Effect of Exercise Training on the Mental and Physical Well-Being of Caregivers for Persons Living With Chronic Illnesses: A Systematic Review and Meta-Analysis

Abstract

Increased demands associated with caregiving may lead to deleterious physical and mental health outcomes. Caregiving has proven to have consequences that affect both physical and psychological well-being. The purpose of this systematic review and meta-analysis was to assess the effects of exercise training on the mental and physical health of caregivers for persons living with chronic illnesses. A systematic review following the Prisma methodology was performed searching eight databases. Thirteen out of 1,632 screened studies were included for analysis. The standardized mean difference was used as the effect size (ES) and was calculated such that a positive ES indicated efficacy of exercise training for improving health. Overall, the meta-analysis yielded a statistically significant and small-to-medium ES (overall ES = 0.30; 95% confidence interval = [0.08, 0.52]; p = .007). Our analysis supports exercise training to improve the mental and physical health of family caregivers of persons living with chronic illnesses.

Keywords

physical activity caregiving health outcomes mental health well-being

Introduction

Approximately 34.2 million people in the United States provide unpaid caregiving to individuals aged 50 and older (National Alliance for Caregiving & AARP Public Policy Institute, 2015). Similarly, it is estimated that nearly 40 million people are providing care to individuals living with disabilities or chronic illness (Family Caregiver Alliance, 2016). Informal caregivers or family caregivers are not only important resources for persons with chronic conditions, but they also play crucial role in the overall health care system (National Research Council, 2010). With an increasing number of older adults and incidence of chronic disease conditions, caregiving has become a critical issue (Schulz & Sherwood, 2008).

Providing care to a family member can be perceived as a satisfying and rewarding experience (Epps, 2014). However, caregiving is a demanding task which becomes more challenging when the person has chronic physical or cognitive disabilities (Sullivan & Miller, 2015). Although the importance of family caregiving in management of chronic illnesses is evident, the negative impact of caregiving on a caregiver’s physical health, psychological functioning, and personal finance cannot be denied (Corvin et al., 2017). Family caregiving to individuals with severe cognitive decline and behavioral issues can be extremely tiring and emotionally draining, which can potentially negatively impact caregivers’ health (Andreakou et al., 2016; Knight et al., 2007; Roth et al., 2015; Sullivan & Miller, 2015). When compared with non-caregivers, caregivers tend to have more negative mental and physical health impacts (Roth et al., 2015).

Mental health effects of caregiving include stress, anxiety, depression (Chang et al., 2010; Family Caregiver Alliance, 2016; Schulz & Sherwood, 2008). Studies have shown that family caregiving is associated with increased burden, improper health practices, and decreased well-being of the caregivers (Chang et al., 2010; Schulz & Sherwood, 2008; Verbakel et al., 2018). Caregivers experiencing burden often reported significant psychological stress than those who reported no burden (Thompson et al., 2008). More specifically, dementia family caregivers reported anxiety, mood disorders, and higher level of depressive symptoms in comparison with other caregivers (Tremont, 2011).

Caregiving has also been associated with deleterious physical health outcomes for caregivers (i.e., impaired health habits, increased heart disease, mortality) that accompany the psychological ones (Family Caregiver Alliance, 2016; Schulz & Sherwood, 2008). As a result of the demands associated with caregiving, family caregivers are most likely to struggle with their own declining physical health status as they age concurrently with the person they are providing care for (Family Caregiver Alliance, 2016; Northouse et al., 2010). However, the impacts of caregiving on caregivers’ physical health have not received as much attention as mental health effects (Chang et al., 2010). Some argue caregiving may not cause physical declines directly, but the burden may increase the risks of having physical conditions such as arthritis, back problems, cardiovascular conditions, headaches, and gastric ulcers (Chang et al., 2010).

Family caregivers are a critical national health care resource (Schulz & Sherwood, 2008). It is important to understand caregiving roles and its negative impacts on the health of caregivers. We also need a better understanding of the different types of caregiving experiences, their effects on health and the needs of caregivers (American Psychological Association, 2018). The objective of this systematic review and meta-analysis was to determine the effects of exercise training on physical and mental well-being of caregivers for individuals living with chronic conditions.

