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Li Z, Guo H, Liu X. What exercise strategies are best for people with cognitive impairment and dementia? A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 124:105450. [PMID: 38692156 DOI: 10.1016/j.archger.2024.105450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/03/2024] [Accepted: 04/19/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Explore the types of exercise that are appropriate for people with dementia, as well as the intensity and frequency of exercise training that is appropriate for older patients to carry out. METHODS Cochrane Library, PubMed, Embase, Web of Science, Scopus databases were searched by computer to collect RCT studies that met the inclusion criteria of this article. The search time limit was until January 2024. Two reviewers independently screened literature, extracted data, and assessed the quality and risk of bias of the included studies. Then, meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. RESULTS The results of our study showed that physical exercise improved patients' cognitive ability and walking ability, with aerobic and multicomponent training showing the best improvement, and that the number of training sessions should not be too high, with the experimental group showing the best results when the total number of interventions was less than 30. CONCLUSION We recommend long-term exercise training for middle-aged and elderly patients with dementia or those who are predisposed to dementia. The type of training we recommend is multi-component training and aerobic training, and we recommend 2-3 sessions of exercise per week for about 60 min each.
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Affiliation(s)
- Zecheng Li
- College of Sports Science, Harbin Normal University, Harbin, China
| | - Hongpeng Guo
- College of Sports Science, Harbin Normal University, Harbin, China.
| | - Xuebin Liu
- College of Sports Science, Harbin Normal University, Harbin, China
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McCartney A, Crosswell J, Rafnsson SB, Hoe J. The effectiveness of structured physical activity on agitation in people with dementia: a rapid review. Aging Ment Health 2024; 28:1067-1077. [PMID: 38683159 DOI: 10.1080/13607863.2024.2345129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 04/13/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Managing agitation and other behaviours that challenge is a significant dementia care challenge. The priority is to find effective non-pharmacological interventions as drug treatments can have significant side effects. This review evaluates the effectiveness of structured physical activity on agitation in dementia. METHOD Our rapid review searched four electronic databases, Cochrane CENTRAL, MEDLINE, CINAHL and Embase, for interventional studies using a structured physical activity programme in people with dementia and studied the effect of this activity on behaviours that challenge. Study quality was assessed using CASP criteria and data was narratively synthesised. RESULTS We included 13 studies in this review (four rated as high quality), involving a total of 1546 participants. Results were analysed according to exercise type, frequency and intensity of the intervention. Exercise is effective in reducing agitation and studies with higher adherence to exercise demonstrated more positive effects on agitation and behaviours that challenge. CONCLUSION Physical activity can be effective in reducing agitation in older adults with dementia. Further research is needed to clarify the type of intervention that is most beneficial. Strategies to make physical activity more acceptable and available to people with dementia need to be established.
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Affiliation(s)
- A McCartney
- Estuary View Medical Centre, Whitstable Medical Practice, Kent, United Kingdom
| | - J Crosswell
- Estuary View Medical Centre, Whitstable Medical Practice, Kent, United Kingdom
| | - S B Rafnsson
- Geller Institute of Ageing and Memory, School of Biomedical Sciences, University of West London, London, United Kingdom
| | - J Hoe
- Geller Institute of Ageing and Memory, School of Biomedical Sciences, University of West London, London, United Kingdom
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Papamichail P, Sagredaki ML, Bouzineki C, Kanellopoulou S, Lyros E, Christakou A. The Effectiveness of an Exercise Program on Muscle Strength and Range of Motion on Upper Limbs, Functional Ability and Depression at Early Stage of Dementia. J Clin Med 2024; 13:4136. [PMID: 39064174 PMCID: PMC11278101 DOI: 10.3390/jcm13144136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/10/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Dementia involves the loss of cognitive abilities and represents a decline from the prior level of function, which impairs functional abilities in day-to-day life. The purpose of the present study is to examine the effectiveness of an exercise program on the muscle strength and range of motion of the upper limbs, the functional status, and the depression of elderly people with early stage dementia. Methods: The sample consisted of 60 elderly people with early stage dementia who were randomly divided into a control and an experimental group of 30 participants each. The experimental group received a 12-week Otago exercise program with 45 min duration of each session. The control group received usual care without doing exercise. The outcome measures of muscle strength and range of motion of the upper limbs, the functional status, and the depression were assessed by valid instruments and tests at the beginning and at the end of the intervention program. Repeated measures one-way ANOVA and Mann-Whitney tests examined the differences between the two groups at the end of the 12-week exercise program. Results: Statistically significant differences were found between the experimental and control groups in the entire outcome measures (functional ability F = 9.35 p < 0.05; muscle strength right hand F = 32.33, p < 0.05 left hand U = 95.50 p < 0.01; e.g., range of motion shoulder extension U = 104.00 p < 0.01), except depression. Conclusions: Both muscle strength and range of motion of the upper limbs, as well as the functional ability, were improved by the exercise program. Further research is needed to investigate the present results, in particular to explore the long-term cognitive, behavioral, and functional status outcomes of exercise in the early stages of dementia.
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Affiliation(s)
- Panagiotis Papamichail
- Department of Physiotherapy, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece; (P.P.); (M.-L.S.); (E.L.)
- Intensive Care Unit, Bioclinic Athens, 11525 Athens, Greece
| | - Maria-Louiza Sagredaki
- Department of Physiotherapy, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece; (P.P.); (M.-L.S.); (E.L.)
| | | | | | - Epameinondas Lyros
- Department of Physiotherapy, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece; (P.P.); (M.-L.S.); (E.L.)
| | - Anna Christakou
- Department of Physiotherapy, Lab Biomechanics, School of Health Sciences, University of Peloponnese, 23100 Sparta, Greece
- Department of Physiotherapy, University of West Attica, 12243 Athens, Greece
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Yin Z, Li Y, Bao Q, Zhang X, Xia M, Zhong W, Wu K, Yao J, Chen Z, Sun M, Zhao L, Liang F. Comparative efficacy of multiple non-pharmacological interventions for behavioural and psychological symptoms of dementia: A network meta-analysis of randomised controlled trials. Int J Ment Health Nurs 2024; 33:487-504. [PMID: 38012101 DOI: 10.1111/inm.13254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/14/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Abstract
Non-pharmacological interventions can improve the behavioural and psychological symptoms of dementia (BPSD). However, the optimal non-pharmacological treatments remain controversial. This study aimed to compare the efficacy of multiple non-pharmacological methods and identify the optimal therapy for BPSD. Potential randomised controlled trials (RCTs) were searched and selected from 15 databases and sources from the inception of the databases until 1 October 2022. Two independent authors implemented study screening, data extraction, and methodological quality assessment. Primary outcome was reduction of Neuropsychiatric Inventory (NPI). The secondary outcome were changes of Cornell Scale for Depression in Dementia (CSDD), the Cohen-Mansfield Agitation Inventory (CMAI), the Quality of Life in Alzheimer's Disease (QoL-AD), the Abilities of Daily Living scale, and the Apathy Evaluation Scale. Meta-analyses were performed using STATA v15.0 and ADDIS v1.16.8. The GRADE approaches were utilised to evaluate evidence quality. The present study included 43 RCTs with 4978 participants. The global methodological quality of the RCTs was moderate. Regarding NPI reduction, with moderate-certainty evidence, exercise plus treatment as usual (TAU) outperformed TAU (mean difference [MD]: -7.13; 95% confidence interval [CI]: -13.22, -0.76) and ranked as the optimal treatment. For reduction in CSDD, with low- to moderate-certainty evidence, massage plus TAU (MD: -15.26; 95% CI: -20.13, -10.52) and music plus TAU (MD: -2.40; 95% CI: -4.62, -0.12) were associated with greater reduction compared with TAU. For reduction in CMAI, with moderate-certainty evidence, aromatherapy plus massage (MD: -15.84; 95% CI: -29.76, -2.42) and massage plus music (MD: -13.12; 95% CI: -25.43, -0.76) were significantly more effective than TAU. For improvement in QoL-AD, with critically low- to low-certainty evidence, there were no statistical differences between any of non-pharmacological treatments and TAU. Due to the limited number of included studies, network meta-analysis was not performed for other outcomes. In conclusion, non-pharmacological treatments are effective for overall symptoms, depression, and agitation. Exercise plus treatment as usual may be an optimal non-pharmacological intervention for improving the overall BPSD. This may help to guide patients, doctors, and policymakers.
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Affiliation(s)
- Zihan Yin
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Yaqin Li
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qiongnan Bao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Xinyue Zhang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Manze Xia
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Wanqi Zhong
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Kexin Wu
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Jin Yao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Zhenghong Chen
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Mingsheng Sun
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Ling Zhao
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
| | - Fanrong Liang
- School of Acu-Mox and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Acupuncture Clinical Research Center of Sichuan Province, Chengdu, China
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Yuan Y, Yang Y, Hu X, Zhang L, Xiong Z, Bai Y, Zeng J, Xu F. Effective dosage and mode of exercise for enhancing cognitive function in Alzheimer's disease and dementia: a systematic review and Bayesian Model-Based Network Meta-analysis of RCTs. BMC Geriatr 2024; 24:480. [PMID: 38824515 PMCID: PMC11143595 DOI: 10.1186/s12877-024-05060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/08/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE Research the dose-response relationship between overall and certain types of exercise and cognitive function in older adults with Alzheimer's disease and dementia. DESIGN Systemic and Bayesian Model-Based Network Meta-Analysis. METHODS In our study, we analyzed data from randomized controlled trials investigating the effects of different exercises on cognitive outcomes in older adults with AD. We searched the Web of Science, PubMed, Cochrane Central Register of Controlled Trials, and Embase up to November 2023. Using the Cochrane Risk of Bias tool (Rob2) for quality assessment and R software with the MBNMA package for data analysis, we determined standard mean differences (SMDs) and 95% confidence intervals (95%CrI) to evaluate exercise's impact on cognitive function in AD. RESULTS Twenty-seven studies with 2,242 AD patients revealed a nonlinear relationship between exercise and cognitive improvement in AD patients. We observed significant cognitive enhancements at an effective exercise dose of up to 1000 METs-min/week (SMDs: 0.535, SD: 0.269, 95% CrI: 0.023 to 1.092). The optimal dose was found to be 650 METs-min/week (SMDs: 0.691, SD: 0.169, 95% CrI: 0.373 to 1.039), with AE (Aerobic exercise) being particularly effective. For AE, the optimal cognitive enhancement dose was determined to be 660 METs-min/week (SMDs: 0.909, SD: 0.219, 95% CrI: 0.495 to 1.362). CONCLUSION Nonlinear dose-response relationship between exercise and cognitive improvement in Alzheimer's disease, with the optimal AE dose identified at 660 METs-min/week for enhancing cognitive function in AD.
