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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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Yang JG, Thapa N, Park HJ, Bae S, Park KW, Park JH, Park H. Virtual Reality and Exercise Training Enhance Brain, Cognitive, and Physical Health in Older Adults with Mild Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13300. [PMID: 36293881 PMCID: PMC9602597 DOI: 10.3390/ijerph192013300] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED We investigated the effectiveness of virtual-reality-based cognitive training (VRCT) and exercise on the brain, cognitive, physical and activity of older adults with mild cognitive impairment (MCI). METHODS This study included 99 participants (70.8 ± 5.4) with MCI in the VRCT, exercise, and control groups. The VRCT consisted of a series of games targeting different brain functions such as executive function, memory, and attention. Twenty-four sessions of VRCT (three days/week) were performed, and each session was 100 min long. Exercise intervention consisted of aerobic and resistance trainings performed in 24 sessions for 60 min (2 times/week for 12 weeks). Global cognitive function was measured using the Mini-Mental State Examination (MMSE) test. Resting-state electroencephalography (EEG) of the neural oscillatory activity in different frequency bands was performed. Physical function was measured using handgrip strength (HGS) and gait speed. RESULTS After the intervention period, VRCT significantly improved the MMSE scores (p < 0.05), and the exercise group had significantly improved HGS and MMSE scores (p < 0.05) compared to baseline. One-way analysis of variance (ANOVA) of resting-state EEG showed a decreased theta/beta power ratio (TBR) (p < 0.05) in the central region of the brain in the exercise group compared to the control group. Although not statistically significant, the VRCT group also showed a decreased TBR compared to the control group. The analysis of covariance (ANCOVA) test showed a significant decrease in theta band power in the VRCT group compared to the exercise group and a decrease in delta/alpha ratio in the exercise group compared to the VRCT group. CONCLUSION Our findings suggest that VRCT and exercise training enhances brain, cognitive, and physical health in older adults with MCI. Further studies with a larger population sample to identify the effect of VRCT in combination with exercise training are required to yield peak benefits for patients with MCI.
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Affiliation(s)
- Ja-Gyeong Yang
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Korea
| | - Ngeemasara Thapa
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Korea
| | - Hye-Jin Park
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Korea
| | - Seongryu Bae
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Korea
| | - Kyung Won Park
- Department of Neurology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Jong-Hwan Park
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Korea
| | - Hyuntae Park
- Department of Health Sciences, Graduate School, Dong-A University, Busan 49315, Korea
- Laboratory of Smart Healthcare, Dong-A University, Busan 49315, Korea
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Preventing dementia? Interventional approaches in mild cognitive impairment. Neurosci Biobehav Rev 2021; 122:143-164. [PMID: 33440197 DOI: 10.1016/j.neubiorev.2020.12.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/13/2020] [Accepted: 12/19/2020] [Indexed: 12/19/2022]
Abstract
Mild cognitive impairment (MCI) is defined as an intermediate state between normal cognitive aging and dementia. It describes a status of the subjective impression of cognitive decline and objectively detectible memory impairment beyond normal age-related changes. Activities of daily living are not affected. As the population ages, there is a growing need for early, proactive programs that can delay the consequences of dementia and improve the well-being of people with MCI and their caregivers. Various forms and approaches of intervention for older people with MCI have been suggested to delay cognitive decline. Pharmacological as well as non-pharmacological approaches (cognitive, physiological, nutritional supplementation, electric stimulation, psychosocial therapeutic) and multicomponent interventions have been proposed. Interventional approaches in MCI from 2009 to April 2019 concerning the cognitive performance are presented in this review.
