Having a family member diagnosed with Alzheimer’s disease is a daunting experience as you face the reality that you or your loved one has a serious, progressive, and ultimately fatal neurodegenerative condition. As the cognitive and physical abilities of people with Alzheimer’s progressively decline, family members face challenging emotional and financial decisions regarding long-term care. Thus early diagnosis, support group participation, appropriate nutrition, and regular physical activity are important for both the person with Alzheimer’s and the health of those providing care.
Once considered a relatively rare disorder, Alzheimer’s disease is listed as the sixth leading cause of death in the United States and considered a major public health challenge affecting more than 5 million Americans, the majority of whom are over the age of 65 years. The prevalence of dementia, with Alzheimer’s disease accounting for two-thirds of the cases, increases with age, affecting nearly 14 percent of the population over the age of 70 years. This creates a challenging public health issue, as the prevalence of neurodegenerative conditions like Alzheimer’s doubles every five years beyond age 65 (38). At the dawn of the 21st century, approximately 35 million Americans (12.4 percent of the total population) were 65 years or older. By 2015, nearly 46 million Americans (15 percent) had reached the age of 65; and by 2030, when the last of the baby boom generation hits this milestone, one in five Americans will be over age 65 (14).
Alzheimer’s disease is named after Dr. Alois Alzheimer, the German neurologist and psychiatrist who first described the condition, in 1906, when he reported on changes in the brain tissue in a woman who had died of an unusual mental illness. Her cluster of symptoms included memory loss, language challenges, disorientation, behavioral problems, and hallucinations. Following her death, Dr. Alzheimer studied her brain tissue and described two of the primary hallmarks of Alzheimer’s disease—numerous abnormal clumps or globs of sticky proteins (now referred to as amyloid plaques) and tangled bundles of fibers within the neurons (now called neurofibrillary or tau tangles) (38).
Despite intensive and ongoing research efforts, currently there is no medication or other medical intervention that can “cure” Alzheimer’s. Thus medical treatment focuses on managing symptoms and prolonging, for as long as possible, the person’s ability to carry out activities of daily living.
Q&A
How does the brain work to regulate daily activities?
The brain is a phenomenal organ that allows each person to carry out every aspect of daily living, from internal body functions such as breathing and digestion to conscious functions such as speaking, moving, and making decisions. The brain is made up of more than 100 billion nerve cells or neurons and is served by over 400 billion tiny blood vessels called capillaries. The vast majority of the brain consists of the left and right cerebral hemispheres, which are connected by a large bundle of nerve fibers. Each of these cerebral hemispheres has an outer layer (cerebral cortex) where the brain regulates cognitive functions such as learning, remembering, and decision making; controlling voluntary movements; and processing sensory information.
Effect of Alzheimer’s on the Brain
Alzheimer’s disease is present years before symptoms of memory loss and other cognitive deficits appear. This is referred to as the preclinical stage of Alzheimer’s disease, in which people appear to function normally but a number of toxic changes within the brain are progressing. Among the abnormal changes, two primary features have been identified (38):
· Amyloid plaques—These consist of insoluble deposits of beta-amyloid, a toxic protein fragment. Generally found in the spaces between the brain’s nerve cells, they are more abundant in people with Alzheimer’s disease.
· Neurofibrillary or tau tangles—Found inside the nerve cell, these consist of abnormally shaped or twisted protein collections that stick together and build up, eventually disrupting cell communication and even causing cell death.
These toxic changes can cause healthy neurons to shrink, lose connections with other brain cells, stop functioning, and even die. As more and more neurons are affected, the given brain areas lose volume and shrink (see figure 15.1). This appears to initially occur in the hippocampus (a critical area for learning, short-term memory, and conversion of short-term memories to long-term storage in other areas of the brain) but then spreads to other areas of the brain, eventually affecting one’s cognitive abilities. By the final stage of Alzheimer’s, the damage is pervasive and brain volume significantly declines.
Figure 15.1 Cross sections of the brain comparing healthy brain to brain affected by Alzheimer's disease.
