Skip to content

Dementia – Reduce stress, reduce anxiety and improve mood

Reduce stress, reduce anxiety and improve mood

Evidence summary

There is some trial evidence to support combined exercise training with teaching care-givers behavioural management techniques to reduce carer and patient stress and improved physical health and depression in patients with cognitive decline.

Systematic review evidence for the benefits of physical activity for anxiety symptoms and mood is limited.

Expert opinion recommends physical activity and exercise participant to maintain social contact, reduce loneliness and promote sense-of-self for individuals with cognitive decline as strategies to maintain mood.

Expert opinion recommends seeking expert advice and professional support to promote physical activity for participants with established diagnosis of cognitive decline to reduce potential carer and family stress.

Quality of evidence

Grade B – there is significant heterogeneity in study design and outcomes used. Small numbers recruited to studies. Limited number of studies.

Strength of recommendation

Low – for individuals with established diagnosis of dementia.

Strong – from expert opinion, qualitative opinion from patients and cares support rationale for physical activity participant to maintain social contact, reduce loneliness and promote sense-of-self.


Consider options to maintain participation in physical activities with groups and family, help family and carers to look for strategies to use physical activity to reduce stress and anxiety for individuals with cognitive decline, help carers identify strategies to overcome stress barriers to promote  activity

Selected references

A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia.

Potter, R., Ellard, D., Rees, K. and Thorogood, M. (2011),

Int. J. Geriat. Psychiatry, 26: 1000-1011.

13 randomised controlled trials with 896 participants. Three of six trials that reported walking as an outcome found an improvement, as did four of the five trials reporting timed get up and go tests. Only one of the four trials that reported depression as an outcome found a positive effect. Both trials that reported quality of life found an improvement.

There is some evidence that physical activity interventions improve physical function in older people with dementia. Evidence for an effect on depression and quality of life is limited.

The Mental Activity and eXercise (MAX) trial: Effects on physical function and quality of life among older adults with cognitive complaints

Middleton, Laura E. et al.

Contemporary Clinical Trials 2017, Volume 64 , 161 – 166

Participants (n = 126, age 73 ± 6 years, 65% women), randomized to 12 weeks of exercise (aerobic exercise or stretching/toning, 3 × 60 min/week) plus mental activity (computer-based cognitive training or educational DVDs, 3 × 60 min/week) using a factorial design. Assessments included the Senior Fitness Test (physical function), Short Form-12 physical and mental sub-scales (HRQOL), and CHAMPS questionnaire (physical activity).

Improvements over time in most physical function measures [chair stands (p-for-time = 0.001), arm curls (p-for-time < 0.001), step test (p-for-time = 0.003), sit & reach (p-for-time = 0.01), and back scratch (p-for-time = 0.04)] and in physical HRQOL (p-for-time = 0.04). Changes in most physical function measures and physical HRQOL correlated with physical activity changes.

Combined mental activity and exercise interventions of various types can improve both physical function and physical HRQOL among sedentary older adults with cognitive complaints. Exercise control group design should be carefully considered as even light exercise may induce benefits in vulnerable older adults.

Exercise Plus Behavioral Management in Patients With Alzheimer Disease A Randomized Controlled Trial. 

Teri L, Gibbons LE, McCurry SM, et al. Exercise Plus Behavioral Management in Patients With Alzheimer DiseaseA Randomized Controlled Trial. JAMA. 2003;290(15):2015–2022.

Randomized controlled trial of 153 community-dwelling patients with Alzheimer disease,.

Patient-caregiver dyads were randomly assigned to the combined exercise and caregiver training progam, Reducing Disability in Alzheimer Disease (RDAD), or to routine medical care (RMC). The RDAD program was conducted in the patients’ home over 3 months.

At 3 months, in comparison with the routine care patients, more patients in the RDAD group exercised at least 60 min/wk (odds ratio [OR], 2.82; 95% confidence interval [CI], 1.25-6.39; P = .01) and had fewer days of restricted activity (OR, 3.10; 95% CI, 1.08-8.95; P<.001). Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group (mean difference, 19.29; 95% CI, 8.75-29.83; P<.001). Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores (mean difference, −1.03; 95% CI, −0.17 to −1.91; P = .02). At 2 years, the RDAD patients continued to have better physical role functioning scores than the RMC patients (mean difference, 10.89; 95% CI, 3.62-18.16; P = .003) and showed a trend (19% vs 50%) for less institutionalization due to behavioral disturbance. For patients with higher depression scores at baseline, those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale (mean difference, 2.21; 95% CI, 0.22-4.20; P = .04) and maintained that improvement at 24 months (mean difference, 2.14; 95% CI, 0.14-4.17; P = .04).

Exercise training combined with teaching care-givers behavioral management techniques improved physical health and depression in patients with Alzheimer disease.