Daniel J. Green is ACE’s Senior Project Manager and Editor for Publications and Content Development. In addition to his work with organizations including the International Association of Fire Fighters and Agriculture Future of America, Daniel writes an ongoing blog series covering lifestyle change for NBCbetter.com. He has also written feature articles for local publications in Western North Carolina (WNC), including WNC Parent and WNC Magazine.
The Role of Physical Activity in the Fight Against Cognitive Impairment
For people with cognitive impairment—as well as their loved ones and caregivers—the experience can sometimes feel like a boulder rolling downhill. There is nothing you can do to stop it, reroute it or even slow it down. However, ongoing research into the effects of physical activity on cognitive impairment offers a glimmer of hope in an area where such optimism is rare.
Defining Mild Cognitive Impairment
Nearly everyone experiences memory or thinking problems as they age. The term mild cognitive impairment (MCI) is used when those problems occur earlier or more rapidly or severely than is expected based on a person’s age. While there is no single cause of MCI, some conditions, including diabetes, depression and stroke, may increase a person’s risk. One of the most common causes of MCI is Alzheimer’s disease.
Signs and symptoms of MCI include having memory lapses, losing things often, forgetting to attend meetings or appointments, and having trouble coming up with words during conversation.
Laura Baker, PhD, professor of gerontology and geriatric medicine at Wake Forest University School of Medicine, describes this as a “gray area,” where people do not have normal cognition but don’t need caregiver support and are competent to live life on their own.
Importantly, people with MCI do not experience the personality changes or more extreme symptoms displayed by people with Alzheimer’s dementia. However, MCI may be an early sign for future Alzheimer’s dementia, which is why finding ways to slow or even halt its progression is a focus of so much research.
A Glimmer of Hope
Dr. Baker led research as part of the larger Exercise in Adults with Mild Memory Problems (EXERT) study, which evaluated the effects of physical activity on cognition, functional status, brain atrophy, blood flow and cerebrospinal fluid biomarkers of Alzheimer’s disease in adults with MCI.
Dr. Baker, whose area of focus is Alzheimer’s disease prevention, describes herself as “a strong advocate of lifestyle interventions to protect cognitive function and protect against cognitive decline.” She often echoes the language used by ACE when describing physical activity and behavior change, as she speaks of meeting people where they are rather than having a one-size-fits-all prescriptive approach. She also encourages building self-efficacy to support sustainability and using tools like motivational interviewing to empower individuals to take control of their own health and become their own advocates.
For this study, which lasted a full year, Dr. Baker and her fellow researchers targeted older adults who were in the aforementioned gray area, as they are at very high risk for cognitive decline but can still take some responsibility for their own health. This was a national, multi-site trial with about 300 participants at 14 sites across the United States, conducted in partnership between Wake Forest University School of Medicine and the University of California San Diego.
The participants were selected by specialists with experience identifying individuals with MCI. In addition to choosing current MCI patients, the specialists recruited members of the local communities who were concerned about their cognitive health. Importantly, many participants were experiencing very early and very mild impairment, and all of them were living sedentary lifestyles prior to the study.
The participants were randomly assigned to two groups:
- The “moderate/high-intensity group” performed cardiorespiratory exercise (primarily on a treadmill) at approximately 70 to 80% of their heart-rate reserve (HRR) for 30 minutes, with an additional 10-minute warm-up and 5-minute cool-down, four days per week.
- The “low-intensity group” performed stretching, balance, range of motion and very light strength-training exercise for 30 minutes, with an additional 10 minutes for warm-up and 5 minutes for cool-down, four days per week while staying at or below 35% of their HRR.
All participants were given free access to their local YMCA as part of the study and were asked to exercise four times a week at the facility, twice in one-on-one sessions with a personal trainer and twice on their own. The actual participation level was about 3.4 workouts completed per week for both groups.
Each session lasted 45 to 50 minutes, including a warm-up and cool-down. Dr. Baker highlights the fact that this model forced all participants to get up and out of their homes and to the gym and to interact with others.
What the researchers found was that over the course of the 12-month study, neither group showed any cognitive decline. “By definition,” says Dr. Baker, “if they have MCI, that puts them at high risk for Alzheimer’s dementia in the future, and they have early-stage neurodegenerative disease. This means cognitive decline over 12 months is expected.”
In other words, 12 months of regular exercise, regardless of exercise type or intensity, appears to have stopped the downhill boulder in its tracks, or at least eased it onto a plateau.
At first, Dr. Baker admits she was a bit surprised by the results, as she had expected the high-intensity group to show more benefits than the low-intensity group, but she came to realize that the findings are actually quite profound.
If the results of this research had shown that only high-intensity cardiorespiratory exercise were protective against continued cognitive decline, that would be an important finding and great news, but not very practical in the real world. After all, asking people to get on the treadmill four times a week to exercise at a high intensity is a tough sell for anyone, but particularly for people with MCI.
Instead, this research shows that moving the body for 45 to 50 minutes three or four times per week is enough to impact the progression of MCI. This type of movement is more accessible for people and may be more realistic as a therapeutic approach over the long term.
One of the key ingredients of this study was personal trainer–supported exercise, as people with MCI often cannot adhere to a long-term exercise program on their own. As Dr. Baker explains, the machinery in the brain that allows us to plan and prioritize—and then do it again day after day—does not work well in this population. These skills are essential if exercise is to be a regular part of a person’s day.
Anecdotally, the researchers found that the participants did not want to miss their trainer-supported sessions, but they more begrudgingly completed the sessions where they were on their own. And, the participants’ moods were lifted when working with a trainer.
