Exercise and Blood Flow to the Brain

And tonight I’m gonna teach you the module on exercise. So when we think about foundations for health, we know this is sort of common sense, but again, not common practice. We know that we all foundationally to be healthy, need plenty of good nourishment. And yesterday we talked about that ketogenic diet and especially great if you can get an organic ketogenic diet with lots and lots of veggies. We talk about sleep, rest, exercise is what we’re gonna focus on right now. We also knew that deep, personal connection and stress management and love that we talked about on day two, and then that sense of adventure, keeping things fresh and exciting. And we can do some of that through exercise. So, the science lets us know that those who exercise versus those who don’t have better cognitive function. So this study showed that among patients with dementia or mild cognitive impairment. So even with dementia, even with a diagnosed dementia, so this is more progressed, randomized control trials documented better cognitive scores, after six to 12 months of exercise compared with people who didn’t exercise or who were sedentary. So this is magic, right? If we could bottle exercise, there wouldn’t be dementia. What we wanna do is make sure that regardless of that phase of diagnosis you’re in, whether it’s subjective cognitive impairment, maybe even just genetic risk, where you’re concerned about this happening later, and you wanna prevent, or if you have mild measurable cognitive impairment or even diagnose Alzheimer’s, the more you move the better. 

And we’ll talk about ways to do that. So the benefits of exercise, this comes from a meta-analysis. So this paper that I’m referring to here is a meta-analysis, which means it’s taken a bunch of other research and then it puts it together to see if we can be more confident in the conclusions that we’re drawing. And so this is at the tippy top of the type of research that is most validated, that has the most compelling sort of conclusions. So what it says here is at randomized control trials, so RCTs, again this is at the top of the research hierarchy, when you can randomize and control a trial, you can draw more conclusions and be more confident in those results. So, with randomized controlled trials of aerobic exercise in healthy adults, so this is people who do not have dementia yet, healthy adults were associated with significantly improved cognitive scores. So when you take healthy people and you have some that exercise and some that don’t, you see that those who exercise are sharper, they do better cognitively. After one year of aerobic exercise in a large randomized controlled trial with seniors that was associated, exercise was associated with significantly larger hippocampal volumes. The hippocampus is a part of the brain that controls memory, that’s responsible for memory, and better spatial memory. So this is where we are in space, remembering where things are. Cross sectional studies similarly reported significantly larger hippocampal or gray matter volumes among physically fit seniors compared with unfit seniors. Right? What do we want as we’re aging? We want more cognitive reserve. We want bigger brains. We don’t want them shrinking or atrophying. This is associated with poor function, poor cognitive function, which in turn can lead to dementia and the loss of independence. 

So what we want is to exercise to get this. Brain cognitive networks studied with FMRI, this is functional magnetic resonance imaging, displayed improved connectivity after six to 12 months of exercise. So when we take the brain and image it, if you’ve ever been in one of those MRI machines, they’re kind of claustrophobic, but when you get in there, we can get some amazing data, particularly on the FMRIs. So we can see what’s going on with the connectivity of the brain. After six to 12 months of exercise it’s improved in those who exercise. And we can see that we’re starting to connect the dots between how exercise is so helpful. And then in animal studies, different from human studies, but it certainly in animal studies, we have more flexibility, because we can be more cruel to the animals than we can to humans. So we can dissect them. They also have shorter lifespans, so we can get more information about the whole, their whole life expectancy, their life history without having to wait 80 or 90 years. So animal studies indicate that exercise facilitates neuroplasticity. This neuroplasticity is one of these concepts that has become much more popular in the last five to 10 years. And that idea is that our brain can change. For a long time we thought, oh, our brains don’t change after 30, 40 years old, but no, in fact they can and exercise facilitates that. 

