The role of increasing cognitive reserve to prevent clinical manifestation of brain related pathology such as dementia and alzheimers has been well researched. Personal trainers, with the assistance of physicians and other health care professionals, may be able to help increase cognitive reserve.
The concept of cognitive reserve deals with the brain’s resilience to clinical symptoms following neuro-pathological damage. There are many definitions of cognitive reserve, however, for purposes of this article, activities (cognitive training, visual training, and vestibular training) that may help to decrease risk for brain related pathological symptoms will be grouped into the concept of cognitive reserve. The methods such as cognitive training, visual training, and vestibular training will be discussed in this article.
Personal trainers should always defer to physicians and other health professionals who have more experience with brain related pathology and should not work with clients on an exercise program that elicits symptoms related to brain pathology including mild traumatic brain injury (MTBI). In addition, personal trainers should not be involved in any return-to-play decisions and even if symptoms following a MTBI resolve an individual may still be at risk for second impact syndrome. Second impact syndrome is a serious and life- threatening consequence of repeated MTBI.
This article serves only as a suggestion of exercises that can be done in an attempt to increase cognitive reserve. Personal trainers should not advertise that they can prevent or treat symptoms related to MTBI, however, personal trainers can work to increase cognitive reserve.
Adding cognitive training, visual training, and vestibular training can help to reduce a clients risk for dementia and increase their balance. The role of increasing cognitive reserve and its relationship to MTBI is in need of further investigation.
Cognitive training or brain games may help to improve visual and spatial memory. A recent research project by the author showed an increase in visual and spatial memory on a neuro-cognitive assessment in a group that underwent a five week “brain training” program compared to a control group. Personal trainers may wish to spend some of their time with clients on brain training exercises or schedule additional sessions that work on brain training exclusively. Another option is to incorporate “brain training exercises into their physical fitness. Brain training should incorporate memory, concentration, problem solving, and vocabulary type games. There are many online program and “apps” that can be used for brain fitness. There is little to no downside to incorporating brain training games into an overall fitness program. There is exercise equipment available on the market that incorporates both physical exercise and brain training.
Personal trainers may need to use creativity as most facilities will not have equipment that is designed to work an individual both physically and cognitively. One option is to use the internet and have your clients play brain games as they ride a stationary bike or use the treadmill. A mobile device that is Internet capable can download brain training based games. A second option is to develop your own brain games. Make a list of 20 words and read them to your client as they are exercising. Ask them to recall as many words as they can 2-3 minutes later. To increase concentration trying to find differences in pictures that look very similar works well.
An often utilized tool regarding brain pathology and visual testing is the King-Devick test. Although utilized as a quick and effective sideline screening test to determine if a concussion is present, the King-Devick test can be utilized for visual training. This training can be administered during exercise and may help to improve performance through increasing visual tracking. Again, personal trainers should not perform these exercises on any individual suffering any MTBI related symptoms.
There are several other visual tracking exercises in addition to the King-Devick test that can be done and that are easily made. For example, on one sheet of paper write the numbers 1-20 large enough to read if the client is running on a treadmill and you are standing in front of it. Say numbers in a rapid random order and have the client find the numbers without moving their head.
A second exercise is to have one letter or number on a sheet and while the client is on a treadmill or bike have them keep their head still and move the paper around to practice tracking. Then, have the client move his or her head in the direction opposite of the paper. Return the piece of paper to the center once the number is out of their field of vision. The visual training exercises listed above can also be done while challenging a client’s balance. Please see figures 1,2, and 3 for visual tracking exercises being done while a client is on a treadmill.
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The vestibular system refers to the system in the body that is responsible for maintaining balance, and posture. The vestibular system includes parts of the inner ear and the nervous system. Most personal trainers will have had minimal training with regard to vestibular exercises. Personal trainers are not certified in vestibular rehabilitation and any client who is suffering from vertigo or other types of balance disorders should be referred to a specialist who is professionally trained in vestibular rehabilitation.
Vestibular exercises should not be done by a personal trainer on any client who is still having symptoms from a concussion and should stop immediately if a client complains of symptoms during any vestibular exercises. Personal trainers typically incorporate balance exercises into their client’s routines and this will challenge the vestibular system.
Other exercises that include eye and head movements can further train the vestibular system. Cawthorne’s vestibular exercises can be done easily either during a break between sets or when a client is exercising. The exercises include looking up and then down, starting slowly and the quickly. The client does this approximately twenty times and then stops. Having a client focus on your finger and track your finger up, down, and side to side with their head still, can be done while a client is exercising and will also work the vestibular system. Lastly any exercises that involve stooping or turning can also train the vestibular system.
There are many benefits to increasing cognitive reserve. Benefits may include a decreased risk for brain related pathology. Additionally, increasing cognitive reserve may improve performance and increase balance, visual tracking, and memory.
There are several different components of cognitive reserve. This article discussed cognitive, visual, and vestibular training as part of increasing cognitive reserve. Key points to remember are to stop exercise on any client who is experiencing symptoms of any brain related pathology including MTBI. Referral is important if your client is experiencing any symptoms or needs more advanced care from a specialist.
About the Author
Dr. Douglas Mann is an associate professor at Rowan Univesity in the Health and Exercise Science department. He is a certified athletic trainer and has worked at the high school, olympic trial, college, and professional levels. He can be reached at [email protected]