Exercise, Brain Health, and Dementia: What the Research Says

Everyone knows that exercise improves your physical well-being. It helps you fit in your jeans and open pickle jars. It can lift your mood and your sex drive. More recently, researchers have shown how exercise improves our brain’s ability to reason, concentrate, and remember. A 2013 research review concluded that exercise improves brain function in children and adults. New brain imaging technology has documented the positive changes that occur in our brain when we exercise. A more recent research review looked at exercise, cognition, and normal aging. It found clear evidence that exercise helps our brains stay healthy as we age.

But what about the impact of exercise on people with dementia? A recent Cochrane review examined studies on exercise and Alzheimer’s disease. They found 17 studies involving a total of 1,067 participants. The studies looked at whether exercise could improve Alzheimer’s symptoms. Some of the studies measured cognitive tasks like memory, reasoning, and spatial abilities. Others looked at psychological function, behavior, mental health, and the ability to do daily activities. The studies used a wide variety of exercise programs and lasted for different amounts of time. Combined results from six studies showed that patients who exercised were better able to do daily tasks, but no firm conclusions could be made since the studies were small and the results variable. There was no evidence of improved thinking, behavior, or psychological or mental health.

Why the difference between this review and the findings on normal aging? It is possible that bigger, better studies will show that exercise improves brain function in dementia. The reviewed studies on normal aging included more than 33,000 subjects, over thirty times as many as the Alzheimer’s studies in the Cochrane review. It is also possible that whatever causes Alzheimer’s is not affected by exercise. Unfortunately, extensive research has yet to find a cause, cure, or effective long-term treatment for Alzheimer’s disease. However, studies have shown that diabetes and heart disease both increase your risk of dementia. More research is needed on exercise, Alzheimer’s, and other forms of dementia. But if you are worried about your risk, both the Alzheimer’s Association and the National Institute on Aging recommend making exercise a part of your daily routine.

TENS and Pain Relief: The Shock that Soothes

Thousands of years before the first battery or light bulb, our ancestors began using electricity to help patients heal. What was their power source?  One of many species of electric fish that exist throughout the world. In 43 CE Scribonius Largus, physician to Emperor Claudius, recommended putting a torpedo fish on your head to cure even the worst headache. When the first electricity-producing machines were built in the 18th century, many were used to treat a wide variety of ailments. Today, transcutaneous electrical nerve stimulation, or TENS, is increasingly used to help relieve pain. Unlike an electric eel, TENS devices give patients a mild “tingly” sensation via electrodes on the skin. In 2014 the FDA approved the first TENS device designed to help prevent migraines.  A Cochrane team recently reviewed existing studies on TENS and pain relief to determine what we know about its effectiveness for treating acute pain.

The review team found 19 studies using TENS to treat acute pain associated with surgery, injury or medical procedures. The sources of pain in the reviewed studies ranged from rib fractures to blood draws. Some of the studies compared TENS to no other treatment. Others compared it to pain medication or other pain treatments. Six studies compared TENS to a placebo, or “fake” TENS treatment in which no current was delivered. The reviewers found that TENS was more effective than a placebo in treating acute pain. However, many of the studies were small and had problems with design and reporting. Therefore, the reviewers made clear that these findings were tentative. Although some people reported mild itching or discomfort, no serious harms from TENS were reported. The reviewers concluded that TENS may offer a promising option for managing acute pain.

If you are interested in trying TENS for a pain condition, talk to your healthcare team about whether TENS might be an option for you. Some pain specialists may be able to lend you a machine to try before you buy.  TENS devices range widely in price, so make sure you research all your options.  The National Health Service in the UK offers many more useful TENS tips in its online guide to home TENS use.    More research is needed on the effectiveness of TENS for both acute and chronic pain. We may find that although the TENS device has changed, Scribonius Largus’ prescription for pain relief still holds true today.

 

Cannabis for Cancer: What the Evidence Tells Us

Since 1995, the U.S. death rate from cancer has dropped 23%.  We have more treatment options than ever before to help cancer patients live longer.  But along with cancer cells, these treatments can also kill day-to-day well being. According to the NIH, about half of all cancer patients experience nausea and vomiting caused by cancer treatments. Over 90% report a big impact on their quality of life.  Although many anti-nausea drugs are now available, they often don’t work.  Only half of all patients on these drugs experience relief from their symptoms. Despite its illegality, many cancer patients turn to cannabis (marijuana) to ease their stomach. But does it actually help? A recent Cochrane review looked at the evidence on cannabis and chemotherapy-caused nausea and vomiting.

