Original research
Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia

https://doi.org/10.1016/j.jsams.2015.05.007Get rights and content

Abstract

Objectives

Long-term interventions aimed at analyzing the impact of physical exercise on important health markers in institutionalized individuals with dementia are relatively scarce. This longitudinal study intends to identify the effects of a physical exercise program on cognitive decline, memory, depression, functional dependence and neuropsychiatric disturbances in institutionalized individuals with dementia.

Methods

Homecare residents with dementia were assigned to an exercise (EG) or to a control group (CG). Participants in the EG cycled for at least 15 min daily during 15 months, while those in the CG performed alternative sedentary recreational activities. The Mini-Mental State Examination (MEC), the Timed “Up & Go” Test, the Neuropsychiatric Inventory, the Katz Index, the Cornell Scale for Depression in Dementia and the Fuld Object Memory Evaluation were administered before and after the intervention.

Results

Sixty-three individuals in the CG and 51 individuals in the EG completed the intervention. A statistically significant decline in cognitive function was observed in individuals included in the CG (p = 0.015), while a slight improvement was observed in those included in the EG. Significant improvement was observed in the neuropsychiatric symptoms (p = 0.020), memory function (p = 0.028) and functional mobility (p = 0.043) among those who exercised. Exercise seemed to have a greater effect in those suffering from severe cognitive impairment.

Conclusions

This study provides evidence that aerobic physical exercise has a significant impact on improving cognitive functioning, behavior, and functional mobility in institutionalized individuals 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

  • Daily aerobic exercise may slow cognitive decline as well as improve functional mobility, neuropsychiatric symptoms and memory function in institutionalized individuals with dementia.

  • 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.

  • 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).

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