GEROTOLOGICAL MENTAL HEALTH
Weight training improves symptoms of anxiety and depression in old people, study confirms
Brazilian researchers analyzed more than 200 articles on the subject and identified the types of training most indicated for these cases. Their findings are reported in the journal Psychiatry Research
Weight training can help reduce body fat and increase muscle strength and mass in older people, contributing to functional autonomy and avoidance of falls and injury. Furthermore, recent studies have shown that it can also benefit the mental health of older people, especially those who suffer from anxiety and depression.
These benefits were confirmed by a study reported in the journal Psychiatry Research. The study involved a systematic review and meta-analysis of more than 200 articles on the subject. The analysis was conducted by Paolo Cunha, a postdoctoral fellow with a scholarship from FAPESP at the Albert Einstein Jewish-Brazilian Institute of Education and Research (IIEPAE) in São Paulo, Brazil.
“Resistance training has been shown to be one of the most effective non-pharmacological strategies for healthy aging. It promotes countless health benefits, including improvements to mental health,” Cunha said.
The findings of the study are highly promising, he continued. Besides improvements to symptoms of anxiety and depression in the general population, weight training appears to have a more significant effect on people with a confirmed diagnosis of anxiety or depression disorder.
“Epidemiological studies have shown that the decrease in muscle strength and mass that occurs naturally as we age may be associated with an increase in mental health problems, given the existence of various physiological mechanisms that bring about functional and structural changes and that are controlled by the brain,” Cunha said.
Another important mental health benefit, he added, is that when weight training is done in a group, it contributes to more social interaction among those involved.
Recommended exercises
The investigation also pointed to the best ways of structuring one’s training to improve mental health. “How the training is done appears to influence the results achieved. The information obtained so far suggests that older people should ideally do weight training exercises three times a week, with three sets of each exercise and sessions that are not too long – six exercises would seem to be sufficient. Do less, but do it well: a short set produces better results. This is meaningful information, as we lack guidelines with specific recommendations for resistance training that focuses on mental health parameters,” Cunha said.
While there are many possible ways to prescribe resistance training programs designed to improve the health, autonomy and quality of life for older people, most result directly or indirectly in improvements to symptoms of anxiety and depression, regardless of the intensity and volume of the exercises involved, according to Edilson Cyrino, last author of the article and principal investigator for the study. He is a professor at the State University of Londrina (UEL) and coordinates the Active Aging Longitudinal Study, a project begun in 2012 to analyze the impact of resistance training on parameters relating to the health of older women.
Another point observed by the researchers was that the use of training machines and free weights appears to be more beneficial for mental health than exercises that involve elastic bands or calisthenics (using the weight of the person’s body), for example.
“We don’t have statistics comparing the two kinds of training, but the analysis showed that resistance training with weights and other gear is more effective in terms of improving the mental health of older people, largely because the intensity and volume of the exercises can be more precisely controlled,” Cunha explained.
In the article, the researchers note that despite the incontestable mental health benefits of weight training, important gaps remain and should be filled by further studies. “Generally speaking, most studies have involved a small number of volunteers, which hinders an understanding of how the phenomenon occurs and the main mechanisms that explain it. This research field has expanded in recent years and has ample room for more advances,” Cunha said.
Cunha is currently conducting a project in partnership with the Research Group on Clinical Intervention and Cardiovascular Disease (GEPICARDIO) at the Albert Einstein Jewish Brazilian Hospital (HIAE) to analyze the impact of long periods of sedentarism on vascular and cognitive functions in older people.
About São Paulo Research Foundation (FAPESP)
The São Paulo Research Foundation (FAPESP) is a public institution with the mission of supporting scientific research in all fields of knowledge by awarding scholarships, fellowships and grants to investigators linked with higher education and research institutions in the State of São Paulo, Brazil. FAPESP is aware that the very best research can only be done by working with the best researchers internationally. Therefore, it has established partnerships with funding agencies, higher education, private companies, and research organizations in other countries known for the quality of their research and has been encouraging scientists funded by its grants to further develop their international collaboration. You can learn more about FAPESP at www.fapesp.br/en and visit FAPESP news agency at www.agencia.fapesp.br/en to keep updated with the latest scientific breakthroughs FAPESP helps achieve through its many programs, awards and research centers. You may also subscribe to FAPESP news agency at http://agencia.fapesp.br/subscribe.
