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Singh B, Olds T, Curtis R, Dumuid D, Virgara R, Watson A, Szeto K, O'Connor E, Ferguson T, Eglitis E, Miatke A, Simpson CE, Maher C. Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. Br J Sports Med 2023; 57:1203-1209. [PMID: 36796860 PMCID: PMC10579187 DOI: 10.1136/bjsports-2022-106195] [Citation(s) in RCA: 116] [Impact Index Per Article: 116.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To synthesise the evidence on the effects of physical activity on symptoms of depression, anxiety and psychological distress in adult populations. DESIGN Umbrella review. DATA SOURCES Twelve electronic databases were searched for eligible studies published from inception to 1 January 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews with meta-analyses of randomised controlled trials designed to increase physical activity in an adult population and that assessed depression, anxiety or psychological distress were eligible. Study selection was undertaken in duplicate by two independent reviewers. RESULTS Ninety-seven reviews (1039 trials and 128 119 participants) were included. Populations included healthy adults, people with mental health disorders and people with various chronic diseases. Most reviews (n=77) had a critically low A MeaSurement Tool to Assess systematic Reviews score. Physical activity had medium effects on depression (median effect size=-0.43, IQR=-0.66 to -0.27), anxiety (median effect size=-0.42, IQR=-0.66 to -0.26) and psychological distress (effect size=-0.60, 95% CI -0.78 to -0.42), compared with usual care across all populations. The largest benefits were seen in people with depression, HIV and kidney disease, in pregnant and postpartum women, and in healthy individuals. Higher intensity physical activity was associated with greater improvements in symptoms. Effectiveness of physical activity interventions diminished with longer duration interventions. CONCLUSION AND RELEVANCE Physical activity is highly beneficial for improving symptoms of depression, anxiety and distress across a wide range of adult populations, including the general population, people with diagnosed mental health disorders and people with chronic disease. Physical activity should be a mainstay approach in the management of depression, anxiety and psychological distress. PROSPERO REGISTRATION NUMBER CRD42021292710.
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Affiliation(s)
- Ben Singh
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Timothy Olds
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Rachel Curtis
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Dorothea Dumuid
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Rosa Virgara
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Amanda Watson
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kimberley Szeto
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Edward O'Connor
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Ty Ferguson
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Emily Eglitis
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Aaron Miatke
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Catherine Em Simpson
- Allied Health & Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Carol Maher
- Health and Use of Time (HUT) Group, University of South Australia, Adelaide, South Australia, Australia
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2
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Wang W, Zhong Y, Zhou Y, Yu Y, Li J, Kang S, Ma Z, Fan X, Sun L, Tang L. Low-intensity pulsed ultrasound mitigates cognitive impairment by inhibiting muscle atrophy in hindlimb unloaded mice. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2023; 154:1427-1438. [PMID: 37672304 DOI: 10.1121/10.0020835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
Microgravity leads to muscle loss, usually accompanied by cognitive impairment. Muscle reduction was associated with the decline of cognitive ability. Our previous studies showed that low-intensity pulsed ultrasound (LIPUS) promoted muscle hypertrophy and prevented muscle atrophy. This study aims to verify whether LIPUS can improve cognitive impairment by preventing muscle atrophy in hindlimb unloaded mice. In this study, mice were randomly divided into normal control (NC), hindlimb unloading (HU), hindlimb unloading + LIPUS (HU+LIPUS) groups. The mice in the HU+LIPUS group received a 30 mW/cm2 LIPUS irradiation on gastrocnemius for 20 min/d. After 21 days, LIPUS significantly prevented the decrease in muscle mass and strength caused by tail suspension. The HU+LIPUS mice showed an enhanced desire to explore unfamiliar environments and their spatial learning and memory abilities, enabling them to quickly identify differences between different objects, as well as their social discrimination abilities. MSTN is a negative regulator of muscle growth and also plays a role in regulating cognition. LIPUS significantly inhibited MSTN expression in skeletal muscle and serum and its receptor ActRIIB expression in brain, upregulated AKT and BDNF expression in brain. Taken together, LIPUS may improve the cognitive dysfunction in hindlimb unloaded rats by inhibiting muscle atrophy through MSTN/AKT/BDNF pathway.
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Affiliation(s)
- Wanzhao Wang
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Yi Zhong
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Yaling Zhou
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Yanan Yu
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Jiaxiang Li
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Sufang Kang
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Zhanke Ma
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Xiushan Fan
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Lijun Sun
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Liang Tang
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
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3
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Hall AJ, Manning F, Goodwin V. Qualitative study exploring health care professionals' perceptions of providing rehabilitation for people with advanced dementia. BMJ Open 2023; 13:e072432. [PMID: 37524545 PMCID: PMC10391829 DOI: 10.1136/bmjopen-2023-072432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore healthcare professionals' principles for providing and delivering rehabilitation interventions for people with advanced dementia. DESIGN This was a qualitative study with three focus groups undertaken virtually. The data were analysed using a process of reflexive thematic analysis in order to gain an in-depth understanding of rehabilitation principles for this population. SETTING AND PARTICIPANTS 20 healthcare professionals who were specialists in treating and rehabilitating people with advanced dementia were recruited. These healthcare professionals had a wide range of experience in a variety of different settings including primary care, secondary care as well as specialist mental health teams. Purposive sampling focused on the requirement for participants to have significant experience of treating people with dementia. Participants were from the UK and Denmark. Data collection was undertaken during August and September 2022. RESULTS Three overarching themes were developed following analysis-organisational culture, knowledge and personal values of the healthcare professional. The first explored how the culture of an organisation affects a person with advanced dementia as well as the healthcare professional. The organisation needed to promote positive approaches to person-centred care and provide effective situational leadership to embed such approaches. Knowledge was a key consideration and was closely linked to the personal values of the healthcare professional, which formed the final theme. This study suggests that the interrelationship of these three factors influences the outcomes for the person with dementia and effective outcomes required consideration of all domains. CONCLUSIONS Effective interventions for people with advanced dementia require the healthcare professional to have the knowledge about dementia and positive personal values, but the culture of the organisation is also key to ensure that the healthcare professional is able to deliver successful interventions.
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Affiliation(s)
- Abigail J Hall
- Public Health and Sports Science, University of Exeter, Exeter, UK
| | - Fay Manning
- Department of Medical Imaging, University of Exeter Medical School, Exeter, UK
| | - Victoria Goodwin
- Public Health and Sports Science, University of Exeter, Exeter, UK
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Lin LL, Liu CC. Effectiveness of Comprehensive Physical Activity Health Promotion Program on the Essential Physical Functions of Older Patients With Multiple Diseases and Dementia in Rural Area. Gerontol Geriatr Med 2023; 9:23337214231184127. [PMID: 37435006 PMCID: PMC10331075 DOI: 10.1177/23337214231184127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
Against the backdrop of aging populations worldwide, physical activity programs aimed at promoting the health of older adults have begun to flourish. However, few studies have focused on elderly residents in rural areas who may have multiple comorbidities. Therefore, the current study aimed to investigate the effects of a 12-week physical activity program on health promotion among rural elderly with multiple diseases. The study included 18 elderly participants, with a mean age of 82.39 years, who had dementia and one or more additional diseases. Among the participants, 89% were female. The results showed that the 12-week physical activity program intervention significantly improved participants' walking speed and range of motion of the arm joints. Based on these findings, it is hoped that this study will provide a reference for future researchers and practitioners targeting rural or elderly populations who may have multiple diseases to develop more comprehensive physical activity programs.
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Affiliation(s)
- Lain-Li Lin
- Ching Kuo Institute of Management and Health, Keelung, Taiwan
| | - Chih-Chi Liu
- National Taiwan Normal University, Taipei, Taiwan
- Hsin Sheng College of Medical Care and Management, Taoyuan, Taiwan
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Abdul-mumin KH, Maideen AA, Lupat A, Mohd-alipah SN, Mohammad-alli RH, Abd-manaf HH, Osman A, Fata HMRA, busrah N, Darling-fisher C, Idris DR. “We must be strong in our heart, in our mind and in our soul”: An exploratory qualitative study on nurses’ psychological self-care in strengthening their mental health while providing COVID-19 care.. [DOI: 10.21203/rs.3.rs-2160729/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Abstract
Background
It is two years since the unprecedented and massive COVID-19 pandemic affected the world. Since its emergence, nurse frontliners across the globe faced various challenges that lead them to experience adverse mental health. An important yet often overlooked or underappreciated initial coping strategy is psychological self-care. Research has shown that nurses’ psychological self-care practices strengthened their mental well-being when facing the unpredicted nature and chaos of COVID-19. This study examined the specific positive psychological self-care practices used by nurses who provided care for COVID-19 patients.
Methods
An exploratory qualitative study was conducted on 40 nurses who worked in providing care for confirmed and suspected COVID-19 patients across Brunei. Data was collected using focus groups aided by semi-structured open-ended questions and analysed thematically using the principles underpinning Constructivist Grounded Theory (Charmaz, 2021).
Results
Four themes emerged: 1) ‘Care of the mind, heart and soul’ – explained the meaning and importance of psychological self-care practices to the nurses; 2) ‘Physical care for the psychological well-being’- illuminated efforts undertaken to strengthen knowledge and practices for preparedness in caring for suspected and confirmed COVID-19 patients; 3) ‘Venting out and distraction’ – demonstrated the measures undertaken to release and relieve stress; 4) ‘Have faith, think and stay positive’ – described the importance of having faith in the higher being or supreme entity such as God for protection, and enduring the daily challenges positively
Conclusions
Due to the challenges of dealing with a worldwide pandemic, nurses’ mental well-being was unintentionally placed at risk while the government strategized and prioritised containing and preventing the spread of and death from COVID-19. This study describes specific psychological self-care practices undertaken by nurses to strengthen their mental health and develop resilience in their professional care role while addressing the challenges of the COVID-19 era. Health administrators, as well as nursing educators, need to promote and developing resources to strengthen nurses’ positive psychological self-care practices. This will not only benefit individual nurses but will help promote the wellbeing of patients and employees, improve the health of all, and counteract any unintended stressful situations, even beyond the COVID-19 pandemic.
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Affiliation(s)
- Khadizah H. Abdul-Mumin
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah, Institute of Health Sciences, Universiti Brunei Darussalam
| | | | - Agong Lupat
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah, Institute of Health Sciences, Universiti Brunei Darussalam
| | | | | | | | - Abd-Rani Osman
- Department of Nursing Services, Ministry of Health, Brunei Darussalam
| | | | - nani busrah
- Department of Nursing Services, Ministry of Health, Brunei Darussalam
| | | | - Deeni Rudita Idris
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah, Institute of Health Sciences, Universiti Brunei Darussalam
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Thuesen J, Graff L. Ageing, dementia and the future - ambivalent futurework in rehabilitation-focused dementia care. DEMENTIA 2022; 21:2210-2230. [PMID: 35921632 PMCID: PMC9483685 DOI: 10.1177/14713012221117412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Due to its goal-orientation, rehabilitation may be considered a future-oriented practice.