And that’s what we want. We want our brains to be malleable, to be changed, so that we can choose those tracks of brain function, so that they serve us into our 70s, 80s, 90s, and neuroplasticity means new memories. When we can change our brain, we can create new memories, we can draw on those old ones, and this is all happening via a variety of bio mechanisms. So there’s multiple ways that this is happening. So multiple things that are going on in the brain that help to facilitate that neuroplasticity when there’s exercise involved with improved learning outcomes. Don’t we all wanna be able to remember how to do that? Remember how to use our new phone? Remember how to, you know, get somewhere new? Remember a new recipe? We all wanna be continuing to learn our entire lives. This is what makes life exciting and adventurous, and so getting exercise helps that. The induction of brain neurotrophic factors, by exercise, has been confirmed in multiple animal studies, with indirect evidence for this process in humans. So we don’t know for sure, but we have a pretty good hunch, because this is confirmed in animals, that this is also happening in humans. So what is it that’s going on? Neurotrophic factors. The induction of neurotrophic factors means that we are stimulating the signaling going to the brain to tell the brain to build more neurons to grow. And this is what we want. 

We want bigger brains, we want more connection, we want more memories. We want to be able to go back and find those memories in the brain as well. Find those words. Remember how to get places. That is the goal of anything related to improving cognitive function and exercise does it as well as any other one of these interventions, if not better. Besides a brain neuroprotective effect, so we have neuroplasticity, which is brain changes coming from exercise, neurotrophic induction, which is signals telling the brain to grow, and then we have a neuroprotective effect of exercise. If we could bottle this, it would be amazing, life changing for so many people, but it takes work. We’ve gotta exercise. We’ve gotta find that motivation, get out there and do it. Besides the brain neuroprotective effect, physical exercise may also attenuate cognitive decline via mitigation of cerebral vascular risk. So this means if you’ve ever been told that you have stenosis in your arteries, you have a high calcium score, cardiac calcium score, you have vascular dementia, if anybody has ever mentioned words like that to you, exercise is crucial. You must be getting plenty of it. And I would say all four types. So, if you have, and also traumatic brain injuries, we need new blood flow in order to heal inflammation or injury in the brain. And so mitigating cerebral vascular risk is a massive, massive benefit to exercise. And this just happens because we’re increasing blood flow, we’re using those vessels, including the contribution of small vessel disease to dementia, right? So this is our vascular dementia. And even when those capillary beds aren’t, so that’s where the oxygen and nutrients diffuse, they go across from the blood vessels into the tissues where they do the work. 

And if we can’t get that across, then they’re not gonna be able to, all those nutrients, all that oxygen, all that great food that you’ve been eating, isn’t gonna get into the brain to do the work that is needed for repair. And so getting exercise helps with delivery of all of those great things you’re eating. Exercise should not be overlooked as an important therapeutic strategy. I hope I’ve inspired you. Thanks for hanging in there with me as we review the science and what it’s saying about how important exercise is. So what do we want? Bigger brains. What do we want? Bigger brains. How do we get them? Through improved blood circulation, improved blood flow, improved delivery of nutrients that are needed for the brain. And Dr. Bredesen says over and over again, that ultimately what’s going on with dementia is that we’re not getting enough energy. It’s an energy utilization, dysfunction, dysregulation. And so by getting more exercise and getting better flow, we can optimize the delivery of everything that turns into energy production, right, all of the glucose, if that’s what we’re still using, the ketones, hopefully we’ve already shifted. This also leads to synaptic plasticity we talked about, neurogenesis, which is the growth of new neurons, neurotrophic factors we discussed. That’s the signaling that says to make new neurons. Exerkines, many of us have heard of cytokines, because of the pandemic, because of COVID-19, it causes the cytokine storm that’s associated with inflammation. Well, this is the opposite of that. This is a storm of good things in the blood and telling the brain basically, again, more signaling to the brain to create bigger brains, more resilient brains. 

