Background Impairment of cognitive functioning impacts a patient's mobility and activities of daily living (ADLs). It is suggested that persons with lower levels of cognition are less likely to achieve independence in ADLs and ambulation (Wells et al, 2003). Nursing home residents are viewed as too frail or cognitively impaired to benefit from exercise rehabilitation, and an MMSE score below 25 is often an exclusion criteria for physical rehabilitation services. Diamond et al (1996) and Goldstein (1997) concluded that geriatric patients with mild to moderate cognitive impairments were just as likely as the cognitively intact patients to improve in functional abilities as a result of participation in exercise rehabilitation. Geriatric rehabilitation services designed to enhance and restore functional ability may allow a less restrictive environment for older people with cognitive impairments, and it might decrease health care costs associated with geriatric disability.
Aim The aim of this study is to compare by meta-analysis method physical rehabilitation outcomes of randomized trials that included cognitively impaired/CI (MMSE < 23) and cognitively intact/IN (MMSE ≥ 24) older adults.
Methods Published articles were identified by using electronic and manual searches. Key search words: exercise, training, strength, endurance, rehabilitation, cognitive impairment, MMSE, dementia, Alzheimer's disease, aged, older adult, and geriatric(s). Articles were included if they included evidence from randomized controlled trials (RCTs) or well-designed control studies.
Results Forty-one trials met the inclusion criteria (21 with CI individuals and 20 with IN individuals). The total sample size is 3,645 individuals (IN = 1,829, CI = 1,816). MMSE score from CI subjects ranged from 6 to 24 (16 ± 5.7) and from 26 to 29 (27.4 ± 1.0) from the IN subjects. Moderate to large effect sizes (ES) (ES = dwi, adjusted by Hedges gi ) were found when strength and endurance outcomes were combined for the CI studies (dwi = .51, Effects = 31, 95% CI = 0.42-0.60), and for the IN studies (dwi =. 49, Effects = 33, 95% CI = 0.40-0.58). No statistically significant difference ES was found between the CI and IN studies on strength (t = 1.675, df = 8, p =.132) and endurance (t = 1.904, df = 14, p = .078) outcomes.
Conclusions These meta-analysis results suggest that cognitively impaired older adults who participate in exercise rehabilitation programs have similar strength and endurance outcomes as cognitively intact participants and therefore should not be excluded from rehabilitation programs.
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