Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia

Annika Toots, Håkan Littbrand, Nina Lindelöf, Robert Wiklund, Henrik Holmberg, Peter Nordström, Lillemor Lundin-Olsson, Yngve Gustafson, Erik Rosendahl, Annika Toots, Håkan Littbrand, Nina Lindelöf, Robert Wiklund, Henrik Holmberg, Peter Nordström, Lillemor Lundin-Olsson, Yngve Gustafson, Erik Rosendahl

Abstract

Objectives: To investigate the effects of a high-intensity functional exercise program on independence in activities of daily living (ADLs) and balance in older people with dementia and whether exercise effects differed between dementia types.

Design: Cluster-randomized controlled trial: Umeå Dementia and Exercise (UMDEX) study.

Setting: Residential care facilities, Umeå, Sweden.

Participants: Individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs (N=186).

Intervention: Ninety-three participants each were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.

Measurements: Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months.

Results: Linear mixed models showed no between-group effect on ADL independence at 4 (FIM=1.3, 95% confidence interval (CI)=-1.6-4.3; BI=0.6, 95% CI=-0.2-1.4) or 7 (FIM=0.8, 95% CI=-2.2-3.8; BI=0.6, 95% CI=-0.3-1.4) months. A significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8-6.6). In interaction analyses, exercise effects differed significantly between dementia types. Positive between-group exercise effects were found in participants with non-Alzheimer's dementia according to the FIM at 7 months and BI and BBS at 4 and 7 months.

Conclusion: In older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program appears to slow decline in ADL independence and improve balance, albeit only in participants with non-Alzheimer's dementia.

Keywords: activities of daily living; dementia; exercise; postural balance; residential facilities.

© 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Figures

Figure 1
Figure 1
Flow of participants through the study. Recruitment and baseline assessment were performed in August and September 2011, interventions were implemented between October 2011 and February 2012, first follow-up assessments were performed in March–April 2012, and last follow-up assessments were performed in May and June 2012. ADLs  =  activities of daily living; MMSE = Mini-Mental State Examination; SD=standard deviation.
Figure 2
Figure 2
Changes in Functional Independence Measure, Barthel Index of activities of daily living (ADLs), and Berg Balance Scale (A–C) and according to dementia type (D–F). Values are least square means of changes from baseline, with 95% confidence intervals, from linear mixed-effects models of the complete sample (n = 186) adjusted for age, sex, and antidepressant use. Non-AD dementia included vascular dementia, mixed Alzheimer's disease (AD) and vascular dementia, and all other types of non-Alzheimer's dementia. ES = effect size.

