Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older Exercise is medicine, for the body and the brain A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment–ThinkingFit: pilot and feasibility study for a randomized controlled trial Affecting Cognition and Quality of Life via Aerobic Exercise in Alzheimer's Disease Twelve-week physical and leisure activity programme improved cognitive function in community-dwelling elderly subjects: a randomized controlled trial. Physical activity and risk of cognitive impairment and dementia in elderly persons. Multiple Biological Pathways Link Cognitive Lifestyle to Protection from Dementia Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial Would Older Adults with Mild Cognitive Impairment Adhere to and Benefit from a Structured Lifestyle Activity Intervention to Enhance Cognition?: A Cluster Randomized Controlled Trial A community-based exercise programme to improve functional ability in people with Alzheimer's disease: a randomized controlled trial. Higher levels of objectively measured sedentary behavior is associated with worse cognitive ability: Two-year follow-up study in community-dwelling older adults Leisure-time physical activity at midlife and the risk of dementia and Alzheimer's disease Poor Aerobic Fitness May Contribute to Cognitive Decline in HIV-infected Older Adults. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. Cognitive change is more positively associated with an active lifestyle than with training interventions in older adults at risk of dementia: a controlled interventional clinical trial On Your Feet to Earn Your Seat: pilot RCT of a theory-based sedentary behaviour reduction intervention for older adults
Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores Cognitive decline is one of the most pressing healthcare issues of the 21st century . Worldwide , one new case of major cognitive decline ( ie , dementia ) is detected every 4 s.1 Given that no effective pharmacological treatment to alter the progress of cognitive decline exists , there is much interest in lifestyle approaches for preventing or treating dementia . Ideally , such strategies should be cost-efficient and widely accessible at a societal level to have the largest benefit for older adults with varying income and functional status levels . One attractive solution that aligns with the above criteria is exercise . However , despite a large and consistent pool of evidence generated over the past five decades linking exercise to improved cognitive functions in older adults,2 there is a reluctance among academics , healthcare practitioners and the public alike to embrace exercise as a prevention and treatment strategy for cognitive decline . For example , the National Institutes of Health ( NIH ) consensus statement from 20103 concedes that there appears to be preliminary data to support the efficacy of exercise in improving cognitive function . However , they caution that there is currently no strong evidence to suggest that modifiable lifestyle factors can alter the trajectory of cognitive decline . Adding fuel to the fire are publications such as a 2013 systematic review of r and omised controlled trials ( RCTs ) ( prior to 31 October 2011 ) reporting ‘ weak ’ evidence for the effects of exercise on cognition.4 We must highlight that the search strategy used in that systematic review failed to capture many pertinent papers providing evidence from RCTs that exercise  promotes cognitive and brain plasticity not only in healthy older adults but also in those with cognitive impairment . Furthermore , there are a number of animal studies that provide insight into the molecular and cellular mechanisms by which exercise  promotes neuroplasticity.5 In a previous commentary , Background Dementia affects 35 million people worldwide and is currently incurable . Many cases may be preventable because regular participation in physical , mental and social leisure activities during middle age is associated with up to 47 % dementia risk reduction . However , the majority of middle-aged adults are not active enough . MCI is therefore a clear target for activity interventions aim ed at reducing dementia risk . An active lifestyle during middle age reduces dementia risk but it remains to be determined if increased activity reduces dementia risk when MCI is already evident . Before this can be investigated conclusively , complex multimodal activity programmes are required that ( 1 ) combine multiple health promoting activities , ( 2 ) engage people with MCI , and ( 3 ) result in sufficient adherence rates . Methods We design ed the ThinkingFit programme to engage  people with MCI  in a complex intervention comprised of three activity components : physical activity , group-based cognitive stimulation ( GCST ) and individual cognitive stimulation ( ICST ) . Engagement and adherence was promoted by applying specific psychological techniques to enhance behavioural flexibility in an early pre-phase and during the course of the intervention . To pilot the intervention , participants served as their own controls during a 6- to 12-week run-in period , which was followed by 12 weeks of activity intervention . Results Out of 212 MCI patients screened , 163 were eligible , 70 consented and 67 completed the intervention ( mean age 74 years ) .  Activity adherence rates were high : physical activity = 71 % ; GCST = 83 % ; ICST = 67 % . Significant treatment effects ( p < .05 ) were evident on physical health outcomes ( decreased BMI and systolic blood pressure , [ pre/post values of 26.3/25.9 kg/m2 and 145/136 mmHg respectively ] ) , fitness ( decreased resting and recovery heart rate [ 68/65 bpm and 75/69 bpm ] ) , and cognition ( improved working memory [ 5.3/6.3 items ] ) . Conclusions We found satisfactory recruitment , retention and engagement rates , coupled with significant treatment effects in elderly MCI patients . It appears feasible to conduct r and omized controlled trials of the dementia prevention potential of complex multimodal activity programmes like ThinkingFit . Trial registration Clinical Trials.gov registration nr : NCT01603862 ; date : 17/5/2012 Aerobic exercise is a promising behavioral therapy for Alzheimer ’s disease ( AD ) , yet few studies have investigated the effect of aerobic exercise on cognition in AD . The purpose of this pilot study was to examine the effect of 6-month aerobic exercise on the change in executive function , global cognition , quality of life ( QOL ) , and depression in community-dwelling older adults with mild to moderate AD . A single group , repeated measures design with outcomes measured at baseline , 3 months , and 6 months was used . Results show that there were no significant changes in any measures except for depression ( p = .026 ) . There was a trend toward improvement in executive function and QOL with moderate effect sizes ( ESs ) and a trend toward deterioration in global cognition with moderate to large ESs . R and omized controlled trials are needed to evaluate the therapeutic effect of aerobic exercise in older adults with AD BACKGROUND Japan is one of the most rapidly ageing societies in the world . A number of municipalities have started services for the prevention of cognitive decline for community-dwelling elderly individuals , but the effectiveness of these services is currently insufficient . Our study explored the efficacy of a comprehensive intervention programme consisting of physical and leisure activities to prevent cognitive decline in community-dwelling elderly subjects . METHOD We administered a 12-week intervention programme consisting of physical and leisure activities aim ed at enhancing participants ' motivation to participate and support one another by providing a pleasant atmosphere , empathetic communication , praise , and errorless support . This programme for the prevention of cognitive decline was conducted as a service by the city of Maebashi . All participants underwent the Five-Cog test , which evaluated the cognitive domains of attention , memory , visuospatial function , language , and reasoning . Executive function was evaluated by the Wechsler Digit Symbol Substitution Test and Yamaguchi Kanji-Symbol Substitution Test . Subjective health status , level of social support , functional capacity , subjective quality of life , and depressive symptoms were assessed with a question naire . Grip strength test , timed up- and -go test , 5-m maximum walking times test , and functional reach test were performed to evaluate physical function . Fifty-two participants were r and omly allocated to  intervention ( n = 26 ) and control ( n = 26 ) groups . Twenty-six participants , aged between 65 - 87 years , received intervention once a week at a community centre . The programme was conducted by health-care professionals , with the help of senior citizen volunteers . RESULTS The intervention group ( n = 19 ) showed significant improvement on the analogy task of the Five-Cog test ( F(1,38 ) = 4.242 , P = 0.046 ) and improved quality of life ( F(1,38 ) = 4.773 , P = 0.035 ) as compared to the control group ( n = 24 ) . CONCLUSION A community-based 12-week intervention programme that aim ed to enhance motivation to participate in activities result ed in improvements in some aspects of cognitive function and quality of life .  