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Dean Sherzai, M.D., MPH, MAS Ayesha Sherzai M.D.
Dean Sherzai, M.D., MPH, MAS Ayesha Sherzai M.D.

What Type of Exercise Protects You Against Alzheimer’s?

The Alzheimer’s epidemic may be preventable with lifestyle changes.

The biggest Tsunami facing our healthcare system and our society is diseases of the brain. Whether it’s depression, anxiety disorder, Parkinson’s disease, stroke, Alzheimer’s or other types of dementias, we as a society are already feeling the burden of these diseases socially and financially.

More than 47 million people are living with Alzheimer’s worldwide. This is a staggering number that has increased at an alarming rate over the last several years. Doctors predict more than half of adults will be diagnosed with the disease by age 85. In the last ten years, while every other chronic disease has been in decline, prevalence of Alzheimer’s has increased more than 80 percent.

Despite the terrifying statistics, the truth is 90 percent of Alzheimer’s cases are preventable through lifestyle factors–and the younger we begin, the better.

After fifteen years of research and practice, we are certain that lifestyle has a profound effect on the health of the brain, and we know that lifestyle medicine, a field of medicine devoted to addressing the factors that contribute to chronic disease, is the only way to both avoid Alzheimer’s and even treat some of the symptoms once a person has been diagnosed. Every day, we are learning more about how our lifestyle choices can change the trajectory of our health. It affects the expression of our genes and determines our risk of developing chronic disease.

One very powerful form of lifestyle medicine is exercise.

Exercise Prescription

We often view exercise as something that predominantly benefits the cardiovascular system and how we fit into our jeans. Exercise is a powerful medicine for our brain health. Both in the short term with daily sharpness and clarity as well as the long term, by decreasing our risks of cognitive decline and Alzheimer’s. In a study focusing on 600 elderly women, the results found that the women who walked the most were less likely to develop cognitive decline in the 6-8 year follow-up.1 In another large, prospective study of older women, higher levels of long-term regular exercise were strongly associated with higher levels of cognitive function and less cognitive decline. Specifically, the apparent cognitive benefits of greater physical activity were similar in extent to being about three years younger in age and were associated with a 20 percent lower risk of cognitive impairment. The association was not restricted to women engaging in vigorous activities: walking the equivalent of at least 1.5 hours per week at a 21-30 min/mile pace was also associated with better cognitive performance.2

In fact, research shows us time and time again that exercise is critical to optimal long term brain health and the more sedentary our lifestyle becomes, the more our risk of developing these devastating diseases increases.

But is all exercise created equal? Certainly moving our bodies more will always carry benefits, but as it specifically relates to preventing brain and other chronic diseases, what should you be doing?

We recommend three exercise habits that research shows are important for optimal brain health.

  1. Consistent Vigorous Exercise. We are finding that we must exercise a little more often and with a little more effort than we initially thought. We classify consistent vigorous exercise as being 20-30 minutes, 4-5 times per week. There is no need to monitor your heart rate as long as you are exercising to the point where carrying on a conversation is hard because you are out of breath.
  2. Constant Natural Movement. Exercise should be dedicated to a small window of our day. People who experience the optimal cognitive benefits are those that incorporate exercise into their life. Whether it’s getting up from their desks at work several times a day to walk the stairs or do squats, or if they experience additional exercise through maintaining an outdoor garden or participating in an active hobby. When we dedicate a small window of time for exercise, but then fail to incorporate constant natural movement throughout the rest of the day, we negate the powerful effects of that short window of exercise. The great news is that there are so many easy ways to adopt a keep-it-moving lifestyle, including parking further away, walking places you used to only drive, and even standing up every hour from your desk to engage in brief physical activity.
  3. Leg strength is linked to brain strength. By promoting leg strength in your exercise habits, you are affecting the largest muscle in your body. Improving leg strength improves the flow of blood into the brain, which improves brain function. In a study of twins, we find consistent and strong evidence that increased leg power at baseline was associated with improved cognitive aging over the following 10 years. Also, increased leg power within twin pairs was associated with bigger brain volumes and greater brain activation on functional MRI studies after 12 years.3

