Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-23T06:57:41.271Z Has data issue: false hasContentIssue false
  • English
  • Français

The effectiveness of physical exercise interventions in the management of neuropsychiatric symptoms in dementia patients: a systematic review

Published online by Cambridge University Press:  05 April 2021

Komanthi Kouloutbani ,
Fotini Venetsanou ,
Alexandra Markati ,
Konstantinos E. Karteroliotis  and
Antonios Politis
Komanthi Kouloutbani
Affiliation:
School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni, Greece
Fotini Venetsanou
Affiliation:
School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni, Greece
Alexandra Markati
Affiliation:
School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni, Greece
Konstantinos E. Karteroliotis
Affiliation:
School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Dafni, Greece
Antonios Politis*
Affiliation:
Professor, First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
*
Correspondence should be addressed to: Antonios Politis, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave., 11528Athens, Greece. Phone: +302107289408-272; Fax: +302107242020. E-mail: apolitis@med.uoa.gr.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The management of neuropsychiatric symptoms (NPS) in patients with dementia is a major challenge. Since no effective therapy has been found to date and drug treatments are associatedwith significant side effects, there seems to be a pressing need for alternative non-pharmacological interventions.

Objectives:

The current study aims to investigate and compare the effect of different types of physical exercise on the NPS.

Methods:

A systematic review of the literature was conducted according to the PRISMA guidelines. Five databases (SCOPUS, PubMed, SPORT Discus, Web of science and ScienceDirect) were searched using the appropriate algorithm. What was sought out was randomized control trials (RCTs) that applied physical activity interventions with specific characteristics (type, frequency, intensity, and duration) in patients with dementia or mild cognitive impairment, studied the effect of exercise on their NPS and compared this effect with a control group that did not follow an exercise program.

Results:

From 512 articles, 13 studies were included in this review, involving a total of 1,925 patients. The results were analyzed and synthesized according to the type of exercise applied – aerobic exercise, multidimensional interventions and muscular strength training programs. In particular, the results showed that repetitive aerobic exercise three to five times a week had a positive effect on NPS, whereas multidimensional interventions combining different types of exercise did not appear to be as effective. Strength training programs have been found to significantly reduce depression symptoms and behavioral problems in demented patients with mobility problems.

Conclusions:

There is clear evidence that physical activity and especially aerobic exercise may be effective in the management of NPS. However, it is necessary to apply specific practical recommendations and specially designed programs to incorporate physical exercise into the daily routine of these patients.

