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Dementia – Reduce stress, reduce anxiety and improve mood

Evidence summary (updated 2022)
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(1).
Systematic review evidence for the benefits of physical activity for anxiety symptoms and mood is limited(2). Improved mood and reduced depression can occur in multi-component PA interventions, however evidence is again limited by marked heterogeneity(3) .
A small reduction in depression level and improved mood were seen in some quantitative studies of multi-component physical activity interventions, including walking. Due to high heterogeneity in the quantitative studies, a single summary of the effect of physical activity on behavioural and psychological symptoms of dementia should be interpreted with some caution. Across the qualitative studies, the common themes about the importance of physical activity were its ‘socially rewarding’ nature, the ‘benefits of walking outdoors’ and its contribution to ‘maintaining self-good ’.
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. This is consistent with qualitative studies reporting PA to be ‘socially rewarding’ amongst other reported benefits(3).
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. Overall, the supporting evidence has significant heterogeneity and relatively small participant numbers.

Quality of evidence
Grade B – Moderate

Strength of recommendation
1 – Strong

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 barriers to promote activity


  1. Teri L, Gibbons LE, McCurry SM, Logsdon RG, Buchner DM, Barlow WE, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA [Internet]. 2003 Oct 15 [cited 2022 Jul 22];290(15):2015–22. Available from:
  2. Potter R, Ellard D, Rees K, Thorogood M. A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia. Int J Geriatr Psychiatry [Internet]. 2011 Oct [cited 2022 Jul 22];26(10):1000–11. Available from:
  3. Junge T, Ahler J, Knudsen HK, Kristensen HK. The effect and importance of physical activity on behavioural and psychological symptoms in people with dementia: A systematic mixed studies review. Dementia [Internet]. 2020 Apr 1 [cited 2022 Jul 22];19(3):533–46. Available from: