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Home or community-based exercise programs lasting more than 3 months improve function and balance in older people who have cognitive impairment

Lewis M, Peiris CL, Shields N Long-term home and community-based exercise programs improve function in community-dwelling older people with cognitive impairment: a systematic review. J Physiother. 2017;63:23-9.

Review question

In older people who have cognitive impairment, do exercise programs in the home or in the community that last longer than 3 months improve function and balance, reduce falls, or prevent hospital stays?

Background

Cognitive impairment includes problems with thinking, memory, language, and decision-making and gets progressively worse. Over time, this can lead to worsening physical strength, balance, and fitness, which increase the risk for falling. Exercise can help slow down cognitive decline, maintain physical function, and prevent falls in older people.

How the review was done

The researchers did a systematic review, searching for studies published to March 2016. They found 7 randomized controlled trials with 945 people who had cognitive impairment (average age 74 to 82 years or older, 64% women).

The key features of the trials were:

  • people had cognitive impairment and lived in the community or in an independent living unit;
  • cognitive impairment could include vascular dementia, Lewy Body dementia, Alzheimer dementia, short-term memory loss, fronto-temporal dementia, or progressive supranuclear palsy;
  • exercise programs took place in the home or in the community, lasted 3 months or more, and were supervised by a physiotherapist (or other exercise professional) or by a trained carer or family member;
  • exercise could include aerobic training, resistance training, balance, walking, stretching or a combination of exercise types;
  • supervised exercise was compared with usual care or no supervised exercise.

What the researchers found

Exercise programs were 4 months to 12 months long.

Average cognitive impairment scores were moderate in 2 trials and mild in 5 trials.

Exercise programs included a combination of stretching, strengthening, aerobic, and balance exercises in 5 trials, treadmill walking in 1 trial, and a chair-based program in 1 trial.

Exercise programs improved basic activities of daily living (e.g., dressing, feeding) by a moderate amount, instrumental activities of daily living (e.g., shopping, cleaning) by a small amount, and balance by a small amount.

Conclusion

Home or community-based exercise programs lasting more than 3 months improve function and balance in older people who have cognitive impairment.

Home or community-based exercise programs vs no exercise program or usual care in older people with cognitive impairment

Outcomes

Number of trials (number of people)

Effect of exercise programs

Quality of the evidence

Basic activities of daily living*

3 trials (180 people)

Moderate improvement

Low

Instrumental activities of daily living*

2 trials (255 people)

Small improvement

Low

Balance

3 trials (89 people)

Small improvement

Moderate

Falls

2 trials

Exercise reduced falls by 30% to 33%

Not reported

Hospital stays

1 trial

No difference

Not reported

*Basic activities of daily living include eating, bathing, dressing, toileting, transferring (walking), and continence. Instrumental activities of daily living allow a person to live independently in a community and include housework, preparing meals, taking medications as prescribed, and managing money.




Glossary

Cognitive impairment
Trouble remembering, learning new things, concentrating, or making decisions that affect everyday life.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

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DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

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