Five questions for Patricia Heyn

Researcher examines impact of exercise – physical and mental – on Alzheimer’s


Bodies and brains change as we age, but as we enjoy longer lives, we strive to fend off some of the debilitating diseases that diminish our mobility and mental acuity.

Patricia Heyn, an associate professor in the CU School of Medicine at the Anschutz Medical Campus, has spent years studying how physical and cognitive activities affect cognitive function, especially for people with Alzheimer’s.

In 2004, she was conducting cutting-edge research on the effects of exercise on cognition and Alzheimer’s during a post-doctoral fellowship at the University of Texas Medical Branch. She received an invitation to join the geriatric medicine division at the CU School of Medicine to develop and establish her area of research with the IMAGE Research Group, which conducts investigations in metabolism, aging, gender and exercise. Some of her research included a study investigating the effects of exercise versus pioglitazone treatment on the cognitive function of older people.

Five questions for Patricia Heyn

In 2008, she joined the Physical Medicine and Rehabilitation Department to work on research projects with the Assistive Technology Partners and continues to assist the center with “unique research related to assistive technologies for individuals with cognitive impairments.”   

Heyn last month presented research results at the Gerontological Society of America annual meeting in New Orleans, where she also was awarded with her second fellow designation award. The first award came from the American Congress of Rehabilitation.

Heyn also is working with the Center for Gait and Movement Analysis on a longitudinal research health outcome study evaluating the effects of aging on disability for people with cerebral palsy.

“When these individuals reach adulthood, they usually are underserved and neglected and do not receive proper health care services due to the lack of knowledge from adult health care professionals about their disability and health needs. Therefore, our study is evaluating health outcomes after transition to adulthood,” she said. Pediatric care is quite specialized and a foundation exists to properly treat children with disabilities.

She also works with Rocky Mountain Alzheimer’s Disease Center​ (RMADC) investigators. Currently, she is working with Tim Boyd on evaluating neurotrophic brain markers and cognitive function in individuals with cerebral palsy.

“My work is multidisciplinary, and to be successful in this line of research, you need to work collaborativelly and effectively with the disciplines involved in advacing the science of Alzheimer’s disease for individuals with complex disabilities.”

1. How did you choose this profession? Was there a person or event that influenced your decisions?

Growing up in Brazil exposed me to a broad range of social issues, diversity and inequality. In Brazil in the 1980s, individuals with disabilities were significantly underserved and neglected. Their health needs were so blaring that when I was a college student, I volunteered with nonprofit organizations to assist with the needs of the underserved population.

Project Agape - Reaching Underserved and Neglected Communities (Winter 1988, Sao Paulo, Brazil)
Project Agape - Reaching Underserved and Neglected Communities (Winter 1988, Sao Paulo, Brazil)

In 1988, when I was an exercise physiology research intern at the Hypertension Lab from the Heart Institute of Sao Paulo, I was asked by one of the volunteering organizations, Project Agape, to develop physical therapies for neglected adults with intellectual and developmental disabilities. I understood well the importance and significance of what I was asked to do and I immediately accepted the challenge. This experience gave me the strength and creativity to investigate exercise-based approaches that could increase the well-being of these individuals, and, at the same time, decrease the burden of social neglect.

Juqueri Psychiatry Hospital, Sao Paulo, Brazil. (Hospital Psiquiátrico do Juqueri, 1988)
Juqueri Psychiatry Hospital, Sao Paulo, Brazil. (Hospital Psiquiátrico do Juqueri, 1988)

While all my lab peers, who were also interning at the Hypertension Lab, were investigating the cardiovascular responses to exercise training, I was developing a new passion and career path by investigating novel exercise approaches as a potential therapy for mental and cognitive enhancement. It was the birth of my research on physical and sensory-based cognitive therapies for adults with cognitive impairments. I integrated music, musical instruments, physical movements, storytelling and sensory objects to stimulate physical and mental engagement in individuals with severe cognitive impairments.

Participants with Intellectual and Developmental Disabilities Participating in the “Heyn Exercise and Dance Therapy”.
Participants with Intellectual and Developmental Disabilities Participating in the “Heyn Exercise and Dance Therapy”.

I moved to the United States in 1991 for my graduate studies and expanded my initial work to focus on aging and dementia. In 2001, I completed my doctoral studies investigating the effects of exercise training on Alzheimer’s disease. I developed an exercise-based, multi-sensory cognitive therapy for individuals with severe Alzheimer’s disease and I presented my study results at professional meetings and published the findings. Due to the innovation and originality of my work, I received several postdoc fellowship invitations and decided to join in 2002 the neurologic and cognitive rehabilitation postdoctoral fellowship program at the University of Texas Medical Branch. Under the mentorship of the renowned Dr. Kenneth Ottenbacher, I developed several approaches for cognitive enhancement, including a unique virtual reality program for individuals with stroke.

