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Hernandez-Martinez J, Ramos-Espinoza F, Muñoz-Vásquez C, Guzman-Muñoz E, Herrera-Valenzuela T, Branco BHM, Castillo-Cerda M, Valdés-Badilla P. Effects of active exergames on physical performance in older people: an overview of systematic reviews and meta-analysis. Front Public Health 2024; 12:1250299. [PMID: 38655514 PMCID: PMC11037520 DOI: 10.3389/fpubh.2024.1250299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/29/2024] [Indexed: 04/26/2024] Open
Abstract
This overview assessed the available body of published peer-reviewed systematic reviews and meta-analyses related to the effects of active exergames compared with active/passive control on physical performance outcomes in older people. The methodological quality and certainty of evidence were assessed using PRISMA, AMSTAR 2, and GRADE. The protocol was registered in PROSPERO (code: CRD42023391694). The main outcomes indicate that 4,477 records, five systematic reviews, and 10 meta-analyses were included. The AMSTAR-2 reported six meta-analyses with high methodological quality, four moderate quality, two systematic reviews with low quality, and three very-low quality. Meta-analysis was performed on balance using the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG) tests, on cardiorespiratory fitness using the 6-min walk test, and on upper and lower limbs muscle strength using the handgrip strength, knee extension, and 30-s chair stand tests. Significant differences in favor of the active exergames groups concerning active/passive groups were reported in BBS (SMD = 0.85; 95% CI = 0.12-1.58; I2 = 96%; p = 0.02), TUG (SMD = 1.44; 95% CI = 0.71-2.16; I2 = 97%; p < 0.0001), and 30-s chair stand test (SMD = 0.79; 95% CI = 0.33-1.25; I2 = 88%; p = 0.0008). However, no significant differences were reported in favor of the active exergames groups in 6-min walk (SMD = 0.93; 95% CI = -0.64 to 2.50; I2 = 95%; p = 0.24), handgrip strength (SMD = 0.67; 95% CI = -0.04 to 1.38; I2 = 84%; p = 0.06), and knee extension tests (SMD = 0.20; 95% CI = -0.05 to 0.44; I2 = 95%; p = 0.12) compared to active/passive control. However, it was impossible to perform a meta-analysis for the variables of walking speed as a fall risk due to the diversity of instruments and the small number of systematic reviews with meta-analysis. In conclusion, interventions utilizing active exergames have shown significant improvements in the static and dynamic balance and lower limb muscle strength of apparently healthy older people, compared to control groups of active/inactive participants, as measured by BBS, TUG, and 30-s chair stand tests. However, no significant differences were found in the 6-min walk, HGS, and knee extension tests. Systematic review registration PROSPERO, CRD42023391694.
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Affiliation(s)
- Jordan Hernandez-Martinez
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
- Programa de Investigación en Deporte, Sociedad y Buen Vivir, Universidad de los Lagos, Osorno, Chile
| | - Francisco Ramos-Espinoza
- Doctoral Program in Psychology, Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile
| | - Cristopher Muñoz-Vásquez
- Department of Health, Programa de Prevención y Rehabilitación Cardiovascular, CESFAM Dr. Juan Carlos Baeza, San Clemente, Chile
| | - Eduardo Guzman-Muñoz
- Faculty of Health, School of Kinesiology, Universidad Santo Tomás, Talca, Chile
- Faculty of Health Sciences, School of Kinesiology, Universidad Autónoma de Chile, Talca, Chile
| | - Tomas Herrera-Valenzuela
- Department of Physical Activity, Sports and Health Sciences, Faculty of Medical Sciences, Universidad de Santiago de Chile (USACH), Santiago, Chile
| | | | - Maria Castillo-Cerda
- Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
| | - Pablo Valdés-Badilla
- Department of Physical Activity Sciences, Faculty of Education Sciences, Universidad Católica del Maule, Talca, Chile
- Sports Coach Career, School of Education, Universidad Viña del Mar, Viña del Mar, Chile
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Tuan SH, Chung JH, Tsai YJ, Huang WC, Chen GB, Tsai YJ, Lin KL. Predischarge oxygen uptake efficiency slope has short and long-term value in the prognosis of patients after acute myocardial infarction. J Chin Med Assoc 2024; 87:414-421. [PMID: 38445889 DOI: 10.1097/jcma.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Patients who survive an acute myocardial infarction (AMI) have a higher risk of having a major cardiovascular event (MACE). Cardiopulmonary exercise testing (CPET) could develop prognostic stratification and prescribing exercise prescription. Patients after AMI frequently terminate CPET early with submaximal testing results. We aimed to look at the characteristics of patients' predischarge CPET variables after AMI intervention and find potential CPET variables with prognostic value. METHODS Between July 2012 and August 2017, we recruited patients who survived first AMI after primary percutaneous coronary intervention and received predischarge CPET retrospectively in a tertiary medical center of Taiwan. Patients were followed-up on a MACE or administrative censoring occurred (up to 5 years). To identify significant predictors of a MACE, a Cox regression model was used. RESULTS One hundred thirteen patients (103 men and 10 women) were studied, with an average age of 58.32 ± 12.49. MACE over 3 months, 2-years, and 5-years was 17.70%, 53.10%, and 62.83%, respectively. The oxygen uptake efficiency slope during the whole during of CPET (OUES 100) divided by body surface area (OUES 100/BSA) was found to be a significant event predictor for MACE at 3-month, 2- and 5-years. Cox regression analysis revealed that those with OUES 100/BSA <0.722 ( p = 0.004), OUES 100/BSA <0.859 ( p = 0.002), and OUES 100/BSA <0.829 ( p = 0.002) had a 7.14-fold, 3.47-fold, and 2.72-fold increased risk of 3-month, 2-year, and 5-year MACE, respectively. CONCLUSION It is critical to identify a submaximal predictor during CPET for patients who survive AMI. Our findings suggested that OUES could be a significant prognostic indicator in patients after first AMI in both the short and long term.