References

    1. World Health Organization. Dementia: A Public Health Priority [on-line]. Available at Accessed September 14, 2014.
    1. Allan LM, Ballard CG, Burn DJ, et al. Prevalence and severity of gait disorders in Alzheimer's and non-Alzheimer's dementias. J Am Geriatr Soc. 2005;53:1681–1687.
    1. Morgan D, Funk M, Crossley M, et al. The potential of gait analysis to contribute to differential diagnosis of early stage dementia: Current research and future directions. Can J Aging. 2007;26:19–32.
    1. Pettersson AF, Olsson E, Wahlund LO. Motor function in subjects with mild cognitive impairment and early Alzheimer's disease. Dement Geriatr Cogn Disord. 2005;19:299–304.
    1. Sherrington C, Whitney JC, Lord SR, et al. Effective exercise for the prevention of falls: A systematic review and meta-analysis. J Am Geriatr Soc. 2008;56:2234–2243.
    1. Morie M, Reid KF, Miciek R, et al. Habitual physical activity levels are associated with performance in measures of physical function and mobility in older men. J Am Geriatr Soc. 2010;58:1727–1733.
    1. Guralnik JM, Ferrucci L, Pieper CF, et al. Lower extremity function and subsequent disability: Consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55A:M221–M231.
    1. Wennie Huang WN, Perera S, VanSwearingen J, et al. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. J Am Geriatr Soc. 2010;58:844–852.
    1. Andersen CK, Wittrup-Jensen KU, Lolk A, et al. Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia. Health Qual Life Outcomes. 2004;2:52.
    1. Åberg AC, Sidenvall B, Hepworth M, et al. On loss of activity and independence, adaptation improves life satisfaction in old age—a qualitative study of patients’ perceptions. Qual Life Res. 2005;14:1111–1125.
    1. Liu CJ, Latham NK. Progressive resistance strength training for improving physical function in older adults. Cochrane Database Syst Rev. 2009;3:CD002759.
    1. American College of Sports Medicine. Chodzko-Zajko WJ, Proctor DN, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41:1510–1530.
    1. Angevaren M, Aufdemkampe G, Verhaar HJ, et al. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst Rev. 2008;3:CD005381.
    1. Singh MA. Exercise to prevent and treat functional disability. Clin Geriatr Med. 2002;18:431–462. , vi–vii.
    1. Augustsson J, Esko A, Thomee R, et al. Weight training of the thigh muscles using closed vs. open kinetic chain exercises: A comparison of performance enhancement. J Orthop Sports Phys Ther. 1998;27:3–8.
    1. de Vreede PL, Samson MM, van Meeteren NL, et al. Functional-task exercise versus resistance strength exercise to improve daily function in older women: A randomized, controlled trial. J Am Geriatr Soc. 2005;53:2–10.
    1. Krebs DE, Scarborough DM, McGibbon CA. Functional vs. strength training in disabled elderly outpatients. Am J Phys Med Rehabil. 2007;86:93–103.
    1. Olivetti L, Schurr K, Sherrington C, et al. A novel weight-bearing strengthening program during rehabilitation of older people is feasible and improves standing up more than a non-weight-bearing strengthening program: A randomised trial. Aust J Physiother. 2007;53:147–153.
    1. Sherrington C, Lord SR, Herbert RD. A randomized controlled trial of weight-bearing versus non-weight-bearing exercise for improving physical ability after usual care for hip fracture. Arch Phys Med Rehabil. 2004;85:710–716.
    1. Dick MB, Hsieh S, Bricker J, et al. Facilitating acquisition and transfer of a continuous motor task in healthy older adults and patients with Alzheimer's disease. Neuropsychology. 2003;17:202–212.
    1. Dick MB, Hsieh S, Dick-Muehlke C, et al. The variability of practice hypothesis in motor learning: Does it apply to Alzheimer's disease? Brain Cogn. 2000;44:470–489.
    1. Littbrand H, Stenvall M, Rosendahl E. Applicability and effects of physical exercise on physical and cognitive functions and activities of daily living among people with dementia: A systematic review. Am J Phys Med Rehabil. 2011;90:495–518.
    1. Forbes D, Thiessen EJ, Blake CM, et al. Exercise programs for people with dementia. Cochrane Database Syst Rev. 2013;12:CD006489.
    1. Pitkälä KH, Pöysti MM, Laakkonen ML, et al. Effects of the Finnish Alzheimer Disease Exercise Trial (FINALEX): A randomized controlled trial. JAMA Intern Med. 2013;173:894–901.
    1. Kmietowicz Z. Evidence grows for benefits of exercise in dementia. BMJ. 2013;347:f7196.
    1. Vidoni ED, Burns JM. Exercise programmes for older people with dementia may have an effect on cognitive function and activities of daily living, but studies give inconsistent results. Evid Based Nurs. 2015;18:4.
    1. McCarney R, Warner J, Iliffe S, et al. The Hawthorne Effect: A randomised, controlled trial. BMC Med Res Methodol. 2007;7:30.
    1. Simonsick EM, Kasper JD, Phillips CL. Physical disability and social interaction: factors associated with low social contact and home confinement in disabled older women (The Women's Health and Aging Study) J Gerontol B Psychol Sci Soc Sci. 1998;53B:S209–S217.