JOURNAL
Psychiatry Research
ARTICLE TITLE
Can resistance training improve mental health outcomes in older adults? A systematic review and meta-analysis of randomized controlled trials
Improving dementia care in nursing homes: Learning from the pandemic years
REGENSTRIEF INSTITUTE
INDIANAPOLIS – No one associated with nursing homes – as residents or their families, friends, staff or administrators – is unaware of the massive impact of the pandemic on these facilities which provide essential services to a growing number of older adults, many living with cognitive impairment.
In “Learning from the experience of dementia care for nursing home residents during the pandemic,” an editorial published in the Journal of the American Geriatrics Society, Regenstrief Institute and Indiana University School of Medicine researcher-clinician Kathleen Unroe, M.D., MHA, M.S., and University of Utah College of Nursing faculty member Gail Towsley, PhD, NHA, focus on the continual need to integrate quality dementia-specific care into nursing homes.
“Nursing home leaders [during the pandemic] had to balance competing demands including pressures to off-load hospitals by admitting new patients, as well as responsibilities to protect staff and established residents. The constant assessment of risks versus benefits often resulted in trade-offs between safety (or at least, what was believed at the time provided safety) and quality of life,” the editorial notes.
The authors highlight the uncertainties and stressors faced by extended care providers and those for whom they care, focusing on challenges including resident social isolation, staff recruitment, training and retention as well as the troublesome conflict between best practice infection control and best practice dementia care.
“A majority of people who receive care in nursing homes have cognitive impairment,” said Dr. Unroe. “High-quality care for people with cognitive impairment, including people with a diagnosis of dementia, should be person-centered, which requires knowing a person's goals for their care and their treatment preferences and making sure that those goals and preferences are documented and then met, including for those with limited ability or even no ability to participate in these discussions anymore.
“People in nursing homes are, by the nature of living in a nursing home, often isolated from their community, their prior neighborhoods and contacts as well as their families,” she added. “We need to take extra steps to make sure that we maintain these important connections, making it as easy as possible for people to come and participate in life in the nursing home and for people to be able to leave the facility and participate in life in their neighborhoods and with their families.”
According to Dr. Unroe, the pandemic highlighted:
- Need for dementia care specific staff training
- Value of telehealth communication
- Importance of expansion of family’s role in nursing home care
In 2022, the National Academies of Sciences, Engineering and Medicine issued “The National Imperative to Improve Nursing Home Quality,” which noted “the devastating impact of the COVID-19 pandemic on nursing home residents and staff has renewed attention to the long-standing weaknesses that impede the provision of high-quality nursing home care.” The report calls for the Centers for Medicare and Medicaid Services (CMS) and states to improve oversight of nursing homes to avoid a repeat of failures that occurred during the COVID-19 pandemic.
Highlighting the importance of exploration of opportunities to “coalesce around solutions” to solve persistent challenges in nursing home settings, Drs. Unroe and Towsley conclude, “While the pandemic included lessons we wish we did not have to experience, we have an opportunity to shift our practices and re-focus on high quality dementia care.”
Kathleen Unroe, M.D., MHA, M.S.
In addition to being a research scientist with the Indiana University Center for Aging Research at Regenstrief Institute, Kathleen Unroe, M.D., MHA, M.S., is an associate professor of medicine at Indiana University School of Medicine and a practicing geriatrician. Dr. Unroe is the founder and an executive officer of Probari, a healthcare start-up supporting nursing home care.