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Affiliation(s)
- Yuan Yuan
- Department of Physical Education, Kunsan National University, Daehak-RoJeollabuk-Do, Gunsan-Si, 541150, Korea
| | - Yong Yang
- Laboratory of Kinesiology and Rehabilitation, School of Physical Education and Sport, Chaohu University, Hefei, 238000, China
| | - XiaoFei Hu
- The School of Physical Education, Handan University, Handan, 056005, China
| | - Lin Zhang
- Department of Rehabilitation, West China Hospital Sichuan University Jintang Hospital, Chengdu, 610499, China.
| | - Zhiyu Xiong
- The School of Physical Education and Health, East China Jiaotong University, Nanchang, 330013, China
| | - Ying Bai
- Department of Physical Education, Kunsan National University, Daehak-RoJeollabuk-Do, Gunsan-Si, 541150, Korea
| | - JiaLe Zeng
- The School of Physical Education, Jiangxi Normal University, Nanchang, 330224, China
| | - Feng Xu
- College of Physical Education, Fujian Normal University, FuZhou, 350007, China
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Clemente-Suárez VJ, Redondo-Flórez L, Beltrán-Velasco AI, Belinchón-deMiguel P, Ramos-Campo DJ, Curiel-Regueros A, Martín-Rodríguez A, Tornero-Aguilera JF. The Interplay of Sports and Nutrition in Neurological Health and Recovery. J Clin Med 2024; 13:2065. [PMID: 38610829 PMCID: PMC11012304 DOI: 10.3390/jcm13072065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
This comprehensive review explores the dynamic relationship between sports, nutrition, and neurological health. Focusing on recent clinical advancements, it examines how physical activity and dietary practices influence the prevention, treatment, and rehabilitation of various neurological conditions. The review highlights the role of neuroimaging in understanding these interactions, discusses emerging technologies in neurotherapeutic interventions, and evaluates the efficacy of sports and nutritional strategies in enhancing neurological recovery. This synthesis of current knowledge aims to provide a deeper understanding of how lifestyle factors can be integrated into clinical practices to improve neurological outcomes.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (A.C.-R.); (J.F.T.-A.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
| | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, C/Tajo s/n, Villaviciosa de Odón, 28670 Madrid, Spain;
| | | | - Pedro Belinchón-deMiguel
- Department of Nursing and Nutrition, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Agustín Curiel-Regueros
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (A.C.-R.); (J.F.T.-A.)
| | - Alexandra Martín-Rodríguez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (A.C.-R.); (J.F.T.-A.)
| | - José Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (V.J.C.-S.); (A.C.-R.); (J.F.T.-A.)
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Morella I, Negro M, Dossena M, Brambilla R, D'Antona G. Gut-muscle-brain axis: Molecular mechanisms in neurodegenerative disorders and potential therapeutic efficacy of probiotic supplementation coupled with exercise. Neuropharmacology 2023; 240:109718. [PMID: 37774944 DOI: 10.1016/j.neuropharm.2023.109718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/01/2023]
Abstract
Increased longevity is often associated with age-related conditions. The most common neurodegenerative disorders in the older population are Alzheimer's disease (AD) and Parkinson's disease (PD), associated with progressive neuronal loss leading to functional and cognitive impairments. Although symptomatic treatments are available, there is currently no cure for these conditions. Gut dysbiosis has been involved in the pathogenesis of AD and PD, thus interventions targeting the "gut-brain axis" could potentially prevent or delay these pathologies. Recent evidence suggests that the skeletal muscle and the gut microbiota can affect each other via the "gut-muscle axis". Importantly, cognitive functions in AD and PD patients significantly benefit from physical activity. In this review, we aim to provide a comprehensive picture of the crosstalk between the brain, the skeletal muscle and the gut microbiota, introducing the concept of "gut-muscle-brain axis". Moreover, we discuss human and animal studies exploring the modulatory role of exercise and probiotics on cognition in AD and PD. Collectively, the findings presented here support the potential benefits of physical activity and probiotic supplementation in AD and PD. Further studies will be needed to develop targeted and multimodal strategies, including lifestyle changes, to prevent or delay the course of these pathologies.
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Affiliation(s)
- Ilaria Morella
- Neuroscience and Mental Health Innovation Institute, School of Biosciences, Cardiff University, Cardiff, UK
| | - Massimo Negro
- Centro di Ricerca Interdipartimentale Nelle Attività Motorie e Sportive (CRIAMS)-Sport Medicine Centre, University of Pavia, Voghera, Italy
| | - Maurizia Dossena
- Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, 27100 Pavia, Italy
| | - Riccardo Brambilla
- Neuroscience and Mental Health Innovation Institute, School of Biosciences, Cardiff University, Cardiff, UK; Department of Biology and Biotechnology "Lazzaro Spallanzani", University of Pavia, 27100 Pavia, Italy
| | - Giuseppe D'Antona
- Centro di Ricerca Interdipartimentale Nelle Attività Motorie e Sportive (CRIAMS)-Sport Medicine Centre, University of Pavia, Voghera, Italy; Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy.
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8
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Ding Z, Leung PY, Lee TL, Chan AS. Effectiveness of lifestyle medicine on cognitive functions in mild cognitive impairments and dementia: A systematic review on randomized controlled trials. Ageing Res Rev 2023; 86:101886. [PMID: 36806378 DOI: 10.1016/j.arr.2023.101886] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
Mild cognitive impairment (MCI) and dementia are associated with lifestyle risk factors, making lifestyle medicine a potentially viable intervention for people with MCI and dementia. The present study aims to examine the effectiveness of lifestyle medicine on cognitive functions among people with MCI and dementia, by performing a systematic review and meta-analysis on randomized controlled trials (RCT). A systematic literature search was conducted to extract RCTs adopting lifestyle interventions of diet, exercise, and stress management or emotional well-being. Results showed that 65 studies were eligible. Exercise was the most promising lifestyle intervention that improved various cognitive functions among people with MCI and dementia, and was more effective in MCI than in dementia. Interventions on stress management or emotional well-being did not show a significant effect on people with MCI, and the evidence for people with dementia was insufficient to conclude. Similarly, due to the lack of RCTs on a healthy dietary pattern, the effectiveness of diet interventions was not examined. In conclusion, the exercise component of lifestyle medicine can be an effective and clinically significant intervention for protecting people with MCI and dementia against cognitive declines, especially when served as an early intervention at the stage of MCI.
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Affiliation(s)
- Zihan Ding
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Pui-Ying Leung
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; Research Centre for Neuropsychological Well-Being, The Chinese University of Hong Kong, Hong Kong, China
| | - Tsz-Lok Lee
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Agnes S Chan
- Neuropsychology Laboratory, Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China; Research Centre for Neuropsychological Well-Being, The Chinese University of Hong Kong, Hong Kong, China.
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Yang J, Dong Y, Yan S, Yi L, Qiu J. Which Specific Exercise Models Are Most Effective on Global Cognition in Patients with Cognitive Impairment? A Network Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2790. [PMID: 36833483 PMCID: PMC9957167 DOI: 10.3390/ijerph20042790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/22/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
(1) Introduction: Physical exercise interventions can impart significant cognitive benefits to older adults suffering from cognitive impairment (CI). However, the efficacy of these interventions can vary widely, depending on the type, intensity, duration and frequency of exercise. (2) Aim: To systematically review the efficacy of exercise therapy on global cognition in patients with CI using a network meta-analysis (NMA). (3) Methods: The PubMed, Embase, Sport Discus (EBSCO) and Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) on exercise for patients with CI from inception to 7 August 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. The NMA was performed using the consistency model. (4) Results: A total of 29 RCTs comprising 2458 CI patients were included. The effects of different types of exercise on patients with CI were ranked as follows: multicomponent exercise (SMD = 0.84, 95% CI 0.31 to 1.36, p = 0.002), short duration (≤45 min) (SMD = 0.83, 95% CI 0.18 to 1.19, p = 0.001), vigorous intensity (SMD = 0.77, 95% CI 0.18 to 1.36, p = 0.011) and high frequency (5-7 times/week) (SMD = 1.28, 95% CI 0.41 to 2.14, p = 0.004). (5) Conclusion: These results suggested that multicomponent, short-duration, high-intensity, and high-frequency exercise may be the most effective type of exercise in improving global cognition in CI patients. However, more RCTs based on direct comparison of the effects of different exercise interventions are needed. (6) NMA registration identifier: CRD42022354978.
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Affiliation(s)
- Junchao Yang
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Yunfeng Dong
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Shuting Yan
- School of Sport Science, Beijing Sport University, Beijing 100084, China
| | - Longyan Yi
- China Institute of Sports and Health, Beijing Sport University, Beijing 100084, China
| | - Junqiang Qiu
- School of Sport Science, Beijing Sport University, Beijing 100084, China
- Beijing Sports Nutrition Engineering Research Center, Beijing 100084, China
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10
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Kouloutbani K, Venetsanou F, Karteroliotis KE, Politis A. Physical Exercise as a Nonpharmacological Intervention for the Treatment of Neuropsychiatric Symptoms in Persons With Dementia: A Meta-analysis of Randomized Controlled Trials. Alzheimer Dis Assoc Disord 2023; 37:73-81. [PMID: 36821178 DOI: 10.1097/wad.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/28/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are prevalent in dementia and affect both patients and caregivers in multiple ways. Because of the complications of drug treatments, nonpharmacological interventions, such as exercise, are of particular value. This study aimed to investigate the effect of exercise on the NPS of dementia and draw recommendations for the disease management. METHODS Meta-analyses were conducted on the findings of randomized controlled trials identified during an initial systematic review of the literature, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The included studies examined the effect of exercise interventions on patients with dementia or mild cognitive impairment using valid assessment tools. The quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluation analysis. RESULTS The meta-analyses revealed that exercise significantly limits NPS [mean difference: -5.28, (95% CI, -9.46, -1.11), P = 0.01] and symptoms of depression [standardized mean difference: -0.16, (95% CI, -0.29, -0.02), P = 0.02], and has a beneficial effect on agitation symptoms. The Grading of Recommendations, Assessment, Development, and Evaluation analysis results showed that exercise has a moderate and high confidence positive effect on NPS and depression, respectively. CONCLUSIONS Exercise could be an alternative approach for nonpharmacological treatment of NPS in dementia. Therefore, exercise could be utilized as a treatment of choice or to support existing treatment regimens.
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Affiliation(s)
- Komanthi Kouloutbani
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni
| | - Fotini Venetsanou
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni
| | | | - Antonios Politis
- First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
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11
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The effects of aerobic exercise and transcranial direct current stimulation on cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2022; 81:101738. [PMID: 36162707 DOI: 10.1016/j.arr.2022.101738] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Aerobic exercise (AE) may slow age-related cognitive decline. However, such cognition-sparing effects are not uniform across cognitive domains and studies. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation and is also emerging as a potential alternative to pharmaceutical therapies. Like AE, the effectiveness of tDCS is also inconsistent for reducing cognitive impairment in ageing. The unexplored possibility exists that pairing AE and tDCS could produce synergistic effects and reciprocally augment cognition-improving effects in older individuals with and without cognitive impairments. Previous research found such synergistic effects on cognition when cognitive training is paired with tDCS in older individuals with and without mild cognitive impairment (MCI) or dementia. AIM The purpose of this systematic review with meta-analysis was to explore if pairing AE with tDCS could augment singular effects of AE and tDCS on global cognition (GC), working memory (WM) and executive function (EF) in older individuals with or without MCI and dementia. METHODS Using a PRISMA-based systematic review, we compiled studies that examined the effects of AE alone, tDCS alone, and AE and tDCS combined on cognitive function in older individuals with and without mild cognitive impairment (MCI) or dementia. Using a PICOS approach, we systematically searched PubMed, Scopus and Web of Science searches up to December 2021, we focused on 'MoCA', 'MMSE', 'Mini-Cog' (measures) and 'cognition', 'cognitive function', 'cognitive', 'cognitive performance', 'executive function', 'executive process', 'attention', 'memory', 'memory performance' (outcome terms). We included only randomized controlled trials (RTC) in humans if available in English full text over the past 20 years, with participants' age over 60. We assessed the methodological quality of the included studies (RTC) by the Physiotherapy Evidence Database (PEDro) scale. RESULTS Overall, 68 studies were included in the meta-analyses. AE (ES = 0.56 [95% CI: 0.28-0.83], p = 0.01) and tDCS (ES = 0.69 [95% CI: 0.12-1.26], p = 0.02) improved GC in all three groups of older adults combined (healthy, MCI, demented). In healthy population, AE improved GC (ES = 0.46 [95% CI: 0.22-0.69], p = 0.01) and EF (ES = 0.27 [95% CI: 0.05-0.49], p = 0.02). AE improved GC in older adults with MCI (ES = 0.76 [95% CI: 0.21-1.32], p = 0.01). tDCS improved GC (ES = 0.69 [90% CI: 0.12-1.26], p = 0.02), all three cognitive function (GC, WM and EF) combined in older adults with dementia (ES = 1.12 [95% CI: 0.04-2.19], p = 0.04) and improved cognitive function in older adults overall (ES = 0.69 [95% CI: 0.20-1,18], p = 0.01). CONCLUSION Our systematic review with meta-analysis provided evidence that beyond the cardiovascular and fitness benefits of AE, pairing AE with tDCS may have the potential to slow symptom progression of cognitive decline in MCI and dementia. Future studies will examine the hypothesis of this present review that a potentiating effect would incrementally improve cognition with increasing severity of cognitive impairment.
