Funding for this paper was provided by Namseoul University year 2017

* ch-shin88@hanmail.net

Copyrightⓒ2018 KAHPERD

International Journal of Human Movement Science, 2018, Vol. 12, No. 1, 93-102

https://doi.org/10.23949/ijhms.2018.04.12.1.9 ISSN 1976-4391(Print) / ISSN 2586-078X(Online)

Clinical Brain SPECT Changes in Accordance to Physical Activity

of Seniors Woman

Shin Chul Ho* Namseoul University, South Korea

Abstract

The purpose of this study is to investigate about the change which can delay the aging of mind. When senior woman perform

aerobic exercise consistently for an extended amount of time, improvements of regional blood flow in brain could be noticed.

This could lead to advance research about positive effects of increased brain blood flow to investigate the relation of

neurotransmitter, hormone, and relation with cerebrovascular disease. The effects of SPECT(Single Photo Emission

Computed Tomography) scan results to brain blood flow. Improvement of blood stream in prefrontal and temporal lobe will

help to prevent the dementia. But, to get positive results, it is important to have the seniors exercise. Exercise prescription

guideline to the seniors is difficult and demands long period of time to reach the expected goal. One of the important issues

is to overcome metabolic syndrome which is often found in seniors. It decreases metabolism of the senior gradually reducing

brain activity, eventually failing all physical functions. As a result, it is essential to increase the neurotransmitter and brain

blood flow to in order to provide healthy life quality to the seniors. Of all exercises, aerobic exercise increases the oxygen

being supplied to brain. It brings positive influence and effect to nervous system and cardiopulmonary monitor, resulting

active brain activity. Therefore, in this current society where the senior population is increasing, it is important that we invest

in this research within the field of physical education and provide a healthy solution for the '100 year life' generation.

Key words: SPECT Scan, Brain blood flow, Neurotransmitter, Brain, Metabolic

Introduction

The modern society has environmental factors that

can limit the physical activity due to the

development of machine civilization. However, due

to the improvement of living standard and the level

of medical care, the mortality rate has been reduced

and the life expectancy has been extended.

In this regard, as the elderly population aged over

80 is increasing, the elderly dependents who cannot

perform their day to day life due to various geriatric

disease physical/ mental disorders are appearing as a

social problem ( Hakkinen et al.,2001).

It has been reported that aging can reduce or

prevent muscle strength. This however could be

prevented by prolonged exercise. Aoyagi &

Shepherd(1992) reported that continuous low

intensity exercise is needed to prevent cardiovascular

disease which increases with the decrease in physical

activity in old age with the increase of

cerebrovascular disease more social attention is

given to dementia. In the United States, it accounts

for 4 million deaths in 4 million patients and predicts

15 million patients by the mid-2000s. Alzheimer's

and Parkinson's dementia is a disease in which

human cognitive function is deteriorated. Serious

impairment in cognitive function including memory

is caused (Kang et al., 2002) and deterioration of

94 Shin Chul Ho

cognitive function occurs due to acquired brain

damage. (Jung & Na , 2003) As the metabolism

begins to decrease in the frontal and temporal lobes

it decreases the blood flow and local glucose

metabolism in the parietal lobe. This affects the

function of the brain gradually damaging memories,

thoughts, and behaviors. Dementia can be divided in

to Parkin’s dementia and Alzeheimer’s dementia and

cause of Alzeheimer’s is not yet known. However,

the loss of neurons(nerve cell) in the Acetylcholine

is related to the atrophy of the frontal lobe and

temporal lobe and also directly related to

ageing(Behl, 1999). As a result of increase of brain

disease in the senior population, social attention to

dementia is also increasing. As its solution, there are

reports that continual low intensity exercise is

needed for its prevention. Especially, the increasing

number of senior population, namely seniors over

the age of 80, are becoming more dependent due to

their lacking ability to handle everyday activities

because of the affects from dementia. Population of

senior not able to maintain health conditions are

increasing and it now becoming a social problem.

Medication and exercise therapy not only works as a

preventative act for dementia but is now also a

prerequisite condition to prolong life and to maintain

health (Kim, 2000). As a result, regular exercise is

mandatory to maintain healthy aging (Ok JeongSuk

et al., 1999) and active research is being done to

support this case. Fitness of a senior can be

developed through exercise through attribution of

neuro-transmitters or sex hormones and increase.

Vermeulen(1980) stated that aerobic exercise

increases hormone secretion. For movement disorder

in the central nervous system, (Jung & Na, 2003)

suggested that gradual loss of blood flow in the brain

resulting in a decrease in cerebral blood flow leads

to clinical symptoms such as slowing, shaking and

posture instability. Research on aging conducted in

Korea reveals that physiological and psychological

changes of the seniors are somewhat researched.

