Healthy Living: July 23, 2019

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BANGOR, Maine (WABI) - Over the past year there have been reports from several fronts of the possible beneficial effects of exercise to ward off the evils of progressive dementia Based on several studies suggesting a potential association between exercise and decreased progression of memory loss, the American Alzheimer's Research and Prevention Foundation made the claim that regular exercise could decrease by 50% one's chances of developing Alzheimer's Disease (1). And just last week National Public Radio released a story highlighting a new ongoing research study known as the 'EXERT' trial that is looking at this very question by doing a prospective study of 300 people who have some qualifying memory loss defined as 'mild cognitive impairment'. The study entails dividing the group up randomly so that half will be assigned to a exercise group performing aerobic exercise on a treadmill, and the others would be assigned to a group doing primarily stretching exercises.(2)

A Mental Health Coordinator was approved for Bay District Schools. (MGN)

While this study is only in the recruitment phase and results won't be available for about 2 years, it is fair to say there's some popular culture 'buzz' right now about exercise preventing dementia in aging men and women. As a scientist physician, how should I look at this? I'm tempted to relate an optimistic story about how a balanced diet, clean living, sunshine (in moderation) and exercise has been proven once again to be good for what ails us. But while making those claims that feel good on one level, how does that square with the experience that I have as 30+ year clinician, and what are the potential implications of this unproven claim?

First I would have to let it be known that the most serious and tragic case of Alzheimer's that I had experienced was of a women in her 50's who rode her bike everywhere and was more fit than I until she began a downward spiral of progressive memory loss to the extreme that she did not recognize her husband of many decades, and ultimately had to be institutionalized by her early 60's because she could not perform simple self-care. Now I realize that one case does not 'disprove' the potential benefit that exercise can afford all of us -- perhaps she would have had symptoms 5 years earlier if she had been a couch-dweller. But my point is that we need to be careful when we confuse association with causation. In other words, those who exercise might do better in the long run because they actually have a milder form of dementia in the first place.
Probably the best argument for being careful regarding some of these claims is the tendency for this logic to extend to the idea 'if you have that disease you must not have been good at getting regular exercise'. This mistaken moral judgment used to be applied to those who suffered from cancers, epilepsy, and many forms of mental illness: that there is some personal shortcoming or fault that is shared by those suffering from that affliction. To this day I remember my excellent mentor in oncology at medical school challenging my fellow students to look at the data, and to be mindful of our non-scientific bias we might bring about what failing caused Mr Smith's pancreatic cancer. Did he drink too much caffeine, how about alcohol, did he have a negative outlook on life?…..None of these variables 'caused' his illness. As I went among the patients' on the cancer ward at Dartmouth, I began to see the men and women in a new light. I saw how they were as human as any collection of individuals with illness with any other problems. There were some brave survivors who never complained, those with a look of sadness when they had visits with their loving family, those with a look of fear in their eyes regarding their unknown fates. But they were the full gamut of individuals, and no one 'deserved' their illness that a simplistic judgment might suggest.

Bottom line? Exercise is good for a lot of things, but be careful when you make the obverse claim that someone who has dementia, has not exercised enough. Some day we may have a better understanding of dementia, with a biologic treatment for some of its many forms, but we are a long way off. Be compassionate for those who suffer, as someday it could be yourself in their shoes.

1. Smith, Melinda, et al --
2. Hamilton, Jon – Is Aerobic Exercise the Right Prescription for Staving Off Alzheimer's? All Things Considered. NPR July 18, 2019