There is little doubt that regular exercise improves health. It helps to lower blood pressure, improve blood sugar levels, decrease waist circumference, improve fitness, maintain weight, improve mood, and decrease anxiety.1-4 These benefits are especially important for individuals with Alzheimer’s disease who often have comorbid chronic diseases and changes to mood. In addition, regular exercise can aid in slowing the progressive cognitive decline of individuals with Alzheimer’s disease.5 Individuals with Alzheimer’s disease or their caretakers may wonder if regular exercise is safe and what exercises should be done. So, what kinds of exercise should individuals with Alzheimer’s disease be doing?
The FITT model provides an easy way to think about appropriate exercises for individuals with Alzheimer’s disease. FITT is used to describe the frequency, intensity, time, and type of exercise. The US government has guidelines for engaging in exercise6 that cover all components of the FITT model and can be used as a guide for individuals with Alzheimer’s disease. Let’s look at each of these components.
Frequency: The guidelines indicate that aerobic activity be conducted on most days of the week and that muscle-strengthening activity be conducted at least two days per week. It is important for older adults to gradually build up to these goals. This means that activity may start on one or two days the first week, and individuals should gradually build up to most days over several weeks.
Intensity: The guidelines indicate that exercise should be conducted at a moderate to vigorous intensity level. Any activity that requires a similar effort as brisk walking or raking the yard would qualify as moderate intensity.
Time: The guidelines also recommend that aerobic activity be conducted for a minimum of 150 minutes per week. In addition, muscle-strengthening activities be conducted on two days per week.
Type: The guidelines recommend that individuals should participate in both aerobic and muscle-strengthening activities. It also has specific recommendations for older adults, which is especially relevant for individuals with Alzheimer’s disease because most will fall in this category. The guidelines state that “As part of their weekly physical activity, older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities.” In fact, many exercise studies involving individuals with Alzheimer’s disease have been multicomponent, incorporating aerobic, strength, balance, and flexibility activities in one program.
When selecting the types of activities, it is important to choose those that are enjoyable and sustainable, meaning that the individual can stick with over a long period of time. This process may take some time, but individualizing exercise routines leads to long-term success. Maintaining a regular exercise program is important because the benefits of any exercise program go away once you stop exercising. Below are examples of these different kinds of activities.
- Aerobic activities: brisk walking, water aerobics, tai chi, dancing, yard work, bicycling less than 10 mph, yoga.
- Muscle-strengthening activities: use of exercise bands, hand-held weights or weight machines, body weight exercises (e.g. push-ups, chin-ups), some forms of tai chi and yoga.
- Balance: standing on one foot, walking heel-to-toe, toe raises.
It is also important to warm-up before exercising and to cool down after exercising. Warming up helps prepare the heart and lungs for activity, and cooling down helps gradually slow the heart and lungs. Stretching can also be incorporated into the warm-up and cool down. Stretching helps to maintain flexibility of the joints.
Further Considerations for Older Adults
Older adults should consult with their doctor before starting any exercise program. The national guidelines also provide precautions for older adults related to engaging in activity relative to their fitness levels and to gauge the degree to which chronic health conditions may affect one’s ability to be active. For those unable to engage in 150 minutes, older adults are encouraged to engage in as much activity as possible. Therefore, individuals with Alzheimer’s disease should strive to achieve the levels of activity outlined in the national guidelines, taking into consideration their current physical health status.
What Does Research Say?
Studies have generally shown that individuals with Alzheimer’s disease experience positive effects of regular exercise.5,7 A study showed that a home-based multicomponent exercise program with a caregiver that combined aerobic, strength, and balance training resulted in improvements in executive function compared to a control group, although there were no changes in other cognitive measures.8 The exercises included walking, ankle weights, using a balance pillow, and dual-tasking (talking while walking). Another multicomponent exercise program with a caregiver, including agility, strength, flexibility, and balance, showed that the intervention group maintained physical functionality, whereas there were decreases in the control group.9 This study also found improvements in neuropsychiatric symptoms.9 Exercise studies in individuals with Alzheimer’s disease have also resulted in few injuries.
These are just a few examples of studies showing that a multicomponent exercise programs, similar to what the national guidelines recommend, provide physical and mental health benefits for individuals with Alzheimer’s disease. It is important to note that most of these studies have utilized a caregiver. These types of multicomponent exercise programs have also been shown to have positive health effects in individuals with mild cognitive impairment and those at risk for developing Alzheimer’s disease. The current authors are utilizing a multicomponent exercise program in African Americans, who have a high risk for developing Alzheimer’s disease.
So…What’ s the Best Exercise?
In summary, there are many different exercises that are appropriate and safe for individuals with Alzheimer’s disease. It is important to engage in several different categories of exercise, including aerobic, muscle strengthening, balance, and flexibility. In addition, there are national recommendations that can serve as a guide for individuals with Alzheimer’s disease. Therefore, the answer to the question “what’s the best exercise for individuals with Alzheimer’s disease” is…all exercises that are safe, enjoyable, and sustainable.
- Alzheimer’s Disease Toolkit (Helpful Information to Understand and Manage Alzheimer's Disease)
- Expert Information on Alzheimer’s Disease (Articles)
- Decreasing Your Risk of Alzheimer’s (Article)
- Alzheimer’s Prevention: Nutrition & Lifestyle (Fact Sheet)
- Exercise and Brain Health (Article)
- Program for African American Cognition and Exercise (BrightFocus-Funded Research from Drs. Newton and Carmichael)
- Bond V, Bartels MN, Sloan RP, et al. Exercise training favourably affects autonomic and blood pressure responses during mental and physical stressors in African-American men. J Hum Hypertens. 2009;23(4):267-273.
- Martin CK, Church TS, Thompson AM, Earnest CP, Blair SN. Exercise dose and quality of life: a randomized controlled trial. Arch Intern Med. 2009;169(3):269-278.
- Church TS, Blair SN, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2010;304(20):2253-2262.
- Newton RL, Jr., Johnson WD, Larrivee S, et al. A Randomized Community-based Exercise Training Trial in African American Men: ARTIIS. Med Sci Sports Exerc. 2019.
- Jia RX, Liang JH, Xu Y, Wang YQ. Effects of physical activity and exercise on the cognitive function of patients with Alzheimer disease: a meta-analysis. BMC geriatrics. 2019;19(1):181.
- USDHHS. Physical Activity Guidelines for Americans: 2nd Edition. United States Department of Health and Human Services;2018.
- Almeida SIL, Gomes da Silva M, Marques A. Home-Based Physical Activity Programs for People With Dementia: Systematic Review and Meta-Analysis. Gerontologist. 2019.
- Öhman H, Savikko N, Strandberg TE, et al. Effects of Exercise on Cognition: The Finnish Alzheimer Disease Exercise Trial: A Randomized, Controlled Trial. J Am Geriatr Soc. 2016;64(4):731-738.
- Canonici AP, Andrade LP, Gobbi S, Santos-Galduroz RF, Gobbi LT, Stella F. Functional dependence and caregiver burden in ’” Alzheimer’s disease: a controlled trial on the benefits of motor intervention. Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society. 2012;12(3):186-192.
This content was last updated on: July 5, 2020
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