The Alzheimer's Disease (AD) is a neurodegenerative disease characterized by or accumulation of proteins such as Tau or β-amyloid, which causes progressive dementia in adulthood, leading to a state of total disability and death. 1,2 AD currently affects in Spain about 600 000 people (25% of those over 65 years) and about 44 million people worldwide. It is the most common cause of dementia in Europe and perhaps the most common neurodegenerative disease worldwide. The costs of caring for people with this disease in Spain amounted to 37 000 million euros annually.

Exercise has previously been proven to have a positive effect on AD patients. Exercise can increase levels of brain-derived neurotrophic factor (BDNF) and other growth factors, stimulate neurogenesis, increase resistance to brain injury, improve learning and mental performance, arouse the growth of blood vessels, reduce of amyloid load, etc. (Table 1). 3–6 But the point is what kind of training?

Most authors focus on exercises for improving the manifestations of physical fitness in isolation way, and as an indirect result, seek to reduce the advance of the disease. In our opinion, this is an error because nature does not work in that way. There is not a separation between body and mind. All levels, in body and nature, are connected and influence each other. Sport reality shows us that in its different levels (including brain), structure, shape and functionality evolve in time and are closely related to performance. 7–14 This is the result of an evolutionary process through nonlinear interactions in many biological and non-biological systems. 15–20

Consequently, and following the asseveration: “I am I and my circumstance”, 21 it is not possible to understand the reality of an individual by isolating of the relationships with his own universe. Interaction means cooperation-opposition among individual systems and environment (physical and social). In fact, a long-standing problem in biological and social sciences is to understand the conditions required for the emergence and maintenance of cooperation in evolving populations. 22,23 Ergo the key strategy we propose is the interaction of well-defined units in order to promote cooperation among body systems, to promote self-organization. That is why we applied the concept of Holistic Training (body systems synergy: The whole is greater than the sum of its parts) in order to develop a training program for AD. This is a very interesting tool due to the availability, low cost, no invasiveness and improvement of comorbidities associated with aging.

The concept of self-organization can be expressed as the general tendency of a given system to generate behavior patterns from local interactions of its constituent elements and the relationships with the environment. 8,24–27 This phenomenon enables people to develop sport skills, resolve mental challenges, assimilate training loads and improve, keep body temperature, repair wounds, etc. According to Goodwin, if want to improve the system, the ideal is to investigate the conditions that promote self-organization. 28 It is true that if we review the literature about exercise and AD, we can observe that there are not clear methodologies to deal with AD patients. Perhaps this may be because the sources causes of patients crisis and conditions associated with AD (depression, stress, etc.) are different in each case and display different outputs to the same stimulus. This does not allow generalize as in other study populations.

The MMSE, STI, CDT and TMT-A screening tests data showed no significant differences (see Table 3), while the CRICHTON and TMT-B showed statistically significant differences (p = 0.022; p = 0.018). There was a moderate reduction in cognitive impairment, which suggests a slowed disease progression, at least in terms of executive function. There was a remarkable decrease in TMT-A execution time (TE = 0.31 s). TMT-B shows statistically significant differences (p < 0.05) in regards to the achievement of the test time (time conditioned by the execution).

There was a marked improvement in the 30 seconds chair stand test (see Fig. 1). Repetitions increased by 7.1% (PRE: 8.78 ± 3.46; POST: 9.44 ± 3.68 repetitions). In the foot up and go test, the time to get up, cover the distance (2.45 m), and sit down, decreased slightly (2.2%) (PRE: 11.95 ± 5.19; POST: 11.69 ± 4.43 seconds).

Fig. 1.

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Box plot of the results of the 30″ chair stand (up) and foot up and go (below) tests.

The results show that patient's self-organization was increased and behaviors that had atrophied or inhibited tended to reappear, which can be understood as an emergency. 31–34 New properties emerged due to these controlled perturbations, which stimulate self-organization. 32,35,36 These perturbations produce bifurcations involving order parameter in terms of learning rates, which some authors describe by several equations. 32

Furthermore, in the beginning of the program, the subjects were unable to carry out the motor and cognitive tasks simultaneously. They stopped the movement and then answered the questions. Their systems were not synchronized. But after a while, with training, they were able to resolve the tasks simultaneously. Self-organization, that provides an example on a human scale of the synchronization processes that occur in numerous natural systems, finally appeared. Néda 37 give us a beautiful example of how initially, the clapping of the audience is non-synchronized, but after a while they settles down in a common rhythmic and synchronized clapping pattern.

In fact, one of the keys to our success was to establish appropriate working groups. We selected the couples with more affinity, able to help each other and to produce a pleasant sensation for the workmate. Unconsciously, our minds are connected. We create networks with people nearby through mirror neurons. 38 These mechanisms encourage the processes of our mental networks, and with adequate training mental (stimulation) synchronization processes are positively enhanced. Perception plays an important role, because is a bipolar process (cognitive-sensorial). 39 According to James 39 one part of what we perceive comes through the senses, what we have in front of us. And another part always comes from our own mind. Hence it is called bipolar process because of this dual side: sensory and cognitive. Perception depends on the individual and personal characteristics of each subject. It depends on stimuli and sensory organs. In short, it depends on the activity of perceiving subject and perceptual schemas. In perception are involved learning, past experiences, cultural, motivations, expectations, skills, personality, habits and memories. Perception is an active process. All influence on the selection and interpretation of data and content. Therefore, our training has taken a multidimensional approach. Information flow is generated by the constituent elements that in turn changes the status of the source, 40 because interactions between units in systems usually give rise to intricate networks with non-trivial structure, which affects the dynamics and properties of the system. 41

Our findings suggest that AD patients who trained using concepts from complexity theory may be able to manifest improvements in both their mental and physical abilities. They showed a slight tendency of stabilization or a slowing of cognitive impairment aspects assessed in the MMSE, Crichton, STI and CDT; and a clear improvement of executive procedures by reducing the execution time of part A and B of the TMT.

The authors have no conflicts of interest to declare.