Physical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia: A Systematic Review

Michelle Brasure, PhD, MSPH, MLIS; Priyanka Desai, MSPH; Heather Davila, MPA; Victoria A. Nelson, MSc; Collin Calvert, MPH; Eric Jutkowitz, PhD; Mary Butler, PhD, MBA; Howard A. Fink, MD, MPH; Edward Ratner, MD; Laura S. Hemmy, PhD; J. Riley McCarten, MD; Terry R. Barclay, PhD; Robert L. Kane, MD (†)

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Abstract

Background:

The prevalence of cognitive impairment and dementia is expected to increase dramatically as the population ages, creating burdens on families and health care systems.

Purpose:

To assess the effectiveness of physical activity interventions in slowing cognitive decline and delaying the onset of cognitive impairment and dementia in adults without diagnosed cognitive impairments.

Data Sources:

Several electronic databases from January 2009 to July 2017 and bibliographies of systematic reviews.

Study Selection:

Trials published in English that lasted 6 months or longer, enrolled adults without clinically diagnosed cognitive impairments, and compared cognitive and dementia outcomes between physical activity interventions and inactive controls.

Data Extraction:

Extraction by 1 reviewer and confirmed by a second; dual-reviewer assessment of risk of bias; consensus determination of strength of evidence.

Data Synthesis:

Of 32 eligible trials, 16 with low to moderate risk of bias compared a physical activity intervention with an inactive control. Most trials had 6-month follow-up; a few had 1- or 2-year follow-up. Evidence was insufficient to draw conclusions about the effectiveness of aerobic training, resistance training, or tai chi for improving cognition. Low-strength evidence showed that multicomponent physical activity interventions had no effect on cognitive function. Low-strength evidence showed that a multidomain intervention comprising physical activity, diet, and cognitive training improved several cognitive outcomes. Evidence regarding effects on dementia prevention was insufficient for all physical activity interventions.

Limitation:

Heterogeneous interventions and cognitive test measures, small and underpowered studies, and inability to assess the clinical significance of cognitive test outcomes.

Conclusion:

Evidence that short-term, single-component physical activity interventions promote cognitive function and prevent cognitive decline or dementia in older adults is largely insufficient. A multidomain intervention showed a delay in cognitive decline (low-strength evidence).

Primary Funding Source:

Agency for Healthcare Research and Quality.