Physical exercise as a non-pharmacological strategy for reducing behavioral and psychological symptoms in elderly with mild cognitive impairment and dementia: a systematic review of randomized clinical trials.

BACKGROUND: Elderly people with dementia may exhibit behavioral and psychological symptoms throughout the course of disease. Non-pharmacological therapies, such as regular physical activity, are considered strategies for managing these symptoms. OBJECTIVE: The aim of this study was to investigate whether participation in physical exercise programs is effective in reducing behavioral and neuropsychiatric symptoms in elderly people with Mild Cognitive Impairment (MCI) and dementia. METHODS: A literature review was carried out in MEDLINE (PubMed), SciELO, Web of Science, Scopus and SPORTDiscus databases from 2010 to 2020. The eligible studies were randomized clinical trials involving elderly people with mild cognitive impairment or dementia and assessing changes in neuropsychiatric and psychological symptoms as primary or secondary outcomes. The studies had a group with only physical exercise as an intervention compared to a control group. RESULTS: Of 175 publications identified in the initial survey, only 7 studies met the eligibility criteria. Four out of 7 studies demonstrated positive effects in reducing behavioral symptoms, while the others did not report differences between gains according to the type of protocol. CONCLUSIONS: Moderate to intense aerobic and muscle strengthening exercises may have a potential benefit in the management of behavioral and psychological symptoms in dementia, but studies varied in their conclusions. This review indicates the need for further intervention studies to investigate, as a primary outcome, the absolute effect of physical exercise and its impact on behavioral and psychological symptoms in elderly people with MCI dementia, especially in the early stages of the disease.

Physical exercise as a non-pharmacological strategy for reducing behavioral and psychological symptoms in elderly with mild cognitive impairment and dementia: a systematic review of randomized clinical trials / Exercício físico como estratégia não farmacológica para a redução de sintomas psicológicos e comportamentais em idosos com comprometimento cognitivo leve e demência: revisão sistemática de ensaios clínicos randomizados

ABSTRACT Background: Elderly people with dementia may exhibit behavioral and psychological symptoms throughout the course of disease. Non-pharmacological therapies, such as regular physical activity, are considered strategies for managing these symptoms. Objective: The aim of this study was to investigate whether participation in physical exercise programs is effective in reducing behavioral and neuropsychiatric symptoms in elderly people with Mild Cognitive Impairment (MCI) and dementia. Methods: A literature review was carried out in MEDLINE (PubMed), SciELO, Web of Science, Scopus and SPORTDiscus databases from 2010 to 2020. The eligible studies were randomized clinical trials involving elderly people with mild cognitive impairment or dementia and assessing changes in neuropsychiatric and psychological symptoms as primary or secondary outcomes. The studies had a group with only physical exercise as an intervention compared to a control group. Results: Of 175 publications identified in the initial survey, only 7 studies met the eligibility criteria. Four out of 7 studies demonstrated positive effects in reducing behavioral symptoms, while the others did not report differences between gains according to the type of protocol. Conclusions: Moderate to intense aerobic and muscle strengthening exercises may have a potential benefit in the management of behavioral and psychological symptoms in dementia, but studies varied in their conclusions. This review indicates the need for further intervention studies to investigate, as a primary outcome, the absolute effect of physical exercise and its impact on behavioral and psychological symptoms in elderly people with MCI dementia, especially in the early stages of the disease.

RESUMO Antecedentes: Idosos com demência podem manifestar sintomas comportamentais e psicológicos durante o percurso da doença. Terapias não farmacológicas, como por exemplo a atividade física regular, são consideradas como uma das estratégias para manejar esses sintomas. Objetivo: O objetivo deste estudo é investigar se a participação em programas de exercício físico é efetiva na redução de sintomas comportamentais e neuropsiquiátricos de idosos com comprometimento cognitivo leve (CCL) e demência. Métodos: Foi realizada uma revisão da literatura nas bases de dados Medical Literature Analysis and Retrieval System Online — MEDLINE (PubMed), Scientific Electronic Library Online (SciELO), Web of Science, Scopus e SPORTDiscus de 2010 a 2020. Os estudos elegíveis foram: ensaios clínicos randomizados envolvendo idosos com CCL ou demência, que medissem como desfecho primário ou secundário a mudança nos sintomas neuropsiquiátricos e psicológicos. Os estudos tiveram grupo com apenas o exercício físico como intervenção em comparação a um grupo controle. Resultados: De 175 publicações identificadas na pesquisa inicial, apenas sete estudos atenderam aos critérios de elegibilidade. Quatro em sete estudos demonstraram efeitos positivos na redução dos sintomas comportamentais, enquanto os demais não fizeram diferenciação entre os ganhos conforme o tipo de protocolo. Conclusões: Exercícios aeróbicos e de fortalecimento muscular de intensidade moderada a vigorosa podem ter um benefício potencial no manejo dos sintomas psicológicos e comportamentais da demência. Esta revisão mostrou a necessidade de mais estudos de intervenção, buscando investigar como desfecho primário o efeito absoluto do exercício físico e seu impacto nos sintomas comportamentais e psicológicos de idosos com CCL e demência, principalmente nas fases iniciais da doença.

Efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com parkinson / Effects of treatment with non-immersive virtual reality in the quality of life of people with parkinson's disease

O objetivo desta pesquisa foi verificar os efeitos do tratamento com realidade virtual não imersiva na qualidade de vida de indivíduos com doença de Parkinson, antes e após o tratamento com aplicação do questionário da doença de Parkinson PDQ-39. Corresponde a um estudo experimental, do tipo ensaio clínico não controlado, de natureza quantitativa. O estudo envolveu 14 indivíduos, que passaram por 20 sessões individuais de tratamento distribuídas em duas sessões semanais, com duração entre 30 e 40 minutos cada. Na análise dos dados, foi utilizado o teste de Wilcoxon, para encontrar o valor da significância estatística p≤0,05. Os escores do Questionário da Doença de Parkinson-39 total e seus domínios diminuíram quando comparados aos do período da avaliação e da reavaliação dos pacientes. No entanto, os valores de p expressam que essa diminuição foi significativa especificamente para os domínios mobilidade, bem-estar emocional, estigma e cognição, e o escore do Questionário da Doença de Parkinson-39 total. Assim, os resultados demonstraram que a realidade virtual não imersiva contribuiu positivamente sobre a qualidade de vida desses indivíduos.

This research aimed to investigate the effects of treatment with non-immersive virtual reality in the quality of life of individuals with Parkinson's disease before and after treatment with the questionnaire of Parkinson's disease PDQ-39. It corresponds to an experimental study, quantitative, of uncontrolled clinical trial type. It involved 14 individuals who underwent 20 individual treatment sessions divided into two weekly sessions lasting 30 to 40 minutes each. In the data analysis, the Wilcoxon test was used to find the value of statistical significance p = 0.05. The scores of Questionnaire Parkinson's disease-39 overall and its domains decreased when compared to the evaluation period and the revaluation of patients. However, p values express that this decrease was significant if specific areas for mobility, emotional well-being, stigma and cognition, and the Questionnaire score of Parkinson's Disease-39 overall. Thus, the results demonstrated that non-immersive virtual reality contributed positively on the quality of life of these individuals.