Physical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia: A Systematic Review.

Author: Brasure M1, Desai P1, Davila H1, Nelson VA1, Calvert C1, Jutkowitz E1, Butler M1, Fink HA1, Ratner E1, Hemmy LS1, McCarten JR1, Barclay TR1, Kane RL1
Affiliation: <sup>1</sup>From University of Minnesota, Minneapolis, Minnesota; Brown University, Providence, Rhode Island; and Minneapolis VA Health Care System and HealthPartners, Minneapolis, Minnesota.
Conference/Journal: Ann Intern Med.
Date published: 2017 Dec 19
Other: Special Notes: doi: 10.7326/M17-1528. [Epub ahead of print] , Word Count: 287

Background: The prevalence of cognitive impairment and dementia is expected to increase dramatically as the population ages, creating burdens on families and health care systems.

Purpose: To assess the effectiveness of physical activity interventions in slowing cognitive decline and delaying the onset of cognitive impairment and dementia in adults without diagnosed cognitive impairments.

Data Sources: Several electronic databases from January 2009 to July 2017 and bibliographies of systematic reviews.

Study Selection: Trials published in English that lasted 6 months or longer, enrolled adults without clinically diagnosed cognitive impairments, and compared cognitive and dementia outcomes between physical activity interventions and inactive controls.

Data Extraction: Extraction by 1 reviewer and confirmed by a second; dual-reviewer assessment of risk of bias; consensus determination of strength of evidence.

Data Synthesis: Of 32 eligible trials, 16 with low to moderate risk of bias compared a physical activity intervention with an inactive control. Most trials had 6-month follow-up; a few had 1- or 2-year follow-up. Evidence was insufficient to draw conclusions about the effectiveness of aerobic training, resistance training, or tai chi for improving cognition. Low-strength evidence showed that multicomponent physical activity interventions had no effect on cognitive function. Low-strength evidence showed that a multidomain intervention comprising physical activity, diet, and cognitive training improved several cognitive outcomes. Evidence regarding effects on dementia prevention was insufficient for all physical activity interventions.

Limitation: Heterogeneous interventions and cognitive test measures, small and underpowered studies, and inability to assess the clinical significance of cognitive test outcomes.

Conclusion: Evidence that short-term, single-component physical activity interventions promote cognitive function and prevent cognitive decline or dementia in older adults is largely insufficient. A multidomain intervention showed a delay in cognitive decline (low-strength evidence).

Primary Funding Source: Agency for Healthcare Research and Quality.

PMID: 29255839 DOI: 10.7326/M17-1528