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Am Fam Physician. 2014;90(5):287

Clinical Question

Do exercise programs for older patients with dementia improve cognition, activities of daily living, challenging behavior, depression, and mortality?

Evidence-Based Answer

There is some evidence that exercise improves cognitive function and the ability to perform activities of daily living in patients with dementia. (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

More than 5 million U.S. adults have dementia.1 Because there may be an association between exercise and delay of cognitive decline, a primary interest of the study authors was to determine whether physical activity can improve cognition in patients with dementia.2 This is an update of a 2008 Cochrane review that found insufficient evidence about the effect of exercise on cognition, function, behavior, depression, or mortality in adults with dementia.3 Since then, several additional trials have been conducted.

This review included 16 trials with a total of 937 participants, and examined a variety of exercise programs varying in duration from two weeks to 12 months. Exercise was defined as “body movement that is produced by the contraction of skeletal muscles and that increases energy expenditure.”4 The trials used various combinations of aerobic, strength, and balance training. The control groups received usual care or were given non–exercise-related social activities.

Seven studies with a total of 308 participants measured the effect of exercise on improved cognition. Meta-analysis was performed and results favored the exercise program vs. the control program, but they were not statistically significant (standardized mean difference [SMD] = 0.31; 95% confidence interval [CI], −0.11 to 0.74).

Six studies with a total of 289 participants explored the effect of exercise on activities of daily living. Meta-analysis was performed and results were statistically significant in favor of the exercise program (SMD = 0.68; 95% CI, 0.08 to 1.27). Six studies that measured the effect of exercise on depression found no significant benefit. Four trials examined the effect of exercise on challenging behaviors, and the results were inconclusive. No trials evaluated mortality in patients with dementia, and no significant adverse effects were reported.

Two trials involving 40 participants who cared for patients with dementia evaluated the effect of exercise on caregiver burden. Although the number of participants was small, there was a statistically significant improvement in caregiver burden for those who participated in an exercise program as measured by the Screen for Caregiver Burden and the Zarit Burden Interview Scale (mean difference = −15.30; 95% CI, −24.73 to −5.87).

There is limited evidence that exercise improves cognitive function and performance of activities of daily living in persons with dementia. No adverse effects were noted in any study. Further, exercise programs seem to improve caregiver burden. Current guidelines for dementia recommend graded assistance, memory training, manual activities, and self-management therapy as nonpharmacologic treatments to improve cognitive performance and activities of daily living.5 Other recommendations stress patient-centered care and patient preferences.6 Family physicians may consider encouraging exercise as part of a treatment plan for persons with dementia.

The views expressed in this article are those of the authors and do not reflect the policy or position of the U.S. Army Medical Department, Department of the Army, Department of Defense, or the U.S. government.

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