What are the factors associated with physical activity (PA) participation in community dwelling adults with dementia? A systematic review of PA correlates

Highlights

• We investigated all factors associated with PA in people with dementia.

• Faster gait speed and improved function are positively associated with PA.

• Higher HRQOL & social functioning & reduced apathy are positively associated with PA.

• Polypharmacy, falls and lower ADL function are negatively associated with PA.

• However, we were unable to identify any consistent correlates (reported >4 studies).

Abstract

PA shows promise as a modifiable lifestyle intervention to benefit pathological symptoms of dementia. However, little is known about the factors associated with participation in PA in community dwelling adults with dementia. A systematic review was undertaken to identify PA correlates. Two independent reviewers searched major electronic databases and extracted data on studies reporting quantitative correlates of PA participation in community dwelling adults with dementia. PA correlates were analyzed using the summary code approach within the socio-ecological model. Out of a potential of 118 articles, 12 met the eligibility criteria encompassing 752 participants. We conducted secondary analysis on nine data sets. Increased energy intake, resting metabolic rate, fat free mass, gait speed, global motor function, overall health related quality of life (HRQOL), physical HRQOL, higher levels of social functioning and reduced apathy were positively associated with PA. Taking ≥four medications, dizziness, lower activities of daily living (ADL) function, a history of falls, less waking hours in the day, more autonomic problems and delirium were negatively associated with PA. Increasing age and lower global cognition were not consistently associated with PA participation. It is surprising that increasing age and lower global cognition do not appear to influence PA participation. All significant correlates should be confirmed in prospective studies with particular focus on the relationship of PA and gait speed, ADL function, falls history and dietary intake and the progression of frailty and nursing home admission as a priority.

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.