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The effect of exercise interventions on cognitive outcome in Alzheimer's disease: a systematic review

  • Nicolas Farina (a1), Jennifer Rusted (a1) and Naji Tabet (a2)



Non-pharmacological interventions may have a role in both the prevention and slowing down of disease progression in Alzheimer's disease (AD). The role of exercise in disease prevention, for example, has been extensively evaluated in large epidemiological studies. Much less is known about the potential benefit of exercise in patients already diagnosed with AD. It was therefore the aim of this systematic review to assess the effectiveness of exercise in attenuating cognitive decline within AD.


A systematic review was conducted statistically accompanied by a meta-analysis. Publications between January 1991 and October 2012 were identified by searching the electronic databases PubMed, Science Direct, Web of Knowledge, and PsychINFO. Selected studies required AD patients to take part in an exercise-based randomized controlled trial (RCT) and have a cognitive outcome measure.


Six RCTs were identified that exclusively considered the effect of exercise in AD patients. Exercise generally had a positive effect on rate of cognitive decline in AD. A meta-analysis found that exercise interventions have a positive effect on global cognitive function, 0.75 (95% CI = 0.32–1.17).


From the six studies reviewed, the evidence suggests that exercise can have a positive effect on rate of cognitive decline in AD. However, the variation between study designs makes conclusions regarding the optimum intervention on cognitive outcome in AD difficult. Well-designed and powered RCTs are still needed to ascertain the efficacy of exercise in slowing down cognitive impairment in AD patients. However, a positive initial indication for exercise efficacy justifies such efforts.


Corresponding author

Correspondence should be addressed to: Nicolas Farina, School of Psychology, University of Sussex, Brighton, BN1 9QH, UK. Phone: +44 (0)1273-872776. Email:


