Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial
<h4>Objectives</h4> <p>To estimate the effect of a moderate to high intensity aerobic and strength exercise training program on cognitive impairment and other outcomes in people with mild to moderate dementia. </p> <h4>Design</h4> <p>A multicentre, pragmati...
| Main Authors: | , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2018
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| _version_ | 1826298280276918272 |
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| author | Lamb, S Sheehan, B Atherton, N Nichols, V Collins, H Mistry, D Dosanjh, S Slowther, A Khan, I Petrou, S Lall, R |
| author_facet | Lamb, S Sheehan, B Atherton, N Nichols, V Collins, H Mistry, D Dosanjh, S Slowther, A Khan, I Petrou, S Lall, R |
| author_sort | Lamb, S |
| collection | OXFORD |
| description | <h4>Objectives</h4> <p>To estimate the effect of a moderate to high intensity aerobic and strength exercise training program on cognitive impairment and other outcomes in people with mild to moderate dementia. </p> <h4>Design</h4> <p>A multicentre, pragmatic, investigator-masked, randomised controlled trial with one year follow up. Participants and clinical providers were not masked. Random allocation was 2:1 in favour of the exercise arm.</p> <h4>Setting</h4> <p>We identified 494 people with dementia in NHS primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions. We delivered interventions in community gym facilities and NHS premises.</p> <h4>Participants</h4> <p>The average age was 77 (SD 7.9) years and 301/494 (61%) were male.</p> <h4>Main outcome measures</h4> <p>The primary outcome was the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health-related quality of life, and carer quality of life and burden. We measured physical fitness (including the 6-minute walk test) in the exercise arm during the intervention.</p> <h4>Interventions</h4> <p>Usual care plus four months of supervised exercise and support for on-going physical activity, or usual care only.</p> <h4>Results</h4> <p>By 12 months the mean ADAS-cog score increased to 25·2 (SD12·3) in the exercise group and 23·8 (SD 10·4) in the usual care group (adjusted between group difference -1·4 (95% CI -2·6 to -0·2, p=0·026) This indicates greater cognitive impairment in the exercise group but the average difference is small and clinical relevance uncertain. There were no differences in secondary outcomes or pre-planned sub-group analyses of dementia type (Alzheimer or other), severity of cognitive impairment, gender, and mobility. Compliance with exercise was good. Over (214/329) 65% of participants attended more than three-quarters of scheduled sessions. Six minute walking distance improved over 6 weeks (mean change 18.1m (95% CI 11.6 to 24.6)).</p> <h4>Conclusion</h4> <p>A moderate to high intensity aerobic and strength exercise training program does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but no other clinical outcomes responded in a positive direction. </p> |
| first_indexed | 2024-03-07T04:44:26Z |
| format | Journal article |
| id | oxford-uuid:d2c26930-d110-42db-940e-c6f20a14c1b6 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T04:44:26Z |
| publishDate | 2018 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:d2c26930-d110-42db-940e-c6f20a14c1b62022-03-27T08:06:26ZDementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:d2c26930-d110-42db-940e-c6f20a14c1b6EnglishSymplectic Elements at OxfordBMJ Publishing Group2018Lamb, SSheehan, BAtherton, NNichols, VCollins, HMistry, DDosanjh, SSlowther, AKhan, IPetrou, SLall, R <h4>Objectives</h4> <p>To estimate the effect of a moderate to high intensity aerobic and strength exercise training program on cognitive impairment and other outcomes in people with mild to moderate dementia. </p> <h4>Design</h4> <p>A multicentre, pragmatic, investigator-masked, randomised controlled trial with one year follow up. Participants and clinical providers were not masked. Random allocation was 2:1 in favour of the exercise arm.</p> <h4>Setting</h4> <p>We identified 494 people with dementia in NHS primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions. We delivered interventions in community gym facilities and NHS premises.</p> <h4>Participants</h4> <p>The average age was 77 (SD 7.9) years and 301/494 (61%) were male.</p> <h4>Main outcome measures</h4> <p>The primary outcome was the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) score at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health-related quality of life, and carer quality of life and burden. We measured physical fitness (including the 6-minute walk test) in the exercise arm during the intervention.</p> <h4>Interventions</h4> <p>Usual care plus four months of supervised exercise and support for on-going physical activity, or usual care only.</p> <h4>Results</h4> <p>By 12 months the mean ADAS-cog score increased to 25·2 (SD12·3) in the exercise group and 23·8 (SD 10·4) in the usual care group (adjusted between group difference -1·4 (95% CI -2·6 to -0·2, p=0·026) This indicates greater cognitive impairment in the exercise group but the average difference is small and clinical relevance uncertain. There were no differences in secondary outcomes or pre-planned sub-group analyses of dementia type (Alzheimer or other), severity of cognitive impairment, gender, and mobility. Compliance with exercise was good. Over (214/329) 65% of participants attended more than three-quarters of scheduled sessions. Six minute walking distance improved over 6 weeks (mean change 18.1m (95% CI 11.6 to 24.6)).</p> <h4>Conclusion</h4> <p>A moderate to high intensity aerobic and strength exercise training program does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but no other clinical outcomes responded in a positive direction. </p> |
| spellingShingle | Lamb, S Sheehan, B Atherton, N Nichols, V Collins, H Mistry, D Dosanjh, S Slowther, A Khan, I Petrou, S Lall, R Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |
| title | Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |
| title_full | Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |
| title_fullStr | Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |
| title_full_unstemmed | Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |
| title_short | Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial |
| title_sort | dementia and physical activity dapa trial of moderate to high intensity exercise training for people with dementia randomised controlled trial |
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