Source: National Institutes of Health and Human Services, National Institute on Aging.
While Alzheimer’s can occur early in life, 95 percent of the cases are late onset and occur after the age of 60 years. Early-onset Alzheimer’s is thought to be caused by gene changes inherited from a parent, but a small number of cases currently have no specifically identified cause. The more prevalent late-onset form results from a variety of factors that occur and progress over decades. These include possible genetic mutations (such as the apolipoprotein E gene, or APOE), environmental and social factors, and poor lifestyle choices.
Since Alzheimer’s disease develops over a period of many years, the condition can go unrecognized until outward symptoms are displayed. Early in the Alzheimer’s disease process, symptomatic changes are very subtle. You or your loved one may experience memory problems that are fairly mild but slightly greater than expected based on age, but they generally do not interfere with everyday activities. As Alzheimer’s progresses, memory challenges increase and other cognitive difficulties are manifested, such as personality and behavior changes, difficulty handling money and paying bills, challenges with multistep tasks such as dressing and cooking, and wandering. At the severe stage of Alzheimer’s, people lose their ability to communicate, often becoming completely dependent on others for their daily care and perhaps requiring admittance to a care facility.
Healthy Approaches to Managing Alzheimer’s
What can you do to stay healthy and independent as you grow older? Similar to the risk factors for heart disease and other chronic health conditions, eating poorly, not exercising, smoking, being overweight, or having high blood pressure or type 2 diabetes increases your susceptibility to Alzheimer’s disease. The good news is that research suggests that modifying these lifestyle factors and conditions may help optimize brain health with age. While the importance of these risk factors differs from person to person, it appears that what you choose to eat and how much you move each day are critical factors in maintaining good health and thinking power. Being physically active also provides opportunities to interact with others, thus maintaining important social connections.
Focusing on Nutrition
A nutritious diet with appropriate portion sizes is critical for overall health and well-being, regardless of one’s current age and health status. Consuming appropriate nutrients and calories is especially important if you are an older adult striving to maintain your physical and mental functions, independence, and associated quality of life.
Although healthy eating patterns have been associated with a lower risk of cognitive decline, there is no definitive answer yet about the role lifestyle factors may play in reducing Alzheimer’s disease risk (29, 42, 44, 51). However, healthy food choices and regular physical activity can help manage your waistline, lower the risk of chronic diseases, and improve overall health and well-being.
The strongest evidence so far suggests that what’s good for the heart also benefits brain health. Memory loss in Alzheimer’s disease is linked to the abnormal clumping of protein in the nerve cells, causing them to malfunction and die. The presence or absence of vascular disease may explain why some people develop characteristic Alzheimer’s plaques and tangles but do not develop cognitive decline. The role of atherosclerosis in the development of cognitive impairment and dementia may be related to the degree of atherosclerotic calcification in the brain (9). Eating a heart-healthy diet, one rich in fruits and vegetables and lower in saturated fat, appears to help keep the mind and body healthy.
Healthy Fat Recommendations
A growing body of evidence indicates that while total fat intake is not a key factor in brain health, eating healthy fats and less saturated fat may help protect your brain. Most of the fat you eat should come from unsaturated food sources (fish, nuts, vegetable oil). Omega-3 fatty acids, monounsaturated fat, and polyunsaturated fat are considered heart-healthy fats. Saturated fats are primarily found in food from animals, such as meat and whole-fat dairy products, as well as many processed foods. All types of fat are high in calories, so healthy fats should be substituted for saturated fats rather than adding more fat to your diet. Table 15.1 provides examples of healthy fat choices (1).
Diet Plans
Both the Dietary Approaches to Stop Hypertension (DASH) eating plan and the Mediterranean diet have been found to help reduce heart disease and may also lower dementia risk (45). The longevity of people living in the Mediterranean region has led to research on the role their traditional diet may play. While there is no one “Mediterranean” diet, the typical meal plan consists of plant-based foods (fruits, vegetables, whole grains, nuts, legumes), seafood, and olive oil while limiting intake of red meat, sweets, and eggs. Most of the fat in a Mediterranean diet comes from unsaturated sources (fish, nuts, and olive oil) (27, 32). Consider these tips on adopting a Mediterranean-inspired diet:
· Include fruits and vegetables at every meal and choose them for snacks as well.