Senior citizens who volunteered in the present intervention enabled the smooth implementation of the programme and alleviated the burden on professional staff CONTEXT Dementia is common , costly , and highly age related . Little attention has been paid to the identification of modifiable lifestyle habits for its prevention . OBJECTIVE To explore the association between physical activity and the risk of cognitive impairment and dementia .  DESIGN , SETTING , AND SUBJECTS Data come from a community sample of 9008 r and omly selected men and women 65 years or older , who were evaluated in the 1991 - 1992 Canadian Study of Health and Aging , a prospect i ve cohort study of dementia . Of the 6434 eligible subjects who were cognitively normal at baseline , 4615 completed a 5-year follow-up .  Screening and clinical evaluations were done at both waves of the study . In 1996 - 1997 , 3894 remained without cognitive impairment , 436 were diagnosed as having cognitive impairment-no dementia , and 285 were diagnosed as having dementia . MAIN OUTCOME MEASURE Incident cognitive impairment and dementia by levels of physical activity at baseline . RESULTS Compared with no exercise , physical activity was associated with lower risks of cognitive impairment , Alzheimer disease , and dementia of any type . Significant trends for increased protection with greater physical activity were observed . High levels of physical activity were associated with reduced risks of cognitive impairment ( age- , sex- , and education-adjusted odds ratio , 0.58 ; 95 % confidence interval , 0.41 - 0.83 ) , Alzheimer disease ( odds ratio , 0.50 ; 95 % confidence interval , 0.28 - 0.90 ) , and dementia of any type ( odds ratio , 0.63 ; 95 % confidence interval , 0.40 - 0.98 ) . CONCLUSION Regular physical activity could represent an important and potent protective factor for cognitive decline and dementia in elderly persons BACKGROUND An active cognitive lifestyle is linked to diminished dementia risk , but the underlying mechanisms are poorly understood . Potential mechanisms include disease modification , neuroprotection , and compensation . Prospect i ve , population -based brain series provide the rare opportunity to test the plausibility of these mechanisms in humans . METHODS Participants came from the United Kingdom Medical Research Council Cognitive Function and Ageing Study , comprising 13,004 individuals aged over 65 years and followed for 14 years . In study 1 , a  Cognitive Lifestyle Score ( CLS )  was computed on all Cognitive Function and Ageing Study subjects to define low , middle , and high groups . By August 2004 , 329 individuals with CLS data had come to autopsy and underwent Consortium to Establish a Registry of Alzheimer 's Disease assessment . Study 2 involved more detailed quantitative histology in the hippocampus and Brodmann area 9 in 72 clinical ly matched individuals with high and low CLS . RESULTS CLS groups did not differ on several Alzheimer disease neuropathologic measures ; however , high CLS men had less cerebrovascular disease after accounting for vascular risk factors , and women had greater brain weight . No group differences were evident in hippocampal neuronal density . In Brodmann area 9 , cognitively active individuals had significantly greater neuronal density , as well as correlated increases in cortical thickness . CONCLUSIONS An active cognitive lifestyle was associated with protection from cerebrovascular disease in men , but there was no evidence for Alzheimer disease modification or hippocampal neuroprotection . Men and women both exhibited neurotrophic changes in the prefrontal lobe linked to cognitive lifestyle , consistent with a compensatory process . Lifespan complex cognitive activity may therefore protect against dementia through multiple biological pathways Abstract Objective To estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia . Design Multicentre , pragmatic , investigator masked , r and omised controlled trial . Setting National Health Service primary care , community and memory services , dementia research registers , and voluntary sector providers in 15 English regions . Participants 494 people with dementia : 329 were assigned to an aerobic and strength exercise programme  and 165 were assigned to usual care . R and om allocation was 2:1 in favour of the exercise arm . Interventions Usual care plus four months of supervised exercise and support for ongoing physical activity , or usual care only . Interventions were