SALT LAKE CITY — Most mornings, Lonnie Wollin rolls out of bed early and one of his first tasks is clocking a half-hour or so on his stationary bike, unless he has an actual bike ride or a hike planned early with his equally active wife and pals.
Wollin, who turns 75 this month, also does some strength training a few times a week because he’s serious about staying as healthy as possible from head to toe.
Especially, the head. Wollin has lost eight family members to Alzheimer’s disease, including his father. He’s doing his best to forestall or avoid that fate himself.
Science says he might be able to do quite a bit. Effective medication to treat Alzheimer’s has proven stubbornly elusive and it’s been more than a decade since any new drug received Food and Drug Administration approval. But research yields tantalizing clues that have experts increasingly convinced behaviors, not a pill, may be key to securing extra years of quality life — even for those at increased risk of Alzheimer’s.
Could 150 minutes of exercise a week make a difference in how long one stays healthy? That’s very possible, experts say, based on research. Add other healthy behaviors, and the odds climb higher.
The National Institute on Aging, the Alzheimer’s Association and others are funding ongoing randomized clinical trials — the gold standard of research — to figure out what role behaviors might play for health or harm. Rewards could be great, adding quality years and forestalling dementia.
The institute announced in June results from two observational studies that followed 3,000 participants long term. Researchers concluded healthy lifestyle behaviors yield “substantially lower risk” for Alzheimer’s disease. Their measures were exercising for at least 150 minutes a week, intellectual stimulation, good nutrition, not smoking and low to moderate alcohol consumption.
Dr. Klodian Dhana, assistant professor at Rush University, who led the study, said those who practiced two or three of the lifestyle choices had a 37% lower risk and those with four or all five had 60% reduced risk of Alzheimer’s, compared to those with no or one of the lifestyle factors.
Research released in March had already found higher daily step counts were associated with lower mortality risk from all causes.
“What is good for the heart is good for the brain,” says Dr. Norman Foster, neurologist and professor at the University of Utah in Alzheimer’s clinical and imaging research. “There’s a lot of good, objective scientific evidence that supports these kinds of changes, which also make a lot of common sense.”
That’s hopeful news for people like Wollin who are disciplined in trying to keep their brains healthy.
“I don’t think lifestyle changes take the place of finding a treatment or a cure,” said Wollin, a financial adviser, attorney and longtime advocate who helped found the Alzheimer’s Association decades ago. “But it is certainly something that people can do now.”
Pinning down details
Alzheimer’s is a progressive neurological disease and the most common form of dementia, affecting more than 5 million people in the United States, according to the Centers for Disease Control and Prevention, which projects the number will nearly triple by 2060. Risk climbs with advanced age.
Experts say the disease likely begins well before symptoms appear. Lifestyle might change the “when.”
“It’s more realistic to talk about delaying onset than to talk about prevention for someone who has risk factors,” Dallas Anderson, program director in the institute’s Division of Neuroscience, told the Deseret News.
He recommends a “program of activity and maybe some other things to get more years in life that are dementia-free.”
Exercise must be moderate to vigorous to be effective, but Foster said even walking provides excellent benefits to health. One has to do it long enough and fast enough to feel warm and get the heart pumping. It should be part of one’s regular routine.
People can do multiple beneficial things at once, like a walk with a friend that includes stimulating conversations. After all, Anderson said, research suggests multiple factors contribute to disease risk.
The body needs to be fueled by high-quality nutrition, preferably similar to the Mediterranean-DASH diet that focuses on plant-based foods, experts said.
“Do the things that are good for the heart — diabetes management, blood pressure control, exercise — and you help the brain, too. They are good for trying to reduce the risk of Alzheimer’s disease,” Foster said.
Anderson said people who have been relatively sedentary benefit the most when they get moving.
It’s a matter of both habit and scheduling, said Foster, who warns it’s easy to do too much at once, leading to pain, exhaustion and quitting. But he doesn’t think dribs and drabs of activity yield the same effect, noting that 2,000 continuous steps are different than 2,000 steps a day 10 steps at a time.
The most important thing is to begin, to form a habit and to choose something enjoyable that you’ll keep doing.
Reaching for gold
Evidence in the United States, Canada and Western Europe suggest that the rate — though not the number — of age-specific risk for Alzheimer’s has been declining. But there are a lot of aging baby boomers, so the number of people with Alzheimer’s will grow, Anderson said.
The upside, he noted, is boomers are more educated than earlier generations and probably had better medical care to control things like diabetes and blood pressure. On the down side, the number who are obese is rising — bad news because that increases Alzheimer’s risk.
While drug development has been painfully slow — the most recent drug for Alzheimer’s was approved more than a decade ago and none prevent or cure Alzheimer’s — studies are chipping away at the mystery of the disease.
The institute is funding more than 230 active clinical trials on Alzheimer’s and dementia and 100 are nondrug interventions. They join completed studies from China on aerobics and balance training, Washington state and Cache County, Utah, among others, that show exercise is brain-protective.
Randomized nondrug trials are underway, said Kristina McLinden, a National Institute of Aging program director who oversees dementia clinical trials not focused on pharmaceutical treatments.
One study looks at the effects of aerobic exercise on further decline in those with mild cognitive impairment. The trial partners with the YMCA at multiple sites where people are assigned to different exercise classes to see the impact. If an exercise program works, it could quickly be expanded to other YMCAs around the country, she said.
Some trials look at exercise alone or in combination with drugs. Social interaction and nutrition are being studied.
Building off a famed study from Finland that showed exercise and diet improve mental processing speed and cognition, a U.S. version funded primarily by the Alzheimer’s Association with ancillary funding from the institute will soon enroll participants to try to localize it to America.
Another institute study examines neuroimaging to see how exercise changes the brain.
The goal of the long list of studies is to, as McLinden says, “tease out what actually has the effect.”
A new Alzheimer’s drug?
The drug drought for Alzheimer’s treatment may be changing.
Biogen last week applied to the Food and Drug Administration for approval of aducanumab, an immunotherapy drug it says significantly slows decline in memory, orientation and language in patients who take it in early stages of Alzheimer’s. The pharmaceutical company says people can continue doing normal activities like managing their finances and cleaning their houses longer.
The drug has been controversial. At one point, Biogen declared it a failure after a study showed the drug effect was comparable to placebo. Biogen adjusted the dose and relaunched; the drug fared better then.
So why is 150 minutes of exercise a week often suggested as a fitness goal?
The number hammers home suggestions to exercise 30 minutes a day, five days a week, though that’s not set in stone.
“I think a lot of that comes out of cardiovascular research where we do know a lot more and we have handled large-scale, randomized clinical trials,” said McLinden. “I think in general we know that what’s good for the heart is good for the brain. So that’s really informing the choice to go after these targets.”
When the trials are done, McLinden hopes science will be able to say what the drugs contribute, what exercise contributes and if they work together.
Foster warns that COVID-19 has complicated exercise for some and many older people are suffering from isolation, which won’t help their cognition.
“The damage when you don’t keep physically active and socially engaged is much more than I ever thought. And it has to do with many things that many of us can relate to, even without Alzheimer’s disease or without being 85 or older,” he said.
Folks like Wollin are waiting anxiously for the study findings to roll in. But they aren’t waiting to take steps to protect their own brain health, instead incorporating into their behaviors what science suggests might help.
So he walks. And hikes. And bikes.