Forbes D Forbes Sc Blake Cm Et Al Exercise Programs for People With Dementia (Review
Sao Paulo Medical Journal
Print version ISSN 1516-3180
Sao Paulo Med. J. vol.132 no.3 São Paulo 2014
https://doi.org/10.1590/1516-3180.20141323T2
Cochrane Highlights
Exercise programs for people with dementia
Abstruse
BACKGROUND:
This is an update of our previous 2008 review. Several contempo trials and systematic reviews of the impact of exercise on people with dementia are reporting promising findings.
OBJECTIVE:
Main: Do exercise programs for older people with dementia better cognition, activities of daily living (ADLs), challenging behaviour, depression, and mortality in older people with dementia? Secondary: Exercise practise programs for older people with dementia have an indirect impact on family unit caregivers' burden, quality of life, and bloodshed? Exercise exercise programs for older people with dementia reduce the use of healthcare services (e.thousand. visits to the emergency department) by participants and their family caregivers?
METHODS:
Search methods: We identified trials for inclusion in the review by searching ALOIS (www.medicine.ox.air-conditioning.uk/alois), the Cochrane Dementia and Cognitive Comeback Group's Specialised Annals, on 4 September 2011, and again on xiii August 2012. The search terms used were: 'physical activeness' OR exercise OR cycling OR swim* OR gym* OR walk* OR danc* OR yoga OR 'tai chi'. Pick criteria: In this review, we included randomized controlled trials in which older people, diagnosed with dementia, were allocated either to practise programs or to control groups (usual care or social contact/activities) with the aim of improving cognition, ADLs, behaviour, depression, and bloodshed. Secondary outcomes related to the family unit caregiver(s) and included caregiver burden, quality of life, bloodshed, and use of healthcare services. Data collection and analysis: Independently, at least ii authors assessed the retrieved articles for inclusion, assessed methodological quality, and extracted information. Data were analysed for summary furnishings using RevMan 5.one software. Nosotros calculated mean differences or standardized mean departure (SMD) for continuous data, and synthesized data for each outcome using a fixed-effect model, unless there was substantial heterogeneity between studies, when we used a random-effects model. We planned to explore heterogeneity in relation to severity and type of dementia, and blazon, frequency, and duration of do program. Nosotros too evaluated agin events.
Primary RESULTS:
Sixteen trials with 937 participants met the inclusion criteria. However, the required data from three trials and some of the information from a fourth trial were not published and not fabricated bachelor. The included trials were highly heterogeneous in terms of subtype and severity of participants' dementia, and type, elapsing and frequency of practice. Only two trials included participants living at home. Our meta-analysis suggested that exercise programs might take a significant bear upon on improving cerebral functioning (eight trials, 329 participants; SMD 0.55, 95% confidence interval (CI) 0.02 to 1.09). All the same, there was substantial heterogeneity between trials (I 2 value eighty%), almost of which we were unable to explain. Nosotros repeated the analysis omitting ane trial, an outlier, that included merely participants with moderate or astringent dementia. This reduced the heterogeneity somewhat (I2 value 68%), and produced a result that was no longer significant (seven trials, 308 participants; SMD 0.31, 95% CI -0.11 to 0.74). We constitute a significant result of practice programs on the ability of people with dementia to perform ADLs (six studies, 289 participants; SMD 0.68, 95% CI 0.08 to i.27). However, again we observed considerable unexplained statistical heterogeneity (I2 value 77%) in this meta-analysis. This ways that there is a need for caution in interpreting these findings. In further analyses, we constitute that the burden experienced by informal caregivers providing care in the home may be reduced when they supervise the participation of the family member with dementia in an exercise program (one study, 40 participants; MD -15.xxx, 95% CI -24.73 to -5.87), simply we found no significant outcome of exercise on challenging behaviours (one study, 110 participants; MD -0.threescore, 95% CI -4.22 to 3.02), or low (six studies, 341 participants; MD -0.fourteen, 95% CI -0.36 to 0.07). We could not examine the remaining outcomes, quality of life, mortality, and healthcare costs, as either the advisable data were not reported, or we did non retrieve trials that examined these outcomes.
AUTHORS' CONCLUSIONS:
In that location is promising evidence that exercise programs can have a significant impact in improving ability to perform ADLs and possibly in improving knowledge in people with dementia, although some caution is brash in interpreting these findings. The programs revealed no significant effect on challenging behaviours or depression. There was trivial or no show regarding the remaining outcomes of interest.
This is the abstract of a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) 2013, issue 12, Art. No.: CD006489. DOI: 10.1002/14651858.CD006489.pub3 (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006489.pub3/abstract;jsessionid=EB059310003BD3AC29CC6D77710D8779.f01t02). For total citation and authors' details see reference 1.
The total text is available from:http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006489.pub3/abstract.
The abstract is also available in the Portuguese, French and Spanish languages from: http://summaries.cochrane.org/CD006489/exercise-programs-for-people-with-dementia.
COMMENTS
This systematic review published past Forbes et al. is a continuation and update of the study that they published in 2008. It aimed to identify the benefits of physical practice for elderly people with impaired cognition. The review included randomized studies with control groups. The quality of the studies was very well defined and there was an involvement in selecting studies in which the intervention consisted of physical activity unassociated with other forms of treatment.
In the systematic review conducted in 2008, a meta-assay was conducted and the results were insufficient to evidence whatever evidence of benefits from exercise in relation to the principal objectives. In the study of 2013, information technology was observed that the subjects presented improved ability to carry out activities of daily living, possibly with improved noesis. In relation to the other primary and secondary objectives, the data were insufficient or inconclusive.
In preclinical studies, the action of do has been seen to involve structural and functional changes to neurons. Exercise-related neurogenesis and neuron remodeling have been observed through increased production of brain-derived synaptic proteins (BDNF). However, neuroplasticity besides results from the action of other factors involving serotonin reuptake, N-methyl-D-aspartate (NMDA) receptors and calorie and cholesterol restriction; and from manipulation of cognitive magnetic fields and electric activity. Considering that information technology is possible and likely that interactions between multiple factors result in modifications to the response to the treatment used, it can exist comprehended that such interactions make information technology difficult to identify the effect of one intervention alone. In this regard, these authors' rigorous methodological care has placed value on their findings and partly explains the lack of evidence relating to the other objectives.
REFERENCE
i. Forbes D, Thiessen EJ, Blake CM, Forbes SC, Forbes S. Exercise programs for people with dementia. Cochrane Database Syst Rev. 2013;12:CD006489. [ Links ]
Source: http://old.scielo.br/scielo.php?pid=S1516-31802014000300195&script=sci_arttext
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