A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. And the number of people who declined to participate in the study was high; more men than women participated, even though dementia is more common in women in western Europe.
For the latest study, researchers took 494 people in England who had been diagnosed with dementia, and assigned 329 of them to an exercise programme. We used a very specialized exercise program. We followed people up for much longer than most studies do.
The DAPA trial was funded by the National Institute for Health Research (NIHR) and received additional support from the NIHR Local Clinical Research Networks and NIHR Oxford CLAHRC and Biomedical Research Centre. The usual-care group had an average score of 23.8, compared with 25.2 for the exercise group (adjusted estimate -1.4, 95% confidence interval [CI] -2.6 to -0.2).
Currently, as a dementia therapy that does not involve medication, the NHS recommends group cognitive stimulation therapy classes, where sufferers undertake exercises created to improve their memory, problem-solving skills and language ability. Good exercise compliance was seen; more than 65 percent of participants attended more than 75% of scheduled sessions.
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The authors added, "These benefits do not, however, translate into improvements in cognitive impairment, activities in daily living, behaviour, or health-related quality of life".
Researchers at New York's Union College found older adults with mild cognitive impairment - often a precursor to Alzheimer's disease - showed significant improvement after playing video games that require physical exercise. The main (primary) outcome was an Alzheimer's disease assessment score (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, number of falls, and quality of life.
DAPA was designed as a superiority trial, and "whether the effect on cognitive impairment we observed is important is uncertain", the authors wrote.
This was clearly a disappointing result for the researchers, who were hoping exercise could be recommended as a treatment for people with dementia on the NHS.
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A surprising study by a team of United Kingdom researchers says people with dementia should avoid intense physical activities.
However, that does not mean other gentle exercise - such as walking or dancing - is not appropriate or helpful for people with dementia. Enjoyable activity, be it in the gym or elsewhere, is worthwhile in its own right, regardless of whether it slows people's dementia symptoms. This suggests the type of exercise programme may not have been particularly attractive, particularly to women with dementia.
Over the 12-month follow-up period, cognitive impairment declined in both groups.
"On this basis, I don't think we should ignore the possibility that exercise might actually be slightly harmful to people with dementia".
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