Strong Hands, Strong Mind

If you struggle opening a can of beans or jar of jam, closing buttons on a coat, or find yourself fumbling with the change given to you at the supermarket checkout, it may signify a loss of manual dexterity and handgrip strength. This is a common sign of aging and often makes its appearance after the age of 60. If this issue is age-related and not due to a medical condition, the good news is that some simple exercises can help preserve function. And that’s not all these exercises can preserve. Manual dexterity and handgrip strength exercises can also maintain, and may even improve, the health of your brain and your memory. Getting older affects us physically in multiple ways, one of which is a loss of hand flexibility. This is defined as the ability to control finger movements accurately and rapidly in a coordinated and adaptive manner, such as fine control in grasping and manipulation of small objects.¹ A loss of flexibility can lead to difficulties in a variety of everyday tasks such as writing, gardening, using scissors, tying shoes, cooking, and much more. Preserving manual dexterity is therefore important to living independently and maintaining a good quality of life. And yet the problems related to a loss of dexterity go much further than using our fingers and hands for manual tasks because it’s also linked to a loss of cognitive abilities, especially executive function. Hand Flexibility Linked To Executive Function Executive function allows us to resist temptation and impulsive behaviors, filter out irrelevant or distracting information, plan and make judgments, mentally play with ideas, and use our working memory, which allows us to hold on to information long enough so we can make use of it. A decline in executive function would therefore limit our ability to carry out many day-to-day activities. A study published in 2021 included 35 men and women between the ages of 65 and 84. Researchers used various tests to examine different aspects of executive function, and they used another test to measure manual dexterity. The researchers found all areas of executive function they tested, apart from working memory, were significantly linked to manual dexterity. In their conclusion they wrote that “integration of complex cognitive and sensory mechanisms constitutes a crucial component of hand motor function…”² As well as dexterity, handgrip strength is also linked to cognitive health. The firmer the grip the less cognitive decline and related functional disability. Stronger Hands – Better Brains After reviewing 15 studies, researchers from Wayne State University, Detroit, concluded their review by writing: "Findings here support the use of handgrip strength as a way to monitor cognitive changes and show that reduced handgrip strength over time may serve as a predictor of cognitive loss with advancing age."³ In a large study that included nearly half a million adults, researchers at the University of Manchester, England found people with stronger handgrips performed better in every cognitive test they measured. They therefore concluded that handgrip strength is an indicator of brain health. First author Joseph Firth explained, saying, "When taking multiple factors into account such as age, gender, bodyweight and education, our study confirms that people who are stronger do indeed tend to have better functioning brains."⁴ The evidence for this has become so strong that handgrip strength is now considered to be a clinically useful biomarker of cognitive decline. So, what’s more important for keeping executive function in good working order, manual dexterity, or handgrip strength? Since this had never been tested, community health researchers in Tokyo designed a study to find out. Manual Dexterity Uses Complex Cognitive Processes They enrolled 326 physically and mentally healthy Japanese men and women over the age of 60. They gave each one handgrip strength and dexterity tests, three tests of executive function and a commonly used all round test of mental ability called the Mini-Mental State Examination. The results revealed hand dexterity, not handgrip strength, was significantly associated with executive function. “These findings” they wrote, “suggest that hand dexterity may be considered a measurable motor risk factor for the early detection of executive function impairment among older adults...”⁵ The researchers believe the reason why dexterity may be more important than grip is because it requires not only hand and finger co-ordination with the eyes, but also requires complex cognitive processes seen in executive function. They believe these processes have a lesser role in muscle strength but a strong role in performing fine motor movements. Handgrip strength has established itself in importance and it seems from this study that manual dexterity may eventually also establish itself as a key brain health indicator. This is supported by not only the above study but also by the following two studies. Manual Dexterity Lost Even In Healthy Aging The first study explored the relationship between executive function, working memory, and dexterity performance in 15 young and 15 healthy elderly people. They found variability of hand movements was linked with executive function abilities in older adults.⁶ Two years later a pilot study aimed to distinguish between changes in manual dexterity due to normal aging and those that come about because of cognitive decline. To do so the researchers enrolled 40 volunteers and divided them into four groups: cognitively intact elderly, cognitively impaired elderly, healthy young adults, and healthy middle-aged adults. A battery of procedures – far more than usually used - tested grip, pinch force, object manipulation, finger dexterity, touch sensitivity, delicate movements, and heavy hand movements. Other tests measured cognitive abilities. The conventional hand function tests were unable to spot any differences between elderly subjects with and without cognitive decline. Yet the wider range of tests used revealed two different patterns of impaired manual dexterity: one related to cognitive decline and another related to healthy aging. The researchers believe these findings “could provide valuable clinical markers for early sensitive detection of age-related cognitive decline.”⁷ The above studies suggest manual dexterity and handgrip strength can be used as indicators of cognitive decline. What they don’t tell us is whether exercising the hands can prevent cognitive decline or even improve brain function. Although the literature on this is sparse, there’s reason to be hopeful. Squeezing A Ball Improves Episodic Memory The studies that exist on handgrip demonstrate that “optimal” handgrip tension - 30 seconds to a minute of moderate pressure - is linked to improved memory and processing speed. When utilized after a word learning task, it enhanced memory for word lists. In older adults, the improvement brought memories in line with those of younger adults.⁸ Recalling words is an example of semantic memory. Another type is episodic memory, which involves recalling events in a person’s life. Cognitive aging research often focuses on this area of memory because it deteriorates consistently with advancing age. A study published in 2014 enrolled 47 healthy men and women over the age of 60. Researchers gave them two tests of episodic memory. One involved listening to a short story that was read to them and another that showed visual images. The researchers divided them into two groups. One group had no treatment while the other squeezed a sand-filled latex ball for one minute. Two weeks later they were tested for their ability to recall the story and images. The results showed the isometric exercise group performed significantly better. The researchers concluded by writing that these findings in older people “suggest that a simple form of isometric exercise can have practical effects, such as aiding memory for stories and images.”⁹ As for manual dexterity, little research exists but a recent study was carried out by a research team at the University of Tsukuba in Japan and published in April. It set out to see if cognitive function could be enhanced in older adults with home-based manual dexterity training. Manual Dexterity Training Boosts Executive Function For 20 minutes a day for 12 weeks, 57 healthy adults aged 65 to 88 were randomly assigned to either a control group or a training group. Researchers asked the control group to perform their usual daily activities while the intervention group received training for both hands using a special device developed by the researchers. The training program consisted of seven modes intended to stimulate elements of executive, attention, and memory functions. At baseline and during some of the training periods the participants wore a functional near-infrared spectroscopy device on their heads to monitor blood flow and oxygenation in the prefrontal cortex. Researchers also gave them tests for manual dexterity and cognition. The findings showed that the more intense the training, the greater the level of oxygenation in the prefrontal cortex. Cognitive functions improved in the intervention group compared to controls, but the star beneficiary was executive function which improved considerably compared to controls. The researchers concluded that home-based manual dexterity training can improve hand dexterity and cognitive functioning in older adults.¹⁰ The overall research shows dexterity and strength are linked, and preliminary studies suggest exercises may even improve cognition, so it’s well worth spending a few minutes a day carrying them out. How To Improve Handgrip and Hand Dexterity The following exercises have all been designed to improve handgrip^11,12 and dexterity¹³ and are suitable for older adults. Handgrip exercises

