A home-based exercise intervention for caregivers of persons with dementia: study protocol for a randomised controlled trial

Wai Chi Chan, Nicola Lautenschlager, Briony Dow, Suk Ling Ma, Corine Sau Man Wong, Linda Chiu Wa Lam, Wai Chi Chan, Nicola Lautenschlager, Briony Dow, Suk Ling Ma, Corine Sau Man Wong, Linda Chiu Wa Lam

Abstract

Background: Family members, who provide the majority of care for persons with dementia, are especially vulnerable to developing depression. Interventions targeting their depressive symptoms have been proposed but their efficacies vary considerably. It has been suggested that interventions carried out in the home setting and involving both caregivers and care recipients are more efficacious. This study aims to compare the efficacy of a home-based structured exercise programme involving both persons with dementia and their caregivers with nonexercise social contact control in treating depression among caregivers.

Methods/design: This is a parallel-group, assessor-blind, randomised controlled trial. A total of 136 caregiver-care-recipient dyads (i.e. 272 participants in total) will be recruited and randomly allocated to either a home-based structured exercise (sitting Tai Chi) group or a social contact control group. The trial comprises a 3-month intervention phase followed by an extended observation phase of another 3 months. All participants will be assessed at baseline, 6th week, 12th week and 24th week. The primary outcome will be the reduction in depression among caregivers as measured by the Hamilton Rating Scale for Depression. The secondary outcomes will be burden, quality of life, cognitive performance and balance ability of the caregivers, as well as the neuropsychiatric symptoms, cognitive function, balance and functional abilities of the persons with dementia. We will also examine whether the brain-derived neurotrophic factor gene modulates mood changes in response to exercise.

Discussion: The findings offer a potential avenue of intervention by providing a low-cost, safe and effective treatment for depression among dementia caregivers, which may in turn also benefit the care recipients.

Trial registration: ClinicalTrials.gov Identifier: NCT02132039 , registered on 28 April 2014.

Keywords: Caregivers; Dementia; Depression; Home-based exercise; Randomised controlled trial; Tai Chi.

Figures

Fig. 1
Fig. 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram of the home-based exercise trial

