The facts are sobering: Over two-thirds of individuals have a risk factor for developing dementia. Many of these factors are not modifiable, but others are. In this study, we will look at how exercise’s brain-boosting benefits can help reduce your risk of dementia, offer insights into the factors involved, and provide some guidelines for incorporating physical activity into your daily life.

 

 

Dementia and Its Risk Factors: An Overview

 

Dementia is not a single condition but an umbrella term for several cognitive impairments, with Alzheimer’s disease accounting for 60 - 80% of cases. According to the World Health Organization, there are approximately 55 million people worldwide living with dementia, with another 10 million new cases diagnosed each year.

 

The effects of dementia are widespread –it negatively impacts the physical, psychological, social, and economic status of patients. However, the effects also impact caregivers, families, and society. As our population continues to age, these numbers will only increase. Current estimates say that by 2030, the number of those diagnosed with dementia will reach 78 million, and by 2050, over 139 million will be living with dementia.¹

 

Is dementia preventable?

 

Well, yes and no.

 

Certain risk factors, such as age and genetics, are beyond our control. However, lifestyle choices—diet, sleep, and exercise—are, and are emerging as essential factors in reducing our risk of dementia. Of all the risk factors for dementia, exercise is a low-cost and nonpharmaceutical way to reduce your risk.

 

The Lancet Commission on Dementia showed that twelve modifiable risk factors were responsible for 40% of dementia cases globally, and the two important factors were lack of cognitive engagement and exercise.²

 

 

Sweat for Sanity: Exercise’s Effects on Your Brain

 

Exercise offers many benefits for brain health and is not limited to a single type. Instead, a combination of aerobic exercise, strength training, and balance and flexibility all play a role in preserving brain function.

 

How much is enough exercise?

 

No need to spend hours at the gym – The Alzheimer’s Association states that just thirty minutes of exercise five times a week can help lower your risk of dementia.⁴

 

Five Key Benefits of Exercise for Dementia Prevention

 

1. Improved Cerebral Blood Flow—It makes sense. Exercise increases blood flow to the brain, crucial for delivering oxygen and nutrients to brain cells. Dr. Jonathan S. Stamler explains, “It’s not about how much oxygen you carry in your blood; it’s about how much oxygen is actually delivered to your tissues and organs.⁴

 

2. Improved Neuroplasticity—What is neuroplasticity? It is the brain's ability to make new neural connections and adapt to new situations. Exercise augments neuroplasticity by stimulating new cell growth and strengthening existing connections. One study showed that the hippocampus, a key brain area for memory, could be increased with only moderate exercise.⁵

 

3. Reduction of Oxidative Stress and Inflammation—Several studies have established a link between oxidative stress, inflammation, and cognitive decline. Exercise's anti-inflammatory effects reduce these markers in both the body and brain.

 

4. Promotion of Brain-Derived Neurotrophic Factor (BDNF)—BDNF is a protein that plays a critical role in brain cell growth, maturation, and maintenance. A study published in 2023 showed that resistance training increased BDNF levels more than high-intensity training.

Also, the study showed that OSE or open-skill exercise, which occurs in unpredictable environments, such as tennis or table tennis, had a more significant impact on BDNF than closed-skill exercise, such as running or cycling. This study suggested that a combination of resistance training, high intensity, interval training, and open-skill exercise would benefit BDNF levels the most.⁶

5. Improvement in Other Dementia Risk Factors – Exercise benefits more than your brain – it affects other risk factors that increase your risk for dementia, such as diabetes, obesity, stress, and sleep quality.

With these five substantial benefits and the robust amount of data behind them, it is easy to see that exercise is perhaps the most effective tool for reducing dementia risk. Although it may be the biggest time commitment and the hardest habit to form, the impact of frequent exercise on the brain is so great that regular physical activity should be a priority for anyone serious about preventing cognitive decline / saving their memory / reducing their dementia or Alzheimer’s risk. (you choose the ending)

 

Optimal exercise recommendations for dementia prevention

 

Current guidelines include recommendations from the World Health Organization and the American Heart Association:

●       A minimum of 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week

●       Muscle strengthening activities involving all major muscle groups on two or more days a week

●       Balance and flexibility exercises, particularly for older adults

These are simply general guidelines. Talk with your healthcare practitioner about what program is most appropriate for you. Choose options that are both effective and fun. The best way to start a habit is to make it enjoyable. If going to the gym isn’t your thing, try taking up a sport or finding a fun outdoor activity. Keep in mind muscle strengthening activities are not limited to lifting weights. These exercises include yoga, Pilates, or other bodyweight movements like pushups or squats.

