Slowing Alzheimer’s Disease Progression with Physical Therapy
Alzheimer’s disease is a progressive neurodegenerative disease in the elderly associated with dementia, memory loss, severe cognitive impairments, and eventually physical limitations. Alzheimer’s disease develops due to microscopic changes that take place in the brain, such as amyloid beta protein plaques, increased neuro-inflammation, decreased nerve growth factors, oxidative stress, and decreased synaptic connections in the brain, all of which damages brain cells and nerves and leads to the physical and cognitive symptoms of the condition. Physical therapy can slow Alzheimer’s disease progression and help individuals maintain physical and cognitive function as much as possible through a targeted exercise program.
Understanding Alzheimer’s Disease
Alzheimer’s disease is a progressive neurodegenerative disease in the elderly associated with dementia, memory loss, severe cognitive impairments, and eventually physical limitations. In the United States, 6.5 million people aged 65 and older live with Alzheimer’s with 70% of them age 75 or older. Alzheimer’s disease is the fifth leading cause of death among American adults over 65. Alzheimer’s disease also accounts for 60 to 80% of all dementia cases.
Alzheimer’s disease develops due to microscopic changes that take place in the brain, such as amyloid beta protein plaques, increased neuroinflammation, decreased nerve growth factors, oxidative stress, and decreased synaptic connections in the brain, all of which damages brain cells and nerves and leads to the physical and cognitive symptoms of the condition. There are also lifestyle factors that can contribute to the development of Alzheimer’s: physical inactivity, smoking, insulin resistance and diabetes, abdominal obesity, high cholesterol, high blood pressure, and diet.
Signs of Alzheimer’s Disease
Alzheimer’s disease often develops years before diagnosis with mild symptoms like a slowed gait and lapses in memory before progressing to more serious physical and cognitive limitations like memory loss or confusion about time and place.
Common signs of Alzheimer’s disease include:
Memory loss and changes that disrupt daily life
Difficulty making decisions, planning, and solving problems, like planning and cooking a meal
Confusion about time and place
Difficulty completing familiar tasks like bathing or dressing
Trouble comprehending visual images or spatial relationships
Struggling to find the right words to speak or write
Misplacing items in odd places or losing the ability to retrace steps
Poor or decreased judgment about safety
Withdrawal from work and social activities
Changes in mood or personality such as depression or mood swings
In later stages of the disease, individuals with Alzheimer’s may become restless and wander in the late afternoon or evening, called “sundowning.” Alzheimer’s also has physical symptoms that negatively affect the body’s ability to correct its balance or manage spatial awareness, causing those with the condition to have a heightened risk of falling and injury. People with dementia fall twice as often as their cognitively intact counterparts due to increased gait variability and instability, causing a higher incidence of falls and fractures.
Physical Therapy’s Role in Slowing Alzheimer’s Disease Progression
Physical therapy can slow Alzheimer’s disease progression and help individuals with the condition maintain physical and cognitive function as much as possible through a targeted exercise program. Research has shown that regular exercise can not only delay the onset of Alzheimer’s disease in healthy older adults, but also improve the function and quality of life of Alzheimer’s patients. In fact, higher levels of physical activity are linked to a decreased incidence of all-cause dementia and Alzheimer’s disease. One study of 160,000 participants found that regular exercise reduced the risk of Alzheimer’s disease by 45%.
A physical therapy exercise program can include therapeutic exercise like aerobic exercise (walking, cycling, aquatic therapy) and resistance training; balance training; manual therapy soft tissue and joint mobilizations; gait and neuromuscular retraining; and functional training.
Benefits of Exercise for Alzheimer’s Disease
Exercise provides numerous benefits against the neurodegenerative processes of Alzheimer’s disease:
Exercise improves neurotransmitter release, stimulates the production of antioxidant molecules and endorphins, and reduces inflammation in the body and neuroinflammation in the brain.
Exercise boosts blood circulation to the brain which activates brain vascularization, plasticity, and neurogenesis and improves oxygen and nutrient delivery to the brain. These processes are essential to maintain and enhance brain function and promote the growth of new brain cells.
Exercise can enhance attention, executive function, and information processing speed.
Exercise stimulates the production and release of neurotrophic factors, such as BDNF (brain-derived neurotrophic factor), which aids with glucose control and provides neuroprotective properties.
Exercise increases the volume of the hippocampus and can even reverse hippocampal volume reduction, improving and preserving memory performance.
Exercise restores the permeability and integrity of the BBB (blood-brain barrier) by repairing damage to brain cells and preventing the entry of inflammatory agents and immune cells into the brain.
Exercise helps produce a hormone called irisin that increases neprilysin levels, which can help fight the brain-damaging abnormal protein amyloid beta (AB) that forms plaques in the brains of those with Alzheimer’s.
Exercise improves cardiovascular health like resting heart rate and blood pressure; decreases the risk of falls; enhances sleep and boosts mood; can reduce anxiety and depression; help patients control emotional symptoms associated with Alzheimer’s like irritability and restlessness; and slows cognitive function loss.
Numerous research studies support the use of exercise as a way to prevent and slow the progression of Alzheimer’s disease. Aerobic exercise has been shown to significantly increase BDNF plasma levels in those with Alzheimer’s and improve brain energy metabolism and cognitive disorders by increasing the absorption of ketones and glucose in the brain. One study assessed the impact of moderate-to-high-intensity aerobic exercise on a treadmill or stationary bike in patients with mild Alzheimer’s and found that this intervention preserved cognitive function while improving physical parameters. Another study used an intervention of aerobic, resistance, and combined training for 6 weeks, 3 times a week in Alzheimer’s patients and found that freezing time (lack of movement in the head, trunk, and limbs) was reduced and working memory was improved.
Researchers have found that physical activity can reduce the risk of cognitive decline, helping to delay the onset of Alzheimer’s disease, and that exercise is beneficial for brain health regardless of when it was initiated (even later in life in the 50s, 60s, and 70s). Several large-scale, long-term follow-up studies have revealed that higher levels of physical activity were linked to decreased incidence of both all-cause dementia and Alzheimer’s disease.
Both aerobic and resistance training are effective in slowing symptoms of Alzheimer’s disease and improving cognitive and physical health. A metanalysis of the effect of aerobic exercise on Alzheimer’s patients found that aerobic exercise can improve intellectual and cognitive impairments in Alzheimer’s patients, improving verbal episodic memory, visual-spatial reasoning abilities, processing speed, and selective attention. Studies suggest that aerobic exercise promotes neuroplasticity, induces increased hippocampal neurogenesis, and protects against or reverses age-related hippocampal atrophy. Resistance training has been found to improve global and executive function and slow the degeneration process of the Alzheimer’s vulnerable hippocampus up to 12 months post-intervention.
Alzheimer’s disease is a difficult, progressive disease for both the patient and their families. As physical therapists, we are here to support you and your loved one as you navigate this condition, help slow symptoms of the disease, and improve your loved one’s overall fitness and quality of life. Give us a call to start your journey towards improved quality of life today!
