Linking cognition and mobility

Dementia, balance and mobility impairments, and falls are three major challenges to the function and care of older adults. These issues are quite common among older adults and often co-exist. Dementia is defined by declines in thinking abilities (i.e., cognitive impairment) (1), but poor balance, unsteady or slow walking, and falls may also result from dementia (2). The brain and body can both benefit from exercise (3;4). Regular physical activity is one key strategy to reduce your risk of dementia and improve mobility (4;5).

Dementia describes cognitive impairment that negatively impacts daily activities or function. It has many causes, including Alzheimer’s disease and vascular disease (vascular dementia) (1). Dementia becomes more common with greater age, but it’s not an inevitable part of aging (6). People with dementia or milder forms of cognitive impairment have a higher risk of falls than people without cognitive impairment (7;8). On the other hand, changes in balance, slowing of walking speed, or frequent falls seem to be related to greater risk of dementia, perhaps due to reduced activity levels (9-11). Compared with people who are inactive, people who are physically active have a 30% to 40% lower risk of all types of dementia (12;13). Within Canada, later life physical inactivity is estimated to account for about 10% of dementia cases (14).

What the research tells us

Exercise can benefit physical functioning such as improving strength, walking speed, balance, and endurance (4;15). It can even reduce falls (16-19). Exercise can also be beneficial to cognitive function (20)!

Clinical trials of exercise have studied many different types and intensities of exercise (21). Research shows both aerobic exercise (e.g., walking, swimming, or cycling) and non-aerobic exercise (e.g., strength training or tai chi) can improve cognitive function among older adults (3;22-26). Even those with cognitive impairments including dementia can show improvements in cognitive function after exercise (22;23;27-29). Multicomponent exercise that combines aerobic and non-aerobic exercises may be even more beneficial to cognitive function and mobility than aerobic or non-aerobic exercise alone (4;15;30), though more research is needed to be sure. Dance is another type of physical activity that may be beneficial to cognitive function—and enjoyable for many people (31-33)!

Becoming more physically active can feel hard. Creating a plan for your activities and building a supportive network will increase your chance of success. People are more likely to stick with it if they have specific and realistic goals (34). Create a plan that includes how, where, and with whom you will be active and share that plan with others. Having people to encourage you towards your goals is one of the strongest predictors of success (35;36). Engage your family, friends, or exercise leaders to support you towards your goals.

If you have health conditions, it’s always wise to check with a healthcare professional before you get started.

Here are a few recommendations to help you get physically active:

• Choose a form of exercise that you like and enjoy (35). The best exercise for your health is the one that you will do! Some physical activity is better than none (37).
• Exercise parameters:
  • Aim for 30 minutes of moderate intensity (you are trying but it’s not exhaustive) or 15 minutes of vigorous intensity physical activity most days of the week (37;38)
  • Incorporate muscle-strengthening exercises at least 2 times per week (38)
  • Including endurance, strength, balance, and flexibility exercises each week is likely most beneficial (35; 39;40)
  • You can break up your physical activity into shorter chunks rather than doing 30 minutes or 60 minutes at a time
• Be creative—you can do strength exercises with milk jugs or backpacks. Run on the spot, do squats, do calf raises, and fit in balance exercises during a commercial break or while waiting in line. 

References

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3. Cao Q, Tan CC, Xu W, et al. The prevalence of dementia: A systematic review and meta-analysis. J Alzheimers Dis. 2020; 73(3):1157-66. doi: 10.3233/JAD-191092. 
4. Modarresi S, Divine A, Grahn JA, et al. Gait parameters and characteristics associated with increased risk of falls in people with dementia: A systematic review. Int Psychogeriatr. 2019; 31(9):1287-303. doi: 10.1017/S1041610218001783.
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