Dr. Art Kramer on Why We Need Walking Book Clubs to Enhance Cognitive Fitness and Brain Health

Dr. Arthur Kramer is a Pro­fes­sor in the Uni­ver­si­ty of Illi­nois Depart­ment of Psy­chol­o­gy, the Cam­pus Neu­ro­science Pro­gram, the Beck­man Insti­tute, and the Direc­tor of the Bio­med­ical Imag­ing Cen­ter at the Uni­ver­si­ty of Illinois.

I am hon­ored to inter­view him today.

Dr. Kramer, thank you for your time. Let’ start by try­ing to clar­i­fy some exist­ing mis­con­cep­tions and con­tro­ver­sies. Based on what we know today, and your recent Nature piece (ref­er­enced below), what are the 2–3 key lifestyle habits would you sug­gest to a per­son who wants to delay Alzheimer’s symp­toms and improve over­all brain health?

First, Be Active. Do phys­i­cal exer­cise. Aer­o­bic exer­cise, 30 to 60 min­utes per day 3 days per week, has been shown to have an impact in a vari­ety of exper­i­ments. And you don’t need to do some­thing stren­u­ous: even walk­ing has shown that effect. There are many open ques­tions in terms of spe­cif­ic types of exer­cise, dura­tion, mag­ni­tude of effect but, as we wrote in our recent Nature Reviews Neu­ro­science arti­cle, there is lit­tle doubt that lead­ing a seden­tary life is bad for our cog­ni­tive health. Car­dio­vas­cu­lar exer­cise seems to have a pos­i­tive effect.

Sec­ond, Main­tain Life­long Intel­lec­tu­al Engage­ment. There is abun­dant prospec­tive obser­va­tion­al research show­ing that doing more men­tal­ly stim­u­lat­ing activ­i­ties reduces the risk of devel­op­ing Alzheimer’s symptoms.

Let me add, giv­en all media hype, that no “brain game” in par­tic­u­lar has been shown to have a long-term impact on Alzheimer’s or the main­te­nance of cog­ni­tion across extend­ed peri­ods of time. It is too ear­ly for that-and con­sumers should be aware of that fact. It is true that some com­pa­nies are being more sci­ence-based than oth­ers but, in my view, the con­sumer-ori­ent­ed field is grow­ing faster than the research is.

Ide­al­ly, com­bine both phys­i­cal and men­tal stim­u­la­tion along with social inter­ac­tions. Why not take a good walk with friends to dis­cuss a book? We lead very busy lives, so the more inte­grat­ed and inter­est­ing activ­i­ties are, the more like­ly we will do them.

Great con­cept: a walk­ing book club! Now, part of the con­fu­sion we observe is due to the search of “mag­ic solu­tions” that work for every­one and every­thing. We pre­fer to talk about sev­er­al pil­lars of brain health, and dif­fer­ent pri­or­i­ties for dif­fer­ent indi­vid­u­als. Can you elab­o­rate on what inter­ven­tions seem to have a pos­i­tive effect on spe­cif­ic cog­ni­tive abil­i­ties and individuals?

Per­haps one day we will be able to rec­om­mend spe­cif­ic inter­ven­tions for indi­vid­u­als based on genet­ic test­ing, for exam­ple, but we don’t have a clue today. We are only begin­ning to under­stand how the envi­ron­ment inter­acts with our genome.

But I agree on the premise that there prob­a­bly won’t be a gen­er­al solu­tion that solves all cog­ni­tive prob­lems, but we need a mul­ti­tude of approach­es. And we can’t for­get, for exam­ple, the cog­ni­tive ben­e­fits from smok­ing ces­sa­tion, sleep, phar­ma­co­log­i­cal inter­ven­tions, nutri­tion, social engagement.

Phys­i­cal exer­cise tends to have rather broad effects on dif­fer­ent forms of per­cep­tion and cog­ni­tion, as seen in the Col­combe and Kramer, 2003, meta-analy­sis pub­lished in Psy­cho­log­i­cal Sci­ence (Note:  ref­er­enced below).

Cog­ni­tive train­ing also works for a mul­ti­tude of per­cep­tu­al and cog­ni­tive domains  but has shown lit­tle trans­fer beyond trained tasks.

No sin­gle type of inter­ven­tion is suf­fi­cient. Today there is no clear research on how those dif­fer­ent lifestyle fac­tors may inter­act. The Nation­al Insti­tute on Aging is start­ing to spon­sor research to address pre­cise­ly that.

