Abstract
Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward. A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later. Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items. ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.
Highlights
Dementia currently affects 24.3 million people, with 4.6 million new cases every year worldwide (Ferri et al, 2005)
While patients suffering from dementia are frequently admitted to acute hospital wards because of Behavioral and Psychological Symptoms of Dementia (BPSD), independence in activities of daily living (ADL) is a major issue for the future of patients since a positive relationship exists between BPSD, level of independence in ADL, and caregiver burden (Miyamoto et al, 2010)
The review of Bürge et al (2012) showed only weak evidence regarding the impact of exercise programs on ADL among patients with moderate or severe dementia
Summary
Dementia currently affects 24.3 million people, with 4.6 million new cases every year worldwide (Ferri et al, 2005). Forbes et al (2008) conducted a systematic review on the effectiveness of physical activity programs in managing or improving cognition or function in people with dementia. Increasing evidence links alterations in executive function and attention to gait disturbances (Camicioli et al, 1997; Yogev-Seligmann et al, 2008) These studies support the hypothesis that the decline in ADL capacities in patients with dementia may be due to disease progression and to physical inactivity (Littbrand et al, 2009). This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward
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