Exercise Reduces Agitation in Residents

Abstract

Patrice Wendling is with the Chicago bureau of Elsevier Global Medical News. CHICAGO — A brief exercise program reduced agitated behavior in a pilot study of 50 nursing home residents with severe cognitive impairment. Other studies had already shown that exercise programs can reduce agitation and depression and improve the ability to perform activities of daily living. The current study involved 30 minutes of supervised exercise for 3 days per week for 3 weeks. Residents of locked special needs units at two nursing homes walked outdoors for 15 minutes in large groups and did 5 minutes each of weight lifting, sitting and standing, and throwing a beach ball in small groups. At baseline, the mean St. Louis Mental Status Examination score among the 50 residents was 1.45 on a 30-point scale, with 30 indicating full cognitive faculty. Mean Pittsburgh Agitation Scale (PAS) scores improved significantly from 5.8 at baseline to 4.5 post intervention on a 16-point scale, with 0 meaning no agitation, Edris Aman reported at the annual meeting of the American Geriatrics Society. Those categorized with the highest PAS scores at baseline (9.1 mean) had the largest reductions in PAS scores (to 6.1). An audience member asked how a 3-point drop in PAS score would translate clinically and if exercise influenced psychotropic use. “When you have a structured exercise program it seems like it kind of changes the way they think, especially when they interact one-on-one” said Mr. Aman, a medical student at St. Louis University School of Medicine in Missouri. “A lot of times in the locked units, a lot of the nurses leave the residents alone because it's much easier to deal with agitated patients if they're quiet, sitting alone. “I feel like the continuity, where they'd see one person 3 days a week who's talking with them, really helps the resident,” he said. Continuous activity programming, in which residents are engaged in meaningful activities such as exercise or casual conversation whenever they are in the main activity area, has been shown to reduce the number of days with agitation and psychoactive medication use and improve sleep in two dementia special care units (J. Am. Med. Dir. Assoc. 2006;7:426-31). Mr. Aman said that anecdotally, nurses reported that after a week of exercising patients who were previously up all night began sleeping through the night and remaining awake during the day. He theorized that exercise could be used at times in place of psychotropics, but said that medication use was not specifically evaluated in the study and that further research is needed. When asked how he was able to get patients with such poor mental status to exercise, Mr. Aman said that it wasn't difficult to get patients to go outdoors because they wanted to join the group, but that at times he had to passively guide a patient's arm to get them to understand a specific exercise pattern. “If you're enthusiastic and really happy they will actually do what you want,” he said. “The biggest problem I had was getting them to exercise the first time. Once they exercised once, it was easy.” Mr. Aman reported no conflicts of interest. The study was funded by a grant from the American Foundation for Aging Research. This study is good news, but hardly surprising. Exercise has other well-known positive effects on health status, including reduced falls. The normalization of the sleep-wake cycle would be a great benefit for both demented and cognitively intact patients. If facilities had the manpower and commitment to make structured, supervised exercise a priority for their residents, we would probably see improvement in the quality of life of many residents.