Inside the Effects of Exercise: From Cellular to Psychological Benefits

So what do I want to convey? Today I will convey how long we live and what impacts the quantity and quality of our lives. I will talk about how

exercise

could extend the quantity and quality of our lives and also how we can increase

exercise

. in previously inactive adults and has an impact on health, everyone is familiar with the life expectancy in which we are born and then slowly, over time, after we have many successes, hopefully and some setbacks throughout our life, we will eventually die, there is nothing we can do. about that, there's been something about death, there's nothing we can do about it until there's a pill available, there's been a really great study that was published a couple of years ago in The Lancet and this is the economist. they took their data and their hundreds of data points and summarized it into this beautiful figure and right now let's not look at all the different colors let's look at the end of the red this is the shelf life this site is for women and this size is for men , let's look at the life expectancy of women who were born in 2013 and how long they are expected to live, which is around 86 years in Japan and for men it is about 80 years 79 years. of age, if we look at the United States, that changes considerably where the life expectancy is 72 years for the pitiful 79 years for women and 72 years for men, so that is our life expectancy, the life expectancy expected for the average person in Japan or what an average person in the United States would experience if they were born in 2013.

But there is also this concept of a period of health, what happens in our later years, what happens during the period since we enter an advanced age before dying. and now let's look at these colors and let me break them down. This is in Japan. For an average man who was born in 1990, he was likely to die at the age of 76, while his health encompassed how long, how many years, he was healthy. Before illness took hold, he was an average of 68 years old, so an eight-year period of illness and morbidity is expected. If a person was born in 2013, the life expectancy is expected to be about four years, so now they are expected to live to be 80 or older, but their health span increases not so much by four years, but by three. years, so there is an increase in their health span, so it is likely that in Japan men probably live to age 71. healthy and then spend the next nine years on average living an unhealthy life .

What is happening in the United States? Life expectancy in 1990 was 72 for men and for women it was 79. Their life expectancy was 63 and 67, so nine years. difference here an eight-year difference here of unhealthy years for those born in 2013 there is an extension of four additional years in their life expectancy for men an extension of two additional years for women and the duration of health increases by three years So you can see by the time adults in the United States reach age 60 they will probably live another eight, nine or ten years with the disease in Canada we take this seriously, very seriously, there is a campaign that has been available for the last few years, if you can see, it's called how.

You'll spend your last 10 years and it's an image of a person in a kayak or a hospital bed versus a fisherman? And I'm just going to show you the commercial that we've had on television and also online, what will your The last 10 years look like: will you be quick enough to play tag with your grandson strong enough to embrace every moment? Will you grow old with vitality or grow old with an illness? It's time to decide that the average Canadian will spend their last 10 years sick. change your future at makehealthlast.ca the first time I watched it I think I cried so now I try to hold back all my tears when I watch that video so on the same Canadian Heart and Stroke Foundation website , there are tips on how to extend your life by looking at some of the lifestyle risk factors you'll see unhealthy diet physical inactivity unhealthy weight smoking stress and excessive alcohol and drug use I'm going to guide you through this, so don't worry, this is data from Ontario Ontario is one of our provinces, we have 10 of them and this is in Ontario, the average age expectation is 10 years.

These data at this time the average age expectation in Ontario was around 82 years old in 2007. and what you Here you can see what it means to smoke or not to smoke. So, this is not smoking. How many extra years or more does it add to your lifespan compared to smoking? How much does it decrease in its useful life? You can see that smoking has a serious impact. decrease in how long we will live there is data about alcohol data about physical activity data about diet and stress levels and what the five risk factors provide and what decreases in someone's life and you can see here that there is a decrease 20 years old for those who are categorized as having high stress, not eating well, which for them of this measure was really just a questionnaire about fruits and vegetables consuming physical activity or physical inactivity, excessive alcohol or drug consumption and being A smoker decreases life expectancy compared to those people who do not have any of these factors by approximately 20 years.

What happens if you change your behaviors? How many extra years does it add to your life? You can see that on average by cutting back on smoking and becoming a smoker. non-smoker reduce alcohol consumption become physically active at levels recommended by the CDC or the Public Health Agency of Canada improve diet reduce stress will add about 10 years to your life, so what you take home so far is as As important as quality is life, health behaviors and stress are important and I focus on the importance of physical activity. Hippocrates in a time when man was dominant said that walking is man's best medicine.