The reviewers identified 23 studies looking at the how effective cannabis was at reducing nausea and vomiting in chemotherapy patients. Most found cannabis to be more effective than a placebo (fake drug). Many also found it to be as effective as anti-nausea drugs. Overall, the review found promising evidence that cannabis can help. But cannabis side effects caused problems for many patients. Not surprisingly, patients using cannabis reported higher levels of dizziness, euphoria, and “feeling high”. A number of patients withdrew from the studies due to these side effects.

All of the reviewed studies were done between 1975 and 1991. In the early 1990’s, changes in drug laws led to a dramatic decrease in cannabis research. Since that time many new anti-nausea drugs have been developed. This means that the reviewed studies only compared cannabis to older, possibly less-effective drugs. Many of the studies also had design and reporting problems. The reviewers called for more high-quality studies comparing cannabis to newer drugs.

So if you are a cancer patient struggling with chemotherapy, is cannabis an option for you? If you live somewhere that medical or recreational marijuana is legal, the answer could be yes. However, this decision should only be made in partnership with your cancer care team. You also should consider how the side effects might impact your day-to-day functioning. The American Cancer Society offers an online guide to cannabis and cancer treatment. Like many medical organizations, the American Cancer Society has called for an easing of legal restrictions on medical cannabis research. With more research, we may identify new ways to use this ancient treatment to help improve well-being for millions of people now living with cancer.

Improving Cancer Comfort: Can Massage Help?

This year about 1.7 Americans will be diagnosed with cancer.  Many will turn to massage to help manage their symptoms.   For thousands of years, massage has been used to help humans feel better.  Scientists have found that friendly touch makes pleasure hormones rise and stress hormones fall.  But can massage be an effective treatment for cancer side effects?

A recent Cochrane review looked at whether massage could relieve pain and anxiety and improve quality of life in cancer patients. Eight studies (678 participants) in the review looked specifically at aromatherapy massage. Aromatherapy massage uses massage with essential oils such as lavender, rose or chamomile to promote healing and relaxation. The studies compared aromatherapy massage to no massage or to massage with carrier oils.

While some studies showed that aromatherapy massage was helpful for pain, anxiety, and quality of life, other studies did not show this. The available information on aromatherapy massage was low quality because the studies were small and different studies gave different results. The studies were also not well conducted. The researchers concluded that there is currently no reliable evidence that aromatherapy massage can relieve physical or mental symptoms or improve quality of life in people with cancer.

Does this mean that cancer patients should not use massage? Not at all. Cancer can rob you of even simple life pleasures. The comfort of a caring touch and the aroma of scented oils can provide welcome relief. Massage is widely available, relatively affordable, and appears safe. It is possible that additional, larger and better-conducted studies will reveal new evidence linking massage to cancer symptom relief. In the meantime, for a general sense of well-being, a massage can be just what the doctor ordered.

Easing the Ache: Acupuncture for Tension Headaches

Dull, aching pain. Tightness across your scalp. Sore neck and shoulders. These are the familiar symptoms of a tension headache. Up to 78% of the U.S. population reports having tension headaches, making it the most common form of headache. For most of us, tension headaches are an occasional problem. But frequent headaches can make every life activity more difficult. These frequent headaches can be especially hard to treat. Long-term use of either over-the-counter or prescription painkillers can have serious side effects. But a recent Cochrane review found that acupuncture may be able to help ease the burden of frequent headache sufferers.

The reviewers found twelve studies that compared acupuncture to one or more non-acupuncture treatments for tension headache. Together they involved 2349 participants. Two studies compared acupuncture to usual treatment, four studies compared acupuncture to a physiotherapy, massage or relaxation treatment, and seven compared true acupuncture to “fake” acupuncture. In “fake” acupuncture the needles did not go into the skin or were not put in the right places.

Researchers consider comparing true acupuncture to ‘fake’ acupuncture to be the best way to discover whether the effects of acupuncture treatment are due to needles in the skin at acupuncture points, or due to something else (such as belief in the treatment). In the studies comparing true and “fake” acupuncture both treatments cut headache frequency. But true acupuncture was more effective than “fake” acupuncture. With true acupuncture the proportion of people having their number of headaches cut in half was 52 out of 100. With “fake” acupuncture the proportion of people having their number of headaches cut in half was 43 out of 100.  People getting true acupuncture also had about 2 more headache-free days each month, compared to people getting “fake” acupuncture.

The two studies comparing usual treatment to acupuncture were very different from each other. Because of this, although people getting acupuncture were more likely to cut their headache rate by half or more in both studies, the researchers couldn’t make definite conclusions about how helpful acupuncture might be. Studies comparing acupuncture to physiotherapy, massage or relaxation didn’t have any useful information. However, based on the comparison between true and “fake” acupuncture, the researchers concluded that acupuncture may be a useful option for treating frequent tension headache.

Many national acupuncture professional associations now offer directories to help you find a trained and licensed practitioner. If cost is an issue, low-cost or sliding scale programs may be available. Before trying acupuncture, check with your medical team to make sure it will be safe for you. But if tension headaches are robbing you of life’s enjoyments, acupuncture may offer a way to improve your health and ability to enjoy life.

Lungs, mind, and breath: The positive effects of yoga on asthma

If you don’t have asthma yourself, you almost certainly know someone who does. Over 300 million people worldwide suffer from asthma’s shortness of breath and fatigue. Even with medical treatment, asthma can take a big toll. Over half of all children and a third of all adults with asthma miss school or work each year due to their disease. A recent Cochrane review suggests that yoga may be a promising way to improve health and well-being asthma patients.

The reviewers identified 15 studies involving 1048 patients. Five looked only at yoga breathing exercises. The other studies included breathing, posture, and meditation. All of the studies compared yoga to either regular care, no care, or “sham yoga”. The studies measured health impact in a variety of ways. Some looked at lung function or amount of medications used. Some tracked rates of bad events like hospital visits. Others looked at overall measures of health like reported symptoms and quality of life.

The reviewers found significant evidence that yoga improves quality of life and reduces asthma symptoms. There was a small amount of evidence that yoga might also reduce the need for asthma medication. Overall, the reviewers concluded that yoga probably improved health and well-being for asthma patients.

There are still many unanswered questions about yoga and asthma. More studies are needed on how yoga affects lung function and medication usage. But unlike other asthma treatments, doing yoga can be free, rarely causes side effects, and may have other mental and physical benefits. Yoga can be tailored to your health status and fitness level. Before trying yoga, you should check with your doctor about any special precautions. But whether you roll out your mat at your health club or your living room floor, yoga may offer a new way to help you breathe easier.

Omega-3 for Dementia: What Cochrane Evidence Shows

As we get older, many of us worry about the confusion, memory loss, and other challenges that come with dementia.  About 5 million Americans over age 65 are now living with Alzheimer’s disease.  Right now, there are very few available treatments for slowing down or halting the progress of the disease. One supplement sometimes recommended for brain health is omega-3 fatty acids. These fats come from foods like fish, vegetable oils, nuts, flax seeds, and leafy vegetables. They play a key role in normal brain growth and health.  A Cochrane team recently looked at the evidence to see whether omega-3 fatty acids could help improve brain function in people with dementia.

The reviewers found three studies enrolling 632 people with mild to moderate Alzheimer’s disease. In each study, the participants were randomly assigned to take either an omega-3 fatty acid supplement or a placebo (a pill with no medicine). After six months, both groups took a variety of tests to measure brain function. The tests measured learning and memory, quality of life, and mental health. They also tested how well people could perform simple everyday tasks. None of the studies showed that taking omega-3 supplements had any impact on these areas. The reviewers concluded that there is currently no evidence that omega-3 fatty acids can improve brain health in patients with mild to moderate Alzheimer’s disease. For those of us not yet diagnosed with Alzheimer’s disease, more research is needed to show whether omega-3 fatty acids might play a role in its prevention.

So what can you do to keep your brain as healthy as possible? The National Institute on Aging offers a number of tips for protecting your brain as you age. These include exercising daily and eating a healthy diet. Connecting with other people and doing activities you enjoy may also help keep your brain young. Many scientists are working on identifying new treatments to prevent or cure dementia. But for now, these simple steps may help you stay healthy, active, and connected.