· Switch from refined to whole-grain bread, cereal, rice, and pasta products.
· Nuts and seeds supply protein, healthy fat, and fiber. Limit your portion to no more than a 1-ounce serving (approximately 1/3 cup), as they are high in calories.
· Eat fish at least twice per week. Limit red meat to no more than a few times per month.
· Use spices and herbs to flavor foods instead of salt.
Wine is commonly consumed in the Mediterranean diet. Moderate intake is defined as no more than 5 ounces (148 mL) of wine daily in women and men older than age 65, and in younger men no more than 10 ounces (296 mL) daily. Although some research indicates that light to moderate alcohol intake may have a positive impact on dementia risk, the U.S. Dietary Guidelines make it clear that no one should begin drinking or drink more often on the basis of potential health benefits (44).
The DASH eating plan is lower in sodium than the typical American diet (less than 2,300 milligrams daily). It limits intake of saturated fat and emphasizes foods rich in potassium, calcium, magnesium, and fiber. The plan is based on research studies sponsored by the National Heart, Lung, and Blood Institute (NHLBI), which showed that DASH lowers high blood pressure, improves levels of fats in the bloodstream, and reduces the risk of developing heart disease. The DASH eating plan emphasizes daily intake of vegetables, fruits, fat-free or low-fat dairy products, more whole grains, lean protein (fish, poultry, legumes, nuts, seeds) and vegetable oils and less sodium, sweets, sugary beverages, and red meats. The DASH plan recommendations are summarized in chapter 12 (37).
Researchers from Rush University in Chicago combined elements from the heart-healthy Mediterranean diet and the DASH diet to create the MIND diet (Mediterranean–DASH Intervention for Neurodegenerative Delay). The Rush Memory and Aging Project found that people whose diet most closely conformed to the MIND diet had a 53 percent lower risk of developing Alzheimer’s. Participants who had moderate adherence demonstrated a 35 percent reduced disease risk. High adherence to the DASH and the Mediterranean diets also conferred protective benefits (30).
The MIND diet focuses on 10 brain-healthy foods and five foods you should limit to avoid “brain drain” (see table 15.2). The diet was specifically designed to include the foods and nutrients that evidence has shown to be good for the brain. Researchers believe that people who follow the diet for long periods of time acquire the greatest protection from Alzheimer’s. The MIND diet includes the following components:
· Plant-based foods (berries, vegetables, nuts, legumes, and whole grains)
· Olive oil as a healthy fat source
· Eating fish at least once a week and poultry twice per week
· Drinking wine in moderation
Q&A
Does type 2 diabetes impact the risk of developing Alzheimer’s?
Type 2 diabetes and Alzheimer’s disease have been thought to be independent disorders whose incidence increases with aging. Evidence now suggests that having diabetes increases the risk of developing Alzheimer’s disease and that insulin resistance may contribute to amyloid deposition in the brain (2, 4, 49). Even among people who do not have diabetes, higher blood glucose levels have been associated with a greater risk of dementia (16). The results of these studies reinforce the importance of achieving and maintaining optimum levels of blood sugar.
Nutritional Supplements
The National Center for Complementary and Integrative Health reports that there is no convincing evidence from a large body of research that any dietary supplement can prevent the worsening of cognitive impairment. This includes research on the use of ginkgo biloba, omega-3 fatty acids, vitamins B and E, Asian ginseng, grape seed extract, and curcumin (derived from turmeric root) (31). Research on the use of Huperzine A, a moss extract that has been used in traditional Chinese medicine, also demonstrated no effect in delaying or preventing Alzheimer’s disease (5, 33, 34).
The Role of Antioxidants
As you age, damaging molecules called free radicals can build up in nerve cells and may play a role in the development of Alzheimer’s. Research results on the use of antioxidants (natural substances such as vitamins E and C, beta-carotene, flavonoids) that are thought to help protect the body from the damaging effects of free radicals have been mixed (18, 23, 48).