delivered in community gym facilities and NHS premises . Main outcome measures The primary outcome was score on the Alzheimer ’s disease assessment scale-cognitive subscale ( ADAS-cog ) at 12 months . Secondary outcomes included activities of daily living , neuropsychiatric symptoms , health related quality of life , and carer quality of life and burden . Physical fitness ( including the six minute walk test ) was measured in the exercise arm during the intervention . Results The average age of participants was 77 ( SD 7.9 ) years and 301/494 ( 61 % ) were men . By 12 months the mean ADAS-cog score had increased to 25.2 ( SD 12.3 ) in the exercise arm and 23.8 ( SD 10.4 ) in the usual care arm ( adjusted between group difference −1.4 , 95 % confidence interval −2.6 to −0.2 , P=0.03 ) . This indicates greater cognitive impairment in the exercise group , although the average difference is small and clinical relevance uncertain . No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type ( Alzheimer ’s disease or other ) , severity of cognitive impairment , sex , and mobility . Compliance with exercise was good . Over 65 % of participants ( 214/329 ) attended more than three quarters of scheduled sessions . Six minute walking distance improved over six weeks ( mean change 18.1 m , 95 % confidence interval 11.6 m to 24.6 m ) . Conclusion A moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia . The exercise training programme improved physical fitness , but there were no noticeable improvements in other clinical outcomes . Trial registration Current Controlled Trials IS RCT N10416500 Background Epidemiologic evidence suggests that cognitive and physical activities are associated with better cognition in late life . The present study was conducted to examine the possible benefits of four structured lifestyle activity interventions and compare their effectiveness in optimizing cognition for older adults with mild cognitive impairment ( MCI ) . Method and Findings This was a 12-month cluster r and omized controlled trial . 555 community-dwelling Chinese older adults with MCI ( 295 with multiple-domain deficits ( mdMCI ) , 260 with single-domain deficit ( sdMCI ) ) were recruited . Participants were r and omized into physical exercise ( P ) , cognitive activity ( C ) , integrated cognitive and physical exercise ( CP ) , and social activity ( S , active control ) groups . Interventions comprised of one-hour structured activities three times per week . Primary outcome was Clinical Dementia Rating sum of boxes ( CDR-SOB ) scores . Secondary outcomes included Chinese versions of Alzheimer ’s Disease Assessment Scale - Cognitive subscale ( ADAS-Cog ) , delayed recall , Mini-Mental State Examination , Category Verbal Fluency Test ( CVFT ) and Disability Assessment for Dementia – Instrumental Activities of Daily Living ( DAD-IADL ) . Percentage adherence to programs and factors affecting adherence were also examined . At 12th month , 423 ( 76.2 % ) completed final assessment . There was no change in CDR-SOB and DAD-IADL scores across time and intervention groups . Multilevel normal model and linear link function showed improvement in ADAS-Cog , delayed recall and CVFT with time ( p<0.05 ) . Post-hoc subgroup analyses showed that the CP group , compared with other intervention groups , had more significant improvements of ADAS-Cog , delayed recall and CVFT performance with sdMCI participants ( p<0.05 ) . Overall adherence rate was 73.3 % . Improvements in ADAS-Cog and delayed recall scores were associated with adherence after controlling for age , education , and intervention groups ( univariate analyses ) . Conclusions Structured lifestyle activity interventions were not associated with changes in everyday functioning , albeit with some improvements in cognitive scores across time . Higher adherence was associated with greater improvement in cognitive scores . Factors to enhance adherence should be specially considered in the design of psychosocial interventions for older adults with cognitive decline . Trial Registration Clinical Trials.gov RATIONALE Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains . This decline impacts not only on the person with dementia , but also on their informal carers and health and aged care systems . With the number of people with dementia rapidly increasing and few effective treatments , there is now a critical need for interventions to improve functional ability in those with the condition . AIMS AND OBJECTIVE This study assesses the effectiveness of a community-based home exercise programme in improving cognitive and physical function