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Cited by 154Dementia and Cognitive Impairment ResearchPhysical Activity and HealthDown syndrome and intellectual disability research

Exercise programs for people with dementia

Forbes, Dorothy, Thiessen, Emily J, Blake, Catherine M, Forbes, Scott C, Forbes, Sean·2013·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006489.pub3
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Abstract

BACKGROUND: This is an update of our previous 2008 review. Several recent trials and systematic reviews of the impact of exercise on people with dementia are reporting promising findings. OBJECTIVES: Primary: Do exercise programs for older people with dementia improve cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia?Secondary: Do exercise programs for older people with dementia have an indirect impact on family caregivers' burden, quality of life, and mortality?Do exercise programs for older people with dementia reduce the use of healthcare services (e.g. visits to the emergency department) by participants and their family caregivers? SEARCH METHODS: We identified trials for inclusion in the review by searching ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group's Specialised Register, on 4 September 2011, and again on 13 August 2012. The search terms used were: 'physical activity' OR exercise OR cycling OR swim* OR gym* OR walk* OR danc* OR yoga OR 'tai chi'. SELECTION CRITERIA: In this review, we included randomized controlled trials in which older people, diagnosed with dementia, were allocated either to exercise programs or to control groups (usual care or social contact/activities) with the aim of improving cognition, ADLs, behaviour, depression, and mortality. Secondary outcomes related to the family caregiver(s) and included caregiver burden, quality of life, mortality, and use of healthcare services. DATA COLLECTION AND ANALYSIS: Independently, at least two authors assessed the retrieved articles for inclusion, assessed methodological quality, and extracted data. Data were analysed for summary effects using RevMan 5.1 software. We calculated mean differences or standardized mean difference (SMD) for continuous data, and synthesized data for each outcome using a fixed-effect model, unless there was substantial heterogeneity between studies, when we used a random-effects model. We planned to explore heterogeneity in relation to severity and type of dementia, and type, frequency, and duration of exercise program. We also evaluated adverse events. MAIN RESULTS: Sixteen trials with 937 participants met the inclusion criteria. However, the required data from three trials and some of the data from a fourth trial were not published and not made available. The included trials were highly heterogeneous in terms of subtype and severity of participants' dementia, and type, duration and frequency of exercise. Only two trials included participants living at home. Our meta-analysis suggested that exercise programs might have a significant impact on improving cognitive functioning (eight trials, 329 participants; SMD 0.55, 95% confidence interval (CI) 0.02 to 1.09). However, there was substantial heterogeneity between trials (I(2) value 80%), most of which we were unable to explain. We repeated the analysis omitting one trial, an outlier, that included only participants with moderate or severe dementia. This reduced the heterogeneity somewhat (I(2) value 68%), and produced a result that was no longer significant (seven trials, 308 participants; SMD 0.31, 95% CI -0.11 to 0.74). We found a significant effect of exercise programs on the ability of people with dementia to perform ADLs (six studies, 289 participants; SMD 0.68, 95% CI 0.08 to 1.27). However, again we observed considerable unexplained statistical heterogeneity (I(2) value 77%) in this meta-analysis. This means that there is a need for caution in interpreting these findings. In further analyses, we found that the burden experienced by informal caregivers providing care in the home may be reduced when they supervise the participation of the family member with dementia in an exercise program (one study, 40 participants; MD -15.30, 95% CI -24.73 to -5.87), but we found no significant effect of exercise on challenging behaviours (one study, 110 participants; MD -0.60, 95% CI -4.22 to 3.02), or depression (six studies, 341 participants; MD -0.14, 95% CI -0.36 to 0.07) . We could not examine the remaining outcomes, quality of life, mortality, and healthcare costs, as either the appropriate data were not reported, or we did not retrieve trials that examined these outcomes. AUTHORS' CONCLUSIONS: There is promising evidence that exercise programs can have a significant impact in improving ability to perform ADLs and possibly in improving cognition in people with dementia, although some caution is advised in interpreting these findings. The programs revealed no significant effect on challenging behaviours or depression. There was little or no evidence regarding the remaining outcomes of interest.

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  • Exercise programs reduce the progression of dependence in activities of daily living in people with dementia.

    “A Cochrane review including 17 randomized controlled trials (RCTs) confirmed the positive effect of exercise programs in reducing the progression of dependence in ADL in people with dementia but showed limited evidence of benefit for the remaining outcomes (i.e., cognition, BPSD, QoL, depression, mortality, caregiver burden, and use of healthcare services) (39).”

    From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [39]

  • Evidence of benefit of exercise programs for cognition, BPSD, quality of life, depression, mortality, caregiver burden, and use of healthcare services in people with dementia is limited.

    “A Cochrane review including 17 randomized controlled trials (RCTs) confirmed the positive effect of exercise programs in reducing the progression of dependence in ADL in people with dementia but showed limited evidence of benefit for the remaining outcomes (i.e., cognition, BPSD, QoL, depression, mortality, caregiver burden, and use of healthcare services) (39).”

    From The Multidisciplinary Approach to Alzheimer’s Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment (2018) · cites this paper as [39]

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Authors
Forbes, D., Thiessen, E. J., Blake, C. M., Forbes, S. C., & Forbes, S.
Affiliations
  • University of Alberta (CA)
  • Western University (CA)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
John Wiley & Sons, Ltd
Published
2013-12-04
Issue
12
Pages
CD006489-CD006489
ISSN
1361-6137 (ISSN-L)
DOI
10.1002/14651858.cd006489.pub3
OpenAlex
W4211184021
Cited by
154
References
85
Citations by year
2026: 1 · 2025: 1 · 2024: 4 · 2023: 6 · 2022: 10 · 2021: 9 · 2020: 17 · 2019: 9 · 2018: 13 · 2017: 14 · 2016: 21 · 2015: 39 · 2014: 10
Type
reference entry
Language
en
Update notices
new_version (2015-04-15)
Open access
closed
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
Keywords
exercise program, dementia, physical activity, cognitive function, activities of daily living, behavioral problems, depression, mortality, family caregivers, caregiver burden, quality of life, health care utilization, Tai Chi, yoga, walking, cycling, older adults, adverse events, exercise frequency and duration, exercise intensity, exercise duration
MeSH terms
Aged, Cognition, Dementia, Depression, Exercise Therapy, Humans, Motor Activity, Yoga, Exercise, Randomized Controlled Trials as Topic, Tai Ji

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