Exercise helps patients cope with Alzheimer's Disease
Pam LeBlanc, Fit City
John Duncan jogs around Lady Bird Lake two mornings a week, a personal trainer at his side.
Gravel crunches under his sneakers as he plods along, shielding his eyes from the streaming sunlight. As Duncan rounds the bend at Lou Neff Point, a harmonica-playing musician perched on a limestone ledge cheers him on.
Duncan's marathon days are far behind him. He doesn't remember crossing the finish line at the Boston, Chicago or New York City marathons 25 years ago. Alzheimer's disease has stolen those moments. But exercising with a trainer has helped him cope with the frustrations and symptoms that come with his illness.
In addition to jogging, Duncan, 74, a former economics professor and husband of Austin attorney Becky Beaver, spends an hour twice a week doing strength and balance training with certified personal trainer Randeen Torvik Ragan.
Experts have long known that heart-pumping exercise helps delay normal cognitive decline in healthy aging adults. They also believe it can improve brain cell function in people with Alzheimer's disease, which impairs memory and thinking skills. And it helps patients maintain physical mobility and balance as their illness progresses.
"The recommendation is usually 100 to 150 minutes a week, and that would include mostly aerobic — walking, indoor cycling, swimming," says neurologist Dr. Ronald Devere, director of the Alzheimer's Disease and Memory Disorders Center in Lakeway and a board member of the Capital of Texas Chapter of the Alzheimer's Association. "The jury is still out on weights and tai chi. I think there's evidence (that it helps), but it isn't as strong as the aerobic exercise."
Exercise increases blood flow to the brain, where brain cells still multiply as we get older, and triggers the release of brain-derived growth hormone, which seems to improve cell function, Devere says. Physical activity also helps control high blood pressure, high cholesterol and diabetes, all of which are risk factors for stroke and cognitive decline.
An estimated 5.4 million American's have Alzheimer's disease, the most common form of dementia, and the number is expected to grow as the population ages, according to the Alzheimer's Association.
On the trail, Ragan eggs Duncan along as they jog, encouraging him to speed up for short bursts.
"Hang in there, John," she says as they near the end of their hourlong, 3-mile loop. After they finish, they stretch a few minutes and chat. Most of Duncan's comments are short.
Did he run with a group when he trained for his marathons? "I don't remember."
Does running make him feel better? "I guess."
"We ought to do a 5K, John," Ragan suggests.
He brightens. "Yeah, I'd do it," he says.
The next day, Ragan takes Duncan through an hourlong strength and balance workout at Duncan's home in Central Austin.
As he warms up on a treadmill, Ragan urges him to pick up his feet. They shift to a rowing machine for a few minutes before heading into the backyard. Duncan slams a weighted medicine ball into the ground over and over, then jogs up and down the yard, tossing the ball back and forth with Ragan. Then it's a litany of single leg squats, cable rows, pushups and lunges. Duncan works his way agreeably through all of it, before wrapping up the session with some crunches and stretching.
"As always, great job," Ragan says, patting his arm. He pats hers in return.
Since he started exercising with Ragan, Duncan has worked up to heavier medicine balls, dumbbells and resistance bands.
"He inspires me because I see that having an illness like that is not an invitation to sit on your butt," Ragan says. "The continuing message is that exercise is good for everyone."
A quiet, soft-spoken man with a dry sense of humor, Duncan has always been affable and easygoing. He graduated from Austin College in Sherman and did graduate work at Tulane University. He taught economics at Loyola University and Xavier University in New Orleans, and later at Austin College and Texas Tech University in Lubbock.
He then headed the legislative analysis group at the Texas Comptroller's office, and served as assistant to two commissioners on the Public Utilities Commission of Texas.
A skilled photographer who was handy around the house, he started showing Alzheimer's symptoms about 10 years ago. He couldn't remember things and had trouble with electronics, including the television remote control.
He was officially diagnosed in 2005 with Alzheimer's disease. A few years later, he developed Parkinsonism, a neurological syndrome characterized by shuffling of the feet, rigidity, imbalance, tremor and decreased movement.
Today he doesn't recall some of his extended family members. He doesn't remember much about running track in high school or college, or the specifics of teaching. Still, he proudly shows off a framed poster from his days as executive director of the Texas Chapter of the American Civil Liberties Union, advertising a 1982 debate between himself and Cal Thomas, the vice president of the Moral Majority.
"He's sort of at the point where he truly lives in the moment now," Beaver says.
A year ago, she hired Ragan to work with him.
"It occurred to me that exercise might help him maintain some confidence in his movement, but I had no idea how much improved he would be both mentally and physically when he began the regular exercise," says Beaver, 59, who has been married to Duncan for 35 years. They have three children. "That has worked really, really well for him and he seems to enjoy it. And his Parkinsonism symptoms have essentially disappeared."
Kim Butrum, a nurse practitioner who works with Duncan at Seton Brain and Spine Institute Neurology, says the exercise has "absolutely" benefited him.
"Six years into the Alzheimer's diagnosis and three years into Parkinsonism, to be able to jog — that's spectacular in terms of maintaining functional ability and preventing falls," Butrum says.
Not only does exercise helps people maintain function, avoid falls and stop shuffling as they cope with Alzheimer's disease and Parkinsonism, it also helps with the agitation and restlessness that some Alzheimer's patients feel, she says.
"We tell families that in managing sleep, mood and overall well-being — everything is usually better with exercise," she says. "And it doesn't have to be any fancier than walking."
Duncan's exercise session is done for the day, but he'll be jogging on the trail again next week and plugging his way through Ragan's lineup of sweat-inducing squats, pushups and resistance-band tugs.
It's part of Duncan's routine.
More than that, it's part of how he copes with a frustrating disease.
It helps him sleep, it helps with weight management and it allows him to participate in light hikes when he travels with his wife.
And for that, she is grateful.
"I'm really proud of John, proud of him for persisting the way he has and not giving up," Beaver says.