A more intensive exercise program specifically designed for people in hospital with dementia has been shown to add benefits over normal rehabilitation, say researchers set to publish their findings in a February 2014 issue of the Journal of Alzheimer's Disease.
The researchers, led by the department of surgery at the University of Arizona in Tucson, say better rehabilitation care received by patients with dementia will improve their basic motor functions - of the kind we may take for granted, and important for the independence of older people with advanced forms of dementia, including Alzheimer's disease.
Michael Schwenk PhD, lead author, says:
"Rehabilitation of basic functional tasks, such as the ability to rise from a chair or walking, is of utmost importance to reduce fall risk, prevent loss of independence and increase mobility-related quality of life in patients with dementia."
Dr. Schwenk, a research associate specializing in motor performance healthcare, says his paper brings new findings to support higher-intensity rehabilitation.
"There has been a lack of evidence whether patients with dementia can benefit from more intensive rehabilitation exercise programs," he says.
Motor functions improved with intensive exercise
The patients in the study who received the novel intensive training "improved substantially" in basic motor functions, which the researchers say are linked to the high risk of falls in people hospitalized with advanced dementia.
The improved functions included:
- Lower-extremity muscle strength
- Ability to move from one position to another (transfer ability)
- Postural balance.
"Improvement in lower extremity strength was four times higher in the group that received the new training program compared to the group that received usual rehabilitation care only," says Dr. Schwenk.
The study split patients in the geriatric department between 74 receiving the specifically designed intensive training and another 74 receiving usual care in the control group. It took place in a geriatric hospital in Germany.
The main tests of improved outcome were:
- Maximal lower extremity strength as measured by a leg-press device
- Duration of the 5 chair-stand test as a measure of functional performance.
The study, says Dr. Schwenk, suggests that traditional barriers to more intensive rehabilitation, based on views about the diminished mental powers of people with dementia, are unfounded.
"Results indicate that medium to high training adherence can be achieved in the majority of geriatric inpatients despite cognitive impairment and acute functional impairment."
The researchers' work was against a background of several studies that had suggested cognitive impairment was a negative predictor of how well functional rehabilitation can work to improve the health outcomes of people with an advanced neurodegenerative brain disorder.
This previous research suggested "that memory loss, language impairments or lack of motivation may be barriers for effective rehabilitation."
Dr. Schwenk calls for better development of exercise training programs specifically designed for patients with dementia, because "geriatricians and therapists struggle with which type of exercise and what level of intensity is appropriate for these patients, and that little guidance is available as to which exercise program is the most suitable."
"The study provides important insight as to how geriatric rehabilitation exercise programs in patients with dementia can be adjusted and rendered more effective."