The Effect of Physical Activity to Decreased of Dementia

(Mild,Moderate and Severe) in Elderly: A Systematic Review

Dwi indah Lestari, Antonia Helena Hamu, Suhardiana Rachmawati, Dina Palayukan Singkali and Ah
Yusuf
Nursing Faculty, Universitas Airlangga, Mulyorejo Street, Surabaya, Indonesia
@dwiindah343@gmail.com, @hamuantonia.2017@gmail.com, @diana_r2880@gmail.com,
@dinasingkalipalu@gmail.com , ah-yusuf@fkp.unair.ac.id

Keywords: Physical activity, dementia, elderly.

Abstract: Dementia is a syndrome characterized as a decrease in cognitive function, memory, language,

environmental orientation, emotional control changes, social behavior, motivation and physical abilities.
Physical activity is any body movement produced by skeletal muscles that require energy expenditure.
Physical exercise is a non-pharmacological treatment that can be given to the elderly who have dementia.
The purpose of this review is to determine the effect of physical activities on the state of dementia that
occurs in the elderly.systematic Methods of the study were systematic review of dementia elderly with
study selection criteria using Scopus, Science Direct, and Pubmed databases by Randomized Control Trial
(RCT). The result of the 15 journals conducted and reviewed with relevant keyword The results showed that
the physical activity which performed by someone who suffered from mild ,moderate and severe dementia
will decrease after doing physical activity.

1 INTRODUCTION The increased prevalence of dementia will also

Dementia is a progressive neurodegenerative
condition characterized by cognitive impairment of
memory, language, recognition and movement
disturbing daily activities. Dementia is one of the
most common neurodegenerative diseases in elderly
people worldwide.According to (DSM IV) dementia
is defined to be two.memory impairment with
cognitive impairment that causes aphasia (language
disorder), apraxia (motor disturbance), agnosia
(decrease in object recognition) or executive
function (planning, sequencing, abstract).While the
latter is a decrease in functional ability such as social
ability or self-care associated with cognitive deficits
Global prevalence rates About 60% of dementia
cases in developed countries are caused by
Alzheimer's disease and about 20% are vascular
dementia. Dementia affects the elderly at a much
greater rate than in younger individuals. The
prevalence of dementia in developed countries under
1% for people aged 65-69 years, increased to about
35% at age 95-99 years, and prevalence doubled at
the age of 65 - 99.(Atherton et al., 2016)
be followed by an increase in health costs including
medical expenses, nursing costs, caregiver salaries
and caregiver training costs, so there is a need for
optimal care of the functional ability of the elderly.
Functional ability is an important aspect in the
treatment of dementia patients. Therefore, the
development of nonpharmacologic interventions to
reduce functional degradation in dementia patients is
an important implication of elderly health (Souto et
al., 2016).
Many journals suggest that reducing physical
activity may interfere with mental health, impair
social function, occupation, health-related quality of
life. In addition, depressive symptoms associated
with more severe cognitive functioning occur in the
elderly with dementia. Therefore, developing an
effective strategy for improving cognitive function
and depressive symptoms has attracted attention and
alternatives that can be done in the elderly with
dementia. (Groot et al., 2016).
Treatment of elderly with dementia is important as it
is the provision of antipsychotic atypical drugs (eg,
risperidone and olanzapine) and acetylcholinesterase
inhibitors, has been considered the treatment of