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12
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Dai Y, Ding H, Lu X, Wu X, Xu C, Jiang T, Ming L, Xia Z, Song C, Shen H, Hao W, Huang S. CCRT and aerobic exercise: a randomised controlled study of processing speed, cognitive flexibility, and serum BDNF expression in schizophrenia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:84. [PMID: 36261468 PMCID: PMC9581987 DOI: 10.1038/s41537-022-00297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Computerised cognitive remediation therapy (CCRT) and aerobic exercise are often used to rehabilitate social functioning in patients with schizophrenia. However, there is limited knowledge regarding the effects of CCRT combined with aerobic exercise on cognitive function and brain-derived neurotrophic factor (BDNF) levels in patients with schizophrenia and cognitive impairment. Ninety-six patients with schizophrenia and cognitive impairment were included in this study and randomly divided into control, aerobic exercise (AE), and CCRT combined with aerobic exercise (CAE) groups. Changes in processing speed and cognitive flexibility at week 8 were evaluated as primary and secondary cognitive outcomes using the Trail Making Test: Part A, the Brief Assessment of Cognition in Schizophrenia: Symbol Coding Test, and the Stroop Colour-Word Test. Positive and Negative Syndrome Scale (PANSS) scores and serum BDNF expression were determined as other secondary outcomes. The CAE group showed significantly better performance in terms of changes in processing speed and cognitive flexibility than the control and AE groups at week 8 (p < 0.05); however, no significant improvements in processing speed and cognitive flexibility were found between the control and AE groups. The CAE group showed significant improvements in the PANSS negative symptoms than the control group at week 8 (p < 0.05), but the AE group showed no significant difference in the changes of PANSS negative symptoms when compared with the other two groups. The CAE group and AE group showed a greater increase in serum BDNF levels than the control group (p < 0.01), but there was no significant difference in serum BDNF expression between the CAE group and AE group. In conclusion, 8-week CCRT combined with aerobic exercise may improve some cognitive performance and negative symptoms in patients with schizophrenia. Aerobic exercise may have an immediate effect on serum BDNF levels rather than cognitive function.
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Affiliation(s)
- Yuanyuan Dai
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Hongyan Ding
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Xiaozi Lu
- grid.452792.fQingdao Mental Health Center, Qingdao, 266034 China
| | - Xiumei Wu
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Chunhua Xu
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Tingting Jiang
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Liang Ming
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Zhong Xia
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Chuanfu Song
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
| | - Hongxian Shen
- grid.452708.c0000 0004 1803 0208National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Wei Hao
- grid.452708.c0000 0004 1803 0208National Clinical Research Center for Mental Disorders, and Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 China
| | - Shucai Huang
- The Fourth People’s Hospital of Wuhu, Wuhu, 241000 China
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13
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Major G, Bagnall AM, Bhar S, Bryant C, Dow B, Dunt D, Fearn M, Harper R, Leung WY, Mnatzaganian G, O'Bree B, Doyle C. A Scoping Review of the Measurement of Depression in Older Adults with Cognitive Impairment. Clin Gerontol 2022:1-13. [PMID: 36163627 DOI: 10.1080/07317115.2022.2126809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Depression and cognitive impairment are disabling conditions that commonly occur together in older adults. The interaction is challenging when choosing appropriate measurement scales. This review aimed to summarize the scales to measure depression symptoms in older people with cognitive impairment, investigating how cognitive impairment is related to the choice of measurement, and how the setting may affect the choice of measurement. METHODS A scoping review of literature published between 2015 and 2021. RESULTS After screening 1580 articles, 26 were included in the review with 11 different measures of depression symptoms identified. The measures mostly commonly used were the Geriatric Depression Scale (GDS), Cornell Scale for Depression in Dementia (CSDD) and the Neuropsychiatric Inventory (NPI-Q). Most studies did not report on the usability of depression scales used with people with cognitive impairment and only two scales (CSDD and NPI-Q, not GDS) have been validated for use with this population. CONCLUSIONS Severe cognitive impairment was under-represented in the identified studies, and no association was detected between study setting, cognitive impairment and type of measure used. CLINICAL IMPLICATIONS Clinicians and researchers should consider both the cognitive status of participants and the setting they live in when choosing a measure of depression symptoms.
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Affiliation(s)
- Georgia Major
- Aged Care Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Anne-Marie Bagnall
- School of Health and Community Studies, Leeds Beckett University Leeds, United Kingdom
| | - Sunil Bhar
- Psychology Department, Swinburne University, Melbourne, Victoria, Australia
| | - Christina Bryant
- Emeritus, The University of Melbourne, Melbourne, Victoria, Australia
| | - Briony Dow
- Aged Care Division, National Ageing Research Institute, Melbourne, Victoria, Australia.,Emeritus, The University of Melbourne, Melbourne, Victoria, Australia
| | - David Dunt
- Emeritus, The University of Melbourne, Melbourne, Victoria, Australia
| | - Marcia Fearn
- Aged Care Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Robin Harper
- Aged Care Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Wing-Yin Leung
- Aged Care Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - George Mnatzaganian
- The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Paramedicine, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Bridget O'Bree
- Aged Care Division, National Ageing Research Institute, Melbourne, Victoria, Australia
| | - Colleen Doyle
- Aged Care Division, National Ageing Research Institute, Melbourne, Victoria, Australia.,Psychology Department, Swinburne University, Melbourne, Victoria, Australia
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14
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Li L, Luo J, Reangsing C, Schneider JK. Effects of exercise on depressive symptoms among nursing home residents: a meta-analysis. Aging Ment Health 2022; 26:1514-1523. [PMID: 34282683 DOI: 10.1080/13607863.2021.1951658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined the effects of exercise on depression in older adults living in nursing homes and explored the moderator effects of participants, methods, and intervention characteristics. METHODS We searched 8 databases from inception to January 2020 without date restrictions. We retrieved primary studies measuring exercise with 60-year-olds with depression that were written in English. Two researchers independently coded each primary study and compared codes for discrepancies. They consulted a third researcher to come to consensus. We used random-effects model to compute effect sizes using Hedges' g, a forest plot, and Q and I2 statistics as measures of heterogeneity. We also examined moderator analyses. RESULTS Twenty-one studies included 2,594 participants (81.8 ± 4.8 years old). Overall, exercise showed a small improvement in depression compared to controls (ES=.25; 95%CI 0.11, 0.38; p=.000). Interestingly, interventionists by physiotherapists had a smaller effect on depressive symptoms (.04) than other health interventionists (.37). As people aged, exercise was less effective in reducing depression (slope=-.03, Qmodel=5.03, p=.025). Researchers who included a higher percentage of women in exercise showed less improvement of depression (slope=-.01, Qmodel=8.60, p=.003). Also, when researchers used depression scales with higher reliability values, they measured higher levels of depression (slope = 5.48, Qmodel=5.60, p=.018). No other quality indicators moderated the effects of exercise on depression. CONCLUSION Exercise significantly improved depressive symptoms among older adults in nursing homes. Exercise might be used as adjunct/alternative complementary treatment for improving depressive symptoms in older adults in nursing homes.
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Affiliation(s)
- Lixiang Li
- School of Nursing, Guizhou Medical University, The affiliated hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Jing Luo
- School of Nursing, Guizhou Medical University, Guiyang, Guizhou, China
| | - Chuntana Reangsing
- Trudy Busch Valentine School of Nursing, Saint Louis University, MO, USA.,School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand
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15
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Venegas-Sanabria LC, Cavero-Redondo I, Martínez-Vizcaino V, Cano-Gutierrez CA, Álvarez-Bueno C. Effect of multicomponent exercise in cognitive impairment: a systematic review and meta-analysis. BMC Geriatr 2022; 22:617. [PMID: 35879665 PMCID: PMC9316334 DOI: 10.1186/s12877-022-03302-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/23/2022] [Indexed: 11/21/2022] Open
Abstract
Background Multicomponent physical exercise is the most recommended type of physical intervention in older adults. Experimental data suggest the relevance of the muscle-brain axis and the relationship between muscle contraction and release of brain-derived neurotrophic factor, however, the impact of this relationship on cognition remains unclear, especially in people with diagnosis of cognitive impairment. This study assesses the effect of multicomponent physical exercise on global cognition in people with mild cognitive impairment or dementia. Methods Randomized controlled trials published until January 2021 were searched across three electronic databases (PubMed, Scopus, and Cochrane Database). Data about exercises included in the multicomponent intervention (endurance, strength, balance, or flexibility), the inclusion of aerobic exercise, and the change in global cognition were extracted. The effect size was represented as a standardized mean difference. Risk of bias was assessed by the RoB2 tool. Results A total of 8 studies were included. The overall effect size suggested an effect of multicomponent exercise on global cognition. However, the subgroup analysis showed an effect only when aerobic exercise was included in the intervention. No effect when mild cognitive impairment and dementia were assessed separately was found. Conclusion This study suggests that multicomponent physical exercise could have an effect on global cognition in people with mild cognitive impairment or dementia only when aerobic exercise is included in the intervention. Our results support the inclusion of structured physical exercise programs in the management of people with cognitive impairment. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03302-1.
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Affiliation(s)
- Luis Carlos Venegas-Sanabria
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Instituto Rosarista para el Estudio del Envejecimiento y la Longevidad, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia.,Hospital Universitario Mayor, Méderi, Bogotá, Colombia
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain. .,Rehabilitation in Health Research Center (CIRES), Universidad de Las Américas, Santiago, Chile. .,Facultad de Enfermería de Cuenca, C/ Santa Teresa Jornet, s/n. Cuenca, Spain.
| | - Vicente Martínez-Vizcaino
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago, Chile
| | - Carlos Alberto Cano-Gutierrez
- Aging Institute, Medicine School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Department of Internal Medicine, Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Universidad Politécnica Y Artística del Paraguay, Asunción, Paraguay
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16
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Nora CD, de Lima JD, Teixeira IA, Silva FDO, de Almeida JS, Monteiro FC, Marinho V, Dourado MCN, Deslandes AC. Online physical exercise and the neuropsychiatric symptoms in patients with dementia: a cross-sectional study during the COVID-19 pandemic. Dement Neuropsychol 2022; 16:253-260. [PMID: 36619833 PMCID: PMC9762384 DOI: 10.1590/1980-5764-dn-2021-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 01/11/2023] Open
Abstract
Social isolation is necessary during the COVID-19 pandemic but can be harmful to mental health, especially in people with neurocognitive disorders. Although physical exercise can alleviate neuropsychiatric symptoms and improve quality of life (QoL), sedentary behavior increased during the pandemic. Online interventions can contribute to improving physical activity and mental health. Objective The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. Methods In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer's Disease (QoL-AD) scale. Results There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Conclusions Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.
