Exercise to prevent Alzehimer’s dementia

Dementia is a defined as a cognitive decline resulting in a decline in daily function. The most common cause of dementia is Alzheimer’s Dementia (AD). In the United States there are over 5.3 million people in the United States who have AD. This number is estimated to triple by 2050. The main risk factor for developing AD is aging. The majority of other major risk factors including diabetes, obesity, and physical inactivity, are potentially modifiable thus we have control over. (Barnes, 2011)

Out of all the risk factors physical inactivity may have the largest impact on prevention of AD. It has been estimated that over 1.1 million cases of AD are potentially attributable to physical inactivity.(Barnes, 2011) Such that those who engage in the highest physical activity have been estimated to have a decreased risk of AD by 45% compared to lowest physical activity category. (Hamer, 2009)

Exercise has indirect effects of improving your brain by improving health conditions that are also risk factors for AD. Specifically exercise results in weight loss that then decreases risk of obesity. Diabetes and hypertension are also improved with exercise. Improvement in these health conditions, then, potentially may result in a decrease risk of strokes.

Epidemiological studies have shown that increased lifetime engagement in physical activity can reduce the risk of developing dementia in cognitively normal elderly persons. (Taafee, 2007) Specially, moderate activity during mid-life is associated with 39% decreased risk of developing mild cognitive impairment (which is one of first stage of AD). The good new is that even starting an exercise program later in life is also associated with a 32% lower risk for mild cognitive impairment. (Bherer, 2013).

Evidence is also growing that exercise may not only reduce the risk of dementia but also have some benefit in improving memory as we age and if you already have dementia. Exercise has been shown to preserves memory, processing speed, and executive function that typically decline with age. (Bherer, 2013) Exercise in patients with dementia overall has a positive effect on cognitive function based on a meta- analysis of 18 randomized studies. (Groot, 2016) Exercise also improves balance, mobility and thus reduced the risk of falls.

The beneficial effects of exercise are supportive by the brain imaging research that has been done. These studies have noted a decrease rate of the shrinking of brain in those who have higher aerobic fitness levels. Also shown is that the area involved in memory, the hippocampus, has a larger volume with exercise. (Kelly, 2014)

How exercise is believed to result in these changes are of course not completely know. Things that are believed is that exercise has neuro-protective effects on the brain. One of the main factors believed to be contributive to age related diseases and AD is oxidative stress mediated by reactive oxygen species. Exercise has been shown to decreases reactive oxygen species and increases the activity of antioxidant systems.   Exercise also increases a neuropeptide, brain derived neurotropic factor (BDNF) that helps to promote neurogenesis in the hippocampus. (Radak, 2010) (Bherer, 2013)

How much exercise is needed? To reduce risk of cognitive decline in cognitively normal persons over the age of 65 the World Health Organization recommends: A weekly minimum of 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous intensity aerobic activity. (Groot, 2016) I would also recommend adding some muscle strengthening exercises to help improve strength. To help prevent falls consider adding in some yoga or Tai Chi to help with balance.




Barnes, D. Y. (2011). The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurology, 10, 819-828.

Bherer, L. E. (2013). A Review of the Effects of Physical Activity and Exercise on Cognitive and Brain Functions in Older Adults. Journal of Aging Research, 1-8.

Erickson, E. E. (2011). Exercise training increases size of hippocampus and improves memory. Proceeding of the National Academy of Sciences of the United States of America , 108 (7), 3017-3022.

Groot, C. E. (2016). The effect of physical activity of cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Research Reviews , 25, 13-23.

Hamer, M. C. (2009). Physical activity and risk of neurodegenerative disease: a systemic review of prospective evidence. Psychol. Med , 39, 3-11.

Kelly, M. E. (2014). The impact of exercise on the cognitive functioning of healthy older adults: A systemic review and meta-analysis. Aging Research Reviews , 16, 12-31.

Radak, Z. E. (2010). Exercise Plays a Preventive Role Against Alzhemier’s Diease. Journal of Alzheimer’s Diease , 20, 777-783.

Soli, F. (2011). Physical activity and risk of cognitive decline: a meta- analysis of prospective studies. Journal of Internal Medicine, 269, 107-117.