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choice. Previous studies have suggested that the use
of pharmacotherapy is accompanied by adverse
events (eg, increased risk of cerebrovascular side
effects and metabolic syndrome.(Groot et al., 2016).
Physical exercise is a non-pharmacological
treatment for dementia that has no side effects. The
ultimate goal is to increase the functional potential
of the depressed elderly and develop biomotor
abilities to the highest degree (Karssemeijer et al.,
2017). Physical exercise in its execution is more
focused on the process of fostering physical
conditions such as physical exercise as a whole,
physical exercise is one of the most important
factors that should be considered as an element that
is needed in the healing process in the elderly with
dementia in order to achieve optimal health..
Physical activity is much done for people
with dementia there are 17 studies that state it, nine
of whom assess the effect of physical exercise play a
role in cognition change. The authors conclude that
the effectiveness of physical activity can improve
cognitive abilities and other abilities that elderly
people have with dementia (Atherton et al., 2016)
So it can be concluded that treatment in
elderly with dementia there are 2 kinds of
pharmacology and nonpharmacology.
Pharmacologic management of dementia has been
shown to have a rapid effect but its effects are
included in the short term. While non-
pharmacological management can provide long-term
effects and have a fairly good effectiveness
(Holthoff et al., 2015) .
Non pharmacological management one of
them is physical latian. Physical exercise done in a
planned, structured, repetitive, is a much
intervention in doing so is supported by research
research conducted. The results of physical exercise
performed by the elderly with dementia may
enhance functional ability, physical function,
neuropsychiatric symptoms (especially depression),
and even cognitive function (Souto et al., 2016).
Physical activity is often associated with a lower risk
of dementia. The relationship seems not only related
to the number of calories spent during exercise, but
also with the number of activities that indicate that
there is a synergy between exercise and cognitive
stimulation. Research data have shown the
relationship between physical activity with cognitive
function and risk of dementia. A study showed that a
physical exercise program for 6 months or about 150
minutes per week can improve cognitive function
(Gitlin et al., 2016).
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To reduce the high incidence of dementia in the
elderly. Physical activity is one of the
nonpharmacologic therapies proposed as decreased
incidence of dementia in the elderly it has been
supported by many research studies that support it
2 METODE
2.1 Data Search dan Source
The search strategy of the journal begins by asking a
research question, namely "is there any effect of
physical activity on the decrease of dementia (mild,
moderate, severe)?". Search results of research on all
scopus indexed journals with Randomized
Controlled Trials (RCT) type, related to therapy of
physical activity for dementia.
The database used for journal searching is
Database in Proquest, Science Direct, and scopus.
Keywords used are physical activity, and dementia.
The journal is limited by the publication year 2011-
2018, with nursing journal areas, medicine, and
psychology, as well as journals with English.
2.2 Selection Study and Criteria
The inclusion criteria set out in this criterion 1)
Design a quantitative study of both observation and
experimentation; 2) maximum span of 10 years ago;
3) Subjects of elderly men and women with
dementia; 4) Intervention given in the form of
physical activity; 5) research in select type
Randomize Control Trial (RCT)
3. RESULTS
3.1 Search result and study selection
In the selection of journals to be used in systematic
journal review should have the same characteristics
and Feasibility study, it is assessed by using PICOT
approach so it is easier and easier to understand in
writing systematic review.
Population: the population used in this study was
aged elderly (>60 year) with mild and severe
dementia
Intervensi: 1. physical activity interventions that
include aerobic exercise (Atherton et al., 2016),
physical exercise (Souto et al., 2016)(Holthoff et al.,
2015). The dance movement (Tin et al., 2015)
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handmovement program (Eggermont et al., 2009)
foot massage (Moyle et al., 2014) daily jogging
exercise (Zeng et al., 2016).
Comparisson: Participants were randomized to at
least one control group and the same treatment
group were treated, but for the control group, the
usual treatment of physical activity, while the group
treatment group performed the usual treatment
interventions and added with the exercise
intervention..
Output: pre- and post-intervention data for both
intervention and control for one or more outcomes
related to physical activity and dementia. And the
results are measured in DSM IV (Souto et al., 2016)
