DIMENSIONS Autumn 1999


by Cheryl Dawes

Researchers from the University of Washington and Group Health Cooperative have been investigating whether training caregivers as exercise coaches spurs people with Alzheimer's disease to take part in activities that may reduce the problems they experience, and improve their quality of life.

Regular exercise is likely to be good for anyone, including a person with AD. Research has shown that people with dementia are at increased risk for falls and fractures--even greater risk than older adults without dementia. Based on studies of non-demented older adults, the investigators led by Dr. Linda Teri, UW professor of psychosocial and community health in the School of Nursing, hypothesized that a regimen of lower-body strengthening and balance exercises in patients with AD might decrease their risk. However, establishing an exercise program can be difficult for a person who may not be able to remember to do the exercises, or how to do them properly. In long-term care facilities, professional staff are often available to organize and lead an exercise program, but such professional guidance is not generally available to people with AD who live in the community with a family caregiver.

The first step was to assess the feasibility of teaching caregivers to guide patients through an exercise program. To find out, the team conducted a study in which they trained family caregivers of community-dwelling Alzheimer's patients to become exercise coaches. The training covered the exercise basics such as how to stretch properly and lift weights safely, and much more. Caregivers learned communication and behavior management skills--strategies for improving patient behavior and mood--as they were learning how to lead their patients through specific physical activities.

For 12 weeks, caregivers in the exercise study coached their patients in an individualized fitness program of endurance activities, strength training, and balance and flexibility exercises. Caregivers were trained by the study's interventionists--home health workers specifically trained in the management of AD. The fitness program each caregiver learned was individualized to take into account his or her own health as well as the patient's physical status, to ensure that both could safely participate.

During the treatment, the interventionist made nine visits to caregivers and patients in their homes. At the beginning, the interventionist would guide the patient through the exercises. As treatment progressed, the caregiver took over and the interventionist would watch as the caregiver coached the patient. During the visits, the interventionist spent an increasing amount of time with the caregiver discussing additional topics such as nutrition, driving safety, caregiver respite and problem solving.

Caregivers kept an exercise log and recorded the amount patients participated. All of the patients completed at least some of the exercises and one-third of them completed all of the assigned exercises during the 12 weeks.

The memory loss of AD can't be changed, but there may be some effective methods for remedying other disabilities. Finding those methods is what Teri and her research team are aiming for. "We're interested in reducing the disability that stems from treatable conditions such as depression and agitation, as well as the debilitating falls and fractures that result from the inevitable physical decline, which is part of AD," she says.

It's possible that increased physical activity can improve mood and psychological functioning. It is also possible that maintaining some level of physical fitness for as long as possible can reduce the number of falls taken by people with AD, or make them less likely to break a hip if they do fall. "We're awaiting the outcomes that tell us about the effectiveness of interventions we've been studying," says Teri. "In the meantime, we do know that with training and support, caregivers can safely guide patients with AD in a systematic fitness program and that patients can be willing participants."

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