How to Safely and Effectively Apply High-Intensity Strength Training in Older Adults with Alzheimer's Disease: A Case Report

Introduction: High-intensity Resistance Training (RT) is gaining attention as a potential non-pharmacological intervention to mitigate functional and cognitive decline in Alzheimer’s Disease (AD). However, its feasibility, safety, and real-world dosing parameters remain poorly documented in individuals with prodromal AD or Mild Cognitive Impairment (MCI). This case report presents a supervised, high-intensity flywheel RT intervention applied to an older adult with prodromal AD (GDS-3), offering detailed monitoring of physiological responses and objective mechanical performance rarely described in the literature. Case Presentation: We report the case of a 69-year-old man diagnosed with prodromal AD (GDS- 3). After a 3-week period of assessment and familiarization, he completed a 16-week supervised high-intensity flywheel RT program (two sessions/week; seated row, chest press, front half-squat; 5 × 20-s sets per exercise; 0.025-0.050 kg·m² inertia). Pre-and post-assessments included physical fitness (gait speed, dual-task tests, sit-to-stand, handgrip strength, 6-min walk), cognition (ADASCog, Trail Making Test A/B, INECO Frontal Screening), quality of life (SF-36), and motivation (RSE, BREQ-2, BPNES). Blood pressure and blood lactate were monitored, and mechanical performance was recorded for every repetition. The intervention was safe, with no musculoskeletal adverse events. The patient showed improvements in lower-limb functional performance, particularly dual-task gait speed and sit-to-stand, alongside increases in self-esteem and external motivation. Overall quality of life remained stable except for a decline in social functioning. Cognitive outcomes showed domain-specific changes, with slight worsening in memory and attention but a small improvement in executive function. Systolic blood pressure decreased progressively across sessions, while lactate responses indicated consistently high metabolic demand. Conclusion: This case demonstrates that supervised H-MIRT can be delivered safely and feasibly in a patient with prodromal AD, improving functional performance and motivation while largely maintaining quality of life. These observations highlight the potential utility of high-effort RT as an adjunctive therapeutic strategy in early AD, warranting further investigation in larger controlled studies with biomarker and neuroimaging outcomes.