Method

Systematic Review

A comprehensive search of the research literature was performed conforming to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement (Moher et al., 2015). The research question upon which the search was based was “Compared to usual activity or baseline conditions, does exercise training affect the mental and physical well-being of caregivers for persons living with chronic illnesses?” Our literature search began March 2017 and continued through September 2017. We, however, did not impose any restriction on the time frame in which a study was conducted. PubMed, EBSCO, CINAHL, ProQuest, Health Source, Embase, and PsychInfo databases were searched. The search terms and strategy used for PubMed were as follows: “Caregivers”[Mesh] AND “exercise”[MeSH Terms]. The search terms were broad to ensure critical studies were not overlooked. In addition, the search terms and strategy were modified as needed for the other databases.

Study Inclusion and Exclusion Criteria

Studies meeting the following criteria were considered for review: (a) unpaid family caregivers, (b) caregivers provided care for an individual living with chronic illnesses, (c) the exercise intervention lasted at least 6 weeks to observe a response (Swain, 2014), and (d) the study employed a measure of physical and/or mental health. Mental health was defined as state of psychological and emotional well-being and measured by scales and questionnaires such as the 36-Item Short Form Health Survey (SF-36), Beck Depression Inventory (BDI), and Zarit Caregiver Burden scale. Physical health was defined as the body’s physiological status and ability to carry out physical tasks and was reported using measures of strength, endurance, balance, and vital signs. Studies were excluded if there was neither a comparison control group nor a single subject group with pre–post measurements. Pre–post comparisons were included due to the small number of studies with a comparison control group.

Selection of Studies

The Rayyan application was used to manage records and data throughout the review (Ouzzani et al., 2016). A total of 1,632 study reports were originally identified through the database searches. Of those, 1,578 were excluded based on review of titles and abstracts. At this point, the 54 remaining study reports were evaluated through a careful review of the full text. On the basis of inclusion and exclusion criteria described above and duplicate data, 40 study reports were excluded, leaving 13 study reports. Each phase of the study selection process was performed independently through the Rayyan application by two of the present study’s authors. Any disagreements were settled through discussion between the authors and/or mediation from a third author. The review and selection processes for the studies in the systematic review are summarized in Figure 1.

Figure 1.

PRISMA flowchart for review and selection of studies in the systematic review.

Data Extraction and Assessment of Study Quality and Bias

For the meta-analysis, physical and mental health outcomes were extracted in the form of means, standard deviations (SDs), and sample sizes in all studies except one (Lowery et al., 2014), which reported odds ratio and 95% confidence interval (CI) for comparison of the exercise training and control groups. For each study, data were extracted for pre- and post-intervention for all participants, including both exercise training and control groups. Data extraction was conducted independently done by two of the present study’s authors. Any disagreements were settled through discussion between the authors. A risk of bias assessment was performed to assess the methodological quality on all studies as recommended by the Cochrane Collaboration (Higgins et al., 2011) and reported in Table 1. In these assessments, we evaluated six categories: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, and selective reporting bias.

Table 1.

Study Characteristics.

Reference	Research design	Intervention type	Sample size	Subject age (mean)	Total dose of exercise (hours)	Physical outcomes	Mental outcomes	Chronic condition of care recipient	Sex of caregiver (% female)	Number of High risk of bias categories
Batista et al. (2016)	Single-group, pre–post design	Resistance	22	41	24	n/a	Emotional Health, Depression, Stress	Cerebral Palsy	100	4
Canonici et al. (2012)	Controlled Trial (control = usual activity)	Resistance, Aerobic, Other^a	27	54	72	n/a	Stress	Dementia	94	5
Connell & Janevic (2009)	RCT (control = usual activity)	Resistance, Aerobic, Other^a	137	67	36	n/a	Depression, Stress	Dementia	100	3
Farran et al. (2016)	RCT (control = education)	Resistance, Aerobic, Other^a	169	62	120	n/a	Stress, Depression	Dementia	82	0
Hill et al. (2007)	Single-group, pre–post design	Individualized	88	64	n/a	Balance, Endurance, Strength	Depression, Stress, Emotional Health	Not stated	85	4
Hirano et al. (2011)	RCT (control = usual activity)	Individualized	31	74	n/a	Physiological^b	Stress, Depression	Dementia	68	4
King & Brassington (1997)	RCT (control = usual activity)	Aerobic	23	62	37	Physiological,^b Endurance	Depression, Stress, Emotional Health	Dementia	87	3
King et al. (2002)	RCT (control = education)	Aerobic	85	63	112	Physiological^b	Stress, Depression	Dementia	100	3
Lowery et al. (2014)	RCT (control = usual activity)	Aerobic	119	63	25	n/a	Stress, Depression	Dementia	57	3
Martin & Keats (2014)	Single-group, pre–post design	Other^a	12	41	15	n/a	Stress, Emotional Health	Cancer	92	4
Prick et al. (2015)	RCT (control = education)	Resistance, aerobic, Other^a	111	72	18	n/a	Depression, Stress	Dementia	80	3
Van Puymbroeck et al. (2007)	RCT (control = usual activity)	Other^a	11	59	20	Physiological,^b Strength, Endurance, Flexibility, Balance	n/a	Not stated	69	2
Winters-Stone et al. (2016)	RCT (before, during, after) (control = usual activity)	Resistance	62	67	48	Physiological,^b Strength	Emotional Health	Prostate Cancer	100	4