References

    1. World Health Organization. The epidemiology and impact of dementia: current state and future trends. Geneva; 2015. Available from: . Accessed date 8 Apr 2016.
    1. Chan SW. Family caregiving in dementia: the Asian perspective of a global problem. Dement Geriatr Cogn Disord. 2010;30(6):469–78. doi: 10.1159/000322086.
    1. Cuijpers P. Depressive disorders in caregivers of dementia patients: a systematic review. Aging Ment Health. 2005;9(4):325–30. doi: 10.1080/13607860500090078.
    1. Mahoney R, Regan C, Katona C, Livingston G. Anxiety and depression in family caregivers of people with Alzheimer disease: the LASER-AD study. Am J Geriatr Psychiatry. 2005;13(9):795–801. doi: 10.1097/00019442-200509000-00008.
    1. Ho SC, Chan A, Woo J, Chong P, Sham A. Impact of caregiving on health and quality of life: a comparative population-based study of caregivers for elderly persons and noncaregivers. J Gerontol A Biol Sci Med Sci. 2009;64(8):873–9. doi: 10.1093/gerona/glp034.
    1. Ory MG, Hoffman RR, Yee JL, Tennstedt S, Schulz R. Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. Gerontologist. 1999;39(2):177–85. doi: 10.1093/geront/39.2.177.
    1. Chan WC, Ng C, Mok CCM, Wong FLF, Pang SL, Chiu HFK. Lived experience of caregivers of persons with dementia in Hong Kong: a qualitative study. East Asian Arch Psychiatry. 2010;20(4):163–8.
    1. Jensen M, Agbata IN, Canavan M, McCarthy G. Effectiveness of educational interventions for informal caregivers of individuals with dementia residing in the community: systematic review and meta-analysis of randomised controlled trials. Int J Geriatr Psychiatry. 2015;30(2):130–43. doi: 10.1002/gps.4208.
    1. Dam AE, de Vugt ME, Klinkenberg IP, Verhey FR, van Boxtel MP. A systematic review of social support interventions for caregivers of people with dementia: are they doing what they promise? Maturitas. 2016;85:117–30. doi: 10.1016/j.maturitas.2015.12.008.
    1. Elvish R, Lever S-J, Johnstone J, Cawley R, Keady J. Psychological interventions for carers of people with dementia: a systematic review of quantitative and qualitative evidence. Couns Psychother Res. 2013;13(2):106–25. doi: 10.1080/14733145.2012.739632.
    1. Boots LM, de Vugt ME, van Knippenberg RJ, Kempen GI, Verhey FR. A systematic review of Internet-based supportive interventions for caregivers of patients with dementia. Int J Geriatr Psychiatry. 2014;29(4):331–44. doi: 10.1002/gps.4016.
    1. Smits CHM, de Lange J, Dröes R-M, Meiland F, Vernooij-Dassen M, Pot AM. Effects of combined intervention programmes for people with dementia living at home and their caregivers: a systematic review. Int J Geriatr Psychiatry. 2007;22(12):1181–93. doi: 10.1002/gps.1805.
    1. Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41(1):15–28. doi: 10.2190/PM.41.1.c.
    1. De Fazio P, Ciambrone P, Cerminara G, Barbuto E, Bruni A, Gentile P, et al. Depressive symptoms in caregivers of patients with dementia: demographic variables and burden. Clin Interv Aging. 2015;10:1085–90. doi: 10.2147/CIA.S74439.
    1. Stathopoulou G, Powers MB, Berry AC, Smits JAJ, Otto MW. Exercise interventions for mental health: a quantitative and qualitative review. Clin Psychol Sci Pract. 2006;13(2):179–93. doi: 10.1111/j.1468-2850.2006.00021.x.
    1. Schuch FB, Deslandes AC, Stubbs B, Gosmann NP, Silva CTB, Fleck MPA. Neurobiological effects of exercise on major depressive disorder: a systematic review. Neurosci Biobehav Rev. 2016;2(61):1–11. doi: 10.1016/j.neubiorev.2015.11.012.
    1. Schuch FB, Vancampfort D, Richards J, Rosenbaum S, Ward PB, Stubbs B. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiatr Res. 2016;77:42–51. doi: 10.1016/j.jpsychires.2016.02.023.
    1. Hirano A, Suzuki Y, Kuzuya M, Onishi J, Ban N, Umegaki H. Influence of regular exercise on subjective sense of burden and physical symptoms in community-dwelling caregivers of dementia patients: a randomized controlled trial. Arch Gerontol Geriatr. 2011;53(2):e158–63. doi: 10.1016/j.archger.2010.08.004.
    1. King AC, Baumann K, O’Sullivan P, Wilcox S, Castro C. Effects of moderate-intensity exercise on physiological, behavioral, and emotional responses to family caregiving: a randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2002;57(1):M26–36. doi: 10.1093/gerona/57.1.M26.
    1. Waelde LC, Thompson L, Gallagher-Thompson D. A pilot study of a yoga and meditation intervention for dementia caregiver stress. J Clin Psychol. 2004;60(6):677–87. doi: 10.1002/jclp.10259.
    1. Lowery D, Cerga-Pashoja A, Iliffe S, Thuné-Boyle I, Griffin M, Lee J, et al. The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. Int J Geriatr Psychiatry. 2014;29(8):819–27. doi: 10.1002/gps.4062.
    1. Hill K, Smith R, Fearn M, Rydberg M, Oliphant R. Physical and psychological outcomes of a supported physical activity program for older carers. J Aging Phys Act. 2007;15(3):257–71. doi: 10.1123/japa.15.3.257.
    1. Etkin CD, Farran CJ, Barnes LL, Shah RC. Recruitment and enrollment of caregivers for a lifestyle physical activity clinical trial. Res Nurs Health. 2012;35(1):70–81. doi: 10.1002/nur.20466.
