It’s Never Too Late: The Benefits of High Intensity Exercise for Dementia

Contributed by Fiona Callender, Research Assistant, University of Toronto

We are all connected to someone who suffers from one form of dementia or another – whether it is directly or through caregivers, friends or relatives. With incidence rising, and Alzheimer’s and other forms of dementia now being the leading cause of disability and death in the aging population (Fratiglioni et al., 2000; Colantuoni et al., 2010), it is a disease that affects us all. In past articles we have discussed how high intensity exercise can help change the course of disease during the critical period before the onset of dementia; however, the research has been unclear regarding how individuals who are suffering from the disease could benefit from this type of exercise, especially in terms of their neuropsychiatric symptoms. 

In one of my previous contributions to Fast Twitch Grandma I referenced an article that discussed mild cognitive impairment being a risk factor for dementia, and how strength training could help alter the course of cognitive decline during this critical period. As it turns out, it’s not too late even once dementia has set in! High intensity and strength training exercise are valuable tools for everyone and every brain. In the recent article entitled Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial, Telenius, Engedal and Bergland discuss the positive effects of high intensity exercise training on elderly nursing home residents suffering from mild to moderate dementia.

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Dementia encompasses physical, neuropsychiatric and cognitive symptoms. More than 80% of people with dementia in nursing homes have at least one neuropsychiatric symptom (Ballard et al., 2001; Selbaek et al., 2013). These symptoms include agitation, irritability, euphoria, apathy, depression, anxiety, delusions and hallucinations, the most prevalent being apathy, agitation and mood symptoms (Ballard et al., 2001; Selbaek et al., 2013; Selbaek & Engedal, 2012). These symptoms affect not only the patient but also those closest to them, and although there are drugs available to treat these symptoms, they can have very serious side effects (Ballard et al., 2006). Unfortunately, most studies focus on the impact of exercise on the physical symptoms rather than cognitive and neuropsychiatric (Borisovskaya et al., 2014).  If we could improve neuropsychiatric symptoms in addition to the physiological benefits with exercise, why wouldn’t we?

As Telenius, Engedal, and Bergland (2015) discuss, the research on exercise in dementia patients is scarce, but their current, randomized controlled study provides some glimmers of hope for the management of symptoms in this population. In their study, they recruited 170 nursing home patients in Norway who suffer from dementia. They divided the participants into two groups: one group who followed an exercise intervention twice per week for 12 weeks, and another control group who participated in leisure activities  of their choosing. For the exercise intervention, the researchers conducted a program called the High Intensity Functional Exercises (HIFE) program (Littbrand et al., 2006) which was developed in Sweden. It consisted of a warm-up, leg strengthening exercises and balancing exercises, lasting about 50 to 60 minutes. The course instructors where taught to emphasize high intensity and the use of weighted belts in the training sessions.

The group who performed the exercise showed a reduction in apathy and agitation compared to the control group. The control group appeared to maintain their level of apathy throughout the intervention while the exercise group decreased their apathy, as assessed by The Neuropsychiatric Inventory questionnaire. Agitation was also found to be lower in the exercising group. In fact, it has been proposed that the less physically active a person with dementia is, the more agitation he or she will experience (Scherder et al., 2010). Although this study did not have significant statistics to show that exercise prevented the decline in ability to perform activities of daily life, other studies have demonstrated this in dementia populations. It is likely that the light exercise and short duration of the study didn’t allow the significant decline to be observed.

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Although further research in the area of exercise and neuropsychiatric symptoms of dementia is definitely necessary, this study provides some hope for the lives of those who suffer from, or who are caring for someone suffering from dementia. High intensity exercise appears to be a beneficial tool for everyone from nursing home residents to professional athletes.

Sources:

Ballard, C.G., Margallo-Lana, M., Fossey, J., Reichelt, K., Myint, P., Potkins, D. et al. (2001). A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. The Journal of clinical psychiatry, 62, 8, 631–6.

Ballard, C., Waite, J., Birks, J. (2006). Atypical antipsychotics for aggression and psychosis in Alzheimer’s disease. Cochrane Database of Systematic Reviews, 1.

Bergland, A., Engedal, K., Telenius, E.W. (2015). Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial. Plos one.

Borisovskaya, A., Pascualy, M., Borson, S. (2014). Cognitive and neuropsychiatric impairments in Alzheimer’s disease: current treatment strategies. Current Psychiatry Reports, 16, 9, 470-.

Colantuoni, E., Surplus, G., Hackman, A., Arrighi, H.M., Brookmeyer, R. (2010). Web-based application to project the burden of Alzheimer’s disease. Alzheimer’s & dementia: the journal of the Alzheimer’s Association, 6, 5, 425–8.

Fratiglioni, L., Launer, L.J., Andersen, K., Breteler M.M., Copeland, J.R., Dartigues, J.F., et al. (2000). Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group, Neurology, 54, 11, 10–5.

Littbrand, H., Rosendahl, E., Lindelöf, N., Lundin-Olsson, L., Gustafson, Y., Nyberg, L. (2006). A High-Intensity Functional Weight-Bearing Exercise Program for Older People Dependent in Activities of DailyLiving and Living in Residential Care Facilities: Evaluation of the applicability With Focus on Cognitive Function. Physical Therapy, 86, 4, 489–98.

Scherde, E.J.A., Bogen, T., Eggermont, L.H.P., Hamers, J.P.H., Swaab, D.F. (2010). The more physical inactivity, the more agitation in dementia. International Psychogeriatrics, 22, 8, 1203–8.

Selbaek, G., Engedal, K., Bergh, S. (2013). The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. Journal of the American Medical Directors Association, 14, 3, 161–9.

Selbaek, G. and Engedal, K. (2012). Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. International psychogeriatrics, 24, 1, 62–73.

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