Every morning, Geno Meyers, 67, wakes up and asks his wife, “Do we have a race today?”
Early-onset Alzheimer’s disease has rendered him unable to answer the question for himself. Diagnosed at age 62, Meyers, from Grass Valley, California, can no longer run on his own - he got lost 10 miles from home during a workout in 2014. But he has not lost his desire to hit the pavement.
“Occasionally he’ll get depressed, and that’s hard,” said his wife, Cathy Anderson-Meyers. “I’ll say, ‘Let’s go for a run,’ and try to get him out to cheer him up.”
Increasingly, researchers believe that for people like Meyers, running may indeed enhance mood. For those with mild to moderate Alzheimer's, it may also improve some brain functions that affect daily living. And for those at high risk of developing the disease, physical activity may do even more: A growing body of research indicates regular cardiovascular exercise can protect the brain and delay the onset of Alzheimer’s symptoms, improving both cognition and quality of life.
At the Alzheimer’s Association International Conference in July, Laura D. Baker, Ph.D., an associate professor of gerontology and geriatric medicine at the Wake Forest School of Medicine, presented study results that suggest exercise may be able to do what drugs so far cannot in those at high risk for developing Alzheimer’s dementia: slow the progression of the disease.
Baker studies people who have mild cognitive impairment with memory loss, which means that they have a high likelihood of developing Alzheimer’s. Though there’s no definitive test to determine whether a person has the disease, Baker’s subjects likely have it by the time she studies them.
Her study revealed that after six months, participants who built up to exercising at an elevated heart rate (specific to each person) for 30 minutes, four times a week, improved their cognition and had decreased levels of phosphorylated tau protein compared to those in a stretching-only control group.
Scientists use tau protein levels as a measure of how Alzheimer’s disease is progressing. The protein naturally increases with age in everyone, but in people with Alzheimer’s, it increases considerably more. In Baker’s study, the exercise group saw a slight decrease in their levels after six months.
No currently approved drug has had the same effect.
“We’ve been trying all these medications, but so far, we have none that can treat disease in the pre-dementia phase,” Baker told Runner’s World. “Nothing has changed this key Alzheimer’s biomarker in the cerebral spinal fluid.”
Improving quality of life
For Meyers, running has been the one constant in a life profoundly changed by Alzheimer’s.
As a young man, he once ran a 4:06 mile, and when he was inducted into California State University-Chico’s Athletic Hall of Fame in 1999, he was described as “one of the best, if not the best, distance runners to wear a uniform for Chico State.”
Meyers has run for most of his adult life. But before a race in 2014, he and his wife realised his disease had progressed to the point where he couldn’t warm up alone because he might get lost.
An old acquaintance ran by and invited Meyers to warm up with his running group, the Trkac Racing Team. Since then, Meyers has joined the group for workouts three times a week. Each time he goes out, he runs with a teammate who keeps track of his intervals. On Tuesdays and Wednesdays, he runs four miles with Cathy biking alongside him.
With the help of Trkac members, Meyers also races, completing at least one 5K a month. In July, he won his age group in one event and in October, maintained a 9:37 pace in a four-miler.
Greg O’Brien, 65, of Brewster, Massachusetts, is also a lifelong exerciser. He was diagnosed with early-onset Alzheimer’s disease at age 59.
O’Brien writes and speaks regularly about living with Alzheimer’s, and is the author of On Pluto: Inside the Mind of Alzheimer’s. He’s working on a second book about his experiences.
In conversation, it can be hard to tell he has Alzheimer’s. He says it's because he's still in an early stage, but more and more, he has trouble identifying common household products and recognising people he loves. He is beset by the depression, rage, paranoia and hallucinations that come with the disease.
“The end stage [is] a horrific stage, but the early and mid stages, in their own way, are equally horrific, because we know what’s happening,” O’Brien said. “In the end stage, you're out of it. You don’t know.”
O’Brien kept running after his diagnosis. As the disease has damaged his spine, he’s adjusted his regimen, and now gets his heart rate up by run-walking on a treadmill set at an incline.
“[Exercise] makes you more alert. It’s like taking your boat out and revving it up and cleaning out the carburetors because there’s a lot of gunk that gets in there,” O’Brien said. “It’s temporary, but I’ll take the temporary now. The running, or how I’m working out now, is my salvation. I look forward to it every day, and it makes me whole again.”
While Baker’s study shows the benefits of exercise for people in the early stages of Alzheimer’s disease, there’s scant evidence to show running can help improve memory for those who already have more advanced symptoms.
But exercise may have positive effects on other brain functions.
Dr Steen G. Hasselbalch, of the Danish Dementia Research Centre in Copenhagen, studied 200 people with mild to moderate Alzheimer’s disease. His results, also presented at the July conference, found that those who exercised at 70 to 80 percent of their maximum heart rate for 60 minutes three times a week performed better on some tests.
“We did not see an effect on memory, but we did find an effect on attention and mental speed, which also are important cognitive functions that affect activities of daily living,” Hasselbalch wrote in an email to Runner’s World.
The exercise group also had significantly fewer neuropsychiatric symptoms such as anxiety, irritability and depression.
Those mood improvements that O’Brien and Meyers experience, experts say, are likely the work of endorphins. “When you take the cloud of stress away from your experience of life for a little while, everyone feels better,” Baker said.
Plus, unlike medications, there are no side effects to exercise and plenty of health benefits, said Baker. She theorises that a complex combination of these benefits helps spur changes in the brain.
“A lot of times you take a drug and it’s targeting one specific deficiency in the brain or in the body,” Baker said. “With exercise, you’re boosting health in multiple systems, whether you’re improving your stress response, mood, cardiovascular response, coronary response, blood flow to very small vessels in the brain. You’re increasing the neurons’ resistance to injury.”
The younger the better
It's no surprise then that people often pose researchers a perplexing question: Why, if my loved one has been exercising her whole life, has she developed Alzheimer’s?
Sangram Sisodia, PhD, a professor of neurobiology and neurology at the University of Chicago, says that changes in the brains of people with a genetic predisposition to Alzheimer’s occur years before any symptoms appear.
“Your brain can sustain a lot of damage for a long time, but then it gets to a certain point, like a tipping point, where now you have lost the ability to make and store memory,” Sisodia said. “[Alzheimer’s is] a chronic disease - it’s a function of aging - so the earlier you start exercising and running, the better off you are.”
Baker is more blunt in her response to anguished relatives who wonder why running hasn’t spared a family member.
“My answer is, ‘Think about how this has extended his life. Can you say for sure that he would not have developed dementia sooner had he not been exercising?’” Baker said. “Exercising may have postponed symptoms by a few years. If we can accomplish that goal - that’s a huge success.”
Sisodia points to a 2011 study that found that exercise had a protective effect on the hippocampus, a region of the brain associated with memory, which shrinks in the early stages of Alzheimer’s disease and is largely missing in people with advanced Alzheimer’s. While the hippocampus tends to naturally shrink with age even in those without Alzheimer’s, the study’s exercise protocol increased hippocampus volume by 2 per cent, essentially reversing the natural age-related loss by one to two years.
Baker is now undertaking an 18-month study that will look at the longer term effects of high intensity exercise in people with mild cognitive impairment. Though every scientist emphasises that exercise can’t cure Alzheimer’s, they stand firmly by its benefits.
“If I had a family member with mild cognitive impairment, I would make sure they started exercising,” Baker said. “Maybe, worst case scenario, let’s just say I’m wrong, and [exercise] doesn’t benefit the brain. [But] this person is going to have a different quality of experience because of it.”