How Exercise Reduces Risk of Alzheimer’s Disease

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By Tanya Thakur, MBBS

Alzheimer’s disease (AD) is one of the most devastating illnesses among older adults. The disease not only degrades memories but also affects one’s independence and takes a toll on family members.

AD is a progressive neurodegenerative disorder caused by the accumulation of abnormal misfolded protein deposits in the brain, including beta-amyloid plaques, tau tangles, and Hirano bodies. These deposits disrupt normal neuronal function, leading to the gradual loss of memory, cognitive skills, and, eventually, the ability to carry out daily activities.

AD is the most common cause of dementia, accounting for approximately 60 to 80 percent of cases. Presently, an estimated 6.7 million individuals in the U.S. have AD. In 2019, Alzheimer’s was ranked as the sixth leading cause of mortality among individuals aged 65 and above. Notably, between 2000 and 2019, while fatalities from stroke, heart disease, and HIV declined, deaths related to Alzheimer’s increased by more than 140 percent.

Even though scientists are working toward curing AD, we can take preventative measures by incorporating healthy habits, such as regular exercise, into our routine.

“It is a common misconception that we have minimal control over our risk of developing Alzheimer’s disease. However, nearly half of the Alzheimer’s cases could have been prevented or delayed by modifiable factors, including lifestyle changes,” says Sarita Khemani, MD, Clinical Associate Professor of Medicine and Neurosurgery Hospitalist at Stanford University. “Therefore, we should do everything in our power to incorporate healthy lifestyle habits as early as possible.”

The Link Between Exercise and Alzheimer’s Disease

There are many things we can do to reduce our risk of developing dementia. Several research studies have concluded that physical activity is one of the best ways to reduce risk significantly. For example, after analyzing 16 studies on exercise and dementia, the Alzheimer’s Society found that regular exercise reduces the risk of developing dementia by 28 percent and, specifically, AD by 45 percent.

The connection between the brain and aerobic exercise is likely due to neuroplasticity, which is the brain’s ability to adapt and form new neural connections or strengthen the existing ones. During aerobic exercise, our brain expresses cAMP response element binding (CREB) proteins that influence the transcription of synaptic genes, including those encoding for brain-derived neurotrophic factor (BDNF). BDNF supports neurogenesis (the formation of new neuron cells), neuroprotection, and angiogenesis (the formation of new blood vessels). BDNF also increases the volume of gray matter and the hippocampus (the site of memory in the brain).

Physical activity also serves as a potent modulator of other health risk factors, including hypertension, hypercholesterolemia, and insulin resistance, all of which increase the risk of developing dementia. Vascular damage caused by atherosclerosis can accelerate the cognitive decline associated with AD due to reduced blood and oxygen flow to the brain, leading to hypoxia of neural cells.

“Brain changes associated with Alzheimer’s begin approximately 20 years before symptoms appear,” says Dr. Khemani. “Exercise stands out as one of the most effective strategies for prevention, offering a low-cost, non-pharmacological, and low-risk option accessible to everyone.”

The Best Exercises to Prevent Alzheimer’s

While aerobic exercise increases BDNF levels, resistance exercises, such as lifting weights, are thought to have a greater influence on insulin-like growth factor-1 (IGF-1) levels. IGF-1 is a hormone that manages the effects of growth hormone in the body and is essential for promoting cognitive abilities.

Because aerobic and resistance exercises elicit different neurophysiological changes, studies have indicated that combining both modalities can enhance exercise-induced neuroplasticity to a greater extent than either modality alone.

For example, one study compared the effects of combined aerobic and strength training, aerobic exercise alone, and no exercise on cognitive function among dementia patients. After nine weeks, the combined exercise regimen yielded the most pronounced results across cognitive domains. Also, the observed gains in both motor and cognitive areas regressed towards baseline levels more than two months post-intervention, meaning it is essential to exercise regularly to sustain its neurological benefits.

Regarding the type of aerobic exercise most effective for AD prevention, Dr. Khemani recommends incorporating sprint intervals into our workouts. “We encourage our patients to engage in moderate-intensity exercises incorporating some high-intensity interval training, if possible, as these activities have been shown to be more impactful for Alzheimer’s prevention than light exercise alone,” she says.

