Practical Considerations in Using Exercise As Treatment for ADHD

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1 Practical Considerations in Using Exercise As Treatment for ADHD Michael Lara, MD Diplomate, American Board of Psychiatry and Neurology Private Practice Psychiatry, Belmont CA 1

2 Born To Move Evolution of the Brain through Physical Activity 1 Pumping Neurons How Physical Activity Changes The Brain 2 Primal Fitness The Fitness Prescription for ADHD 3 Exercise in a Pill? Nutritional Strategies for Optimizing the Effect of Physical Activity 4 2

3 It is exercise alone that supports the spirits, and keeps the mind in vigor. Marcus Tullius Cicero 3

4 Born To Move Evolution of the Brain through Physical Activity 1 Pumping Neurons How Physical Activity Changes The Brain 2 Primal Fitness The Fitness Prescription for ADHD 3 Exercise in a Pill? Nutritional Strategies for Optimizing the Effect of Physical Activity 4 4

5 Evolutionary Milestones Humans evolved primarily as hunter gatherer species 84,000 Generations From emergence of Homo species 2.4 million years ago, humans have survived primarily as hunter gatherer species 350 Generations Ago Agricultural Revolution 75 Generations Ago Industrial Revolution 2 Generations Digital Age 5

6 Energy Expended Hunter Gatherers v. Moderns Resting Metabolic Rate Total Energy Expenditure Day Range (Miles) Kung Ache Modern Office Worker

7 Typical Activities of Hunter-Gatherer Physical activities of our paleolithic ancestors have correlates in modern day forms of exercise Slow Cardio: 5-10 miles/day of low intensity walking Hunter gatherers cover 5-15 miles per day Resistance Training: Lifting, Throwing, and Carrying Objects Encompass functional movements such as pushing, pulling, sprinting, and jumping Interval Training: Periodic bursts of high-intensity activity Brief bouts of sprinting alternating with walking or 7

8 Evolution Through Movement Up to a two line subtitle, generally used to describe the takeaway for the slide 8

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10 Born To Move Evolution of the Brain through Physical Activity 1 Pumping Neurons How Physical Activity Changes The Brain 2 Primal Fitness The Fitness Prescription for ADHD 3 Exercise in a Pill? Nutritional Strategies for Optimizing the Effect of Physical Activity 4 10

11 Why Exercise Is Good For Your Brain Physical activity increases the release of chemical messengers and protects against stress Induces cascade of chemical messengers that improve cognitive functioning Neurotransmitters: serotonin, norepinephrine, dopamine Growth Factors: BDNF, VEGF, IGF-1 Others: BMP, noggin Inoculates the brain against psychological stress Protects against overactivity of the hypothalamicpituitary adrenal (HPA) axis 11

12 Neurotransmitters and ADHD Physical activity increases neurotransmitter release in the brain Neurotransmitters Serotonin Norepinephrine Cognitive Function Serotonin associated with mood and memory Norepinephrine associated with alertness, concentration, and energy Dopamine associated with pleasure and reward Dopamine 12

13 The Effect of Exercise on Neurotransmitters A single bout of aerobic exercise raises catecholamine levels 13

14 Intermittent Fasting Intermittent fasting associated with better brain health Fasting raises catecholamine levels Norepinephrine and dopamine levels rise in the first 8 hours of fasting Fasting reduces markers of chronic inflammation Reductions of inflammatory markers (IL-1, IL-6) observed in the first 12 hours of fasting Fasting increases BDNF levels Intermittent fasting increase brain-derived neurotrophic factor 14

15 Born To Move Evolution of the Brain through Physical Activity 1 Pumping Neurons How Physical Activity Changes The Brain 2 Primal Fitness The Fitness Prescription for ADHD 3 Exercise in a Pill? Nutritional Strategies for Optimizing the Effect of Physical Activity 4 15

16 Exercising to Improve ADHD Symptoms Characteristics of an idealized exercise program for ADHD ADHD ADHD Exercise Symptoms Program Structure Variety Novelty Often has difficulty organizing tasks and activities Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort Often has difficulty sustaining attention in tasks or play activities Structured workouts that are part of a larger exercise program Incorporate constantly varied functional movements: squatting, pushing, pulling, sprinting, throwing Learning and acquisition of new skills; encourages playfulness Monitoring Is often easily distracted by extraneous stimuli Exercise outdoors at high and low-intensities 16

17 Nature Deficit Disorder Diminished use of senses and attentional difficulties due to alienation from nature 17

18 Exercise Programs for ADHD Programs that include cross-training outdoors Crossfit Fit by Nature constantly varied, high-intensity functional movements with goal of increasing work capacity across broad time and modal domains crossfit.com Outdoor fitness program incorporating cross-training and body weight exercises across different terrains. Adventx.com Primal Fitness Moving frequently at a slow pace, lift heavy things, and sprint. marksdailyapple.com 18

19 Primal Fitness The Primal Blueprint by Mark Sisson Sprint All Out efforts once every 7-10 days, for <10 minutes Lift Heavy Things Brief, intense sessions of fullbody functional movements for up to 30 minutes 1-3x/week Move Frequently at a Slow Pace Walk, hike or jog at 55-75% maximum heart rate for 2-5 hours/week 19

20 Born To Move Evolution of the Brain through Physical Activity 1 Pumping Neurons How Physical Activity Changes The Brain 2 Primal Fitness The Fitness Prescription for ADHD 3 Exercise in a Pill? Nutritional Strategies for Optimizing the Effect of Physical Activity 4 20

21 Stimulant Medication and Exercise When and How? Take stimulant medication about 2 hours after exercise Consider dosage changes if physical activity is abruptly increased or decreased No evidence of ergogenic effects of psychostimulants among recreational athletes 21

22 Creatine Immediate energy source for brain and muscle Creatine may improve cognitve function by improving neuronal energy capacity Improves working memory and intelligence in adults Neuroprotective effects Reduces toxicity of excessive glutamate and betaamyloid Individuals with ADHD may have abnormalities in creatine synthesis and turnover Striatal creatine/glutamine dysregulation in ADHD 22

23 L-Glutamine Conditionally essential amino acid L-glutamine is used as cellular energy source Readily crosses blood-brain barrier and converted to glucose Evidence of glutamate/glutamine dysregulation in ADHD 23

24 Omega-3 Fatty Acids Maintain fluidity of cell membranes and reduce inflammation Modestly effective in the treatment of ADHD Small but significant effect in improving symptoms of ADHD Improve glucose utilization in brain and muscle tissue Sensitizes insulin receptors Reduce markers of chronic inflammation 24

25 Summary of Exercise Recommendations Exercising for ADHD Include a variety of functional movements such as pushing, pulling, sprinting and jumping Exercise at a range of intensities; higher-intensity activity associated with unique cognitive benefits Exercise outdoors whenever possible Exercise at the end of a brief fasting periods to optimize effects of exercise Consider supplementing with creatine, L-glutamine, and omega-3s 25