Michelle Brasure, PhD, MSPH, MLIS; Priyanka Desai, MSPH; Heather Davila, MPA; Victoria A. Nelson, MSc; Collin Calvert, MPH; Eric Jutkowitz, PhD; Mary Butler, PhD, MBA; Howard A. Fink, MD, MPH; Edward Ratner, MD; Laura S. Hemmy, PhD; J. Riley McCarten, MD; Terry R. Barclay, PhD; Robert L. Kane, MD †
Disclaimer: Findings and conclusions are those of the authors, who are responsible for the article's contents; findings and conclusions do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or the U.S. Department of Health and Human Services.
Financial Support: This manuscript is based on research conducted by the Minnesota Evidence-based Practice Center under AHRQ contract 290-2015-00008-I.
Disclosures: Dr. Jutkowitz reports grants from AHRQ outside the submitted work. Drs. Ratner, Hemmy, and Barclay report grant support from AHRQ during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1528.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol: Available at https://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=2202. Statistical code: Not applicable. Data set: See Systematic Review Data Repository at https://srdr.ahrq.gov/.
Requests for Single Reprints: Michelle Brasure, PhD, MSPH, MLIS, Division of Health Policy and Management, University of Minnesota, 420 Delaware Street Southeast, Mayo Memorial Building D351, Minneapolis, MN 55455; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Brasure and Butler, Ms. Desai, Ms. Davila, and Ms. Nelson: Division of Health Policy and Management, University of Minnesota, 420 Delaware Street Southeast, Mayo Memorial Building D351, Minneapolis, MN 55455.
Mr. Calvert: Division of Epidemiology, University of Minnesota, 1300 South 2nd Street, Room 300 West Bank Office Building, Minneapolis, MN 55454.
Dr. Jutkowitz: Brown University, School of Public Health, Box G-S121-6, 121 South Main Street, 6th Floor, Providence, RI 02912.
Drs. Fink, Ratner, Hemmy, and McCarten: Geriatric Research Education and Clinical Center, VA Health Care System, One Veterans Drive, 11-G, Minneapolis, MN 55417.
Dr. Barclay: Department of Neurology, University of Minnesota, 295 Phalen Boulevard, Mailstop 41203C, St. Paul, MN 55130.
Author Contributions: Conception and design: M. Brasure, M. Butler, H.A. Fink, L.S. Hemmy, J.R. McCarten, R.L. Kane.
Analysis and interpretation of the data: M. Brasure, P. Desai, H. Davila, V.A. Nelson, E. Jutkowitz, M. Butler, H.A. Fink, E. Ratner, L.S. Hemmy, J.R. McCarten, T.R. Barclay.
Drafting of the article: M. Brasure, P. Desai, C. Calvert, E. Jutkowitz, M. Butler, L.S. Hemmy, T.R. Barclay, R.L. Kane.
Critical revision for important intellectual content: M. Brasure, C. Calvert, M. Butler, H.A. Fink, E. Ratner, L.S. Hemmy, J.R. McCarten, T.R. Barclay.
Final approval of the article: M. Brasure, P. Desai, H. Davila, V.A. Nelson, C. Calvert, E. Jutkowitz, M. Butler, H.A. Fink, E. Ratner, L.S. Hemmy, J.R. McCarten, T.R. Barclay.
Provision of study materials or patients: M. Brasure.
Statistical expertise: M. Brasure.
Obtaining of funding: M. Brasure, M. Butler, R.L. Kane.
Administrative, technical, or logistic support: M. Brasure, P. Desai, H. Davila, V.A. Nelson.
Collection and assembly of data: M. Brasure, P. Desai, H. Davila, V.A. Nelson, C. Calvert, E. Jutkowitz, M. Butler.
The prevalence of cognitive impairment and dementia is expected to increase dramatically as the population ages, creating burdens on families and health care systems.
To assess the effectiveness of physical activity interventions in slowing cognitive decline and delaying the onset of cognitive impairment and dementia in adults without diagnosed cognitive impairments.
Several electronic databases from January 2009 to July 2017 and bibliographies of systematic reviews.
Trials published in English that lasted 6 months or longer, enrolled adults without clinically diagnosed cognitive impairments, and compared cognitive and dementia outcomes between physical activity interventions and inactive controls.
Extraction by 1 reviewer and confirmed by a second; dual-reviewer assessment of risk of bias; consensus determination of strength of evidence.
Of 32 eligible trials, 16 with low to moderate risk of bias compared a physical activity intervention with an inactive control. Most trials had 6-month follow-up; a few had 1- or 2-year follow-up. Evidence was insufficient to draw conclusions about the effectiveness of aerobic training, resistance training, or tai chi for improving cognition. Low-strength evidence showed that multicomponent physical activity interventions had no effect on cognitive function. Low-strength evidence showed that a multidomain intervention comprising physical activity, diet, and cognitive training improved several cognitive outcomes. Evidence regarding effects on dementia prevention was insufficient for all physical activity interventions.
Heterogeneous interventions and cognitive test measures, small and underpowered studies, and inability to assess the clinical significance of cognitive test outcomes.
Evidence that short-term, single-component physical activity interventions promote cognitive function and prevent cognitive decline or dementia in older adults is largely insufficient. A multidomain intervention showed a delay in cognitive decline (low-strength evidence).
Agency for Healthcare Research and Quality.
Brasure M, Desai P, Davila H, et al. Physical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia: A Systematic Review. Ann Intern Med. 2018;168:30–38. [Epub ahead of print 19 December 2017]. doi: 10.7326/M17-1528
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Published: Ann Intern Med. 2018;168(1):30-38.
Published at www.annals.org on 19 December 2017
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