Effectiveness of exercise interventions for adults over 65 with moderate-to-severe dementia in community settings: a systematic review

  • Annabelle LongEmail author
  • Katie Robinson
  • Sarah Goldberg
  • Adam L. Gordon

Key summary points


To review the literature on the effectiveness of exercise interventions for people with moderate-to-severe dementia in community settings.


The literature was of low quality, but suggested exercise programmes may improve physical function of people with moderate-to-severe dementia. There was no evidence that exercise programmes improve mood.


More research is needed to improve the quality of the evidence to better understand the effectiveness of exercise programmes in community-dwelling older people with moderate-to-severe dementia.



To conduct a systematic review of the literature to evaluate the effectiveness of exercise interventions for people with moderate-to-severe dementia in community settings.


Eight electronic databases (MEDLINE, Embase, CINAHL, AMED, PsycINFO, PEDro, The Cochrane Library and BNI) were searched from inception to July 2018. Snowball searching identified additional articles not identified initially. Articles were included if they: reported randomised or quasi-randomised controlled trials comparing exercise with usual care or no treatment; and involved people over 65 with moderate-to-severe dementia in community settings. Outcome measures of interest were strength, endurance, mobility, mood and quality of life. Titles and abstracts of all studies were screened by one reviewer. Two reviewers independently screened full text articles for all eligible studies, extracted data and assessed quality and risk of bias.


Eight studies with 819 participants were included. Interventions were variable in terms of content, duration and frequency. There was some evidence exercise programmes may improve physical function of people with moderate-to-severe dementia, with significant effects seen for gait speed and endurance, and a trend towards improvement in strength. There was little evidence to suggest exercise programmes improve mood. Most studies were of low quality.


Exercise was associated with improvements in gait speed and endurance for older people with moderate-to-severe dementia living in the community, but the quality of evidence was low. There was no conclusive evidence regarding effect on strength or mood. Findings are limited by the quality of the available evidence.


Dementia Aged Exercise Systematic review 


Author contributions

All authors wrote the protocol for the review, contributed to the analysis and wrote the manuscript. AL and KR conducted the review and led the analysis.


This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent


Supplementary material

41999_2019_236_MOESM1_ESM.docx (14 kb)
Supplementary material 1 (DOCX 14 kb)


