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New Study - Exercise Does Not Improve Cognition

Insights and discussion from the cutting edge with reference to journal articles and other research papers.
Silverlining
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New Study - Exercise Does Not Improve Cognition

Postby Silverlining » Thu May 17, 2018 3:34 am

Study published yesterday claiming moderate to high intensity exercise for people with mild to moderate dementia does not improve cognition and may in fact worsen it.

https://www.bmj.com/content/361/bmj.k1675

Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial

Abstract


Objective To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia.


Design Multicentre, pragmatic, investigator masked, randomised controlled trial.


Setting National Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.


Participants 494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm.


Interventions Usual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises.


Main outcome measures The primary outcome was score on the Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention.


Results The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference −1.4, 95% confidence interval −2.6 to −0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer’s disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).


Conclusion A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.

Orangeblossom
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Re: New Study - Exercise Does Not Improve Cognition

Postby Orangeblossom » Thu May 17, 2018 9:26 am

It may possibly not improve things when people have dementia, but that is different from it helping with prevention, though. That seems not to be in dispute. Alzheimer's UK lists it as the top things we can do in terms of prevention.

https://www.alzheimers.org.uk/about-dem ... l-exercise

NF52
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Re: New Study - Exercise Does Not Improve Cognition

Postby NF52 » Thu May 17, 2018 12:15 pm

Thanks for sharing, Silverlining!
I think there’s a ray of silverlining possible in this study, due to the short period and the heterogeneous group.

The average difference between the two groups was only 1.4 points, with a confidence interval of 2.6-0.2. That means that it they re-did the tests, the difference might be anywhere between 0.2 pts lower or 2.6 pts lower for the exercise group. They note that the clinical significance is uncertain. Since the secondary outcomes include things people care about in daily living, including caregiver burden, quality of life and behavioral symptoms (which could be viewed as primary challenges for families!) I think the headline is misleading and the best conclusion is “No differences in daily living skills or caregiver burden after 4 months of exercise for mixed dementia population.”
Meanwhile the large FINGER study in Finland has triggered numerous countries to try pre-AD lifestyle interventions due to significant effects in at-risk groups.
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Re: New Study - Exercise Does Not Improve Cognition

Postby slacker » Thu May 17, 2018 7:01 pm

It's also possible that exercise ALONE is not enough to see improvement, but done in conjunction with other interventions will be helpful. Monotherapy is most likely not going to be enough for those already suffering with cognitive decline.
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Re: New Study - Exercise Does Not Improve Cognition

Postby chrissyr » Sat May 19, 2018 9:54 am

I'm sure there is bias in what I'm thinking, but it seems this study would have to be repeated and the larger the better. We certainly have read lots of studies suggesting the opposite.
There is such a huge difference with the progression of dementia for different people, some progressing quickly and some ever so slowly; could this be a factor-- the people in the two groups could not have been homogeneous in the type of dementia that they had-- as that is not the nature of the beast? Of course, that is true for any dementia study. Only 165 people in the "usual care" group. But I realize that if this study said the opposite, I would be thinking the sample size was fine, so there's the bias!

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Re: New Study - Exercise Does Not Improve Cognition

Postby Tincup » Sat May 19, 2018 2:31 pm

Exercise did not ward off cognition issues with my mom. I'd moved her 700 miles to be near me and she lived in a large senior apartment complex (for seniors who could take care of themselves). She walked around the outside of the complex all day long as she was bored. I had a woman who would take her to a senior exercise class a few times a week as well as shopping. When I had to move her to a group home for memory care, she had less opportunities, though I would go by and walk her daily (she could not leave without supervision). She continued going to the exercise classes.

That being said, I think the exercise contributed greatly to her quality of life. She remained mobile, without needing a walker and despite breaking a hip in a fall, till she passed at 87.
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Exercise fails to slow down, might even accelerate dementia

Postby ApropoE4 » Sat May 26, 2018 1:26 pm

https://www.alzforum.org/news/research- ... e-dementia

A yearlong program of brisk exercise in people with mild to moderate dementia left participants more physically fit, but no better off in terms of mental functioning, daily living, or quality of life. In fact, the intensive exercise program may have slightly worsened their cognition. The results of the randomized trial, led by Sallie Lamb of the University of Oxford, appeared May 16 in The BMJ.

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Re: Exercise fails to slow down, might even accelerate dementia

Postby NF52 » Sat May 26, 2018 5:34 pm

Below is a link to the full article. While the mean score in the exercise group increased (i.e. worsened) by 1.4 points, which is statistically significant, that doesn't mean that the implication for exercise is clinically significant, due to the wide standard deviation. In the exercise group, the mean score increased to 25.2, but the standard deviation (the range that would include 68% of the participants) is 12.3. So two thirds of the exercise group of 329 people scored between 12.9 and 37.5 one year later. The mean score of the 125 people in the standard care group was 23.8, with a standard deviation of 10.4, for a 68% group range of 13.4 to 37.2.
I think that's why the results quoted below refer to the clinical relevance as "uncertain." The smaller the control group, and the larger the standard deviation, the more overlap there might be between the two groups.
What seems the most useful news of of this study is that none of the "secondary outcomes" listed below, which I would argue should be the primary areas of interventions with people with moderate dementia, changed at all. Maybe that's worth researching instead of time on a bicycle.

Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden.
Results The average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference −1.4, 95% confidence interval −2.6 to −0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer’s disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).
[Emphasis added.]


https://www.bmj.com/content/361/bmj.k1675
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Re: New Study - Exercise Does Not Improve Cognition

Postby aphorist » Sun May 27, 2018 4:43 pm

Exercise fails to curb dementia because AMPK is already in overdrive and exercise just makes it worse. These people with dementia are likely frail and need anabolism (intranasal insulin?).

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Re: New Study - Exercise Does Not Improve Cognition

Postby Verax » Sun May 27, 2018 4:57 pm

The study participants already had mild to moderate dementia so this study cannot conclude that there is no relation between physical activity or inactivity and later dementia. In Lancet 2011, "The Projected Impact of Risk Factor Reduction on Alzheimer's Disease Prevalence," https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3647614/ physical inactivity was estimated to have a relative risk of 1.82 for AD. "To our knowledge, there are no published RCTs to determine whether an exercise intervention can lower or delay AD incidence, although several trials are planned or ongoing." As well, "Worldwide, approximately 13% (nearly 4.3 million) AD cases may be attributable to physical inactivity, including 21% (>1.1 million) in the US. A 10% reduction in the prevalence of physical inactivity could potentially prevent more than 380,000 AD cases globally and nearly 90,000 cases in the US, while a 25% reduction in physical inactivity prevalence could potentially prevent nearly 1 million AD cases globally and 230,000 in the US." Including other possible known preventative interventions, they estimate some 40% of AD might be prevented.

One point we should emphasize is that the study did not test for nor report ApoE allele status but included unspecified dementia. The CVD risk is significantly raised by some alleles and this affects the dementia risk of AD. Many men die of CVD before they would possibly have become demented, which partially explains why more women have AD. Physical activity as part of lifestyle changes can affect many health risks as well as possibly helping to prevent dementia or not. The exercise programs appeared to have no adverse effects.

I am a bit surprised that the exercise programs here improved fitness but did not increase mobility and help with activities of daily living. We should not overlook that the walking speed increased on the six minute walk test. I will try to discuss elsewhere some papers about the possible refinement of one biomarker, the dual-task gait test, currently researched by several labs.


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