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Effects of physical activity training in patients with Alzheimer's dementia: results of a pilot RCT study.

Holthoff VA, Marschner K, Scharf M, Steding J, Meyer S, Koch R, Donix M - PLoS ONE (2015)

Bottom Line: Analysis of activities of daily living in the patients (ADCS ADL total score) revealed a significant group × time interaction effect (95% CI of the difference between both groups at T2: 5.01-10.51).This study suggests that PA in a home-based setting might be an effective and intrinsically attractive way to promote PA training in AD and modulate caregiver burden.The results demonstrate transfer benefits to ADL, cognitive and physical skill in patients with AD.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, Division of Old Age Psychiatry and Cognitive Neuropsychiatry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany; DZNE, German Center for Neurodegenerative Diseases, Dresden, Germany.

ABSTRACT

Background: There is evidence that physical activity (PA) is of cognitive benefit to the ageing brain, but little is known on the effect in patients with Alzheimer's disease (AD). The present pilot study assessed the effect of a home-based PA training on clinical symptoms, functional abilities, and caregiver burden after 12 and 24 weeks.

Methods: In an RCT thirty patients (aged 72.4±4.3 years) with AD (MMSE: 20.6±6.5 points) and their family caregivers were allocated to a home-based 12-week PA intervention program or the usual care group. The program changed between passive, motor-assisted or active resistive leg training and changes in direction on a movement trainer in order to combine physical and cognitive stimuli.

Results: Analysis of activities of daily living in the patients (ADCS ADL total score) revealed a significant group × time interaction effect (95% CI of the difference between both groups at T2: 5.01-10.51). The control group experienced decreases in ADL performance at week 12 and 24 whereas patients in the intervention group remained stable. Analyses of executive function and language ability revealed considerable effects for semantic word fluency with a group × time interaction (95% CI of the difference between both groups at T2: 0.18-4.02). Patients in the intervention group improved during the intervention and returned to initial performance at week 12 whereas the controls revealed continuous worsening. Analyses of reaction time, hand-eye quickness and attention revealed improvement only in the intervention group. Caregiver burden remained stable in the intervention group but worsened in the control group.

Conclusions: This study suggests that PA in a home-based setting might be an effective and intrinsically attractive way to promote PA training in AD and modulate caregiver burden. The results demonstrate transfer benefits to ADL, cognitive and physical skill in patients with AD.

Trial registration: ClinicalTrials.gov NCT02196545.

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Related in: MedlinePlus

a-e. Effects of physical activity on clinical performance.This figure shows the effects of physical activity on the patients when compared to the control group for the three time points (T0- baseline, T1–3 months later or after completion of the intervention and T2- 3 month follow-up). Activities of daily living (ADCS ADL total scores): patients in the control group experienced significant decreases in their performance over 12 weeks and at the 3 month follow-up whereas patients in the intervention group remained stable during the study period and follow-up (Fig 2a). Neuropsychiatric symptom profiles (NPI total scores): controls suffered a considerable increase in behavioural changes over 24 weeks whereas patients in the intervention group remained stable over 24 weeks (Fig 2b). Executive function and language ability: patients in the intervention group improved during the intervention period and returned to initial performance after completion but without revealing the continuous worsening over 24 weeks demonstrated in the controls (Fig 2c). Reaction time, hand-eye quickness and attention (FETZ-test or Ruler Drop Test): only patients in the intervention group improved their performance during the study period (Fig 2d). Caregiver burden (NPI): burden increased in the control group during the first 3 months whereas caregiver burden remained stable in the intervention group during the study period (Fig 2e).
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pone.0121478.g002: a-e. Effects of physical activity on clinical performance.This figure shows the effects of physical activity on the patients when compared to the control group for the three time points (T0- baseline, T1–3 months later or after completion of the intervention and T2- 3 month follow-up). Activities of daily living (ADCS ADL total scores): patients in the control group experienced significant decreases in their performance over 12 weeks and at the 3 month follow-up whereas patients in the intervention group remained stable during the study period and follow-up (Fig 2a). Neuropsychiatric symptom profiles (NPI total scores): controls suffered a considerable increase in behavioural changes over 24 weeks whereas patients in the intervention group remained stable over 24 weeks (Fig 2b). Executive function and language ability: patients in the intervention group improved during the intervention period and returned to initial performance after completion but without revealing the continuous worsening over 24 weeks demonstrated in the controls (Fig 2c). Reaction time, hand-eye quickness and attention (FETZ-test or Ruler Drop Test): only patients in the intervention group improved their performance during the study period (Fig 2d). Caregiver burden (NPI): burden increased in the control group during the first 3 months whereas caregiver burden remained stable in the intervention group during the study period (Fig 2e).