I would like to say that walking is a person's best medicine and at this point I have proof. I'm going to ask you to raise your hand. Usually if you go to see a talk by a physical activity researcher, they ask you to stand up and then you have to do some jumping jacks and I'm not going to do that. I force anyone to do that right now, but I'll do a test, so the first question and I don't show it in the answer yet is how many minutes of moderate physical activity are recommended per week, so a moderate activity level is three to six metabolic. equivalent tasks, so the acronym is mets, three metabolic tasks, the equivalent task is three times the amount of energy needed to support movement and the body compared to just sitting, so the average for sitting is one , so three for a met is three. times the amount of energy it takes for your body to function while performing that behavior some types of examples are brisk walking ballroom dancing gardening and water aerobics I want to see who wants to guess how many minutes it takes here 150 minutes she is right, I'm not going to ask you the next thing, there's no way, um, they're also in Canada and this actually comes from the recommendations of the CDC and a task force that it requires 150 minutes total spread over five days with 30 minutes during each. . activity there is also a requirement that each one must last a minimum of ten minutes.

Okay, so how many minutes of vigorous activity are recommended per week? If you did not do moderate activity, vigorous activity is greater than six men, so six times the amount of energy is required. doing these types of activities and those types of activities are jogging, running, swimming, jumping, etc., jumping rope is actually, I think a gathering of about ten people is considered one of the most strenuous activities one could do . I'll ask the same. Woman, to answer this for vigorous it is 75 minutes, so what is recommended is half the amount of time to spend 75 minutes per week spread over three days in 25 minute periods or a combination of the two, for which is recommended between 75 and 150 minutes.

For optimal health, then how many days of strength training are recommended? Does anyone want to answer this question? two. Two days are recommended for strength training. muscle strength activities. two days a week. It says high intensity here, but you'll see it also says moderate. intensity moderate intensity is okay for some reason they're highlighting this high intensity because that's where a lot of people really like to do some workouts lately, so moderate intensity weightlifting doing some lunges doing exercises on the muscles and bones, what? as? We're doing in the world in terms of physical activity levels, so this is physical inactivity among adults in the unit around the world, you'll see some very deep reds, those very deep reds are more than 50 percent of the self-reports. of its population and that is important. self-report that they are physically inactive in the United States is between 30 and 40.

In Canada it is between 20 and 30. This is self-reported if you ask people in the United States how much they say how much activity they do. they do, it's about 50 percent and that's consistent in pretty much every study I've ever had 50 to 55 say they're physically active in the United States, if you put an accelerometer on them and track them for a whole week, it's in somewhere around twenty percent and that's consistent in Canada as well, there's fifty, forty, sixty percent that say they're physically active and thirty percent are actually kids, I think because kids have to do 60 minutes. of movement per day for children with accelerometers, is 15 percent, so why is this important?

Well, we've been talking about health span and life expectancy and I'm going to show you some data here recently published in in jama published in 2015 by aaron and his colleagues and let me explain this to you. Never put a figure here without explaining the results. Here you see a few hours of exercise per week, so the minimum amount of mets is a moderate level in 150 minutes and a moderate and brisk walk is three mets, 150 minutes is two and a half hour, so two and a half hours times three is 7.5, so we have here this is for people who basically meet the requirements recommended by the CDC or other agencies that have the exact same requirements and this is if you multiply how many more, this person actually performs 10 times the amount of recommended physical activity.

What does mortality look like? Look, look at this drastic drop just by doing a physical exam, but just by being physically active at the recommended levels there is a 20% lower risk of early mortality and when you get to this area of ​​being three to five times there is a forty decrease percent, but the

benefits

of exercise don't just extend to mortality, they bet this is from the US government of the United Kingdom, that is, the

benefits

of exercise reduce the risk of cardiovascular disease. in 30 percent type 2 diabetes in 40 cancers in 30 and so on, at the end of the day, there is a significant amount of research accumulated over the last many decades that physical activity is essential for disease outcomes and for reduce the risk of disease to slow disease progression and to decrease early mortality and at the root of many of these diseases of aging are called diseases of aging at the root of many of these diseases is our immune system and functions of our immune system. to keep uh to keep our body intact under control it responds to a physical blow if someone attacks me and I have a cut my immune system will heal it will heal that cut if I have a cold my immune system works better to be able to deal with the virus or the bacteria, that is the importance of our immune system and what they have discovered is that over time our immune system ages.

