The effects of physical exercise on functional performance, quality of life, cognitive impairment and physical activity levels for older adults aged 65 years and older with a diagnosis of dementia: a systematic review

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Physical inactivity is considered the primary precursor to unmet needs for older adults with dementia and exercise has shown potential to benefit healthy, older adults. While no conclusive evidence is available to suggest these benefits extend to older adults with dementia, a growing body of literature targets this question specifically.


The primary, overarching question asked by this review was: does physical exercise affect functional performance, quality of life, cognitive impairment and physical activity levels of older adults (>65 years) with a diagnosis of dementia?

Inclusion criteria

Types of participants

Inclusion criteria

Participants were older adults, aged 65 years and over, with a confirmed dementia diagnosis

Inclusion criteria

Types of intervention(s)

Inclusion criteria

Physical exercise interventions were included

Inclusion criteria

Types of studies

Inclusion criteria

Randomized and quasi-randomized controlled trials were included.

Inclusion criteria

Types of outcomes

Inclusion criteria

Four primary outcome measures were the focus on this review: cognition, functional ability, quality of life and physical activity levels

Search strategy

Published material was sourced from the following four databases: MEDLINE, EMBASE, CINAHL, ISI Web of Science. Grey literature was searched for using ALOIS, Google Scholar and ProQuest. Initial keywords included: “cognitive impairment”, “dementia”, “Alzheimer's disease”, “cognitive defect” OR “cognition disorders” AND “exercise”, “physical activity”, “exertion”, OR “functional” AND “intervention”, “program”, “training” OR “treatment” AND “older adults”, “elderly”, “old age” OR “geriatric”

Methodological quality

The methodological quality of included studies was assessed using Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) software.

Data collection

Data was extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI.

Data synthesis

A quantitative meta-analysis was performed where possible. Otherwise, data-synthesis is in the form of narrative review.


Seventeen studies were included in this review; they evaluated the effectiveness of aerobic, resistance and multimodal exercise interventions on a wide range of outcome measures, including: cognition, general physical function, mobility, strength, balance, flexibility, cardiovascular fitness, quality of life and physical activity levels. Only three studies were found to be of “good” quality and showed benefits for older adults in the domains of: cognition, activities of daily living, mobility, strength and balance. Results from “moderate” and “poor” quality studies were mixed and inconclusive.


While potential exists for exercise to benefit the older adult with dementia, no definitive conclusion can be reached, as the volume of “good” quality literature is limited for this population.

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