Ashwini K. Rao, Aileen Chou, Brett Bursley, Jaclyn Smulofsky, Joel Jezequel; Systematic Review of the Effects of Exercise on Activities of Daily Living in People With Alzheimer’s Disease. Am J Occup Ther 2014;68(1):50-56. doi: 10.5014/ajot.2014.009035.
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© 2019 American Occupational Therapy Association
OBJECTIVE. Alzheimer’s disease (AD) results in a loss of independence in activities of daily living (ADLs), which in turn affects the quality of life of affected people and places a burden on caretakers. Limited research has examined the influence of physical training (aerobic, balance, and strength training) on ADL performance of people with AD.
METHOD. Six randomized controlled trials (total of 446 participants) fit the inclusion criteria. For each study, we calculated effect sizes for primary and secondary outcomes.
RESULTS. Average effect size (95% confidence interval) for exercise on the primary outcome (ADL performance) was 0.80 (p < .001). Exercise had a moderate impact on the secondary outcome of physical function (effect size = 0.53, p = .004).
CONCLUSION. Occupational therapy intervention that includes aerobic and strengthening exercises may help improve independence in ADLs and improve physical performance in people with AD. Additional research is needed to identify specific components of intervention and optimal dosage to develop clinical guidelines.
Physical training, which is often included in occupational therapy practice, can help improve ADL performance in people with Alzheimer’s disease. Occupational therapy practitioners may be involved in planning and delivering physical training, identifying and correcting compensatory mechanisms, and providing support to minimize adverse events such as falls. The studies reviewed highlight the clinical feasibility of an exercise program for people with AD.
Intervention should include components of aerobic, strength, balance, and coordination training.
Physical training was equally effective in long-term care facilities and in home-based settings.
Occupational therapy practitioners may enlist the help of caregivers or trained assistants (e.g., aides) in improving adherence to physical training programs. However, interventions should be structured so as not to increase caregiver burden.
Although physical training is not routinely recommended for people with AD, this review provides evidence to support inclusion of aerobic exercise and strength, balance, and coordination training in occupational therapy practice. Physical training is a reimbursable service and may be included in occupational therapy practice.
Well-designed randomized controlled trials with large sample sizes are needed to assess the effects of exercise on ADL performance in people with AD.
Additional studies are needed to clarify the specific components of physical training that are most effective and clinically feasible.
Research is needed to examine optimal length and intensity of intervention to develop clinical guidelines for exercise in this population.
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