Evidence brief: Exercise programs for people with
dementia
Key messages
For people 65 and over with dementia, exercise may have a beneficial effect on cognitive
function and ability to perform day to day activities.

?
We do not have sufficient high quality evidence to determine whether exercise programs
make any difference to other outcomes for people with dementia or family caregivers.
Inside
1
Purpose of this statement
2
Dementia and its impact
3
Why is it important to know about the effects of exercise programs for people with dementia?
4
Do exercise programs improve outcomes for people with dementia and their family caregivers?
5
Summary of what is known about the effects of exercise programs for people over 65 years
with dementia
6
The Cochrane Review at a glance
7
References
1. Purpose of this statement
This statement is designed to provide information based on the best evidence available at the time of
publication to assist in decision-making. The contents of this statement are based on evidence from a single
Cochrane Systematic Review. Cochrane reviews are reviews of clearly formulated questions that use
systematic and explicit methods to identify, select, and critically appraise relevant research, and to collect and
analyse data from the studies that are included in the review. Other published evidence was not considered.
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2. Dementia and its impact
Dementia refers to a collection of symptoms caused by diseases that affect brain function. It may affect
cognitive functions such as memory, understanding information, judgment, and language skills. Common
forms of dementia include Alzheimer’s disease and dementia caused by damage to the blood vessels in the
brain (vascular dementia) [1, 2].
The impact on those living with dementia, their families and caregivers, and the health system is substantial.
Among people 65 years and over, dementia is the leading cause of disability burden [2]. People with dementia
may experience difficulties performing daily tasks, mood and personality changes. As the symptoms progress,
people with dementia may require assistance with self care, mobility, and communication [1, 2].
3. Why is it important to know about the effects of exercise programs
on people with dementia?
Around 300,000 people in Australia were estimated to be living with dementia in 2012 [2]. Without new ways to
delay the onset or slow the progression of dementia, this number is expected to rise to more than 900,000 by
2050 [1, 2]. Exercise may help slow the progression of the symptoms of dementia. It may also have a role in
lessening the impact of symptoms. We need to understand whether exercise makes an important difference
for people with dementia and the types of exercise that are most likely to be beneficial.
4. Do exercise programs improve outcomes for people with dementia
and their family caregivers?
A recent Cochrane systematic review evaluated published scientific evidence about the effects of exercise
programs on people 65 years and over with dementia [3, 4]. Most of the 16 included studies were conducted in
residential aged care facilities. The review found that, compared to usual care or social contact, exercise
programs may have a small beneficial effects on cognitive function and ability to perform activities required for
day to day living. Exercise programs had uncertain effects on depression, challenging behaviours (e.g.
agitation, aggression), and other outcomes for people with dementia.
The programs varied in the type of exercise performed, and in the frequency and duration of exercise
sessions. It is unclear from the available evidence which type, frequency and duration of exercise is most
beneficial or whether the effects of exercise vary depending on the severity and type of dementia.
The impact of exercise programs on family caregivers is uncertain. None of the included studies examined
quality of life among caregivers and only two small studies examined caregiver burden, both with uncertain
effects.
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5. Summary of what is known about the effects of exercise programs
for people over 65 years with dementia
Outcome
What do we know about the effects of exercise programs on this
outcome?1
Cognitive function includes memory,
attention, use of language, problem
solving and other thinking functions of
the brain
Exercise programs had a beneficial effect on cognition (0.55 standard
deviations higher among those who received exercise compared to those
who received usual care or social contact, 95% confidence interval 0.02 to
1.09 higher; 8 trials, 329 people with dementia; low quality evidence). This
effect is equivalent to a 2 point improvement on the Mini-Mental State
Examination (95% confidence interval 0.06 to 3.5 point increase; MMSE
scale range 0 to 30 point where higher scores indicate better cognition).
The effects varied across trials. This may be due to differences in the
exercise programs or study participants, but there is insufficient evidence
to tell.