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Affiliation(s)
- Caroline Dalla Nora
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Juliana Dias de Lima
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | - Ivan Abdalla Teixeira
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | | | - Júlia Silva de Almeida
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | | | - Valeska Marinho
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
| | | | - Andrea Camaz Deslandes
- Universidade Federal do Rio de Janeiro, Instituto de
Psiquiatria, Rio de Janeiro RJ, Brazil
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17
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Burley CV, Burns K, Lam BCP, Brodaty H. Nonpharmacological approaches reduce symptoms of depression in dementia: A systematic review and meta-analysis. Ageing Res Rev 2022; 79:101669. [PMID: 35714853 DOI: 10.1016/j.arr.2022.101669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/09/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression is a common psychological symptom associated with dementia. Pharmacological approaches are often used despite two large negative trials of efficacy. This meta-analysis examines nonpharmacological (i.e., psychosocial) approaches for symptoms of depression in people living with dementia and reports statistical and clinical significance. METHODS Relevant studies published between 2012 and 2020 were sourced by searching electronic databases: MEDLINE, EMBASE, PsychINFO, Social Work Abstracts and the Cochrane Central Register of Controlled Trials. Studies were assessed for methodological quality. Random-effects meta-analysis was performed to calculate a pooled effect size (ES) and 95% confidence intervals (CI). RESULTS Overall, 37 nonpharmacological studies were identified including 2,636 participants. The mean quality rating was high (12/14, SD=1.4). Meta-analysis revealed that nonpharmacological approaches were significantly associated with reduced symptoms of depression with a medium effect size (ES=-0.53, 95%CI [-0.72, -0.33], p < 0.0001). There was considerable heterogeneity between studies. Meta-regression revealed this was not driven by intervention type or setting (residential versus community). CONCLUSIONS Nonpharmacological approaches such as reminiscence, cognitive stimulation/ rehabilitation, therapeutic, music-based approaches and education/ training, have the potential to reduce symptoms of depression in dementia.
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Affiliation(s)
- Claire V Burley
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
| | - Kim Burns
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Ben C P Lam
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, Australia; Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
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18
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Balbim GM, Falck RS, Barha CK, Starkey SY, Bullock A, Davis JC, Liu-Ambrose T. Effects of exercise training on the cognitive function of older adults with different types of dementia: a systematic review and meta-analysis. Br J Sports Med 2022; 56:bjsports-2021-104955. [PMID: 35577539 DOI: 10.1136/bjsports-2021-104955] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect of exercise training on the cognitive function of older adults living with different types of dementia, as well as potential moderators of exercise efficacy. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central, PsycINFO, Embase, Medline and CINAHL. ELIGIBILITY CRITERIA Peer-reviewed, randomised controlled trials, in English (1990-present), which examined the effects of exercise training on the cognitive function of older adults living with dementia. STUDY APPRAISAL AND SYNTHESIS Risk of bias and study quality were assessed (Cochrane Risk of Bias Tool 2.0 and Physiotherapy Evidence Database Scale). We performed random-effects models using robust variance estimation and tested moderators using the approximate Hotelling-Zhang test. RESULTS Twenty-eight studies (n=2158) were included in the qualitative review and 25 in the meta-analysis. For all-cause dementia, a small effect of exercise training on cognitive function was observed (g=0.19; 95% CI 0.05 to 0.33; p=0.009). Type of dementia and exercise training characteristics did not moderate the effects of exercise training on cognitive function (p>0.05). Adherence to the intervention moderated the cognitive outcome effect size such that greater mean adherence was associated with greater cognitive outcome effect sizes (b=0.02; SE=0.01; p=0.005). CONCLUSION Exercise training showed small benefits for the cognitive function of older adults living with all-cause dementia. More research and standardised reporting of exercise training characteristics can strengthen the evidence for what works best for which types of dementia. PROSPERO REGISTRATION NUMBER CRD42020198716.
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Affiliation(s)
- Guilherme Moraes Balbim
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Cindy K Barha
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha Y Starkey
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexis Bullock
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- Faculty of Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
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19
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Chen PJ, Chen KM, Hsu HF, Belcastro F. Types of exercise and training duration on depressive symptoms among older adults in long-term care facilities. Ageing Res Rev 2022; 77:101613. [PMID: 35339704 DOI: 10.1016/j.arr.2022.101613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/15/2022] [Accepted: 03/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression is associated with a greater risk of disability, cognitive impairment, and suicide. Older adults in long-term care facilities (LTCFs) are more likely to develop depression due to changes in family roles and separation from family members. The aim of this study was to synthesize and analyze the effects of different types of exercise and training duration on depressive symptoms of older adults in LTCFs. METHODS Relevant peer-reviewed journal articles published in English were identified through a search of six electronic databases up to June 2021. RESULTS A total of 25 studies were included in the systematic review and 22 in the meta-analysis. The results of meta-analysis showed that exercise interventions reduced depression in cognitively intact older adults and in cognitively impaired older adults. Both exercising less than 150 min per week or more than 150 min per week, reduced depressive symptoms of older adults. In terms of exercise types, mind-body exercises, exergames, and strength training reduced depressive symptoms. CONCLUSION Exercise has a positive effect on reducing depressive symptoms with mind-body exercises, exergames, and strength training producing the best effect. Regardless of cognitive impairment, older adults in LTCFs benefited from exercise in reducing depressive symptoms.
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Affiliation(s)
- Po-Jung Chen
- Center for Long-Term Care Research, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708 Taiwan.
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung 80708, Taiwan; Center for Long-Term Care Research, Kaohsiung Medical University, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Taiwan.
| | - Hui-Fen Hsu
- Center for Long-Term Care Research, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708 Taiwan.
| | - Frank Belcastro
- Department of Education and Psychology, University of Dubuque, 2000 University Ave., Dubuque, IA 52001, USA.
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20
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Huang X, Zhao X, Li B, Cai Y, Zhang S, Wan Q, Yu F. Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:212-223. [PMID: 34004389 PMCID: PMC9068743 DOI: 10.1016/j.jshs.2021.05.003] [Citation(s) in RCA: 102] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/16/2021] [Accepted: 03/15/2021] [Indexed: 05/09/2023]
Abstract
BACKGROUND Exercise is a promising nonpharmacological therapy for cognitive dysfunction, but it is unclear which type of exercise is most effective. The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment (MCI) or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment. METHODS We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia. Primary outcomes included global cognition, executive cognition, and memory cognition. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, and quality of life. Pairwise analyses and network meta-analyses were performed using a random effects model. RESULTS A total of 73 articles from 71 trials with 5606 participants were included. All types of exercise were effective in increasing or maintaining global cognition, and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition (standard mean difference (SMD) = 1.05, 95% confidence interval (95%CI): 0.56-1.54), executive function (SMD = 0.85, 95%CI: 0.21-1.49), and memory function (SMD = 0.32, 95%CI: 0.01-0.63) in patients with cognitive dysfunction. Subgroup analyses for patients with MCI revealed different effects, and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition (SMD = 0.99, 95%CI: 0.44-1.54) and executive function (SMD = 0.72, 95%CI: 0.06-1.38). However, only resistance exercise showed significant effects on memory function for patients with MCI (SMD = 0.35, 95%CI: 0.01-0.69). Exercise interventions also showed various effects on the secondary outcomes. CONCLUSION Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive decline in patients with cognitive dysfunction, especially in patients with dementia. Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.
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Affiliation(s)
- Xiuxiu Huang
- School of Nursing, Peking University, Beijing 100191, China
| | - Xiaoyan Zhao
- School of Nursing, Peking University, Beijing 100191, China
| | - Bei Li
- School of Nursing, Peking University, Beijing 100191, China
| | - Ying Cai
- School of Nursing, Peking University, Beijing 100191, China
| | - Shifang Zhang
- School of Nursing, Peking University, Beijing 100191, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing 100191, China.
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ 85004, USA
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21
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The effectiveness of physical exercise interventions in the management of neuropsychiatric symptoms in dementia patients: a systematic review. Int Psychogeriatr 2022; 34:177-190. [PMID: 33818342 DOI: 10.1017/s1041610221000193] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The management of neuropsychiatric symptoms (NPS) in patients with dementia is a major challenge. Since no effective therapy has been found to date and drug treatments are associatedwith significant side effects, there seems to be a pressing need for alternative non-pharmacological interventions. OBJECTIVES The current study aims to investigate and compare the effect of different types of physical exercise on the NPS. METHODS A systematic review of the literature was conducted according to the PRISMA guidelines. Five databases (SCOPUS, PubMed, SPORT Discus, Web of science and ScienceDirect) were searched using the appropriate algorithm. What was sought out was randomized control trials (RCTs) that applied physical activity interventions with specific characteristics (type, frequency, intensity, and duration) in patients with dementia or mild cognitive impairment, studied the effect of exercise on their NPS and compared this effect with a control group that did not follow an exercise program. RESULTS From 512 articles, 13 studies were included in this review, involving a total of 1,925 patients. The results were analyzed and synthesized according to the type of exercise applied - aerobic exercise, multidimensional interventions and muscular strength training programs. In particular, the results showed that repetitive aerobic exercise three to five times a week had a positive effect on NPS, whereas multidimensional interventions combining different types of exercise did not appear to be as effective. Strength training programs have been found to significantly reduce depression symptoms and behavioral problems in demented patients with mobility problems. CONCLUSIONS There is clear evidence that physical activity and especially aerobic exercise may be effective in the management of NPS. However, it is necessary to apply specific practical recommendations and specially designed programs to incorporate physical exercise into the daily routine of these patients.
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Rodrigues SLDS, Silva JMD, Oliveira MCCD, Santana CMFD, Carvalho KM, Barbosa BJAP. Physical exercise as a non-pharmacological strategy for reducing behavioral and psychological symptoms in elderly with mild cognitive impairment and dementia: a systematic review of randomized clinical trials. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:1129-1137. [PMID: 34877985 DOI: 10.1590/0004-282x-anp-2020-0539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Elderly people with dementia may exhibit behavioral and psychological symptoms throughout the course of disease. Non-pharmacological therapies, such as regular physical activity, are considered strategies for managing these symptoms. OBJECTIVE The aim of this study was to investigate whether participation in physical exercise programs is effective in reducing behavioral and neuropsychiatric symptoms in elderly people with Mild Cognitive Impairment (MCI) and dementia. METHODS A literature review was carried out in MEDLINE (PubMed), SciELO, Web of Science, Scopus and SPORTDiscus databases from 2010 to 2020. The eligible studies were randomized clinical trials involving elderly people with mild cognitive impairment or dementia and assessing changes in neuropsychiatric and psychological symptoms as primary or secondary outcomes. The studies had a group with only physical exercise as an intervention compared to a control group. RESULTS Of 175 publications identified in the initial survey, only 7 studies met the eligibility criteria. Four out of 7 studies demonstrated positive effects in reducing behavioral symptoms, while the others did not report differences between gains according to the type of protocol. CONCLUSIONS Moderate to intense aerobic and muscle strengthening exercises may have a potential benefit in the management of behavioral and psychological symptoms in dementia, but studies varied in their conclusions. This review indicates the need for further intervention studies to investigate, as a primary outcome, the absolute effect of physical exercise and its impact on behavioral and psychological symptoms in elderly people with MCI dementia, especially in the early stages of the disease.
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Affiliation(s)
| | | | | | | | | | - Breno José Alencar Pires Barbosa
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife PE, Brazil
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área Acadêmica de Neuropsiquiatria, Recife PE, Brazil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil
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Lewis LK, Henwood T, Boylan J, Hunter S, Lange B, Lawless M, Milte R, Petersen J. Re-thinking reablement strategies for older adults in residential aged care: a scoping review. BMC Geriatr 2021; 21:667. [PMID: 34847860 PMCID: PMC8638477 DOI: 10.1186/s12877-021-02627-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).
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Affiliation(s)
- Lucy K Lewis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Tim Henwood
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Jo Boylan
- Southern Cross Care (SA, NT & Vic) Inc., PO Box 155, Glen Osmond, SA, 5064, Australia
| | - Sarah Hunter
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Belinda Lange
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Michael Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Rachel Milte
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Jasmine Petersen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
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Evaluation of the instrumented Timed Up and Go test as a tool to measure exercise intervention effects in nursing home residents: results from a PROCARE substudy. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [DOI: 10.1007/s12662-021-00764-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abstract
Background and objectives
To achieve independence in activities of daily living, a certain level of functional ability is necessary. The instrumented Timed Up and Go (iTUG) test provides guidance for appropriate interventions, for example, when considering the subphases within the TUG. Therefore, we evaluated the iTUG as a tool to measure the effects of a multicomponent exercise intervention on the iTUG subphases in nursing home residents.