Note. RCT = randomized controlled trial.

Other = nontraditional exercise (i.e., yoga, tai-chi), nonspecified forms of exercise.

Physiological = blood pressure, body mass index, heart rate, body fat percentage, lean mass percentage.

Meta-Analysis

The extracted mental and physical health outcomes were converted to a standard format by calculating the standardized mean difference, which will be referred to as the effect size (ES). The ES calculation was set up so that a positive ES indicated better health outcomes in the exercise training group compared with the control group (for studies with a control group) or for the posttest (for studies with a single group employing a pre/post comparison). For independent group studies in which means, SDs, and sample sizes were reported (i.e., the most common scenario [n = 11 studies]), standardized mean differences were calculated (Borenstein et al., 2009). Because these calculations require intertrial correlations and no individual subject data were available to use for such calculations, we assumed an intertrial correlation of .5 for all of the outcome measures. For the three pre–post studies in which means, P values, and sample sizes were reported, the standardized mean difference was calculated as previously described (Borenstein et al., 2009).

Meta-analyses were run using a random-effects model. A random-effects model was chosen over a fixed-effect model because of the wide variation in experimental factors among the 13 studies (e.g., exercise dosage, types of chronic conditions, outcomes assessed). The extent of heterogeneity (i.e., between-study variation in ES) was assessed using both the I² value and a chi-square test of the Q value. Because moderate heterogeneity was observed, we sought to determine the role of various experimental factors in explaining that heterogeneity; experimental factors can be treated as moderator variables in a meta-analysis. Meta-regression, using a method-of-moments model, was used to assess continuous moderator variables, that is, session length (minutes), number of session per week, length of program (weeks), total dose of exercise training (hours), age of caregiver, sex (measured as percent female of study population), and number of “high risk of bias” categories. Subgroup meta-analysis was used to assess nominal moderator variables in which subsets of studies are compared using Q tests on the basis of analysis of variance (ANOVA). This test, along with the assumption of a common among-study variance component across subgroups was used to probe several factors, that is, type of outcome measure (mental vs. physical health outcomes), intervention types (aerobic exercise vs. resistance exercise vs. nontraditional exercise), type of mental outcome measure (depression vs. emotional well-being vs. stress), type of physical outcome measure (endurance vs. strength vs. physiological measure), the diagnosis of the care recipient’s chronic illness (dementia vs. other), and type of study (controlled trial vs. single group pre–post). Only subgroups with three or more studies were analyzed.

All meta-analysis procedures were conducted using the software Comprehensive Meta-Analysis (version 3.3; Biostat Inc). An α level of .05 was used in all analyses. ESs of 0.2, 0.5, and 0.8 were considered to be small, moderate, and large, respectively (Cohen, 1988; Thompson et al., 2008). Publication bias in the primary meta-analysis was assessed using a funnel plot of study ES versus standard error.

Results

Description of Included Studies

In total, 13 studies were included for meta-analysis of the effect of exercise training on caregiver health. The characteristics of these investigations are summarized in Table 1 and Supplemental File 1. All studies were published as articles in peer-reviewed journals. Nine studies used randomized controlled trial (RCT) research designs with two or more independent groups, whereas one study used a non-randomized controlled trial, and three studies used a pre–post design. Two studies used an intervention of resistance exercise only (Batista et al., 2016; Winters-Stone et al., 2016), whereas three used aerobic exercise only (King & Brassington, 1997; King et al., 2002; Lowery et al., 2014). Two studies used nontraditional exercise (i.e., yoga or Tai-Chi) (Martin & Keats, 2014; Van Puymbroeck et al., 2007), and six used a combination of exercise types with individualized training plans (Canonici et al., 2012; Connell & Janevic, 2009; Farran et al., 2016; Hill et al., 2007; Hirano et al., 2011; Prick et al., 2015). There were 897 subjects used in the 13 studies. Subject mean age varied from 41 to 74 years.