 

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Jumping into the Ice Bath Trend! Mental Health Benefits of Cold Water Immersion

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By Maya Shetty, BS

Key Takeaways

  • Research shows that cold water immersion (CWI) may improve mental health by increasing endorphin and norepinephrine levels. 
  • CWI may also improve resilience to stress by decreasing cortisol levels.
  • CWI can be adapted to meet different wellness goals, whether for immediate relief or long-term mental health benefits.
    • For individuals seeking a quick boost in mood, daily cold water face immersions and occasional full-body plunges might be beneficial.
    • For those aiming for long-lasting benefits such as lowered cortisol levels, enhanced mood regulation, and increased resilience to stress, research shows that consistent full-body CWI may be beneficial.

Have you ever considered how taking a cold plunge might affect your mental state? Beyond the initial shock, CWI is proving to have profound effects on brain health and mental well-being. Initially popular as a recovery technique among athletes, it has now evolved into a bold wellness practice for those seeking to enhance their overall health. This practice, which involves plunging into cold water (roughly 10-15°C, 50-60°F), has ignited significant research interest, and emerging studies now suggest that CWI can improve mood, decrease stress, and potentially slow the progression of neurodegenerative diseases.

“I personally do cold water immersion and find it to be an immensely rejuvenating activity,” says Stanford Psychiatrist, Vanika Chawla, MD, member of the Lifestyle Medicine Cognitive Enhancement pillar.

CWI can take many forms, each involving its own protocol and equipment. The most common forms include:

  • Ice Baths: Traditionally utilized by athletes for recovery after intense physical activity, ice baths require submerging the body up to the neck in ice-cold water. Also known as cold plunging, this practice generally lasts only a few minutes and involves limited movement.
  • Cold Showers: A more accessible form of CWI, taking cold showers can offer many of the same benefits as ice baths but are easier to incorporate into daily routines.
  • Open Water Swimming: This active form of CWI involves swimming in cold rivers, lakes, or oceans, allowing for longer exposure times to the cold.
  • Cryotherapy Chambers: Though they do not involve water, cryotherapy chambers expose the body to extremely cold air temperatures for brief periods, stimulating a physiological response similar to that achieved through water immersion.

Choosing the type, temperature, and duration of CWI depends on your cold tolerance and the resources available to you. It is generally recommended to aim for a temperature that feels uncomfortable but still safe (no colder than 10°C, 50°F). If you have any form of access to cold water, whether it be a lake, a river, or your home shower and bathtub, you can participate in CWI and begin to explore its benefits.

Can Cold Water Plunges Improve Mental Health?

While the idea of diving into extremely  cold water seems unappealing to most, recent studies have shown that CWI offers emotional benefits. In 2021, researchers recruited undergraduate students to take a 20-minute dip in chilly sea water (13.6°C, 56.5°F) and report their emotions before and after using a Profile of Mood States questionnaire. Compared to controls, the students who engaged in CWI experienced a shift in mood, noting a significant decrease in negative emotions like tension, anger, depression, fatigue, and confusion. Moreover, they experienced boosts in positive emotions such as vigor and self-esteem. Further research involving thirty-three adults new to cold-water swimming highlighted similar benefits. After immersing in a cold bath (20°C, 68°F) for just five minutes, participants reported feeling more active, alert, attentive, proud, and inspired.

These studies, which utilize self-reported questionnaires, indicate that cold-water immersion may significantly enhance mood and overall psychological well-being. It appears to activate traits associated with increased motivation and vitality, while simultaneously diminishing feelings of distress and nervousness. 

How to Lower Cortisol Levels Naturally

CWI presents a unique stimulus for the body, prompting significant shifts in its hormonal stress response, particularly involving cortisol, a key regulator of stress. Unlike other stress hormones such as noradrenaline, cortisol levels remain relatively unchanged during the initial shock of cold water. Research highlights an intriguing aspect of cortisol dynamics: while levels do not significantly change during CWI, they significantly decrease afterward.

For example, a study concluded that a one-hour CWI session, whether in thermoneutral (32°C, 90°F), cooler (20°C, 68°F), or cold (14°C, 57°F) water, did not lead to an increase in blood cortisol concentrations. Instead, cortisol levels tended to decrease across all temperatures tested and remained below initial levels an hour after immersion. These findings suggest that cortisol production is not significantly activated by CWI, contrary to what might be expected under typical stress conditions. In fact, CWI may have potent stress-modulating effects. Further research indicates that cortisol levels remain considerably lower for up to three hours after just 15 minutes of CWI (10°C, 50°F). This pattern of response reveals a sophisticated regulatory mechanism, suggesting that CWI can effectively diminish feelings of stress following a session.

