Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by memory loss and multiple cognitive disorders. Alzheimer's disease is associated with common causes of dementia and is estimated to account for 60–80% of these cases. Aging can be treated as the greatest risk factor for AD progression. 

Dementia is a global issue. Currently, more than 55 million people have dementia worldwide, and every year there are nearly 10 million new cases according to the World Health Organisation (2023).

Also, the World Health Organization (WHO) estimates that 1 billion people will be over the age of 60 in 2020 and that this age category will double to 2.1 billion people by 2050, two-thirds of whom will be living in lower- and middle-income countries. The number of people aged 80 years or older is meanwhile expected to triple during the same time frame to reach 426 million. It is essential to act now to ensure that these people can live as healthily as possible, for as long as possible. As our societies age, the number of people living with dementia across the world is expected to rise from 55 million in 2019 to 139 million in 2050, according to the WHO. The costs associated with dementia are also expected to more than double from US$1.3 trillion per year in 2019 to $2.8 trillion by 2030.

The diagnosis and treatment of AD involves many challenges. Studies have shown that drug combinations are effective and that there is no efficient treatment for patients diagnosed with preclinical AD or MCI. With respect to the definition of MCI, it is regarded as a syndrome of cognitive decline that is higher than the expectation of the age of the individual and level of education without significantly obstructing daily living activities. Notably, it develops into AD during 5 years in over half of the MCI patients. Based on the possibility of side effects of drugs, people are very interested in the non-pharmacological treatment of AD. Inconsistent benefits of treatments, comprising cognitive training and cognitive stimulation, have been reported.

There is an intention to prevent and treat AD, MCI, and dementia via regular exercise. “Dementia prevention programmes” cannot live up to the promise of the name. As people age, their risk of developing dementia grows inexorably. But the way they live can reduce it. And they can delay the onset of dementia. For the individuals concerned, their families and carers, and for society as a whole, that in itself is an enormous benefit. Most of these programmes start with the body – “a healthy mind in a healthy body”. Although the precise nature of the links between mental and physical health remains complicated, mysterious, and subject to intensive scientific research, much has been learned about how physical factors influence cognitive decline.

Many of these factors overlap and reinforce each other. Physical inactivity is a risk factor for weight gain, which in turn increases the risk of diabetes. All three are dementia risk factors. So the basic message is one: that is often trotted out as a bromide: what’s good for the heart is good for the brain. The best way to look after both is to pursue what has for decades been recognised as a “healthy lifestyle” – eating a diet rich in fibre, unprocessed foods, vegetables, and fruit, and avoiding too much meat and fat; taking plenty of physical exercise; sleeping well and enough; not smoking and not drinking too much; staying free of infectious diseases; doing sports and being active!

Prospective studies have shown that physical activity can reduce the likelihood of dementia and AD, even at mild to moderate intensity. Exercise could help diminish the occurrence of dementia and AD so that it has been cited as a possible lifestyle intervention.

Being active can help people with Alzheimer’s disease and related dementia (ADRD) feel better, move better, and sleep better. Experts now say that any physical activity counts toward better health — even just a few minutes!

Regular physical activity helps those with ADRD develop better strength, balance, walking speed, and endurance. It also reduces physical decline and preserves day-to-day function, including sleeping habits.

When people with ADRD become active, safety is a priority.

People with Alzheimer's need to be active and do things they enjoy. However, activities they used to enjoy may become challenging for them as the disease worsens. They may have trouble deciding what to do or starting tasks.

As a caregiver, you can learn how to adapt activities to make them easier and more enjoyable.

Caregivers and health professionals should always exercise with the person with ADRD. That way, both will reap the health benefits of being active!

WHAT TYPES OF EXERCISE

• Aerobic activity increases heart rate and breathing to build stamina. Build up to doing at least 90-180 minutes/week of moderate-intensity activity (like a brisk walk, light cycling, dancing, or water exercise). If the person with ADRD is not able to achieve this amount, they shouldn’t be discouraged. Some activity is better than none!
• Strength training can make daily activities like lifting laundry baskets or yardwork easier and safer. Getting stronger, particularly in the legs, stomach, and back, can help prevent falls.
• Balance exercises: These exercises can help to improve balance, reduce the risk of falls, and improve physical function. Balance exercises can include simple activities such as standing on one foot, walking heel-to-toe, or tai chi.
• Dance and movement: This exercise combines physical activity with social interaction and can be enjoyable for individuals with dementia. Dance and movement activities can include line dancing, ballroom dancing, or movement classes.
• Finally, it’s important to keep in mind that individuals with dementia may have different physical and cognitive abilities, so it’s important to tailor the exercise program to their specific needs and abilities. A physical therapist or occupational therapist can help design a safe and effective exercise program for dementia care.

References

1. “Ageing and Health,” World Health Organization, accessed July 31, 2023, https:// www.who.int/news-room/fact-sheets/detail/ageing-and-health.

2. “Dementia,” World Health Organization, accessed July 31, 2023, https://www.who.int/news-room/facts-in-pictures/detail/dementia.

3. Alzheimer’s Association [AA] (2016). Alzheimer’s disease facts and figures.Alzheimers Dement. 12 459–509. 10.1016/j.jalz.2016.03.001.

4. ALZHEIMER’S DISEASE INTERNATIONAL | WORLD ALZHEIMER REPORT 2023

5. Andel R., Crowe M., Pedersen N. L., Fratiglioni L., Johansson B., Gatz M. (2008). Physical exercise at midlife and risk of dementia three decades later: a population-based study of Swedish twins.J. Gerontol. A Biol. Sci. Med. Sci. 63 62–66. 10.1093/gerona/63.1.62

6. Gauthier S., Reisberg B., Zaudig M., Petersen R. C., Ritchie K., Broich K., et al. (2006). Mild cognitive impairment.Lancet 367 1262–127.

7. https:// www.thelancet.com/article/S0140-6736(20)30367-6/fulltext

8. Livingston, G. et al. (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission, The Lancet, 396 (10248), 413–446.

9. Norton S., Matthews F. E., Barnes D. E., Yaffe K., Brayne C. (2014). Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data.Lancet Neurol. 13 788–794. 10.1016/S1474-4422(14)70136-X.

10. Raggi A., Tasca D., Ferri R. (2017). A brief essay on non-pharmacological treatment of Alzheimer’s disease.Rev. Neurosci. 28 587–597. 10.1515/revneuro-2017-0002.

11. www.acsm.org Exercise is Medicine 2021

Scientific research and authorship:

Dr. Vasiliki Garopoulou M.Sc^s., Ph.D., P.D.

Dr. Christos A. Mouzakidis MSc., PhD.

Teacher of Physical Education and Sports Science. A.U.Th. 

Academic tutor "Neuroscience and Neurodegeneration" M.Sc. Medical School A.U.Th

Hellenic Association of Alzheimer’s Disease and Related Disorders (Alzheimer Hellas)

Scientific Collaborator at the Panhellenic Institute of Neurodegenerative Diseases

Member of Exercise is Medicine Greece’s Neurodegenerative Diseases Committee

Board Member / Tresurer of ENALMH Network