Abstract
Dementia is a syndrome characterized by a progressive deterioration of cognitive and physical functions. The aim of this systematic review was to investigate the effects of high-intensity exercise training (HIT) programs on cognitive and mental health, physical performance, activities of daily living (ADLs) and quality of life (QoL) in people with dementia. A systematic literature search for randomized controlled trials was performed until July 2019. We calculated mean difference (MD) or standardized MD (SMD) and the 95% confidence interval (CI), and assessed heterogeneity using I2 statistic. Nine studies from three large-scale research projects which were based on the high-intensity functional exercise (HIFE) program incorporating strength, balance and mobility exercises of the lower limbs, including 456 participants (85.5 ± 7.0 years), were considered. There was an overall good study quality (mean PEDro score = 7.6 ± 0.7). Compared to seated control activities, strength and balance HIT resulted in statistically significant but small positive effects on balance performance (MD = 2.31, 95% CI = 0.44–4.17, p = 0.02; I2 = 73%) and on the abilities to independently perform ADLs (SMD = 0.28, 95% CI = 0.12–0.44, p = 0.0006; I2 = 0%). No differences were found in cognitive function, depressive symptoms and QoL. The qualitative analyses yielded sporadic beneficial results (mobility, psychological well-being and apathetic behaviour) in favour of HIT. There is only limited evidence for an intensity-related dose–response relationship. Further well-designed studies are needed to identify the best exercise type for different types and stages of dementia.
Highlights
Dementia is one of the most common mental and neurological disorders affecting nearly 50 million people worldwide (Prince et al, 2015)
9 articles were included in the present review, which are solely based on the following three large-scale studies: (1) the Frail Older People–Activity and Nutrition in Umeå (FOPANU) study (Conradsson et al, 2010; Littbrand et al, 2011; Littbrand, Lundin-Olsson, Gustafson, & Rosendahl, 2009), (2) the Exercise and Dementia (EXDEM) study (Telenius, Engedal, & Bergland, 2015a, 2015b), and (3) the Umeå Dementia and Exercise (UMDEX) study
An intrarater test–retest reliability assessment by Conradsson et al (2007) showed that due to high intrapersonal variabilities a change of 8 Berg Balance Scale (BBS) points is required to reveal a genuine change in function among older people who are dependent in ADLs and living in residential care facilities
Summary
Dementia is one of the most common mental and neurological disorders affecting nearly 50 million people worldwide (Prince et al, 2015). The prevalence of dementia doubles every 5 years after the age of 65 (Fiest et al, 2016) meaning that more than two thirds of all affected individuals have already reached the age of 80. Due to demographic transition and increasing societal ageing, the financial burden of this disease will continuously grow in the coming years. In 2012, the World Health Organization (WHO) declared dementia a public health priority, highlighting the high global prevalence and economic impact (World Health Organization & Alzheimer’s Disease International, 2012). Dementia is a syndrome which pathoetiologically affects the brain and is characterized by a progressive deterioration in intellect including memory, learning, orientation, language, comprehension and judgment (Hugo & Ganguli, 2014). Gait and balance disturbances increase the risk of falls (Kato-Narita, Nitrini, & Radanovic, 2011) and are related to reduced lower-limb muscle strength (Muehlbauer, Gollhofer, & Granacher, 2015), habitual physical activity (Morie et al, 2010), and the ability to perform activities of daily living (ADLs) independently (Wennie Huang, Perera, VanSwearingen, & Studenski, 2010)
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