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Lenox ER, Jones MW. Balance-based exercise programs on balance in older adults with mild to moderate dementia: A critically appraised topic. Ageing Res Rev 2023; 91:102073. [PMID: 37709056 DOI: 10.1016/j.arr.2023.102073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE It is well established that exercise programs including balanced-based exercises are practical and beneficial for cognitively healthy older adults. However, there is limited evidence to determine if these types of training regimens are effective for individuals with dementia. We conducted a critical appraisal to determine if the addition of balance-based exercise programs, compared with usual care at residential homes, improved balance in adults diagnosed with mild to moderate dementia. MATERIALS AND METHODS Four databases were searched for randomized control trials implementing balanced-based exercise programs with individuals diagnosed with mild to moderate dementia. The articles were evaluated based on the Centre for Evidence Based Medicine level of evidence criteria and appraised using the PEDro scale. RESULTS A comprehensive literature search revealed four studies relevant to the clinical question that fit the inclusion and exclusion criteria. All four studies indicated an improvement in balance following a weekly physical therapy program implementing balance-based exercises. CONCLUSIONS There is sufficient evidence to suggest that the use of physical therapy programs that include balance-based exercises, performed 1-2 times a week over the course of 12-25 weeks, improves balance in elderly adults with mild to moderate dementia.
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Affiliation(s)
- Ella R Lenox
- Biological Sciences Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407, USA.
| | - Michael W Jones
- Biological Sciences Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407, USA.
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Ullrich P, Werner C, Bongartz M, Eckert T, Abel B, Schönstein A, Kiss R, Hauer K. Increasing Life-Space Mobility in Community-Dwelling Older Persons With Cognitive Impairment Following Rehabilitation: A Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2020; 76:1988-1996. [PMID: 33021670 DOI: 10.1093/gerona/glaa254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. METHODS Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17-26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. RESULTS One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89-13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00-0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. CONCLUSIONS The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.
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Affiliation(s)
- Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | - Christian Werner
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany.,Center of Geriatric Medicine, Heidelberg University, Germany
| | - Martin Bongartz
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | - Tobias Eckert
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | - Bastian Abel
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany
| | | | - Rainer Kiss
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany.,FHM Bielefeld, University of Applied Sciences, Germany
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Germany.,Center of Geriatric Medicine, Heidelberg University, Germany
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Pomiersky R, Abel B, Werner C, Lacroix A, Pfeiffer K, Schäufele M, Hauer K. Increasing Physical Activity in Persons With Dementia: A Randomized Controlled Trial. J Aging Phys Act 2020; 28:588-597. [PMID: 31896078 DOI: 10.1123/japa.2019-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/06/2019] [Accepted: 11/12/2019] [Indexed: 11/18/2022]
Abstract
This study investigated the effectivity and sustainability of a physical activity (PA) promotion and motor training programs and analyzed predictors for PA changes in persons with dementia. A total of 122 participants with mild-to-moderate dementia were randomized to the intervention program designed for persons with dementia (intervention group) or a motor placebo activity (control group). The primary outcome was the Physical Activity Questionnaire for the Elderly assessed at the baseline, after the 3-month intervention, and at a 3-month follow-up. The PA promotion program significantly increased PA in the intervention group compared with the control group during the training intervention phase. Both groups showed an increase in habitual PA when intervention-induced activities were excluded. PA was sustainably increased in both groups at follow-up. Low baseline PA was predictive for increased PA after the intervention and low baseline PA, high motor performance, and low comorbidity for increased PA at follow-up.