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Bisbe M, Fuente-Vidal A, López E, Moreno M, Naya M, de Benetti C, Milà R, Bruna O, Boada M, Alegret M. Comparative Cognitive Effects of Choreographed Exercise and Multimodal Physical Therapy in Older Adults with Amnestic Mild Cognitive Impairment: Randomized Clinical Trial. J Alzheimers Dis 2020; 73:769-783. [PMID: 31868666 PMCID: PMC7029368 DOI: 10.3233/jad-190552] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Recent research on mild cognitive impairment (MCI) has primarily focused on searching for measures to prevent or delay the progression of MCI to dementia. Physical exercise has shown to be effective in the prevention of age-related cognitive decline in elderly adults with MCI. However, the most effective type and dose of exercise for the improvement of cognition are yet to be determined. Objective: To compare the cognitive effects of choreographed exercise (Choreography group) with a multimodal physical therapy program (Physical Therapy group) in elderly adults with amnestic MCI, a population with an increased risk of developing dementia. Methods: We conducted a randomized clinical trial with two parallel groups under allocation concealment and assessor blinding. Participants were allocated into Choreography or Physical Therapy group and performed exercises twice per week in 60-minute sessions during 12 weeks. Results: Thirty-six participants with amnestic MCI, ages 65 to 85, were assessed at baseline and after 12 weeks of intervention, by comprehensive validated neuropsychological and physical assessments. A Repeated measures General Lineal Model showed statistically significant differences in cognitive and physical outcomes. Both groups significantly improved in visual delayed recall. The Choreography group exhibited significantly more benefits on verbal recognition memory than the Physical Therapy group. Conclusion: Greater cognitive benefits were achieved in the choreographic intervention than in the multimodal physical therapy, mainly in those functions more related to the risk of conversion to dementia. Additional studies are needed to confirm whether the observed effects are related to delayed onset of Alzheimer’s disease in elderly adults with amnestic MCI.
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Affiliation(s)
- Marta Bisbe
- Department of Physical Therapy and Nursing of Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain.,Department of Psychology of Blanquerna Faculty of Psychology, Education and Sports Sciences, Ramon Llull University, Barcelona, Spain
| | - Andrea Fuente-Vidal
- Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), University of Vic, Barcelona, Spain
| | - Elisabet López
- Department of Psychology of Blanquerna Faculty of Psychology, Education and Sports Sciences, Ramon Llull University, Barcelona, Spain
| | - Marta Moreno
- Physical Therapy Ambulatory Service, Barcelona, Spain
| | - Marian Naya
- Physical Therapy Ambulatory Service, Barcelona, Spain
| | | | - Raimon Milà
- Department of Physical Therapy and Nursing of Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Olga Bruna
- Department of Psychology of Blanquerna Faculty of Psychology, Education and Sports Sciences, Ramon Llull University, Barcelona, Spain
| | - Mercè Boada
- Research Center and Memory Clinic. Fundació ACE. Institut Català de Neurociències Aplicades. Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Alegret
- Research Center and Memory Clinic. Fundació ACE. Institut Català de Neurociències Aplicades. Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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5
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Cox KL, Cyarto EV, Ellis KA, Ames D, Desmond P, Phal P, Sharman MJ, Szoeke C, Rowe CC, Masters CL, You E, Burrows S, Lai MMY, Lautenschlager NT. A Randomized Controlled Trial of Adherence to a 24-Month Home-Based Physical Activity Program and the Health Benefits for Older Adults at Risk of Alzheimer's Disease: The AIBL Active-Study. J Alzheimers Dis 2020; 70:S187-S205. [PMID: 30372680 PMCID: PMC6700652 DOI: 10.3233/jad-180521] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Previous studies have demonstrated that physical activity (PA) interventions can improve physical and cognitive outcomes in older adults, but most have been relatively short in duration (<1 year) with a few having specifically targeting individuals at risk of developing Alzheimer’s disease. Objective: To examine adherence and physical health outcomes in a 24-month home-based PA intervention in older adults at risk of Alzheimer’s disease. Methods: Participants 60 years and older with mild cognitive impairment (MCI) or subjective memory complaints (SMC) with at least 1 cerebrovascular risk factor recruited from The Australian Imaging Biomarkers and Lifestyle Flagship Study of Aging (AIBL) were randomized to a PA or control group (n = 106). The control group continued with their usual lifestyle. The PA group received a 24-month home-based program with a target of 150 minutes/week of moderate PA and a behavioral intervention. Retention (participants remaining) and PA adherence (PA group only, percent PA completed to the PA prescribed) were determined at 6, 12, 18, and 24 months. Assessments at baseline, 6, 12, and 24 months included, PA; fitness; body composition and fat distribution. Key outcome measures were PA adherence and PA. Results: The 24-month retention rate (97.2%) and the median PA adherence 91.67% (Q1–Q3, 81.96, 100.00) were excellent. In the long-term the intervention group achieved significantly better improvements in PA levels, leg strength, fat mass and fat distribution compared to the control. Conclusion: This study demonstrates that in this target group, long-term PA adherence is achievable and has physical health benefits.
