Original researchEffects of a long-term aerobic exercise intervention on institutionalized patients with dementia
Introduction
Research on the effects of long-term physical exercise programs on the cognitive status in institutionalized individuals with dementia is still scarce.1 Most studies hold various methodological limitations such as unspecific or unclear exercise interventions,2 absence of specific or complementary cognitive measurements,3, 4 small sample size and lack of information regarding the effects of exercise on important outcomes such as depression or quality of life.5 Information is scarce regarding the impact of physical exercise on other important dementia-related features such as functional independence or neuropsychiatric symptoms. For instance, although the effects of exercise on non-cognitive outcomes in dementia patients including physical function, ease of transfers, hospitalizations, mortality and caregiver burden have been documented, some have only included women,6 others designed a short intervention and included only individuals with Alzheimer's disease7 or did not include an interventional arm in their study design.8
Herein, we present a longitudinal study performed on institutionalized individuals with dementia in order to identify the effects of a physical exercise program on cognitive decline and impairment, memory, depression, functional independence and neuropsychiatric disturbances.
Section snippets
Methods
Participants in this study were recruited through a collaborative agreement between the University of Vigo (Spain) and Geriatros S.A., a Management Organization of residential homecare for the elderly. Individuals who met the following criteria were included: (a) over 65 years of age, (b) diagnosis of dementia according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria,9 (c) able to stand and walk for 30 m without shortness of breath, (d) able to walk safely
Results
Individuals in the EG exercised for a mean of 108.45 ± 7.99 min per week and the mean attendance rate was approximately 88%. At baseline, there were no significant differences in the variables analyzed between groups. Table 2 presents the intention-to-treat analysis for the main outcome measurements. Significant differences were observed when comparing the results obtained at baseline and at the end of the intervention in both groups. With the exception of depression, all variables improved in the
Discussion
This study addresses the impact of aerobic physical exercise on various cognitive, emotional and functional domains in institutionalized individuals with dementia. The results, both in the intention-to-treat and the complete-case analysis, indicate that individuals with dementia who did not perform exercise worsened in almost all the variables assessed compared to those who exercised. The main exception was depression which, in the intention-to-treat analysis, was the only variable that
Conclusions
The results of this study provide evidence suggesting that aerobic exercise has a significant impact on improving cognitive functioning, behavior and functional mobility in institutionalized individuals with dementia.
Practical implications
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Daily aerobic exercise may slow cognitive decline as well as improve functional mobility, neuropsychiatric symptoms and memory function in institutionalized individuals with dementia.
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A mean of 15 min of daily soft aerobic cycling per week is a feasible exercise recommendation for institutionalized individuals with severe cognitive dysfunction or dementia.
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The potential benefits of aerobic exercise on institutionalized individuals with dementia seem to be influenced by the degree of cognitive
Acknowledgments
The authors would like to thank to Geriatros S.A and their medical staff for their help and support with this study.
This work was supported by the programme “INCITE” Conselleria de Industria Xunta de Galicia, Spain (grant no.09SEC001374PR).
References (30)
- et al.
Physical activity attenuates neuropsychiatric disturbances and caregiver burden in patients with dementia
Clinics
(2011) - et al.
The Spanish versions of the Barthel index (BI) and the Katz index (KI) of activities of daily living (ADL): a structured review
Arch Gerontol Geriatr
(2009) - et al.
Walking one hour or more per day prevented mortality among older persons: results from ilSIRENTE study
Prev Med
(2008) - et al.
The effect of exercise training on cognitive function in older adults with mild cognitive impairment: a meta-analysis of randomized controlled trials
Am J Geriatr Psychiatry
(2013) - et al.
Prolonged exercise induces angiogenesis and increases cerebral blood volume in primary motor cortex of the rat
Neuroscience
(2003) - et al.
The association between decline in physical functioning and atrophy of medial temporal areas in community-dwelling older adults with amnestic and nonamnestic mild cognitive impairment
Arch Phys Med Rehabil
(2011) - et al.
Mobility decline of unknown origin in mild cognitive impairment: an MRI-based clinical study of the pathogenesis
Brain Res
(2008) - et al.
Effects of the Finnish Alzheimer Disease Exercise Trial (FINALEX): a randomized controlled trial
JAMA Intern Med
(2013) - et al.
Physical training improves motor performance in people with dementia: a randomized controlled trial
J Am Geriatr Soc
(2012) - et al.
Effect of exercise on cognitive performance in community-dwelling older adults: review of intervention trials and recommendations for public health practice and research
J Am Geriatr Soc
(2011)
Exercise program for nursing home residents with Alzheimer's Disease: A 1 year randomized, controlled trial
J Am Geriatr Soc
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
Resistance training promotes cognitive and functional brain plasticity in seniors with probable mild cognitive impairment
Arch Intern Med
A randomized controlled trial of an activity specific exercise program for individuals with Alzheimer disease in long-term care settings
J Geriatr Phys Ther
Diagnostic and statistical manual of mental disorders (DSM-IV-TR)
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