Exercise doesn’t slow progression of dementia

Exercise doesn’t slow progression of dementia

“‘Surprising’ study suggests exercise may make dementia worse,” reports The Daily Telegraph.

A trial in which people with dementia took part in a moderately intense exercise programme for 4 months found their mental decline did not slow and may even have worsened faster than in people who did not take part in the programme.

The disappointing results are a setback for researchers, who had hoped an exercise programme might improve people’s ability to carry out everyday tasks such as washing and dressing. They said they cannot exclude the possibility that exercise may have made dementia worse, although the differences in decline were small.

While the exercise programme did improve people’s physical fitness, at least in the short term, it did not improve their quality of life or ability to care for themselves, or the quality of life of those caring for them.

It’s important to note this does not change what we know about exercise’s ability to protect against dementia. People who exercise more are less likely to get dementia, possibly because it maintains blood flow to the brain.

However, once the brain has been damaged by dementia, exercise may not help prevent further damage.

Read more about how a healthy lifestyle may help lower your dementia risk.

Where did the story come from?

The study was carried out by researchers from the University of Oxford, Warwick University, Coventry and Warwick Partnership Trust, and John Radcliffe Hospital in Oxford. It was funded by the National Institute of Health Research and published in the peer-reviewed British Medical Journal on an open-access basis, so it’s free to read online.

The research received wide coverage in the UK media. While some of the headlines were a bit alarmist – such as The Independent’s “Exercise could make dementia progression worse not better” – most of the reports were balanced and accurate.

What kind of research was this?

The researchers carried out a randomised controlled trial (RCT), which is usually the best way to see if a treatment works.

People taking part in RCTs usually do not know whether they’re in the treatment or control group, but this was impossible to hide for an exercise study.

What did the research involve?

Researchers invited people who had mild to moderate dementia and were living in the community (not in a nursing home) to take part in the study. They were recruited through memory clinics – specialist services that help people who have problems with their memory – and GP surgeries. Carers were asked to take the decision on behalf of people whose dementia meant they were unable to.

The 494 participants were randomly assigned to either the control group (165 people), who continued with all usual care, or the exercise group (329 people), who underwent an exercise programme as well as usual care.

Participants’ memory and thinking abilities were tested at the start of the study, then after 6 months and 12 months, using the Alzheimer’s disease assessment scale cognitive subscale (ADAS-cog). ADAS-cog uses a series of tests designed to assess cognitive functions such as memory, language abilities, understanding and reasoning.

Researchers also assessed people’s behaviour, quality of life and ability to carry out everyday tasks. Those taking part in the exercise programme had their physical fitness measured at the start of the programme and again after 6 weeks.

The exercise programme consisted of 4 months of twice-weekly 60- to 90-minute gym sessions. These included:

  • cycling at moderate intensity on an exercise bike
  • using free weights
  • standing up from sitting using a weight belt

Exercises were tailored to the person’s health and abilities, and were designed to improve cardiovascular fitness and strength.

Researchers adjusted the results to account for age, sex, mental ability at the start of the study and where the person was being treated.

What were the basic results?

After 12 months, people who had taken part in the exercise programme had slightly worse results for memory and thinking abilities than the control group.

ADAS-cog results run on a scale from 0 to 70, with higher scores suggesting greater impairment. The usual-care group had an average score of 23.8, compared with 25.2 for the exercise group (adjusted estimate -1.4, 95% confidence interval [CI] -2.6 to -0.2).

There was no difference between the groups in terms of behaviour, quality of life, ability to carry out everyday tasks or numbers of falls (which can be a cause of injury in people with dementia).

The physical fitness of the exercise group improved over the first 6 weeks of the exercise programme, as measured by the 6-minute-walk test. After taking part in the programme, people were able to walk 361.8 metres on average, an improvement of 18 metres.

How did the researchers interpret the results?

The researchers said their exercise programme “does not slow cognitive decline in people with mild to moderate dementia”. Although it improved short-term physical fitness, this “did not translate to improvements in activities of daily living, behavioural outcomes or health-related quality of life”.

Regarding the question of whether exercise might worsen dementia, they noted that those who did the most exercise had worse outcomes, saying it was “possible” the programme may have worsened mental abilities. However, they added that it was uncertain “whether the effect on cognitive impairment we observed is important”.