JOURNAL
Journal of the American Geriatrics Society
ARTICLE TITLE
Learning from the experience of dementia care for nursing home residents during the pandemic
Brain stimulation treatment may improve depression, anxiety in older adults
UNIVERSITY OF FLORIDA
A noninvasive brain stimulation treatment improved depression and anxiety symptoms among older adults in a new University of Florida-led study.
Improvements in depression and anxiety symptoms were greatest among patients who reported higher symptom levels before treatment. Among participants who experienced moderate to severe state anxiety — or anxiety associated with stressful situations or events — the treatment benefits persisted at a one-year followup.
The findings, published in the journal Brain Stimulation, suggest the treatment, known as transcranial direct current stimulation, or tDCS, holds promise as a noninvasive, drug-free option to treat depression and anxiety symptoms, which affect 1 in 4 older adults.
“Depression and anxiety can impact our overall mental health, cognitive function and ability to function independently as we age,” said the study’s senior author Adam Woods, Ph.D., the associate dean for research and a professor of clinical and health psychology at the UF College of Public Health and Health Professions and co-director of UF’s Center for Cognitive Aging and Memory Clinical Translational Research. “Often, front-line treatments involve medication and/or therapy, which can both be effective. However, there is also a pressing need for accessible and noninvasive options that can be deployed in people who are either nonresponsive to pharmaceutical treatment, unable to access or participate in clinic-based intensive treatment programs, or for a variety of other reasons.”
Treatment benefits in the UF-led study were seen among participants with subclinical depression and anxiety, meaning their symptoms may not meet the criteria for diagnosis. Yet, even subclinical depression and anxiety can be associated with cognitive decline in older adults, the researchers say.
The tDCS treatment is delivered by a safe and weak electrical current passed through electrodes placed on a person’s head. Researchers targeted the prefrontal cortex, an area of the brain associated with cognition and emotion regulation.
The new study was conducted as part of the National Institute on Aging-funded Augmenting Clinical Training in Older Adults Study, the largest study of its kind with older adults participating at UF and University of Arizona study sites. Nearly 400 older adults were randomly assigned to one of two groups: 12 weeks of tDCS paired with cognitive training designed to improve working memory and processing speed, or 12 weeks of cognitive training paired with a placebo version of tDCS.
Investigators also collected a wealth of data from cognitive, functional and neuroimaging tests as well as self-report measures of psychological symptoms, including depression and anxiety.
After controlling for factors such as prescription drugs that may impact depression and anxiety symptoms, the study team found that participants who received the tDCS treatment had significant improvements in mild depression and moderate to severe state anxiety, compared with the group that did not receive tDCS.
“Extensive research has demonstrated the efficacy of active stimulation to this area of the brain in reducing psychological symptoms in individuals with diagnosed psychiatric disorders,” said Hanna Hausman, the study’s lead author and a UF PHHP clinical psychology Ph.D. student in neuropsychology. “It was an unexpected yet welcome surprise to witness similar effects in our sample of older adults without significant psychiatric histories, especially on a large scale. Demonstrating this therapeutic effect is important because even subclinical depression and anxiety symptoms in older adults are associated with adverse outcomes.”
Next steps for this research should include a phase 3 randomized clinical trial designed to assess the effect of tDCS and cognitive training on anxiety among a large and diverse group of older adults, the investigators say. The Korea Food and Drug Administration has approved tDCS as an at-home treatment for depression for adults in South Korea, and with additional study, it could become an accessible and easy-to-use treatment in the U.S. once sufficient evidence is available for U.S. Food and Drug Administration approval.
“tDCS treatment is cost-effective, portable and can be seamlessly integrated with existing mental health therapies or used as a standalone intervention,” Hausman said. “Its potential for at-home self-administration would further expand accessibility and reduce personnel costs, making it a promising intervention for individuals who may experience barriers accessing face-to-face clinical care.”
JOURNAL
Brain Stimulation
METHOD OF RESEARCH
Randomized controlled/clinical trial
SUBJECT OF RESEARCH
People
ARTICLE TITLE
tDCS reduces depression and state anxiety symptoms in older adults from the augmenting cognitive training in older adults study (ACT)
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