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BMC Geriatrics
Published in: BMC Geriatrics 1/2015

Open Access 01-12-2015 | Research article

Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial

Authors: Elisabeth Wiken Telenius, Knut Engedal, Astrid Bergland

Published in: BMC Geriatrics | Issue 1/2015

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Abstract

Background

Research indicates that exercise can have a positive effect on both physical and mental health in nursing home patients with dementia, however the lasting effect is rarely studied. In a previously published article we investigated the immediate effect of a 12 weeks functional exercise program on physical function and mental health in nursing home residents with dementia. In this paper we studied the long-term effect of this exercise program. We explored the differences between the exercise and control group from baseline to 6 months follow-up and during the detraining period from month 3 to 6.

Methods

A single blind, randomized controlled trial was conducted and a total of 170 nursing home residents with dementia were included. The participants were randomly allocated to an intervention (n = 87) or a control group (n = 83). The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks. The control condition was leisure activities. Thirty participants were lost between baseline and six-month follow-up. Linear mixed model analyses for repeated measurements were used to investigate the effect of exercise after detraining period.

Results

The exercise group improved their scores on Berg Balance Scale from baseline to 6 months follow-up by 2.7 points in average. The control group deteriorated in the same period and the difference between groups was statistically significant (p = 0.031). The exercise group also scored better on NPI agitation sub-score after 6 months (p = 0.045).