And, of course, clearer cognition. And then epigenetic factors. So, exercise is one of these epigenetic factors, like toxic exposure, like diet, like stress. All of these inputs into the system tell our genetics what to express. And so when we can tell our genetics to express the best of our potential, we get better outcomes. Exercise, of course, allows us to discharge and release stress from our systems and really helps with mood modulation, of course, insulin sensitivity and so many other great things. But this is why it’s so important for cognitive function. So, I mentioned we are gonna discuss four types of exercise. There’re aerobic exercise, strength training, the cognitive physical combo, which you may not have heard about before, but I’m gonna go deep into why that’s so important, and then LiveO2 or contrast oxygen therapy. I grew up in Hawaii and this woman is dancing hula, and hula is one of these, any dancing really, but hula in particular, requires strength, grace, memory, to remember the steps, to learn the steps of the dance. It requires being attuned to the music and maybe to the people around you who are dancing with you. So really a beautiful way to create community, to create strength, to get that physical combo, exercise, physical-cognitive combo exercise going, and then it does get your heart rate up. It’s harder than it often looks. In fact, part of the point of many of the dances is to make it look easy, even though it requires lots of training, lots of strength, lots of aerobic flexibility and that cognitive function to remember the steps. 

So, then type one, there, you can take out a pen and paper here and do this math problem yourself. Aerobic exercise examples are biking, dancing, rowing, jogging, any, I like to row. I have a rower and I find it very efficient and it gets lots of the different big muscle groups in your body, you can do it quickly and easily. Other people love getting outside. I also love going for a run on the beach, it’s one of my favorite ways to get some aerobic exercise. And so whatever works for you to get your heart rate up, the goal is to spend 200 minutes a week. This comes from the Framingham Study, a big heart study that came off out of the east coast and at 200 minutes a week is where the switch seems to flip around getting you that cardiovascular benefit and protection. So the way that we calculate where we want your heart rate at for those 200 minutes a week, so we want you in this moderate vigorous exercise spot. So that’s 75% to 85% of your maximum heart rate. And so we calculate your maximum heart rate by taking the number 200 minus your age. So for example, if your age was 67, right now, then you get the number 133. That’s your maximum heart rate. So we don’t want you there for 200 minutes a week. We want you just below that. So pushing it, but not overdoing it. So that would mean your heart rate, your target heart rate is 100 to 113 beats per minute. So hopefully if you just take 133 and multiply it by 0.75 or 75%, and then 133 multiplied by 0.85 or 85%, you’ll get that 100, and then that 113. And that’s the zone that we want you in. That is how you’re going to get that benefit of aerobic exercise. So walking is not enough. And then strength training. Strength training is very important because those neurotrophic factors, things like testosterone are neurotrophic factors. They tell, right, you can remember when you were 19 or 21 and how you’ve got all of those hormones, those sex hormones, estrogen, progesterone, testosterone, DHEA, pregnenolone, all of those hormones going to the brain. 

They help you to learn. This is why we’re in school. We’re building new skills. We’re learning how to do the, you know, whatever it is that our job will be. And it’s easier for us to develop those new skills, whether it’s working on the computer or doing certain types of math or communication and human interaction, whatever that skill is that we’re developing, it’s much easier to do in your early 20s than in your late 60s. And part of that is because of the neurotrophic factors present. So at the height of our hormones, when we’re in our late teens and early 20s, it’s easier to develop those skills. Then as we age and have less of those hormones, it’s harder. And muscle helps us to improve the amount of those hormones that are available endogenously, or that are naturally there. If we start to waste away those, that muscle, testosterone, begets muscle, but muscle begets testosterone. And so we wanna have plenty of muscle present. And the way to get that is through exercise. Now, the extra benefits here are that for somebody who’s frail or at risk of falling through strength training, they will become much stronger. And we reduce that fall risk, which when we think about kind of the, the biggest issues that come up with aging really are falls and dementia. They, you know, not that I want anyone ever to be diagnosed with cancer, but cancer is something that comes up later in life, more frequently, as well. And yet many cancers are highly treatable and yet dementia, although I believe highly treatable, it takes a lot of effort and we wanna prevent it. And falls are in the same category. 

