|Volume 5 Issue 288 Published - 14:00 UTC 08:00 EST 15-Oct-2003 Next Update - 14:00 UTC 08:00 EST 16-Oct-2003||Editor: Susan K. Boyer, RN
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Study shows people with Alzheimer's can benefit from exercise combined with caregiver training
A new study, published today in The Journal of the American Medical Association (JAMA) by a recipient of the Alzheimer's Association's Pioneer Award, demonstrates that a regular exercise program combined with caregiver education and training on supervising exercise improved the physical and emotional health of individuals with moderate to severe Alzheimer's disease.
"Through programs of exercise and caregiver training, such as the one demonstrated in this study, people with Alzheimer's may be able to maintain their physical health and share more positive interactions with their caregivers. That is potentially a big quality of life improvement for patients, caregivers, and family members – in fact, everyone touched by this devastating disease," said Cornelia Beck, Ph.D., R.N., F.A.A.N., of the Alzheimer's Association Medical & Scientific Advisory Council.
"This research is consistent with the Alzheimer's Association's emphasis on social and behavioral research as a way to enable people coping with Alzheimer's to better manage the disease and maximize their quality of life," said Jennifer Ward-Robinson, Ph.D., Director, Medical & Scientific Affairs for the Alzheimer's Association.
"We want to demonstrate scientifically the effectiveness of procedures used in daily care and management of people with Alzheimer's disease. We've heard repeatedly from caregivers that these low tech but high impact techniques can help prevent challenging behaviors, enhance independence, and delay institutionalization for people with Alzheimer's disease," Ward-Robinson said. "These results from a well conducted clinical trial provide solid evidence for the value of these non-pharmaceutical interventions, and show us avenues for ongoing evidence-based research into similar therapeutic approaches."
In the study, 153 patient-caregiver pairs were randomly assigned to a combined exercise and caregiver training program, known as Reducing Disability in Alzheimer Disease (RDAD), or to routine medical care (RMC). The RDAD program was conducted in the home of the person with Alzheimer's disease over three months.
Home healthcare workers showed the people with Alzheimer's how to do a series of exercises. They also taught caregivers how to encourage and assist the people with Alzheimer's with their exercises, plus gave them information about the disease, how it affects people, how to avoid situations that may cause distress, and how to respond to problems that may occur.
The study found that people with Alzheimer's in the RDAD program showed significantly higher levels of physical activity, lower rates of depression, and better physical health and function than those who had routine care.
"The participants in this study also showed a lower rate of nursing home placement for behavioral problems," said Beck. "This is welcome because it meets an expressed desire from many caregivers to have their loved ones with them at home, rather than in a nursing facility. Plus, home-based care can be less expensive for both the family and the healthcare system."
"The fact that the effects persisted at 24 months is especially encouraging, and that the benefits were apparent to caregivers as well as to the study investigators. Many studies have not looked at these more long-term effects," Beck added.
The authors suggest that caregivers may also have experienced improved physical health and well-being, though caregiver benefits were not formally measured as part of the study.
"It is important to understand that this treatment strategy is not just about exercise," Beck continued. "An equally important part of the intervention were the 12 hour-long sessions with caregivers teaching them how to introduce exercise, make it easy and fun to do, fit it into their schedule, and handle conflicts that might arise. It is likely that the program would not have been as successful without this caregiver education piece."
Behavior management training (BMT) has been shown to help reduce depression in people with Alzheimer's who are still living in their communities. In BMT, therapists work with caregivers to define psychiatric problems in terms of specific behaviors such as crying, withdrawing, and pacing. Therapists then help caregivers develop techniques for minimizing triggers of these troubling behaviors or for changing the way that they respond to them. The ultimate goal is to replace negative, unrewarding behaviors with more positive, satisfying ones.
Background on the Study:
Linda Teri, Ph.D., of the University of Washington School of Nursing and Group Health Cooperative's Center for Health Studies, Seattle, and colleagues conducted a study to determine whether a home-based exercise program for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems would help decrease the frailty and behavioral impairment that are often prevalent and that can lead to increased functional disability and institutionalization. The program's goal was to have the people with Alzheimer's disease moderately exercise for 30 minutes a day.
The study was a randomized, controlled trial that included 153 community-dwelling patients with Alzheimer disease. The trial was conducted between June 1994 and April 1999.
At three months, in comparison with the routine care patients, more patients in the RDAD group exercised at least 60 minutes per week and had fewer days of restricted activity. Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for those in the RMC group. People in the RDAD disease group had improved scores on the Cornell Depression Scale for Depression in Dementia while the RMC group had worse scores.
At two years, people in the RDAD group continued to have better physical role functioning scores than those in the RMC group and showed a trend for less institutionalization due to behavioral disturbance. For study participants with higher depression scores at baseline, those in the RDAD disease group improved significantly more at three months on the Hamilton Depression Rating Scale and maintained that improvement at 24 months.
"Though the sessions with the home healthcare workers lasted for only three months, the skills the caregivers learned through the program enabled some benefits to continue for two years," Beck said.