title: Effectiveness of exercise programs to reduce falls in older people with dementia living in the community: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The objective of this systematic review and meta-analysis is to evaluate the effectiveness of exercise programs to reduce falls in older people with dementia who are living in the community.
  
  
  METHODS
  Peer-reviewed articles (randomized controlled trials [RCTs] and quasi-experimental trials) published in English between January 2000 and February 2014, retrieved from six electronic databases - Medline (ProQuest), CINAHL, PubMed, PsycInfo, EMBASE and Scopus - according to predefined inclusion criteria were included. Where possible, results were pooled and meta-analysis was conducted.
  
  
  RESULTS
  Four articles (three RCT and one single-group pre- and post-test pilot study) were included. The study quality of the three RCTs was high; however, measurement outcomes, interventions, and follow-up time periods differed across studies. On completion of the intervention period, the mean number of falls was lower in the exercise group compared to the control group (mean difference [MD] [95% confidence interval {CI}] =-1.06 [-1.67 to -0.46] falls). Importantly, the exercise intervention reduced the risk of being a faller by 32% (risk ratio [95% CI] =0.68 [0.55-0.85]). Only two other outcomes were reported in two or more of the studies (step test and physiological profile assessment). No between-group differences were observed in the results of the step test (number of steps) (MD [95% CI] =0.51 [-1.77 to 2.78]) or the physiological profile assessment (MD [95% CI] =-0.10 [-0.62 to 0.42]).
  
  
  CONCLUSIONS
  Findings from this review suggest that an exercise program may potentially assist in preventing falls of older people with dementia living in the community. However, further research is needed with studies using larger sample sizes, standardized measurement outcomes, and longer follow-up periods, to inform evidence-based recommendations.
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia ; Research Department, Silver Chain, Perth, WA, Australia.
authors.forename: Elissa
authors.initials: E
authors.lastname: Burton
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia.
authors.forename: Vinicius
authors.initials: V
authors.lastname: Cavalheri
authors.affiliation: Community Services, West Gippsland Healthcare Group, Warragul, VIC, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Adams
authors.affiliation: Falls Prevention for People Living with Dementia Project, Central West Gippsland Primary Care Partnership, Moe, VIC, Australia;
authors.forename: Colleen Oakley
authors.initials: CO
authors.lastname: Browne
authors.affiliation: Falls Prevention for People Living with Dementia Project, Central West Gippsland Primary Care Partnership, Moe, VIC, Australia;
authors.forename: Petra
authors.initials: P
authors.lastname: Bovery-Spencer
authors.affiliation: Community Services, West Gippsland Healthcare Group, Warragul, VIC, Australia.
authors.forename: Audra M
authors.initials: AM
authors.lastname: Fenton
authors.affiliation: Allied Health, Latrobe Regional Hospital, Traralgon, VIC, Australia.
authors.forename: Bruce W
authors.initials: BW
authors.lastname: Campbell
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, Australia ; Preventive and Public Health Division, National Ageing Research Institute, Melbourne, VIC, Australia.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Hill
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000061:Accidents, Home / Q000517:prevention & control; D000368:Aged; D003704:Dementia / Q000534:rehabilitation*; D015444:Exercise; D006801:Humans; D008875:Middle Aged; D010349:Patient Compliance; D010865:Pilot Projects
keywords: cognitive impairment; community dwelling; fallers; older people; physical activity