Exercise seems to help those with Alzheimer’s and dementia think better and behave more appropriately

By Judie L. Kinonen

Eight elderly people—most seated in folding chairs, a couple in wheelchairs—each wrap the ends of a brightly-colored necktie around both hands and stare ahead at a video, awaiting further instruction. On screen, a cheery middle-aged woman in a pink leotard, speaking above the upbeat cadences of ragtime music, asks the students to bend at the waist and wrap the necktie under the instep of one foot. Most students gradually comply, several of them managing a bent-knee stretch. Others can only lean forward, hold out their arms and crane their necks.

Overseeing the workout is Mari Berend, program director for Libbie’s Place Adult Day Service in Galveston, a program offering recreational and social activities for older adults, particularly those with Alzheimer’s disease or dementia—a group of conditions that gradually destroys brain cells and leads to progressive decline in mental function.

Berend, a tall, athletic-looking woman in her late 30s, watches the class and notes with more than a hint of irony, “They’re not exactly synchronized.” But citing benefits far beyond increased flexibility, strength, or endurance, she says time spent in any physical activity with this group is time well spent. “I definitely notice a difference in their attitude, both mentally and socially, after they exercise,” she says.

That difference in attitude was one focus of recent research by UTMB rehabilitation specialists, who analyzed studies of older people with dementia and Alzheimer’s disease who were involved in some kind of exercise routine. The findings suggest that exercise not only made these subjects more physically fit but it significantly improved their ability to think clearly and behave appropriately, reducing some of the most troubling symptoms of Alzheimer’s, such as agitation, confusion, and aggression.

The findings will come as no surprise to anyone who has tried exercise as an intervention with older people, according to lead investigator Patricia Heyn, former postdoctoral fellow in UTMB’s Division of Rehabilitation Sciences who now conducts dementia and exercise physiology research for the University of Colorado Health Science Center. Heyn says the seed for this study was planted by her own casual observation of a group of elderly people.

As wellness and health promotion manager for the City of Casselberry, Florida, in 1997, Heyn developed an exercise program for the city’s seniors. Within just a few weeks, she saw what she expected—marked gains in the participants’ physical fitness levels. But she also saw something more surprising. “Many of my students had cognitive impairments, and I noticed that after the exercises these students were more alert, spoke more ably, and presented in a better mood.”

Her curiosity piqued, Heyn developed an exercise program in 1999 specifically for people with moderate to advanced Alzheimer’s disease. After only a few weeks, participants’ caregivers reported great improvements in their patients’ mood, awareness, and disposition. These findings were published last year in the American Journal of Alzheimer’s Disease and Other Dementias, but they were greeted with skepticism by scientists in the gerontological professional community, Heyn says.

At that point, there was some disagreement in the literature about the benefit of exercise among older people with dementia, says Kenneth Ottenbacher, senior associate dean in UTMB’s School of Allied Health Sciences and an investigator on Heyn’s more recent study. Everyone knows—as research has already established—that exercise has positive effects on the general population and on older people. But there had never been an attempt to look at the body of research related to older people with dementia. Research addressing this group had small sample sizes and yielded inconsistent findings. What the literature lacked was a synthesis of these small studies, Ottenbacher says.

So he, Heyn, and Beatriz Abreu, UTMB clinical professor of occupational therapy, gathered the thirty best studies on exercise intervention for people with dementia, asking whether physical activity benefited them in four areas: physical, functional, behavioral, and cognitive. The findings of this so-called meta-analysis confirmed Heyn’s observation that exercise has significant, across-the-board benefits for older people with dementia, and causes a striking increase in what the authors called
“positive behavior.”

The study, published in the October 2004 issue of Archives of Physical Medicine & Rehabilitation, raises more questions than it answers, Ottenbacher acknowledges: How much exercise is beneficial? How does a caregiver motivate people in this group to exercise? What specific type of exercise is best? The study also left unanswered the question of why. What is it about physical exercise that has a positive effect on the brain, even after dementia has set in? Heyn says this heart-brain connection is a scientific mystery outside the scope of this one paper.

What this research does offer, however, is a possible alternative to today’s most common treatment for dementia—psychiatric drugs. Heyn says demand is growing for psycho-behavioral therapies which are non-drug strategies caregivers can use to address behavior problems in patients with dementia. She predicts that more people will choose these therapies as studies like hers prove they work.
She does not need to convince Berend or her Libbie’s Place participants. Together, they do some sort of exercise every day, including tai chi, dancing, indoor volleyball, miniature golf, and walks along the beach.

Heyn says workouts in the analyzed studies were mostly aerobic, such as walking or swimming, and they were conducted four times per week for about forty-five minutes. This is a good rule of thumb for caregivers, but the health care community has yet to design specific guidelines or recommendations. Heyn, Ottenbacher, and Abreu hope this study will prod them to do so.