A recent research review found no convincing evidence that vitamin E is of benefit in the treatment of Alzheimer’s disease or mild cognitive impairment (20), although some studies suggest that consuming a diet rich in vitamin E and vitamin C may be associated with a reduced risk of Alzheimer’s (29). Vegetable oils, almonds, and sunflower seeds are among the richest sources of vitamin E, and significant amounts are found in green leafy vegetables and fortified cereals (35). Sources of vitamin C include citrus fruits, broccoli, peppers, and fortified foods and beverages.
Vitamin D
Studies have demonstrated an association between vitamin D deficiency and increased risk of Alzheimer’s disease (2, 7). Vitamin D deficiency is common among older adults due to reduced sun exposure and their skin’s decreased ability to synthesize vitamin D. Fish liver oil and fatty fish such as salmon, tuna, and mackerel are natural sources of vitamin D. Small amounts are also found in beef liver, cheese, and egg yolks. Foods fortified with vitamin D such as milk, orange juice, and breakfast cereal provide the majority of vitamin D in the American diet. While it appears there is a link between vitamin D and the development of Alzheimer’s, more research is needed to determine cause and effect.
Omega-3 Fatty Acids
Increased intake of omega-3 fatty acids, such as docosahexaenoic acid (DHA) found in fish, may also have beneficial effects on brain function (50, 53). Docosahexaenoic acid is one of the most abundant fatty acids in the brain and is critical for healthy development and function. Its anti-inflammatory effects promote cardiovascular health and may also be beneficial to the brain (17, 26). Thus far, research in relation to dementia risk has yielded mixed results, so there is not yet sufficient evidence to recommend DHA or other fatty acid supplements to treat or prevent Alzheimer’s disease (5, 6, 12, 40).
Homocysteine and B Vitamins
An elevated level of the blood protein homocysteine is an established cardiovascular risk factor and also appears to increase the risk of Alzheimer’s disease. Certain B vitamins (folate, B6, B12) have been shown to lower blood homocysteine levels, leading to hopes that supplementation may prevent or halt the progression of Alzheimer’s. However, while supplementation can lower homocysteine levels, studies generally have not reported improvements in cognitive performance, and additional research is needed (13).
Resveratrol
Resveratrol, a compound found in red grapes that has both anti-inflammatory and antioxidant properties, has been correlated with a lower risk of dementia in a small number of studies (47). Researchers continue to explore whether resveratrol therapy can delay or alter memory deterioration and functional decline in Alzheimer’s disease.
Impact of Combining Supplements
Most studies of individual vitamins and supplements have shown limited to no benefit. More recent findings suggest that improved cognitive function may occur with formulations containing a combination of nutrients (41). Future research studies are needed to examine various combinations and the potential for benefits related to cognitive function.
Because there is no known cause or cure for Alzheimer’s disease, people are often tempted to try dietary supplements or “medical foods” that are touted to boost brain health. Supplements are not regulated by the Food and Drug Administration as stringently as medications, and there may be concerns regarding their effectiveness and safety as well as potential reactions with other medications. Always check with your physician before using supplements or alternative therapies.
Practical Aspects of Diet for Someone With Alzheimer’s
While good nutrition is generally not a concern in the early stages of Alzheimer’s disease, help with cooking and grocery shopping may be needed. Behaviors related to disease progression include refusal to eat or to sit long enough for meals, problems with chewing and swallowing, and changes in physical activity level. These changes may result in issues with weight loss, poor nutrition, and dehydration. The National Institute on Aging suggests these Alzheimer’s caregiving tips (36):
· Avoid new routines. Serve meals at consistent times in a familiar place and way whenever possible.
· Be patient. Extra time may be required to finish meals.
· Serve well-liked foods and respect cultural and religious food preferences.
