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Keywords:

  • dementia;
  • Alzheimer’s disease;
  • physical exercise;
  • randomized controlled trial;
  • functional ability;
  • cognition;
  • mobility;
  • activities of daily living;
  • carer burden

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

Scand J Caring Sci; 2012; 26; 12–19 A community-based exercise programme to improve functional ability in people with Alzheimer’s disease: a randomized controlled trial

Rationale:  Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains. This decline impacts not only on the person with dementia, but also on their informal carers and health and aged care systems. With the number of people with dementia rapidly increasing and few effective treatments, there is now a critical need for interventions to improve functional ability in those with the condition.

Aims and objective:  This study assesses the effectiveness of a community-based home exercise programme in improving cognitive and physical function and independence in activities of daily living (ADL) in people with Alzheimer’s disease, the most common form of dementia.

Methods:  In a 4-month randomized controlled trial, 40 community-dwelling patients diagnosed with Alzheimer’s disease and their informal carers were randomly allocated to either the treatment (exercise plus usual treatment) or control (usual treatment) group. The exercise programme consisted of daily exercises and walking under the supervision of their carer. Patients were assessed at baseline and 4-months follow-up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using standardized assessment scales.

Results:  Sixteen men and 24 women diagnosed with Alzheimer’s disease participated in the study. They had a mean age of 74.1 years (range 51–89) and a mean Mini Mental State Examination score of 22.0 (range 10–28), indicating mild to moderate dementia. At 4-months follow-up, patients who exercised, compared with controls, had improved cognition (increased Mini Mental State Examination scores by 2.6 points, p < 0.001), better mobility (2.9 seconds faster on Timed Up and Go, p = 0.004) and increased Instrumental Activities of Daily Living scores by 1.6 (p = 0.007).

Conclusion:  This study suggests that participation in a community-based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimer’s disease.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

Dementia is a common degenerative neurological disorder in older age with symptoms including cognitive impairment, behavioural disturbance and eventual physical decline. Approximately 35 million people worldwide are currently identified as living with dementia, and as the world population ages, this number is expected to increase dramatically to 66 million in 2030 and 115 million in 2050 (1). This will place a significant burden on healthcare services in all countries as people with dementia and their informal carers require services that include not only medical care, but also physical, social, psychological and emotional support. With the pharmacological treatments available for dementia showing limited benefit in reducing cognitive and functional decline (2), the development of new interventions that can treat or reduce the care needs of people with dementia is now critical. Such interventions could result in improved quality of life for the person with dementia, reduce the physical and emotional burden on their informal carers, and reduce the costs to the community associated with community support and residential care.

In recent years, attention has turned to the possible role of physical exercise in the treatment of dementia, based on growing evidence of a link between exercise and cognition. A recent meta-analysis of randomized controlled trials of aerobic exercise with general adult populations concluded that exercise was associated with modest improvements in neurocognitive function including attention and processing speed, executive function and memory (3). For older adults already experiencing some subjective cognitive impairment, a 6-month programme of physical activity resulted in a modest improvement in cognition (4). Moreover, cross-sectional and longitudinal studies have demonstrated that physically active people have a lower risk of developing dementia when compared with sedentary controls. A large prospective study of men and women aged 65 or older found that physical activity (compared with no exercise) was associated with lower risks of cognitive impairment and dementia at 5-year follow-up (5) and in an another study, regular exercise was associated with a delayed onset of dementia (6). In addition, fitness training has been linked with reduced brain tissue loss with ageing (7).

It has now been suggested that exercise may be effective in the treatment of people who already have dementia, improving cognitive and physical functioning and reducing behavioural disturbance. A randomized controlled trial of a combined exercise and behaviour management programme for people with Alzheimer’s disease (the most common form of dementia) reported improved physical health and depression for those in the intervention group (8). A small study found that a gym-based programme with one-on-one supervision resulted in improvements in fitness and cognition for people with dementia (9). A meta-analysis of the effects of exercise training on people with cognitive impairment and dementia concluded that, while few studies have been undertaken, there was ‘preliminary evidence for the effectiveness of exercise treatments for people with dementia’ (10). More recently, a study of nursing home residents with Alzheimer’s disease found physical exercise slowed functional decline (11) and an evaluation of an exercise intervention delivered by caregivers to community-dwelling patients with Alzheimer’s disease reported a trend (although not statistically significant) for improved functional performance (12).

