Effects of low- and high-intensity physical exercise on physical and cognitive function in older persons with dementia: a randomized controlled trial.
ApoE4
Cognitive decline
Dementia
Dose-response relationship
Exercise intensity
Physical exercise
Journal
Alzheimer's research & therapy
ISSN: 1758-9193
Titre abrégé: Alzheimers Res Ther
Pays: England
ID NLM: 101511643
Informations de publication
Date de publication:
19 03 2020
19 03 2020
Historique:
received:
27
05
2019
accepted:
11
03
2020
entrez:
21
3
2020
pubmed:
21
3
2020
medline:
23
6
2021
Statut:
epublish
Résumé
Potential moderators such as exercise intensity or apolipoprotein-E4 (ApoE4) carriership may determine the magnitude of exercise effects on physical and cognitive functions in patients with dementia (PwD). We determined the effects of a 24-week aerobic and strength training program with a low- and high-intensity phase on physical and cognitive function. In an assessor-blinded randomized trial, 91 PwD (all-cause dementia, recruited from daycare and residential care facilities, age 82.3 ± 7.0 years, 59 women, Mini-Mental State Examination 20.2 ± 4.4) were allocated to the exercise or control group. In the exercise group, PwD participated in a walking and lower limb strength training program with 12 weeks low- and 12 weeks high-intensity training offered three times/week. Attention-matched control participants performed flexibility exercises and recreational activities. We assessed adherence, compliance, and exercise intensity for each session. We assessed physical (endurance, gait speed, mobility, balance, leg strength) and cognitive (verbal memory, visual memory, executive function, inhibitory control, psychomotor speed) functions with performance-based tests at baseline and after 6, 12, 18, 24, and 36 weeks (follow-up). ApoE4 carriership was determined post-intervention. Sixty-nine PwD were analyzed. Their mean attendance was ~ 60% during the study period. There were no significant effects of the exercise vs. control intervention on endurance, mobility, balance, and leg strength in favor of the exercise group (Cohen's d = 0.13-0.18). Gait speed significantly improved with ~ 0.05 m/s after the high-intensity phase for exercise participants (Cohen's d = 0.41) but declined at follow-up. There were no significant effects of the exercise vs. control intervention on any of the cognitive measures (Cohen's d ~ - 0.04). ApoE4 carriership did not significantly moderate exercise effects on physical or cognitive function. Exercise was superior to control activities for gait speed in our sample of PwD. However, the training effect provided no protection for mobility loss after detraining (follow-up). There were no beneficial effects of the exercise vs. control group on cognitive function. Exercise intensity moderated the effects of exercise on gait speed. ApoE4 carriership moderated the effect of exercise on global cognition only (trend level). Netherlands Trial Register, NTR5035. Registered on 2 March 2015.
Sections du résumé
BACKGROUND
Potential moderators such as exercise intensity or apolipoprotein-E4 (ApoE4) carriership may determine the magnitude of exercise effects on physical and cognitive functions in patients with dementia (PwD). We determined the effects of a 24-week aerobic and strength training program with a low- and high-intensity phase on physical and cognitive function.
METHODS
In an assessor-blinded randomized trial, 91 PwD (all-cause dementia, recruited from daycare and residential care facilities, age 82.3 ± 7.0 years, 59 women, Mini-Mental State Examination 20.2 ± 4.4) were allocated to the exercise or control group. In the exercise group, PwD participated in a walking and lower limb strength training program with 12 weeks low- and 12 weeks high-intensity training offered three times/week. Attention-matched control participants performed flexibility exercises and recreational activities. We assessed adherence, compliance, and exercise intensity for each session. We assessed physical (endurance, gait speed, mobility, balance, leg strength) and cognitive (verbal memory, visual memory, executive function, inhibitory control, psychomotor speed) functions with performance-based tests at baseline and after 6, 12, 18, 24, and 36 weeks (follow-up). ApoE4 carriership was determined post-intervention.
RESULTS
Sixty-nine PwD were analyzed. Their mean attendance was ~ 60% during the study period. There were no significant effects of the exercise vs. control intervention on endurance, mobility, balance, and leg strength in favor of the exercise group (Cohen's d = 0.13-0.18). Gait speed significantly improved with ~ 0.05 m/s after the high-intensity phase for exercise participants (Cohen's d = 0.41) but declined at follow-up. There were no significant effects of the exercise vs. control intervention on any of the cognitive measures (Cohen's d ~ - 0.04). ApoE4 carriership did not significantly moderate exercise effects on physical or cognitive function.