Exercise is known to benefit the immune system. Our immune system ages over time and the basis of all these diseases is an worn out immune system. system that is pumping all this pro inflammation into our body that then circulates through our blood and attacks different areas of different physiological physiological systems and that one of the markers of an aging immune system is the telomere. Has everyone here heard about the telomere I'm going to do a little crash course that will take two minutes on what a telomere is, so telomeres are the ones highlighted in yellow here at the end of a chromosome, the purple codes for DNA and the yellow It is simply a repeated sequence of ttaggg. repeated thousands of times it was discovered by elizabeth blackburn of ucsf and they want a nobel prize for discovering telomeres and also discovering the enzyme that extends or extends telomeres every time a cell divides and that enzyme is called telomerase so DNA, like many of you know, is transcribed into aRNA molecule that is then translated into a protein.

The blue that was on the previous slide, purple, blue is important for coding proteins. Damage occurs preferentially when damage occurs to the chromosome, it occurs preferentially at the ends of the chromosome, so if you are going to damage something, let's damage something that does code so that the telomeres do not code for anything, they are there to protect all the blue they are there to keep the cell viable to keep the chromosomes viable to keep the proteins are produced as proteins that can still function well, but every time a cell divides, even if we have telomerase, the telomeres get shorter and at some point the telomeres They reach such a short length that the cell stops dividing because it realizes that further division any further loss will begin to affect some of the proteins that are part of the DNA that codes for some very essential proteins, so the cell stops dividing, Sometimes the cell dies and sometimes the cell enters a state of senescence.

Senescence is a cell that is not dead and is pumping out inflammatory proteins and this is one of the fundamental causes of the diseases of aging is shortened telomeres. There's always a debate in the literature about whether it's really important, whether it's a marker and there's some research that actually shows that this. It's a meta-analysis of the association between telomere length and cardiovascular disease and it says retrospective data here, so these are data studies where I have a whole room full of you and you, unknowingly, I've taken your blood, I know if I really have to give my consent and I will take his blood and also find out if he has cardiovascular disease.

Right now, in all of these different studies, there is an increased chance of having cardiovascular disease at the same time as short telomeres are damaged, an 80 increase in having cardiovascular disease here are some prospective studies these are healthy participants in all of these different studies none of them have heart disease but in the future they will develop it some of them will develop heart disease what is their rate what is the risk of having short telomeres with developing cardiovascular diseases in the future here their highest risk is 54 percent similarly we have mortality risk and here is a recent figure on the relationship between having short telomeres and having a higher chance of early mortality and here is an increased risk of 54 If you are short compared to the longest group in this sample of participants, what is the research on exercise and telomere length since 2007 or eight?

Studies have been published, most of those samples have been small samples. When looking at the relationship between self-reported physical activity, cardiovascular fitness and also sedentary time and accelerating physical activity levels based on accelerometry, all of those studies predominantly showed that cardiorespiratory fitness had a good heart and a strong heart and was able to absorb oxygen and use it. well it is related to longer telomeres telomeres the physical activity literature because of the sample size product, I would say that in the majority it demonstrated links between exercise and short and longer telomeres, but there were many studies that showed operations that showed

effects

nulls that rate change with this nationally representative sample and Haines Larry Tucker entered the data. 5,843 participants had data on telomere length and they also had data on their physical activity levels, so they wanted to create different physical activity groups, four different groups, by quartile, the lowest. physically active until reaching the top 25 percent of most physically active, unfortunately found that 50.8 of the participants reported zero physical activity compared to the previous period during the time when they did not assess physical activity, so they really couldn't do These quartiles were evenly distributed at 25 percent, so you said you divided these 50 and the remaining 49 were divided into three tertiles and what did you find?

