The Radiance Wellness Institute is an organization dedicated to the health and vitality of all human beings. In the study that we propose with this document, we are interested in the relationship between wellness and aging well, where one remains physically, emotionally and cognitively healthy. We believe that wellness is a learned behavior; the more time we invest in minimizing the harmful effects of stress, eating well and focusing on mind and body fitness, the healthier lifestyle we have. The word wellness invokes thoughts of nutrition, exercise, weight management and smoking cessation. Wellness, however, is more than physical health. Wellness is a state of complete wellbeing in your mind, body, emotions and also socially and economically. Wellness is a lifelong process of moving toward improving your physical, intellectual, emotional, social and environmental wellbeing. Our program for aging well is called Radiant Wellness. Radiant Wellness is a state of health and well-being in all areas of life: physical, mental, emotional, social and spiritual. One can achieve it by choosing a lifestyle that restores, rebalances, rejuvenates and increases one’s ability to feel and look radiant naturally.
We are seeking funding to investigate the relationship between wellness and aging. We propose a single-subject blind study that will collect pre- and post-measurements of the participants’ telomeres lengths, cortisol levels in saliva, cognitive performance and subjective experience of wellness. This within-subject design is an approach to applied research that allows us to evaluate the Radiance Wellness Institute’s program in an efficient and cost-effective approach. The affordable, practical study we propose is applicable to clinical environments, wellness centers, independent senior living residences and adult day cares.
A global epidemic of Alzheimer’s disease (AD) looms on the horizon as the world’s population ages and the incident of AD and other types of age-related dementia soars (Alzheimer’s Association, 2015; Brookmeyer, Johnson, Ziegler-Graham, & Arrighi, 2007; Rodgers, 2008). The Alzheimer’s Association estimates, based on the current trajectory, the number of Americans 65 and older living with AD will increase from 5.1 million in 2015 to 13.5 million in 2050 (Alzheimer’s Association, 2015). They estimate that in 2015, 11 percent of American seniors have AD; but they believe that by 2050, without an effective intervention, this number may grow to 16 percent of the American adult population 65 and over. This means millions of Americans may spend their retirement living with AD or caring for someone who does. This is by no means limited to senior adults living in the United States. Brookmeyer et al. (2007) estimate that by 2050, 1 in 85 persons worldwide will be living with AD. They believe that about 43% of these cases will need the equivalent of nursing home care. This dramatic increase in dementia will have far-reaching economic implications for global societies and may be arguably one of the greatest public health challenges of the 21st century (Alzheimer’s Association, 2015; Nilsson, 2014).
However, even a modest advance in preventive strategies that lead to even a small delay in the onset or progression of AD will significantly reduce the burden of the disease. Brookmeyer et al. (2007), for example, note that if there were interventions that delay or prevent the onset or progression of AD modestly by a year, then there could be as many as 9.2 million fewer cases in 2050.
In 2010, the NIH estimates the funding for AD research was close to $79M (source: report.nih.gov/categorical_spending.aspx). In 2015, the NIH expects this funding to rise to close to $566M however; this still lags far behind better-known diseases such as AIDS/HIV, heart disease, lung ailments and obesity. In addition, a large percentage of this research funding goes towards pharmacological interventions (Rue, 2010). We believe, however, that preventative approaches that incorporate simple lifestyle changes may prove more efficacious in addressing the looming AD epidemic; therefore, we propose this study that will investigate whether lifestyle interventions recommended by the Radiance Wellness Institute can increase wellness and slow the aging process and thereby delay or prevent cognitive impairment and the onset of AD.
