DIMENSIONS Winter 2005

Spotlight on Research: Exercise and Caregiver Education Improve Health and Depression in People with AD

photo of a caregiver with a man

It is well known that Alzheimer's disease (AD) affects cognitive, emotional and behavioral functioning. Less well-known are the harmful effects of AD on physical conditioning. However, there are a number of studies linking Alzheimer's disease with physical deterioration. For example, when compared with age-matched controls, persons with AD show more signs of undernutrition, higher risk of falls and fractures, and more rapid decline on measures of mobility. Once injured, those with AD are at a greater risk of subsequent injury than age- and sex-matched controls. Reduced muscle mass has also been associated with loss of independence. Consequently, improved physical conditioning for people with AD may extend their independent mobility and enhance their quality of life despite progression of the disease.

University of Washington ADRC researcher Dr. Linda Teri and her colleagues Drs. Laura Gibbons, Susan McCurry, Rebecca Logsdon, David Buchner, William Barlow, Walter Kukull, Andrea LaCroix, Wayne McCormick, and Eric B. Larson did a study referred to as RDAD Reducing Disabilities in Alzheimer's Disease, to evaluate whether a home-based exercise program, combined with caregiver training in behavioral management techniques, would reduce physical dependence and delay institutionalization of individuals with Alzheimer's disease.

In the RDAD study, 153 community-dwelling AD participants and their caregivers were randomly assigned to either a treatment condition an exercise and caregiver training program (RDAD), or to a control condition routine medical care (RMC). The RDAD program was conducted in the participants' homes for three months.

Project therapists Janine Jordan and Daryl Thomas, trained family caregivers in the RDAD group to facilitate and supervise exercise in individuals with Alzheimer's disease, while also teaching them strategies to prevent or reduce behavioral disturbances. Caregivers were taught to guide participants in individualized programs of endurance, strength training, and balance and flexibility exercises. In conjunction with the exercise program, caregivers learned to use behavior management strategies to reduce disruptive behavior and mood disturbances. Participants in the RMC condition received routine medical care, including acute medical or crisis intervention provided at community health care centers. This could include nonspecific advice and support routinely provided by nurses and primary care physicians or community support services. Specific exercise and behavioral management training was not provided to control participants.

After three months, the RDAD group was significantly more likely to exercise at least 60 minutes a week, and had fewer days of restricted activity, compared to the RMC group. RDAD participants also had improved physical role functioning and fewer symptoms of depression, while those in RMC were worse in both areas. At two years, RDAD participants continued to have better physical role functioning than RMC participants, and were less likely to have been placed in a nursing home due to behavioral disturbance. For participants with higher depression scores at baseline, those in RDAD improved significantly more than those in RMC and maintained their improvement at two years.

The study demonstrated that caregivers can provide a structured exercise program to persons with dementia by learning exercise activities plus behavior management techniques, and that dementia participants successfully increased their level of exercise with such a program. It concluded that exercise training, combined with teaching caregivers behavioral management techniques, improved physical health and depression in participants with Alzheimer's disease, and decreased rates of institutionalization for behavioral disturbance.

Dr. Teri remarks, "This is a very exciting finding. We have a number of ways of helping persons with AD and their caregivers. This gives us one more avenue of hope. By improving the physical health of those with AD and thereby reducing their risk of falls, fractures and additional disability, we can improve the quality of their lives and increase the likelihood that they can remain at home as long as possible."

For the full research article on the RDAD study, refer to: Teri L, Gibbons LE, McCurry SM, Logsdon RG, Buchner DM, Barlow WE, Kukull WA, LaCroix AZ, McCormick W, Larson EB. Exercise plus behavioral management in patients with Alzheimer disease. JAMA. 2003, 290, (15), pp 2015-2022. or at http://jama.ama-assn.org/cgi/reprint/290/15/2015.

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