HIGH INTENSITY EXERCISE DOES NOT DELAY COGNITIVE DECLINE IN MILD TO MODERATE DEMENTIA: RCT
Lamb SE., Mistry D., Lall R., Khan I., Dosanjh S., Petrou S., Sheehan B.
Abstract Several small trials suggest exercise may delay cognitive decline in people with Alzheimer’s, Vascular or Mixed dementia. In a multicentre trial (registration ISRCTN10416500,15 centres), we randomly assigned 494 people with mild or moderate dementia to either a 4-month supervised high intensity exercise training regime and on-going supported physical activity programme or usual care. All participants had a standardised Mini-Mental State Examination (sMMSE) score greater than 10. The primary outcome was the Alzheimer’s Disease Assessment Scale-cognitive (ADAS-cog) score at 12 months. Secondary outcomes were physical fitness, ADLs, neuropsychiatric symptoms, quality of life and health service resource use. We undertook pre-specified sub-group analyses and investigated impact on carers Baseline sample means were ADAS-cog 21 (SD 8.2); age 77 (SD 7.7) and 60% were men. Compliance with exercise classes was high and physical fitness improved. By 12 months, mean ADAS-cog was 25 (SD12.3) in the exercise group and 24 (SD 10.4) in the usual care group (adjusted between group difference -1.4 (95% CI -2.62,-0.17, p 0.026 higher score indicates worse cognition). Pre-randomisation disease type, sMMSE, physical status and gender were not significant sub-group factors. There were no significant differences in secondary or carer outcomes between groups. The exercise intervention was not cost effective. In this large, well conducted trial, high intensity exercise training did not reduce decline in cognition in mild to moderate dementia. Although physical fitness improved, the impacts on other important clinical outcomes was null and the intervention was not cost effective from a UK Health care perspective.