Methods
Fifty long-term nursing home residents (34 women, 82.7 ± 6.46 [65–91] years; 16 men, 78.6 ± 7.0 [62–90] years) performed the iTUG test before and after a 16-week intervention period (2 × 45–60 min/week). According to the attendance rates, participants were divided into three groups.
Results
The total iTUG duration decreased from baseline to posttest, F(2,46) = 3.50, p = 0.038, η2p = 0.132. We observed significant correlations between the attendance rates and the total iTUG duration (r(50) = 0.328, p = 0.010). However, we did not observe significant group × time interaction effects in the subphases. The Barthel Index moderated the effect between attendance rate and the total duration of the iTUG test, ΔR2 = 8.34%, F(1,44) = 4.69, p = 0.036, 95% CI [0.001, 0.027].
Conclusions
We confirmed the effectiveness of the iTUG as a tool to measure exercise intervention effects in nursing home residents, especially when participants exhibit high attendance rates. That said, mobility needs to be considered in a more differentiated way, taking into account parameters in the subphases to detect changes more sensitively and to derive recommendations in a more individualized way.
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25
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Hui EK, Tischler V, Wong GHY, Lau WYT, Spector A. Systematic review of the current psychosocial interventions for people with moderate to severe dementia. Int J Geriatr Psychiatry 2021; 36:1313-1329. [PMID: 34350626 DOI: 10.1002/gps.5554] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/15/2021] [Accepted: 03/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Dementia, a global epidemic, currently affects 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life (QoL) to evaluate what treatments are working and whether improvements are possible. METHODS A systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or QoL in randomized controlled trials (RCTs), published between 2000 and 2020. RESULTS The search identified 4193 studies, and 74 articles were assessed for full-text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality. CONCLUSIONS Aromatherapy and reminiscence therapy showed the strongest evidence in improving QoL. There was some evidence that aerobic exercise enhanced cognition, and a multicomponent study improved QoL. However, a quality assessment, using pre-specified criteria, indicated many methodological weaknesses. While we found improvements in cognition and QoL for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions.
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Affiliation(s)
- Esther K Hui
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Tischler
- European Center for Environment and Human Health, The University of Exeter, Truro, UK
| | - Gloria H Y Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - W Y Tiffany Lau
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Cardona MI, Afi A, Lakicevic N, Thyrian JR. Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168753. [PMID: 34444501 PMCID: PMC8394441 DOI: 10.3390/ijerph18168753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical activity (PA) has emerged as an alternative nonpharmacological approach to effectively address the effects of dementia. The primary aim was to identify and summarize PA interventions and their effects on cognitive function among persons with dementia (PwD). METHODS A systematic review was conducted with a meta-analysis using different electronic databases, such as PubMed, Embase, APA PsycNET, and the Web of Science. The identified and selected studies were randomized controlled trials (RCTs) that were written in English, published between 2000 and 2020, and implemented among PwD who received a PA intervention and whose cognitive function was measured at baseline and during a follow-up. RESULTS Twenty-two PA intervention studies met the eligibility criteria and showed a medium-size effect on the cognitive function of PwD, 0.4803 (95% CI = 0.1901-0.7704), with a high percentage of heterogeneity (I2 = 86%, p ≤ 0.0001). Moreover, this review complements other reviews by including eight studies that have not previously been considered. Overall, studies have methodological limitations. However, six studies implemented in the past five years have shown more robust methodological designs, including larger sample sizes and more comprehensive measurement tools. CONCLUSION It is not yet possible to draw a conclusion on the ideal PA intervention for this population due to the high proportion of heterogeneity within the included studies. More emphasis is needed on the intensity of PA monitoring and adherence to such programs.
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Affiliation(s)
- Maria Isabel Cardona
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
- Correspondence: ; Tel.: +49-383-486-7593; Fax: +49-383-4861-9551
| | - Adel Afi
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
| | - Nemanja Lakicevic
- Sport and Exercise Sciences Research Unit, University of Palermo, 90133 Palermo, Italy;
| | - Jochen René Thyrian
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Rostock/Greifswald, Ellernholzstr. 1–2, 17489 Greifswald, Germany; (A.A.); (J.R.T.)
- Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1–2, 17489 Greifswald, Germany
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27
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Jung D, De Gagne JC, Lee H, Lee M. Factors associated with eating performance in older adults with dementia in long-term care facilities: a cross-sectional study. BMC Geriatr 2021; 21:365. [PMID: 34130643 PMCID: PMC8207627 DOI: 10.1186/s12877-021-02315-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/06/2021] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study was to investigate factors influencing eating performance in older adults with dementia (OAWDs) in long-term care (LTC) facilities. Methods This cross-sectional study examined risk factors for compromised eating performance by comparing both independent and dependent older adults with dementia. The study participants were 117 OAWDs in LTC facilities in South Korea. Measurements included (a) general characteristics, (b) activities of daily living (ADL) including eating performance, (c) cognitive function, (d) physical capability, (e) grip strength, (f) Behavioral Psychological Symptoms of Dementia (BPSD), and (g) depression. Data were analyzed by the percentage, mean and standard deviation, Chi-square test, t-test, and logistic regression. Results The eating independent group had more comorbidities than the dependent group (t = 2.793, p < .006); had significantly higher cognition (t = 4.108, p < .001) and physical capability (t = 5.258, p < .001); and had stronger grip strength (t = 2.887, p = .005). Comorbidities and physical capability were determinants for independent eating performance (Odds Ratio [OR] = 1.969, p = .014; OR = 1.324, p < .001). Conclusions It is suggested that maintaining physical capability should be encouraged to support independent eating performance by OAWDs in LTC facilities. The results of this study could serve as a basis for developing function-focused care to maintain the residual eating performance of OAWDs in Korean LTC facilities. This is a subject area that has not been fully explored.
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Affiliation(s)
- Dukyoo Jung
- College of Nursing, Ewha Womans University, Seoul, Korea
| | | | - Hyesoon Lee
- College of Nursing, Ewha Womans University, Seoul, Korea
| | - Minkyung Lee
- Department of Thoracic Surgery, Mount Sinai Hospital, New York, USA.
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Lee S, Cho EJ, Kwak HB. Personalized Healthcare for Dementia. Healthcare (Basel) 2021; 9:healthcare9020128. [PMID: 33525656 PMCID: PMC7910906 DOI: 10.3390/healthcare9020128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 01/07/2023] Open
Abstract
Dementia is one of the most common health problems affecting older adults, and the population with dementia is growing. Dementia refers to a comprehensive syndrome rather than a specific disease and is characterized by the loss of cognitive abilities. Many factors are related to dementia, such as aging, genetic profile, systemic vascular disease, unhealthy diet, and physical inactivity. As the causes and types of dementia are diverse, personalized healthcare is required. In this review, we first summarize various diagnostic approaches associated with dementia. Particularly, clinical diagnosis methods, biomarkers, neuroimaging, and digital biomarkers based on advances in data science and wearable devices are comprehensively reviewed. We then discuss three effective approaches to treating dementia, including engineering design, exercise, and diet. In the engineering design section, recent advances in monitoring and drug delivery systems for dementia are introduced. Additionally, we describe the effects of exercise on the treatment of dementia, especially focusing on the effects of aerobic and resistance training on cognitive function, and the effects of diets such as the Mediterranean diet and ketogenic diet on dementia.
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Affiliation(s)
- Seunghyeon Lee
- Program in Biomedical Science and Engineering, Inha University, Incheon 22212, Korea; (S.L.); (E.-J.C.)
- Department of Chemical Engineering, Inha University, Incheon 22212, Korea
| | - Eun-Jeong Cho
- Program in Biomedical Science and Engineering, Inha University, Incheon 22212, Korea; (S.L.); (E.-J.C.)
| | - Hyo-Bum Kwak
- Program in Biomedical Science and Engineering, Inha University, Incheon 22212, Korea; (S.L.); (E.-J.C.)
- Correspondence: ; Tel.: +82-32-860-8183
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Group-Based Exercise as a Therapeutic Strategy for the Improvement of Mental Outcomes in Mild to Moderate Alzheimer’s Patients in Low Resource Care Facilities. Asian J Sports Med 2021. [DOI: 10.5812/asjsm.106593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Exercise is related to enhanced cognitive functioning and brain plasticity. Exercise might represent a potential adjunctive treatment for neuropsychiatric disorders, such as Alzheimer's disease (AD). Furthermore, group exercise may prove especially useful due to its additional benefits. Objectives: This study aimed to determine the effect of low-cost, group-based exercise on mental outcomes in patients with mild to moderate AD. Methods: Participants with mild to moderate AD were randomized to either a non-exercising control (CON) group or a group-exercise (GEX) group (n = 20 each). The GEX participated in eight weeks of three-times-weekly non-consecutive 45-minute sessions consisting of balance, resistance, aerobic, and flexibility exercises to determine their effect on mental outcomes, namely, cognitive function, activities of daily living (ADLs), and quality of life (QOL). Results: The intervention program showed a significant (P ≤ 0.05) increase in Mini-Mental State Examination (MMSE) scores (P = 0.023). While the GEX were found to have no change in their (Alzheimer’s disease cooperative study activities of daily living) ADCS-ADL scores (P = 0.574). The CON demonstrated a significant, but deleterious 13.77% decrease in their ADCS-ADL scores from pre- to mid-test (P = 0.023) and from pre- to post-test (P = 0.038). Quality of Life-Alzheimer’s Disease (QOL-AD) scores were unchanged in both the GEX and CON. Conclusions: Our results indicate that a low-cost, multidimensional group exercise intervention can positively influence cognitive function and improve patients with mild to moderate AD ability to perform ADLs.
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Yu F, Salisbury D, Mathiason MA. Inter-individual differences in the responses to aerobic exercise in Alzheimer's disease: Findings from the FIT-AD trial. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:65-72. [PMID: 32505710 PMCID: PMC7858037 DOI: 10.1016/j.jshs.2020.05.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/29/2020] [Accepted: 05/10/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Despite the strong evidence of aerobic exercise as a disease-modifying treatment for Alzheimer's disease (AD) in animal models, its effects on cognition are inconsistent in human studies. A major contributor to these findings is inter-individual differences in the responses to aerobic exercise, which was well documented in the general population but not in those with AD. The purpose of this study was to examine inter-individual differences in aerobic fitness and cognitive responses to a 6-month aerobic exercise intervention in community-dwelling older adults with mild-to-moderate dementia due to AD. METHODS This study was a secondary analysis of the Effects of Aerobic Exercise for Treating Alzheimer's Disease (FIT-AD) trial data. Aerobic fitness was measured by the shuttle walk test (SWT), the 6-min walk test (6MWT), and the maximal oxygen consumption (VO2max) test, and cognition by the AD Assessment Scale-Cognition (ADAS-Cog). Inter-individual differences were calculated as the differences in the standard deviation of 6-month change (SDR) in the SWT, 6MWT, VO2max, and ADAS-Cog between the intervention and control groups. RESULTS Seventy-eight participants were included in this study (77.4 ± 6.3 years old, mean ± SD; 15.7 ± 2.8 years of education; 41% were female). VO2max was available for 26 participants (77.7 ± 7.1 years old; 14.8 ± 2.6 years of education; 35% were female). The SDR was 37.0, 121.1, 1.7, and 2.3 for SWT, 6MWT, VO2max, and ADAS-Cog, respectively. CONCLUSION There are true inter-individual differences in aerobic fitness and cognitive responses to aerobic exercise in older adults with mild-to-moderate dementia due to AD. These inter-individual differences likely underline the inconsistent cognitive benefits in human studies.
