Training Clients with Dementia

September is World Alzheimer’s Month; it is a time to raise awareness about Alzheimer’s disease, promote brain health, and support those affected by the condition.

As part of my education to become a Personal Trainer, I had to learn about working with “special populations;” this can refer to youth, those with chronic diseases, and those with disabilities. After my certification as a trainer, I studied to become a Functional Aging Specialist. After obtaining that specialization, I was better prepared to work with older adults living with a wide variety of physical and cognitive conditions. I thought I knew all that I needed to know to work with people living with dementia.

Book-learning and seminars, however, are no substitute for hands-on experience. Over the last seven years, I have had the opportunity to work with several clients at various stages of Alzheimer’s Disease or other forms of cognitive decline. It is interesting and challenging work, and I have learned a lot.

There is a question, though, about what the benefit of such an exercise program might be. I have posted about this in the past, but it bears repeating as we work our way through World Alzheimer’s Month. The only non-medical way in which brain health can be improved is through exercise in conjunction with a proper diet and sufficient rest. The heart pumps and circulates nutrient rich blood to all parts of the body; when we exercise (especially cardio) that process speeds up and brings more nourishment to the cells, including those in the brain. Research shows that regular exercise can help to slow the progression of the disease.

There is another aspect though which should not be overlooked. For some of my clients with dementia, the time that I spend with them is an opportunity to engage socially with someone aside from family or caregivers. I always come prepared for a workout especially designed for the client and his/her capabilities; in that respect, they are no different than my other clients. What is different is the way the session may proceed. I usually need to demonstrate exercises several times–even after we just completed a set; this requires patience on my part, but I have gotten accustomed to this and it has changed the way that I cue all my clients for the better.

Related to this is that I must modulate the conversation that I have with my clients with dementia. Ask any of my clients and they will tell you that I love to chat during our sessions; it helps to engage the client and make the session appear to move more quickly–while still getting the same amount of work done. The kinds of questions I may ask clients with Alzheimer’s Disease and the topics we might discuss are different. In most cases, I cannot ask “how was your weekend?” as they may not remember. I can usually ask about things that happened many years ago (those memories are often preserved), but most of the time I focus on the present moment. I may talk about what is going on in my life or the weather or the local sports teams. I like to focus on the present moment and making the most out of it for my client–from an exercise and social standpoint.

World Alzheimer’s Month is a time to reflect on the way that this disease has affected so many individuals and families. It is a time to advocate for more research (rather than cuts in funding). It is also a month in which we can reach out to those around us with dementia and help to make their present moment just a little bit brighter. I am proud of my role as Personal Trainer in helping to make that a reality.

Funding Cuts and Alzheimer’s Disease

Anyone who has been following the news knows that the current US administration has made “government efficiency” one of its goals. While almost everyone agrees that waste should be eliminated wherever possible, many have concerns that in the long run some cuts will do more damage than good. Many point to pauses or cancellation of federal funding for medical research as a clear example of this; these actions are often the result of an over-arching initiative to eliminate all Diversity Equity and Inclusion (DEI) programs at institutions that receive funding for these studies.

CNN recently reported on the effect this is having on research to prevent and treat Alzheimer’s Disease and other forms of dementia. The article talks about one study at UC-Davis entitled: “The Clinical Significance of Incidental White Matter Lesions on MRI Amongst a Diverse Population with Cognitive Complaints (INDEED).” This study has the word “diverse” in its title which triggered an automatic pause in funding; as is apparent from the context, this study does not have to do with issues of merit-based advancement but rather various populations that are affected by Alzheimer’s Disease–which is basically every ethnic group that exists. The funding was eventually restored but a great deal of money was wasted as the study was shut down and then restarted–not exactly government efficiency.

