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.
Keywords
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References
- The incidence of dementia.Neurology. 1998; 51: 728-733
- DSM-V diagnostic and statistical manual of mental disorders. 5th ed. APA, Washington (DC)2000
- Recognition and initial assessment of Alzheimer’s disease and related dementias. Clinical practice guideline no. 19. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Rockville1996 (AHCPR Publication No. 97-0702.)
- Toward healthy aging 2010.Aging Today. 2002; XXIII: 7-10
- Uses of evidence in disability outcomes and effectiveness research.Milbank Q. 2002; 80: 325-345
- Have we oversold the benefit of late-life exercise?.J Gerontol A Biol Sci Med Sci. 2001; 56: M412-M423
- Disability models.Arthritis Rheum. 2003; 49: 114-120
- Aging and physical disability.Exerc Sport Sci Rev. 2002; 30: 166-170
- Late Life Function and Disability Instrument: II. Development and evaluation of the function component.J Gerontol A Biol Sci Med Sci. 2002; 57: M217-M222
- Major public health benefits of physical activity.Arthritis Care Res. 2003; 49: 122-128
- Exercise comes of age.J Gerontol A Biol Med Sci. 2002; 57: M262-M282
- A prospective study of physical activity and cognitive decline in elderly women.Arch Intern Med. 2001; 161: 1703-1708
- The effects of physical conditioning on older individuals. II. Motor performance and cognitive function.J Gerontol. 1966; 21: 192-199
- Response of institutionalized geriatric mental patients to a twelve-week program of regular physical activity.J Gerontol. 1975; 30: 565-573
- Physiological effects of an exercise training regimen upon men aged 52–88.J Gerontol. 1970; 25: 325-336
- Aerobic exercise training and improved neuropsychological function of older individuals.Neurobiol Aging. 1984; 5: 35-42
- Psychological effects of exercise therapy upon institutionalized geriatric mental patients.J Gerontol. 1974; 29: 157-161
- Effects of exercise on mental functioning.J Sports Med. 1975; 15: 125-131
- Physical dimensions of aging. Human Kinetics, Champaign1995
- Physiological effects of training upon institutionalized geriatric men.J Gerontol. 1972; 27: 451-455
- Effects of physical exercise for elderly patients with physical impairments.J Am Geriatr Soc. 1988; 36: 130-135
- The role of exercise in the aging.JAMA. 1975; 165: 70-71
- A randomized trial of a combined physical activity and environmental intervention in nursing home residents.J Am Geriatr Assoc. 1999; 47: 784-791
- Elder rehab.Gerontologist. 1999; 39: 729-735
- Clinical feasibility of free-weight strength training program for older adults.J Am Board Fam Pract. 1998; 11: 445-451
- Exercise training and nutritional supplementation for physical frailty in very elderly people.JAMA. 1994; 330: 1769-1775
- The effects of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia.Am J Alzheimers Dis Other Demen. 2003; 18: 247-251
- The impact of daily exercise on the mobility, balance, and urine control of cognitively impaired nursing homes.Int J Nurs Stud. 1991; 28: 45-151
- Nursing rehabilitation and exercise strategies in the nursing home.J Gerontol A Biol Sci Med Sci. 1999; 54: M494-M500
- Effect of a combined walking and conversation intervention on functional mobility of nursing home residents with Alzheimer’s disease.Alzheimer Dis Assoc Disord. 2000; 14: 196-201
- Therapeutic recreation as an intervention for persons with dementia and agitation. Pennsylvania State Univ, State College (PA)1994
- The effect of planned walking on communication in Alzheimer’s disease.J Am Geriatr Soc. 1991; 39 (670-654)
- Behavior management in senile dementia of the Alzheimer’s type through exercise [dissertation]. Univ California, Davis (CA)1991
- A randomized controlled trial of a home exercise program for elderly people with poor mobility.Age Ageing. 1995; 24: 425-428
- Improving cognitive performance in psychogeriatric patients.Age Ageing. 1977; 6: 58-64
- The effects of regular exercise on muscle strength and functional abilities of late stage Alzheimer’s residents.Am J Alzheimers Dis. 1997; 12: 122-127
- Planning activities for patients with dementia.J Gerontol Nurs. 1996; Sept: 33-38
- A controlled trial of exercise by residents of old people’s home.Age Ageing. 1993; 22: 11-15
- The effects of a three-month exercise program on neuropsychological function in elderly institutionalized women.Age Ageing. 1988; 17: 303-310
- Effects of aerobic training on the cognitive performance of elderly patients with senile dementia of Alzheimer type.Arch Gerontol Geriatr. 1996; 5: 47-50
- Walking as a symptom management technique for Alzheimer’s disease [dissertation]. Univ Alberta, Edmonton (AB)1999
- The effects of therapeutic aquatic exercise on patients with Alzheimer’s disease [dissertation]. Union Institute, Cincinnati (OH)1992
- The feasibility of conducting strength and flexibility programs for elderly nursing home residents with dementia.Gerontologist. 1995; 35: 263-266
- Gait performance in dementia.Int J Geriatr Psychiatry. 2002; 17: 329-334
- Fitness effects on the cognitive function of older adults.Psychol Sci. 2003; 14: 125-130
- Aerobic fitness reduces brain tissue loss in aging humans.J Gerontol A Biol Sci Med Sci. 2003; 58: 176-180
- A case-control study of Alzheimer’s disease in Australia.Neurology. 1990; 40: 1698-1707
- Physical activity and risk of cognitive impairment and dementia in elderly persons.Arch Neurol. 2001; 58: 498-504
- A three-year follow-up study of age-related dementia in an urban area of Beijing.Acta Psychiatr Scand. 1991; 83: 99-104
- Regulation of brain function by exercise.Neurobiol Dis. 2003; 13: 1-14
- Lifelong exercise may help ward off Alzheimer’s disease.Paper presented at: American Academy of Neurology’s Annual Meeting. 1998 (April 25-May 2; Minneapolis (MN).)
