Exercise
I wish Mrs. Dell had developed an exercise routine back when she was first diagnosed with Alzheimer’s. It would have been even better if she had done so when she was forty, or even earlier. But she didn’t have any idea the importance exercise would have for her future.
Regular physical activity is more effective in reducing the risk of Alzheimer’s than any drug available.
Exercise and the Brain
A study in the journal Healthy Aging Research revealed that exercise resulted in a significant increase in the size of the hippocampus in a group of females. As you know, the hippocampus is a primary part of the brain involved with memory. Researchers compared the individuals who exercised the most with the ones who exercised the least. They concluded, “Individuals with the lowest 10% of daily activity were reported to have a two-fold higher risk of developing Alzheimer’s disease compared to individuals in the top 10% of activity levels.” That’s double the risk. Does their conclusion make you think twice about how active you are and how active you are going to become?
An article published in the Canadian Family Physician showed that there are multiple ways exercise protects the neurons of the brain. It strengthens the heart, protects the health of the arteries, and helps keep blood flowing to the neurons of the brain. The report showed that even in elderly people who already had cognitive impairment or dementia, their mental function improved with exercise. I point this out because in Mrs. Dell’s case, this shows that exercise would have been beneficial even after she developed stage 2 MCI or even Alzheimer’s dementia.
Here is the takeaway from this study. Regular physical activity, as compared with no exercise, was associated with a lower risk of cognitive impairment and Alzheimer’s. High levels of exercise reduced the incidence of Alzheimer’s dementia by half. The report showed that even in elderly people who already had cognitive impairment or dementia, mental function improved with exercise.
This same report examined the results of another study that found elderly people who did less than an hour of exercise daily, as compared with those who did more than an hour, had a twofold increase in risk of cognitive decline.
An Archives of Neurology article gave similar results, reporting that individuals who had symptoms of stage 2 Alzheimer’s and who began exercising reduced their progression of symptoms when compared with those who did not exercise.
Strengthening the muscles of the heart helps it pump the maximum amount of blood with each beat. Only exercise builds the heart’s strength and efficiency.
An article in Neurology reported a study that measured how much blood was pumped with each beat of the heart. Researchers studied 1,504 participants. None had any signs of a stroke or of impaired blood flow to the brain, and none showed any symptoms of Alzheimer’s. The purpose of the study was to show that impaired heart muscle function is associated with a lower amount of blood to the brain and that this results in earlier signs of stage 1 Alzheimer’s. MRI studies showed that the individuals with less heart strength, measured as cardiac index, showed shrinkage of certain parts of the brain even before symptoms of Alzheimer’s were apparent. Their conclusion: “Decreasing cardiac function is associated with accelerated brain aging.”
Work to increase your cardiac function—the strength of your heart. And remember, there is no medication that can strengthen your heart muscles. Only exercise can. Exercise is a large part of your plan for the prevention of even stage 1.
If you exercise, you will eat better. Exercise convinces your mind that you really mean business and gives you that extra boost in your eating lifestyle as well as your weight goals. So even brisk walking is going to have an additive effect on your overall prevention plan.
An article published in the Annals of Internal Medicine addressed the significance of exercise in people sixty-five and older. It is much better to begin your exercise program as young as possible, but exercise is important even at an older age.
Studies performed in middle age usually show individuals exercising much more intensely than studies of people over sixty-five. However, this report proves that even with very light exercise, there is a great protective cover against the progression of any dementia or Alzheimer’s.
The study looked at whether people sixty-five and older who had normal mental function and exercised regularly were less likely to develop dementia over the coming years than those who did not exercise. The 1,740 participants all underwent routine mental testing and were followed for a six-year period.
The study also referred to other studies showing that the higher levels of physical fitness related to a greater tissue mass of the hippocampus, which you have learned plays a major role in memory. They suggested that the reason for this finding was because exercise improved blood flow to the hippocampus with increased oxygen and nutrient delivery.
The next part of their report caught my attention. The exercise assessment was unlike findings I had seen in so many other articles that pointed out that the more strenuous the exercise, the better protection of the arteries and the lower the risk of developing Alzheimer’s. Most previous reports recommended thirty minutes a day for five to six days a week.
Researchers compared people who exercised more than three days a week with those who exercised less than three days a week. The duration of exercise was fifteen minutes per day. The type of exercise was not strenuous. The lightest type included walking, hiking, and stretching, while the more strenuous type included bicycling, swimming, and aerobics.
Those who exercised three or more times a week had a 32 percent reduction in their risk for Alzheimer’s. Researchers pointed out that the results of this study were consistent with earlier studies showing that even modest levels of physical exercise were associated with a delayed onset of Alzheimer’s.
An interesting study done at Rush University Medical Center addressed the significance of exercise in older people. Researchers put a little device on the participants that recorded their average daily movements. The average age of the participants was eighty-two, and all were free from symptoms of Alzheimer’s. Over the next four years, 10 percent of them developed Alzheimer’s. The report concluded that those who were in the least active 10 percent were twice as likely to develop Alzheimer’s as those in the most active 10 percent.