Ear­li­er you said that no brain soft­ware in par­tic­u­lar has been shown to main­tain cog­ni­tion across extend­ed peri­ods of time. Now, did­n’t the ACTIVE tri­al (Note: ref­er­enced below) 5‑year results show how cog­ni­tive train­ing (com­put­er­ized or not) can result in pret­ty durable results? For con­text, are there com­pa­ra­ble con­trolled stud­ies to ACTIVE where 10 or so hours of phys­i­cal exer­cise today can result in mea­sur­able (yet, incom­plete) cog­ni­tive ben­e­fits 5 years from now?

The ACTIVE study showed a good deal of 5‑year reten­tion of the tasks that were trained for 10 hours each, but lim­it­ed trans­fer of train­ing was found for oth­er untrained tasks. It seems unlike­ly that sig­nif­i­cant trans­fer may ocur­ring with the rel­a­tive­ly lit­tle train­ing (e.g. 10 hours in the ACTIVE study) and focused tasks that have been pro­vid­ed in train­ing stud­ies thus far.

On whether there are con­trolled stud­ies sim­i­lar to ACTIVE that have mea­sured the long-term cog­ni­tive ben­e­fits of phys­i­cal exer­cise, not that I know of.

To wrap up this part of the con­ver­sa­tion, what’s in your mind the best way to explain the rel­a­tive ben­e­fits of phys­i­cal vs. cog­ni­tive exer­cise? From a fun­da­men­tal point of view, it seems clear that phys­i­cal exer­cise can help enhance neu­ro­ge­n­e­sis (Note: the cre­ation of new neu­rons), yet learning/ cog­ni­tive exer­cise con­tributes to the sur­vival of those neu­rons by strength­en­ing synaps­es, so I see more how those two “pil­lars” are com­pli­men­ta­ry than “one or the other”.

I agree. Giv­en what we know today I would rec­om­mend both intel­lec­tu­al engage­ment and phys­i­cal exer­cise. How­ev­er, we do know, from a mul­ti­tude of ani­mal stud­ies, that phys­i­cal exer­cise has a mul­ti­tude of effects on brains beyond neu­ro­ge­n­e­sis, includ­ing increas­es in var­i­ous neu­ro­trans­mit­ters, nerve grown fac­tors, and angio­gen­e­sis (the for­ma­tion of new blood vessels).

Tell us more about your work with cog­ni­tive train­ing for old­er adults.

We have now a study in press where we eval­u­ate the effect of a com­mer­cial­ly avail­able strat­e­gy video game on old­er adults cognition.

Let me first give some con­text. It seems clear that, as we age, our so-called crys­tal­lized abil­i­ties remain pret­ty sta­ble, where­as the so-called flu­id abil­i­ties decline. One par­tic­u­lar set of flu­id abil­i­ties are called exec­u­tive func­tions, which deal with exec­u­tive con­trol, plan­ning, deal­ing with ambi­gu­i­ty, pri­or­i­tiz­ing, mul­ti-task­ing. These skills are cru­cial to main­tain inde­pen­dent living.

In this study, we exam­ined whether play­ing strat­e­gy-based video game can train those exec­u­tive func­tions and improve them. We showed that play­ing a strat­e­gy-based video game (Rise of Nations Gold Edi­tion) can result in not only becom­ing a bet­ter video game play­er but it trans­ferred to untrained exec­u­tive func­tions. We saw a sig­nif­i­cant improve­ment in task switch­ing, work­ing mem­o­ry, visu­al short-term mem­o­ry, and men­tal rota­tion. And some, but more lim­it­ed, ben­e­fits in inhi­bi­tion and reasoning.

I can share a few details on the study: the aver­age age was 69 years, and the exper­i­ment required around 23 hours of train­ing time. We only includ­ed indi­vid­u­als who had played video games 0 hours/ week for the last 2 years.

That last cri­te­ria is inter­est­ing. We typ­i­cal­ly say that good “brain exer­cise” requires nov­el­ty, vari­ety and chal­lenge. So, if you take adults who are 69-years-old and haven’t played a videogame in 2 years, how do you know if the ben­e­fit comes from the par­tic­u­lar videogame they played vs. just the val­ue of deal­ing with a new and com­plex task?

That’s a great ques­tion. The real­i­ty is that we don’t know, since we had a “wait­ing list con­trol group. In the future per­haps we should com­pare dif­fer­ent videogames or oth­er men­tal­ly stim­u­lat­ing activ­i­ties against each oth­er and see what method is the most effi­cient. Per­haps the Nation­al Insti­tutes on Health may be inter­est­ed in fund­ing such research.

In any case, your study rein­forces an impor­tant point: old­er brains can, and do, learn new skills.