Taafee, D. e. (2007). Physical activity, physical function, and incident dementia in elderly men: the Honolulu-Asia Aging Study. Journal Gerontology , 63 (5), 529-535.




Obesity increases risk of migraines

Yes, being obese can actually increase your risk of having more migraines headaches!

Obesity affects one and a half billion adults worldwide, with estimates of a third of adults in the United States being obese. Obesity is associated with many health issues including heart disease, stroke, diabetes, and cancer, making obesity is a significant health problem.  Obesity also has a negative effect on quality of life due to increased back and joint pain. What may be surprising to some people is the fact that obesity is also associated with an increased risk of migraine headaches.

Studies have shown obesity is a strong risk factor for having migraines. Being overweight or obese is associated with a two-fold increased risk of having migraines. As the BMI increases so does the risk of having migraine headaches. Additionally, obesity is also associated with having greater than five times the risk of developing chronic migraines. By definition, a chronic headache is having >15 migraines a month, which are typically more difficult to treat.

The fact that obesity increases the risk of both chronic and episodic migraines has been shown in multiple studies.   The first was in 2003 by a study by Ann Scher.  This study showed that not only that the risk of having migraines increased with obesity, but also that compared to those with normal weight, individuals with episodic headaches who also had obesity at baseline were at increased odds of developing chronic migraine at follow up. These results have since been confirmed in several other studies.

What is the mechanism?

The cause of increased migraine in obesity is not exactly known, but most likely it is related to the pro-inflammatory properties of adipose tissue. Adipose tissue is more than just fat that piles up where we don’t want it; it is also a functioning active endocrine organ. Adipose tissue produces and releases pro-inflammatory cytokines including tumor necrosis factor and interleukin-1. Additionally, several hypothalamic peptides adiponectin and orexin, typically felt to be anti-inflammatory, are low in people who are obese.   This increased systemic inflammation has been implicated in the pathogenesis of migraine headaches.  Increased inflammation also is associated with increased central sensitization, which then leads to more frequent and harder to treat migraines.

Can weight loss help prevent migraines?

Currently, the only studies on the effects of weight loss in adults were in people who underwent surgical treatment for weight loss. The two small clinical studies that looked at headache frequency after weight loss from bariatric surgery, found that at 6 months after surgery the frequency of migraines did indeed decrease from a pre-surgery average of four per month down to 1-2 per month. There was also an improvement in headache duration, pain severity, disability, and use of pain medications.

The only study looking at non-surgical intervention for weight loss to date was in adolescents. This study looked at whether a behavioral weight loss intervention would reduce migraine frequency. The behavior intervention consisted of encouragement of exercise program and dietary education of the adolescent and their parents. This study showed that a decrease in BMI was associated with a reduction in migraine frequency. With the greater decrease in BMI was a greater decrease in migraine frequency.

How can weight loss cause an improvement in migraine headaches?

Just as obesity is associated with pro-inflammation, weight loss is anti-inflammatory. Weight loss decreases pro-inflammatory cytokines (TNF and IL-1) and the peptides leptin.   Weight loss also increases anti-inflammatory peptides; Orexin A, and adiponectin. Thus with weight loss, there is less neurogenic inflammation resulting in less frequent migraines but also less central sensitization and decreased the severity of those migraines.

Additionally, there are also the benefits of physical activity on prevention of migraines. Several studies have been published that have reported beneficial effects on both migraine frequency and severity. Also, a study showed that exercise might be just as beneficial as topiramate in the prevention of migraines. Exercise is also felt to be anti-inflammatory and also increases the feel good, pain-reducing chemicals in your brain. In addition, people who exercise, tend to eat better, sleep better and have less stress which all can also decrease migraines.


Given that there is proven benefits seen with both exercise and weight loss in improvement in both frequency and severity of migraines, what is stopping you from giving it a try? I would love to help find an exercise and weight loss program that is right for you.

Your Name: *

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How may I help?

Please leave this field empty.


Evan, R. W. (2012, February). The Association of Obesity with Episodic and Chronic Migraine. Headache.

Lockett, D. C. (1992). The effects of aerobic exercise on migraine. Headache, 32 (1), 50-54.

