Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

Abstract

Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.

Exercise in cirrhosis: Translating evidence and experience to practice

“…Studies in patients with acute brain injury, dementia, and serious mental illness support the efficacy and feasibility of exercise despite cognitive issues. [49][50][51] Although thrombocytopenia is not considered a contraindication to exercise, in keeping with data in stem cell transplant patients, 52 exercises with high risk of injury or falling should be avoided, especially if platelets are <20,000/ll.…”

External Validation of the ‘PHYT in Dementia’, a Theoretical Model Promoting Physical Activity in People with Dementia

“…Empirical data gathered in exercise intervention studies with people with dementia give preliminary support to the relevance of some of the constructs identified in the original version of the PHYT-in-dementia. For example, a recent review of the literature [25] has found that higher motivation to adhere to an intervention programme is linked to certain intervention characteristics, including the use of behaviour change techniques (e.g., motivational interviewing), the provision of tailored supervision/activities to meet participants' individual needs, the setting of SMART (i.e., specific, measurable, attainable, realistic, time-bound) goals, and the use of booklets/guidance on how to do the exercises. The construct "carer's characteristics" has also proved relevant in relation to motivation to exercise in people with dementia.…”

Physical activity engagement strategies in people with mild cognitive impairment or dementia – a focus group study

“…Exercise and physical activity have multiple benefits in people with mild cognitive impairment (MCI) or dementia including positive effects on functional abilities, mood, mobility and cognition (Forbes, 2015;Brett, Traynor, & Stapley, 2016;Rao, Chou, Bursley, Smulofsky, & Jezequel, 2014;Barreto, 2015;Bossers et al, 2014;Hernandez, 2015). Three recent systematic reviews (van Alphen, Hortobagyi, & van Heuvelen, 2016;van der Wardt et al, 2017;Nyman, Adamczewska, & Howlett, 2018) identified barriers and facilitators for exercise and physical activity engagement in people with dementia. In addition to practical support strategies such as exercise recording sheets, reminders and pedometers, the reviews identified intra-and interpersonal factors that might support exercise and physical activity engagement in people with dementia.…”