ReviewWhat are the factors associated with physical activity (PA) participation in community dwelling adults with dementia? A systematic review of PA correlates
Introduction
The aging population and the number of people affected by dementia are reaching epidemic levels (Prince et al., 2013). The inherent cognitive decline observed in dementia is associated with profound loss of independence, increased falls risk, a reduction in capacity to undertake ADL, nursing home admission and increased mortality (Butler and Radhakrishnan, 2012, Pitkälä et al., 2013, Prince et al., 2013, Smith et al., 2013). Unsurprisingly, the prevention and management of dementia is an International political and health priority (Prince et al., 2013).
Within recent years interest has risen in PA as an effective non-pharmacological intervention in the prevention and management of dementia (Ahlskog, Geda, Graff-Radford, & Petersen, 2011). For instance, Erickson, Weinstein, and Lopez (2012) recently concluded that there is convincing evidence that PA reduces the risk of AD, improves brain health and decreases the risk of pathological symptoms associated with AD. Other recent reviews (Blankevoort et al., 2010, Pitkälä et al., 2013, Potter et al., 2011) have established that PA interventions can improve mobility and functional limitations in people with dementia. This is exemplified in a recent randomized control trial (Hauer et al., 2012) involving PA which resulted in significant improvements in strength (p < 0.001) and functional performance (p < 0.001) in community dwelling adults with mild and moderate dementia. In a recent updated Cochrane review, Forbes et al. (2013) concluded that structured PA (exercise) can have a positive influence on cognition and a person with dementia's ability to undertake their ADL. In addition, a recent randomized controlled (RCT) (Lowery et al., 2013) demonstrated that PA program for people with dementia resulted in a reduction of caregiver burden from 23% to 17% (p = 0.01) while the burden doubled in the control arm.
Despite these positive findings, there remain concerns that community-dwelling adults with dementia are physically inactive (James, Boyle, Bennett, & Buchman, 2012). A recent randomized control trial found that only 30.7% achieved the prescribed frequency of the PA intervention and the authors concluded that it is essential research is undertaken to identify factors influencing participation in PA in community dwelling adults with dementia (Lowery et al., 2013). A systematic review of quantitative research would identify potential factors associated with PA and this information can be used to target future PA interventions for persons with dementia. One approach that is potentially useful to understand the factors associated with PA uptake is the socio-ecological model (Sallis et al., 2006). This model posits that multiple levels may impact upon an individual's participation in PA, including intrapersonal factors (e.g. socio-demographic or psychological) factors, interpersonal factors (e.g. social support); environment factors (e.g. access to facilities) and policy factors (e.g. regulations) (Bauman et al., 2012, Sallis et al., 2006). The socio-ecological model has been successfully used to identify influential factors in the uptake of PA within the general population (Bauman et al., 2012, Sallis et al., 2006), persons with mental illness (Vancampfort et al., 2014). Given the promising benefits associated with PA for community dwelling adults with dementia, it is important to understand the multiple levels over which PA participation may be affected.
To the best of our knowledge, no author has systematically reviewed the literature to establish the factors associated with PA participation in community dwelling adults with dementia. This information would provide essential information that can be utilized by clinicians, researchers and policy makers. With this in mind we conducted a systematic review to establish quantitative correlates of PA participation in community dwelling adults with dementia utilizing the socio-ecological approach.
Section snippets
Data sources and searches
Two independent reviewers conducted an electronic search of PsycINFO, CINAHL, PubMed and Embase from the inception of these databases until October 2013. The medical subject headings used were ‘PA’ or ‘exercise’ or ‘physical inactivity’ or ‘sedentary’ and ‘dementia’, or ‘AD’ or ‘vascular dementia (VAD)’ or ‘frontotemporal dementia’ or ‘Lewy Body dementia’ in the title, abstract or index term fields. We also conducted manual searches of the reference lists of identified articles.
Eligibility criteria
Inclusion
Study selection
We identified 2603 articles from the searches and following screening of these we obtained the full text of 118 articles to assess their eligibility. At this stage, we contacted 19 research groups requesting additional information on the correlates with PA and nine provided us with additional analysis and/or provided their data set so we could conduct secondary analysis of their data set (see acknowledgements). Seven groups were not contactable or able/willing to provide additional data and
Conclusion
There are indications that difficulty in undertaking ADL, gait speed, dietary intake and physical HRQOL are important factors associated with PA participation. From the review we were able to determine that increasing age and lower global cognition do not appear to be negatively associated with participation in PA. However, we found no consistent correlates (reported in >4 studies) of factors associated with PA in community dwelling adults with dementia. With the mounting political and health
Conflict of interest
All authors report that they do not have any conflicts of interest to declare.
Authors contribution
All authors formulated the research question and designed the study. BS, LH and DV undertook the searches and decided on the final list of included articles. BS and LH undertook data extraction. BS, LH and DV analyzed the data and all authors contributed to the interpretation of the data analysis and writing of the manuscript. All authors have approved the final version of the manuscript.
Role of funding source
Not applicable, the project was self-funded.
Acknowledgments
We would like to express our gratitude to the authors who kindly provided us with additional data including Dr Louise Allen, Newcastle University, Dr Jason Leung, Chinese University Hong Kong, Dr Ylva Cedervall, Uppsala University, Dr Renaud David, Nice University, Dr Kirk Erickson, University of Pittsburgh, Dr Bryan D. James, Rush Alzheimer's Disease Center, Dr Sue McCurry, University of Washington, Dr Thays Martins Vital, Cognitiva para Pacientes com Doença de Alzheimer (PRO-CDA), Dr Amber
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