Meta-analysis
The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis1,

https://doi.org/10.1016/j.apmr.2004.03.019Get rights and content

Abstract

Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil 2004;85:1694–704.

Objective

To determine by meta-analysis whether physical exercises are beneficial for people with dementia and related cognitive impairments.

Data sources

Published articles and nonpublished manuscripts from 1970 to 2003 were identified by using electronic and manual searches. Key search words included exercise, rehabilitation, activities of daily living, dementia, Alzheimer’s disease, aged, and geriatrics.

Study selection

Reviewed studies were limited to randomized trials evaluating exercise in persons 65 years of age or older with cognitive impairment. Studies included quantitative results (means, standard deviations, t tests, F tests) for physical fitness, physical functioning, cognition, or behavior outcomes.

Data extraction

One reviewer extracted data on study characteristics and findings. Selected articles were evaluated for methodologic quality by 2 raters.

Data synthesis

A total of 2020 subjects participated in the 30 trials that met the inclusion criteria. Summary effects were computed using a fixed effects (Hedge’s gi) model. Significant summary effect sizes (ES) were found for strength (ES=.75; 95% confidence interval [CI], .58–.92), physical fitness (ES=.69; 95% CI, .58–.80), functional performance (ES=.59; 95% CI, .43–.76), cognitive performance (ES=.57; 95% CI, 0.43–1.17), and behavior (ES=.54; 95% CI, .36–.72). The overall mean ES between exercise and nonexercise groups for all outcomes was .62 (95% CI, .55–.70).

Conclusions

Exercise training increases fitness, physical function, cognitive function, and positive behavior in people with dementia and related cognitive impairments.

Section snippets

Data sources

Computer-aided searches71 were conducted using the following databases: PubMed, MEDLINE, Ageline, CINAHL, PsycLIT, PsycINFO, Sport Discuss (SIRC/CDC), Cochrane Register, PEDro, Educational Resources Information Center, and Dissertation Abstracts International. An extensive manual search and cross-referencing from review and original articles were also performed. Articles not written in English were excluded.

The key words used in the search of computerized databases included physical activity,

Results

The 30 selected trials generated a sample size of 2020 subjects. Treatment and control and comparison groups were composed of 1023 and 997 subjects, respectively. Subjects’ mean age ± SD was 80±6.1 years (range, 66–91y). Gender proportions (72% women, 28% men) were identified from the original sample sizes. Twenty-nine studies reported random assignment procedure, and 1 study86 reported a delayed intervention design with control condition. Only 6 studies reported a blinding procedure; 5 studies

Discussion

This meta-analysis investigated the effectiveness of exercise training for people with dementia and calculated the ES of exercise training on physical, behavioral, functional, and cognitive outcome measures. To our knowledge, this is the first research synthesis to evaluate the effects of physical training on older people with cognitive impairment. Previous studies of exercise interventions in older adults have not specifically targeted people with cognitive impairments,46 have excluded older

Conclusions

Exercise was associated with statistically significant positive treatment effects in older patients with dementia and cognitive impairments. The meta-analysis results suggest a medium to large treatment effect for health-related physical fitness components, and an overall medium treatment effect for combined physical, cognitive, functional, and behavioral outcomes. The results provide preliminary evidence for the effectiveness of exercise treatments for persons with dementia and related

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    Supported by the Advanced Rehabilitation Research Training Program, National Institute on Disability and Rehabilitation Research (grant no. H133P990001), and the National Institute on Aging (grant nos. R01-AG017638, KO2-AG019736).

    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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