@article{StroehleSchmidtSchultzetal.2015,
  author    = {Stroehle, Andreas and Schmidt, Dietlinde K. and Schultz, Florian and Fricke, Nina and Staden, Theresa and Hellweg, Rainer and Priller, Josef and Rapp, Michael A. and Rieckmann, Nina},
  title     = {Drug and Exercise Treatment of Alzheimer Disease and Mild Cognitive Impairment: A Systematic Review and Meta-Analysis of Effects on Cognition in Randomized Controlled Trials},
  series = {The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry},
  volume    = {23},
  journal   = {The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry},
  number    = {12},
  publisher = {Elsevier},
  address   = {New York},
  issn      = {1064-7481},
  doi       = {10.1016/j.jagp.2015.07.007},
  pages     = {1234 -- 1249},
  year      = {2015},
  abstract  = {Objective: Demographic changes are increasing the pressure to improve therapeutic strategies against cognitive decline in Alzheimer disease (AD) and mild cognitive impairment (MCI). Besides drug treatment, physical activity seems to be a promising intervention target as epidemiological and clinical studies suggest beneficial effects of exercise training on cognition. Using comparable inclusion and exclusion criteria, we analyzed the efficacy of drug therapy (cholinesterase inhibitors, memantine, and Ginkgo biloba) and exercise interventions for improving cognition in AD and MCI populations. Methods: We searched The Cochrane Library, EBSCO, OVID, Web of Science, and U.S Food and Drug Administration data from inception through October 30, 2013. Randomized controlled trials in which at least one treatment arm consisted of an exercise or a pharmacological intervention for AD or MCI patients, and which had either a non-exposed control condition or a control condition that received another intervention. Treatment discontinuation rates and Standardized Mean Change score using Raw score standardization (SMCR) of cognitive performance were calculated. Results: Discontinuation rates varied substantially and ranged between 0\% and 49\% with a median of 18\%. Significantly increased discontinuation rates were found for galantamine and rivastigmine as compared to placebo in AD studies. Drug treatments resulted in a small pooled effect on cognition (SMCR: 0.23, 95\% CI: 0.20 to 0.25) in AD studies (N = 45, 18,434 patients) and no effect in any of the MCI studies (N = 5, 3,693 patients; SMCR: 0.03, 95\% CI: 0.00 to 0.005). Exercise interventions had a moderate to strong pooled effect size (SMCR: 0.83, 95\% CI: 0.59 to 1.07) in AD studies (N = 4, 119 patients), and a small effect size (SMCR: 0.20, 95\% CI: 0.11 to 0.28) in MCI (N = 6, 443 patients). Conclusions: Drug treatments have a small but significant impact on cognitive functioning in AD and exercise has the potential to improve cognition in AD and MCI. Head-to-head trials with sufficient statistical power are necessary to directly compare efficacy, safety, and acceptability. Combining these two approaches might further increase the efficacy of each individual intervention. Identifier: PROSPERO (2013:CRD42013003910).},
  language  = {en}
}
@article{HeinzelLawrenceKalliesetal.2015,
  author    = {Heinzel, Stephan and Lawrence, Jimmy B. and Kallies, Gunnar and Rapp, Michael A. and Heissel, Andreas},
  title     = {Using Exercise to Fight Depression in Older Adults},
  series = {GeroPsych : the journal of gerontopsychology and geriatric psychiatry},
  volume    = {28},
  journal   = {GeroPsych : the journal of gerontopsychology and geriatric psychiatry},
  publisher = {Hogrefe},
  address   = {Cambridge, Mass. ; G{\"o}ttingen [u.a.]},
  issn      = {1662-9647},
  doi       = {10.1024/1662-9647/a000133},
  pages     = {149 -- 162},
  year      = {2015},
  abstract  = {Depression is the most prevalent psychiatric disorder in the general population. Despite a large demand for efficient treatment options, the majority of older depressed adults does not receive adequate treatment: Additional low-threshold treatments are needed for this age group. Over the past two decades, a growing number of randomized controlled trials (RCT) have been conducted, testing the efficacy of physical exercise in the alleviation of depression in older adults. This meta-analysis systematically reviews and evaluates these studies; some subanalyses testing specific effects of different types of exercise and settings are also performed. In order to be included, exercise programs of the RCTs had to fulfill the criteria of exercise according to the American College of Sports Medicine, including a sample mean age of 60 or above and an increased level of depressive symptoms. Eighteen trials with 1,063 participants fulfilled our inclusion criteria. A comparison of the posttreatment depression scores between the exercise and control groups revealed a moderate effect size in favor of the exercise groups (standardized mean difference (SMD) of -0.68, p < .001). The effect was comparable to the results achieved when only the eleven trials with low risk of bias were included (SMD = -0.63, p < .001). The subanalyses showed significant effects for all types of exercise and for supervised interventions. The results of this meta-analysis suggest that physical exercise may serve as a feasible, additional intervention to fight depression in older adults. However, because of small sample sizes of the majority of individual trials and high statistical heterogeneity, results must be interpreted carefully.},
  language  = {en}
}