In 2015, the World Health Organization identified dementia as a “global public health priority” because 1 new case is diagnosed every 4 seconds globally. The number of people with Alzheimer’s disease (AD) and other dementias is approximately 47 million, and this number is expected to grow to 75 million by 2030.
No cure has been developed for dementia. However, lifestyle strategies targeting known risk factors for cognitive impairment may help delay the progressive disease. These lifestyle strategies center on diet, exercise, and social activities.
Patients with cognitive impairment frequently have poor physical function and muscle strength. Aging and dementia increase the risk of falls, fall-related fractures, and other comorbidities. Evidence supports the higher risk of falls in patients in even the early stages of dementia or mild cognitive impairment (MCI). A normal gait depends on the biomechanical structure and appropriate timing of muscle action, normal vision, sensory ability, vestibular system, and proprioception. The deterioration of these in patients with dementia leads to an increased risk of falls and injuries.
Some exercises can help in slowing the loss of physical function, which in turn mitigates the risk of falls or injuries. Cognitive function in elderly adults can range from normal to complete dementia. The effect of exercise also falls along a wide range of outcomes. Intensive, dementia-adjusted training is possible and improves the gait in patients with dementia.
Even while evidence grows that exercise and mental activities can improve cognitive function, one randomized controlled trial with moderate- to high-intensity exercise training for patients with dementia did not produce those results. Still, the American College of Sports Medicine recommends exercise to improve the functional independence and quality of life in the elderly.
A recent report in the journal Medicine looked at the impact of regular exercise on patients with mild to moderate dementia.
The impact of exercise on adults with Alzheimer’s
This study investigated the benefits of exercise in patients with Alzheimers and produced 4 key findings.
- For all patients with dementia, initial exercise resulted in better aerobic endurance, upper body strength, and balance.
- For every participant, initiating exercise produced no statistically significant differences in etiology, unexpected hospitalization, gastrointestinal bleeding, urinary tract infection, or delirium.
- Exercise helped patients with mild dementia with better aerobic endurance, lower body strength, some flexibility, some upper body strength, balance, and agility. Exercise did not seem to help patients with moderate dementia.
- Patients with mild dementia experienced less unexpected hospitalizations.
Musculoskeletal fitness appeared to be important for the elderly and maintaining functional independence. Many daily activities rely on musculoskeletal fitness rather than aerobic capacity. Exercise improved many factors of overall physical wellness, including functional mobility and aerobic fitness. It also resulted in a lower risk of chronic disease.
There are 3 possible reasons that exercise produced benefits in patients with mild dementia in this study.
- With only 80 participants, the small study size may have impacted the results.
- The drugs for moderate to severe dementia treatment may mask the effect of improved physical fitness.
- The moderate to severe dementia status may mask the benefits of exercise.
Exercise benefits patients with AD, and falls appeared to decrease in the group that exercised. During the study, 3 participants in the no-exercise group had falls. None of the participants with mild dementia in the exercise group had falls. The group that exercised demonstrated better balance, which most likely lowered the risk of falls.
Aspiration pneumonia is common and a leading cause of death among the elderly. In this study, 4 participants developed pneumonia in the no-exercise group. None in the exercise group developed pneumonia.
Evidence is still lacking on the prevention of pneumonia and improvement in the swallowing function. Because the normal swallowing process is performed involuntarily by the pharyngeal phase of the swallowing reflex. Typically, exercise does not improve this reflex. However, the activity of abdominal muscles is important for the cough function, which is an important defense reaction to preventing aspiration. However, the study showed that exercise is linked with lower hospitalization in patients with mild dementia.
Physical activity is essential to preventing chronic disease and premature death. It also produced health benefits in the group with mild dementia. However, the study did not determine the optimal amount of exercise like frequency, duration, and intensity. It did not determine a minimum amount of exercise to produce benefits.
Of the 38 participants who exercised regularly, the most common activities were running, walking, Tai Chi, dance, and swimming. Recently, investigators have postulated that even lower levels of weekly energy expenditure may be associated with health benefits. This means that the results confirmed that exercise, even at low intensities, could possibly improve physical fitness too.
The economic burden of dementia
Dementia is a long process of deterioration that can take 8 to 10 years or longer. The physical deterioration includes reduced muscle mass, which can result in more falls, fractures, and hospitalizations. The loss of their ability to cope with activities of daily living could decrease their quality of life, institutionalization, and increase the risk of death. In addition, people with dementia are more frequently hospitalized due to infectious diseases, fractures, or nutritional disorders than those without dementia. However, the most possible preventable factors of hospitalization are trauma, falling, and fracture. Thus, it is necessary for them to keep their daily functions during their late life.
Final thoughts
The main strengths of this analysis are that the cohort study was designed for an outcome analysis. It did this using individual-level data to reach a conclusion regarding exercise as an effect in people with dementia. Plus, the researchers used scientific measurements of the patients’ fitness and regular follow-ups were done. The data are valid. There are several limitations to this study. The researchers could not demonstrate the exercise frequency and severity. However, they confirmed the exercise habits by double-checking with the patients and caregivers. Second, they focused on patients with mild and moderate dementia only, and the findings may not apply to people with no dementia. Third, the physical performance test appeared less suitable to monitor performance changes because of the large standard deviation. However, the physical performance tests evaluated detected differences in performance between older people with mild to moderate dementia by cross-sectional analysis.
This study produced strong data that says exercise benefits elderly patients with mild dementia and results in fewer hospitalizations. More study is needed on patients with moderate dementia. If you have a loved one with mild symptoms, check with their physician about initiating an exercise program.