CWI may have the potential to modify our body’s stress response to stressors in everyday life. In a study where participants engaged in winter swimming (water 0-2°C, 32-36°F) for twenty seconds or cryotherapy (-110°C, -166°F) for two minutes, three times a week for twelve weeks, the body adapted remarkably. After just four weeks, participants showed significantly lower cortisol levels post-exposure, with levels continuing to drop in the following weeks. This adaptation contrasted with the noradrenaline response, which remained consistent even as the body became accustomed to the cold stress. This reduced cortisol response not only diminished the stress perceived from cold but also potentially enhanced the body’s capacity to manage other stressors more effectively. 

The main take away from this study is that by reducing cortisol production in response to repeated cold exposure, participants might also release less cortisol in response to other stressors in everyday life, thus fostering a more resilient physiological state over time.

“Resilience is the ability to adapt to life’s stressors and adversities,” says Dr. Chawla. “The body and mind are interconnected, therefore greater physiological resilience may lead to greater psychological resilience as well.”

How Cold Water Immersion Impacts the Brain

CWI has been scientifically observed to influence brain function, affecting mood, stress response, and potentially brain health through several mechanisms. The immediate physiological response triggered by CWI is largely due to the dramatic change in temperature. A dense concentration of cold receptors in the skin detects this change, leading to a surge of electrical impulses from peripheral nerve endings to the brain. This intense stimulation activates various neural pathways, initiating a cascade of chemical responses designed to help the body manage and adapt to the stressor.

During the initial shock of CWI, the body experiences stress and discomfort due to the sudden drop in temperature. To counteract this, endorphins, the body’s natural pain relievers, are released. These endorphins not only reduce pain but also enhance feelings of well-being, akin to the “runner’s high” that often occurs in other physically demanding or stressful situations. 

CWI also activates the sympathetic nervous system (SNS), which controls our “fight-or-flight” responses. This activation leads to a significant increase in noradrenaline (also known as norepinephrine), an excitatory neurotransmitter that not only helps manage stress but also boosts energy and focus. The surge in noradrenaline increases blood flow to the brain, potentially causing feelings of euphoria.

These two neurotransmitters play complementary roles. While norepinephrine prepares the body to handle acute stress by enhancing alertness and readiness, endorphins work to soothe pain and promote a positive mood. This dual response helps individuals cope with the immediate impacts of cold exposure more comfortably and can make the experience of cold water immersion more tolerable–and potentially even rewarding.

Regarding whether CWI has long-term positive effects on the brain, research indicates inconsistent results with respect to the increase of endorphin levels. It is possible that not everyone experiences this endorphin response to CWI, and among those who do, the effect may diminish over time, as the body becomes accustomed to the cold exposure. On the contrary, the increase in noradrenaline continues with each session of CWI, even after the body has adapted after months of regular practice. 

These findings underscore the potential of CWI to be used as a reliable tool for improving energy, focus, and mood. These findings also point to the potential of CWI to be used in the treatment of neurological conditions that involve low noradrenaline, including anxiety and depression. However, more research is needed to understand if CWI has long-term effects on emotional well-being outside the water.

Also, CWI may improve brain function through the release of cold-shock proteins, which are produced by the body in response to cold conditions. Animal studies reveal that proteins like RNA binding protein (RBM3) play a crucial role in repairing and regenerating nerve cell connections after they’ve been exposed to cold. Additionally, studies have demonstrated that over-expressing RBM3 can help prevent neuronal connection loss in mice with neurodegenerative diseases. Although there is limited evidence in humans, these findings in mice suggest that regular CWI could potentially boost the expression of such beneficial proteins in humans, offering protection against or slowing the progression of neurodegenerative diseases by preserving and reinforcing neural connections. 

Reaction to Cold Water: Full-Body vs. Facial Immersion

Physiological responses to CWI differ significantly based on whether the exposure is to the full body or just the face. Full-body immersion exposes a significant surface area to cold, inducing thermal stress that can substantially lower skin and core body temperatures. This extensive exposure activates the sympathetic nervous system, which in turn triggers a release of neurotransmitters and hormones that drive the stress response. Consequently, this leads to vasoconstriction, an increased heart rate, and a heightened metabolic rate, all of which help preserve body heat and maintain core temperature.

