New Evidence that an Ancient Folk Medicine is the Most Powerful and Inexpensive Way to Prevent Dementia

A newly-published study in the Journal of the American Medical Association Neurology confirms the anti-aging benefits of an inexpensive treatment first recommended by physicians well over 2,500 years ago. Even better, this research shows for the first time how to target this ancient remedy to specifically protect your brain against cognitive decline and dementia.

Textbooks written in the 5th Century BC credit the Greek physician and educator, Hippocrates, with the prescription “walking is the best medicine.” The JAMA Neurology article shows massive evidence to back this truth. Walking—and equivalent exercises—improve blood pressure, bone health, cholesterol, brain function, and many other health markers. 

Scientists have also identified the optimal dose—usually expressed as steps per day, at a specific pace—confirming that too little or too much exercise can produce less-than-optimal benefits. 

The study, entitled “Association of Daily Step Count and Intensity With Incident Dementia in 78,430 Adults Living in the UK,” examined the effects of steps on rates of dementia in a genetically-varied population. 

The authors note that lower step counts—6,000 to 8,000 daily—may be enough to optimally reduce all-cause mortality, which is the scientific term for death due to any cause. However, higher step counts are associated with lower risks of death due to cardiovascular disease, cancer, and other diseases.

While past studies have found that about 10,000 steps a day are an optimal number for general health, this study set out to address the deficiency of existing research on walking and dementia—including Alzheimer’s disease (AD). The timing of this article may be even more important than the authors knew, because another very recent study published in the Journal of Alzheimer’s Disease reports that older people who survived COVID-19 may have a 69% greater risk of developing AD within a year of infection. 

In fact, the walking and dementia study may have identified a particular regimen of walking that almost perfectly cancels the risk of getting AD within a year of COVID-19. Continued over time, we believe that the benefits may be even greater.

The Research

More than 100,000 participants wore an accelerometer on their dominant wrist 24 hours a day, 7 days a week from February 2013 to December 2015. Subjects were tracked through October 31, 2021, with a median follow-up of almost 7 years.

After eliminating those with conditions that could skew results, 78,430 participants aged 40 to 79 remained. Their steps and cadence (speed of walking) data were analyzed along with the incidence of fatal and non-fatal dementia. Those who developed dementia within the first two years were excluded from the study based on the assumption that prior unmeasured behaviors may be responsible for their outcomes. 

The Anti-Dementia Formula 

The researchers found that taking 9,826 steps per day was associated with a 51% decrease in the risk of dementia. A 25% risk reduction—about half of that produced by 10,000 steps—was associated with a step count of 3,826. 

Breaking the number down further, researchers identified three types of steps cadence: incidentalpurposeful, and peak.

Incidental cadence is defined as fewer than 40 steps per minute. This rate is typical of indoor walking, going from one room to another. 

Purposeful cadence is defined as 40 or more steps per minute. This is the rate that’s associated with walking for exercise. 

Peak cadence is the speed of walking for the fastest 30 minutes of the day—which is not necessarily consecutive in either minutes or steps. 

Those who moved with a cadence of 40+ steps per minute for 6,315 steps per day showed the biggest reduction in dementia risk—a whopping 57%. 

Even more dramatically, those who walked at a pace of 112 steps per minute for 30 minutes experienced a 68% decrease in risk. 

How to Do It

A pace of 112 steps per minute is not actually as fast as it might sound, and there’s a simple technique used by joggers that can make it incredibly easy to maintain this pace—walking to music. With a play list of songs that bop at 112 beats per minute (BPM), you can walk to the beat and get your steps at the optimal pace. 

For example, “Everybody Wants to Rule the World” by Tears for Fears, “Let’s Dance” by David Bowie, and “Crazy” by Gnarls Barkley are all 112 beats per minute. There are many lists of songs categorized by BPM online. And remember, researchers found that the 30 minutes of 112 steps per minute do not have to be consecutive!  

If you’re not able or don’t like to walk, you can substitute other activities that are step equivalents. The goal is for you to do physical activity you love. 

