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ALZHEIMER'S DISEASE & EXERCISE

What is Alzheimer’s Disease (AD)?

Alzheimer’s is a progressive neurodegenerative disease. It is most common in individuals over 65 years of age and is predicted to become more prevalent as our population ages.  


The healthy human brain contains tens of billions of neurons which send messages between different regions of the brain. With AD, there is an abnormal build-up of proteins called amyloid and tau.  These proteins clump together to form plaques inside and between neurons. The accumulation of these proteins disrupts processes vital to the function of neurons, in turn leading to cell death and decreased brain volume (atrophy). 

Brain neurons

Symptoms

AD often develops slowly over several years, so symptoms are not always obvious at first. 

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Early symptoms of AD may include:

  • Regularly forgetting recent events, names, and faces

  • Becoming increasingly repetitive, e.g. repeating the same question

  • Regularly misplacing items or putting them in odd places

  • Confusion of dates or time of day

  • Being unsure of whereabouts or getting lost

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As Alzheimer’s progresses, further symptoms may include:

  • Changes to sleep patterns 

  • Becoming sad, depressed, or frustrated about daily challenges 

  • Problems with walking, balance, and swallowing  

  • Hallucinations and delusions

Risk Factors

There are a mix of risk factors for AD. Some, like age and genetics, are non-modifiable. Many of the modifiable risk factors that we can influence are the same as for cardiovascular disease.

       Modifiable risk factors for AD:

  • Physical activity / exercise levels 

  • Smoking 

  • Nutrition 

  • Blood pressure

  • Cholesterol 

  • Body weight

  • Alcohol consumption

  • Participation in cognitive activities

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(Generations Magazine)

Studies and clinical trials show that better fitness is associated with lower cognitive decline.


Additionally, several cellular/molecular pathways appear to be involved in the development and progression of AD, including:

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  • Chronic inflammation 

  • Vascular health 

  • Oxidative stress and metabolism 

  • Regulation of cell turnover and cell death 

  • Synaptic plasticity 

Alzheimer's disease and related molecular pathways

Alzhaimer's disease and related molucelar pathways

Treatments

Currently, pharmacological treatments available in the UK for AD do not slow or stop the disease from getting worse, but they may help manage symptoms for a time. 

Pharmacological options include:

  • Cholinesterase inhibitors 

  • Memantine

 

In 2022 results from a trial were released showing a drug called lecanemab was successful in helping remove amyloid from the brain, slowing down the decline in memory and cognitive ability.  The changes were small, but it has been interpreted as the ‘herald of a new era – the arrival of a treatment that is proven to slow the course of Alzheimer’s disease.’

How can exercise help?

Accumulating evidence suggests that physical activity and exercise has the potential to be an effective strategy for counteracting the processes implicated in AD and delaying its development, slowing its progression, and reducing its severity. 


As mentioned earlier, many of the modifiable risk factors for AD that we can influence are the same as for cardiovascular disease.  A combination of aerobic and resistance training has been robustly demonstrated to positively affect these risk factors.  


When it comes to the impact of exercise on the brain specifically, research shows that higher levels of physical activity are associated with reduced levels of amyloid plaques in individuals with AD (remember, the accumulation of amyloid is one of the main causes of AD).


Exercise has been shown to preserve brain mass and function in areas affected by AD. It can:

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  • increase brain volume in both grey and white matter

  • increase cerebral blood flow (delivery of oxygen and nutrition)

  • increase hippocampus volume 

  • improve brain plasticity (creation of new neuronal connections).

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The reported positive day to day effects of exercise for those with AD include improvements in cognitive function, physical function, and the ability to perform activities of daily living. 


Exercise has been demonstrated to positively impact risk factors and cellular mechanisms implicated in AD. By taking steps to look after our brain and heart health we can reduce our risk of developing and delaying the onset of AD later in life.

Exercise for Alzheimer's didease

The Vitruvian Team.

Physical Exercise and Alzheimer’s Disease: Effects on Pathophysiological Molecular Pathways of the Disease 

Lopez-Ortiz et al.  International Journal of Molecular Sciences.  2021


Cognitive Effects of Aerobic Exercise in Alzheimer’s Disease: A Pilot Randomised Controlled Trial

Yu et al. Journal of Alzheimer’s Disease. 2021


Healthy lifestyle and the risk of Alzheimer’s dementia

Dhana et al. Neurology. 2020


Alzheimer’s Research UK


What happens to the brain in Alzheimer’s Disease?

National Institute on Ageing. 2017

     
Aerobic exercise training increases brain volume in ageing humans                   

Colcombe et al.  Journal of Gerontology and Biological Science. 2006

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