Desain studi: Randomized control trials (RCT).
Number of journals : 940 journals
 Scopus (n=330)
 Proquest (n=440)
 Science Direct (n=170)
incompatible n= 840
Review Abstrak
n=100
incompatible Variable
physical activity,
dementia n = 63
Review Full Text
n=37
incompatible inclusion
and exclusion criteria
removed n=22
Related articles
n=15
Gambar 1: Search Flow
3.2 Characteristics of the Study
Characteristics of the study are described in table 1.
All the journals obtained from the results of the
study have physical activity therapy performed on
clients with dementia. All studies have age criteria
of repondent 60 years and over. All 15 studies were
clients with mild, moderate, severe dementia..
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3.3 Study Review Results
Scientific study results are done by writers who get
from Proquest, Medline, and Science Direct, and
scopus. The overall total of all study participants
was 940 with age >60 years and have a good
dementia disorders were light and heavy
interventions are used in all the studies are
multicomponent interventions including behavioral,
educational and cognitive techniques used in
physical activity. With an average duration of
therapy for 6 weeks with an average 24-week
follow-up. From all the research mostly using
measuring devices the same: Scale-cognitive
subscale (ADAS-cog)(Atherton et al., 2016), DSM
IV (Souto et al., 2016) Mini-Mental State (sMMSE)
(Holthoff et al., 2015) College of Sports Medicine
(ACSM) (Karssemeijer et al., 2017)
neuropsychological, MRI and Bloodbase (Zeng et
al., 2016) and physical exercise its other like dance,
foot massage, recreational (Souto et al., 2016).
increased mood with socialization (Tin et al., 2015)
movement of hand and finger movements
(Eggermont et al., 2009)
From several literature journals that have been
done PICOT there is a statistically significant effect
found from physical activity (physical activity)
which includes aerobics, dancing, gymnastics,
cycling and other physical activities provide
significant results. After doing the routine and
scheduled treatment
Then do measurements using measuring
instruments that have berstandart. The results
obtained in the elderly with both mild and severe
dementia can experience significant reductions, and
mempu improve the quality of life of the elderly.
4 DISCUSSION
The authors selected 15 journals with similar
characteristics in the systematic writing of this
review. The authors chose to look at the influence
between physical activity and the incidence of
dementia occurring in the elderly. From the review
several studies have shown that the application of
physical activity to treat patients with mild and
severe dementia showed significant results on the
decline of dementia status in different measurements
using Scale-Cognitive subscale (ADAS-
cog)(Atherton et al., 2016), DSM IV, (Souto et al.,
2016), Mini-Mental State (sMMSE) (Holthoff et al.,
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2015) College of Sports Medicine (ACSM)
(Karssemeijer et al., 2017) neuropsychological, MRI
and Bloodbase (Zeng et al., 2016). Of all the results
shown lead to improvement of the incidence of
dementia in the elderly, which in doing intervention
and physical training.Physical.
activity One non-pharmacological approach is
the use of activities that utilize the individual's
ability to engage as well as the social role, which is
very useful for his or her interests, thus people with
dementia can effectively engage in daily activities,
thereby reducing the symptoms of depression.
Activities are adjusted to the ability of the elderly, so
as to prevent the occurrence of saturation and
discomfort.(Gitlin et al., 2016)
Scheduled exercise programs that are easy to
apply in the treatment of dementia significantly
reduce the signs of neuropsychiatric signs and
symptoms in patients suffering from moderate and
severe (Fleiner et al., 2017) signs of
neuropsychiatric and dementia symptoms include
various symptoms of depression, agitation and
apathy. Both became the most common. Thus
physical activity can be termed as an alternative non
pharmacological treatment that can be done in
patients with dementia, it also has many advantages
among them can be easily applied in daily activities,
but to get the results the maximum physical activity
(physical activity) is done in a scheduled and routine
so that will get the maximum results (Rathore, 2017)
4.1 Implications
The results of various research reviews can be
implicated in the nursing sphere especially on
mental nursing. Which in the client with dementia
both mild moderate and severe by doing physical
activityis one of non-pharmacological skills and
handlers that can reduce the incidence of dementia
in the elderly.
physical activity is one form of nursing
intervention that can be easily applied in daily
activities and is non-pharmacological, and can also
provide nursing orders. However, it is still necessary
to do a more in-depth study, sehinnga physical
activity can be applied and entered in a sensual
intervention, especially in patients with dementia.