It is important to note that, prior to the onset of the study, the trainers received education on what it’s like to live with MCI so that they could be better prepared to form a genuine bond and relationship with the participants. If you work with this population or plan on doing so, it would be best to educate yourself on the day-to-day struggles of those with MCI, as well as how to effectively communicate with this population.
According to Dr. Baker, when the research team solicited feedback from the trainers, they repeatedly heard things like, “We were here to change their lives, but they changed ours.” Communicating with people with MCI forces you to be truly focused, slow down and listen carefully. This often makes trainers and others working with this population slow down in their own lives and be more appreciative of their own cognitive abilities.
Jonathan Ross is a two-time Personal Trainer of the Year award winner (ACE and IDEA), creator of Funtensity, a program that combines physical activity with cognitive challenges, and author of the Alzheimer’s Fitness Specialist Course. Ross agrees with the sentiment expressed by the study’s personal trainers, saying, “There’s a transformation where it’s no longer just about the exercise. There’s a person in there who might be struggling to understand.” You gain insight and an understanding and modify your typical approach in terms of both training and communication, but seeing progress is exhilarating and rewarding.
One final note: Dr. Baker points out that we currently have only two medications that slow cognitive decline. They are both expensive and, therefore, not accessible to everyone. Importantly, the magnitude of change is very small for those who do have access adn are able to take these medications.
Researchers on the pharmaceutical side of things typically target a specific mechanism that may be the key to unlocking a cure or treatment for whatever they are studying. Dr. Baker’s research, on the other hand, takes a more holistic approach by combining physical activity with personal training in a way that provides social support and accountability. While it may be impossible to separate out the effects of each of these elements, Dr. Baker asks, does it really matter? Exercise—particularly trainer-supported exercise—may be the most potent intervention for brain health because it hits all of the body’s systems and creates synergistic effects that aren’t really possible through medications.
Exercise Programming for People With MCI
As a health coach or exercise professional, you can give people with MCI a sense of self-efficacy by empowering them to see that they can be physically active in a sustainable way. For individuals who often feel as though critical aspects of their lives are slipping out of their control, showing them that they can do things they thought were impossible is a vital element of improving their overall well-being.
The work that Ross does with his Funtensity program mirrors Dr. Baker’s assertion that real-world solutions require a more holistic approach. Research, he explains, is about isolating variables, while practical approaches are just the opposite, as working with human beings involves integrated variables and multifactorial experiences.
This practical approach is reflected in two primary elements to Ross’s work: movement intensity and cognitive challenge. Lower-intensity movements can often be paired with more difficult cognitive challenges, while higher-intensity exercise can be coupled with easier cognitive challenges. The key is to adjust those dials and modify the two variables to create an appropriate and engaging challenge for each individual. Try to avoid dialing down the intensity to the point where you’re compromising the physiological benefits of the workout experience. The key is to find the right mix of intensity and cognitive challenge so that both physiological and cognitive benefits occur.
Ross points out that just about any form of exercise can become “mind-body exercise” with a few simple modifications. For example, you can add a cognitive challenge by having clients count their repetitions by three (i.e., a set of 10 would be counted as 3, 6, 9 and so on). Another option might be instead of having a client perform 15 jumping jacks then 15 squats, couple those exercises and have them perform five of each, four of each, three of each, two of each then one of each. Simple challenges like these can effectively pair physical work with cognitive work.
In the video below, Ross presents additional approaches and techniques that can be incorporated into a client’s workout routine. It is important to note that the exercise examples Ross offers are not meant to reflect the exercises used in Dr. Baker’s research. Instead, it combines Ross’s brain fitness concepts with the low-intensity movements found to be effective in that study.
The results of this research have a direct impact on the work that health coaches and exercise professionals do every day. Clients don’t necessarily need to set aside extra time to complete “cognitive training,” as low-intensity work is enough to provide adequate stimulus to drive meaningful results.
More intense exercise will, of course, provide additional benefits to physical fitness and overall health, but if you have clients who are not interested in more intense workouts—or not physically or mentally able to complete them—you can assure them that performing simple movements for 45 minutes or so on most days of the week is enough to yield benefits to both mind and body.
Consistency over the long term is the key, and that is where your role as a supportive health coach or exercise professional comes into play. By offering accountability, social support and a friendly, understanding camaraderie, you can help individuals with MCI enjoy a better quality of life and perhaps stave off additional cognitive decline for a bit longer.
Expand Your Knowledge
The NEW and IMPROVED ACE Senior Fitness Specialist Program teaches you how to safely and effectively help senior clients maintain vibrancy through health and fitness. You’ll discover a holistic approach to both body and brain health, combining rapport-building, behavior change, exercise programming, nutrition and cognitive health. Most older adults are impacted by some type of age-related chronic illness, injury or cognitive decline, so this specialized expertise will help increase your value and client pool.
In this course, you’ll discover the fundamentals of neuroscience, such as neuroplasticity, neuroanatomy, cognition and cognitive reserve, as well as the myriad effects of different types of exercise on the brain. You’ll discover resources for practically applying these strategies in a health and fitness setting and learn how to create exercise programs geared toward brain health outcomes.
The U.S. Census Bureau predicts that 83.7 million people aged 65 and older will be living in the United States by 2050, creating a high demand for trained professionals to help older adults focus on their health and fitness. From strength training and motivation to body and brain improvement, the Essentials for Training Older Adults – Course Bundle dives deep into improving your senior clients’ fitness and quality of life.