This is just one of many cases affecting research on Alzheimer’s Disease. On paper, these studies seem like easy targets. First, much of the research takes place at research universities; these institutions have been a target of recent anti-DEI efforts. Second, a large number of older adults have Alzheimer’s Disease which means that support and research costs the US government quite a lot; to eliminate would make a positive impact on the “bottom line.” In a related vein, care for those with dementia is approximately 2 to 3 times more costly than for those without it; this makes investment in Alzheimer’s Disease seem to have a lower return on investment.

The key question for me is whether these short-term (and perhaps short-sighted cuts and pauses) will ultimately save money in the long-term or end up costing a lot more later on as research costs rise. Again, everyone agrees that waste should be eliminated where possible, but one has to wonder about the wisdom of these clearly politically-motivated (anti-DEI) measures and whether we are cutting off our noses to spite our faces.

Let your elected representatives know what you think. As we age, these matters will become more important. Let’s not allow our future health and well-being be sacrificed on the altar of political game-playing.

Brain and Brawn

The question of which is more important in getting through life–brains or brawn–has been around for a long time. What brings the greatest success–physical strength or intellect? The truth is that at different times one or the other may be more critical to overcome an obstacle. The ability to pivot between them is key. A recent study shows that there is an important connection between them for older adults.

An article that came out in early December, 2024, in Medical News Today describes the results a study at Johns Hopkins Medical Institution that will be formally presented in the near future connecting sarcopenia and dementia. Sarcopenia is a condition in which a person loses strength and/or muscle mass; this generally occurs as a result of inactivity and is seen a great deal in older adults.

Researchers looked at the temporalis muscle in a statistically significant group of older adults; this is the muscle that is responsible for closing the jaw. A small temporalis is associated with smaller overall muscle mass in the body, and a larger temporalis points to larger overall muscle mass; this makes it an easy indicator to assess whether a person has sarcopenia or not. The temporalis of each study participant was evaluated and it was found that those with smaller ones (ie., with lower muscle mass) were much more likely to develop dementia at the end of the study (around six years later).

This news is significant because it points to another way that dementia can be identified early, and even how the odds of it developing can be reduced. The greater the muscle mass, the lower the risk. How can muscle mass be increased? Two main factors are at play. First is exercise; resistance exercises (using weights) help to increase muscle mass. There is a misconception that older adults necessarily lose muscle mass, but it can be prevented or slowed with continued exercise. The second is consuming enough protein; protein is what helps to maintain and build muscle. Protein can be found in meat, poultry, fish, and eggs, but there are many plant-based options such as beans, nuts, and lentils.

People ask me why individuals use a personal trainer in their senior years. The motivation, in general, is different than younger folks; it is less about appearance or sports performance and more about maintaining general health and independence. We have known for a while that cardio exercise (the kind that gets your heart pumping like running, cycling, dancing, etc.) is good for the brain; it gets the blood to circulate so that it brings rich nutrients to all the cells–including brain cells. Add to this now that resistance exercise is another brain healthy activity!

This study is just one more reason for us to ensure that we are getting both cardio and resistance exercise. It is not just good for our muscles, but for our brains too!

Can Friends Keep You Healthy?

One of the greatest challenges facing older adults is loneliness. When we are younger, we are often surrounded by partners, children, and friends. As we age, though, spouses and friends may no longer be with us, and in our highly mobile society, children often move away from where they grew up. Being surrounded by loving and supporting people might be something we unfortunately take for granted in our younger years, but it becomes more and more precious as time passes.

Loneliness can also have an adverse effect on physical health. A recent article from AARP, highlights the way that friendships can influence our physical well-being. The article notes that a “new study of older adults finds that even momentary social interactions with friends reduce fatigue and stress. It follows a wealth of earlier research showing that friendships later in life forestall dementia, Alzheimer’s and physical decline.” Social interactions are thought to stimulate the brain much in the same way that some puzzles do: activating thinking, remembering information, and being mentally nimble. Lack of social interaction can be worse than the effects of obesity, smoking 15 cigarettes a day, and physical inactivity.