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Affiliation(s)
- Kay L Cox
- Medical School University of Western Australia, Perth, Australia
| | - Elizabeth V Cyarto
- Bolton Clarke Research Institute, Melbourne, Australia.,Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Kathryn A Ellis
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - David Ames
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Australia
| | - Pramit Phal
- Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Australia.,Epworth Medical Imaging, Richmond, Victoria, Australia
| | - Matthew J Sharman
- School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Cassandra Szoeke
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, Australia.,School of Psychology, Australian Catholic University, Melbourne, Australia
| | - Christopher C Rowe
- Department of Molecular Imaging & Therapy, Austin Health, Melbourne, Australia.,Melbourne Dementia Research Centre, University of Melbourne, Melbourne, Australia
| | - Colin L Masters
- The Florey Institute, The University of Melbourne, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Sally Burrows
- Medical School University of Western Australia, Perth, Australia
| | - Michelle M Y Lai
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,WA Centre for Health & Ageing, University of Western Australia, Perth, Australia.,NorthWestern Mental Health, Melbourne Health, Melbourne, Australia
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Chong TW, Curran E, Ellis KA, Southam J, You E, Cox KL, Hill KD, Pond D, Dow B, Anstey KJ, Hosking D, Cyarto E, Lautenschlager NT. Physical activity for older Australians with mild cognitive impairment or subjective cognitive decline – A narrative review to support guideline development. J Sci Med Sport 2020; 23:913-920. [DOI: 10.1016/j.jsams.2020.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/12/2020] [Accepted: 03/08/2020] [Indexed: 11/30/2022]
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7
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Vseteckova J, Dadova K, Gracia R, Ryan G, Borgstrom E, Abington J, Gopinath M, Pappas Y. Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review. Eur Rev Aging Phys Act 2020; 17:15. [PMID: 32973961 PMCID: PMC7507295 DOI: 10.1186/s11556-020-00246-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/06/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND & AIMS Evidence suggests that targeted exercise is important for people living with dementia. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to walking group exercise of older people living with dementia in the community. METHODS We have searched appropriate electronic databases between January 1990 until September 2019, in any language. Additionally, we searched trial registries (clinicaltrial.gov and WHO ICTRP) for ongoing studies. We included all study designs. Studies were excluded when participants were either healthy older people or people suffering from dementia but living in residential care. Narrative synthesis was used. FINDINGS 10 papers met the inclusion criteria. The narrative analysis focused on barriers, facilitators, and adherence. All studies reported on barriers and facilitators. Barriers included: bio-medical reasons (including mental wellbeing and physical ability); relationship dynamics; and socio-economic reasons and environmental issues. Facilitators included: bio-medical benefits & benefits related to physical ability; staff, group relationship dynamics and social aspect of walking group; environmental issues and individual tailoring; and participants perceptions about the walks & the program. Most studies did not provide data about adherence or attendance; where reported, adherence ranged from 47 to 89%. CONCLUSIONS This systematic review of literature has highlighted known barriers and facilitators to adherence to walking groups type of exercise for people living with dementia in community. Carers' willingness to engage, their circumstances, perspectives and previous experiences of exercise seem to play a key role in facilitating adherence but there is little research that explores these. Also, the design, location and organisation of walking groups facilitate adherence. This reflects the need for such activities to be part of a wider 'program of care', tailored to the needs of the individual, flexible and convenient. Knowledgeable and well-trained instructors or healthcare professionals are recommended as group exercise leaders.
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Affiliation(s)
- J. Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - K. Dadova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - R. Gracia
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - G. Ryan
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - E. Borgstrom
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - J. Abington
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - M. Gopinath
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - Y. Pappas
- Institute for Health Research, University of Bedfordshire, Bedford, UK
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Lam FM, Huang MZ, Liao LR, Chung RC, Kwok TC, Pang MY. Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. J Physiother 2018; 64:4-15. [PMID: 29289581 DOI: 10.1016/j.jphys.2017.12.001] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/03/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022] Open
Abstract
QUESTION Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS People with mild cognitive impairment or dementia as the primary diagnosis. INTERVENTION Physical exercise. OUTCOME MEASURES Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls. RESULTS Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact. CONCLUSION People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15].