However, the neuro-motor and cerebral vasculature

changes in the seniors as a result of exercise still

demands more research. Studies regarding the

adverse effects of hormone administration were

rarely conducted. Therefore, the study of cerebral

vascular and aerobic exercise should be activated to

solidify and formulate theory of its effects on

psychological aging.

In this study, we investigated the changes of

cerebral blood flow which can delay mental aging in

low-intensity long-term aerobic exercise in normal

elderly people, and observed increase of cerebral

blood flow through SPECT brain scan This study

examines whether there is a positive effect on cerebral

blood flow (Alzheimer's) and on the relationship

between hormones and neuro-transmitters to increase

cerebral blood flow. In the diagnosis and treatment of

cerebrovascular disease, SPECT scan is used to

measure cerebral blood flow In the early of the

research, dementia was regarded as a something that

dose not appear on the entire brain at once but rather

happens by a general atrophy of the cerebral cortex,

and the difference in sympotoms was due to a

pathological environment. However, as the

pathological research finding has shown that there is a

localized change within a certain part of the brain, the

blood flow in the brain after exercise was observed

and tracked to investiged the cause. The purpose of

this study is to provided a right exercise method and

information and to suggest guidelines for improvement

of cerebral blood flow in the elderly.

Clinical Brain SPECT Changes in Accordance to Physical Activity of Seniors Woman 95

Discourse

The theoretical background which releated of

measurement of brain blood flow about the senior

exercise

Physiological characteristics of cerebral blood flow

in the seniors

The participant of this study execute with 4

voluntary participant in 69 ~73 years old who didn't

have a drug. The cerebral blood flow of the seniors

is significantly lower than that of the younger

(Tatsch, 2001). It is more apparent in the temporal

and the frontal region. This phenomenon can lead to

dementia, and as the dementia progresses, functional

impairment also appears in the areas of the frontal

lobe and occipital lobe. Similar metabolic

degenerative symptoms are shown during presenile

and senile stages and related symptoms include

personality disorder due to memory impairment,

computing disability, reading and writing disorder

(Jung & Na , 2003) Therefore, the exercise capacity

gradually decreases thus resulting difficulties in

pursuing independent life for the seniors.

The neuro-plasticity of seniors

Exercise stimulates the brain, and the stimulated

brain aids the activity of the cranial nerves by

biochemical action. Minor changes or large changes

in the brain are directly linked to synaptic activity

and dendrites. This phenomenon is called

neuro-plasticity. This change is cause in the area of

the back of the central furrow of the brain where the

somatic movement is performed. It is related to the

skin and senses and is connected to movement

(Baker et al., 2000) In the somatosensory there is an

area where external stimuli are accepted and

transferred to project appropriate actions.

This area helps to move specific organs of the

human body sensitively, providing high level of

activity, and growing the cranial nerve cells. The

nerve cell does not grow during the senior years but

the brain function could be stimulated could be

stimulated by activating the dendritic activity.

Exercise and nerve reflexes

Injuries during exercise, cranial nerve damage

and slowing of cranial nerves will remind the pain.

After a period of time, it will be more sensitive

during rehabilitation. This is because the brain

remembers the degree of pain caused by the injury

(Barbeau, 1961). By Increasing the amount of

oxygen supplied to the brain through aerobic

exercise, or rehabilitation, it allows the ability for the

muscle to alert. Therefore, such activity is needed to

maintain healthy brain condition for seniors as well

as patients with brain damage.

Hormones and Neuro-transmitters

Hormones and Neuro-transmitters are substances

that secretes from the nerve cells transmitting impact

and information to another nerve cell. It is a

substance that helps the nerve and muscles.

Therefore, hormones and neuro-transmitters are very

important factors in studying the brain. In general,

intra-cellular chemical action of neuro-transmitters

occurs in the synapses and in neuro muscular

junctions. This action, when stimulated by the

96 Shin Chul Ho

synaptic nerve, must be accompanied by electrical

stimulation and release of the substance from the

synapse cleft. In addition, the released substance

should be transmitted to another nerve, and electrical

stimulation should be accompanied by excitation and

inhibition depending on the situation (Marek &

Selby, 2000).

SPECT imaging

Cerebral angiography was performed for 30

minutes after dermal administration of radioisotopes.

All subjects were instructed to stop drinking alcohol

day before the experiment and quit smoking one

hour before the test.

