You probably see it on a weekly basis in your practice. A formerly well-appointed, successful patient arrives for their appointment with the assistance of a family member or caregiver. They need help getting into the chair, and you are surprised by the decline in their health since you saw them last, especially when you remember that your patient is only a few years older than you are.
The Globe and Mail reported in January 2010 that the annual cost of dementia is growing rapidly. Dementia is the number one cause of disability over age 65 and this is only worsening as the large numbers of baby boomers age. Dementia is the medical term describing the slow loss of intellectual function. It encompasses a number of conditions including Alzheimer’s – which is the most common form of dementia. Alzheimer’s is the second most feared diagnosis after cancer. There is no cure – just a handful of medications that may slow the inevitable, progressive decline. According to researchers, some of the leading factors promoting Alzheimer’s disease are smoking, poor diet, lack of intellectual stimulation and physical inactivity.
The first recommendation on a recent report commissioned by the Alzheimer Society of Canada is to provide education to promote physical and mental exercise that can delay the onset of dementia. Mark Mattson, of the National Institute on Aging agrees. He says: ‘Many of the same factors that can reduce our risk for cardiovascular disease and diabetes also reduce the risk for age-related neurodegenerative disorders.’
Unfortunately, our sedentary society is not even coming close to meeting the minimum requirements for brain health. Only 8% of men and 4% of women actively participate in a complete exercise programme, which includes cardiovascular activity, strength training and flexibility.
Exercise is medicine
Exercise is like a miracle drug. It helps to prevent heart disease, stroke, diabetes, obesity, and even some cancers. It will make your bones stronger, improve your blood lipid profile (cholesterol and fats in the blood), increase your strength, and restore your balance. Exercise stimulates new blood vessel growth in your brain, heart, and skeletal muscle, increasing the amount of oxygen and nutrients to these areas. People with the least cognitive decline have three things in common: education, self-efficacy, and exercise.
Team spirit
In 2007, German researchers conducted a human study that tested participants on vocabulary words before and after exercise sessions and the rate of learning increased by 20% after exercise. Is a lunch hour walking group starting to sound like a better idea? In 2004, Kramer showed that aerobic exercisers performed better on a test of executive function. This includes the ability to correct errors, react to new situations and plan or make decisions. The Journal of the American Medical Association published results from the Nurse’s Health Study, which showed that women who were the most active had a 20% lower chance of being cognitively impaired when tested on general intelligence and memory. Considering that women often make up a large part of the dental team, it pays to have your staff be more physically fit.
In 2004, researchers at Leeds Metropolitan University in England studied 210 participants who used their company’s gym for aerobics, weight training, or yoga classes during their lunch breaks.
The workers demonstrated more productivity and reported they were better able to handle their workloads. They also felt less stress and fatigue in the afternoon. Henry Lodge, the co-author of Younger Next Year, says that the chemical make up of your blood will change for most of the day after you exercise. This positive chemical change promotes the regeneration of cells in the body and the brain. Who says that exercise can’t be a gift that keeps on giving? Can you imagine being alert and focused – being aware of your patients’ responses to your treatment, and finishing that crown and bridge procedure right on time at the end of a long day? Your staff and patients will be thrilled!
In 2007, researchers at Columbia University showed increased blood flow to a part of the brain responsible for memory, after only three months of regular exercise. The participants also experienced faster reaction times – can you see yourself grabbing that temporary crown as it falls toward the floor? Exercise stimulates growth factor proteins, reports Carl Cottman, director of the Institute for Brain Aging and Dementia at the University of California, Irvine. His team found a direct link between cognitive function and movement. He showed that exercise increases brain-derived neurotrophic factor (BDNF), which is a chemical that helps to build and maintain the neuron connections in the brain. Neuroscientist Arthur Kramer did brain scans before and after six months of exercise intervention with 60-72-year-old participants. A control group did a stretching routine while the exercise group performed three one-hour cardio sessions per week. The amazing findings: the exercise group had frontal and temporal brain lobe volume increases!
Brain fitness prescription
A good workout for brain health combines aerobic activity with a sport or activity that challenges the brain. We recommend activities like ballroom dancing, aerobic classes with choreography, and figure skating (by the way, there is no age limit on learning to skate). You can also perform moderate to vigorous cardiovascular activity before or after a yoga, ballet, pilates, karate, or rock climbing session. Or combine aerobics with interval circuits of resistance training. More studies are needed to determine the best prescription to provide the ultimate brain benefits. And there is little known about resistance/weight training and brain health – scientists have yet to figure out how to get lab mice to lift weights!
• References available on request
Cues and consequences
• Can’t remember the patients name in the waiting room – do you avoid your waiting room for fear of speaking with a patient and not remembering their name?
• Constantly asking your assistants the lab’s phone number
• Losing focus in the middle of a conversation
• Rejections to case presentations set you back for the rest of your day
• A lack of life-force energy
• Trouble with decision makingDevelop your team’s mental muscle
• Start a lunchtime walking group that walks for 20-30 minutes each day and provide incentives for participation
• Purchase gym passes or massage gift certificates for staff as a holiday present
• Have an active staff party (hire a dance instructor, rock climbing, partner yoga)
• Consider an active retreat for your next staff professional development location
• Have staff participate in a run/walk or ride for a cause and train together
• Bring in a trainer, physiotherapist, chiropractor or nutritionist for a lunch and learn.Dr Uche Odiatu DMD is the author of The Miracle of Health and an NSCA certified personal trainer. He has a busy dental practice in Toronto, Canada, and has lectured at the largest dental conferences in the US. Uche is speaking at Dentistry LIVE, 7-8 June London 2013. For more, visit www.dentistrylive.co.uk or call 0800 371 652.
