopped walking outside here in Santa Monica, not because of the weather, not because of anything else, except they were afraid to walk near people because of COVID risk.

Dr. Bredesen: Yeah.

Ryan Glatt: And so, they just got afraid and they stayed inside, and they had no modalities inside for exercising. And so maybe getting an exercise bike or an exercise machine, or some sort of remote or virtual based fitness intervention would help alleviate that concern.

Dr. Bredesen: Absolutely. Yeah, and make sure that you’re not in grizzly bear country before you go outdoors.

Ryan Glatt: Hmm.

Dr. Bredesen: And start running around.

Ryan Glatt: That’s right.

Dr. Bredesen: So, okay. So one of the thing that before we get to the questions, there’s some excellent questions here, but last thing I wanted to ask you about is wearables. And I know certainly Julie has talked a lot about her wonderful experience with wearables. I use my Apple Watch and look at HRV and the nocturnal oxygenation and all these sorts of things all the time, VO2 max. And in fact, I could see when I got COVID. the VO2 max really declined and then started back up again. So are there specific wearables that you like to see people using or that you like to work with for exercise?

Ryan Glatt: Yeah, I wouldn’t say one wearable for me is preferred over the other. The Apple Watch, I mean, apple is just amazing what they do, and they clearly have hostile takeover in terms of wellness in mind. And I just use hostile.

Dr. Bredesen: Yeah.

Ryan Glatt: Clearly, I’m joking, but they’re addressing wellness extremely well. I think.

Dr. Bredesen: Yeah.

Ryan Glatt: Each wearable device has its own pros and cons. And if we’re going to use a device, it’s got to be coachable information in my mind. And so there’s more dashboards coming out that allow this information to be presented differently, to be more coachable, if someone presents with a wearable, I’m not going to say, get rid of that one and get this one, instead, I’m going to use what we have available to coach those behaviors. I love the Apple Watch for its ability to close the rings and track HRV and predict VO2 max, and all the things you just said, whatever information they’re willing to share with me, I will try to coach them and modify their program based on that information. I think being able to just simply track intensity, low, moderate, and high intensity is so big for people. And it sounds so easy and so obvious that the complexities of the Apple Watch is like, oh, it’s too basic. But people are still very much stuck as what a moderate intensity feels like and what it looks like in compared to their heart rate. A lot of people don’t know that that’s a basic competency that I think needs to be in place and that we need to teach people using wearables. And because that’s such a basic read of low, moderate to high intensity, I think a lot of wearables can do that quite well.

Dr. Bredesen: Yeah, absolutely. And do you have a timing where you say, I want you to get above X, like 70% or whatever of your maximum heart rate? Do you have a time that you want them to stay in that range?

Ryan Glatt: To a degree, I think, the research shows that with the, if we’re looking to perform aerobic exercises for instance, we have that 70 to 80% of heart rate max or VO2 max, and realistically, most people are not going to get those tests done. Those calculations are complex, they’re difficult and then even when you do those calculations, you’re going to find research sort of opposing the accuracy of those calculations. But there’s been so much research on RPE, that one to 10 scale, showing that if you have a six to eight out of a 10, well, that’s a 60 to 80% of your max, right?

Dr. Bredesen: Yeah.

Ryan Glatt: That’s actually a lot easier for me to coach because not only is it a reliable measure, there’s some considerations, sometimes people are inaccurate, they overestimate, typically they overestimate how much they’re doing, but if you start to kind of, well, let’s reassess that, this is a six, now how would you rate it, so on and so forth.

Dr. Bredesen: Right.

Ryan Glatt: Keeping a sense of what a moderate might really feel like and look like according to a wearable perhaps. Individuals with cognitive impairment for instance, they might be a little inaccurate in terms of their estimation, but also if we overwhelm them with these calculations and numbers, that may not lead to adherence in their behaviors and they kind of get overwhelmed a little bit. So if they have the willingness and the capacity to take on that information, I’ll give it to them. But I kind of make them ask for it first before I impose it upon them and then I just use the talk test or the RPE as the measure. And it also, if you don’t have a wearable, you can use that as well. So I try to think about what’s the most behaviorally sound metric I could give them to enhance the likelihood that they’ll exercise at an intensity, that research shows it will elicit brain benefits, but they won’t be overwhelmed.

