Skip to main content
SpringerLink
Log in

Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: A meta-analysis

  • Published:
The Journal of Nutrition Health and Aging

Abstract

Background: Dementia is a common syndrome in the geriatric population. Subsequent impairment of cognitive functioning impacts the patient’s mobility, ADLs, and IADLs. It is suggested that older persons with lower levels of cognition are less likely to achieve independence in ADLs and ambulation (1–2). Frequently, nursing home residents are viewed as too frail or cognitively impaired to benefit from exercise rehabilitation. Often, persons with Mini Mental State Score (MMSE) score below 25 are excluded from physical rehabilitation programs. However, Diamond (3) and Goldstein (4) concluded that geriatric patients with mild to moderate cognitive impairment were just as likely as cognitively intact patients to improve in functional abilities as a result of participation in exercise rehabilitation programs.Purpose: The objective of this study is to compare, through a meta-analysis endurance and strength outcomes of Cognitively Impaired (MMSE < 23) and Cognitively Intact (MMSE >24) older adults who participate in similar exercise programs.Methods: Published articles were identified by using electronic and manual searches. Key search words included exercise, training, strength, endurance, rehabilitation, cognitive impairment, cognition, MMSE, older adult, aged, and geriatrics. Articles were included if the were from RCTs or well-designed control studies.Results: A total of 41 manuscripts met the inclusion criteria. We examined 21 exercise trials with cognitively impaired individuals (CI=1411) and 20 exercise trials with cognitively intact individuals (IN=1510). Degree of cognitive impairment is based on the reported MMSE score. Moderate to large effect sizes (ES = dwi, Hedges gi) were found for strength and endurance outcomes for the CI groups (dwi = .51, 95% CI=. 42-.60), and for the IN groups (dwi =. 49, 95% CI=. 40 -.58). No statistically significant difference in ES was found between the CI and IN studies on strength (t=1.675, DF= 8, P=.132), endurance (t=1.904, DF= 14, P=.078), and combined strength and endurance effects (t=1.434, DF= 56, P=. 263).Conclusions: These results suggest that cognitively impaired older adults who participate in exercise rehabilitation programs have similar strength and endurance training outcomes as age and gender matched cognitively intact older participants and therefore impaired individuals should not be excluded from exercise rehabilitation programs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Barnes C, Conner D, Legault L, Reznickova N, Harrison HF. Rehabilitation outcomes in cognitively impaired patients admitted to skilled nursing facilities from the community. Arch Phys Med Rehabil 2004, 85(10): 1602–1607.

    Article  PubMed  Google Scholar 

  2. Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part II: clinical challenges. Arch Phys Med Rehabil. 2003; 84(6): 898–903.

    Article  PubMed  Google Scholar 

  3. Diamond PT, Felsenthal G, Macciocchi SN, Butler DH Lally-Cassady D. Effect of cognitive impairment on rehabilitation outcomes. Am J Phys Med Rehabil. 1996; 75: 40–3.

    Article  PubMed  CAS  Google Scholar 

  4. Goldstein FC, Strasser DC, Woodard JL, Roberts VJ. Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc.1997; 45: 35–42.

    PubMed  CAS  Google Scholar 

  5. Paolucci S, Antonucci G, Gialloreti LE, et al. Predicting stroke inpatient rehabilitation outcome (the prominent role of neuropsychological disorders). Eur Neurol. 1996; 36: 385–390.

    Article  PubMed  CAS  Google Scholar 

  6. Ozdemir F, Birtane M, Tabatabaei R, Ekuklu G, Kokino S. Cognitive evaluation and functional outcome after stroke. Am J Phys Med Rehabil. 2001;80: 410–415.

    Article  PubMed  CAS  Google Scholar 

  7. Galski T, Bruno RL, Zorowitz R, Walker J. Predicting length of stay, functional outcome and aftercare in the rehabilitation of stroke patients. Stroke. 1993;24: 1794–1800 Comment in: Stroke 1994;25:1295.

    PubMed  CAS  Google Scholar 

  8. Lichtenberg PA, MacNeill SE, Mast BT. Environmental press and adaptation to disability in hospitalized live-alone older adults. Gerontologist. 2000;40: 549–556

    PubMed  CAS  Google Scholar 

  9. Patel MD, Coshall C, Rudd AG, Wolfe CD. Cognitive impairment after stroke (clinical determinants and its associations with long-term stroke outcomes). J Am Geriatr Soc. 2002;50: 700–706.

