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Randomized Controlled Trial
. 2016 Jan;64(1):55-64.
doi: 10.1111/jgs.13880.

Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia

Annika Toots  1   2 , Håkan Littbrand  1   2 , Nina Lindelöf  1   2 , Robert Wiklund  1   2 , Henrik Holmberg  3 , Peter Nordström  2 , Lillemor Lundin-Olsson  1 , Yngve Gustafson  2 , Erik Rosendahl  1   2
Affiliations
Randomized Controlled Trial

Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia

Annika Toots et al. J Am Geriatr Soc. 2016 Jan.

Abstract

Objectives: To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living (ADLs) 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 ADLs (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.

Keywords: activities of daily living; dementia; exercise; postural balance; residential facilities.

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Figures

Figure 1
Figure 1
Flow of participants through the study. Recruitment and baseline assessment were performed in August and September 2011, interventions were implemented between October 2011 and February 2012, first follow-up assessments were performed in March–April 2012, and last follow-up assessments were performed in May and June 2012. ADLs  =  activities of daily living; MMSE = Mini-Mental State Examination; SD=standard deviation.
Figure 2
Figure 2
Changes in Functional Independence Measure, Barthel Index of activities of daily living (ADLs), and Berg Balance Scale (A–C) and according to dementia type (D–F). Values are least square means of changes from baseline, with 95% confidence intervals, from linear mixed-effects models of the complete sample (n = 186) adjusted for age, sex, and antidepressant use. Non-AD dementia included vascular dementia, mixed Alzheimer's disease (AD) and vascular dementia, and all other types of non-Alzheimer's dementia. ES = effect size.
See this image and copyright information in PMC

References

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