Dr. Bredesen: Yeah.

Ryan Glatt: To answer your question in terms of duration in these different zones, certainly 20 to 30 minutes minimum within the moderate zone seems to have the most reliable benefits on cognition and brain health. There’s unique benefits to high intensity interval training, for example, compared to moderate, it seems to enhance processing speed more than moderate, but then if we look at the average of intensities over all modalities of exercise and their benefits on brain health and cognition, for some reason, moderate seems to come out on top. And I don’t know if it’s because it’s truly superior or if it’s just the most researched, like the aerobic exercise is as a modality. and then in terms of duration, I’d say about 20 to 60 minutes is that range, it’s a wide range, but I think that’s a good thing because it gives people a lot of flexibility. I like to use units of 30 minutes, and if people have a hard time sustaining a moderate intensity for 30 minutes, that’s where I will invite the benefit of interval training. Where it actually allows them more rest periods.

Dr. Bredesen: Hmm.

Ryan Glatt: And even if it’s not high intensity, it’s not HIIT, but it’s MIIT, moderate intensity interval training.

Dr. Bredesen: Yeah.

Ryan Glatt: Certainly, better than nothing, especially if it allows for those alternating elevations in heart rate, if it allows them to complete it for 30 minutes and get that feeling that you were explaining, Julia, that improvement of those acute psycho-neurophysiological benefits that people could feel as a result of that training.

Dr. Bredesen: Yeah. So before we get to the question, sorry, one final thing, which I think is critical to talk about before we do that, you have two people come to you, similar symptoms, let’s say they both have a SCI. So have got some subjective cognitive impairment, one of them has a BMI of 30, the other one has a BMI of 17 and a half. What are you going to say differently to these two people in terms of how to get going on exercise?

Ryan Glatt: You know, this is interesting. I think just as you said, well, people with vascular concerns, we’re going to recommend aerobic, people with metabolic and flexibility or insulin resistance, we’re going to recommend resistance training. However, there’s more research coming out showing that sometimes resistance training might have superior cardiovascular benefits than aerobic training. This is kind of rocking the exercise science world a little bit.

Dr. Bredesen: Yeah.

Ryan Glatt: Like what, doesn’t X equal Y? Doesn’t aerobic equal aerobic adaptations? And the answer is yes, but when it comes to insulin resistance and metabolic flexibility and cardiovascular adaptations, once again, resistance training is having its moment sometimes showing superiority. And so with BMI, we think, well, weight loss, right? We want to lose weight. You got to do aerobic exercise, but resistance training has its place as well. Now, the neuromotor or coordinative category, what could be the value of that for BMI? That might work on the frontal executive systems directly because it’s a coordinative motor exercise type activity, well, sometimes when you’re engaged in activity, especially when that social, especially when you enjoy it, you might actually have increased energy expenditure because you’re engaged in the activity.

Dr. Bredesen: Right.

Ryan Glatt: Maybe you’re competing, maybe you’re feeling accountable, maybe you’re just in this flow state, you’re having so much fun, you find yourself exerting more energy.

Dr. Bredesen: Yeah.

Ryan Glatt: That often happens. And so for that individual with a BMI of 30, I probably try to get them on some sort of multimodal aerobic and resistance, because that’s going to be more successful than just one modality alone.

Dr. Bredesen: Yeah.

Ryan Glatt: So, that research of multimodal training for preventing cognitive decline and reducing dementia risk isn’t just for the central nervous system, it also seems to be helpful for weight loss and cardiovascular outcomes. For that individual with a BMI of 17, you know, in terms of things like frailty, we really want to prevent frailty and resistance training certainly has its benefits there. Resistance training with protein supplementation has a great amount of evidence for preventing and even improving the condition of those that are frail. And so that’s.

Dr. Bredesen: yeah.

Ryan Glatt: Probably what I consider is, and I look at other factors as well, not just their BMI, I’d want to look at levels of fitness, both strength, endurance and cardiovascular fitness, and there’s different tests for doing that. And you could give me some additional data, but it really does depend, but that’s probably what I’d say if I just was looking at BMI with SCI.

