Exercise can help ease some Alzheimer’s symptoms
It's never too late to start
Karen Miller | 5/22/2015, 6 a.m.
The Physical Activity Guidelines for Americans are pretty clear. They recommend that adults 18 years and older get at least 150 minutes a week of moderate-intensity exercise, such as brisk walking, as well as two or more days a week of muscle-strengthening exercises that work all muscle groups.
Unfortunately, not many people are paying attention. In 2012 only 20 percent of adults in this country met the guidelines, according to a report by the Centers for Disease Control and Prevention. The good news is that half followed the recommendations for aerobic physical activity. Apparently, it’s that weight lifting part that people avoid.
Yet, physical activity has shown to prevent or minimize the risk of a myriad of chronic conditions, including high blood pressure, type 2 diabetes, heart disease, obesity and even some cancers.
It benefits the brain as well. Physical activity stimulates the growth of new blood vessels in the brain, which provide energy and nourishment. It also increases levels of a protein growth factor called brain-derived neurotrophic factor — BDNF for short — which protects the health of brain cells. These changes also strengthen communication between brain cells.
But they do a lot more.
It’s well known that exercise can increase muscle size, but certain parts of the brain bulk up as well. Several studies have shown that regular moderate-intensity exercise for extended periods of time increases the volume of the hippocampus. It is the hippocampus that is responsible for memory and cognition, and a part of the brain that is severely impacted by Alzheimer’s disease.
The increase in volume is largely attributed to higher levels of blood flow and protein growth factors. All these factors work in concert to protect against cognitive decline.
There is no guarantee that taking a brisk walk around the block will stave off AD or another form of dementia, but the benefits are undebatable.
The Physical Activity Guidelines apply to those with AD as well. Exercise helps ease some of its symptoms, improves mood and helps people sleep better and feel more alert during the day.
The type of exercise that works best depends on individual symptoms, fitness level and overall health. While gardening and walking are preferable for some, swimming, yoga and tai chi may work better for others.
Stefan Mogielnicki, a certified exercise physiologist with Forever Fit LLC, works mostly with people with AD. He admits it’s a bit of a challenge.
“You have to use a different approach,” he explained, “because reasoning and judgment are often diminished and memory is impaired.” For instance, he has modified his communication to validate instead of correct his patients when they confuse the past with the present. In utilizing this technique, he redirects their attention away from those thoughts toward exercise participation.
Repetitive activities like full range of motion exercises are easier to achieve since they require less concentration. He makes use of fitness equipment — weights, resistance bands and even medicine balls, and a whole lot of encouragement.
His 40-minute regimen, which is based on his company’s template, focuses on activities for strength, endurance and balance. One third of adults aged 65 and older fall each year, according to the CDC. Falls due to poor balance are common among people with AD and a leading cause of death.
Mogielnicki explained that the best times to exercise are between 9 a.m. and 3 p.m. “Those are the peak times for cognition,” he explained. “After 4 p.m., the sundowning effect begins.” Sundowning, or the sundown syndrome, is a state of confusion that occurs at the end of the day and into the evening. The syndrome, which effects up to 20 percent of people with AD, causes agitation, wandering and even aggression.
Exercise makes the sundown syndrome less severe.
Although it might take patients a little longer to complete the exercise programs, Mogielnicki can see improvement. “They have more energy,” he explained. “They are cognitively more alert.”
He has to be alert as well. “Some people wander away during exercise,” he said.
The good news is that it is never too late to start an exercise program — even for those with AD. “No question about it,” said Mogielnicki. “By implementing exercise, you prevent further deterioration.”
Brigham and Women's Hospital