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Affiliation(s)
- Sheng-Hui Tuan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Jin-Hui Chung
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan, ROC
| | - Yi-Ju Tsai
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
- Department of Physical Therapy, College of Medicine, National Chen Kung University, Tainan, Taiwan, ROC
| | - Wei-Chun Huang
- Department of Critical Care Medicine and Cardiology Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, National Defense Medical Center, Kaohsiung, Taiwan, ROC
| | - Yun-Jeng Tsai
- Jia Huan Rehabilitation Clinic, Kaohsiung, Taiwan, ROC
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan, ROC
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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3
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Polese JC, Ada L, Lana RDC, Boson K, Faria-Fortini I, Teixeira-Salmela LF. Oxygen uptake efficiency slope in community-dwelling ambulant stroke survivors during walking and stair climbing: a cross-sectional study. Top Stroke Rehabil 2023; 30:246-252. [PMID: 34994300 DOI: 10.1080/10749357.2021.2019177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Oxygen uptake efficiency slope during submaximal tests has been proposed as a more appropriate measure of aerobic capacity after suffering a stroke, since some individuals cannot tolerate maximal exercise testing. However, it has not yet been investigated whether the oxygen uptake efficiency slope is able to differentiate between healthy individuals and those who have suffered a stroke. OBJECTIVES To compare the oxygen uptake efficiency slope during walking and stair climbing between stroke survivors and age- and sex-matched healthy controls. METHODS This is a cross-sectional study in which 18 individuals who had suffered a stroke (stroke survivors) and 18 healthy controls matched for sex and age were included. Oxygen consumption and minute ventilation were collected breath-by-breath during walking (6-min Walk Test) and stair climbing. The oxygen uptake efficiency slope was estimated by the slope of the line obtained through linear regression. RESULTS The stroke survivors had a lower oxygen uptake efficiency slope during the 6-min Walk Test than the healthy controls (MD 498, 95% CI 122 to 873, p = .01). The between-group difference for the Stair Test was smaller and not statistically significant (MD 349, 95%CI -73 to 772, p = .10). CONCLUSIONS Stroke survivors had lower oxygen uptake efficiency slope during the performance of the 6-min Walk Test when compared to sex- and age-matched healthy controls. This suggests that stroke survivors have worse cardiopulmonary capacity.
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Affiliation(s)
- Janaine C Polese
- Post Graduate Program of Health Sciences, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, Brazil.,Department of Physical Therapys, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Raquel de Carvalho Lana
- Department of Physical Therapys, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, Brazil
| | - Karina Boson
- Department of Physical Therapys, Faculdade Ciencias Medicas de Minas Gerais, Belo Horizonte, Brazil
| | - Iza Faria-Fortini
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luci F Teixeira-Salmela
- Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Edmunds KJ, Driscoll I, Hagen EW, Barnet JH, Ravelo LA, Plante DT, Gaitán JM, Lose SR, Motovylyak A, Bendlin BB, Okonkwo OC, Peppard PE. Cardiorespiratory Fitness Attenuates the Deleterious Effects of Sleep Apnea on Cerebral Structure and Perfusion in the Wisconsin Sleep Cohort Study. J Alzheimers Dis 2023; 95:427-435. [PMID: 37545229 PMCID: PMC10810251 DOI: 10.3233/jad-220910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Emerging evidence suggests that age-related changes in cerebral health may be sensitive to vascular risk modifiers, such as physical activity and sleep. OBJECTIVE We examine whether cardiorespiratory fitness modifies the association of obstructive sleep apnea (OSA) severity with MRI-assessed measures of cerebral structure and perfusion. METHODS Using data from a cross-sectional sample of participants (n = 129, 51% female, age range 49.6-85.3 years) in the Wisconsin Sleep Cohort study, we estimated linear models of MRI-assessed total and regional gray matter (GM) and white matter (WM) volumes, WM hyperintensity (WMH:ICV ratio), total lesion volume, and arterial spin labeling (ASL) cerebral blood flow (CBF), using an estimated measure of cardiorespiratory fitness (CRF) and OSA severity as predictors. Participants' sleep was assessed using overnight in-laboratory polysomnography, and OSA severity was measured using the apnea-hypopnea index (AHI), or the mean number of recorded apnea and hypopnea events per hour of sleep. The mean±SD time difference between PSG data collection and MRI data collection was 1.7±1.5 years (range: [0, 4.9 years]). RESULTS OSA severity was associated with reduced total GM volume (β=-0.064; SE = 0.023; p = 0.007), greater total WM lesion volume (interaction p = 0.023), and greater WMHs (interaction p = 0.017) in less-fit subjects. Perfusion models revealed significant differences in the association of AHI and regional CBF between fitness groups (interaction ps < 0.05). CONCLUSION This work provides new evidence for the protective role of cardiorespiratory fitness against the deleterious effects of OSA on brain aging in late-middle age to older adults.
