%0 Journal Article %J J Alzheimers Dis %D 2023 %T The Effect of Exercise on Falls in People Living with Dementia: A Systematic Review. %A Jehu, Deborah A %A Davis, Jennifer C %A Gill, Jessica %A Oke, Olabamibo %A Liu-Ambrose, Teresa %K Dementia %K Exercise %K Female %K Humans %K Independent Living %X

BACKGROUND: People living with dementia (PWD) are at a heightened risk for falls. However, the effects of exercise on falls in PWD are unclear.

OBJECTIVE: To conduct a systematic review of randomized controlled trials (RCTs) examining the efficacy of exercise to reduce falls, recurrent falls, and injurious falls relative to usual care among PWD.

METHODS: We included peer-reviewed RCTs evaluating any exercise mode on falls and related injuries among medically diagnosed PWD aged ≥55years (international prospective register of systematic reviews (PROSPERO) ID:CRD42021254637). We excluded studies that did not solely involve PWD and were not the primary publication examining falls. We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register and grey literature on 08/19/2020 and 04/11/2022; topical categories included dementia, exercise, RCTs, and falls. We evaluated the risk of bias (ROB) using the Cochrane ROB Tool-2 and study quality using the Consolidated Standards of Reporting Trials.

RESULTS: Twelve studies were included (n = 1,827; age = 81.3±7.0 years; female = 59.3%; Mini-Mental State Examination = 20.1±4.3 points; intervention duration = 27.8±18.5 weeks; adherence = 75.5±16.2%; attrition = 21.0±12.4%). Exercise reduced falls in two studies [Incidence Rate Ratio (IRR) range = 0.16 to 0.66; fall rate range: intervention = 1.35-3.76 falls/year, control = 3.07-12.21 falls/year]; all other studies (n = 10) reported null findings. Exercise did not reduce recurrent falls (n = 0/2) or injurious falls (n = 0/5). The RoB assessment ranged from some concerns (n = 9) to high RoB (n = 3); no studies were powered for falls. The quality of reporting was good (78.8±11.4%).

CONCLUSION: There was insufficient evidence to suggest that exercise reduces falls, recurrent falls, or injurious falls among PWD. Well-designed studies powered for falls are needed.

%B J Alzheimers Dis %V 92 %P 1199-1217 %8 2023 %G eng %N 4 %R 10.3233/JAD-221038 %0 Journal Article %J J Alzheimers Dis %D 2017 %T Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1. %A Gregory, Michael A %A Boa Sorte Silva, Narlon C %A Gill, Dawn P %A McGowan, Cheri L %A Liu-Ambrose, Teresa %A Shoemaker, J Kevin %A Hachinski, Vladimir %A Holmes, Jeff %A Petrella, Robert J %K Aged %K Aged, 80 and over %K Analysis of Variance %K Blood Pressure %K Blood Pressure Monitoring, Ambulatory %K Carotid Intima-Media Thickness %K Cognition Disorders %K Exercise %K Exercise Therapy %K Female %K Follow-Up Studies %K Gait %K Humans %K Independent Living %K Male %K Middle Aged %K Neuropsychological Tests %X

This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p < 0.001), verbal fluency [digit symbol coding (p < 0.001), phonemic verbal fluency (p < 0.001)], and memory [immediate recall (p < 0.001) and delayed recall (p < 0.001)]; mobility: usual & dual-task gait speed (p = 0.002 and p < 0.001, respectively) and step length (p = 0.001 and p = 0.003, respectively); and vascular health: cIMT (p = 0.002). No changes were seen in the remaining outcomes. In conclusion, 26 weeks of dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.

%B J Alzheimers Dis %V 57 %P 747-763 %8 2017 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/28304305?dopt=Abstract %R 10.3233/JAD-161240