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The effect of transcutaneous electrical nerve stimulation on pain, muscle strength, balance, and gait in individuals with dementia: A double blind, pilot randomized controlled trial. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.100932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Booth V, Harwood R, Hancox JE, Hood-Moore V, Masud T, Logan P. Motivation as a mechanism underpinning exercise-based falls prevention programmes for older adults with cognitive impairment: a realist review. BMJ Open 2019; 9:e024982. [PMID: 31221867 PMCID: PMC6588958 DOI: 10.1136/bmjopen-2018-024982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 03/13/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This review aimed to identify mechanisms underlying participation in falls prevention interventions, in older adults with cognitive impairment. In particular we studied the role of motivation. DESIGN A realist review of the literature. DATA SOURCES EMBASE, MEDLINE, CINAHL, the Cochrane Library, PsycINFO and PEDRO. ELIGIBILITY CRITERIA Publications reporting exercise-based interventions for people with cognitive impairment, including dementia, living in the community. DATA EXTRACTION AND SYNTHESIS A 'rough programme theory' (a preliminary model of how an intervention works) was developed, tested against findings from the published literature and refined. Data were collected according to elements of the programme theory and not isolated to outcomes. Motivation emerged as a key element, and was prioritised for further study. RESULTS An individual will access mechanisms to support participation when they think that exercise will be beneficial to them. Supportive mechanisms include having a 'gate-keeper', such as a carer or therapist, who shares responsibility for the perception of exercise as beneficial. Lack of access to support decreases adherence and participation in exercise. Motivational mechanisms were particularly relevant for older adults with mild-to-moderate dementia, where the exercise intervention was multicomponent, in a preferred setting, at the correct intensity and level of progression, correctly supported and considered, and flexibly delivered. CONCLUSION Motivation is a key element enabling participation in exercise-based interventions for people with cognitive impairment. Many of the mechanisms identified in this review have parallels in motivational theory. Clinically relevant recommendations were derived and will be used to further develop and test a motivationally considered exercise-based falls intervention for people with mild dementia. PROSPERO REGISTRATION NUMBER CRD42015030169.
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Affiliation(s)
- Vicky Booth
- Division of Rehabilitation Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Rowan Harwood
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Jennie E Hancox
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Victoria Hood-Moore
- Division of Rehabilitation Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Tahir Masud
- Health Care of the Older Person, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Phillipa Logan
- Division of Rehabilitation Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
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Wiloth S, Werner C, Lemke NC, Bauer J, Hauer K. Motor-cognitive effects of a computerized game-based training method in people with dementia: a randomized controlled trial. Aging Ment Health 2018; 22:1124-1135. [PMID: 28682124 DOI: 10.1080/13607863.2017.1348472] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To examine the effects of a computerized, game-based training on motor-cognitive performances, the transfer of training effects on untrained tasks, and the sustainability of training gains in people with dementia. METHOD Ninety-nine individuals with a mean age of 82.9 (5.8) and dementia participated in a 10-week randomized controlled trial with three-month follow-up. The intervention group (IG) received a motor-cognitive training on (Physiomat®) including concurrent dual-tasks of balance control with cognitive demands (Physiomat®-Trail Making Tasks (PTMTs)). The control group (CG) performed non-specific, low-intensity exercises. Duration and accuracy at different complexity levels of trained and untrained PTMTs and the number of successfully performed tasks (PTMT score) were assessed. RESULTS Physiomat® training significantly improved the duration and accuracy at almost all complexity levels of trained (P ≤ 0.001-0.047, ηp2 = 0.065-0.589) and untrained PTMTs (P < 0.001-0.005, ηp2 = 0.073-0.459). Significant effects were also found for the PTMT score of trained (P < 0.001, ηp2 = 0.211) and untrained PTMTs (P < 0.001, ηp2 = 0.184). Training gains were partly sustained at follow-up. CONCLUSION Physiomat® is feasible and has the potential to sustainably improve motor-cognitive performances in people with dementia.