Many people take a quick trip downhill after a fall. And so anything we can do to prevent this and exercise really is anti-cancer, as well. This is gonna help everything, but in particular, those big issues that come up as we age, the fall risk, and then the dementias that make us less and less independent. Those things are really scary, really debilitating, very expensive, even financially, morally, emotionally. They’re very, very trying. So we want to use exercise to our advantage in every way that we can by reducing the fall risk there, and then also improving bone health. So the more exercise we get, the better our bone health. And when we combine this with the right nutrients and hormonal support, we can often see osteoporosis start to improve, osteopenia improve, so that, again, there’s less risk for breaking bones later in life. And then not to mention looking good and feeling good, right, that we get with having those more defined muscles, more tone. So some examples of this type of exercise, it’s just weights we have at Marama. We have small weights that we can use, calisthenics, things like sit ups, push ups or crunches, pull ups, those kinds of things are really great for building muscle, of course. And hopefully if you’re working with a trainer, which I highly recommend, ’cause we wanna do this safely, make sure there’s no herniated discs or falls or anything like that. We don’t wanna create new problems, but working with a trainer, they can talk you through calisthenics, isometrics, maybe using bands, maybe using small weights, all of the things that can help you to build muscle, build strength and do it in a really safe way. Type three, so this is the most important one and probably something you’ve never heard of before. So what we wanna do, the best, most effective way to get improved cognitive function from exercise is to combined exercise for your brain, with exercise for your body, at the same time. 

So this is a little bit of the science about what’s going on there. So this analysis showed a small to medium positive effect of combined cognitive physical interventions on global cognitive function in older adults with mild cognitive impairment or dementia. So we’re getting a small to medium positive effect on people who have dementia when they combine these two things for all global cognitive function. It’s a small to medium. We say, huh, well, is it worth it? I’m going to convince you why. A combined intervention was equally beneficial in patients with dementia and mild cognitive impairment. That means regardless of where you are on the spectrum of decline, even if you have severe dementia, you still get benefit. I mean, this is incredible. This is so important to be harnessing the power of this type of exercise. In addition, the analysis showed no longer a small to medium positive effect, but a moderate to large positive effect after combined cognitive and physical interventions for activities of daily living. So if you’ve never heard that term before, this is really important in the space of cognitive function and dementias. Activities of daily living are the things like being able to dress yourself, feed yourself, go to the bathroom on your own, take a shower by yourself. These activities of daily living are what maintains your dignity and independence. And then what sends you down that path of being completely dependent on caregivers or loved ones to provide for you and to make sure that you’re safe day to day in getting everything you need just to stay alive. 

And that is so hard to watch and see, and this sort of intervention can even improve your ability to fulfill those activities of daily living to a moderate to large positive extent. I mean, this is radically amazing and beneficial. I cannot recommend this type of thing more. There’s also a small to medium positive effect for mood. And when we think about how depressing it can be to be going through something like dementia, whether you’re on the caregiving side or you’re experiencing it as a patient, we know depression, anxiety, and dementia often all come together, because of just how challenging this can be. And so if we get any improvement in mood, this is well worth doing. So improvements in global cognitive function, big improvements and activities of daily living and improvements in mood. This is hands down, one of the most important interventions. And so how to do it. When, excuse me, I got ahead of myself there. So how to do this. Some examples of this are things like yoga, Pilates, exercise classes where you’re listening to the cues of an instructor, that requires heavy lifting. The other thing you can do is get on a treadmill or go for a brisk walk. You wanna be going fast enough that your heart rate is up, but you still have your breath. So, right, if you’re sprinting, it’s hard to think. But if you are running at a quick pace, you have your heart rate up, but not at max heart rate, you can have a conversation with someone who can be quizzing you, maybe listing all of the Presidents of the United States in order, maybe listing the states and their capitals, doing math problems, anything that requires heavy lifting of the brain, while you are at the same time, getting pretty heavy lifting with your physical exercise. 

