Physical activity and exercise for the prevention and management of mild cognitive impairment and dementia: a collaborative international guideline

Author: Nicola Veronese1, Pinar Soysal2, Jacopo Demurtas3, Marco Solmi4,5,6, Olivier Bruyère7, Nikos Christodoulou8,9, Rodrigo Ramalho10, Paolo Fusar-Poli11,12, Andreas S Lappas13,14, Daniel Pinto15, Kristian Steen Frederiksen16, Grazia Maria Corbi17, Olga Karpenko18, Jean Georges19, João Durães20,21, Mathias Schlögl22, Ozlem Yilmaz23, Cornel Sieber24,25, Susan D Shenkin26, Lee Smith27, Jean-Yves Reginster28, Stefania Maggi29, Federica Limongi29, Joan Ars30,31, Mario Barbagallo32, Antonio Cherubini#33, Terry Quinn#34,35; Alzheimer Europe; European College of Neuropsychopharmacology; European Geriatric Medicine Society (Lead Society); European Interdisciplinary Council on Ageing; European Society of Clinical and Economic Aspects of Osteoporosis and Osteoarthritis; International Association of Gerontology and Geriatrics-European Region; Scottish Brain Health ARC; World Psychiatry Association-Preventive Psychiatry Section; endorsed by the European Academy of Neurology
Affiliation:
1 Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy. nicola.veronese@unipa.it.
2 Faculty of Medicine, Department of Geriatric Medicine, Bezmialem Vakif University, Istanbul, Turkey.
3 Clinical and Experimental Medicine PhD Program, Università di Modena e Reggio Emilia, Modena - Azienda USL Sud Est Toscana, Grosseto, Italy.
4 Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
5 Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
6 Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
7 Division of Public Health, Epidemiology and Health Economics, World Health Organization, Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium.
8 Department of Psychiatry, University of Thessaly Medical School, Volos, Greece.
9 World Psychiatric Association, Section of Preventive Psychiatry, University of Nottingham Medical School, Nottingham, UK.
10 Department of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand.
11 Department of Psychosis Studies, King's College London, London, UK.
12 Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
13 Faculty of Medicine, Department of Psychiatry, University of Thessaly, Larissa, Greece.
14 Aneurin Bevan University Health Board, Newport, Wales, UK.
15 Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, WI, USA.
16 Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
17 Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy.
18 Chair of the WPA Preventive Psychiatry Section, Mental-Health Clinic No. 1 Named After N.A. Alexeev, Moscow, Russia.
19 Alzheimer Europe, Luxembourg, Luxembourg.
20 Neurology Department, Coimbra University Hospital Centre, Coimbra, Portugal.
21 Faculty of Medicine, Coimbra University, Coimbra, Portugal.
22 Division of Geriatric Medicine, Clinic Barmelweid, Barmelweid, Switzerland.
23 Department of Geriatric Medicine, Istanbul Training and Research Hospital, Samatya, Istanbul, Turkey.
24 Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.
25 Department of Medicine, Kantonsspital Winterthur, Brauerstrasse 15, Postfach 834, 8401, Winterthur, Zurich, Switzerland.
26 Ageing and Health Research Group and Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.
27 Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
28 Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
29 National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy.
30 RE-FiT Barcelona Research Group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Spain.
31 Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
32 Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro, 141, 90127, Palermo, Italy.
33 Geriatria, Accettazione Geriatrica e Centro di Ricerca Per l'invecchiamento, IRCCS INRCA, Ancona, Italy.
34 Department of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK.
35 Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Conference/Journal: Eur Geriatr Med
Date published: 2023 Sep 28
Other: Special Notes: doi: 10.1007/s41999-023-00858-y. , Word Count: 265

Background:
Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines.

Objectives:
To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia.

Methods:
Guideline content was developed with input from several scientific and lay representatives' societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels.

Recommendations:
Physical activity may be considered for the primary prevention of dementia. In people with MCI there is continued uncertainty about the role of physical activity in slowing the conversion to dementia. Mind-body interventions have the greatest supporting evidence. In people with moderate dementia, exercise may be used for maintaining disability and cognition. All these recommendations were based on a very low/low certainty of evidence.

Conclusions:
Although the scientific evidence on the beneficial role of physical activity and exercise in preserving cognitive functions in subjects with normal cognition, MCI or dementia is inconclusive, this panel, composed of scientific societies and other stakeholders, recommends their implementation based on their beneficial effects on almost all facets of health.

Keywords: Cognition; Dementia; Exercise; Guidelines; Mild cognitive impairment; Older adult; Physical activity.

PMID: 37768499 DOI: 10.1007/s41999-023-00858-y

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