BMJ 2013;347:f7196 doi: 10.1136/bmj.f7196 (Published 4 December 2013)
Page 1 of 1
Research News
RESEARCH NEWS Evidence grows for benefits of exercise in dementia Zosia Kmietowicz BMJ
Reviewers have found more evidence that exercise can benefit people with dementia by improving their cognitive functioning and ability to carry out everyday activities. But exercise did not improve symptoms of depression or challenging behaviour in people with dementia, and more evidence is needed to understand how exercise might reduce the burden on carers and health systems, says the Cochrane systematic review.1
In 2008, when the reviewers previously analysed the evidence on exercise and dementia, just four trials met the inclusion criteria for meta-analysis. In the latest review 16 studies with 937 participants met the criteria, although the data from four studies were not published or were unavailable.
All participants were aged over 65 years and took part in exercise programmes that lasted from two weeks to 12 months and involved sessions twice a week to every day. The exercise sessions lasted from 20 to 75 minutes and included aerobic, strengthening, and balance elements, such as catching and throwing a ball, exercises with leg weights, walking, and dance. The reviewers found evidence from eight trials and 329 participants that exercise programmes can significantly improve cognitive functioning (standardised mean difference 0.55 (95% confidence interval 0.02 to 1.09)). However, they found much heterogeneity among the trials, and when they excluded one study that included only moderate to severe dementia the effect was no longer significant (standardised mean difference 0.31 (−0.11 to 0.74)).
Data from six studies involving 289 people showed that exercise could improve the ability of elderly people with dementia to carry out daily activities such as walking short distances or getting up from a chair (standard mean difference 0.68 (0.09 to 1.27)). But again there was considerable heterogeneity in this analysis, said the reviewers, meaning that the results should be interpreted with caution.
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One study involving 40 participants found that the burden on carers may be reduced when their relative with dementia takes part in an exercise programme (mean difference −15.3 (−24.7 to −5.9)). But there was no significant effect of exercise on challenging behaviour (one study with 110 participants) or depression (six studies with 341 participants).
Dorothy Forbes, an associate professor of nursing at the University of Alberta in Edmonton and the review’s lead author, said, “In our previous review we were unable to draw any conclusions about the effectiveness of exercise in older people with dementia, due to a shortage of appropriate trials. Following this new review, we are now able to conclude that there is promising evidence for exercise programmes improving cognition and the ability to carry out daily activities. However, we do still need to be cautious about how we interpret these findings.” She added, “Clearly, further research is needed to be able to develop best practice guidelines to enable healthcare providers to advise people with dementia living at home or in institutions. We also need to understand what level and intensity of exercise is beneficial for someone with dementia.”
1
Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev 2013;11:CD006489.
Cite this as: BMJ 2013;347:f7196 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
Page 1 of 1
Research News
RESEARCH NEWS Evidence grows for benefits of exercise in dementia Zosia Kmietowicz BMJ
Reviewers have found more evidence that exercise can benefit people with dementia by improving their cognitive functioning and ability to carry out everyday activities. But exercise did not improve symptoms of depression or challenging behaviour in people with dementia, and more evidence is needed to understand how exercise might reduce the burden on carers and health systems, says the Cochrane systematic review.1
In 2008, when the reviewers previously analysed the evidence on exercise and dementia, just four trials met the inclusion criteria for meta-analysis. In the latest review 16 studies with 937 participants met the criteria, although the data from four studies were not published or were unavailable.
All participants were aged over 65 years and took part in exercise programmes that lasted from two weeks to 12 months and involved sessions twice a week to every day. The exercise sessions lasted from 20 to 75 minutes and included aerobic, strengthening, and balance elements, such as catching and throwing a ball, exercises with leg weights, walking, and dance. The reviewers found evidence from eight trials and 329 participants that exercise programmes can significantly improve cognitive functioning (standardised mean difference 0.55 (95% confidence interval 0.02 to 1.09)). However, they found much heterogeneity among the trials, and when they excluded one study that included only moderate to severe dementia the effect was no longer significant (standardised mean difference 0.31 (−0.11 to 0.74)).
Data from six studies involving 289 people showed that exercise could improve the ability of elderly people with dementia to carry out daily activities such as walking short distances or getting up from a chair (standard mean difference 0.68 (0.09 to 1.27)). But again there was considerable heterogeneity in this analysis, said the reviewers, meaning that the results should be interpreted with caution.
For personal use only: See rights and reprints http://www.bmj.com/permissions
One study involving 40 participants found that the burden on carers may be reduced when their relative with dementia takes part in an exercise programme (mean difference −15.3 (−24.7 to −5.9)). But there was no significant effect of exercise on challenging behaviour (one study with 110 participants) or depression (six studies with 341 participants).
Dorothy Forbes, an associate professor of nursing at the University of Alberta in Edmonton and the review’s lead author, said, “In our previous review we were unable to draw any conclusions about the effectiveness of exercise in older people with dementia, due to a shortage of appropriate trials. Following this new review, we are now able to conclude that there is promising evidence for exercise programmes improving cognition and the ability to carry out daily activities. However, we do still need to be cautious about how we interpret these findings.” She added, “Clearly, further research is needed to be able to develop best practice guidelines to enable healthcare providers to advise people with dementia living at home or in institutions. We also need to understand what level and intensity of exercise is beneficial for someone with dementia.”
1
Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev 2013;11:CD006489.
Cite this as: BMJ 2013;347:f7196 © BMJ Publishing Group Ltd 2013
Subscribe: http://www.bmj.com/subscribe