Cochrane risk of bias assessment (Higgins et al., 2011) was performed on all 13 studies. Overall, risk of bias appeared to be moderate. Most of the studies included in the analysis were judged to have high risk of bias in the “allocation concealment” and “blinding of participants and personnel” categories due to the nature of the studies (i.e., an exercise training is difficult to blind). Most of the studies have two or more “high risk of bias” categories, with three of the studies containing four “high risk of bias” categories (Batista et al., 2016; Hill et al., 2007; Martin & Keats, 2014).

Meta-Analysis

In total, 77 ESs were calculated for the 13 studies, yielding an average of ~6 ESs per study. From these ESs, a single average ES was then calculated for each study and used in the remaining analyses except when stated otherwise. Considerable variation was found in ESs among the 13 studies, with study ESs ranging from −0.38 to 1.82 (Figure 2). The ES calculated for only mental outcomes and the ES calculated for only physical outcomes is shown in Figure 3; these ESs were similar in magnitude (i.e., 0.27–0.38), and both were significantly greater than zero. A subgroup analysis was run to compare the two categories of outcomes; and a P value of .53 was yielded, indicating that there is no significant difference found between those two subgroups. Therefore, separate analyses for physical outcomes and mental outcomes were not performed as there is a beneficial effect of exercise training on health regardless of whether it is mental or physical in nature. Only the first two studies in Figure 2 exhibited negative ESs, meaning that the control condition did better overall than the exercise training condition in those studies. Conversely, 11 of the 13 studies exhibited positive, beneficial effects of exercise training compared with control. Meta-analysis on the 13 studies yielded a statistically significant and small-to-medium overall ES, indicating that exercise training does cause minor to moderate improvements in caregiver health (overall ES = 0.30; 95% CI = [0.08, 0.52]; p = .007) (Figure 2). If the three studies judged to have four high risk of bias categories (Batista et al., 2016; Hill et al., 2007; Martin & Keats, 2014) were removed from the analysis, the overall ES would remain similar (overall ES = 0.26; 95% CI = [−0.03, 0.55]; p = .08), but would no longer be statistically significant. Those three studies were also characterized as pre–post study type. We examined the difference between the pre–post studies versus the controlled trial studies and found a nonsignificant difference between the groups (p = .44), so we decided to include the pre–post studies alongside the RCTs in our meta-analysis.

Figure 2.

Forest plot of effect sizes (ESs) from the 13 studies that assessed the effect of exercise on the overall health (mental and physical) of caregivers of individuals with chronic medical conditions. A square in the plot represents the ES for a given study with the size of the square being proportional to the weighting of that study in the meta-analysis. A horizontal line indicates the 95% confidence interval (CI) for a study ES. Studies are arranged from the lowest to highest ES. The diamond at the bottom represents the overall ES calculated using a random-effects model. The width of the diamond represents the 95% CI for the overall ES.

Figure 3.

Forest plot of effect sizes (ESs) from the studies that assessed the effect of exercise training on (a) mental health outcomes and (b) physical health outcomes.

In our assessment of the effect of publication bias on the primary meta-analysis, a funnel plot was examined for asymmetry. Asymmetry was noticeable but was not that typically associated with publication bias. The atypical asymmetry seemed to result mostly from the (Van Puymbroeck et al., 2007) study. Because of this observation and the substantial heterogeneity observed, it was not feasible to calculate an overall ES adjusted for publication bias using Duval and Tweedie’s trim and fill correction (Peters et al., 2007; Terrin et al., 2003).

Between-study variance in ES was determined to be moderate to large (i.e., I² = 64%) and statistically significant (Q-df = 21.4, p = .0008). This justifies using subgroup meta-analysis and meta-regression to investigate potential moderator variables in an attempt to explain the between-study variance. Table 2 summarizes the findings of the subgroup meta-analyses probing roles for eight nominal moderator variables. None of the eight variables could explain a significant portion of the between-study variance. Table 3 summarizes the findings of meta-regression analyses probing possible roles for six continuous moderator variables in explaining ES variation among the 13 studies. None of the continuous moderator variables could explain a significant portion of the between-study variance.