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Affiliation(s)
- Stefanie Wiloth
- a The Institute for the Study off Christian Social Service , University of Heidelberg , Heidelberg , Germany
| | - Christian Werner
- b AGAPLESION Bethanien Hospital , Geriatric Centre of the University of Heidelberg , Heidelberg , Germany
| | - Nele Christin Lemke
- b AGAPLESION Bethanien Hospital , Geriatric Centre of the University of Heidelberg , Heidelberg , Germany
| | - Jürgen Bauer
- b AGAPLESION Bethanien Hospital , Geriatric Centre of the University of Heidelberg , Heidelberg , Germany
| | - Klaus Hauer
- b AGAPLESION Bethanien Hospital , Geriatric Centre of the University of Heidelberg , Heidelberg , Germany
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Falls and Physical Activity in Persons With Mild to Moderate Dementia Participating in an Intensive Motor Training: Randomized Controlled Trial. Alzheimer Dis Assoc Disord 2018. [PMID: 28628488 DOI: 10.1097/wad.0000000000000201] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Physical activity is beneficial in people with dementia. As physical activity increases risk exposure for falls, safety concerns arise. Prior exercise trials in people with dementia have not measured physical activity. Falls in relation to exposure time rather than person-years as outcome measure has been promoted but not investigated in people with dementia. METHODS Patients with mild to moderate dementia (n=110) were randomized to an intensive, progressive strength and functional training intervention or to a low-intensity group training for 12 weeks each. Physical activity was measured with a standardized questionnaire. Falls were documented prospectively by calendars for 12 months. RESULTS During the intervention, physical activity was significantly higher in the intervention group (P<0.001) without an increased fall rate (intervention group vs. CONTROL GROUP 2.89 vs. 1.94; incidence rate ratio, 1.49; 95% confidence interval, 0.66-3.36; P=0.333). In the subgroup of multiple fallers, the number of falls per 1000 hours of activity was significantly lower in the intervention group (8.85 vs. 18.67; P=0.017). CONCLUSIONS Increased physical activity during exercise intervention was safe in people with mild to moderate dementia. Fall rate adjusted for physical activity is a useful and sensitive outcome measure in addition to fall rate per person-years.
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Nyman SR, Adamczewska N, Howlett N. Systematic review of behaviour change techniques to promote participation in physical activity among people with dementia. Br J Health Psychol 2017; 23:148-170. [PMID: 28980370 DOI: 10.1111/bjhp.12279] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/03/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The objective of this study was to systematically review the evidence for the potential promise of behaviour change techniques (BCTs) to increase physical activity among people with dementia (PWD). METHODS PsychINFO, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched 01/01/2000-01/12/2016. Randomized controlled/quasi-randomized trials were included if they recruited people diagnosed/suspected to have dementia, used at least one BCT in the intervention arm, and had at least one follow-up measure of physical activity/adherence. Studies were appraised using the Cochrane Collaboration Risk of Bias Tool, and BCTs were coded using Michie et al., 2013, Annals of Behavioral Medicine, 46, 81. taxonomy. Intervention findings were narratively synthesized as either 'very promising', 'quite promising', or 'non-promising', and BCTs were judged as having potential promise if they featured in at least twice as many very/quite promising than non-promising interventions (as per Gardner et al., 2016, Health Psychology Review, 10, 89). RESULTS Nineteen articles from nine trials reported physical activity findings on behavioural outcomes (two very promising, one quite promising, and two non-promising) or intervention adherence (one quite promising and four non-promising). Thirteen BCTs were used across the interventions. While no BCT had potential promise to increase intervention adherence, three BCTs had potential promise for improving physical activity behaviour outcomes: goal setting (behaviour), social support (unspecified), and using a credible source. CONCLUSIONS Three BCTs have potential promise for use in future interventions to increase physical activity among PWD. Statement of contribution What is already known on this subject? While physical activity is a key lifestyle factor to enhance and maintain health and wellbeing amongst the general population, adults rarely participate in sufficient levels to obtain these benefits. Systematic reviews suggest that specific behaviour change techniques can increase physical activity, although one review suggested that self-regulatory techniques may be counterproductive when promoting physical activity among older people. Until now, no systematic review has been conducted to assess which behaviour change techniques may be associated with greater participation in physical activity among people with dementia. What does this study add? Interventions showed mixed promise for increasing physical activity and little effect on participant adherence. Goal setting (behaviour), social support (unspecified), and using a credible source are promising approaches. No technique showed promise for increasing adherence to physical activity interventions among people with dementia.
