clinical focus
Get moving
Nation ’ s first exercise guidelines to lower dementia risk
By Elise Hartevelt
Australia ’ s first guidelines on physical exercise to reduce cognitive decline and improve mental health have been launched .
Regular physical exercise has been linked to reducing anxiety and depression and lowering the risk of dementia-onset by up to 30 per cent .
Yet , Melbourne University ’ s director of the Psychiatry of Old Age unit , Professor Nicola Lautenschlager , said Australia lacked definitive guidelines on the types and frequency of exercise .
“ After more than 20 years of global research , there ’ s enough evidence to show that non-pharmacological approaches or lifestyle intervention can make a huge difference ,” she said .
“ But implementing all that knowledge is our big challenge now .”
Among physical activity , research has identified 12 risk factors that can increase the risk of dementia .
People who follow a lifestyle with a healthy diet , no smoking , low to no alcohol intake , and preventing or effectively treating depression and anxiety are less likely to have cognitive decline .
On the other hand , medical conditions such as high blood pressure , diabetes and head injury are associated with a higher risk .
Currently , over 15 per cent of Australia ’ s older population is living with dementia , and the figure is projected to exceed 20 per cent in the next 30 years .
In February , federal data revealed that dementia had become the leading cause of disease burden , injury and premature death for people over 65 .
While it ’ s normal for people to become more forgetful as they become older , confusion and progressive memory loss are not age-related .
Lautenschlager said people often worry about their memory as they age because of the high prevalence of dementia .
Every week , Lautenschlager works in a memory clinic and diagnoses people on a regular basis .
It ’ s probably the primary chronic disease of the 21st century , so it just indicates how many people are impacted by the disease , she said . “ There ’ s a big fear and worry about it . “ We feel as if dementia is waiting for us the older we get . “ It ’ s almost like a price we pay for longevity and better healthcare .”
Nevertheless , Lautenschlager said regular exercise can significantly improve memory , protect cognitive function and help stave off dementia .
The study ’ s exercise guidelines include four primary recommendations to reduce mild cognitive decline .
Older people should engage in moderateintensity aerobic exercise for at least 150 minutes
each week on top of regular physical activity , such as walking to the supermarket .
Aerobic exercise suitable for people over 65 includes anything from brisk walking , yoga , water aerobics and gardening .
“ We consistently found that brain health and function , including a reduced risk of chronic disease like diabetes , was reduced in older adults through aerobic exercise ,” Lautenschlager said .
At least twice a week , they recommended that older people practise progressive resistance training using elastic bands or weights and engage in balance-improving activities .
While initially , the researchers planned to develop the guidelines , they saw an opportunity for a second study when the pandemic hit in 2020 .
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We received amazing feedback .
After federal and state governments enforced Covid restrictions , Australians between 65 and 74 experienced the most significant increase in anxiety and depression .
The pandemic also led to people 74 and over becoming most at risk of psychological distress due to socia ; isolation .
The team responded by creating an individualised physical activity intervention called ‘ Exercise for Cognitive Health ( EXCEL ).’
“ We started and conducted most of the study during the pandemic peak in Melbourne , where we had one of the strictest Covid measures in place ,” Lautenschlager said .
“ We received amazing feedback – people felt more engaged , happier and fitter after regular exercise .”
The over 50 participants each received a tailor-made package containing access to more than 700 exercise videos , a headband , weights and a Fitbit .
The exercise program differed for each person based on their medical history , age , previous injuries , what type of activities they liked and general interests .
Over 12 weeks , participants had regular check-ins with their coach and physiotherapist over Zoom .
Lautenschlager said one theme that emerged was that coaching helped turn a participant ’ s intention into action by building confidence and strategies to overcome barriers . “ We set the bar very low at first because most hadn ’ t exercised for a long time ,” Lautenschlager said .
“ Over time , their confidence grew , and they became more dedicated and excited .” One participant said the coach ‘ helped her to get moving ’ and that ‘ any exercise was better than nothing .’
She said , ‘ I ’ ll just go and walk around the block – at least I can say I ’ ve gone for a walk .’ “ Of course , I would walk further than just around the block .”
After the 12-week program ended , she realised how much her health and fitness had improved .
“ I wouldn ’ t get as puffed as before ,” she said .
“ I actually had to push myself to get puffed , whereas before walking down the street … my heart rate would be increasing , whereas now , it doesn ’ t .” ■
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