Heart Health & Brain Health Go Hand-in-Hand

According to the Center of Disease Control and Prevention, heart disease accounts for one of every four deaths in the United States. Many of the causes of heart disease are well-known, including hypertension, hyperlipidemia, diabetes and obesity. Fortunately, there are also well-known lifestyle and behavior changes that can drastically reduce the risk of heart disease and include: smoking cessation, eating a healthy diet and exercising.

Despite the multitude of data showing that lifestyle behaviors can reduce the risk of heart disease and improve cardiovascular health, the Framingham Offspring Study recently reported that the percentage of people with ideal cardiovascular health (using the American Heart Association’s definition of Ideal Cardiovascular Health) has declined over the past 20 years.

Even in the absence of heart disease, the increasing percentage of Americans with less than ideal cardiovascular health translates to greater risk of heart disease and increased all-cause mortality. Because the heart and cardiovascular system are vital factors in overall health, other organ systems will be affected by less-than-ideal cardiovascular health. Importantly, adults having an ideal cardiovascular health score during the middle-aged years had a lower risk of cognitive decline and dementia. In addition, large-scale epidemiological studies have continued to show a strong correlation between cardiovascular health and brain health.

What is the link between cardiovascular health and brain health?

It is possible that heart disease and Alzheimer’s disease or dementia have common risk factors and that is why there are correlations between these conditions. However, the brain requires a large amount of blood flow, which needs to be precisely controlled to maintain optimal neuronal function. If a patient has a problem with the function of the heart or blood vessels, this could prevent adequate blood flow supply to the brain and eventually affect brain function and cognition. We know that patients with congestive heart failure have higher incidence of dementia. In heart failure patients, a reduced capacity of the left ventricle to pump blood (i.e. ejection fraction) is associated with poor cognitive test scores.

The function of the large vessels supplying blood flow to the brain are also important to overall brain health. A paper published almost 70 years ago first reported that patients with carotid occlusion (due to atherosclerosis) eventually progressed to dementia. This early case study was the first to suggest that mild hypoperfusion of the brain, due to large vessel stenosis, could lead to dementia.

Dysfunction in the heart (or pump) or the large blood vessels (or conduits) is associated with reduced cognitive function, but the small blood vessels in the brain that control the blood supply to neurons may also contribute to the link between cardiovascular health and brain health. This hypothesis was first proposed decades ago, based on evidence of disrupted microvessel structure in the brains of Alzheimer’s disease patients. Disruption in the microvessels can lead to hypoperfusion, disrupt the blood-brain-barrier or reduce the ability of the brain to utilize glucose. Collectively, an interruption at any segment of the blood delivery system (heart, large and small blood vessels) could impair the ability of the brain to function optimally.

physical activity recommendationsNow, for the good news: Because of the link between heart health and brain health, we know that lifestyle behaviors (like exercise!) can reduce the risk of developing heart disease AND developing cognitive decline. Older adults who are more physically active have better brain health compared with sedentary counterparts, suggesting a protective effect of exercise. And although more research is necessary to determine how exercise may promote healthy brain aging and what might be the optimal training program, using what we know about what works for heart health and following ACSM’s guidelines for physical activity is a great place to start. Remember to take care of our heart so that our heart can take care of our brain.

By: Jill Barnes, Ph.D., FACSM, is an Assistant Professor at the University of Wisconsin-Madison in the Department of Kinesiology and has an affiliate faculty appointment in the Division of Geriatrics and Gerontology in the School of Medicine and Public Health.

Related Article: Heart disease and brain health: Looking at the links

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Concussions in Cheerleaders: Symptoms and Treatment

By Tara Hackney, PT, DPT, OCS, KTTP for Athletico Physical Therapy

Cheerleaders are commonly seen on the sidelines of school and professional sporting events, but the sport is no longer reserved for the sidelines. Cheerleaders have their own competitions where they are in the spotlight. Competitive cheerleading participation is on the rise with teams ranging in age from 5 years old through college.

All-Star cheerleading is the name used to refer to cheer groups created for competition and not associated with any school or team. Competitive cheerleading is divided into groups according to age and each group has different levels according to experience. Cheerleaders perform tumbling, stunting and pyramids as part of their routines. As with any sport, injuries can occur.

Did you know that the most common injury in competitive cheerleading is concussions? The overall injury rate in cheerleading is low; however of those injuries, concussions account for 31.1 percent.1 You may be thinking this high rate of concussions would be from cheerleaders falling and landing on their heads. However, the cheerleading position that suffers the most concussions are the bases, the athletes who support the flyers in the air by holding them up and catching them. This position is at risk for concussions as a flyer may fall on top of them, or from a foot or elbow hitting them in the head as the flyer comes down from a stunt. In fact, it is more likely in cheerleading for a concussion to occur after contact with another athlete than with contact with the floor.