Table 2.

Summary of Subgroup Meta-Analyses Examining Nominal Moderator Variables That Might Explain Between-Study Variance in Effect Size.

Moderator variable	Comparison^a	p value
Study type	Controlled trials (n = 10, ES = 0.26 [−0.03–0.55]) versus pre–post studies (n = 3, ES = 0.44 [0.08–0.80])	.44
Study type	Randomized controlled trials (n = 9, ES = 0.13 [−0.09–0.34]) versus pre–post studies (n = 3, ES = 0.44 [0.08–0.80])	.14
Outcome type	Mental outcomes (n = 12, ES = 0.38 [0.10–0.65]) versus Physical outcomes (n = 6, ES = 0.27 [0.10–0.44])	.53
Intervention type: studies that included aerobic exercise versus studies that did not	Aerobic exercise (n = 7, ES = 0.18 [−0.14–0.50]) versus No aerobic exercise (n = 4, ES = 0.44 [0.08–0.79])	.30
Intervention type: studies that included resistance exercise versus studies that did not	Resistance exercise (n = 6, ES = 0.30 [−0.03–0.62]) versus No resistance exercise (n = 5, ES = 0.23 [−0.23–0.69])	.82
Intervention type: studies that included nontraditional exercise versus studies that did not	Nontraditional exercise (n = 6, ES = 0.43 [0.05–0.01]) versus No nontraditional exercise (n = 5, ES = 0.13 [−0.15–0.40])	.23
Type of mental health outcome	Depression (n = 8, ES = 0.27 [0.01–0.53]) versus Emotional well-being (n = 4, ES = 0.29 [0.09–0.48]) versus Stress (n = 11, ES = 0.45 [0.10–0.80])	.67
Type of physical health outcome	Physical Performance: Endurance (n = 3, ES = 0.29 [0.08–0.49]) versus Physical Performance: Strength (n = 3, ES = 0.35 [0.15–0.54]) versus Vital Signs/Body Composition (n = 5, ES = 0.24 [−0.04–0.51])	.81
Care-recipient medical condition	Dementia (n = 8, ES = 0.29 [−0.05–0.56]) versus Other (n = 5, ES = 0.33 [0.11–0.56])	.85

Note. ES = effect size.

Sample size (n) refers to the number of studies in a subgroup. Values within square brackets represent the 95% confidence interval for the subgroup ES.

Table 3.

Summary of Meta-Regressions Examining Continuous Moderator Variables That Might Explain Between-Study Variance in Effect Size.

Moderator variable	Slope	p value
Exercise dose per session (minutes)	0.0016	.67
Number of exercise sessions per week	−0.0974	.45
Duration of exercise training (weeks)	−0.0078	.48
Total exercise training dose (minutes)	−0.0000	.91
Mean age of caregiver (years)	−0.0191	.09
Sex of caregiver (% female)	0.0085	.32
Number of high risk of bias categories^a	0.0328	.70

According to the Cochrane risk of bias tool.

Discussion

The objective of this systematic review and meta-analysis was to determine the effects of exercise training on physical and mental well-being of caregivers for individuals living with chronic conditions. Studies included in this review were inclusive of majority female caregivers, older caregivers, and dementia caregivers. Results showed that exercise training was found to elicit a small, significant increase in both physical and mental health of family caregivers. Therefore, results do not argue for a strong beneficial effect of exercise on the well-being of caregivers. When outcomes were examined separately, exercise training affected mental outcomes greater than physical health outcomes for caregivers. Mental outcomes had a larger but nonsignificant ES when compared with physical outcomes. Out of all mental outcomes measured, stress improved the most in the analysis. Out of all the physical outcomes measured, the greatest improvement was observed in caregivers’ strength. Overall, there was a small, significant ES throughout the study. However, if we attempt to correct for publication bias or eliminate studies with likely bias, the overall effect of exercise training on the mental and physical health of the caregivers is no longer significant. There was large heterogeneity between in the results. However, when subgroup analyses and meta-regressions were performed, there were no significant differences between the moderator variables.