In contrast, immersing just the face in cold water activates parasympathetic activity, which is responsible for “rest and digest” functions in the body. This effect is likely due to the mammalian diving reflex—an evolutionary adaptation that optimizes respiration and conserves oxygen by preferentially directing oxygen to vital organs. The diving reflex is mediated by the vagus nerve, which activates the parasympathetic system and releases a sense of calm. The trigeminal nerve in the face also plays a crucial role when stimulated by cold, sending signals that further enhance parasympathetic output, decreasing heart rate, and boosting digestive activity. 

These differences highlight how CWI can be strategically used to target specific physiological responses and therapeutic outcomes, depending on whether the exposure is localized to the face or involves the entire body.

“I sometimes recommend facial cold water immersion to my patients as part of the T in TIPP skills to help people with emotion regulation. TIPP stands for temperature, intense exercise, progressive muscle relaxation, and paced breathing,” says Dr. Chawla. “These skills involve changing your body chemistry to shift emotions. Some people find brief facial immersion in cold water or taking a cold shower to be helpful in shifting their body chemistry and thereby shifting their emotional state.” 

Safety Considerations

CWI can offer several health benefits, but it’s essential to approach this practice with caution due to potential risks. One of the most obvious risks is hypothermia, as immersing in cold water significantly drops body temperature. To prevent hypothermia, limit immersion time to no more than 10 minutes. 

Furthermore, it is important to understand the cold shock response. Entering cold water suddenly can trigger an involuntary gasp reflex followed by hyperventilation. Hyperventilation increases the risk of drowning (especially in open water plunging) and can also lead to arrhythmias or even a heart attack, particularly in those with underlying heart issues. To better manage the cold shock response, it’s advised to enter the water slowly, allowing your body to adjust to the temperature gradually. 

It is also important to never swim alone regardless of your swimming strength or experience. Having a partner ensures that help is readily available in case of an emergency, such as cramps, sudden illness, or difficulty in the water.

Finally, remember to allow your body to gradually acclimatize to whatever CWI technique you choose. If you are a beginner, begin with shorter durations (2 minutes) in warmer water (roughly 20°C, 68°F), progressively moving to colder temperatures with longer durations as your body adapts.

“This intervention is not for everyone. It’s important for people to consider what works best for their individual needs,” says Chawla. “If you are going to try CWI, be mindful of how it impacts your mind and body and incorporate the activity into your routine accordingly.”

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The Impact of Exercise on Brain Health and Preservation

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By Carly Smith, BS, MPH(c) 

The foundation of longevity science exists in a balance of healthy physical, mental, and emotional aging. In the past, researchers have studied these aspects of health as independent subjects, but now scientists emphasize that every aspect of our health is intertwined. One of the major motivations behind the Stanford Lifestyle Medicine movement is to increase awareness of how total health is dependent upon the interactions between the pillars of our lives. 

Recently, members of the Stanford Lifestyle Medicine team collaborated to conduct a systematic review of existing research on “The Role of Physical Exercise in Cognitive Preservation.” The article, which was published in the American Journal of Lifestyle Medicine, responds to a call for more scientific investigations to focus on the prevention of cognitive disabilities associated with old age, such as dementia. 

“After conducting this review, a major takeaway is that we should be motivated beyond physical improvements to continue moving our bodies to promote long-term cognitive benefits,” says Matthew Kaufman, MD, lead author of the review article.

Exercise and the Brain

Both aerobic exercise and strength training are widely researched lifestyle interventions for quality health improvement.The US Department of Health and Human Services (USDHHS) recommends weekly exercise of at least ​​150 minutes of moderate-intensity aerobic exercise and two days of strength training for improving physical and mental health. 

There are multiple proposed mechanisms that define how regular physical activity combats cognitive decay. As you exercise, your heart increases the amount of blood that it pumps out to the rest of the body to compensate for the increased workload. This increase in cardiac output also increases cerebral blood flow, which is linked to heightened neural activity and reduced oxidative stress (or an improved ability to detoxify agents in the body). Another proposed mechanism is the increase in trophic factors (proteins that aid cell survival and growth), such as BDNF, VEGF, and IGF-1. These trophic factors support neuroplasticity (the structural reorganization of the brain to support learning) and angiogenesis (the growth of new blood vessels). Therefore, it is reasonable to promote exercise as a lifelong tool for optimizing brain health.

“It is important to understand the physiology of this relationship in order to maximize exercise regimens for prolonged cognitive benefits and goal setting,” says Dr. Kaufman, current Stanford Physical Medicine and Rehabilitation Resident.  