What were the odds of having short telomeres compared to the taller group than those who had zero? Physical activity during the time of assessment had a 95 percent increase in the probability of having short telomeres in the sample, which is almost twice as likely to be in the short telomere group compared to the no telomere group. short, those in the low physical activity group, so they participate. In some health cases some physical activity, but not a lot, in this sample there is a 66 percent greater chance of having been categorized as low compared to the high group and even those who did a moderate amount of physical activity still had a 73 higher risk of having short telomeres compared to the tall group this was replicated in a different sample: an older woman by sadhyab.

They use data from the Healthy Women's Initiative study that shows that leisure-time physical activity is also associated with telomere length and this was also a fairly large sample in the group. The same sample uses data, not from self-reported physical activity levels, but from physical activity levels measured by accelerometry, so when you put on an accelerometer like a Fitbit or one used for research purposes, the actigraph or active friend , there are all these different ones. companies also found a relationship between the amount of sedentary time people spent in these women and their short telomeres the more sedentary they were the more time sitting the more time sitting in front of computers not moving much was related to the length of the telomeres shorter telomeres which was quite a study and received a lot of attention in the media.

This is just one of the Time magazine articles that says that staying too long ages you eight years. That was his main message. My main message is that any increase. I think exercise is important for your health and your life but the effect and

effects

can be seen deep within ourselves but of course more is better that's my conclusion from here so this says that for those who cannot see, I am prescribing it. exercise, think of it as a stress pill that takes 30 minutes to swallow, why am I adding stress to this? I'm a health psychologist and I work a lot on stress and the first article I read was a never read article in my entire life, but the first article I read about research that really excited me was this research by Alyssa Epple on stress and telomere length.

How is stress measured? It can be measured with questionnaires. You can observe different events that happen in people's lives. lives, you can look at their

psychological

experience, you can look at acute stressors like a hurricane or you can look at a chronic stressor like caregiving and alyssa dr epple um I was interested in looking at family caregiving why family caregiving family caregivers uh put four , there are 40 million family caregivers in the United States in 2013 they dedicated 37 billion hours of caregiving, representing 470 billion of unpaid services. This is from the Alzheimer's association or the caregiver alliance, comparing what those ma with what those 470 billion dollars are equivalent to, it is similar to The money made at Walmart is more than Medicaid expenses, why what is this important?

They report that they dedicate an average of 18 hours per week to providing care. 60 percent care for an adult while employed. 68 use their own money and 39 feel in financial difficulties. one in four workers are 72 of workers have been providing care for more than 40 years and are still working family caregiving doubles the risk of depression increases the risk of cardiovascular disease by double and has a 63 percent increased risk of more early mortality, so as I was saying, Dr. Apple published the first paper that I was so excited about and when I first heard her talk about this research and she's one of the most interesting speakers I've ever heard in science and not saying that just because you're sitting here you really are... published a paper in the proceedings of the national academy of sciences linking short telomeres to life stress and caregivers.

She had a sample of premenopausal women caring for a child for a time. disabled for a child with a disability, she looked just had a sample of these caregivers and looked at how many years they have provided this care to the patient for their child and what their relationship was between the number of years they were providing care and the length of their telomeres and what he found was a strong relationship accounting for 20 percent of the variation in telomere length by the number of years they provided care, so the older the years the shorter the telomeres, he also found that if you had a sample not only of red caregivers but also of blue control participants who reported low or actually low levels of stress, reported low levels of stress, and did not have a child with a disability, but were mothers and also completed a measure

psychological

called the perceived stress scale and found that an increase in all women in this study an increase in their perceptions of stress over the past month was related to shorter telomeres since then studies have been conducted on prenatal maternal stressors, diversity in early childhood. and this list goes on and on socioeconomic disadvantages like lower income, poor education, poverty, unemployment, domestic violence and other articles linking psychological and psychosocial stressors with shorter telomeres, the question for us was what happens if you accumulate stress over time?

Throughout your life, most of those studies have been single cases that look cross-sectionally at people who are currently stressed or reporting domestic violence or what their telomere length is right now. What happens over time can cause you to build up stress and get under your skin, embedding itself, and changing its length. of their telomeres we had the opportunity to look at this question in a sample drawn from the nationally representative US Health and Retirement Study. I'm not going to explain all of this, but the Health and Retirement Studies began in 1992 and have been tracking adults in the past, now we are in 2018, so actually from 90 for the last 26 years there are different cohorts, there are 50 to 64 participants from 50 to 65 years old, men and women, and there is also a group of 65 to 80 years you tracked During the first few years and as people dropped out of the study for health or mortality reasons or just dropped out of the study, they kept reintroducing new cohorts into the study and that's what all these arrows represent: there were 20,000 people in the study.