As rehabilitation is increasingly recognized as contributing to dementia care it is
important to explore how rehabilitation corresponds with the future orientation of older
people with dementia. The aim of this study was to explore the futurework of home-dwelling people with mild to
moderate dementia in the context of rehabilitation-focused municipal dementia care, that
is, their thinking and practices regarding their future and how these correspond with
institutionalized practices. The study was conducted as a case-study inspired by the methodology of Institutional
Ethnography (IE). The study setting was two Danish municipalities sampled as a
paradigmatic case. Eight older people living with early-stage dementia (mean age: 78
years, age range: 65–91) were strategically sampled and each interviewed recurringly
within a period of six through 15 months. In total, 29 interviews were completed. An
abductive analysis was subsequently conducted based on these interviews. Findings included three dimensions of futurework: Extending the present state into the
near future; avoiding being confronted with an anticipated future; and adjusting to
decline and preparing for future losses. Based on these findings, a notion of ‘ambivalent
futurework’ is suggested. The futurework of older people did not always correspond with
the institutional arrangements in a rehabilitation-focused dementia care. Findings show
that the institutional arrangements in dementia care may support as well as challenge the
futurework of the participants. Paying attention to the ambivalences of older people
living with dementia and recognizing the ambivalent futurework may be essential in
rehabilitation-focused dementia care.
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Affiliation(s)
- Jette Thuesen
- Department of Public Health, 6174University of Southern Denmark, Syddanmark, Denmark.,Centre for Nutrition and Rehabilitation, 165104Absalon University College, Sjælland, Denmark.,REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, 6174University of Southern Denmark, Syddanmark, Denmark
| | - Lea Graff
- The Danish Center for Social Science Research, 4298VIVE, Copenhagen, Denmark
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Evidence Quality Assessment of Tai Chi Exercise Intervention in Cognitive Impairment: An Overview of Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5872847. [PMID: 35509627 PMCID: PMC9060972 DOI: 10.1155/2022/5872847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/10/2022] [Accepted: 04/16/2022] [Indexed: 12/14/2022]
Abstract
Background Tai Chi (TC) exercise has recently received wide attention for its efficacy in the management of cognitive impairment. The purpose of this overview is to summarize the available evidence on TC treatment of cognitive impairment and assess its quality. Methods We retrieved relevant systematic reviews/meta-analyses (SRs/MAs) from 7 databases from the time they were established to January 2, 2022. Two reviewers independently evaluated the methodological quality, risk of bias, report quality, and evidence quality of the included SRs/MAs on randomized controlled trials (RCTs). The tools used are Assessment System for Evaluating Methodological Quality 2 (AMSTAR-2), the Risk of Bias In Systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews And Meta-Analysis (PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results This overview finally included 8 SRs/MAs. According to the results of AMSTAR-2, all included SRs/MAs were rated as very low quality. Based on the ROBIS tool, none of the SR/MA had a low risk of bias. In light of PRISMA, all SRs/MAs had reporting deficiencies. According to the GRADE system, there was only 1 high-quality piece of evidence. Conclusion TC is a promising complementary and alternative therapy for cognitive impairment with high safety profile. However, in view of the low quality of the included SRs/MAs supporting this conclusion, high-quality evidence with a more rigorous study design and a larger sample size is needed before making a recommendation for guidance.
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8
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Venegas-Sanabria LC, Martínez-Vizcaino V, Cavero-Redondo I, Chavarro-Carvajal DA, Cano-Gutierrez CA, Álvarez-Bueno C. Effect of physical activity on cognitive domains in dementia and mild cognitive impairment: overview of systematic reviews and meta-analyses. Aging Ment Health 2021; 25:1977-1985. [PMID: 33143444 DOI: 10.1080/13607863.2020.1839862] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the effect of physical activity on cognitive domains in persons with dementia or mild cognitive impairment. DESIGN An overview of systematic reviews and meta-analyses of randomized controlled trials were performed. METHODS A literature search was performed in PubMed, Scopus, and Cochrane Database of Systematic Reviews databases up to February 2020. Data about the change in cognitive domains after physical activity intervention was extracted and plotted. RESULTS We included 11 meta-analyses in this overview. The most frequent type of physical activity for the intervention group was the aerobic exercise with a duration between 6 and 78 weeks. Global cognition was the most common form of assessing the cognitive function, follow of executive function, delayed recall, attention, and verbal fluency. We found a positive effect of physical activity on global cognition, executive function, and delayed recall, but no effect on verbal fluency, attention, and immediate recall. CONCLUSION Physical activity shows a positive effect on cognition in people with dementia and mild cognitive impairment, especially when it was assessed as global cognition. Positive effects on executive function and memory were also shown. This result confirms the relevance of physical activity in the treatment of persons with cognitive impairment.
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Affiliation(s)
- Luis Carlos Venegas-Sanabria
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Aging Institute, Medicine School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Department of Internal Medicine, Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Vicente Martínez-Vizcaino
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain.,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Región Metropolitana, Chile
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Diego Andres Chavarro-Carvajal
- Aging Institute, Medicine School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Department of Internal Medicine, Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Carlos Alberto Cano-Gutierrez
- Aging Institute, Medicine School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Department of Internal Medicine, Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
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9
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Effect of Tai Chi on Cognitive Function among Older Adults with Cognitive Impairment: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6679153. [PMID: 34394392 PMCID: PMC8360724 DOI: 10.1155/2021/6679153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 02/03/2023]
Abstract
Background Cognitive decline occurs in all persons during the aging process and drugs can only alleviate symptoms and are expensive. Some researches demonstrated that Tai Chi had potential in preventing cognitive decline while others' results showed Tai Chi had no influence on cognitive impairment. Therefore, we conduct a systematic review and meta-analysis to assess the efficacy and safety of cognitive impairment patients practicing Tai Chi. Methods A comprehensive literature search was carried out in multiple databases, including PubMed, Cochrane, MEDLINE (Ovid), Web of Science, Embase, Scopus, PsycInfo (Ovid), CKNI, Wan Fang, VIP, SinoMed, and ClinicalTrails, from their inception to 1 July 2020 to collect randomized controlled trials about practicing Tai Chi for patients with cognitive impairment. Primary outcomes included changes of cognitive function and secondary outcomes included changes of memory functions. Data were extracted by two independent individuals and Cochrane Risk of Bias tool version 2.0 was applied for the included studies. Systematic review and meta-analysis were performed by RevMan 5.3 software. Results The results included 827 cases in 9 studies, of which 375 were in the experimental group and 452 were in the control group. Meta-analysis showed that Mini-Mental State Examination WMD = 1.52, 95% CI [0.90, 2.14]; Montreal Cognitive Assessment WMD = 3.5, 95% CI [0.76, 6.24]; Clinical Dementia Rating WMD = −0.55, 95% CI [−0.80, −0.29]; logical memory delayed recall WMD = 1.1, 95% CI [0.04, 2.16]; digit span forward WMD = 0.53, 95% CI [−0.65, 1.71]; and digit span backward WMD = −0.1, 95% CI [−0.38, 0.19]. No adverse events were reported in the included articles. Conclusion There is limited evidence to support that practicing Tai Chi is effective for older adults with cognitive impairment. Tai Chi seems to be a safe exercise, which can bring better changes in cognitive function score.
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10
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Clarkson P, Challis D, Hughes J, Roe B, Davies L, Russell I, Orrell M, Poland F, Jolley D, Kapur N, Robinson C, Chester H, Davies S, Sutcliffe C, Peconi J, Pitts R, Fegan G, Islam S, Gillan V, Entwistle C, Beresford R, Abendstern M, Giebel C, Ahmed S, Jasper R, Usman A, Malik B, Hayhurst K. Components, impacts and costs of dementia home support: a research programme including the DESCANT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background
Over half of people with dementia live at home. We know little about what home support could be clinically effective or cost-effective in enabling them to live well.
Objectives
We aimed to (1) review evidence for components of home support, identify their presence in the literature and in services in England, and develop an appropriate economic model; (2) develop and test a practical memory support package in early-stage dementia, test the clinical effectiveness and cost-effectiveness of routine home support in later-stage dementia and design a toolkit based on this evidence; and (3) elicit the preferences of staff, carers and people with dementia for home support inputs and packages, and evaluate the cost-effectiveness of these approaches in early- and later-stage dementia.
Design
We undertook (1) an evidence synthesis, national surveys on the NHS and social care and an economic review; (2) a multicentre pragmatic randomised trial [Dementia Early Stage Cognitive Aids New Trial (DESCANT)] to estimate the clinical effectiveness and cost-effectiveness of providing memory aids and guidance to people with early-stage dementia (the DESCANT intervention), alongside process evaluation and qualitative analysis, an observational study of existing care packages in later-stage dementia along with qualitative analysis, and toolkit development to summarise this evidence; and (3) consultation with experts, staff and carers to explore the balance between informal and paid home support using case vignettes, discrete choice experiments to explore the preferences of people with dementia and carers between home support packages in early- and later-stage dementia, and cost–utility analysis building on trial and observational study.
Setting
The national surveys described Community Mental Health Teams, memory clinics and social care services across England. Recruitment to the trial was through memory services in nine NHS trusts in England and one health board in Wales. Recruitment to the observational study was through social services in 17 local authorities in England. Recruitment for the vignette and preference studies was through memory services, community centres and carers’ organisations.
Participants
People aged > 50 years with dementia within 1 year of first attendance at a memory clinic were eligible for the trial. People aged > 60 years with later-stage dementia within 3 months of a review of care needs were eligible for the observational study. We recruited staff, carers and people with dementia for the vignette and preference studies. All participants had to give written informed consent.
Main outcome measures
The trial and observational study used the Bristol Activities of Daily Living Scale as the primary outcome and also measured quality of life, capability, cognition, general psychological health and carers’ sense of competence.
Methods
Owing to the heterogeneity of interventions, methods and outcome measures, our evidence and economic reviews both used narrative synthesis. The main source of economic studies was the NHS Economic Evaluation Database. We analysed the trial and observational study by linear mixed models. We analysed the trial by ‘treatment allocated’ and used propensity scores to minimise confounding in the observational study.
Results
Our reviews and surveys identified several home support approaches of potential benefit. In early-stage dementia, the DESCANT trial had 468 randomised participants (234 intervention participants and 234 control participants), with 347 participants analysed. We found no significant effect at the primary end point of 6 months of the DESCANT intervention on any of several participant outcome measures. The primary outcome was the Bristol Activities of Daily Living Scale, for which scores range from 0 to 60, with higher scores showing greater dependence. After adjustment for differences at baseline, the mean difference was 0.38, slightly but not significantly favouring the comparator group receiving treatment as usual. The 95% confidence interval ran from –0.89 to 1.65 (p = 0.56). There was no evidence that more intensive care packages in later-stage dementia were more effective than basic care. However, formal home care appeared to help keep people at home. Staff recommended informal care that cost 88% of formal care, but for informal carers this ratio was only 62%. People with dementia preferred social and recreational activities, and carers preferred respite care and regular home care. The DESCANT intervention is probably not cost-effective in early-stage dementia, and intensive care packages are probably not cost-effective in later-stage dementia. From the perspective of the third sector, intermediate intensity packages were cheaper but less effective. Certain elements may be driving these results, notably reduced use of carers’ groups.
Limitations
Our chosen outcome measures may not reflect subtle outcomes valued by people with dementia.
Conclusions
Several approaches preferred by people with dementia and their carers have potential. However, memory aids aiming to affect daily living activities in early-stage dementia or intensive packages compared with basic care in later-stage dementia were not clinically effective or cost-effective.
Future work
Further work needs to identify what people with dementia and their carers prefer and develop more sensitive outcome measures.
