Aerobic physical activity to improve memory and executive function in sedentary adults without cognitive impairment: A systematic review and meta-analysis

Hoffmann, C. M., Petrov, M. E. & Lee, R. E. | 2021| Aerobic physical activity to improve memory and executive function in sedentary adults without cognitive impairment: A systematic review and meta-analysis | Preventive Medicine Reports |

The reviewers of this systematic review and meta-analysis set out to examine whether aerobic physical activity improves cognitive function, specifically memory and executive function, in sedentary adults (aged
50 years and over) without cognitive impairment. Overall they report that their hypothesis was supported and they observe a a significant improvement in at least one measure of cognitive function (either memory, executive
function, or both) in adults aged 50 and up who engaged with physical activity interventions


The worldwide population of adults ages 50 and older continues to increase and is projected to reach over 2.3
billion by 2030. Aging is the biggest risk factor for cognitive impairment and dementia. Aerobic physical activity
may improve cognitive functioning, thus delaying aging-related cognitive decline.
The purpose of this review was to examine the effect of aerobic physical activity on memory and executive
function in sedentary adults with no known cognitive impairment.
PubMed, CINAHL, Psycinfo, and Cochrane Library databases were systematically searched for peer-reviewed
articles up to July 2019. Randomized controlled trials of sedentary adults, aged 50 and older, that compared an
aerobic physical activity intervention to either no treatment or alternative active comparator and reported
outcome measures of memory and/or executive function were included. A random effects meta-analysis was
performed to examine the separate effect sizes for memory and executive function.
Nine studies met inclusion criteria and contributed either memory and/or executive function effect sizes (n equal to
547). Results from the random effects meta-analysis suggested, by post-intervention, a large effect size for the
aerobic physical activity interventions on memory (g equal to 0.80, 95 per cent CI: 0.14–1.47; n equal to 7; p equal to 0.02) and a small effect on executive function (g equal to 0.37, 95 per cent CI: 0.04–0.69; n equal to 6; p equal to 0.03).
Aerobic physical activity may improve memory and executive function in sedentary adults without cognitive
impairment. Policymakers and providers should promote aerobic physical activity in this population, and further
research should investigate the most effective ways to promote aerobic physical activity in mid-life to older

Aerobic physical activity to improve memory and executive function in sedentary adults without cognitive impairment: A systematic review and meta-analysis [primary paper]

Activity interventions to improve the experience of care in hospital for people living with dementia

This review finds a small number of studies that suggest activity-based interventions implemented in hospitals may be effective in improving aspects of the care experience for people living with dementia | BMC Geriatrics

An increasingly high number of patients admitted to hospital have dementia. Hospital environments can be particularly confusing and challenging for people living with dementia (Plwd) impacting their wellbeing and the ability to optimize their care. Improving the experience of care in hospital has been recognized as a priority, and non-pharmacological interventions including activity interventions have been associated with improved wellbeing and behavioral outcomes for Plwd in other settings. This systematic review aimed at evaluating the effectiveness of activity interventions to improve experience of care for Plwd in hospital.


Systematic searches were conducted in 16 electronic databases up to October 2019. Reference lists of included studies and forward citation searching were also conducted. Quantitative studies reporting comparative data for activity interventions delivered to Plwd aiming to improve their experience of care in hospital were included. Screening for inclusion, data extraction and quality appraisal were performed independently by two reviewers with discrepancies resolved by discussion with a third where necessary. Standardized mean differences (SMDs) were calculated where possible to support narrative statements and aid interpretation.


Six studies met the inclusion criteria (one randomized and five non-randomized uncontrolled studies) including 216 Plwd. Activity interventions evaluated music, art, social, psychotherapeutic, and combinations of tailored activities in relation to wellbeing outcomes. Although studies were generally underpowered, findings indicated beneficial effects of activity interventions with improved mood and engagement of Plwd while in hospital, and reduced levels of responsive behaviors. Calculated SMDs ranged from very small to large but were mostly statistically non-significant.


The small number of identified studies indicate that activity-based interventions implemented in hospitals may be effective in improving aspects of the care experience for Plwd. Larger well-conducted studies are needed to fully evaluate the potential of this type of non-pharmacological intervention to improve experience of care in hospital settings, and whether any benefits extend to staff wellbeing and the wider ward environment.

Full reference: Lourida, I., Gwernan-Jones, R., Abbott, R. et al. | Activity interventions to improve the experience of care in hospital for people living with dementia: a systematic review | BMC Geriatrics |  20, 131 (2020).

Physical activity engagement strategies in people with mild cognitive impairment or dementia

Veronika van der Wardt et al. | Physical activity engagement strategies in people with mild cognitive impairment or dementia – a focus group study | Aging & Mental Health | Published online: 07 Apr 2019

Objective: This focus group study aimed to explore how to motivate people with mild cognitive impairment (MCI) or dementia and their carers to engage in exercise and physical activity.