Peterlin BL, R. A. (2010). Migraine and obesity: Epidemiology, mechanisms, and implications. Headache, 50, 631-648.

Varkey, E. e. (2011). Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalalgia, 31 (4), 1428-1438.

Verrotti, A. e. (2013). Impact of a weight loss program on migraine in obese adolescents. European Journal of Neurology (20), 394-397.

alz brain

Exercise prevents Alzheimer’s pathology

Exercise can prevent Alzheimer’s pathology in the brain

Age is considered the #1 risk factor for the development of Alzheimer’s Dementia (AD). The pathological changes in the brain of a patient with AD include abnormal beta–amyloid deposition in plaques and neurofibrillary tangles  resulting in neuronal loss and shrinkage of the brain. These changes, however, can be seen as early as 30 years before clinical symptoms occur but increase as we age.

As of yet there are not any drug or medical treatments that have been shown to prevent or reverse these changes in the brain of patients with AD. However, a recent study just published in the November 2014 issue of Neurology showed that exercise lessens these preclinical pathological biomarkers of AD.

Prior to this recent study, we had multiple studies that showed the following: (1) exercise can help to preserve memory as we age; (2) exercise has been shown to improve cognition in patients who already have Alzheimer’s and (3) exercise can improve brain volumes, most specifically, in the memory processing areas of the brain, the hippocampus. This is the first study that specifically looks at the pathological changes of AD resulting from exercise.

This study looked at late middle-aged adults (ages 40-65 at entry) who were cognitively normal but at high risk for AD. They investigated whether engagement in physical activity lessons age association alterations in beta-amyloid accumulation, cerebral glucose metabolism, hippocampal volume and cognitive function. Being physically active was based on the American Heart Association recommendation of 30 minute of moderate exercise 5 days a week.

The study found was that the physically active individuals had less beta-amyloid burden, improved glucose metabolism, hippocampal volume, immediate memory, and visuospatial ability compared to physically inactive persons.  This study provides more confirmatory support to the many other studies that show the beneficial effect of physical activity on the aging brain.

Since physical exercise has been shown to improve cognition, improve brain volumes and now decrease the age related disease markers of AD what are you waiting for? There is so much we do not have control over in our lives, but this is not one of them. You have the power to get and keep your brain fit and, potentially, prevent AD.  If you do not know where to start I would be happy to help find a program just for you.


Dr Deb

Works Cited:

Okonwo, O. e. (2014). Physical activity attenuates age-related biomarker alterations in preclinical AD. Neurology , 83, 1753-1760.


A Healthy lifestyle can reduce YOUR risk of stroke

How you can decrease your risk of stroke

As a neurologist, I see on a daily basis how devastating and debilitating a stroke can be. Unfortunately, the effects are typically irreversible. Therefore, prevention is of great importance. Controllable risk factors for stroke include hypertension, diabetes, high cholesterol, and smoking.   Thus, living a healthy lifestyle, which potentially would improve those risk factors, could decrease your risk for stroke.

Researchers in a recent study analyzed the combined effect of five factors that typically are associated with living a healthy lifestyle to see if living a healthy lifestyle would indeed decrease the risk of stroke. The 5 factors studied and recommended for a healthy lifestyle include: having a healthy diet, i.e., eating within the top 50% of a recommended foods, modest alcohol consumption (not greater than 3-9 drinks per week), not smoking, 40 minutes of being physically active per day and BMI of <25 kg/m2

The study found that women who had all 5 factors of healthy lifestyle compared with women with none had a 62% lower risk of ischemic stroke. All 5 components of the low risk lifestyle were inversely associated with the risk of ischemic stroke. The risk of stroke steadily decreased with each additional healthy lifestyle factor.

Once again research documents the importance of exercise as a part of a healthy lifestyle AND prevention of a devastating stroke. If you wish to add exercise to decrease your risk of a stroke but don’t know where to start, I would love to help you.


Dr Deb

Works Cited

Larsson, S. C. (2014). Healthy diet and lifestyle and risk of stroke in a prospective cohort of women. Neurology , 83, 1699-1704.


stroke cut

Stroke Prevention Made Simple

 Stroke Prevention

It just starts with one simple step


I was recently at a stroke prevention talk for physicians and medical students. The speaker started the talk by asking the audience several questions.  The first was; “If you had a stroke, how many of you would want to be on a treatment program to prevent a second one?”  Everyone’s hand shot up.  The second question was; “If you haven’t had a stroke how many of you would want to be on a treatment program to prevent a stroke in the first place?” Again everyone’s hand went up.