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Adlard, P. A., Perreau, V. M., Pop, V. and Cotman, C. W. (2005). Voluntary exercise decreases amyloid load in a transgenic model of Alzheimer's disease. The Journal of Neuroscience, 25, 42174221. doi:10.1523/JNEUROSCI.0496-05.2005
Akbaraly, T. al. (2009). Leisure activities and the risk of dementia in the elderly. Neurology, 73, 854861.
Andel, R., Crowe, M., Pedersen, N. L., Fratiglioni, L., Johansson, B. and Gatz, M. (2008). Physical exercise at midlife and risk of dementia three decades later: a population-based study of Swedish twins. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 63, 6266.
Angevaren, M., Aufdemkampe, G., Verhaar, H. J., Aleman, A. and Vanhees, L. (2008). Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. The Cochrane Database of Systematic Reviews, CD005381.
Barberger-Gateau, al. (2007). Dietary patterns and risk of dementia. Neurology, 69, 19211930.
Blumenthal, J. al. (1991). Effects of exercise training on cardiorespiratory function in men and women older than 60 years of age. The American Journal of Cardiology, 67, 633639.
Borson, S., Scanlan, J., Brush, M., Vitaliano, P. and Dokmak, A. (2000). The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15, 10211027.
Brunnström, H., Gustafson, L., Passant, U. and Englund, E. (2009). Prevalence of dementia subtypes: a 30-year retrospective survey of neuropathological reports. Archives of Gerontology and Geriatrics, 49, 146149.
Buchman, A. S., Boyle, P. A., Yu, L., Shah, R. C., Wilson, R. S. and Bennett, D. A. (2012). Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology, 78, 13231329.
Coelho, F. G. de M., Santos-Galduroz, R. F., Gobbi, S., Stella, F., Gomes, F. and Coelho, D. M. (2009). Atividade física sistematizada e desempenho cognitivo em idosos com demência de Alzheimer: uma revisão sistemática. Revista Brasileira de Psiquiatria, 31, 163170. doi:10.1590/S1516-44462009000200014
Cotman, C. W. and Berchtold, N. C. (2002). Exercise: a behavioural intervention to enhance brain health and plasticity. TRENDS in Neurosciences, 25, 295301.
Cotman, C. W. and Berchtold, N. C. (2007). Exercise builds brain health: key roles of growth factor cascades and inflammation. TRENDS in Neurosciences, 30, 464672.
De la Torre, J. C. (2004). Is Alzheimer's disease a neurodegenerative or a vascular disorder? Data, dogma, and dialectics. Lancet neurology, 3, 184190. doi:10.1016/S1474-4422(04)00683-0
Etgen, T., Sander, D., Huntgeburth, U., Poppert, H., Förstl, H. and Bickel, H. (2010). Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Archives of Internal Medicine, 170, 186193.
Forbes, D., Forbes, S., Morgan, D. G., Markle-Reid, M., Wood, J. and Culum, I. (2008). Physical activity programs for persons with dementia. The Cochrane Database of Systematic Reviews, CD006489. doi:10.1002/14651858.CD006489.pub2
Fratiglioni, L., Wang, H.-X., Ericsson, K., Maytan, M. and Winblad, B. (2000). Influence of social network on occurrence of dementia: a community-based longitudinal study. The Lancet, 355, 13151319
Gu, Y., Nieves, J. and Stern, Y. (2010). Food combination and Alzheimer disease risk: a protective diet. Archives of Neurology, 67, 699706. doi:10.1001/archneurol.2010.84.Food
Hardy, J. and Selkoe, D. J. (2002). The amyloid hypothesis of Alzheimer's disease: progress and problems on the road to therapeutics. Science, 297, 353356. doi:10.1126/science.1072994
Hernandez, S., Coelho, F., Gobbi, S. and Stella, F. (2010). Effects of physical activity on cognitive functions, balance and risk of falls in elderly patients with Alzheimer's dementia. Revista Brasileira de Fisioterapia, 14, 6874.
Jagger, C., Clarke, M. and Cook, A. (1989). Mental and physical health of elderly people: five-year follow-up of a total population. Age and Ageing, 18, 7782.
Kalaria, R. (2002). Similarities between Alzheimer's disease and vascular dementia. Journal of the Neurological Sciences, 204, 2934.
Kalaria, R. N. and Ballard, C. (1999). Overlap between pathology of Alzheimer disease and vascular dementia. Alzheimer Disease and Associated Disorders, 13(Suppl 3), S115–S123.
Karran, E., Mercken, M. and De Strooper, B. (2011). The amyloid cascade hypothesis for Alzheimer's disease: an appraisal for the development of therapeutics. Nature Reviews Drug Discovery, 10, 698712.
Kemoun, al. (2010). Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dementia and Geriatric Cognitive Disorders, 29, 109114. doi:10.1159/000272435
Larson, E. al. (2006). Exercise is Associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine, 144, 7381.
Laurin, D., Verreault, R., Lindsay, J., MacPherson, K. and Rockwood, K. (2001). Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of Neurology, 58, 498504.