Conclusion

The results demonstrate long-time positive effects of a high intensity functional exercise program on balance and indicate a positive effect on agitation, after an intervention period of 12 weeks followed by a detraining period of 12 weeks.
Identifier at ClinicalTrials.gov: NCT02262104
Literature
1.
Fratiglioni L, Launer LJ, Andersen K, Breteler MM, Copeland JR, Dartigues JF, et al. Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(11 Suppl 5):S10–5.PubMed
2.
Colantuoni E, Surplus G, Hackman A, Arrighi HM, Brookmeyer R. Web-based application to project the burden of Alzheimer's disease. Alzheimer's & dementia : the journal of the Alzheimer's Association. 2010;6(5):425–8.CrossRef
3.
Geldmacher DS, Frolich L, Doody RS, Erkinjuntti T, Vellas B, Jones RW, et al. Realistic expectations for treatment success in Alzheimer's disease. The Journal Of Nutrition, Health & Aging. 2006;10(5):417–29.
4.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984;34(7):939–44.CrossRefPubMed
5.
van Iersel MB, Hoefsloot W, Munneke M, Bloem BR, Olde Rikkert MG. Systematic review of quantitative clinical gait analysis in patients with dementia. Zeitschrift fur Gerontologie und Geriatrie. 2004;37(1):27–32.CrossRefPubMed
6.
Selbaek G, Kirkevold Ø, Engedal K. The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry. 2007;22(9):843–9.CrossRefPubMed
7.
Nygaard HA. Sykehjemmet som medisinsk institusjon – et fatamorgana? Tidsskr Nor Lægeforen. 2002;122:823–5.PubMed
8.
Helvik A-S, Engedal K, Benth JS, Selbæk G. A 52 month follow-up of functional decline in nursing home residents – degree of dementia contributes. BMC Geriatr. 2014;14:45.PubMedCentralCrossRefPubMed
9.
Bennett HP, Corbett AJ, Gaden S, Grayson DA, Kril JJ, Broe GA. Subcortical vascular disease and functional decline: a 6-year predictor study. J Am Geriatr Soc. 2002;50(12):1969–77.CrossRefPubMed
10.
Thomas VS, Vandenberg EV, Potter JF. Non-neurological factors are implicated in impairments in gait and mobility among patients in a clinical dementia referral population. Int J Geriatr Psychiatry. 2002;17:128–33.CrossRefPubMed
11.
van Doorn C, Gruber-Baldini AL, Zimmerman S. Dementia is a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc. 2003;51:1213–8.CrossRefPubMed
12.
Feldman HH, Van Baelen B, Kavanagh SM, Torfs KE. Cognition, function, and caregiving time patterns in patients with mild-to-moderate Alzheimer disease: a 12-month analysis. Alzheimer disease and associated disorders. 2005;19(1):29–36.CrossRefPubMed
13.
14.
Blankevoort CG, van Heuvelen MJ, Boersma F, Luning H, de Jong J, Scherder EJ. Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dement Geriatr Cogn Disord. 2010;30(5):392–402.CrossRefPubMed
15.
Mazoteras Munoz V, Abellan van Kan G, Cantet C, Cortes F, Ousset PJ, Rolland Y, et al. Gait and balance impairments in Alzheimer disease patients. Alzheimer disease and associated disorders. 2010;24(1):79–84.CrossRefPubMed
16.
Tinetti ME, Doucette J, Claus E, Marottoli R. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc. 1995;43(11):1214–21.CrossRefPubMed
17.
Jensen J, Nyberg L, Gustafson Y, Lundin-Olsson L. Fall and injury prevention in residential care--effects in residents with higher and lower levels of cognition. J Am Geriatr Soc. 2003;51(5):627–35.CrossRefPubMed
18.
Stubbs B, Patchay S, Soundy A, Schofield P. The Avoidance of Activities due to Fear of Falling Contributes to Sedentary Behavior among Community-Dwelling Older Adults with Chronic Musculoskeletal Pain: A Multisite Observational Study. Pain medicine (Malden, Mass). 2014.
19.
Morley JE. Managing persons with dementia in the nursing home: high touch trumps high tech. J Am Med Dir Assoc. 2008;9(3):139–46.CrossRefPubMed
20.
Ballard CG, Margallo-Lana M, Fossey J, Reichelt K, Myint P, Potkins D, et al. A 1-year follow-up study of behavioral and psychological symptoms in dementia among people in care environments. The Journal of clinical psychiatry. 2001;62(8):631–6.CrossRefPubMed
21.
Selbaek G, Engedal K, Bergh S. The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: a systematic review. J Am Med Dir Assoc. 2013;14(3):161–9.CrossRefPubMed
22.
Phillips VL, Diwan S. The incremental effect of dementia-related problem behaviors on the time to nursing home placement in poor, frail, demented older people. J Am Geriatr Soc. 2003;51(2):188–93.CrossRefPubMed
23.
Selbaek G, Engedal K. Stability of the factor structure of the Neuropsychiatric Inventory in a 31-month follow-up study of a large sample of nursing-home patients with dementia. Int Psychogeriatr. 2012;24(1):62–73.CrossRefPubMed
24.
Sylliaas H, Selbaek G, Bergland A. Do behavioral disturbances predict falls among nursing home residents? Aging Clin Exp Res. 2012;24(3):251–6.CrossRefPubMed
25.
Samus QM, Rosenblatt A, Steele C, Baker A, Harper M, Brandt J, et al. The association of neuropsychiatric symptoms and environment with quality of life in assisted living residents with dementia. Gerontologist. 2005;45 Spec No 1(1):19–26.CrossRefPubMed
26.
Kong EH, Evans LK, Guevara JP. Nonpharmacological intervention for agitation in dementia: a systematic review and meta-analysis. Aging Ment Health. 2009;13(4):512–20.CrossRefPubMed
