Table 3.
Summary of reviews examining the effects of exercise interventions on symptoms associated with Alzheimer’s disease and related dementias
| Review | Quality score | # Studies in reviewa | Type | Characteristics | Outcomes | ||||
|---|---|---|---|---|---|---|---|---|---|
| Participants | Design | Interventions | Physical | Psycho-logical | ADL and quality of life | ||||
| Blankevoort et al., 2010b [26] | 9 | 16 | NR/MA | Elderly (mean age >70 years) with dementia | 10 RCT, 6 case series | Various structured exercise programs |
Physical Function:
↑ Gait Speed, fast (k = 2) ES = 0.14; ↑ Gait speed, normal (k = 6) ES = 0.29; ↑ Endurance (k = 5) ES = 1.08; ↑ Lower extremity strength (k = 7) ES = 0.85 ↑ Functional mobility (k = 6) ES = 0.28 Balance and Falls: ↑ Balance (k = 5) ES = 1.76 |
↑ ADL (k = 4) d = 0.68 |
|
| Boote et al., 2006 [27] | 8 | 1 | NR | Mod-severe AD | RCT | Group exercise |
Physical Function:
<>Functional ability (0/1), ↑ Physical Therapy Assessment (1/1) Balance and Falls: ↑ Balance (1/1) |
||
| Brett et al., 2015 [12] | 9 | 12 | SR | Dementia living in nursing home | RCT | Any PA |
Physical Function:
↑ Mobility (3/5) Balance and Falls: ↑ Balance (1/2) |
Cognition:
↑ Cognition (5/7); Affect: ↑ Mood (3/4); ↓ Agitation (1/1) |
↑ ADL (3/5) |
| Burton et al., 2015 [28] | 11 | 4 | SR/MA | Dementia living in the community | 3 RCT and 1 quasi-experi-mental | Strength, balance and mobility exercises |
Balance and Falls:
↓ Falls (k = 2) MD = -1.06*; <>Fall risk (k = 2) MD = -0.1; <>Balance (k = 2) MD = 0.51 |
||
| Cooper et al., 2012 [13] | 10 | 1 | NR | Dementia | RCT | Comprehensive exercise program | <>QOL (1/1) | ||
| de Souto Barreto et al., 2015 [14] | 8 | 20 | SR/MA | Dementia | RCT | Any exercise |
Affect:
↓ Depression (k = 7) SMD= -0.31* Behaviours: <>Behaviours (k = 4) MD= -3.88 |
||
| Farina et al., 2014 [15] | 10 | 3 | MA | AD | RCT | Any exercise (min. 4 weeks) |
Cognition:
↑ Global cognition (k = 3) SMD = 0.75* |
||
| Forbes et al, 2013 [16] | 11 | 16 | CR | Older adults (>65 years old) with dementia | RCT | Any exercise |
Cognition:
↑ Global cognition (k = 8) SMD = 0.55* Behaviours: <>Challenging behaviours (k = 1) SMD=-0.60 Affect: <> Depression (k = 5) SMD = -0.14 |
↑ ADL (k = 6) SMD = 0.68* |
|
| Forbes et al, 2015 [17] | 11 | 17 | CR | Older adults (>65 years old) with dementia | RCT | Any exercise |
Cognition:
<>Global cognition (k = 9) SMD = 0.43; [excluding moderate-severe dementia (k = 8) SMD = 0.21] Affect: <> Depression (k = 5) SMD = -0.14 Behaviours: <>Challenging behaviours (k = 1) MD= -0.60 |
↑ ADL (k = 6) SMD = 0.68* |
|
| Groot et al., 2016 [52] | 9 | 18 | MA | All dementia except those that affect motor system (e.g., Huntington’s, Parkinson’s) | RCT | Any physical activity |
Cognition:
↑ Cognition (k = 16) SMD = 0.42* |
↑ ADL (k = 4) SMD = 1.18* |
|
| Hermans et al., 2007 [18] | 9 | 0 | CR | Dementia living in domestic setting | RCT | Walking and exercise therapy |
Behaviours:
No studies of wandering met inclusion criteria |
