Introduction

The general benefits of exercise are well-known. From improving balance and sleep to decreasing depression and stiffness, there are many reasons to encourage exercise at any age. However, the number one benefit of exercise lies in how it affects the brain—not only in terms of improving thinking and memory but in its potential to slow the progression of both physical and cognitive decline through neuroplasticity.

Emerging data on the benefits of exercise demonstrate great promise regarding its role in exercise-dependent neuroplasticity. In particular, forcing the brain to learn new behaviors through skill training has the potential for synaptogenesis, neurogenesis, neuronal sprouting, and increased synaptic strength. Put more simply, proper application of multiple modes of exercise (including skill training) can help the brain develop more connections between neurons, increasing the capacity to send and receive messages and therefore, the elasticity of the brain. As this grows, the brain is able to retain more information and ideas.

The result can be seen in improved cognition, motor control, and even mood or motivation. This “healthy brain” effect is most notable when goal-directed motor learning is combined with aerobic exercise. Moreover, resistance training provides additional corticospinal benefits.

For therapists working with patients who have neurologic conditions such as Parkinson’s or brain injury, this research is beyond exciting. The potential for a treatment breakthrough utilizing exercise to help the brain has many looking for ways to put what has been learned in these studies into action. Therein, however, lies the challenge.

How does one effectively combine skill training, resistance training, and aerobic exercise in a way that will convey their neurological benefits in a therapeutic setting?

As experienced therapists can attest, real-world patients have real-world worries, insecurities, and preferences. Finding an exercise system that can provide the goal-directed skill training needed to stimulate the brain while still providing ample opportunity for aerobic exertion and sufficient strength/resistance training to meet both physical and mental needs is difficult enough. What’s more, such a system needs to be intuitive, motivating, and easy-to-use. Otherwise, patients will not get the full neurological benefit of the combined exercise.

 

Background

The evidence for the neurological benefits of skill training, aerobic exercise, and resistance training come from a wide variety of studies with varied results. While a full overview would be overwhelming here, it is worth reviewing just a few of those findings, especially as they relate to Parkinson’s, dementia, and the effects of aging on the brain.

Exercise interventions in individuals with Parkinson’s Disease demonstrate that goal-based motor skill training allows patients to become more cognitively engaged in learning movements that were previously considered automatic. One study in which subjects with early-stage Parkinson’s were “forced” to pedal stationary tandem bicycles at a rate 30% higher than their preferred one found that the combination of cognitive engagement and aerobic exercise led to improved automatic manual dexterity and increased activity in those regions of the brain involved in automatic control.[1]

In a separate study of nursing home residents with dementia, progress towards the goals based on the performance of basic activities of daily living was measured relative to three different exercise approaches, which are: skill-based, traditional simulation, and regular care (the control group). While significant differences were found in both groups with therapeutic interventions, the largest improvement was observed in the skill training group.[2]

 

 

While it may seem obvious that skill training would positively affect the brain, aerobic exercise also has separate and valuable cognitive benefits. The use of imaging has shown that aerobic exercise intervention can alter cerebral white matter integrity in the regions of the brain that are most susceptible to the influence of aging, supporting the idea that aerobic fitness is related to cognitive improvement.[3]

Nor can the effects of strength training be overlooked. A study of the physiological effects of resistance training found that neural adaptations to strength training encompass corticospinal excitability and inhibition. [4] Though, the response did vary by the type of training and target muscles.

In a discussion before the U.S. Senate Subcommittee on Retirement and Aging, Arthur Kramer of the Beckman Institute and Department of Psychology at the University of Illinois stated unequivocally that, “exercise training positively influences cognition.”^[5]

While the effects may vary based on age, lifestyle, health, cognitive baseline, and other factors, it is unquestionable that neurological benefits of exercise training are most notable in the executive control processes (such as working memory, planning, and multi-tasking). In other words, the greatest benefits are associated with the same functions that are most vulnerable to decline with age. Even some research on changes to brain structure and function indicates changes in brain volume—both in terms of grey matter and (in a separate study) cerebral blood volume—following involvement in an aerobic exercise program. Based on the results of previous animal-based research, this increase in cerebral blood volume is a promising indication of neurogenesis.^[6]

The following is a summary of the evidence of neurological benefits from aerobic, skill, and resistance training.

