Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Objective
2.1. Primary Objective
2.2. Secondary Objective
3. Materials and Methods
3.1. Methodological Approach
3.2. Criteria for Inclusion
3.3. Criteria for Exclusion
3.4. Search Strategy
3.5. Study Selection
3.6. Data Extraction
3.7. Synthesis of Results
3.8. Methodological Quality Assessment
4. Results
4.1. Study Selection
4.2. Participants at Baseline
4.3. Assessment Methods of Cognitive Function
4.4. Measurement Periods
4.5. PA Interventions
4.6. PA Modality
4.7. PA Duration, Frequency, and Total Length
4.8. PA Intensity
4.9. Adherence Rate
4.10. Primary Outcome: Effects of PA on the Cognitive Function of PwD
4.11. Meta-Analysis
4.12. Quality Assessment
5. Discussion
- Alternative forms of exercise need to be explored for PwD. For example, additional exercises designed to improve functional activity, a variable that has been proven to be influenced by PA among PwD, are needed [42];
- Exergaming combined with cognitive training is a method that promotes participants’ initiation and adherence to PA through the innovative combination of technology and exercising [35];
- Engaging in long-term, individualized, home-based training may have some effect on the executive functions of PwD [48];
- Future programs should also examine the individual characteristics of participants (type and severity of dementia), as they may influence the effects of PA on cognition. It is also essential to examine who may benefit the most from PA [35].
Limitations
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Study | Participants | IG (n) | CG (n) | Dementia Severity Baseline MMSE | IG | CG | Length Frequency Duration | PA Modality | PA Intensity | Cognitive Assessment | Follow up | Adherence Rate | PA Impact on Cognition |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Karssemeijer et al., (2019) [35] | 115/AD, VaD, MD/MMSE score ≥ 17/community-dwelling | IG1: 38 IG2: 38 | 39 | 22.9 Mild dementia | IG1: cognitive and aerobic bicycle training IG2: Cycling on a stationary bike | Relaxation and flexibility exercises | 30–50 min, 3× week, 12 weeks | Combined cognitive and PA training Only aerobic training | Light intensity IG: 41.8% and 43.5% of maximal HR | MMSE; TMT Part B; SCWT; Letter Fluency; Rule Shift Cards Test; WAIS-III (Digit Span); WMS-III (Spatial Span); LLT-R | 12 and 24 weeks | Good adherence (85.4%) | − |
Huang et al., (2019) [54] | 80/UD/MMSE score not specified/care facility | 40 | 40 | 20.76 Mild dementia | Tai-Chi exercises | Routine treatments and personalized daily care | 20 min, 3× week, 10 months | Combined PA training | Moderate exercise intensity | MMSE; MoCA; WHO-UCLA-AVLT; TMT | 5 and 10 months | Good Adherence (%NR) | +*f |
Lamb et al., (2018) [42] | 494/AD, MD, VaD, UD/MMSE score ≥ 10/community-dwelling | 329 | 165 | 21.8 Mild dementia | Supervised Gym program: Static cycling, arms and legs strength training Unsupervised prescribed Home program | Usual Care | 60–90 min, 2× week, 4 months. Plus 60 min, weekly PA at home 150 min each week | Combined PA training | Vigorous intensity | ADAS- Cog | 12 months | Good adherence (65%) | − |
Henskens et al., (2018) [37] | 87/AD, VaD, Mixed VaD and AD, UD/ MMSE score < 24/care facility | IG1: 21 IG2: 22 IG3: 22 | 22 | 12.27 Severe dementia | IG1: ADLs training IG2: Multicomponent PA training: Strength seated upper, lower extremities and torso exercises. Outdoor walking IG3: multicomponent PA and ADLs training | Care as usual and social activity intervention | 30–45 min, 3× week, 6 months | Combined PA training | Progressive increase intensity | MMSE; SIB-S; GIT (fluency subtest); WAIS (digit Span Task Backward); go-no-go test; FAB (conflicting instructions test) | 3 and 6 months | Poor adherence (%NR) | − |
Toots et al., (2017) [38] | 186/AD, VaD, MD; UD/MMSE score ≥ 10/care facility | 93 | 93 | 15.0 Moderate dementia | Exercise program for limb strength, balance, and mobility | Structured activities (e.g., singing, reading) | 45 min, 5 sessions per two-week period, 4 months | Combined PA training | Vigorous intensity | ADAS- Cog; MMSE; and VF | 4 and 7 months | Good adherence (71.5%) | − |
Öhman et al., (2016) [48] | 210/AD/MMSE score not specified/community-dwelling | IG1:70 IG2:70 | 70 | 18.0 Moderate dementia | IG1: Home-base with physiotherapist supervision IG2: Group-based in a day care centre Both implemented aerobic, balance, strength and dual-tasking training | Usual community care | 60 min, 2× week, 12 months | Combined cognitive and PA training | NR | CDT; CDR, and MMSE | 3, 6, and 12 months | Good adherence (81%) | + * a |
Kim et al., (2016) [45] | 38/AD/MMSE score ≤ 20/care facility | 19 | 19 | 14.8 Moderate dementia | Multicomponent intervention + stretching, lower-limb aerobic exercises using TERASUERUGO | Multicomponent intervention: art and social activities | 60 min, 5× week, 6 months | Combined cognitive and PA training | Moderate intensity 40–60% of the maximum HR | ADAS- Cog, MMSE, and CDT | 6 months | Good adherence (100%) | − |
Cancela et al., (2016) [51] | 189/UD //MMSE score not specified/care facility | 73 | 116 | 15.05 Moderate dementia | Cycling sessions | Recreational activities (e.g., card-playing, craftwork) | 15 min, daily, 15 months | Only aerobic training | Light intensity | MMSE; FOME | 3, 6, 9, 12, and 15 months | Poor adherence (%NR) | + |
Hoffmann et al., (2015) [46] | 200/AD/MMSE score ≥ 19/community-dwelling | 107 | 93 | 24.0 Mild dementia | Strength training of lower extremities and exercises in ergometer bicycle, cross trainer, and treadmill | Treatment as usual | 60 min, 3× week, 16 weeks | Combined PA training | Moderate to vigorous intensity. 70–80% of maximal HR | SDMT; ADAS-Cog; SCWT; incongruent score; verbal fluency; MMSE | 16 weeks | Good adherence (84%) | − |
Bossers et al., (2015) [43] | 109/AD, VaD, MD, UD// MMSE score ≥ 9 and ≤23/Care facility | IG1: 37 IG2: 36 | 36 | 15.6 Mild dementia | IG1: Two strengthening and two walking sessions per week IG2: Four walking sessions per week | Social visits | 30 min, 36 individual sessions, 9 weeks | Combined PA training Only aerobic training | Moderate to vigorous intensity | MMSE; WMS-R; RBMT; SCWT; animals and professions | 9 and 18 weeks | Good adherence (89.2%) | + * ae |
Yang et al., (2015) [39] | 50/AD, VaD/MMSE score ≥ 10 and ≤24 /community-dwelling | 25 | 25 | 20.66 Mild dementia | Cycling training | Health education | 40 min, 3× week, 3 months | Only aerobic training | Vigorous intensity 70% of maximal HR | MMSE; ADAS-Cog | 3 months | NR | + |
Cheng et al., (2014) [36] | 110/AD, VaD, UD/MMSE score ≥ 10 and ≤24/Care facility | IG1:36 IG2: 39 | 35 | 18.8 Moderate dementia | IG1: Cognitive stimulation-board game Mahjong IG2: 12-Form Yang style Tai-Chi | Simple handcrafts | 60 min, 3× week, 3 months | Combined PA training | NR | MMSE; Forward and backward digit sequence/digit span; delayed recall Categorical verbal fluency | 3, 6, and 9 months | Good adherence (%NR) | + |
Vreugdenhil, et al., (2012) [50] | 40/AD/MMSE score ≥ 10 and ≤28/community-dwelling | 20 | 20 | 22.0 Mild dementia | Aerobic walking, strengthening and balance training | Usual treatment | 30 min, 5× week, 4 months | Combined PA training | Moderate intensity | ADAS- Cog, MMSE | 4 months | NR | + |
Venturelli, et al., (2011) [44] | 21/AD// MMSE score ≥ 5 and ≤15/Care facility | 12 | 11 | 12.5 Severe dementia | Walking program | Daily organized activities (e.g., bingo, music therapy) | 30 min, 4× week, 24 weeks | Only aerobic training | Moderate intensity | MMSE | 24 weeks | Good adherence (93.4%) | − |
Kemoun et al., (2010) [49] | 31/AD/MMSE score ≤ 23 /care facility | 16 | 15 | 12.8 Severe dementia | Articular mobilization and muscle stimulation trough walking, equilibrium, stamina, and dancing | No PA participation | 60 min, 3× week, 15 weeks | Combined PA training | Moderate intensity 60% and 70% of maximal HR | French RECF | 15 weeks | NR | + * |
Steinberg et al., (2009) [47] | 27/AD/MMSE score ≥ 10/community-dwelling | 14 | 13 | 17.7 Moderate dementia | Home-based program, caregivers instructed during visits on daily walking, strength training of major muscle groups, balance and flexibility | Home safety assessment | 120 min per visit, 3 visits, 12 weeks | Combined PA training | Moderate intensity | MMSE, BNT, HVLT | 6 and 12 weeks | Good adherence (59%) | + |
Eggermont et al., (2009a) [53] | 97/UD/MMSE score ≤ 10 and ≥24/care facility | 51 | 46 | 17.7 Moderate dementia | Walking program | Received social visits | 30 min, 5× week, 6 weeks | Only aerobic training | Self-selected speed | RBMT (face and picture recognition test); eight words test; digit span from the WMS-R; category fluency and letter fluency | 6 and 12 weeks | NR | − |
Eggermont et al., (2009b) [52] | 61/UD/MMSE score ≤ 10 and ≥24/care facility | 23 | 24 | 17.7 Moderate dementia | Hand motor activity (finger movements, pinching, handling rubber rings, etc.) | Read aloud program | 30 min, 5× week, 6 weeks | Hand movement training | NR | RBMT; Digit Span from the WMS-R; category fluency; Stop Signal task; and Attention Network Test | 6 and 12 weeks | NR | − |
Miu et al., (2008) [34] | 85/AD, VaD, MD, UD/MMSE score ≥ 10 and ≤26/community-dwelling | 36 | 49 | 18.9 Moderate dementia | Treadmill, bicycle, and arm ergometer training | Social visits and discussions on health-related topics | 45–60 min, 2× week, 3 months | Only aerobic training | NR | MMSE and ADAS-Cog | 3-, 6-, 9-, and 12-months post training | Good adherence (%NR) | − |
Christofoletti et al., (2008) [40] | 41/AD and MD// MMSE score no specified/care facility | IG1: 12 IG2: 12 | 17 | 14.0 Moderate dementia | IG1: Interdisciplinary program with strength, balance and cognition training IG2: Physiotherapy session | No motor intervention | 120 min, 5× week, 6 months 60 min, 3× week, 6 months | Combined PA training | NR | MMSE and Brief Cognitive Screening Battery | 6 months | NR | − |
Stevens & Killeen, (2006) [33] | 75/AD, UD/MMSE score ≥ 10 and ≤23/care facility | 24 | CG1: 30 CG2: 21 | 15.0 Moderate dementia | Gentile aerobic exertion of joints and large muscle groups | CG1: no intervention CG2: Social visits | 30 min, 3× week, 12 weeks | Only aerobic training | Light intensity | MMSE, and CDT | 12 weeks | NR | + |
Van de Winckel et al., (2004) [41] | 25/AD, VaD/MMSE score ≤ 23/care facility | 15 | 10 | 12.0 Severe dementia | Training while sitting focus on upper and lower body strengthening, balance, trunk movements, and flexibility | Daily one-to-one conversation with therapist | 30 min, daily, 3 months | Combined PA training | NR | MMSE and ADS-6 | 6 weeks and 3 months | NR | + * |
Control Group | PA Intervention | |||||||
---|---|---|---|---|---|---|---|---|
Authors | Mean | SD | n | Mean | SD | n | t | p |
Huang et al., (2019) [54] | 19.47 | 5.73 | 38 | 21.17 | 5.47 | 36 | 1.304 | 0.196 |
Lamb et al., (2018) [42] | 23.8 | 10.4 | 137 | 25.2 | 12.3 | 278 | 1.145 | 0.252 |
Henskens et al., (2018) [37] | 9.4 | 5.8 | 16 | 11.6 | 6.5 | 16 | 1.010 | 0.320 |
Öhman et al., (2016) [48] | 17.17 | 7.29 | 59 | 17.02 | 7.18 | 51 | −0.108 | 0.913 |
Hoffmann et al., (2015) [46] | 23.9 | 3.9 | 88 | 23.9 | 3.4 | 102 | 0.000 | 1.000 |
Bossers et al., (2015) [43] | 15.17 | 4.5 | 36 | 17.16 | 4.33 | 37 | 1.926 | 0.058 |
Yang et al., (2015) [39] | 19.54 | 3.43 | 25 | 22.83 | 2.75 | 25 | 3.742 | 0.000 |
Cheng et al., (2014) [36] | 18.5 | 1.4 | 35 | 19.4 | 1.4 | 39 | 2.761 | 0.007 |
Vreugdenhil, et al., (2012) [50] | 19 | 7.7 | 20 | 23.9 | 5 | 20 | 2.387 | 0.022 |
Venturelli, et al., (2011) [44] | 6 | 2 | 10 | 12 | 2 | 11 | 6.866 | <0.000 |
Kemoun et al., (2010) [49] | 23.23 | 8.37 | 15 | 30.38 | 7.66 | 16 | 2.489 | 0.019 |
Eggermont, et al., (2009a) [53] | 0.2 | 0.63 | 46 | 0.24 | 0.78 | 51 | 0.276 | 0.783 |
Eggermont, et al., (2009b) [52] | 0.47 | 0.97 | 31 | 0.07 | 0.37 | 30 | −2.114 | 0.038 |
Miu et al., (2008) [34] | 19.2 | 4.2 | 28 | 17.4 | 5.7 | 24 | −1.308 | 0.196 |
Christofoletti et al., (2008) [40] | 14.8 | 1.3 | 17 | 20.2 | 1.6 | 12 | 10.017 | <0.000 |
Van de Winckel, et al., (2004) [41] | 11.5 | 5.21 | 9 | 14.4 | 4.4 | 15 | 1.460 | 0.158 |
Study | Quality Assessment Tool for Quantitative Studies | Overall Score | |||||||
---|---|---|---|---|---|---|---|---|---|
Selection Bias | Study Design | Confounders | Blinding | Data Collection Methods | Withdrawals and Dropouts | Intervention Integrity | Analyses | ||
Karssemeijer et al., (2019) [35] | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Huang et al., (2019) [54] | 2 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Lamb et al., (2018) [42] | 1 | 1 | 1 | 2 | 2 | 1 | 1 | 1 | 1 |
Henskens et al., (2018) [37] | 2 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Toots et al., (2017) [38] | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Öhman et al., (2016) [48] | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Kim et al., (2016) [45] | 3 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 2 |
Cancela et al., (2016) [51] | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Hoffmann et al., (2015) [46] | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Bossers et al., (2015) [43] | 1 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Yang et al., (2015) [39] | 3 | 2 | 1 | 3 | 2 | 3 | 1 | 1 | 3 |
Cheng et al., (2014) [36] | 1 | 2 | 1 | 3 | 2 | 1 | 1 | 1 | 2 |