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5 CONCLUSION
In conclusion, this review indicates that physical
activity in clients with dementia can be lowered
according to the results of research indicating that
physical activity with various types of physical
exercise has a significant effect on the incidence of
dementia experienced by the elderly. This can be
used as a guide and become a reference for further
research that is tailored to the demographic client's
characteristic
Non-pharmacological therapy, such as physical
activity intervention, is an interesting alternative or
add-on for non-pharmacological therapy when
cognitive symptoms in patients with dementia
(Groot et al., 2016)
Acknowledgements
The authors would like to thank the parties who
helped the implementation of this systematic review.
Thank you to Airlangga University for giving us the
opportunity, thanks also to our mentors who always
helped to provide feedback and guidance on this
systematic review. Thanks to all members of the
group who have given the spirit and dedication for
the implementation of this systematic review, and all
parties who helped and we can not mention one by
one
REFERENSI
Atherton, N. et al. (2016) ‘Dementia and Physical Activity
( DAPA ) - an exercise intervention to improve
cognition in people with mild to moderate dementia :
study protocol for a randomized controlled trial’,
Trials. Trials, pp. 1–12. doi: 10.1186/s13063-016-
1288-2.
Bloom, R. et al. (2017) ‘Computerized cognitive training
for older diabetic adults at risk of dementia : Study
protocol for a randomized controlled trial’,
Alzheimer’s & Dementia: Translational Research &
Clinical Interventions. Elsevier Inc., 3(4), pp. 636–
650. doi: 10.1016/j.trci.2017.10.003.
Eggermont, L. H. P. et al. (2009) ‘Hand motor activity ,
cognition , mood , and the rest – activity rhythm in
dementia A clustered RCT’, 196, pp. 271–278. doi:
10.1016/j.bbr.2008.09.012.
Fleiner, T. et al. (2015) ‘Evaluation of a hospital-based
day-structuring exercise programme on exacerbated
behavioural and psychological symptoms in dementia
- the exercise carrousel : study protocol for a
The 9th International Nursing Conference 2018
 randomised controlled trial’, Trials. Trials, pp. 1–8.
doi: 10.1186/s13063-015-0758-2.
Fleiner, T. et al. (2017) ‘Structured physical exercise
improves neuropsychiatric symptoms in acute
dementia care : a hospital-based RCT’. Alzheimer’s
Research & Therapy, pp. 1–9. doi: 10.1186/s13195-
017-0289-z.
Gitlin, L. N. et al. (2016) ‘Reducing neuropsychiatric
symptoms in persons with dementia and associated
burden in family caregivers using tailored activities :
Design and methods of a randomized clinical trial ☆’,
Contemporary Clinical Trials. Elsevier Inc., 49, pp.
92–102. doi: 10.1016/j.cct.2016.06.006.
Groot, C. et al. (2016) ‘The effect of physical activity on
cognitive function in patients with dementia : A meta-
analysis of randomized control trials’. Elsevier B.V.,
25, pp. 13–23.
Holthoff, V. A. et al. (2015) ‘Effects of Physical Activity
Training in Patients with Alzheimer ’ s Dementia :
Results of a Pilot RCT Study’, pp. 1–11. doi:
10.1371/journal.pone.0121478.
Jøranson, N. et al. (2015) ‘Effects on Symptoms of
Agitation and Depression in Persons With Dementia
Participating in Robot-Assisted Activity : A Cluster-
Randomized Controlled Trial’, Journal of the
American Medical Directors Association. Elsevier
Inc., pp. 1–7. doi: 10.1016/j.jamda.2015.05.002.
Karssemeijer, E. G. A. et al. (2017) ‘The effect of an
interactive cycling training on cognitive functioning in
older adults with mild dementia : study protocol for a
randomized controlled trial’. BMC Geriatrics, 9101,
pp. 1–8. doi: 10.1186/s12877-017-0464-x.
Moyle, W. et al. (2014) ‘International Journal of Nursing
Studies Foot massage versus quiet presence on
agitation and mood in people with dementia : A
randomised controlled trial’, International Journal of
Nursing Studies. Elsevier Ltd, 51(6), pp. 856–864. doi:
10.1016/j.ijnurstu.2013.10.019.
Rathore, A. (2017) ‘The effects of chronic and acute
physical activity on working memory performance in
healthy participants : a systematic review with meta-
analysis of randomized controlled trials’. Systematic
Reviews, pp. 1–16. doi: 10.1186/s13643-017-0514-7.
Souto, P. De et al. (2016) ‘Effects of a long-term exercise
programme on functional ability in people with
dementia living in nursing homes : Research protocol
of the LEDEN study , a cluster randomised controlled
trial’, Contemporary Clinical Trials. Elsevier Inc., 47,
pp. 289–295. doi: 10.1016/j.cct.2016.02.004.
Tin, R. et al. (2015) ‘A 3-arm randomized controlled trial
on the effects of dance movement intervention and
exercises on elderly with early dementia’, BMC
Geriatrics. BMC Geriatrics, pp. 1–8. doi:
10.1186/s12877-015-0123-z.
Zeng, Z. et al. (2016) ‘Effect of physical activity training
on dementia patients : A systematic review with a
meta-analysis’, Chinese Nursing Research. Elsevier
Ltd, 3(4), pp. 168–175. doi:
10.1016/j.cnre.2016.11.006.

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