Study registration
Current Controlled Trials ISRCTN12591717. The evidence synthesis is registered as PROSPERO CRD42014008890.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Clarkson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Challis
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jane Hughes
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Brenda Roe
- Evidence-based Practice Research Centre, Edge Hill University, Ormskirk, UK
| | - Linda Davies
- Health Economics Research Team, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ian Russell
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Jolley
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Narinder Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Catherine Robinson
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Helen Chester
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Sue Davies
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Caroline Sutcliffe
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Julie Peconi
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rosa Pitts
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Greg Fegan
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Vincent Gillan
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Charlotte Entwistle
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rebecca Beresford
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Michele Abendstern
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Clarissa Giebel
- Institute of Population Health Sciences, University of Liverpool, Liverpool, UK
| | - Saima Ahmed
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Rowan Jasper
- Social Policy Research Unit, University of York, York, UK
| | - Adeela Usman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Baber Malik
- Social Care and Society, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karen Hayhurst
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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High-intensity exercise programs in people with dementia — a systematic review and meta-analysis. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2020. [DOI: 10.1007/s12662-020-00688-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AbstractDementia is a syndrome characterized by a progressive deterioration of cognitive and physical functions. The aim of this systematic review was to investigate the effects of high-intensity exercise training (HIT) programs on cognitive and mental health, physical performance, activities of daily living (ADLs) and quality of life (QoL) in people with dementia. A systematic literature search for randomized controlled trials was performed until July 2019. We calculated mean difference (MD) or standardized MD (SMD) and the 95% confidence interval (CI), and assessed heterogeneity using I2 statistic. Nine studies from three large-scale research projects which were based on the high-intensity functional exercise (HIFE) program incorporating strength, balance and mobility exercises of the lower limbs, including 456 participants (85.5 ± 7.0 years), were considered. There was an overall good study quality (mean PEDro score = 7.6 ± 0.7). Compared to seated control activities, strength and balance HIT resulted in statistically significant but small positive effects on balance performance (MD = 2.31, 95% CI = 0.44–4.17, p = 0.02; I2 = 73%) and on the abilities to independently perform ADLs (SMD = 0.28, 95% CI = 0.12–0.44, p = 0.0006; I2 = 0%). No differences were found in cognitive function, depressive symptoms and QoL. The qualitative analyses yielded sporadic beneficial results (mobility, psychological well-being and apathetic behaviour) in favour of HIT. There is only limited evidence for an intensity-related dose–response relationship. Further well-designed studies are needed to identify the best exercise type for different types and stages of dementia.
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Vseteckova J, Dadova K, Gracia R, Ryan G, Borgstrom E, Abington J, Gopinath M, Pappas Y. Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review. Eur Rev Aging Phys Act 2020; 17:15. [PMID: 32973961 PMCID: PMC7507295 DOI: 10.1186/s11556-020-00246-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 09/06/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND & AIMS Evidence suggests that targeted exercise is important for people living with dementia. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to walking group exercise of older people living with dementia in the community. METHODS We have searched appropriate electronic databases between January 1990 until September 2019, in any language. Additionally, we searched trial registries (clinicaltrial.gov and WHO ICTRP) for ongoing studies. We included all study designs. Studies were excluded when participants were either healthy older people or people suffering from dementia but living in residential care. Narrative synthesis was used. FINDINGS 10 papers met the inclusion criteria. The narrative analysis focused on barriers, facilitators, and adherence. All studies reported on barriers and facilitators. Barriers included: bio-medical reasons (including mental wellbeing and physical ability); relationship dynamics; and socio-economic reasons and environmental issues. Facilitators included: bio-medical benefits & benefits related to physical ability; staff, group relationship dynamics and social aspect of walking group; environmental issues and individual tailoring; and participants perceptions about the walks & the program. Most studies did not provide data about adherence or attendance; where reported, adherence ranged from 47 to 89%. CONCLUSIONS This systematic review of literature has highlighted known barriers and facilitators to adherence to walking groups type of exercise for people living with dementia in community. Carers' willingness to engage, their circumstances, perspectives and previous experiences of exercise seem to play a key role in facilitating adherence but there is little research that explores these. Also, the design, location and organisation of walking groups facilitate adherence. This reflects the need for such activities to be part of a wider 'program of care', tailored to the needs of the individual, flexible and convenient. Knowledgeable and well-trained instructors or healthcare professionals are recommended as group exercise leaders.
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Affiliation(s)
- J. Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - K. Dadova
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - R. Gracia
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - G. Ryan
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - E. Borgstrom
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - J. Abington
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - M. Gopinath
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, MK7 6AA UK
| | - Y. Pappas
- Institute for Health Research, University of Bedfordshire, Bedford, UK
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Minn YK, Choi SH, Suh YJ, Jeong JH, Kim EJ, Kim JH, Park KW, Park MH, Youn YC, Yoon B, Choi SJ, Oh YK, Yoon SJ. Effect of Physical Activity on the Progression of Alzheimer's Disease: The Clinical Research Center for Dementia of South Korea Study. J Alzheimers Dis 2019; 66:249-261. [PMID: 30282355 DOI: 10.3233/jad-180333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a lack of research on the effects of physical activity (PA) on the progression of Alzheimer's disease (AD). OBJECTIVES We investigated whether PA is associated with progression of dementia and mortality in AD. METHODS In the present study, 934 patients with mild-to-moderate AD were included. PA was evaluated using a questionnaire written by the caregiver. The outcome measures were the Clinical Dementia Rating-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living (S-IADL), Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), a global composite score of neuropsychological subtests, and mortality. They were evaluated annually and received a maximum of three follow-up examinations. RESULTS Between-group differences compared with the no PA group in the change of CDR-SB scores were -0.431 (95% CI = -0.824∼-0.039; p = 0.031) for the moderate PA group (150-750 minutes per week of moderate intensity PA), and -1.148 (-1.656∼-0.639; p < 0.001) for the high PA group (>750 minutes per week). As PA increased, there was a significant trend to slow the rate of increase in the CDR-SB, S-IADL, and CGA-NPI scores. The patients with ≥150 minutes per week for each of non-recreational and recreational PAs had a lower risk of mortality compared to those with <150 minutes per week for each of the PAs (hazard ratio 0.22, 95% CI = 0.05∼0.88; p = 0.033). CONCLUSION More PA is associated with slower progression of dementia severity, functional decline, and abnormal behavior, and with a lower risk of mortality in AD.
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Affiliation(s)
- Yang-Ki Minn
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, South Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, South Korea
| | - Moon Ho Park
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Young Chul Youn
- Department of Neurology, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Bora Yoon
- Department of Neurology, College of Medicine, Konyang University, Daejeon, South Korea
| | - Seok-Jin Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Youn Kyung Oh
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University School of Medicine, Daejeon, South Korea
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Maltais M, Rolland Y, Haÿ PE, Armaingaud D, Vellas B, de Souto Barreto P. Six-month observational follow-up on activities of daily living in people with dementia living in nursing homes after a 6-month group based on either exercise or social activities. Aging Clin Exp Res 2019; 31:361-366. [PMID: 29876831 DOI: 10.1007/s40520-018-0984-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Studies have demonstrated changes in activities of daily living after an exercise intervention in people with dementia (PWD) living in nursing homes (NH). However, some discrepancies are shown during follow-up. AIMS Our objective was to measure activities of daily living (ADL) performance during a 6-month observational follow-up after a 6-month exercise or social activity intervention in PWD living in NH. METHODS After cluster randomisation, 91 PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). After the intervention, 85 PWD were assessed for post-intervention follow-up. Instrumental and basic activities of daily living (IADL, ADL) were measured at 6-month observational follow-up after the intervention using the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer's Disease (ADCS-ADL-sev) scale (scores ranging from 0 to 51, higher is better). RESULTS Compared to participants in the social activity, those who participated to the exercise intervention had a significant decrease of their ADCS-ADL-sev score (between-group adjusted mean difference: 4.6 points, p = 0.001) with IADL having the most decrease (2.8 points, p = 0.004). DISCUSSION Unexpectedly, exercisers declined sharply in the performance of ADLs and IADLs, whereas participants in the social intervention group maintained their levels. The potential mechanisms to explain these findings remain still to be elucidated.
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Affiliation(s)
- Mathieu Maltais
- Gérontopôle de Toulouse, Institut du Vieillissement, Bâtiment B, Centre Hospitalo-Universitaire de Toulouse, 37 Allée Jules Guesdes, 31000, Toulouse, France.
| | - Yves Rolland
- Gérontopôle de Toulouse, Institut du Vieillissement, Bâtiment B, Centre Hospitalo-Universitaire de Toulouse, 37 Allée Jules Guesdes, 31000, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
| | | | | | - Bruno Vellas
- Gérontopôle de Toulouse, Institut du Vieillissement, Bâtiment B, Centre Hospitalo-Universitaire de Toulouse, 37 Allée Jules Guesdes, 31000, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
| | - Philipe de Souto Barreto
- Gérontopôle de Toulouse, Institut du Vieillissement, Bâtiment B, Centre Hospitalo-Universitaire de Toulouse, 37 Allée Jules Guesdes, 31000, Toulouse, France
- UMR INSERM, 1027 University of Toulouse III, Toulouse, France
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Abstract
INTRODUCTION AND OBJECTIVE Palliative care can be of great help to people with dementia during their old ages. The aim of this study was to assess the use of palliative care in patients with dementia. METHODS Search was conducted in PubMed, ScienceDirect, Google Scholar, and Scopus databases. A step-by-step approach was used to identify relevant studies, and related studies of were demarcated and other studies were excluded. This study has used empirical studies, review studies, and guidelines for health organizations in different countries. RESULTS A total of 65 sources were used, of which 24 were completely related to the subject of the study. In related studies, the use of various ways and means of palliative care to improve quality of life, reduce pain, and prevent falling in people with dementia is discussed. DISCUSSION AND CONCLUSION Palliative care can help people with dementia to improve their quality of life; however, more research is needed on the application and proper management of palliative care in patients with dementia.
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Affiliation(s)
- Masoumeh Pandpazir
- Department of Medical Librarianship and Information, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mozhdeh Tajari
- Department of Critical Care Nursing, Kermanshah University of Medical Sciences, Kermanshah, Iran
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16
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Henskens M, Nauta IM, van Eekeren MC, Scherder EJ. Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial. Dement Geriatr Cogn Disord 2018; 46:60-80. [PMID: 30145595 PMCID: PMC6187838 DOI: 10.1159/000491818] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/03/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND/AIMS There is no consensus regarding the optimal nonpharmacological intervention to slow down dementia-related decline. We examined whether physical stimulation interventions were effective in reducing cognitive, physical, mood, and behavioral decline in nursing home residents with dementia. METHODS Eighty-seven nursing home residents with dementia were randomly assigned to 3 physical activity interventions: activities of daily living (ADL) training, multicomponent exercise training, or combined multicomponent exercise and ADL training. Outcomes were measured at baseline, and after 3 and 6 months. RESULTS A 6-month ADL training benefitted executive functions, physical endurance, and depression among men. Exercise training benefitted only grip strength of participants with mild-to-moderate cognitive impairment. A combined training benefitted functional mobility compared to ADL training, depressive symptoms and agitation compared to exercise training, and physical endurance compared to no physical stimulation. CONCLUSIONS ADL training appears to be effective for nursing home residents with moderately severe dementia. It remains unclear whether exercise training is an effective type of stimulation.
