Prescribing physical activity as a preventive measure for middle-aged Australians with dementia risk factors
Michael Annear A D , Peter Lucas B , Tim Wilkinson C and Yasuo Shimizu A
+ Author Affiliations
- Author Affiliations
A Department of Health and Physical Education, International Christian University, 3-10-2 Osawa, Mitaka, Tokyo 181-0015, Japan.
B Faculty of Health, University of Tasmania, Hobart, Tas. 7000, Australia.
C Otago Medical School, University of Otago, Christchurch 8140, New Zealand.
D Corresponding author. Email: michael.annear@gmail.com
Australian Journal of Primary Health 25(2) 108-112 https://doi.org/10.1071/PY18171
Submitted: 26 October 2018 Accepted: 21 January 2019 Published: 15 March 2019
Abstract
Dementia is increasing in Australia in line with population ageing and is expected to peak by mid-century. The development of common forms of dementia, including Alzheimer’s disease, is associated with lifestyle-related risk factors that are prevalent among middle-aged Australians, including obesity, hypertension, high cholesterol, diabetes and depression. These risk factors can be significantly ameliorated through regular participation in moderate aerobic physical activity (PA). Current national and international guidelines recommend at least 150 min of aerobic PA per week for achieving health protective effects. Lifestyle intervention is a critical area for action as there are currently no medical or pharmaceutical interventions that can halt the progression of common dementias. Physician–patient discussions concerning risk reduction via habitual aerobic PA offers a complementary intervention as part of broader dementia management. Evidence suggests that to achieve the highest rates of adherence to PA, physician advice in primary care should be supported by wider policies, institutions and community services that offer a meaningful referral pathway and patient follow up after initial assessment. International Green Prescription programs provide examples of physician-led interventions in primary care that could inform further action in Australia.
Additional keywords: cognitive health, exercise, Green Prescription.
References
Abbott RD, White LR, Ross GW, Masaki KH, Curb JD, Petrovitch H (2004) Walking and dementia in physically capable elderly men. Journal of the American Medical Association 292, 1447–1453.| Walking and dementia in physically capable elderly men.Crossref | GoogleScholarGoogle Scholar | 15383515PubMed |
Ahlskog JE, Geda YE, Graff-Radford NR, Petersen RC (2011) Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clinic Proceedings 86, 876–884.
| Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging.Crossref | GoogleScholarGoogle Scholar | 21878600PubMed |
Albright CL, Cohen S, Gibbons L, Miller S, Marcus B, Sallis J, Imai K, Jernick J, Simons-Morton DG (2000) Incorporating physical activity advice into primary care: physician-delivered advice within the activity counseling trial. American Journal of Preventive Medicine 18, 225–234.
| Incorporating physical activity advice into primary care: physician-delivered advice within the activity counseling trial.Crossref | GoogleScholarGoogle Scholar | 10722989PubMed |
Annear M, Keeling S, Wilkinson T, Cushman G, Gidlow B, Hopkins H (2014) Environmental influences on healthy and active ageing: a systematic review. Ageing and Society 34, 590–622.
| Environmental influences on healthy and active ageing: a systematic review.Crossref | GoogleScholarGoogle Scholar |
Ashby-Mitchell K, Burns R, Shaw J, Anstey KJ (2017) Proportion of dementia in Australia explained by common modifiable risk factors. Alzheimer’s Research & Therapy 9, 11
| Proportion of dementia in Australia explained by common modifiable risk factors.Crossref | GoogleScholarGoogle Scholar |
Australian Bureau of Statistics (2016) National health survey: first results 2014–15. (Australian Government: Canberra, ACT, Australia) Available at http://www.abs.gov.au/AUSSTATS/ [Verified 14 August 2018].
Australian Institute of Health and Welfare (2012) Dementia in Australia. Australian Government No. AGE70. Australian Government: Canberra, ACT, Australia.
Australian Institute of Health and Welfare (2014) Leading causes of death. (Australian Government: Canberra, ACT, Australia) Available at http://www.aihw.gov.au/deaths/leading-causes-of-death/ [Verified 11 May 2018]
Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H (2015) Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective. Alzheimer’s & Dementia 11, 718–726.
| Summary of the evidence on modifiable risk factors for cognitive decline and dementia: a population-based perspective.Crossref | GoogleScholarGoogle Scholar |
Blondell SJ, Hammersley-Mather R, Veerman JL (2014) Does physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studies. BMC Public Health 14, 510
| Does physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studies.Crossref | GoogleScholarGoogle Scholar | 24885250PubMed |
Department of Health (2014) Health assessment for people aged 45 to 49 years who are at risk of developing chronic disease. (Australian Government: Canberra, ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/ [Verified 14 October 2018]
Department of Health (2017) Australia’s physical activity and sedentary behaviour guidelines. (Australian Government: Canberra, ACT, Australia) Available at http://www.health.gov.au/internet/main/publishing.nsf/ [Verified 11 October 2018]
Eden KB, Orleans CT, Mulrow CD, Pender NJ, Teutsch SM (2002) Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine 137, 208–215.