99mTc-HMPAO SPECT image acquisition

The single photon emission computed tomography

(SPECT) device used for brain activation studies was

MULTISPECT II (siemens Medical System,

Hoffman Estates, IL, USA). The images were taken

at the same time on the same day as the images in

non-active state without visual stimulation. As in the

study of Kim (2002), image acquisition was

performed at 60° intervals with 6° intervals and 60

frames were obtained using a low energy high

resolution collimator. In addition, 925 MBq of

Tc-HMPAO was intravenously injected to obtain

images, and after 5 minutes, they were scanned for

30 minutes. During the recording, the subject was

kept in a relaxed state, minimized head movement,

kept the room quiet, and kept the lighting dim. Brain

activated images were injected intravenously with

radioactive isotopes, and then stimulated with 8 Hz

red light emitting diodes for 5 minutes.

Usefulness of brain SPECT scan

SPECT Scan is most useful for measuring

cerebral blood flow after exercise. In particular,

evaluation of cerebral blood flow before and after

exercise can evaluate exercise as effective for

prevention of dementia. In particular, the level of

neuro-transmitters in the blood can be used to

observe differences in the amount of brain .

Exercise prescription

Exercise intensity and program design

In order to see the substances secreted by the

mood and feelings of the seniors, it is necessary to

exclude forced programs and control their exercise

capacity. Applying Borg's RPE (Rating of Perceived

Exertion) is an important factor to see the results of

exercise. The reason is that not all exercises are

suitable for the seniors. Therefore, it is very

important not closely examine the exercise regimen

before having it applied to them. This is because

seniors have physical variables that are difficult to

predict. The most important thing when guiding the

seniors to exercise is to let the elderly themselves

control their physical abilities. Therefore, at the

beginning of the exercise, the strength of the RPE is

preferably 7 (very light). This is because the

intensity of the lower exercise is not expected to be

effective. Also, this exercise is recommended for

10-40 minutes and RPE strength should be 11-15

(slightly lighter – harder). In the last 10 minutes, it is

shown that the most appropriate exercise for the

seniors is to perform the recovery exercise (13: a

little hard) with light steps.

Clinical Brain SPECT Changes in Accordance to Physical Activity of Seniors Woman 97

Warm up (stretching, 10min) →Exercises

(Aerobic Exercise) 10-40min)→

Stretching

(10min)

Table 1. Exercise intensity

Time(Min) 10 10 - 20 20 - 40 40 - 50

RPE(Intensity) 7 11 15 13

Table 2. Borg's RPE

rest for 1min.

Non-activation for 4-5min.Maintained close eyes

Scan for 30min.

Non-activation state(visual normal state)Intravenous injection of 99mTc-HMPAO(925MBq)

rest for 1min.

Non-activation for 4-5min.Maintained close eyes

Scan for 30min.

Non-activation state(visual normal state)Intravenous injection of 99mTc-HMPAO(925MBq)

Figure. 1 Brain SPECT scan

Transverse Coronals Sagittals

V1

V2

V3

V4

Figure 2Transverse: 7 frames of 24 frames obtained

Coronals: 3 frames of 16 frames obtained

Sagittals: 2 frames of 16 frames obtained

Exercise Frequency

Aerobic exercise should be performed at least

twice a week, but may be increased to five days per

week unless otherwise specified (ACSM, 1995).

However, patients with limb paralysis with a VO2

peak of less than 15.5 ml / kg / min unable to endure

20~30 minutes of exercise should do 5 to 10 minutes

of short continuous exercise ( Lee et al., 2013).

The method of increasing exercise is usually

appropriate for the training program in the early

period of exercise (ACSM, 1995). Muscle aches

occur in the early stage, but it improves after 2

weeks. The duration of this exercise should be about

30 minutes during the improvement stage.(Ju et al.,

2002)

The following is an observation of the brain area

that can be regarded as an indeex of cerebral blood

flow evaluation before and after physical activity.(Ju

et al, 2002).

98 Shin Chul Ho

Transverse Coronals Sagittals

V1

V2

V3

V4

Figure 3Transverse: 7 frames of 24 frames obtained

Coronals: 3 frames of 16 frames obtained

Sagittals: 2 frames of 16 frames obtaine

Increase in cerebral blood flow

(frontal lobe, temporal lobe) observed post-exercise

Pre-exercise V2 frontal lobe (1-2term) Post-exercise V2 frontal lobe (1-2term)

(Transverse : 7 frames of 24 frames obtained)

Pre-exercise V2 frontal lobe (1-2term) Post-exercise V2 frontal lobe (1-2term)

(Coronals : 3 frames of 16 frames obtained)

Pre-exercise V2 temporal lobe (3-4term) Post-exercise V2 temporal lobe (3-4term)

(Sagittals : 2 frames of 16 frames obtained)

Pre-exercise V1 frontal lobe (1-2term) Post-exercise V1 frontal lobe (1-2term)

(Transverse : 3 frames of 16 frames obtained)

Pre-exercise V1 temporal lobe (1-2term) Post-exercise V2 temporal lobe (1-2term)

This research paper was cited by precedence research

Figure 4. Images of frontal lobe pre/post exercise

Effects of Aerobic Exercise on seniors’

Cerebrovascular Disease

The results of previous studies on exercise,

hormone and neurotransmitter changes are not

always in line with the researchers' arguments.