Next she asked;  “How many of you currently do these things: exercise regularly, on average greater than 150 hours a week; maintain a healthy diet and weight; don’t smoke; limit alcohol intake; maintain normal blood pressure, sugars and cholesterol?”  After this question only a few hands went up.   The audience appeared embarrassed.  They knew that doing these few things is indeed the best treatment program to prevent strokes, and they were not practicing what they preached to their patients.

Just like the doctors in the audience, most people know that they need to have a healthy life style, which includes regular exercise, not smoking and healthy eating. Unfortunately, many of us, doctors included, do not start these simple preventive measures until it is too late, after we already start to have problems.

We as a society are too much into instant gratification, ‘we want it now’ mentality. Darren Hardy talks about this in his book, The Compound Effect.  In this book he states that if we knew that eating unhealthy foods like a Big Mac would cause us to have a stroke at that instant we would not eat that Big Mac.  The problem is that since you do not have a stroke at that instant we keep on eating the unhealthy foods.  Unfortunately, there is a negative affect; it is just delayed.  Over time these unhealthy habits of eating fatty food, lack of regular exercise, and smoking leads to narrowing of the blood vessels (atherosclerosis), high blood pressure and diabetes.  Having these conditions then increase your risk for stroke.

Stroke is the 4th leading cause of death and the leading cause of disability in the United States.

A stroke occurs when the blood supply to the brain is blocked or interrupted.  This results in damage to that area of brain tissue.   Typically, this causes a sudden onset of symptoms including weakness or numbness to one side of the body, problems talking, visual changes, lack of control of movements or dizziness.

What causes this lack of blood flow to the brain?  It can be caused by a narrowing of the blood vessels in the brain from the build up of the fatty deposits (atherosclerosis).  Those small arteries in the brain can also be narrowed by vasoconstriction from high blood pressure.  The other main cause of blockage is from clots that break off of atherosclerotic plagues from the neck, or from blood clots from the heart that travels through the brain’s blood vessels until it reaches vessels too small to let it pass.

stroke picture

What are the main controllable risk factors for stroke?

  • High blood pressure
  • Heart disease
  • High cholesterol levels (specifically, high LDL or “bad” cholesterol)
  • Obesity
  • Type 2 diabetes
  • Smoking

The best defense against having a stroke is controlling these risk factors.  This is not done by taking a pill but instead by starting these simple healthy behaviors of what the American Heart Association describe as  “Life’s simple 7”:

  1. Get active or exercise
  2. Control cholesterol
  3. Eat better
  4. Manage blood pressure
  5. Lose weight
  6. Reduce blood sugar
  7. Stop smoking

I know that this seems like a lot to do all at once.  So just take one step at a time.  A good first step is to start by exercising 30 minutes, 5 days a week.  This one simple activity can have a positive compounding effect over time. Regular exercise will then help with some of the other risk factors by lowering your blood pressure and help you lose weight.  The changes in weight will not start the first time you exercise but if you continue it, the weight loss benefits will come and hopefully will decrease your risk for a stroke.

We all have a choice, do you want to choose a simple action (regular exercise) that can improve your health or one that can have a negative affect (eating that big mac).

If you are ready to start to do all you can to prevent that stroke let me know. I would love to help you get fit for your brain!

Alz-dementia word

Alzheimer’s Dementia

 What is Alzheimer’s Dementia and how can I prevent it?

As a neurologist I often get asked:  How can I prevent myself from getting Alzheimer’s?   My normal answer is to increase your physical and mental activity and keep yourself healthy and you will keep your brain healthy.  I will explain the reasoning below along with some basic information regarding Alzheimer’s dementia (AD)

What is Alzheimer’s Dementia?

Alzheimer’s dementia is the most common cause of dementia. Dementia by definition is a progressive decline in cognitive functioning.  It is a decline in thinking, remembering and reasoning to an extent that it interferes with a person’s daily life and activities.  Per estimates from the Alzheimer’s Association, 5.3 million Americans have AD. This number is estimated to triple in the next 40 years as the population continues to age and live longer.