“A higher level of total daily physical activity is associated with a reduced risk of Alzheimer’s Disease.” That was the concluding statement following a study of more than seven hundred older individuals who didn’t have any symptoms of Alzheimer’s, as reported in the medical journal Neurology. The intensity of the physical activity was divided into tenths of percentiles. The exercise activities that were graded on intensity included everything from gardening to walking, calisthenics, bicycle riding, swimming, and water exercise. The study showed that a person with high total daily physical activity, which put them in the highest tenth percentile of exercisers, was 2.3 times less likely to develop Alzheimer’s than those who did the least exercise.
A report in Archives of Neurology looked at a group of over four thousand people who were studied for a five-year follow-up period. The individuals were evaluated on the amount of exercise they did and placed into the three categories of low, moderate, and high levels of activity. Researchers concluded that moderate and high levels of physical activity were associated with a 60 percent reduction in the risk for Alzheimer’s.
An article in the Journal of Alzheimer’s Disease compared the intensity of the exercise to how well individuals did on mental tests and whether their MRI studies showed thicker or thinner brain mass. This study compared two groups of people who were sixty-five years or older. The individuals in the first group had no symptoms, while those in the second group were cognitively impaired. In other words, they showed symptoms of impairment related to mental function, reasoning, and memory. Researchers found that high levels of physical activity resulted in larger gray matter volumes in different lobes of the brain, including the hippocampus. But what was really significant was that larger volumes were seen in both groups, the asymptomatic individuals as well as those who were cognitively impaired—those who had symptoms.
If all you can do is walk, will that help increase the size of your gray matter? A significant study looked into this question and was published in the journal Neurology. Researchers took 299 adults, mean age seventy-eight years old, who walked as their personal exercise routine and followed them for thirteen years. The group was divided into four tiers depending on how many blocks they walked. Researchers wanted to find out if walking had any effect on brain volume. They did MRIs to see if the brain matter in the people who didn’t walk was different from the thickness of those who did. They also did mental testing on both to see if there was any difference in their scores. After following the participants for thirteen years, the conclusion was astonishing. Researchers found that those who walked the greatest amounts had a greater amount of gray matter volume and also a reduced risk of cognitive impairment. The area found to be the most positively affected was the hippocampus.
An interesting study called the Honolulu-Asia Aging Study looked at the relationship between walking and the mental problem of dementia. Researchers studied 2,257 men between the ages of seventy-one and ninety-three. The men who walked less than one-quarter mile a day had almost twice the risk of developing dementia as the men who walked more than two miles a day.
The takeaway from all these studies is this: if you don’t have symptoms, exercise to prevent Alzheimer’s; if you have symptoms, exercise to slow the progression of the disease. Do all you can do at any age, whether it is walking or high intensity exercise, to protect your brain.
I had believed walking was low in significance in terms of exercise. After reading the conclusions from these studies, never again will I look at older adults out walking and think they are wasting their time. No, I will now have the urge to go up and congratulate them for doing something great for their health.
Exercise:
Some Facts and Figures on Exercise and Alzheimer’s
Here are some of the interesting numbers gleaned from the studies cited in this chapter.
Exercise and the Heart
Exercise strengthens the heart, lowers resting heart rate, lowers blood pressure, and lowers the oxygen demand of the heart muscle. All of these assist the heart in pumping more oxygen-rich blood to the brain.
Aerobic exercise, which is sustained exercise that increases the heart rate, is so important because it keeps the heart operating at peak performance. The stronger the heart, the easier it is to get blood throughout the body. The heart muscle is just like any other muscle. If it is forced to exercise, it becomes thicker and stronger.
I remember my first day of medical school like it was yesterday. “The heart is the single most important organ in your body except for your brain,” our professor told us in anatomy lab. That anatomy class was exciting because I got to hold a human heart in my hand. I was able to look closely at the muscle makeup. I could see each artery lying on the surface of the muscle. When the professor spoke of the anterior descending coronary artery, I could see it, touch it.
He then had us gather around the dissecting table. Several cadaver hearts were laid out on the slab, some with the muscle cut through and some with the arteries sliced open longitudinally to show blockages within the vessels. He wore a white lab coat, all three buttons neatly through each buttonhole. His head was freshly shaved, but you could tell he was mostly bald to begin with. And his shoes had been shined. His appearance was enough to make you pay attention to what he was about to say, but my eyes were fixed on what he held out toward us in his hands. In each hand, he held a human heart, both split open to show the main chamber.
I have never forgotten what he said next: “The heart in my right hand belonged to a gentleman who was what I call a couch potato. He was grossly overweight. He never exercised a day in his life. From his medical records, we know he was on numerous medications. As you can see, the wall of his left ventricle is only a few millimeters thick. His heart was a poor excuse for a pump, which he depended on every minute he was alive. Remember the thickness. Autopsy results revealed that he died from a massive heart attack—at the age of fifty-two.