At the beginning of the study on average in 2008 they got saliva data for telomere length and what we did was we analyzed this data from 20 or 16 years and tried to find all kinds of events that can be considered a stressor did they report unemployment sometime? Did they report financial loss at any time? We looked at the questionnaire and found out that at some point they also said, "Hey, what happened in your early life?" and there were questions related to them having to move as children to a new home due to financial difficulties, that their father was not unemployed at a certain time, so there were adversities in childhood and then adversities in adulthood, such as experiencing the death of a child. from a spouse and also some financial difficulties in adulthood, what we found in this study was that none of these are in adjusted or unadjusted or adjusted models, so we can ignore that, let's look at the adjusted models, which means that I am in this model. m covarying and controlling for everything under the sun your current education level your current marital status your current health behaviors your current medication use your current disease state after adjusting for all those factors nothing really dominated on its own the length of their telomeres or predicted the length of their telomeres, but when you added them up there was a significant relationship between the addition and accumulation of stressors throughout life and having short telomeres and this was an eight percent increase in the probability that for each additional event no particular event but for each additional event, there was an eight percent greater chance of having short telomeres, so life stressors can predict the degree to which we age healthily or unhealthy, but we also have factors that make us more vulnerable. or make us more resistant to stress.

I predominantly look at healthy lifestyle and physical activity almost all the time, but there are other factors that we have examined to see if they buffer or mitigate the effects of stress on aging and our health. I have analyzed theresilience to psychological stress. Are you a good emotional coper? Are you emotionally resilient? Don't you reflect a lot and have strong social connections? I'll show you the first study, so I was excited by Alyssa's article and sent her an email. I met her at a conference and I think I harassed her for a good year trying to convince her that we need to look to see if you are physically active.

Does stress still have an impact? Then she said they finally come to San Francisco. I broke it, so what we looked at was that she had a new sample of keepers. These were not family caregivers, but they were not premenopausal, they were caring for a child with a disability, they were postmenopausal, they were caring for a spouse, a parent, a sibling. who had Alzheimer's disease or another type of dementia and instead of looking closely first, I looked at the entire sample and found a similar link to the previous study that due to the greater amount of psychological stress these participants the control that we all said that a participant also had of lateral shell control, so they were postmenopausal and not providing care, so the amount of stress that all of these participants reported was similarly related to shorter telomeres, but I split, we had a few days of how much physical activity They reported at the end. of a day saying how much physical activity you did so I separated it and found the partitions that said none during those few days and the ones that said yes they did and I separated it and luckily it was none or people complied with the CDC recommendation . so it was a good split and what we found was that the relationship between those who were not physically active at all, the relationship between their psychological stress and the length of their telomeres was even stronger than for the entire sample and for those who were They may have been stressed but it had no impact or no relationship with their telomere length, but this is cross-sectional and there are always problems with cross-sectional studies, so we then created and designed a study where we wanted to look at The determinants of telomere lengthening or shortening over a one-year period only and we asked people to report at the end of that year that they had blood from two different times year in that year they became family caregivers they lost a home they got divorced they had financial difficulties and what we found was that for every additional event that occurred during that one year period and some women actually reported six events during that one year period.