    1. Kolanowski A, Litaker M. Social interaction, premorbid personality, and agitation in nursing home residents with dementia. Arch Psychiatr Nurs. 2006;20:12–20.
    1. Crocker T, Forster A, Young J, et al. Physical rehabilitation for older people in long-term care. Cochrane Database Syst Rev. 2013;2:CD004294.
    1. Rosendahl E, Lindelöf N, Littbrand H, et al. High-intensity functional exercise program and protein-enriched energy supplement for older persons dependent in activities of daily living: A randomised controlled trial. Aust J Physiother. 2006;52:105–113.
    1. Littbrand H, Carlsson M, Lundin-Olsson L, et al. Effect of a high-intensity functional exercise program on functional balance: Preplanned subgroup analyses of a randomized controlled trial in residential care facilities. J Am Geriatr Soc. 2011;59:1274–1282.
    1. Littbrand H, Lundin-Olsson L, Gustafson Y, et al. The effect of a high-intensity functional exercise program on activities of daily living: A randomized controlled trial in residential care facilities. J Am Geriatr Soc. 2009;57:1741–1749.
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Ed., Text Revision. Washington, DC: American Psychiatric Association; 2000.
    1. Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963;185:914–919.
    1. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198.
    1. Littbrand H, Lindelöf N, Rosendahl E. The HIFE Program: The High-Intensity Functional Exercise Program. 2nd Ed. Umeå: Umeå University, Department of Community Medicine and Rehabilitation, Geriatric Medicine; 2014.
    1. Littbrand H, Rosendahl E, Lindelöf N, et al. A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: Evaluation of the applicability with focus on cognitive function. Phys Ther. 2006;86:489–498.
    1. Delorme TL. Restoration of muscle power by heavy-resistance exercises. J Bone Jt Surg. 1945;27:645–667.
    1. Cotter EM, Burgio LD, Stevens AB, et al. Correspondence of the Functional Independence Measure (FIM) self-care subscale with real-time observations of dementia patients’ ADL performance in the home. Clin Rehabil. 2002;16:36–45.
    1. Daving Y, Andren E, Nordholm L, et al. Reliability of an interview approach to the functional independence measure. Clin Rehabil. 2001;15:301–310.
    1. Ottenbacher KJ, Hsu Y, Granger CV, et al. The reliability of the functional independence measure: A quantitative review. Arch Phys Med Rehabil. 1996;77:1226–1232.
    1. Collin C, Wade DT, Davies S, et al. The Barthel ADL Index: A reliability study. Int Disabil Stud. 1988;10:61–63.
    1. Ranhoff AH. Reliability of nursing assistants’ observations of functioning and clinical symptoms and signs. Aging (Milano) 1997;9:378–380.
    1. McDowell I. Measuring Health. 3rd Ed. New York: Oxford University Press; 2006.
    1. Berg KO, Wood-Dauphinee SL, Williams JI, et al. Measuring balance in the elderly: Validation of an instrument. Can J Public Health. 1992;83(Suppl 2):S7–S11.
    1. Conradsson M, Lundin-Olsson L, Lindelöf N, et al. Berg balance scale: Intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities. Phys Ther. 2007;87:1155–1163.
    1. Guigoz Y, Vellas B, Garry PJ. Mini nutritional assessment: A practical assessment tool for grading the nutritional state of elderly patients. Facts Res Gerontol. 1994;S2:15–59.
    1. Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clin Gerontol. 1986;5:165–172.
    1. Pocock SJ, Assmann SE, Enos LE, et al. Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: Current practice and problems. Stat Med. 2002;21:2917–2930.
    1. Assmann SF, Pocock SJ, Enos LE, et al. Subgroup analysis and other (mis)uses of baseline data in clinical trials. Lancet. 2000;355:1064–1069.
    1. Rolland Y, Pillard F, Klapouszczak A, et al. Exercise program for nursing home residents with Alzheimer's disease: A 1-year randomized, controlled trial. J Am Geriatr Soc. 2007;55:158–165.
    1. Schnelle JF, Kapur K, Alessi C, et al. Does an exercise and incontinence intervention save healthcare costs in a nursing home population? J Am Geriatr Soc. 2003;51:161–168.
    1. Schnelle JF, Alessi CA, Simmons SF, et al. Translating clinical research into practice: A randomized controlled trial of exercise and incontinence care with nursing home residents. J Am Geriatr Soc. 2002;50:1476–1483.
    1. Ouslander JG, Griffiths PC, McConnell E, et al. Functional incidental training: A randomized, controlled, crossover trial in Veterans Affairs nursing homes. J Am Geriatr Soc. 2005;53:1091–1100.
    1. Van Halteren-van Tilborg IA, Scherder EJ, Hulstijn W. Motor-skill learning in Alzheimer's disease: A review with an eye to the clinical practice. Neuropsychol Rev. 2007;17:203–212.
    1. Ames D, Burns A, O'Brien J, et al. Dementia. 4th Ed. London: Hodder Arnold; 2010.
    1. Hamilton JM, Salmon DP, Raman R, et al. Accounting for functional loss in Alzheimer's disease and dementia with Lewy bodies: Beyond cognition. Alzheimers Dement. 2014;10:171–178.
    1. Granger CV, Cotter AC, Hamilton BB, et al. Functional assessment scales: A study of persons after stroke. Arch Phys Med Rehabil. 1993;74:133–138.

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