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The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda

  • I. C. V. Thuné-Boyle (a1), S. Iliffe (a1), A. Cerga-Pashoja (a2), D. Lowery (a2) and J. Warner (a2)...


Background: Behavioral and psychological symptoms of dementia (BPSD) are common and are core symptoms of the condition. They cause considerable distress to the person with dementia and their carers and predict early institutionalization and death. Historically, these symptoms have been managed with anxiolytic and antipsychotic medication. Although potentially effective, such medication has been used too widely and is associated with serious adverse side-effects and increased mortality. Consequently, there is a need to evaluate non-pharmacological therapies for behavioral and psychological symptoms in this population. One such therapy is physical activity, which has widespread health benefits. The aim of this review is to summarize the current findings of the efficacy of physical activity on BPSD.

Method: Published articles were identified using electronic and manual searches. Rather than systematically aggregating data, this review adopted a rapid critical interpretive approach to synthesize the literature.

Results: Exercise appears to be beneficial in reducing some BPSD, especially depressed mood, agitation, and wandering, and may also improve night-time sleep. Evidence of the efficacy of exercise on improving other symptoms such as anxiety, apathy, and repetitive behaviors is currently weak or lacking.

Conclusion: The beneficial effect of exercise type, its duration, and frequency is unclear although some studies suggest that walking for at least 30 minutes, several times a week, may enhance outcome. The methodological shortcomings of current work in this area are substantial. The research and clinical implications of current findings are discussed.


Corresponding author

Correspondence should be addressed to: I. C. V. Thuné-Boyle, Research Department of Primary Care and Population Health, UCL Medical School, Royal Free Hospital Campus, Rowland Hill Street, London, NW3 2PF, UK. Phone: +44 (0)20 7794 0500, ext. 36724; Fax: +44 (0)20 7794 1224. Email:


