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Physical Activity Recommendations for the Aging Brain: A Clinician-Patient Guide

      The positive benefits of regular physical activity on cognitive function are well-known today.
      • Heyn P.
      • Abreu B.C.
      • Ottenbacher K.J.
      The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis.
      • Heyn P.C.
      • Johnsons K.E.
      • Kramer A.F.
      Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analytic.
      • Heyn P.
      The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia.

      Centers for Disease Control and Prevention. Healthy Brain Initiative. Available at: www.cdc.gov/aging/healthybrain/index.htm. Accessed March 8, 2016.

      • Buchman A.S.
      • Boyle P.A.
      • Yu L.
      • Shah R.C.
      • Wilson R.S.
      • Bennett D.A.
      Total daily physical activity and the Risk of AD and cognitive decline in older adults.
      • Colcombe S.J.
      • Kramer A.F.
      • McAuley E.
      • Erickson K.I.
      • Scalf P.
      Neurocognitive aging and cardiovascular fitness: recent findings and future directions.
      • Institute of Medicine
      Cognitive aging: progress in understanding and opportunities for action.
      However, older adults experience challenges beginning or sustaining regular exercise throughout their lives. At a time when >40 million people in the United States are ≥65 years old,
      • Institute of Medicine
      Cognitive aging: progress in understanding and opportunities for action.
      there is a need for health care providers to advise patients and their families on safe physical activity practice aimed to maintain or improve cognitive health.
      • Institute of Medicine
      Cognitive aging: progress in understanding and opportunities for action.
      Setting achievable physical activity goals, developing a patient-centered active lifestyle plan, and monitoring for physical training adjustments at medical office visits have been shown to enhance physical activity levels among older adult patients, including older individuals with cognitive impairments.

      Exercise is Medicine. American College of Sports Medicine. Available at: www.exerciseismedicine.org. Accessed March 8, 2016.

      • Hirsch M.A.
      • Sanjak M.
      • Englert D.
      • Iyer S.S.
      • Quinlan M.M.
      Parkinson patients as partners in care.
      This educational page is designed to guide the health care professional in providing physical activity recommendations for the older adult patient during the office visit.

      Importance of regular physical activity to achieve optimal cognitive health in the older patient

      • Physical activity is strongly associated with healthy aging,
        • Institute of Medicine
        Cognitive aging: progress in understanding and opportunities for action.
        • Nelson M.E.
        • Rejeski W.J.
        • Blair S.N.
        • et al.
        Physical activity and public health in older adults: recommendation from the American College of Sports medicine and the American Heart Association.
        and it has shown to help older adults maintain optimal physical and cognitive function throughout life. In addition, physical activity reduces the risk for developing dementia.
        • Blondell S.J.
        • Hammersley-Mather R.
        • Veerman J.L.
        Does physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studies.
        • Lautenschlager N.T.
        • Cox K.
        • Cyarto E.V.
        The influence of exercise on brain aging and dementia.
        • Scarmeas N.
        • Luchsinger J.A.
        • Schupf N.
        • et al.
        Physical activity, diet, and risk of Alzheimer disease.
      • Sedentary older adults who become physically active show significantly less formation of beta amyloid. Beta amyloid is a brain protein involved in the development of Alzheimer disease.
        • Heyn P.
        • Abreu B.C.
        • Ottenbacher K.J.
        The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis.
        • Heyn P.C.
        • Johnsons K.E.
        • Kramer A.F.
        Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analytic.
        • Heyn P.
        The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia.
        • Buchman A.S.
        • Boyle P.A.
        • Yu L.
        • Shah R.C.
        • Wilson R.S.
        • Bennett D.A.
        Total daily physical activity and the Risk of AD and cognitive decline in older adults.

      Methods to increase your older patient's physical activity levels

      • Discuss your patients' lifestyle behavior, physical activity levels, diet, and overall cognitive health (memory, sleep behavior, depression, and anxiety). Discuss obstacles that the patient might face to reach a healthy lifestyle.
        • Hirsch M.A.
        • Hirsch H.V.
        Novel activities enhance performance of the aging brain.
      • Record and monitor your patient's lifestyle behaviors (ie, physical activity levels, diet plan, smoking) as part of the patients' integrated treatment.
        • Burbank P.M.
        • Reibe D.
        • Padula C.A.
        • Nigg C.
        Exercise and older adults: changing behavior with the transtheoretical model.
      • Educate your patient about the benefits of exercise and the dangers of a sedentary lifestyle.
        • Barnidge E.K.
        • Baker E.A.
        • Estlund A.
        • Motton F.
        • Hipp P.R.
        • Brownson R.C.
        A participatory regional partnership approach to promote nutrition and physical activity through environmental and policy change in rural Missouri.
      • Develop healthy lifestyle achievable goals with patient input and participation (eg, health contract, peer mentoring, access to exercise environments).
      • Use a multidisciplinary, multifaceted, patient-centric approach to promote physical activity.
        • Nijkrake M.J.
        • Keus S.H.
        • Overeem S.
        • et al.
        The ParkinsonNet concept: development, implementation and initial experience.
      • Review your patients' physical activity progress at every office visit and promote shared decision-making.
        • van Nimwegen M.
        • Speelman A.D.
        • Overeem S.
        • et al.
        Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial.

      Additional considerations to encourage patient/provider discussion about increasing physical activity levels

      • Regularly discuss and review health conditions and medications that might influence cognitive health and activity participation with your older adult patient.
        • Barnidge E.K.
        • Baker E.A.
        • Estlund A.
        • Motton F.
        • Hipp P.R.
        • Brownson R.C.
        A participatory regional partnership approach to promote nutrition and physical activity through environmental and policy change in rural Missouri.
      • Evaluate physical capacity and readiness to engage in physical activities (eg, issues related to exercise safety and awareness).
        • van Nimwegen M.
        • Speelman A.D.
        • Overeem S.
        • et al.
        Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial.
      • Provide structured referrals into community-based activity programs staffed with health care professionals with expertise in promoting physical activity among older adults (eg, health coaches).
        • Hirsch M.A.
        • Hirsch H.V.
        Novel activities enhance performance of the aging brain.
      • Use cognitive-behavioral strategies to motivate older adults to increase their daily physical activity level.
        • Bandura A.
        Health promotion by social cognitive means.

      Physical Activity Recommendations for the Aging Brain: A Patient Guide

      Tabled 1
      Common Patient QuestionsRecommendation
      What exercises are good for my brain?Any exercise is good for you, but the aerobic types use the large groups of muscles from your body and for a longer time, increasing the blood flow to your brain. This helps to protect your brain from cognitive decline. Examples of these types of exercises are
      • 1.
        Mobility activities (eg, walking, jogging, cycling)
      • 2.
        Household activities (eg, gardening, house cleaning, chores)
      • 3.
        Recreational indoor and outdoor activities (eg, tennis, racquetball, swimming, skiing)
      • 4.
        Planned and structured exercises (eg, group fitness class)
      How can I get the benefits of exercise without getting hurt?
      • When you exercise, connect your mind to your body and try to feel your muscles contracting.
      • Keep a steady breathing while performing the movements.
      • Feel your body temperature rising gradually while you exercise. Keep in mind that any drastic changes in temperature or breathing might be a sign that you are doing too much and you will need to slow down.
      • Start with easy and basic movements and gradually add more effort to your movements (eg, moving your arms and legs together and faster).
      • Make sure to use the FIT principle by interchanging the exercise
        • 1.
          Frequency (the number of times you exercise during the week)
        • 2.
          Intensity (the duration you exercise each session)
        • 3.
          Types (changing the exercise type such as cycling versus walking)
      • If you have balance or musculoskeletal problems, start by exercising gently and progressively increase the frequency (the times per week that you exercise) and the intensity (your exercise duration).
      How much exercise do I need to do to gain the cognitive benefits?
      • The right exercise amount for you is the amount that is possible for you to do safely.
      • You should start with an exercise amount that you feel comfortable in performing. Add more exercises slowly with the goal to achieve the desirable public health recommendation.
      • The public health recommendation is to participate in physical activities that use moderate aerobic intensity for at least 30 minutes on 5 days per week, or opt for slightly more intense exercises for at least 20 minutes on 3 days per week.
      What type of exercise should I do to get stronger and more independent?
      • Perform strengthening activities on at least 2 days per week. This maintains or increases your muscle strength and independence.
      • Use handheld weights or strength machines to help your achieve greater strength. Start with 2 sets of 8 repetitions and gradually increase to 3 to 4 sets of 12 repetitions.
      • Include exercises that work different muscles groups and body areas (ie, arms, trunk, legs).
      • When you are doing strength resistance exercises (eg, hand weights), always perform them in a slow and well-controlled way.
      • Participation in more than the minimum recommended amount of aerobic and strengthening exercises leads to additional health benefits and higher levels of fitness.
      What exercises are good to improve my balance and reduce my risk of falls?
      • Stretching exercises may increase flexibility, balance, and daily function. Stretching exercises can also improve the range of motion of your joints.
      • Exercises that maintain or improve balance (holding on a chair, standing on 1 leg at time) can reduce the risk of falls and related injuries.
      • Hold a stretch for about 30 seconds, then switch sides and repeat.
      • Do not bounce while stretching. If you feel pain during stretching, reduce the stretch intensity.
      • Perform activities that maintain or increase flexibility for at least 10 minutes and at least 2 days per week.
      • If you have health conditions or injuries, discuss with your doctor or physical therapist the types of stretches that are right for you.
      What should I add to my exercise plan to maximize cognitive function?The brain is constantly responding to different sensory stimuli, so adding additional sensory stimuli to your exercise program might stimulate and integrate other brain areas while you move. Examples of additional sensory activities to perform while exercising are
      • 1.
        Carrying on a conversation
      • 2.
        Listening to a story or music
      • 3.
        Complex movements such as dance choreography/ballroom dance
      • 4.
        Balance exercises
      What can I do to improve my enjoyment and adherence to an exercise program?
      • Leisure-type activities (eg, daily social, family, and community activities) can be more fun, but the best exercise is the one that makes you feel happy and that you have fun doing alone or with others.
      • If you are a social type of person, try bowling or similar social activities.
      • Some people prefer individual-type exercise (eg, running, swimming).
      NOTE. Physical activity recommendations are mostly based on the American College of Sports Medicine/American Heart Association guidelines.
      • Heyn P.
      • Abreu B.C.
      • Ottenbacher K.J.
      The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis.
      • van Nimwegen M.
      • Speelman A.D.
      • Overeem S.
      • et al.
      Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial.

