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Integrating Health Promotion Into Physical Therapy Practice to Improve Brain Health and Prevent Alzheimer Disease

McGough, Ellen PT, PhD; Kirk-Sanchez, Neva PT, PhD; Liu-Ambrose, Teresa PT, PhD

Journal of Neurologic Physical Therapy: July 2017 - Volume 41 - Issue - p S55–S62
doi: 10.1097/NPT.0000000000000181
Special Interest Articles

Background and Purpose: Alzheimer disease is the most common cause of dementia, and brain pathology appears years before symptoms are evident. Primary prevention through health promotion can incorporate lifestyle improvement across the lifespan. Risk factor assessment and identifying markers of disease might also trigger preventive measures needed for high-risk individuals and groups.

Summary of Key Points: Many potential risk factors are modifiable through exercise, and may be responsive to early intervention strategies to reduce the downward slope toward disability. Through the use of common clinical tests to identify cognitive and noncognitive functional markers of disease, detection and intervention can occur at earlier stages, including preclinical stages of disease. Physical activity and exercise interventions to address modifiable risk factors and impairments can play a pivotal role in the prevention and delay of functional decline, ultimately reducing the incidence of dementia. This article discusses prevention, prediction, plasticity, and participation in the context of preserving brain health and preventing Alzheimer disease and related dementias in aging adults.

Recommendations for Clinical Practice: Rehabilitation professionals have opportunities to slow disease progression through research, practice, and education initiatives. From a clinical perspective, interventions that target brain health through lifestyle changes and exercise interventions show promise for preventing stroke and associated neurovascular diseases in addition to dementia. Physical therapists are well positioned to integrate primary health promotion into practice for the prevention of dementia and other neurological conditions in older adults.

Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (E.M.); University of Miami School of Medicine, Coral Gables, Florida (N.K.-S.); and Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada (T.L.-A.).

Correspondence: Ellen McGough, PT, PhD, Department of Rehabilitation Medicine, University of Washington, 1959 NE Pacific, Box 356490, Seattle, WA 98195 (

Supported by Alzheimer's Association International, New Investigator Award (P.I. McGough).

The authors have no conflict of interest.

© 2017 Academy of Neurologic Physical Therapy, APTA