Newcastle University, Newcastle, United Kingdom.
University of Auckland, Auckland, New Zealand.
J Med Internet Res. 2023 May 18;25:e44352. doi: 10.2196/44352.
Participating in habitual physical activity (HPA) can support people with dementia and mild cognitive impairment (MCI) to maintain functional independence. Digital technology can continuously measure HPA objectively, capturing nuanced measures relating to its volume, intensity, pattern, and variability.
To understand HPA participation in people with cognitive impairment, this systematic review aims to (1) identify digital methods and protocols; (2) identify metrics used to assess HPA; (3) describe differences in HPA between people with dementia, MCI, and controls; and (4) make recommendations for measuring and reporting HPA in people with cognitive impairment.
Key search terms were input into 6 databases: Scopus, Web of Science, Psych Articles, PsychInfo, MEDLINE, and Embase. Articles were included if they included community dwellers with dementia or MCI, reported HPA metrics derived from digital technology, were published in English, and were peer reviewed. Articles were excluded if they considered populations without dementia or MCI diagnoses, were based in aged care settings, did not concern digitally derived HPA metrics, or were only concerned with physical activity interventions. Key outcomes extracted included the methods and metrics used to assess HPA and differences in HPA outcomes across the cognitive spectrum. Data were synthesized narratively. An adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess the quality of articles. Due to significant heterogeneity, a meta-analysis was not feasible.
A total of 3394 titles were identified, with 33 articles included following the systematic review. The quality assessment suggested that studies were moderate-to-good quality. Accelerometers worn on the wrist or lower back were the most prevalent methods, while metrics relating to volume (eg, daily steps) were most common for measuring HPA. People with dementia had lower volumes, intensities, and variability with different daytime patterns of HPA than controls. Findings in people with MCI varied, but they demonstrated different patterns of HPA compared to controls.
This review highlights limitations in the current literature, including lack of standardization in methods, protocols, and metrics; limited information on validity and acceptability of methods; lack of longitudinal research; and limited associations between HPA metrics and clinically meaningful outcomes. Limitations of this review include the exclusion of functional physical activity metrics (eg, sitting/standing) and non-English articles. Recommendations from this review include suggestions for measuring and reporting HPA in people with cognitive impairment and for future research including validation of methods, development of a core set of clinically meaningful HPA outcomes, and further investigation of socioecological factors that may influence HPA participation.
PROSPERO CRD42020216744; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216744 .
参与习惯性身体活动（HPA）可以帮助痴呆症和轻度认知障碍（MCI）患者保持功能独立性。数字技术可以客观地连续测量 HPA，捕捉与其量、强度、模式和可变性相关的细微测量值。
为了了解认知障碍患者的 HPA 参与情况，本系统评价旨在：（1）确定数字方法和方案；（2）确定用于评估 HPA 的指标；（3）描述痴呆症、MCI 和对照组之间 HPA 的差异；（4）提出用于测量和报告认知障碍患者 HPA 的建议。
将关键搜索词输入到 6 个数据库中：Scopus、Web of Science、Psych Articles、PsychInfo、MEDLINE 和 Embase。如果文章包括社区居住的痴呆症或 MCI 患者，报告源自数字技术的 HPA 指标，以英文发表且经过同行评审，则将其纳入。如果文章仅考虑没有痴呆症或 MCI 诊断的人群、基于老年护理环境、不涉及数字衍生的 HPA 指标或仅涉及体力活动干预，则将其排除在外。提取的主要结果包括用于评估 HPA 的方法和指标以及认知谱上 HPA 结果的差异。数据以叙述方式进行综合。使用国家卫生研究院质量评估工具的改编版评估文章的质量，该工具用于观察性队列和横断面研究。由于存在显著的异质性，因此无法进行荟萃分析。
共确定了 3394 个标题，经过系统评价后纳入了 33 篇文章。质量评估表明，研究的质量为中等至良好。佩戴在手腕或下背部的加速度计是最常见的方法，而与 HPA 量相关的指标（例如每日步数）是最常用的测量 HPA 的指标。痴呆症患者的 HPA 量、强度和可变性较低，与对照组相比，白天 HPA 的模式也不同。MCI 患者的研究结果存在差异，但与对照组相比，他们表现出不同的 HPA 模式。
本综述强调了当前文献中的局限性，包括方法、方案和指标缺乏标准化；方法的有效性和可接受性信息有限；缺乏纵向研究；以及 HPA 指标与有临床意义的结果之间的关联有限。本综述的局限性包括排除了功能性体力活动指标（例如，坐/站）和非英文文章。本综述的建议包括针对认知障碍患者测量和报告 HPA 的建议，以及未来的研究建议，包括方法的验证、一套有临床意义的 HPA 指标的开发，以及进一步研究可能影响 HPA 参与的社会生态因素。
PROSPERO CRD42020216744; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216744 。