Methods: Four focus groups were conducted with six people with MCI or dementia, three carers and four clinicians (nurse, occupational therapist, physiotherapists). A thematic analysis of the data was undertaken.

Results: Five main themes were identified: ‘memory problems’, ‘self-motivation’, ‘external motivation’, ‘design of activities’ and ‘barriers’. Participants viewed exercise positively but emphasised that it needed to fit into their daily routine. Goal-setting was seen as helpful by some participants but others saw this as a source of potential failure. Enjoyment was seen as key to engagement.

Conclusion: Exercise and physical activity interventions need an individualised approach to engage people with MCI or dementia, with a positive emphasis on enjoyment. Goal-setting should be used with caution in this group of people.

Full document available at Aging & Mental Health


Setting personal goals for dementia care

Research finds that goal setting may help people with dementia work with healthcare professionals and caregivers to identify and achieve realistic goals that are most important to them. | Journal of the American Geriatrics Society | News Medical

New research published in the Journal of the American Geriatrics Society has concluded that “goal attainment scaling” (GAS) can be used in clinical care to help people with dementia and their caregivers set and achieve personalised health goals.

old-690842_1920The researchers developed a process for using GAS to set goals and to measure whether participants reached those goals. In a first phase of the study, they tested goal setting with 32 people who had dementia and their caregivers.

In the next phase, the dementia care managers helped an additional 101 people with dementia and their caregivers set care goals. The research team used a scale to measure how well the participants achieved their goals 6 and 12 months after setting them.

Most often, the goals focused on improving quality of life for the person with dementia, followed by caregiver support goals. Some commonly chosen goals for the person with dementia included:

  • Maintaining physical safety
  • Continuing to live at home
  • Receiving medical care related to dementia
  • Avoiding hospitalization
  • Maintaining mental stimulation
  • Remaining physically active

Commonly chosen caregiver goals included:

  • Maintaining the caregiver’s own health
  • Managing stress
  • Minimizing family conflict related to dementia caregiving

Full story: Personalized goal setting to improve dementia care | News Medical

Full reference: Lee A. Jennings et al. | Personalized Goal Attainment in Dementia Care: Measuring What Persons with Dementia and Their Caregivers Want | Journal of the American Geriatrics Society | 2018


Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921

 Sibbett, R. A., Russ, T.C.,  Allerhand, M., Deary, I.J., &  Starr, J. M. | 2018| Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921 |BMC Psychiatry |  18 | 285 |

A new article in the BMC Psychiatry examines physical fitness and dementia risk in the very old (participants aged 79 at starting point of the study). Unlike previous studies whch have found an association with old age and dementia risk, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia.



Previous studies have demonstrated that individual measures of fitness – such as reduced pulmonary function, slow walking speed and weak handgrip – are associated with an increased risk of dementia. Only a minority of participants included in these studies were aged over 80. The aim of this study was therefore to investigate the association between physical fitness and dementia in the oldest old.


Subjects (n = 488) were enrolled in the Lothian Birth Cohort 1921 and aged 79 at baseline. Dementia cases arising after enrolment were determined using data from death certificates, electronic patient records and clinical reviews. Fitness measures included grip strength, forced expiratory volume in 1 s (FEV1) and walking speed over 6 m, measured at 79 years. Dementia risk associated with each fitness variable was initially determined by logistic regression analysis, followed by Cox regression analysis, where death was considered as a competing risk. APOE ε4 status, age, sex, height, childhood IQ, smoking, history of cardiovascular or cerebrovascular disease, hypertension and diabetes were included as additional variables. Cumulative incidence graphs were calculated using Aalen-Johansen Estimator.


Although initial results indicated that greater FEV1 was associated with an increased risk of dementia (OR (odds ratio per unit increase) 1.93, p = 0.03, n = 416), taking into account the competing risk of mortality, none of the fitness measures were found to be associated with dementia; FEV1 (HR (hazard ratio per unit increase) 1.30, p = 0.37, n = 416), grip strength (HR 0.98, p = 0.35, n = 416), walking speed (HR 0.99, p = 0.90, n = 416). The presence of an APOE ɛ4 allele was however an important predictor for dementia (HR 2.85, p < 0.001, n = 416). Cumulative incidence graphs supported these findings, with an increased risk of dementia for APOE ɛ4 carriers compared with non-carriers. While increased FEV1 was associated with reduced risk of death, there was no reduction in risk for dementia.


In contrast to previous studies, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia. This finding is not explained by those with poorer physical fitness, who would have been more likely to develop dementia, having died before onset of dementia symptoms.