The small, significant increase in health outcomes of caregivers after exercise training in this analysis supports that physical fitness activities can be somewhat beneficial for the well-being of caregivers (Farran et al., 2016). Exercise training may be helpful in performing caregiving tasks by promoting strength and positivity (Orgeta & Miranda-Castillo, 2014). In fact, regular exercise for dementia caregivers can facilitate healthy lifestyles, enhance mental and physical well-being, improve sleep patterns, and expand their ability to cope with caregiving strain (Hirano et al., 2011).

Despite the benefits of participating in exercise to a caregiver’s health, we must acknowledge that numerous obstacles exist to prevent caregivers from engaging in physical fitness activities. These obstacles include decreased self-motivation, stress, anxiety, and other health problems, as well as lack of support (Farran et al., 2008; King et al., 1997; Marquez et al., 2012). Caregiving duties and not having enough time were additional factors which prevented caregivers from engaging in physical fitness activities (Martin & Keats, 2014; Winters-Stone et al., 2016). Preexisting health conditions of caregivers and their attitudes toward self-care behaviors are also predetermining factors in engaging in physical fitness activities (Etkin et al., 2008). This analysis suggests that nontraditional forms of exercise or the ability to choose a preferred method of exercise may help more so than aerobic exercise for improving mental and physical health.

Potential limitations of our systematic review and meta-analysis include the following: (a) inclusion of studies with a high risk of bias, (b) publication bias, (c) a small number of studies, (d) exclusion of studies conducted after 2017, and (e) the use of an assumed intertrial correlation value. Three studies in our analysis were identified as having a high risk of bias. All three studies were controlled trials that were not randomized, so they scored “high” on the Cochrane risk of bias assessment tool for random sequence generation, allocation concealment, and blinding of outcome assessment. If the three studies were excluded from our analysis, the overall ES would still be positive but not significant (overall ES = 0.26; p = .08).

Publication bias occurs when research that appears in the published literature is systematically unrepresentative of the population of completed studies (Sutton, 2009). The tendency is for studies with nonsignificant and/or negative findings to not be published (Hall et al., 2007; Hopewell et al., 2009). Meta-analyses will therefore tend to be biased toward the published studies because of the difficulty of identifying unpublished research and obtaining from those studies the results necessary to calculate the ES. In our assessment of the effect of publication bias on the meta-analysis, asymmetry was noted in the funnel plot, but it could not be totally attributed to publication bias.

Our literature search was performed over a 6 month period and ended in September 2017. Thus, our systematic review and meta-analysis did not include studies conducted and published beyond 2017. We, however, do acknowledge that more recent studies have been conducted that would add to the knowledge base in relation to examining exercise training on physical and mental well-being of caregivers for individuals living with chronic conditions (Brewster et al., 2020; Gary et al., 2020; Lorig et al., 2019).

The remaining limitation is the assumption of intertrial correlations in most of the studies. This is a common issue for data extraction from primary research studies (Borenstein et al., 2009). No individual subject data were available to use for ES calculations and an intertrial correlation of .5 was assumed for all of the outcome measures.

Conclusion

Through the findings from this systematic review and meta-analysis, we are able to suggest that exercise training improves the physical and mental well-being of caregivers of persons with chronic illnesses. Caregivers are less likely to care for their own health and practice healthy behaviors due to the demanding nature of their work (Tremont, 2011). Building partnerships with community agencies and clinicians to remove perceived barriers to participation in exercise training programs may increase caregiver participation. It is vital to address caregiver needs to provide optimal health care delivery to care recipients. Future research should be focused on caregivers’ abilities to maintain exercise and other physical fitness activities post interventions while addressing role demands and other generational or gender specific issues. Further randomized controlled trials should be conducted to determine whether exercise training, in fact, has a more beneficial effect on the physical health outcome compared with mental health outcomes in caregivers.

Supplemental Material

Supplemental_File_1 – Supplemental material for Effect of Exercise Training on the Mental and Physical Well-Being of Caregivers for Persons Living With Chronic Illnesses: A Systematic Review and Meta-Analysis

Supplemental material, Supplemental_File_1 for Effect of Exercise Training on the Mental and Physical Well-Being of Caregivers for Persons Living With Chronic Illnesses: A Systematic Review and Meta-Analysis by Fayron Epps, Helen To, Tao Tony Liu, Asmita Karanjit and Gordon Warren in Journal of Applied Gerontology

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Fayron Epps

Supplemental Material

Supplemental material for this article is available online.

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