Keywords

physical activitydementiaAlzheimer’s diseaseneuropsychiatric symptomsmild cognitive impairmentpsychosocial interventions
Type
Review Article
Information
International Psychogeriatrics , Volume 34 , Issue 2: Issue Theme: Technology, Virtual Reality, and Other Promising Interventions for Older Adults , February 2022 , pp. 177 - 190
Copyright
© International Psychogeriatric Association 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abd El Kader, S. M. and Al-Jiffri, O. H. (2016). Aerobic exercise improves quality of life, psychological well-being and systemic inflammation in subjects with Alzheimer’s disease. African Health Sciences, 16, 1045–1055. doi: 10.4314/ahs.v16i4.22.CrossRefGoogle ScholarPubMed
Ballard, C. and Cream, J. (2005). Drugs used to relieve behavioural symptoms in people with dementia or an unacceptable chemical cosh? International Psychogeriatrics, 17, 4–12. doi: 10.1017/S1041610205221026.CrossRefGoogle ScholarPubMed
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long term follow-up of a randomised placebo-controlled trial. The Lancet Neurology, 8, 151–157. doi: 10.1016/S1474-4422(08)70295-3.CrossRefGoogle ScholarPubMed
Cancela, J. M., Ayán, C., Varela, S. and Seijo, M. (2016). Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia. Journal of Science and Medicine in Sport, 19, 293–298. doi: 10.1016/j.jsams.2015.05.007.CrossRefGoogle ScholarPubMed
Chen, K-M., Kuo, C-C., Chang, Y-H., Huang, H-T. and Cheng, Y-Y. (2017). Resistance Band Exercises Reduce Depression and Behavioral Problems of Wheelchair-Bound Older Adults with Dementia: A Cluster-Randomized Controlled Trial. Journal of the American Geriatrics Society, 65, 356–363. doi: 10.1111/jgs.14526.CrossRefGoogle ScholarPubMed
Christie, G. J. et al. (2017). Do lifestyle activities protect against cognitive decline in aging? A review. Frontiers in Aging Neuroscience, 9, 381. doi: 10.3389/fnagi.2017.00381.CrossRefGoogle ScholarPubMed
Cummings, J. L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. A. and Gornbein, J. (1994). The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314. doi: 10.1212/WNL.44.12.2308.CrossRefGoogle ScholarPubMed
D’Amico, F. et al. (2016). Cost-effectiveness of exercise as a therapy for behavioural and psychological symptoms of dementia within the EVIDEM-E randomised controlled trial. International Journal of Geriatric Psychiatry, 31, 656–665. doi: 10.1002/gps.4376.CrossRefGoogle ScholarPubMed
de Oliveira, A. M. et al. (2015). Nonpharmacological interventions to reduce behavioral and psychological symptoms of dementia: a systematic review. BioMed Research International, 1–9. doi: 10.1155/2015/218980.Google ScholarPubMed
de Souto Barreto, P., Demougeot, L., Pillard, F., Lapeyre-Mestre, M. and Rolland, Y. (2015). Exercise training for managing behavioral and psychological symptoms in people with dementia: a systematic review and meta-analysis. Ageing Research Reviews, 24, 274–285. doi: 10.1016/j.arr.2015.09.001.CrossRefGoogle Scholar
Gilley, D. W., Bienias, J. L., Wilson, R. S., Bennett, D. A., Beck, T. L. and Evans, D. A. (2004). Influence of behavioral symptoms on rates of institutionalization for persons with Alzheimer’s disease. Psychological Medicine, 34, 1129–1135. doi: 10.1017/S0033291703001831.CrossRefGoogle ScholarPubMed
Hersch, E. C. and Falzgraf, S. (2007). Management of the behavioral and psychological symptoms of dementia. Clinical Interventions in Aging, 2, 611–621.10.2147/CIA.S1698CrossRefGoogle ScholarPubMed
Hoffmann, K. et al. (2016). Moderate-to-high intensity physical exercise in patients with Alzheimer’s disease: a randomized controlled trial. Journal of Alzheimer’s Disease, 50, 443–453. doi: 10.3233/JAD-150817.CrossRefGoogle ScholarPubMed
Hui, T. S., Wong, A. and Wijesinghe, R. (2016). A review on mortality risks associated with antipsychotic use in behavioral and psychologic symptoms of dementia (BPSD). The Mental Health Clinician, 6, 215–221. doi: 10.9740/mhc.2016.09.215.CrossRefGoogle Scholar
Hulme, C., Wright, J., Crocker, T., Oluboyede, Y. and House, A. (2010). Non-pharmacological approaches for dementia that informal carers might try or access: a systematic review. International Journal of Geriatric Psychiatry, 25, 756–763. doi: 10.1002/gps.2429.Google ScholarPubMed
Iliffe, S. et al. (2015). Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM). Programme Grants for Applied Research, 3. doi 10.3310/pgfar03030.CrossRefGoogle Scholar
Kales, H. et al. (2007). Mortality risk in patients with dementia treated with antipsychotics versus other psychiatric medications. American Journal of Psychiatry, 164, 1568–1576. doi: 10.1176/appi.ajp.2007.06101710.CrossRefGoogle ScholarPubMed
Kindermann, S. S., Dolder, C. R., Bailey, A., Katz, I. R. and Jeste, D. V. (2002). Pharmacological treatment of psychosis and agitation in elderly patients with dementia. Drugs & Aging, 19, 257–276.Google ScholarPubMed
Lamb, S. E. et al. (2018). Dementia and physical activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. BMJ, 361, k1675. doi: 10.1136/bmj.k1675.Google ScholarPubMed
Langoni, C. D. S. et al. (2019). The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial. Clinical Rehabilitation, 33, 439–449. doi: 10.1177/0269215518815218.CrossRefGoogle ScholarPubMed
Leng, M. et al. (2018). Effects of physical exercise on depressive symptoms in patients with cognitive impairment. A systematic review and meta-analysis. The Journal of Nervous and Mental Disease, 206, 809–823. doi: 10.1177/0269215518815218.Google ScholarPubMed
Liberati, A. et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 339, b2700. doi: 10.1136/bmj.b2700.CrossRefGoogle ScholarPubMed
Lowery, D. et al. (2014). The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. International Journal of Geriatric Psychiatry, 29, 819–827. doi: 10.1002/gps.4062.CrossRefGoogle ScholarPubMed
