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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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P. A. Adlard , V. M. Perreau , V. Pop and C. W. Cotman (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

T. N. Akbaraly et al. (2009). Leisure activities and the risk of dementia in the elderly. Neurology, 73, 854861.

R. Andel , M. Crowe , N. L. Pedersen , L. Fratiglioni , B. Johansson and M. Gatz (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.

P. Barberger-Gateau et al. (2007). Dietary patterns and risk of dementia. Neurology, 69, 19211930.

J. A. Blumenthal et 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.

S. Borson , J. Scanlan , M. Brush , P. Vitaliano and A. Dokmak (2000). The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15, 10211027.

H. Brunnström , L. Gustafson , U. Passant and E. Englund (2009). Prevalence of dementia subtypes: a 30-year retrospective survey of neuropathological reports. Archives of Gerontology and Geriatrics, 49, 146149.

A. S. Buchman , P. A. Boyle , L. Yu , R. C. Shah , R. S. Wilson and D. A. Bennett (2012). Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology, 78, 13231329.

F. G. de M. Coelho , R. F. Santos-Galduroz , S. Gobbi , F. Stella , F. Gomes and D. M. Coelho (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

C. W. Cotman and N. C. Berchtold (2002). Exercise: a behavioural intervention to enhance brain health and plasticity. TRENDS in Neurosciences, 25, 295301.

C. W. Cotman and N. C. Berchtold (2007). Exercise builds brain health: key roles of growth factor cascades and inflammation. TRENDS in Neurosciences, 30, 464672.

J. C. De la Torre (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

T. Etgen , D. Sander , U. Huntgeburth , H. Poppert , H. Förstl and H. Bickel (2010). Physical activity and incident cognitive impairment in elderly persons: the INVADE study. Archives of Internal Medicine, 170, 186193.

L. Fratiglioni , H.-X. Wang , K. Ericsson , M. Maytan and B. Winblad (2000). Influence of social network on occurrence of dementia: a community-based longitudinal study. The Lancet, 355, 13151319

Y. Gu , J. Nieves and Y. Stern (2010). Food combination and Alzheimer disease risk: a protective diet. Archives of Neurology, 67, 699706. doi:10.1001/archneurol.2010.84.Food

J. Hardy and D. J. Selkoe (2002). The amyloid hypothesis of Alzheimer's disease: progress and problems on the road to therapeutics. Science, 297, 353356. doi:10.1126/science.1072994

C. Jagger , M. Clarke and A. Cook (1989). Mental and physical health of elderly people: five-year follow-up of a total population. Age and Ageing, 18, 7782.

R. N. Kalaria and C. Ballard (1999). Overlap between pathology of Alzheimer disease and vascular dementia. Alzheimer Disease and Associated Disorders, 13(Suppl 3), S115–S123.

E. Karran , M. Mercken and B. De Strooper (2011). The amyloid cascade hypothesis for Alzheimer's disease: an appraisal for the development of therapeutics. Nature Reviews Drug Discovery, 10, 698712.

G. Kemoun et 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

E. B. Larson et 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.

D. Laurin , R. Verreault , J. Lindsay , K. MacPherson and K. Rockwood (2001). Physical activity and risk of cognitive impairment and dementia in elderly persons. Archives of Neurology, 58, 498504.

H. Littbrand , M. Stenvall and E. Rosendahl (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

K. E. Nichol , A. I. Parachikova and C. W. Cotman (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

L. Palleschi et 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.

F. K. Penrose (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

J. J. Ratey and J. E. Loehr (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.

G. Ravaglia et al. (2008). Physical activity and dementia risk in the elderly. Neurology, 70 (19 Part 2), 17861794.

R. L. Rogers , J. S. Meyer and K. F. Mortel (1990). After reaching retirement age physical activity sustains cerebral perfusion and cognition. Journal of the American Geriatric Society, 38, 123128.

D. Royall et 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.

M. Steinberg , J.-M. S. Leoutsakos , L. J. Podewils and C. G. Lyketsos (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

A. Van de Winckel , H. Feys , W. De Weerdt and R. Dom (2004). Cognitive and behavioural effects of music-based exercises in patients with dementia. Clinical Rehabilitation, 18, 253260. doi:10.1191/0269215504cr750oa

B. M. van Gelder , M. A. Tijhuis , S. Kalmijn , S. Giampaoli , A. Nissinen and D. Kromhout (2004). Physical activity in relation to cognitive decline in elderly men: the FINE Study. Neurology, 63, 23162321.

M. Venturelli , R. Scarsini and F. Schena (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

J. Verghese et al. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348, 25082516. doi:10.1056/NEJMoa022252

M. W. Voss , L. S. Nagamatsu , T. Liu-Ambrose and A. F. Kramer (2011) Exercise, brain, and cognition across the life span. Journal of Applied Physiology, 111, 15051513.

A. Vreugdenhil , J. Cannell , A. Davies and G. Razay (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

E. Walker , A. V. Hernandez and M. W. Kattan (2008). Meta-analysis: its strengths and limitations. Cleveland Clinic Journal of Medicine, 75, 431439.

H.-X. Wang , A. Karp , B. Winblad and L. Fratiglioni (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.

L. Yágüez , K. N. K. Shaw , R. Morris and D. Matthews (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

F. Yu and A. Kolanowski (2009). Facilitating aerobic exercise training in persons with Alzheimer's disease. Geriatric Nursing, 30, 250259

F. Yu , K. Savik , J. F. Wyman and U. G. Bronas (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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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
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