27.
Ruths S, Sorensen PH, Kirkevold O, Husebo BS, Kruger K, Halvorsen KH, et al. Trends in psychotropic drug prescribing in Norwegian nursing homes from 1997 to 2009: a comparison of six cohorts. International journal of geriatric psychiatry. 2013;28(8):868–76.CrossRefPubMed
28.
Ballard C, Waite J, Birks J. Atypical antipsychotics for aggression and psychosis in Alzheimer’s disease. Cochrane Database Syst Rev. 2006;1:CD003476.PubMed
29.
Wetzels RB, Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM. Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International psychogeriatrics / IPA. 2011;23(8):1249–59.CrossRefPubMed
30.
Testad I, Auer S, Mittelman M, Ballard C, Fossey J, Donabauer Y, et al. Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England. International journal of geriatric psychiatry. 2010;25(7):725–31.CrossRefPubMed
31.
Huber M, Kölzsch M, Rapp MA, Wulff I, Kalinowski S, Bolbrinker J, et al. Antipsychotic drugs predominate in pharmacotherapy of nursing home residents with dementia. Pharmacopsychiatry. 2012;45(5):182–8.PubMed
32.
Furniss L, Craig SK, Burns A. Medication use in nursing homes for elderly people. Int J Geriatr Psychiatry. 1998;13(7):433–9.CrossRefPubMed
33.
Landi F, Onder G, Cesari M, Barillaro C, Russo A, Bernabei R. Psychotropic medications and risk for falls among community-dwelling frail older people: an observational study. The journals of gerontology Series A, Biological sciences and medical sciences. 2005;60(5):622–6.CrossRefPubMed
34.
Sterke CS, Ziere G, van Beeck EF, Looman CW, van der Cammen TJ. Dose-response relationship between selective serotonin re-uptake inhibitors and injurious falls: a study in nursing home residents with dementia. British journal of clinical pharmacology. 2012;73(5):812–20.PubMedCentralCrossRefPubMed
35.
Huybrechts KF, Gerhard T, Crystal S, Olfson M, Avorn J, Levin R, et al. Differential risk of death in older residents in nursing homes prescribed specific antipsychotic drugs: population based cohort study. BMJ (Clinical research ed). 2012;344:e977-e. doi:ttp://​dx.​doi.​org/​10.​1136/​bmj.​e977
36.
Thuné-Boyle ICV, Iliffea S, Cerga-Pashojaa A, Lowerya D, Warner J. The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda. International Psychogeriatrics. 2012;24(7):1046–57.CrossRefPubMed
37.
38.
Littbrand H, Stenvall M, Rosendahl E. Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: a systematic review. Am J Phys Med Rehabil. 2011;90:495–518.CrossRefPubMed
39.
Pitkälä K, Savikko N, Poystri M, Standberg T, Laakkonen M-L. Efficacy of physical exercise intervention on mobility and physical functioning in older people with dementia: A systematic review. Experimental Gerontology. 2013;43:85–93.CrossRef
40.
Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S. Exercise programs for people with dementia. The Cochrane database of systematic reviews. 2015;4:Cd006489.
41.
Telenius EW, Engedal K, Bergland A. Effect of a high-intensity exercise program on physical function and mental health in nursing home residents with dementia: an assessor blinded randomized controlled trial. PLoS One. 2015;10(5):e0126102.PubMedCentralCrossRefPubMed
42.
Connelly DM, Vandervoort AA. Effects of detraining on knee extensor strength and functional mobility in a group of elderly women. J Orthop Sports Phys Ther. 1997;26(6):340–6.CrossRefPubMed
43.
de Vreede PL, Samson MM, van Meeteren NLU, Duursma SA, Verhaar HJJ. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized, controlled trial. Journal Of The American Geriatrics Society. 2005;53(1):2–10.CrossRefPubMed
44.
Geirsdottir OG, Arnarson A, Ramel A, Briem K, Jonsson PV, Thorsdottir I. Muscular strength and physical function in elderly adults 6–18 months after a 12-week resistance exercise program. Scandinavian journal of public health. 2015;43(1):76–82.CrossRefPubMed
45.
Fatouros IG, Kambas A, Katrabasas I, Leontsini D, Chatzinikolaou A, Jamurtas AZ, et al. Resistance training and detraining effects on flexibility performance in the elderly are intensity-dependent. Journal of strength and conditioning research / National Strength & Conditioning Association. 2006;20(3):634–42.
46.
Kalinowski S, Wulff I, Kölzsch M, Kopke K, Kreutz R, Dräger D. Physical activity in nursing homes-- barriers and facilitators: a cross-sectional study. Journal of aging and physical activity. 2012;20(4):421–41.PubMed
47.
Toraman NF, Ayceman N. Effects of six weeks of detraining on retention of functional fitness of old people after nine weeks of multicomponent training. Br J Sports Med. 2005;39(8):565–8.PubMedCentralCrossRefPubMed
48.
Toulotte C, Thevenon A, Fabre C. Effects of training and detraining on the static and dynamic balance in elderly fallers and non-fallers: a pilot study. Disabil Rehabil. 2006;28(2):125–33.CrossRefPubMed
49.
Vogler CM, Menant JC, Sherrington C, Ogle SJ, Lord SR. Evidence of detraining after 12-week homebased exercise programs designed to reduce fall-risk factors in older people recently discharged from hospital. Arch Phys Med Rehabil. 2012;93(10):1685–91.CrossRefPubMed
