Exercise as it relates to Disease/How can behavioural management and general exercise programs affect Alzheimer's Disease sufferers?

What is the background to this research?

Alzheimer’s disease negatively affects the memory, behaviour and thinking skills of sufferers through damage in the brain, and is the most common form of Dementia. Although predominantly found in older adults over the age of 85 years, Alzheimer’s can affect anyone, regardless of age. This is referred to as Sporadic Alzheimer’s and is very uncommon. An even more rare form is that of Familial Alzheimer’s which is genetic and can have an onset age of less than 65 years old. Many studies have investigated ways to decrease the chance of being affected by Alzheimer’s disease, how we can delay the onset of the disease, and how to manage. This particular study investigates the effect of exercise and behavioural management in patients with Alzheimer disease.

Where is the research from?

The research was published in the Journal of the American Medical Association and was conducted by Linda Teri et al. of the Psychosocial and Community Health department in conjunction with the Biostatistics, Epidemiology and Medicine departments at the University of Washington.

What kind of research was this?

A randomized controlled trial was undertaken to determine whether it is possible to reduce functional dependence and to delay the need for institutionalisation by utilising an exercise program as well as giving caregivers the skills to manage behavioural problems that would otherwise increase the frailty of a patient. 153 patients from a community-housing dwelling who met the criteria of Alzheimer’s disease were involved in the trial during the period between June 1994 and April 1999. The final copy was released in October 2003.

What did the research involve?

The caregivers were assigned to one of two groups: one group to implement a combined exercise and caregiver-training program conducted in patient homes over 3 months (RDAD), the other group was the control group; to implement routine medical care (RMC). Physical functioning tests and depression rating scales were used to determine success of the program. Patients in the RDAD group were seen in their homes by caregivers for two 12-hour sessions per week for the first three weeks, followed by once a week sessions for 4 weeks, and then fortnightly sessions for 4 weeks. Follow up sessions were then conducted 3 times over the following 3 months to check on patients and answer questions. The exercise component consisted of 30 minutes per day twice a week of moderate intensity exercise. This included aerobic, strength, flexibility and balance training sessions supervised by caregivers who had weekly sessions with physical therapists to learn how to encourage and help patients and correct technique. The sessions were filmed and reviewed by independent trainers to ensure that the training was following the correct protocol. Patients in the RMC group received regular medical checks. This included crisis support and acute medical support and advice, however these patients did not receive any behavioural interventions or exercise programs.

What were the basic results?

For both the physical function tests and depression rating scales, the RDAD group improved, but the control group declined. There were also major differences between the groups in secondary health and function measures with the results of the RDAD group improving more significantly than the control group. Days of limited activity decreased in the RDAD group but increased in the RMC group. No other major differences were observed. A follow-up was conducted after 2 years where a physical functioning test and a mobility test were undertaken. In both of these, the RDAD group had significantly higher scores than the control group in terms of functionality and performance. Of the 153 patients to participate in the study, 140 completed the 3 months. Patient institutionalisation was the major reason for not completing the post testing. These patients were institutionalised due to behavioural problems or caregiver health and availability. The patients from both groups who did complete the whole program, and did the 2-year follow-up had less cognitive impairment than those who left the program early.

How did the researchers interpret the results?

From the positive results received by the RDAD group, the researchers concluded that the trial was a success. They believe that the study proved that a program specifically designed to implement behavioural management and exercise programs for Alzheimer’s sufferers in a community setting improves physical function and health.

What conclusions should be taken away from this research?

This research is a good indication that physical activity helps older adults with their mental and physical function. Physical activity improves cognition in children and visuospatial memory in young adults, and this research supports these facts due to the significant improvements  seen in the Alzheimer’s patients. From this study and supporting evidence, we can safely take away that physical activity has positive benefits on cognition in all age groups.

What are the implications of this research?

This research provides a strong base on which study can be conducted and information may be compiled to support the results that the researchers found. Further research would be relevant to investigate behavioural management and exercise prescription separately to determine their individual effects. It would also be beneficial to replicate this study with patients of other diseases and disorders, for example – depression sufferers.

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