A paper published in the British Medical Journal caught my attention. You can read it by following the link here. It describes a English trial of an exercise programme for people with dementia. For the control group life carried on as normal and it was noted that very few of these got involved in structured fitness activities. Active participants participated in four months of supervised aerobic and strength training of moderate to high intensity. This was tailored to take account of their fitness and physical health. During the period they were asked to exercise at home for a further hour weekly. After this initial period they engaged in a home based exercise programme totalling two and a half hours a week until follow up. It was hoped that the participants would not only show a reduction in cognitive decline but the programe would also yield quality of life and behavioural benefits and reduce carer strain.
It seemed to surprise the researchers when their results did not support this. Whilst the active group achieved improvements in physical fitness whilst on the programme they showed no significant difference from the control group in terms of quality of life or behaviour. More surprisingly the cognition of the group that had participated in the exercise programme was slightly worse than the control group when the participants were followed up twelve months later. The researchers acknowledged that there might be physiological reasons for this. For instance, other studies with healthy humans have indicated that high intensity exercise can cause short term brain inflammation and slower reoxygenation of cortical areas. The conclusion was this exercise programme could not be recommended as an intervention to manage cognitive impairment in people with mild to moderate dementia.
- In spite of the result contra-indicating the programme it’s great to see large scale non pharmacological trials being published and adding to the evidence base.
- This research does not give the younger population an excuse to become couch potatoes! It is believed that there is strong evidence that exercise is a preventative factor in the fight against dementia.
- The study reminds that caution is needed before someone embarks on an exercise regime. Relevant health professionals such as GPs and physiotherapists should be consulted especially if a person has pre-existing medical conditions.
- There was just a small difference in terms of the cognitive deterioration experienced by the active and the control group in this study. But as the researchers acknowledge they would have be hopeful for the intervention if the results were reversed so it still merited reporting. Notwithstanding this it might not rule out moderate to high intensity exercise for people with dementia on an individual basis. For example some people when they are diagnosed might already be engaging in physical activity at this level and I, personally would not be advising them to give this up if they were still able and nothing else contra-indicated my advice. For them cessation of a habitual practice could cause issues with self esteem and self worth. Those who choose to engage in vigorous sporting activities are often those who are sensory seeking and to withdraw could impact on their well-being due to deprivation of the sensory activities that have historically contributed towards maintaining their well-being.
It was seen as a positive that people with dementia could comply and engage with the programme and improve their fitness. This is encouraging news with widespread implications.
- I wondered whether more tailoring of the exercise programme to match the interests and proclivities of participants might encourage neuroplasticity, the ability of the brain to rewire itself. Activity with specific meaning to the individual might yield different results.
People with mild to moderate dementia can engage and comply with moderate to high intensity aerobic and strengthening exercise and improve physical fitness.
The study does not preclude gentle exercise so there is no reason to believe that this should not be encouraged.