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Affiliation(s)
- Freddy Mh Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Mei-Zhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Lin-Rong Liao
- Department of Rehabilitation, Jiangsu Provincial Yixing Jiuru Rehabilitation Hospital, Yixing, China
| | - Raymond Ck Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy Cy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Marco Yc Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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Strout KA, David DJ, Dyer EJ, Gray RC, Robnett RH, Howard EP. Behavioral Interventions in Six Dimensions of Wellness That Protect the Cognitive Health of Community-Dwelling Older Adults: A Systematic Review. J Am Geriatr Soc 2016; 64:944-58. [PMID: 27160762 DOI: 10.1111/jgs.14129] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To systematically identify, appraise, and summarize research on the effects of behavioral interventions to prevent cognitive decline in community-dwelling older adults using a holistic wellness framework. DESIGN Systematic review of randomized controlled trials that tested the effectiveness of behavioral interventions within each of the six dimensions of wellness: occupational, social, intellectual, physical, emotional and spiritual. Databases searched included PubMed MEDLINE, EMBASE, CENTRAL, PsycINFO, CINAHL, ALOIS, and The Grey Literature Report through July 1, 2014. SETTING Community. PARTICIPANTS Individuals aged 60 and older (N = 6,254). MEASUREMENTS Consolidated Standards of Reporting Trials Checklist. RESULTS Eighteen studies met the inclusion criteria. Interventions in the physical dimension of wellness were most common (11 studies); interventions in the spiritual dimension were least common (0 studies). Fifty-nine different measures were used to measure multiple cognitive domains, with memory being the most commonly measured (17 studies) and language being the least commonly measured (5 studies). Fifty percent of the interventions examined in the 18 studies demonstrated statistically significant outcomes on at least one cognitive measure. Interventions in the intellectual dimension that examined cognitively stimulating activities using pen and paper or a computer represented the greatest percentage of statistically significant outcomes. CONCLUSION Intellectual and physical interventions were most studied, with varied results. Future research is needed using more-consistent methods to measure cognition. Researchers should include the National Institutes of Health Toolbox Cognition Battery among measurement tools to facilitate effective data harmonization, pooling, and comparison.
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Affiliation(s)
- Kelley A Strout
- Department of Nursing, University of Maine School of Nursing, Orono, Maine
| | - Daniel J David
- Department of Nursing, Regis College, Weston, Massachusetts
| | | | - Roberta C Gray
- Library Services, University of New England, Portland, Maine
| | - Regula H Robnett
- Department of Occupational Therapy, University of New England, Portland, Maine
| | - Elizabeth P Howard
- School of Nursing, Bouve College of Health Science, Northeastern University, Boston, Massachusetts
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Vidoni ED, Watts AS, Burns JM, Greer CS, Graves RS, Van Sciver A, Black JR, Cooper SK, Nagely AC, Uphoff E, Volmer JM, Bieberle NA. Feasibility of a Memory Clinic-Based Physical Activity Prescription Program. J Alzheimers Dis 2016; 53:161-70. [PMID: 27104905 PMCID: PMC5839638 DOI: 10.3233/jad-160158] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Effective programs for promoting physical activity are needed for those with cognitive impairment. OBJECTIVE To test the feasibility of mobile Health (mHealth) technology-supported physical activity prescription from a tertiary care memory clinic. METHODS This feasibility study was designed as a 16-week randomized, crossover trial of a physical activity prescription: 8 weeks of intervention, 8 weeks of baseline or maintenance phase data collection. We recruited 2 cohorts: 21 individuals with Alzheimer-related cognitive impairment (mean age 72.3 (5.2), 9 females), and 9 individuals with normal cognition (mean age 69.6 (5.8), 8 females). We gave each cohort an mHealth accelerometer-based physical activity prescription to double number of steps taken. Our primary outcomes were feasibility and safety. Our secondary outcomes were change in weekly steps taken, Dementia Quality of Life Scale, Self-efficacy Scale, 6-minute Walk, and mini-Physical Performance Test. RESULTS Set-up and use of the device was not a barrier to participation. However, only 62% of participants with cognitive impairment completed the intervention. The cohort with cognitive impairment did not change their weekly step count above Week 1. All participants in the cohort with normal cognition were able to set up and use their device and increased their weekly step count above Week 1. There were no differences between Week 1 and Week 8 for any secondary measures in either cohort. CONCLUSIONS Setup and daily use of mHealth technology appears to be feasible for a person with cognitive impairment with the help of a partner, but increasing daily step counts over 8 weeks was not achieved. Future work needs to assess alternative activity prescription goals or additional support for patients and their partners.
