Physical Activity for Executive Function and Activities of Daily Living in AD Patients: A Systematic Review and Meta-Analysis

Abstract

Objectives: The present study aimed to systematically analyze the effects of physical activity on executive function, working memory, cognitive flexibility, and activities of daily living (ADLs) in Alzheimer's disease (AD) patients and to provide a scientific evidence-based exercise prescription.Methods: Both Chinese and English databases (PubMed, Web of Science, the Cochrane Library, EMBASE, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were used as sources of data to search for randomized controlled trials (RCTs) published between January 1980 and December 2019 relating to the effects of physical activity on executive function, working memory, cognitive flexibility, and ADL issues in AD patients. Sixteen eligible RCTs were ultimately included in the meta-analysis.Results: Physical activity had significant benefits on executive function [standard mean difference (SMD) = 0.42, 95% confidence interval (CI) 0.22–0.62, p < 0.05], working memory (SMD = 0.28, 95% CI 0.11–0.45, p < 0.05), cognitive flexibility (SMD = 0.23, 95% CI −0.02 to 0.47, p < 0.01), and ADLs (SMD = 0.68, 95% CI 0.19–1.16, p < 0.05) among AD patients. Subgroup analysis indicated that, for executive function issues, more than 60 min per session for 16 weeks of moderate-to-high-intensity dual-task exercises or multimodal exercise had a greater effect on AD patients. For working memory and cognitive flexibility issues, 60–90 min of moderate-intensity dual-task exercises 1–4 times/week was more effective. For ADL issues, 30–90 min of multimodal exercise at 60–79% of maximal heart rate (MHR) 3–4 times/week had a greater effect on AD patients.Conclusions: Physical activity was found to lead to significant improvements in executive function, working memory, cognitive flexibility, and ADLs in AD patients and can be used as an effective method for clinical exercise intervention in these patients. However, more objective, scientific, and effective RCTs are needed to confirm this conclusion.

Physical Activity Improves Cognition and Activities of Daily Living in Adults with Alzheimer’s Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…Although many meta-analyses have indicated the effects of exercise on adults with AD [17,27,53], there are differences in selection criteria between our study and previous studies. Due to the different mechanisms of dementia, abnormal protein deposits may coexist with neuro-vasculature at different stages of dementia and influence brain function [54].…”

“…Therefore, we included participants with only Alzheimer's type of dementia in this current study. Some meta-analyses intended to target people with AD, but the actual analysis included people with different types of dementia [17,27,53]. Zhu et al conducted the meta-analysis by including both RCTs and non-RCTs, which directly increased the risk of bias [53].…”

Effect of Physical Exercise on Cognitive Function of Alzheimer's Disease Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trial

“…Several previous meta-analyses reported a significant positive effect of physical exercise interventions on attenuating a cognitive decline in patients with AD ( 57 – 59 ). The present study was consistent with using the MMSE test for significant positive effects of exercise on cognitive performance interventions.…”

Personalized treatment interventions: nonpharmacological and natural treatment strategies in Alzheimer’s disease

“…Systematic review of existing meta-analyses confirmed the beneficial potential of physical activity (such as aerobic exercise, cycle ergometer exercise, or brisk walking) for general cognition in AD patients [18]. Regular physical activity also improved executive function, working memory, and cognitive flexibility [19]. However, such advantages of physical activity on cognition in people with AD were not universal across studies (reviewed in [20]), probably owing to heterogeneous samples and methodologies, and the lack of standardized protocols.…”

“…In patients with AD, high-frequency interventions had no greater effects on cognition than low-frequency intervention [44]. In fact, the effect of lower intensity physical activity was better for executive functions and higher intensity physical activity for working memory, in patients with AD [19].…”