Exercise programmes may have a significant effect on improving cognitive functioning in the ability of older people with dementia to perform activities of daily living
Citation: Andrews L (2014) Benefits of exercise programmes for people with dementia. Nursing Times; 110: 28, 25.
Author: Lesley Andrews is teaching fellow at the School of Nursing, Midwifery and Health, University of Stirling and a member of the Cochrane Nursing Care Field.
- This article summarises the findings of a Cochrane review
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Exercise is associated with numerous physical health benefits, including reduced risk of conditions such as cardiovascular disease, stroke, diabetes and osteoporosis. There is growing evidence that it may also improve aspects of psychological functioning, such as depression, and may enhance cognitive function in older adults with dementia. With an ageing population and a rise in dementia, it is important to establish the specific benefits that exercise may offer older adults with dementia.
Cochrane review questions
This Cochrane review explored two questions:
- Do exercise programmes for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression and mortality?
- Do exercise programmes for older people with dementia have an indirect impact on family caregivers’ burden, quality of life, mortality, or use of healthcare services (Forbes et al, 2013)?
The review included 16 randomised controlled trials published between 1997 and 2012 involving 937 participants. Participants were aged over 65 years with a diagnosis of dementia, living in nursing homes (10 trials), graduated residential care (one trial), psychiatric facilities (three trials) and participants’ own homes (two trials).
In nine trials, participants had a diagnosis of Alzheimer’s disease (AD), in one trial they had a diagnosis of vascular disease combined with AD and in the remaining six trials participants had an unspecified type of dementia.
Participants’ stage of dementia ranged from mild (one trial), mild to moderate (six trials), mild to severe (four trials), moderate (one trial), moderate to severe (three trials) and severe (one trial). Only 10 of the trials detailed participants’ level of physical activity, which varied greatly.
The exercise programme interventions ranged in type, frequency and duration. Control groups ranged from usual care with no additional interventions (eight studies), to social contact alone (four studies), or social contact with additional activities such as films, singing and reading (three studies). One study did not provide any information about the control group.
The primary outcomes of interest were cognitive function, ADLs, challenging behaviours, depression and mortality. Secondary outcomes included caregiver burden, quality of life, mortality and use of healthcare services. The methodological quality of included trials was variable due to incomplete or unclear data reporting.
Summary of key evidence
Meta-analysis revealed significant results for the effect of exercise on cognition in eight trials and ADLs in six trials. However, these results should be treated with caution due to substantial unexplained heterogeneity, which was not reduced as a result of the meta-analysis.
Two of the four studies that examined the effect of exercise on challenging behaviour reported improvement. However, each failed to provide statistical evidence to support this claim; the two remaining trials revealed no significant effect. No significant results were reported for the effect of exercise on depression (six studies).
A significant improvement was reported on caregiver burden in one trial involving 40 participants.
It was not possible to ascertain a dose-response between the type, duration or frequency of exercise, or the degree of protection from cognitive decline and other outcomes.
Best practice recommendations
The results suggest that exercise programmes may have a significant positive effect on cognitive functioning and the ability to perform ADLs in older people with dementia. However, further research is required to identify best type, frequency and duration of exercise as well as differentiating between the different types and stages of dementia.
The burden experienced by informal caregivers providing care in the home may also be reduced if they supervise their family member with dementia while they participate in an exercise programme. Further community-based research is needed to specifically examine the effect of exercise on caregiver quality of life.
Forbes D et al (2013) Exercise programs for people with dementia. Cochrane Database of Systematic Reviews; 12, CD006489.