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PURPOSE: An estimated 5.8 million people in the United States live with dementia. By the year 2060, this number is expected to climb as high as 14 million people (CDC, 2019). Performance and participation in activities of daily living (ADLs) is a primary goal of occupational therapy. Exercise intervention is an occupational therapy approach for individuals with dementia that will increase ADL performance (Giebel et al., 2015). The present study examined the effects of physical exercise to maintain or improve activities of daily living performance for adults with dementia.
DESIGN: This systematic review of systematic reviews examined whether physical activity interventions maintained or improved ADL performance among older adults with dementia.
METHOD: Inclusion criteria for this study were systematic reviews and meta-analyses written in English and published from 2012-2024 with participants that were adults over eighteen years old who had dementia at the time of data collection, used physical exercise as an intervention measure, and reported an ADL outcome measure. The exclusion criteria for this study were reviews containing greater than or equal to half of studies identical to another systematic review. We screened 337 titles and abstracts from four literature databases: CINAHL, Pubmed, Cochrane Library and Scopus. We retrieved and reviewed 33 full-text articles. Two researchers reviewed each abstract, which led to full-text reviews of papers that appeared to meet the inclusion criteria. Two reviewers then read each full-text article to determine inclusion. Disagreements were resolved through consensus. Seven articles met inclusion criteria. We examined the effects of exercise frequency, duration, and intensity (high intensity included strength training, dance, brisk walking; low intensity exercise included yoga, Tai Chi, walking). The US Preventative Services Task Force levels of certainty and grade definitions were used to describe the strength of evidence.
RESULTS: This study demonstrated a general improvement in ADL performance when low-intensity or high-intensity exercise were used. Four studies had positive outcomes related to ADLs and three reported mixed outcomes. There was strong evidence supporting routine use of low-intensity, long duration exercise (> 30 mins per session), over less frequent (≤ 3 times per week), and a longer intervention period ( > 8 weeks) to improve or maintain ADL performance among adults with dementia. There was less evidence supporting high-intensity, short duration (≤ 30 mins per session), over a more frequent (> 3 times a week), and shorter intervention period (≤ 8-week).
CONCLUSION: This study found strong support for low-intensity, long duration, less frequent exercise over a longer period of time to improve ADL performance among adults with dementia. This systematic review may guide practitioners in making physical activity dosage recommendations to improve performance in ADLs. Future research could address how dementia severity and medical comorbidities interact with exercise characteristics and ADL performance.
Centers for Disease Control and Prevention. (2019, August 20). Minorities and Women Are at Greater Risk for Alzheimer's Disease. U.S. Department of Health and Human Services. https://www.cdc.gov/aging/publications/features/Alz-Greater-Risk.html
Giebel, C. M., Sutcliffe, C., & Challis, D. (2015). Activities of daily living and quality of life across different stages of dementia: a UK study. Aging & Mental Health, 19(1), 63–71. https://doi.org/10.1080/13607863.2014.915920
physical activity, exercise, ADL, ADL performance, older adults, dementia, systematic review
Hesseltine, Clancy; Heun, Josiah; Porter, Murphy; Wyrick, Sam; Smallfield, Stacy; and Whitlow, Molly, "Physical Activity for ADL Performance in Older Adults with Dementia: A Systematic Review" (2022). Student Systematic Reviews: Occupational Therapy. 1.