2. You mentioned using everything from music to movement to protect or enhance functions of an aging or diseased brain. What activities have been used to fend off brain issues and who should engage in these types of activities?

The past 20 years has been filled with abundant information about different approaches aimed to impact positively the brain health span. Although the evidence is still uncertain, exercise (especially endurance-type exercise like swimming, biking, walking) has been shown to be one of the most effective treatments for cognitive enhancement. Abundant evidence supports the benefit of exercise to ameliorate cognitive decline as well as to be protective against dementia development.

The Mediterranean Diet (rich in fresh vegetables, whole grains, seafood, nuts, olive oil, etc.) also shows promise for protective and enhancing benefits on cognition. Lately, and probably because of the explosion of mobile technologies and apps, the brain gaming training approach, which is a new science, also is showing potential to aid in the health span of cognitive function.

My suggestion is to do them all: combine endurance exercise, including complex physical activities like dance with the goal to increase sensory activity, with the Mediterranean Diet, cognitive training (gaming, or learning a new language or how to play a musical instrument) and have an engaging full and rich social life. All these approaches together will most likely increase your chances for good health, wellness and vital cognitive function for lifetime.

Also, try to learn something new every day with the goal of stimulating new memories and brain proteins to enhance brain activity. Exposing the brain to new information is similar to what exercise does for muscle tissue.

3. Does it matter at what age you begin these activities? Do young people, who constantly use gaming technology, have an advantage later in life?

I always say that “one” is better than “zero,” and that means any stimulation, be it physical or mental, is better than none. You must use it or you will lose it, and the earlier you start with physical and mental training, the better are your chances to benefit from them.

Regarding the use of the brain gaming approach and its longitudinal effects, this knowledge most likely will emerge in the coming years. I believe the next 10 years will provide us with ample scientific information about the effects of brain gaming technologies on health, including whether too much of a good thing is a bad thing.

There are several questions that need to be answered in regard to the brain gaming technology science, such as what type of gaming context and type of exposure (like training dose) is appropriate? Who are the best candidates for this approach (stroke patients, children, etc.), and what are the side effects involved in its chronic use? Will it induce more sedentary behavior, or visual or postural problems?

This is a growing field, especially for neuroscience, and in the upcoming years, we hopefully will have some of the important answers to this new cognitive enhancer approach. It will be a challenge since the technology is always changing. To be effective in this field of study, cognitive scientists will need to work closely with computer engineers and software developers in designing technologies that will have the proper usability features to positively impact human health span.

I am the chair of the Applied Cognition Task Force of the American Congress of Rehabilitation Medicine (ACRM). For the past two years, the task force has been evaluating the brain gaming technology evidence that has been published related to older adults with cognitive impairments in order to generate a guideline report and recommendations for future research. We just presented the results at the ACRM Annual Meeting in Chicago. Although we have not completed the evidence summaries, there seems to be a trend towards the possible positive effects of brain gaming on memory and attention of older individuals with mild cognitive impairment, including Alzheimer’s type.

4. What other research/topics are you focusing on now?

My current research includes investigating the early timing of chronic disease development in individuals at risk for health decline due to the process of growing older with a disability. The question is, if someone has a disability (like a brain or spinal cord injury or Down syndrome), how early can we identify health risk factors associated with cardiovascular disease or Alzheimer’s disease? Cardiovascular disease is associated with Alzheimer’s disease; therefore, are individuals with a lifetime disability at higher risk for developing such conditions, and if so, why and when does the disease process start in these individuals?

This research has important health care implications as well as great potential for positive quality of life impact for patients with disabilities.

We don’t know much about the development of Alzheimer’s disease in individuals with disabilities. We need to understand and learn more about how Alzheimer’s manifests in persons with disabilities to properly treat, manage and improve the person’s quality of life.

Living a life with a disability can be quite challenging for the person and for their family. Developing chronic health conditions while the person with a disability is growing older can have detrimental effects on the person’s lifespan, function and quality of life.

5. Do you follow your own advice and continue to be physically and mentally active every day?

Yes. I swim, walk, run, bike and love to dance. I also love to learn about world cultures, behaviors and languages. If a day was composed of 48 hours, I would be learning Latin, Italian and French – and how to play a Spanish guitar.