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Dementia – Prevent frailty, falls and improve mobility

Evidence summary (updated 2022)
There is a large body of evidence from the general older adult community that promotes the benefits of physical activity for the prevention of falls and frailty(1–4). The evidence base is weaker for individuals with established cognitive decline with moderate to severe impairment.
There is some evidence that engaging in physical activity results in improvements in the short and medium term in terms of balance and strength in people living with dementia(4,5).
Combined mental activity and exercise interventions have been shown to improve physical function(6) but in some cases this evidence is shown to be limited(7).
Overall, the recommendation is in favour of multicomponent interventions incorporating both physical and cognitive components, which demonstrate positive effects on balance, functional mobility and gait speed when compared with a control and had significantly better effect on balance and gait speed within mild cognitive impairment populations(8).
For individuals with established cognitive decline the expert recommendation is to seek support to deliver the intervention, either through group-based exercise with charity and local community groups with experience working with clients with cognitive decline, or to seek expert support from physiotherapist, occupational therapies and physical activity professionals with experience working with individuals with cognitive decline.
Expert opinion recommends mixed activity types which includes resistance training, balance and flexibility and aerobic activity.
Qualitative evidence suggests conducting undertaking physical activity in supportive environments which are uncluttered and perceived as safe and comfortable. Complex and unfamiliar movement patterns should be avoided(5).

Quality of evidence
B – Moderate

Strength of recommendation
2 – Weak

Being physically active maintains muscles – through combined resistance and balance training – to prevent frailty and falls. Expert opinion is that this should be a strong recommendation to people living with dementia.


  1. Lipardo DS, Aseron AMC, Kwan MM, Tsang WW. Effect of Exercise and Cognitive Training on Falls and Fall-Related Factors in Older Adults With Mild Cognitive Impairment: A Systematic Review. Arch Phys Med Rehabil [Internet]. 2017 Oct 1 [cited 2022 Jul 22];98(10):2079–96. Available from:
  2. Pahor M, Guralnik JM, Ambrosius WT, Blair S, Bonds DE, Church TS, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA [Internet]. 2014 Jun 18 [cited 2022 Jul 22];311(23):2387–96. Available from:
  3. De Labra C, Guimaraes-Pinheiro C, Maseda A, Lorenzo T, Millán-Calenti JC. Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials. BMC Geriatr [Internet]. 2015 Dec 2 [cited 2022 Jul 22];15(1). Available from: /pmc/articles/PMC4667405/
  4. Hauer K, Schwenk M, Zieschang T, Essig M, Becker C, Oster P. Physical Training Improves Motor Performance in People with Dementia: A Randomized Controlled Trial. J Am Geriatr Soc [Internet]. 2012 Jan 1 [cited 2022 Jul 22];60(1):8–15. Available from:
  5. Professor CV, Mansfield L, O’connell N, Gifford J, Prescott A. Physical Activity and Dementia: Rapid Evidence Reviews. 2021.
  6. Middleton LE, Ventura MI, Santos-Modesitt W, Poelke G, Yaffe K, Barnes DE. The Mental Activity and eXercise (MAX) Trial: Effects on Physical Function and Quality of Life among Older Adults with Cognitive Complaints. Contemp Clin Trials [Internet]. 2018 Jan 1 [cited 2022 Jul 22];64:161. Available from: /pmc/articles/PMC5760217/
  7. Potter R, Ellard D, Rees K, Thorogood M. A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia. Int J Geriatr Psychiatry [Internet]. 2011 Oct [cited 2022 Jul 22];26(10):1000–11. Available from:
  8. Booth V, Hood V, Kearney F. Interventions incorporating physical and cognitive elements to reduce falls risk in cognitively impaired older adults: a systematic review. JBI database Syst Rev Implement reports [Internet]. 2016 May 1 [cited 2022 Jul 22];14(5):110–35. Available from: