Skip to main content

Dementia and physical activity

Already today, the increase in life expectancy and the accelerated increase in longevity—the number of centenarians will triple from the year 2000 to 2050 [15]—confronts us with questions which are not easily answered. But what we can realize from social and economic development is that we will be forced not only to cure diseases but much more to prevent them. This particularly applies to those diseases which coincide with the aging development as Alzheimer’s disease and other forms of dementia. There is not only need of reliable and valid dementia diagnosis [8] and of effective medication but there is also an urgent need to discover and implement effective physical activity interventions.

With the worldwide demographic trend of population aging, Alzheimer’s disease and other forms of dementia will become an increasingly major public health problem among the elderly. The term “dementia” describes a syndrome associated with a range of diseases which are characterized by the progressive impairment of brain functions, including language, memory, perception, personality, and cognitive skills. These diseases lead to a decline in the ability to perform everyday activities. These declines in mental function may manifest themselves through different symptoms at various times. Alzheimer’s disease is the most common form of dementia, estimated to be responsible for 70% of dementia cases. It is followed by vascular dementia as probably the next common type. Depression affects up to 40% of patients with dementia, usually when dementia is mild or moderate, and may cause vegetative symptoms, e.g., withdrawal, anorexia, weight loss, or insomnia (cf. [12]).

Wimo et al. [18] estimated the worldwide occurrence of dementia in 2000 and during the period 1950–2050. The calculations were based on worldwide demographics of the elderly and age-specific prevalence and incidence values of dementia, estimated from a meta-analysis. The worldwide number of persons with dementia in 2000 was estimated at about 25 million persons. Almost half of the demented persons (46%) lived in Asia, 30% in Europe, 12% in North America, 7% in Latin America, and 5% in Africa. About 6.1% of the population of 65 years of age and older suffered from dementia (about 0.5% of the worldwide population) and 59% were female.

Incidence rates were recently calculated from United Nations estimations and projections from prevalence, remission, and mortality data by Ferri et al. [4]. Though evidence from well-planned representative epidemiological surveys is scarce in many regions, they found that 24–30 million people have dementia today, with four to six million new cases of dementia every year (one new case every 7 s). The number of people affected will double every 20 years to 81–100 million by 2040. Most people with dementia live in developing countries—60% in 2001 and rising to 71% by 2040. Rates of increase are not uniform; numbers in developed countries are forecasted to increase by 100% between 2001 and 2040 and by more than 300% in India, China, and their south Asian and western Pacific neighbors. These detailed estimates seem to constitute the best currently available basis for policymaking, planning, and allocation of health and welfare resources. We must conclude that dementia is one of the most common causes of institutionalization, morbidity, and mortality among the elderly and we have to face the obvious consequences.

Although in mild cognitive impairment memory or another aspect of cognition is impaired (not merely slowed), this impairment is not severe enough to interfere with daily functioning. Up to 50% of patients with mild cognitive impairment that affects memory develop dementia within 3 years. Currently, there is no clear way to predict which patients will develop dementia. The natural history varies depending on the cause of dementia. It is typical, however, that intellectual and other cognitive functions inexorably decline over 2 to 10 years. Although the decline occurs in a continuum, symptoms can be divided into mild (early), moderate, and severe (late). Personality and behavior changes may develop during any stage [12].

Patients with dementia are susceptible to muscle disuse atrophy, which can be delayed by adequate physical exercise and nutrition. A regular supervised exercise program (e.g., 15 to 20 min/day of walking) is recommended. According to a preliminary report by Mechling and Brach [9], these programs can be extended to 60 min/day twice a week with people showing mild and moderate symptoms. Exercise can reduce restlessness, improve balance, maintain cardiovascular tone, help improve sleep, and reduce frequency and severity of behavior disorders and falls [5]. A supportive environment includes encouragement of and opportunities for physical and mental activity and social interaction. These activities may help to slow cognitive, physical, social, affective, and functional decline. Delaying the onset of symptoms of dementia and slowing the vicious circle to dependence will not only help the individual affected but also caring relatives, nursing staff, and society as a whole [1].

