Exercise and caregiver training improve mood and physical health in people with Alzheimer disease
Patients with Alzheimer disease are less depressed
and have better physical health when they exercise and their caregiver
receives behavioral management training, according to an article
in the October 15th issue of The Journal of the American Medical
Association.
Linda Teri, Ph.D., and her American colleagues
conducted a study to determine whether a home-based exercise program
for patients with Alzheimer disease plus behavioral management training
for caregivers would help decrease the physical frailty and behavioral
impairment that are often prevalent and can lead to increased functional
disability and institutionalization of affected patients.
The study was a randomized controlled trial
that included 153 community-dwelling patients meeting National Institute
of Neurological and Communicative Diseases and Stroke/Alzheimer
Disease and Related Disorders Association criteria for Alzheimer
disease. The trial was conducted between June 1994 and April 1999.
Patient-caregiver pairs were randomly assigned
to the combined exercise and caregiver training program, called
Reducing Disability in Alzheimer Disease (RDAD), or to routine medical
care (RMC). The combination program was conducted in the patients'
homes over 3 months.
At 3 months, there were significant differences
in physical activity between the 2 groups of patients. Patients
in the combination group were almost 3 times more likely to exercise
at least 1 hour per week, and they were more than 3 times more likely
to have fewer days of restricted activity. The patients who received
the combination patient/caregiver training had improved scores for
physical function. In addition, the combination group had improved
scores on the Cornell Depression Scale for Depression in Dementia,
whereas the routine care patients had decreased scores relative
to baseline.
At 2 years, the combination patients continued
to have better physical function scores than the routine care patients
and showed a trend toward less institutionalization due to behavioral
disturbance. Among patients with higher baseline depression scores,
people in the combination group improved significantly more at 3
months on the Hamilton Depression Rating Scale than the routine
care patients and they maintained that improvement at 24 months.
"This study demonstrated that an integrated
treatment program designed to train dementia patients and their
caregivers in exercise and behavioral management techniques was
successfully implemented in a community setting. Caregivers were
able to learn how to encourage and supervise exercise participation,
and patients participating in this program achieved increased levels
of physical activity, decreased rates of depression, and improved
physical health and function," the authors wrote.
"Because exercise is also associated
with reduced depression in adults without dementia, targeting patients
with coexisting depression and dementia might enhance treatment
effects. Given these results and the consistently strong association
between physical exercise and health in older adults without dementia,
the potential health benefits of a simple exercise program for older
adults with dementia should not be overlooked," the researchers
concluded.
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