The full article can be read at BMC Psychiatry

How physical exercise prevents dementia

Physical exercise seems beneficial in the prevention of cognitive impairment and dementia in old age, numerous studies have shown. Now researchers have explored in one of the first studies worldwide how exercise affects brain metabolism | ScienceDaily


In order to further advance current state of knowledge on the positive influence of physical activity on the brain, gerontologists and sports physicians at Goethe University Frankfurt have examined the effects of regular exercise on brain metabolism and memory of 60 participants aged between 65 and 85 in a randomised controlled trial. Their conclusion: regular physical exercise not only enhances fitness but also has a positive impact on brain metabolism.


Physical function and depression in nursing home residents with dementia

Among elderly people in general, better physical function is associated with lower incidence of depressive symptoms. It is also related to better mental health, quality of life and well-being | BMJ Open
Image source: sima dimitric – Flickr // CC BY 2.0

Objectives: The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed.

Results: Nursing home residents with dementia are a heterogeneous group in terms of physical function and depression. By applying the recommended cut-off of 8 on CSDD, 23.5% of the participants were classified as being depressed. The results revealed significant associations between higher scores on CSDD (indicating more symptoms of depression) and lower scores on BBS (95% CI −0.12 to −0.02, p=0.006), 30 s CST (95% CI −0.54 to −0.07, p=0.001) as well as maximum walking speed (95% CI −4.56 to −0.20, p=0.003) (indicating lower level of physical function).

Conclusion: Better muscle strength, balance and higher walking speed were significantly associated with less depressive symptoms. The potential interaction of dementia with poor physical function and depression indicates an area to explore in future epidemiological studies with a prospective design.

Full reference: Kvæl, L.A.H. et al.  (2017) Associations between physical function and depression in nursing home residents with mild and moderate dementia: a cross-sectional study. BMJ Open. 7:e016875.

Interventions to prevent cognitive decline & dementia

Evidence supporting three interventions that might slow cognitive decline and the onset of dementia is encouraging but insufficient to justify a public health campaign focused on their adoption | ScienceDaily

Image source: NASEM

Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine.  Additional research is needed to further understand and gain confidence in their effectiveness, said the committee that conducted the study and wrote the report.

Cost-effectiveness of physical activity in Alzheimer’s disease

This study explores the cost-effectiveness of a supervised moderate-to-high intensity aerobic exercise programme in people diagnosed with Alzheimer’s disease (AD) and estimate incremental cost-effectiveness ratios (ICER) using participant-reported and proxy-reported measures of health-related quality of life (HRQoL) | BMJ Open

Interventions: Control group received treatment as usual. The intervention group performed 1 hour of supervised moderate-to-high intensity aerobic exercise three times weekly for 16 weeks.

Primary and secondary outcomes measures: Different physical, functional and health measures were obtained at inclusion (baseline) and 4 and 16 weeks after. HRQoL (EuroQol-5 Dimensions-5 Levels/EQ-Visual Analogue Scale) was reported by the participants and the primary caregivers as proxy respondents. Differences in HRQOL as reported by the participant and caregiver were explored as were different values of caregiver time with respite from care tasks.

Results: The intervention cost was estimated at €608 and €496 per participant, with and without transport cost, respectively. Participants and caregivers in the intervention group reported a small, positive non-significant improvement in EQ-5D-5L and EQ-VAS after 16 weeks. The ICER was estimated at €72 000/quality-adjusted life year using participant-reported outcomes and €87000 using caregiver-reported outcomes.

Conclusions: The findings suggest that the exercise intervention is unlikely to be cost-effective within the commonly applied threshold values. The cost of the intervention might be offset by potential savings from reduction in use of health and social care.

Full reference: Sopina, E. et al. (2017) Cost-effectiveness of a randomised trial of physical activity in Alzheimer’s disease: a secondary analysis exploring patient and proxy-reported health-related quality of life measures in Denmark. BMJ Open. 7:e015217.

Exercising can protect the brain from Alzheimer’s disease

Physical activity is associated with a reduced risk of Alzheimer’s disease, a new study concludes. 


Research published in BMC Public Health also confirmed that regular physical activity may improve the performance of daily activities for people afflicted with Alzheimer’s.

Authors looked at data from more than 150 research articles about the impact of physical activity on people with Alzheimer’s. Some of the work explored how physical activity improves the patient’s quality of life and the others examined the risk of developing Alzheimer’s based on the amount of activity in which an individual participated.

The authors concluded that regular physical activity improves activities of daily living and mobility in older adults with Alzheimer’s and may improve general cognition and balance. They also established that older adults not diagnosed with Alzheimer’s who are physically active, were significantly less likely to develop the disease compared to people who were inactive.

Full reference: Martin Ginis, K. et. al. Formulation of evidence-based messages to promote the use of physical activity to prevent and manage Alzheimer’s disease.  BMC Public Health. 2017 17:209.

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