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Affiliation(s)
- Fang Yu
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Dereck Salisbury
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michelle A Mathiason
- Adult and Gerontological Health Cooperative, School of Nursing, University of Minnesota, Minneapolis, MN 55455, USA
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Yu F, Vock DM, Zhang L, Salisbury D, Nelson NW, Chow LS, Smith G, Barclay TR, Dysken M, Wyman JF. Cognitive Effects of Aerobic Exercise in Alzheimer's Disease: A Pilot Randomized Controlled Trial. J Alzheimers Dis 2021; 80:233-244. [PMID: 33523004 PMCID: PMC8075384 DOI: 10.3233/jad-201100] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Aerobic exercise has shown inconsistent cognitive effects in older adults with Alzheimer's disease (AD) dementia. OBJECTIVE To examine the immediate and longitudinal effects of 6-month cycling on cognition in older adults with AD dementia. METHODS This randomized controlled trial randomized 96 participants (64 to cycling and 32 to stretching for six months) and followed them for another six months. The intervention was supervised, moderate-intensity cycling for 20-50 minutes, 3 times a week for six months. The control was light-intensity stretching. Cognition was assessed at baseline, 3, 6, 9, and 12 months using the AD Assessment Scale-Cognition (ADAS-Cog). Discrete cognitive domains were measured using the AD Uniform Data Set battery. RESULTS The participants were 77.4±6.8 years old with 15.6±2.9 years of education, and 55% were male. The 6-month change in ADAS-Cog was 1.0±4.6 (cycling) and 0.1±4.1 (stretching), which were both significantly less than the natural 3.2±6.3-point increase observed naturally with disease progression. The 12-month change was 2.4±5.2 (cycling) and 2.2±5.7 (control). ADAS-Cog did not differ between groups at 6 (p = 0.386) and 12 months (p = 0.856). There were no differences in the 12-month rate of change in ADAS-Cog (0.192 versus 0.197, p = 0.967), memory (-0.012 versus -0.019, p = 0.373), executive function (-0.020 versus -0.012, p = 0.383), attention (-0.035 versus -0.033, p = 0.908), or language (-0.028 versus -0.026, p = 0.756). CONCLUSION Exercise may reduce decline in global cognition in older adults with mild-to-moderate AD dementia. Aerobic exercise did not show superior cognitive effects to stretching in our pilot trial, possibly due to the lack of power.
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Affiliation(s)
- Fang Yu
- University of Minnesota Division of Biostatistics, Minneapolis, MN, USA
| | - David M. Vock
- University of Minnesota Division of Biostatistics, Minneapolis, MN, USA
| | - Lin Zhang
- University of Minnesota Division of Biostatistics, Minneapolis, MN, USA
| | | | | | - Lisa S. Chow
- University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Glenn Smith
- University of Florida Department of Clinical and Health Psychology, Gainesville, FL, USA
| | | | - Maurice Dysken
- University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Jean F. Wyman
- University of Minnesota School of Nursing, Minneapolis, MN, USA
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Yao L, Fang H, Leng W, Li J, Chang J. Effect of Aerobic Exercise on Mental Health in Older Adults: A Meta-Analysis of Randomized Controlled Trials. Front Psychiatry 2021; 12:748257. [PMID: 34867538 PMCID: PMC8634786 DOI: 10.3389/fpsyt.2021.748257] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: The recommendation of exercise programs in the senior population may benefit inactive and sedentary individuals and improve and help to treat specific health conditions. The purpose of this review is to summarize the published evidence from RCT studies of aerobic exercise interventions for mental health in older adults over the last 20 years. Methods: A literature search was conducted using electronic databases including Web of Science, PubMed/Medline, and ProQuest. Results: A total of 15 studies met the inclusion criteria. The subjects of these studies were aged 60 years or older and had various physical health statuses. In 15 studies, the mean effect size for the experimental outcome was 0.56 ± 0.39 (95%CI: 0.36-0.76). One-way ANOVA indicated no significant differences in the intervention duration [F (2,15) = 0.919, p = 0.420], subject category [F (2,15) = 0.046, p = 0.955], or measurement category [F (3,14) = 0.967, p = 0.436]. However, there were significant differences in exercise frequencies [F (2,15) = 6.03, p = 0.012]. Conclusion: The available evidence suggests that aerobic exercise is beneficial for improving the mental health of adults aged 60 years and older. The intervention effect can be achieved regardless of the type of subject and the duration of the intervention. Further, the present study indicates that low-frequency, long-term and regular aerobic exercise is more effective for older adults. Therefore, we recommend that older adults to exercise at a low frequency depending on their physical condition.
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Affiliation(s)
- Lei Yao
- School of Physical Education, Southwest University, Chongqing, China.,Institute of Motor Quotient, Southwest University, Chongqing, China
| | - Hanliu Fang
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Wanchun Leng
- Qingdao Mental Health Center, Qingdao University, Qingdao, China
| | - Junfeng Li
- Ministry of Sports, Shandong Technology and Business University, Yantai, China
| | - Jindong Chang
- School of Physical Education, Southwest University, Chongqing, China.,Institute of Motor Quotient, Southwest University, Chongqing, China
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Miller KJ, Areerob P, Hennessy D, Gonçalves-Bradley DC, Mesagno C, Grace F. Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. F1000Res 2020; 9:1325. [PMID: 34158928 PMCID: PMC8191520 DOI: 10.12688/f1000research.27123.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12
th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis (
n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges’
g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges’
g = -0.06,
PrI = -0.91, 0.79), mind-body versus aerobic (Hedges’
g = -0.12,
PrI = -0.95, 0.72), mind-body versus resistance (Hedges’
g = -0.06,
PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO
CRD42018115866 (23/11/2018).
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Affiliation(s)
- Kyle J Miller
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Pinyadapat Areerob
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Declan Hennessy
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | | | - Christopher Mesagno
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Fergal Grace
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
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34
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Miller KJ, Areerob P, Hennessy D, Gonçalves-Bradley DC, Mesagno C, Grace F. Aerobic, resistance, and mind-body exercise are equivalent to mitigate symptoms of depression in older adults: A systematic review and network meta-analysis of randomised controlled trials. F1000Res 2020; 9:1325. [PMID: 34158928 PMCID: PMC8191520 DOI: 10.12688/f1000research.27123.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/08/2021] [Indexed: 08/29/2023] Open
Abstract
Background: Exercise has been identified as an allied health strategy that can support the management of depression in older adults, yet the relative effectiveness for different exercise modalities is unknown. To meet this gap in knowledge, we present a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the head-to-head effectiveness of aerobic, resistance, and mind-body exercise to mitigate depressive symptoms in adults aged ≥ 65 years. Methods: A PRISMA-NMA compliant review was undertaken on RCTs from inception to September 12 th, 2019. PubMed, Web of Science, CINAHL, Health Source: Nursing/Academic Edition, PsycARTICLES, PsycINFO, and SPORTDiscus were systematically searched for eligible RCTs enrolling adults with a mean age ≥ 65 years, comparing one or more exercise intervention arms, and which used valid measures of depressive symptomology. Comparative effectiveness was evaluated using network meta-analysis to combine direct and indirect evidence, controlling for inherent variation in trial control groups. Results: The systematic review included 82 RCTs, with 69 meeting eligibility for the network meta-analysis ( n = 5,379 participants). Pooled analysis found each exercise type to be effective compared with controls (Hedges' g = -0.27 to -0.51). Relative head-to-head comparisons were statistically comparable between exercise types: resistance versus aerobic (Hedges' g = -0.06, PrI = -0.91, 0.79), mind-body versus aerobic (Hedges' g = -0.12, PrI = -0.95, 0.72), mind-body versus resistance (Hedges' g = -0.06, PrI = -0.90, 0.79). High levels of compliance were demonstrated for each exercise treatment. Conclusions: Aerobic, resistance, and mind-body exercise demonstrate equivalence to mitigate symptoms of depression in older adults aged ≥ 65 years, with comparably encouraging levels of compliance to exercise treatment. These findings coalesce with previous findings in clinically depressed older adults to encourage personal preference when prescribing exercise for depressive symptoms in older adults. Registration: PROSPERO CRD42018115866 (23/11/2018).
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Affiliation(s)
- Kyle J. Miller
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Pinyadapat Areerob
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Declan Hennessy
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | | | - Christopher Mesagno
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
| | - Fergal Grace
- School of Health and Life Sciences, Federation University, Ballarat, Victoria, 3350, Australia
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35
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Di Lorito C, Bosco A, Booth V, Goldberg S, Harwood RH, Van der Wardt V. Adherence to exercise interventions in older people with mild cognitive impairment and dementia: A systematic review and meta-analysis. Prev Med Rep 2020; 19:101139. [PMID: 32793408 PMCID: PMC7414005 DOI: 10.1016/j.pmedr.2020.101139] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
Adherence to physical exercise is associated with multiple benefits in people with mild cognitive impairment (MCI) and dementia. Given the gap in research, this systematic literature review aimed to determine in the context of exercise intervention studies for people with MCI and dementia: 1. How adherence is defined, monitored and recorded; 2. Adherence rates; 3. Attrition, compliance and adverse events and 4. Intervention characteristics associated with adherence. Embase, Medline, PsychInfo, SPORTDiscus, AMED, CINAHL and the International Bibliography of Social Sciences were searched in November 2018. The data were analyzed through descriptive and correlation/inferential statistics. Forty-one studies were included, 34 involving participants with dementia (n = 2149) and seven participants with MCI (n = 970). Half of the studies operationally defined adherence. Mean adherence rate was 70% [CI, 69-73%]. Adherence was significantly associated with endurance/resistance training, and interventions not including walking. The review found a lack of consistency around reporting of adherence and of key variables mediating adherence, including compliance, attrition and adverse events. Further research using more reliable measures is needed to confirm whether a correlation exists between length of interventions and adherence in participants with MCI and dementia and to identify the factors or strategies that mediate adherence in this population. Relevant implications for practice include a consideration in the development of new interventions of elements associated with higher adherence in this review, such as endurance/resistance training, and the provision of exercise in group formats.
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Affiliation(s)
- Claudio Di Lorito
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Alessandro Bosco
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham NG7 2TU, United Kingdom
| | - Vicky Booth
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Veronika Van der Wardt
- Wissenschaftliche Mitarbeiterin, Zentrum für Methodenwissenschaften und Gesundheitsforschung Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg Karl-von-Frisch-Straße 4, 35032 Marburg, Germany
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36
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D’Cunha NM, Isbel ST, Frost J, Fearon A, McKune AJ, Naumovski N, Kellett J. Effects of a virtual group cycling experience on people living with dementia: A mixed method pilot study. DEMENTIA 2020; 20:1518-1535. [DOI: 10.1177/1471301220951328] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Social isolation and sedentary behaviour are common in residential aged care facilities (also known as nursing homes or long-term care). Use of new technologies such as virtual and augmented reality are currently under investigation for their potential to provide exciting and engaging activities for older people in residential aged care facilities. However, there is limited evidence on whether these technologies can promote physical activity in a small group setting for people with cognitive impairment. Using mixed methods, we examined the use of a virtual cycling experience in a sample of 10 participants with cognitive impairment living in residential aged care facilities. In a randomised crossover design, participants engaged in a 25-minute, self-paced, facilitated seated virtual cycling experience and a time-matched seated physical activity session in groups of five. All participants completed a brief pre- and post-intervention mood questionnaire. Video analysis was used for both conditions to compare levels of environmental stimulation, apathy and engagement using both the Person–Environment Apathy Rating Scale and the Engagement of a Person with Dementia Scale. A thematic analysis of semi-structured interviews following the virtual cycling experience was also performed. No differences were observed between conditions for all outcomes except for environmental stimulation, where there was a lower response in the intervention than the control condition ( p = 0.032). This was primarily driven by lower scores for the virtual cycling experience than control in physical accessibility ( p = 0.012). Participants reported the virtual cycling experience to be immersive and challenging and reminisced about cycling earlier in life. The activity manager observed that the virtual cycling experience was an overall positive experience and emphasised benefits of safety screening and preparation prior to the activities. The findings of this study support the use of the virtual cycling experience as an immersive and engaging alternative to usual activities, which might encourage higher levels of physical activity in residential aged care facilities.
