Physical activity and exercise for the prevention and management of mild cognitive impairment and dementia: a collaborative international guideline
Nicola Veronese, Pınar Soysal, Jacopo Demurtas, Marco Solmi, Olivier Bruyère, Nikos Christodoulou, Rodrigo Ramalho, Paolo Fusar‐Poli, Andreas S. Lappas, Daniel Pinto, Kristian Steen Frederiksen, Graziamaria Corbi, Olga Karpenko, Jean Georges, João Durães, Mathias Schlögl, Özlem Yılmaz, Cornel Sieber, Susan D. Shenkin, Lee Smith, Jean‐Yves Reginster, Stefania Maggi, Federica Limongi, Joan Ars, Mario Barbagallo, Antonio Cherubini, Terry Quinn, on behalf of Alzheimer Europe, Jean Georges, Paolo Fusar‐Poli, Marco Solmi, European Geriatric Medicine Society (Lead Society), Javier Alonso Ramírez, Mariana Alves, Gülistan Bahat, Jürgen M. Bauer, Ivan Bautman, Rui Buzaco, Álvaro Casas Herrero, Matteo Cesari, Yaohua Chen, Antonio Cherubini, Graziamaria Corbi, Alfonso J. Cruz‐Jentoft, Anne‐Marie De Cock, Jacopo Demurtas, Burcu Balam Doğu, Ellen Freiberger, Miriam L. Haaksma, Marina Kotsani, Sarah E Lamb, M. Lamloum, Évelyne Liuu, René J. F. Melis, Laura Monica Perez Bazan, Maria Cristina Polidori, Joan Ars Ricart, Almudena Medina‐Rincón, Yves Rolland, Román Romero‐Ortuño, Guillaume Sacco, Mathias Schlögl, Daniel Schoene, Debbie Shapiro, Susan D. Shenkin, Cornel Sieber, Lee Smith, Pinar Soysal, Thomas Tannou, Nicola Veronese, Ozlem Yilmaz, Agar Brugiavini, Federica Limongi, Stefania Maggi, Olivier Bruyère, Daniel Pinto, Jean‐Yves Reginster, Mario Barbagallo, Scottish Brain Health ARC, Nikos Christodoulou, Olga Karpenko, Andreas S. Lappas, Rodrigo Ramalho, João Durães, Reinhold Schmidt, Kristian Steen Frederiksen
Abstract
BACKGROUND: Physical activity and exercise have been suggested as effective interventions for the prevention and management of mild cognitive impairment (MCI) and dementia, but there are no international guidelines. OBJECTIVES: To create a set of evidence- and expert consensus-based prevention and management recommendations regarding physical activity (any bodily movement produced by skeletal muscles that results in energy expenditure) and exercise (a subset of physical activity that is planned, structured, repetitive), applicable to a range of individuals from healthy older adults to those with MCI/dementia. METHODS: Guideline content was developed with input from several scientific and lay representatives' societies. A systematic search across multidisciplinary databases was carried out until October 2021. Recommendations for prevention and management were developed according to the GRADE and complemented by consensus statements from the expert panels. RECOMMENDATIONS: Physical activity may be considered for the primary prevention of dementia. In people with MCI there is continued uncertainty about the role of physical activity in slowing the conversion to dementia. Mind-body interventions have the greatest supporting evidence. In people with moderate dementia, exercise may be used for maintaining disability and cognition. All these recommendations were based on a very low/low certainty of evidence. CONCLUSIONS: Although the scientific evidence on the beneficial role of physical activity and exercise in preserving cognitive functions in subjects with normal cognition, MCI or dementia is inconclusive, this panel, composed of scientific societies and other stakeholders, recommends their implementation based on their beneficial effects on almost all facets of health.