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Affiliation(s)
- Eric D Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | - Amber S Watts
- University of Kansas, Department of Psychology, Lawrence, KS, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | - Colby S Greer
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | - Rasinio S Graves
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | - Jessica R Black
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS, USA
| | - Sarah K Cooper
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS, USA
| | - Allison C Nagely
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS, USA
| | - Elaine Uphoff
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS, USA
| | - Jennifer M Volmer
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS, USA
| | - Natalie A Bieberle
- University of Kansas Medical Center, Department of Physical Therapy and Rehabilitation Science, Kansas City, KS, USA
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11
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Zheng G, Xia R, Zhou W, Tao J, Chen L. Aerobic exercise ameliorates cognitive function in older adults with mild cognitive impairment: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2016; 50:1443-1450. [PMID: 27095745 DOI: 10.1136/bjsports-2015-095699] [Citation(s) in RCA: 179] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the effect of aerobic exercise on cognitive function in people with mild cognitive impairment (MCI). DESIGN Systematic review and meta-analysis of aerobic exercise intervention for cognitive function in older adults with MCI. DATA SOURCES PubMed, EMBASE, SinoMed, China National Knowledge Infrastructure (CNKI), Wanfang and Chinese Science and Technology Periodical (VIP) databases from their inception to 31 January 2015, the Cochrane Central Register of Controlled Trials (Cochrane Library, 2015, Issue 3) and the reference lists of all retrieved articles. ELIGIBILITY CRITERIA Randomised controlled trials, older adults with MCI, aerobic exercises compared with no specific exercise intervention for global cognitive ability and any specific domains of cognition. DATA SYNTHESIS Meta-analysis was conducted with RevMan V.5.3 software using the fixed-effect model for the available data without significant heterogeneity, or the random-effect model was used if appropriate. RESULTS 11 studies were identified involving 1497 participants. Meta-analysis showed that aerobic exercise significantly improved global cognitive ability (Mini-Mental State Examination (MMSE) scores: MD=0.98, 95% CI 0.5 to 1.45, p<0.0001; Montreal Cognitive Assessment (MoCA) scores: MD=2.7, 95% CI 1.11 to 4.29, p=0.0009); weakly, positively improve memory (immediately recall: SMD=0.29, 95% CI 0.13 to 0.46, p=0.0005; delay recall: SMD=0.22, 95% CI 0.09 to 0.34, p=0.0005). No significant improvement was found in other domains of cognition. CONCLUSIONS Aerobic exercise led to an improvement in global cognitive ability and had a positive effect with a small effect size on memory in people with MCI. However, owing to the limitations of the included studies, these findings should be interpreted cautiously.