Focusing on Physical Activity
As discussed in chapter 1, physical activity is an essential component of a healthy lifestyle that reduces the risk of developing cardiovascular disease, diabetes, and other chronic health conditions; burns additional daily calories to promote maintenance of normal weight; and keeps muscles and joints strong and mobile to allow life to be lived to the fullest. Being physically active is also important for maintaining the health of your brain as you move through life.
Regular physical activity improves attention, focus, and academic performance in children; enhances attention, working memory, and the ability to multitask in young adults; and can delay the process of cognitive decline and neurodegenerative diseases such as Alzheimer’s in older adults (39). Numerous scientific research studies have analyzed the relationship between physical activity and the risk of developing Alzheimer’s disease with aging. The findings have consistently shown that people who regularly exercised (three or more days per week) had slower rates of cognitive decline and were less likely to develop full-blown Alzheimer’s disease than those who exercised less.
However, while these studies have highlighted a strong association between physical activity and Alzheimer’s disease, they do not definitively show that a true cause-and-effect relationship exists, nor do they reveal why certain benefits occur. Thus scientists continue to conduct a variety of animal and human research studies to confirm these associations, better understand their underlying mechanisms, and hopefully, at some point, uncover specific causation and curative treatments.
Being physically active is one of the most important steps you can take to maintain and even improve your overall health profile. And while scientists continue to dig deeper in their efforts to identify effective prevention strategies for Alzheimer’s, exercise is recommended to promote health for those at risk for as well as those with Alzheimer’s.
Physical Activity and Cognitive Decline Prevention
Many research studies have noted that regular physical activity has positive benefits on cognitive function. Benefits identified include delaying the onset of dementia, decreasing the chance of developing Alzheimer’s, and slowing progression in those diagnosed with the disease (3, 15, 25, 28, 52). Studies have shown a significantly higher risk of developing Alzheimer’s, and significantly greater dementia, in people who did minimal physical activity versus their more active counterparts (22). For example, in a recent study in which daily physical activity was tracked (including cleaning, gardening, cooking), those with the highest activity had a twofold decreased risk for developing Alzheimer’s compared with the most inactive individuals (10). Thus, there is evidence that maintaining a physically active lifestyle supports your brain health and may lower your risk of developing Alzheimer’s disease.
However, while these and other research studies highlight the association between aerobic fitness, improved cognitive function, and decreased manifestation of dementia and Alzheimer’s disease, the specific physiological mechanisms are not yet clearly defined (11). Development of Alzheimer’s is a progressive and complex disease process; thus the positive physiological mechanisms induced by physical activity are most likely multifactorial and interlinked. This section describes a few possibilities.
Maintenance of Cerebral Blood Flow
Similar to the effect that cardiovascular disease has on blood flow to the heart and vasculature, atherosclerotic cerebrovascular disease affects blood flow to the brain. Many of the same risk factors that affect your heart, such as hypertension, hyperlipidemia, obesity, glucose intolerance, diabetes, smoking, and inflammatory processes also increase your risk for stroke and cognitive decline (11, 24). Physical activity is an important intervention for each of these risk factors. By keeping your heart effectively pumping and the arteries serving your brain functioning appropriately, blood flow to your brain is maintained. Physical activity may also stimulate the development of additional cerebral blood vessels or capillaries. These vessels provide the key chemicals and nutrients that help maintain the brain’s network connections and can also induce the growth of new connections that are vital to our cognitive abilities.
Brain-Derived Neurotrophic Factor
Perhaps the most extensively studied brain chemical is brain-derived neurotrophic factor (BDNF), one of the chemicals (neurotrophins) that stimulate neurogenesis, which simply means the brain’s ability to grow new neurons (brain cells) and synapses (connections). Brain-derived neurotrophic factor also increases the release of neurotransmitters that enhance communication connections within the brain, and may provide a protective factor for existing brain cells against the toxicity resulting from the development of amyloid plaques. Low levels of BDNF have been documented in the brain tissue of people who died from Alzheimer’s disease. Numerous animal and human studies have documented increased levels of BDNF following both long-term aerobic and short-term vigorous exercise training (3). This exercise-stimulated increase in BDNF has been correlated with improved cognitive function and increased hippocampal volume.
