Comparative efficacy of exercise interventions on depressive symptoms and related outcomes in patients with Alzheimer's disease, cognitive impairment, and Parkinson's disease: a systematic review and network meta-analysis.

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BackgroundPatients with Alzheimer's disease, cognitive impairment, and Parkinson's disease often experience depressive symptoms, which negatively impact quality of life and disease management. Exercise is an important non-pharmacological treatment in these populations; however, the relative efficacy of different exercise modalities remains unclear. This study used a systematic review and network meta-analysis to compare the effects of various exercise interventions on depressive symptoms and related outcomes.MethodsWe systematically searched Chinese and English databases for randomized controlled trials evaluating exercise interventions in patients with Alzheimer's disease, cognitive impairment (including mild cognitive impairment and dementia), and Parkinson's disease. The primary outcome was depressive symptoms, assessed by using Geriatric Depression Scale (GDS) and Beck Depression Inventory (BDI); the secondary outcomes were cognitive function and motor function, assessed by using Mini-Mental State Examination (MMSE) and Unified Parkinson's Disease Rating Scale Part III (UPDRS III), respectively. Network meta-analysis was performed using Stata 16.0, and supplementary pairwise meta-analyses by disease type were conducted for the primary outcomes. RevMan 5.4 was used to assess the risk of bias, and the CINeMA framework was used to evaluate the credibility of the evidence.ResultsA total of 23 randomized controlled trials involving 1,596 subjects were included. For the primary outcomes, no exercise modality showed an overall statistically significant advantage over the control group in improving depressive symptoms. For the secondary outcome, cognitive exercise significantly improved the MMSE scores compared with daily activities (MD = 3.50, 95% CI [2.29, 4.71]). For UPDRS III, no significant overall difference was observed between exercise interventions and the control group.ConclusionThe available evidence does not provide stable or modestly consistent support for a clear overall benefit of different exercise interventions on depressive symptoms in patients with Alzheimer's disease, cognitive impairment, and Parkinson's disease. Cognitive exercise may help improve cognitive function, whereas the potential benefits of multicomponent exercise for motor function in Parkinson's disease should be interpreted with caution. In the future, large randomized controlled trials with clearer stratification, specific protocols, and standardized exercise prescriptions are needed to further define the optimal populations and intervention effects of different exercise modalities.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD420261280926.

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