'Surprising' study suggests exercise may make dementia worse

It is generally accepted that exercise can delay the onset of Alzheimer’s and other forms of dementia

Prof Martin Rossor, professor of clinical neurology at University College London, said the evidence showed that exercise for people living with well-established dementia may be of limited value.

Nearly 500 people with dementia took part, with 329 embarking on a special exercise programme and 165 receiving their usual care.

Currently, as a dementia therapy that does not involve medication, the NHS recommends group cognitive stimulation therapy classes, where sufferers undertake exercises created to improve their memory, problem-solving skills and language ability.

The authors wrote: "People with mild to moderate dementia can engage and comply with moderate to high intensity aerobic and strengthening exercise and improve physical fitness".

They took part in 60-90-minute group sessions in a gym twice a week for about four months, and home exercises as an additional hour per week.

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The study also found that so-called secondary outcomes (ones that weren't the primary focus of the study) - such as the participants' ability to perform activities of daily living, their neuropsychiatric symptoms, the number of falls they had, their health-related quality of life and the quality of life of the family members caring for them - were also similar in both groups. It was funded by the National Institute of Health Research and published in the peer-reviewed British Medical Journal on an open-access basis, so it's free to read online.

They discovered that the people on the exercise regimen had higher ADAS-cog scores than the people who were on usual care. "It may also be that better off people have greater social and cultural opportunities that allow them to remain actively engaged with the world".

Compliance with exercise was good and participants were assessed again at six and 12 months. Lamb commented that dementia is a complicated issue to tackle. Other (secondary) outcomes included activities of daily living, number of falls, and quality of life.

Moderate to high intensity aerobic and strength exercise training did not slow cognitive impairment, researchers found, and this sort of exercise may even worsen the condition, the authors suggested. We know that gentle exercise is good for you.

This was clearly a disappointing result for the researchers, who were hoping exercise could be recommended as a treatment for people with dementia on the NHS. She said numerous studies have shown that exercise has benefits for brain cell health, including the growth of new cells in the hippocampus, the brain's memory center. One factor not measured was whether people with dementia enjoyed the exercise. This suggests the type of exercise programme may not have been particularly attractive, particularly to women with dementia.

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