Can Physical Activity Help Prevent & Combat Mild Cognitive Impairment’s and Dementia?

Hi Everyone


I hope all is well


This is a the next post of 2020. It is from my friend and colleague Tom Wing all around Dementia and Physical Activity.





Hope all my readers you find this useful :)


Enjoy!


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Hi Everyone,

Thank you for taking the time read this post!

I am currently studying MSc Physiotherapy (Pre-registration) at Teesside University, following graduating top of my class with 1st class honours in Sport’s Therapy and Rehabilitation. Since I have become a fully accredited member of the British Association of Sport Rehabilitators and Trainers (BASRaT) and was present with the GrayBrook award in 2019 for the highest academic degree classification for all Sports Rehabilitation courses in the United Kingdom.  I would like to state I am NOT an expert on Dementia care but as a healthcare professional I am an advocate of Physical Activity and Exercise.

If anyone would like guidance on Physical Activity and Exercise, please contact me via my company’s (Teesside Athletic Academy) Facebook or Instagram page.   The links are at the end of the article 

Introduction

The word dementia originates from the Latin words – de and mens - translating as out of mind, leading to the development cultural stigma surrounding the illness (Mukadam, and Livingston 2012). Subsequently the loss of independence and autonomy experienced by patients with dementia (PwD) maybe due to the combination of cultural stigma and the illness (Mukadam, and Livingston, 2012; Yates et al., 2019). Dementia was referred historically to as a clinical syndrome affecting the brain and manifesting as a reduced cognitive status, typically within the elderly demographic (Breitner, 2006; Mukadam, and Livingston, 2012). This led some researchers to infer the pathology is a mental health disorder, adding to the aforementioned  cultural stigma surrounding the disorder (Mukadam, and Livingston, 2012). The illness should now be recognized as a neurocognitive condition (Palm et al., 2016). Epidemiological data suggests the condition is the greatest international challenge to 21^st century health/social care and due to the ageing populace, prevalence is set to triple by 2050 (Mukadam, and Livingston, 2012; Livingston et al., 2017; Beydoun, and Kivimaki, 2019; World Health Organization, 2019). A systematic review by Suijkerbuijk et al., (2019), expresses the need to develop interventions promoting independence and well-being in PwD. The Lancet Commission for dementia care substantiates this, adding despite the underlying neurological condition remaining largely uncurable, the clinical manifestations may be modifiable with excellent care (Livingston et al., 2017). Physical Activity and Exercise maybe one such intervention.

Prevention of Mild Cognitive Impairment and Dementia

It is well documented increased exercise and physical activity in the older population positively impact upon falls, mood, function, mortality and combats risk factors of dementia - diabetes, hypertension, and obesity (Blake et al., 2009; Almeida et al., 2014; de Labra et al., 2015; Livingston et al., 2017; Blond et al., 2019; de Souto Barreto et al., 2019; Ekelund et al., 2019; García-Hermoso et al., 2020). A meta-analysis of prospective cohort studies (n=33,816) by Sofi et al., (2011) conducted  high levels physical activity and exercise had a significant effect in mitigating cognitive decline in PwD. As explored throughout the Lancet Commission adults who perform regular physical activity and exercise display a greater prospect of maintaining cognitive function than those that do not, appearing to have an inverse relationship with rates of the cognitive decline or dementia (Livingston et al., 2017). The effectiveness of physical activity and exercise  in combating cognitive decline is substantiated by a meta-analysis (n=163,797), suggesting that rates of dementia are lower in persons who perform high levels of physical activity and exercise  (Hamer and Chida, 2009). Due to the lack of randomized controlled trials (RCT) within the meta-analyses both Hamer and Chida, (2009); Sofi et al., (2011) have low internal validity. Nevertheless, clinical relevance may still be taken from Hamer and Chida, (2009); Sofi et al., (2011)  due to the large sample size within reducing the impact of within-subject variation, thus increasing the reliability of the results (Hopkins 2000; Hopkins 2019).

