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PHYSICAL ACTIVITY AND EXERCISE IN MILD COGNITIVE IMPAIRMENT AND DEMENTIA: AN UMBRELLA REVIEW OF INTERVENTION AND OBSERVATIONAL STUDIES

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Jacopo Demurtas, Daniel Schoene, Gabriel Torbahn, Alessandra Marengoni, Giulia Grande, Liye Zou, Mirko Petrovic, Stefania Maggi, Matteo Cesari, Sarah Lamb, Pinar Soysal, Wolfgang Kemmler, Cornel Sieber, Christoph Mueller, Susan D. Shenkin, Lukas Schwingshackl, Lee Smith, Nicola Veronese

Original languageEnglish
JournalJournal Of The American Medical Directors Association
Accepted/In press24 Aug 2020

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Abstract

Objectives: The aim of this umbrella review was to determine the effect of physical activity/exercise on improving cognitive and non-cognitive outcomes in people with MCI (mild cognitive impairment) and dementia.
Design: Umbrella review of systematic reviews (SR), with or without meta-analyses (MAs) of randomized controlled trials (RCTs) and observational studies.
Settings and participants: People with MCI or dementia, confirmed through validated assessment measures. Any form of physical activity/exercise was included. As controls, we included participants not following any pre-specified physical activity/exercise intervention or following the same standard protocol with the intervention group.
Methods: The protocol was registered in PROSPERO (CDR 164197). Major databases were searched until 31 December 2019. The certainty of evidence of statistically significant outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. SRs’ findings, without a formal MA, were reported descriptively.
Results: Among 1,160 articles initially evaluated, 27 SRs (9 without MA) for a total of 28,205 participants with MCI/dementia were included. In patients with MCI, mind-body intervention (standardized mean difference, SMD=0.36; 95% confidence intervals, CI: 0.20-0.52; low certainty) and mixed physical activity interventions (SMD=0.30; 95%CI: 0.11-0.49; moderate certainty) had a small effect on global cognition, whereas resistance training (SMD=0.80; 95%CI: 0.29-1.31; very low certainty) had a large effect on global cognition. In people affected by dementia, physical activity/exercise was effective in improving global cognition in Alzheimer’s disease (SMD=1.10; 95%CI: 0.65-1.64; very low certainty) and in all types of dementia (SMD=0.48; 95%CI: 0.22-0.74; low certainty). Finally, physical activity/exercise improved non-cognitive outcomes in people with dementia including falls, and neuropsychiatric symptoms.
Conclusions and implications: Supported by very low-to-moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and non-cognitive outcomes in people with MCI and dementia, but RCTs, with low risk of bias/confounding, are still needed to confirm these relationships.  

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