User:Bt1718/sandbox

Add "By ..." to add the author of a pic in.

What is the background to this research?[edit]
Alzheimer's Disease is a debilitating disease that progressively prevents those with the disease from performing activities of daily living (ADLs).[1]

In the past decade, there has been a strong focus on the development of therapeutic agents to slow the impairment of Alzheimer's, with only a few analysing the effect of exercise.[1] It has been shown that exercise improves function in nursing home patients with Alzheimer's[2] and with so few studies including a randomised, controlled design, it was important for the researchers to analyse the effect of exercise on ADL decline.

To the best of the authors' knowledge, no previous studies have been conducted on the ability of people with Alzheimer's to perform ADLs,[1] which means there is limited data relating to nursing home populations and the effect of exercise on not only their health, but the management of falls,[3] depression[4] and malnutrition.[5] The need for research is high as ADLs are a vital determinant of a person's quality of life[1] and importantly, it not only just affects the individual, but the caregiver too.

The aim of the research was to determine whether a 12-month exercise program would reduce ADL decline in those with Alzheimer's. It was believed the exercise would not only improve physical health, but nutritional status and psychological disturbance as well.

Perhaps try to have a clearer coherent story for the background that leads into the need for this research to have been completed. At the moment it is justified in the middle of the background and then more so. It just doesnt quite flow and reads like most of the ideas for the background have purely come from the actual paper being critiqued

Where is the research from?[edit]
This study was conducted in Toulouse, France, the country in which the main author resides. This location provides data from .... however, this location is limited in its applicability to the rest of the world.

Access to a number of nursing homes was provided with no conflict of interest as mentioned at the end of the study.[1]

what does this section suggest in terms of the context of the findings, or the implications. What other "from" information is there? What might it tell you about the level of evidence being presented?

What kind of research was this?[edit]
This study was a randomised, controlled, single-blind trial of groups of ambulatory patients at five different nursing homes in Toulouse, France who had Alzheimer's Disease. The nursing homes were randomised, rather than the patients to prevent any confounding effects on the setting area.[1]

The exercise program was individualised and carefully laid out depending on measures of physical performance via the 6-meter walking speed test[6], get-up-and-go test[7] and the one-leg balance test,[8] all of which have been tested before on frail, elderly people.[1] Nutrition, behaviour and depression were also assessed using three different scales all believed to be reliable tools that are frequently used with the cognitively impaired.[1]

research type section - probably needs more lay explanation of what it means, and what it means in terms of the level of evidence it provides to the area

What did the research involve?[edit]
To be eligible for the study, all patients needed to meet the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for possible, or probable Alzheimer's, all had to have lived in a nursing home for at least 12 months and they had to be able to transfer themselves from a chair to walk at least six metres without assistance. The Mini-Mental State Examination was...

A score of 25 or less was required for the Mini-Mental State Examination was also required.

Of all 429 nursing home residents, 242 met the criteria and informed consent was obtained from 134 of the patients (or their caregiver, or legal guardian). Approval for the study was granted by the Institutional Review Boards of each nursing home.[1]

The research involved a total of 88 sessions per participant between February 2004 and February 2005. An hour long session was conducted in the afternoon twice a week, with at least a two day break in between each exercise session. All sessions were run by the same therapist and each group had two to seven participants based on their pre-screening scores.

A stretching warm up and a brisk walk was conducted before each session around a circular track specifically built outside each patient's room for the purpose of the program. This track was used over the entire 12 months to encourage confidence and adherence. After the warm up, aerobic, strength, flexibility and balance exercises that focused on the lower extremities were completed, as well as extra walking which made up half of the exercise program. Foam rubber ground sheets and guardrails were provided for safety concerns.

research involved - as an example there is information about an MMSE score of 25, but the lay audience will not know what this means, nor its implications for the study. Think about the critique from this perspective.

What were the basic results?[edit]
Improvements in walking speed were seen after 6 months and 12 months, particularly at the 6 month mark for the exercise group and at 12 months for the control group. This improvement was significantly higher in the exercisers than the control. ADL scores declined significantly in both groups at the 6 and 12 month mark. After 12 months, that score declined even more so in the exercise group than the control group. Adherence was analysed with 19.4% of patients having high adherence (> 60 sessions), 28.4% had intermediate adherence (> 30-60 sessions), 41.8% had low adherence (< 30 sessions) and 10.4% attended no sessions, due to either unwillingness, behaviour disorder difficulties, or increased disability in ADLs. ......

No significant effect on nutrition, behavioural disturbance or depression was obtained.[1]

What conclusions can we take from this research?[edit]
This study provided vital evidence to suggest that exercise has a positive effect on Alzheimer's patients who must complete ADLs. While this effect was small, a significant difference in walking speed was detected. However, there were no changes to depression, nutritional status or behavioural disturbance, suggesting that a more targeted approach would have been beneficial to these factors. Future studies could incorporate this approach by....

As this study is the first to target ADL decline in patients with Alzheimer's, comparisons are difficult to make. This study did incorporate a number of scales to measure mental health that have proven to be sensitive to change over time, robust and applicable for the elderly, making it a reliable study.[1]

One issue involves the use of a control group, which in this study was not a typical control group as the group received routine medical care and saw an increase in walking speed as well as the experimental group.

Practical advice[edit]
This study was the first to observe the role of ADLs and it showed that exercise could be a positive intervention for those with Alzheimer's. Although, more evidence is needed in relation to exercise and mental health in order to align with the multiple studies there are that prove exercise is one of the most influential factors on health. Future studies should be careful when conducting research on the elderly, as falls and hospitilisation were common throughout this study due to the nature of the tasks and frailness of certain patients.[1]

Actual Group

 * all sessions conducted by same therapist with two to seven participants that were selected based on their baseline physical performance scores, MMSE score and behaviour disturbances and interaction between participants
 * began light and gradually increased over the first month
 * stretching warm up and brisk walk to get heart rate up. Music accompanied the sessions
 * aerobic, strength (lower extremities - repeated stand ups or squats, lateral elevation of the legs in a standing position and rising on toes), flexibility and balance exercises (small step trial exercises using cones and hoops on the ground and one or two leg balance exercises on the ground or rubber sheets) were spread around the track with foam rubber ground sheets and guardrails around for safety
 * at least half the sessions involved walking around a circular trail that was created around the rooms for adherence and adapted for each exercise. Encouragement was provided by therapist. Same trail used for the 12 months to ritualize the session and confidence

Control Group

 * participants received routine medical care. They had no exercise or behaviour management training.

Primary Outcome Measure
of follow-up
 * KATZ ADL score with decline in ADL score of the control group at 12 month follow up
 * the Katz Index of ADL was used to address whether exercise may prevent the worsening of disabilities in nursing home residents suffering from AD
 * scale is robust, sensitive to change over time and appropriate for evaluating clinically meaningful effect
 * scoring system = 0-6 on questions relating to eating, transferring from bed to chair, walking, using toilet, bathing and dressing (scored from 0-1) - create TABLE for this