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Affiliation(s)
- Samuel R Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - Natalia Adamczewska
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, Poole, Dorset, UK
| | - Neil Howlett
- Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Trautwein S, Scharpf A, Barisch-Fritz B, Niermann C, Woll A. Effectiveness of a 16-Week Multimodal Exercise Program on Individuals With Dementia: Study Protocol for a Multicenter Randomized Controlled Trial. JMIR Res Protoc 2017; 6:e35. [PMID: 28258048 PMCID: PMC5357320 DOI: 10.2196/resprot.6792] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/14/2016] [Accepted: 02/08/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increasing prevalence of dementia in the next decades is accompanied by various societal and economic problems. Previous studies have suggested that physical activity positively affects motor and cognitive skills in individuals with dementia (IWD). However, there is insufficient evidence probably related to several methodological limitations. Moreover, to date adequate physical activity interventions specifically developed for IWD are lacking. OBJECTIVE This study aims to investigate the effectiveness of a multimodal exercise program (MEP) on motor and cognitive skills in IWD in a high-quality multicenter trial. METHODS A multicenter randomized controlled trial with baseline and postassessments will be performed. It is planned to enroll 405 participants with dementia of mild to moderate stage, aged 65 years and older. The intervention group will participate in a 16-week ritualized MEP especially developed for IWD. The effectiveness of the MEP on the primary outcomes balance, mobility, and gait will be examined using a comprehensive test battery. Secondary outcomes are strength and function of lower limbs, activities of daily living, and cognition (overall cognition, language, processing speed, learning and memory, and visual spatial cognition). RESULTS Enrollment for the study started in May 2015. It is planned to complete postassessments by the beginning of 2017. Results are expected to be available in the first half of 2017. CONCLUSIONS This study will contribute to enhancing evidence for the effects of physical activity on motor and cognitive skills in IWD. Compared to previous studies, this study is characterized by a dementia-specific intervention based on scientific knowledge, a combination of motor and cognitive tasks in the intervention, and high standards regarding methodology. Findings are highly relevant to influence the multiple motor and cognitive impairments of IWD who are often participating in limited physical activity. TRIAL REGISTRATION German Clinical Trials Register DRKS00010538; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010538 (Archived by WebCite at http://www.webcitation.org/6oVGMbbMD).
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Affiliation(s)
- Sandra Trautwein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Andrea Scharpf
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Bettina Barisch-Fritz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Christina Niermann
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Effects of a long-term aerobic exercise intervention on institutionalized patients with dementia. J Sci Med Sport 2015; 19:293-8. [PMID: 26087884 DOI: 10.1016/j.jsams.2015.05.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 05/13/2015] [Accepted: 05/28/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Long-term interventions aimed at analyzing the impact of physical exercise on important health markers in institutionalized individuals with dementia are relatively scarce. This longitudinal study intends to identify the effects of a physical exercise program on cognitive decline, memory, depression, functional dependence and neuropsychiatric disturbances in institutionalized individuals with dementia. DESIGN Randomized controlled trial. METHODS Homecare residents with dementia were assigned to an exercise (EG) or to a control group (CG). Participants in the EG cycled for at least 15min daily during 15 months, while those in the CG performed alternative sedentary recreational activities. The Mini-Mental State Examination (MEC), the Timed "Up & Go" Test, the Neuropsychiatric Inventory, the Katz Index, the Cornell Scale for Depression in Dementia and the Fuld Object Memory Evaluation were administered before and after the intervention. RESULTS Sixty-three individuals in the CG and 51 individuals in the EG completed the intervention. A statistically significant decline in cognitive function was observed in individuals included in the CG (p=0.015), while a slight improvement was observed in those included in the EG. Significant improvement was observed in the neuropsychiatric symptoms (p=0.020), memory function (p=0.028) and functional mobility (p=0.043) among those who exercised. Exercise seemed to have a greater effect in those suffering from severe cognitive impairment. CONCLUSIONS This study provides evidence that aerobic physical exercise has a significant impact on improving cognitive functioning, behavior, and functional mobility in institutionalized individuals with dementia.
