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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia

R Potter, D Ellard, K Rees, and M Thorogood.

Review published: 2011.

Link to full article: [Journal publisher]

CRD summary

This review concluded that there was some evidence that physical activity interventions can improve physical function in older people with dementia but the evidence for depression and quality of life was limited. The results of this generally well-conducted review need a cautious interpretation because of the poor quality and heterogeneity of the available evidence.

Authors' objectives

To assess the effects of physical activity on depression, quality of life and physical functioning in people with dementia.

Searching

MEDLINE, EMBASE, CINAHL, PsycINFO, AMED, Cochrane Central Register of Controlled Trials (CENTRAL), NRR and Current Controlled Trials were searched to February 2009 for studies published in English. Search terms were reported. Reference lists of relevant papers were searched.

Study selection

Controlled trials (randomised or not) that assessed any form of physical activity for a minimum of 12 weeks in people aged 60 or more (or those described as older, seniors and older people) with some form of cognitive impairment or dementia were eligible for inclusion. Participants could be resident in the community, residential care or hospital. Interventions could take place in any setting. Studies had to report on at least one outcome from depression, health related quality of life, physical function and balance (including falls).

The included trials were conducted in North America, Europe, Korea and Israel. Most trials delivered the intervention in the participant's residence; others were given in a community facility, participant's home or sheltered housing complex. Mean age ranged from 73 to 88 years. More participants were female (where reported). Dementia was formally diagnosed in 62% of studies. Baseline physical ability varied between trials. Most interventions included some element of strength, flexibility or balance training and most were delivered for between 12 and 16 weeks. Most trials did not report exercise intensity but of those that did one was low, one was moderate and one had a self-paced intensity. Most trials delivered the intervention to groups of between two and 15 participants. Control groups received a non-active or no-intervention control. Outcomes reported were timed get up and go tests, timed walking tests (including a six-minute walk test), walking speed, balance (Berg balance test), functional reach, flexibility, lower limb strength, depression and quality of life.

Studies were selected by at least two reviewers independently. Disagreements were resolved by discussion.

Assessment of study quality

Study quality was assessed using a nine-item checklist for randomised and non-randomised studies which was adapted from The Cochrane Handbook.

At least two reviewers independently performed the assessment.

Data extraction

Mean changes from baseline with standard deviations were extracted or estimated. Where results for more than one time point were reported the longest follow-up was used.

At least two reviewers independently performed data extraction. Authors were contacted for additional data.

Methods of synthesis

Results were pooled using fixed-effect meta-analysis unless there was significant heterogeneity (measured using the Ι² statistic) where a random-effects model was used. Weighted mean differences (WMD) were calculated. Where meta-analysis was not possible, results were presented in a narrative synthesis. Sensitivity analysis was used to explore the effect of any studies with outlying results.

Results of the review

Thirteen trials were included (896 participants, range 16 to 191). Six trials had adequate methods of randomisation and three of these also provided methods of allocation concealment. Eight trials reported losses to follow-up and six used intention-to-treat analysis. Five trials reported sample size calculations for their primary outcome. Ten trials reported attrition rates (range from 4% at 12 weeks to 32% at two years).

Timed get up and go tests (five trials): There was a reduction in timed get up and go with the intervention (WMD -1.39 seconds, 95% CI -2.59 to -0.19; three trials) but heterogeneity was very high (Ι²=96%). When the trial with outlying result was removed, this result was no longer statistically significant.

Timed walking tests (six trials): Three trials showed a significant increase in walking speed with the intervention, one an increase in walking distance and one a small but non-significant decrease in walking distance. The results of two trials that used a six-minute walk test were pooled but no significant difference was found and heterogeneity was high (Ι²=85%). Walking speed was pooled for four trials and showed a statistically significant improvement in speed (WMD 0.06 metres per second, 95% CI 0.01 to 0.1; Ι²=0%).

Balance and functional reach: Seven trials measured balance and one trial measured functional reach. Two trials that used the Berg balance scale were pooled and found a significant improvement for the intervention (WMD 3.4 points, 95% CI 1.08 to 5.72; Ι²=0%).

Flexibility and lower limb strength: Two out of three trials that reported flexibility found significant improvements with the intervention. Three out of four trials that reported lower limb strength found a significant improvement with the intervention.

Depression and quality of life: Four trials reported depression outcomes, all using a different measure. Three trials did not find any significant differences. One trial found a significant improvement for a subgroup of patients (58% of the total sample) at 24 months using the Cornell scale for depression in dementia. Two trials measured quality of life using a variety of questionnaires. One trial found significant differences in four out of seven measures with higher scores for comprehensive exercise compared to social conversation. The other trial found improvements in physical role function at three months.

Authors' conclusions

There was some evidence that physical activity interventions can improve physical function in older people with dementia. Evidence for an effect on depression and quality of life was limited

CRD commentary

This review had clear inclusion criteria for study design, interventions, participants and outcomes. The search included a range of databases and sources of unpublished studies but was limited to studies in English so language bias was a possibility. Study selection, data extraction and quality assessment were performed by two independent people, which reduced risks error and bias. Studies were combined using meta-analysis even where heterogeneity was high and the authors suggested a cautious interpretation of the results.

The results of this generally well-conducted review need a cautious interpretation because of the poor quality and heterogeneity of the available evidence.

Implications of the review for practice and research

The authors did not state any implications for practice and research.

Funding

Birmingham Science City Translational Medicine Clinical Research and Infrastructure Trials Platform; National Institute for Health Research, Health Technology Assessment.

Bibliographic details

Potter R, Ellard D, Rees K, Thorogood M. A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia. International Journal of Geriatric Psychiatry 2011; 26(10): 1000-1011. [PubMed: 21905096]

Indexing Status

Subject indexing assigned by NLM

MeSH

Aged; Aged, 80 and over; Dementia /psychology /rehabilitation; Depressive Disorder /epidemiology; Exercise Therapy /psychology; Female; Humans; Male; Middle Aged; Motor Activity; Prevalence; Quality of Life; Randomized Controlled Trials as Topic

AccessionNumber

12011006291

Database entry date

20/09/2012

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 21905096

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