Wellness is a concept of human health and well-being that goes beyond the absence of disease. As such, these concepts focus on what it means to flourish, to have a sense of purpose and direction in life, to possess quality relationships and to have the opportunity to realize one’s potential (Ryff, Singer, & Dienberg Love, 2004). The core assumption is that wellness contributes to healthy biological functioning and that it helps individuals from succumbing to diseases, or, if they do, that wellness helps them recovery quickly. Eudaimonic, a concept of well-being related to self-development, personal growth and purposeful engagement (Ryff et al., 2004), revolves around self-acceptance, purpose in life, personal growth, positive relations with others, the ability to manage the demands of everyday life and autonomy. On the other hand, hedonic well-being relates to experiences of happiness and satisfaction and the absence of negative affect and pain. Studies (Ryff et al., 2004) have shown that individuals with higher levels of eudaimonic well-being had lower levels of salivary cortisol, pro-inflammatory cytokines, cardiovascular risk and longer REM sleep compared with those with lower levels of eudaimonic well-being. However, hedonic well-being only showed just a minimal linkage to these same biomarker assessments. The Radiance Wellness Institute defines wellness as a state of optimal conditions needed for normal biological function that engages the whole person: body, mind, emotions and spirit. The institute maintains that wellness is a lifestyle choice; that it focuses on self-responsibility; that it is an “appreciation that everything you do, think, feel and believe has an impact on your state of wellbeing and the health of the planet” (source: http://www.radiancewellnessinstitute.org/programs. As such, the institute’s definition of wellness clearly relates to eudaimonic well-being. Therefore, individuals who participate in the Institute’s wellness programs may experience a decrease in similar biomarkers. Specifically, we believe they should experience a lengthening of telomeres measured in white blood cells, a reduction of cortisol measured in saliva, an increase in cognitive performance as measured by the Cogstate assessment and an increase of subjective wellbeing revealed by pre- and post-program interviews.
The Radiance Wellness Institute designed its SELF-Care program around four principles that numerous studies have linked to a lifestyle that promotes wellness: Serenity, Exercise, Love and Food. Wellness, like wellbeing, goes beyond the mere absence of disease. These concepts focus on what it means to flourish, to have a sense of purpose and direction in life, quality relationships and the opportunity to realize one’s potential (Ryff et al., 2004). The core assumption is that wellness contributes to the healthy functioning of numerous biological systems and that they help keep one from succumbing to disease; or, if illness does occur, they help promote recovery.
The Radiance Wellness Institute sees serenity as the opposite of stress. Some research suggests that stress may initiate a cascade of neuropathology, which links depression and AD (Aznar & Knudsen, 2011). Other research has shown that that memory performance in otherwise healthy individuals decreases when cortisol levels increase (Newcomer et al., 1999). Other research suggests that work-related stress may increase the risk of vascular dementia (Andel et al., 2012). We believe that The Radiance Wellness Institute may reduce stress by activating the individual’s relaxation response. The program participants learn to activate calm, peaceful and yet alert states of mind through practices such as mindfulness meditation, deep breathing, imagery, laughter and chi-gong.
Exercise is physical movement to produce energy and restore vitality. Studies associate higher levels of cardiovascular fitness with better prefrontal oxygenation and executive function (Colcombe & Kramer, 2003; Dupuy et al., 2015). “Fitness training was found to have robust but selective benefits for cognition, with the largest fitness-induced benefits occurring for executive-control processes” (Colcombe & Kramer, 2003, p. 125). Aerobic exercise correlates with improved hippocampal functioning and increases Brain Derived Neurotropic Factors BDNF (Griffin et al., 2011). Physical exercise helps builds brain health and fitness. It plays a key role in stimulating growth factor cascades and decreases in inflammation, which is thought by some to be a significant contributing factor in the development of AD and other types of dementia (Cotman, Berchtold, & Christie, 2007).
The Radiance Wellness Institute views love, especially self-love, as a subtle energy for the individual. Researchers have long known of the association between the positive psychological well-being induced by love and cardiovascular health (Boehm & Kubzansky, 2012). The Radiance Wellness Institute sees love in terms of meaning and purpose in one’s life: “Experience new meaning and purpose in life through understanding of love as a subtle energy for yourself and the universe” – (source: www.radiancewellnessinstitute.org). Like Ryff et al. (2004) the concept focuses on what it means to have a sense of purpose and direction in life along with quality relationships with self and others. Indeed, there has been much research that focuses on the need for individuals to determine for themselves meaning and purpose in their lives and the relationship to happiness; e.g., Ryan and Deci’s 2001 work on self-determination theory.