The main problems accompanying the development from cognitive impairment to the different forms of dementia is that activities which could stimulate cognitive or physical performance are reduced or even given up. Thus, it seems to be conceivable that Morley concludes that “…cognitive decline is associated with a decline in physical performance” ([11], p. 24). The reduction of physical activity leads to a dramatic increase in the age-dependent deterioration of strength. This leads to a reduction of competence and independence and, ultimately, to limitations in activities of daily living, social retreat, and isolation [10].

Physical activity can reduce the risk of dementia [7] and cognitive performance can be improved by physical exercise and by increasing the physical fitness level [6]. Strength training contributes to the improvement of balance performance [13] and strength control [16]. But improvements will only occur when sensory, cognitive, and motor systems are addressed simultaneously [17]. This shows how close the relationship between physical and cognitive performance is and how this might contribute to cope better with everyday demands. Several research results confirm the positive influence of physical activity and training on information processing, memory, executive functions, motor coordination, and motor learning [2, 3, 14].

What do we really know about these physical activity interventions? Are these direct or indirect effects? Does physical activity protect directly by better oxygen supply and transmitter metabolism? Or does it rather protect indirectly by reducing the risks that impair cognition as hypertension and diabetes? What are the adequate forms of intervention? What type of physical activity and training program (intensity, frequency, duration) is required for achieving positive effects on cognition? Which types of skill (e.g., closed, open, skills with enforced cognitive demands) are recommendable to gain positive effects on cognition? Will positive effects be observed in different groups which show mild, moderate, or severe symptoms of dementia?

The data on prevalence, incidence on dementia, the demands, and the questions raised underscore the urgency of research in this area. Unless there are significant breakthroughs in the treatment and/or prevention of dementia, the prevalence of dementia is expected to continue to increase in line with the worldwide aging population. Though the causal effects of physical activity have not been understood in all details, there is enough evidence and experience not to hesitate any longer to start physical activity intervention programs to contribute to the prevention of cognitive impairment, Alzheimer’s disease, and other forms of dementia.

References

  1. 1.

    Baumgarten M, Battista RN, Infante-Rivard C, Hanley JA, Becker R, Gauthier S (1992) The psychological and physical health of family members caring for an elderly person with dementia. J Clin Epidemiol 45:61–70

    PubMed  Article  CAS  Google Scholar 

  2. 2.

    Colcombe SJ, Kramer AF (2003) Fitness effects on the cognitive function of older adults: a meta-analytic approach. Psychol Sci 14:125–130

    PubMed  Article  Google Scholar 

  3. 3.

    Etnier JL, Nowell PN, Landers DM, Sibley A (2006) A meta-regression to examine the relationship between aerobic fitness and cognitive performance. Brain Res Rev 52:119–130

    PubMed  Article  Google Scholar 

  4. 4.

    Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, Hall K, Hasegawa K, Hendrie H, Huang Y, Jorm A, Mathers C, Menezes PR, Rimmer E, Scazufca M (2006) Global prevalence of dementia: a Delphi consensus study. The Lancet 366:2112–2117

    Article  Google Scholar 

  5. 5.

    Hauer K, Becker CU, Beyer N (2006) Effectiveness of physical training on motor performance and fall prevention in cognitively impaired older persons. Am J Phys Med Rehab 85:847–857

    Article  CAS  Google Scholar 

  6. 6.

    Kramer AF, Colcombe SJ, McAuley E, Eriksen KI, Scalf P, Jerome GJ, Marquez DX, Elavsky S, Webb AG (2003) Enhancing brain and cognitive function of older adults through fitness training. J Mol Neurosci 20:213–221

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Larson EB, Wang L, Bowen JD, McCormick WC, Teri L, Crane P, Kukull W (2006) Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med 144(2):73–81

    PubMed  Google Scholar 

  8. 8.