    Article  PubMed  Google Scholar 

  10. Moroney JT, Desmond DW. Factors predictive of stroke outcome in a rehabilitative setting. Neurology. 1997;48: 1475–1477

    PubMed  CAS  Google Scholar 

  11. Heruti RJ, Lusky A, Barell V, Ohry A, Adunsky A. Cognitive status at admission (does it affect the rehabilitation outcome of elderly patients with hip fracture?). Arch Phys Med Rehabil. 1999;80: 432–436

    Article  PubMed  CAS  Google Scholar 

  12. Cardoc-Davies TH. Medical profiles of patients admitted to a geriatric assessment and rehabilitation unit. N Z Med J. 1987; 100: 557–559.

    Google Scholar 

  13. Lehmann JF, de Lateur BJ, Fowler Jr RS, et al. Stroke rehabilitation (outcome and prediction). Arch Phys Med Rehabil. 1975;56: 383–389

    PubMed  CAS  Google Scholar 

  14. Rubenstein LZ, Wieland D, English P, Josephson K, Sayre JA, Abrass IB. The Sepulveda VA Geriatric Evaluation Unit (data on four-year outcomes and predictors of improved patient outcomes). J Am Geriatr Soc. 1984;32: 503–512

    PubMed  CAS  Google Scholar 

  15. Billig N, Ahmed SW, Kenmore PI. Hip fracture, depression, and cognitive impairment (a follow-up study). Orthop Rev. 1988; 17: 315–320

    PubMed  CAS  Google Scholar 

  16. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Predictors of functional recovery one year following hospital discharge for hip fracture (a prospective study). J Gerontol. 1990;45: M101-M107.

    PubMed  CAS  Google Scholar 

  17. Landi F, Bernabei R, Russo A, et al. Predictors of rehabilitation outcomes in frail patients treated in a geriatric hospital. J Am Geriatr Soc. 2002;50: 679–684.

    Article  PubMed  Google Scholar 

  18. Marcantonio ER, Flacker JM, Michaels M, Resnick NM. Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc. 2000;48: 618–624

    PubMed  CAS  Google Scholar 

  19. Ruchinskas RA, Singer HK, Repetz NK. Clock drawing, clock copying, and physical abilities in geriatric rehabilitation. Arch Phys Med Rehabil. 2001;82: 920–924.

    Article  PubMed  CAS  Google Scholar 

  20. Friedman PJ, Baskett JJ, Richmond DE. Cognitive impairment and its relationship to gait rehabilitation in the elderly. N Z Med J. 1989; 102: 603–606

    PubMed  CAS  Google Scholar 

  21. Schuman JE, Beattie JE, Steed DA, Merry GM, Kraus AS. Geriatric patients with and without intellectual dysfunction: effectiveness of a standard rehabilitation program. Arch Phys Med Rehabil.1981;62: 612–618.

    PubMed  CAS  Google Scholar 

  22. Billig N, Ahmed SW, Kenmore P, Amaral D, Shakhashire M. Assessment of depression and cognitive impairment after hip fracture. J Am Geriatr Soc. 1986;34: 499–503.

    PubMed  CAS  Google Scholar 

  23. Cummings SR, Phillips SL, Wheat ME, et al. Recovery of function after hip fracture. The role of social supports. J Am Geriatr Soc. 1988;36: 801–806.

    PubMed  CAS  Google Scholar 

  24. Resnick B, Daly MP. The effect of cognitive status on outcomes following rehabilitation. Fam Med. 1997; 29: 400–405.

    PubMed  CAS  Google Scholar 

  25. Barnes B. Ambulation outcomes after hip fracture. Phys Ther. 1984;64: 317–320.

    PubMed  CAS  Google Scholar 

  26. Davies AD, Gargaro P, Dodd A, Smith C. Mental status and occupational therapy outcome in teaching dressing skills to the disabled elderly. Clin Rehabil. 1989;3: 293–298.

    Article  Google Scholar 

  27. Diamond T, Felsenthal G, Macciocchi SN, Butler DH, Lally-Cassady D. Effect of cognitive impairment on rehabilitation outcome. Am J Phys Med Rehabil. 1996;75: 40–43.

    Article  PubMed  CAS  Google Scholar 

  28. Goldstein FC, Strasser DC, Woodard JL, Roberts VJ. Functional outcomes of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc. 1997;45: 35–42 Comment in: J Am Geriatr Soc 1997;45:1406–7.

