U-shaped association between vigorous exercise, Alzheimer’s disease

According to a new study, the amount of vigorous physical activity during leisure time is inversely correlated with Alzheimer’s, but after a certain point the connection is reversed. [1].

Overcoming Dementia

Thanks to the aging of the population and the success of drugs for other age-related diseases, Alzheimer’s disease has become one of the leading causes of death in developed countries. However, no effective treatment has been introduced, except for a handful of drugs that can only moderately slow the progression of the disease in some patients. Instead of such treatments, lifestyle changes such as physical activity are still the best course of action for people who want to reduce their chances of getting the disease as they age. [2].

Previous studies have shown no or a moderate inverse association between physical activity and Alzheimer’s [3]. Since randomized controlled trials to prevent Alzheimer’s disease are hardly possible, we must rely on epidemiological studies, which are notoriously unreliable and can only demonstrate correlation rather than causation. However, by conducting more of these studies, researchers can gauge a general trend, as a new study published in Lancet Healthy Longevity diary.

Better something than nothing, but not too much

The study analyzed 22 consecutive waves of the US National Health Interview Survey between 1997 and 2018, with a total of nearly 100,000 participants aged 68 and over. The median follow-up period was 6.5 years. The researchers claim that this is the first Alzheimer’s disease study to report physical activity by intensity while estimating the number of preventable deaths.

After controlling for several confounding variables, including smoking, alcohol use, chronic diseases, activity limitations, body mass index, strength training, and education level, the researchers found a nonsignificant negative association between Alzheimer’s prevalence and moderate physical activity. activities. More interestingly, a significant U-shaped association emerged between Alzheimer’s disease and vigorous physical activity.

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Exercise for Alzheimer's disease

The largest reduction in Alzheimer’s risk (21%) was associated with 140 minutes of vigorous exercise per week. After that, the hazard ratio gradually rose back up. The researchers also identified a minimum amount of vigorous physical activity associated with a risk reduction of 50% from the optimal amount, which was 40 minutes per week.

These results may seem surprising, but they are not unheard of. More and more research shows that overtraining is possible [4]. Specifically for Alzheimer’s disease, a study based on a huge UK biobank found a similar L-shaped association between objectively measured moderate to vigorous physical activity and accidental dementia. [5].

Theoretically, 31,000 lives were saved

The researchers also estimated how many lives in the United States due to Alzheimer’s disease could be saved by physical activity. In a theoretical scenario where all older Americans engage in optimally vigorous exercise, while none of them do any, the number of deaths prevented was about 31,000. Notably, this scenario is not entirely unrealistic, as only 20% of the study participants reported engaging in any vigorous exercise. Maintaining moderate physical activity would reduce Alzheimer’s-related deaths by 10%.

This study has its limitations, starting with the fact that it is based on self-reported levels of physical activity, which are prone to recall bias. In the future, we can expect more studies based on objectively measured physical activity levels with wearable devices. Residual confounding and reverse causation are often unavoidable in population studies, even when researchers try to minimize them. Despite these limitations, this study adds to our growing understanding that, first, vigorous physical activity is much better than none, and second, exercise enthusiasm can be taken too far.

To our knowledge, this study is the first to examine dose-response associations of recreational MPA and VPA with Alzheimer’s disease-related mortality. The study also provides new estimates of the number of potential Alzheimer’s-related deaths that could be avoided by physical activity in the United States. Our results show that 20190 weekly min of VPA is associated with a lower risk of Alzheimer’s disease-related mortality. We found a minimum dose of 40 min of VPA per week and an optimal dose of 140 min of VPA to reduce the risk of Alzheimer’s-related mortality, which may prevent 10% and 31% of annual Alzheimer’s-related deaths in the United States, respectively. respectively.

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Literature

[1] Lpez-Bueno, R., Yang, L., Stamatakis, E., & del Pozo Cruz, B. (2023). Moderate and vigorous leisure-time physical activity in older adults and Alzheimer’s disease-related mortality in the United States: 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 and dementia risk in a Korean national cohort. JAMA Web Open, 4(12), e2138526-e2138526.

[4] Schnohr, P., OKeefe, JH, Lavie, CJ, Holtermann, A., Lange, P., Jensen, GB, & Marott, JL (2021, December). U-shaped association between duration of sports activity and mortality: the 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 relationship between device-measured physical activity and incident dementia: a UK Biobank prospective study. BMC Medicine, 19, 1-13.

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