To the Editors,
We recently published evidence-based guidelines for the role of exercise in the prevention of dementia.1 The guidelines combined an umbrella review and expert consensus, and has important implications for psychiatry.
Evidence from published studies was evaluated using the GRADE assessment. We found scarce and relatively low-quality evidence in the literature, particularly for the primary prevention of dementia.
Our GRADE-informed evidence synthesis yielded the following conclusions:
Following a consensus process, we recommended physical activity/exercise for all three purposes, namely primary, secondary, and tertiary prevention (improve cognition and reduce disability) of dementia. The recommendation of exercise was largely contingent on its positive effects on mental health,2,3 in conjunction with the extensive body of evidence linking mental disorder with dementia.4
The guidelines highlight the need for further research on multidisciplinary interventions for both the primary and secondary prevention of dementia. A question remains whether the positive effect of physical activity on mood/behaviour applies to the MCI group, as it does to the dementia group. More research is required in people with established dementia and in less common forms of dementia. The guidelines also make an implicit research recommendation in support of heurism, in the sense that they integrate the evidence-based expectation that exercise is likely to be beneficial both for mental and physical health. Indeed, employing heurism may be inherently necessary in prevention research.5
Overall, these guidelines offer an evidence-based insight into the effectiveness of physical activity/exercise for the prevention (primary, secondary, and tertiary) of dementia. Importantly, they necessitate the inclusion of mental health in a multi-component approach.
In doing so, they emphasize the necessity of mental health promotion and mental illness prevention in the prevention and management of dementia.
Nikos Christodoulou
Department of Psychiatry, Faculty of Medicine, University of Thessaly, Greece
Email: This email address is being protected from spambots. You need JavaScript enabled to view it. , This email address is being protected from spambots. You need JavaScript enabled to view it.
Andreas Lappas
Aneurin Bevan University Health Board, Newport, Wales, UK
Olga Karpenko
Mental-Health Clinic No. 1 Named After N.A. Alexeev, Moscow, Russia
Rodrigo Ramalho
Department of Social and Community Health, School of Population Health, The University of Auckland, Auckland, New Zealand
Myrto Samara
Department of Psychiatry, Faculty of Medicine, University of Thessaly, Greece
Marco Solmi
Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
Paolo Fusar-Poli
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, UK
OASIS Service, South London and the Maudsley National Health Service Foundation Trust, London, UK
Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
Department of Psychiatry and Psychotherapy, Ludwig- Maximilian- University Munich, Germany
Nicola Veronese
Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
References