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Affiliation(s)
- Kyle J Edmunds
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Ira Driscoll
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison
- Psychology Department, University of Wisconsin-Milwaukee
| | - Erika W Hagen
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Jodi H Barnet
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Laurel A Ravelo
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
| | - David T Plante
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Julian M Gaitán
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Sarah R Lose
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Alice Motovylyak
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Barbara B Bendlin
- Wisconsin Alzheimer’s Institute, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Ozioma C Okonkwo
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin-Madison
| | - Paul E Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison
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The Pre-Discharge Oxygen Uptake Efficiency Slope Predicts One-Year Cardiovascular Events in Acute Decompensated Heart Failure Patients. Life (Basel) 2022; 12:life12091449. [PMID: 36143485 PMCID: PMC9505351 DOI: 10.3390/life12091449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Heart failure is a complex disease leading to functional disability. Cardiopulmonary exercise testing (CPET) is the gold standard in assessing aerobic capacity and formulating function-based prognostic stratification; however, patients with acute heart failure after medical treatment usually remain with markedly reduced exercise capacity, leading to early termination of CPET with submaximal testing results. The current study aimed to assess the cardiorespiratory fitness and characteristics of CPET variables of patients after acute heart failure treatment and determine potential CPET variables with prognostic value. (2) Methods: We recruited patients during hospitalization after management of acute heart failure, and pre-discharge CPET was performed. All enrolled patients were followed for one year for major adverse cardiovascular events (MACE). (3) Results: 85 patients were enrolled, with average left ventricular ejection fraction of 30.52%, and peak oxygen consumption of 10.85 mL/min/kg at baseline. The one-year MACE was 50%. Oxygen uptake efficiency slope (OUES) was a significant event predictor, with lower one-year MACE in those with OUES ≥ 1.25 (p < 0.001). Cox regression analysis showed a 5.421-fold increased risk of MACE in those with OUES < 1.25 (p = 0.004). (4) Conclusions: The current results suggested OUES is a significant prognostic indicator in patients with acute heart failure. This also emphasized the critical role of CPET in patients with heart failure for prognostic stratification.
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Vesperman CJ, Wang R, Schultz SA, Law LL, Dougherty RJ, Ma Y, Oh JM, Edwards DF, Gallagher CL, Chin NA, Asthana S, Hermann BP, Sager MA, Johnson SC, Cook DB, Okonkwo OC. Cardiorespiratory fitness and cognition in persons at risk for Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12330. [PMID: 35845261 PMCID: PMC9270660 DOI: 10.1002/dad2.12330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 01/25/2023]
Abstract
Introduction This study examined the relationship between cardiorespiratory fitness (CRF) and longitudinal cognitive functioning in a cohort enriched with risk factors for Alzheimer's disease (AD). Methods A total of 155 enrollees in the Wisconsin Registry for Alzheimer's Prevention completed repeat comprehensive neuropsychological evaluations that assessed six cognitive domains. Peak oxygen consumption (VO2peak) was the primary measure of CRF. Random effects regression was used to investigate the effect of CRF on cognitive trajectories. Results Higher CRF was associated with slower decline in the cognitive domains of verbal learning and memory (P < .01) and visual learning and memory (P < .042). Secondary analyses indicated that these effects were stronger among men than women, and for noncarriers of the apolipoprotein E ε4 allele. Discussion Higher CRF was associated with a slower rate of the decline in episodic memory that occurs as a natural consequence of aging in a cohort enriched with risk factors for AD.
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Affiliation(s)
- Clayton J. Vesperman
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Rui Wang
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- The Swedish School of Sport and Health SciencesGIHStockholmSweden
- Department of NeurobiologyCare Sciences and SocietyKarolinska InstitutetStockholmSweden
| | - Stephanie A. Schultz
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of RadiologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of RadiologyWashington University in St. Louis School of MedicineSt. LouisMissouriUSA
| | - Lena L. Law
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Ryan J. Dougherty
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of KinesiologyUniversity of Wisconsin School of EducationMadisonWisconsinUSA
| | - Yue Ma
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Jennifer M. Oh
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Dorothy F. Edwards
- Department of KinesiologyUniversity of Wisconsin School of EducationMadisonWisconsinUSA
| | - Catherine L. Gallagher
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Bruce P. Hermann
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Mark A. Sager
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Dane B. Cook
- Department of KinesiologyUniversity of Wisconsin School of EducationMadisonWisconsinUSA
- Research ServiceWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
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7
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Dougherty RJ, Lose SR, Gaitán JM, Mergen BM, Chin NA, Okonkwo OC, Cook DB. Five-year changes in objectively measured cardiorespiratory fitness, physical activity, and sedentary time in mid-to-late adulthood. Appl Physiol Nutr Metab 2022; 47:206-209. [PMID: 34822304 PMCID: PMC9169430 DOI: 10.1139/apnm-2021-0500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This study examined 5-year changes in cardiorespiratory fitness, physical activity, and sedentary time in mid-to-late aged adults. Fifty-seven participants completed baseline and follow-up treadmill exercise tests and physical activity monitoring. We observed a 14% decline in fitness (p < 0.001), 12% decrease in physical activity (p = 0.010), and non-significant increase in sedentary time (p = 0.196). Age was negatively associated with 5-year change in physical activity (r = -0.31; p = 0.02) and this decline was strongest among APOE ε4 carriers (g = -0.75). Novelty: Cardiorespiratory fitness and physical activity significantly declined from mid-to-late adulthood, these findings were most pronounced among older adults and those with genetic risk for Alzheimer's disease.