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Aalten, P. et al. (2003). Behavioral symptoms in dementia: a factor analysis of the neuropsychiatric inventory. Dementia and Geriatric Cognitive Disorders, 15, 99105.
Alessi, C. A., Martin, J. L., Webber, A. P., Kim, E. C., Harker, J. O. and Josephson, K. R. (2005). Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents. Journal of the American Geriatrics Society, 53, 803810.
Alessi, C. A., Yoon, E. J., Schnelle, J. F., Al Samarrai, N. R. and Cruise, P. A. (1999). A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve? Journal of the American Geriatrics Society, 47, 784791.
Alzheimer's Society (2008). Dealing with Aggressive Behaviour: Factsheet 509. Available at:
Aman, E. and Thomas, D. R. (2009). Supervised exercise to reduce agitation in severely cognitively impaired persons. Journal of the American Medical Directors Association, 10, 271276.
Areosa, S. A., Sherriff, F. and McShane, R. (2005). Memantine for dementia. Cochrane Database for Systematic Reviews, 3, Art. No. CD003154. doi: 10.1002/14651858.CD003154.pub4. PMID 16034889.
Ballard, C. et al. (2005). Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial. British Medical Journal, 330, 874.
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, 8, 151157.
Banerjee, S. (2009). The Use of Antipsychotic Medication in People with Dementia: Time for Action. London: Department of Health.
Banerjee, S., Murray, J., Foley, B., Atkins, L., Schneider, J. and Mann, A. (2003). Predictors of institutionalization in people with dementia. Journal of Neurology, Neurosurgery and Psychiatry, 74, 13151316.
Boeve, B. F., Silber, M. H. and Ferman, T. J. (2002). Current management of sleep disturbances in dementia. Current Neurology and Neuroscience Reports, 2, 169177.
Bradley, K. M. et al. (2002). Cerebral perfusion SPET correlated with Braak pathological stage in Alzheimer's disease. Brain, 125, 1772–1781.
Cerga-Pashoja, A. et al. (2010). Evaluation of exercise on individuals with dementia and their carers: a randomised controlled trial. BMC Trials, 11, 53.
Cole, C. S. and Richards, K. C. (2006). Sleep in persons with dementia: increasing quality of life by managing sleep disorders. Journal of Gerontological Nursing, 32, 4853.
Deschenes, C. L. and McCurry, S. M. (2009). Current treatments for sleep disturbances in individuals with dementia. Current Psychiatry Reports, 11, 2026.
Dixon-Woods, M. et al. (2006). Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups. BMC Medical Research Methodology, 6, 35.
Donaldson, C., Tarrier, N. and Burns, A. (1998). Determinants of carer stress in Alzheimer's disease. International Journal of Geriatric Psychiatry, 13, 248256.
Edwards, K. and Larson, E. (1992). Benefits of exercise for older adults: a review of existing evidence and current recommendations for the general population. Clinics in Geriatric Medicine, 8, 3550.
Edwards, N., Gardiner, M., Ritchie, D. M., Baldwin, K. and Sands, L. (2008). Effect of exercise on negative affect in residents in special care units with moderate to severe dementia. Alzheimer Disease & Associated Disorders, 22, 362368.
Eggermont, L. H. P. and Scherder, E. J. A. (2006). Physical activity and behaviour in dementia: a review of the literature and the implications for psychosocial interventions in primary care. Dementia, 5, 411428.
Finkel, S., Silva, J. C. E., Cohen, G., Miller, S. and Sartorius, N. (1997). Behavioral and psychological signs and symptoms of dementia: a consensus statement on current knowledge and implications for research and treatment. International Journal of Geriatric Psychiatry, 12, 10601061.
Forbes, D., Forbes, S., Morgan, D. G., Markle-Reid, M., Wood, J. and Culum, I. (2009). Physical activity programs for persons with dementia. Cochrane Database for Systematic Reviews, 16, Art. No. CD006489.
Heyn, P., Abreu, B. C. and Ottenbacher, K. J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Archives of Physical Medicine and Rehabilitation, 85, 16941704.
Hokkanen, L., Rantala, L., Remes, A. M., Härkönen, B., Viramo, P. and Winblad, I. (2003). Dance/movement therapeutic methods in management of dementia. Journal of the American Geriatrics Society, 51, 576577.
Hope, T., Keene, J., McShane, R. H., Fairburn, C. G., Gedling, K. and Jacoby, R. (2001). Wandering in dementia: a longitudinal study. International Psychogeriatrics, 13, 137147.
Howard, R. J. et al. (2007). Donepezil for the treatment of agitation in Alzheimer's disease. New England Journal of Medicine, 357, 13821392.
Kverno, S. K., Black, B. S., Nolan, M. T. and Rabins, P. V. (2009). Research on treating neuropsychiatric symptoms of advanced dementia with non-pharmacological strategies, 1998–2008: a systematic review. International Psychogeriatrics, 21, 825843.
Lindsay, J. and Anderson, L. (2004). Dementia/Alzheimer's disease. BMC Women's Health, 4, S20.
Mather, A. S. (2002). Effect of exercise on depressive symptoms in older adults with poorly responsive depressive disorder: a randomised control trial. British Journal of Psychiatry, 180, 411415.
McCurry, S. M., Gibbons, L. E., Logsdon, R. G., Vitiello, M. V. and Teri, L. (2005). Nighttime insomnia treatment and education for Alzheimer's disease: a randomized, controlled trial. Journal of the American Geriatrics Society, 53, 793802.
McCurry, S. M., Reynolds, C. F., Ancoli-Israel, S., Teri, L. and Vitiello, M. V. (2000). Treatment of sleep disturbance in Alzheimer's disease. Sleep Medicine Reviews, 4, 603628.
Montgomery, P. and Dennis, J. A. (2002). Physical exercise for sleep problems in adults aged 60+. Cochrane Database of Systematic Reviews, 4, Art. CD003404. doi: 10.1002/14651858.
National Collaborating Centre for Mental Health (2007). Dementia: ANICESCIE Guideline on Supporting People with Dementia and their Carers in Health and Social Care. London: The British Psychological Society, The Royal College of Psychiatrists and Gaskell.
NICE (National Institute for Health and Clinical Excellence) (2006). Supporting People with Dementia and their Carers in Health and Social Care: CG42. London: National Institute for Health and Clinical Excellence.
Overshott, R. and Burns, A. (2005). Treatment of dementia. Journal of Neurology and Neurosurgery Psychiatry, 76, 5359.
Overshott, R., Byrne, J. and Burns, A. S. (2004). Nonpharmacological and pharmacological interventions for symptoms in Alzheimer's disease. Expert Review of Neurotherapeutics, 4, 809821.
Regan, C., Katona, C., Walker, Z. and Livingston, G. (2005). Relationship of exercise and other risk factors to depression of Alzheimer's disease: the LASER-AD study. International Journal of Geriatric Psychiatry, 20, 261268.
Richards, K. C., Beck, C., O'Sullivan, P. S. and Shue, V. M. (2005). Effect of individualized social activity on sleep in nursing home residents with dementia. Journal of the American Geriatrics Society, 53, 15101517.
Robinson, L. et al. (2006). A systematic literature review of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technology Assessment, 10, iii & ix–108.
Royal College of Psychiatrists, Faculty for the Psychiatry of Old Age (2006). Atypical Antipsychotics and Behavioral and Psychiatric Symptoms of Dementia: Prescribing Update for Old Age Psychiatrists. London: Royal College of Psychiatrists. Available at:
Schneider, L. S. et al. (2006). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 15251538.
Schur, D. and Whitlatch, C. J. (2003). Circumstances leading to placement: a difficult caregiving decision. Lippincotts Case Management, 8, 187195.
Shub, D., Darvishi, R. and Kunik, M. E. (2009). Non-pharmacologic treatment of insomnia in persons with dementia. Geriatrics, 64, 2226.
Siders, C. et al. (2004). Evidence for implementing nonpharmacological interventions for wandering. Rehabilitation Nursing, 29, 195206.
Steinberg, M., Sheppard Leoutsakos, J., Podewils, L. and Lyketsos, C. (2009). Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the maximising independence in dementia (MIND) study. International Journal of Geriatric Psychiatry, 24, 680685.
Teri, L., Logsdon, R. D. and McCurry, S. M. (2008). Exercise interventions for dementia and cognitive impairment: the Seattle Protocols. Journal of Nutrition, Health and Aging, 12, 391394.
Teri, L. et al. (2003). Exercise plus behavioral management in patients with Alzheimer's disease. Journal of the American Medical Association, 290, 20152022.
Vital, T., Hernandez, S., Gobbi, S., Costa, J. and Stella, F. (2010). Systematised physical activity and depressive symptoms in Alzheimer's dementia: a systematic review. Journal Brasileiro de Psiquiatria, 59, 5864.
Volicer, L., Simard, J., Pupa, J. H., Medrek, R. and Riordan, M. E. (2006). Effects of continuous activity programming on behavioral symptoms of dementia. Journal of the American Medical Directors Association, 7, 426431.
Williams, C. L. and Tappen, R. M. (2008). Exercise training for depressed older adults with Alzheimer's disease. Aging and Mental Health, 12, 7280.



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