Activities of daily living refers to ability
to perform daily activities such as
bathing, feeding, and dressing
Exercise programs had a beneficial effect on activities of daily living (0.68
standard deviations higher among those who received exercise compared
to those who received usual care or social contact, 95% confidence interval
0.08 to 1.27 higher; 6 trials, 289 people with dementia; low quality
evidence). This effect is equivalent to a 5 point improvement on the Barthel
Index for assessing activities of daily living (95% confidence interval 0.6 to
9.6 point increase; Barthel Index range 0 to 100 points where higher scores
indicate greater independence in performing day to day tasks). The effects
varied across trials. This may be due to differences in the exercise programs
or study participants, but there is insufficient evidence to tell.
Depression
The effects of exercise programs on depression are uncertain (0.14
standard deviations lower among those who received exercise compared to
usual care or social contact, 95% confidence interval 0.36 lower to 0.07
higher; 5 trials, 314 people with dementia; moderate quality evidence). The
evidence suggests exercise may lead to small improvements in depression,
but we cannot exclude the possibility that exercise has no effect on
depression.
Challenging behaviours include
agitation, aggression, and wandering
The effects of exercise programs on challenging behaviours are uncertain.
Results varied across studies. Two studies reported little or no difference
between those who received exercise compared to those who received
usual care, and two studies reported improvement with exercise (4 trials,
221 participants; very low quality evidence).
Outcomes for family caregivers include
caregiver burden, quality of life, and
mortality
The effects of exercise programs on caregiver burden are uncertain (2
trials, 52 participants; very low quality evidence). None of the included
studies reported other outcomes for caregivers.
Use of healthcare services
None of the included studies reported outcomes relating to the use of
healthcare services.
1
The 95% confidence interval indicates the range in which the actual effect is likely to be.
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6. The Cochrane Review at a glance
Included studies
The review included 16 randomised trials involving 937 people aged 65 years and over with a diagnosis of
dementia. Severity of dementia varied from mild to severe. There are 8 ongoing studies (1990 participants),
not yet included in the review. The people who participated in the studies were residents of aged care
facilities (11 studies), in psychiatric facilities (3 studies) and in the community (2 studies). The studies were
set in Australia (2 studies), Belgium, Brazil, France (2 studies), Italy, the Netherlands (2 studies), South
Korea, Spain, Sweden, and the United States (4 studies).
Interventions evaluated
Exercise programs involving any combination of aerobic-, strength- or balance-training. The programs
varied in the type of exercise, length of sessions (from 20 to 75 minutes), and frequency of sessions (from
two to seven times per week). Exercise programs were compared to usual care alone or social contact (e.g.
reading, singing, conversation). Social contact aimed to provide similar levels of interaction without a
physical exercise component.
Outcomes measured
Cognition, activities of daily living, challenging behaviours (e.g. agitation, aggression, wandering),
depression, and mortality were the primary outcomes for this review. All outcomes were measured at the
completion of the exercise program, which ranged from two to 52 weeks (median 12 weeks) across the
studies.
Quality of the evidence
The evidence contributing to this review varied in quality from very low to moderate. Findings for cognitive
function and activities of daily living are based on low quality evidence. This means that further research is
very likely to change our confidence in the estimates of effect and is likely to change these estimates. For
some outcomes, the evidence was of very low quality because the outcome was measured in only a few
studies, with a small number of participants.
Key dates
Review published December 2013
Review content assessed as up-to-date August 2012
7. References
1. Alzheimer's Australia. Understanding dementia and memory loss. 2013 [cited 2014 February]; Available
from: http://www.fightdementia.org.au/.
2. Australian Institute of Health and Welfare, Dementia in Australia. Cat. no. AGE 70. 2012, AIHW: Canberra.
3. Plain language summary of Cochrane Systematic Review: Exercise programs for people with dementia.
Cochrane Database Syst Rev 2013; Available from: http://summaries.cochrane.org/CD006489/exerciseprograms-for-people-with-dementia.
4. Forbes, D., et al., Exercise programs for people with dementia. Cochrane Database Syst Rev, 2013. 12: p.
CD006489. DOI: 10.1002/14651858.CD006489.pub3.
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