‘Reversing’ Alzheimer’s: Here are exercises to make the brain more resilient

Can Alzheimer’s disease be reversed?

Dr. Heather Sandison, a renowned expert in Alzheimer's and related dementia care, believes that reversal isn’t just possible — but that it’s already happening in multiple patients.

In her new book "Reversing Alzheimer's: The New Tool Kit to Improve Cognition and Protect Brain Health," which was published by HarperCollins on June 11, Sandison — who is based in California — offers a step-by-step guide to helping Alzheimer’s patients improve their overall brain health.

One of the core elements of Sandison’s program is exercise, which she identifies as one of the most important lifestyle factors in preventing and controlling dementia.

Research has shown that physical activity can reduce the likelihood and progression of Alzheimer’s.

In the excerpt below, Sandison offers some specific recommendations for the types of exercise that can benefit patients living with the disease.

Read an excerpt from ‘Reversing Alzheimer’s'

Dr. Heather Sandison: Need a new motivation to be active? Exercise is medicine for the brain and provides an amazing array of benefits.

Most obviously, exercise increases blood flow throughout the body, including to the brain. That means getting your body moving will deliver more oxygen and nutrients to your brain while also flushing away more waste products.

Exercise also strengthens the cardiovascular system, which helps improve blood flow even when you’re not working out; it also reduces the risk of arterial plaques that might disrupt blood flow to the brain and contribute to dementia.

The overarching reason that exercise is such a powerful intervention is that it is what’s known as a hormetic, or a beneficial stressor.

Basically, when you put your body through its paces, the body is forced to use up resources, and your tissues can even be broken down a bit. (That’s what happens when you lift weights: Your muscles tear a tiny bit.)

In that sense, you’re introducing stress to your system, but that stress is a force for good, because it triggers your body to get more efficient at using its resources and your tissues to grow back even stronger. In other words, exercise makes your body — including your brain — more resilient.

Exercise benefits several of the root causes of neurological disease.

It improves structure by increasing your cardiovascular capacity and boosting circulation, which delivers oxygen and nutrients to the brain.

It reduces stress in multiple ways — by giving you an outlet to blow off steam, by producing feel-good hormones such as endorphins and lowering the stress hormone cortisol, and, depending on what kind of exercise you choose, getting you outside and into nature, which is a well-known stress reliever.

It can also be social, and a great way to spend time with friends or even meet new people, which helps address the loneliness and social isolation that The Lancet lists as one of the modifiable risk factors for Alzheimer’s disease.

It improves sleep by tiring you out.

It strengthens immune function, which reduces the risk and effects of infections — all those muscular contractions and moving against gravity improve the flow of lymphatic fluid, which delivers immune cells and flushes away invader cells.

"Exercise benefits several of the root causes of neurological disease."

It promotes detox, both through increased circulation and through sweating.

It improves signaling, as challenging and strengthening your muscles triggers the release of multiple signaling molecules, known as exerkines, that have demonstrated neuroprotective functions.

If you do only one thing: Change up your current exercise routine in a way that challenges your brain and amps up the intensity.

If you are a devoted walker, find a new route that includes hills or stairs. If you’re open to trying something different, check out a new exercise class that you’ve been meaning to try.

Categories of exercise: some familiar, some cutting-edge

There are four types of exercise that you want to prioritize. Four may sound like a lot, but they are not mutually exclusive.

You can combine at least two types of exercise in one session — you can turn strength training into cardio by performing your strength moves in high-intensity intervals, or you can make your cardio dual task by doing something that requires your brain while you move.

Aerobic exercise is what we think of as "cardio" — it gets your heart and blood pumping and includes forms of exercise such as walking, jogging, biking, dancing, and swimming.

Aerobic exercise strengthens your heart, and what’s good for your heart is also good for your brain, because your heart sends the brain the blood, oxygen, and nutrients that your brain relies on to function.

Your first goal with adding more exercise to your life is to get 150 to 200 minutes of aerobic exercise each week so that you get your heart rate into the vigorous zone of 70-85% of maximum heart rate.

Listening to your body and adjusting your intensity level based on your perceived exertion is one of the best ways to know if you are pushing yourself hard enough.

Strength training — also known as resistance training — is just what it sounds like: using weights or other forms of resistance to build muscle tissue.

Building muscle — particularly in the big muscle groups of the legs, hips, and torso — is directly related to brain health, because these muscles generate brain-derived neurotrophic factor (BDNF), a "fertilizer" for the brain, cueing it to create new neuronal connections and promoting neuroplasticity.

You want to aim for at least two strength-training sessions per week. Strength training doesn’t have to involve your standard barbells and bench pressing your body weight.

You can use resistance bands, light dumbbells, or even the weight of your own body in exercises like squats, lunges, and planks.

Even climbing stairs or hills counts as strength training and cardio in one activity, because they get your heart rate up as they also keep the muscles of the legs and hips strong.

This next-level form of exercise combines physical movement with a cognitive challenge. The simplest form of this is walking and talking.

What is a cognitive challenge will vary from person to person, but if you’re in prevention mode, listening to a foreign language lesson or a nonfiction book while you walk outside or ride the stationary bike, and then pausing the recording to recap what you’ve just learned every few minutes, is a good option.

For some people, going to a Pilates or yoga class or other class where you really have to pay attention to the teacher’s cues constitutes dual-task training — but not if it’s something you’ve been doing for long enough that you can zone out.

"Exercise is such a powerful health intervention that if we could just bottle it, we could probably get rid of chronic disease."

And if you have already started experiencing measurable cognitive decline, dual-task training may look like going on a walk while pointing out the names of the plants that you pass along the way, or having someone quiz you on the names of family members, or recalling important dates.

Wherever you are, you want to be working right on your edge — you can almost feel the wheels of your brain turning in order to stay focused.

This relatively unique form of training alternates the amount of oxygen in the air you breathe as you exercise — an approach that encourages the tiniest blood vessels (known as your microvasculature) throughout your body, including your brain, to open up, resulting in greatly enhanced blood flow.

It’s similar to going to altitude to train and build your aerobic capacity, and it is incredibly valuable for cognitive function.

This type of exercise does require specialized gear. You can buy the device, or go find a clinic near you where you can try it out. It does require you to wear a mask that is hooked up to a machine while you exercise, and when the oxygen saturation is low, it can be intense because you have to work harder to bring in enough air.

In other words, contrast oxygen therapy is not for everyone. But if you are willing and able, it can be dramatically helpful.

Honestly, exercise is such a powerful intervention that if we could just bottle it, we could probably get rid of chronic disease.

Exercise does take time and effort, but making this one activity a regular part of your life addresses so many causal factors of dementia that it can profoundly reduce your risk.