      Authorship

      This page was developed by the ACRM Neurodegenerative Diseases Networking Group (NDNG): Patricia C. Heyn, PhD, Associate Professor, University of Colorado Anschutz Medical Campus; Mark A. Hirsch, PhD, Senior Scientist, Department of Physical Medicine and Rehabilitation, Carolinas Medical Center; Michele K. York, PhD, Head of the Section of Neuropsychology, Baylor College of Medicine; and Deborah Backus, PT, PhD, FACRM, Director of Multiple Sclerosis Research at Shepherd Center.

      Disclaimer

      This information is not meant to replace the advice from a medical professional. This Information/Education Page may be reproduced for noncommercial use for health care professionals to share with patients and their care partners. Any other reproduction is subject to approval by the publisher.

      References

        • Heyn P.
        • Abreu B.C.
        • Ottenbacher K.J.
        The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis.
        Arch Phys Med Rehabil. 2004; 85: 1694-1704
        • Heyn P.C.
        • Johnsons K.E.
        • Kramer A.F.
        Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analytic.
        J Nutr Health Aging. 2008; 12: 401-409
        • Heyn P.
        The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia.
        Am J Alzheimers Dis Other Demen. 2003; 18: 247-251
      1. Centers for Disease Control and Prevention. Healthy Brain Initiative. Available at: www.cdc.gov/aging/healthybrain/index.htm. Accessed March 8, 2016.

        • Buchman A.S.
        • Boyle P.A.
        • Yu L.
        • Shah R.C.
        • Wilson R.S.
        • Bennett D.A.
        Total daily physical activity and the Risk of AD and cognitive decline in older adults.
        Neurology. 2012; 78: 1323-1329
        • Colcombe S.J.
        • Kramer A.F.
        • McAuley E.
        • Erickson K.I.
        • Scalf P.
        Neurocognitive aging and cardiovascular fitness: recent findings and future directions.
        J Mol Neurosci. 2004; 24: 9-14
        • Institute of Medicine
        Cognitive aging: progress in understanding and opportunities for action.
        The National Academies Press, Washington (DC)2015
      2. Exercise is Medicine. American College of Sports Medicine. Available at: www.exerciseismedicine.org. Accessed March 8, 2016.

        • Hirsch M.A.
        • Sanjak M.
        • Englert D.
        • Iyer S.S.
        • Quinlan M.M.
        Parkinson patients as partners in care.
        Parkinsonism Relat Disord. 2014; 20: S174-S179
        • Nelson M.E.
        • Rejeski W.J.
        • Blair S.N.
        • et al.
        Physical activity and public health in older adults: recommendation from the American College of Sports medicine and the American Heart Association.
        Med Sci Sports Exerc. 2007; 39: 1435-1445
        • Blondell S.J.
        • Hammersley-Mather R.
        • Veerman J.L.
        Does physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studies.
        BMC Public Health. 2014; 14: 510
        • Lautenschlager N.T.
        • Cox K.
        • Cyarto E.V.
        The influence of exercise on brain aging and dementia.
        Biochim Biophys Acta. 2012; 1822: 474-481
        • Scarmeas N.
        • Luchsinger J.A.
        • Schupf N.
        • et al.
        Physical activity, diet, and risk of Alzheimer disease.
        JAMA. 2009; 302: 627-637
        • Hirsch M.A.
        • Hirsch H.V.
        Novel activities enhance performance of the aging brain.
        Journal of Physical Education, Recreation and Dance. 1998; 69: 15-19
        • Burbank P.M.
        • Reibe D.
        • Padula C.A.
        • Nigg C.
        Exercise and older adults: changing behavior with the transtheoretical model.
        Orthop Nurs. 2002; 21 (quiz 61-3): 51-61
        • Barnidge E.K.
        • Baker E.A.
        • Estlund A.
        • Motton F.
        • Hipp P.R.
        • Brownson R.C.
        A participatory regional partnership approach to promote nutrition and physical activity through environmental and policy change in rural Missouri.
        Prev Chronic Dis. 2015; 12: 140593
        • Nijkrake M.J.
        • Keus S.H.
        • Overeem S.
        • et al.
        The ParkinsonNet concept: development, implementation and initial experience.
        Mov Disord. 2010; 25: 823-829
        • van Nimwegen M.
        • Speelman A.D.
        • Overeem S.
        • et al.
        Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial.
        BMJ. 2013; 346: f576
        • Bandura A.
        Health promotion by social cognitive means.
        Health Educ Behav. 2004; 31: 143-164