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Affiliation(s)
- Marinda Henskens
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ilse M. Nauta
- Department of Neurology, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - Erik J.A. Scherder
- Department of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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17
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Yu F, Vock DM, Barclay TR. Executive function: Responses to aerobic exercise in Alzheimer's disease. Geriatr Nurs 2018; 39:219-224. [PMID: 29031520 PMCID: PMC5897173 DOI: 10.1016/j.gerinurse.2017.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 10/18/2022]
Abstract
Executive dysfunction occurs early and is prevalent in Alzheimer's disease (AD). This study tested the ability of different measures for identifying changes in executive function and the effect of 6-months of aerobic exercise on executive function in older adults with mild to moderate AD, using a single-group, repeated-measures design (n = 28, age 78.1 ± 8.37). Factor analysis and linear mixed-effects model analyses showed that individually the Exit Interview-25 (EXIT-25), Behavioral Dyscontrol Scale (BDS), and Golden Stroop test were the preferred instruments for measuring changes in executive function in the sample. The COWAT and TMT had substantial floor effects limiting their ability to identify changes in executive function. A single latent factor was sufficient to describe the heterogeneity of executive function. Over 6 months, aerobic exercise maintained executive function (effect size = -0.11, -0.24, -0.27, and -0.21 for the EXIT-25, BDS, Stroop, and latent factor, respectively). Decline in the latent factor (effect size = -0.21, p = 0.06) was minimal and comparable to that in global cognition (effect size = -0.20, p = 0.34). Aerobic exercise may be effective on maintaining executive function in AD.
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Affiliation(s)
- Fang Yu
- University of Minnesota School of Nursing, Minneapolis, MN, USA.
| | - David M Vock
- University of Minnesota School of Public Health Division of Biostatistics, Minneapolis, MN, USA.
| | - Terry R Barclay
- University of Minnesota Department of Neurology, Minneapolis, MN, USA.
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18
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Lam FM, Huang MZ, Liao LR, Chung RC, Kwok TC, Pang MY. Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. J Physiother 2018; 64:4-15. [PMID: 29289581 DOI: 10.1016/j.jphys.2017.12.001] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 09/03/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022] Open
Abstract
QUESTION Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training? DESIGN Systematic review with meta-analysis of randomised trials. PARTICIPANTS People with mild cognitive impairment or dementia as the primary diagnosis. INTERVENTION Physical exercise. OUTCOME MEASURES Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls. RESULTS Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact. CONCLUSION People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15].
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Affiliation(s)
- Freddy Mh Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Mei-Zhen Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Lin-Rong Liao
- Department of Rehabilitation, Jiangsu Provincial Yixing Jiuru Rehabilitation Hospital, Yixing, China
| | - Raymond Ck Chung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy Cy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Marco Yc Pang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
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Ohrnberger J, Fichera E, Sutton M. The relationship between physical and mental health: A mediation analysis. Soc Sci Med 2017; 195:42-49. [PMID: 29132081 DOI: 10.1016/j.socscimed.2017.11.008] [Citation(s) in RCA: 346] [Impact Index Per Article: 49.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 10/23/2017] [Accepted: 11/04/2017] [Indexed: 12/14/2022]
Abstract
There is a strong link between mental health and physical health, but little is known about the pathways from one to the other. We analyse the direct and indirect effects of past mental health on present physical health and past physical health on present mental health using lifestyle choices and social capital in a mediation framework. We use data on 10,693 individuals aged 50 years and over from six waves (2002-2012) of the English Longitudinal Study of Ageing. Mental health is measured by the Centre for Epidemiological Studies Depression Scale (CES) and physical health by the Activities of Daily Living (ADL). We find significant direct and indirect effects for both forms of health, with indirect effects explaining 10% of the effect of past mental health on physical health and 8% of the effect of past physical health on mental health. Physical activity is the largest contributor to the indirect effects. There are stronger indirect effects for males in mental health (9.9%) and for older age groups in mental health (13.6%) and in physical health (12.6%). Health policies aiming at changing physical and mental health need to consider not only the direct cross-effects but also the indirect cross-effects between mental health and physical health.
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Affiliation(s)
- Julius Ohrnberger
- Manchester Centre for Health Economics, University of Manchester, United Kingdom.
| | | | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, United Kingdom
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20
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Harris JB, Johnson CS. The Impact of Physical versus Social Activity on the Physical and Cognitive Functioning of Seniors with Dementia. ACTIVITIES ADAPTATION & AGING 2017. [DOI: 10.1080/01924788.2017.1306383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - C. Shanthi Johnson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada
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Payne C, Wiffen PJ, Martin S. WITHDRAWN: Interventions for fatigue and weight loss in adults with advanced progressive illness. Cochrane Database Syst Rev 2017; 4:CD008427. [PMID: 28387447 PMCID: PMC6478103 DOI: 10.1002/14651858.cd008427.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fatigue and unintentional weight loss are two of the commonest symptoms experienced by people with advanced progressive illness. Appropriate interventions may bring considerable improvements in function and quality of life to seriously ill people and their families, reducing physical, psychological and spiritual distress. OBJECTIVES To conduct an overview of the evidence available on the efficacy of interventions used in the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness by reviewing the evidence contained within Cochrane reviews. METHODS We searched the Cochrane Database of Systematic Reviews (CDSR) for all systematic reviews evaluating any interventions for the management of fatigue and/or unintentional weight loss in adults with advanced progressive illness (The Cochrane Library 2010, Issue 8). We reviewed titles of interest by abstract. Where the relevance of a review remained unclear we reached a consensus regarding the relevance of the participant group and the outcome measures to the overview. Two overview authors extracted the data independently using a data extraction form. We used the measurement tool AMSTAR (Assessment of Multiple SysTemAtic Reviews) to assess the methodological quality of each systematic review. MAIN RESULTS We included 27 systematic reviews (302 studies with 31,833 participants) in the overview. None of the included systematic reviews reported quantitative data on the efficacy of interventions to manage fatigue or weight loss specific to people with advanced progressive illness. All of the included reviews apart from one were deemed of high methodological quality. For the remaining review we were unable to ascertain the methodological quality of the research strategy as it was described. None of the systematic reviews adequately described whether conflict of interests were present within the included studies. Management of fatigueAmyotrophic lateral sclerosis/motor neuron disease (ALS/MND) - we identified one systematic review (two studies and 52 participants); the intervention was exercise.Cancer - we identified five systematic reviews (116 studies with 17,342 participants); the pharmacological interventions were eicosapentaenoic acid (EPA) and any drug therapy for the management of cancer-related fatigue and the non pharmacological interventions were exercise, interventions by breast care nurses and psychosocial interventions.Chronic obstructive pulmonary disease (COPD) - we identified three systematic reviews (59 studies and 4048 participants); the interventions were self management education programmes, nutritional support and pulmonary rehabilitation.Cystic fibrosis - we identified one systematic review (nine studies and 833 participants); the intervention was physical training.Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) - we identified two systematic reviews (21 studies and 748 participants); the interventions were progressive resistive exercise and aerobic exercise.Multiple sclerosis (MS) - we identified five systematic reviews (23 studies and 1502 participants); the pharmacological interventions were amantadine and carnitine. The non pharmacological interventions were diet, exercise and occupational therapy.Mixed conditions in advanced stages of illness - we identified one systematic review (five studies and 453 participants); the intervention was medically assisted hydration. Management of weight lossALS/MND - we identified one systematic review but no studies met the inclusion criteria for the systematic review; the intervention was enteral tube feeding.Cancer - we identified three systematic reviews with a fourth systematic review also containing extractable data on cancer (66 studies and 5601 participants); the pharmacological interventions were megestrol acetate and eicosapentaenoic acid (EPA) (this systematic review is also included in the cancer fatigue section above). The non pharmacological interventions were enteral tube feeding and non invasive interventions for patients with lung cancer.COPD - we identified one systematic review (59 studies and 4048 participants); the intervention was nutritional support. This systematic review is also included in the COPD fatigue section.Cystic fibrosis - we identified two systematic reviews (three studies and 131 participants); the interventions were enteral tube feeding and oral calorie supplements.HIV/AIDS - we identified four systematic reviews (42 studies and 2071 participants); the pharmacological intervention was anabolic steroids. The non pharmacological interventions were nutritional interventions, progressive resistive exercise and aerobic exercise. Both of the systematic reviews on exercise interventions were also included in the HIV/AIDS fatigue section.MS - we found no systematic reviews which considered interventions to manage unintentional weight loss for people with a clinical diagnosis of multiple sclerosis at any stage of illness.Mixed conditions in advanced stages of illness - we identified two systematic reviews (32 studies and 4826 participants); the interventions were megestrol acetate and medically assisted nutrition. AUTHORS' CONCLUSIONS There is a lack of robust evidence for interventions to manage fatigue and/or unintentional weight loss in the advanced stage of progressive illnesses such as advanced cancer, heart failure, lung failure, cystic fibrosis, multiple sclerosis, motor neuron disease, Parkinson's disease, dementia and AIDS. The evidence contained within this overview provides some insight into interventions which may prove of benefit within this population such as exercise, some pharmacological treatments and support for self management.Researchers could improve the methodological quality of future studies by blinding of outcome assessors. Adopting uniform reporting mechanisms for fatigue and weight loss outcome measures would also allow the opportunity for meta-analysis of small studies.Researchers could also improve the applicability of recommendations for interventions to manage fatigue and unintentional weight loss in advanced progressive illness by including subgroup analysis of this population within systematic reviews of applicable interventions.More research is required to ascertain the best interventions to manage fatigue and/or weight loss in advanced illness. There is a need for standardised reporting of these symptoms and agreement amongst researchers of the minimum duration of studies and minimum percentage change in symptom experience that proves the benefits of an intervention. There are, however, challenges in providing meaningful outcome measurements against a background of deteriorating health through disease progression. Interventions to manage these symptoms must also be mindful of the impact on quality of life and should be focused on patient-orientated rather than purely disease-orientated experiences for patients. Systematic reviews and primary intervention studies should include the impact of the interventions on standardised validated quality of life measures.
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Affiliation(s)
- Cathy Payne
- University of UlsterAll Ireland Institute of Hospice and Palliative Care, School of Health SciencesBelfastNorthern IrelandUK
| | - Philip J Wiffen
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordOxfordshireUKOX3 7LE
| | - Suzanne Martin
- University of UlsterFaculty of Life and Health SciencesShore RoadNewtownabbeyCo. Antrim Northern IrelandUKBT37 0QB
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Regier NG, Gitlin LN. Psychosocial and Environmental Treatment Approaches for Behavioral and Psychological Symptoms in Neurocognitive Disorders: an Update and Future Directions. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2017; 4:80-101. [PMID: 37465053 PMCID: PMC10353767 DOI: 10.1007/s40501-017-0105-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Nearly all persons with dementia will exhibit behavioral and psychological symptoms (BPSD) at some point during the course of the disease. These symptoms often pose significant challenges for formal and informal caregivers, and their treatment is unclear. Current guidelines recommend implementing nonpharmacological interventions as the first-line approach to managing BPSD. Given the recent proliferation of research evaluating the use of nonpharmacological interventions for BPSD, there is a continuing need to reevaluate and synthesize the findings in this area. The current review examines the evidence for using psychosocial and environmental strategies, focusing on the past 3 years of research efforts and assessing how this research augments what is known from prior reviews. We conclude that the results in the recent literature concerning the efficacy of psychosocial and environmental treatment approaches to behavioral symptoms in dementia continue to be promising, yet results are also mixed. We recommend the consideration of music therapy and tailored activities when utilizing a nonpharmacological approach, as these appear particularly promising throughout the literature. We also find that multisensory stimulation and animal-assisted therapy warrant further evaluation. In contrast, in this and previous reviews, approaches such as bright light therapy and aromatherapy have consistently been shown to be ineffective and, thus, cannot be recommended with confidence based on the evidence. We discuss limitations of current research studies and make recommendations for future research in the area of psychosocial and environmental interventions for BPSD.
