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Exercises helpful for people with dementia: study

By Shereen Jegtvig

NEW YORK (Reuters Health) - Regular exercise can help people with dementia think a little more clearly, and care for themselves a bit more, a new study finds.

"If the person with dementia is living at home, there are usually exercise programs offered at community day programs for persons with dementia. I would encourage family caregivers to connect with these programs and/or home care to learn about the available resources in their community," said Dorothy Forbes, an associate professor at the Faculty of Nursing, University of Alberta in Edmonton, who led the study.

For patients with dementia who can no longer live at home, "Most residential settings should be offering exercise programs for their residents," Dr. Zaldy Tan, a dementia expert who was not involved in the new study, told Reuters Health. "If not, family caregivers may wish to advocate for these."

People are considered to have dementia if their mental function is bad enough to interfere with daily activities. Alzheimer's disease is the most common cause, accounting for about 60 to 80 percent of cases. The next most common cause of dementia is stroke.

Dementia leads to poorer quality of life for patients, and it also puts a burden on families and caregivers - as Forbes, who led the study, knows all too well.

"For over 20 years I worked as a community health nurse where health promotion was my focus and in home care where I attempted to support and provide the needed resources with many family caregivers and persons with dementia in rural and inner city homes," Forbes told Reuters Health in an email. "My mother also had dementia and died in an acute care setting where the health care providers did not understand how to care for her dementia symptoms."

"These experiences made me realize how difficult it was to care for someone with dementia at home and in other care settings, especially with little knowledge about what was helpful in managing the symptoms and available resources," Forbes said.

"There is strong evidence regarding the benefits of exercise on older adults, but we did not know if there were benefits for persons diagnosed with dementia," she explained.

In 2006, therefore, when "there was little research conducted in this area," Forbes and her colleagues pooled the data from four studies of the role of exercise for patients with dementia. Their new study, published online by the Cochrane Library, is an update of that earlier effort.

"This updated review includes 16 trials," Forbes said. "We plan to do another update in six months as additional trials have already come to our attention. There is now a great deal of interest in this area of research."

The 16 trials altogether involved nearly a thousand elderly adults with dementia. Each trial tested the effects of exercise programs on such outcomes as thinking skills, activities of daily living, challenging behavior, and depression.

All 16 trials were so-called "randomized, controlled studies," which means the research teams used the most dependable methods. Even so, the studies utilized different types and duration of exercise programs, and the participants were in different stages of dementia, so the results were not uniform.

Still, despite the differing nature of the studies, Forbes and her team found that on average, exercise improved cognitive functioning and the ability to perform activities of daily living.

"Exercise is not only beneficial for older adults (in general) but also for persons with dementia in delaying memory problems and prolonging their ability to care for themselves (i.e., activities of daily living such as dressing, bathing)," Forbes said.

Exercise didn't have an effect on depression or mood, however, and there wasn't enough evidence to draw firm conclusions about its effects on other outcomes.

"I think it's really important topic," Tan, who is the medical director of the Alzheimer's and Dementia Care Program at the University of California, Los Angeles, told Reuters Health.

"The challenge here is, as the authors pointed out, that these studies they reviewed were quite heterogeneous," he said.

"But with that said," he added, "it's promising that even with quite different interventions and studies, they found that it appears to be beneficial for cognition and also activities of daily living."

Tan sees a practical side to exercise that goes beyond its impact on measurable cognitive skills.

"I think exercise is one intervention that's going to turn out to be good for other things like, for example, reducing one's risk for falls," he said. "Falling is one thing that is a big problem for people with dementia."

Tan expects to see more research in the future, including studies of how exercise programs might affect the children and caregivers of people with dementia.

SOURCE: http://bit.ly/19a1A8c The Cochrane Library, December 4, 2013.

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