Am Fam Physician. 2004 May 15;69(10):2456-2458.
Alzheimer’s disease adversely affects cognitive, emotional, and behavioral function, and also may have negative effects on physical conditioning. Teri and colleagues hypothesize that exercise training might prevent deconditioning and functional decline in patients with Alzheimer’s disease. This randomized controlled study was designed to determine whether a home-based exercise program involving patients and caregivers could reduce the patients’ functional dependence and delay institutionalization.
A total of 153 community-dwelling patients with Alzheimer’s disease who were 55 to 93 years of age were randomized to receive routine care or an exercise-behavior intervention. Patients in the active treatment group received 12 one-hour sessions, with the intervention ending after three months. The goal was for patients to engage in moderate-intensity exercise for a minimum of 30 minutes per day. Caregivers were taught behavior management techniques, including identification of activities that were pleasant for the patients. Primary outcomes were physical health and function, and affective status. Physical health and function were assessed according to sub-scales of the 36-item Short-Form Health Survey (SF-36; higher scores indicate better function) and three subscales of the Sickness Impact Profile (SIP; higher scores indicate worse function). Affective function was assessed through two depression scales. Secondary outcomes included walking speed, functional reach, and standing balance.
Of the 153 patients who entered the study, 140 (92 percent) completed the post-test assessment; of these, 89 patients (58 percent) completed the 24-month assessment that constituted the last in a series of blinded follow-up visits. At three months, significant differences between groups were obtained for the primary measures of physical role function and affective status. In both function and depression, the treatment group improved, while the routine-care group declined.
At three months, 23 percent more patients in the treatment group were exercising 60 minutes per day compared with baseline, while only 6 percent more of routine-care patients were exercising at that level. At 24-month follow-up, significant functional improvement remained in the intervention group. There were no statistically significant differences between groups regarding hospitalization; however, in the control group, more patients were institutionalized because of behavioral problems.
In this study, an integrative treatment program involving exercise and behavior techniques and targeting patients with Alzheimer’s disease and their caregivers increased physical activity levels, decreased depression rates, and improved physical health and function. Patients in the treatment group did significantly better than those in the control group in SF-36 scores and depression scale scores. The number of restricted activity days was significantly reduced in the intervention group.
Because more control patients were institutionalized for behavior problems, the study also suggests that this program has the potential to delay institutionalization in patients with Alzheimer’s disease. Finally, adherence to the program was high, indicating that the program can be implemented readily in a community setting.
Teri L, et al. Exercise plus behavioral management in patients with Alzheimer disease. A randomized controlled trial. JAMA. October 15, 2003;290:2015–22.
Copyright © 2004 by the American Academy of Family Physicians.
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