and independence in activities of daily living ( ADL ) in people with Alzheimer 's disease , the most common form of dementia . METHODS In a 4-month r and omized controlled trial , 40 community-dwelling patients diagnosed with Alzheimer 's disease and their informal carers were r and omly allocated to either the treatment ( exercise plus usual treatment ) or control ( usual treatment ) group . The exercise programme consisted of daily exercises and walking under the supervision of their carer . Patients were assessed at baseline and 4-months follow-up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using st and ardized assessment scales . RESULTS Sixteen men and 24 women diagnosed with Alzheimer 's disease participated in the study . They had a mean age of 74.1 years ( range 51 - 89 ) and a mean Mini Mental State Examination score of 22.0 ( range 10 - 28 ) , indicating mild to moderate dementia . At 4-months follow-up , patients who exercised , compared with controls , had improved cognition ( increased Mini Mental State Examination scores by 2.6 points , p < 0.001 ) , better mobility ( 2.9 seconds faster on Timed Up and Go , p = 0.004 ) and increased Instrumental Activities of Daily Living scores by 1.6 ( p = 0.007 ) . CONCLUSION This study suggests that participation in a community-based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimer 's disease Background : A number of cross‐sectional studies have suggested that higher levels of  sedentary behavior ( SB ) are associated with worse cognitive abilities  in older age . There is a paucity of longitudinal studies investigating this relationship utilizing objective ly assessed SB . This study investigated the relationship between objective ly assessed SB and future cognitive abilities in a cohort of older adults . Methods : A longitudinal study over 22.12 ± 1.46 months including 285 community‐dwelling older adults across 14 regions in Taiwan was undertaken . Cognitive ability was ascertained using a Chinese version of the Ascertain Dementia 8‐item Question naire ( AD8 ) and SB captured by 7 days accelerometer data . Multivariable negative binomial regression models adjusted for confounders were undertaken . Results : 274 community‐dwelling older adults finished the study ( age = 74.6 ± 6.2 , % female = 54.4 % ) . At baseline , 20.1 % ( n = 55 ) , 48.5 % ( n = 133 ) and 31.4 % ( n = 86 ) of the sample engaged in high ( 11 + h ) , medium ( 7–10.99 h ) and low ( < 7 h ) of SB respectively . In the fully adjusted model , higher levels of SB were associated with an increased risk of worse cognitive ability at follow up ( adjusted rate ratio (ARR)1.09 ( 95%CI:1.00–1.19 ) ) , with the strongest relationship evident in those engaging in over 11 h of SB ( ARR 2.27 ( 95%CI:1.24–4.16 ) ) . The relationship remained evident after adjusting for depressive symptoms and physical activity . Conclusion : Our data suggests that objective ly assessed SB , particularly when over 11 h a day , is independently associated with worse cognitive ability over a two year period . Our data adds to the pressing reasons to reduced SB in older age . HighlightsFirst prospect i ve study to investigate objective  ly sedentary behavior ( SB ) and cognition in older adults . Higher levels of objective SB were independently associated with worse cognitive ability over two years . This relationship was most pronounced in older people spending over 11 h a day being sedentary BACKGROUND Physical activity may help maintain cognitive function and decrease dementia risk , but epidemiological findings remain controversial . The aim of our study was to investigate the association between leisure-time physical activity at midlife and the subsequent development of dementia and Alzheimer 's disease ( AD ) . METHODS Participants were r and omly selected from the survivors of a population -based cohort previously surveyed in 1972 , 1977 , 1982 , or 1987 . 1449 persons ( 72.5 % ) age 65 - 79 years participated in the re-examination in 1998 ( mean follow-up , 21 years ) . 117 persons had dementia and 76 had AD .  