Conclusion

This was clearly a disappointing result for the researchers, who were hoping exercise could be recommended as a treatment for people with dementia on the NHS. It comes after a number of small studies looking at exercise for people with dementia had conflicting results.

The present study clearly showed this type of fairly intensive, gym-based physical-fitness-building programme does not seem to slow dementia symptoms in people already in the early stages of the disease.

However, that does not mean other gentle exercise – such as walking or dancing – is not appropriate or helpful for people with dementia. One factor not measured was whether people with dementia enjoyed the exercise. Enjoyable activity, be it in the gym or elsewhere, is worthwhile in its own right, regardless of whether it slows people’s dementia symptoms.

More than a third of the people invited to take part in the study declined, and 60% of the participants were men, which is unusual in dementia studies because more women than men have the condition. This suggests the type of exercise programme may not have been particularly attractive, particularly to women with dementia.

The study was well designed but had some limitations:

  • fitness was measured only in the exercise group and only once during the programme
  • everyone in the study knew which group they were in, as did 25% of the assessors carrying out the cognitive tests
  • numbers of falls were gathered by asking carers at 6-month intervals, not by recording them in a diary, meaning they may have been underreported

While the study did not find any benefit for dementia patients, this does not mean exercise is not useful for people without dementia. There’s good evidence that keeping active and taking physical exercise may reduce the chances of getting the condition by around 30%.

Find out more about the benefits of physical exercise.

Dez Bryant Doesn’t Regret Passing on Ravens’ Contract Offer, Criticizes Media

Dez Bryant Doesn’t Regret Passing on Ravens’ Contract Offer, Criticizes Media
ARCHIVO - En esta foto del 17 de diciembre de 2017, Dez Bryant, receptor de los Cowboys de Dallas, conduce el balón en un partido ante los Raiders de Oakland (AP Foto/Eric Risberg, archivo)

Eric Risberg/Associated Press

Free-agent wide receiver Dez Bryant said Tuesday that he doesn’t regret his decision to not sign with the Baltimore Ravens earlier this offseason.

Additionally, Bryant blasted the media and said he has been portrayed as someone who’s “not easy to get along with.”

NFL Network’s Ian Rapoport reported in April that the former Dallas Cowboys wideout turned down a multiyear offer from the Ravens due to his preference to sign a one-year deal instead.

Dallas released Bryant last month after eight seasons with the team.

Baltimore is no longer an option for Bryant since the Ravens signed Willie Snead to an offer sheet and the New Orleans Saints didn’t match it.

With Snead, Michael Crabtree and John Brown occupying the top three spots on Baltimore’s receiver depth chart, Bryant isn’t a logical fit anymore.

The 29-year-old veteran has struggled in recent years with no 1,000-yard seasons to his credit since 2014.

Although Bryant is a three-time Pro Bowler and the Cowboys’ all-time leader in touchdown receptions with 73, he isn’t the same explosive player he was earlier in his career.

As quarterback Dak Prescott’s No. 1 option last season, Bryant finished with just 69 receptions for 838 yards and six touchdowns.

On Monday, Bryant’s former Cowboys teammate Jason Witten said on The Adam SchefterPodcast (h/t Zach Kruse of USA Today) that he believes Bryant will sign with the Green Bay Packers.

Bryant would boost an already formidable Green Bay offense by joining forces with receivers Davante Adams and Randall Cobb, as well as tight end Jimmy Graham.

Bryant is the most accomplished wideout still available in free agency, and there is a market for him as teams figure out where they stand in terms of their receiver depth charts.

CIA nominee says she doesn’t believe torture works

CIA nominee says she doesn’t believe torture works

Deb Riechmann and Kevin Freking, The Associated Press


Published Thursday, May 10, 2018 8:46AM EDT

WASHINGTON — President Donald Trump’s CIA nominee said during her confirmation hearing that she doesn’t believe torture works as an interrogation technique and that her “strong moral compass” would prevent her from carrying out any presidential order she found objectionable.

Under questioning Wednesday by members of the Senate Intelligence Committee, acting CIA Director Gina Haspel said she would not permit the spy agency to restart the kind of harsh detention and interrogation program it ran at black sites after Sept. 11. It was one of the darkest chapters of the CIA’s history and tainted America’s image worldwide.

Senators asked how she would respond if Trump — who has said he supports harsh interrogation techniques like waterboarding and “a hell of a lot worse” — ordered her to do something she found morally objectionable.

