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Evid Based Nurs 10:89 doi:10.1136/ebn.10.3.89
  • Treatment

An exercise programme led to a slower decline in activities of daily living in nursing home patients with Alzheimer’s disease


 
 Q In patients with Alzheimer’s disease (AD) in nursing homes, does an exercise programme slow the decline in ability to do activities of daily of living (ADLs)?

METHODS

GraphicDesign:

randomised controlled trial.

GraphicAllocation:

{concealed}.*

GraphicBlinding:

blinded (outcome assessors and {data analysts}*).

GraphicFollow up period:

12 months.

GraphicSetting:

5 nursing homes in Toulouse, France.

GraphicPatients:

134 patients who were 62–103 years of age (mean age 83 y, 75% women), met the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for probable or possible AD, had lived in the nursing home for ⩾2 months, and were able to transfer from a chair and walk ⩾6 metres without human assistance. Exclusion criteria were vascular dementia or Parkinson’s disease, surgery in the coming year, cardiac condition that could worsen with exercise, or terminal illness with life expectancy <6 months.

GraphicIntervention:

exercise (n = 67) or routine medical care (n = 67). Patients in the exercise group were divided into small groups of 2–7 (mean 5) patients according to their physical, cognitive, and behavioural performance. The exercise programme was individualised and included aerobic, strength, flexibility, and balance training. At least half of each session consisted of walking. The sessions were held for 1 hour in the afternoon twice a week, with ⩾2 days between exercise sessions.

GraphicOutcomes:

decline from baseline in Katz ADL score (range 0–6, 0  =  dependent, 6  =  independent).

GraphicPatient follow up:

82% (100% included in intention to treat analysis).

MAIN RESULTS

At 12 months, patients in the exercise group showed less decline in performance of ADLs than patients in the routine medical care group (table). Exercise and routine medical care did not differ for number of falls (139 v 136), fractures (5 v 2), or deaths (7 v 8).

Exercise v routine medical care for patients with Alzheimer’s disease in nursing homes

CONCLUSION

In nursing home patients with Alzheimer’s disease, an exercise programme led to a slower decline in the ability to do activities of daily living.

A modified version of this abstract appears in ACP Journal Club.

Commentary

  1. Dorothy A Forbes, RN, PhD
  1. University of Western Ontario,
 London, Ontario, Canada

      The study by Rolland et al makes an important and unique contribution to the literature as few studies have specifically examined the effectiveness of exercise in managing the symptoms of AD. A meta-analysis showed that exercise training increased fitness, physical function, cognition, and positive behaviour in older people with cognitive impairment and dementia.1 Although this review included 30 randomised controlled trials (RCTs), not all studies targeted people with AD or even dementia. In addition, most non-pharmacological intervention studies that aim to manage the symptoms of dementia have not used an RCT design and/or an adequate sample size.2 Rolland et al are the exception. They have done a well designed RCT with an adequate sample size.

      The authors correctly state that adherence to the exercise programme was low (35 of 67 participants attended less than one third of sessions). However, the results suggest that exercise adherence was significantly related to less deterioration in ADL scores. Thus, further research should focus on exploring the barriers and facilitators to improving adherence. Perhaps, adherence could be improved if exercise programmes were matched to the needs, capabilities, and preferences of people with dementia and if adequate funding was provided to support regular, appropriate programmes and settings over extended periods by qualified instructors. Further research that examines the cost effectiveness of exercise programmes would also be beneficial.

      There are potentially immense individual, caregiver, and public health benefits to slowing the progression of AD. The study by Rolland et al shows the contribution of a simple exercise programme in slowing the decline of clinically meaningful activities in people with dementia.

      References

      Footnotes

      • * Information provided by author.

      • For correspondence: Dr Y Rolland, Hôpital La Grave-Casselardit, Toulouse, France. yvesmrolland{at}yahoo.fr

      • Sources of funding: Caisse Nationale d’Assurance Maladie et du Travail and University Hospital of Toulouse.

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