Key Takeaways from the Systematic Review

After reviewing over 1,600 total studies, 17 met the team’s final criteria for further analytical evaluation. To be included in the final review, studies must have been a randomized controlled trial published after 2000, excluded cognitive impairments more severe than moderate diagnoses, and included at least one physical activity intervention that lasted for 12 weeks or more and followed the USDHHS recommended guidelines. For this review, both aerobic exercise and strength training were included as exercise interventions. The final 17 studies selected for “qualitative synthesis” looked at the relationships of exercise and global cognition, exercise and memory, and exercise and executive function. 

The review team found the largest consensus in the research for improvements in memory for individuals with moderate, mild, or no cognitive impairments following the 12-week exercise interventions. For individuals with mild cognitive impairments, exercise was shown to improve cognition. Although weaker, there was also evidence found for relationships between regular exercise and improved global cognition and executive functioning. Some studies also found significant associations between improvements in physical and cognitive fitness and increases in regional brain volume or blood flow. 

However, included studies that analyzed the lasting effects of exercise following the study indicated a need for continued exercise. Improvements in memory and cognitive health were not always maintained once regular exercise stopped. This suggests the importance of exercise as a long-term principle of lifestyle medicine for adequate prevention of late-stage diseases. 

“Given that our review demonstrates that people did not see lasting benefits after stopping their exercise, the importance of routine exercise to continue reaping benefits is suggested,” says Dr. Kaufman. “It also strengthens our association that exercise interventions can, in fact, improve cognition.”

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How Yoga Affects the Brain and Body to Reduce Stress

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By Vanika Chawla, MD, Stanford Psychiatrist

This blog is part of the Stress Management newsletter. If you like this content, sign up here to receive our monthly newsletter!

As a clinician at the Stanford Lifestyle Psychiatry clinic, I consider the impact of lifestyle factors such as sleep, nutrition, exercise, and mind-body practices such as yoga on my patients’ mental health and integrate these modalities into my treatment plans. I especially have a clinical and research interest in the therapeutic use of yoga as a lifestyle intervention. Yoga has been instrumental in my own wellbeing, therefore I am passionate about sharing the practice as a holistic intervention that promotes wellbeing in the body, mind, and spirit.

I was first immersed in yoga when I completed my 200-hour yoga teacher training in 2010, prior to medical school. I discovered that yoga was much more than physical postures – yoga is an integrative and holistic system of practices that aims to alleviate suffering. 

There are many different lineages and traditions of yoga, each emphasizing various components of the practice, including postures, breathwork, meditation, lifestyle, ethics and values, and recognizing our interconnectedness. There is a famous aphorism that captures the essence of yoga: yogas chitta vritti nirodhah. This Sanskrit phrase translates to, “Yoga is the calming of mental fluctuations or storms of the mind.” Thus, it was no surprise that on my journey to become a psychiatrist, I noticed parallels between yoga and psychiatry, including yoga’s therapeutic potential in addressing unmet needs in our current mental health care treatment models. 

On a personal note, my yoga practice provided me with a set of tools to manage the stresses and rigors of medical training, whether it was cultivating new perspectives when faced with challenges or practicing breathwork before a big exam to help with stress. 

How Yoga Improves Mental Health

While yoga is an ancient practice originating in India, it has only recently been applied for therapeutic purposes, and thus, the clinical evidence is in its early stages. There are many possible mechanisms for how yoga may improve mental health and counteract stress. One well-accepted mechanism is that yoga helps regulate the autonomic nervous system (ANS) and hypothalamic-pituitary axis (HPA), both of which are stress response systems. While stress is an inevitable and necessary part of life, prolonged and chronic stress can lead to dysfunction in these systems, potential negative physiological and physical consequences, and can even contribute to the development of mental health disorders. 

Yoga is proposed to exert its benefits through top-down and bottom-up processes facilitating bi-directional communication between the brain and body. Top-down mechanisms are conscious and intentional inputs from the brain to the body, such as setting an intention to relax. Bottom-up processes are inputs from the body to the brain, where signals travel from the muscles, heart, lungs, and other systems to different parts of the brain. Practices like yoga postures and breathing can change the signals that are carried to our brain, such as assessments of our sense of safety and wellbeing. Through top-down and bottom-up pathways, yoga can counteract the “fight, flight, or freeze” responses that may persistently arise in the face of stress. Accordingly, yoga has been shown to confer several changes in physiological markers implicated in stress, including cortisol, inflammatory cytokines, heart rate variability, as well as the release of neurotransmitters, such as GABA. 

