Walking Away from Alzheimer’s and Depression

Dr. Rusk says…

Exercise as a treatment option for many illnesses and diseases, including Alzheimer’s, is currently being scientifically studied. This post will discuss exercise as a possibly preventative measure for Alzheimer’s, exercise as a possible intervention for Alzheimer’s, the effect of exercise on depression, and ways in which to integrate exercise in your life.

Prevention

Studies like Liang et al.’s show that biomarkers of Alzheimer’s disease (proteins and other measurable physical changes indicating the development of Alzheimer’s) are lower in people who exercise more versus those who are more sedentary. However, as the National Institute on Aging points out, it is unclear whether this is because exercise prevents Alzheimer’s or other factors (such as healthier eating by those who also happen to exercise more, or unseen genetic contributions) reduce risk for Alzheimer’s.

Nonetheless, exercise has a number of other benefits like improving mood, reducing stress, and preventing other illnesses, so the side effects of this particular intervention are healthy!

Treatment

Exercise as a intervention for Alzheimer’s Disease is somewhat promising. A one-year trial of an exercise program in nursing homes indicated that exercise slowed the decrease in ability to perform daily tasks and physical activities (such as walking) in comparison to normal treatment.

Although the measures for mood regulation did not change between normal treatment and exercise in this study, the researchers mentioned below found a decrease in depression scales when the exercise occurred more than twice a week.

Comorbidities (Alzheimer’s and Depression)

Alzheimer’s patients often have depression as well, with rates around 87% of older adults with Alzheimer’s also suffering from depression. Less than half of these patients treated via psychopharmacology (such as antidepressants) are reported to improve and some patients do not have easy access to talk therapy or psychopharmacology. Exercise is an alternative treatment option for these patients. Williams & Tappen report that both comprehensive exercise (described below) and supervised individual walking (also below) decreased depression ratings in comparison to casual conversation of the same type. Comprehensive exercise seemed more effective than walking exercise. The exercises are detailed below, although supervision is highly recommended to prevent accidents:

  • Comprehensive individual exercise: Part One of the comprehensive exercise treatment consisted of ten minutes of strength, balance and flexibility exercises. Strength training included shallow knee bends, toe rises and pushpulls. Balance exercises included side stepping first to the right, then left, then backwards and finally in circles. The number of repetitions progressed each week beginning with three per exercise and adding two repetitions each week up to nine repetitions. Part Two of the comprehensive exercise treatment consisted of walking. The walking component of the comprehensive exercise was progressed up to 20 minutes in duration.
  • Supervised individual walking: Walking pace was individualized according to the participant’s ability. Participants were permitted to rest as needed. Sessions were progressed to increase time walked up to a maximum of 30 minutes. The interventionist used a gait belt and walked beside the participant lending assistance when needed. If the participant normally used an assistive device such as a walker or cane, they continued to use it during the walking sessions.

Growth Factors

Growth factors are substances in the body that regulate cell division and survival. Essentially, they maintain cells’ health and connections, including those in the brain. BDNF is a growth factor involved in learning, memory, and possibly mood that is decreased in people with Alzheimer’s, Parkinson’s, and Huntington’s. Increasing BDNF levels in these patients is especially important to help maintain a healthy brain.

Exercise has been shown to increase BDNF levels in the hippocampus (an especially important brain structure for learning and memory) as well as the cerebellum, cortex, and spinal cord in rats. This data has been replicated in humans and shown that exercise has a particularly strong effect in populations suffering from mental decline through aging or disease. Researchers have also found that longer, more intense exercise has the best outcomes. We will discuss this more below.

Types of Exercise

Aerobic exercise (aka “cardio” such as swimming or running) has been demonstrated to be effective in people without dementia. However, a combination of strength training (focusing on the lower limbs) and aerobic exercise has been shown to be most effective with dementia patients compared to aerobic exercise alone. A full description of the type of exercise employed in this study can be found under “Strength Exercises” in the linked article.