Recent research presented at the American Academy of Neurology annual meeting in 2022 showed that even light physical activity can reduce the risk of dementia and Alzheimer’s disease by 33%.⁷

 

Challenges of starting a new exercise routine

 

Maybe you’re out of shape, and it’s been years since you’ve exercised. You know you should exercise for your body, and now you know you should exercise for your brain.

Where do you start?

We have some simple suggestions to get you started and help you maintain your exercise program:

●       Start with small, achievable goals

●       Choose activities you enjoy

●       Make an appointment with exercise as you would with anyone else

●       Find an exercise partner in your exercise will be more enjoyable, and you will be more accountable

●       Use technology, such as fitness trackers, to show your progress and monitor your goals

As with many activities, consistency is key. Regular activity – even light exercise – is more beneficial than intense, sporadic activity. Dr. Starmler stresses, “If we can do this right, my hope is that everyone over 60 years old and at risk for dementia will be customizing their exercise to promote a longer, healthier life.”⁴

With exercise, some is always better than none. If you fell out of a three-day-per-week routine you established, there’s no need to throw in the towel. Ease yourself back in by adding just one day per week at a time. Even once weekly exercise will be far more beneficial than none at all.

Dr. Peter Attia, a physician known for promoting a healthy lifestyle, addresses this topic in podcast #307 ‒ Exercise for aging people: where to begin and how to minimize risk while maximizing potential.

In this episode, Dr. Attia addresses the questions that many have about starting exercise after the age of 50. Many wonder if it’s too late to start, they have no training, or they’re afraid of injury. He addresses all of these questions and emphasizes. It’s never too late to start exercising. He provides solid advice about how to start, reduce your risk, and maximize the benefits of exercise.⁸

Exercise Plus: Get More Bang for Your Buck

 

Exercise is great for your brain and body, but combining it with other lifestyle choices. The benefit is amplified. These include:

Diet — Adopting a brain-healthy diet, such as the Mediterranean diet, will benefit your brain and your waistline.

Mentally stimulating activities — multiple studies have shown the benefits of performing mentally stimulating activities, such as:

●       Learn something new – a second language or a musical instrument.

●       Play board games or get your friends together for a weekly game of cards. The bonus of activities like these is social connections (see below).

●       Work on crossword, number, or other kinds of puzzles.

●       Play online memory games or video games.

●       Read, write, or sign up for local adult education classes.

Social connections — as mentioned above, social isolation increases your risk for dementia. Maintaining social relationships can improve your mood, reduce your risk of depression as well as dementia.

Stress management techniques—In addition to promoting relaxation and improved sleep, activities such as yoga, tai chi, or meditation can reduce stress and improve cognitive abilities.

Quality sleep—the evidence is there—improves mental abilities, helps the brain recover during sleep, and reduces amyloid plaque formation.

Combining exercise with any of these above activities benefits you in several ways. An important study at the Fingers Brain Health Institute is an international global study on the modifiable lifestyle factors in reducing dementia. While the study is ongoing, it has already demonstrated the importance of early intervention in reducing dementia.⁹

Open-skill exercise (OSE) vs Closed-skill exercise (CSE): an emerging trend

Several studies have examined the benefits of open-skill exercise (OSE) and closed-skill exercise (CSE) in reducing dementia. While both are beneficial, OSE has shown more improvement in cognitive function.

	Open-skill exercise (OSE)	Closed-skill exercise (CSE)
Environment	Unpredictable - movement changes throughout the exercise	Stable - movement is determined by the exerciser
Examples	Badminton, table tennis, team sports, racket sports	Jogging, brisk walking

Some studies that support the benefits of OSE over CSE:

●       O'Brien et al., 2017: Found that OSE improved audio-visual perception, while both OSE and CSE improved immediate memory

●       Tsai et al., 2017: Found that OSE improved cognitive flexibility, while CSE improved working memory

●       Hung et al., 2018: Found that OSE improved cognitive flexibility more than CSE¹⁰

One message from these studies is that exercise that involves quick thinking and adaptability may provide additional benefits beyond traditional exercise.