Mentions: Longitudinal analysis of the patients’ ADL (ADCS ADL total scores, the primary outcome) revealed a significant group × time interaction effect (95% CI of the difference between both groups at T2: 5.01–10.51). Patients in the control group experienced considerable decreases in their performance in ADL over 12 weeks and at the 3 month follow-up whereas patients in the intervention group remained stable during the study period and follow-up (Fig 2a, Table 2). Neuropsychiatric symptom profiles as measured by NPI total scores showed a considerable group × time interaction effect (95% CI of the difference between both groups at T2: 1.83–9.55). Controls suffered a considerable increase in behavioural changes over 24 weeks whereas patients in the intervention group remained stable over 24 weeks (Fig 2b, Table 2). Analyses of the specific behavioural symptoms (NPI subscores) showed that depression (main effect of group estimated to 1.12 with s.e. = 0.51) and anxiety (main effect group x time interaction estimated to 1.50 with s.e. = 0.67) revealed clinically relevant worsening in the controls. Analyses of executive function and language ability revealed considerable effects for semantic word fluency with a considerable group × time interaction (95%CI of the difference between both groups at T2: 0.18–4.02) (Fig 2c, Table 2). Patients in the intervention group considerably improved during the intervention period and returned to initial performance after completion but without revealing the continuous worsening over 24 weeks demonstrated in the controls. The measure for global cognitive function as measured by MMSE (20.6±6.5 points) did not reach significance (F = 0.77, df = 2, 53, p = 0.4659).


Effects of physical activity training in patients with Alzheimer's dementia: results of a pilot RCT study.

Holthoff VA, Marschner K, Scharf M, Steding J, Meyer S, Koch R, Donix M - PLoS ONE (2015)

a-e. Effects of physical activity on clinical performance.This figure shows the effects of physical activity on the patients when compared to the control group for the three time points (T0- baseline, T1–3 months later or after completion of the intervention and T2- 3 month follow-up). Activities of daily living (ADCS ADL total scores): patients in the control group experienced significant decreases in their performance over 12 weeks and at the 3 month follow-up whereas patients in the intervention group remained stable during the study period and follow-up (Fig 2a). Neuropsychiatric symptom profiles (NPI total scores): controls suffered a considerable increase in behavioural changes over 24 weeks whereas patients in the intervention group remained stable over 24 weeks (Fig 2b). Executive function and language ability: patients in the intervention group improved during the intervention period and returned to initial performance after completion but without revealing the continuous worsening over 24 weeks demonstrated in the controls (Fig 2c). Reaction time, hand-eye quickness and attention (FETZ-test or Ruler Drop Test): only patients in the intervention group improved their performance during the study period (Fig 2d). Caregiver burden (NPI): burden increased in the control group during the first 3 months whereas caregiver burden remained stable in the intervention group during the study period (Fig 2e).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4401690&req=5

