High-intensity exercise programs in people with dementia — a systematic review and meta-analysis

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.

Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews

“…One systematic review 45 Adults with depression n=11 63 64 66-73 75 Dementia n=5 [107][108][109][110][111] Older adults n=5 [33][34][35][36][37] Chronic obstructive pulmonary disease n=4 78 112-114 Multiple sclerosis n=4 81 115-117 Pregnant or postnatal or post-partum women n=4 [38][39][40][41] Adults with various chronic diseases n=3 [118][119][120] Apparently healthy adults n=3 [42][43][44] Anxiety disorders n=3 84 85 121 Cardiovascular disease n=3 80 122 123 Older adults with depression n=4 63 65 74 124 Renal disease n=3 86 125 126 Stroke n=3 21 127 128 Arthritis and rheumatic diseases n=2 82 129 130 Cognitive impairment n=2 77 131 HIV/AIDS n=2 76 132 Post-traumatic stress disorder n=2 133 134 Various mental health disorders n=2 83 135 Fatigue n=1 136 Knee osteoarthritis n=1 129 Neurological disorders n=1 137 Schizophrenia n=1 138 Substance use disorder n=1 79…”

Physical activity interventions in older adults with a cognitive impairment: A critical review of reviews

“…Groot et al (2016) 14 included 18 studies comparing aerobic exercise with, non‐aerobic or combined exercise, and reported benefits for cognitive function only when intervention included aerobic exercise alone or combined with non‐aerobic exercise. The remaining multicomponent exercise programs include revisions of functional training, 32 , 38 , 39 , 40 and others which combine different types of exercise such as Tai chi, virtual reality, or exergames, yoga, and mind body exercise. 38 , 41 , 42 Only two reviews 40 , 43 failed to report benefits in cognitive function.…”

“…The remaining multicomponent exercise programs include revisions of functional training, 32 , 38 , 39 , 40 and others which combine different types of exercise such as Tai chi, virtual reality, or exergames, yoga, and mind body exercise. 38 , 41 , 42 Only two reviews 40 , 43 failed to report benefits in cognitive function. Assorted differences in the exercise protocols make it difficult to identify general guidelines for multicomponent exercise intervention.…”

Putting It All Together: An Evidence-Based Guide to High-Intensity Interval Exercise Prescription for Patients With Complex Comorbidities

“…61,62 Within the HIIT framework, interventions encompassing the patient's goals and functional demands are critical to recovery and ameliorating neurological symptoms. 61,62 A recent systematic review and meta-analysis by Russ et al 63 found small but positive effects of HIIT for patients with various types of dementia, including improved balance and independence with ADL performance. Integrating functional and meaningful activities into a HIIT framework shows promise for simultaneously meeting physiological and physical goals while producing maximum patient benefit.…”