How can loneliness be counteracted? The answer is particular to each individual. Introverts may actually fare much better than extroverts in this regard; there are those who simply get more stimulation and fulfillment from reading a book, watching a movie, or going for a walk alone. For older extroverts, however, the need to be with others can be complicated. We make most of our friends at work, at school, through our children, and by being out and about; these opportunities are often limited as we age. The COVID-19 pandemic showed us, though, that even folks who have a hard time getting out of their homes can still find ways to meet new people. Those who do not have mobility issues or have better access to transportation can get involved in senior groups at houses of worship, community centers, or libraries. Many find new friends at the local gym, in adult education classes, and in group travel. It requires some effort, but ultimately there is a positive payoff.

Nobody wants to be lonely. Humans are social beings. Not only can strengthening and creating friendships be good for our emotions and spirits, but we should not forget that it can also impact the way we feel and how we age in a healthier way.

Why Are Rates of Alzheimer’s Disease in the US Dropping?

The most recent issue of AARP Bulletin (March, 2024) has a cover story on Alzheimer’s Disease. It reports that, for the first time in close to 20 years, new drugs are being approved for the treatment of the disease. Not only that, there may soon be better ways to diagnose it–including a simple blood test. The focus among researchers has shifted as well from only looking at the plaque which is found in the brain of those with Alzheimer’s Disease to also looking at neural connections and inflammation. The article is full of information and definitely worth a read.

What I found most compelling was the surprising news that Alzheimer’s Disease diagnoses are actually on the decline. From 2000 to 2016, the rate dropped 30% in the United States according to a 2022 Rand Corporation study! What accounts for this stunning trend?

As noted above, it is NOT because of any new drugs. Instead, researchers believe that the focus placed on heart health over the last 20 years has paid dividends in other areas such as dementia. According to another 2022 study–this one from the University of Minnesota–“41 percent of Alzheimer’s and related dementias were attributed to a dozen modifiable risk factors, of which high blood pressure, obesity and physical inactivity had the most impact.” In other words, we can change our behaviors and lower our odds of getting dementia.

A sidebar in the article pointed out a number of behaviors that can prevent Alzheimer’s Disease.

Don’t smoke! Enough said.
Keep blood pressure and blood sugar at healthy levels. Hypertension and Diabetes increase the risk of memory and thinking problems by 41%.
Get regular exercise. Get moving and lower your risk for all dementias by 28% and Alzheimer’s by 45%.
Eat more healthy foods. A diet limited in red meats, saturated fats, and added sugars that is also high in produce can lower your chances of getting AD and dementia by 48%. Berries and spinach are thought to protect brain cells.
Take a multivitamin. Multivitamins cannot replace a good diet but they have been shown to have a beneficial effect on the brain.
Care for your ears and eyes. A University of Toronto study in 2022 showed that hearing and/or vision loss increase the risk for cognitive problems by 20-50%. Hearing aids and vision care can help.
Be attentive to mental health issues. Stress, depression, anxiety, and loneliness over time can contribute to cognitive decline. Seek help for these conditions.
Get quality, regular sleep. Sleeping is what allows our brains to clear out waste; sleeping problems can prevent that from occurring. Take appropriate steps to improve sleep.

Alzheimer’s Disease and other dementias are frightening–to those who receive the diagnosis and for their loved ones. It is reassuring to see that progress is being made in research for diagnosis and treatment. What is most exciting to me is knowing that our own actions can have a positive impact. It is not just a crapshoot (or even based solely on genetics). We can (up to a point) help prevent cognitive decline as we age!

Slow Down, You Move Too Fast…Or Not

A recent article on CNN.com reports on a new large study appearing in the Journal of the American Medical Association that shows a connection between slower walking speeds (or gait) and development of dementia. The research seems to show that a decrease in the speed at which older adults walk year to year may be an early indicator of cognitive decline and dementia. The study looked at the pace of walking as well as the ability of participants to answer certain cognitive/memory questions, then drew conclusions about their relationship.

