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Meta-Analysis
. 2008 Jun-Jul;12(6):401-9.
doi: 10.1007/BF02982674.

Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis

P C Heyn  1 , K E Johnson, A F Kramer
Affiliations
Meta-Analysis

Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: a meta-analysis

P C Heyn et al. J Nutr Health Aging. 2008 Jun-Jul.

Abstract

Background: Dementia is a common syndrome in the geriatric population. Subsequent impairment of cognitive functioning impacts the patient's mobility, ADLs, and IADLs. It is suggested that older persons with lower levels of cognition are less likely to achieve independence in ADLs and ambulation (1-2). Frequently, nursing home residents are viewed as too frail or cognitively impaired to benefit from exercise rehabilitation. Often, persons with Mini Mental State Score (MMSE) score below 25 are excluded from physical rehabilitation programs. However, Diamond (3) and Goldstein (4) concluded that geriatric patients with mild to moderate cognitive impairment were just as likely as cognitively intact patients to improve in functional abilities as a result of participation in exercise rehabilitation programs.

Purpose: The objective of this study is to compare, through a meta-analysis endurance and strength outcomes of Cognitively Impaired (MMSE < 23) and Cognitively Intact (MMSE superior 24) older adults who participate in similar exercise programs.

Methods: Published articles were identified by using electronic and manual searches. Key search words included exercise, training, strength, endurance, rehabilitation, cognitive impairment, cognition, MMSE, older adult, aged, and geriatrics. Articles were included if the were from RCTs or well-designed control studies.

Results: A total of 41 manuscripts met the inclusion criteria. We examined 21 exercise trials with cognitively impaired individuals (CI=1411) and 20 exercise trials with cognitively intact individuals (IN=1510). Degree of cognitive impairment is based on the reported MMSE score. Moderate to large effect sizes (ES = dwi, Hedges gi) were found for strength and endurance outcomes for the CI groups (dwi = .51, 95% CI= .42- .60), and for the IN groups (dwi = .49, 95% CI= .40- .58). No statistically significant difference in ES was found between the CI and IN studies on strength (t=1.675, DF= 8, P= .132), endurance (t=1.904, DF= 14, P=.078), and combined strength and endurance effects (t=1.434, DF= 56, P= .263).

Conclusions: These results suggest that cognitively impaired older adults who participate in exercise rehabilitation programs have similar strength and endurance training outcomes as age and gender matched cognitively intact older participants and therefore impaired individuals should not be excluded from exercise rehabilitation programs.

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Figures

Figure 1
Figure 1
Flow Chart of Literature Selection and Analysis
Figure 2
Figure 2
Cognitivelly intact endurances & strength outcomes
Figure 3
Figure 3
Cognitivelly impaired endurance & strength outcomes
See this image and copyright information in PMC

References

    1. Barnes C, Conner D, Legault L, Reznickova N, Harrison HF. Rehabilitation outcomes in cognitively impaired patients admitted to skilled nursing facilities from the community. Arch Phys Med Rehabil. 2004;85(10):1602–1607. - PubMed
    1. Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part II: clinical challenges. Arch Phys Med Rehabil. 2003;84(6):898–903. - PubMed
    1. Diamond PT, Felsenthal G, Macciocchi SN, Butler DH, Lally-Cassady D. Effect of cognitive impairment on rehabilitation outcomes. Am J Phys Med Rehabil. 1996;75:40–3. - PubMed
    1. Goldstein FC, Strasser DC, Woodard JL, Roberts VJ. Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc. 1997;45:35–42. - PubMed
    1. Paolucci S, Antonucci G, Gialloreti LE, et al. Predicting stroke inpatient rehabilitation outcome (the prominent role of neuropsychological disorders) Eur Neurol. 1996;36:385–390. - PubMed

Meta-Analysis Selected Studies

    1. Alessi CA, Schnelle JF, et al. Does Physical Activity Improve Sleep in Impaired Nursing Home Residents? Journal of the American Geriatrics Society. 1995;43:1098–1102. - PubMed
    1. Alessi CA, Yoon EJ, et al. A Randomized Trial of a Combined Physical Activity and Environmental Intervention in Nursing Home Residents: Do Sleep and Agitation Improve? Journal of the American Geriatrics Society. 1999;47:784–791. - PubMed
    1. Alexander NB, Galecki AT, et al. Task-Specific Resistance Training to Improve the Ability of Activities of Daily Living-Impaired Older Adults to Rise from a Bed and From a Chair. Journal of the American Geriatric Society. 2001;49:1418–1427. - PubMed
    1. Bastone AC, Filho WJ. Effect of an Exercise Program on Functional Performance of Institutionalized Elderly. Journal of Rehabilitation Research & Development. 2004;41(5):659–668. - PubMed
    1. Baum EE, Jajoura D, et al. Effectiveness of a Group Exercise Program in a Long-Term Care Facility: A Randomized Pilot Trial. Journal of the American Medial Directors Association. 2003;4:74–80. - PubMed

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