    Lim WS, Chong MS, Sahadevan S (2007) Utility of the clinical dementia rating in Asian populations. Clin Med Res 5:61–70

    PubMed  Article  Google Scholar 

  9. 9.

    Mechling H, Brach M (2007) fit für 100—Förderung der Mobilität und Selbstständigkeit für Hochaltrige. Praxisleitfaden zur Einrichtung von Bewegungsangeboten für alle Bereich der Altenhilfe (Fit for 100—improvement of mobility and independence in high aged people. An orientation for the implementation of physical activity in all types of old age homes). Deutsche Sporthochschule, Köln

    Google Scholar 

  10. 10.

    Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR (2007) Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 68:2077–2084

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Morley JE (2004) The top 10 hot topics in aging. J Gerontol Biol Sci 59A:M24–M33

    Google Scholar 

  12. 12.

    Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Ofstedal MB, Burke JR, Hurd MD, Potter GG, Rodgers WL, Steffens DC, Willis RJ, Wallace RB (2007) Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology 29:125–132

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Redfern MS, Jennings JR, Martin C, Furman JM (2001) Attention influences sensory integration for postural control in older adults. Gait Posture 14:211–216

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Seidler RD (2007) Older adults can learn to learn new motor skills. Behav Brain Res 183(1):118–122

    PubMed  Article  Google Scholar 

  15. 15.

    United Nations (2001) UN world population aging: 1950–2050. Department of Economic and Social affairs—Population. Division (ST/ESA/SER.A/207) UN, New York

    Google Scholar 

  16. 16.

    Voelcker-Rehage C, Alberts JL (2005) Age-related changes in grasping force modulation. Exp Brain Res 166(1):61–70

    PubMed  Article  Google Scholar 

  17. 17.

    Westlake KP, Wu Y, Culham EG (2007) Sensory-specific balance training in older adults: effects on position, movement, and velocity sense at the ankle. Phys Ther 87:560–568

    PubMed  Article  Google Scholar 

  18. 18.

    Wimo A, Winblad B, Aguero-Torres H, von Strauss E (2003) The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord 17:63–67

    PubMed  Article  Google Scholar 

Download references

Acknowledgement to Reviewers

The Editors would like to thank the following reviewers for their most helpful support of the EURAPA 2007 issues:

Ayalon, Mosh, Netanya, Israel

Ben-Sira, David, Netanya, Israel

Boecker, Henning, Bonn, Germany

Carmeli, Eli, Ramat Aviv, Israel

Chodzko-Zajko, Wojtek

Duarte, Alberto, Porto, Portugal

Goldhammer, Ehud, Netanya, Israel

Haywood, Kathleen M., Saint Louis, MO, USA

Klein, Penelope, Buffalo, NY, USA

Konczak, Jürgen, Minneapolis, MN, USA

Munzert, Jörn, Gießen, Germany

Netz, Yael, Netanya, Israel

Newell, Karl M., PA, USA

Oliveira, Jose, Porto, Portugal

Raeburn, Peter, Queensland, Australia

Sagiv, Moran, Netanya, Israel

Spirduso, Waneen W., Austin, TX, USA

Suominen, Harri, Jyväskylä, Finland

Viidik, Andrus, Aarhus, Denmark

Voelcker-Rehage, Claudia, Bremen, Germany

Vogelaere, Peter, Evora, Portugal

Woll, Alexander, Konstanz, Germany

Wu, Ge, VT, USA

Author information

Affiliations

Authors

Corresponding author

Correspondence to Heinz Mechling.

Rights and permissions

Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Mechling, H. Dementia and physical activity. Eur Rev Aging Phys Act 5, 1–3 (2008). https://doi.org/10.1007/s11556-008-0033-6

Download citation