We all know that physical activity does wonderful things for the body. Less well known is how being physically active is also great for brain health, and how it can be protective against developing dementia.
By Pauline Mah, Marilyn Chua, Annette Chua and Mavis Yong, Department of Physiotherapy, SKHBy Dr Adeline Chuo, Department of Geriatric Medicine, SKH
Dementia is becoming part of the everyday landscape in Singapore as the nation ages. Yet, like other chronic diseases, lifestyle plays a big part in making us vulnerable to dementia, or protecting us from it. Exercise and other physical activity can have a significant impact on our brain and mental health, and boost how well we age cognitively.
Dementia isn’t just about a loss in memory, learning and mental sharpness, which are signs of cognitive decline. According to SKH’s physiotherapists, people with dementia tend to have poorer balance, walking and coordination, because they are less likely to participate in group exercises. Poorer physical ability increases the risk of falls even more in persons with dementia who tend to have a sedentary lifestyle.
There are several risk factors for dementia, explains Dr Adeline Chuo, Senior Consultant, Department of Geriatric Medicine, SKH. Apart from depression, social isolation, smoking and other causes, a lack of physical activity is one of the big risk factors in dementia. Addressing these factors can reduce the risk of dementia by 40 percent, adds Dr Chuo, but being active or sedentary is a lifestyle choice. In that choice lies our power to create the healthy life we desire.
Exercise can help slow down cognitive decline and improve the protective mechanism in the brain. It boosts both the physical and cognitive aspects of the brain.
Exercise is defined as structured activity specifically planned to develop and maintain physical fitness. Any physical activity that can raise the heart rate can be considered exercise. While the recommended dose for exercise to slow down the decline of our thinking ability is at least a moderate-intensity workout, research has shown that doing light, simple exercises is better than nothing.
What is important is to have a physical activity routine that includes all the four types of exercise: aerobic, strength, balance and flexibility.
Aerobic exercises help to improve our heart and lung health, and endurance. Aerobic exercises include brisk walking, jogging and swimming.
Strength exercises help make us stronger, stimulate bone growth, aid weight control, improve balance and posture, and reduce stress on joints. Strength-training exercises include those that use body weight for resistance (e.g., pull ups, push ups, sit ups and squats), or working with resistance bands and weights.
Balance exercises help improve balance and prevent falls. They include standing on one leg or lunges.
Flexibility or stretching exercises improve the range of motion of our joints as well as reduce pain and the risk of injury. Examples are side stretches or hamstring stretches.
What is enough? The recommendation is aerobic exercise of moderate intensity for a minimum of 150 minutes weekly; or if you lack the time, you can break it up into a manageable 30 minutes, five times a week (or as recommended by your physiotherapist).
What does moderate intensity feel like?
Talk Test
Low intensity: You can talk and sing with little difficulty
Moderate intensity: You can talk comfortably, but not sing
Vigorous intensity: You are not able to say more than a few words without gasping for breath
Target Heart Rate (THR)
Moderate intensity exercise should be 50-70% of one's maximum heart rate.Maximum heart rate can be calculated as 220 minus your age.
Moderate intensity exercise should be 50-70% of one's maximum heart rate.
Maximum heart rate can be calculated as 220 minus your age.
For example: Moderate intensity exercise for a 60-year-old would be: THR = 50-70% x (220-60) = 80 - 112 beats per minute.
If you have health concerns and/or are an older adult, first get clearance and guidance from your doctor.
No pressing health issues? Pick an exercise class that appeals to you and is appropriate for your level of fitness. It is easy to find something happening near your home or workplace. Start with the range offered on the Health Promotion Board’s Healthy 365 mobile app, and at community centres or senior activity centres. You can also choose to hire a personal trainer.
Older adults and those with health conditions can visit a polyclinic to get a physiotherapist referral to customise an exercise routine for their specific needs.
However, one should not forget that exercise is only part of the intervention. Most importantly, a balanced and healthy lifestyle is recommended as a more holistic approach to fighting dementia.
Exercising with others brings benefits that include making friends and feeling part of a group. This can help improve mood by staving off loneliness. Keeping fit with others can also be motivating and help maintain an active lifestyle.
For those diagnosed with dementia, regular interactions with exercise buddies can potentially reduce the depression and behaviour disturbances they may have.
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Currently, 1 in 10 above the age of 60 and 1 in 2 above the age of 80 (WiSE1 study by IMH)
A sedentary lifestyle accounts for 13% (nearly 4.3 million) of Alzheimer’s Disease (AD) cases worldwide (World Alzheimer Report 2014)
Older adults who participated in high physical activity are associated with a reduced risk of dementia of all types by 26%, and AD by 45%, when compared to people who follow a sedentary lifestyle. (Psychological Medicine, Volume 39, Issue 1)
[Figures were supplied by Dr Chuo and the physiotherapists]
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