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Affiliation(s)
- Ryan J. Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Sarah R. Lose
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Julian M. Gaitán
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Brandon M. Mergen
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Nathaniel A. Chin
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Dane B. Cook
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA; Department of Kinesiology, University of Wisconsin School of Education, Madison, Wisconsin, USA
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Zhang G, Li M, Zheng M, Cai X, Yang J, Zhang S, Yilifate A, Zheng Y, Lin Q, Liang J, Guo L, Ou H. Effect of Surgical Masks on Cardiopulmonary Function in Healthy Young Subjects: A Crossover Study. Front Physiol 2021; 12:710573. [PMID: 34566679 PMCID: PMC8461071 DOI: 10.3389/fphys.2021.710573] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/26/2021] [Indexed: 12/21/2022] Open
Abstract
Objective: Mask plays an important role in preventing infectious respiratory diseases. The influence of wearing masks in physical exercise on the human body needs to be studied. The purpose of this study is to explore the influence of wearing surgical masks on the cardiopulmonary function of healthy people during exercise. Methods: The physiological responses of 71 healthy subjects (35 men and 36 women, age 27.77 ± 7.76 years) to exercises with and without surgical masks (mask-on and mask-off) were analyzed. Cardiopulmonary function and metabolic reaction were measured by the cardiopulmonary exercise test (CPET). All tests were carried out in random sequence and should be completed in 1 week. Results: The CPETs with the mask-on condition were performed undesirably (p < 0.05), and the Borg scale was higher than the mask-off (p < 0.001). Rest oxygen uptake ( V . O 2 ) and carbon dioxide production ( V . CO2) with the mask-on condition were lower than mask-off (p < 0.01), which were more obvious at peak exercise ( V . O2 peak : 1454.8 ± 418.9 vs. 1628.6 ± 447.2 ml/min, p < 0.001; V . CO2 peak : 1873.0 ± 578.7 vs. 2169.9 ± 627.8 ml/min, p = 0.005), and the anaerobic threshold (AT) brought forward (p < 0.001). At different stages of CPET with the mask-on condition, inspiratory and expiratory time (Te) was longer (p < 0.05), and respiratory frequency (Rf) and minute ventilation ( V . E ) were shorter than mask-off, especially at peak exercise (Rf peak : 33.8 ± 7.98 vs. 37.91 ± 6.72 b/min, p < 0.001; V . Epeak : 55.07 ± 17.28 vs. 66.46 ± 17.93 l/min, p < 0.001). V T was significantly lower than mask-off just at peak exercise (1.66 ± 0.45 vs. 1.79 ± 0.5 l, p < 0.001). End-tidal oxygen partial pressure (PetO2), end-tidal carbon dioxide partial pressure (PetCO2), oxygen ventilation equivalent ( V . E / V . O2), and carbon dioxide ventilation equivalent ( V . E / V . CO2) with mask-on, which reflected pulmonary ventilation efficiency, were significantly different from mask-off at different stages of CPET (p < 0.05), but no significant difference in percutaneous oxygen saturation (SpO2) was found. Differences in oxygen pulse ( V . O2/HR), oxygen uptake efficiency slope (OUES), work efficiency (△ V . O2/△W), peak heart rate (HR), and peak systolic blood pressure (BP) existed between two conditions (p < 0.05). Conclusion: Wearing surgical masks during aerobic exercise showed certain negative impacts on cardiopulmonary function, especially during high-intensity exercise in healthy young subjects. These results provide an important recommendation for wearing a mask at a pandemic during exercises of varying intensity. Future research should focus on the response of wearing masks in patients with related cardiopulmonary diseases.
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Affiliation(s)
- Guolin Zhang
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Mei Li
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, China
| | - Meifeng Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, China
| | - Xiaoqing Cai
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Rehabilitation Medicine, Guangzhou Medical University, Guangzhou, China
| | - Jinyu Yang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shengqing Zhang
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Anniwaer Yilifate
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuxin Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Lin
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Key Laboratory of Enhanced Recovery After Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Junjie Liang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lan Guo
- Department of Cardiac Rehabilitation, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Haining Ou
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Guangzhou Key Laboratory of Enhanced Recovery After Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Feter N, Häfele CA, Cassuriaga J, Smith EC, Häfele V, Rosseto L, Coombes JS, Rombaldi AJ, da Silva MC. Two-minute exercise testing is sufficient to estimate maximal cardiorespiratory fitness in people with epilepsy. Epilepsy Behav 2021; 121:108086. [PMID: 34111765 DOI: 10.1016/j.yebeh.2021.108086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/18/2022]
Abstract
We aimed to examine the agreement between submaximal cardiopulmonary exercise testing (CPET) measures and peak oxygen consumption (VO2peak) in adults with epilepsy. Data from a randomized controlled trial with adults with epilepsy (N = 21) were analyzed. VO2peak was assessed using indirect calorimetry during a treadmill graded maximal CPET. Oxygen uptake efficiency slope (OUES) was calculated from the relationship between oxygen uptake and minute ventilation during the entire test (OUESpeak) and the first 2 (OUES2min), 3 (OUES3min), and 4 (OUES4min) minutes of the CPET. The strength of the association between measures was tested by Pearson correlation. Linear regression models were used to predict VO2peak based on OUES from the different testing durations. Agreement between measured and predicted maximal values was tested using intraclass correlation coefficient (ICC) and Bland-Altman plots. OUES2min, OUES3min, and OUES4min were highly associated with absolute (r = 0.84, r = 0.76, r = 0.75, respectively) and relative (r = 0.84, r = 0.78, r = 0.78, respectively) VO2peak. Agreement (ICC = 0.83) between CPET-measured and OUES-predicted VO2peak values was stronger with OUES2min than the other time-based OUES markers. Bland-Altman plot showed satisfactory agreement between predicted and measured CPET measures with the narrowest limits of agreement observed with the OUES2min. No potential bias was identified between these two measurements (p = 0.33). Changes in absolute (r = 0.77) and relative (r = 0.88) VO2peak were highly associated with the change in OUES2min. OUES2min can be used as a surrogate for maximal cardiorespiratory fitness in adults with epilepsy. Studies with larger samples size are encouraged to confirm our findings in a more heterogeneous population.