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Affiliation(s)
- Natalie G. Regier
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
| | - Laura N. Gitlin
- Center for Innovative Care in Aging, Johns Hopkins School of Nursing, 525 North Wolfe Street, SON House Room 301, Baltimore, MD, 21205, USA
- Department of Community and Public Health, Johns Hopkins School of Nursing, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
- Department of Psychiatry, Johns Hopkins School of Medicine, 525 N. Wolfe Street, Suite 316, Baltimore, MD, 21205, USA
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Ortoleva Bucher C, Dubuc N, von Gunten A, Morin D. Du soin pratiqué au quotidien au consensus d’experts : état de l’évidence sur les interventions infirmières et leur priorisation selon le profil clinique des personnes âgées hospitalisées pour des symptômes comportementaux et psychologiques de la démence. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.124.0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Telenius EW, Engedal K, Bergland A. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial. BMC Geriatr 2015; 15:158. [PMID: 26630910 PMCID: PMC4668642 DOI: 10.1186/s12877-015-0151-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/20/2015] [Indexed: 11/26/2022] Open
Abstract
Background Research indicates that exercise can have a positive effect on both physical and mental health in nursing home patients with dementia, however the lasting effect is rarely studied. In a previously published article we investigated the immediate effect of a 12 weeks functional exercise program on physical function and mental health in nursing home residents with dementia. In this paper we studied the long-term effect of this exercise program. We explored the differences between the exercise and control group from baseline to 6 months follow-up and during the detraining period from month 3 to 6. Methods A single blind, randomized controlled trial was conducted and a total of 170 nursing home residents with dementia were included. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities. Thirty participants were lost between baseline and six-month follow-up. Linear mixed model analyses for repeated measurements were used to investigate the effect of exercise after detraining period. Results The exercise group improved their scores on Berg Balance Scale from baseline to 6 months follow-up by 2.7 points in average. The control group deteriorated in the same period and the difference between groups was statistically significant (p = 0.031). The exercise group also scored better on NPI agitation sub-score after 6 months (p = 0.045). Conclusion The results demonstrate long-time positive effects of a high intensity functional exercise program on balance and indicate a positive effect on agitation, after an intervention period of 12 weeks followed by a detraining period of 12 weeks. Identifier at ClinicalTrials.gov: NCT02262104
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Affiliation(s)
- Elisabeth Wiken Telenius
- Department of physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, PO Box 4 St Olavs plass, 0130, Oslo, Norway.
| | - Knut Engedal
- Norwegian Centre of Aging and Health, Department of Psychiatry, Vestfold Health Trust, Tønsberg and Oslo University Hospital, Oslo, Norway.
| | - Astrid Bergland
- Department of physiotherapy, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, PO Box 4 St Olavs plass, 0130, Oslo, Norway.
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Öhman H, Savikko N, Strandberg TE, Pitkälä KH. Effect of physical exercise on cognitive performance in older adults with mild cognitive impairment or dementia: a systematic review. Dement Geriatr Cogn Disord 2015; 38:347-65. [PMID: 25171577 DOI: 10.1159/000365388] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/19/2022] Open
Abstract
Numerous studies have shown that physical exercise has positive effects on cognition in healthy adults. Less is known about the effectiveness of exercise interventions in older individuals already suffering from mild cognitive impairment (MCI) or dementia. The aim of this study was to systematically review the evidence from randomized controlled trials (RCTs) of the effects of physical exercise on cognition in older subjects with MCI or dementia. PubMed, Cochrane and DARE databases were systematically searched for RCTs using terms related to cognition and physical exercise. Altogether, 22 trials were found. The studies on older subjects with MCI reported some positive effects of physical exercise on cognition, mainly on global cognition, executive function, attention and delayed recall. However, most studies performed on older subjects with dementia showed no effect of exercise on cognition. The studies had methodological problems in defining dementia/MCI diagnosis, blinding, inadequate sample sizes and not reporting dropouts, compliance or complications. More studies of good quality on older adults with dementia are needed.
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Affiliation(s)
- Hanna Öhman
- Rehabilitation and Care Services, City of Helsinki Hospital, Helsinki, Finland
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Olsen CF, Telenius EW, Engedal K, Bergland A. Increased self-efficacy: the experience of high-intensity exercise of nursing home residents with dementia - a qualitative study. BMC Health Serv Res 2015; 15:379. [PMID: 26369554 PMCID: PMC4570641 DOI: 10.1186/s12913-015-1041-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 09/04/2015] [Indexed: 12/25/2022] Open
Abstract
Background There has been increasing interest in the use of non-pharmacological interventions, such as physical exercise, to improve the well-being of nursing home residents with dementia. For reasons regarding disease symptoms, persons with dementia might find it difficult to participate in exercise programs. Therefore, it is important to find ways to successfully promote regular exercise for patients in residential care. Several quantitative studies have established the positive effects of exercise on biopsychosocial factors, such as self-efficacy in older people; however, little is known regarding the qualitative aspects of participating in an exercise program among older people with dementia. From the perspective of residents, we explored the experiences of participating in a high-intensity functional exercise program among nursing home residents with dementia. Methods The participants were eight elderly people with mild-to-moderate dementia. We conducted semi-structured interviews one week after they had finished a 10-week supervised high-intensity exercise program. We analyzed the data using an inductive content analysis. Results Five overreaching and interrelated themes emerged from the interviews: “Pushing the limits,” “Being invested in,” “Relationships facilitate exercise participation,” “Exercise revives the body, increases independence and improves self-esteem” and “Physical activity is a basic human necessity—use it or lose it!” The results were interpreted in light of Bandura’s self-efficacy theory. The exercise program seemed to improve self-efficacy through several mechanisms. By being involved, “being invested in” and having something expected of them, the participants gained a sense of empowerment in their everyday lives. The importance of social influences related to the exercise instructor and the exercise group was accentuated by the participants. Conclusions The nursing home residents had, for the most part, positive experiences with regard to participating in the exercise program. The program seemed to increase their self-efficacy through several mechanisms. The instructor competence emerged as an important facilitating factor. The participants emphasized the importance of physical activity in the nursing home.
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Affiliation(s)
- Cecilie Fromholt Olsen
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, 0130, Norway.
| | | | - Knut Engedal
- Oslo university Hospital, Ageing and Health, Norwegian Centre for Research, Education and Service Development, Oslo, 0424, Norway.
| | - Astrid Bergland
- Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, 0130, Norway.
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Yu F, Thomas W, Nelson NW, Bronas UG, Dysken M, Wyman JF. Impact of 6-month aerobic exercise on Alzheimer's symptoms. J Appl Gerontol 2015; 34:484-500. [PMID: 24652914 PMCID: PMC5696627 DOI: 10.1177/0733464813512895] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/20/2013] [Indexed: 11/17/2022] Open
Abstract
Little is known about how aerobic exercise affects Alzheimer's disease (AD). The purpose of this pilot study was to test the impact of 6-month cycling on AD symptoms in community-dwelling older adults with mild-to-moderate AD, using a single-group, repeated-measures design (n = 26). AD symptoms were measured with the AD Assessment Scale-Cognitive (ADAS-Cog), Disability in AD (DAD), and Neuropsychiatric Inventory-Caregiver (NPI-Q) scales at baseline, 3 and 6 months. Data were analyzed using mixed linear models. The ADAS-Cog, DAD, and NPI-Q severity scores remained unchanged over the 6-month period, while caregiver distress decreased 40% (p < .05). We conclude that aerobic exercise may reduce AD symptoms and appears effective in decreasing caregiver distress. Further randomized controlled trials are needed to examine the effects of aerobic exercise in AD.
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Affiliation(s)
- Fang Yu
- University of Minnesota, Minneapolis, USA
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Telenius EW, Engedal K, Bergland A. Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial. PLoS One 2015; 10:e0126102. [PMID: 25974049 PMCID: PMC4431827 DOI: 10.1371/journal.pone.0126102] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/28/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Dementia is among the leading causes of functional loss and disability in older adults. Research has demonstrated that nursing home patients without dementia can improve their function in activities of daily living, strength, balance and mental well being by physical exercise. The evidence on effect of physical exercise among nursing home patients with dementia is scarce and ambiguous. Thus, the primary objective of this study was to investigate the effect of a high intensity functional exercise program on the performance of balance in nursing home residents with dementia. The secondary objective was to examine the effect of this exercise on muscle strength, mobility, activities of daily living, quality of life and neuropsychiatric symptoms. DESIGN AND METHODS This single blinded randomized controlled trial was conducted among 170 persons with dementia living in nursing homes. Mean age was 86.7 years (SD = 7.4) and 74% were women. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities. RESULTS The intervention group improved the score on Bergs Balance Scale by 2.9 points, which was significantly more than the control group who improved by 1.2 points (p = 0.02). Having exercised 12 times or more was significantly associated with improved strength after intervention (p<0.05). The level of apathy was lower in the exercise group after the intervention, compared to the control group (p = 0.048). CONCLUSION The results from our study indicate that a high intensity functional exercise program improved balance and muscle strength as well as reduced apathy in nursing home patients with dementia. TRIAL REGISTRATION ClinicalTrials.gov NCT02262104.
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Affiliation(s)
- Elisabeth Wiken Telenius
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
| | - Knut Engedal
- Norwegian Centre of Aging and Health, Department of Psychiatry, Vestfold Health Trust, Tønsberg, Norway
| | - Astrid Bergland
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Department of Physiotherapy, Oslo, Norway
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Dawson A, Bowes A, Kelly F, Velzke K, Ward R. Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach. BMC Geriatr 2015; 15:59. [PMID: 25967742 PMCID: PMC4465454 DOI: 10.1186/s12877-015-0053-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 04/21/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND This paper synthesises research evidence about the effectiveness of services intended to support and sustain people with dementia to live at home, including supporting carers. The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards. However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes. METHODS Systematic searches of relevant electronic bibliographic databases crossing medical, psychological and social scientific literatures (CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science) in November 2012 were followed by structured review and full-text evaluation processes, the latter using methodology-appropriate quality assessment criteria drawing on established protocols. RESULTS Of 131 publications evaluated, 56 were assessed to be of 'high' quality, 62 of 'medium' quality and 13 of 'low' quality. Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions. Thematic analysis revealed multiple gaps in the evidence base, including in relation to take-up and use of self-directed support by people with dementia, use of rapid response teams and other multidisciplinary approaches, use of technology to support community-dwelling people with dementia, and support for people without access to unpaid or informal support. CONCLUSIONS In many areas, policy and practice developments are proceeding on a limited evidence base. Key issues affecting substantial numbers of existing studies include: poorly designed and overly narrowly focused studies; variability and uncertainty in outcome measurement; lack of focus on the perspectives of people with dementia and supporters; and failure to understanding the complexities of living with dementia, and of the kinds of multifactorial interventions needed to provide holistic and effective support. Weaknesses in the evidence base present challenges both to practitioners looking for guidance on how best to design and deliver evidence-based services to support people living with dementia in the community and their carers and to those charged with the inspection of services.