The Neuroscience of Yoga

In addition, there is evidence of changes in both brain structure and function related to the practice of yoga. These include changes in the prefrontal cortex (PFC), amygdala, hippocampus, and default mode network (DMN). The PFC manages our highest-order cognitive abilities, such as decision-making and goal-setting. Stress and other strong emotions can negatively impact the abilities of the PFC. 

Research shows that regular yoga practice leads to increased activation of the PFC and thus may counteract deleterious effects of stress on the brain. Further, yoga impacts the activity of the amygdala, which is involved in processing emotions. Yoga may also increase the volume of the hippocampus, which is involved with memory and learning and is known to decrease in size with age. Finally, the DMN is involved in rumination and mind wandering, which may interfere with cognitive function and lead to decreased wellbeing. The DMN is implicated in many psychiatric disorders, such as depression and ADHD, and yoga has been shown to modulate the activity of the DMN. 

While yoga cannot change our external stressors, it can allow us to respond rather than react to stress. Yoga can counteract the harmful physical effects of stress and lead to changes in the body, brain, and mind that increase resilience and adaptability. 

Tips for People New to Yoga

From Kundalini to Vinyasa flow, there are many different types of yoga, so I recommend those new to yoga try different styles and see which practice aligns with their needs and feels safe and supportive. I suggest taking classes from credentialed teachers (with a minimum of RYT-200 hr training) who offer modifications and adaptations. There are resources like Yoga-X online classes, which provide holistic yoga practices at no cost. If you are seeking yoga for a specific health or therapeutic purpose, then community classes may have limitations. You may instead look for therapeutic yoga classes or yoga therapy in conjunction with support and consultation from your healthcare provider.

 

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Dr. Vanika Chawla’s Journey to Enhancing Mental Health with Yoga

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By Maya Shetty, BS

This blog is part of the Stress Management newsletter. If you like this content, sign up here to receive our monthly newsletter!

Vanika Chawla, MD, FRCPC, a psychiatrist, registered yoga teacher, and member of the Stanford Lifestyle Medicine Cognitive Enhancement pillar, has dedicated her career to improving mental health treatment through innovative and holistic approaches. Her distinctive background, combining both yoga and Psychiatry, offers a unique perspective on the potential of accessible stress management interventions.

“I view yoga as a novel lens for approaching mental health – one that can concurrently complement our existing treatment models and empower providers and patients to expand their therapeutic toolbox,” says Dr. Chawla.

Dr. Chawla works alongside Douglas Noordsy, MD, Assistant Director of Stanford Lifestyle Medicine, at Stanford Medicine’s Lifestyle Psychiatry Clinic. Leveraging her unique blend of medical and yoga expertise, she focuses on innovative approaches to psychiatric care that incorporate lifestyle changes and holistic interventions into her patients’ treatment plans. In addition to her clinical work, she is actively engaged in a 300-hour Yoga Teacher Training program offered through Stanford Yoga-X, which focuses on integrating yoga into health care in an evidence-based yet holistic manner.

“I am so happy to be at Stanford because they are thinking outside the box in terms of how we can support people and enhance their mental health,” says Dr. Chawla. “It’s really cool that I found a place to work that allows me to integrate my lifelong interests in yoga and healthcare.”

Dr. Chawla’s research interests are also centered around yoga as an intervention in mental health. “Yoga is definitely a big research area that has made a lot of progress in recent years, however, significant gaps remain in the current literature,” she says. “Future research is needed to deepen our comprehension of the intricate mechanisms of how yoga affects the brain and body.”

In residency, she was involved in research projects focused on using yoga to address anxiety in children. In 2022, she was one of two recipients of the inaugural Stanford Lifestyle Medicine Seed Grants, securing a $10,000 grant to further her research in the field of Lifestyle Medicine. The project, titled ACTIVATE, seeks to create a digital tool that helps individuals with mental health disorders and make positive lifestyle changes to enhance their psychological and physical well-being.

Originally from Peterborough, Canada, Dr. Chawla completed her undergraduate studies in health sciences at McMaster University in Ontario. Here, she began exploring her interests in the mental health field. Her journey took a pivotal turn during a volunteer trip to India that exposed her to yoga as a cultural practice. This encounter sparked her fascination with the practice, leading Dr. Chawla to complete her 200-hour registered yoga teacher training the following year.

“There is so much more to yoga practice than most people realize. There is such a big psychological and social component,” says Dr. Chawla. “It’s not just the postures. There’s breathing, meditation, ethics, values, connection, and community. It’s such a broad, diverse practice and I was really blown away by that.”

