Abstract
We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in a 3:1 ratio to an intervention group (IG; n = 53) and control group (CG; n = 19), where the IG’s subjects were admitted to live in a State Reference Center of Alzheimer’s disease, which offers the targeted exercise program, while the CG’s subjects resided in independent living. A multidisciplinary health team assessed all patients before allocation, and dependent outcomes were again assessed at one, three, and six months. During the study, falls were recorded, and in all evaluations, bone mineral density was measured using a calcaneal quantitative ultrasound densitometer; balance and gait were measured using the performance-oriented mobility assessment (POMA), the timed up and go test (TUG), the one-leg balance test (OLB), and the functional reach test (FR). There were no differences between groups at baseline for all outcome measures. The prevalence of falls was significantly lower in the IG (15.09%) than in the CG (42.11%) (χ2 = 5.904; p = 0.015). We also found that there was a significant time*group interaction, with a post hoc Šidák test finding significant differences of improved physical function, especially in gait, for the IG, as assessed by POMA-Total, POMA-Gait, and TUG with a large effect size (ƞ2p = 0.185–0.201). In balance, we found significant differences between groups, regardless of time, and a medium effect size as assessed by POMA-Balance and the OLB (ƞ2p = 0.091–0.104). Clinically relevant effects were observed, although without significant differences in bone health, with a slowing of bone loss. These results show that a multimodal physical exercise program reduces fall risk and produces an improvement in gait, balance, and bone mineral density in the short and medium term in institutionalized patients with Alzheimer’s disease.
Highlights
We found significant differences in age and cognitive status variables (MMSE and Global Deterioration Scale (GDS)) between groups in the baseline assessment, so these were considered as covariates in subsequent analysis
During the study development, we considered some possible differences between both groups, fundamentally those derived from the fact that their place of residence was different, and that we were comparing institutionalized with community-dwelling older people with Alzheimer’s disease
We considered the beneficial effects of physical exercise on risk factors for falls and fractures, such as cognitive decline, bone mass loss, gait, and balance, as well as the positive effects on quality of life and autonomy in ADLs for Alzheimer’s disease (AD) patients, as stated in some previous studies [2,32,84]
Summary
The aging of the population is a process that is affecting the provision of health and social care from a public health perspective, and the situation is expected to worsen in the future. Frailty is an age-related state characterized by a progression toward functional decline and increased risk of poor clinical outcomes [5,6]. Consensus is lacking on some aspects of frailty, such as on a definition of frailty, and validation for different economic and clinical contexts. This is required to optimize frailty assessments and subsequent treatment choices and care planning [8]
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