  1. 1.
    Palm R, Jünger S, Reuther S, Schwab CGG, Dichter MN, Holle B, Halek M (2016) People with dementia in nursing home research: a methodological review of the definition and identification of the study population. BMC Geriatr 16(1):78CrossRefGoogle Scholar
  2. 2.
    WHO (2017) Global action plan on the public health response to dementia 2017–2025. World Health Organisation, GenevaGoogle Scholar
  3. 3.
    Teri L, Logsdon RG, McCurry SM (2008) Exercise interventions for dementia and cognitive impairment: the seattle protocols. J Nutr Health Aging 12(6):391–394CrossRefGoogle Scholar
  4. 4.
    Lautenschlager NT, Cox K, Kurz AF (2010) Physical activity and mild cognitive impairment and Alzheimer’s disease. Curr Neurol Neurosci Rep 10(5):352–358CrossRefGoogle Scholar
  5. 5.
    P.A.G.A.C (2018) Physical Activity Guidelines Advisory Committee Scientific Report. In: Services DoHaH (ed). WashingtonGoogle Scholar
  6. 6.
    Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S (2015) Exercise programs for people with dementia. Cochrane Database Syst Rev 4:Cd006489Google Scholar
  7. 7.
    Chou C, Hwang C, Wu Y (2012) Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehabil 93(2):237–244CrossRefGoogle Scholar
  8. 8.
    Weening-Dijksterhuis E, de Greef MH, Scherder EJ, Slaets JP, van der Schans CP (2011) Frail institutionalized older persons: a comprehensive review on physical exercise, physical fitness, activities of daily living, and quality-of-life. Am J Phys Med Rehabil 90(2):156–168CrossRefGoogle Scholar
  9. 9.
    Windle G, Hughes D, Linck P, Russell I, Woods B (2010) Is exercise effective in promoting mental well-being in older age? A systematic review. Aging Ment Health 14(6):652–669CrossRefGoogle Scholar
  10. 10.
    McGrath JA, O’Malley M, Hendrix TJ (2011) Group exercise mode and health-related quality of life among healthy adults. J Adv Nurs 67(3):491–500CrossRefGoogle Scholar
  11. 11.
    Robinson KR, Long AL, Leighton P, Armstrong S, Pulikottill-Jacob R, Gladman JR et al (2018) Chair based exercise in community settings: a cluster randomised feasibility study. BMC Geriatr 18(1):82CrossRefGoogle Scholar
  12. 12.
    Brittle N, Patel S, Wright C, Baral S, Versfeld P, Sackley C (2009) An exploratory cluster randomized controlled trial of group exercise on mobility and depression in care home residents. Clin Rehabil 23(2):146–154CrossRefGoogle Scholar
  13. 13.
    Long A, Robinson K. Systematic review of effectiveness of exercise over usual care for adults over 65 with moderate to severe dementia in community settings: A Protocol York: NIHR; 2018 [updated 15/10/18. Available from:
  14. 14.
    Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. The Cochrane Collaboration.
  15. 15.
    Rolland Y, Pillard F, Klapouszczak A, Reynish E, Thomas D, Andrieu S et al (2007) Exercise program for nursing home residents with Alzheimer’s disease: a 1-year randomized, controlled trial. J Am Geriatr Soc 55(2):158–165CrossRefGoogle Scholar
  16. 16.
    Cott CA, Dawson P, Sidani S, Wells D (2002) The effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease. Alzheimer Dis Assoc Disord 16(2):81–87CrossRefGoogle Scholar
  17. 17.
    Roach KE, Tappen RM, Kirk-Sanchez N, Williams CL, Loewenstein D (2011) A randomised controlled trial of an activity specific exercise program for individuals with Alzheimer disease in long-term care settings. J Geriatr Phys Ther 34(2):50–56CrossRefGoogle Scholar
  18. 18.
    Venturelli M, Scarsini R, Schena F (2011) 6-month walking program changes cognitive and ADL performance in patients with Alzheimer. Am J Alzheimers Dis Demen 26(5):381–388CrossRefGoogle Scholar
  19. 19.
    Cancela JM, Ayan C, Varela S, Seijo M (2016) Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia. J Sci Med Sport 19(4):293–298CrossRefGoogle Scholar
  20. 20.
    Kemoun G, Thibaud M, Roumagne N, Carette P, Albinet C, Toussaint L et al (2010) Effects of a physical training programme on cognitive function and walking efficiency in elderly persons with dementia. Dement Geriatr Cogn Disord 29(2):109–114CrossRefGoogle Scholar
  21. 21.
    Meng-Chun C, Kuei-Min C, Chu-Lin C, Ya-Hui C, Yin-Yin C, Hsin-Ting H (2016) Elastic band exercises improved activities of daily living and functional fitness of wheelchair-bound older adults with cognitive impairment. A cluster randomized controlled trial. Am J Phys Med Rehabil 95(11):789–799CrossRefGoogle Scholar
  22. 22.
    Williams CL, Tappen RM (2007) Effect of exercise on mood in nursing home residents with Alzheimer’s disease. Am J Alzheimers Dis Other Demen 22(5):389–397CrossRefGoogle Scholar
  23. 23.
    Sheehan B (2012) Assessment scales in dementia. Ther Adv Neurol Disord 5:349–358CrossRefGoogle Scholar
  24. 24.
    Potter R, Ellard D, Rees K, Thorogood M (2011) A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia. Int J Geriatr Psychiatr 26(10):1000–1011CrossRefGoogle Scholar
  25. 25.
    Blankevoort CG, van Heuvelen MJG, Boersma F, Luning H, de Jong J, Scherder EJA (2010) Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dementia Geriatr Cognit Disorders 30(5):392–402CrossRefGoogle Scholar
  26. 26.
    Pitkälä K, Savikko N, Poysti M, Strandberg T, Laakkonen ML (2013) Efficacy of physical exercise intervention on mobility and physical functioning in older people with dementia: a systematic review. Exp Gerontol 48(1):85–93CrossRefGoogle Scholar
  27. 27.
    Fleiner T, Leucht S, Förstl H et al (2016) Effects of short-term exercise interventions on behavioral and Psychological symptoms in patients with dementia: a systematic review. J Alzheimer’s Dis 55:1583–1594CrossRefGoogle Scholar
  28. 28.
    Tierney JF, Vale C, Riley R et al (2015) Individual participant data (IPD) meta-analyses of randomised controlled trials: guidance on their use. PLoS Med 12:e1001855CrossRefGoogle Scholar

Copyright information

© European Geriatric Medicine Society 2019

Authors and Affiliations

  1. 1.Division of Rehabilitation and Ageing, School of Medicine, B109, Medical School, Queen’s Medical CentreUniversity of NottinghamNottinghamUK
  2. 2.Research and InnovationNottingham University Hospitals NHS TrustNottinghamUK
  3. 3.East Midlands Collaboration for Leadership in Applied Health Research and Care (EM-CLAHRC)NottinghamUK
  4. 4.School of Health SciencesUniversity of NottinghamNottinghamUK
  5. 5.Division of Medical Sciences and Graduate Entry MedicineUniversity of NottinghamDerbyUK
  6. 6.University Hospitals of Derby and Burton NHS Foundation TrustDerbyUK

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