Dear Colin: I read that physical therapy can help people with Alzheimer’s disease. Is this true? How? My 71-year-old dad has been showing a steady decline since being diagnosed four years ago, and we’re looking for credible ways to help him.
– Betty from Vancouver, Washington
There is research suggesting exercise therapy, a specific form of physical therapy, may help people with Alzheimer’s. It’s important to differentiate the type of physical therapy because “conventional” physical therapy (ultrasound, hot packs, manual therapy, low-intensity exercise) probably won’t do a thing for him.
But professionally prescribed exercise therapy has been shown to positively affect people with early to moderate stage Alzheimer’s and those at risk for it (those over 65), although research hasn’t identified ideal protocols (Aging Mental Health 2005; Journal of the American Medical Association 2008).
Studies also suggest that various forms of exercise therapy can help protect against dementia (The Lancet 2004 and 2005). Particularly, daily exercise has been shown to improve function of specific brain areas most vulnerable in developing Alzheimer’s, such as the frontal and parietal lobes (Neurobiology of Aging 2011). This is potentially a big deal because damage to those areas can result in personality changes and loss of planning skills, seriously compromising independence.
Research also suggests exercise therapy can lead to the sprouting of new nerve cells and their connections in key areas of the brain (Journal of the International Neuropsychological Society 2007). Early onset Alzheimer’s usually shows a loss of nerve cells and their connections, leading some researchers to believe exercise therapy may help to at least partially reverse these progressions (Dementia and Geriatric Cognitive Disorders Extra 2012). This could also be a big deal, because exercise may help improve how your dad’s brain actually functions in daily life.
In addition to exercise consistency (as in, daily), another crucial component for those either at risk for Alzheimer’s or who already have it is exercise intensity, how hard you’re working during exercise. The Rate of Perceived Exertion scale (RPE) is a scientifically sound, practical and reliable way to measure intensity. A commonly used RPE scale is 0-10, with 0 meaning “no exertion at all.” 5 is “moderate exertion” and 10 means you’re about ready to have a baby.
Depending on the exercise your dad is doing, the intensity will largely dictate the extent to which it is beneficial (Medicine and Science in Sports and Exercise 2004 & 2007). For example, if your dad is doing strengthening exercises, his RPE should be around a 7 for it to be effective (Journal of the American Medical Directors Association 2008). Endurance exercise, such as walking, should probably be around 4 to 5, although some studies show even greater benefits reaching higher RPE levels. It’s important to realize that your dad will gradually work up to these intensity levels with consistent practice in his home program. It’s the physical therapist’s job to keep him safe during the process.
Given that exercise therapy is a relatively new concept in helping treat and prevent Alzheimer’s, you may have to alert your dad’s physician and physical thearpist to its inclusion in his plan of care. As always, it’s important your dad be taught how to do as much as possible for himself to minimize effects of Alzheimer’s.
Dr. Colin Hoobler is a physical therapist practicing at c.h. Physical Therapy in Oregon
Citation: Special to the Oregonian. “Colin Hoobler: Exercise Therapy May Benefit People with Alzheimer’s” The Oregonian. The Oregonian, 31 July 2012. Web. 01 Aug. 2012. http://www.oregonlive.com/health/index.ssf/2012/07/colin_hoobler_exercise_therapy_1.html