Long-term home and community-based exercise programs improve function in community-dwelling older people with cognitive impairment: a systematic review.

Lewis M
Peiris CL
Shields N

J Physiother. 2017 Jan;63(1):23-29. doi: 10.1016/j.jphys.2016.11.005. Epub 2016 Nov 27. (Review)
PMID: 27993488

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Disciplines

Family Medicine (FM)/General Practice (GP)

Relevance - 6/7
Newsworthiness - 5/7
General Internal Medicine-Primary Care(US)

Relevance - 6/7
Newsworthiness - 5/7
Geriatrics

Relevance - 6/7
Newsworthiness - 5/7
Neurology

Relevance - 6/7
Newsworthiness - 4/7
Physical Medicine and Rehabilitation

Relevance - 5/7
Newsworthiness - 4/7

Abstract

QUESTION: Do long-term (> 3 months) home or community-based exercise programs improve function, reduce falls and prevent hospital readmissions in older people with cognitive impairment?

DESIGN: Systematic review and meta-analysis of randomised, controlled trials. Electronic databases (CINAHL, PubMed, Medline, Embase, AMED) were searched from the earliest date possible until March 2016.

PARTICIPANTS: Older adults (= 65 years) with cognitive impairment living in the community.

INTERVENTION: Supervised home or community-based exercise programs longer than 3 months.

OUTCOME MEASURES: The primary outcomes were function (including balance and activities of daily living), falls and hospital readmissions.

RESULTS: Of 1011 studies identified, seven trials with 945 participants met the inclusion criteria. Compared with no intervention, long-term exercise programs improved functional independence in basic activities of daily living by a moderate and significant amount (SMD 0.77, 95% CI 0.17 to 1.37, I2=67%), and improved functional independence in instrumental activities of daily living by a small and significant amount (SMD 0.44, 95% CI 0.03 to 0.86, I2=42%). Long-term exercise improved balance (mean difference in functional reach test 5.2cm, 95% CI 0.5 to 9.9, I2=76%). Data from two individual trials suggest that long-term exercise programs also reduce falls in older people with cognitive impairment. However, there was limited reporting of the effect of exercise on hospital readmissions for this group of people.

CONCLUSIONS: Long-term home and community-based exercise programs improve function in older adults living in the community with cognitive impairment. Review registration: PROSPERO CRD42015029602. [Lewis M, Peiris CL, Shields N (2016) Long-term home and community-based exercise programs improve function in community-dwelling older people with cognitive impairment: a systematic review.Journal of Physiotherapy63: 23-29].

Clinical Comments

General Internal Medicine-Primary Care(US)

This is an extremely well done review and meta-analysis of randomized trials of the effect of community based exercise long-term (>3 months) programs on older adults with cognitive impairment. The exercise programs improved the participants' ability to perform ADLs, and possibly IDLs. The results obviously apply to many patients who are fairly inactive at baseline.

General Internal Medicine-Primary Care(US)

Good selection of endpoints: falls and readmissions. I would love to see a cost effectiveness analysis to support insurance coverage for long term Physical Therapy.

Geriatrics

Exercise has such profound physiological effects throughout the body that it should be considered a drug therapy. Exercise has been described as a miracle drug, but unfortunately this is not the case. An inherent limitation is that exercise takes time and effort and does not come in a pill. The benefits that have been ascribed to exercise also are not absolute. Not all individuals will benefit from exercise to the same extent. Individual physical limitations may preclude some patients from engaging in certain forms of exercise, but the broad array of aerobic, resistance, or stretching exercises that are potentially available may permit some type of physical activity for nearly everyone. Within reasonable limits and precautions, the exercise drug should be prescribed for all patients. Physicians should strive to identify exercises that are amenable for each patient they treat.

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