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Cadore EL, Moneo ABB, Mensat MM, Muñoz AR, Casas-Herrero A, Rodriguez-Mañas L, Izquierdo M. Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. AGE (DORDRECHT, NETHERLANDS) 2014; 36:801-11. [PMID: 24243397 PMCID: PMC4039260 DOI: 10.1007/s11357-013-9599-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/04/2013] [Indexed: 05/13/2023]
Abstract
This study investigated the effects of a multicomponent exercise intervention on muscle strength, incidence of falls and functional outcomes in frail elderly patients with dementia after long-term physical restraint, followed by 24 weeks of training cessation. Eighteen frail elderly patients with mild dementia (88.1 ± 5.1 years) performed a multicomponent exercise program, which consisted of 4 weeks of walking, balance and cognitive exercises, followed by 4 weeks of resistance exercise performed twice weekly [8-12 repetitions at 20-50 % of the one-repetition maximum (1RM)], combined with walking, balance and cognitive exercises. Before and after training, as well as after 24 weeks of training cessation, strength outcomes, Barthel Index, balance, gait ability, rise from a chair ability, dual task performance, incidence of falls and Mini-Mental State Examination were assessed. After the first 4 weeks of training, there was a significant improvement only in the balance test, whereas no additional changes were observed. However, after the second part of the training, the participants required significantly less time for the time-up-and-go test (P < 0.05), and improved the isometric hand grip, hip flexion and knee extension strength, as well as the leg press 1RM (P < 0.01). A significant reduction was also observed in the incidence of falls (P < 0.01). After 24 weeks of training cessation, abrupt decreases were observed in nearly all of the physical outcomes (P < 0.05). The exercise intervention improved strength, balance and gait ability in frail elderly patients with dementia after long-term physical restraint, and these benefits were lost after training cessation.
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Affiliation(s)
- Eduardo L. Cadore
- />Department of Health Sciences, Public University of Navarre, Campus of Tudela Av. de Tarazona s/n, 31500 Tudela, Navarra Spain
| | - Ana B. Bays Moneo
- />Department of Health Sciences, Public University of Navarre, Campus of Tudela Av. de Tarazona s/n, 31500 Tudela, Navarra Spain
| | | | | | - Alvaro Casas-Herrero
- />Division of Geriatric Medicine, Complejo Hospitalario de Navarra, Pamplona, Navarra Spain
| | | | - Mikel Izquierdo
- />Department of Health Sciences, Public University of Navarre, Campus of Tudela Av. de Tarazona s/n, 31500 Tudela, Navarra Spain
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Ferrer A, Formiga F, Sanz H, de Vries OJ, Badia T, Pujol R. Multifactorial assessment and targeted intervention to reduce falls among the oldest-old: a randomized controlled trial. Clin Interv Aging 2014; 9:383-93. [PMID: 24596458 PMCID: PMC3940644 DOI: 10.2147/cia.s57580] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The purpose of this study was to assess the effectiveness of a multifactorial intervention to reduce falls among the oldest-old people, including individuals with cognitive impairment or comorbidities. Methods A randomized, single-blind, parallel-group clinical trial was conducted from January 2009 to December 2010 in seven primary health care centers in Baix Llobregat (Barcelona). Of 696 referred people who were born in 1924, 328 were randomized to an intervention group or a control group. The intervention model used an algorithm and was multifaceted for both patients and their primary care providers. Primary outcomes were risk of falling and time until falls. Data analyses were by intention-to-treat. Results Sixty-five (39.6%) subjects in the intervention group and 48 (29.3%) in the control group fell during follow-up. The difference in the risk of falls was not significant (relative risk 1.28, 95% confidence interval [CI] 0.94–1.75). Cox regression models with time from randomization to the first fall were not significant. Cox models for recurrent falls showed that intervention had a negative effect (hazard ratio [HR] 1.46, 95% CI 1.03–2.09) and that functional impairment (HR 1.42, 95% CI 0.97–2.12), previous falls (HR 1.09, 95% CI 0.74–1.60), and cognitive impairment (HR 1.08, 95% CI 0.72–1.60) had no effect on the assessment. Conclusion This multifactorial intervention among octogenarians, including individuals with cognitive impairment or comorbidities, did not result in a reduction in falls. A history of previous falls, disability, and cognitive impairment had no effect on the program among the community-dwelling subjects in this study.
