Dementia: The Effectiveness of Physiotherapy According to Scientific Research

Introduction

Dementia is a progressive neurodegenerative condition that leads to cognitive decline, impaired motor function, and loss of independence in daily activities. Despite the widespread use of pharmacological therapy, drug-based treatment has limited effectiveness and does not alter the course of the disease. As a result, increasing attention is being directed toward non-pharmacological approaches, particularly physiotherapy and therapeutic exercise.

The aim of this article is to summarise current scientific evidence and evaluate the effectiveness of physiotherapeutic interventions in dementia.

Physiotherapy in Dementia: Types of Interventions

A systematic review including 194 experimental studies (up to July 2022) showed that the most commonly used physiotherapy interventions were:

• aerobic training — 42% of studies;

• resistance (strength) exercises — 41%;

• balance training — 25%;

• stretching — 11%.

Many studies employed combined programs incorporating multiple types of exercise, reflecting the modern multicomponent approach.

Effects of Physiotherapy on Motor Function

Most studies demonstrate that physiotherapy has a consistently positive effect on motor function, including:

• improved gait and balance;

• reduced risk of falls;

• increased muscle strength;

• improved physical endurance.

Even in patients with moderate to severe dementia, functional movement-based interventions help preserve mobility and reduce physical dependence.

Effects on Cognitive Function

Evidence regarding the impact of physiotherapy on cognitive function remains mixed:

• a meta-analysis of 20 randomised controlled trials (2,051 participants) found no statistically significant improvement in overall cognitive outcomes;

• subgroup analysis showed a positive effect in patients younger than 80 years;

• sensitivity analyses suggest that under certain conditions (duration, regularity, individualised intensity), exercise may slow cognitive decline.

Thus, physiotherapy is not a replacement for cognitive therapy but may play a supportive role, particularly in the early stages of dementia.

Activities of Daily Living (ADL)

The strongest evidence relates to improvements in activities of daily living:

• multicomponent exercise programs demonstrated a moderate but statistically significant effect on functional independence;

• patients receiving physiotherapy performed better in self-care activities compared with those receiving standard care alone.

This is particularly important, as preservation of ADL is closely associated with quality of life and reduced caregiver burden.

Effects on Depression

Most studies did not identify a significant effect of physiotherapy on depressive symptoms in patients with dementia. While some individual studies reported mood improvement, meta-analyses conclude that the effect is inconsistent and requires further investigation.

Safety of Physiotherapy in Dementia

Current scientific evidence indicates that when exercise intensity is individually tailored and medically supervised, physiotherapy is generally well tolerated in patients with dementia. In published studies, most reported adverse events were mild and transient, including short-term fatigue, moderate muscle soreness, and temporary discomfort.

Serious complications were rare and typically associated with exercise intensity that exceeded the patient’s functional capacity. This highlights that with appropriate assessment and gradual progression, physiotherapy can be considered a relatively safe non-pharmacological support strategy across different stages of dementia.

Why an Individualised Approach Is Especially Important

Analysis of the literature shows that the effectiveness of physiotherapy in dementia largely depends on program structure and alignment with the patient’s individual capabilities. Variability between studies reflects:

• diversity of physiotherapy protocols;

• differences in training duration and intensity;

• heterogeneity in dementia stage and physical status;

• limited data in patients with advanced dementia.

These factors emphasise that no universal protocol exists, and optimal outcomes are achieved through personalised, step-by-step, long-term programs integrated into comprehensive medical care.

Key Findings

Based on current scientific evidence, the following conclusions can be drawn:

• physiotherapy is an effective non-pharmacological intervention in dementia, particularly for motor function and activities of daily living;

• cognitive benefits are possible but depend on age, disease stage, and exercise parameters;

• multicomponent and long-term programs tailored to individual capacity appear most promising;

• further large-scale randomised trials are needed to establish standardised physiotherapy protocols for different stages of dementia.
  

Conclusion

Physiotherapy does not cure dementia, but it can significantly improve quality of life, support physical activity, and preserve functional independence. Incorporating physiotherapy programs into comprehensive dementia care is a scientifically supported and promising direction in modern medicine.

Discuss an individualised support program for dementia Physiotherapy may form part of an integrated medical approach aimed at maintaining mobility and daily function. An individual medical consultation allows assessment of whether a personalised support program may be appropriate for a specific clinical situation.

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