Because exercise physiological studies on human

body have many uncontrollable variables, there are

many limitations in fully accepting results of certain

studies. Studies on the effects of exercise on

testosterone started in the 1980 there are numerous

study cases that could be referred to. Over the years

Clinical Brain SPECT Changes in Accordance to Physical Activity of Seniors Woman 99

the research interest directed to find out if exercise

lead to increases secretion of testosterone. It is

known that changes in testosterone associated with

exercise have a significant effect on the body during

the physiological process (Brooks, 1998). In

addition, recent studies have suggested that amount

of testosterone in the blood was significantly

increased in the elderly male aged between 64 and

73 with the escalation of the exercise (Hakkinen et

al., 2001)

In a recent report, Kramer. et al.(1990) reported

that the difference in the degree of hormone response

in resistance exercise sessions was controlled by

resting between exercises. Changes in cerebral blood

flow as in the above image, shows the pattern

changes in cerebral blood flow before and after

exercise. This may be related to dysfunction in the

control axis of the hypothalamus-pituitary-testis.

This hypothesis is based on the levels of stabilizing

neuro-transmitters and abnormalities of luteinizing

hormone and pituitary gland (Hackney et al., 1990)

In addition, Gooren(1996) reported that aerobic

exercise increased the serum testosterone levels in

the seniors. This affects dementia-related

amyloid-protein expression. Brooks (1976) reported

that the exercise of the seniors decreased the amount

of amyloid protein, the cause of dementia

(Alzheimer's, Parkinson's). These results support that

exercise is effective in the prevention of dementia

for the seniors. In conclusion, the increase of

testosterone and the increase of cerebral blood flow

will affect the change of amyloid-protein expression

level. Therefore, the aerobic exercise increases the

cerebral blood flow, which is very beneficial for

mental illness in seniors. In addition, Hong (1999)

suggest that the decrease of testosterone may be

accompanied by disturbed mental activity,

depression, and headache. However, there is a need

to establish a guideline in future studies to determine

what clinical symptoms are present at the normal

level of blood testosterone and how much of the

hormone is to increase from exercise. There is also a

close relationship between physical fitness and

cognitive ability. Research suggests that regular

exercise of the seniors can improve brain function

and exercise (aerobic exercise) in accordance with

rhythm is suggested as effective method to help

memory and learning for them. Level of serum

hormones and neuro-transmitters are very situation

dependent, so one of the most important part of this

study is the observation of the cerebral vascularity

before and after exercise.

In particular, when the image of Figure 2-4 is

analyzed, the improvement of the blood flow per

frame in the frontal region and the temporal region

can be observed. These results indicate that local

cerebral blood flow is generally directly related to

cerebral metabolism. Therefore, aerobic exercise for

the seniors is very important for preventing

cerebrovascular disease and it is necessary to

observe the condition of cerebral blood flow. In this

regard, ideal brain blood flow tracing should be able

to pass through normal cerebrovascular barriers and

it should be extracted completely from the blood into

the brain tissue. It should also be distributed

proportionally to the cerebral blood flow and should

remain metabolically and not redistributed within the

brain tissue for a long period of time. (Na, 2003).

After these conditions are met, SPECT scan can

compare cerebral vasculature before and after

exercise, thus the cerebral blood flow shown in this

figure can be relied on.

100 Shin Chul Ho

Conclusion

It is very difficult to guide exercise prescription

for the seniors, and it takes much time to achieve the

goals set. But most importantly, exercise is

inevitable to maintain a healthy life fighting against

metabolic syndrome and complications that can

occur in the senior years. Deterioration in the

metabolism in particular rapidly reduces the activity

of the brain eventually affecting performance of the

entire body. In this regard, exercise regimen which

increases the cerebral blood flow related to the

increase of neurotransmitter is a very effective

method to maintain the health and the quality of life

for the seniors. Of course, we cannot conclude that

all exercises increase cerebral blood flow, but

aerobic exercise increases the amount of oxygen

supplied to the brain, which in turn will make blood

levels healthier, which will have a positive effect on

the nervous system response and cardiopulmonary

functions of the seniors. Therefore, it is important for

the elderly to increase muscle strength, but it is

considered as important to induce subtle calm

physical activity slowly while listening to music. It

is preferable to continuously perform physical

activities by being involved in light dance or

physical movement that would be suitable for the

individual. It is believed that planning and

researching new programs for elderly people, will

become a role of exercise prescription specialist in in

this era where we are expecting a 100 years life

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Received: March 8, 2018Final Revision: April 29, 2018Accepted: April 30, 2018

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