Positive Effects of Physical Activity for People with Alzheimer’s Disease
By, Elyse Morin, Undergraduate Student, College of Health and Human Performance; University of Florida, Gainesville, FL

Alzheimer’s (AD) is a neurodegenerative disease that begins to progressively affect the brain at around age 60. The chances of getting AD increase with age and if a family member has also had the disease, as three genes have been pinpointed that cause early familial AD. It is predicted that by the year 2040, about 14 million people living in the United States will have AD or some other form of dementia (1). The disease itself is caused by an extreme accumulation of amyloid protein in the brain causing abnormal clumps, or plaques, and the tangling of fiber bundles.

Behaviorally, people with AD exhibit “memory loss, language deterioration, impaired ability to mentally manipulate visual information, poor judgment, confusion, restlessness, and mood swings.” The progression to full blown AD can take anywhere from five to twenty years depending upon physical and mental health. The disease eventually causes loss of mental functioning, personality, and ability to operate normally and independently. On the surface, it is easy to miss the early signs of AD because loss of memory and forgetfulness are also expected signs of aging. Once diagnosed, there is no cure for AD nor is there any way to halt or slow progression. Some drug therapies have been created that help improve some of the cognitive and behavioral symptoms temporarily. Current drug research is exploring the effects of alternative medications that are usually prescribed for other health problems to determine if they have any effect on slowing or preventing AD (2).

The neurological effects of AD are widely studied and are knowledge of the general public, yet the progressive deterioration of the physical condition of the person with AD is less acknowledged. The lack of attention and interest to this issue could be due to how it is concealed behind the decline in physical condition that accompanies old age. Compared with the normal population of the same age, people with AD experience a more rapid deterioration of mobility, ambulation, body care, and home management skills. Not only does a loss of muscle mass affect the physical health of the person with AD, it exponentially affects the loss of independence.

Diseases such as AD and others that effect brain function and cognition cause the greatest increase in risk of falls. Coupled with the normal frailty of old age, the large incidence of falls is a big cause for concern and these falls and the complications that result are a leading cause of death among people with AD (3). The largest hurdle in the diagnosis of the need and the treatment of mental and physical health issues in people with AD is the physician. Doctors rarely order “interventions that enhance orientation, improve amount of meaningful communication, improve recall of autobiographical information, decrease frequency of disruptive vocalization, and improve affect and mood” since they are more focused on treating the brain itself as an organ that is not functioning properly (1). However, it is the physical health and other more basic cognitive functions that may be responsive to intervention and prevention therapies. The decline in level of fitness is accompanied by the inability to perform activities of daily living (ADLs). The increasing severity of AD takes away the independence of the person, which is directly related to their quality of life, and also increases their risk of other medical problems and death, causing the patient to become an encumbrance on their family (4).

If the necessity of exercise in the lives of people with AD is obvious, the question is why then is it not implemented if it is actually feasible? One exercise study utilized the leadership of the caregiver in an exercise program for people with AD, aiming to investigate the success and also the adherence to the 12 week program. Caregivers were educated on specific exercises focused on increasing balance, strength, flexibility, and endurance, and were prompted to implement them in the daily life of the patient. The results indicated an almost perfect adherence, showing that the integration of such exercises into basic care is feasible, advantageous, and also completely necessary (3).

Based on these findings, another study began which combined this home based exercise regimen with behavioral management techniques taught to the caregiver. The aim was to reduce the dependence of the person with AD because of loss of function, and also reduce the time before the person needs to be living in some sort of home where they can get around the clock treatment. The study compared the new program, Reducing Disability in Alzheimer Disease (RDAD), to routine medical care over a period of three months. Both patient baseline fitness and level of depression were recorded, as depression often accompanies AD, especially due to the person’s loss of independence. One important aspect of this study was that it not only involved implementing exercise, but it also sought to modify patient behavioral problems, especially in how they are dealt with by the caregiver.

Caregivers were given special instruction on how to deal with dementia, and were presented with a more educated outlook on what the patient is actually going through, teaching empathy and understanding where it may have been lacking. The results of this study revealed that caregivers became better able to interact with their patients and were successful in encouraging and supervising participation in the daily exercises. Not only did the physical fitness of the people with AD improve dramatically, but also their average mood became elevated. However, this relief of depression can also be attributed to the simple effect of exercise on the brain, the release of endorphins. Compared with the control group that only received routine medical care, patients in the RDAD group scored significantly better on both the scale of depression and physical health (5).

Exercise has been found to alter brain function through animal studies. These studies show that physical activity increases serum calcium levels and therefore motivates the production of dopamine, which has various physiological and behavioral effects. Lowered levels of dopamine in mice lead to abnormal behavior such as convulsions and seizures, which help to increase dopamine levels and return the mouse to equilibrium. Moderate exercise has the same effect on humans as the movement of the mouse during these seizures to normalize dopamine levels. Studies reveal that, matched up against no exercise, moderate daily exercise helps to decrease the risk of dementia as we age, including AD, because of the increased stimulation in the production of dopamine, as dopamine function is reduced in AD and dementia (6).

Building upon the beneficial findings of exercise studies, another program was introduced that focused on a multisensory approach, looking at its effects on engagement (cognitive functioning) and behavior (mood) as well as general health. Because of the damage that AD causes to the central nervous system, the person has deficits in communication, attention, and following directions. We are able to see these issues in behavior such as “apathy, agitation, and wandering, that lead to disengagement,” working against therapies such as exercise programs. Therapy programs that offer stimulation to multiple senses have been found to be successful in attaining increased attention and engagement. Multisensory therapy is a way to enrich the environment so that participating in physical exercise is “meaningful, engaging, and pleasurable.”

Two important sources of multisensory stimulation are storytelling and imagery, which stimulate the participants to utilize many of their senses, both consciously and subconsciously. Using PET and fMRI, researchers were able to distinguish the neurological relationship between performing an act and imagining the act by observing brain activity. Many of the same physiological changes occurred as a result of imagining the activity, therefore supporting the basis of these techniques; the cortical areas that are stimulated during exercise are the same areas that are stimulated during storytelling and imagery exercises. Overall, as a result of multisensory therapy, people with AD displayed “improvement in resting heart rate, overall mood, and in engagement of physical activity (7)."

Overall, daily exercise is good for everyone, especially people with AD who are already experiencing failing health on top of this disease. No real harm can be done unless the exercises are too intense, so the real problem is getting their caregivers or family to have the person complete these exercises, and also keep the exercises interesting so that the person is motivated and wants to participate. Physical activity not only helps to increase the muscle mass and endurance so that the person with AD does not fall victim to the increasing odds of a frailty-related accident in their old age, but also helps gain some of their independence back, because they are better able to maneuver and function, elevates their mood, gives them something to look forward to each day. With any disease, it is important to ask questions and always think past what the physician prescribes, because it will usually just be medication, so that you are actively seeking help and not falling prey to the effects of the disease.

The most important aspect in treating someone with Alzheimer’s Disease or any form of dementia is to keep them active.

 

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