    PubMed  CAS  Google Scholar 

  29. Cartwright DL, Madill HM, Dennis S. Cognitive impairment and functional performance of patients admitted to a geriatric assessment and rehabilitation centre. Phys Occup Ther Geriatr. 1996; 14(3): 1–21

    Article  CAS  Google Scholar 

  30. Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil. 2004;85 (10): 1694–704.

    Article  PubMed  Google Scholar 

  31. Magsi H. and Malloy T. Underrecognition of Cognitive Impairment in Assisted Living Facilities Journal of the American Geriatrics Society 53 (2), 295–298

  32. Meheroz H. Rabadi, Freny M. Rabadi, Lisa Edelstein, Margaret Peterson. Cognitively Impaired Stroke Patients Do Benefit From Admission to an Acute Rehabilitation Unit Arch Phys Med Rehabil.2008; 89 (3): 441–448.

    Article  Google Scholar 

  33. Rockwood, Kenneth, Song, Xiaowei, MacKnight, Chris, Bergman, Howard, Hogan, David B., McDowell, Ian, Mitnitski, Arnold. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489–495 04; 125:517–519

    PubMed  Google Scholar 

  34. Whitmer RA, Gustafson DR, Barrett-Connor E, Haan MN, Gunderson EP, Yaffe K. Central obesity and increased risk of dementia more than three decades later. Neurology 2008 Mar 26 [Epub ahead of print] [01.wnl.0000306313.89165.efvl].

  35. Glass GV, McGraw B, Smith ML. Meta-analysis in social research. Beverly Hills: Sage; 1981;.

    Google Scholar 

  36. Glass GV. Integrating findings (the meta-analysis of research). Rev Res Educ. 1977;5: 351–379.

    Google Scholar 

  37. Cohen J. In: Statistical power analysis for the behavioral sciences. 2nd ed.. Hillsdale: Lawrence Erlbaum Associates; 1988.

    Google Scholar 

  38. Hedges LV. Estimation and testing for differences in effect size (a comment on Hsu). Psychol Bull. 1982; 91: 691–693

    Article  Google Scholar 

  39. Lipsey MW, Wilson DB. In: Practical meta-analysis (applied social research methods). Vol. 49: Thousand Oaks (CA): Sage Publications; 2001.

    Google Scholar 

  40. G Kochersberger, F Hielema, and R Westlund. Rehabilitation in the nursing home: how much, why, and with what results. Public Health Rep. 1994 May-Jun; 109(3): 372–376

    PubMed  CAS  Google Scholar 

Meta-Analysis Selected Studies

  1. Alessi CA, Schnelle JF et al. Does Physical Activity Improve Sleep in Impaired Nursing Home Residents? Journal of the American Geriatrics Society. 1995; 43: 1098–1102.

    PubMed  CAS  Google Scholar 

  2. Alessi CA, Yoon EJ et al. A Randomized Trial of a Combined Physical Activity and Environmental Intervention in Nursing Home Residents: Do Sleep and Agitation Improve? Journal of the American Geriatrics Society. 1999; 47: 784–791.

    PubMed  CAS  Google Scholar 

  3. Alexander NB, Galecki AT et al. Task-Specific Resistance Training to Improve the Ability of Activities of Daily Living-Impaired Older Adults to Rise from a Bed and From a Chair. Journal of the American Geriatric Society. 2001; 49: 1418–1427.

    Article  CAS  Google Scholar 

  4. Bastone AC, Filho WJ. Effect of an Exercise Program on Functional Performance of Institutionalized Elderly. Journal of Rehabilitation Research & Development. 2004; 41(5): 659–668.

    Article  Google Scholar 

  5. Baum EE, Jajoura D et al. Effectiveness of a Group Exercise Program in a Long-Term Care Facility: A Randomized Pilot Trial. Journal of the American Medial Directors Association. 2003; 4: 74–80.

    Article  Google Scholar 

  6. Bean JF, Herman S et al. Increased Velocity Exercise Specific to Task (InVEST) Training: A Pilot Study Exploring Effects on Leg Power, Balance, and Mobility in Community-Dwelling Older Women. Journal of the American Geriatric Society. 2004; 52: 799–804.

    Article  Google Scholar 

  7. Binder EF, Brown M et al. Effects of Extended Outpatient Rehabilitation After Hip Fracture. Journal of the American Medical Association. 2004; 292(7): 837–846.

    Article  PubMed  CAS  Google Scholar 

  8. Buettner LL. Therapeutic Recreation as an Intervention for Persons With Dementia and Agitation: An Efficacy Study. The Pennsylvania State University College of Health and Human Development. 1994: 1–127.