    1. Gitlin LN, Hodgson NA, Choi SSW. Home-based interventions targeting persons with dementia: what is the evidence and where do we go from here? In: Boltz M, Galvin JE, editors. Switzerland: Dementia care: an evidence-based approach: Springer International Publishing; 2016. p. 167-88.
    1. Steinberg M, Leoutsakos JMS, Podewils LJ, Lyketsos CG. Evaluation of a home-based exercise program in the treatment of Alzheimer’s disease: the Maximizing Independence in Dementia (MIND) study. Int J Geriatr Psychiatry. 2009;24(7):680–5. doi: 10.1002/gps.2175.
    1. Thinnes A, Padilla R. Effect of educational and supportive strategies on the ability of caregivers of people with dementia to maintain participation in that role. Am J Occup Ther. 2011;65(5):541–9. doi: 10.5014/ajot.2011.002634.
    1. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18. doi: 10.1186/1741-7015-8-18.
    1. Lee HCB, Chiu HFK, Kwok WY, Leung CM, Kwong PK, Chung DWS. Chinese elderly and the GDS short form: a preliminary study. Clin Gerontologist. 1993;14(2):37–42.
    1. Chiu HF, Lee H, Chung W, Kwong P. Reliability and validity of the Cantonese version of Mini-mental State Examination: a preliminary study. J Hong Kong Coll Psychiatry. 1994;4(Suppl 2):25–8.
    1. Surveillance and Epidemiology Branch, Department of Health, HKSAR Tai Chi for health. Non-Communicable Disease Watch. 2012;5(4):1–6.
    1. Li JX, Hong Y, Chan KM. Tai chi: physiological characteristics and beneficial effects on health. Br J Sports Med. 2001;35(3):148–56. doi: 10.1136/bjsm.35.3.148.
    1. Lam LC, Chau RC, Wong BM, Fung AW, Tam CW, Leung GT, et al. A 1- year randomized controlled trial comparing mind body exercise (Tai Chi) with stretching and toning exercise on cognitive function in older Chinese adults at risk of cognitive decline. J Am Med Dir Assoc. 2012;13(6):568.e15-20.
    1. Lee KY, Jones AY, Hui-Chan CW, Tsang WW. Kinematics and energy expenditure of sitting t’ai chi. J Altern Complement Med. 2011;17(8):665–8. doi: 10.1089/acm.2011.0147.
    1. Bendall S, Killackey E, Jackson H, Gleeson J. Befriending manual. University of Melbourne: OXYGEN Research Centre; 2003.
    1. Zheng YP, Zhao JP, Phillips M, Liu JB, Cai MF, Sun SQ, et al. Validity and reliability of the Chinese Hamilton Depression Rating Scale. Br J Psychiatry. 1988;152:660–4. doi: 10.1192/bjp.152.5.660.
    1. Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatry. 1988;45(8):742–7. doi: 10.1001/archpsyc.1988.01800320058007.
    1. Chan TSF, Lam LCW, Chiu HFK. Validation of the Chinese version of the Zarit Burden Interview. Hong Kong J Psychiatry. 2005;15(1):9–13.
    1. Lam CLK, Tse EYY, Gandek B. Is the standard SF-12 health survey valid and equivalent for a Chinese population? Qual Life Res. 2005;14(2):539–47. doi: 10.1007/s11136-004-0704-3.
    1. Chan SMS, Chiu FKH, Lam CWL. Correlational study of the Chinese version of the Executive Interview (C-EXIT25) to other cognitive measures in a psychogeriatric population in Hong Kong Chinese. Int J Geriatr Psychiatry. 2006;21(6):535–41. doi: 10.1002/gps.1521.
    1. Zheng L, Goldberg LR, Zheng Y, Zhao Y, Tang Y, Liu L. Reliability and concurrent validation of the IPIP Big-Five factor markers in China: consistencies in factor structure between Internet-obtained heterosexual and homosexual samples. Pers Individ Dif. 2008;45(7):649–54. doi: 10.1016/j.paid.2008.07.009.
    1. Lin JN, Wang JJ. Psychometric evaluation of the Chinese version of the Cornell Scale for Depression in Dementia. J Nurs Res. 2008;16(3):202–10. doi: 10.1097/01.JNR.0000387307.34741.39.
    1. Leung VP, Lam LC, Chiu HF, Cummings JL, Chen QL. Validation study of the Chinese version of the Neuropsychiatric Inventory (CNPI) Int J Geriatr Psychiatry. 2001;16(8):789–93. doi: 10.1002/gps.427.
    1. Mok CCM, Siu AMH, Chan WC, Yeung KM, Pan PC, Li S-W. Functional disabilities profile of Chinese elderly people with Alzheimer’s disease—a validation study on the Chinese version of the disability assessment for dementia. Dement Geriatr Cogn Disord. 2005;20(2-3):112–9. doi: 10.1159/000086612.
    1. Leung SOC, Chan CCH, Shah S. Development of a Chinese version of the modified Barthel Index—validity and reliability. Clin Rehabil. 2007;21(10):912–22. doi: 10.1177/0269215507077286.
    1. Mok EHL, Lam LCW, Chiu HFK. Category verbal fluency test performance in Chinese elderly with Alzheimer’s disease. Dement Geriatr Cogn Disord. 2004;18(2):120–4. doi: 10.1159/000079190.
    1. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992;83(Suppl 2):S7–11.
    1. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45(6):M192–7. doi: 10.1093/geronj/45.6.M192.
    1. Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142–8. doi: 10.1111/j.1532-5415.1991.tb01616.x.
    1. Kerse N, Hayman KJ, Moyes SA, Peri K, Robinson E, Dowell A, et al. Home-based activity program for older people with depressive symptoms: DeLLITE—a randomized controlled trial. Ann Fam Med. 2010;8(3):214–23. doi: 10.1370/afm.1093.
    1. Lam LCW, Tam CWC, Lui VWC, Chan WC, Chan SSM, Wong S, et al. Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. Int Psychogeriatr. 2008;20(1):135–48. doi: 10.1017/S1041610207006199.
    1. Patterson TL, Grant I. Interventions for caregiving in dementia: physical outcomes. Curr Opin Psychiatry. 2003;16(6):629–33. doi: 10.1097/00001504-200311000-00005.

Source: PubMed

3
Suscribir