Effects of Multicomponent Exercise Training Program on Biochemical and Motor Functions in Patients with Alzheimer’s Dementia

Effects of Exercise Intervention on Functional Mobility among Older Adults with Cognitive Impairment: A Quantitative Evidence

OBJECTIVES

This meta-analysis aimed to assess the effect of exercise interventions on functional mobility among older adults with cognitive impairments such as dementia or mild cognitive impairment, followed by further investigation on the possible moderators of exercise-induced effects on this outcome.

DESIGN

A meta-analysis of controlled trials on exercise interventions reporting functional mobility outcomes was conducted. PubMed, Embase, EBSCO, SPORTDiscus, and Web of Science were searched for relevant studies published in English-language journals through July 2024.

SETTING AND PARTICIPANTS

Clinical and community settings across 15 countries, including a total of 1104 older adults with cognitive impairment, were involved in the study.

METHODS

We computed pooled effect sizes based on standardized mean difference (SMD) using the random-effects models. The subgroup analyses and meta-regression were conducted for multiple moderating variables (eg, exercise, sample, and study characteristics). The study quality was evaluated using the Physiotherapy Evidence Database Scale.

RESULTS

This meta-analysis finally included 22 studies. Results revealed that exercise interventions effectively improved functional mobility as compared with that of the control group (SMD, -0.42; 95% CI, -0.61 to -0.24; P < .001). Exercise intervention characteristics (ie, weekly training frequency and session duration) and sample characteristic (ie, percentage of women) moderated the exercise-induced effects on this interesting outcome. Subgroup analyses showed intervention with low frequency (1-2 times/wk) (SMD, -0.71; 95% CI, -1.01 to -0.42; P < .001) had a larger improvement in mobility, followed by medium frequency (SMD, -0.33; 95% CI, -0.56 to -0.10; P < .01). In addition, interventions with a session duration of > 60 minutes (SMD, -0.60; 95% CI, -0.84 to -0.36; P < .001) and 45 to 60 minutes (SMD, -0.60; 95% CI, -0.91 to -0.29; P < .001) had a significant improvement in mobility. Moreover, exercise training had a significant improvement in mobility for studies with a high percentage of women (SMD, -0.49; 95% CI, -0.67 to -0.31; P < .001).

CONCLUSIONS AND IMPLICATIONS

Exercise intervention is a promising way to improve functional mobility among older adults with cognitive impairment. Further evidence suggests that larger effects were observed in exercise intervention features of more than 45-minute session duration 1 to 3 times a week for at least 6 weeks regardless of exercise type. In addition, women benefit more from exercise interventions than men. Our study highlights that health care providers should prioritize integrating structured exercise programs into routine care for this population.

Twelve weeks of exercise training improves cognitive status, physical performance and quality of life in Alzheimer's disease: A systematic review and meta-analysis

Alzheimer's disease (AD) is a progressive neurodegenerative disorder in which there is slow and gradual impairment of mental function. Considering the increase in cases due to population aging, the potential benefits of physical training in AD are of great importance and need further elucidation. This study aims to identify the impact of physical training on crucial aspects of AD such as cognitive status, physical performances, quality of life and activities of daily living. The bibliographic research was conducted according to the guidelines outlined in PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). After the selection process, 26 studies were included in the systematic review and meta-analysis. Physical training for up to 12 weeks had a moderate effect on the cognitive status (SMD: 0.34; 95 % CI: 0.07-0.61; p = 0.016), the physical performance (SMD: 0.75; 95 % CI: 0.43-1.06; p = 0.000) and the quality of life (SMD: 0.40; 95 % CI: 0.17-0.63; p = 0.567) of patients with AD, but did not affect their daily living activities (SMD: -0.10; 95 % CI: -0.31-0.12; p = 0.621). Physical training lasting from 16 to 24 weeks had a moderate effect only on the physical performance (SMD: 0.51; 95 % CI: 0.23-0.79; p = 0.000) of patients. Physical training for up to 12 weeks already leads to gains on the cognition, the physical performance and the quality of life of individuals with AD. Beyond the available evidence on health promotion resulting from physical training, guidelines should be established to define ideal training loads for patients with AD. Specific practical recommendations concerning the types, frequency, intensity or duration of physical exercise that may be the most efficient for ameliorating cognition, physical performance and quality of life of individuals with AD are still unclear.

A systematic review of lifestyle-based interventions for managing Alzheimer's disease: Insights from randomized controlled trials

BACKGROUND

Alzheimer's disease (AD) presents a significant challenge in healthcare, prompting exploration into non-pharmacological interventions to complement traditional treatments.

OBJECTIVE

This systematic review explores the efficacy of lifestyle-based interventions in managing AD.

