Benefits of Physical Exercise for Older Adults With Alzheimer's Disease

The impact of exercise on Alzheimer's disease progression

INTRODUCTION

The preventive effects of chronic physical exercise (CPE) on Alzheimer's disease (AD) are now admitted by the scientific community. Curative effects of CPE are more disputed, but they deserve to be investigated, since CPE is a natural non-pharmacological alternative for the treatment of AD.

AREAS COVERED

In this perspective, the authors discuss the impact of CPE on AD based on an exhaustive literature search using the electronic databases PubMed, ScienceDirect and Google Scholar.

EXPERT OPINION

Aerobic exercise alone is probably not the unique solution and needs to be complemented by other exercises (physical activities) to optimize the slowing down of AD. Anaerobic, muscle strength and power, balance/coordination and meditative exercises may also help to slow down the AD progression. However, the scientific evidence does not allow a precise description of the best training program for patients with AD. Influential environmental conditions (e.g. social relations, outdoor or indoor exercise) should also be studied to optimize training programs aimed at slowing down the AD progression.

Group-Based Exercise as a Therapeutic Strategy for the Improvement of Mental Outcomes in Mild to Moderate Alzheimer’s Patients in Low Resource Care Facilities

Background: Exercise is related to enhanced cognitive functioning and brain plasticity. Exercise might represent a potential adjunctive treatment for neuropsychiatric disorders, such as Alzheimer's disease (AD). Furthermore, group exercise may prove especially useful due to its additional benefits. Objectives: This study aimed to determine the effect of low-cost, group-based exercise on mental outcomes in patients with mild to moderate AD. Methods: Participants with mild to moderate AD were randomized to either a non-exercising control (CON) group or a group-exercise (GEX) group (n = 20 each). The GEX participated in eight weeks of three-times-weekly non-consecutive 45-minute sessions consisting of balance, resistance, aerobic, and flexibility exercises to determine their effect on mental outcomes, namely, cognitive function, activities of daily living (ADLs), and quality of life (QOL). Results: The intervention program showed a significant (P ≤ 0.05) increase in Mini-Mental State Examination (MMSE) scores (P = 0.023). While the GEX were found to have no change in their (Alzheimer’s disease cooperative study activities of daily living) ADCS-ADL scores (P = 0.574). The CON demonstrated a significant, but deleterious 13.77% decrease in their ADCS-ADL scores from pre- to mid-test (P = 0.023) and from pre- to post-test (P = 0.038). Quality of Life-Alzheimer’s Disease (QOL-AD) scores were unchanged in both the GEX and CON. Conclusions: Our results indicate that a low-cost, multidimensional group exercise intervention can positively influence cognitive function and improve patients with mild to moderate AD ability to perform ADLs.

Four-month treadmill exercise prevents the decline in spatial learning and memory abilities and the loss of spinophilin-immunoreactive puncta in the hippocampus of APP/PS1 transgenic mice

BACKGROUND

Previous studies have reported that exercise could improve the plasticity of hippocampal synapses. However, the effects of exercise on synapses in the hippocampus in Alzheimer's disease (AD) are not completely known.

METHODS

In this study, thirty 12-month-old male APP/PS1 double transgenic mice were randomly divided into a sedentary group (n = 15) and a running group (n = 15). Fifteen 12-month-old male wild-type littermates were assigned to the control group (n = 15). While running mice were assigned to treadmill running for four months, the control mice and sedentary mice did not run during the study period. After Morris water maze testing, five mice in each group were randomly selected for a stereological assessment of spinophilin-immunoreactive puncta in the CA1, CA2-3 and dentate gyrus (DG) of the hippocampus.

RESULTS

Morris water maze testing revealed that while the learning and memory abilities in sedentary APP/PS1 mice were significantly worse than those in wild-type control mice, the learning and memory abilities in running APP/PS1 mice were significantly better than those in sedentary APP/PS1 mice. The stereological results showed that the spinophilin-immunoreactive puncta numbers of the CA1, CA2-3 and DG in the hippocampus of sedentary APP/PS1 mice were significantly lower than those of wild-type control mice and that the numbers of these spines in the CA1, CA2-3 and DG in the hippocampus of running APP/PS1 mice were significantly higher than those of sedentary APP/PS1 mice. Moreover, a running-induced improvement in spatial learning and memory abilities was significantly correlated with running-induced increases in the spinophilin-immunoreactive puncta numbers in the CA1 and DG of the hippocampus.

CONCLUSIONS

Four-month treadmill exercise induced a significant improvement in spatial learning and memory abilities and a significant increase in the number of spinophilin-immunoreactive puncta of the CA1, CA2-3 and DG in the hippocampus of APP/PS1 mice. Running-induced improvements in spatial learning and memory abilities were significantly correlated with running-induced increases in the spinophilin-immunoreactive puncta numbers in the CA1 and DG of the hippocampus.

Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review

OBJECTIVE

Neuropsychiatric symptoms (NPs) affect almost all patients with Alzheimer disease (AD). Because of the complications associated with the pharmacological treatment, nonpharmacological treatment (such as physical activity) can be considered as an additional complementary treatment option for NPs. The aim of this review is to evaluate the impact of physical activity on NPs in patients with AD.

METHODS

We searched Pubmed and Google Scholar for potential eligible articles until March 1, 2018.

RESULTS

Although there are contradictory results showing the impact of physical exercise on NPs, most of them reported that it had a significant effect on depression and sleep disturbances in patients with AD. The beneficial effects could be explained through several mechanisms, including modulated production of neurotransmitters; increasing neurotrophins, such as brain-derived neurotrophic factor; reduction of oxidative stress and inflammation; elevation of cerebral blood flow; hypothalamic pituitary adrenal axis regulation; and support of neurogenesis and synaptogenesis. Physical activity can also improve cardiovascular risk factors, which may exaggerate NPs. There is limited evidence for other NPs such as agitation, disinhibition, apathy, hallucinations, and anxiety.

CONCLUSION

Physical activity may ameliorate depression and sleep disturbances in patients with AD. Therefore, physical activity can be a "potential" add-on treatment to drugs to reduce or prevent these symptoms onset and recurrence in patients with AD. However, further studies are needed to focus on relationship between physical activity and other NPs.

Observing brain function via functional near-infrared spectroscopy during cognitive program training (dual task) in young people

[Purpose] To study the brain function during a dual task (cycling exercise and cognitive training) via functional near-infrared spectroscopy in young males. [Participants and Methods] Twenty Japanese young male participants were divided into intervention and control groups by simple randomization (n=10 per group). In the intervention group, participants were given a cognitive program training and cycling exercise (dual task). The control group was given the cognitive program training (single task) only. The cognitive program training consisted of a warm up, followed by 2 minutes of rock-paper-scissors, 2 minutes of numeric memory, 2 minutes of color matching, 2 minutes of calculations, and a cool down. Brain function tests were performed individually throughout the programs by functional near-infrared spectroscopy. [Results] The oxyhemoglobin levels significantly increased in the frontal lobe of the intervention and control groups after program completion compared to before. And the oxyhemoglobin levels of the intervention group also significantly increased more than control group in the prefrontal cortex and motor area. [Conclusion] This program used by Cognibike was also effective for improving hemoglobin oxygen levels at the frontal lobe in young males.

Sex Differences in the White Matter and Myelinated Fibers of APP/PS1 Mice and the Effects of Running Exercise on the Sex Differences of AD Mice

Previous studies have suggested that changes in the white matter might play an important role in the pathogenic processes of Alzheimer's disease (AD). However, no study has investigated sex differences in these changes. Previous studies found that running exercise could delay both the decline in spatial learning and memory abilities as well as the changes in the white matter during early AD in male mice. However, whether exercise also has an effect on the changes in the white matter in female AD mice remains unknown. To address these questions, 6- and 10-month-old male and female APP/PS1 double transgenic AD mice were used. The 6-month-old male and female APP/PS1 double transgenic AD mice underwent a 4-month running exercise regime. The white matter volume and parameters of the myelinated fibers in the white matter of the 10-month-old exercised and non-exercised male and female AD mice were investigated using electron microscopy and stereological methods. There were no significant differences in the mean escape latencies between the male and female AD mice in the non-exercised groups, but after 4 months of treadmill exercise, the mean escape latencies of the female exercised AD mice had significantly shortened compared with those of the male exercised AD mice. The total white matter volume and most of the parameters of the myelinated fibers of the white matter in the female AD mice were significantly lower than those of the male AD mice. The total length of the myelinated fibers with diameters ranging from 0.6 to 0.7 μm, the axonal diameter of the myelinated fibers and the g-ratio of the myelinated fibers in the white matter of the exercised female AD mice were significantly increased compared with those of the non-exercised female AD mice. There were sex-specific differences in the white matter and myelinated fibers of white matter in the AD mice. Running exercise more effectively delayed the decline in spatial learning and memory abilities and delayed the changes in the myelinated fibers of the white matter in female transgenic mice with early AD than in male transgenic mice.

The Role of Caregivers in Physical Activity for Older Adults With Alzheimer's Disease

This study examined the determinants of physical activity (PA) for older adults with Alzheimer's disease (AD) to learn more about how to promote PA in this population. Caregivers of older adults with AD (N = 99) provided information related to care recipient's PA, as well as addressed sociodemographics and perceptions about their care recipient's PA. Gender of care recipient was a significant predictor of PA (β = .80, P < .05); men with AD participated in more PA than women with AD. Also, caregiver's outcome expectation for care recipient's PA also predicted more PA (β = .82, P < .05). Caregiver's perceived benefits of PA (outcome expectation) for their care recipient partially mediated the relationship between self-efficacy for care recipient's PA and the reported levels of PA for the care recipient. This study demonstrated the importance of caregiver perceptions about care recipient's PA.