Dr. Bredesen: Yeah. Fantastic, all right, thank you. So let’s the three of us take some of these wonderful questions here, so Tim says my long high intensity walks daily may have been to my cerebral benefits. Absolutely, and I know Tim is continuing to do the right things and sustaining improvement, which is great. So thank you for that Tim.

Rajia says, I assume that dance would be so helpful for brain health, but it turns out walking is much more effective. Now, obviously they’re doing two different things there and then of course it depends a lot on what kind of dance you’re talking about. What would be your comment on dance versus walking?

Ryan Glatt: Yeah, I would say, my stance on these modalities is that one is not better than the other, I’d say they all offered their unique benefits and how can we identify which of those benefits are we as an individual looking for. And the more data you have, the more you can figure that out, the imaging and cognitive testing blood labs, BMI, other anthropomorphics, your preferences, what you enjoy, what you have access to, et cetera. And so I would never say one is better than the other.

Dr. Bredesen: Yeah.

Ryan Glatt: I’d say both are important and both have their unique value propositions. So dance, lots of evidence for dance and lots of evidence for walking. I’d say you could pick one, you could do both. They.

Dr. Bredesen: Yeah.

Ryan Glatt: Probably have different cognitive benefits. I don’t know if there’s enough research to support that, but it depends what you’re doing while you’re walking, where you’re walking, whom you’re walking with, when you’re doing dance, is it more social than the walking? Are you walking with friends and that’s why you enjoy it more? Lots to talk about there.

Dr. Bredesen: Yeah. And then Gia is asking about the three types that you mentioned, and of course, you’ve talked about resistance, you talked about aerobic and you also talked about coordination, or as you mentioned, neuromotor.

Ryan Glatt: Mm-hmm.

Dr. Bredesen: So, you know. things like ping pong or something that’s really gonna get your hand-eye coordination to be good as well.

Ryan Glatt: Yeah, just to better define that neuromotor category.


Dr. Bredesen: Yeah.

Ryan Glatt: It’s actually two sub-categories, there’s ones that are more metabolically demanding, that could be any sport like ping pong or table tennis or tennis, any racket sport, actually the sub study of the Framingham heart study found that individuals who played racket sports tend to live longer than those that only did gym-based activities and.

Dr. Bredesen: Okay.

Ryan Glatt: Theories out there, is it socioeconomics? Is it that the fact it’s cognitive and social? Is that that there’s greater cognitive or cardiovascular benefits? I thought that was interesting. But then there’s the other subdivision of neuro motor, which is that mind body category, which is yoga, Tai-Chi, Pilates, Qigong, all of it show great cognitive benefits, great neuro-biological benefits and great cardiovascular benefits, even though they’re not cardiovascularly demanding. So once again, X does not always equal Y.

Dr. Bredesen: Yeah, great point. And it’s interesting, we’ve talked about the metabolic subtypes and because we want to know how to target this, are we targeting more of the insulin resistance? The vascular, et cetera? There’s also of course, subtypes based on radiology and there is more of a temporal lobe type. And this again, gets back to the sort of thing that you talk about with the different types of exercise, which really fits in very nicely.

Ryan Glatt: Yeah. And with the temporal lobe stuff, I’d say that I asked my recommendations and aerobic exercise and just daily physical activity, number of steps.

Dr. Bredesen: Yeah.

Ryan Glatt: That has been correlated to temporal lobe volume. I think sedentary behavior has been correlated to medial temporal lobe atrophy, and of course, so much research on aerobic exercise in the hippocampus and the temporal lobes. Interestingly enough, once again, with resistance training, there are certain sub-fields of the hippocampus that resistance training seems to affect positively as well.

Dr. Bredesen: Yeah. Linda says, I love doing choreographed workouts that require coordination like less, I don’t know if this is Les Mills power jump or if this is French.

Ryan Glatt: Yeah.

Dr. Bredesen: Les Mills power jump but I presume it’s Les Mills.

Ryan Glatt: Les Mills. Les Mills.

Dr. Bredesen: Bar and body step. Les Mills bar also requires balance. I tend to exercise for about 60 to 90 minutes a day. Fantastic Linda. It sounds like she’s doing the right thing.