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Affiliation(s)
- Natan Feter
- School of Physical Education, Federal University of Pelotas, Pelotas, Brazil; Centre for Research on Exercise, Physical Activity and Health - Researchers, The University of Queensland, School of Human Movement and Nutrition Sciences, St Lucia Campus, Brisbane, Australia.
| | - César A Häfele
- School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Júlia Cassuriaga
- School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Emily C Smith
- Centre for Research on Exercise, Physical Activity and Health - Researchers, The University of Queensland, School of Human Movement and Nutrition Sciences, St Lucia Campus, Brisbane, Australia
| | - Vítor Häfele
- School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Lucas Rosseto
- School of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Jeff S Coombes
- Centre for Research on Exercise, Physical Activity and Health - Researchers, The University of Queensland, School of Human Movement and Nutrition Sciences, St Lucia Campus, Brisbane, Australia
| | - Airton J Rombaldi
- School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Marcelo C da Silva
- School of Physical Education, Federal University of Pelotas, Pelotas, Brazil
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10
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Dougherty RJ, Jonaitis EM, Gaitán JM, Lose SR, Mergen BM, Johnson SC, Okonkwo OC, Cook DB. Cardiorespiratory fitness mitigates brain atrophy and cognitive decline in adults at risk for Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2021; 13:e12212. [PMID: 34268447 PMCID: PMC8274307 DOI: 10.1002/dad2.12212] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/03/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Cardiorespiratory fitness (CRF) may mitigate Alzheimer's disease (AD) progression. This study examined the longitudinal associations of CRF with brain atrophy and cognitive decline in a late-middle-aged cohort of adults at risk for AD. METHODS One hundred ten cognitively unimpaired adults (66% female, mean age at baseline 64.2 ± 5.7 years) completed a baseline graded treadmill exercise test, two brain magnetic resonance imaging scans (over 4.67 ± 1.17 years), and two to three cognitive assessments (over 3.26 ± 1.02 years). Linear mixed effects models examined the longitudinal associations adjusted for covariates. RESULTS Participants with higher baseline CRF had slower annual decline in total gray matter volume (P = .013) and cognitive function (P = .048), but not hippocampal volume (P = .426). Exploratory analyses suggested these effects may be stronger among apolipoprotein E ε4 carriers. DISCUSSION CRF is a modifiable physiological attribute that may be targeted during the preclinical phase of AD in effort to delay disease progression, perhaps most effectively among those with genetic risk.
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Affiliation(s)
- Ryan J. Dougherty
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Erin M. Jonaitis
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Julian M. Gaitán
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sarah R. Lose
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Brandon M. Mergen
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Sterling C. Johnson
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Wisconsin Alzheimer's InstituteUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
- Geriatric Research Education and Clinical CenterWilliam S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Dane B. Cook
- William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
- Department of KinesiologyUniversity of Wisconsin School of EducationMadisonWisconsinUSA
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11
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Recenti M, Ricciardi C, Edmunds KJ, Gislason MK, Sigurdsson S, Carraro U, Gargiulo P. Healthy Aging Within an Image: Using Muscle Radiodensitometry and Lifestyle Factors to Predict Diabetes and Hypertension. IEEE J Biomed Health Inform 2021; 25:2103-2112. [PMID: 33306475 DOI: 10.1109/jbhi.2020.3044158] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The strong age dependency of many deleterious health outcomes likely reflects the cumulative effects from a variety of risk and protective factors that occur over one's life course. This notion has become increasingly explored in the etiology of chronic disease and associated comorbidities in aging. Our recent work has shown the robust classification of individuals at risk for cardiovascular pathophysiology using CT-based soft tissue radiodensity parameters obtained from nonlinear trimodal regression analysis (NTRA). Past and present lifestyle influences the incidence of comorbidities like hypertension (HTN), diabetes (DM) and cardiac diseases. 2,943 elderly subjects from the AGES-Reykjavik study were sorted into a three-level binary-tree structure defined by: 1) lifestyle factors (smoking and self-reported physical activity level), 2) comorbid HTN or DM, and 3) cardiac pathophysiology. NTRA parameters were extracted from mid-thigh CT cross-sections to quantify radiodensitometric changes in three tissue types: lean muscle, fat, and loose-connective tissue. Between-group differences were assessed at each binary-tree level, which were then used in tree-based machine learning (ML) models to classify subjects with DM or HTN. Classification scores for detecting HTN or DM based on lifestyle factors were excellent (AUCROC: 0.978 and 0.990, respectively). Finally, tissue importance analysis underlined the comparatively-high significance of connective tissue parameters in ML classification, while predictive models of DM onset from five-year longitudinal data gave a classification accuracy of 94.9%. Altogether, this work serves as an important milestone toward the construction of predictive tools for assessing the impact of lifestyle factors and healthy aging based on a single image.
