Since he was diagnosed with early-stage Alzheimer’s disease four years ago, Phil Echert has found himself frustrated by some of the solutions he and his wife have tried to slow or manage his dementia.
The 62-year-old Champlin man tried brain puzzles, but found them exasperating. His wife, Heather, put a GPS locator on his bicycle in case he got lost, but on long trail rides he can forget how to use it.
So when the couple learned of a HealthPartners pilot study to determine if structured exercise and strength training can slow dementia, they were among the first to sign up. Because unlike puzzles or gadgets, exercise is something they know they can do, and they believe it has already helped Phil.
“They think the exercise we do is keeping it at bay,” said Heather, who noted that Phil had symptoms for four years even before his diagnosis. “Most people, when they’ve had it for eight years, they aren’t at the level that he is at.”
Minnesota is an epicenter in an urgent and growing national effort to study exercise and whether it can inhibit dementia — a race accentuated by the aging of the U.S. population.
The U.S. Centers for Disease Control and Prevention estimates the national Alzheimer’s population will increase from 5 million to 14 million by 2060.
On the other hand, recent studies have found a decline in the rates of dementia — with education level and wealth being protective factors. Some public health experts have suggested that improved exercise and heart health in the elderly might explain that decline.
In addition to the HealthPartners study, which examines the value of structured workouts using a high-tech training machine, University of Minnesota nursing researcher Fang Yu has studied the way exercise impacts the course of dementia.
“The evidence is super strong that your cognition actually improves over time if you do aerobic exercise,” she said, “with the strongest improvement occurring in executive functioning” that is responsible for planning and problem-solving.
However, she said more research is needed on whether exercise can slow the progression toward dementia in people with mild cognitive impairment (MCI), or can inhibit symptoms in people who already have Alzheimer’s.
In some ways, clinical practice is racing ahead of research on these issues, because exercise offers so many undisputed benefits.
The World Health Organization’s global action plan on dementia, for example, recommends exercise based on existing evidence that it has protective effects, and proposes to reduce the number of physically inactive people in the world by 10 percent by 2025.
Yu received a grant from the Minnesota Board on Aging to create a certification program that teaches caregivers how to incorporate aerobic exercise into the routines of people with dementia.
One of her recent studies found that exercise over the course of six months helped people with early-stage Alzheimer’s to at least maintain their cognitive levels, but it also found that stress among their family caregivers declined by 40 percent. “They are stronger and they are able to do things better,” she said. “Family members report improved quality of life and reduced stress.”
‘Miracle-Gro for the brain’
One goal of the research is to learn how exercise fundamentally changes the brain — and what biomarkers can track those changes.
One theory about the benefits of exercise is that it reduces the buildup of amyloid plaques that can disrupt neurons — the thinking cells in the brain. Exercise also appears to prevent shrinkage of the hippocampus lobes of the brain, which play a role in the storage of long-term memories. And it appears to stoke the production of BDNF protein, which was described by a Harvard neuropsychiatrist as “Miracle-Gro for the brain.”
Tracking such changes through imaging scans can be expensive, so Yu said research needs to identify biomarkers in blood that can alert doctors to changes in brain function.
One national study followed adults, including residents in northwest Minneapolis, over the course of 20 years and found that those who had signs of chronic inflammation as middle-aged adults were more likely to experience cognitive decline as they aged.
The results, published in the journal of the American Academy of Neurology, suggest that exercise and healthy choices are important early in life because they can reduce chronic inflammation, said Dr. Dave Knopman, a neurologist who became involved in the study at the U before moving to the Mayo Clinic.
“Lead a healthy life and don’t wait until you’re an old person to start doing that,” said Knopman, who also is involved in the Mayo Clinic Study on Aging, which has found that exercise can decrease the odds of developing MCI.
Researchers would also like to know more about the type of exercise that could be most beneficial. That’s where the HealthPartners study comes in. Researchers there are conducting an initial pilot study using a new strength-training machine made by IncludeHealth of Cincinnati that tracks and records patients’ progress.
The Echerts are one of six couples in the study, which will determine the workout regimen for a second, larger study that compares outcomes for people who use the machine with those who don’t.
“We want to determine if this technology can help people … be independent longer,” said Marny Farrell, director of rehabilitation services for HealthPartners’ Regions Hospital in St. Paul.
Couldn’t use snowblower
Phil Echert made clay pots for a living, and the quiet, hands-on nature of his work might have masked the developing problems with his memory. Eventually his family and friends demanded that he get checked. He was struggling to remember how to properly mix chemicals for the pottery glazes, and was frequently repeating himself.
At first, they checked to see if exposure to chemicals was causing reversible cognitive problems. But he was eventually diagnosed with early-onset Alzheimer’s and given medication that helped.
Forgetfulness emerges in many ways, though, like walking to the kitchen and forgetting why. Last week Heather found her husband shoveling snow off the driveway because he couldn’t remember how to prime the snowblower.
Phil already was an avid bicyclist, riding more than 4,000 miles each year. But he said he was eager to try the HealthPartners program because he had never done proper strength training.
Finishing a set of arm lifts on Tuesday with the IncludeHealth machine, Phil laughed at how both his wife and HealthPartners strength trainer Christa Lence kept on him about correct form.
“They’re sticklers,” he said. “Good thing I take direction.”
Exercise isn’t a cure-all. Phil Echert is case in point. He’s biked enough miles in his lifetime to circle the globe. But he and his wife said they are driven to do what they can to keep Phil’s symptoms from getting worse.
The study was both a chance for them to give back through research, and to challenge Phil with something new.
“You have to try new things,” his wife said, “to keep your brain moving in new directions.”