Could Exercise Actually Worsen Dementia?

Moderate-to-high intensity exercise likely does not slow cognitive decline in patients with dementia, despite conflicting evidence from previous systematic reviews, according to a new study.

In fact, the results of the study indicated that this type of exercise may actually worsen cognitive impairment in some patients and cannot be recommended to help alleviate cognitive impairment in dementia, the authors of the study said.
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These new findings emerged from the Dementia and Physical Activity (DAPA) trial, which included 494 English participants with dementia.

Each participant was randomly assigned 2:1 to an aerobic and strength exercise program (n = 329) or usual care (n = 165) for 4 months.

The primary outcome was defined as 12-month Alzheimer’s disease assessment scale-cognitive subscale (ADAS-cog) scores. Secondary outcomes were daily-living activities, neuropsychiatric symptoms, health-related quality of life, and caregiver quality of life and burden.

Overall, participants complied well with exercise, with more than 65% of participants attending more than 75% of scheduled sessions and 6-minute walking distance improving over 6 weeks (mean change 18.1 m).

However, results showed that 12-month mean ADAS-cog scores had increased to 25.2 in the exercise arm and 23.8 in the usual care arm, suggesting that participants in the exercise arm experienced greater cognitive impairment.

The researchers noted that the average difference was small with uncertain clinical relevance, but that investigators should consider this finding in future studies of the association between physical activity and cognitive decline in dementia.

No between-group differences were observed in secondary outcomes or preplanned subgroup analyses by dementia type, severity of cognitive impairment, sex, and mobility.

—Christina Vogt

Reference:

Lamb SE, Sheehan B, Atherton N, et al; DAPA Trial Investigators. Dementia and Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomized controlled trial [Published online May 16, 2018]. BMJ. https://doi.org/10.1136/bmj.k1675

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