Evidence map›Paper›PMID 29769247›Full record

Trial reportBMJ (Clinical research ed.)2018

Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial.

Sarah E Lamb, Bart Sheehan, Nicky Atherton, Vivien Nichols, Helen Collins, Dipesh Mistry, Sukhdeep Dosanjh, Anne Marie Slowther, Iftekhar Khan, Stavros Petrou and 2 more

Abstract readMulticenter StudyRandomized Controlled TrialPragmatic Clinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 188 papers, 26 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
188citing papers in PubMed, 26 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

188 citing papers in PubMed, 26 syntheses or guidelines pooled it.

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128 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Sarah E LambCentre for Rehabilitation Research and Centre for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology & Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford OX3 7LD, UK sarah.lamb@ndorms.ox.ac.uk.
Bart SheehanCoventry and Warwickshire Partnership Trust, Coventry, UK.
Nicky AthertonCoventry and Warwickshire Partnership Trust, Coventry, UK.
Vivien NicholsWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Helen CollinsOxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK.
Dipesh MistryWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Sukhdeep DosanjhWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Anne Marie SlowtherDivision of Health Sciences, University of Warwick, Coventry, UK.
Iftekhar KhanWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Stavros PetrouWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
Ranjit LallWarwick Clinical Trials Unit, University of Warwick, Coventry, UK.
DAPA Trial Investigators

Funding

Department of Health 09/80/04Medical Research Council G0501681Medical Research Council G0700452
6 · The paper itself

Abstract

objectiveTo estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia.

designMulticentre, pragmatic, investigator masked, randomised controlled trial.

settingNational Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.

participants494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm.

interventionsUsual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises.

main outcome measuresThe primary outcome was score on the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention.

resultsThe average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference -1.4, 95% confidence interval -2.6 to -0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer's disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).

conclusionA moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.

trial registrationCurrent Controlled Trials ISRCTN10416500.

Indexed as

Activities of Daily LivingAgedCaregiversCognitionDementiaEnglandExercise TherapyFemaleHumansMalePhysical FitnessQuality of LifeResistance Training

Identifiers

PMID29769247
PMCPMC5953238

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.