Factors Affecting Physical Activity in People with Dementia: A Systematic Review and Narrative Synthesis

Abstract

Physical activity (PA) has positive effects on the physical and cognitive functioning of people with dementia. Knowledge about what limits and stimulates people with dementia to participate in PA is essential to promote effective PA implementation and enhance PA levels. Previous reviews primarily included opinion-based studies, using data from interviews, focus groups or dyads. By including implementation studies, we aimed to elaborate on previous reviews by identifying new barriers to PA and new facilitators and motivators for PA. We conducted systematic searches in Pubmed, PsychInfo and Web of Science for studies published up to the 21st of September 2021. Search terms were related to the population of people with dementia, PA interventions and implementation outcomes. Studies were included if PA participation was investigated during actual PA implementation. No restrictions were made regarding study design, date of publication, PA type or outcome measures. Studies not implementing PA or not evaluating the implementation were excluded. Based on 13 empirical studies, we identified 35 barriers, 19 facilitators and 12 motivators. Of these, 21 barriers, 11 facilitators and 4 motivators were not identified by previous reviews. New factors are related to the support for people with dementia from informal and formal caregivers, e.g., revealing the importance of a trusting relationship. Furthermore, support for staff from the institution or an external party is needed to overcome doubts about PA, for example, related to safety and effects. New factors also suggested specific recommendations for the content and organization of the PA intervention, for instance, related to how to give instructions. Overall, factors affecting PA identified with opinion-based or implementation studies are complementary. Our extended overview shows the complexity of PA implementation and may help to personalize PA, develop implementation strategies, facilitate actual PA implementation and free up resources needed for effective implementation.

An Assessment of Physical Activity and Risk Factors in People Living with Dementia: Findings from a Cross-Sectional Study in a Long-Term Care Facility in Vietnam

“…Evidence from the literature demonstrated that dementia gradually impairs cognitive and behavioral functioning, which is the most important cause of care reliance [ 55 , 56 , 57 , 58 ]; therefore, patients with severe dementia require greater assistance from caregivers because of a lack of capacity to manage their physical and psychological needs. As explored in the study by Feenstra (2023), factors influencing PA in PLWD revealed potential barriers and facilitators; hence, addressing such problems is crucial in promoting physical activity and mitigating dependence [ 59 ]. Furthermore, engaging in exercise, as highlighted by Chen’s study, leads to better upper body strength, aerobic endurance, and balance in PLWD [ 60 ].…”