Brain Volume and Cognitive Reserve
In middle age, the hippocampus decreases in size by approximately 1 to 2 percent per year, and over time this shrinkage can affect memory and other cognitive functions. Regular aerobic exercise can slow this atrophy process and even promote the growth (neurogenesis) of new brain cells. This new growth is important for preserving the size of the hippocampus and other brain areas that are essential for memory and other mental processes.
Brain imaging studies have noted Alzheimer’s disease pathology in the brains of older adults who never displayed the cognitive deficits and symptoms typical of Alzheimer’s (19). Why this occurs is not well understood, but researchers have proposed the concept of “cognitive reserve” as one possible explanation (8). In research studies, the primary difference between the brains of people with and without manifestation of symptomatic Alzheimer’s disease was their brain size, particularly that of the hippocampus area. Preservation of brain size, or cognitive reserve, might allow the brain to maintain its function by recruiting alternate brain networks or connections that have developed over time (8, 43). Exercise appears to be one mechanism that stimulates this preservation process by stimulating brain chemicals such as BDNF, blood flow enhancements, and other factors that preserve hippocampus volume (21).
What is important to note is that a growing body of scientific evidence suggests that regular physical activity is beneficial for long-term brain health and maintenance of cognitive capabilities. While additional research will help to refine recommendations on the amount, intensity, and type of physical activities that promote optimal brain health, considering all the health benefits of being active, there is no reason to wait to get started. Since cognitive decline and the development of Alzheimer’s disease occur over a period of many years, the sooner you can incorporate physical activity into your daily routine, the greater the benefits may be. Now is the time to get moving!
Key Physical Activity Tips for Alzheimer’s
Physical activity is encouraged for all adults and older adults. Specific exercise programs may need to be individualized as Alzheimer’s disease progresses; general tips on promoting physical activity are included here.
Start Now
It is never too early or too late in life to get started; the benefits are substantial and too important not to take advantage of. Remember, most chronic health conditions like Alzheimer’s develop over long periods of time and ultimately impair your quality of life.
Exercise Regularly
The key to gaining fitness and preventing Alzheimer’s and other chronic health conditions is consistency over time. You should be physically active on most if not all days of the week.
Move More
Look for ways throughout the day to move and try to avoid extended periods of sitting when at home or at work. See Sit Less, Move More in chapter 1.
Set Goals
Strive to meet or even exceed the recommended guidelines for your age group as discussed in chapters 10 and 11. At a minimum you should build up to and maintain at least 150 minutes or more of moderate-intensity exercise each week (e.g., five 30-minute sessions of walking, cycling, swimming, or some other form of aerobic activity you enjoy). As your fitness improves, including short bouts of higher-intensity exercise can stimulate further fitness gains.
Mix It Up
Incorporate a number of different exercise activities into your routine; mix it up and don’t do the exact same thing day after day.
Add Resistance Training
Some form of resistance training at least two times per week is important. This can consist of lifting weights, using dumbbells and resistance bands, or performing functional exercises that use your body weight for resistance. Maintenance of muscle strength is an important component of maintaining independence with aging and prevention of falls.
Be Social
Maintaining social links and interacting with others may be an important component in preventing Alzheimer’s. Consider participating in a group exercise class. Most fitness centers and many community centers offer group classes that range from chair exercises for older adults to more intense aerobic activities such as spinning, functional training, and step aerobics. Dancing can be fun and is an excellent aerobic activity that connects you with others.
Consult a Professional
Degreed and certified professionals such as Personal Trainers, Exercise Physiologists, and Clinical Exercise Physiologists can assist you with developing your exercise program and provide guidance as you progress along your health and fitness journey. Ask your health care provider if this might be beneficial for you.
Role of Physical Activity in Treating Alzheimer’s Disease
People diagnosed with Alzheimer’s disease should remain physically active for as long as possible. A consistent routine of physical activity promotes better sleep, improves mood, reduces anxiety, slows the rate of cognitive and physical decline, and allows you or your loved one to remain independent for a longer period of time.
