Can physical activity be used to maintain cognitive function in nursing home residents with dementia? A literature review

Background: Dementia is a noncommunicable disease with no effective prevention, treatment or cure. Evidence is emerging for the use of exercise to decelerate cognitive decline; however, few studies exist among nursing home residents and an optimum exercise protocol is yet to be determined. Objectives: To determine the effectiveness of physical activity in maintaining cognitive function in nursing home residents with dementia. Methods: Databases searched included CINAHL, MEDLINE complete, SPORTDiscus and ScienceDirect. Six relevant studies were identified and critically appraised using the Effective Public Health Practice Project Quality Assessment Tool. Results: All trials included different exercise programmes with various activity types and duration; all control interventions were social activities. Three studies demonstrated improved cognition in the intervention group, whilst one study observed a slower decline. Four studies found statistically significant cognitive decline in the control groups. Two studies observed no significant changes in either the intervention or control groups. Overall, there is moderate-to-moderate evidence strong evidence that physical activity can effectively maintain cognitive function in nursing home residents with dementia. Conclusions: All interventions had a favourable effect on cognition. Results suggest that aerobic exercise of longer duration may be most effective for those with mild-to-moderate cognitive impairment; whilst multimodal programmes may be most effective for moderate-to-severe dementia. Combining an exercise programme with standard daily activities appears no more effective than exercise alone. Future research should aim to determine an optimum exercise protocol and whether the positive effects on cognition can be maintained long term with continued exercise.