Ryan Glatt: I would also say that Linda, these classes are interesting. they’re typically multimodal in nature, they often consist of balance, some coordination, some strengths, some aerobic, and each program, the sort of different licensed programs, Zumba, Les mills, they all have different types of classes and sometimes people have their favorites and I’ll try to coach variability within their favorite sort of types of classes. And also 60 to 90 minutes, that’s a good amount of minutes there, you’re probably well over the 300 minutes a week. In addition, there’s coordination involved, and when we’re following an instructor, especially with learning new movements that’s cognitively demanding, but I also challenge people to directly work on their memory by seeing if they can memorize choreography. And so it’s not to say that if you’re not doing that, that you’re not getting memory benefits, but we talk about cognitive training and exercise, especially these neuromotor exercises should and can be recognized as a form of cognitive training. You’re just active while you’re doing it. And so with the different types of dance for instance, there’s more skill based dance, like salsa or ballroom, there’s more cardio based dance like Zumba, there’s more choreography heavy dance, which might act more on the memory systems. So I think even with dance, we could come up with an individual prescription. We just need more evidence, and we need to understand who that individual is and what their specific goals are.

Dr. Bredesen: Thank you. So Susie has, my mother walked three times for years, three miles for years, and it didn’t change a thing for her cognitive decline, this is the first I’ve heard about being a threefold thing. Yeah, I think this is a common thing. I think it’s really important to set the record straight, people will say, so-and-so did you know one thing and it didn’t seem to make a difference. Absolutely.

Ryan Glatt: Right.

Dr. Bredesen: This is why we’re saying you have to identify all the different pieces and then you have to go after those, target those. And yes, this is something new that people hadn’t gotten a cognitive decline to turn around before this. So you really want to make sure it’s not just one thing, and as Ryan’s talking about here with the three different approaches, very, very helpful. Now she’s asking here, when you’re doing all three, what’s the time commitment required that would really make a difference if you’re going to be doing all three?

Ryan Glatt: Yeah, once again, as long as we hit that 150 to 300 minutes, that’s the minimum, pretty much any activity would count for those minutes. The interesting.

Dr. Bredesen: Yeah.

Ryan Glatt: Comment on, the walking comment is very interesting. You know, I often think that, okay, here’s an MCI patient or a dementia patient and I look at their exercise history and they’ve been just walking. I think they might experience worsen cognitive decline without the walking, but you really can’t help but think, could we have done better? And there’s pros and cons to that type of thinking, you just got to do what you got to do. Or they’ve been working with a trainer for five or 10 years and they’ve been doing the same thing and there’s no novelty there, there’s no learning, there, there’s no variability in the different types of exercise there. And maybe that walking wasn’t intense enough where we just did one type, but we didn’t resistance training or a neuromotor category. Yes, martial arts would fall into the coordination part. I find that when I talk about martial arts with older adults, there tends to be a gut reaction, either they used to do it and they no longer do it or they think of, oh, that’s not for me. But if you look at a rock steady boxing classes for Parkinson’s or I mean, I think self-defense for older adults is awesome and it’s really about the motor.

Dr. Bredesen: yeah.

Ryan Glatt: The social, the metabolic components that come from it, but also Tai-Chi is considered a martial art, it’s a softer martial art. So yes, martial arts would fall into the coordination aspect.

Dr. Bredesen: Yeah, great point. And there’s, you and I talked briefly before we came on here, Parkinson’s has been another area where a huge gains for people doing exercise, it seems to be another key area.

Ryan Glatt: And also that’s skill-based category on neuro motor coordination skills, synonymous, Dr. Giselle Petzinger’s work at USC, she’s finding that individuals who participate in skill based modalities, which include dance, which include Tai-Chi, which include ping pong, which include boxing, they’re all in that neuromotor category seem to have these really positive benefits for individuals with Parkinson’s. If you look at things like powertrain or PWR, Parkinson’s wellness regeneration training, they harness those elements of external focus of social, of cognitive, of philosophy, of aerobic demand. And so, interestingly enough, this multimodal prescription of exercise could be modified to help people with neurological conditions like Parkinson’s and that’s what the research is starting to show.