“This man’s heart is different,” he said, indicating the heart in his left hand. “You see it is three to four times thicker than the first heart—much more muscle mass. It was strong right up to its last beat. He was trim, took good care of his body, didn’t smoke, and was a frequent tennis player. This heart belonged to a sixty-one-year-old gentleman who died in an automobile accident. He was physiologically younger than the fifty-two-year-old couch potato. If you want to live younger, the only advice I can draw from these hearts is to be as active as you can be.”
Next, he showed us a heart in which he had opened an artery longitudinally. He passed it around. The inside of the artery was as clean as a whistle. Then he passed around several hearts that had partial or complete blockages inside the arteries. He pointed out that most of the cadaver hearts he received from people who had died a non-accidental death had such blockages. He didn’t know the actual cause of the blockages, but he knew they were the cause of the heart muscle not getting the oxygen it needed, resulting in the demise of that particular patient.
Then he made another statement I’ve never forgotten: “The ones with the least amount of blockage are the ones who lived longer.”
When I think back to this, I have to remind myself of the statement in today’s literature about Alzheimer’s: what’s good for the heart is good for the brain.
Exercise is the key to strengthening the muscles of your heart. Strengthening your heart muscle is similar to strengthening your biceps. The more you exercise it, the thicker and stronger the heart muscle gets. If you put a work force on the muscle, it responds by getting stronger. The greater the work force, the more times it will beat per minute during that work force. When you die, you want the pathologist to look at your heart and remark how thick and strong the muscle looks.
Your Personal Exercise Plan
I would like to give you a simple plan for strengthening the muscles in your heart so that it can sustain the amount of blood for your brain to function at peak performance.
Jogging is one of the best ways to strengthen your heart because it keeps your heart at an elevated sustained heart rate for a specific period of time. An article in the Archives of Internal Medicine points this out. The study, which began in 1976, involved twenty thousand men and women. Their ages ranged from twenty to ninety-three. The study compared a subgroup of joggers to a subgroup of non-joggers. The difference they found between the two groups is significant. The joggers ran for thirty minutes a day, two to five days a week.
There was a significant increase in life expectancy for the group that jogged. The study showed that the risk of death was reduced by 44 percent in the jogging group. The data showed that jogging was linked with an added 6.2 years of life expectancy in men and 5.6 years in women. The better the blood supply to your heart, the better the blood supply will be to your brain.
The question to ask is, why does jogging extend your life? The most significant reason that exercise such as jogging extends your life is that it strengthens your heart muscle. I encourage you to perform some type of aerobic exercise thirty minutes a day, six days a week. Not only will you extend your life expectancy, but you will also have quality time during each of those extra years. The first thing to do is commit to a plan. Then stick with it.
Aerobic Exercise Plan
Let’s begin with a plan to get you moving if exercise is new for you. If you cannot jog yet, simply begin with a thirty-minute walk at a steady pace, six days a week. The following week, move to a faster walk, and eventually to a brisk walk. Committing to a thirty-minute walk may be the most significant decision you ever make. You will have “begun.” Do what you can do and keep working to improve.
It doesn’t matter where you are on your exercise continuum: just commit to starting a thirty-minute program. Remember, there is much more to it than just how vigorous the exercise is. Exercising sends a message to your brain about your commitment to eat the proper foods and get to your ideal weight. If exercise is new for you, here is a plan to get you started. It will help you strengthen your heart so it can supply the amount of blood your brain needs to function at peak performance.
| Week 1, Days 1–6 | 30 minutes walking |
| Week 2, Days 1–3 | 2 minutes jogging, 28 minutes walking |
| Week 2, Days 4–6 | 3 minutes jogging, 27 minutes walking |
| Week 3, Days 1–3 | 4 minutes jogging, 26 minutes walking |
| Week 3, Days 4–6 | 5 minutes jogging, 25 minutes walking |
| Week 4, Days 1–3 | 6 minutes jogging, 24 minutes walking |
| Week 4, Days 4–6 | 7 minutes jogging, 23 minutes walking |
| Week 5, Days 1–3 | 8 minutes jogging, 22 minutes walking |
| Week 5, Days 4–6 | 9 minutes jogging, 21 minutes walking |
| Week 6, Days 1–3 | 10 minutes jogging, 20 minutes walking |
| Week 6, Days 4–6 | 12 minutes jogging, 18 minutes walking |
| Week 7, Days 1–3 | 14 minutes jogging, 16 minutes walking |
| Week 7, Days 4–6 | 16 minutes jogging, 14 minutes walking |
| Week 8, Days 1–3 | 18 minutes jogging, 12 minutes walking |
| Week 8, Days 4–6 | 20 minutes jogging, 10 minutes walking |
| Week 9, Days 1–3 | 22 minutes jogging, 8 minutes walking |
| Week 9, Days 4–6 | 24 minutes jogging, 6 minutes walking |
| Week 10, Days 1–3 | 26 minutes jogging, 4 minutes walking |
| Week 10, Days 4–6 | 28 minutes jogging, 2 minutes walking |
| Week 11, Days 1–6 | 30 minutes jogging |
After you can jog for thirty consecutive minutes, focus on increasing your pace. Set your own personal goals. But above all else, get off the couch and get started.