Multiple logistic regression methods were used to analyse the association between leisure-time physical activity and dementia or AD . FINDINGS Leisure-time physical activity at midlife at least twice a week was associated with a reduced risk of dementia and AD ( odds ratio [ OR ] 0.48 [ 95 % CI 0.25 - 0.91 ] and 0.38 [ 0.17 - 0.85 ] , respectively ) , even after adjustments for age , sex , education , follow-up time , locomotor disorders , APOE genotype , vascular disorders , smoking , and alcohol drinking . The associations were more pronounced among the APOE epsilon4 carriers . INTERPRETATION Leisure-time physical activity at midlife is associated with a decreased risk of dementia and AD later in life . Regular physical activity may reduce the risk or delay the onset of dementia and AD , especially among genetically susceptible individuals The HIV-infected older adult ( HOA ) community is particularly vulnerable to cognitive impairment . Previous studies in the general older adult population have reported that lower scores on tests of cognitive function often correlate negatively with aerobic fitness [ 5 - 7 ] . HIV-infected individuals have significantly reduced aerobic fitness and physical function compared to HIV-uninfected individuals . Determining important correlates of cognitive ability may be beneficial in not only detecting precursors to future cognitive impairments , but also target areas for interventions . The purpose of this study was to investigate the relationship between cognitive ability and aerobic fitness in HIV-infected older adults . We conducted a cross-sectional study of HOA on antiretroviral therapy ( ART ) > 50 years of age . Domain specific cognitive function was assessed by means of a neuropsychological battery . Aerobic fitness ( VO2peak ) was assessed using a grade d , progressive treadmill test .  Thirty-seven HOA on ART ( mean±SD : age 59±6 years , BMI 28±5 , CD4 663±337 cells/ml , duration since HIV diagnosis 17±7 years ; 81 % males ) completed the cognitive tests . Several domains of cognition were significantly associated with VO2peak by Spearman correlation analysis ( p<0.05 ) . By step-wise adjusted regression VO2peak was most frequently and significantly related to many cognitive domains such as verbal and visual memory , visual perception , and language ( p<0.05 ) . We found that participants with higher Vo2peak were less likely to have more severe forms of HIV-associated neurocognitive disorders ( H AND ) such as mild neurocognitive disorder ( OR=0.65 ; p=0.01 ) and HIV-associated dementia ( OR=0.64 ; p=0.0006 ) . In HOA and in conclusion , aerobic fitness is related to cognitive performance on various tasks . The likelihood of cognitive impairment increased with lower fitness levels . Therefore , increased fitness may serve an important factor in maintenance of cognition and neural integrity for aging HIV-infected individuals . Future prospect i ve and large scale studies are needed to evaluate the effect of fitness and vascular stiffness and function on cognition and brain structure among HOA BACKGROUND Modifiable vascular and lifestyle-related risk factors have been associated with dementia risk in observational studies . In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability ( FINGER ) , a proof-of-concept r and omised controlled trial , we aim ed to assess a multidomain approach to prevent cognitive decline in at-risk elderly people from the general population . METHODS In a double-blind r and omised controlled trial we enrolled individuals aged 60 - 77 years recruited from previous national surveys . Inclusion criteria were CAIDE ( Cardiovascular Risk Factors , Aging and Dementia ) Dementia Risk Score of at least 6 points and cognition at mean level or slightly lower than expected for age . We r and omly assigned participants in a 1:1 ratio to a 2 year multidomain intervention ( diet , exercise , cognitive training , vascular risk monitoring ) , or a control group ( general health advice ) . Computer-generated allocation was done in blocks of four ( two individuals r and omly allocated to each group ) at each site . Group allocation was not actively disclosed to participants and outcome assessors were masked to group allocation . The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery ( NTB ) Z score . Analysis was by modified intention to treat ( all participants with at least one post-baseline observation ) . This trial is registered at Clinical Trials.gov , number NCT01041989 . FINDINGS Between Sept 7 , 2009 , and Nov 24 , 2011 , we screened 2654 individuals and r and omly assigned 1260 to the intervention group ( n=631 ) or control group ( n=629 ) . 591 ( 94 % ) participants in the intervention group and 599 ( 95 % ) in the control group had at least one post-baseline assessment and were included in the modified intention-to-treat analysis . Estimated mean change in NTB total Z score at 2 years was 0·20 ( SE 0·02 , SD 0·51 ) in the intervention group and 0·16 ( 0·01 , 0·51 ) in the control group . Between-group difference in the change of NTB total score per year was 0·022 ( 95 % CI 0·002 - 0·042 , p=0·030 ) . 