How do you diagnosis AD?

Currently doctors can only diagnosis AD clinically, based on symptoms and excluding other causes of dementia that can be treated (vitamin deficiencies, hydrocephalus, tumors, depression etc). Unfortunately, the only way to confirm the diagnosis AD is by autopsy of your brain. The pathological changes that are seen in the brains of patients of AD include amyloid plaques (abnormal clumps of amyloid proteins) and neurofibrillary tangles (abnormal bundles of fibers).  It is unclear how or why these plaques and tangles form.  Once they are there, neurons in the brain lose their ability to function and communicate with each other.  Over time the neurons eventually die causing brain atrophy (shrinking of the brain). This process is thought to start up to 30 years before clinical symptoms develop.

What causes AD?

Scientists are not sure what causes AD.  It is most likely due to a combination of genetic, environmental and lifestyle factors. We do know some of the risk factors that can increase your risk of develop AD.  The more risk factors you have the more likely you are to develop AD.

What are the Risk Factors for Dementia?

  • The biggest risk factor for developing AD is age.  Currently the risk of AD doubles every 5 years after age of 65.
  • Genetics:  Genetics plays a big part in what is called “familial AD” which is a young onset AD (typically onset in the 40-50s). This type is autosomal dominant and has strong connection to genetics. This type of AD, however, only accounts for 5% of all AD.  The most common type of AD, “late onset AD” may be linked to an abnormal gene: the apolipoprotein E.  The linkage is not however 100%.  Thus not everyone who has this abnormal gene gets AD, and you may still get AD even if you don’t have the abnormal ApO E gene.
  • Diabetes (DM):   Studies have shown that people with DM are twice as likely to develop AD.  The good news is that people who are at risk for diabetes who changed their lifestyles could reduce their risk of DM by 58% over a 3 year period, thus possibly decreasing their risk for developing AD.   There may be several different reasons why people with diabetes are at an increased risk of dementia.
      • First of all they have an increased risk of having a stroke which itself increases the risk of dementia.
      • DM itself also causes micro-vascular disease which decreases blood flow into the brain thus increasing risk for dementia.
      • AD could be from a problem with the way the brain uses insulin. Nerve cells require a lot of energy; they get this energy from glucose and oxygen.  With diabetes cells lose their ability to respond to insulin, and brain is not able to use glucose properly.  (Think of it as DM of the brain).
      • Insulin also is known to regulate the metabolism of beta-amyloid and tau (the building blocks of the AD pathology) in the brain.
  • Depression:  A meta-analysis of 13 studies showed that people with a history of depression had almost a two times increased risk of dementia compared to controls without depression.
  • Cardiovascular disease:
    • Hypertension: Studies have shown people who have uncontrolled high blood pressure in midlife, are more likely to develop AD.  Hypertension also increases the risk for stroke.
    • High cholesterol: Cholesterol is felt to drive the production of beta amyloid.
    • Increased risk of stroke, patients with DM, hypertension, and high cholesterol are all associated with an increase of having strokes.  Having a stroke is felt to double your risk for dementia.
    • Belly fat:  Obesity has been associated with an increase risk of dementia.  The association between dementia and body weight appears to be most associated with a larger “waist to height” ratios than “body-mass index”.  The association is also greater for obesity during midlife instead of late life obesity.  A 2008 study in the journal “Neurology” found that people in their 40’s who have the highest amount of abdominal fat were more likely to have dementia when they reached their 70s. They found that those with the highest amount of belly fat were nearly 3 times more likely to develop dementia than those with the lowest amount of belly fat.
  • Head injury:  The best data to date show that people who have had moderate to severe traumatic brain injury have a 2-4 fold increase risk of dementia.  There is unclear association with mild head injuries or concussions.  More and more evidence is emerging regarding the risk of dementia after multiple head injuries as seen in boxers and professional football players (what is described in the literature as “chronic traumatic encephalopathy”)
  • Physical inactivity: A meta-analysis of 16 prospective studies and a systemic review of 24 longitudinal studies show that the lowest physical activity groups are associated with higher risks of developing AD.  The good news is that the risks of AD can be decreased with higher levels of physical activity as shown in a study reported in 2012.  Exercise has been shown to improve memory and to increase the size of the hippocampus (the area in the brain that works with memory), by 2% thus reversing age related volume loss by 1-2 years.
  • Cognitive inactivity and low education levels: Multiple studies have showed that the risk for dementia is lower in people who have higher education levels, intelligence, occupational attainment, and mentally stimulating leisure activities.  These studies are supported by randomized control studies, which reported cognitive interventions in healthy older adults are associated with improvement in cognitive function.