Although it was a large study (17,000 subjects), more research should follow. As I read the article, I wondered about a chicken and egg question. Did walking speed decrease because of lower cognition, or did cognition somehow decrease because of slower walking? If the second is the case, then it would make sense that we should regularly monitor people to see if they are literally slowing down; if so, they should be put on a program to increase the velocity of their gait. The research does show that when both factors (slower walking and cognitive decline) are present, there is a much greater chance of dementia–as opposed to mild cognitive impairment, which is a “normal” part of the aging process.

The study seems to indicate that the connection may exist in the right hippocampus–the area of the brain associated with memory. Believe it or not, the size of the right hippocampus can actually be increased with regular aerobic exercise (the kind that elevates heart and breating rates). It is not as if we simply have to accept the fact that once we slow down we are on a slippery slope to dementia; keeping up the pace of our exercise can have a positive impact. Even stretching exercises were shown to make a difference.

More research will surely be forthcoming. This study will certainly become an important tool in assessing the risks of dementia. It also provides another reason why it is so important for older adults to remain active and engage in regular exercise. It is not just about our physical health, but about our mental well-being too!

Dementia and Physical Fitness

I recently had a discussion with a loved one about doing personal training with individuals who have irreversible medical conditions and/or cognitive decline. The focus was on whether it is ethical to accept payment to work with someone when there is little chance that the work we are doing will improve the situation.

I wrote about this tangentially in a blog post a couple of years ago in which I talked about the statement “All Lives Matter,” concluding that many people who say that really do not act in way that truly reflects it. I shared a story about an incarcerated individual with whom I have corresponded and visited for over twenty years. He is currently serving a life sentence. In 2002, he was diagnosed with a terrible cancer and called on me to counsel him on what he should do. Ultimately, he decided to undergo treatment and beat the odds by becoming cancer-free (he did the same again with a later diagnosis). One might wonder what the point is of curing one’s cancer if when it is all over s/he will still be still be incarcerated for the rest of one’s life. Is the life of an incarcerated person somehow not worth living? I learned that it is, and I have seen it played out over and over again since 2002.

In a similar vein, one could ask whether there is any point to training someone with Alzheimer’s or another end-stage disease. I addressed this in a more recent post, remembering a client who was on hospice care when I began training him. He had been athletic his whole life and his family knew that he loved to work out; in the last several months of his life, that is what we did together. Did it hold off the disease? Did it cure him? No. Did it add quality to his life on the days we were together? I would like to think so.

I do work with clients who experience cognitive decline. There are all kinds of considerations that go into carrying out this kind of training and my certifying organiation, The American Council on Exercise, has even written about it. There is research that indicates that aerobic exercise can actually help maintain (and perhaps even improve) cognitive function, but even if there was not, the quality time spent together is worth it. As with all my clients, I meet them where they are–physically, emotionally, spiritually, and mentally. I consider it a special honor to work with older adults; I believe that I make a difference in the lives of these clients (and in their families), and I know it has made a difference in mine.

What Did I Come Into this Room for…and Other Things I Worry About

PET scan of an healthy brain compared to a brain at an early stage of Alzheimer's disease.

A short, but informative and helpful, article appeared on CNN.com’s health page today that sparked my interest. Entitled, “Is My Senior Moment the Start of Dementia?,” it explores the difference between milder forms of cognitive impairment such as forgetfulness and more serious forms such as Alzheimer’s Disease. The author, Laurie Archbald-Pannone, is an associate professor of geriatric medicine at the University of Virginia.

As I have grown older, I have accepted that my memory is not what it once was. I have noticed that it seems to be much worse when I am under a lot of stress. I will make what I consider to be stupid mistakes like going to the grocery store to buy one thing and leaving with five things–none of which was the original product I intended to buy. I sometimes cannot remember a name or find the right word to express myself. I got so worried at one point (soon after my move to Cleveland and starting three jobs), that I went to a doctor and asked for a test…man, woman, person, camera, TV…I passed too!

