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

Abstract

ObjectiveTo 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.DesignMulticentre, pragmatic, investigator masked, randomised controlled trial.SettingNational Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.Participants494 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.InterventionsUsual 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 measuresThe 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.ResultsThe 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).ConclusionA 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.Trial registrationCurrent Controlled Trials ISRCTN10416500.

Accelerometer‐determined physical activity and cognitive function in middle‐aged and older adults from two generations of the Framingham Heart Study

“…There is also a breadth of data suggesting that self-reported PA is associated with better cognitive outcomes [1,[6][7][8][9]. But randomized controlled trials of exercise interventions have been more inconsistent, possibly due to population differences, exercise protocol differences, and necessarily short follow-up times of lifestyle interventions [4], including a recent clinical trial reporting that participation in an MVPA intervention resulted in steeper cognitive decline in patients with dementia [27]. In a striking positive example, Erickson et al [28] reported a better maintenance of hippocampal volume (measured by magnetic resonance imaging) and memory in older adults without baseline cognitive impairment who were exposed to a one-year exercise intervention, compared with the control group.…”

A program of exercise, brain training, and lecture to prevent cognitive decline

“…However, it is also important to select subjects who will benefit the most from these activities. A study of patients with mild‐to‐moderate dementia found that moderate‐ to high‐intensity aerobic and strength exercise training improved physical fitness but not cognitive function . Although the current study did not use strict diagnostic criteria for inclusion, these benefits were likely obtained by selecting subjects with extremely MCD using a dementia screening test (MSP‐1000).…”

“…A study of patients with mild-to-moderate dementia found that moderate-to high-intensity aerobic and strength exercise training improved physical fitness but not cognitive function. 18 Although the current study did not use strict diagnostic criteria for inclusion, these benefits were likely obtained by selecting subjects with extremely MCD using a dementia screening test (MSP-1000). Since the MSP-1000 is a computerized test, it is possible to conduct uniform screening anywhere.…”

Effects of nonpharmacological interventions on functioning of people living with dementia at home: A systematic review of randomised controlled trials

“…26 The third RCT was a small pilot study (n = 30), comparing an in-home Wii fit video game-led exercise programme (involving yoga, strength, aerobics, balance, and dual-task exercise) for 20 minutes, 5 days a week for 8 weeks and a walking-based control in people with mild dementia. 26 The third RCT was a small pilot study (n = 30), comparing an in-home Wii fit video game-led exercise programme (involving yoga, strength, aerobics, balance, and dual-task exercise) for 20 minutes, 5 days a week for 8 weeks and a walking-based control in people with mild dementia.…”

“…The 13 studies with lower ROB were conducted in the United Kingdom, 26,30,[37][38][39] United States, 29,31 Netherlands, 34,56 Finland, 27,28,33 Germany, 32,36 Denmark, 25 and France. 35 .…”