Getting Active

If you would like to exercise more, please remember to be safe by going at your own pace and asking others to participate with you. Social exercise is considered especially helpful for depression, so joining or forming a walking group with friends or family would be very beneficial. Boulder County has various programs, such as a Walk with Ease and a Healthy Moves class, for adults and seniors to safely exercise. The NIH also publishes tips specifically for those with Alzheimer’s to exercise. Again, make sure you talk to your doctor before making any changes and get your friends and family involved so you can improve your health together!

Contributions by Emma Easterly

Works Cited

“Depression and Alzheimer’s | Caregiver Center.” Alzheimer’s Association. N.p., n.d. Web. 13 Feb. 2017.

“BDNF Brain Derived Neurotrophic Factor [Homo Sapiens (human)] – Gene – NCBI.” National Center for Biotechnology Information. U.S. National Library of Medicine, 20 Feb. 2017. Web. 23 Feb. 2017.

“BDNF Gene – Genetics Home Reference.” U.S. National Library of Medicine. National Institutes of Health, 21 Feb. 2017. Web. 23 Feb. 2017.

Bossers, Willem J.R., Lucas H.V. Van Der Woude, Froekje Boersma, Tibor Hortobágyi, Erik J.A. Scherder, and Marieke J.G. Van Heuvelen. “A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial.” The American Journal of Geriatric Psychology 23.11 (2015): 1106-116. ScienceDirect. Elsevier Science Ltd., 3 Jan. 2015. Web. 23 Feb. 2017.

Cotman, Carl W., and Nicole C. Berchtold. “Exercise: A Behavioral Intervention to Enhance Brain Health and Plasticity.” Trends in Neuroscience 25.6 (2002): 295-301. ScienceDirect. Elsevier Science Ltd., 19 June 2002. Web. 23 Feb. 2017.

Cotman, Carl W., Nicole C. Berchtold, and Lori-Ann Christie. “Exercise Builds Brain Health: Key Roles of Growth Factor Cascades and Inflammation.” Trends in Neurosciences 30.9 (2007): 464-72. ScienceDirect. Elsevier Science Ltd., 31 Aug. 2007. Web. 23 Feb. 2017.

Liang, Kelvin Y., Mark A. Mintun, Anne M. Fagan, Alison M. Goate, Julie M. Bugge, David M. Holtzman, John C. Morris, and Denise Head. “Exercise and Alzheimer’s Disease Biomarkers in Cognitively Normal Older Adults.” Annals of Neurology 68.3 (2010): 311-18. Wiley Online Library. 31 Aug. 2010. Web. 13 Feb. 2017.

“NCI Dictionary of Cancer Terms.” National Cancer Institute. U.S. Department of Health & Human Services, n.d. Web. 23 Feb. 2017.

Rolland, Yves, Fabien Pillard, Adrian Klapouszczak, Emma Reynish, David Thomas, Sandrine Andrieu, Daniel Rivière, and Bruno Vellas. “Exercise Program for Nursing Home Residents with Alzheimer’s Disease: A 1‐Year Randomized, Controlled Trial.” Journal of the American Geriatrics Society 55.2 (2007): 158-65. Rolland – 2007 – Journal of the American Geriatrics Society – Wiley Online Library. 8 Jan. 2007. Web. 13 Feb. 2017.

United States of America. Boulder County Colorado. Healthy Aging Programs. Boulder County, n.d. Web. 13 Feb. 2017.

United States of America. National Institute of Health. National Institute on Aging. National Institutes of Health. U.S. Department of Health and Human Services, n.d. Web. 13 Feb. 2017.

United States of America. U.S. Department of Health and Human Services. National Institute on Aging. National Institutes of Health. U.S. Department of Health and Human Services, 25 July 2016. Web. 13 Feb. 2017.

United States of America. U.S. Department of Health and Human Services. National Institute on Aging. NIHSeniorHealth: Exercise: Benefits of Exercise – Health Benefits. N.p., Jan. 2015. Web. 13 Feb. 2017.

Williams, C. L., and R. M. Tappen. “Aging & Mental Health.” Aging & Mental Health 12.1 (2008): 72-80. Exercise Training for Depressed Older Adults with Alzheimer’s Disease: Aging & Mental Health: Vol 12, No 1. 25 Feb. 2008. Web. 13 Feb. 2017.

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