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Affiliation(s)
- Guohua Zheng
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Shangjie University Town, Fuzhou, China.,College of Health Information Technology and Management, Shanghai University of Health & Medicine Science. Pudong New District, Shanghai, China
| | - Rui Xia
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Shangjie University Town, Fuzhou, China
| | - Wenji Zhou
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Shangjie University Town, Fuzhou, China
| | - Jing Tao
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Shangjie University Town, Fuzhou, China
| | - Lidian Chen
- Fujian University of Traditional Chinese Medicine, Shangjie University Town, Fuzhou, China
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12
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Szeto JYY, Lewis SJG. Current Treatment Options for Alzheimer's Disease and Parkinson's Disease Dementia. Curr Neuropharmacol 2016; 14:326-38. [PMID: 26644155 PMCID: PMC4876589 DOI: 10.2174/1570159x14666151208112754] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/16/2015] [Accepted: 10/09/2015] [Indexed: 12/30/2022] Open
Abstract
Alzheimer's disease (AD) and Parkinson's disease (PD) are the two most common neurodegenerative disorders encountered in clinical practice. Whilst dementia has long been synonymous with AD, it is becoming more widely accepted as part of the clinical spectrum in PD (PDD). Neuropsychiatric complications, including psychosis, mood and anxiety disorders, and sleep disorders also frequently co-exist with cognitive dysfunctions in AD and PDD patients. The incidence of such symptoms is often a significant source of disability, and may aggravate pre-existing cognitive deficits. Management of AD and PDD involves both pharmacological and non-pharmacological measures. Although research on pharmacological therapies for AD and PDD has so far had some success in terms of developing symptomatic treatments, the benefits are often marginal and non-sustained. These shortcomings have led to the investigation of non-pharmacological and novel treatments for both AD and PD. Furthermore, in light of the diverse constellation of other neuropsychiatric, physical, and behavioural symptoms that often occur in AD and PD, consideration needs to be given to the potential side effects of pharmacological treatments where improving one symptom may lead to the worsening of another, rendering the clinical management of these patients challenging. Therefore, the present article will critically review the evidence for both pharmacological and non-pharmacological treatments for cognitive impairment in AD and PD patients. Treatment options for other concomitant neuropsychiatric and behavioural symptoms, as well as novel treatment strategies will also be discussed.
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Affiliation(s)
| | - Simon J G Lewis
- Brain & Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, New South Wales, Australia.
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The FABS trial: a randomised control trial of the effects of a 6-month physical activity intervention on adherence and long-term physical activity and self-efficacy in older adults with memory complaints. Prev Med 2013; 57:824-30. [PMID: 24076011 DOI: 10.1016/j.ypmed.2013.09.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 09/12/2013] [Accepted: 09/17/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study is to assess in older adults with memory complaints, the effects of a 6-month home-based physical activity (PA) intervention on short-term adherence, short and long-term self-efficacy and the predictors of adherence. METHODS Participants with memory complaints with or without mild cognitive impairment (MCI) were recruited from Perth, Western Australia between May 2004 and July 2006 and randomly assigned to a control or an intervention group. The intervention group received a 6-month PA programme and recorded sessions on a diary. Pedometer readings, questionnaires, and physical and cognitive measures were completed at 0, 6, 12 and 18 months. RESULTS One hundred and seventy participants started the study. Retention rates were similar for both groups at all time-points however retention was higher for men than women (P<0.01). Adherence to the prescribed PA was 72.8% (95% CI, 70.8 74.9%). Men had higher adherence rate than women (P<0.001). Those with and without MCI had similar adherence. Compared to controls self-efficacy was higher in the intervention group after 6 months only (P<0.01). CONCLUSIONS Older adults with memory complaints, with or without MCI, can successfully participate in and enjoy home-based PA programmes. Long-term adherence to such interventions may require continued support and increased self-efficacy. ( TRIAL REGISTRATION ACTRN012605000136606.).
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Malchow B, Reich-Erkelenz D, Oertel-Knöchel V, Keller K, Hasan A, Schmitt A, Scheewe TW, Cahn W, Kahn RS, Falkai P. The effects of physical exercise in schizophrenia and affective disorders. Eur Arch Psychiatry Clin Neurosci 2013; 263:451-67. [PMID: 23873090 DOI: 10.1007/s00406-013-0423-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 07/08/2013] [Indexed: 01/23/2023]
Abstract
Affective and non-affective psychoses are severe and frequent psychiatric disorders. Amongst others, they not only have a profound impact on affected individuals through their symptomatology, but also regarding cognition, brain structure and function. Cognitive impairment influences patients' quality of life as well as their ability to work and being employed. While exercise therapy has been implemented in the treatment of psychiatric conditions since the days of Kraepelin and Bleuler, the underlying mechanisms have never been systematically studied. Since the early 1990s, studies emerged examining the effect of physical exercise in animal models, revealing stimulation of neurogenesis, synaptogenesis and neurotransmission. Based on that body of work, clinical studies have been carried out in both healthy humans and in patient populations. These studies differ with regard to homogenous study samples, sample size, type and duration of exercise, outcome variables and measurement techniques. Based on their review, we draw conclusions regarding recommendations for future research strategies showing that modern therapeutic approaches should include physical exercise as part of a multimodal intervention programme to improve psychopathology and cognitive symptoms in schizophrenia and affective disorders.