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12
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Barros CR, Monte-Silva K, Sales CB, Souza RP, Santos T, Pessoa M, Viana R, Alcoforado L, Lima AMJ, Fernandes J, Brandão DC, Dornelas de Andrade A. Oxygen uptake efficiency slope: A submaximal test evaluation tool that provides cardiopulmonary reserve data in individuals with Parkinson's disease. Braz J Phys Ther 2021; 25:641-647. [PMID: 34001424 DOI: 10.1016/j.bjpt.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 01/07/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Oxygen uptake efficiency slope (OUES) is a method for investigating cardiorespiratory fitness and is proposed as an alternative to overcome the limitations of traditional measures such as peak oxygen consumption (VO2peak) for patients who do not achieve a maximum response, such as in Parkinson's disease (PD). OBJECTIVE To assess the performance of individuals with PD during the six-minute walk test (6MWT) using the OUES. METHODS This is an observational cross-sectional study including 12 individuals with PD and 12 healthy controls. Participants performed the 6MWT along with an analysis of exhaled gas kinetics. The OUES was determined from the last 16 s of the walk test. Multiple linear regression analyses were computed to explore associations between the independent (OUES) and the dependent variables (VO2peak) controlled by group. RESULTS The OUES was associated to VO2peak on the 6MWT (β=0.24, p<0.01) in individuals with PD. The PD group had low performance on the 6MWT with a shorter distance walked (mean difference: -113.1 m; 95% CI: -203.2, -59.1) and worse cardiopulmonary condition with lower OUES values (mean difference: -0.52 [l/minO2]/[l/minVE]; 95% CI: -0.83, -0.21) found in this same group. CONCLUSIONS Our results suggest that OUES is related to VO2peak during the 6MWT, and therefore it could be used as a submaximal test evaluation tool which provides cardiopulmonary reserve data in individuals with PD.
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Affiliation(s)
- Carlos Rego Barros
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Camilla Boudoux Sales
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Renata Pereira Souza
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Thaís Santos
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Maíra Pessoa
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Rodrigo Viana
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Luciana Alcoforado
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Anna Myrna Jaguaribe Lima
- Department of Morphology and Animal Physiology, Universidade Federal Rural de Pernambuco (UFRPE), Recife, PE, Brazil
| | - Juliana Fernandes
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Daniella Cunha Brandão
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Armèle Dornelas de Andrade
- Cardiopulmonary Physiotherapy Laboratory, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.
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13
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Dougherty RJ, Boots EA, Lindheimer JB, Stegner AJ, Van Riper S, Edwards DF, Gallagher CL, Carlsson CM, Rowley HA, Bendlin BB, Asthana S, Hermann BP, Sager MA, Johnson SC, Okonkwo OC, Cook DB. Fitness, independent of physical activity is associated with cerebral blood flow in adults at risk for Alzheimer's disease. Brain Imaging Behav 2020; 14:1154-1163. [PMID: 30852709 PMCID: PMC6733668 DOI: 10.1007/s11682-019-00068-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patterns of decreased resting cerebral blood flow (CBF) within the inferior temporal gyri, angular gyri, and posterior cingulate are a feature of aging and Alzheimer's disease (AD) and have shown to be predictive of cognitive decline among older adults. Fitness and physical activity are both associated with many indices of brain health and may positively influence CBF, however, the majority of research to date has examined these measures in isolation, leaving the potential independent associations unknown. The purpose of this study was to determine the unique contributions of fitness and physical activity when predicting CBF in cognitively healthy adults at risk for AD. One hundred participants (63% female) from the Wisconsin Registry for Alzheimer's Prevention underwent a maximal exercise test, physical activity monitoring, and a 3-D arterial spin labeling magnetic resonance imaging scan. For the entire sample, fitness was significantly associated with CBF while accounting for physical activity, age, gender, APOE ε4, family history of AD, education, and handedness (p = .026). Further, fitness explained significantly more variance than the combined effect of the covariates on CBF (R2 change = .059; p = .047). These results appear to be gender dependent, our data suggest fitness level, independent of physical activity, is associated with greater CBF in regions that are known to decline with age and AD for female (p = .011), but not male participants.
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Affiliation(s)
- Ryan J Dougherty
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Elizabeth A Boots
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, 60607, USA
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Jacob B Lindheimer
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
| | - Aaron J Stegner
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
| | - Stephanie Van Riper
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
| | - Dorothy F Edwards
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Catherine L Gallagher
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Howard A Rowley
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Bruce P Hermann
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Mark A Sager
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Ozioma C Okonkwo
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, 53726, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA
| | - Dane B Cook
- William S. Middleton Memorial Veterans Hospital, Madison, WI, 53705, USA.
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, 53706, USA.
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14
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Morris JK, Zhang G, Dougherty RJ, Mahnken JD, John CS, Lose SR, Cook DB, Burns JM, Vidoni ED, Okonkwo O. Collective effects of age, sex, genotype, and cognitive status on fitness outcomes. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12058. [PMID: 32695870 PMCID: PMC7364859 DOI: 10.1002/dad2.12058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/04/2020] [Accepted: 06/04/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Individuals with Alzheimer's disease (AD) broadly exhibit lower cardiorespiratory fitness (CRF) compared to cognitively healthy older adults. Other factors, such as increasing age and female sex, are also known to track with lower CRF levels. However, it is unclear how these factors together with AD diagnosis and genetic risk (apolipoprotein e4 ; APOE4) collectively affect CRF. METHODS Our primary objective was to characterize the collective relationship of age, sex, APOE4 carrier status , and cognitive status (nondemented or AD) with two commonly reported CRF outcomes, VO2 max and oxygen uptake efficiency slope (OUES). To interrogate the unique and combined effect of age, sex, APOE4, and cognitive status on CRF, we pooled multiple datasets and tested several statistical models allowing all possible interactions. RESULTS AD diagnosis was consistently associated with lower maximal CRF, which declined with increasing age. APOE4 was also associated with lower maximal CRF (VO2max), but only in male subjects. Submaximal CRF (OUES) was lower in APOE4 carriers of both sexes, although this difference converged in male subjects with advancing age. DISCUSSION This multi-cohort analysis (n = 304) suggests that APOE4 carrier status and sex are important considerations for studies that evaluate maximal and submaximal CRF.