| Does counseling by clinicians improve physical activity? A summary of the evidence for the US Preventive Services Task Force.Crossref | GoogleScholarGoogle Scholar | 12160371PubMed |
Elley CR, Kerse N, Arroll B, Swinburn B, Ashton T, Robinson E (2004) Cost-effectiveness of physical activity counselling in general practice. The New Zealand Medical Journal 117, U1216
Farrow M, Ellis K (2013) ‘Physical Activity for Brain Health and Fighting Dementia.’ (Alzheimer’s Australia: Canberra, ACT, Australia)
Fratiglioni L, Paillard-Borg S, Winblad B (2004) An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology 3, 343–353.
| An active and socially integrated lifestyle in late life might protect against dementia.Crossref | GoogleScholarGoogle Scholar | 15157849PubMed |
Geense WW, van de Glind IM, Visscher TLS, van Achterberg T (2013) Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study. BMC Family Practice 14, 20
| Barriers, facilitators and attitudes influencing health promotion activities in general practice: an explorative pilot study.Crossref | GoogleScholarGoogle Scholar | 23394162PubMed |
Glanz K, Rimer BK, Viswanath K (2008) ‘Health Behavior and Health Education: Theory, Research, and Practice.’ (John Wiley & Sons: San Francisco, CA, USA)
Hallal PC, Andersen LB, Bull FC, Guthold R, Haskell W, Ekelund U (2012) Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 380, 247–257.
| Global physical activity levels: surveillance progress, pitfalls, and prospects.Crossref | GoogleScholarGoogle Scholar | 22818937PubMed |
Hamlin MJ, Yule E, Elliot CA, Stoner L, Kathiravel Y (2016) Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative. Public Health 140, 102–108.
| Long-term effectiveness of the New Zealand Green Prescription primary health care exercise initiative.Crossref | GoogleScholarGoogle Scholar | 27569778PubMed |
Hills AP, Street SJ, Harris N (2014) Getting Australia more active: challenges and opportunities for health promotion. Health Promotion Journal of Australia 25, 30–34.
| Getting Australia more active: challenges and opportunities for health promotion.Crossref | GoogleScholarGoogle Scholar | 24739776PubMed |
Horne M, Skelton D, Speed S, Todd C (2010) The influence of primary health care professionals in encouraging exercise and physical activity uptake among White and South Asian older adults: experiences of young older adults. Patient Education and Counseling 78, 97–103.
| The influence of primary health care professionals in encouraging exercise and physical activity uptake among White and South Asian older adults: experiences of young older adults.Crossref | GoogleScholarGoogle Scholar | 19443171PubMed |
Joy EA, Pescatello LS (2016) Pre-exercise screening: role of the primary care physician. Israel Journal of Health Policy Research 5, 29–34.
| Pre-exercise screening: role of the primary care physician.Crossref | GoogleScholarGoogle Scholar | 27358724PubMed |
Kerse N, Elley CR, Robinson E, Arroll B (2005) Is physical activity counseling effective for older people? A cluster randomized, controlled trial in primary care. Journal of the American Geriatrics Society 53, 1951–1956.
| Is physical activity counseling effective for older people? A cluster randomized, controlled trial in primary care.Crossref | GoogleScholarGoogle Scholar | 16274377PubMed |
Khan KM, Weller R, Blair SN (2011) Prescribing exercise in primary care: ten practical steps on how to do it. British Medical Journal 343, 806–807.
Knox ECL, Esliger DW, Biddle SJH, Sherar LB (2013) Lack of knowledge of physical activity guidelines: can physical activity promotion campaigns do better? BMJ Open 3, e003633
| Lack of knowledge of physical activity guidelines: can physical activity promotion campaigns do better?Crossref | GoogleScholarGoogle Scholar |
Kurrle S, Brodaty H, Hogarth R (2012) ‘Physical Comorbidities of Dementia.’ (Cambridge University Press: New York, NY, USA)
Larson EB, Wang L, Bowen JD, McCormick WC, Teri L, Crane P, Kukull W (2006) Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine 144, 73–81.
| Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older.Crossref | GoogleScholarGoogle Scholar | 16418406PubMed |
Lautenschlager NT, Cox KL, Flicker L, Foster JK, van Bockxmeer FM, Xiao J, Greenop KR, Almeida OP (2008) Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. Journal of the American Medical Association 300, 1027–1037.
| Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial.Crossref | GoogleScholarGoogle Scholar | 18768414PubMed |
Lawton BA, Rose SB, Elley CR, Dowell AC, Fenton A, Moyes SA (2008) Exercise on prescription for women aged 40–74 recruited through primary care: two year randomised controlled trial. British Medical Journal 337, a2509
| Exercise on prescription for women aged 40–74 recruited through primary care: two year randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 19074218PubMed |
Messier SP, Loeser RF, Miller GD, Morgan TM, Rejeski WJ, Sevick MA, Ettinger WH, Pahor M, Williamson JD (2004) Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis and Rheumatism 50, 1501–1510.
| Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial.Crossref | GoogleScholarGoogle Scholar | 15146420PubMed |
Ministry of Health (2016) Green prescriptions. (New Zealand Government: Wellington, New Zealand) Available at https://www.health.govt.nz/our-work/preventative-health-wellness/physical-activity/green-prescriptions [Verified 16 October 2018]
Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, Volicer L, Givens JL, Hamel MB (2009) The clinical course of advanced dementia. The New England Journal of Medicine 361, 1529–1538.
| The clinical course of advanced dementia.Crossref | GoogleScholarGoogle Scholar | 19828530PubMed |
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després J-P, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DP, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB, on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2016) Heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation 133, e38–e360.
Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, Bäckman L, Hänninen T, Jula A, Laatikainen T (2015) A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet 385, 2255–2263.
| A 2-year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar | 25771249PubMed |
Patel A, Schofield GM, Kolt GS, Keogh JW (2011) General practitioners’ views and experiences of counselling for physical activity through the New Zealand Green Prescription program. BMC Family Practice 12, 119
| General practitioners’ views and experiences of counselling for physical activity through the New Zealand Green Prescription program.Crossref | GoogleScholarGoogle Scholar | 22044577PubMed |
Petrella RJ, Lattanzio CN, Overend TJ (2007) Physical activity counseling and prescription among Canadian primary care physicians. Archives of Internal Medicine 167, 1774–1781.
| Physical activity counseling and prescription among Canadian primary care physicians.Crossref | GoogleScholarGoogle Scholar | 17846397PubMed |
Reiner M, Niermann C, Jekauc D, Woll A (2013) Long-term health benefits of physical activity–a systematic review of longitudinal studies. BMC Public Health 13, 813–822.
| Long-term health benefits of physical activity–a systematic review of longitudinal studies.Crossref | GoogleScholarGoogle Scholar | 24010994PubMed |
Rolland Y, van Kan GA, Vellas B (2008) Physical activity and Alzheimer’s disease: from prevention to therapeutic perspectives. Journal of the American Medical Directors Association 9, 390–405.
| Physical activity and Alzheimer’s disease: from prevention to therapeutic perspectives.Crossref | GoogleScholarGoogle Scholar | 18585641PubMed |
Román GC (2002) Vascular dementia may be the most common form of dementia in the elderly. Journal of the Neurological Sciences 203–204, 7–10.
| Vascular dementia may be the most common form of dementia in the elderly.Crossref | GoogleScholarGoogle Scholar | 12417349PubMed |
Román GC, Erkinjuntti T, Wallin A, Pantoni L, Chui HC (2002) Subcortical ischaemic vascular dementia. Lancet Neurology 1, 426–436.
| Subcortical ischaemic vascular dementia.Crossref | GoogleScholarGoogle Scholar | 12849365PubMed |
Rovio S, Kåreholt I, Helkala E-L, Viitanen M, Winblad B, Tuomilehto J, Soininen H, Nissinen A, Kivipelto M (2005) Leisure-time physical activity at midlife and the risk of dementia and Alzheimer’s disease. Lancet Neurology 4, 705–711.
| Leisure-time physical activity at midlife and the risk of dementia and Alzheimer’s disease.Crossref | GoogleScholarGoogle Scholar | 16239176PubMed |
Sampson EL (2010) Palliative care for people with dementia. British Medical Bulletin 96, 159–174.
| Palliative care for people with dementia.Crossref | GoogleScholarGoogle Scholar | 20675657PubMed |
Short CE, Hayman M, Rebar AL, Gunn KM, De Cocker K, Duncan MJ, Turnbull D, Dollman J, Van Uffelen JG, Vandelanotte C (2016) Physical activity recommendations from general practitioners in Australia. Results from a national survey. Australian and New Zealand Journal of Public Health 40, 83–90.
| Physical activity recommendations from general practitioners in Australia. Results from a national survey.Crossref | GoogleScholarGoogle Scholar | 26456595PubMed |
Singh-Manoux A, Kivimaki M, Glymour MM, Elbaz A, Berr C, Ebmeier KP, Ferrie JE, Dugravot A (2012) Timing of onset of cognitive decline: results from Whitehall II prospective cohort study. British Medical Journal 344, d7622
| Timing of onset of cognitive decline: results from Whitehall II prospective cohort study.Crossref | GoogleScholarGoogle Scholar | 22223828PubMed |
Stokes G (2017) ‘Challenging Behaviour in Dementia: A Person-Centred Approach.’ (Routledge: London, England)
van der Steen J, Radbruch L, Hertogh C, de Boer M, Hughes J, Larkin P, Francke A, Jünger S, Gove D, Firth P, Koopmans R, Volicer L (2014) White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliative Medicine 28, 197–209.
| White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care.Crossref | GoogleScholarGoogle Scholar | 23828874PubMed |
Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, Cedazo-Minguez A, Dubois B, Edvardsson D, Feldman H (2016) Defeating Alzheimer’s disease and other dementias: a priority for European science and society. Lancet Neurology 15, 455–532.
| Defeating Alzheimer’s disease and other dementias: a priority for European science and society.Crossref | GoogleScholarGoogle Scholar | 26987701PubMed |
World Health Organization (2010) ‘Global Recommendations on Physical Activity for Health.’ (World Health Organization: Geneva, Switzerland)