So they’re beta testing an app called Genius Gyms. One of the scientists, Sarah McEwen, who was interviewed today, she contributed a lot to this research. She’s a PhD researcher and her product is a way that you can get some ideas about how to do this. But, anytime you are maybe say going for a brisk walk or a run, maybe you’re on the treadmill or you’re outside and you’re listening to a podcast or something else, ’cause I know a lot of people say, “Oh, well when I’m walking, I listen to a podcast.” Well, one, you have to be doing more than walking. You really need to get your heart rate up, not maxed out, but get it up. It can’t be a leisurely stroll. And then two, if you’re just listening, you’re not really cognitively engaging. So what you could do is listen to your podcast and then pause it and then say out loud, what I got from that was and make your brain work to think about that information. Quiz yourself a little bit. Who was that speaker? What was their name? What did they say? What were the conclusions from the study they were referring to? When you do that, you increase that workload on your brain. And when you do that with exercise, that’s when we get all of these incredible benefits. This is free. This doesn’t cost anything. It just requires time, effort, and energy, and it is so worth it. All right. The fourth type of exercise is contrast oxygen therapy. And so I wanted to share an example of someone who really, really benefited. In December of 2019, I got a phone call from a woman up in Oregon. And we had just announced that we were opening Marama in the spring, and we were getting lots of calls from different people. And she said, you know, there’s no way my husband and I can come to Marama. We are very well planted in Oregon. And she had this, this wife, she had is some debilitating autoimmune condition that required, you know, her to be pretty dependent on her husband and her husband started to have cognitive decline, and she was terrified, because both of them were going to be in a position of being very dependent on other people. 

And she, staring down the barrel of that was very anxiety provoking for her. So we chatted for a bit. And she said, “If we could do one thing, because this is very overwhelming for me, if we could do one thing, what would you recommend?” And I said, no, no, you can’t do that to me. I have to give you two things. The ketogenic diet and LiveO2 contrast oxygen therapy. And I got a message from them, so this is December of 2019, so in the midst of this pandemic, so several fast forward four or five months, in the midst of this pandemic, we have some great news about my husband’s condition, which was cognitive decline. His intelligence has improved from the 75th to the 84th percentile, memory went from the 78th to the 85th percentile, people skills went from 86th to 94th percentile and navigation went from 87th to 96th percentile. Wow. They were able to measure this decline. They were involved in, they were signed up for the Recode program. And so they had access to brain HQ and CS vital signs, and that’s where they were measuring this. And so we got this objective data, we got great information about how much his brain was improving. And they were feeling and seeing the benefits too. He was still able to help care for his wife. And so their life didn’t get turned upside down traumatically, and they weren’t suffering more, they were actually improving, which is a miracle. So how to do this. This is a picture of one of our residents at Marama and she is hooked up by mask to an oxygen reservoir. So this is concentrated oxygen. When we’ve talk about this, I wanna compare it to air. So air that we breathe, typically, day to day, is 20% oxygen. 

And the concentrated oxygen is at 80%. So what happens is an oxygen concentrator, that’s a little bit cut out of this picture here, but that oxygen concentrator, we turn it on about an hour before our residents are going to go down there and get exercise. And when we turn it on, it starts to fill this bag, this reservoir with concentrated oxygen that will be available when they’re on the bike. And so then we switch back and forth to get that contrast. What we do is switch back and forth from positive, 80% oxygen, down to -O2, which is about 8% oxygen, much less than, not zero, but much less than air. So, there’s a couple different ways that you can do this. You can just do EWOT, exercising with oxygen therapy and just do exercise with extra oxygen. You don’t have to do the contrast and you still get benefit. Although from my experience, I see people get more benefit when they push it a little bit and go into -O2, especially during the sprints. So this is really exciting, really fun. I’ve seen great, great, great results with this. I’ve personally felt it, it is hard work, but again, it’s worth it. People get a lot of great detox support from this, a lot of great, again, strength and aerobic exercise, so you’re getting those first two together. We use here, the Schwinn Airdyne, they don’t pay me, don’t worry. But, the Schwinn Airdyne is one that we see works well with the tubing, you get the arms and the legs going. We have a rower at Marama, ’cause I love them, but that gets caught up in the tubing. So the, a bike like this or a treadmill are the best ways to do it with, because you’ve got this elephant trunk coming from your face, so you don’t wanna get all tangled up. So what’s going on here? When we do contrast oxidant therapy, what we’re getting at the benefit of the Hormetic Effect. 

