The effect of exercise interventions on cognitive outcome in Alzheimer's disease: a systematic review

ABSTRACT Background: Non-pharmacological interventions may have a role in both the prevention and slowing down of disease progression in Alzheimer's disease (AD). The role of exercise in disease prevention, for example, has been extensively evaluated in large epidemiological studies. Much less is known about the potential benefit of exercise in patients already diagnosed with AD. It was therefore the aim of this systematic review to assess the effectiveness of exercise in attenuating cognitive decline within AD. Method: A systematic review was conducted statistically accompanied by a meta-analysis. Publications between January 1991 and October 2012 were identified by searching the electronic databases PubMed, Science Direct, Web of Knowledge, and PsychINFO. Selected studies required AD patients to take part in an exercise-based randomized controlled trial (RCT) and have a cognitive outcome measure. Results: Six RCTs were identified that exclusively considered the effect of exercise in AD patients. Exercise generally had a positive effect on rate of cognitive decline in AD. A meta-analysis found that exercise interventions have a positive effect on global cognitive function, 0.75 (95% CI = 0.32–1.17). Conclusions: From the six studies reviewed, the evidence suggests that exercise can have a positive effect on rate of cognitive decline in AD. However, the variation between study designs makes conclusions regarding the optimum intervention on cognitive outcome in AD difficult. Well-designed and powered RCTs are still needed to ascertain the efficacy of exercise in slowing down cognitive impairment in AD patients. However, a positive initial indication for exercise efficacy justifies such efforts.

[1]  M. Stenvall,et al.  Applicability and Effects of Physical Exercise on Physical and Cognitive Functions and Activities of Daily Living Among People With Dementia: A Systematic Review , 2011, American journal of physical medicine & rehabilitation.

[2]  L. Fratiglioni,et al.  Physical exercise at midlife and risk of dementia three decades later: a population-based study of Swedish twins. , 2008, The journals of gerontology. Series A, Biological sciences and medical sciences.

[3]  C. Cotman,et al.  Three weeks of running wheel exposure improves cognitive performance in the aged Tg2576 mouse , 2007, Behavioural Brain Research.

[4]  C. Lyketsos,et al.  Evaluation of a home‐based exercise program in the treatment of Alzheimer's disease: The Maximizing Independence in Dementia (MIND) study , 2009, International journal of geriatric psychiatry.

[5]  S. Gobbi,et al.  Atividade física sistematizada e desempenho cognitivo em idosos com demência de Alzheimer: uma revisão sistemática , 2009 .

[6]  J. Lindsay,et al.  Physical activity and risk of cognitive impairment and dementia in elderly persons. , 2001, Archives of neurology.

[7]  R. Westendorp,et al.  Leisure activities and the risk of dementia. , 2003, The New England journal of medicine.

[8]  H. Feys,et al.  Cognitive and behavioural effects of music-based exercises in patients with dementia , 2004, Clinical rehabilitation.

[9]  Fiona K. Penrose BAppSc.  Can Exercise Affect Cognitive Functioning in Alzheimer's Disease? A Review of the Literature , 2005 .

[10]  K. Coburn,et al.  The cognitive correlates of functional status , 2007 .

[11]  J. C. de la Torre,et al.  For Personal Use. Only Reproduce with Permission the Lancet Publishing Group. Personal View Is Ad Neurodegenerative or Vascular? Is Ad Neurodegenerative? Is Alzheimer's Disease a Neurodegenerative or a Vascular Disorder? Data, Dogma, and Dialectics , 2022 .

[12]  Luc Vanhees,et al.  Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. , 2008, The Cochrane database of systematic reviews.

[13]  R. L. Rogers,et al.  After Reaching Retirement Age Physical Activity Sustains Cerebral Perfusion and Cognition , 1990, Journal of the American Geriatrics Society.

[14]  A. Kolanowski,et al.  Facilitating aerobic exercise training in older adults with Alzheimer's disease. , 2009, Geriatric nursing.

[15]  M. Clarke,et al.  Mental and physical health of elderly people: five-year follow-up of a total population. , 1989, Age and ageing.

[16]  J. Wyman,et al.  Maintaining Physical Fitness and Function in Alzheimer’s Disease , 2011, American journal of Alzheimer's disease and other dementias.

[17]  Marc Paccalin,et al.  Effects of a Physical Training Programme on Cognitive Function and Walking Efficiency in Elderly Persons with Dementia , 2010, Dementia and Geriatric Cognitive Disorders.

[18]  A. Kramer,et al.  Exercise, brain, and cognition across the life span. , 2011, Journal of applied physiology.

[19]  Helen Handoll,et al.  The Cochrane database of systematic reviews , 2002 .

[20]  Victoria M Perreau,et al.  Voluntary Exercise Decreases Amyloid Load in a Transgenic Model of Alzheimer's Disease , 2005, The Journal of Neuroscience.

[21]  J. Hardy,et al.  The Amyloid Hypothesis of Alzheimer ’ s Disease : Progress and Problems on the Road to Therapeutics , 2009 .

[22]  B. Strooper,et al.  The amyloid cascade hypothesis for Alzheimer's disease: an appraisal for the development of therapeutics , 2011, Nature Reviews Drug Discovery.

[23]  D. Forbes,et al.  Physical activity programs for persons with dementia. , 2008, The Cochrane database of systematic reviews.

[24]  J. Cannell,et al.  A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial. , 2012, Scandinavian journal of caring sciences.

[25]  J. Ratey,et al.  The positive impact of physical activity on cognition during adulthood: a review of underlying mechanisms, evidence and recommendations , 2011, Reviews in the neurosciences.

[26]  F. Stella,et al.  [Effects of physical activity on cognitive functions, balance and risk of falls in elderly patients with Alzheimer's dementia]. , 2010, Revista brasileira de fisioterapia (Sao Carlos (Sao Paulo, Brazil)).

[27]  S. Borson,et al.  The Mini‐Cog: a cognitive ‘vital signs’ measure for dementia screening in multi‐lingual elderly , 2000, International journal of geriatric psychiatry.

[28]  R N Kalaria,et al.  Overlap between pathology of Alzheimer disease and vascular dementia. , 1999, Alzheimer disease and associated disorders.

[29]  B. H. Thomas,et al.  A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. , 2004, Worldviews on evidence-based nursing.

[30]  R. Coleman,et al.  Effects of exercise training on cardiorespiratory function in men and women older than 60 years of age. , 1991, The American journal of cardiology.

[31]  Yaakov Stern,et al.  Food combination and Alzheimer disease risk: a protective diet. , 2010, Archives of neurology.

[32]  Hans Förstl,et al.  Physical activity and incident cognitive impairment in elderly persons: the INVADE study. , 2010, Archives of internal medicine.

[33]  F. Yu,et al.  Guiding Research and Practice: A Conceptual Model for Aerobic Exercise Training in Alzheimer’s Disease , 2011, American journal of Alzheimer's disease and other dementias.

[34]  P. Barberger-Gateau,et al.  Dietary patterns and risk of dementia , 2007, Neurology.

[35]  F. Schena,et al.  Six-Month Walking Program Changes Cognitive and ADL Performance in Patients With Alzheimer , 2011, American journal of Alzheimer's disease and other dementias.

[36]  A. Nissinen,et al.  Physical activity in relation to cognitive decline in elderly men , 2004, Neurology.

[37]  Li Wang,et al.  Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older , 2006, Annals of Internal Medicine.

[38]  B. Winblad,et al.  Influence of social network on occurrence of dementia: a community-based longitudinal study , 2000, The Lancet.

[39]  Michael W Kattan,et al.  Meta-analysis: Its strengths and limitations. , 2008, Cleveland Clinic journal of medicine.

[40]  C. Cotman,et al.  Exercise: a behavioral intervention to enhance brain health and plasticity , 2002, Trends in Neurosciences.

[41]  D A Bennett,et al.  Total daily physical activity and the risk of AD and cognitive decline in older adults , 2012, Neurology.

[42]  Kazuo Abe,et al.  Total daily physical activity and the risk of AD and cognitive decline in older adults , 2012, Neurology.

[43]  G. Ravaglia,et al.  Physical activity and dementia risk in the elderly , 2008, Neurology.

[44]  V Marigliano,et al.  Effect of aerobic training on the cognitive performance of elderly patients with senile dementia of Alzheimer type. , 1996, Archives of gerontology and geriatrics.

[45]  Laura Fratiglioni,et al.  Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen project. , 2002, American journal of epidemiology.

[46]  J. Dartigues,et al.  Leisure activities and the risk of dementia in the elderly , 2007 .

[47]  Hans Brunnström,et al.  Prevalence of dementia subtypes: a 30-year retrospective survey of neuropathological reports. , 2009, Archives of gerontology and geriatrics.

[48]  Carl W. Cotman,et al.  Exercise builds brain health: key roles of growth factor cascades and inflammation , 2007, Trends in Neurosciences.

[49]  L. Yágüez,et al.  The effects on cognitive functions of a movement‐based intervention in patients with Alzheimer's type dementia: a pilot study , 2011, International journal of geriatric psychiatry.

[50]  G. Schuler,et al.  Physical Activity , 2001, International Journal of Obesity.

[51]  S. Gobbi,et al.  Efeitos de um programa de atividade física nas funções cognitivas, equilíbrio e risco de quedas em idosos com demência de Alzheimer , 2010 .

[52]  Kevin J Black,et al.  The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. , 2007, The Journal of neuropsychiatry and clinical neurosciences.

[53]  R. Coleman,et al.  Effects of exercise training on cardiorespiratory function in men and women >60 years of age , 1991 .

[54]  R. Kalaria.  Similarities between Alzheimer's disease and vascular dementia , 2002, Journal of the Neurological Sciences.