What are step equivalents? The general rule is that one minute of moderate activity equals a hundred steps. Mowing the lawn, riding a bike, and grocery shopping all count as moderate activity. If you do 20 minutes of moderate swimming, count that as 2,000 steps. 

One minute of intense activity counts as 200 steps.

Knowledge is Power – And So is Walking

There is a tendency to underestimate just how powerful walking and other forms of exercise are as therapies. Just to put things in perspective:

  • clinical trial of the drug Lecanemab rightly generated HUGE headlines because it reduced the pace of cognitive decline in people with early Alzheimer’s by 27% over 18 months when compared with a placebo
  • The AMBAR trials showed even better results, and may be even as good as walking (see our Therapeutic Plasma Exchange article in the Reboot Your Age app library)

Hippocrates had it right—walking is powerful medicine. And now we have the scientific data to prove it over 2,500 years later. 

Get 10,000 steps or step equivalents a day, at 112 BPM, to ward off dementia and live a healthier—younger—life.

The Abstract

Association of Daily Step Count and Intensity With Incident Dementia in 78,430 Adults Living in the UK

AUTHORS: Borja del Pozo Cruz, PhD; Matthew Ahmadi, PhD; Sharon L. Naismith, PhD; Emmanuel Stamatakis, PhD

IMPORTANCE: Step-based recommendations may be appropriate for dementia-prevention guidelines. However, the association of step count and intensity with dementia incidence is unknown. 

OBJECTIVE: To examine the dose-response association between daily step count and intensity and incidence of all-cause dementia among adults in the UK. 

DESIGN, SETTING, AND PARTICIPANTS: UK Biobank prospective population-based cohort study (February 2013 to December 2015) with 6.9 years of follow-up (data analysis conducted May 2022). A total of 78 430 of 103 684 eligible adults aged 40 to 79 years with valid wrist accelerometer data were included. Registry-based dementia was ascertained through October 2021. 

EXPOSURES: Accelerometer-derived daily step count, incidental steps (less than 40 steps per minute), purposeful steps (40 steps per minute or more), and peak 30-minute cadence (ie, mean steps per minute recorded for the 30 highest, not necessarily consecutive, minutes in a day). 

MAIN OUTCOMES AND MEASURES: Incident dementia (fatal and nonfatal), obtained through linkage with inpatient hospitalization or primary care records or recorded as the underlying or contributory cause of death in death registers. Spline Cox regressions were used to assess dose-response associations. 

RESULTS: The study monitored 78 430 adults (mean [SD] age, 61.1 [7.9] years; 35 040 [44.7%] male and 43 390 [55.3%] female; 881 [1.1%] were Asian, 641 [0.8%] were Black, 427 [0.5%] were of mixed race, 75 852 [96.7%] were White, and 629 [0.8%] were of another, unspecified race) over a median (IQR) follow-up of 6.9 (6.4-7.5) years, 866 of whom developed dementia (mean [SD] age, 68.3 [5.6] years; 480 [55.4%] male and 386 [54.6%] female; 5 [0.6%] Asian, 6 [0.7%] Black, 4 [0.4%] mixed race, 821 [97.6%] White, and 6 [0.7%] other). Analyses revealed nonlinear associations between daily steps. The optimal dose (ie, exposure value at which the maximum risk reduction was observed) was 9826 steps (hazard ratio [HR], 0.49; 95% CI, 0.39-0.62) and the minimal dose (ie, exposure value at which the risk reduction was 50% of the observed maximum risk reduction) was 3826 steps (HR, 0.75; 95% CI, 0.67-0.83). The incidental cadence optimal dose was 3677 steps (HR, 0.58; 95% CI, 0.44-0.72); purposeful cadence optimal dose was 6315 steps (HR, 0.43; 95% CI, 0.32-0.58); and peak 30-minute cadence optimal dose was 112 steps per minute (HR, 0.38; 95% CI, 0.24-0.60). 

CONCLUSIONS AND RELEVANCE: In this cohort study, a higher number of steps was associated with lower risk of all-cause dementia. The findings suggest that a dose of just under 10 000 steps per day may be optimally associated with a lower risk of dementia. Steps performed at higher intensity resulted in stronger associations.