||
| Heyn et al., 2004 [19] | 10 | 30 | MA | Older adults (≥65 years) with cognitive impairment (MMSE <26) | RCT | Any exercise |
Physical Fitness:
↑ Health-related physical fitness (k = 40) ES = 0.69*; ↑ Cardiovascular (k = 18) ES = 0.62*; ↑ Strength (k = 17) ES = 0.75*; ↑ Flexibility (k = 4) ES = 0.91* Physical Function: ↑ Functional performance (k = 20) ES = 0.59* |
Cognition:
↑ Cognition (k = 12) ES = 0.57* Behaviour: ↑ Behaviour (k = 13) ES = 0.54* |
|
| Jensen and Padilla, 2011 [29] | 6 | 6 | NR | Dementia | Mixed | Exercise and motor-based interventions for falls prevention (2 group-based; 4 individual) |
Balance and Falls:
↓ Fall risk (3/4) ↑ Balance (1/1) |
||
| Littbrand et al., 2011 [20] | 9 | 10; results from 6 low quality studies not reported | NR | Dementia | RCT | Walking and combined exercise |
Physical Function:
↑ Walking performance (2/2); <> Mobility (0/2) Balance and Falls: <> Balance (0/1) |
↑ ADL (1/1) | |
| O’Connor et al., 2009 [21] | 8 | 1 | NR | Dementia | RCT, RM | Any PA or exercise |
Affect:
↑ Positive affect, (1/2); ↓ Negative affect, (1/2) |
||
| Pitkala et al., 2013 [30] | 8 | 20 | NR | Dementia | RCT | Any PA |
Physical Function:
↑ Physical function (16/20); ↑ Mobility or ↓ functional limitations (8/9 moderate-to-high quality studies) |
||
| Rao et al., 2014 [22] | 5 | 6 | SR | Ambulatory older adults (>65 years) with AD | RCT with sample size >15 | Aerobic, strength, and balanced or any combination of the three |
Physical Function:
Functional ability (k = 6) ES = 0.53* |
↑ ADL (k = 6) ES = 0.80* | |
| Thuné-Boyle et al., 2012 [23] | 6 | 16 | RCIA | Dementia | Exercise inter-vention studies (6) and reviews (10) | Any exercise |
Affect:
↓ Agitation (4/4); ↓ Depression (4/8); Behavior: ↓ Wandering (1/2); ↑ Night time sleep (3/5) |
||
| Yu, 2011 [24] | 6 | 12 | NR | AD | Experi-mental or quasi-experi-mental | Aerobic exercise (alone or combination; >2weeks) |
Physical Fitness:
↑ 6 min walk (1/1); ↑ Strength (1/1); Physical Performance ↑ Physical performance (4/5) |
Cognition:
↑ Global cognition, MMSE (4/4) Affect: ↑ Mood (4/6) |
↓ ADL limitations (2/2) |
| Yu et al., 2006 [25] | 8 | 18 | NR | AD | Any | Aerobic exercise |
Cognition:
↑ Global cognition (2/2) |
||
Note: AD Alzheimer’s disease, ADL activities of daily living, CR Cochrane review, MA meta analysis, NR narrative review, PA physical activity, QOL quality of life, RCT randomized controlled trial, RCIA rapid critical interpretive approach, SMD standard mean difference, MD mean difference, ES effect size; k number of studies
Values in parentheses indicate the number of studies or effect sizes in a review that addressed that outcome (denominator) and the number that indicated significant improvements (numerator)
*Significant effect size, p < .05
aFor meta-analyses, ‘# of studies’ refers to the number of unique studies included in the reported meta-analyses
bBlankevoort et al. did not report the statistical significance of effect sizes nor did they report confidence intervals