U-Shaped Association Between Vigorous Exercise, Alzheimers

According to a new study, the amount of leisure time vigorous physical activity is inversely related to Alzheimer’s, but after a certain point, the association reverses. [1].

Outrunning dementia

Due to the aging of the population and drug breakthroughs against other age-related diseases, Alzheimer’s disease has become one of the leading causes of mortality in the developed world. However, no effective treatment has been introduced, apart from a small number of drugs that only slow the progression of the disease in some patients. Instead of such treatments, lifestyle changes, such as physical activity, remain the best course of action for people who want to reduce their chances of getting the disease as they age. [2].

Previous research has shown either no relationship or a moderate inverse relationship between physical activity and Alzheimers [3]. Since randomized controlled trials for the prevention of Alzheimers are almost impossible, we must rely on epidemiological studies, which are notoriously unreliable and can only show correlation rather than causation. However, by doing more of those studies, scientists can gauge the overall trend, which was done in a new study published in Lancet Healthy Longevity Diary.

Something is better than nothing, but not too much

The study analyzed 22 consecutive waves of the US National Health Interview Survey from 1997 to 2018, which, in total, recruited nearly 100,000 participants aged 68 years or older. The median follow-up period was 6.5 years. Researchers say this is the first Alzheimer’s study to stratify physical activity by intensity while also estimating the number of preventable deaths.

After controlling for several confounding variables, such as smoking, alcohol consumption, chronic conditions, functional limitations, body-mass index, strength training, and educational attainment, the researchers found a non-significant negative correlation between the incidence of Alzheimer’s and the amount of moderate physical activity. activity. More interestingly, a significant U-shaped relationship between Alzheimers and vigorous physical activity emerged.


Exercise for Alzheimer's

The greatest decrease in Alzheimers risk (21%) was associated with 140 minutes of vigorous exercise per week. After that point, the hazard ratio gradually climbs again. The researchers also identified a minimally relevant amount of vigorous physical activity, associated with a risk reduction of 50% from the optimal amount, and this was 40 minutes per week.

These results may seem surprising, but they are not unheard of. A growing body of research shows that it is possible to get too much exercise [4]. Specifically for Alzheimers, a study based on the large UK Biobank found a similar L-shaped relationship between moderate to vigorous physical activity and incidence of dementia. [5].

31,000 lives were theoretically saved

The researchers also estimated how many lives lost to Alzheimer’s in the US could be saved through physical activity. In a theoretical scenario, in which all older Americans engaged in the optimal amount of vigorous exercise versus none of them doing anything, the number of deaths prevented would be about 31,000. Interestingly, this scenario is not entirely unrealistic as only 20% of study respondents reported getting any vigorous exercise. Maintaining a small amount of vigorous physical activity will result in a 10% reduction in Alzheimer’s-related deaths.

This study has its share of limitations, starting with the reliance on self-reported amounts of physical activity, which is prone to recall bias. In the future, we can expect more studies based on physical activity levels actually measured by wearable devices. Residual confounding and reverse causation are often unavoidable in population studies, although researchers have tried to minimize them. Despite those limitations, this study adds to our growing understanding that, first, some vigorous physical activity is significantly better than none, and second, exercise intensity is may be too far.

To our knowledge, this study is the first to examine dose-response associations of leisure time MPA and VPA with Alzheimer’s disease-related mortality. The study also provides new estimates of the potential number of Alzheimer’s disease-related deaths that could be prevented through physical activity in the USA. Our results show that 20190 weekly min of VPA is associated with a reduced risk of Alzheimer’s disease-related mortality. We found a minimal dose of 40 weekly min of VPA and an optimal dose of 140 weekly min of VPA for reducing the risk of Alzheimer’s disease-related mortality, potentially preventing 10% and 31% of annual deaths related to Alzheimer’s disease in the USA, respectively.

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[1] Lopez-Bueno, R., Yang, L., Stamatakis, E., & del Pozo Cruz, B. (2023). Moderate and vigorous leisure-time physical activity in the elderly and Alzheimer’s disease-related mortality in the USA: a dose-response, population-based study. The Lancet Healthy Longevity, 4(12), e703-e710.


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[2] Flicker, L. (2010). Modifiable lifestyle risk factors for Alzheimer’s disease. Journal of Alzheimer’s disease, 20(3), 803-811.

[3] Yoon, M., Yang, PS, Jin, MN, Yu, HT, Kim, TH, Jang, E., … & Joung, B. (2021). Association of physical activity level with risk of dementia in a nationwide cohort in Korea. JAMA Open Network, 4(12), e2138526-e2138526.

[4] Schnohr, P., OKeefe, JH, Lavie, CJ, Holtermann, A., Lange, P., Jensen, GB, & Marott, JL (2021, December). U-shaped relationship between duration of sports activities and mortality: Copenhagen City Heart Study. In Mayo Clinic Proceedings (Vol. 96, No. 12, pp. 3012-3020). Elsevier.

[5] Petermann-Rocha, F., Lyall, DM, Gray, SR, Gill, JM, Sattar, N., Welsh, P., … & Celis-Morales, C. (2021). Dose-response association between device-measured physical activity and incident dementia: a prospective study from the UK Biobank. BMC medicine, 19, 1-13.

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