Research Article

Effectiveness of Exercise Programs on Patients with Dementia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Table 1

Baseline characteristic of studies included in the systematic review and meta-analysis.

StudyPublication yearCountrySample sizeMean age (years)Percentage maleSettingInterventionControlTreatment durationDiagnosis criteriaReported outcomesJadad scale

Francese et al. [14]1997USA6/5NANANursing homeExercises targeting strength and function that included the use of music, various types of exercise balls, and parachute leg weightsSocial contact plus sing-along group that watched music videos7 weeksClinicalADL (CADS)3

de Winckel et al. [15]2004Belgium15/1081.60.0Public psychiatric hospitalIntervention focused on strength training, balance, trunk movements, and flexibilitySocial contact 1-on-1 conversation with therapist3 monthsNIN CDS-ARDRACognition (MMSE, ADS 6)4

Rolland et al. [16]2007France67/6783.024.6Nursing homeAerobic (walking), strength (lower extremity), flexibility, and balance training, gradually increased in intensityUsual care12 monthsNIN CDS-ARDRAADL (Katz index of ADLs), depression (MADRS)6

Christofoletti et al. [17]2008Brazil17/2074.332.4NAPhysiotherapy kinesiotherapy exercises (strength, balance, memory, and recognition exercise using balls, elastic ribbons, and proprioceptive plates)Usual care6 monthsICD-10, CMBD, and confirmed by the patient’s performance on the MMSE and on KADL scaleCognition (MMSE)4

Williams and Tappen [18]2008USA33/1287.911.0Nursing homeExercise focusing on strength, flexibility, and balance; supervised walkingSocial contact-conversation16 weeksNINCDS-ADRDADepression (CSDD)4

Eggermont et al. [19]2009The Netherlands51/4685.418.6Nursing homeWalking group, walks occurred on unit wards and in public placesSocial contact6 weeksClinicalCognition (MMSE)5

Eggermont et al. [20]2009The Netherlands30/3184.6NANursing homeHand movement activity group performing activities such as “finger movement, pinching a soft ball, or handling a rubber ring”Social contact plus read out loud program6 weeksDSM-IVCognition (RBMT), depression (GDS)5

Conradsson et al. [21]2010Sweden19184.727.0Nursing homeThe high-intensity group exercise (3–9 participants per exercise group) focused on weight bearing and progressively increased in difficulty. Activity consisted of strength and balance exercises including walking, squats, and trunk exercisesSocial contact plus seated activities provided by occupational therapists13 weeksKADL scaleADL (Katz index of ADLs)5

Kemoun et al. [22]2010France20/1881.921.1Nursing homeThe exercise program included three different sessions each week, i.e., (1) walking, (2) stamina exercise, and (3) a combination of walking, stamina, and balance exercises. For the first 2 weeks of the program, participants prepared for the routine program with specific muscles and joint exercisesUsual care15 weeksDSM-IVCognition (ERFC French version)3

Hwang and Choi [23]2010Korea10/881.5NANAA dance program consisting mainly of upper body exercises, with a 10-minute warm-up and warm-downUsual care8 weeksClinicalCognition (MMSE)2

Venturelli et al. [24]2011Italy12/1284.037.5Nursing homeA minimum of 30 minutes of moderate walking 4 times a week for 6 monthsUsual care at the home, which consisted of bingo, sewing, and music therapy6 monthsClinicalCognition (MMSE), ADL (Barthel index of ADL)5

Vreugdenhil et al. [25]2012Australia20/2074.140.0Outpatient memory disorders clinicExercises progressively became more challenging, and targeted strength and balanceUsual care4 monthsDSM-IVCognition (ADAS-cog), ADL (The instrumental ADL), depression (GDS)6

Volkers [26]2012The Netherlands50/3882.1NANASupervised walksUsual care18 monthsClinicalCognition (MMSE)3

Yang et al. [27]2015China25/2572.034.0Neurology clinic5 min warm-up, 30 min target intensity exercise, 5 min reorganization movementHealth education3 monthsNINDS-AIREN and MMSECognition (MMSE, adas-cog), ADL (Qol-AD)3

Ohman et al. [28]2016Finland70/7078.163.6CommunityDual-task exercises, and strength, balance, endurance, and aerobic training; aerobic, endurance, balance, and strength training, and dual taskingUsual care12 monthsNINCDS-ADRDACognition (CDT, VF, CDR, MMASE)5

Toots et al. [29]2016Sweden93/9385.124.2Residential care facilitiesHigh-intensity functional exercise program, which aims to improve lower limb strength, balance, and mobilitySeated control activity7 monthsDSM-IV-TRCognition (BBS), ADL (FIM and Barthel index of ADLs), depression (GDS)6

Hoffmann et al. [30]2016Denmark107/9370.556.5NAThe first four weeks of exercise (adaption) emphasized getting used to exercising and building up strength, primarily of the lower extremities (twice weekly). Participants were also introduced to aerobic exercise (once weekly). For the remaining 12 weeks, patients performed aerobic exercise of moderate-to-high intensity (in total 3 × 10 min on an ergometer bicycle, cross trainer, and treadmill with 2–5 min rest between)Usual care16 weeksNINCDS-ADRDACognition (SDMT), ADL (ADCS-ADL), depression (HAMD-17)5

Barreto et al. [31]2017France44/4787.615.4Nursing home10 minutes of warm-up, 10 minutes of coordination and balance exercises, 10–15 minutes of muscle strengthening, 20 minutes of aerobic exercise, and 5–10 minutes of cool downMusic mediation or arts and crafts24 weeksDSM-IV and MMSECognition (MMSE), ADL (ADCS-ADL-sev)6

Bürge et al. [32]2017Switzerland78/8281.448.8Psychiatric hospitalSquatting at different levels (or repeated stand-ups from a chair), lateral elevation of the legs in a standing position, and rising on the toesWatching videos about different topics or playing together6 weeksCIM-10, and CDRADL (Barthel index of ADLs)6

Lamb et al. [33]2018UK278/13777.360.7National health service primary care, community and memory servicesArm exercises using hand held dumb bells, including at least a biceps curl and, for more able individuals, shoulder forward raise, lateral raise, or press exercises, and leg strength training exercises using a sit-to-stand weighted vest (all proexercise products, FL) or a waist belt (Rehabus, Lerum, Sweden), or bothUsual care12 monthsDSM-IV and MMSECognition (ADAS-cog), ADL (Bristol ADL)5