The Effect of Physical Activity and Exercise on Mild Cognitive Impairment

As discussed through the Lancet Commission there is a developing body of research suggesting exercise and physical activity may be beneficial for suffers of the mild cognitive impairment  (Livingston et al., 2017). Despite this, there is conflicting evidence documenting the effectiveness of exercise and physical activity as an intervention to improve cognition in an older demographic. Furthermore, the National Institute for Health and Care Excellence (NICE) Guidelines, (2018) only recommended exercise for dementia patients with disturbed sleep. A Cochrane review of 12 studies (n=754) reported that there is no evidence to supporting the utilization of aerobic exercise as an intervention to improve cognition in healthy elderly adults (Young et al., 2015). A meta-analysis by Kelly et al., (2014), of 25 RCT’s corroborate findings of the Cochrane review, suggesting the evidence surrounding aerobic exercise to improve cognition to be inconclusive. As the meta-analysis has a high number of RCT’s the meta-analysis has an exceptionally high internal validity as RCT’s are considered to be level 1 evidence for evidence-based practice (Hshieh et al., 2015). Despite this, aerobic exercise may be an effective intervention for elderly adults suffering with cognition impairments such as dementia. A meta-analysis of 11 papers by Zheng et al., (2016) found aerobic interventions were effective in improving global cognition in the elderly populace with cognitive impairment. This is validated by a recent meta-analysis of 5 RCT’s by Zhu et al., (2020) discovered aerobic dance had positive effects on global cognition (Mean difference=1.43; 95% CI: [0.59, 2.27]; p=0.0009). Due to all the studies within the meta-analysis being RTC’s, Zhu et al., (2020) has a high internal validity. Despite this, as aerobic dance is an emerging intervention to improve cognition there is a limited number of studies available for analysis, reducing external validly. Further research is needed to verify finding by Zhu et al., (2020) before aerobic dance can be utilized as intervention. Nonetheless, this adds to the expanding body of research supporting the use of aerobic activity by healthcare professionals to improve cognition in elderly patients suffering with cognitive deficiency.

The Effect of Physical Activity and Exercise on Dementia

A Cochrane review of 17 trials studies (n=1067) found no evidence exercise improved cognitive function in PwD and deemed the evidence to be very low quality (Forbes et al., 2015). Studies within the review are dated pre 2013, more contemporary evidence endorses the utilization of exercise and physical activity to enhance cognition. Subsequent systematic-reviews/meta-analyse investigating physical actively and exercise as an intervention in patients living with Alzheimer’s disease and dementia, thus disputing the findings of Cochrane review (Groot et al., 2016; Karssemeijer et al., 2017; Du et al., 2018; Jia et al., 2019; Law et al., 2020). The Lancet Commission concluded, exercise programs for PwD suffering mild to moderate dementia is well accepted with high-intensity exercise groups well evidenced among-st Alzheimer’s suffers (Livingston et al., 2017). A systematic review of 50 papers (n=5099) by Law et al., (2020), uphold findings by the Lancet Commission, inferring there is moderate evidence supporting the use of aerobic exercise at moderate to high intensity to improve global cognition in PwD. Nevertheless, Egger’s regression asymmetry test discovered publication bias to be present among-st studies within the review, hence impacting upon the validity of the results (Hussain et al., 2011). Healthcare professionals may still take clinical relevance from the Lancet Commission and Law et al., (2020) as it highlights the importance of reaching aerobic threshold during high intensity exercise sessions to facilitate hippocampal neurogenesis (Erickson et al., 2011; Erickson, Gildengers and Butters, 2013; Livingston et al., 2017).