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Affiliation(s)
- Berend Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nußbaumstraße 7, 80336, Munich, Germany.
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15
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Nascimento CMC, Ayan C, Cancela JM, Gobbi LTB, Gobbi S, Stella F. Effect of a multimodal exercise program on sleep disturbances and instrumental activities of daily living performance on Parkinson's and Alzheimer's disease patients. Geriatr Gerontol Int 2013; 14:259-66. [DOI: 10.1111/ggi.12082] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Carla Manuela Crispim Nascimento
- Laboratory of Aging and Physical Activity (LAFE); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
- HealthyFyt Group, Faculty of Sports Science; University of Vigo; Vigo Spain
| | - Carlos Ayan
- HealthyFyt Group, Faculty of Sports Science; University of Vigo; Vigo Spain
| | - Jose Maria Cancela
- HealthyFyt Group, Faculty of Sports Science; University of Vigo; Vigo Spain
| | - Lilian Teresa Bucken Gobbi
- Posture and Gait Studies Lab (LEPLO); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
| | - Sebastião Gobbi
- Laboratory of Aging and Physical Activity (LAFE); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
| | - Florindo Stella
- Laboratory of Aging and Physical Activity (LAFE); UNESP - São Paulo State University at Rio Claro; Rio Claro São Paulo Brazil
- Laboratory of Neuroscience (LIM-27); Department and Institute of Psychiatry; Faculty of Medicine; University of São Paulo; São Paulo Brazil
- Clinical Geriatric Psychiatry; Faculty of Medical Sciences; State University of Campinas; São Paulo Brazil
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Simon SS, Yokomizo JE, Bottino CMC. Cognitive intervention in amnestic Mild Cognitive Impairment: a systematic review. Neurosci Biobehav Rev 2012; 36:1163-78. [PMID: 22322184 DOI: 10.1016/j.neubiorev.2012.01.007] [Citation(s) in RCA: 149] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 01/13/2012] [Accepted: 01/24/2012] [Indexed: 12/16/2022]
Abstract
Mild Cognitive Impairment (MCI) represents a transitional state between normal aging and early dementia and is commonly associated with memory impairment (amnestic or A-MCI). Several studies have investigated therapeutic approaches to A-MCI, including cholinestherase inhibitors (I-ChEs), although this practice is still controversial. Thus, there is a current need to determine the effects of cognitive interventions either in combination with I-ChEs or alone. To assess the efficacy of such treatments, neuropsychological instruments and self-evaluated scoring of memory, mood, daily life activities and quality of life are employed. Recently, some studies have used functional magnetic resonance imaging (fMRI) in order to understand the neurobiological effects of these interventions. The aim of this systematic review is to investigate the effectiveness of cognitive interventions on the enhancement of learning abilities as well as their impacts on cognitive measurements of mood, everyday functioning and functional neuroimaging. This review also focused on the methodological aspects of such studies and attempted to introduce new perspectives on cognitive interventions in this population. The authors concluded that a-MCI patients are capable to learn new information and memory strategies. Although findings in standardized neuropsychological tests are limited, non-standardized cognitive measures and subjective measures show significant changes. Furthermore, fMRI reveals changes in the patterns of brain activation and increase of connectivity.
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Affiliation(s)
- Sharon Sanz Simon
- Old Age Research Group (PROTER), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil.
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17
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Varela S, Ayán C, Cancela JM, Martín V. Effects of two different intensities of aerobic exercise on elderly people with mild cognitive impairment: a randomized pilot study. Clin Rehabil 2011; 26:442-50. [DOI: 10.1177/0269215511425835] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate the effect of different intensities of aerobic exercise on elderly people with mild cognitive impairment. Design: A randomized trial. Setting: Residential care homes for elderly people. Subjects: Forty-eight patients were included in the study. Interventions: The patients were randomized in three groups. Group A performed aerobic exercise at 40% of heart rate reserve, group B did the same at 60% and group C carried out recreational activities. The duration of the study was three months. Main measures: Cognitive level and functional ability were assessed by means of the Mini Mental State Examination and the Timed Up and Go test before the intervention, at the end of it and three months later as a follow-up. Results: After completion of the aerobic training programme, the patients’ Mini Mental State Examination scores improved marginally (group A from 19.8 ± 5.1 to 20.6 ± 7.3; group B from 20.8 ± 4.6 to 21 ± 5.4). A similar trend was observed for the Timed Up and Go test scores (group A from 18.8 ± 5.3 to 18.5 ± 5 seconds; group B from 15.4 ± 4.2 to 14.3 ± 5.1 seconds). However, no statistically significant differences were found at any time during the evaluation regarding cognitive level and functional autonomy among the three groups. Conclusion: In this pilot study, intensity does not seem to be a determining factor when aerobic exercise is performed by people with mild cognitive impairment.