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Affiliation(s)
- Alison Dawson
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
| | - Alison Bowes
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
| | - Fiona Kelly
- Bournemouth University Dementia Institute (BUDI), Bournemouth University, Bournemouth, BH12, UK.
| | - Kari Velzke
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
| | - Richard Ward
- School of Applied Social Science, University of Stirling, Stirling, FK9 4LA, UK.
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Abstract
Behavioral and psychological symptoms of dementia include agitation, depression, apathy, repetitive questioning, psychosis, aggression, sleep problems, wandering, and a variety of inappropriate behaviors. One or more of these symptoms will affect nearly all people with dementia over the course of their illness. These symptoms are among the most complex, stressful, and costly aspects of care, and they lead to a myriad of poor patient health outcomes, healthcare problems, and income loss for family care givers. The causes include neurobiologically related disease factors; unmet needs; care giver factors; environmental triggers; and interactions of individual, care giver, and environmental factors. The complexity of these symptoms means that there is no "one size fits all solution," and approaches tailored to the patient and the care giver are needed. Non-pharmacologic approaches should be used first line, although several exceptions are discussed. Non-pharmacologic approaches with the strongest evidence base involve family care giver interventions. Regarding pharmacologic treatments, antipsychotics have the strongest evidence base, although the risk to benefit ratio is a concern. An approach to integrating non-pharmacologic and pharmacologic treatments is described. Finally, the paradigm shift needed to fully institute tailored treatments for people and families dealing with these symptoms in the community is discussed.
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Affiliation(s)
- Helen C Kales
- Section of Geriatric Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA Geriatric Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Laura N Gitlin
- Department of Community Public Health, School of Nursing, Johns Hopkins University, Baltimore, MD, USA Division of Geriatrics and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Constantine G Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview and Johns Hopkins University, Baltimore, MD, USA
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Yu F, Demorest SL, Vock DM. Testing a modified perceived exertion scale for Alzheimer's disease. Psych J 2015; 4:38-46. [DOI: 10.1002/pchj.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/17/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Fang Yu
- School of Nursing; University of Minnesota; Minneapolis Minnesota USA
| | | | - David M. Vock
- Department of Biostatistics; University of Minnesota; Minneapolis Minnesota USA
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Dhami P, Moreno S, DeSouza JFX. New framework for rehabilitation - fusion of cognitive and physical rehabilitation: the hope for dancing. Front Psychol 2015; 5:1478. [PMID: 25674066 PMCID: PMC4309167 DOI: 10.3389/fpsyg.2014.01478] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/01/2014] [Indexed: 12/29/2022] Open
Abstract
Neurorehabilitation programs are commonly employed with the goal to help restore functionality in patients. However, many of these therapies report only having a small impact. In response to the need for more effective and innovative approaches, rehabilitative methods that take advantage of the neuroplastic properties of the brain have been used to aid with both physical and cognitive impairments. Following this path of reasoning, there has been a particular interest in the use of physical exercise as well as musical related activities. Although such therapies demonstrate potential, they also have limitations that may affect their use, calling for further exploration. Here, we propose dance as a potential parallel to physical and music therapies. Dance may be able to aid with both physical and cognitive impairments, particularly due to it combined nature of including both physical and cognitive stimulation. Not only does it incorporate physical and motor skill related activities, but it can also engage various cognitive functions such as perception, emotion, and memory, all while done in an enriched environment. Other more practical benefits, such as promoting adherence due to being enjoyable, are also discussed, along with the current literature on the application of dance as an intervention tool, as well as future directions required to evaluate the potential of dance as an alternative therapy in neurorehabilitation.
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Affiliation(s)
- Prabhjot Dhami
- Department of Biology, York UniversityToronto, ON, Canada
| | - Sylvain Moreno
- Rotman Research Institute at Baycrest HospitalToronto, ON, Canada
- Department of Psychology, University of TorontoToronto, ON, Canada
| | - Joseph F. X. DeSouza
- Department of Biology, York UniversityToronto, ON, Canada
- Department of Psychology, Centre for Vision Research, York UniversityToronto, ON, Canada
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Boyle CP, Raji CA, Erickson KI, Lopez OL, Becker JT, Gach HM, Longstreth WT, Teverovskiy L, Kuller LH, Carmichael OT, Thompson PM. Physical activity, body mass index, and brain atrophy in Alzheimer's disease. Neurobiol Aging 2015; 36 Suppl 1:S194-S202. [PMID: 25248607 PMCID: PMC4303036 DOI: 10.1016/j.neurobiolaging.2014.05.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/23/2014] [Accepted: 05/08/2014] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to use a novel imaging biomarker to assess associations between physical activity (PA), body mass index (BMI), and brain structure in normal aging, mild cognitive impairment, and Alzheimer's dementia. We studied 963 participants (mean age: 74.1 ± 4.4 years) from the multisite Cardiovascular Health Study including healthy controls (n = 724), Alzheimer's dementia patients (n = 104), and people with mild cognitive impairment (n = 135). Volumetric brain images were processed using tensor-based morphometry to analyze regional brain volumes. We regressed the local brain tissue volume on reported PA and computed BMI, and performed conjunction analyses using both variables. Covariates included age, sex, and study site. PA was independently associated with greater whole brain and regional brain volumes and reduced ventricular dilation. People with higher BMI had lower whole brain and regional brain volumes. A PA-BMI conjunction analysis showed brain preservation with PA and volume loss with increased BMI in overlapping brain regions. In one of the largest voxel-based cross-sectional studies to date, PA and lower BMI may be beneficial to the brain across the spectrum of aging and neurodegeneration.
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Affiliation(s)
- Christina P. Boyle
- Imaging Genetics Center, and Departments of Neurology, Psychiatry, Pediatrics, Engineering, Radiology, and Ophthalmology, Keck USC School of Medicine, University of Southern California, Los Angeles, CA
| | - Cyrus A. Raji
- Imaging Genetics Center, and Departments of Neurology, Psychiatry, Pediatrics, Engineering, Radiology, and Ophthalmology, Keck USC School of Medicine, University of Southern California, Los Angeles, CA
- Department of Radiology, UCLA School of Medicine, Los Angeles, CA
| | - Kirk I. Erickson
- Department of Psychology University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Oscar L. Lopez
- Department of Neurology University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - James T. Becker
- Department of Psychology University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Neurology University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Psychiatry University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - H. Michael Gach
- Department of Radiology at University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - W. T. Longstreth
- Departments of Neurology and Epidemiology, University of Washington, Seattle, WA
| | - Leonid Teverovskiy
- Department of Psychology University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Lewis H. Kuller
- Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health at Pittsburgh, PA
| | | | - Paul M. Thompson
- Imaging Genetics Center, and Departments of Neurology, Psychiatry, Pediatrics, Engineering, Radiology, and Ophthalmology, Keck USC School of Medicine, University of Southern California, Los Angeles, CA
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Frederiksen KS, Sobol N, Beyer N, Hasselbalch S, Waldemar G. Moderate-to-high intensity aerobic exercise in patients with mild to moderate Alzheimer's disease: a pilot study. Int J Geriatr Psychiatry 2014; 29:1242-8. [PMID: 24733599 DOI: 10.1002/gps.4096] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 12/11/2013] [Accepted: 02/03/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Physical exercise may modulate neuropathology and symptoms of Alzheimer's disease (AD). This pilot study assessed the feasibility of conducting a study of moderate-to-high intensity aerobic exercise in home-dwelling patients with mild AD. METHODS An uncontrolled preintervention-postintervention test design with a single group receiving the same intervention. A total of eight patients with mild to moderate AD from the Copenhagen Memory clinic were included in the study. The intervention lasted for 14 weeks and consisted of supervised, 1-h sessions of aerobic exercise three times per week (50-60% of heart rate reserve for a two-week adaptation period and 70-80 % of heart rate reserve for the remaining 12 weeks) Feasibility was assessed based on acceptability, including attendance and drop-out, safety, and patients' and caregivers' attitudes towards the intervention as well as other relevant parameters. RESULTS Attendance (mean, range: 90 %, 70-100 %) and retention (seven out of eight) rates were very high. No serious adverse events were observed. In general, patients and caregivers were positive towards the intervention. CONCLUSION This study shows that it is feasible to conduct moderate-to-high intensity aerobic exercise in community-dwelling patients with mild AD. Our findings indicate that aspects such as a longer adaptation period, information about injury prevention, and need for involvement and support from caregivers should be addressed when planning an exercise intervention in an AD population.
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Affiliation(s)
- Kristian S Frederiksen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Rigshospitalet, Copenhagen, Denmark
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Matta Mello Portugal E, Cevada T, Sobral Monteiro-Junior R, Teixeira Guimarães T, da Cruz Rubini E, Lattari E, Blois C, Camaz Deslandes A. Neuroscience of exercise: from neurobiology mechanisms to mental health. Neuropsychobiology 2014; 68:1-14. [PMID: 23774826 DOI: 10.1159/000350946] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 03/24/2013] [Indexed: 11/19/2022]
Abstract
The neuroscience of exercise is a growing research area that is dedicated to furthering our understanding of the effects that exercise has on mental health and athletic performance. The present study examined three specific topics: (1) the relationship between exercise and mental disorders (e.g. major depressive disorder, dementia and Parkinson's disease), (2) the effects of exercise on the mood and mental health of athletes, and (3) the possible neurobiological mechanisms that mediate the effects of exercise. Positive responses to regular physical exercise, such as enhanced functional capacity, increased autonomy and improved self-esteem, are frequently described in the recent literature, and these responses are all good reasons for recommending regular exercise. In addition, physical exercise may improve both mood and adherence to an exercise program in healthy individuals and might modulate both the performance and mental health of athletes. Exercise is associated with the increased synthesis and release of both neurotransmitters and neurotrophic factors, and these increases may be associated with neurogenesis, angiogenesis and neuroplasticity. This review is a call-to-action that urges researchers to consider the importance of understanding the neuroscience of physical exercise and its contributions to sports science.
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Zhu CW, Sano M, Ferris SH, Whitehouse PJ, Patterson MB, Galasko D, Schneider LS, Aisen PS. Alzheimer's Disease Cooperative Study Prevention Instrument Project assessing resource use and volunteer and paid work in healthy elders: a longitudinal study. J Am Geriatr Soc 2014; 62:985-8. [PMID: 24828933 DOI: 10.1111/jgs.12816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carolyn W Zhu
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York
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Lowery D, Cerga-Pashoja A, Iliffe S, Thuné-Boyle I, Griffin M, Lee J, Bailey A, Bhattacharya R, Warner J. The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. Int J Geriatr Psychiatry 2014; 29:819-27. [PMID: 24338799 DOI: 10.1002/gps.4062] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/01/2013] [Accepted: 11/17/2013] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the effectiveness of a simple dyadic (person with dementia and their main carer) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia. METHOD A two arm, pragmatic, randomised, controlled, single-blind, parallel-group trial of a dyadic exercise regimen (individually tailored walking regimen designed to become progressively intensive and last between 20-30 min, at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following: clinically significant behavioural and psychological symptoms, a carer willing and able to co-participate in the exercise regimen, and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study. RESULTS One hundred and thirty-one dyads were recruited to this study. There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not (adjusted difference in means (intervention minus control) = -1.53, p = 0.6, 95% CI [-7.37, 4.32]). There was a significant between-group difference in caregiver's burden as measured by the Zarit Caregiver Burden Inventory at week 12 (OR = 0.18, p = 0.01, CI [0.05, 0.69]) favouring the exercise group. CONCLUSIONS This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia, but did seem to attenuate caregiver burden. Further study to improve exercise uptake are needed.