Dr. Bredesen: Yeah, this is fascinating because all these things linked together, we think neurophysiological and neuroanatomical terms, we think of Alzheimer’s as really being a disease of neuroplasticity, it’s synaptoblastic to synaptoclastic ratio where the synaptoclastic ratio is too high. When we switch over to Parkinson’s, it’s the same concept, but it’s a different subsystem. So now we’re really talking about a motor control, it’s not so much about neuro-plasticity, it’s really about motor control, which is why you walk more slowly, you have tremors, you can’t hold things quite as steadily, you fall down more easily. It is about motor control. And the critical piece there for its synaptic loss is really in that case about mitochondrial complex one, and again, there’s a whole system that works together with protein degradation, et cetera, but the focus there is on mitochondria. So you’re right, you’re really training a different piece. It’s different trophic factors, it’s different neurotransmitters, there is some overlap in fat and insulin resistance, common to both of them, for example, inflammation common to both, but then they each have their own unique aspects.

Ryan Glatt: The other thing about that Dr. Bredesen is that there’s some really interesting systematic reviews coming out on the differential effects of neuromotor exercise on the basal ganglia.

Dr. Bredesen: Yeah.

Ryan Glatt: Which are those effects versus aerobic training where aerobic training has beneficial effects on the basal ganglia, as well as the cerebellum, those more posterior regions of the brain responsible for motor control and coordination. And it does make sense, this is probably a sensical X equals Y relationship where activities that require and train and stress motor control, any neuro motor exercise, like dancing, racket sports, other sports, martial arts, improve both cognitive and motor symptoms in Parkinson’s. But that systematic review has also showed that neuromotor exercise affects the basal ganglia more significantly than aerobic exercise. So even without Parkinson’s.

Dr. Bredesen: Interesting.

Ryan Glatt: Without Parkinson’s. So there’s been a lot of individuals that I’ve seen that present with MCI. There’s no hippocampal atrophy beyond the normal for their age, but there’s basal ganglia and sometimes unilateral cerebral atrophy. They’re doing aerobic exercise, but they’re not doing anything in the neuro motor or coordination category. So that I’m thinking neuro-biological chicken of the egg, regardless.

Dr. Bredesen: Yeah.

Ryan Glatt: Let’s start doing some sort of neuro motor activity.

Dr. Bredesen: Absolutely. And then Gia says, I’ve never heard of using creatine outside of muscle weightlifting, so using for neural support is new to me. I’ll look that up, great. Some recent interesting studies on cognition. Julie, have you ever used Creatine and your overall program?

Julie Gregory: No, but I am intrigued.

Dr. Bredesen: Yeah.

Julie Gregory: I’m going to give it a try.

Dr. Bredesen: I am as well.

Ryan Glatt: I mean, happy to send over some of that research, it’s relatively new information for me as well. And I think this kind of supports the biases we have about things like resistance training. Oh, that’s for meatheads, that’s for boys, that’s for athletes, that’s for the, you know, we got to get rid of these biases, especially when there’s such powerful interventions for brain health. And I guess creating comes with that package of assumptions as it did for me. So I’ve been taking it myself now. Yeah.

Dr. Bredesen: You know, it’s interesting, again, coming back to the test tube, what this disease looks like as we’ve been talking about is essentially an insufficiency in a neural network. And it’s a complicated neural network, which supports plasticity. And if you look at this as an insufficiency where you’ve either got too much demand or too little supply, this makes perfect sense with creatine supporting this overall, and the energetics of this network. Next one here is from Chan Tat Hom from Singapore. And welcome to Chan, he says, I’m a practicing medical doctor from Singapore, my work focused on coaching people to modify lifestyle habits, to combat chronic lifestyle-related diseases, individual level and community level. Just want to thank you for being an inspiration to me personally. Thank you very much. I was over in Singapore just a few years ago, actually talking to the group there about whether there could be a national approach to reducing dementia. And actually it was the vice chairman’s wife who had, of Singapore who was very interested in reducing this overall. So yes, I think this would be a fantastic place because there is such good health, such excellent healthcare in Singapore. So a great place to institute approaches that will reduce the global burden of dementia. And he says also a simple short video walking to combat dementia that I did in January. Fantastic, it went viral, fantastic. Yeah. I mean, this is going to reduce the burden of dementia in Singapore. Share my thoughts on this surprise, viral walking to combat dementia in my Facebook post. Great. And yeah, we really appreciate your mentioning this and you know, we’re all looking for, how do we build a program that is not going to be saying, okay, you have to have a million dollar program for each person, that’s just not feasible. How do we build essentially a hierarchical program that does basics for everybody, and then the few people.