  9. Bunout D, Barrera G et al. Effects of Nutritional Supplementation and Resistance Training on Muscle Strength in Free Living Elders. Journal of Nutrition, Health & Aging. 2004; 8: 68–75.

    CAS  Google Scholar 

  10. Chandler JM, Duncan PW et al. Is Lower Extremity Strength Gain Associated With Improvement in Physical Performance and Disability in Frail, Community-Dwelling Elders? Archives of Physical Medicine and Rehabilitation. 1998; 79: 24–30.

    Article  PubMed  CAS  Google Scholar 

  11. Fahlman MM, Boardley D et al. Effects of Endurance Training and Resistance Training on Plasma Lipoprotein Profiles in Elderly Women. Journal of Gerontology. 2002; 57A: B54-B60.

    CAS  Google Scholar 

  12. Fiatarone MA, O’Neill EF et al. Exercise Training and Nutritional Supplementation for Physical Frailty in Very Elderly People. The New England Journal of Medicine. 1994; 330(25): 1769–1775.

    Article  PubMed  CAS  Google Scholar 

  13. Fielding RA, LeBrasseur NK et al. High-Velocity Resistance Training Increases Skeletal Muscle Peak Power in Older Women. Journal of the American Geriatrics Society. 2002; 50: 655–662.

    Article  PubMed  Google Scholar 

  14. Gill TM, Baker DI et al. A Prehabilitation Program for the Prevention of Function Decline: Effect on Higher Level Function. Archives of Physical Medicine and Rehabilitation. 2004; 85: 1043–1049.

    Article  PubMed  Google Scholar 

  15. Hauer K, Specht N et al. Intensive Physical Training in Geriatric Patients After Severe Falls and Hip Surgery. Age and Aging. 2002; 31: 49–57.

    Article  Google Scholar 

  16. Hauer K, Rost B et al. Exercise Training for Rehabilitation and Secondary Prevention of Falls in Geriatric Patients with a History of Injurious Falls. Journal of the American Geriatric Society. 2001; 49: 10–20.

    Article  CAS  Google Scholar 

  17. Judge JO, Whipple RH et al. Effects of Resistance and Balance Exercises on Isokinetic Strength in Older Persons. Journal of the American Geriatric Society. 1994; 42: 937–946.

    CAS  Google Scholar 

  18. Latham NK, Anderson CS et al. A Randomized, Controlled Trial of Quadriceps Resistance Exercise and Vitamin D in Frail Older People. Journal of the American Geriatric Society. 2003; 51: 291–299.

    Article  Google Scholar 

  19. Lazowski DA, Ecclestone NA et al. A Randomized Outcome Evaluation of Group Exercise Programs in Long-Term Care Institutions. Journal of Gerontology: MEDICAL SCIENCES. 1999; 54(12): M621-M628.

    CAS  Google Scholar 

  20. Liu-Ambrose T, Khan KM et al. Resistance and Agility Training Reduce Fall Risk in Women Aged 75 to 85 with Low Bone Mass. Journal of the American Geriatric Society. 2004; 52: 657–665.

    Article  Google Scholar 

  21. MacRae PG, Asplund LA et al. A Walking Program for Nursing Home Residents: Effects on Walk Endurance, Physical Activity, Mobility, and Quality of Life. Journal of the American Geriatrics Society. 1996; 44(2): 175–180.

    PubMed  CAS  Google Scholar 

  22. McMurdo MET, Rennie LM. A Controlled Trial of Exercise by Residents of Old People’s Homes. Age and Ageing. 1993; 22: 11–15.

    Article  PubMed  CAS  Google Scholar 

  23. McMurdo MET, Rennie LM. Improvements in Quadriceps Strength With Regular Seated Exercise in the Institutionalized Elderly. Archives of Physical Medicine and Rehabilitation. 1994; 75: 600–603.

    PubMed  CAS  Google Scholar 

  24. Meuleman JR, Brechue WF et al. Exercise Training in the Debilitated Aged: Strength and Functional Outcomes. Archives of Physical Medicine and Rehabilitation. 2000; 81: 312–318.

    PubMed  CAS  Google Scholar 

  25. Morgan RO, Virnig BA et al. Low-Intensity Exercise and Reduction of the Risk for Falls Among At-Risk Elders. Journal of Gerontology. 2004; 59A: 1062–1067.

    Google Scholar 

  26. Morris JN, Fiatarone M et al. Nursing Rehabilitation and Exercise Strategies in the Nursing Home. Journal of Gerontology: MEDICAL SCIENCES. 1999; 54(10): M494-M500.