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Affiliation(s)
| | - Carlos Ayán
- Special Didactics, University of Vigo, Spain
| | | | - Vicente Martín
- Institute of Biomedicine (IBIOMED), University of Leon, Spain
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18
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Abstract
Both healthy aging and the pathologic incidence of disorders associated with aging involve an array of debilities. Physical exercise harnesses implicit and inherent biologic characteristics amenable to the putative interventional influences under clinical, institutional or laboratory conditions. The neurodegenerative and pathophysiologic progressions that constitute Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), normal aging, and different animal models of AD have shown the existence of several putative mechanisms. A large variety of moderating factors have demonstrated that the ever-proliferating plethora of neurotrophic factors, neurogenesis as observed through generality of expression and neuronal arborization. The insistent efficacy of brain vascular angiogenesis may delay also the comorbid incidence of depressive disorders with dementia pathology. The pathogenesis of aging may be contained by selective treatments: these diverse conditions, linked to the basis of the aging concept, have been shown, to greater or lesser extents, to respond to a variety of scheduled applications of physical exercise. The range of reports that provide accounts of the mechanisms mediating the positive progressive response to exercise intervention is far-ranging; these studies indicate that subtle changes at molecular, neuronal, vascular and epigenetic levels may exert notable consequence at functional expression and, perhaps most essentially, offer convincing expectancy of significant benefits.
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Affiliation(s)
- T Archer
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
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19
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Abstract
PURPOSE OF REVIEW Health professionals are presented with the challenge of prescribing physical activity that is likely to be sustained by the sedentary majority. Walking is eminently suited to physical activity prescription for inactive individuals as it is accessible to men and women of all ages and social groups and poses little risk of injury. This paper reviews recent evidence of the health benefits of walking and promotion of walking behavior. RECENT FINDINGS Large observational studies consistently show associations between walking and cardiovascular disease endpoints over long periods of follow-up. Intervention studies further support the health benefits of walking, showing improvements in clinical biomarkers and measures after shorter periods of follow-up. Walking appears to have cardiovascular disease-related health benefits in younger, middle-aged, and older men and women, in both healthy and patient populations. Pedometer-based, mobile phone-based, and computer-based programs are effective in increasing walking levels. Neighborhood and workplace amenities and programs may be important supports for walking behaviors. SUMMARY Walking has the potential to play a key role in the primary and secondary prevention of cardiovascular disease. Clinicians can prescribe walking to assist patients meet physical activity recommendations and help identify supports available to the patient.
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Lautenschlager NT, Cox K, Kurz AF. Physical activity and mild cognitive impairment and Alzheimer's disease. Curr Neurol Neurosci Rep 2010; 10:352-8. [PMID: 20556547 DOI: 10.1007/s11910-010-0121-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Regular physical activity undoubtedly has many health benefits for all age groups. In the past decade, researchers and clinicians have begun to focus their attention on whether physical activity also can improve health outcomes of older adults who experience mild cognitive impairment (MCI) or dementia. This ongoing question is gaining relevance in light of the aging of the world population and with it the rise of age-related conditions, such as cognitive impairment. Not surprisingly, physical activity is among the potential protective lifestyle factors mentioned when strategies to delay or prevent dementia are discussed. The first large-scale multidomain intervention trials are under way to put this to the test. This review aims to give an overview of recent trials of physical activity in patients with MCI or dementia.
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Affiliation(s)
- Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, St. Vincent's Health, Department of Psychiatry, St. George's Hospital, The University of Melbourne, 283 Cotham Road, Kew, 3103, Victoria, Australia.
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