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Effects of a High‐Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia
Author(s) -
Toots Annika,
Littbrand Håkan,
Lindelöf Nina,
Wiklund Robert,
Holmberg Henrik,
Nordström Peter,
LundinOlsson Lillemor,
Gustafson Yngve,
Rosendahl Erik
Publication year - 2016
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13880
Subject(s) - activities of daily living , dementia , berg balance scale , medicine , physical therapy , balance (ability) , randomized controlled trial , functional independence measure , confidence interval , gerontology , physical medicine and rehabilitation , disease
Objectives To investigate the effects of a high‐intensity functional exercise program on independence in activities of daily living ( ADL s) and balance in older people with dementia and whether exercise effects differed between dementia types. Design Cluster‐randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study. Setting Residential care facilities, Umeå, Sweden. Participants Individuals aged 65 and older with a dementia diagnosis, a Mini‐Mental State Examination score of 10 or greater, and dependence in ADL s (N = 186). Intervention Ninety‐three participants each were allocated to the high‐intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity. Measurements Blinded assessors measured ADL independence using the Functional Independence Measure ( FIM ) and Barthel Index ( BI ) and balance using the Berg Balance Scale ( BBS ) at baseline and 4 (directly after intervention completion) and 7 months. Results Linear mixed models showed no between‐group effect on ADL independence at 4 ( FIM =1.3, 95% confidence interval ( CI )=−1.6–4.3; BI =0.6, 95% CI =−0.2–1.4) or 7 ( FIM =0.8, 95% CI =−2.2–3.8; BI =0.6, 95% CI =−0.3–1.4) months. A significant between‐group effect on balance favoring exercise was observed at 4 months ( BBS =4.2, 95% CI =1.8–6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between‐group exercise effects were found in participants with non‐Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months. Conclusion In older people with mild to moderate dementia living in residential care facilities, a 4‐month high‐intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non‐Alzheimer's dementia.