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Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9‐Week Randomized, Controlled Trial
Author(s) -
Bossers Willem J. R.,
Woude Lucas H. V.,
Boersma Froukje,
Hortobágyi Tibor,
Scherder Erik J. A.,
Heuvelen Marieke J. G.
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.14160
Subject(s) - medicine , activities of daily living , physical therapy , randomized controlled trial , dementia , aerobic exercise , physical medicine and rehabilitation , confidence interval , gerontology , disease
Objectives To compare the effects of two exercise programs on proxy‐ and performance‐based measures of activities of daily living ( ADL s) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia. Design A parallel, three‐group, single‐blind, randomized, controlled trial. Setting Psychogeriatric wards. Participants Individuals with dementia (mean age 85.6 ± 5.1). Interventions Each 9‐week intervention consisted of thirty‐six 30‐minute sessions. A combined group (n = 35) participated in two strength and two walking sessions, an aerobic group (n = 35) participated in four walking sessions, and a social control group (n = 35) participated in four nonexercise social visits per week. The social group was used as a reference for the mediation analysis, which was performed in the combined and aerobic groups. Measurements ADL s were assessed using the Katz index (proxy‐reported ADL performance), Erlangen‐ ADL test (E‐ ADL ) (instrumental ADL performance), and 7‐item Physical Performance Test ( PPT ‐7) (physical ADL performance). Results There was a group effect for Katz index ( P = .02), E‐ ADL ( P < .001), and PPT ‐7 ( P = .003). Differences from baseline to after the intervention were similar in the combined and aerobic groups. Exercise‐induced changes in global cognition mediated changes in Katz index (95% confidence interval ( CI ) = 0.05–0.41), leg muscle strength mediated changes in E‐ ADL (95% CI = 0.03–0.43), and leg muscle strength (95% CI = 0.01–0.36) and walking endurance (95% CI = 0.01–0.43) mediated changes in PPT ‐7 only in the combined group. Conclusion Physical exercise can improve ADL levels in individuals with dementia, but improvements are small and seem independent of exercise type. Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic‐only exercise to effectively target ADL dysfunction in individuals with dementia. Future research is warranted to justify these exercise‐specific findings.