Manipulation of Training Variables

The manipulation of other training variables - such as frequency, session duration and length of intervention may also have beneficial impacts on cognition as well as intensity. A meta-analysis of 13 studies by Jia et al., (2019) reports lower frequency (≤3 sessions a week) and sessions duration  (≤30-minute) of moderate to high intensity sessions to have the greatest impact on cognition in patients suffering from Alzheimer’s. Furthermore, interventions longer than 16 weeks appear to have more beneficial impacts on cognition. This is substantiated by Law et al., (2020), concluding if the total training duration is greater than 24-hours the effectiveness of intervention may increase. Nonetheless, Jia et al., (2019) suggests due to the variation in exercise interventions, more high-quality RCT’s are needed to corroborate these findings. Healthcare professionals therefore maybe able improve patient’s global cognition through the use of ≤30-minute high intensity aerobic exercises ≤3 sessions per week for ≥16 weeks (Groot et al., 2016; Zheng et al., 2016; Karssemeijer et al., 2017; Livingston et al., 2017; Du et al., 2018; Jia et al., 2019; Law et al., 2020; Zhu et al., 2020).

Conclusion

It remains controversial whether physical activity and exercise can prevent mild cognitive impairments and dementia or whether physical activity and exercise can be utilized to treat  the conditions. Nevertheless, there is a growing body of evidence supporting this hypothesis that an increased physical activity and exercise level in the general population and the use of 30-minute high intensity aerobic exercises, 3 sessions per week for 16+ weeks, will decrease rate of cognitive impairments and dementia. It is important to note healthcare professionals or people considering this somewhat aggressive approach must first address patient safety. Therefore, considerations should be made for the patients current physical actively level, aerobic capacity, blood pressure, oxygen saturation levels etc. In addition, the patient should be closely monitored Pre, During and Post any exercise intervention.

Authors  Information

• Thomas Wing BSc (hons), G.S.R, BASRaT-reg
• Facebook Page- Teesside Athletic Academy
• Instagram- @teessideathleticacademy

Reference List

1. Hamer, M. and Chida, Y., (2009). “Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence”. Psychological medicine, 39(1), pp.3-11.
2. Hopkins, W. G. (2019). Sportscience. [online] Sportsci.org. Available at: https://sportsci.org/ [Accessed 11 Apr. 2019].
3. Hopkins, W.G. (2000). ‘Measure of Reliability in Sports Medicine and Science.’ Sports Medicine. 30, (1), 1-15.
4. Sofi, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G.F., Casini, A. and Macchi, C., (2011). “Physical activity and risk of cognitive decline: a meta‐analysis of prospective studies”. Journal of internal medicine, 269(1), pp.107-117.

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Thank you Tom for this insightful post!

I am sure the readers have enjoyed this topic and given them plenty food for thought.

Andrew Richardson, Founder of Strength is Never a Weakness Blog

I have a BSc (Hons) in Applied Sport Science and a Merit in my MSc in Sport and Exercise Science and I passed my PGCE at Teesside University. 

Now I will be commencing my PhD into "Investigating Sedentary Lifestyles of the Tees Valley" this October 2019. 

I am employed by Teesside University Sport and WellBeing Department as a PT/Fitness Instructor.  

My long term goal is to become a Sport Science and/or Sport and Exercise Lecturer. I am also keen to contribute to academia via continued research in a quest for new knowledge.

My most recent publications: 

https://www.sciencedirect.com/science/article/pii/S1752928X19300216

https://www.sciencedirect.com/science/article/abs/pii/S1752928X19301076 

My passion is for Sport Science which has led to additional interests incorporating Sports Psychology, Body Dysmorphia, AAS, Doping and Strength and Conditioning. 

Within these respective fields, I have a passion for Strength Training, Fitness Testing, Periodisation and Tapering. 

I write for numerous websites across the UK and Ireland including my own blog Strength is Never a Weakness. 

I had my own business for providing training plans for teams and athletes. 

I was one of the Irish National Coaches for Powerlifting, and have attained two 3rd places at the first World University Championships, 

in Belarus in July 2016.Feel free to email me or call me as I am always looking for the next challenge. 

Contact details below; 

Facebook: Andrew Richardson (search for)

Facebook Page: @StrengthisNeveraWeakness

Twitter: @arichie17 

Instagram: @arichiepowerlifting

Snapchat: @andypowerlifter 

Email: a.s.richardson@tees.ac.uk

Linkedin: https://www.linkedin.com/in/andrew-richardson-b0039278 

Research Gate: https://www.researchgate.net/profile/Andrew_Richardson7