The effects of exercise programs on cognition, activities of daily living, and neuropsychiatric symptoms in community-dwelling people with dementia—a systematic review

Steichele, Kathrin; Keefer, Anne; Dietzel, Nikolas; Graessel, Elmar; Prokosch, Hans-Ulrich; Kolominsky-Rabas, Peter L.

doi:10.1186/s13195-022-01040-5

Alzheimer's Research & Therapy

Table 2 Included studies evaluating the effect of exercise programs on cognition

From: The effects of exercise programs on cognition, activities of daily living, and neuropsychiatric symptoms in community-dwelling people with dementia—a systematic review

Study	Type of training	Trial duration [weeks]	Frequency [sessions/week]	Intensity	Session duration [min]	Setting	Adherence	Assessment tool	Domain	Outcome Baseline (mean ± SD)			Outcome Follow-up (mean ± SD)		p value	Conclusion
Study	Type of training	Trial duration [weeks]	Frequency [sessions/week]	Intensity	Session duration [min]	Setting	Adherence	Assessment tool	Domain	IG		CG	IG	CG	p value	Conclusion
De Oliveira Silva et al. [41]	Multi-modal training	12	2	70–80% VO₂max	60	Supervised	87%	MMSE	Global cognition	20.58 ± 4.91		21.43 ± 4.18	20.31 ± 4.68	19.5 ± 5.37	.11	No effect
								CDT	Executive function	1.5		1	1	1	.54
								VF	Verbal fluency	12		9	10	10	.16
								ST3	Selective attention, inhibitory control, and processing speed	42		41.53	43.51	40.08	.93
Hoffmann et al. [37]	Aerobic training	16	3	70–80% HRmax	60	Supervised groups of 2–5	76%	SDMT	Mental speed and attention	27.1 ± 14.7		25.4 ± 14.3	26.2 ± 15.6	24.1 ± 14.9	.179	No effect
								ADAS-Cog verbal memory test	Verbal memory (immediate recall)	11.2 ± 4.5		11.2 ± 4.5	11.2 ± 4.6	11.4 ± 4.4	.813
								VF	Verbal fluency	23.2 ± 12		24.2 ± 12.4	23.1 ± 11.8	25.6 ± 14.9	.133
								SCWT	Psychomotor speed	17.6 ± 10.2		18 ± 9.6	17.5 ± 10.4	18.3 ± 9.9	.441
								MSSE	Global cognition	23.8 ± 3.4		24.1 ± 3.8	23.9 ± 3.4	23.9 ± 3.9	.244
Karssemeijer et al. [39]	Aerobic training	12	3	50–75% HRR	30–50	Supervised individually	81.1%	Z-score (TMT-B short, SCWT, VF, and RS)	Executive function	0.05 ± 0.72		− 0.03 ± 0.8	0.15 ± 0.74	− 0.12 ± 0.87	.338	No effect
								Z-score (LLT)	Episodic memory	− 0.08 ± 1.05		− 0.08 ± 0.86	− 0.11 ± 1.15	− 0.34 ± 1.21	.184
								Z-score (WAIS-III DST and WMS-III SS)	Working memory	0.02 ± 0.73		0.15 ± 0.95	0.04 ± 0.80	− 0.12 ± 1.02	.153
								Z-score (TMT-A and SCWT)	Psychomotor speed	0.14 ± 0.73		0.0 ± 0.81	0.32 ± 0.64	− 0.25 ± 1.04	.004^a	Favors intervention
								Z-score (WMS-R LM and HVLT-R)	Episodic memory	NI					.447	No effect
Lamb et al. [42]	Multi-modal training	16	2 (+ 1)^b	Moderate to hard	60–90	Supervised groups of 6–8 and unsupervised home-based	65.63%	ADAS-Cog	Global cognition	21.4 ± 9.6	21.8 ± 7.7		22.9 ± 11.6	22.4 ± 9.4	.24	No effect
Öhman et al. [43]	Multi-modal training	52	2	NI	60	Supervised home based	72.88%	CDT	Executive function	2.32 ± 2.04	2.45 ± 2.09		NI		.03^a	Favors intervention
								CDT	Executive function	2.31 ± 2.09	2.45 ± 2.09		NI		.07	No effect
								VF	Verbal fluency	8.34 ± 4.75	7.89 ± 4.25		NI		.93
						Supervised groups of 10	72.12%	VF	Verbal fluency	8.05 ± 4.3	7.89 ± 4.25		NI		.93
								MMSE	Global cognition	17.8 ± 6.6	17.7 ± 6.2		NI		.74
								MMSE	Global cognition	18.5 ± 6.3	17.7 ± 6.2		NI		.74
Yu et al. [40]	Aerobic training	24	3	50–75% HRR	40–60	Supervised groups up to 3	> 70%	ADAS-Cog	Global cognition	19.3 ± 7.4	17.8 ± 6.5		NI		.386	No effect
								Z-score (WMS-R LM and HVLT-R)	Episodic memory	NI					.447
								Z-score (TMT-B, EXIT-25, and CDT)	Executive function	NI					.849
								WAIS-R DST	Attention	NI					.539
								Z-score (WAIS-III DST and TMT A)	Processing speed	NI					.778
								Z-score (COWAT, VF, and BNT)	Language	NI					.925

ADAS-Cog Alzheimer’s Disease Assessment Scale – Cognitive Subscale, BNT Boston Naming Test, CDT Clock-Drawing Test, CG Control group, COWAT Controlled Oral Word Association Test, HRmax Maximal heart rate, EXIT25 Executive Interview -25 Items, HVLT-R Hopkins Verbal Learning Test—Revised, HRR Heart rate reserve, IG Intervention group, LLT Location Learning Test, MMSE Mini-Mental State Examination, NI No information, RS Rule Shift Card Test, SCWT Stroop Color and Word Test, SDMT Symbol Digit Modalities Test, ST3 Stroop Test – third card, TMT-A Trail Making Test – Subtest A, TMT-B Trail Making Test – Subtest B, VF Verbal Fluency Test, VO₂max Maximal aerobic capacity, WAIS-III DST Wechsler Adult Intelligence Scale – Third Edition Digit Span Test, WAIS-R DST Wechsler Adult Intelligence Scale – Revised Digit Symbol Test, WMS-R Wechsler Memory Scale—Revised Logical Memory, WMS-III SS Wechsler Memory Scale – Third Edition Spatial Span
^a Group differences in the changes marked as significant in publication
^b Group-based training was offered 2 times per week, but participants were encouraged to perform one session at home

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