Given this background, the therapist looking to take advantage of this research will look for exercise modalities with a combination of important features:

• It must allow for constant progression for the benefit of cognition (e.g. changing steps or exercises).
• It must combine aerobic and skill training. Even better results are obtained when the program also combines resistance training.
• It should provide the opportunity to take advantage of the benefits of paired exercise.
• It must build self-confidence for the user. (This also means that it cannot be too intimidating or difficult to use for individuals who are not athletically-inclined.)
• It should foster a sense of joy and pride in accomplishment.
• And it should be fun, providing the user with the motivation to continue the exercise regimen.

Though this may seem like a lot to ask of an exercise device, a breakthrough new system now allows therapists to bring the neurological benefits of exercise to their patients without sacrificing other therapeutic goals.

Solution

Developed with the help of experts in neurologic therapy, the Core Stix Neurobic™ Skill Training System combines aerobic training, strength training, and cognitive skill training in a way that gives therapists more tools to help improve both body and mind. The original Core Stix system won raves from physical therapists for its ability to strengthen the core and mimic the activities of daily life. Moreover, the system’s intuitive, the unintimidating design has been praised for being friendly to users of all ages and abilities.

The Neurobic Skill Training System builds on that critically-praised background to include features that provide neurological benefits found in research linking exercise to improved cognitive function. This includes both accessibility and the possibility of cooperative routines. The wheelchair accessible unit includes up to four independent stations for multiple users. This allows it to accommodate group training for up to four simultaneous users as well as tandem training for paired or synchronized exercise.

Designed specifically to combine goal-based skill training with exercise, the Neurobic System also provides resistance training via the variable “Stix”. Those experienced in working with elderly and neurologic patients say that the Core Stix products are ideal for patients who dislike traditional gym equipment. The Neurobic System provides the upper body, lower body (assisted or resisted), and core strengthening, along with both balance and skill training.

Experts looking for a way to efficiently access the neurologic benefits of combining goal-based skill training with aerobic exercise have praised the Neurobic System, calling it the “future of therapy and exercise.” Dr. Beth Fisher of the University of Southern California’s Division of Biokinesiology and Physical Therapy stated that benefits of the Neurobic system include “improved cognitive control, improved memory, and improved performance of skilled movements in a range of users, including those afflicted with potentially debilitating neurological conditions, such as Parkinson’s Disease.”

Conclusion

While the research on the cognitive benefits of exercise is exciting, experience tells us that all the data in the world cannot help patients unless there is an effective way to put it into practice. That requires a system that not only combines skill training, resistance training, and aerobic exercise, but does so in an accessible, intuitive, and motivating way. The Neurobic Skill Training System is the breakthrough that neurologic patients have been waiting for. And, its potential for users of all kinds in nearly unlimited.

As Dr. Julie Hershberg, an Adjunct Instructor of Physical Therapy at USC, said, the revolutionary Neurobic System means, “We’re not just exercising our bodies and our hearts, but we’re changing our brains so that we can live longer and healthier and be at our optimum cognitive function as we age.”

For more information, please contact us at rehab@corestix.com, or call 855-267-7849. Instructional videos for the Neurobic Skill Training System can be viewed at: www.vimeo.com/channels/Neurobic.

[1] G. M. Petzinger et al., “Exercise-enhanced Neuroplasticity Targeting Motor and Cognitive Circuitry in Parkinson’s Disease,” Lancet Neurol. 2013 July ; 12(7): 716–726.

[2] Ruth M. Tappen, “The Effect of Skill Training on Functional Abilities of Nursing Home Residents with Dementia,” Res Nurs Health. 1994 June ; 17(3): 159–165.

[3] Michael W. Voss et al., “The Influence of Aerobic Fitness on Cerebral White Matter Integrity and Cognitive Function in Older Adults: Results of a One-Year Exercise Intervention,” Human Brain Mapping34: 2972-2985 (2013).

[4] Dawson J. Kidgell, “Physiological Studies Investigating Neurological Adaptations to Resistance Training” (PhD diss., Victoria University, 2010).

[5] Arthur F. Kramer, “Capitalizing on Cortical Plasticity: Influence of Lifestyle Factors on Cognition and Brain Health” (An extended discussion of a presentation to the U.S. Senate Subcommittee on Retirement and Aging – May 15, 2007).

[6] Kramer, “Capitalizing on Cortical Plasticity.”