pone.0121478.g002: a-e. Effects of physical activity on clinical performance.This figure shows the effects of physical activity on the patients when compared to the control group for the three time points (T0- baseline, T1–3 months later or after completion of the intervention and T2- 3 month follow-up). Activities of daily living (ADCS ADL total scores): patients in the control group experienced significant decreases in their performance over 12 weeks and at the 3 month follow-up whereas patients in the intervention group remained stable during the study period and follow-up (Fig 2a). Neuropsychiatric symptom profiles (NPI total scores): controls suffered a considerable increase in behavioural changes over 24 weeks whereas patients in the intervention group remained stable over 24 weeks (Fig 2b). Executive function and language ability: patients in the intervention group improved during the intervention period and returned to initial performance after completion but without revealing the continuous worsening over 24 weeks demonstrated in the controls (Fig 2c). Reaction time, hand-eye quickness and attention (FETZ-test or Ruler Drop Test): only patients in the intervention group improved their performance during the study period (Fig 2d). Caregiver burden (NPI): burden increased in the control group during the first 3 months whereas caregiver burden remained stable in the intervention group during the study period (Fig 2e).
Mentions: Longitudinal analysis of the patients’ ADL (ADCS ADL total scores, the primary outcome) revealed a significant group × time interaction effect (95% CI of the difference between both groups at T2: 5.01–10.51). Patients in the control group experienced considerable decreases in their performance in ADL over 12 weeks and at the 3 month follow-up whereas patients in the intervention group remained stable during the study period and follow-up (Fig 2a, Table 2). Neuropsychiatric symptom profiles as measured by NPI total scores showed a considerable group × time interaction effect (95% CI of the difference between both groups at T2: 1.83–9.55). Controls suffered a considerable increase in behavioural changes over 24 weeks whereas patients in the intervention group remained stable over 24 weeks (Fig 2b, Table 2). Analyses of the specific behavioural symptoms (NPI subscores) showed that depression (main effect of group estimated to 1.12 with s.e. = 0.51) and anxiety (main effect group x time interaction estimated to 1.50 with s.e. = 0.67) revealed clinically relevant worsening in the controls. Analyses of executive function and language ability revealed considerable effects for semantic word fluency with a considerable group × time interaction (95%CI of the difference between both groups at T2: 0.18–4.02) (Fig 2c, Table 2). Patients in the intervention group considerably improved during the intervention period and returned to initial performance after completion but without revealing the continuous worsening over 24 weeks demonstrated in the controls. The measure for global cognitive function as measured by MMSE (20.6±6.5 points) did not reach significance (F = 0.77, df = 2, 53, p = 0.4659).

Bottom Line: Analysis of activities of daily living in the patients (ADCS ADL total score) revealed a significant group × time interaction effect (95% CI of the difference between both groups at T2: 5.01-10.51).This study suggests that PA in a home-based setting might be an effective and intrinsically attractive way to promote PA training in AD and modulate caregiver burden.The results demonstrate transfer benefits to ADL, cognitive and physical skill in patients with AD.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry and Psychotherapy, Division of Old Age Psychiatry and Cognitive Neuropsychiatry, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307, Dresden, Germany; DZNE, German Center for Neurodegenerative Diseases, Dresden, Germany.

ABSTRACT

Background: There is evidence that physical activity (PA) is of cognitive benefit to the ageing brain, but little is known on the effect in patients with Alzheimer's disease (AD). The present pilot study assessed the effect of a home-based PA training on clinical symptoms, functional abilities, and caregiver burden after 12 and 24 weeks.

Methods: In an RCT thirty patients (aged 72.4±4.3 years) with AD (MMSE: 20.6±6.5 points) and their family caregivers were allocated to a home-based 12-week PA intervention program or the usual care group. The program changed between passive, motor-assisted or active resistive leg training and changes in direction on a movement trainer in order to combine physical and cognitive stimuli.

Results: Analysis of activities of daily living in the patients (ADCS ADL total score) revealed a significant group × time interaction effect (95% CI of the difference between both groups at T2: 5.01-10.51). The control group experienced decreases in ADL performance at week 12 and 24 whereas patients in the intervention group remained stable. Analyses of executive function and language ability revealed considerable effects for semantic word fluency with a group × time interaction (95% CI of the difference between both groups at T2: 0.18-4.02). Patients in the intervention group improved during the intervention and returned to initial performance at week 12 whereas the controls revealed continuous worsening. Analyses of reaction time, hand-eye quickness and attention revealed improvement only in the intervention group. Caregiver burden remained stable in the intervention group but worsened in the control group.

Conclusions: This study suggests that PA in a home-based setting might be an effective and intrinsically attractive way to promote PA training in AD and modulate caregiver burden. The results demonstrate transfer benefits to ADL, cognitive and physical skill in patients with AD.

Trial registration: ClinicalTrials.gov NCT02196545.

Show MeSH
Related in: MedlinePlus