CONCLUSIONS
Exercise was superior to control activities for gait speed in our sample of PwD. However, the training effect provided no protection for mobility loss after detraining (follow-up). There were no beneficial effects of the exercise vs. control group on cognitive function. Exercise intensity moderated the effects of exercise on gait speed. ApoE4 carriership moderated the effect of exercise on global cognition only (trend level).
TRIAL REGISTRATION
Netherlands Trial Register, NTR5035. Registered on 2 March 2015.
Identifiants
pubmed: 32192537
doi: 10.1186/s13195-020-00597-3
pii: 10.1186/s13195-020-00597-3
pmc: PMC7082953
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
28Références
Dementia (London). 2018 Sep 7;:1471301218795289
pubmed: 30193536
J Gerontol A Biol Sci Med Sci. 2017 May 1;72(5):655-661
pubmed: 27302701
Int Psychogeriatr. 2016 May;28(5):707-17
pubmed: 26572551
Int J Geriatr Psychiatry. 2002 Apr;17(4):329-34
pubmed: 11994886
Am J Geriatr Psychiatry. 2015 Nov;23(11):1106-16
pubmed: 25648055
AJNR Am J Neuroradiol. 2013 Dec;34(12):2287-93
pubmed: 23828104
Med Sci Sports Exerc. 2007 Aug;39(8):1401-7
pubmed: 17762374
PLoS One. 2019 Jan 10;14(1):e0210036
pubmed: 30629631
J Psychiatr Res. 1975 Nov;12(3):189-98
pubmed: 1202204
Geriatr Gerontol Int. 2015 Apr;15(4):422-7
pubmed: 24730603
Curr Alzheimer Res. 2018;15(1):80-88
pubmed: 28558638
J Gerontol A Biol Sci Med Sci. 2003 Aug;58(8):746-51
pubmed: 12902534
JAMA. 2008 Sep 3;300(9):1027-37
pubmed: 18768414
Int J Sports Med. 2008 Jun;29(6):471-4
pubmed: 18050054
J Nutr Health Aging. 2009 Dec;13(10):881-9
pubmed: 19924348
Lancet. 2015 Jun 6;385(9984):2255-63
pubmed: 25771249
BMC Geriatr. 2015 Jul 01;15:72
pubmed: 26126532
J Am Geriatr Soc. 2017 Sep;65(9):E123-E129
pubmed: 28542742
Nat Rev Neurosci. 2013 May;14(5):365-76
pubmed: 23571845
Dement Geriatr Cogn Disord. 2010;30(5):392-402
pubmed: 20980758
Behav Brain Res. 2017 Sep 15;334:78-85
pubmed: 28756215
Am J Alzheimers Dis Other Demen. 2011 Aug;26(5):381-8
pubmed: 21852281
Brain Behav Immun. 2013 Feb;28:90-9
pubmed: 23123199
Alzheimers Res Ther. 2019 Jan 5;11(1):3
pubmed: 30611286
J Am Geriatr Soc. 1991 Feb;39(2):142-8
pubmed: 1991946
Neurology. 2014 May 6;82(18):1613-9
pubmed: 24706014
Scand J Med Sci Sports. 2018 Apr;28(4):1339-1344
pubmed: 29247985
Brain Res. 1996 Jul 8;726(1-2):49-56
pubmed: 8836544
Neurobiol Aging. 2010 Feb;31(2):224-43
pubmed: 18479783
BMC Geriatr. 2014 Jun 12;14:73
pubmed: 24924703
Clin Interv Aging. 2013;8:19-27
pubmed: 23341738
Dement Geriatr Cogn Dis Extra. 2012 Jan;2(1):589-609
pubmed: 23341825
Trends Neurosci. 2007 Sep;30(9):464-72
pubmed: 17765329
J Alzheimers Dis. 2017;60(1):323-332
pubmed: 28800328
Arch Intern Med. 2007 Apr 23;167(8):781-7
pubmed: 17452540
Aging Clin Exp Res. 2019 Apr;31(4):503-510
pubmed: 29959666
J Am Geriatr Soc. 2008 Oct;56(10):1821-30
pubmed: 18795987
J Gerontol A Biol Sci Med Sci. 1995 Nov;50(6):M291-7
pubmed: 7583799
Contemp Nurse. 2006 Feb-Mar;21(1):32-40
pubmed: 16594879
Phys Ther. 2013 Jan;93(1):69-78
pubmed: 22976448
Alzheimers Res Ther. 2016 Sep 20;8:39
pubmed: 27646601