If you’ve never heard of this, the concept is simple. It’s essentially this idea that our bodies are in a homeodynamic state at all times. There’s things shifting, but we wanna stay within some sort of balance. And when we put a little bit of stress on the system, right, it’s not too little, so just a little bit of stress, doesn’t do much, but when we get to a certain point of stress, like -O2 or exercise or a fasting, mimicking diet, or even hot and cold therapy, what we start to get is this Hormetic Effect, where there’s increase in strength, there’s increase in resilience. So we’re asking the body to do more, so that then when we need it to do more, because something comes up, there’s a cold or a flu or a fall or something that we can’t control, stresses our system, we have more ability to respond and adapt to it. And this is a definition of health, right? How resilient are we? Maybe it’s not even a cold or a flu or a fall, could be a flight across the country to go see your grandchildren, that you want to be resilient to the changes in oxygen when you get on a plane to the potential exposures, to the stress of jet lag, right, these things don’t always have to be big life changing events or really traumatic things. They can be even just the small stressors that come up day to day. Maybe it’s a move, a good move. Now, of course, and particularly in the case of oxygen, this is clear, if you get too much, you have a weakening of the system and you can die. Right? Like, you can suffocate. So what we’re not doing is going there, obviously. Where we’re going is in that space before, under the area, under this curve, in that space is where we get that increased resilience. Particularly if we do this over and over again, day after day. So with contrast oxygen therapy, what we’re getting is vasodilation. So we’re getting bigger blood vessels, which means they can deliver more blood and nutrients. 

We also get pressure changes in the capillary beds and that microvasculature. And that means that we can get more diffusion across those membranes. We get this Hormetic Effect that I was just describing. We also get changes in cell signaling, an increase in the concentrations of the number of mitochondria in each cell over time when we do this. And that means mitochondria, the powerhouses of our cells, they are there to make and create energy or ATP. When we have more of them, we get more energy. And for brains that are suffering with cognitive decline, this is so critically important to good function. And then the other thing that happens is that senescent cells retire. So this means that we can recycle those cells in our brains and our bodies that aren’t really doing the work that they’re meant to. You know, they’re kind of like just getting by, they’re in this gray area of not totally dead, no signal has come for apoptosis or to kill them and recycle them, but they’re not really optimally functioning. So they’re not doing the job that they were built to do. What we wanna do is clear those guys out and get that signaling to create new cells that are going to be in that category of optimally functional. So really exciting ways to get benefit from contrast therapy. So how do you do it? This is how we do it at Marama. 

The first couple of weeks, we just want people getting comfortable. So we don’t wanna scare anyone off. We don’t want anyone to think this isn’t for me. I don’t like it. It doesn’t feel good. We just want them to be comfortable on the bike and comfortable with the mask, ’cause it’s different, it doesn’t feel great the first time, it’s odd. And then after they are comfortable in the first, in those couple weeks, two, three weeks later, we start introducing the -O2 and really cheering them on, encouraging them to push themselves a little bit more with that -O2, ’cause that’s where so much benefit comes from. So, we do, about once we’re week four on, the goal is to be about two thirds of the time in -O2 and a third of the time in +O2. And this helps, again, to get all of those benefits of increased blood circulation, mitochondrial changes, Hormetic Effect, the cell signaling, the senescent cells start to retire. All of those benefits really come when we can spend the majority of our time in -O2. So what does exercise look like at Marama? We have two to three periods of time, yoga also is exercise here at 11, but after breakfast there’s a walking club nearly every day. Sometimes there’s a day off if it’s raining or something comes up, usually on Sundays, there will be church and then they walk after church, but there’s a walking club. So walking is important. Walking is great, it’s a good way to get outside, connect with nature, notice some of the changes in the seasons, great way to connect with each other as this couple is doing here. So walking is wonderful. Sometimes they walk for 30 minutes, sometimes it’s a couple of hours, sometimes at a park, sometimes just in the neighborhood. 