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Affiliation(s)
- Jill K. Morris
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Guanlin Zhang
- Department of Biostatistics and Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Ryan J Dougherty
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Jonathan D. Mahnken
- Department of Biostatistics and Data ScienceUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Casey S. John
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Sarah R. Lose
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
| | - Dane B. Cook
- Department of KinesiologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- William S. Middleton Memorial Veterans HospitalMadisonWisconsinUSA
| | - Jeffrey M. Burns
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Eric D. Vidoni
- Department of NeurologyUniversity of Kansas Medical CenterKansas CityKansasUSA
- University of Kansas Alzheimer's Disease Research CenterFairwayKansasUSA
| | - Ozioma Okonkwo
- Department of MedicineUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Wisconsin Alzheimer's Disease Research CenterMadisonWisconsinUSA
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15
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Gaitán JM, Boots EA, Dougherty RJ, Ma Y, Edwards DF, Mitchell CC, Christian BT, Cook DB, Okonkwo OC. Protocol of Aerobic Exercise and Cognitive Health (REACH): A Pilot Study. J Alzheimers Dis Rep 2020; 4:107-121. [PMID: 32587945 PMCID: PMC7306918 DOI: 10.3233/adr-200180] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2020] [Indexed: 12/29/2022] Open
Abstract
A growing body of evidence supports that aerobic exercise can decrease the risk of future cognitive impairment and Alzheimer's disease (AD). There is a pressing need to rigorously determine whether cognitively normal yet at-risk individuals stand to benefit from the protective effects of exercise. The present study will test the feasibility of an aerobic exercise intervention in such a population and inform the design of a larger-scale randomized, controlled trial examining the effect of aerobic exercise on biomarkers of AD in late-middle-aged, at-risk individuals. This was a single-site, 1 : 1 block-randomized, parallel, two-arm trial. Cognitively normal participants aged 45-80 with documentation of familial and genetic AD risk factors were randomly assigned to one of two interventions. The Usual Physical Activity group was provided educational materials about exercise. The Enhanced Physical Activity intervention delivered 26 weeks of individualized and supervised aerobic exercise. Exercise duration and intensity were incrementally increased to 150 min/week and 70-80% of heart rate reserve, respectively. Retention and adherence were measured to assess study feasibility. In addition, pre- and post- intervention differences between the two arms were evaluated for cardiorespiratory fitness, physical activity, brain glucose metabolism, cerebral structure, vascular health, memory, executive function, and mood. Data from randomized controlled trials of exercise training are needed to identify the proper exercise prescription for reducing accumulation of AD biomarkers in cognitively normal individuals. The current trial will contribute to filling that gap while informing the design of large-scale trials.
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Affiliation(s)
- Julian M. Gaitán
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Elizabeth A. Boots
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ryan J. Dougherty
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Yue Ma
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dorothy F. Edwards
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carol C. Mitchell
- Department of Medicine, Cardiovascular Medicine Division, University of Wisconsin Atherosclerosis Imaging Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bradley T. Christian
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dane B. Cook
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI, USA
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Ozioma C. Okonkwo
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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16
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Frazão M, França LMDSM, Bezerra SCM, Silva PE. Relationship of ventilatory inefficiency and low cardiorespiratory fitness in the elderly: a retrospective observational study. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Objectives : To check if ventilatory inefficiency is related to low cardiorespiratory fitness in the elderly and to identify the variable(s) of the cardiopulmonary exercise test (CPET) best suited to determining this relationship. Methods : A retrospective analysis of 1357 CPETs was performed. Sixty-one subjects over 60 years old with a ventilatory efficiency slope (VE/VCO2) index >35 were selected and divided into two groups: low cardiorespiratory fitness (VO2<80% predicted) (n=22) and normal cardiorespiratory fitness (VO2>80% predicted) (n=39) and were compared with a control group of healthy elderly persons with normal cardiorespiratory fitness and VE/VCO2 slope index <35 (n=16), matched by gender, weight, height, and age. Results : Oxygen consumption had a low correlation with VE/VCO2 slope (r= -0.35, p<0.01), a moderate correlation with the cardiorespiratory optimal point (COP) (r= -0.59, p<0.001) and a strong correlation with oxygen uptake efficiency Slope (OUES) =0.92, p<0.0001). In relation to the ROC curve, the VE/VCO2 slope presented an area under the curve of 0.65, but without statistical significance (p> 0.05); the COP showed an area under the curve of 0.84 (p <0.0001) and the OUES presented an area under the curve of 0.81 (p<0.0001). Conclusion : Ventilatory inefficiency is related to poor cardiorespiratory fitness in the elderly. The COP and OUES were more accurate at predicting low cardiorespiratory fitness.
