04 Nov Exercise and brain health for older adults

The prevention of cognitive decline and onset of dementia has been identified as an international health priority by the World Health Organization. Over 400,000 older Australians currently live with dementia which is expected to double and triple by the year 2030 and 2050, respectively both at a national and international level.

Dementia is an umbrella term for a wide variety of diseases (such as Alzheimer’s disease and Lewy body disease) that lead to a progressive decline in cognition and a person’s daily function. While memory loss is a common symptom of most dementias, other areas of a person’s cognition may be affected (i.e. decision-making, orientation, attention) as well as experiencing other psychological (i.e. depression, anxiety) and physical (i.e. slow movements, tremor, rigidity) symptoms.

Dementia is typically diagnosed through a combination of patient history, cognitive testing and diagnostic procedures.

There is a range of non-modifiable (age, genetics) and modifiable (lifestyle) risk factors that increase the risk of dementia. Promisingly, around half of the risk for dementia comes from potentially modifiable risk factors such as obesity, physical inactivity, smoking, low educational attainment, diabetes, hypertension and depression, which can all be treated by modifying your lifestyle.

Additionally, reducing the prevalence of frailty in older age, a condition characterised by reduced strength and a vulnerability to illness and life’s stressors, significantly decreases the risk of developing dementia.

The benefits of exercise

Currently dementia has no cure. There are however treatments for the symptoms of dementia (such as memory, agitation, depression, etc.). In addition to a limited number of approved medications for the treatment, five lifestyle interventions have emerged as effective lifestyle changes to maintain brain health in older adults.

These interventions are recognised by Australia’s peak dementia body Dementia Australia and include being physically and cognitively active, adhering to a Mediterranean diet, maintaining social networks, and minimising chronic disease burden.

Currently, there are no formal guidelines for exercise and dementia but there is extensive research indicating that if you are more physically active, less sedentary, stronger, fitter and less frail you can reduce your risk of dementia in the future.

Types of exercise recommened

The aims of exercising for brain health and dementia are to maintain and/or improve cognition, independence and mobility, as well as minimising the risk of falls and prolonged periods of bed-rest and sedentary time.

This is best achieved through an exercise prescription involving aerobic exercise, resistance training and dual-task balance training that is of moderate to high intensity. This is the most effective for maintaining the brain’s structure and function, and reducing the risk of frailty and falls, which can often accelerate cognitive decline in older age.

In moderate to severe dementia it may be difficult to maintain the appropriate intensity of aerobic exercise, and therefore frequent, smaller bouts of movement throughout the day to breakup prolonged sedentary time is a good alternative.

Resistance training should be performed with moderate to heavy loads that gradually get heavier with each session on two to three days per week. A combination of machine weights (i.e. horizontal leg press) and functional movements (i.e. chair stand) should be used to target muscles of the thigh, hip, buttocks, upper back, and the back of the arm, as these muscle groups are crucial for maintaining mobility and independence.

Dual-task balance training involves training your balance at the same time as performing cognitive tasks. An example may include walking heel-to-toe as fast and accurately as you can while trying to name as many countries as you can at the same time. This sort of training is best performed under supervision when you are not fatigued, at the start of a session, and with a nearby rail or bench for support.

Lastly, while maintaining balance is a key part of the training, learning to regain your balance by practising taking a purposeful step is also just as important for falls prevention as it trains you to react fast should you begin to fall in everyday life.

Speak to the exercise professionals

If you are concerned about a loved one or yourself, be proactive and seek a cognitive health check-up from your GP and discuss ways to manage your brain health. While there, ask to see an Accredited Exercise Physiologist to get professional guidance on the best exercise prescription for you.

Read more in the Exercise for Older Adults eBook! Download here. 

Expert Contributor: Dr Michael Inskip, PhD; Accredited Exercise Physiologist; Associate Lecturer in Exercise Physiology at James Cook University; and Honorary Associate Lecturer at University of Sydney