50.
Rosendahl E, Lindelof N, Littbrand H, Yifter-Lindgren E, Lundin-Olsson L, Haglin L, et al. High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: a randomised controlled trial. The Australian journal of physiotherapy. 2006;52(2):105–13.CrossRefPubMed
51.
52.
Littbrand H, Rosendahl E, Lindelöf N, Lundin-Olsson L, Gustafson Y, Nyberg L. A High-Intensity Functional Weight-Bearing Exercise Program for Older People Dependent in Activities of DailyLiving and Living in Residential Care Facilities: Evaluation of the applicability With Focus on Cognitive Function. Physical Therapy. 2006;86(4):489–98.PubMed
53.
Berg K, Wood-Dauphinee S, Williams JI, Gauton D. Measuring balance in the elderly: preliminary development of an instrument. Physiotherapy Canada. 1989;41(6):304–11.CrossRef
54.
Studenski S, Perera S, Wallace D, Chandler JM, Duncan PW, Rooney E, et al. Physical performance measures in the clinical setting. J Am Geriatr Soc. 2003;51(3):314–22.CrossRefPubMed
55.
Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport. 1999;70(2):113–9.CrossRefPubMed
56.
Telenius EW, Engedal K, Bergland A. Inter-rater reliability of the Berg Balance Scale, 30 s chair stand test and 6 m walking test, and construct validity of the Berg Balance Scale in nursing home residents with mild-to-moderate dementia. BMJ Open. 2015;5(9):e008321.PubMedCentralCrossRefPubMed
57.
Mahoney FI, Barthel DW. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965;14:61–5.PubMed
58.
Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. International disability studies. 1988;10(2):61–3.CrossRefPubMed
59.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. The British journal of psychiatry : the journal of mental science. 1982;140:566–72.CrossRef
60.
Engedal K, Haugen PK. The prevalence of dementia in a sample of elderly Norwegians. Int J Geriatr Psychiatry. 1993;8:565–70.CrossRef
61.
Nygaard HA, Ruths S. Missing the diagnosis: senile dementia in patients admitted to nursing homes. Scand J Prim Health Care. 2003;21(3):148–52.CrossRefPubMed
62.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed
63.
Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, et al. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. The Journal of neuropsychiatry and clinical neurosciences. 2000;12(2):233–9.CrossRefPubMed
64.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44(12):2308–14.CrossRefPubMed
65.
Alexopoulus GS, Abrams RC, Young RC. Cornell scale for depression in dementia. Biol Psychiatry. 1988;23:271–84.CrossRef
66.
Barca ML, Engedal K, Selbaek G. A reliability and validity study of the cornell scale among elderly inpatients, using various clinical criteria. Dement Geriatr Cogn Disord. 2010;29(5):438–47.CrossRefPubMed
67.
Weiner MF, Martin-Cook K, Svetlik DA, Saine K, Foster B, Fontaine CS. The quality of life in late-stage dementia (QUALID) scale. Journal of the American Medical Directors Association. 2000;1(3):114–6.PubMed
68.
Muir SW, Berg K, Chesworth B, Speechley M. Use of the Berg Balance Scale for predicting multiple falls in community-dwelling elderly people: a prospective study. Phys Ther. 2008;88(4):449–59.CrossRefPubMed
69.
Castell M-V, Sanchez M, Julian R, Queipo R, Martin S, Otero A. Frailty prevalence and slow walking speed in persons age 65 and older: implications for primary care. BMC Family Practice. 2013;14(1):86.PubMedCentralCrossRefPubMed
70.
Conradsson M, Lundin-Olsson L, Lindelof N, Littbrand H, Malmqvist L, Gustafson Y, et al. Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther. 2007;87(9):1155–63.CrossRefPubMed
71.
Carvalho MJ, Marques E, Mota J. Training and detraining effects on functional fitness after a multicomponent training in older women. Gerontology. 2009;55(1):41–8.CrossRefPubMed
72.
Holmberg SK. Evaluation of a clinical intervention for wanderers on a geriatric nursing unit. Arch Psychiatr Nurs. 1997;11(1):21–8.CrossRefPubMed
73.
Aman E, Thomas DR. Supervised exercise to reduce agitation in severely cognitively impaired persons. J Am Med Dir Assoc. 2009;10(4):271–6.CrossRefPubMed
74.
Edwards N, Gardiner M, Ritchie DM, Baldwin K, Sands L. Effect of exercise on negative affect in residents in special care units with moderate to severe dementia. Alzheimer disease and associated disorders. 2008;22(4):362–8.CrossRefPubMed
75.
Iraqi A, Hughes TL. Antipsychotic drug use among nursing home residents taking rivastigmine. J Am Med Dir Assoc. 2006;7(5):337–8.CrossRefPubMed
76.
Buhr GT, White HK. Difficult behaviors in long-term care patients with dementia. J Am Med Dir Assoc. 2006;7(3):180–92.CrossRefPubMed
77.
78.
De Souto Barreto P, Demougeot L, Vellas B, Rolland Y. How much exercise are older adults living in nursing homes doing in daily life? A cross-sectional study. Journal Of Sports Sciences. 2015;33(2):116–24.CrossRef
79.
80.
Metadata
Title
Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial
Authors
Elisabeth Wiken Telenius
Knut Engedal
Astrid Bergland
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2015
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-015-0151-8

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