Use a small rubber ball or tennis ball and squeeze hard for three to five seconds, then relax. Do this up to ten times and then switch hands.
Start with outstretched fingers and then bend the fingers at the middle joints, so the fingertips touch or come towards the top of the palm. Also bend the thumb. Do this clawing movement ten times with both hands.
Repeat the above but bend at the knuckles so the fingers and thumb stay unbent and meet each other.
Put hands flat on a table with fingers and thumb touching and then widen them as much as possible before bringing them back together. Repeat ten times.
Take a can of soup or similar sized can in each hand. With elbows on the table and hands facing down, slowly bend the wrists up and down for a count of ten. Now repeat with hands facing up.

Hand dexterity exercises

With 16 half dollars or similar sized plastic chips on the table, pick up each one with one hand to make a neat pile of eight. Repeat with the other hand. Start again and use both hands together.
Pick up six to ten coins one at a time and hold them in the right hand. Now push them onto the table with your thumb one at a time. Repeat with the left hand. Repeat using both hands together.
Turn every coin over onto the other side with each hand separately and then both hand s together.
Riffle shuffle a pack of cards five times. Deal eight cards onto the table with one hand. Now pick them up one at a time with one hand. Repeat with the other hand. Repeat using both hands together. Spread eight cards on the table and turn each card over with one hand. Repeat with the other hand. Repeat with both hands.
Using eight Styrofoam packing peanuts or small pieces of cotton wool, pick up each with tweezers and put into a container. Repeat with the other hand.
Put the peanuts in a line and flick them one at a time with each finger. Repeat with the other hand.
Bounce a ball on the table and/or floor with hand facing down and then catch it with hand facing up. Do this ten times. Repeat with the other hand.

Our Takeaway The research is just the latest in a number of studies that link muscle strength to physical health and memory performance. What’s more, these brief hand exercises are free and easy to undertake. We encourage you to add at least one of them to your regular exercise routine. Best Regards, The Awakening From Alzheimer’s Team

¹ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6215834/ ² https://www.researchgate.net/publication/363470410_Correlation_between_Executive_Function_and_Manual_ Dexterity_in_Community-Dwelling_Older_Adults ³ https://pubmed.ncbi.nlm.nih.gov/28189666/ ⁴ https://www.manchester.ac.uk/discover/news/research-reveals-stronger-people-have-healthier-brains/ ⁵ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6109297/ ⁶ https://pubmed.ncbi.nlm.nih.gov/27420314/ ⁷ https://www.frontiersin.org/articles/10.3389/fneur.2018.00910/full ⁸ https://www.sciencedirect.com/science/article/abs/pii/S1074742714000094?via%3Dihub ⁹ Ibid. ¹⁰ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121426/ ¹¹ https://www.youtube.com/watch?v=kgqIdCwVivE ¹² https://www.youtube.com/watch?v=QPdrr1NXyNo ¹³ https://www.youtube.com/watch?v=Z3gP3UF9CbQ

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Strong Hands, Strong Mind

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