Littbrand, H., Stenvall, M. and Rosendahl, E. (2011). Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. American Journal of Physical Medicine and Rehabilitation/Association of Academic Physiatrists, 90, 495518. doi:10.1097/PHM.0b013e318214de26
Nichol, K. E., Parachikova, A. I. and Cotman, C. W. (2007). Three weeks of running wheel exposure improves cognitive performance in the aged Tg2576 mouse. Behavioural Brain Research, 184, 124–32. doi:10.1016/j.bbr.2007.06.027
Palleschi, al. (1996). Effect of aerobic training on the cognitive performance of elderly patients with senile dementia of Alzheimer type. Archives of Gerontology and Geriatrics, 22(Suppl. 5), 4750.
Penrose, F. K. (2005). Can exercise affect cognitive functioning in Alzheimer's disease? A review of the literature. Activities, Adaptation and Aging, 29, 1540. doi:10.1300/J016v29n04_02
Ratey, J. J. and Loehr, J. E. (2011). The positive impact of physical activity on cognition during adulthood: a review of underlying mechanisms, evidence and recommendations. Reviews in the Neurosciences, 22, 171185.
Ravaglia, al. (2008). Physical activity and dementia risk in the elderly. Neurology, 70 (19 Part 2), 17861794.
Rogers, R. L., Meyer, J. S. and Mortel, K. F. (1990). After reaching retirement age physical activity sustains cerebral perfusion and cognition. Journal of the American Geriatric Society, 38, 123128.
Royall, al. (2007). The cognitive correlates of functional status: a review from the Committee on Research of the American Neuropsychiatric Association. The Journal of Neuropsychiatry and Clinical Neurosciences, 19, 249265.
Steinberg, M., Leoutsakos, J.-M. S., Podewils, L. J. and Lyketsos, C. G. (2009). Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study. International Journal of Geriatric Psychiatry, 24, 680685. doi:10.1002/gps.2175
Thomas, H., Ciliska, D., Dobbins, M. and Micucci, S. (2004). A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing, 2, 9199.
Van de Winckel, A., Feys, H., De Weerdt, W. and Dom, R. (2004). Cognitive and behavioural effects of music-based exercises in patients with dementia. Clinical Rehabilitation, 18, 253260. doi:10.1191/0269215504cr750oa
van Gelder, B. M., Tijhuis, M. A., Kalmijn, S., Giampaoli, S., Nissinen, A. and Kromhout, D. (2004). Physical activity in relation to cognitive decline in elderly men: the FINE Study. Neurology, 63, 23162321.
Venturelli, M., Scarsini, R. and Schena, F. (2011). Six-month walking program changes cognitive and ADL performance in patients with Alzheimer. American Journal of Alzheimer's Disease and Other Dementias, 26, 381388. doi:10.1177/1533317511418956
Verghese, al. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348, 25082516. doi:10.1056/NEJMoa022252
Voss, M. W., Nagamatsu, L. S., Liu-Ambrose, T. and Kramer, A. F. (2011) Exercise, brain, and cognition across the life span. Journal of Applied Physiology, 111, 15051513.
Vreugdenhil, A., Cannell, J., Davies, A. and Razay, G. (2012). A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial. Scandinavian Journal of Caring Sciences, 26, 1219. doi:10.1111/j.1471-6712.2011.00895.x
Walker, E., Hernandez, A. V. and Kattan, M. W. (2008). Meta-analysis: its strengths and limitations. Cleveland Clinic Journal of Medicine, 75, 431439.
Wang, H.-X., Karp, A., Winblad, B. and Fratiglioni, L. (2002). Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen Project. American Journal of Epidemiology, 155, 10811087.
Yágüez, L., Shaw, K. N. K., Morris, R. and Matthews, D. (2010). The effects on cognitive functions of a movement-based intervention in patients with Alzheimer's type dementia: a pilot study. International Journal of Geriatric Psychiatry, 26, 173181. doi:10.1002/gps.2510
Yu, F. (2011). Guiding research and practice: a conceptual model for aerobic exercise training in Alzheimer's disease. American Journal of Alzheimer's Disease and Other Dementias, 26, 184194. doi:10.1177/1533317511402317
Yu, F. and Kolanowski, A. (2009). Facilitating aerobic exercise training in persons with Alzheimer's disease. Geriatric Nursing, 30, 250259
Yu, F., Savik, K., Wyman, J. F. and Bronas, U. G. (2011). Maintaining physical fitness and function in Alzheimer's disease: a pilot study. American Journal of Alzheimer's Disease and Other Dementias, 26, 406412. doi:10.1177/1533317511414861


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The effect of exercise interventions on cognitive outcome in Alzheimer's disease: a systematic review

  • Nicolas Farina (a1), Jennifer Rusted (a1) and Naji Tabet (a2)


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