What can I do to prevent AD?

Dr. Deborah Barnes from University of California, San Francisco looked at seven potentially modifiable risk factors for AD: diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity, and physical inactivity.  She estimates that up to a half of all the AD cases worldwide might be attributable to these risk factors.  She states that if risk factors prevalence were decreased by 25% then prevalence of AD could potentially be lowered by over 3 million cases worldwide.

Out all of the risk factors, the one that has the largest impact on AD prevention in the US is physical inactivity.  It is estimated that if 25% of sedentary people start exercising, potentially 230,000 cases of AD in the US could be avoided.  Low education potentially contributed to the largest proportion of AD cases worldwide; thus with a 25% reduction in low education and cognitive inactivity could potentially lower AD prevalence by 1.375 million worldwide and 91,000 cases in US.

Are there any medical treatments to prevent AD?

Currently there are NO medications that have been shown to decrease your risk for AD.  There are 4 medications that have been approved by the FDA to treat AD: Aricept, Exelon, Razadyne, and Namenda.  These medications provide modest benefit in slowing the rate of cognitive decline, but they do not change the underlying disease process.

“So how can I prevent AD from occurring?”

The corner stone of dementia prevention, until disease-modifying agents are available, is risk factor modification.  Thus you should try to decrease the bad things that may increase your risk for dementia: midlife obesity, midlife high blood pressure, diabetes, strokes, and tobacco use. Then you need to work on improving the things that have been shown to decrease your risk for dementia: increasing mental activity, regular exercise, remaining socially active, and have a healthy diet.

This site is purely informative and should not be considered medical advice. It is not intended to be used to diagnosis or treat any disease.  Please consult your physician before starting any fitness program or new supplement.



Amen, D. Use Your Brain to Change your Age.

Barnes, D. E. (2011). The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurology , 819-828.

Buchman, A. B. (2012). Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology , 13231329.

Desai, A. K. (2010). Healthy Brain Aging: A Road Map. Clinical Geriatric Medicine , 1-16.

Erickson, K. I. (2011). Exercise training increases size of hippocampus and improves memory. Proceeding of the National Academy of Sciences , 3017-3022.

Paturel, A. (2009, July/August). Your Heart, Your Belly and Alzheimer’s: People with so-called metabolic syndrome may be at a higher risk of developing Alzheimer’s dementia. Neurology Now , pp. 18-25.


Tai Chi for Fibromyalgia

tc fibro

Tai Chi for Fibromyalgia

People who have fibromyalgia live in considerable amount of pain.  They are aerobically unfit, have poor muscle strength, limited flexibility, and have impaired physical performance.  Studies have shown that exercise would benefit all of those symptoms.   Despite knowing that exercise is beneficial, most people who have fibromyalgia do not participate in a regular exercise program.

Why is it that people who have fibromyalgia do not exercise? It is not because people with fibromyalgia cannot be active, since about 2% of competitive sport players have fibromyalgia.  As a Neurologist the two most common reasons that I hear for the lack of exercise is #1 they are too fatigued and #2 they have too much pain.  (I will talk more about how to treat the fatigue in another post in the future).

People who live with fibromyalgia experience a chronic cycle of pain.  They complain of pain, which causes increased muscle tension, which along with increased stress causes limited activity.  This, then, causes increases fatigue, depression, muscle stiffness, and thus pain.  The best way to break this pain-tension cycle is to start moving.  Unfortunately, patients with fibromyalgia are often reluctant to engage in physical activity due to the fear that the one thing that may help the most may instead exacerbate their pain.

chronic pain_cycle

For this reason I typically recommend people who have fibromyalgia to start with either a warm water-based exercise program or a mind–body forms of exercise such as yoga or Tai Chi. I will discuss  Tai Chi.