Archbald-Pannone’s salient point is that memory loss becomes a problem when it interferes with one’s ability to do everyday activities. For instance, not remembering the name of someone you know but haven’t seen in a few years is not a problem; forgetting the name of someone you see everyday might be. Not remembering how to get to a restaurant you went to one time is probably not a problem; getting lost on the way to the dry cleaner you’ve gone to for years probably is.

The author points out that mild cognitive impairment is a natural part of aging and is usually not cause for alarm. In any case, it is always a good idea to keep one’s primary care physician apprised of any changes or concerns. Sometimes these changes are, in fact, the beginnings of something more serious.

It bears repeating (at least on my blog) that according to the the Alzheimer’s Disease Foundation’s website there are things we can do to prevent the onset of dementia. Their website lists: proper nutrition, mental activities, certain dietary supplements, and physical activity. The last one, of course, is the one that is most compelling to me. We know that cardiovascular exercise helps the heart, but when the heart is strong it helps the rest of the body. A healthy heart and vascular system is better able to circulate nutrient-rich blood to the cells. The better fed the cells, the healthier they remain. This includes brain cells. It bears repeating: physical activity becomes all the more important as we age.

To read Archbald-Pannone’s article, click here: https://www.cnn.com/2020/09/21/health/what-are-early-signs-of-dementia-wellness-partner/index.html.

And now, I’m off to the store to get some buttermilk…right?

More News on Dementia and Lifestyle

Image result for factors to prevent dementia

Well, it’s not really “news” since it is simply reconfirming what we already have seen in recent research.

There are studies recently shared at Alzheimer’s Association International Conference last week that show that there are five factors that have been shown to significantly reduce the risk of developing dementia later in life.

Both studies pointed to:

A healthy diet
At least 150 minutes a week of moderate to vigorous physical activity
Light to moderate drinking (alcohol)
No smoking
Engaging in mentally stimulating activity

Engaging in all five decreased risk of Alzheimer’s by 60% compared to those who only had one healthy behavior. Those who added only one of the habits above saw their risk lowered by 22%!

It is becoming more and more clear every day that the decisions we make about our lifestyles at every point in our lives have implications downstream. There is no point at which we are “too late” to add healthy behaviors, and when we do add them the impact is noticeable.

For the full article in http://www.cnn.com, click here: https://www.cnn.com/2019/07/14/health/dementia-risk-lifestyle-study/index.html

Judaism teaches us that we are to pursue life. This means we cannot simply wait around and see what is in store for us health-wise. We must at every moment, make healthy decisions; not only will we sense the difference now, but in the years ahead as well.

Brain Games may be just that…

CNN reported on the new global guidelines from the World Health Organization (WHO) about preventing dementia.

The guidelines reinforce what many of us in the Fitness Industry and who have an interest in brain biology already know. Many of the gimmicks that are advertised to help stave off dementia are just that–gimmicks that are not proven to really work.

For some time now, experts in brain biology have been able to cite only one factor that is known to reduce the chances of developing dementia: cardio exercise. But wait, what does the heart have to do with the brain (sounds like a country music song)? It’s actually not that complicated; the more blood that we get pumping throughout our bodies (which is what cardio exercise does), the more blood that flows to the brain; the more blood to the brain, the healthier it is!

What the WHO guidelines add is that there are now a few other factors that also can contribute to preventing dementia: “regular physical exercise, not using tobacco, drinking less alcohol, maintaining healthy blood pressure and eating a healthy diet — particularly a Mediterranean one. “

Just one more reason to head to the gym…or outside…or to that piece of cardio equipment in the basement. Not only is it good for your heart, it is good for your brain too!

Here is the article from CNN.com:
https://www.cnn.com/2019/05/14/health/who-guidelines-dementia-intl/index.html