This was a study in postmenopausal women, just what we found was that for every additional event there was an increased extra loss of 33 base pairs, fortunately we also repeatedly evaluated their exercise levels, their diet levels and their sleep quality and we calculated over that one-year period, summed it up, scored it, and called it. a healthy behavioral lifestyle, so even if they are stressed or not, they may have engaged in high levels of physical activity, they may have engaged in low levels of physical activity. We summed it all up, created this healthy behavior score and what we found was for the women who participated that they were stressed or they regretted the women who had poor levels of health behavior, so they didn't, they weren't physically active, They didn't eat very well and their sleep quality wasn't as good. the loss in base pairs per event was 55, not the average for the sample of 33, but was 55 for those who participated in moderate activities, it was similar to the average for the entire sample and for those who participated in a physical activity high. physical activity those who ate well and those who reported good quality sleep their um the number of events the number of events that occurred during that one-year period had no relationship to the amount their telomere length shortened during that one-year period a year we similarly looked cross-sectionally in a sample of depressed participants and what we found was that in the depressed participants there was no real effect of our resilience scores on their telomere length, but when we looked at their resilience and I'm going I'll describe this in a moment, but since the number is up, I'll walk you through this for those who are depressed, if they were highly resilient, they were likely to have longer telomeres compared to those who were low resilient and had the longest short of all. telomeres those who had low resilience and had depression, so what was resilience in this study?

Resilience in this study was a mix of and everything was sometimes based on the sample that was collected and these were secondary analyzes on a sample that was already collected they had physical activity level scores and they had sleep quality they had uh what a good regulator of emotions you are you were someone who avoided difficult emotions um and uh we also had social connections so this is a combination of what that bubble Did I show you this idea that you have multiple areas that you can draw from to achieve resilience? Some of them are physical activity and other health behaviors.

Some of them are connections between each other and are also a good regulator of emotions. So what's this take home? message: well, stress builds up and reduces telomere length, but the fact that exercise and other health behaviors, social connections and emotions are a good regulator of movement are also important for length and health of telomeres, which brings me to my interesting findings. I'm going to spend some time on Guide everyone, so this was the quick study that we got, I got funding from the NIH to complete one of the biggest problems with all the previous studies is who are the type of people that when they have five stressors? for a period of one year. eat well diet sleep well stay strong socially connected regulating your emotions with every hit is very difficult so the biggest criticism and I don't say criticism more than an academic criticism of this is what happens if you take someone who is physically inactive and give them the opportunity to become physically active and that's what the rapid study was that fits into this aging and stress study and was intended to improve fitness levels in family caregivers so I'm going to walk you through the study design.

It was a pretty intense study, so they filled out a lot of questionnaires, so ignore all of that. They did a stretching test so we wanted to make sure that they wanted to participate and that they had the motivation to participate in the study, so we asked them to watch a video for 10 minutes every day that was just stretching, we created this video for them and Every day they said yes, I did it or no, I didn't and if they did it three times that week, we were like, you know what you do. They're ready for an exercise intervention, they came in and we drew their blood, then we did cardiorespiratory fitness, the VO2 max test, the stress test, some of you may know that test on the treadmill with the mast and they push you to its maximum. capacity when they look at oxygen consumption, then look at how well their heart works during this test, then we randomly assigned these 68 women and men to either an aerobic exercise intervention arm or a waitlist control group where they simply waited for six months and we asked them to maintain their low levels of physical activity, which some people were actually very happy to do.

We had some participants say, “Oh gosh, I'm so happy I wasn't randomly assigned to that exercise, so we then asked them to complete it.” a bunch of questionnaires and I'll talk about this green thing next week and then we had them come in and repeat all these measurements, how did we get them to exercise for six months? So this is with the permission of our participant, this was our uh. our volunteer um, who is our fitness instructor or fitness trainer? uh, and this is one of our participants, he gave us permission to use this photo in slides, we met them, we gave them a free six-month gym membership to any ymca that was convenient for them, paid. because half of it was done by us and the other half was for the ymca it was a donation we met them at the gym we walked through this is what the next six months will be like for you we provided you with the next solar accelerometer to track your movement we also gave you a heart rate monitor because we gave them based on their VO2 their stress tests, we gave them their range of what moderate activity means for their heart and their heart rate, so it's called heart rate reserve and we used the data from our lab from our test to tell you what your individualized heart rate goals should be in the first week, you see, we said, you know what, let's start with three 20-minute sessions, we'll get you to the low end of your heart rate reserve. what is your goal and this is someone else's, some data from other participants, so we asked them to do 60 minutes of brisk walking for week 9, we gave them up to 150 minutes and we had their goal at 59, sorry, the 59 percent of their moderate zone so we wanted them to stay in their moderate zone keep them healthy make them physically active for six months weekly like I said, they used an accelerometer that they strapped on, they connected their accelerometer to the computer that we gave them in their house, they uploaded their data of accelerometry we download them from the cloud on our end and turn them into a nice report that says look how much light activity you did this week look how many steps you did look how many moderate activity figures you did and look how much vigorous activity and we counted how many minutes and then we sent them an email and then we tabulate it and show them the progression week by week and send them an email with this report saying congratulations, you did 199 minutes this week, great job, keep it up. if you have any questions let us know for those who didn't maintain or reach 150 minutes of our goal we said congratulations you made 20 minutes it must have been a tough week for you but you still made 20 minutes let's talk to let's talk about facilitators and barriers to keep you going for another week five times a week.

