The Effects of Different Exercise Interventions on Patients with Subjective Cognitive Decline: A Systematic Review and Network Meta-Analysis

R. Chen, B. Zhao, J. Huang, M. Zhang, Y. Wang, J. Fu, H. Liang, Hongrui Zhan
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Abstract

Background and Objective

Exercise is a promising non-pharmacological therapy for subjective cognitive decline, but it is unclear which type of exercise is most effective. The objective was to assess the comparative effects and ranks of all exercise-based interventions on cognitive function in patients with subjective cognitive decline (SCD).

Method

In this network meta-analysis, Online databases for Web of Science, PubMed, Embase, Medline, Cochrane Library and PsycINFO were searched from inception to April 30, 2023. The included studies are randomized controlled trials assessing the efficacy of exercise interventions for individuals with SCD. The primary outcome measure is memory, while secondary outcome measures encompass executive function, attention, verbal fluency, and global cognitive function. Represented using Standardized Mean Differences (SMDs) along with their 95% Confidence Intervals (CIs). Bias assessment was conducted in accordance with the ‘Cochrane Risk of Bias Assessment Tool, 2nd Edition’ (RoB 2). Pairwise meta-analysis was carried out using the ‘meta-analysis’ module within STATA 14.0, and network meta-analysis was performed using the ‘mvmeta’ and ‘network’ packages available in STATA 14.0. Registration number CRD42023289687.

Result

This study included a total of 11 randomized controlled trials, encompassing 1,166 patients. Mind-body exercise was found to be efficacious in enhancing or sustaining memory (SMD: 0.58, 95%CI: 0.06 ∼ 1.10) and executive function (SMD: 0.41, 95%CI: 0.09 ∼ 0.73) in individuals with subjective cognitive decline. Furthermore, mind-body exercise exhibited the highest probability of being the most effective measures for improving or preventing the decline in memory (surface under cumulative ranking curve (SUCRA) value: 90.4) and executive function (SUCRA value: 91.8). The second-ranked moderate-intensity aerobic exercise has also shown a positive effect on the improvement of executive function in patients with subjective cognitive decline (SMD: 0.23, 95%CI: 0.03 ∼ 0.43, SUCRA value: 68.2). However, we did not observe a significant effectiveness of exercise interventions on verbal fluency, attention, and overall cognitive function in subjective cognitive decline.

Conclusion

Mind-body exercise may potentially be the optimal strategies for enhancing memory and executive function in individuals with subjective cognitive decline. Additionally, moderate-intensity aerobic exercise has shown a modest positive effect on executive function in subjective cognitive decline. When resources permit, practical application of these findings may be considered. Nevertheless, further support for the conclusions of this study is warranted through larger sample sizes and well-designed multicenter trials.

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不同运动干预对主观认知能力下降患者的影响:系统回顾与网络元分析
背景和目的运动是治疗主观认知功能下降的一种很有前景的非药物疗法,但目前还不清楚哪种运动最有效。方法在这项网络荟萃分析中,检索了从开始到 2023 年 4 月 30 日的 Web of Science、PubMed、Embase、Medline、Cochrane Library 和 PsycINFO 等在线数据库。纳入的研究都是评估运动干预对 SCD 患者疗效的随机对照试验。主要结果指标是记忆力,次要结果指标包括执行功能、注意力、语言流畅性和整体认知功能。使用标准化平均差 (SMD) 及其 95% 置信区间 (CI) 表示。偏倚评估根据 "科克伦偏倚风险评估工具第二版"(RoB 2)进行。配对荟萃分析使用 STATA 14.0 中的 "荟萃分析 "模块进行,网络荟萃分析使用 STATA 14.0 中的 "mvmeta "和 "网络 "软件包进行。注册编号:CRD42023289687.结果本研究共纳入11项随机对照试验,涉及1166名患者。研究发现,心身锻炼能有效增强或维持主观认知能力下降患者的记忆力(SMD:0.58,95%CI:0.06 ∼ 1.10)和执行功能(SMD:0.41,95%CI:0.09 ∼ 0.73)。此外,心身锻炼最有可能成为改善或预防记忆力(累积排名曲线下表面值:90.4)和执行功能(累积排名曲线下表面值:91.8)下降的最有效措施。排名第二的中等强度有氧运动对改善主观认知能力下降患者的执行功能也有积极作用(SMD:0.23,95%CI:0.03 ∼ 0.43,SUCRA 值:68.2)。结论心身锻炼可能是增强主观认知功能下降患者记忆力和执行功能的最佳策略。此外,中等强度的有氧运动对主观认知能力下降患者的执行功能也有一定的积极作用。在资源允许的情况下,可以考虑实际应用这些研究结果。不过,还需要通过更大的样本量和精心设计的多中心试验来进一步支持本研究的结论。
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来源期刊
The Journal of Prevention of Alzheimer's Disease
The Journal of Prevention of Alzheimer's Disease Medicine-Psychiatry and Mental Health
CiteScore
9.20
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期刊介绍: The JPAD Journal of Prevention of Alzheimer’Disease will publish reviews, original research articles and short reports to improve our knowledge in the field of Alzheimer prevention including: neurosciences, biomarkers, imaging, epidemiology, public health, physical cognitive exercise, nutrition, risk and protective factors, drug development, trials design, and heath economic outcomes.JPAD will publish also the meeting abstracts from Clinical Trial on Alzheimer Disease (CTAD) and will be distributed both in paper and online version worldwide.We hope that JPAD with your contribution will play a role in the development of Alzheimer prevention.
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