Lyketsos, C. G. (2007). Neuropsychiatric symptoms (behavioral and psychological symptoms of dementia) and the development of dementia treatments. International Psychogeriatrics, 19, 409–420. doi: 10.1017/S104161020700484X.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Lopez, O., Jones, B., Fitzpatrick, A. I., Breitner, J. and DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: results from the cardiovascular health study. JAMA, 288, 1475–1483. doi: 10.1001/jama.288.12.1475.CrossRefGoogle ScholarPubMed
Matura, S., Carvalho, A. F., Alves, G. S. and Pantel, J. (2016). Physical exercise for the treatment of neuropsychiatric disturbances in Alzheimer’s dementia: possible mechanisms, current evidence and future directions. Current Alzheimer Research, 13, 1112–1123.Google ScholarPubMed
Moher, D., Liberati, A., Tetzlaff, J. and Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Journal of Clinical Epidemiology, 62, 1006–1012. doi: 10.1371/journal.pmed.1000097.Google ScholarPubMed
Müller-Spahn, F. (2003). Behavioral disturbances in dementia. Dialogues in Clinical Neuroscience, 5, 49–59.Google ScholarPubMed
Neil, W. and Bowie, P. (2007). Career burden in dementia-assessing the impact of behavioural and psychological symptoms via self-report questionnaire. International Journal of Geriatric Psychiatry, 23, 60–64. doi: 10.1002/gps.1839.CrossRefGoogle Scholar
Nelson, M. E. et al. (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart association. Medicine & Science in Sports & Exercise, 39, 1435–1445. doi: 10.1249/mss.0b013e3180616aa2.Google ScholarPubMed
Ohman, H. et al. (2017). Effects of frequent and long-term exercise on neuropsychiatric symptoms in patients with Alzheimer’s disease – Secondary analyses of a randomized controlled trial (FINALEX). European Geriatric Medicine, 8, 153–157. doi: 10.1016/j.eurger.2017.01.004.CrossRefGoogle Scholar
Pitkälä, K., Savikko, N., Poysti, M., Strandberg, T. and Laakkonen, M. L. (2013). Efficacy of physical exercise intervention on mobility and physical functioning in older people with dementia: a systematic review. Experimental Gerontology, 48, 85–93. doi.org/10.1016/j.exger.2012.08.008.CrossRefGoogle ScholarPubMed
Plag, J. et al. (2014). Effect of combined cognitive-behavioural therapy and endurance training on cortisol and salivary alpha-amylase in panic disorder. Journal of Psychiatry Research, 58, 12–19. doi: 10.1016/j.jpsychires.2014.07.008.Google ScholarPubMed
Prince, M. J., Wimo, A., Guerchet, M M., Ali, G. C., Wu, Y-T. and Prima, M. (2015). World Alzheimer Report 2015 - The Glodal Impact of Dementia: An analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International.Google Scholar
Radak, Z, Hart, N, Sarga, L, Koltai, E, Atalay, M, Ohno, H. and Boldogh, I. (2010). Exercise plays a preventive role against Alzheimer’s disease. Journal of Alzheimer’s Disease, 20, 777–783. doi: 10.3233/JAD-2010-091531.CrossRefGoogle Scholar
Rolland, Y. et al. (2007). Exercise program for nursing home residents with Alzheimer’s disease: a 1-year randomized, controlled trial. Journal of the American Geriatrics Society, 55, 158–165. doi: 10.1111/j.1532-5415.2007.01035.x.CrossRefGoogle ScholarPubMed
Schulz, K. F., Altman, D. G. and Moher, D. (2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Journal of Pharmacology & Pharmacotherapeutics, 1, 100–107. doi: 10.4103/0976-500X.72352 CrossRefGoogle ScholarPubMed
Sobol, N. A. et al. (2018). Change in fitness and the relation to change in cognition and neuropsychiatric symptoms after aerobic exercise in patients with mild Alzheimer’s disease. Journal of Alzheimer’s Disease, 65, 137–145. doi: 10.3233/JAD-180253.CrossRefGoogle ScholarPubMed
Stella, F., Canonici, A. P., Gobbi, S., Santos-Galduroz, R. F., Cacao, J. C. and Gobbi, L. T. B. (2011). Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer’s disease by motor intervention: a controlled trial. Clinics, 66, 1353–1360. doi: 10.1590/S1807-59322011000800008.Google ScholarPubMed
Theleritis, C., Siarkos, K., Politis, A. A., Katirtzoglou, E. and Politis, A. (2017). A systematic review of non-pharmacological treatment for apathy in dementia. International Journal of Geriatric Psychiatry, 33, e177–e192. doi: 10.1002/gps.4783 CrossRefGoogle ScholarPubMed
Valentine, J. C., Pigott, T. D. and Rothstein, H. R. (2010). How many studies do you need? A primer on statistical power for meta-analysis. Journal of Educational and Behavioral Statistics, 35, 215–247.10.3102/1076998609346961CrossRefGoogle Scholar
Venturelli, M. et al. (2016). Effectiveness of exercise- and cognitive-based treatments on salivary cortisol levels and sundowning syndrome symptoms in patients with Alzheimer’s disease. Journal of Alzheimer’s Disease, 53, 1631–1640. doi: 10.3233/JAD-160392.CrossRefGoogle ScholarPubMed
Veronese, N., Solmi, M., Basso, C., Smith, L. and Soysal, P. (2018). Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: a narrative review. International Journal of Geriatric Psychiatry, 34, 1316–1325.10.1002/gps.4962CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2016). Defeating Alzheimer’s disease and other dementias: a priority for European science and society. The Lancet Neurology, 15, 455–532. doi: 10.1016/S1474-4422(16)00062-4.CrossRefGoogle ScholarPubMed
Woodhead, E. L., Zarit, S. H., Braungart, E. R., Rovine, M. R. and Femia, E. E. (2005). Behavioral and psychological symptoms of dementia: the effects of physical activity at adult day service centers. American Journal of Alzheimer’s Disease & Other Dementias, 20, 171–179. doi: 10.1177/153331750502000314.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Kouloutbani et al. supplementary material

Kouloutbani et al. supplementary material

Download Kouloutbani et al. supplementary material(PDF)
PDF 661.1 KB