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Affiliation(s)
- Assumpta Ferrer
- Primary Healthcare Centre "El Plà" CAP-I, Sant Feliu de Llobregat, Spain
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Spain ; Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Héctor Sanz
- Support Research Unit, Primary Health Department Costa Ponent, IDIAP Jordi Gol, Barcelona, Spain
| | - Oscar J de Vries
- Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Teresa Badia
- Primary Healthcare Centre Martorell, Barcelona, Spain
| | - Ramón Pujol
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, Spain ; Bellvitge Biomedical Research Institute, IDIBELL, L'Hospitalet de Llobregat, Spain
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Falls prevention interventions for community-dwelling older persons with cognitive impairment: a systematic review. Int Psychogeriatr 2013; 25:215-27. [PMID: 23031328 DOI: 10.1017/s1041610212001573] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Globally, falls in older people are a leading cause of injury-related mortality and morbidity. Cognitive impairment is a well-known risk factor for falls in this population group. While there is now a large body of evidence to support effective interventions for falls reduction across care settings, very little is known about interventions in the vulnerable, but increasing population of cognitively impaired community-dwelling older people. Therefore, the purpose of this systematic review is to investigate interventions designed to reduce falls in community-dwelling, cognitively impaired older adults. METHODS A literature search of databases was conducted to identify original research published in English, which met predefined inclusion and exclusion criteria for effective (non-pharmacological) falls prevention interventions in cognitively impaired community-dwelling people over 65 years of age. Data from the selected papers were extracted into data extraction tables and analyzed according to study characteristics, measures, results, and quality. RESULTS The review identified 11 studies providing data from 1,928 participants. Interventions included exercise, health assessment and management of risk, multi-component and cognitive behavioral programs, and hip protectors as falls risk reduction strategies. Seven of the selected studies showed an intervention effect in decreasing falls risk; however, only two of these showed a significant improvement in physical performance measures specifically in a cognitively impaired group. CONCLUSIONS The diversity of interventions, study designs, populations, and quality of the studies, which met inclusion criteria, resulted in conflicting evidence and inconclusive results for falls prevention interventions in this highly complex population.
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Feasibility and accuracy of fall reports in persons with dementia: a prospective observational study. Int Psychogeriatr 2012; 24:587-98. [PMID: 22142666 DOI: 10.1017/s1041610211002122] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The feasibility, test-retest reliability, and accuracy of different fall recording methods have not been studied in older persons with dementia. METHODS This was a prospective observational study, nested within a randomized controlled trial on motor training, in which 110 participants were monitored for falls over 12 months. Seven methods of fall recording were compared: face-to-face interviews; phone interviews: weekly for three months, monthly for 9 months, a final interview after 12 months; prospective calendar method; interviews with a proxy and the general practitioner (GP). Summing the count of falls and removing duplicate reporting of the same fall was found to provide the best approximation of the actual number of falls and was chosen as the criterion-standard. RESULTS The combination of calendar method and phone interviews showed the highest accuracy (74% of falls, 93% of fallers). As a single measure, weekly phone calls were superior to calendars or proxy-report. Monthly phone calls recorded only half the falls that were picked up by weekly calls (p = 0.002) and were inferior to the calendars (p<0.001) and proxy-report (p = 0.015). GPs knew of only 14% of falls and 19% of fallers. In addition, 49% of subjects who documented a fall prospectively did not recall a fall after 12 months. CONCLUSION The combination of fall calendars with regular telephone interviews can be recommended for persons with mild to moderate stage dementia. If feasible, recall periods should be as short as one week; additional information by care-givers increases accuracy of reports. Retrospective recall of falling with long recall periods is not recommended.
