Neurology Department, Hospital Beatriz Ângelo, Loures, Portugal.
Internal Medicine Department, Hospital Professor Doutor Fernando Fonseca, Portugal.
J Stroke Cerebrovasc Dis. 2023 Aug;32(8):107133. doi: 10.1016/j.jstrokecerebrovasdis.2023.107133. Epub 2023 May 6.
Vascular cognitive impairment (VCI) is the second most common cause of cognitive impairment worldwide and includes a spectrum from vascular cognitive impairment no dementia (VCIND) to vascular dementia (VaD). There is no specific pharmacological treatment approved for VCI. Physical activity has been indicated to be a promising preventive measure for cognition, with direct as indirectly benefits, while improving several modifiable vascular risk factors, so potentially effective when considering VCI. Our aim was to conduct a systematic review with a meta-analysis approaching the potential preventive role of physical activity on VCI.
A systematic search was conducted in 7 databases. A total of 6786 studies were screened and assessed for eligibility, culminating in the inclusion of 9 observational prospective studies assessing physical activity impact irrespectively the type for quality assessment and qualitative and quantitative synthesis. Quantitative synthesis was performed using the reported adjusted HRs. Physical activity was handled as a dichotomous variable, with two groups created (high versus low physical activity). Subgroup analyses were done for risk of bias, VaD and length of follow-up.
There was considerable methodological heterogeneity across studies. Only three studies reported significant associations. The overall effect was statistically significant (HR 0.68, 95%CI 0.54-0.86, I 6.8%), with higher levels of physical activity associated with a smaller risk of VCI overtime, particularly VaD.
These findings suggest that physical activity is a potential preventive factor for vascular dementia. Insufficient data is available on VCIND. Randomized studies are desired to confirm these results.
血管性认知障碍（VCI）是全球第二常见的认知障碍病因，包括从血管性认知障碍但无痴呆（VCIND）到血管性痴呆（VaD）的一系列疾病。目前尚无专门针对 VCI 的药物治疗方法。有研究表明，身体活动对认知具有潜在的预防作用，可直接或间接带来益处，同时改善了几个可改变的血管危险因素，因此在考虑 VCI 时可能是有效的。我们的目的是进行系统评价和荟萃分析，探讨身体活动对 VCI 的潜在预防作用。
在 7 个数据库中进行了系统搜索。共筛选了 6786 项研究，并评估其纳入资格，最终纳入了 9 项观察性前瞻性研究，评估了身体活动对 VCI 的影响，无论其类型如何，均进行了质量评估和定性及定量综合分析。使用报告的调整后的 HR 进行定量综合分析。身体活动被视为二分变量，创建了两个组（高体力活动与低体力活动）。进行了偏倚风险、VaD 和随访时间的亚组分析。
研究之间存在相当大的方法学异质性。只有三项研究报告了显著的相关性。总体效应具有统计学意义（HR 0.68，95%CI 0.54-0.86，I²=6.8%），较高水平的身体活动与较低的 VCI 风险相关，尤其是 VaD。
这些发现表明，身体活动是血管性痴呆的一个潜在预防因素。关于 VCIND 的可用数据不足。需要随机研究来证实这些结果。
