Home-based Physical Activity Programs for People With Dementia: Systematic Review and Meta-analysis

Systematic Review and Meta-Analysis

Sara Isabel Lebre de Almeida, MSc; Madalena Gomes da Silva, PhD; Alda Sofia Pires de Dias Marques, PhD

Disclosures

Gerontologist. 2020;60(8):e600-e608. 

In This Article

Abstract and Introduction

Abstract

Background and Objectives: Physical activity has the potential to improve health outcomes in people with dementia, namely when living at home. However, the knowledge about home-based physical activity for this population is scarce. Thus, we aim to identify and synthesize the effects of home-based physical activity for people with dementia.

Research Design and Methods: A systematic review was conducted. Quality of studies was assessed using the Delphi List. Effect sizes (ES) were calculated with MetaXL 2.0. A meta-analysis was conducted for the Mini-Mental Status Examination (MMSE), Neuropsychiatric Inventory (NPI), Cornell Scale for Depression in Dementia, Alzheimer's Disease Cooperative Study Group Activities of Daily Living Scale (ADCS-ADL), Functional Reach test, Timed Up and Go (TUG) test, Short Physical Performance Battery, Dementia Quality of Life, NPI Caregivers subscale and Zarit Burden Interview (ZBI).

Results: Sixteen randomized controlled trials were included. Most were of high quality and published after 2015. A large heterogeneity of interventions was found. Meta-analysis showed significant results in MMSE (ES = 0.71, 95% CI 0.43, 0.99), NPI (ES = −0.37, 95% CI −0.57, −0.17), ADCS-ADL (ES = 0.80, 95% CI 0.53, 1.07), Functional Reach test (ES = 2.24, 95% CI 1.80, 2.68), TUG test (ES = −2.40, 95% CI −2.84, −1.96), NPI Caregivers subscale (ES = −0.63, 95% CI −0.94, −0.32), and ZBI (ES = −0.45, 95% CI −0.77, −0.13). Few minor adverse events and high adherence to intervention were found.

Discussion and Implications: Home-based physical activity seems safe and effective in delaying cognitive function decline and improving changes in behavioral and psychological symptoms of dementia, activities of daily living, health-related physical fitness, and carer's burden in people with dementia living at home.

Introduction

Dementia is a neurodegenerative syndrome that affects approximately 47.5 million people worldwide (Prince et al., 2015). This number is expected to grow to 131.5 million people by 2050 (Prince et al., 2015). Dementia is characterized by a decline in cognition and independence for activities of daily living (WHO, 2012), making it a major cause of incapacity and dependency among older people. Currently, most people with dementia live in their own homes (WHO, 2012), with about one third of them living alone (Ebly, Hogan, & Rockwood, 1999). Therefore, the development of home-based interventions is vital to inform the provision of care for people with dementia (WHO, 2012).

A highly recommended nonpharmacological intervention to manage symptoms of dementia is physical activity (Forbes, Thiessen, Blake, Forbes, & Forbes, 2015; Regier, Hodgson, & Gitlin, 2016; Sallis et al., 2016). Physical activity is defined as ''any body movement produced by skeletal muscles that requires energy expenditure'' (Caspersen, Powell, & Christenson, 1985).

Although studies looking at the effects of home-based physical activity programs exist, results are widespread in the literature. The published systematic reviews on physical activity in people with dementia found improvements in executive function, activities of daily living, falls prevention, cognitive decline, mobility, physical function, fitness, and positive behavior (Blankevoort et al., 2010; Burton et al., 2015; Forbes et al., 2015; Heyn, Abreu, & Ottenbacher, 2004; Pitkälä, Savikko, Poysti, Strandberg, & Laakkonen, 2013; Potter, Ellard, Rees, & Thorogood, 2011; Rao, Chou, Bursley, Smulofsky, & Jezequel, 2014). However, these reviews included studies conducted in different or undistinguishable settings, hindering comparisons across different settings and consequently, conclusions regarding the effects of physical activity at home (Blankevoort et al., 2010; Burton et al., 2015; Forbes et al., 2015; Heyn et al., 2004; Pitkälä, Savikko, et al., 2013; Potter et al., 2011; Rao et al., 2014). Looking at these effects separately is important to guide personalized interventions and future research in the setting where people with dementia spend more time. Thus, the aim of this systematic review was to identify and synthesize the effects of home-based physical activity in people with dementia.

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