Physical activity programs for persons with dementia

Physical activity is a good thing for nearly everybody and clearly boosts alertness and a sense of well-being. So can we use it as a treatment for elderly patients with dementia? That's a good question, but existing research doesn't provide an answer, according to a new Cochrane Library review.

"Physical activity may be beneficial for persons with dementia. But due to the small number of studies we have not been able to demonstrate this," said review lead author Dorothy Forbes, an associate professor with the faculty of health sciences at the University of Western Ontario, in Canada.

On the other hand, there is no evidence that physical activity is harmful either, she said.

Estimates indicate that dementia - known in the past as senility - affects about 14 percent of Americans ages 71 and older. More than one-third of Americans over 90 likely suffer from the condition, which causes forgetfulness, confusion and muddled thinking. A variety of medical conditions causes dementia, including Alzheimer's disease and stroke.

Physicians are unlikely to prescribe physical activity as a treatment for dementia patients because there is little evidence to support its value, Forbes said. Nevertheless, exercise is not impossible for many dementia patients, who might be able to walk, swim and exercise in groups with assistance, she said.

Researchers have shown that exercise can improve cognition and mental health in older adults, and some studies suggest that it could delay dementia from three to six years or reduce the risk that patients will develop cognitive problems, Forbes said.

"It is less clear if physical activity manages or improves other symptoms among persons with a diagnosis of dementia," she said.

In the new review, Forbes and colleagues sought to shed some light on that issue.

The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

While evidence from animal research indicates that physical activity could be a useful treatment for dementia, the review authors only found four studies that examined the effects of exercise in humans.

Two of the studies were not included in the analysis because the reviewers could not get details from the original study authors.

Both of the remaining studies were small and only included Alzheimer disease patients. One looked at just 11 patients; the other examined 134, but many of those did not complete their exercise regimens.

Still, the researchers in the latter study found that those who did exercise seemed to do better at handling the tasks of daily living.

None of the studies looked at the effects on caregivers or on overall health-care costs.

Why have there been so few high-quality studies? Research into dementia is in its early stages, and largely has focused on diagnosis, assessment of severity and drug treatments, Forbes said.

To make things more challenging, funding is limited and it can be difficult to study people who might not be able to give consent or comply easily with the requirements of a study.

While there is little research supporting physical activity as a helpful treatment for elderly people with dementia, there is no evidence that it is harmful, Forbes said.

"Indeed, there is some suggestion that physical activity manages or improves function in persons with dementia," she said. "Further well-designed trials are necessary to demonstrate the effects of physical activity."

Dr. William Thies, vice president of medical and scientific relations for the Alzheimer's Association, agreed that the studies reviewed are not conclusive. "It's true that the studies had a trend toward benefits, but that's not enough to say that physical exercise ought to be a necessary element of everyone's dementia care."

Still, the review findings do not change the fact that exercise remains crucial to long-term health, he said. "The person who has built physical activity into their lifestyle is going to be in better health, more functional and probably happier over the long run," he said.

Forbes D, et al. Physical activity programs for persons with dementia. Cochrane Database of Systematic Reviews 2008, Issue 3.

By Randy Dotinga, Contributing Writer
Health Behavior News Service