Fitness, Cellular Aging, and Caregiver Stress Study

The investigators will prospectively examine whether an aerobic training intervention will
alter markers of immune cell aging (i.e. increase telomerase activity in peripheral blood
mononuclear cells, telomere length in peripheral blood mononuclear cells and leukocytes,
mitochondrial function, epigenetic profiles, and mRNA expression), improve exercise capacity
and blood pressure, and decrease psychological distress over 24 weeks in 32 caregivers
compared to 32 age-matched wait list control caregivers. Our sample will be comprised of
caregivers who provide unpaid care for a family member diagnosed with Alzheimer's disease or
other dementia. Participants in the study will be highly stressed and inactive male and
female caregivers of family members with Alzheimer's disease or other dementia. All eligible
participants will complete one week of ecological momentary assessments (EMA) to examine
whether (1) previously unfit, high-stressed caregivers benefit psychologically from becoming
active, (2) this benefit is derived through changes in how caregivers react to and recover
from stressful events, and (3) whether these salubrious psychological effects mediate
changes in biological outcomes (e.g., cellular aging). Next, participants will participate
in a one-week run-in period of stretching 30 minutes on 4 separate days prior to
randomization to guarantee that the investigators are randomizing well-informed participants
that are willing and able to complete the expected exercise. Next, participants are
randomized into the aerobic exercise or wait list control arm. In the 24th week of the
study, participants complete a second week of the EMAs sub-study, and return after week 24
for a final blood draw.

Research study assessments consist of self-report questionnaires, body composition, physical
performance and fitness tests, and a fasting blood draw. The follow-up visit, 24 weeks
later, consists of a repeat of the same morning health visit.

Inclusion Criteria:

- Age: 50-75

- Men and Women (women must be post-menopausal)

- Body Mass Index must be below 40 (to exclude for extreme obesity, which can confound
outcomes)

- Must be a first or second degree family member providing unpaid caregiving for an
adult relative with Alzheimer's disease or other dementias of longer than 6 months
since diagnosis.

- Must report providing care for 10 or more hours per week.

- Perceived stress ≥ 15 for adults 65 and older; Perceived stress ≥ 18 for adults aged
50-64. (0.5 standard deviation above national average for adults)

- Do not meet Center for Disease Control recommendations for exercise (150 minutes per
week of moderate activity levels or 75 minutes of vigorous)

Exclusion Criteria:

- Major Chronic Disease that interferes with activity levels as advised by a medical
practitioner (Autoimmune disorders; severe asthma; lung disease - emphysema or
chronic bronchitis; history of stroke, heart attack, cardiovascular disease,
epilepsy, or brain injury)

- Heart attack in the past 6 months or repeated experience of chest pain or pressure,
and/or arrhythmia.

- Cancer that is not in remission. Those who underwent chemotherapy or radiation within
the past 5 years will be excluded.

- Eating Disorders

- Current substance dependence that can interfere with activity engagement.

- Current Post Traumatic Stress Disorder

- Current or recent smoking status. We will exclude current smokers and past smokers
(who quit within the past 5 years).

- Confounding medications- Oral Steroids containing prescription drugs use and any
other drugs that might interfere with the outcome measures.

- Current major injuries

- Any physical impairment that prevent participation in moderate levels of physical
activity (e.g. musculoskeletal problems, prosthesis)

- Inability to walk a block or climb stairs without chest pain, losing breath, or
dizziness