Role of physical exercise in Alzheimer's disease

The benefits of physical exercise on the brain and general wellness are well recognised, but not particularly well known to the general public. Understanding the importance of integrating active behavior for overall health is crucial at any age and particularly for the elderly who are at risk of developing Alzheimer's disease (AD), a disease mainly affecting individuals aged >65 years. AD is a neurodegenerative disease characterized by extracellular senile plaques of amyloid-β, intracellular neurofibrillary tangles of the protein tau, brain atrophy and dementia. The beneficial effects of physical exercise have been observed on the maintenance of brain size and efficiency for the prevention of AD risks, such as obesity, hypertension and stroke. These effects are extended to individuals with, or at risk of dementia and other age-related neurodegenerative disorders. Accordingly, although extensive studies are required to fully understand the mechanisms by which physical exercise procures beneficial effects, data suggest the relevance of integrating physical exercise in the prevention and/or cure of AD, disease whose incidence is predicted to increase in the future. Such an increase, may pose medical, social and economical challenges for populations and the health care system worldwide. In the present review we assess the positive aspects of physical exercise with regard to prevention and cure of AD.

Protective Effects of Physical Exercise in Alzheimer's Disease and Parkinson's Disease: A Narrative Review

Alzheimer's disease (AD) and Parkinson's disease (PD) are devastating, frequent, and still incurable neurodegenerative diseases that manifest as cognitive and motor disorders. Epidemiological data support an inverse relationship between the amount of physical activity (PA) undertaken and the risk of developing these two diseases. Beyond this preventive role, exercise may also slow down their progression. Several mechanisms have been suggested for explaining the benefits of PA in the prevention of AD. Aerobic physical exercise (PE) activates the release of neurotrophic factors and promotes angiogenesis, thereby facilitating neurogenesis and synaptogenesis, which in turn improve memory and cognitive functions. Research has shown that the neuroprotective mechanisms induced by PE are linked to an increased production of superoxide dismutase, endothelial nitric oxide synthase, brain-derived neurotrophic factor, nerve growth factor, insulin-like growth factor, and vascular endothelial growth factor, and a reduction in the production of free radicals in brain areas such as the hippocampus, which is particularly involved in memory. Other mechanisms have also been reported in the prevention of PD. Exercise limits the alteration in dopaminergic neurons in the substantia nigra and contributes to optimal functioning of the basal ganglia involved in motor commands and control by adaptive mechanisms involving dopamine and glutamate neurotransmission. AD and PD are expansive throughout our ageing society, and so even a small impact of nonpharmacological interventions, such as PA and exercise, may have a major impact on public health.

Treatment of Alzheimer's disease in Iranian traditional medicine

BACKGROUND

Alzheimer's disease (AD) is a progressive neurodegenerative disease with a high prevalence in recent years. Dramatic growth in AD prevalence has increased the importance of more researches on AD treatment. History has shown that traditional medicine can be a source of inspiration to find new therapies.

OBJECTIVES

This study tried to codify the recommendations of Iranian traditional medicine (ITM) by studying the main medical manuscripts. The second purpose was to compare these findings with new medical information.

MATERIALS AND METHODS

Cardinal traditional medical and pharmacological texts from 10th to 18th century were searched for traditional terms of dementia (Nesyan, Fisad-uz-Zekr, Faramooshkari) focused on treatment methods. The findings were classified into three groups: lifestyle recommendations, dietary approaches, and drug therapies. These findings were compared with new medical findings.

RESULTS

ITM has dietary recommendations for dementia such as increasing consumption of nuts, poultry and eggs, milk, and grape products (like raisin and currant). These compounds are full of unsaturated fatty acids, cholesterol, and polyphenolic compounds. New findings suggest that these substances can help in prevention and treatment of AD. ITM has some lifestyle considerations like increasing physical and mental activities, listening to music, attending musical feasts, and smelling specific perfumes. New medical findings confirm nearly all of these recommendations. Along with the aforementioned items, treatment with natural medicines is in the first line of traditional treatment of dementia. New investigations show that many of these herbs have antioxidant, anti-inflammatory factors and acetylcholine esterase inhibitory effects. A few of them also have N-methyl-D-aspartate (NMDA) blocking activity. When these herbs are put together in traditional formulations, they can comprehensively fight against the disease.

CONCLUSIONS

More ethnopharmacological and ethnomedical studies on ITM antidementia therapy can be followed by fruitful results.

Structured exercise does not stabilize cognitive function in individuals with mild cognitive impairment residing in a structured living facility

Exercise has been shown to have positive effects on the brain and cognition in healthy older adults, though no study has directly examined possible cognitive benefits of formal exercise programs in persons with mild cognitive impairment (MCI) living in structured facilities. Thirty-one participants completed neuropsychological testing and measures of cardiovascular fitness at baseline and after 6 months of a structured exercise program that included aerobic and resistance training. While exercise improved cardiovascular fitness in persons with MCI, there was no improvement in cognitive function. Rather, MCI patients in this sample declined in performance on several tests sensitive to Alzheimer's disease. Examined in the context of past work, it appears exercise may be beneficial prior to the onset of MCI, though less helpful after its onset.