Long Term Physical Activity in Older Adults and Alzheimer’s Disease – What’s the Connection?
We all know that physical activity (PA) is important. Not only does it help keep us fit and improve physical and mental health outcomes, but for individuals who are at an increased risk of Alzheimer’s disease, physical activity has also been shown to improve cognition.
Knowing physical activity is good for us and sticking to a regular exercise routine, however, are two different things. As researcher Prof Nicola Lautenschlager states “behaviour change can be very hard, even if people have the motivation to change behaviour there can be other barriers such as finances, time, support and safe environments to exercise.”
Previous research with older adults which have shown PA interventions to improve physical and cognitive outcomes have mostly been of short duration (less than one year). This new study however, demonstrated that with support, older adult participants were able to maintain a regular exercise routine for 24 months.
106 participants took part and included both males and females aged over 60 years of age, in a community or home-based setting (as opposed to a hospital or research facility). Participants were identified as at risk of Alzheimer’s disease by presenting with either mild-cognitive impairment or subjective memory complaints and at least 1 of the following risk factors: physical inactivity, obesity, hypertension (high blood pressure), heart disease, type II diabetes, smoking and/or hypercholesterolemia (high cholesterol).
The study was divided into 2 groups:
An intervention group
- Were given a structured individualised PA program consisting of moderate PA, with walking being the most common PA undertaken.
- Received newsletters containing strategies and tips about physical activity
- Received regular support phone calls from research staff
- Monitored their own physical activity via a diary for the 24 months
- Had measurements of: physical activity, physical fitness, body weight, body composition, health, lifestyle, and cognitive outcomes at baseline, 6, 12, and 24 months.
- PA group was assessed from self-reported PA diaries that recorded type, frequency, duration, and intensity of the PA.
A control group
- Continued with their usual PA for the 24-month study period.
- Received newsletters containing generic non-PA information
- Were contacted by phone at the same frequency as the intervention group with conversation limited to everyday topics with no discussion about PA. This was to ensure that the control and intervention group had similar study contact.
- The control group were offered a PA workshop at the end of the study.
Both groups were provided with
- Educational material and recommendations for a healthy lifestyle (excluding PA information)
The study team comprised a host of well-renowned ageing and aged care researchers with expertise from various health areas and was “a BIG team effort,” Prof Lautenschlager states. The study showed excellent study retention and adherence to a moderate intensity PA program (mostly walking) over 24 months by these older adults at risk of Alzheimer’s disease. Importantly the results showed that over the 2 years while the control group decreased their everyday PA the PA group increased their PA and were able to maintain this over this time. Further, with the PA program participants achieved an improved health profile such as, improved leg strength and some fat loss and preserved muscle, when compared to control participants. Whilst the participants achieved a reduction in fat it is uncertain whether it was solely due to the PA program or reduction in energy intake (because the study did not monitor in detail participants’ dietary intake). Yet, it is likely that PA was the major contributor as fat loss from diet alone also results in a reduction in muscle which we didn’t see in this study. The increase in leg strength, modest fat loss and preserved muscle taken together are extremely important for everyday function and the prevention of falls in older adults.
Participants described the PA program as “enjoyable” and “acceptable”. Prof. Lautenschlager partly attributes the success of the study was “‘getting participants’ to undertake individual goal setting and to ‘own it’”, therefore taking pride and responsibility of their PA program. The success of the study could also be partly related to the study being comprised of highly motivated volunteers who were recruited from The Australian Imaging, Biomarker & Lifestyle Flagship Study of Ageing (AIBL).
The success of this research is further highlighted as Prof. Lautenschlager notes that “behaviour change research is very expensive”, with the study being funded through a National Health and Medical Research Council (NHMRC) grant; a major funding body for health and medical research in Australia, and though the research budget was cut the authors of the study “did the best they could”.
What does this mean?
The study demonstrated that:
- A PA regime of moderate intensity, predominantly walking, is achievable by older adults without major health conditions as was demonstrated in this group of older adults
- Secondly, being home-based means that PA can be undertaken with minimal or no cost, overcomes the potential barrier of transportation, and can be done at the individual’s convenience
- Thirdly, the low incidence of PA program related injury or musculoskeletal conditions and no major adverse events means that it can be engaged in safely.
What about diet?
In older adults, exercise alone is unlikely to lead to weight loss. If exercising for overall health, including weight loss, then diet needs to also be considered. However diet can be a harder habit to change. Prof. Lautenschlager notes that “people can quite often become overwhelmed with all the different advice”, therefore she recommends to focus on one thing at a time, for example aim for a short walk around the block to start with and then gradually increase the distance walked and maintain this for 6 months to reap the benefits. Once you have mastered this habit, then consider changing another habit you would like to improve on and add this to your ‘active lifestyle’. Slow and steady wins the race.
- In this target group of individuals at risk of Alzheimer’s disease long-term PA adherence is achievable, acceptable, and has health benefits in terms of fitness.
- To date there are no effective pharmacological treatments available for the prevention of cognitive decline, Alzheimer’s disease or dementia implying that adherence to a PA intervention are important for the global efforts to reduce dementia risk.
- This makes the modification of lifestyle that reduces risk factors for Alzheimer’s disease such as physical inactivity, cognitive inactivity, mid-life obesity, hypertension, heart disease, diabetes, smoking, and hypercholesterolemia (high cholesterol) a crucial strategy.
- This is underscored by the estimate that a third of Alzheimer’s disease cases worldwide may be attributed to modifiable risk factors.
So what are Prof Lautenschlager’s top tips for increasing PA in older adults?
1. It’s NEVER too late to start – increasing your PA is doable!
- Just because someone is older or may have issues with their health (for e.g. heart disease, diabetes or their memory), doesn’t mean they cannot change their behaviour and increase their PA.
2. Talk to your GP or family member as a starting point if you want to increase your PA. The following guidelines are a useful place to start. You can bring this flyer to your GP and discuss further.
3. Anything is better than nothing – start small, aim for 1 x 10 min walk 3 times a week. Build up slowly over time and increase endurance and fitness.
4. Not one size fits all – what works well for one person may not work well for you! Find what you like most in terms of movement. Do you like to be social? Do you like to be solitary? Is a walking group the thing for you or would you prefer a short, quiet walk around your neighbourhood?
5. And most important of all: Never give up!
For further details see: Australian Physical Activity Guidelines – For adults aged 60 years and older who experience mild changes to their memory