METHODS

A comprehensive literature search was conducted in PubMed, Web of Science, and Scopus between 2018 and 2023, selecting randomized controlled trials examining factors such as exercise, diet, stress, and cognitive training in AD patients.

RESULTS

The review revealed physical exercise as the predominant non-pharmacological intervention, accompanied by dietary modifications, cognitive training, and therapies such as mindfulness and music. While exercise demonstrated improvements in quality of life, its cognitive benefits were limited. Modified diets, such as Atkins and ketogenic, displayed inconsistent effects on cognitive function but influenced other health-related parameters. Additionally, probiotic therapy and novel cognitive training technologies were explored.

CONCLUSIONS

Despite some interventions showing promise in enhancing cognitive function and slowing disease progression, uncertainties remain regarding the dose-response relationship, underlying mechanisms, and potential synergistic effects. Moreover, consideration of genetic and sex-based disparities is warranted. This synthesis underscores the need for further research to elucidate the nuances of non-pharmacological interventions in managing AD effectively.

PROSPERO REGISTRATION NUMBER

CRD42023432823.

Effects of multicomponent exercise nursing intervention in elderly stroke patients with frailty: a randomized controlled trial

This study examines how multicomponent exercise nursing interventions affect the state of frailty, daily activities, and quality of life in elderly stroke patients with frailty. A total of 125 elderly stroke patients with frailty were randomly assigned to either a control group (n = 62) or an intervention group (n = 63). The control group received standard nursing care, while the intervention group received a multicomponent exercise nursing intervention in addition to standard care. Patients were assessed using the FRAIL Frailty Scale, Modified Barthel Index (MBI), and Short Form Health Survey (SF-36) before the intervention, 4 weeks after the intervention, and 12 weeks after the intervention. Significant differences were observed between the two groups in terms of frailty status, activities of daily living, and quality of life (p < 0.05). The intervention group had lower scores on the FRAIL Frailty Scale and higher scores on the MBI and SF-36 compared to the control group at both 4 and 12 weeks after the intervention (p < 0.05). These findings suggest that multicomponent exercise nursing interventions can effectively reduce frailty and improve activities of daily living and quality of life in elderly stroke patients with frailty.

Incidence and Factors Associated with Falls in Older People in a Long-Term Care Facility: A Prospective Study in Taiwan

BACKGROUND

The effectiveness of applying a fall-risk assessment to prevent falls in residents of long-term care facilities has not been investigated.

METHODS

This prospective study enrolled elderly residents in a long-term care facility in Taiwan. Caregivers were provided with a health-status assessment and fall-risk data to enhance their fall-prevention practices. A multivariate analysis was performed to identify the factors associated with falls.

RESULTS

A total of 123 subjects, including 68 and 55 for general and nursing-care models, respectively, were assessed. Their health status and risk of falls were provided to the care units to enhance their fall-prevention practices. Subjects in the nursing-care model had more dementia and more prescribed medications, worse physiologic conditions, and higher fall risk. Of them, 28 (23%) had subsequent falls. A univariate analysis showed that those with and without falls were similar in demographic characteristics, prescribed medications, physiologic function, and fall risk. There was a tendency for more falls in the nursing-care model residents (accounting for 61% of those who fell; p = 0.053). A regression analysis showed that gender (beta = 1.359; 95% confidence interval = 0.345-2.374; p = 0.010) and NPI score (beta = 0.101; 95% CI = 0.001-0.200; p = 0.047) were associated with the risk of falls.

CONCLUSION

Residents at the long-term care facility had a significant risk of falls despite knowledge of their fall risk and the implementation of preventive measures. In this context of being aware of the risk, gender, and psychiatric symptoms were significantly associated with falls. Caregivers at long-term care facilities should implement further measures to prevent falls based on behavioral and psychological symptoms.

The impact of exercise on Alzheimer's disease progression

INTRODUCTION

The preventive effects of chronic physical exercise (CPE) on Alzheimer's disease (AD) are now admitted by the scientific community. Curative effects of CPE are more disputed, but they deserve to be investigated, since CPE is a natural non-pharmacological alternative for the treatment of AD.

AREAS COVERED

In this perspective, the authors discuss the impact of CPE on AD based on an exhaustive literature search using the electronic databases PubMed, ScienceDirect and Google Scholar.

EXPERT OPINION

Aerobic exercise alone is probably not the unique solution and needs to be complemented by other exercises (physical activities) to optimize the slowing down of AD. Anaerobic, muscle strength and power, balance/coordination and meditative exercises may also help to slow down the AD progression. However, the scientific evidence does not allow a precise description of the best training program for patients with AD. Influential environmental conditions (e.g. social relations, outdoor or indoor exercise) should also be studied to optimize training programs aimed at slowing down the AD progression.