“I would not allow CIA to undertake activity that I thought was immoral, even if it was technically legal,” said Haspel, a 33-year veteran of the agency. “I would absolutely not permit it.”

When asked if she agrees with the president’s assertion that torture works, Haspel said: “I don’t believe that torture works.” She added that she doesn’t think Trump would ask the CIA to resume waterboarding, which simulates drowning.

In a tweet late Wednesday, Trump gushed: “Gina Haspel did a spectacular job today. There is nobody even close to run the CIA!”

Haspel, vying to become the first female CIA director, faces what will likely be a close confirmation vote in the full Senate.

While she has deep experience, her nomination is contentious because she was chief of base of a covert detention site in Thailand where terror suspects were waterboarded. There also have been questions about how she drafted a cable that her boss used to order the destruction of videotapes of interrogation sessions conducted at the site.

After the hearing, Republican Sen. John McCain of Arizona, a leading voice against harsh interrogation, issued a statement urging his colleagues to vote against Haspel’s confirmation.

“I believe Gina Haspel is a patriot who loves our country and has devoted her professional life to its service and defence. However, Ms. Haspel’s role in overseeing the use of torture by Americans is disturbing. Her refusal to acknowledge torture’s immorality is disqualifying,” said McCain, who was detained and beaten in prison during the Vietnam War.

He is at home in Arizona while battling brain cancer and is not expected to be able to vote. While it’s unclear what effect McCain’s stance will have on Haspel’s confirmation, his views carry clout as a voice of principle from the only senator now serving who has been held captive during wartime.

Protesters disrupted the hearing shouting, “Prosecute the torturers!” and “Bloody Gina!” Haspel remained stone-faced as police escorted them out of the room.

“I realize that there are strong disagreements on the effectiveness of the CIA’s detention and interrogation program,” Haspel wrote in answers to more than 100 questions submitted by committee members and released at her hearing.

“In my view — a view shared by all nine former directors and acting directors — the CIA was able to collect valuable intelligence that contributed to the prevention of further terrorist attacks. That said, it is impossible to know whether the CIA could have obtained the same information in another way,” she wrote.

She also said there is little question that the program harmed CIA officers who participated and that it damaged U.S. relations with allies.

Being in the public spotlight is new for Haspel. She spent more than 30 years working undercover, acquiring secret information from dead drops and at meetings in dusty back alleys of third-world capitals.

Still, the 61-year-old intelligence professional portrayed herself as a “typical middle-class American” with a “strong sense of right and wrong.” She said she was born in Kentucky as the eldest of five children. While her family has deep roots there, she grew up as an Air Force brat, following her father to postings all over the world.

She staunchly defended her role in the 2005 destruction of the videotapes. She said that she never saw the videos and was not depicted on them, but that the destruction was important at the time to protect the CIA personnel showed on the tapes from being targeted by militants. She said, however, that she would not support destroying them today.

The Justice Department investigated the destruction of the tapes, but no charges were filed. Six Democratic senators wrote Attorney General Jeff Sessions on Wednesday saying that all senators should be able to see the Justice Department’s investigative report on the destruction of the tapes. The Democrats wrote that they “believe that no senator can consider Ms. Haspel’s nomination in good conscience without first reviewing this document.”

The CIA investigated too. Last month, the CIA released a 2011 memo summarizing a disciplinary review conducted by then-CIA Deputy Director Mike Morell. He said that while Haspel was one of the two officers “directly involved in the decision to destroy the tapes,” he “found no fault” with what she did.

While the CIA director technically reports to the director of national intelligence, Haspel would be the face of the nation’s top spy agency and a top Trump adviser. She has received strong backing from former top intelligence officials and most Republicans. Sen. Joe Manchin, D-W.Va., also announced his support Wednesday. But Sen. Angus King, I-Maine, who announced he will vote against Haspel, and several Democrats on the committee said they thought she was not as forthcoming in her responses as they had hoped.

Haspel’s opponents outside Congress include Amnesty International and Human Rights Watch.

More than 100 former U.S. ambassadors who served both Republican and Democratic presidents sent the Senate a letter opposing Haspel, saying that despite her credentials, confirming her would give authoritarian leaders around the world the license to say U.S. behaviour is “no different from ours.”

The CIA director position opened up after Mike Pompeo was named secretary of state.