She pursued her medical degree at the University of Calgary and her psychiatry residency at the University of Toronto. During her residency training, she observed parallels between psychiatry, psychology, and yoga. “I began to see how yoga could address many unmet needs in our current mental health care models, bridging gaps where medications and psychotherapy may fall short,” says Dr. Chawla. 

These interests led her to Stanford University, where she found many opportunities in the realm of lifestyle medicine and mental health. 

Looking ahead, Dr. Chawla plans to continue exploring innovative ways to improve mental health interventions through research and medical practice, including best practices for incorporating yoga into clinical care. Her vision includes working with marginalized populations, delivering culturally-informed and trauma-informed care, and ensuring that these interventions are accessible to all. To reach these goals, she plans to continue the development of digital applications like ACTIVATE to reach a broader audience.

“Yoga is a comprehensive system that includes a lot of different practices: movement, breathwork, meditation, community, and more,” says Dr. Chawla. “Because of this, it can be tailored and adapted to what people need, to help people of all backgrounds manage their stress through avenues that work best for them.”

 

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Enhancing Memory Through the Power of Aerobic Exercise

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It is generally understood that exercise is good for our physical bodies, but did you know that exercise can also improve cognitive performance? One such benefit of aerobic exercise specifically is its ability to enhance our memory. There have been a multitude of studies designed to investigate the nuances of this exact phenomenon, including a recent systematic review and meta-analysis.

Aerobic Exercise Improved Performance on Memory Tests

The analysis reviewed nine different studies with patients aged 50 years old and older. Six of the studies used exercise regimens that follow the U.S. Department of Health & Human Services recommendations for aerobic physical activity. These guidelines suggest that all adults should engage in at least 150 minutes of moderate aerobic exercise (like brisk walking or cycling) or 75 minutes of vigorous aerobic exercise (like jogging or dancing) on a weekly basis. In the studies, the type of exercises varied from brisk walking to swimming, but all that met the U.S. guidelines reported “significant and large” effects. It is important to note that the duration of the studies ranged from three months to one year, each with its own unique breakdown of how to meet these total weekly minutes. 

In order to study the link between exercise and memory, there are several  memory tests that scientists can use to test the different aspects of our memory. While most of the included studies chose to observe changes in working and logical memory (important for reasoning and decision-making), some used tests to observe the changes in spatial and episodic memory (remembering information like names, places, and colors). The results of the overall meta-analysis concluded that there was a strong relationship between undergoing aerobic exercise and improvements in memory. 

What is BDNF?

Dr. Doug Noordsy, Head of Cognitive Enhancement at Stanford Lifestyle Medicine, hypothesizes that aerobic exercise improves memory by releasing Brain-Derived Neurotrophic Factor (BDNF), which was discussed in the analysis. BDNF is a protein that is released due to the widening of the blood vessels (systemic vasodilation) that occurs during physical activity. Once this protein reaches our brain through the bloodstream, it aids the longevity and growth of healthy neurons, which are vital for learning and memory processes. Also, exercise turns on specific genes that activate neurotrophic factors like BDNF, allowing us to create additional BDNF as we exercise throughout life. 

So, next time you catch yourself recalling an old story or trying to match a name to a face, remember to move your body and get your heart rate up!

 

By: Carly Smith, BS, MPH(c)

Sources:

  1. Hoffmann et al. “Aerobic Physical Activity to Improve Memory and Executive Function in Sedentary Adults without Cognitive Impairment: A Systematic Review and Meta-analysis“. Journal of Preventative Medicine Reports. Sep. 2021.
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Sauna Use As a Lifestyle Practice

Sauna Use As a Lifestyle Practice

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matt@dripdigital.media

By: Vanika Chawla, MD

Emerging evidence suggests that beyond its use for pleasure, sauna bathing may be linked to several health benefits including cardiovascular, neurological and metabolic benefits. A recent review by Patrick & Johnson outlines evidence of the benefits of sauna use, potential mechanisms of action, and adverse effects and contraindications.  Sauna bathing is characterized by short-term exposure to high temperatures (ranging from 113F to 212F), and there are various forms including “dry” and “wet” saunas which differ in the amount of humidity. 