One of the pivotal challenges in Alzheimer’s disease is a progressive decline in physical function and mobility. This process can be accelerated when people with Alzheimer’s stop exercising and become sedentary. The resulting loss of physical fitness places them in a progressive downward spiral that negatively affects their muscles, bones, and physical capabilities. Joints lose their mobility and become stiff, and when this is combined with weakened muscles, gait changes make walking more challenging. The loss of strength and mobility affects balance, predisposing the person to falls, potential fractures, and other medical complications.
As cognition and physical fitness progressively worsen, depression, inadequate sleep, and mood changes become more apparent; daily living functions such as getting dressed and undressed, bathing, preparing meals, and transferring from one place to another become challenging. This results in a loss of autonomy and increases the need for care assistance.
Exercising and staying physically active is critical to slowing this downward slide and maintaining independence and quality of life for as long as possible. The type of physical activity that is best for the person with Alzheimer’s depends on age, abilities, current fitness level, stage of Alzheimer’s disease, symptoms, and other health-limiting conditions. Younger people with Alzheimer’s and those at earlier stages of the disease process may be able to undertake a greater amount and intensity of activity than those who are older, are at later stages of the disease, or have not previously maintained a physically active lifestyle.
Maximize Safety: Steps to Take Before Starting an Exercise Program
Before initiation of an exercise program, consultation with one’s physician is warranted. This is especially important in the presence of any coexisting health factors such as high blood pressure, heart or vascular conditions, or history of falls, or symptoms like shortness of breath, chest discomfort, dizziness, and fainting. Ask the doctor for advice related to these questions:
· What type(s) of physical activities will be best?
· What physical activities should be avoided?
· How frequent should the activity sessions be and for what duration?
· What is the recommended intensity?
· Is referral to a health professional, such as a physical or occupational therapist or ACSM Clinical Exercise Physiologist, who can help create and monitor an appropriate physical activity program recommended?
In the early stages of Alzheimer’s disease it is important to establish a regular exercise routine that can be maintained for as long as possible. The primary objective is to maintain and even improve the physical functions that allow independent living. As the disease progresses, activities need to be modified and simplified. Many community centers and fitness facilities, such as medical fitness centers and YMCAs, offer specific programming for people with dementia and Alzheimer’s. These centers have trained health and fitness professionals who can assist with developing an appropriate program, provide instruction regarding technique, and make modifications as necessary. These are a few things to consider:
· Check all workout areas and your home environment for potential safety hazards such as inadequate lighting, rugs, cords, and other trip-and-fall obstacles.
· Keep it simple, especially as Alzheimer’s progresses and memory becomes more impaired. Remembering how to do complicated movements may be challenging, and safety could become an issue.
· If balance is an issue, installing and exercising within reach of a grab bar or with assistance should be considered.
· Choose activities that are enjoyable; the key is remaining physically active for as long as possible.
· Walking is an excellent activity and does not require complicated equipment. Activities such as gardening, cleaning, cooking, and dancing are also beneficial.
· Some form of resistance training should be incorporated. If a fitness facility is accessible, this could include weight machines and other available equipment. Resistance bands and cords can easily be incorporated at home, as can a variety of body weight exercises.
· Start slow; even 10-minute sessions spaced throughout the day are beneficial.
· As ambulation becomes limited, seated exercise activities can be incorporated.
· Establish a calm and soothing environment that is devoid of loud noises and distractions; familiar, calming music can be helpful.
Over the past century, numerous medical and public health advances have served to significantly increase lifespans, allowing more and more people to live into their 90s and beyond. Parallel to enhanced longevity is a substantial increase in the risk of developing Alzheimer’s disease and other forms of dementia. While additional research is required to carve out the definitive underlying causes, it is apparent that a number of lifestyle factors play a significant role. The health benefits derived from being physically active and consuming a nutritious diet are far-reaching and include the health of your brain. Nutritional and physical activity habits are important components for preventing the development of Alzheimer’s disease in some people and delaying manifestation of symptoms in others, and are important treatment interventions in those who have symptomatic Alzheimer’s.