Lamb SE, Sheehan B, Atherton N, Nichols V, Collins H, Mistry D, Dosanjh S, Slowther AM, Khan I, Petrou S, Lall R, DAPA Trial Investigators. Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. BMJ. 2018 May 16;361:k1675. PubMed.

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  1. There are several contextual factors which may influence the results of exercise studies. The studies with the most positive results are designed and performed under very unusual circumstances by extreme exercise enthusiasts, without concern for the implementation restraints upon actual clinical practice. Motivational factors may also influence the results of dietary and cognitive enrichment programs. In the present case, a British government health service wants to know the cost effectiveness and clinical significance they can expect from an exercise program implemented when patients are usually identified as appropriate (i.e., they already have dementia). Contrast that with a comprehensively funded study designed to identify subjects as early as possible, select out the most motivated, and then give "at least six months of moderate to high-intensity aerobic exercise, with weekly trainer support and accountability." That "dose" level prohibits any consideration of cost, to say nothing of the ways that data are cherry-picked by intervention enthusiasts. The academic issue (whether intensive cardiac intervention improves brain functioning) appears completely divorced from the practical questions about what is "a good investment."

    Dr. Lamb proposes muscle toning that is gentle and enjoyable to maintain quality of life. It would be interesting to see how many of the high-intensity aerobic study subjects would settle for "maintaining their ability to stand up from a chair." As a high-intensity exerciser myself, I have asked others in that group of their plans should they be diagnosed with dementia. None of them report that they would choose to continue living, a reason why the results of cognitive testing must always be conveyed in a controlled clinical setting. 

    View all comments by Emory Hill

  2. These are very interesting findings, highlighting the importance to get a better understanding of the mechanisms by which physical activity confers its beneficial effects on brain function. In line with the mentioned suggestion that dementia brains might be too vulnerable for beneficial effects of exercise, we propose reduced specific reserve capacities of neurodegeneration-affected brains, preventing them from profiting from exercise-imposed challenges. We describe potential mechanisms in a comment to the original article here.

    View all comments by Johannes Burtscher

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  1. Exercise Program Fails to Ease Dementia