 

A large study done by Laukkanen et al., examining data from over 2000 middle-aged men in Finland showed that men who used saunas two to three times a week had a 27% reduction in mortality associated with cardiovascular disease compared to those who used saunas once a week, and men who used saunas four to five times a week had a 50% reduction rate in mortality associated with cardiovascular disease. The risk of mortality from all causes was reduced by 40% in frequent sauna users compared to infrequent users! Duration of sauna use was inversely correlated with the risk of cardiovascular disease and coronary heart disease, meaning those who used saunas for longer than 19 minutes had better outcomes than those who used saunas for less than 11 minutes. Results were adjusted for factors such as socioeconomic status. 

 

Many of the physiological effects of sauna use are similar to those elicited during moderate to vigorous-intensity aerobic exercise. Studies show that aerobic exercise in combination with frequent sauna use has a synergetic effect in reducing cardiovascular and all-cause mortality. Exposure to high temperatures stresses the body and this heat exposure induces protective responses that promote cardiovascular health, such as increased heart rate, decreases in blood pressure, and improved blood flow. Heat stress may lead to improved physical fitness by increasing cardiorespiratory fitness, endurance and preserving muscle mass. During exercise the core body temperature rises and heat acclimation from the sauna optimizes the body for tolerating core body temperature elevations during future exercise, as well as supporting other cardiovascular and thermoregulatory functions that are important in fitness and exercise. pThese mechanisms contribute to muscle mass maintenance and prevent muscle loss that can occur with aging.

 

Further analysis of the data from Finland also showed that men who used saunas four to seven times a week had a 66% lower risk of developing dementia compared to those who used saunas once per week. Proposed mechanisms for improved brain health in response to sauna include heat exposure and the subsequent cardiovascular response increasing the expression of brain-derived neurotrophic factor (BDNF), which is an important factor that supports the development of new neurons in the brain, and increased blood flow to the brain. Heat shock proteins also protect against brain disease. 

 

Findings from the study also show that regular sauna users had a lower risk of developing pneumonia and sauna use may bolster the response of the immune system and promote respiratory health. 

 

Caution should be exercised for sauna use in special populations such as pregnant women and children. There are some reports of reduction in male sperm count following sauna use in a 10-person study, but measures returned to normal within 6 months of sauna use cessation. Some contraindications for sauna use include alcohol use, hypotension, recent heart attack, severe aortic stenosis, and altered or reduced sweat function (such as in certain autoimmune or neurological disorders). Proper hydration is recommended prior to and during sauna use. 

 

You may want to consider using a sauna as you cultivate a positive, healthy lifestyle. It can be pleasant and soothing on a cold winter’s day, and may reduce your risk for some upper respiratory infections. There is no clear evidence indicating whether the benefits of sauna are limited to specific climates or seasons, or whether sauna bathing during hot weather confers health benefits. 

References:

Patrick RP, Johnson TL. Sauna use as a lifestyle practice to extend healthspan. Exp Gerontol. 2021;154:111509. doi:10.1016/j.exger.2021.111509

 

Laukkanen T, Khan H, Zaccardi F, Laukkanen JA. Association between sauna bathing and fatal cardiovascular and all-cause mortality events. JAMA Intern Med. 2015;175(4):542-548. doi:10.1001/jamainternmed.2014.8187

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A Metareview of Lifestyle Psychiatry

Unveiling the Impact of Lifestyle Factors on Mental Health

Recent research has elucidated the role of these lifestyle factors – diet, sleep, and exercise, on our minds. Upon finding a link between various mental disorders to these factors, Firth et al., conducted a review and analysis of the top-tier evidence to examine how physical activity, sleep, dietary patterns and tobacco smoking can impact the development and treatment of a variety of different mental disorders.

Broadly, they found evidence that physical activity is helpful for both the prevention and treatment of a variety of mental health disorders and is one of the most extensively researched “lifestyle factors”. They also found that tobacco smoking was a significant risk factor that contributed to people developing mental illness. Poor sleep was also a modifiable risk factor in both the development and worsening of mental health disorders and symptoms, and in the research, a complex two-way relationship between sleep and mental health symptoms is highlighted. More evidence is needed to establish the role of dietary patterns in mental health.

With these findings, the researchers have made recommendations for the integration and delivery of lifestyle interventions in healthcare settings at a broad scale to help people improve their mental health. A few important steps to optimizing mental health and cognitive performance include taking adequate time for exercise, creating an environment conducive to quality sleep, not smoking tobacco, and fueling your mind and body with healthy, whole foods. 

By: Douglas Noordsy, MD and Vanika Chawla, MD

 

Journal References:

  1. Reference: Firth J, Solmi M, Wootton RE, et al. A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry. 2020;19(3):360-380. doi:10.1002/wps.20773
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