Yes. The rate of learn­ing by old­er adults may be slow­er, and they may ben­e­fit from more explic­it instruc­tion and tech­nol­o­gy train­ing, but, as a soci­ety, it is a mas­sive waste of tal­ent not to ensure old­er adults remain active and productive.

Anoth­er recent study we con­duct­ed, this one still under review, is titled Expe­ri­ence-Based Mit­i­ga­tion of Age-Relat­ed Per­for­mance Declines: Evi­dence from Air Traf­fic Con­trol. It deals with the ques­tion: “Can Age Itself Be an Obsta­cle for some­one to per­form as an Air Con­troller? And the Answer is: age itself, with­in the age range that we stud­ied, is not an obsta­cle. Our results sug­gest that, giv­en sub­stan­tial accu­mu­lat­ed expe­ri­ence, old­er adults can be quite capa­ble of per­form­ing at high lev­els of pro­fi­cien­cy on fast-paced demand­ing real-world tasks.

Now, the field of com­put­er­ized cog­ni­tive train­ing has poten­tial in a vari­ety of appli­ca­tions beyond “healthy aging”. You are obvi­ous­ly famil­iar with Daniel Gopher’s work train­ing mil­i­tary pilots using Space Fortress. Is your lab doing some­thing in that cog­ni­tive enhance­ment direction?

Yes, I have been involved in that area of work since the late 70s, when I helped design the pro­to­cols for Space Fortress. Which pro­vides indeed a very inter­est­ing exam­ple of real-life trans­fer: pilots do seem to fly bet­ter as mea­sured by real-life instruments.

Our lab is now embark­ing on a 5‑year study for the Navy to explore ways to cap­i­tal­ize emerg­ing research on brain plas­tic­i­ty to enhance train­ing and per­for­mance. MIT and my lab will ana­lyze the best train­ing pro­ce­dures to increase the effi­cien­cy and effi­ca­cy of train­ing of indi­vid­ual and team per­for­mance skills, par­tic­u­lar­ly those skills requir­ing high lev­els of flex­i­bil­i­ty. The results from this study will be in the pub­lic domain, so I hope they con­tribute to the matu­ri­ty of the field at large.

That’s an impor­tant point. What does the field of cog­ni­tive fit­ness at large need to mature and become more mainstream?

We need more research. But not any kind of research. What we need is a kind of inde­pen­dent “Seal of Approval” based on inde­pen­dent clin­i­cal tri­als. Most pub­lished research of cog­ni­tive train­ing inter­ven­tions is spon­sored and/ or con­duct­ed by the com­pa­nies them­selves. We need inde­pen­dent, objec­tive and clear stan­dards of excellence.

The Depart­ment of Edu­ca­tion main­tains a What Works Clear­ing­house to review exist­ing evi­dence behind pro­grams that make edu­ca­tion-relat­ed claims. Per­haps we need a sim­i­lar approach for pro­grams mak­ing cog­ni­tive claims with adults. We also see a need for more sol­id and wide­ly-avail­able cog­ni­tive assess­ments, to have bet­ter base­lines and inde­pen­dent mea­sures of cog­ni­tive abilities.

Good news there: the NIH is prepar­ing an “NIH Tool­box” to pro­vide valid, reli­able instru­ments to researchers and clin­i­cians, to solve the prob­lem that exists today, name­ly, the lack of uni­for­mi­ty among many mea­sures used. The ini­tia­tive was launched in 2006, and it is a 5‑year effort, so we’ll need to wait to see results.

Dr. Kramer, many thanks for your time and work. My apolo­gies for hav­ing you stay by your desk dur­ing this inter­view. Next time I am in Illi­nois, I will invite you to a walk­ing interview.

Excel­lent idea! The plea­sure has been mine. Let me thank you as well, for the very impor­tant work you are doing.

 

To Learn More:

Solv­ing the Brain Fit­ness Puz­zle Is the Key to Self-Empow­ered Aging

 

Ref­er­ences:

• Willis SL, Tennst­edt SL, Mar­siske M, et al. Long-term effects of cog­ni­tive train­ing on every­day func­tion­al out­comes in old­er adults. JAMA. 2006;296:2805–14.
• Stan­ley Col­combe, Arthur F. Kramer (2003). Fit­ness effects on the cog­ni­tive func­tion of old­er adults: A Meta-Ana­lyt­ic study. Psy­cho­log­i­cal Sci­ence 14 (2) , 125 130.
• Charles H. Hill­man, Kirk I. Erick­son & Arthur F. Kramer Be smart, exer­cise your heart: exer­cise effects on brain and cog­ni­tion. Nature Reviews Neu­ro­science 9, 58–65.