Vreugdenhil, et al., (2012) [50] | 2 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Venturelli, et al., (2011) [44] | 3 | 2 | 1 | 2 | 1 | 1 | 1 | 1 | 2 |
Kemoun et al., (2010) [49] | 3 | 2 | 1 | 2 | 1 | 1 | 1 | 1 | 2 |
Steinberg et al., (2009) [47] | 3 | 2 | 1 | 2 | 1 | 2 | 1 | 1 | 2 |
Eggermont, et al., (2009a) [53] | 2 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Eggermont et al. (2009b) [52] | 2 | 2 | 1 | 2 | 1 | 1 | 1 | 1 | 1 |
Miu et al., (2008) [34] | 2 | 1 | 1 | 2 | 2 | 2 | 1 | 1 | 1 |
Christofoletti et al., (2008) [40] | 2 | 1 | 1 | 2 | 1 | 3 | 2 | 1 | 2 |
Stevens & Killeen, (2006) [33] | 2 | 1 | 1 | 3 | 1 | 3 | 1 | 1 | 3 |
Van de Winckel, et al., (2004) [41] | 3 | 1 | 1 | 2 | 1 | 1 | 1 | 1 | 2 |
Study | Implementation of Comprehensive Cognitive Measures | Implementation of Measurements Throughout the Intervention Period | Long-Term Follow-Up Measure | Target Dementia Type | Target Dementia Stage | Provide and Describe PA Characteristics of the Intervention | Total Number of Incorporated Recommendations | |||
---|---|---|---|---|---|---|---|---|---|---|
Describe PA Type | Describe PA Duration | Describe PA Frequency | Describe PA Intensity | |||||||
Karssemeijer et al., (2019) [35] | + | − | (+) | − | (+) | + | + | + | + | 5 |
Huang et al., (2019) [54] | + | (+) | − | − | + | + | + | + | − | 5 |
Lamb et al., (2018) [42] | − | (+) | − | − | (+) | + | + | + | + | 4 |
Henskens et al., (2018) [37] | + | (+) | − | − | − | + | + | + | (+) | 4 |
Toots et al., (2017) [38] | (+) | − | (+) | (+) | (+) | + | + | + | + | 4 |
Öhman et al., (2016) [48] | (+) | + | − | + | − | + | + | + | − | 5 |
Kim et al., (2016) [45] | (+) | − | − | + | (+) | + | + | + | + | 5 |
Cancela et al., (2016) [51] | (+) | + | − | − | − | + | + | + | (+) | 4 |
Hoffmann et al., (2015) [46] | + | − | − | + | + | + | + | + | + | 7 |
Bossers et al., (2015) [43] | + | − | (+) | − | (+) | + | + | (+) | + | 4 |
Yang et al., (2015) [39] | − | − | − | − | (+) | + | + | + | + | 4 |
Cheng et al., (2014) [36] | + | − | + | (+) | (+) | + | + | + | − | 5 |
Vreugdenhil, et al., (2012) [50] | − | − | − | + | (+) | + | + | + | − | 4 |
Venturelli, et al., (2011) [44] | − | − | − | + | + | + | + | + | − | 5 |
Kemoun et al., (2010) [49] | − | − | − | + | − | + | + | + | + | 5 |
Steinberg et al., (2009) [47] | + | (+) | − | + | (+) | + | + | − | − | 4 |
Eggermont, et al., (2009a) [53] | + | − | (+) | − | (+) | + | + | + | − | 4 |
Eggermont et al. (2009b) [52] | (+) | − | (+) | − | (+) | + | + | + | − | 3 |
Miu et al., (2008) [34] | − | − | + | − | (+) | + | + | + | − | 4 |
Christofoletti et al., (2008) [40] | − | − | − | − | (+) | + | + | + | − | 3 |
Stevens & Killeen, (2006) [33] | (+) | − | − | − | (+) | + | + | + | − | 3 |
Van de Winckel, et al., (2004) [41] | − | (+) | − | − | − | + | + | + | − | 3 |
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Cardona, M.I.; Afi, A.; Lakicevic, N.; Thyrian, J.R. Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 8753. https://doi.org/10.3390/ijerph18168753
Cardona MI, Afi A, Lakicevic N, Thyrian JR. Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(16):8753. https://doi.org/10.3390/ijerph18168753
Chicago/Turabian StyleCardona, Maria Isabel, Adel Afi, Nemanja Lakicevic, and Jochen René Thyrian. 2021. "Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 16: 8753. https://doi.org/10.3390/ijerph18168753