As you can see, exercise is one of our most powerful forms of preventative care, but what about those already suffering from a chronic illness? Is it too late for this group? It is never too late. One study showed that even in those who have early Alzheimer's, sedentary patients had a significant decline in cognitive test scores, while active patients had an attenuation/slowing in the decline of their cognition. Importantly, among the active Alzheimer's patients, those individuals who engaged in walking for more than 2 hours per week had a significant improvement in cognitive scores.4

Barriers to Exercising

Not many would argue that exercise carries a host of benefits when done consistently. What some might have trouble with is how to incorporate it into their busy lives. It’s hard to not view physical activity as one more to-do on a list of (seemingly) more important tasks that have to be completed. With our hectic schedules it’s easy to give exercise a priority downgrade when we have trouble getting through the day. This is why exercise needs to be more than just a simple task.

When you look at adopting exercise habits, however, it’s important to carefully incorporate it into the life that you are already leading. You may want to ask yourself what is the easiest way to incorporate exercise seamlessly into your own life.

One of the most effective ways we’ve found is to incorporate exercise equipment into your living space. More specifically, we recommend starting with placing a recumbent bike or similar equipment right in front of your television. This way, you don’t have to schedule more time in your day that you likely don’t have, you can incorporate it into things you are already doing such as watching television. This is where you can get your vigorous exercise in during your day.

Additionally, to focus on constant natural movement and improving leg strength, get up every hour and do squats or take a brisk walk. The optimal outcome isn’t to just adopt good exercise habits. Ideally, you want to be a change agent for yourself and your family by creating a culture of exercise in your life.

Exercise is one of the most powerful tools we have to prevent and stop Alzheimer’s in its tracks. In research that studied physically capable elderly men, those who walked less than two miles per day experienced a 1.8 fold excess risk of dementia than those who walked over two miles.5 Not only is exercise a critical component to preventing cognitive decline but it is a powerful medicine for those who are already experiencing the crippling effects of Alzheimer’s.

Whether you are in the throes of a chronic illness or looking down the road at prevention, exercise should be one of the key components to your healthy lifestyle choices. There is no more powerful medicine than incorporating healthy lifestyle activities like exercise into the very fabric of our life.


1 Yaffe, K., Barnes, D., Nevitt, M., Lui, L. Y., & Covinsky, K. (2001). A prospective study of physical activity and cognitive decline in elderly women: women who walk. Archives of internal medicine, 161(14), 1703-1708.

2 Weuve, J., Kang, J. H., Manson, J. E., Breteler, M. M., Ware, J. H., & Grodstein, F. (2004). Physical activity, including walking, and cognitive function in older women. Jama, 292(12), 1454-1461.

3 Steves, C. J., Mehta, M. M., Jackson, S. H., & Spector, T. D. (2016). Kicking back cognitive ageing: leg power predicts cognitive ageing after ten years in older female twins. Gerontology, 62(2), 138-149.

4 Winchester J, Dick MB, Gillen D, Reed B, Miller B, Tinklenberg J, et al. Walking stabilizes cognitive functioning in Alzheimer's disease (AD) across one year. Arch Gerontol Geriatr 2013;56:96–103.

5 Abbott, R. D., White, L. R., Ross, G. W., Masaki, K. H., Curb, J. D., & Petrovitch, H. (2004). Walking and dementia in physically capable elderly men. Jama, 292(12), 1447-1453.

About the Author
Dean Sherzai, M.D., MPH, MAS Ayesha Sherzai M.D.

Dean Sherzai, M.D., Ph.D., is a co-director of the Alzheimer’s Prevention Program at Loma Linda University.
Ayesha Sherzai, M.D., a co-director of the Alzheimer’s Prevention Program at Loma Linda University.

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