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Affiliation(s)
- David Lowery
- Central and North West London NHS Foundation Trust (CNWL), London, UK; Primary Care and Population Health, University College London (UCL), London, UK
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Zabalegui A, Hamers JPH, Karlsson S, Leino-Kilpi H, Renom-Guiteras A, Saks K, Soto M, Sutcliffe C, Cabrera E. Best practices interventions to improve quality of care of people with dementia living at home. PATIENT EDUCATION AND COUNSELING 2014; 95:175-184. [PMID: 24525223 DOI: 10.1016/j.pec.2014.01.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 01/08/2014] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To identify effective interventions which improve quality of care for people with dementia (PwD) living at home. METHODS MEDLINE-(via PubMed), CINAHL, PsycINFO and ISI Web of Science databases were searched. INCLUSION CRITERIA (1) randomized controlled trials; (2) published in English-language, peer-reviewed journals between 1990 and 2012; (3) evaluated strategies to improve quality of care for PwD cared at home; and (4) participants older than 65. RESULTS 23 studies met inclusion criteria. All the studies aimed to improve PwD quality of care and most of them focused on PwD caregivers. Psychoeducational programs are the most frequently assessed interventions and multicomponent interventions produced the most promising results. CONCLUSION Due to the great variety of interventions describing specific samples and contexts, comparison of practice effectiveness is difficult. However, cognitive rehabilitation in PwD is effective when applied at an early stage of the disease. Case managers have demonstrated to reduce PwD institutionalization and the use of other community services. The studies were limited by sample heterogeneity, short follow-up or insufficiently detailed description. PRACTICE IMPLICATIONS To improve PwD homecare, health professionals should educate and support caregivers. Before specific interventional recommendations can be made, further research addressing the limitations of current studies is needed.
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Affiliation(s)
| | - Jan P H Hamers
- Care of Older People at Maastricht University, The Netherlands
| | | | | | | | | | - Maria Soto
- Alzheimer Acute Care Unit, Gérontopôle Toulouse, Department of Geriatric Medicine University Hospital, France
| | | | - Esther Cabrera
- School of Health Sciences at Fundació Tecnocampus Mataró-Maresme Tecnocampus, Spain
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Carvalho A, Rea IM, Parimon T, Cusack BJ. Physical activity and cognitive function in individuals over 60 years of age: a systematic review. Clin Interv Aging 2014; 9:661-82. [PMID: 24748784 PMCID: PMC3990369 DOI: 10.2147/cia.s55520] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND It is unclear whether physical activity in later life is beneficial for maintenance of cognitive function. We performed a systematic review examining the effects of exercise on cognitive function in older individuals, and present possible mechanisms whereby physical activity may improve cognition. METHODS Sources consisted of PubMed, Medline, CINAHL, the Cochrane Controlled Trials Register, and the University of Washington, School of Medicine Library Database, with a search conducted on August 15, 2012 for publications limited to the English language starting January 1, 2000. Randomized controlled trials including at least 30 participants and lasting at least 6 months, and all observational studies including a minimum of 100 participants for one year, were evaluated. All subjects included were at least 60 years of age. RESULTS Twenty-seven studies met the inclusion criteria. Twenty-six studies reported a positive correlation between physical activity and maintenance or enhancement of cognitive function. Five studies reported a dose-response relationship between physical activity and cognition. One study showed a nonsignificant correlation. CONCLUSION The preponderance of evidence suggests that physical activity is beneficial for cognitive function in the elderly. However, the majority of the evidence is of medium quality with a moderate risk of bias. Larger randomized controlled trials are needed to clarify the association between exercise and cognitive function and to determine which types of exercise have the greatest benefit on specific cognitive domains. Despite these caveats, the current evidence suggests that physical activity may help to improve cognitive function and, consequently, delay the progression of cognitive impairment in the elderly.
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Affiliation(s)
- Ashley Carvalho
- Department of Public Health, Queen’s University Belfast, Northern Ireland, UK
- School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Northern Ireland, UK
| | - Irene Maeve Rea
- School of Medicine, Dentistry and Biomedical Science, Queen’s University Belfast, Northern Ireland, UK
| | - Tanyalak Parimon
- Research and Development Service, Veterans Affairs Medical Center, Boise, ID, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Barry J Cusack
- Research and Development Service, Veterans Affairs Medical Center, Boise, ID, USA
- Division of Gerontology and Geriatric Medicine, Department of Medicine, University of Washington, Seattle, WA, USA
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Rodriguez-Sánchez E, Criado-Gutiérrez JM, Mora-Simón S, Muriel-Diaz MP, Gómez-Marcos MA, Recio-Rodríguez JI, Patino-Alonso MC, Valero-Juan LF, Maderuelo-Fernandez JA, García-Ortiz L. Physical activity program for patients with dementia and their relative caregivers: randomized clinical trial in Primary Health Care (AFISDEMyF study). BMC Neurol 2014; 14:63. [PMID: 24684948 PMCID: PMC3972512 DOI: 10.1186/1471-2377-14-63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 03/21/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aging of the population has led to the increase of chronic diseases, especially dementia and cardiovascular diseases, and it has become necessary for their relatives to dedicate more time in caregiving.The objective in the first phase of this study is to evaluate the effectiveness of a Primary Health Care procedure to increase the physical activity of people with dementia and their relative caregivers. Also the effect on the cognitive state and cardiovascular risk will be assessed. METHODS/DESIGN DESIGN Clinical, multicentric and randomized trial. A simple random sampling to select 134 patients diagnosed with dementia will be carried out. After contacting their relatives, his/her participation in the trial will be requested. A basal assessment will be made and the participants will be asigned to control or intervention group (1:1). VARIABLES The main measure will be the assessment of physical activity (podometer and 7-PAR) in patients and caregivers. In patients with dementia: ADAS-cog, functional degree and cardiovascular risk. In caregivers: cardiovascular risk, general health and quality of life. INTERVENTION For 3 months, participants will receive instructions to do physical activity with an adapted program. This program will be designed and applied by Primary Health Care professionals in patients with dementia and their caregivers. The control group will receive regular care. ANALYSIS An intention-to-treat analysis will be carried out by comparing the observed differences between basal, 6 and 12 months measures. Change in the mean of daily steps assessed with the podometer and 7-PAR will be the main result. DISCUSSION If the main hypothesis is confirmed, it could be useful to improve the cognitive state of patients with dementia, as well as the cardiovascular risk of all of them. The results can be good to improve technical features of the devices that register the physical activity in the patients with dementia, and it could facilitate its commercialization. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT02044887.
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Affiliation(s)
- Emiliano Rodriguez-Sánchez
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Medicine Department, University of Salamanca, Salamanca, Spain
- Unidad de Investigación, Centro de Salud La Alamedilla, 37003 Salamanca, Spain
| | | | - Sara Mora-Simón
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Basic Psychology, Psychobiology and Behavioral Sciences Methodology Department, University of Salamanca, Salamanca, Spain
| | - M Paz Muriel-Diaz
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Medicine Department, University of Salamanca, Salamanca, Spain
| | - José I Recio-Rodríguez
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
| | - M Carmen Patino-Alonso
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Statistics Department, University of Salamanca, Salamanca, Spain
| | - Luis F Valero-Juan
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Preventive Medicine, Public Health and Medical Microbiology Department, University of Salamanca, Salamanca, Spain
| | - José A Maderuelo-Fernandez
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
| | - Luis García-Ortiz
- Primary Health Care Research Unit The Alamedilla. The Alamedilla Primary Health Center, Castilla-Leon Health Service–SACYL, IBSAL, Salamanca, Spain
- Medicine Department, University of Salamanca, Salamanca, Spain
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Arcoverde C, Deslandes A, Moraes H, Almeida C, Araujo NBD, Vasques PE, Silveira H, Laks J. Treadmill training as an augmentation treatment for Alzheimer?s disease: a pilot randomized controlled study. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:190-6. [DOI: 10.1590/0004-282x20130231] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 10/30/2013] [Indexed: 11/22/2022]
Abstract
Objective To assess the effect of aerobic exercise on the cognition and functional capacity in Alzheimer’s disease (AD) patients. Method Elderly (n=20) with mild dementia (NINCDS-ADRDA/CDR1) were randomly assigned to an exercise group (EG) on a treadmill (30 minutes, twice a week and moderate intensity of 60% VO2max) and control group (GC) 10 patients. The primary outcome measure was the cognitive function using Cambridge Cognitive Examination (CAMCOG). Specifics instruments were also applied to evaluate executive function, memory, attention and concentration, cognitive flexibility, inhibitory control and functional capacity. Results After 16 weeks, the EG showed improvement in cognition CAMCOG whereas the CG declined. Compared to the CG, the EG presented significant improvement on the functional capacity. The analysis of the effect size has shown a favorable response to the physical exercise in all dependent variables. Conclusion Walking on treadmill may be recommended as an augmentation treatment for patients with AD.
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Affiliation(s)
| | | | | | | | | | | | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro; Instituto Vital Brazil
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TAKADA A, PARK P, SHIGEMUNE Y, TSUKIURA T. HEALTH-RELATED QOL AND LIFESTYLES ARE ASSOCIATED WITH COGNITIVE FUNCTIONS IN ELDERLY PEOPLE. PSYCHOLOGIA 2014. [DOI: 10.2117/psysoc.2014.177] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kirk-Sanchez NJ, McGough EL. Physical exercise and cognitive performance in the elderly: current perspectives. Clin Interv Aging 2013; 9:51-62. [PMID: 24379659 PMCID: PMC3872007 DOI: 10.2147/cia.s39506] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
In an aging population with increasing incidence of dementia and cognitive impairment, strategies are needed to slow age-related decline and reduce disease-related cognitive impairment in older adults. Physical exercise that targets modifiable risk factors and neuroprotective mechanisms may reduce declines in cognitive performance attributed to the normal aging process and protect against changes related to neurodegenerative diseases such as Alzheimer’s disease and other types of dementia. In this review we summarize the role of exercise in neuroprotection and cognitive performance, and provide information related to implementation of physical exercise programs for older adults. Evidence from both animal and human studies supports the role of physical exercise in modifying metabolic, structural, and functional dimensions of the brain and preserving cognitive performance in older adults. The results of observational studies support a dose-dependent neuroprotective relationship between physical exercise and cognitive performance in older adults. Although some clinical trials of exercise interventions demonstrate positive effects of exercise on cognitive performance, other trials show minimal to no effect. Although further research is needed, physical exercise interventions aimed at improving brain health through neuroprotective mechanisms show promise for preserving cognitive performance. Exercise programs that are structured, individualized, higher intensity, longer duration, and multicomponent show promise for preserving cognitive performance in older adults.