We send them text messages of different types. One of our participants said, "I don't think you can write five times." uh 24, so what are those 120 new text messages? for six months and we said you'll see and we said we sent 120 unique text messages five times a week for 24 weeks to these participants today is a great day to walk meet a friend for a quick walk instead of getting coffee if you don't If they didn't meet their goals, we also scheduled a phone call and used motivational interviewing best practices. This idea is that I can have a conversation with someone or at least I trained my coaches on how to do that.

Have a conversation about what your goals are. We need to adjust their goals, what helped them get out during those 20 minutes this week and what made it difficult for them to not reach their goal this week and then we strategize with them on methods to overcome those barriers and how to use that information. who said it made it easier for them to overcome their barriers It was an intense study and it was worth it What we achieved We achieved approximately 73 percent of participants met our goals of 150 minutes per week It's pretty good for an intervention study in high-stress caregivers who at this point hadn't been doing anything, someone told me we're probably going to get five people into the study, but we got 68 and we got 73 of them to reach their goal if you watched 120 minutes, so I lowered the bar a little bit, But this is the majority of interventions, they go for the gold of 120 minutes.

What we found was that 81 of the participants met their weekly goals within 120 minutes, that's pretty good. We improve your cardiovascular fitness, so your VO2 peak, which is your ability to use oxygen and how. a lot of oxygen is being consumed, we improved their VO2 to its peak in the athletes and, as expected, in the control group it did not change over a period of six months and decreased a little, but not significantly, what about the length of your telomeres? In the control group there was a slight decrease that was not significant and in the exercise group their telomeres lengthened by approximately 60 base pairs and this effect, so when you do a test you must first observe if the effect between the groups is different and the effect is significant.

What happened in the exercise group was significantly different from what happened in the wait-list control group. Fortunately, the unweighted control group also received gym membership and some support. At the end of the study, we also changed theirperceived stress levels. Caregiving happens daily in the lives of these individuals, so we use this technique called ecological momentary assessments to assess how they feel and what they think throughout the day. Momentary ecological assessments people wake up, they go to sleep and we divide their day into six intervals and during that day we will ping them in the morning and say: Hello, how are you feeling now?

How much control do you feel over your life? How much do you reflect on stressors? we do it six times at random times during the day and we do it for an entire week and you'll see that it's split randomly, our days are split equally, but it's sent randomly as pings to these participants. I will present some data about what happens in each ping, so in each ping we evaluate how much control they feel over their lives, we evaluate how much they ruminate about stressful situations, so, have you not been able to stop thinking about stressful situations?

And that was asked at all times. point and we ask them about their negative affects, so as we look at their anger, their anxiety, if they feel embarrassed, some fatigue, some frustration, some loneliness, what do we find? We decreased rumination in the athletes, they reduced a significant amount in the amount of rumination, while the control group. group remained the same in terms of how much they reflected daily we changed their ability to control, they felt more control over their lives daily throughout the day in the exercises compared to where they were six months before starting the intervention, while there was no change in the control group and we reduced their negative affect and in fact the exercises reduced their negative affect and how negative their mood was on a daily basis while the control group increased so the take home is that the exercise improves the traditional. and new markers of health and improves the way we experience our days and gives us an understanding of how our motivation, our barriers and the facilitators that we experience, how they affect our health behavior change and it is important, it is essential that when we think about the Our changing our own behaviors is essential that we really sit down and think: am I capable of doing this?

