Table 7.
Effect of exercise on secondary outcomes in dementia
| Certainty assessment | No. of patients | Effect | Certainty | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No. of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Physical activity/exercise | Standard care | Relative (95% CI) | Absolute (95% CI) | ||
| Depressive symptoms in dementia (physical activity mixed interventions) | ||||||||||||
| 15 | Randomized controlled trials | Not serious | Not serious | Not serious | Not serious | Publication bias strongly suspectedc | 707 | 722 | – |
SMD 0.18 SD lower (0.33 lower to 0.02 lower) |
⨁⨁⨁◯ Moderate |
Important |
| Behavioral and psychological symptoms in dementia BPSD (physical activity mixed interventions) | ||||||||||||
| 6 | Randomized controlled trials | Very seriousd | Very seriouse | Not serious | Not serious | None | 497 | 564 | – |
MD 4.62 SD lower (9.08 lower to 0.16 lower) |
⨁◯◯◯ Very low |
Important |
| Risk of falls in dementia (physical activity interventions home-based) | ||||||||||||
| 2 | Randomized controlled trials | Not serious | Not serious | Not serious | Seriousb | Publication bias strongly suspectedc | Not available | Not availaible |
RR 0.69 (0.55–0.86) |
Not possible |
⨁⨁◯◯ Low |
Important |
| Number of falls in dementia (physical activity interventions home-based) | ||||||||||||
| 3 | Randomized controlled trials | Not serious | Not serious | Not serious | Seriousb | None | 137 | 137 | – |
MD 1.06 lower (1.67 lower to 0.46 lower) |
⨁⨁⨁◯ Moderate |
Important |
| Risk of falls in dementia (physical activity mixed interventions) | ||||||||||||
| 3 | Randomized controlled trials | Not serious | Not serious | Not serious | Seriousb | None | 60/134 (44.8%) | 90/137 (65.7%) |
RR 0.69 (0.55–0.85) |
204 fewer per 1.000 (from 296 to 99 fewer) |
⨁⨁⨁◯ Moderate |
Important |
| Depressive symptoms (in AD) (physical activity mixed interventions) | ||||||||||||
| 3 | Randomized controlled trials | Very seriousd | Not serious | not serious | seriousb | None | 110 | 109 | – |
SMD 0.18 SD higher (0.03 lower to 0.39 higher) |
⨁◯◯◯ Very low |
Important |
| Mortality (in dementia) (physical activity mixed interventions) | ||||||||||||
| 10 | Randomized controlled trials | Very seriousd | Not serious | Not serious | Not serious | None | 25/341 (7.3%) | 27/348 (7.8%) |
RR 0.66 (0.43–1.02) |
26 fewer per 1.000 (from 44 fewer to 2 more) |
⨁⨁◯◯ Low |
Important |
| Length of stay in hospital (in dementia) (physical activity mixed interventions) | ||||||||||||
| 3 | Randomized controlled trials | Very seriousd | Not serious | Not serious | Not serious | None | 207 | 205 | – |
MD 0.16 lower (0.36 lower to 0.03 higher) |
⨁⨁◯◯ Low |
Important |
| BPSD (in dementia) (physical activity mixed interventions) | ||||||||||||
| 3 | Randomized controlled trials | Very seriousd | Seriousa | Not serious | Seriousb | None | 145 | 136 | – |
MD 3.89 lower (8.97 lower to 1.2 higher) |
⨁◯◯◯ Very low |
Important |
| Apathy (in dementia) (physical activity mixed interventions) | ||||||||||||
| 3 | Randomized controlled trials | Seriousf | Seriousa | Not serious | Seriousb | None | 117 | 111 | – |
SMD 0.34 SD lower (0.83 lower to 0.15 higher) |
⨁◯◯◯ Very low |
Important |
| Anxiety (in dementia) (physical activity mixed interventions) | ||||||||||||
| 3 | Randomized controlled trials | Seriousd | Seriousa | Not serious | Seriousb | Publication bias strongly suspectedc | 109 | 101 | – |
SMD 0.33 SD lower (0.84 lower to 0.18 higher) |
⨁◯◯◯ Very low |
Important |
| Quality of life (in dementia) (physical activity mixed interventions) | ||||||||||||
| 6 | Randomized controlled trials | Seriousf | Very seriouse | Not serious | Not serious | None | 385 | 380 | – |
SMD 0.33 SD higher (0.2 lower to 0.86 higher) |
⨁◯◯◯ Very low |
Important |
| Rate of Hospitalization (in dementia) (physical activity mixed interventions) | ||||||||||||
| 5 | Randomized controlled trials | Very seriousd | Not serious | Not serious | Not serious | None | 101/299 (33.8%) | 95/294 (32.3%) |
RR 1.05 (0.85–1.31) |
16 more per 1.000 (from 48 fewer to 100 more) |
⨁⨁◯◯ Low |
Important |
CI confidence interval, MD mean difference, RR risk ratio, SMD Standardized mean difference, SD Standard deviation, AD Alzheimer’s disease, BPSD Behavioral And Psychological Symptoms In Dementia
aI2 between 50% and 75%
bSample size less than 400 participants
cEgger's test (p value) < 0.05
dOne or more of the three criteria (randomization, masking, drop-out rate > 30%) is not met in > 30% of trials included
eI2 more than 75%
fOne or more of the three criteria (randomization, masking, drop-out rate > 30%) is not met in 10–30% of trials included