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Affiliation(s)
| | | | - Jane Frost
- Faculty of Health, University of Canberra, Australia
| | - Angie Fearon
- Faculty of Health, University of Canberra, Australia
| | - Andrew J McKune
- Faculty of Health, University of Canberra, Australia; Discipline of Sport and Exercise Science, Research Institute for Sport and Exercise, Faculty of Health, University of Canberra, Australia; Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, South Africa
| | | | - Jane Kellett
- Faculty of Health, University of Canberra, Australia
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37
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Higuti AY, Barbosa SRM, Corrêa LM, Izzo TF, Ansai JH. Effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia: Pilot study. Explore (NY) 2020; 17:292-296. [PMID: 32771267 DOI: 10.1016/j.explore.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 06/22/2020] [Accepted: 07/26/2020] [Indexed: 11/28/2022]
Abstract
AIM Determine the effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia. METHODS A randomized clinical pilot trial was conducted involving 17 institutionalized older adults with moderate to advanced dementia. The participants were allocated to two groups: training with music (TWM) and training without music (TWtM). The TWtM group performed light exercises with a focus on mobility. The TWM group was initially submitted to a cognitive stimulus with music, followed by the same exercises as those performed in the TWtM Group. Sessions were held once a week for 12 weeks. Functional and cognitive assessments were performed at baseline and after the 12-week intervention. RESULTS No significant differences in functional or cognitive performance were found between groups or evaluation times. Both groups maintained their performances after 12 weeks. CONCLUSIONS Listening to music combined with physical exercise training did not exert an effect on functional or cognitive performance in institutionalized older adults with moderate to advanced dementia.
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Affiliation(s)
- Aline Yumi Higuti
- Department of Physical Therapy, Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Suzi Rosa Miziara Barbosa
- Department of Physical Therapy, Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Lucas Magalhães Corrêa
- Department of Physical Therapy, Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Tamires Ferri Izzo
- Department of Physical Therapy, Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Juliana Hotta Ansai
- Movement Science Graduate Program, Integrated Institute of Health, Federal University of Mato Grosso do Sul, Brazil; Department of Gerontology, Federal University of São Carlos, São Carlos, SP, Brazil.
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38
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Torromino G, Maggi A, De Leonibus E. Estrogen-dependent hippocampal wiring as a risk factor for age-related dementia in women. Prog Neurobiol 2020; 197:101895. [PMID: 32781107 DOI: 10.1016/j.pneurobio.2020.101895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/22/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
Women are more prone than men to develop age-related dementia, such as Alzheimer's disease (AD). This has been linked to the marked decrease in circulating estrogens during menopause. This review proposes to change this perspective and consider women's vulnerability to developing AD as a consequence of sex differences in the neurobiology of memory, focusing on the hippocampus. The hippocampus of cognitively impaired subjects tends to shrink with age; however, in many cases, this can be prevented by exercise or cognitive training, suggesting that if you do not use the hippocampus you lose it. We will review the developmental trajectory of sex steroids-regulated differences on the hippocampus, proposing that the overall shaping action of sex-steroids results in a lower usage of the hippocampus in females, which in turn makes them more vulnerable to the effects of ageing, the "network fragility hypothesis". To explain why women rely less on hippocampus-dependent strategies, we propose a "computational hypothesis" that is based on experimental evidence suggesting that the direct effects of estrogens on hippocampal synaptic and structural plasticity during the estrous-cycle confers instability to the memory-dependent hippocampal network. Finally, we propose to counteract AD with training and/or treatments, such as orienteering, which specifically favour the use of the hippocampus.
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Affiliation(s)
- Giulia Torromino
- Telethon Institute of Genetics and Medicine (TIGEM), Telethon Foundation, Pozzuoli, Naples, Italy; Institute of Biochemistry and Cell Biology (IBBC), National Research Council, Monterotondo, Rome, Italy
| | - Adriana Maggi
- Center of Excellence on Neurodegenerative Diseases, University of Milan, Milan, Italy
| | - Elvira De Leonibus
- Telethon Institute of Genetics and Medicine (TIGEM), Telethon Foundation, Pozzuoli, Naples, Italy; Institute of Biochemistry and Cell Biology (IBBC), National Research Council, Monterotondo, Rome, Italy.
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39
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Andreotti DZ, Silva JDN, Matumoto AM, Orellana AM, de Mello PS, Kawamoto EM. Effects of Physical Exercise on Autophagy and Apoptosis in Aged Brain: Human and Animal Studies. Front Nutr 2020; 7:94. [PMID: 32850930 PMCID: PMC7399146 DOI: 10.3389/fnut.2020.00094] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/22/2020] [Indexed: 12/13/2022] Open
Abstract
The aging process is characterized by a series of molecular and cellular changes over the years that could culminate in the deterioration of physiological parameters important to keeping an organism alive and healthy. Physical exercise, defined as planned, structured and repetitive physical activity, has been an important force to alter physiology and brain development during the process of human beings' evolution. Among several aspects of aging, the aim of this review is to discuss the balance between two vital cellular processes such as autophagy and apoptosis, based on the fact that physical exercise as a non-pharmacological strategy seems to rescue the imbalance between autophagy and apoptosis during aging. Therefore, the effects of different types or modalities of physical exercise in humans and animals, and the benefits of each of them on aging, will be discussed as a possible preventive strategy against neuronal death.
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Affiliation(s)
- Diana Zukas Andreotti
- Laboratory of Molecular and Functional Neurobiology, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Josiane do Nascimento Silva
- Laboratory of Molecular and Functional Neurobiology, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Amanda Midori Matumoto
- Laboratory of Molecular and Functional Neurobiology, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Ana Maria Orellana
- Laboratory of Molecular Neuropharmacology, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Paloma Segura de Mello
- Laboratory of Molecular Neuropharmacology, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Elisa Mitiko Kawamoto
- Laboratory of Molecular and Functional Neurobiology, Department of Pharmacology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
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Burley CV, Livingston G, Knapp MRJ, Wimo A, Norman R, Brodaty H. Time to invest in prevention and better care of behaviors and psychological symptoms associated with dementia. Int Psychogeriatr 2020; 32:1-6. [PMID: 32228722 DOI: 10.1017/s104161022000037x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Claire V Burley
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia
| | - Gill Livingston
- Department of Old Age Psychiatry, Division of Psychiatry, University College London, London, UK
| | - Martin R J Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Anders Wimo
- Division of Neurogeriatrics, Department for Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Henry Brodaty
- Dementia Centre for Research Collaboration, University of New South Wales, Sydney, Australia
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41
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Rozanska O, Uruska A, Zozulinska-Ziolkiewicz D. Brain-Derived Neurotrophic Factor and Diabetes. Int J Mol Sci 2020; 21:ijms21030841. [PMID: 32012942 PMCID: PMC7037992 DOI: 10.3390/ijms21030841] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 01/22/2023] Open
Abstract
Diabetes and its chronic complications still represent a great clinical problem, despite improvements made in the diagnosis and treatment of the disease. People with diabetes have a much higher risk of impaired brain function and psychiatric disorders. Neurotrophins are factors that protect neuronal tissue and improve the function of the central nervous system, and among them is brain-derived neurotrophic factor (BDNF). The level and function of BDNF in diabetes seems to be disturbed by and connected with the presence of insulin resistance. On the other hand, there is evidence for the highly beneficial impact of physical activity on brain function and BDNF level. However, it is not clear if this protective phenomenon works in the presence of diabetes. In this review, we summarize the current available research on this topic and find that the results of published studies are ambiguous.
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Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: a systematic review. J Physiother 2020; 66:9-18. [PMID: 31843427 DOI: 10.1016/j.jphys.2019.11.014] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/30/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023] Open
Abstract
QUESTIONS What is the effect of physical exercise on cognitive decline and behavioural problems in people with mild cognitive impairment (MCI) or dementia? What is the effect of physical exercise on particular domains of cognitive function? How do training protocols and patients' characteristics influence the outcomes? DESIGN Systematic review and meta-analysis of randomised trials. PARTICIPANTS People with MCI or dementia as their primary diagnosis. INTERVENTION Physical exercise. OUTCOME MEASURES Cognitive function including global cognition, memory, executive function, reasoning, attention, language, and behavioural problems. RESULTS Forty-six trials involving 5099 participants were included in this review. Meta-analysis of the data estimated that aerobic exercise reduced the decline in global cognition, with a standardised mean difference (SMD) of 0.44, 95% CI 0.27 to 0.61, I2 = 69%. For individual cognitive functions, meta-analysis estimated that exercise lessened working memory decline (SMD 0.28, 95% CI 0.04 to 0.52, I2 = 40%). The estimated mean effect on reducing the decline in language function was favourable (SMD 0.17), but this estimate had substantial uncertainty (95% CI -0.03 to 0.36, I2 = 67%). The effects of exercise on other cognitive functions were unclear. Exercise also reduced behavioural problems (SMD 0.36, 95% CI 0.07 to 0.64, I2 = 81%). CONCLUSION Physical exercise can reduce global cognitive decline and lessen behavioural problems in people with MCI or dementia. Its benefits on cognitive function can be primarily attributed to its effects on working memory. Aerobic exercise at moderate intensity or above and a total training duration of > 24 hours can lead to a more pronounced effect on global cognition.
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43
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Long A, Robinson K, Goldberg S, Gordon AL. Effectiveness of exercise interventions for adults over 65 with moderate-to-severe dementia in community settings: a systematic review. Eur Geriatr Med 2019; 10:843-852. [PMID: 34652766 DOI: 10.1007/s41999-019-00236-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To conduct a systematic review of the literature to evaluate the effectiveness of exercise interventions for people with moderate-to-severe dementia in community settings. METHODS Eight electronic databases (MEDLINE, Embase, CINAHL, AMED, PsycINFO, PEDro, The Cochrane Library and BNI) were searched from inception to July 2018. Snowball searching identified additional articles not identified initially. Articles were included if they: reported randomised or quasi-randomised controlled trials comparing exercise with usual care or no treatment; and involved people over 65 with moderate-to-severe dementia in community settings. Outcome measures of interest were strength, endurance, mobility, mood and quality of life. Titles and abstracts of all studies were screened by one reviewer. Two reviewers independently screened full text articles for all eligible studies, extracted data and assessed quality and risk of bias. RESULTS Eight studies with 819 participants were included. Interventions were variable in terms of content, duration and frequency. There was some evidence exercise programmes may improve physical function of people with moderate-to-severe dementia, with significant effects seen for gait speed and endurance, and a trend towards improvement in strength. There was little evidence to suggest exercise programmes improve mood. Most studies were of low quality. CONCLUSION Exercise was associated with improvements in gait speed and endurance for older people with moderate-to-severe dementia living in the community, but the quality of evidence was low. There was no conclusive evidence regarding effect on strength or mood. Findings are limited by the quality of the available evidence.