    CAS  Google Scholar 

  27. Nelson ME, Layne JE et al. The Effects of Multidimensional Home-Based Exercise on Functional Performance in Elderly People. Journal of Gerontology. 2004; 59A 154–160.

    Google Scholar 

  28. Okumiya K, Matsubayashi K et al. Effects of Exercise on Neurobehavioral Function in Community-Dwelling Older People More Than 75 Years of Age. Journal of the American Geriatric Society. 1996; 44: 569–572.

    CAS  Google Scholar 

  29. Pomeroy VM, Warren CM et al. Mobility and Dementia: Is Physiotherapy Treatment During Respite Care Effective? International Journal of Geriatric Psychiatry. 1999; 14: 389–397.

    Article  PubMed  CAS  Google Scholar 

  30. Rubenstein LZ, Josephson KR et al. Effects of a Group Exercise Program on Strength, Mobility, and Falls Among Fall-Prone Elderly Men. Journal of Gerontology. 2000; 55A: M317-M321.

    Google Scholar 

  31. Schnelle JF, Alessi CA et al. Translating Clinical Research into Practice: A Randomized Controlled Trial of Exercise and Incontinence Care with Nursing Home Residents. Journal of the American Geriatrics Society. 2002; 50: 1476–1483.

    Article  PubMed  Google Scholar 

  32. Schnelle JF, MacRae PG et al. Exercise With Physically Restrained Nursing Home Residents: Maximizing Benefits of Restraint Reduction. Journal of the American Geriatrics Society. 1996; 44: 507–512.

    PubMed  CAS  Google Scholar 

  33. Schnelle JF, MacRae PG et al. Functional Incidental Training, Mobility Performance, and Incontinence Care with Nursing Home Residents. Journal of the American Geriatrics Society. 1995; 43: 1356–1362.

    PubMed  CAS  Google Scholar 

  34. Schoenfelder DP. A Fall Prevention Program For Elderly Individuals: Exercise in Long-Term Care Settings. Journal of Gerontological Nursing. 2000; 43–51.

  35. Seynnes O, Fiatarone Singh MA et al. Physiological and Functional Responses to Low-Moderate Versus High-Intensity Progressive Resistance Training in Frail Elders. Journal of Gerontology. 2004; 59A: 503–509.

    Google Scholar 

  36. Simmons SF, Schnelle JF. Effects of an Exercise and Scheduled-Toileting Intervention on Appetite and Constipation in Nursing Home Residents. Journal of Nutrition, Health & Aging. 2004; 8(2): 116–121.

    CAS  Google Scholar 

  37. Stamford BA, Hambacher W et al. Effects of Daily Physical Exercise on the Psychiatric State of Institutionalized Geriatric Mental Patients. The Research Quarterly. 1974; 45(1): 34–41.

    CAS  Google Scholar 

  38. Tappen RM, Roach KE et al. Effect of a Combined Walking and Conversation Intervention on Functional Mobility of Nursing Home Residents With Alzheimer Disease. Alzheimer Disease and Associated Disorders. 2000; 14(4): 196–201.

    Article  PubMed  CAS  Google Scholar 

  39. Toraman, F, Sahin G. Age Responses to Multicomponent Training Programme in Older Adults. Disability and Rehabilitation. 2004; 26: 448–454.

    Article  PubMed  Google Scholar 

  40. Wolfson L, Whipple R et al. Balance and Strength Training in Older Adults: Intervention Gains and Tai Chi Maintenance. Journal of the American Geriatric Society. 1996; 44: 498–506.

    CAS  Google Scholar 

  41. Worm CH, Vad E et al. Effects of a Multicomponent Exercise Program on Functional Ability in Community-Dwelling, Frail Older Adults. Journal of Aging and Physical Activity. 2001; 9: 414–424.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Medicine, University of Colorado at Denver, Denver, CO

    P. C. Heyn & K. E. Johnsons

  2. Beckman Institute for Advanced Science and Technology, University of Illinois, Urbana, Illinois

    A. F. Kramer

Authors
  1. P. C. Heyn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. E. Johnsons
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. F. Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. C. Heyn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heyn, P.C., Johnsons, K.E. & Kramer, A.F. Endurance and strength training outcomes on cognitively impaired and cognitively intact older adults: A meta-analysis. J Nutr Health Aging 12, 401–409 (2008). https://doi.org/10.1007/BF02982674

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02982674

Key words

Search

Navigation