Finally, many studies have shown that eating a healthful diet over a lifetime can improve the condition of the brain as individuals age (“Food Discoveries for Brain Fitness,” 2010). Diabetes and obesity are risk factors associated with the development of AD. Following the Mediterranean diet reduces the risk of developing Mild Cognitive Impairment (MCI); and foods high in omega-3 improve cognitive performance (Fernandez & Goldberg, 2013). For the prevention of AD and other dementia, diet seems to play an important role.
1. Does participation in the Radiance Wellness Institute’s program promote the lengthening of the participants’ telomeres?
Telomeres are repetitive DNA sequences located at the tips of eukaryotic chromosomes and act as protective tips for those chromosomes (Grodstein et al., 2008). Every time a cell divides, some of its telomeric sequences are lost and as a result, the telomeres become shorter and shorter. Telomere length therefore is a measure of “biological” age. One study associates shorten telomeres with AD and vascular dementia (Kume et al., 2012). Another suggests that telomere length may be an early indicator of AD (Grodstein et al., 2008).
Rough average estimates after having considered many prevalent studies of AD in many countries around the world is that about 2% of the population 65 years and older are diagnosed with AD. About 20% of those who are 80 years and older have the disease, and for those who are 90 years and older, it is about every second person who has AD” (Nilsson, 2014).
Yet one recent study indicates that telomeres may lengthen after adopting positive lifestyle changes (Ornish et al., 2015). We thereby hypothesize that the Radiance Wellness Institute’s program, which consists of positive lifestyle changes, will increase the participants’ telomere and this in turn may reflect a reduced risk for developing AD and other related dementia.
2. Does the Radiance Wellness Institute’s program decrease the participants’ levels of stress as indicated by measures of cortisol in the participants’ salvia?
We believe that telomeres may have a connection to AD through the common denominator of stress. Studies associate chronic stress with shortened telomere length (Malan, Hemmings, Kidd, Martin, & Seedat, 2011). Meanwhile, there is interest in the connection between stress, depression, and AD. Some research suggest that there may be a common neuropathological cascade that connects the three (Aznar & Knudsen, 2011). In fact, research has linked depression to ‘‘accelerated aging’’ (Wolkowitz, Epel, Reus, & Mellon, 2010). Depressed individuals have a higher incidence of diseases associated with aging, including pathological cognitive aging, including AD and other dementias (Wolkowitz et al., 2010). Another study states that work-related stress may increase the risk of dementia, particularly vascular dementia (Andel et al., 2012). Andel et al. recommend modifications to work environments, including the social context and making provisions so that employees play meaningful roles. Finally, Newcomer et al. (1999) have shown that several days of exposure to cortisol at concentrations associated with physical and psychological stress in humans can reversibly decrease specific tasks in memory performance in otherwise healthy individuals. We therefore hypothesize that practices in the Radiance Wellness Institute’s program aimed at reducing participants’ stress will decrease the amount of cortisol as measured in participants’ salvia and thereby reduce the risk of developing AD and other related dementias in addition to increasing their performance on cognitive tasks.
3. Does the Radiance Wellness Institute’s program increase the participants’ performance on cognitive task as indicated by Cogstate assessments?
Despite not including cognitive training, we have good reason to believe that the Radiance Wellness Institute’s program may increase participants’ performance on cognitive assessments. The program includes both physical exercise and dietarian components. Many studies have confirmed the link between physical exercise and cognition. For example, Cotman et al. (2007) note the benefits of exercise, particularly in elderly populations, for learning and memory, protection from neurodegeneration, and alleviation of depression. Physical exercise can affect brain structure by increasing neurogenesis, angiogenesis, and greater dendritic complexity (Cotman et al., 2007). Exercise increases synaptic plasticity, directly affecting synaptic structure and strength, and strengthens the underlying systems that support neurogenesis, metabolism and vascular function.