Concussion Symptoms

Any one or more of the following signs and symptoms may indicate a head injury:

  • Headache
  • Nausea or vomiting
  • Dizziness
  • Coordination or balance issues
  • Blurred or double vision
  • Light and noise sensitivity
  • Feelings of sluggishness
  • Memory or concentration problems
  • Altered sleep patterns

Signs observed by coaches or other team members that may indicate a concussion has occurred:

  • Stunned or confused appearance
  • Forgets arm motions or cheers
  • Confused about formations in routines
  • Unsure of surroundings
  • Moves clumsily
  • Loss of consciousness (long or short)
  • Personality or behavior changes
  • Forgets events right before or after a blow to the head

If a head injury or concussion is suspected, the athlete should not return to play prior to 24 hours after the initial incident and should be cleared by a physician prior to returning to sport.

Concussion Management

Concussion management is evolving through research. There is strong evidence to support an active approach to rehabilitation of concussions. Physical therapy is one way to help manage the symptoms following a concussion. Physical therapy can include management of neck pain and headaches, balance exercises, progression of exercise tolerance and cardiovascular activities, and vision training. Ideally, an athlete will complete a graded exposure program that starts with symptom limited activity, progress through light aerobic activity, and transition to sport-specific incremental intensity training. Finally, the athlete will be cleared to practice prior to being cleared to compete.

Speed of recovery after concussion is individualistic for each athlete and may be affected by severity of trauma, area of the brain injured, age, gender, past medical history, and previous history of concussions.

Please visit our Concussion Page to learn more about our services.

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Ski Holidays and Head Injuries

Image result for skiing head injury

In this segment Dr. Brian Cole of Midwest Orthopedics at Rush, Steve Kashul & Dr. Jeremy Alland discuss Holiday ski trips and what parents (and adults!) should know about concussion.

Dr. Jeremy Alland graduated from Rush Medical College in Chicago, IL, where he was awarded the prestigious William H. Harrison, PhD Award for selfless leadership, aspiration and collaboration. He went on to complete a Family Medicine residency at UPMC St. Margaret Hospital in Pittsburgh, PA, where he served as Chief Resident and was peer-selected as the best resident teacher. After residency, he returned to Rush and his hometown of Chicago to complete a fellowship in sports medicine.

During his training, Dr. Alland served as a team physician for the Chicago White Sox, Chicago Bulls, Chicago Fire Soccer Club, DePaul University and multiple high school football, basketball and wrestling teams. Additionally, he has been a part of the finish line medical team at both the Chicago and Pittsburgh marathons. He is board certified by the American Board of Family Medicine and is a member of the American Medical Society of Sports Medicine, American College of Sports Medicine and American Academy of Family Physicians. Jeremy Alland

As a former collegiate baseball pitcher, Jeremy A. Alland, M.D. has a strong passion for sports and medicine. He finds pride in his ability to relate to his patients and strives to help his patients remain active. He specializes in the care of the entire athlete with special interests in the throwing athlete, the golfing athlete, sports performance, and ultrasound-guided procedures.

Dr. Alland is a team physician for the Chicago White Sox, Chicago Fire Soccer Club, Windy City Bulls (Chicago Bulls NBA D-League team), Chicago Dogs, Chicago Blaze and Mount Carmel High School. He previously served as a team physician for DePaul University. He is an active researcher and has authored numerous papers on topics in sports medicine. He also serves as a peer-reviewer for The Journal of Family Practice.

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A Season of Football Head Impacts Does Not Affect Balance

Image result for athlete balance exercises

There is considerable public concern about the effects of repetitive football head impacts on a player’s brain health. Many studies suggest a link between head impacts and poorer health. Safe and efficient walking and balance are critical for activities of daily living and can reflect a person’s overall health.

In this study, investigators evaluated 34 collegiate football players who wore head impact sensors and compared their walking and balance to 13 cheerleaders before and after a single season at two different colleges. Surprisingly, there was no worsening of walking or balance performance in the football players over the course of the season compared to their status before a season or compared to the cheerleaders. The helmet sensor data showed that these players, on average, were exposed to 538 impacts over the course of the competitive season. However, neither the number of impacts nor the force of the impacts had much influence on walking or balance performance measures in the athletes.

The conclusion of this study is that repetitive football head impacts did not affect walking or balance performance over a single season. The possible effects of these impacts over multiple seasons or in later life remain unknown.

For more information, view the abstract

American College of Sports Medicine

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