153 ( 12 % ) individuals dropped out overall . Adverse events occurred in 46 ( 7 % ) participants in the intervention group compared with six ( 1 % ) participants in the control group ; the most common adverse event was musculoskeletal pain ( 32 [ 5 % ] individuals for intervention vs no individuals for control ) . INTERPRETATION Findings from this large , long-term , r and omised controlled trial suggest that a multidomain intervention could improve or maintain cognitive functioning in at-risk elderly people from the general population . FUNDING Academy of Finl and , La Carita Foundation , Alzheimer Association , Alzheimer 's Research and Prevention Foundation , Juho Vainio Foundation , Novo Nordisk Foundation , Finnish Social Insurance Institution , Ministry of Education and Culture , Salama bint Hamdan Al Nahyan Foundation , Axa Research Fund , EVO funding for University Hospitals of Kuopio , Oulu , and Turku and for Seinäjoki Central Hospital and Oulu City Hospital , Swedish Research Council , Swedish Research Council for Health , Working Life and Welfare , and af Jochnick Foundation CONTEXT Many observational studies have shown that physical activity reduces the risk of cognitive decline ; however , evidence from r and omized trials is lacking . OBJECTIVE To determine whether physical activity reduces the rate of cognitive decline among older adults at risk . DESIGN AND SETTING R and omized controlled trial of a 24-week physical activity intervention conducted between 2004 and 2007 in metropolitan Perth , Western Australia . Assessors of cognitive function were blinded to group membership . PARTICIPANTS We recruited volunteers who reported memory problems but did not meet criteria for dementia . Three hundred eleven individuals aged 50 years or older were screened for eligibility , 89 were not eligible , and 52 refused to participate . A total of 170 participants were r and omized and 138 participants completed the 18-month assessment . INTERVENTION Participants were r and omly allocated to an education and usual care group or to a 24-week home-based program of physical activity . MAIN OUTCOME MEASURE Change in Alzheimer Disease Assessment Scale-Cognitive Subscale ( ADAS-Cog ) scores ( possible range , 0 - 70 ) over 18 months . RESULTS In an intent-to-treat analysis , participants in the intervention group improved 0.26 points ( 95 % confidence interval , -0.89 to 0.54 ) and those in the usual care group deteriorated 1.04 points ( 95 % confidence interval , 0.32 to 1.82 ) on the ADAS-Cog at the end of the intervention . The absolute difference of the outcome measure between the intervention and control groups was -1.3 points ( 95 % confidence interval,-2.38 to -0.22 ) at the end of the intervention . At 18 months , participants in the intervention group improved 0.73 points ( 95 % confidence interval , -1.27 to 0.03 ) on the ADAS-Cog , and those in the usual care group improved 0.04 points ( 95 % confidence interval , -0.46 to 0.88 ) . Word list delayed recall and Clinical Dementia Rating sum of boxes improved modestly as well , whereas word list total immediate recall , digit symbol coding , verbal fluency , Beck depression score , and Medical Outcomes 36-Item Short-Form physical and mental component summaries did not change significantly . CONCLUSIONS In this study of adults with subjective memory impairment , a 6-month program of physical activity provided a modest improvement in cognition over an 18-month follow-up period . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12605000136606 Background While observational studies show that an active lifestyle including cognitive , physical , and social activities is associated with a reduced risk of cognitive decline and dementia , experimental evidence from corresponding training interventions is more inconsistent with less pronounced effects . The aim of this study was to evaluate and compare training- and lifestyle-related changes in cognition . This is the first study investigating these associations within the same time period and sample . Methods Fifty-four older adults at risk of dementia were assigned to 10 weeks of physical training , cognitive training , or a matched wait-list control condition . Lifestyle was operationalized as the variety of self-reported cognitive , physical , and social activities before study participation . Cognitive performance was assessed with an extensive test battery prior to and after the intervention period as well as at a 3-month follow-up . Composite cognition measures were obtained by means of a principal component analysis . Training- and lifestyle-related changes in