A meta study of Tai Chi and Qigong (Jahnke, Larkey, Rogers, Etnier, & Lin, 2010), the latter an aspect of the Radiance Wellness Institute’s program showed numerous health benefits that directly relate to the risk of developing AD and other dementia. These benefits include positive cardiopulmonary effects, increases in heart rate variability, increases in self-efficacy, significant decreases in anxiety and depression, and a significant modulation of Interleukin-6, an important marker of inflammation, in response to the practice of Qigong compared to a no-exercise control group. Cotman et al. (2007) believe the reduction of inflammation through exercise is the means by which exercise reduces risk for cognitive decline and neurodegeneration. Finally, Nilsson (2014) demonstrated that he can associate poor episodic memory and semantic memory performance with a dementia diagnosis up to 20 years after initial baseline measurement. Although the two point measurements we propose in this study will not lead to such a definitive association, it could serve as an important baseline for the participants.
In addition to the quantitative measurements mentioned above, we also wish to conduct a qualitative phenomenological study. Here, we are interested in the lived-experience of the research participants. We would like to understand their experiences of wellness and perceived ability to affect their wellness as expressed in their own words. This aspect of the study may include pre and post survey, interviews, and/or focus groups.
We plan to recruit 15 to 20 participants by advertising in the local papers and/or through a recruit programs at local senior living residences. We will collect demographic data on the participants such as gender, education levels, and income levels but all participants will be over the age of 60. Our basic methodology will be a blind within sample-paired t-test. We will collect pre-program data and compare it to post-program data. We will then use a t-test to determine with the results are statistical significant. If there is a waiting list for the program, then we may elect to change the design by using the waiting list as a control group.
The activities of the Radiance Wellness Institute program are the independent variables of this study. The Institute includes these activities as part of four workshops that align with the four foundations of wellness mentioned above: serenity, exercise, love, and food.
1. The activities for the serenity workshop include breathing, mindfulness meditation, mind-body exercises (Chi-gong and Yoga), gratitude, and laughter.
2. The activities for the exercise workshop include walking, high-intensity interval walking (alternating short bursts of high-intensity walking with gentle recovery periods), and Chi-gong.
3. The activities for the love workshop include positive affirmations and kindness meditations.
4. The activities for the food workshop are primarily educational on the “most up-to-date food choices for wellness and rejuvenation.” This includes information on mindful eating, fasting, caloric restrictions, and food associated with the Japanese and Mediterranean diets, which are rich in Omega 3s and possess anti-inflammatory, anti-oxidants, and phytonutrient properties.
In addition to the four foundations, the Radiance Wellness Institute recognizes six complementary elements for aging well. These elements, which include sleep, kindness, relationships, laughter, gratitude, and altruism, will also appear at various times during the workshop.
This study will be a blind study, meaning that we as researchers will not know which data set belongs to which participant. The participants will complete Radiance Wellness Institute’s three-month program with the goal of helping them develop and maintain healthy lifestyles. This program consists of four workshops conducted over a three-month period. Each workshop focuses on one of the foundation of wellness: Serenity, Exercise, Love and Food. The participants complete the workshops together as cohort. Each participant will have a wellness coach and participate in group education and coaching sessions. We will require each participant to sign a participation and ethics agreement prior to beginning the study.
Before starting the program, the Radiance Wellness Institute will evaluate each participant for wellness. This wellness testing will include measuring blood pressure, Heart Rate Variability (HRV) and a complete blood profile. In addition, prior to starting the program, we will measure the length of each participant’s telomeres and the level of cortisol in their saliva. Each participant will also complete a cognitive assessment by Cogstat. Finally, we will discuss with each participant, either individually or as part of a focus group, their subjective experience of wellness.
After completing the program, we will again measure the length of each participant’s telomeres and the level of cortisol in their saliva. We will also ask each participant to complete another cognitive assessment by Cogstat. Finally, we will discuss with each participant, either individually or as part of a focus group, their subjective experience of wellness. We will then statistically analyze the pre- and post-quantitative independent variables pre and post measurements using a paired sample t-test. This will help us determine whether the results we observe are statistically significant. We will also calculate the effect size to determine how much of the observed change we can attribute to the Radiance Wellness Institute’s program.
The resources we seek to complete this study are modest. We estimate the needed resources in the table below.
Once we have funding in place, we believe we can complete this study according to the following schedule.