Ryan Glatt: Mm-hmm.

Dr. Bredesen: Who slipped through the cracks, okay, then you’re gonna do more extensive evaluation. And then the few people that slip through those cracks, you get to the point that.

Ryan Glatt: Yes.

Dr. Bredesen: The last couple of people you actually have them go in hospital, the reality is we should be able to build a program that would make it so that dementia is truly optional. That’s the goal.

Ryan Glatt: 100% agree.

Dr. Bredesen: Yeah, so thanks very much for your comments. And Ryan at PNI where you are, do you guys have a community program for reducing dementia?

Ryan Glatt: We’re working on that, I currently run a program called “The Fit Brain Program”. I’m kind of working as people’s brain-based personal trainer in some ways where we have a brain gym where we use Exert Gaming and combined cognitive motor dual tasking technologies like virtual reality. I was also in Singapore a couple of years ago.

Dr. Bredesen: Hmm.

Ryan Glatt: Presenting for a company called Smart Fit, which is a big board with different touch base targets with brain games, think about BrainHQ with your body, essentially. And so I’ve worked with these different technologies, it’s a very exciting emerging area of research. However, I try not to plug it because a lot of people when they hear about it, I’m very good at preaching about the different benefits that research is starting to show, but they often jump past that bottom of the pyramid. I agree with you that we’ve got to set the bottom of the pyramid, what is the basic program for most people? And that is the multimodal exercise program. And sometimes I’ll tell people, look, there’s more evidence for dance than for what I’m doing here. We’re trying to contribute to that body of literature, but we want to act like an investment banker for you and invest in the things that are going to give you a most confident return and …

Dr. Bredesen Right.

Ryan Glatt: With more novel modalities, even for what I do, I say, let’s get to that at the top of the pyramid, not the bottom.

Dr. Bredesen: Absolutely.

Ryan Glatt: If it’s appropriate for everybody. I do have a professional training program that teaches health and fitness professionals, health coaches, and sometimes medical professionals on the benefits of exercise in the brain and how to create a multimodal program that’s individual for the people that you serve, and it’s called the Brain Health Trainer Program, which I’m sure we can plug again at the end there.

Dr. Bredesen: Yeah. So just a couple more questions here, Linda’s saying she likes a Polar chest strap to look at which zone she’s in. Do you ever use that?

Ryan Glatt: Yeah, I’ve used the Polar Some people don’t like the chest strap, sometimes a very simple reason is sometimes older adults either have trouble taking on and off certain clothes and limited shoulder mobility, they don’t like the feeling of the chest strap. So it’s really based on preference and upper extremity mobility and how long it takes them. I’ll use a Scosche armband, which can actually go on the forearm, which is just fine as well. Certainly a chest strap is going to be more accurate, so if you’re what I call a zone freak, meaning you’re really dedicated to measure zones.

Dr. Bredesen: Yeah.

Ryan Glatt: That’s going to be the best, but it’s nothing to really freak out over. If you can use some sort of watch, a ring, something on your armband, that’s fine too, and once again, RPE is sufficient for most people.

Dr. Bredesen: Fantastic. Mary Beth says I’ve chosen Peloton for getting in my cardio every day, in addition, cycling offers strength training, which has been amazing. Brain fog lifted after I started Peloton, great to be able to work out at home anytime. Couldn’t agree more Mary Beth and you know, one of the big issues here is the current standard of care is you wait and wait and wait, and people say, there’s not much you can do, so just wait. When we want to switch that to just the opposite, brain fog is a critical thing for people to recognize, recognize your good days and your bad days. We all know that when we haven’t slept all night, the brain is just not the same. So, learn to recognize these and definitely things that improve brain fog are helping you to cut off cognitive decline and of course, to improve your normal cognition. So it’s a huge thing to recognize and congratulations to you.