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Hauer K, Schwenk M, Zieschang T, Essig M, Becker C, Oster P. Physical training improves motor performance in people with dementia: a randomized controlled trial. J Am Geriatr Soc 2011; 60:8-15. [PMID: 22211512 DOI: 10.1111/j.1532-5415.2011.03778.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether a specific, standardized training regimen can improve muscle strength and physical functioning in people with dementia. DESIGN Double-blinded, randomized, controlled trial with 3-month intervention and 3-month follow-up period in 2006 to 2009. SETTING Outpatient geriatric rehabilitation. PARTICIPANTS Individuals with confirmed mild to moderate dementia, no severe somatic or psychological disease, and ability to walk 10 m. Most participants were still living independently with or without supportive care. INTERVENTION Supervised, progressive resistance and functional group training for 3 months specifically developed for people with dementia (intervention, n = 62) compared with a low-intensity motor placebo activity (control, n = 60). MEASUREMENTS Primary outcome measures were one-repetition maximum in a leg press device for maximal strength and duration of the five-chair-stand test for functional performance. Secondary outcome measures were assessed for a number of established parameters for maximal strength, physical function, and physical activity. RESULTS Training significantly improved both primary outcomes (percentage change from baseline: maximal strength, intervention group (IG): +51.5 ± 41.5 kg vs control group (CG): -1.0 ± 28.9 kg, P < .001; functional performance, IG: -25.9 ± 15.1 seconds vs CG: +11.3 ± 60.4 seconds, P < .001). Secondary analysis confirmed effects for all strength and functional parameters. Training gains were partly sustained during follow-up. Low baseline performance on motor tasks but not cognitive impairment predicted positive training response. Physical activity increased significantly during the intervention (P < .001). CONCLUSION The intensive, dementia-adjusted training was feasible and substantially improved motor performance in frail, older people with dementia and may represent a model for structured rehabilitation or outpatient training.
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Affiliation(s)
- Klaus Hauer
- Department of Geriatric Research, Bethanien-Hospital and Geriatric Centre, University of Heidelberg, Rohrbacherstraße 149, 69126 Heidelberg, Germany. khauer@bethanien-heidelberg
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Hauer KA, Kempen GIJM, Schwenk M, Yardley L, Beyer N, Todd C, Oster P, Zijlstra GAR. Validity and sensitivity to change of the falls efficacy scales international to assess fear of falling in older adults with and without cognitive impairment. Gerontology 2010; 57:462-72. [PMID: 20975251 DOI: 10.1159/000320054] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 07/30/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Measures of fear of falling have not yet been validated in patients with dementia, leaving a methodological gap that limits research in a population at high risk of falling and fall-related consequences. OBJECTIVE The objectives of this study are to determine: (1) the validity of the 7-item Short Falls Efficacy Scale International (Short FES-I) in geriatric patients with and without cognitive impairment, and (2) the sensitivity to change of the 10-item Falls Efficacy Scale (FES), the 16-item FES-I and the 7-item Short FES-I in geriatric patients with dementia. METHODS Cross-sectional data of community-dwelling older adults and geriatric rehabilitation patients (n = 284) collected during face-to-face interviews were used to determine construct and discriminant validity by testing for differences within variables related to fear of falling. Sensitivity to change was studied in an intervention study including patients with mild to moderate dementia (n = 130) as determined by standard response means (SRMs). RESULTS The Short FES-I showed excellent construct and discriminant validity in the total group and subsamples according to cognitive status. Sensitivity to change was adequate to good in the FES (range SRM: 0.18-0.77) and FES-I (range SRM: 0.21-0.74), with the Short FES-I showing the highest peak sensitivity to change (range SRM: 0.18-0.91). CONCLUSIONS The Short FES-I is a valid measure to assess fear of falling in frail older adults with and without cognitive impairment, yet it may show floor effects in higher functioning older people. All scales, including the Short FES-I, were sensitive to detecting intervention-induced changes in concerns about falling in geriatric patients with dementia.
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Affiliation(s)
- Klaus A Hauer
- Bethanien-Krankenhaus/Geriatric Centre at the University of Heidelberg, Germany. khauer @ bethanien-heidelberg.de
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Goekint M, De Pauw K, Roelands B, Njemini R, Bautmans I, Mets T, Meeusen R. Strength training does not influence serum brain-derived neurotrophic factor. Eur J Appl Physiol 2010; 110:285-93. [DOI: 10.1007/s00421-010-1461-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2010] [Indexed: 12/21/2022]
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