So mixing it up, keeping that adventure spirit there is great. And starting your day with some movement can also, again, get blood flowing, get circulation going. And then at 11, some days we have yoga. Usually three days a week, there’s yoga or meditation. We always do the Kirtan Kriya Meditation after walking, but another yoga or meditation course class happens before lunch, typically. We have visiting guests who come and provide those services, the yoga teaching and the meditation. And then in the afternoon, five to six days a week, we do the therapy circuit, the therapy exercise circuit. And this is where we have rebounders or mini trampolines. We have the rower, like I mentioned, we have the LiveO2 and the bike and you can do the bike without the LiveO2, whatever works for those residents. But they basically each go from station to station to station in a circuit and get the benefit of all of these things. We have the lightweights, like we talked about with strength training. There’s a Biomat. So, this is the Biomat here. So if someone is feeling really tired and not up to exercise that day or maybe they’ve had an injury recently, something’s come up, they’re not able to be getting a lot of exercise, if they feel agitated even, the Biomat is very calming, very soothing. And because it’s warm, it can help to relax all the muscles on the back. And then you can see we’ve got Dr. G here in the sauna, which is a great way to get again, more blood circulation, more blood flow. 

And then of course detox, this doesn’t replace exercise, but it’s one way to gently get some exercise, especially if you’re between the rower and the bike, and you’ve gotten a lot of good vigorous exercise with your heart rate up for a while. Then you can get in the sauna and relax a little bit, but still keep that blood flowing. And then the Joov Light is why you can see the red light in here, it’s because those Joov lights are on. And, the lights, the red light therapy is another thing that can be very, very helpful for cognitive function. And so we have both the Joov Light and the Vio Light available at Marama. So just a kind of summary, what are some of the things that we have available at Marama and things that I hope that will inspire you to incorporate at home in terms of exercise. So yoga, we don’t do Pilates at Marama, but we have yoga available. And I think Pilates, if you’re getting out to a class, it’s another great way to combine that cognitive exercise with physical exercise, because you’re listening to the cues. And then hula, there’s hula hoops here, but hula dancing, other dancing, very, very important. Again, there’s research around ballroom dancing and ballroom dancing being shown to support cognitive function. And that is because you’re getting this attunement with a partner, you’re memorizing the steps, remembering those steps, you’re listening to music, becoming present, reducing stress, there’s a social aspect and it’s also physically demanding. So that combination of things is fantastic for cognitive function. So if you’ve been thinking about taking up a new hobby, make sure it’s dancing, exercising in some way or another. Then walking, of course, is great, but it’s not enough, don’t forget, it’s not enough to just take your dogs for a walk, especially if they’re little dogs and they stop to pee and poop and sniff. Right? That’s not exercise. 

Then gardening is a wonderful way to connect with nature, be outside, get the benefits of sunlight and sometimes lifting the heavy bags of soil and all that kind of thing, if you’re digging, that can be some physical exercise, squatting down to pick weeds and do things like that, squatting and standing, squatting and standing, that can be physically demanding. And so, just hanging out in the garden, drinking tea is not, but if you do some of the physical exercise there, then that’s a fantastic way to do it. We are quick to recommend PT. We expect that everyone has the ability to heal and get better and physical therapy, getting a good physical therapist involved is a fantastic way to get the benefits of that. We also happen to have a physical therapist we work with, who the ladies love. And so, if you can find a physical therapist that there’s a little bit of attraction to, it can help to motivate, to do all of those exercises, to show up and really give it your all. We’ve seen that phenomenon over and over again at Marama. Everyone loves when Kevin is on the schedule and coming and they will do anything, they will do as many sit to stands, as many step overs, whatever he’s asking for they’re on it. So, hopefully that’s inspired you to get a hot trainer, right away, and get going with your exercise, so you can enjoy the brain benefits that exercise has to offer. Thanks so much. Can’t wait to see you for day six tomorrow on the Reverse Alzheimer’s Summit.