Arch Gen Psychiatry. 2011 Jun;68(6):617-26
pubmed: 21646578
Scand J Public Health. 2015 Feb;43(1):76-82
pubmed: 25431460
Med Sci Sports Exerc. 2011 Jul;43(7):1334-59
pubmed: 21694556
J Gerontol A Biol Sci Med Sci. 1997 Jan;52(1):M52-5
pubmed: 9008669
Science. 1993 Aug 13;261(5123):921-3
pubmed: 8346443
Neuroimage. 2016 May 1;131:142-54
pubmed: 26545456
J Clin Epidemiol. 2005 Jun;58(6):595-602
pubmed: 15878473
Dement Geriatr Cogn Disord. 2010;29(2):109-14
pubmed: 20150731
Neuroimage. 2016 May 1;131:102-12
pubmed: 26265157
Prev Cardiol. 2003 Fall;6(4):197-203
pubmed: 14605513
J Am Geriatr Soc. 2006 May;54(5):743-9
pubmed: 16696738
Mol Psychiatry. 2015 May;20(5):585-93
pubmed: 25311366
Sci Rep. 2017 Sep 7;7(1):10830
pubmed: 28883534
Arq Neuropsiquiatr. 2014 Mar;72(3):190-6
pubmed: 24676435
Arch Phys Med Rehabil. 2017 Jan;98(1):11-24.e3
pubmed: 27568165
J Gerontol A Biol Sci Med Sci. 2016 Apr;71(4):496-501
pubmed: 26290538
J Clin Endocrinol Metab. 1996 Oct;81(10):3492-7
pubmed: 8855791
Int J Clin Exp Med. 2015 Nov 15;8(11):21679-83
pubmed: 26885125
J Alzheimers Dis. 2005 Dec;8(3):247-68
pubmed: 16340083
Cochrane Database Syst Rev. 2012 Feb 15;(2):CD005562
pubmed: 22336813
Brain. 2016 Mar;139(Pt 3):662-73
pubmed: 26912638
JAMA Neurol. 2014 Jan;71(1):55-61
pubmed: 24276217
J Neurol Neurosurg Psychiatry. 2009 Jul;80(7):802-4
pubmed: 19531688
J Gerontol A Biol Sci Med Sci. 1997 Nov;52(6):M363-8
pubmed: 9402943
Med Biol Eng Comput. 2003 May;41(3):283-9
pubmed: 12803292
JAMA. 2011 Jan 5;305(1):50-8
pubmed: 21205966
J Alzheimers Dis. 2017;56(1):297-303
pubmed: 27911292
Int J Geriatr Psychiatry. 2009 Jul;24(7):680-5
pubmed: 19089875
J Neurosci Res. 2006 Sep;84(4):699-715
pubmed: 16862541
Clin Rehabil. 2004 May;18(3):253-60
pubmed: 15137556
Am J Epidemiol. 2005 Apr 1;161(7):639-51
pubmed: 15781953
Scand J Caring Sci. 2012 Mar;26(1):12-9
pubmed: 21564154
Front Aging Neurosci. 2017 Nov 07;9:368
pubmed: 29163146
Front Physiol. 2019 Oct 31;10:1358
pubmed: 31736780
Exp Physiol. 2009 Oct;94(10):1062-9
pubmed: 19666694
Clin Chem Lab Med. 2002 Nov;40(11):1123-31
pubmed: 12521230
Neurosci Biobehav Rev. 2016 May;64:326-45
pubmed: 26915926
Int J Sports Med. 2009 Sep;30(9):652-7
pubmed: 19569007
Horm Metab Res. 2010 Dec;42(13):982-6
pubmed: 21053157
Arch Neurol. 2001 Mar;58(3):449-54
pubmed: 11255449
J Am Geriatr Soc. 2013 Nov;61(11):1919-26
pubmed: 24219193
Alzheimer Dis Assoc Disord. 2002 Apr-Jun;16(2):81-7
pubmed: 12040303
Biol Rev Camb Philos Soc. 2007 Nov;82(4):591-605
pubmed: 17944619
Alzheimers Dement. 2016 Dec;12(12):1207-1215
pubmed: 27344641
PLoS One. 2015 Apr 17;10(4):e0121478
pubmed: 25884637
Front Hum Neurosci. 2014 Dec 11;8:985
pubmed: 25566019
Scand J Med Sci Sports. 2013 Dec;23(6):697-704
pubmed: 22376273
Behav Brain Res. 2014 Feb 1;259:302-12
pubmed: 24269495
J Aging Res. 2012;2012:948981
pubmed: 23304508
Neurology. 2004 Nov 23;63(10):1898-901
pubmed: 15557508
Neuroscience. 2006 Jul 7;140(3):823-33
pubmed: 16650607
BMJ. 2018 May 16;361:k1675
pubmed: 29769247
J Am Geriatr Soc. 2008 Apr;56(4):771-2
pubmed: 18380687
BMC Geriatr. 2015 Dec 03;15:158
pubmed: 26630910