Remediation of cognitive and motor functions in Tunisian elderly patients with mild Alzheimer's disease: implications of music therapy and/or physical rehabilitation

The purpose of this study was to compare the effects of music therapy (MT) and/or physical rehabilitation (PR) on cognitive and motor function in elderly Tunisian male and female patients with mild Alzheimer's disease (AD). Male patients (N: 16; age: 74.19 ± 4.27 years; weight: 76.71 ± 5.22 kg) and female patients (N: 12; age: 71.46 ± 3.36 years; weight: 67.47 ± 4.31 kg) with mild AD were randomly assigned into 4 groups including control group (Co), PR group participated in physical rehabilitation, MT group received music therapy and MT + PR received both music therapy and physical rehabilitation. Participants were required to engage in the study for four months with three 60-min sessions per week. We found all scores of cognitive (MMSE, ADAS-Cog Total and the ADAS-Cog Memory subscale) and motor functions (step length, walking speed, 6MVT and BBS score) evaluated were the greatest in MT + PR compared to the other groups. Our study also demonstrated that MT has a greater effect on cognitive function, while PR has a more pronounced effect on motor function. Changes in MMSE scores were significantly positively correlated in the PR, MT and MT + PR groups with improvements in all motor functions including step length (r = 0.77), walking speed (r = 0.73), 6MVT (r = 0.75) and BBS scores (r = 0.78) in AD patients. In conclusion, the combination of MT and PR seems to be an appropriate intervention approach that needs consideration as a treatment strategy for elderly male and female patients with mild AD.

Effects of a Physical Activity Program that Incorporates Exercises Targeting Balance, Strength, and Proprioception on Cognitive Functions and Physical Performance in Old Adults with Mild Cognitive Impairment

BACKGROUND

Aging often leads to cognitive function decline, sensory structure deterioration, and musculoskeletal system weakening. This impacts postural control during static and dynamic activities like walking, increasing the fall risk among the elderly. Older adults with mild cognitive impairment (MCI) face an elevated fall risk and cognitive decline, magnifying the public health concern.

OBJECTIVE

This study aimed to explore solutions by investigating the effects of a multi-component physical activity program on cognitive and motor functions in MCI patients.

METHODS

Twenty-three participants were enrolled in the study and assigned into two groups: an intervention group (n = 13; age = 85.7±5.5 years) and a control group (n = 9; age = 85±6.7 years). The study spanned two months, with participants engaging in three 60-minute weekly physical exercise sessions. The intervention focused on improving proprioception, muscle strength, and balance.

RESULTS

Results demonstrated significant enhancements in physical performance, fall risk reduction, and balance (p < 0.05). Various tests, including the timed up and go test, Unipedal Stance test, Tinetti test, Short Physical Performance Battery, and 6-minute walking test, indicated these improvements. Cognitive function was evaluated with the Mini-Mental State Examination, revealing non-significant progress (p > 0.05). Predictive models for outcomes were developed using linear regression analysis during the follow-up stage.

CONCLUSIONS

This study underscores the effectiveness of a multi-component physical activity program encompassing balance, proprioception, and muscle-strengthening exercises as a non-pharmaceutical approach in improving balance skills and playing a key role in mitigating the risk of falls among old adults with MCI.

Effects of aerobic exercise training in oxidative metabolism and mitochondrial biogenesis markers on prefrontal cortex in obese mice

BACKGROUND

To evaluate the effects of 8 weeks of Aerobic Physical Training (AET) on the mitochondrial biogenesis and oxidative balance in the Prefrontal Cortex (PFC) of leptin deficiency-induced obese mice (ob/ob mice).

METHODS

Then, the mice were submitted to an 8-week protocol of aerobic physical training (AET) at moderate intensity (60% of the maximum running speed). In the oxidative stress, we analyzed Malonaldehyde (MDA) and Carbonyls, the enzymatic activity of Superoxide Dismutase (SOD), Catalase (CAT) and Glutathione S Transferase (GST), non-enzymatic antioxidant system: reduced glutathione (GSH), and Total thiols. Additionally, we evaluated the gene expression of PGC-1α SIRT-1, and ATP5A related to mitochondrial biogenesis and function.

RESULTS

In our study, we did not observe a significant difference in MDA (p = 0.2855), Carbonyl's (p = 0.2246), SOD (p = 0.1595), and CAT (p = 0.6882) activity. However, the activity of GST (p = 0.04), the levels of GSH (p = 0.001), and Thiols (p = 0.02) were increased after 8 weeks of AET. Additionally, there were high levels of PGC-1α (p = 0.01), SIRT-1 (p = 0.009), and ATP5A (p = 0.01) gene expression after AET in comparison with the sedentary group.

CONCLUSIONS

AET for eight weeks can improve antioxidant defense and increase the expression of PGC-1α, SIRT-1, and ATP5A in PFC of ob/ob mice.