Am I motivated to do this? What are the barriers? It's very cognitive, but sometimes it's boring to go through this, but it actually works. What are the barriers that I face that prevent me from exercising tomorrow or eating well tomorrow and what will help me overcome them and this is a constant reevaluation, another really boring thing that people have to do to become physically active or eat Well, it's programming, we are all very stressed, we like to tell each other that today I am very stressed and we think that suddenly, on the New Year or suddenly on our birthday, we are going to change everything within us.

The context of feeling stressed all the time and part of this is that we don't take care of ourselves when we're stressed, but we also don't take the time to take care of ourselves and it's pretty essential when we are. We're creating a new practice of looking at the calendar and thinking about where I'm going to fit this in and how it becomes as important a task as doing the dishes or grocery shopping. How can I make this a task on my calendar? very boring but it is essential to build a new behavior how do you do it? that a task so you can start carrying it out another important thing that scientists have learned about what keeps people exercising is how good you feel during the exercise. exercise and after exercise the people who struggle in that first week without having exercised for six years and say I'm exercising and I'm going to go to the gym and spend three hours there and take the aerobics class, then I'll take the step class and I'm going to do the weights and then the next day it hurts and no, they didn't enjoy those two hours and their body hurts and they didn't enjoy the experience because they also tried hard, they took CrossFit and suddenly they decided that CrossFit was what they were going to do, but His body was not prepared for it, but psychologically his mind was not prepared for it either.

There is actually research that shows that once you pass the level of how much oxygen you can consume compared to the carbon dioxide expelled at that level and that is in the high intensity zone at that level you start, you go from exercises that you They make exercises that make you feel bad feel good and it is at that point what is called the ventilatory threshold when you exceed or pass that ventilatory threshold now you do not feel good and it has been shown that when you pass that and you are reporting after that you do not I feel good or it wasn't that good that amount That feeling of feeling good predicts future commitments and behaviors, so if anyone here is planning to change a behavior, don't try too hard at first and then if you need to and you start to enjoy it, Your ventilatory threshold changes as you get fitter.

Just keep trying a little harder, what are the next steps? From a biological perspective, all of these telomeres are protected or lengthened by the enzyme telomerase and protected by all of these different proteins that form this shelterin complex that we know from the rodent literature. and with just one acute session of exercise in the lab that all of these protein transcripts, so the amount of protein in the cell of these proteins or the amount of protein of these in the cell, we know that this goes up to even one session acute exercise, so in the future what we hope to do is see if someone exercises for six months.

Are we changing the basal levels of these proteins over a six-month period or is it just in response to the stress that we're also taking? people and we give them a treadmill test in the lab and we put them through different levels of physical activity, so some have high intensity levels, some have moderate intensity levels, some have low levels, and some are sitting. and then we stress them in the lab and we have this stress test which is kind of like when someone gives a speech but none of you laugh and none of you enjoy this talk and all of you are staring at me, so this is a task which is done in the laboratory and what we hope to see is what the effect of the different levels of intensity is on how we feel after the task and all the hormones that flood us like stress hormones.

Cortisol or the increase in our heart rate causes exercise to mitigate some of that stress response immediately after exercising and we're also going to play with how much time passes between exercise and stress. Does exercise only have one effect? 30 minutes later in the stress response or lasts three four hours later as well and we are also bringing all this work to the children. This is a recent movement in Canada, these 24-hour movement guidelines, so instead of just looking at exercise levels in children. For adults, our day is actually made up of 24 hours, so increase exercise or decrease exercise, increase sedentary time or decrease sedentary time, and sleep also changes, so our day is actually made up of 24 hours. recover and it's a children's day.

A child's day is made up of sweating and walking and sleeping and sitting and there are recommendations of 60 minutes per day per child of sweating doing some moderate to vigorous activity walking for 60 minutes per day or several hours actually how much sleep is required nine to 11 hours of uninterrupted sleep in children aged five to 13 years and eight to 10 hours and those aged 14 to 17 years and reduce children's sitting to less than two hours a day, which is a task almost impossible while sitting at school, but that means when you get home from school, reduce the amount of time you spend sitting when you get home from school, so that's my takeaway from this talk, start moving, and i want to thank all the funders, the nih and the alzheimer's association, for funding my projects, uh cihr in canada.

And innovation, which fund finances my laboratory in Canada, all the infrastructure and all my incredible collaborators at UCSF and UBC, thank you.