Effect of multimodal exercise training on physical fitness indices, cognitive status, and depressive symptoms in Alzheimer's disease

Haghighi, Amir Hossein; Barzoei, Masoud; Kakhak, Seyed Alireza Hosseini; Budini, Francesco; Shahrabadi, Hadi

doi:10.1590/1980-5764-DN-2022-0008

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 17 • 2023 • https://doi.org/10.1590/1980-5764-DN-2022-0008 copy

Effect of multimodal exercise training on physical fitness indices, cognitive status, and depressive symptoms in Alzheimer's disease

O efeito do treinamento multimodal em índices de aptidão física, estado cognitivo e sintomas depressivos na doença de Alzheimer

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

In Alzheimer's disease (AD) patients, low levels of physical fitness (PF) and cognitive status are associated with high rates of depression. However, this condition can be improved through physical training.

Objective:

The aim of the present study was to investigate the effect of multimodal exercise training (MET) on aerobic endurance, muscular strength, agility, dynamic balance, cognitive status, and depressive symptoms in men with mild-to-moderate AD.

Methods:

A total of 25 elderly men with a diagnosis of mild-to-moderate AD were randomly categorized into an MET or a control group. The subjects in the MET group participated in a 12-week, three sessions per week MET program that included resistance, balance, and aerobic exercises. While the participants in the control group did not perform any regular exercise training during this period. Patients’ cognitive status and depressive symptoms were assessed by Mini-Mental State Examination and the Geriatric Depression Scale-15 (GDS-15) questionnaires. PF indicators such as aerobic endurance, muscular strength, agility, and dynamic balance, as well as cognitive status and depressive symptoms, were taken from all the subjects before and after MET.

Results:

The participants in the MET group improved handgrip, upper and lower body strength, agility, dynamic balance, and depressive symptoms (p<0.05). The intervention had no significant effect on aerobic endurance and cognitive status (p>0.05).

Conclusions:

MET is an effective strategy to improve muscular strength, agility, dynamic balance, and depressive symptoms in men with mild-to-moderate AD. It is recommended for AD patients to engage in this type of exercise to reduce AD complications.

Keywords:
Exercise; Physical Fitness; Depression; Alzheimer Disease

Exercises training		Weeks
Exercises training		1–3	4–6	7–9	10–12
Resistance training	Sets (n)	3	4	5	6
	Repeats (n)	8–10	8–10	8–10	8–10
	Rest between sets (min)	1–2	1–2	1–2	1–2
Balance exercises	Sets (n)	2	3	4	5
Balance exercises	Rest between circles (min)	1	1	1	1
Aerobic exercise	Intensity (%HR_max/RPE)	70/12	70/12	75/14	75/14
	Sets×time (n×min)	3×2	3×2	4×2	4×2
	Rest between sets (min)	1–1.5	1–1.5	1–1.5	1–1.5

Variables	Groups
Variables	MET (n=12)	Control (n=13)	p-value
Age (years), mean±standard deviation	69.92±8.16	72.92±6.17	0.307^* * Notes: Independent samples t-test;
Height (cm), mean±standard deviation	163.33±5.84	166.15±3.67	0.158^* * Notes: Independent samples t-test;
Weight (kg), median (Q1–Q3)	59.05 (53.37–62.15)	56.20 (54.20–58.05)	0.384^† † Mann-Whitney U test.
BMI (kg/m²), median (Q1–Q3)	21.12 (19.70–24.24)	20.08 (19.25–22.02)	0.192^† † Mann-Whitney U test.

	Groups	Baseline			Post-test			Statistical result
Aerobic endurance (m), mean±standard deviation			Min	Max		Min	Max	F	p-value	pη²
	MET	195.22±62.95	100.00	275.13	199.01±67.53	100.00	288.37	1.558	0.225	0.066
	Control	141.13±32.73	107.90	211.87	138.09±31.87	108.00	211.17	1.558	0.225	0.066
Handgrip strength (kg), median (Q1–Q3)								z	p-value	r
	MET	11.00 (10.00–14.50)	9.00	22.00	12.50 (12.00–14.75)	10.00	16.00	−2.959	0.003^* * Difference between groups is significant at 0.01;	0.592
	Control	9.00 (7.50–11.50)	7.00	13.00	9.00 (7.00–11.50)	6.00	13.00	−2.959	0.003^* * Difference between groups is significant at 0.01;	0.592
Upper body strength (n), mean±standard deviation								F	p-value	pη²
	MET	9.17±2.95	6.00	14.00	10.75±2.80	6.00	16.00	21.054	<0.001^† † Difference between groups is significant at 0.001;	0.489
	Control	7.85±1.57	6.00	11.00	7.92±1.44	6.00	10.00	21.054		0.489
Lower body strength (n), mean±standard deviation								F	p-value	pη²
	MET	8.25±2.01	6.00	12.00	9.08±2.35	6.00	13.00	6.932	0.015^‡ ‡ Difference between groups is significant at 0.05.	0.240
	Control	7.77±1.01	6.00	10.00	7.46±1.20	6.00	10.00	6.932	0.015^‡ ‡ Difference between groups is significant at 0.05.	0.240
Agility/dynamic balance (s), median (Q1–Q3)								z	p-value	r
	MET	16.72 (13.44–20.88)	9.35	25.00	16.19 (11.00–21.90)	9.28	25.00	-2.068	0.039^‡ ‡ Difference between groups is significant at 0.05.	0.414
	Control	21.89 (18.75–23.87)	16.43	26.10	22.34 (19.10–24.63)	15.87	27.02	-2.068	0.039^‡ ‡ Difference between groups is significant at 0.05.	0.414
MMSE, median (Q1–Q3)								z	p-value	r
	MET	18.00 (18.00–20.75)	18.00	23.00	19 (19.00–20.00)	17.00	22.00	-0.978	0.328	0.196
	Control	20.00 (18.50–22.00)	18.00	23.00	20.00 (18.00–21.50)	17.00	24.00	-0.978	0.328	0.196
GDS-15, mean±standard deviation								F	p-value	pη²
	MET	5.17±1.53	2.00	8.00	4.75±1.55	2.00	8.00	4.403	0.048^‡ ‡ Difference between groups is significant at 0.05.	0.167
	Control	5.39±1.12	4.00	8.00	5.54±1.05	4.00	7.00	4.403	0.048^‡ ‡ Difference between groups is significant at 0.05.	0.167

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Correspondence: Amir Hossein Haghighi; Email: ah.haghighi@hsu.ac.ir.