In May 2019, the World Health Organization (WHO) launched the Guidelines for Dementia Risk Reduction as a part of their mandate to provide evidence-based guidance for a public health response. The aim of this initiative is to improve the lives of people with dementia, their caregivers and families, and to reduce the incidence rate of the disease. A key focus of these guidelines is the importance of getting adequate amounts of exercise. One ‘strong’ recommendation is based on the effectiveness of physical activity in adults with normal cognition to reduce the risk of cognitive decline.
An important question to ask here is what exactly is an “adequate” amount of exercise. The WHO recommends “at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity in adults aged over 65.” These figures vary with different age groups. Some examples of such activities are dancing, hiking, sports, and planned exercise routines.
However, it is worrying to know that many individuals do not get the recommended amount of physical exercise. While in part it is up to individuals to make healthier choices, the environment where one lives also has an impact. For example, at Dementia Forum X Mrs. Jacqueline Hoogendam, Ministry of Health, Welfare and Sport, The Netherlands, highlighted the need to design safe outdoor spaces for people with dementia. Citing the guidelines, Dr Dévora Kestel of the WHO also emphasised the “responsibility of governments and institutions to generate spaces so that we can live and promote healthy habits”.
When it comes to seniors, one of the reasons why physical activity levels decline is due of stigmatization. Ageist attitudes towards older people in relation to health and exercise is detrimental to their overall physical and mental well-being. “There is evidence that older people may not recognise themselves as being frail, or want to be considered as such, even if they are happy to accept that they are an older person.”
As societies around the world progress towards becoming more inclusive, ageism and ageist notions are being challenged. Through advocacy, policy, social movements and grassroots initiatives, we are changing the way in which we understand and address the needs of seniors. One example of such an initiative is Styrka CrossFit in Stockholm, Sweden, where Anna Berggren conducts CrossFit training for seniors. CrossFit is high-intensity, multi-disciplinary functional training for improving stamina, strength, balance, speed, agility, and accuracy. A single workout session may incorporate elements from Olympic weightlifting, powerlifting, gymnastics, and other exercises. The average age of the individuals in the senior training class in 65 and the oldest individual is 85.
A session at Styrka CrossFit
We observed a class at Styrka CrossFit where seniors were in full action. Weight lifting, running, cycling, push-ups and burpees – no stone was left unturned. The room was filled with energy and the fast-pace workout music was perfect for the setting.
Anna is also one of the founding members of the Styrka CrossFit. A civil engineer by day, she has been doing CrossFit since it came to Sweden, a little over 16 years ago. Anna is enthusiastic and immensely passionate about the fitness sport. Speaking about what makes CrossFit special, she explains,
“A regular training session at the gym focuses on one part of the body at a time. You could be exercising your biceps or legs or perhaps doing some cardio. With functional training like CrossFit, you train multiple parts of your body at once. You run to increase your stamina, you stretch and climb to work on your arms and legs, you lift to strengthen your core, in combination with each other all in a span of 1-2 hours. CrossFit is well-rounded. The three principles of CrossFit are cardio, weights, and gymnastics and the extent to which these elements are incorporated can be different in each session”
With regards to its importance for the elderly, she says, “The multidisciplinary nature of CrossFit brings a multitude of benefits for the elderly. As we grow older, we naturally lose muscle mass. In fact, from about the age of 30, as much as 3% to 5% of muscle mass is lost per decade. Most men lose about 30% of their muscle mass during their lifetimes (Harvard Health Publishing). Loss of muscle leads to other problems such as reduced balance and increased risk of traumatic injury like fractures from falls because there is nothing to protect the bone from the stress. However, with resistance training, it is possible to slow down this process or even reverse it. In addition, the training builds strength and stamina which enables seniors to live fuller and more independent lives, even if that means being able to carry your groceries back home. A lot of my students are very active even outside the CrossFit box – they play golf, go sailing, travel with their friends and even participate in other kinds of training. Ultimately, the aim of this class is to empower the elderly to continue doing the things which they have enjoyed since they were young. CrossFit is also about community building. I have seen that people like to interact with each other so I encourage them to come 15 minutes before the class to facilitate social interaction. During class if someone finishes their set before the rest, they stay behind to encourage their friends and I think it’s wonderful that we work with each other and improve together.”
CrossFit is multidisciplinary
Anna’s own father, Hans Bjurman (aged 74), is a student in the class. Laughing cheekily, he says that he started working out about a year ago when Anna “gifted” him free passes to the class. He mentions, “I have always been physically active but not in the way that I am right now, after having been in this class. I work in my garden, go out sailing on my boat and even ride my plane (Hans has been a pilot since he was 50) but CrossFit has helped me build a lot of strength and stability. Usually, pilots have to retire when they’re 65 but I can still continue! My vision and cognition are examined every few months for safety reasons and I pass all the tests!”
Left to right: Ida Berggren (Anna’s daughter), Anna Berggren, Hans Bjurman
Anna chimes in, saying “Growing up, we were taught that at certain point, the brain stops developing and that brain damage due to the death of neurons is inevitable. But now we know that it is possible for neurons to regenerate and for new brain-pathways to grow in the brains of older people as well. It is so important that this growth in encouraged through diet and exercise. CrossFit can play a big role in this. This is especially because no two classes are alike. Whether it’s changing the pace of the activity or type, and no matter how small the change, by encouraging the body to move in new ways, we stimulate tissue and muscle-growth and learning. I believe this is also the case with brain tissue.”
In 2018, for the first time, a study led by researchers at Columbia University found that “healthy older men and women can generate just as many new brain cells as younger people. Lead author Maura Boldrini, associate professor of neurobiology, says the findings may suggest that many senior citizens remain more cognitively and emotionally intact than commonly believed.”
When asked why she decided to teach a class of seniors, Anna says that it is primarily because she finds it very inspiring to watch seniors come in with so motivation to be a better version of themselves. Anna mentioned that one of her students had a hip replacement surgery three months prior, but thanks to her outstanding fitness level, she was already back at the CrossFit box partaking in the regular sessions.
“Conducting this class is no different from a class for younger people. The exercises need to be adapted a little bit but not entirely. For example, in a standard class, people climb ropes. For safety reasons, I don’t encourage the seniors to do the same however, they can use the ropes for stretching purposes.”
One of her students joins in, saying, “I have been working out for years and the only thing which is different now is my pace. I am slower than the average young person doing the same thing. But I am not less strong or less able.”