Sondell A1, Littbrand H1, Holmberg H2, Lindelöf N1, Rosendahl E1
1Umeå University, Community Medicine and Rehabilitation, Physiotherapy and Geriatric Medicine, Umeå, Sweden, 2Umeå University, Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
Background: Consequences of dementia are many and complex. In addition to reduced cognitive function, balance and walking impairment contributes to increased risk for falls, fractures, physical inactivity and dependence in activities of daily living (ADL). Further, in people in nursing homes, comorbidity and medical conditions are common. Balance is crucial for physical functioning and independence and can be improved by exercise in people with dementia. However, exercise applicability and motivation may affect the exercise effect.
Purpose: To evaluate whether applicability of the exercise (attendance, exercise intensity and adverse events) and motivation were associated with effect on balance of a high-intensity functional exercise program among people with dementia in nursing homes.
Methods: The Umeå Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial in nursing homes, Umeå, Sweden. Eighty-one people (60 women) with dementia randomized to exercise intervention were included in this study. Mean Mini-Mental State Examination score was 15 and mean age was 85. The High-Intensity Functional Exercise (HIFE) Program was conducted in groups of 3-8 participants, 5 sessions (45 min long) per two-week period, for 4 months (total 40 sessions). Outcome measure was Berg Balance Scale (BBS) assessed at baseline and follow-up and the difference was dichotomized in two groups; ≥5 points (responders) and 5 points (non-responders) according to minimal detectable change. Target variables were measures of applicability and motivation (attendance, and number of sessions attended with; adverse events, high motivation, and high-intensity strength and balance exercises). Associations between each of these variables and the outcome were analyzed using multivariate logistic regressions. Baseline characteristics, newly added medical diagnosis, falls, and hospital stay during the intervention were compared between responders and non-responders and included in the analyses when p 0.10 (cognitive function and ADL).
Results: The majority of participants had high attendance (median 34 sessions) and high motivation (median 20 sessions) and achieved moderate to high exercise intensity (median 32 sessions for strength and 33 for balance, respectively), leading to only minor and temporary adverse events. BBS score was 28.6±14.3 at baseline and 31.2±15.3 at follow up, with the difference between baseline and follow-up score ranging from -35 to 24 points. Twenty-nine (35.8%) participants were responders. The multivariable models analyzing associations between responders vs. non-responders and each target variable, revealed no significant associations.
Conclusion(s): Although there was an individual large variance, a high-intensity functional exercise program during 4 months seems to be able to improve balance in many individuals with dementia in nursing homes, despite having a progressive disease and high prevalence of medical conditions. High attendance, high exercise intensity, and high motivation rate as well as, few adverse events during exercise seem not to be associated with paramount balance response.
Implications: In people with dementia in nursing homes, many can improve their balance by a high-intensity functional exercise program. However, it may not be possible to predict balance exercise response only based on applicability and motivation. Consequently, there is no support for excluding individuals with dementia from exercise for not achieving high exercise intensity or having limited motivation to exercise.
Keywords: Dementia, Exercise, Balance
Funding acknowledgements: Swedish Research Council; Forte - Swedish Research Council for Health, Working Life and Welfare; ;the County Council of Västerbotten
Purpose: To evaluate whether applicability of the exercise (attendance, exercise intensity and adverse events) and motivation were associated with effect on balance of a high-intensity functional exercise program among people with dementia in nursing homes.
Methods: The Umeå Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial in nursing homes, Umeå, Sweden. Eighty-one people (60 women) with dementia randomized to exercise intervention were included in this study. Mean Mini-Mental State Examination score was 15 and mean age was 85. The High-Intensity Functional Exercise (HIFE) Program was conducted in groups of 3-8 participants, 5 sessions (45 min long) per two-week period, for 4 months (total 40 sessions). Outcome measure was Berg Balance Scale (BBS) assessed at baseline and follow-up and the difference was dichotomized in two groups; ≥5 points (responders) and 5 points (non-responders) according to minimal detectable change. Target variables were measures of applicability and motivation (attendance, and number of sessions attended with; adverse events, high motivation, and high-intensity strength and balance exercises). Associations between each of these variables and the outcome were analyzed using multivariate logistic regressions. Baseline characteristics, newly added medical diagnosis, falls, and hospital stay during the intervention were compared between responders and non-responders and included in the analyses when p 0.10 (cognitive function and ADL).
Results: The majority of participants had high attendance (median 34 sessions) and high motivation (median 20 sessions) and achieved moderate to high exercise intensity (median 32 sessions for strength and 33 for balance, respectively), leading to only minor and temporary adverse events. BBS score was 28.6±14.3 at baseline and 31.2±15.3 at follow up, with the difference between baseline and follow-up score ranging from -35 to 24 points. Twenty-nine (35.8%) participants were responders. The multivariable models analyzing associations between responders vs. non-responders and each target variable, revealed no significant associations.
Conclusion(s): Although there was an individual large variance, a high-intensity functional exercise program during 4 months seems to be able to improve balance in many individuals with dementia in nursing homes, despite having a progressive disease and high prevalence of medical conditions. High attendance, high exercise intensity, and high motivation rate as well as, few adverse events during exercise seem not to be associated with paramount balance response.
Implications: In people with dementia in nursing homes, many can improve their balance by a high-intensity functional exercise program. However, it may not be possible to predict balance exercise response only based on applicability and motivation. Consequently, there is no support for excluding individuals with dementia from exercise for not achieving high exercise intensity or having limited motivation to exercise.
Keywords: Dementia, Exercise, Balance
Funding acknowledgements: Swedish Research Council; Forte - Swedish Research Council for Health, Working Life and Welfare; ;the County Council of Västerbotten
Topic: Older people
Ethics approval required: Yes
Institution: Umeå University, Sweden
Ethics committee: Regional Ethical Review Board in Umeå Sweden
Ethics number: 2011-205-31M
All authors, affiliations and abstracts have been published as submitted.