Ryan Glatt: And good job using technology, I mean.

Dr. Bredesen: Yeah.

Ryan Glatt: Peloton is great for some people, they’re actually getting into the gaming side of things now, they’re developing a rhythm based Exert Game. I think it’s called Lanes. And it’s interesting.

Dr. Bredesen: Hmm.

Ryan Glatt: To see how they’re incorporating a more cognitively demanding aerobic exercise game into their platform. I’m really excited to see them get into gaming after gaming specifically, and maybe just on a note on technology as a whole, there’s of course, Peloton, its other competitors, there’s things like Mirror or Tonal out there, there’s things that don’t rely on what we call smart fitness equipment. And they, online fitness programs, virtual fitness programs, I’m not going to do any specific product placement, but Silver Sneakers is changed to this model. 24 hour fitness has changed this model. There’s other specific online exercise programs for older adults for strength training, there’s one specifically for Parkinson’s called Daily Dose Parkinson’s or dailydosepd.com in which I call it the Netflix for Parkinson’s, they have cognitive training, boxing, dancing, hand exercises, face exercises. So I mean the ingenuity and the creativity coming out because of these needs are really incredible. We have a lot of patients who have what I call technological tolerance, meaning they don’t mind buying and setting up the technology, connecting to Wifi and troubleshooting, they can handle it.

Dr. Bredesen: Yeah.

Ryan Glatt: Now Parkinson’s patients that have bought an Oculus Quest to virtual reality headset, and every day they do ping pong and boxing and meditation in virtual reality. And I’m finding that to be very helpful for their exercise programs, it’s cognitively demanding, they expend a lot of energy, they play with friends who live across the country. I mean, it’s tremendous what technology is doing, especially for penetrating wellness and sort of our niche of brain fitness, if you will.

Dr. Bredesen: Yeah, fantastic. All right, and then Susie is asking, Julie, would you talk more about your resistance training?

Julie Gregory: Right, so I just do a basic strength training routine, but I do it with the Kaatsu bands. So I generally start with arms, put that Kaatsu band between the deltoid and bicep, and you put it fairly tight, and I do curls to exhaustion, three sets. I do a lot for triceps. I do a lot for shoulders. Then I move on to legs, put the Kaatsu bands at the very top of your legs, add squats, lunges, leg extensions, wall sits, and so on. Then I keep the leg bands on, and I do a whole core routine. So I try to hold plank a few times for a minute and do other core exercises, and by the end of it, it’s about 30 minutes, I’m exhausted. But the great thing about Kaatsu is that you can do lighter weights. So whereas when I was in the gym, I had access to much heavier weights and machines because the Kaatsu puts a certain demand on your muscles because you’re cutting off a part of your blood supply, increasing nitric oxide.

Dr. Bredesen: Yeah.

Julie Gregory: You can do much lighter weights and get a very similar benefit.

Ryan Glatt: And also, we want to restrict the amount of time those are on for, I think people.

Julie Gregory: Definitely.

Ryan Glatt: Kaatsu, they think more, the better.

Julie Gregory: No.

Ryan Glatt: I always recommend consulting with a physical therapist or a personal trainer.

Dr. Bredesen: Yeah.

Ryan Glatt: Who is certified in Kaatsu or a similar methodology for proper instruction. There’s certainly a lot of DIY stuff out there, but I’ve been hearing more about people, very well-intentioned, very excited about the potential benefits, but there could be some deleterious effects if you’re not using the right protocol with those.

Julie Gregory: Re safety concerns with Kaatsu, I’m gonna link an article that I wrote about this. It puts all the cautions in there.

Ryan Glatt: Great.

Julie Gregory: And gives you the time limits and all that too. That’s fantastic, yeah.

Dr. Bredesen: All right, well, thank you, Ryan, thank you so much, this was enlightening and really fantastic. Julie, thank you so much as always for your tremendous experience. We really appreciate that. And your user-friendly approaches, we really appreciate that. Thank you to both of you and we look forward to seeing everyone next time.

Ryan Glatt: Thanks so much.

Julie Gregory:  Thanks, bye bye.

Dr. Bredesen:  Thanks. Thanks again.