Exercise Physiology for Dementia
What is dementia?
Dementia is a broad term used to describe a group of neurological diseases, the most common of which is Alzheimer’s disease. This cluster of diseases effect an individual’s memory, cognitive function, and ability to perform activities of daily living (World Health Organisation, 2020). The biggest risk factor for dementia is older age where, in an increasingly aging Australian population, the prevalence of dementia is predicted to increase threefold by 2050 (Standfield, 2018). Risk can be further exacerbated by other health factors such as high blood pressure, diabetes, obesity, physical inactivity, and depression (World Health Organisation, 2020). This makes it important to mitigate these factors as we age using modalities, such as exercise, to control them.
Physical activity and dementia
With regards to physical activity and dementia, a sedentary lifestyle has been estimated to contribute to 20% of dementia risk (Mukadam et al., 2019). The contribution of inactivity to dementia risk is also increasing, with the rates of dementia attributed to low physical activity increasing from 2010 to 2016 (Lloyd-Hazlegreaves, 2023). Individuals already living with dementia are also affected by a lack of activity, with links between inactivity and an increased level of agitation in those with dementia (Scherder, 2010). Despite the negative effects sedentary behavior can have, levels of physical activity in individuals with dementia have continued to decline over the past decade (Lloyd-Hazlegreaves, 2023).
Exercise recommendations for exercise
Given, physical activity is such a strong predictor for dementia, increasing the amount of exercise an individual undertakes per week can have a positive impact on brain health and reduce dementia risk (Ahlskog et al., 2011). This also appears to have a dose-response relationship, meaning the more exercise you perform (up to 4.5 hours of running per week, (Xu et al., 2017)), the lower your risk of dementia.
Performing adequate exercise can also be very beneficial for those already diagnosed with dementia (Heyn et al., 2004), having shown to:
- Improve physical function
- Improve cognitive function
- Improve behavior (e.g., decreased agitation)
Exercise is also recommended as a first line of treatment for several of the risk factors (e.g., high blood pressure, diabetes, obesity) related to dementia.
Regarding exercise type, aerobic exercise appears to be the most important for those with dementia, having a greater effect on executive function (i.e, memory, flexible thinking, and self-control) and global cognitive function than other exercise modalities (Erikson et al, 2019). But this doesn’t mean other activities should be ignored, as resistance training (i.e., strength focussed exercise) has been shown to have greater effects on cognitive abilities such as reasoning, as well as combating other age related issues such as sarcopenia (i.e., loss of muscle tissue). Regarding the frequency and amount of exercise, It is recommended by the the World Health Organisation that individuals with dementia try to achieve the following each week (World Health Organisation, 2019):
- At least 150 minutes of moderate intensity aerobic exercise (e.g., bike riding, swimming, jogging, brisk walking)
- 2 or more muscle strengthening focused activities (e.g., gym exercises, heavy resistance pilates).
- 3 or more balance based activities focused on falls prevention (e.g., yoga, tai chi).
Although these guidelines are a good starting point, individuals who can do more should do more. Similarly, individuals who can’t yet meet this amount should do as much as they can and slowly build their exercise amount until they are within these guidelines. Group based exercise should also be considered for individuals with dementia, as social isolation has been shown to be a factor in cognitive decline (Haque et al., 2023).
What can exercise look like for individuals with dementia?
Exercise for individuals with dementia can look very similar to exercise for any other individual. At Performance X Physiology we have seen individuals performing exercises which are both physically and technically demanding. However, cognitive decline may make it challenging to engage individuals in exercise appropriately and safely. This is where engaging with an accredited exercise physiologist (AEP) can be helpful. The role of AEPs is to use evidence-based movement and exercise interventions for chronic disease prevention and management, meaning they have the expertise to work with individuals with dementia or with individuals who would like to reduce their disease risk.
If you or anyone you know is living with dementia and would benefit from advice on how to begin exercising, getting in contact with an Accredited Exercise Physiologist is a great place to start.
Written by Nikolai Steventon-Lorenzon
References
Ahlskog, J. E., Geda, Y. E., Graff-Radford, N. R., & Petersen, R. C. (2011). Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clinic proceedings, 86(9), 876–884. https://doi.org/10.4065/mcp.2011.0252
Erickson, K. I., Hillman, C., Stillman, C. M., Ballard, R. M., Bloodgood, B., Conroy, D. E., … & Powell, K. E. (2019). Physical activity, cognition, and brain outcomes: a review of the 2018 physical activity guidelines. Medicine and science in sports and exercise, 51(6), 1242.
Haque, R., Alam, K., Gow, J., & Neville, C. (2023). Changes in the prevalence of dementia in Australia and its association with geographic remoteness. PLoS One, 18(8), e0289505.
Heyn, P., Abreu, B. C., & Ottenbacher, K. J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Archives of physical medicine and rehabilitation, 85(10), 1694-1704.
Mukadam, N., Sommerlad, A., Huntley, J., & Livingston, G. (2019). Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. The Lancet Global Health, 7(5), e596-e603.
Lloyd-Hazlegreaves, P., Hayes, L., & Pearce, M. S. (2023). Associations between physical inactivity and dementia prevalence: ecological study using global data. Public Health, 225, 299-304.
Scherder, E. J. A., Bogen, T., Eggermont, L. H. P., Hamers, J. P. H., & Swaab, D. F. (2010). The more physical inactivity, the more agitation in dementia. International Psychogeriatrics, 22(8), 1203–1208. doi:10.1017/S1041610210001493
Standfield, L. B., Comans, T., & Scuffham, P. (2018). A simulation of dementia epidemiology and resource use in Australia. Australian and New Zealand Journal of Public Health, 42(3), 291-295.
World Health Organization. (2020). Dementia fact sheet World Health Organization. Geneve, Switzerland: WHO Press.[Google Scholar].
World Health Organization. (2019). Risk reduction of cognitive decline and dementia: WHO guidelines. World Health Organization.
Xu W, Wang HF, Wan Y, et alLeisure time physical activity and dementia risk: a dose-response meta-analysis of prospective studies. BMJ Open 2017;7:e014706. doi: 10.1136/bmjopen-2016-014706
