The effects of physical exercise on older adults, aged 65 years and older, with a diagnosis of dementia: a systematic review protocol

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Abstract

Review question/objective

Does physical exercise affect functional performance, quality of life, cognitive impairment and physical activity levels of older adults (<65yrs) with a diagnosis of dementia?

Review question/objective

More specifically, the objectives are to:

Background

Dementia is not one specific disease, rather it describes a collection of neurodegenerative symptoms that affect cognition more so than the normal ageing process. It is estimated that over 50% of older Australians (> 65yrs of age) living within RACFs have dementia.1 Nationally, it is predicted that the number of adults with dementia will rise to 1.13 million by 2050, a four-fold increase from 2009.2 In the next two decades, dementia will be become the third highest source of health and residential aged care spending, equating to almost 1% of gross domestic profit in Australia.2

Background

Recent studies show that adults with dementia have multiple unmet needs, which include a lack of daytime activities, a productive social environment and help with psychological distress.3 These unmet needs limit the extent of social networks and increase the cost of care associated with dementia. Physical inactivity is considered the primary precursor to these unmet needs and is associated with significant negative health consequences including early mortality, increased risk of institutionalisation, and a decreased capacity in activities of daily living (ADLs).3

Background

Exercise potentially benefits older adults by reducing agitation, behavioral symptoms and depression, while improving coordination, memory and capacity in activities of daily living.4,5 Within an aging population, however, the number of older adults with dementia continues to rise.2 Therefore, the effect of exercise on those with dementia is an area of interest that is increasing in importance. While no current cure for dementia exists, there is a growing body of literature dealing specifically with primary, secondary and tertiary prevention, and the interventions to reduce dementia-related symptoms and disability. In particular, a number of studies have shown promising benefits through exercise and physical activity.4-6 However, a definitive conclusion on the benefits of exercise remains elusive.

Background

Older adults with moderate to severe dementia are an understudied, disadvantaged population. Previous attitudes towards research in this population have not been positive. Francese 8 reports that health carers do not feel that those with severe dementia could participate in or benefit from exercise interventions, despite observing small, statistically insignificant improvements in the ability to weight bear during ADLs and in the use of a walker, as opposed to a wheelchair, following a seven week exercise intervention. In contrast, Huger9 contends that even small, low level physical activity interventions in frail and very old, sedentary adults result in significant health benefits.

Background

Heyn et al.,10 in a meta-analysis of physical activity interventions for adults with dementia, shows exercise has the potential to reduce risk of comorbidities, level of dependence and disability. Included studies also reported improvements in fitness, behavior, cognition, communication and functional wellbeing. Other studies report reduced agitation, behavioral and psychological symptoms (including. depression) and improved coordination, memory and capacity in ADLs.4,5 Importantly, these results suggest that exercise has the potential to reduce carerelated expenses and dependency issues, and improve the patient's quality of life, self-worth and dignity. These findings have huge implications for physical activity levels (PAL) and functional performance (FP) for adults with late stage dementia, and the accuracy of employed measures is paramount. However, the growing body of research investigating exercise and dementia rarely questions the appropriateness of the outcome measures employed to determine FP and PAL.

Background

Hauer,11 in a systematic review, concluded that methodical deficiencies prevent any comprehensive analysis of the benefits of exercise for older adults with cognitive impairment. This differs from previous research due to a critical appraisal of the methodology of included studies. Of note is that ten out of 11 studies did not report on the validity and reliability of chosen outcome measures and eight out of the 11 studies only reported on Mini-Mental State Examination (MMSE) scores of participants, with no specific diagnosis of dementia indicated.

Background

A systematic review is warranted for adults, specifically with a diagnosis of dementia, and not just in non-specific cognitive impairment terms. This systematic review also differs in that the outcome measures being evaluated have not been widely assessed before through a systematic review.

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