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

Abstract

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.

Commentary on: physical activity and exercise for mild cognitive impairment and dementia: a collaborative international guideline

“…In this situation, evidence based international guidelines, offering practical advice to busy health and social care professionals and others affected by dementia is especially welcome. In this commentary, we discuss the evidence on how physical activity and exercise affects cognition – specifically differentiating the prevention and management of both Mild Cognitive Impairment (MCI) and dementia - in the context of a recently published guideline derived from the work of several international scientific societies and lay representatives [ 8 ].…”

“…These collaborative guidelines, involving nine different societies, were published in the middle of August 2023 [ 8 ].…”

“…While our intention was to offer tailored recommendations for dementia subtypes and stages, available trial data were mostly limited to moderate severity Alzheimer’s disease. Finally, we were keen to look at person-centered outcomes such as quality of life or caregiver stress, but these data were not available [ 8 ].…”

Physical Activity and Cognitive Functioning

“…This happens independently of the improvement in cardiopulmonary performance, suggesting that physical activity can bring benefits in terms of survival and quality of life. It should be emphasized that the positive effect, although widespread, is not generic, but mainly oriented towards executive functions and the speed of information processing [17]. The protective effect of physical activity on the cognitive function of the elderly has several explanations.…”

Top-funded digital health companies offering lifestyle interventions for dementia prevention: Company overview and evidence analysis

“…Although dementia risk is strongly correlated with age, studies indicate that lifestyle significantly influences individuals' susceptibility to developing the condition later in life (7). Modifiable risk factors that directly influence dementia risk include, among others, physical activity, diet, and cognitive training (8,9). It is estimated that 30% of all Alzheimer's disease (AD) cases could be prevented through the targeted change of these modifiable risk factors (10).…”