cognition were analyzed using linear mixed effects models . The strength of their association was compared with paired t-tests . Results Neither training intervention  improved global cognition in comparison to the control group ( p = .08 ) . In contrast , self-reported lifestyle was positively associated with benefits in global cognition ( p < .001 ) and specifically in memory ( p < .001 ) . Moreover , the association of an active lifestyle with cognitive change was significantly stronger than the benefits of the training interventions with respect to global cognition ( ps < .001 ) and memory ( ps < .001 ) . Conclusions The associations of an active lifestyle with cognitive change over time in a dementia risk group were stronger than the effects of short-term , specific training interventions . An active lifestyle may differ from training interventions in dosage and variety of activities as well as intrinsic motivation and enjoyment . These factors might be crucial for design ing novel interventions , which are more efficient than currently available training interventions .Trial registration Clinical Trials.gov Identifier NCT01061489 . Registered February 2 , 2010 Background Of all age groups , older adults spend most of the time sitting and are least physically active . This sequential , mixed- methods feasibility study used a r and omised controlled trial design to assess methods for trialling a habit-based intervention to displace older adults ’ sedentary behaviour with light activity and explore impact on behavioural outcomes . Methods Eligibility criteria were age 60–74 years , retired , and ≥6 h/day leisure sitting . Data were collected across four sites in Engl and . The intervention comprised a booklet outlining 15 ‘ tips ’ for disrupting sedentary habits and integrating activity habits into normally inactive setting s , and eight weekly self-monitoring sheets . The control was a non-habit-based factsheet promoting activity and sedentary reduction . A computer-generated 1:1 block-r and omisation schedule was used , with participants blinded to allocation . Participants self-reported sedentary behaviour ( two indices ) , sedentary habit , physical activity ( walking , moderate , vigorous activity ) and activity habit , at pre-treatment baseline , 8- and 12-week follow-ups and were interviewed at 12 weeks . Primary feasibility outcomes were attrition , adverse events and intervention adherence . The secondary outcome was behavioural change . Results Of 104 participants consented , 103 were r and omised ( intervention N = 52 , control N = 51 ) . Of 98 receiving allocated treatment , 91 ( 93 % ; intervention N = 45 ; control N = 46 ) completed the trial . One related adverse event was reported in the intervention group . Mean per-tip adherence across 7 weeks was ≥50 % for 9/15 tips . Qualitative data suggested acceptability of procedures , and , particularly among intervention recipients , the allocated treatment . Both groups appeared to reduce sedentary behaviour and increase their physical activity , but there were no apparent differences between groups in the extent of change . Conclusions Trial methods were acceptable and feasible , but the intervention conferred no apparent advantage over control , though it was not trialled among the most sedentary and inactive population for whom it was developed . Further development of the intervention may be necessary prior to a large-scale definitive trial . One possible refinement would combine elements of the intervention with an informational approach to enhance effectiveness . Trial registration IS RCT N47901994 ( registration date : 16th January 2014 ; trial end date 30th April 2015
Summary Sedentary behaviour is associated with lower cognitive performance , although the attributable risk of sedentary time to all-cause dementia incidence is unclear .
Our systematic review provides evidence that limiting sedentary time and concomitantly engaging in regular moderate-to-vigorous physical activity may best promote healthy cognitive ageing
Aim The increasing rate of all-cause dementia worldwide and the lack of effective pharmaceutical treatments emphasise the value of lifestyle approaches as prevention strategies .
Emerging evidence suggests sedentary behaviour is associated with impaired cognitive function .
A better underst and ing of this association would significantly add to our knowledge of how to best promote healthy cognitive ageing .
Thus , we conducted a systematic review ascertaining the contribution of sedentary behaviour towards associated changes in cognitive function over the adult lifespan .