If you don’t enjoy racket sports, have no fear. A meta-analysis suggests that dancing may provide further benefits for cognition over traditional workouts like walking on a treadmill or riding a stationary bike. While not an actual open-skill exercise, the coordination required for non-repeating movements will likely engage the brain more than a continuous alternative.¹¹

If you have two left feet or prefer a different workout, shadowboxing is always an option. Shadowboxing involves practicing the same movements as boxing without actually making contact. If you want more of an arm workout, feel free to wear weighted gloves.

Future directions in exercise and dementia research

 

Research on the topic of exercise and dementia prevention continues. There are several promising areas of investigation:

●       Developing personalized exercise prescriptions based on genetic profiles and individual risk factors

●       Exploring exercise is a possible therapeutic intervention for those already experiencing cognitive decline

●       Investigating the impacts of different types and intensities of exercise on dementia

●       Examining exercise's effects on specific biomarkers found in dementia

Dr. Jonathan Stamler’s group is investigating the use of fitness wearables to ride real-time feedback to help individuals monitor their exercise in a way that improves cognitive health. They are also working on a device to monitor the levels of nitric oxide in the blood - another promising field of study. ”We personalize our medications, and I would suggest we should be personalizing how we exercise to optimize our health,” Dr. Stamler adds.⁴

Conclusion

The benefits of exercise are well-known for physical health. Now, the evidence shows that it is also good for mental health—not just for mood but cognition. Exercise is a low-cost and easily accessible activity for maintaining cognitive function and physical health.

Whether you exercise regularly or have never done so, now is the time to start. Regardless of your age or fitness level, adding exercise to your daily routine will offer benefits for your mental and physical health, reducing your risk, not only for dementia but heart disease and obesity. As Dr. Borja del Pozo Cruz states, "I think [the message] is clear — do engage in vigorous physical activity to maximize the chances of preventing Alzheimer's disease, and possibly a number of other health benefits will also appear" .⁷

As research continues, the role of exercise in our overall health will continue to evolve. Until then, staying physically active is one of the most important steps you can take for your health.

 

Bibliography

1. Yamasaki T. Preventive strategies for cognitive decline and dementia: Benefits of aerobic physical activity, especially open-skill exercise. Brain Sciences. 2023;13(3):521. doi:10.3390/brainsci13030521
2. O’Neil-Pirozzi TM, Cappon DB, Pascual-Leone A. Adherence to cognitive and physical exercise engagement: A challenge to successful Dementia Risk Reduction and prevention efforts. Frontiers in Dementia. 2023;2. doi:10.3389/frdem.2023.1254986
3. Adi - dementia risk factors infographic. Alzheimer’s Disease International (ADI). October 26, 2020. Accessed September 24, 2024. https://www.alzint.org/resource/dementia-risk-factors-infographic/.
4. UHBlog. The best dementia prevention? A workout for your brain. University Hospitals. October 25, 2022. Accessed September 24, 2024. https://www.uhhospitals.org/blog/articles/2022/10/the-best-dementia-prevention-a-workout-for-your-brain.
5. Sayal N. Exercise training increases size of hippocampus and improves memory. Annals of Neurosciences. 2015;22(2). doi:10.5214/ans.0972.7531.220209
6. Zhou B, Wang Z, Liu TC, Wei Y, Li B. Effects of different physical activity on brain-derived neurotrophic factor: A systematic review and Bayesian network meta-analysis. Published online May 29, 2022. doi:10.37766/inplasy2022.5.0164
7. Dementia: Could exercise help prevent alzheimer’s related deaths? Medical News Today. Accessed September 25, 2024. https://www.medicalnewstoday.com/articles/vigorous-exercise-lower-dementia-alzheimers-related-deaths.
8. Peter Attia. #307 ‒ exercise for aging people: Where to begin, and how to minimize risk while maximizing potential: Peter Attia, M.D. Peter Attia. September 16, 2024. Accessed September 24, 2024. https://peterattiamd.com/exerciseforagingpeople.
9. WW-fingers: Alzheimer’s association. WW-FINGERS | Alzheimer’s Association. Accessed September 25, 2024. https://www.alz.org/wwfingers/overview.asp.
10. Gu Q, Zou L, Loprinzi PD, Quan M, Huang T. Effects of open versus closed skill exercise on cognitive function: A systematic review. Frontiers in Psychology. 2019;10. doi:10.3389/fpsyg.2019.01707
11. Predovan, D., Julien, A., Esmail, A. et al. Effects of Dancing on Cognition in Healthy Older Adults: a Systematic Review. J Cogn Enhanc 3, 161–167 (2019). https://doi.org/10.1007/s41465-018-0103-2