Tai Chi is a mind-body practice that originated in China as a gentle form of martial arts.  It combines meditation with slow, gentle, graceful movements, as well as deep breathing and relaxation.  It has been found to have therapeutic benefits in patients with rheumatoid arthritis, osteoarthritis, and more recently fibromyalgia.

Based on the fact that Tai Chi is beneficial in patients with arthritis and other musculoskeletal disorders there have been several studies, which looked at the use of Tai Chi in patients with fibromyalgia. Basically all the studies show that the Tai Chi participants had significantly improvement in their measurements of pain, quality of life, improved sleep, and decreased fatigue and depression compared to the control group. Thus the Fibromyalgia pain cycle is broken.  Functional mobility and balance also improved which means less falls and injuries.  Tai Chi is also well tolerated meaning it did not produce major exercise related symptoms flares.

The major problem is finding a Tai Chi class.   Typically Tai Chi classes are most readily found at senior centers, and are only rarely found at your local gym.  If you can’t find Tai Chi classes near you then a great alternative is Tai Cheng.

tai ch

Tai Cheng is a 12 week home Tai Chi based exercise program developed by Dr. Mark Cheng.  Dr. Cheng drew on his 3-decade experience in Tai Chi, his PhD in Chinese medicine and acupuncture, and expertise with physical therapy-based corrective exercises to develop Tai Cheng.

Tai Cheng uses fluid, graceful movements, which improve your balance and coordination while increasing range of motion and flexibility.  The goals of regular practice of Tai Cheng as a home exercise program is to increase movement, decrease stiffness and improve strength.  When this happens, pain is decreased and one can begin to move out of the chronic pain cycle seen with Fibromyalgia and so many other chronic pain conditions.


brain small

Exercise to prevent your migraines


Exercise can prevent your migraines!

Did you know that exercise can prevent migraines?  Well, it is true, and there is a recent study that proves it.  As a headache specialist, I always try to encourage my migraine patients to start a regular exercise program as a conservative way to decrease their migraine headaches, but up until now, we did not much scientific evidence to show that it actually helped.

Individuals with migraines and other headaches have been shown to be less physically active than those without headaches.  One of the reasons is that individual with migraines, that their headaches often worsen during physical activity. This is actually one of the major criteria on which migraines are diagnosed.  However, it is unclear if the lack of exercise in individuals with migraines is the cause or effect of having migraines.

The reason why exercise may decrease the frequency of migraine headaches is unclear.  Some of the things that we do know are that exercise can increase the natural endorphins (feel-good chemicals) in our brain.  Exercise can also decrease migraine triggers such as anxiety and stress.  Additionally, your sleep pattern is improved with regular exercise, which may then result in less frequent migraines.  Other risk factors for migraine headaches such as obstructive sleep apnea, hypertension, and obesity are also improved with regular exercise.

In a randomized, controlled trial of adults with migraines where patients were randomized into three groups; an exercise group, a relaxation training group, or a group that received the preventive medication topiramate (Topamax).  The exercise group exercised three times a week for 40 minutes.  The study looked at how frequent migraines occurred compared to their baseline migraine frequency. The study lasted three months.  What was found was that there were no significant differences between the groups, all decreased the frequency of migraines compared with the baseline. No adverse effects were reported in the exercise or relaxation groups.  Adverse effects were reported in 33% of the participants in the topiramate group. Restated, participants in this randomized controlled study who exercised regularly (3 times a week) experienced an improvement in the frequency of their migraine attack that was not significantly different from the participants who received drug preventive medication topiramate.1

Now I am not saying that routine exercise will prevent all migraines.  However, neither does medications.  So wouldn’t you rather try something that is good for you anyway either in addition to or instead of medications?

For more information on the causes and ways to prevent migraines see my Migraine Headache post.

As always please discuss with your physician before starting any strenuous physical activity. Also, please do not suddenly stop any of your medications without discussing with your physician first.  

Sites Referenced:

1Emma Varkey, A. C. (2011). Exercise as migraine prophylaxis: A randomized study using relaxation and topiramate as controls. Cephalagia, 1428-1438.