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Affiliation(s)
- Neva J Kirk-Sanchez
- Department of Physical Therapy, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ellen L McGough
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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‘What I want to do is get half a dozen of them and go and see Simon Cowell’: Reflecting on participation and outcomes for people with dementia taking part in a creative musical project. DEMENTIA 2013; 14:734-50. [DOI: 10.1177/1471301213508128] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This paper presents the findings from an evaluation of a creative musical project led by Scottish Opera. The project included people with dementia and their carers in the development, writing, design and performance of a musical production about their experiences of love. The project involved professional singers, artists and choreographers from the opera company. Activities involved practice sessions and performances. People with dementia and their carers reflected on positive outcomes from the project including improved confidence; being part of a group; improved physical strength and people seeing them in a new way. Within the evaluation framework they also reported on how the project had been run and gave ideas for future development. Key elements in the success of this project were the involvement of professionals, the kudos of working with a national organisation and the performances that, while daunting, provided unique and rewarding experiences.
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Bowes A, Dawson A, Jepson R, McCabe L. Physical activity for people with dementia: a scoping study. BMC Geriatr 2013; 13:129. [PMID: 24274624 PMCID: PMC4222572 DOI: 10.1186/1471-2318-13-129] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 11/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This scoping study aimed to identify how physical activity may benefit people with dementia; how and/or if current service provide these benefits; and what support they need to do so. METHODS Methods included an evidence review using literature; mapping current service provision through a survey; and in-depth interviews with a sample of service providers. RESULTS The 26 studies included in the review indicated the potential effectiveness of physical activity for people with dementia, including improvements in cognition and mood, behaviour and physical condition. Mechanisms of action and the link with outcomes were poorly defined and implemented.The mapping survey and related interviews showed that service providers were delivering a range of services broadly consistent with the scientific evidence. They tended to take a holistic view of possible benefits, and focused on enjoyment and well-being, more than specific cognitive, physical and behavioural outcomes highlighted in literature. Service providers needed more evidence based information and resources to develop services and realise their potential. CONCLUSION Despite potential benefits demonstrated in literature and practice, there is a need for further research to optimise interventions and to consider some neglected issues including delivery at home and in communities; impacts for carers; physical activities through ADLs; and individual needs. Studies are needed which take a more holistic approach to the effects of physical activity, and outcomes should be broader and include mental health and wellbeing.
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Affiliation(s)
- Alison Bowes
- School of Applied Social Science, University of Stirling, Stirling, Scotland FK9 4LA, UK
| | - Alison Dawson
- School of Applied Social Science, University of Stirling, Stirling, Scotland FK9 4LA, UK
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, 20 West Richmond Street, Edinburgh, Scotland EH8 9DX, UK
| | - Louise McCabe
- School of Applied Social Science, University of Stirling, Stirling, Scotland FK9 4LA, UK
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Palm R, Köhler K, Schwab CGG, Bartholomeyczik S, Holle B. Longitudinal evaluation of dementia care in German nursing homes: the "DemenzMonitor" study protocol. BMC Geriatr 2013; 13:123. [PMID: 24237990 PMCID: PMC3840731 DOI: 10.1186/1471-2318-13-123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 11/05/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Germany, the number of people with dementia living in nursing homes is rapidly increasing. Providing adequate care for their special needs is a challenge for institutions and their staff members. Because of the growing number of people with dementia, changes to the conceptual orientation of nursing homes have occurred. These changes include specialized living arrangements and psychosocial interventions recommended for people with dementia. Until now, the provision of dementia care and its association to the residents' behavior and quality of life is not well investigated in Germany. The purpose of this study is to describe the provision of dementia care and to identify resident- as well as facility-related factors associated with residents behavior and quality of life. METHODS/DESIGN The DemenzMonitor study is designed as a longitudinal study that is repeated annually. Data will be derived from a convenience sample consisting of nursing homes across Germany. For the data collection, three questionnaires have been developed that measure information on the level of the nursing home, the living units, and the residents. Data collection will be performed by staff members from the nursing homes. The data collection procedure will be supervised by a study coordinator who is trained by the research team. Data analysis will be performed on each data level using appropriate techniques for descriptions and comparisons as well as longitudinal regression analysis. DISCUSSION The DemenzMonitor is the first study in Germany that assesses how dementia care is provided in nursing homes with respect to living arrangements and recommended interventions. This study links the acquired data with residents' outcome measurements, making it possible to evaluate different aspects and concepts of care.
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Affiliation(s)
- Rebecca Palm
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
- Witten/Herdecke University (UW/H), Faculty of Health, School of Nursing Science, Stockumer Str. 12, 48453, Witten, Germany
| | - Kerstin Köhler
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
| | - Christian GG Schwab
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
- Witten/Herdecke University (UW/H), Faculty of Health, School of Nursing Science, Stockumer Str. 12, 48453, Witten, Germany
| | - Sabine Bartholomeyczik
- Witten/Herdecke University (UW/H), Faculty of Health, School of Nursing Science, Stockumer Str. 12, 48453, Witten, Germany
| | - Bernhard Holle
- German Centre for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 48453, Witten, Germany
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van Schijndel-Speet M, Evenhuis HM, van Empelen P, van Wijck R, Echteld MA. Development and evaluation of a structured programme for promoting physical activity among seniors with intellectual disabilities: a study protocol for a cluster randomized trial. BMC Public Health 2013; 13:746. [PMID: 23938154 PMCID: PMC3751469 DOI: 10.1186/1471-2458-13-746] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 08/02/2013] [Indexed: 11/25/2022] Open
Abstract
Background Older people with intellectual disabilities have very low physical activity levels. Well designed, theory-driven and evidence-based health promotion programmes for the target population are lacking. This paper describes the design of a cluster-randomised trial for a systematically developed health promotion programme aimed at improving physical activity and increasing fitness among seniors with intellectual disabilities. Methods and design The Intervention Mapping protocol was used for programme development. After defining the programme’s objectives, the following behavioural techniques were selected to achieve them: Tailoring, Education, Modelling, Mirroring, Feedback, Reinforcement and Grading. With professionals and managers of provider services for people with intellectual disabilities, we translated these strategies into a structured day-activity programme, that consisted of a physical activity and an education programme. The programme will be executed in five day-activity centres in groups of eight to ten seniors during eight months, whereas seniors in five other centres receive care as usual. The physical activity level, as measured in number of steps a day, will be used as primary outcome measurement. Secondary outcome measurements include motor fitness, cardio respiratory fitness, morphological and metabolic fitness, ADL, functional deterioration and depressive symptoms. Differences in the primary and secondary outcome measures between participants and controls will be analysed using generalized estimation equations, correcting for day-activity center as cluster. Discussion This paper provides insight into the development and content of a theory-driven intervention aimed at behavioural change in a population with a low intellectual level. Its evaluation design is described. The programme’s applicability to other populations is discussed. Trial registration Trial number: ISRCTN82341588
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Affiliation(s)
- Marieke van Schijndel-Speet
- Department of General Practice, Intellectual Disability Medicine, Erasmus Medical Centre Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
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Yu F. Improving recruitment, retention, and adherence to 6-month cycling in Alzheimer's disease. Geriatr Nurs 2013; 34:181-6. [PMID: 23414638 DOI: 10.1016/j.gerinurse.2012.12.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 12/28/2012] [Accepted: 12/31/2012] [Indexed: 11/15/2022]
Abstract
There is a pressing need to establish recruitment, retention, and adherence feasibility to inform clinical trials that will evaluate how exercise affects the symptoms and disease trajectory in Alzheimer's disease (AD). This paper reported the recruitment rate, retention, and adherence from a 6-month cycling study in community-dwelling older adults with mild-to-moderate AD using a single-group, repeated-measures design. Seven recruitment strategies were tested. Participants were prescribed an individualized, 15-45-min moderate intensity cycling 3 times a week for 6 months. The results showed a 1.87 recruitment rate (No. of participants recruited per month per site), 78.6% retention (No. of completers/No. of enrolled participants), and 86.4% adherence (number sessions meeting prescription dose/total number of sessions). The findings addressed a major gap in aerobic exercise studies in AD. Successful recruitment relies on community partnership, whereas strategies for ensuring participant exercise safety collectively improved retention and adherence.
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Affiliation(s)
- Fang Yu
- University of Minnesota, School of Nursing, Minneapolis, MN, USA.
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Bossers WJR, van der Woude LHV, Boersma F, Scherder EJA, van Heuvelen MJG. Recommended measures for the assessment of cognitive and physical performance in older patients with dementia: a systematic review. Dement Geriatr Cogn Dis Extra 2012; 2:589-609. [PMID: 23341825 PMCID: PMC3551396 DOI: 10.1159/000345038] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim/Goal To recommend a set of neuropsychological and physical exercise tests for researchers to assess cognition and physical fitness in clinical trials with older patients with dementia; to create consensus, decrease heterogeneity, and improve research quality. Methods A literature search (2005–2011) yielded 89 randomized controlled trials. To provide information on test recommendations the frequency of test use, effect size of the test outcome, study quality, and psychometric properties of tests were analyzed. Results Fifty-nine neuropsychological tests (cognitive domains: global cognition, executive functioning, memory, and attention) and 10 exercise tests (physical domains: endurance capacity, muscle strength, balance, and mobility) were found. Conclusion The Severe Impairment Battery, Mini Mental State Examination, and Alzheimer Disease Assessment Scale – cognitive subscale were recommended to measure global cognition. The Verbal Fluency Test Category/Letters, Clock Drawing Test, and Trail Making Test-B were recommended to measure executive functioning. No specific memory test could be recommended. The Digit Span Forward, Digit Span Backward, and Trail Making Test-A were recommended to measure attention. As physical exercise tests, the Timed Up and Go and Six Meter Walk for mobility, the Six Minute Walk Distance for endurance capacity, and the Tinetti Balance Scale were recommended.
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Affiliation(s)
- Willem J R Bossers
- Center for Human Movement Sciences, Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Yao L, Giordani BJ, Algase DL, You M, Alexander NB. Fall risk-relevant functional mobility outcomes in dementia following dyadic tai chi exercise. West J Nurs Res 2012; 35:281-96. [PMID: 22517441 DOI: 10.1177/0193945912443319] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Whether persons with dementia benefit from fall prevention exercise is unclear. Applying the Positive Emotion-Motivated Tai Chi protocol, preliminary findings concerning adherence and effects of a dyadic Tai Chi exercise program on persons with Alzheimer's disease (AD) are reported. Using pre/posttest design, 22 community-dwelling AD-caregiver dyads participated in the program. Fall-risk-relevant functional mobility was measured using Unipedal Stance Time (UST) and Timed Up and Go (TUG) tests. Results showed that 19/22 (86.4%) AD patients completed the 16-week program and final assessment; 16/19 dyads (84.2%) completed the prescribed home program as reported by caregivers. UST adjusted mean improved from 4.0 to 5.1 (Week 4, p < .05) and 5.6 (Week 16, p < .05); TUG improved from 13.2 to 11.6 (Week 4, p < .05) and 11.6 (Week 16, p > .05) post intervention. Retaining dementia patients in an exercise intervention remains challenging. The dyadic Tai Chi approach appears to succeed in keeping AD-caregiver dyads exercising and safe.
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Affiliation(s)
- Lan Yao
- College of Nursing, Michigan State University, B515-H West Fee Hall, East Lansing, MI 48824, USA.
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