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Affiliation(s)
- Annabelle Long
- Division of Rehabilitation and Ageing, School of Medicine, B109, Medical School, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Katie Robinson
- Research and Innovation, Nottingham University Hospitals NHS Trust, Nottingham, UK.,East Midlands Collaboration for Leadership in Applied Health Research and Care (EM-CLAHRC), Nottingham, UK
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- East Midlands Collaboration for Leadership in Applied Health Research and Care (EM-CLAHRC), Nottingham, UK.,Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Derby, UK.,University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
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Li B, Liu C, Wan Q, Yu F. An integrative review of exercise interventions among community-dwelling adults with Alzheimer's disease. Int J Older People Nurs 2019; 15:e12287. [PMID: 31750628 DOI: 10.1111/opn.12287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 09/20/2019] [Accepted: 10/24/2019] [Indexed: 12/01/2022]
Abstract
AIMS To synthesise the current research on exercise interventions and health-related outcomes among community-dwelling adults with Alzheimer's disease (AD). METHODS Integrative review of the literature reporting exercise interventions among people with AD living in the communities. RESULTS Seventeen studies presented in 24 quantitative papers with 1,068 participants diagnosed with Alzheimer's disease were reviewed. The interventions varied in intervention programme characteristics (e.g. baseline assessments, type of exercise, exercise dose, outcome measurements). Among them, (a) 13 studies appeared beneficial to physical fitness in different areas; (b) 9 studies reported the effects on cognitive ability and two studies showed the positive effects; (c) 12 studies reported the participants' adherence, but only 2 studies reported the participants' adherence using attendance and training intensity. CONCLUSION Exercise is proven to be effective in physical fitness among community-dwelling patients with AD. Future studies should verify the effects on cognitive function and possible mechanisms of different exercise types using more sensitive and objective outcome measurements. Additionally, treatment fidelity, cost-effectiveness and long-term effects should be explored. IMPLICATION FOR PRACTICE Exercise may be effective and feasible for community-dwelling people with AD, but its effects on cognition need to be verified in the future. This review provided recommendations for assisting nurses and other clinicians in developing, implementing, and/or evaluating exercise interventions for patients with AD.
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Affiliation(s)
- Bei Li
- School of Nursing, Peking University, Beijing, China
| | - Congying Liu
- School of Nursing, Peking University, Beijing, China
| | - Qiaoqin Wan
- School of Nursing, Peking University, Beijing, China
| | - Fang Yu
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
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[Effectiveness of interventions to strengthen cognitive resources in nursing home residents : A systematic review and network meta-analysis]. Z Gerontol Geriatr 2019; 53:778-787. [PMID: 31720830 DOI: 10.1007/s00391-019-01654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Strengthening cognitive resources of residents in nursing homes is an important goal of preventive activities. The aim of this systematic review was to answer the question which intervention is most effective for nursing home residents to strengthen their cognitive resources. METHOD A systematic literature search was carried out in the Cochrane Library and the MEDLINE (PubMed), Embase, CINAHL, PsycINFO and PEDro databases. Reference lists of publications classified as relevant were checked and trial registries were searched. The literature selection, data extraction and assessment of the study quality were carried out by two reviewers independently. A frequentist network meta-analysis was conducted using a random effects model. RESULTS A total of 29 studies with 1816 participants were included. Both physical activity (standardized mean difference [SMD] = 0.70, 95%-confidence interval [CI] 0.35-1.06, p < 0.001) and cognitive activity (SMD = 0.61, 95%-CI 0.22-1.01, p < 0.01) were statistically significantly superior in strengthening cognitive resources compared to usual care. Physical and cognitive activities did not differ statistically significantly from each other. In addition, neither physical activity nor cognitive activity showed statistically significantly better cognitive resources in nursing home residents compared to social activities. CONCLUSION The findings imply that physical activity as well as cognitive activity could be effective to strengthen cognitive resources of nursing home residents. Considering the low-quality of available evidence, performance of high-quality studies is essential in order to verify the robustness of the statistical results.
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Trautwein S, Maurus P, Barisch-Fritz B, Hadzic A, Woll A. Recommended motor assessments based on psychometric properties in individuals with dementia: a systematic review. Eur Rev Aging Phys Act 2019; 16:20. [PMID: 31700552 PMCID: PMC6825725 DOI: 10.1186/s11556-019-0228-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Motor assessments are important to determine effectiveness of physical activity in individuals with dementia (IWD). However, inappropriate and non-standardised assessments without sound psychometric properties have been used. This systematic review aims to examine psychometric properties of motor assessments in IWD combined with frequency of use and effect sizes and to provide recommendations based on observed findings.We performed a two-stage systematic literature search using Pubmed, Web of Science, Cochrane Library, ALOIS, and Scopus (inception - July/September 2018, English and German). The first search purposed to identify motor assessments used in randomised controlled trials assessing effectiveness of physical activity in IWD and to display their frequency of use and effect sizes. The second search focused on psychometric properties considering influence of severity and aetiology of dementia and cueing on test-retest reliability. Two reviewers independently extracted and analysed findings of eligible studies in a narrative synthesis. RESULTS Literature searches identified 46 randomised controlled trials and 21 psychometric property studies. While insufficient information was available for validity, we observed sufficient inter-rater and relative test-retest reliability but unacceptable absolute test-retest reliability for most assessments. Combining these findings with frequency of use and effect sizes, we recommend Functional Reach Test, Groningen Meander Walking Test (time), Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up & Go Test, instrumented gait analysis (spatiotemporal parameters), Sit-to-Stand assessments (repetitions> 1), and 6-min walk test. It is important to consider that severity and aetiology of dementia and cueing influenced test-retest reliability of some assessments. CONCLUSION This review establishes an important foundation for future investigations. Sufficient relative reliability supports the conclusiveness of recommended assessments at group level, while unacceptable absolute reliability advices caution in assessing intra-individual changes. Moreover, influences on test-retest reliability suggest tailoring assessments and instructions to IWD and applying cueing only where it is inevitable. Considering heterogeneity of included studies and insufficient examination in various areas, these recommendations are not comprehensive. Further research, especially on validity and influences on test-retest reliability, as well as standardisation and development of tailored assessments for IWD is crucial.This systematic review was registered in PROSPERO (CRD42018105399).
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Affiliation(s)
- Sandra Trautwein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Philipp Maurus
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta Canada
| | - Bettina Barisch-Fritz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Anela Hadzic
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
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Iizuka A, Suzuki H, Ogawa S, Kobayashi-Cuya KE, Kobayashi M, Takebayashi T, Fujiwara Y. Can cognitive leisure activity prevent cognitive decline in older adults? A systematic review of intervention studies. Geriatr Gerontol Int 2019; 19:469-482. [PMID: 31020777 DOI: 10.1111/ggi.13671] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 03/04/2019] [Accepted: 03/25/2019] [Indexed: 02/05/2023]
Abstract
The aims of this systematic review were to investigate what kind of cognitive leisure activities have been used in intervention studies targeting older adults, and whether these activities improve cognitive function or inhibit cognitive decline. Based on the PRISMA declaration, we searched keywords using three electronic databases: PubMed, PsycINFO and PsycARTICLES. Intervention studies involving cognitive leisure activities with cognitive assessments set as outcomes were included. We regarded cognitive leisure activities as activities for enjoyment or well-being that cause intellectual stimulation (e.g. reading, playing board games). To investigate the influence of each activity on cognitive domains, multicomponent programs (e.g. combined music and art) were excluded. In total, 20 studies were included in the evaluation. Consequently, intervention studies related to arts, writing, board games, reading, handicrafts, a crossword puzzle and learning computer skills were identified. Of the 20 studies, 13 showed improvement in some cognitive domain. In 12 of these 13 studies, the intervention effects were not observed in a specific cognitive domain; rather, the intervention effects were observed across multiple cognitive domains and on working memory. The results of the present review suggest that cognitive function in older adults can be improved through cognitive leisure activity interventions. Activities related to learning new skills, that cause strong intellectual stimulation and that include communication elements were considered particularly effective tools. However, as the number of studies is small, more high-quality research needs to be accumulated. Geriatr Gerontol Int 2019; 19: 469-482.
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Affiliation(s)
- Ai Iizuka
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Hiroyuki Suzuki
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Susumu Ogawa
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kimi Estela Kobayashi-Cuya
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.,Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Momoko Kobayashi
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Yoshinori Fujiwara
- Research Team for Social Participation and Health Promotion, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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Zhang W, Low LF, Gwynn JD, Clemson L. Interventions to Improve Gait in Older Adults with Cognitive Impairment: A Systematic Review. J Am Geriatr Soc 2018; 67:381-391. [PMID: 30506754 DOI: 10.1111/jgs.15660] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/01/2018] [Accepted: 09/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To review intervention programs that measure gait to investigate what features of the intervention may contribute to improving gait in older adults with cognitive impairment or dementia. DESIGN Systematic review using Medline, Cinahl, Scopus, PsychInfo, Amed, Embase, Web of Science, and PubMed for original research published in English between January 1, 2000, and July 23, 2018, to identify interventional controlled trials. Narrative synthesis was undertaken. RESULTS Of 6,379 citations, 36 articles met inclusion criteria. Interventions were categorized as medication or medical devices (8 studies), exercise (19 studies), and exercise plus cognitive training (9 studies). Antidementia medication may improve gait variability in people with Alzheimer's disease. Exercise programs focusing on strength and balance training, especially when combined with functional mobility training, improve gait in people with mild cognitive impairment or dementia. Exercise plus cognitive training programs combining strength and balance training, functional mobility training, and training on attention and executive function also improve gait. CONLUSION Physical and cognitive factors affect gait performance, and both should be addressed in intervention programs. Physical exercises including functional mobility training, especially walking, have better results than physical programs with only static, resistance, and flexibility training. Cognitive intervention should be concomitant with physical exercises rather than separate, with a focus on attention and executive function. Combining physical training with cognitive training in a functional context may assist older adults with cognitive impairment generalize from training to everyday activity. J Am Geriatr Soc 67:381-391, 2019.
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Affiliation(s)
- Weihong Zhang
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia.,Wolper Jewish Hospital, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | - Josephine Diana Gwynn
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | - Lindy Clemson
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
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Effects of Physical Exercise on Depressive Symptoms in Patients With Cognitive Impairment: A Systematic Review and Meta-Analysis. J Nerv Ment Dis 2018; 206:809-823. [PMID: 30273278 DOI: 10.1097/nmd.0000000000000887] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We aimed to evaluate the efficacy of physical exercise in ameliorating depressive symptoms in patients with cognitive impairment. The databases of PubMed, EMBASE, Web of Science, the Cochrane Library, PsycINFO, China National Knowledge Infrastructure, WanFang, and WeiPu (VIP) were searched to identify randomized controlled trials (RCTs) that involved physical exercise for patients with cognitive impairment. A random effects model and a fixed effects model were used to calculate the pooled effect size. Twenty-one studies were identified. The meta-analysis showed that physical exercise significantly ameliorated depressive symptoms (standardized mean difference [SMD] = -0.23; 95% confidence interval [CI], -0.39 to -0.07; p = 0.004). In addition, beneficial improvements in neuropsychiatric symptoms (mean difference, -4.62; 95% CI, -9.07 to -0.16, p = 0.04), quality of life (SMD = 0.23; 95% CI, 0.01-0.46; p = 0.04), and activities of daily living (SMD = 0.27; 95% CI, 0.12-0.43; p = 0.0005) were observed in our study. No significant improvements were found in anxiety or apathy. Nevertheless, further high-quality, multicenter RCTs are needed to identify the clinical value of our results.
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Self-Paced Cycling Improves Cognition on Institutionalized Older Adults Without Known Cognitive Impairment: A 15-Month Randomized Controlled Trial. J Aging Phys Act 2018; 26:614-623. [DOI: 10.1123/japa.2017-0135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed at identifying the effects of self-paced cycling on the cognitive and functional status and fall risk on institutionalized older adults without cognitive impairment. A total of 39 individuals were randomly assigned to an exercise group or to a control group. The exercise group participants cycled at their self-selected intensity at least for 15 min daily during 15 months. The control group participants performed recreational activities. The Mini-Mental State Examination, Fuld object memory evaluation, and symbol digit modality test were used for cognitive assessments. The Katz index, the timed “Up & Go” test, and the World Health Organization questionnaire were used to assess functional independence, mobility, and fall risk. Significant improvements were observed in the exercise group for global cognition and attention, visual scanning, and processing speed. Long-term self-paced cycling training seems to have a protective effect on cognitive status and attention, visual scanning, and processing speed in older institutionalized individuals.
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