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17
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Law LL, Sprecher KE, Dougherty RJ, Edwards DF, Koscik RL, Gallagher CL, Carlsson CM, Zetterberg H, Blennow K, Asthana S, Sager MA, Hermann BP, Johnson SC, Cook DB, Bendlin BB, Okonkwo OC. Cardiorespiratory Fitness Modifies Influence of Sleep Problems on Cerebrospinal Fluid Biomarkers in an At-Risk Cohort. J Alzheimers Dis 2019; 69:111-121. [PMID: 30958346 PMCID: PMC6675618 DOI: 10.3233/jad-180291] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies indicate that cardiorespiratory fitness (CRF) and sleep are each favorably associated with Alzheimer's disease (AD) pathophysiology, including reduced amyloid-β (Aβ) and tau pathology. However, few studies have examined CRF and sleep in the same analysis. OBJECTIVE To examine the relationship between sleep and core AD cerebrospinal fluid (CSF) biomarkers among at-risk healthy late-middle-aged adults and determine whether CRF modifies this association. METHODS Seventy-four adults (age = 64.38±5.48, 68.9% female) from the Wisconsin Registry for Alzheimer's Prevention participated. Sleep was evaluated using the Medical Outcomes Study Sleep Scale, specifically the Sleep Problems Index I (SPI), which incorporates domains of sleep disturbance, somnolence, sleep adequacy, and shortness of breath. Higher scores indicate greater sleep problems. To assess CRF, participants underwent a graded exercise test. CSF was collected via lumbar puncture, from which Aβ42, total-tau (t-tau), and phosphorylated-tau (p-tau) were immunoassayed. Regression analyses examined the association between SPI and CSF biomarkers, and the interaction between SPI and CRF on these same biomarkers, adjusting for relevant covariates. RESULTS Higher SPI scores were associated with greater p-tau (p = 0.027) and higher t-tau/Aβ42 (p = 0.021) and p-tau/Aβ42 (p = 0.009) ratios. Analyses revealed significant SPI*CRF interactions for t-tau (p = 0.016), p-tau (p = 0.008), and p-tau/Aβ42 (p = 0.041); with a trend for t-tau/Aβ42 (p = 0.061). Specifically, the relationship between poorer sleep and these biomarkers was significant among less fit individuals, but not among those who were more fit. CONCLUSION In a late-middle-aged at-risk cohort, CRF attenuated the association between poor sleep and levels of select CSF biomarkers. This suggests fitness may play an important role in preventing AD by protecting against pathology, even in impaired sleep.
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Affiliation(s)
- Lena L. Law
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Kate E. Sprecher
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705 USA
- Wisconsin Center for Sleep Medicine and Research, University of Wisconsin School of Medicine and Public Health, Madison, WI 53719 USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI 53705 USA
| | - Ryan J. Dougherty
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI 53792 USA
| | - Dorothy F. Edwards
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI 53792 USA
| | - Rebecca L. Koscik
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Catherine L. Gallagher
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, WI 53705 USA
| | - Cynthia M. Carlsson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute, London, UK
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Sanjay Asthana
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
| | - Mark A. Sager
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Bruce P. Hermann
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, WI 53705 USA
| | - Sterling C. Johnson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Dane B. Cook
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI 53792 USA
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
| | - Barbara B. Bendlin
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ozioma C. Okonkwo
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
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Vesperman CJ, Pozorski V, Dougherty RJ, Law LL, Boots E, Oh JM, Gallagher CL, Carlsson CM, Rowley HA, Ma Y, Bendlin BB, Asthana S, Sager MA, Hermann BP, Johnson SC, Cook DB, Okonkwo OC. Cardiorespiratory fitness attenuates age-associated aggregation of white matter hyperintensities in an at-risk cohort. Alzheimers Res Ther 2018; 10:97. [PMID: 30249285 PMCID: PMC6154903 DOI: 10.1186/s13195-018-0429-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/06/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Age is the cardinal risk factor for Alzheimer's disease (AD), and white matter hyperintensities (WMH), which are more prevalent with increasing age, may contribute to AD. Higher cardiorespiratory fitness (CRF) has been shown to be associated with cognitive health and decreased burden of AD-related brain alterations in older adults. Accordingly, the aim of this study was to determine whether CRF attenuates age-related accumulation of WMH in middle-aged adults at risk for AD. METHODS One hundred and seven cognitively unimpaired, late-middle-aged adults from the Wisconsin Registry for Alzheimer's Prevention underwent 3 T magnetic resonance imaging and performed graded maximal treadmill exercise testing from which we calculated the oxygen uptake efficiency slope (OUES) as our measure of CRF. Total WMH were quantified using the Lesion Segmentation Tool and scaled to intracranial volume. Linear regression adjusted for APOE4 carriage, family history, body mass index, systolic blood pressure, and sex was used to examine relationships between age, WMH, and CRF. RESULTS As expected, there was a significant association between age and WMH (p < .001). Importantly, there was a significant interaction between age and OUES on WMH (p = .015). Simple main effects analyses revealed that the effect of age on WMH remained significant in the Low OUES group (p < .001) but not in the High OUES group (p = .540), indicating that higher CRF attenuates the deleterious age association with WMH. CONCLUSIONS Higher CRF tempers the adverse effect of age on WMH. This suggests a potential pathway through which increased aerobic fitness facilitates healthy brain aging, especially among individuals at risk for AD.
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Affiliation(s)
- Clayton J. Vesperman
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
| | - Vincent Pozorski
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Ryan J. Dougherty
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI 53792 USA
| | - Lena L. Law
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
| | - Elizabeth Boots
- Department of Psychology, University of Illinois-Chicago, Chicago, IL 60607 USA
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL 60612 USA
| | - Jennifer M. Oh
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
| | - Catherine L. Gallagher
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Cynthia M. Carlsson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Howard A. Rowley
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Yue Ma
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
| | - Barbara B. Bendlin
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Sanjay Asthana
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
| | - Mark A. Sager
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Bruce P. Hermann
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Sterling C. Johnson
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
| | - Dane B. Cook
- Department of Kinesiology, University of Wisconsin School of Education, Madison, WI 53792 USA
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
| | - Ozioma C. Okonkwo
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705 USA
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
- Wisconsin Alzheimer’s Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI 53705 USA
- Department of Medicine and Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792 USA
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