- Genetic and nongenetic risk factors for Alzheimer’s disease.Program and abstracts of the 8th International Conference on Alzheimer’s Disease and Related Disorders. 2002 (July 20–25; Stockholm (Sweden).)
- Risk assessment for Alzheimer’s disease with genetic susceptibility testing.Alzheimers Care Q. 2002; 3: 208-214
- Atherosclerosis, apolipoprotein E, and prevalence of dementia and Alzheimer’s disease in the Rotterdam Study.Lancet. 1997; 349: 151-154
- Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men. The Honolulu-Asia Aging Study.Arterioscler Thromb Vasc Biol. 2000; 20: 2255-2260
- Low blood pressure and blood glucose levels in Alzheimer’s disease.J Intern Med. 1993; 233: 357-363
- Dietary fat intake and the risk of incident dementia in the Rotterdam Study.Ann Neurol. 1997; 42: 776-782
- Coronary artery disease, hypertension, apo E, and cholesterol.Ann N Y Acad Sci. 1997; 826: 128-146
- Changes in physical fitness and all-cause mortality.JAMA. 1995; 273: 1093-1098
- Some health benefits of physical activity.Arch Intern Med. 1979; 139: 857-861
- Physical activity and physical demand on the job and risk of cardiovascular disease and death.Am Heart J. 1986; 112: 820-825
- A natural history of athleticism and cardiovascular health.JAMA. 1984; 252: 491-495
- Effects of physical activity on intellectual development and academic performance.in: Stull G.A. Eckert H. Effect of physical activity and self-esteem development in children. Human Kinetics, Champaign1986: 49-63
- Exercise enhances and protects brain function.Exerc Sport Sci Rev. 2002; 30: 75-79
- Neuroplasticity in old age.Ann Neurol. 2002; 52: 135-143
- Exercise and Alzheimer’s disease.Activities Adaptation Aging. 1996; 20: 21-34
- American College of Sports Medicine ACSM’s exercise management for persons with chronic diseases and disabilities. 2nd ed. Human Kinetics, Champaign2003
- Benefits of exercise for older adults. Univ Wisconsin, Milwaukee1998
- The influence of physical fitness and exercise upon cognitive functioning.J Sport Exerc Psychol. 1997; 19: 249-277
- Exercise effects on health-related physical fitness of individuals with an intellectual disability.Adapted Phys Activity Q. 1998; 15: 119-140
- Meta-analysis in social research. Sage, Beverly Hills1981
- The Delphi list.J Clin Epidemiol. 1998; 51: 1235-1241
- Reliability of the PEDro scale for rating quality of randomized controlled trials.Phys Ther. 2003; 83: 713-721
- Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services. Force on Community Preventive Services.Am J Prev Med. 2000; 18: 44-74
- Synthesizing research a guide for literature reviews. 2nd ed. Sage Publications, Thousands Oaks (CA)1998
- Integrating findings.Rev Res Educ. 1977; 5: 351-379
- Estimation and testing for differences in effect size.Psychol Bull. 1982; 91: 691-693
- Statistical power analysis for the behavioral sciences. 2nd ed. Lawrence Erlbaum Associates, Hillsdale1988
- Practical meta-analysis. Vol 49. Sage Publications, Thousand Oaks (CA)2001
- “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 221-231
- Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders?.Arch Phys Med Rehabil. 1998; 79: 24-30
- A randomized trial of exercise programs among older individuals living in two long-term care facilities.J Am Geriatr Assoc. 2001; 49: 859-865
- A randomized outcome evaluation of group exercise programs in long-term care institutions.J Gerontol. 1999; 54: M621-M628
- Mobility and dementia.Int J Geriatr Psychiatry. 1999; 14: 389-397
- Effects of daily physical exercise on the psychiatric state of institutionalized geriatric mental patients.Res Q. 1974; 45: 34-41
- Walking program for nursing home residents.J Am Geriatr Soc. 1996; 44: 175-180
- Physical activity in aging.J Gerontol A Biol Sci Med Sci. 2001; 56 (Spec No. 2): 13-22
- Does physical activity improve sleep in impaired nursing home residents?.J Am Geriatr Assoc. 1995; 43: 1098-1102
- Improvements in quadriceps strength with regular seated exercise in the institutionalized elderly.Arch Phys Rehabil. 1994; 75: 600-603
- Exercise training in the debilitated aged.Arch Phys Med Rehabil. 2000; 81: 312-318
- Exercise with physically restrained nursing home residents.J Am Geriatr Soc. 1996; 44: 507-512
- Translating clinical research into practice.J Am Geriatr Soc. 2002; 50: 1476-1483
- Functional incidental training, mobility performance, and incontinence care with nursing home residents.J Am Geriatr Soc. 1995; 43: 1356-1362
- Effects of a multicomponent exercise program on functional ability in community-dwelling, frail older adults.J Aging Phys Activity. 2001; 9: 414-424
- The effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer’s disease.Alzheimers Dis Assoc Disord. 2002; 16: 81-87
- The effect of skill training on functional abilities of nursing home residents with dementia.Res Nurs Health. 1994; 17: 159-165
- Acute effects of exercise on neuropsychological function in elderly subjects.J Am Geriatr Soc. 1988; 36: 29-33
- A randomized trial of physical rehabilitation for very frail nursing home residents [see comments].JAMA. 1994; 27: 519-524
- Exercise plus behavioral management in patients with Alzheimer’s disease.JAMA. 2003; 290: 2015-2022
Article info
Footnotes
☆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).
Identification
Copyright
© 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