As well as improving cognition and behavioural functioning, exercise may also bring other benefits for people with dementia. Exercise in older adults that focuses on functional fitness has been associated with significant reductions in the levels of dependence and disability (13). This is particularly relevant for people with dementia, with people with Alzheimer’s disease having a higher risk of falls and fractures and declining more rapidly on measures of mobility (14). In addition, exercise may yield benefits for people with dementia in the area of depression, one of the most frequent comorbid psychiatric disorders in Alzheimer’s disease and other dementias (15). In elderly individuals without dementia, randomized controlled clinical trials have demonstrated that exercise can reduce depression (16).

An intervention that could improve function and reduce the care needs of people with dementia would also bring benefits to their informal carers: family, friends and neighbours who provide care in the community. Most people with dementia live in the community rather than in residential care, with up to 90% of their care provided by family and friends (1). Caring for a person with dementia can be particularly difficult because of the challenging characteristics of the condition and caring often has a negative impact on the health and well-being of the carer. An Australian survey of informal dementia carers found that carers provided 24 hours/week of care on average (20% of carers providing over 55 hours/week), with carers reporting a negative impact on their own physical health (31%) and mental health and emotional well-being (53%) (17).

While there is growing evidence that exercise may improve cognition, behaviour and functional ability in people with dementia, there are few exercise programmes specifically designed to meet the needs of people with dementia who are living in the community. This study, therefore, assesses the effectiveness of a community-based home exercise programme specifically developed for people with dementia to improve functional ability across multiple domains. Primary outcome measures included assessments of cognition, physical function (balance, mobility and lower-body strength) and independence in activities of daily living (ADL). Secondary outcome measures included depression, body mass index, waist-to-hip ratio and carer burden.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

The study was a randomized controlled trial involving 40 consecutive patients diagnosed with Alzheimer’s disease and their carers from a hospital outpatient memory disorders clinic. Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (18), and the diagnosis of Alzheimer’s disease was made according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (19). All participants were community dwelling and either living with an informal carer (family or friend) or had a carer who could visit on a daily basis. Exclusion criteria were any physical condition that could preclude full participation, such as noncontrolled systemic illness or severe physical disability; evidence of any neurodegenerative disorders other than Alzheimer’s disease; commenced dementia medications in the last 3 months; or already participating in resistance training or aerobic exercise more than once a week. Eligibility for the study was assessed during routine patient medical consultations at the local hospital outpatient memory disorders clinic over an 18-month period commencing July 2007. Of the 64 patients invited to participate in the study, 40 agreed. The 24 patients who did not agree to participate had a mean age of 77.7 years and 13 (54%) were men and 11 (46%) were women. The most common reason given for nonparticipation was that patients or their carers were not interested in exercising (12 or 50% of those who declined), with others citing health issues (3) or being too busy (2). Seven did not respond to the invitation to participate in the study.

The 40 patients were randomly allocated to either the treatment (exercise) group or the control group (usual treatment). Those in the treatment group participated in a 4-month at-home exercise programme in addition to their usual treatment and controls received their usual treatment only. Those allocated to the control group were offered training in the exercise programme at the conclusion of the study. The exercise programme involved daily home-based exercises and walking, under the supervision of their carer. The exercise intervention was based on the Home Support Exercise Program for the frail elderly, developed by the Canadian Centre for Activity and Aging (20) and was adapted for use with people with dementia by a hospital rehabilitation physiotherapist (one of the investigators on this study). The exercise programme incorporates ten simple exercises, each with three progressively challenging levels, focusing on upper and lower body strength and balance training in addition to at least 30 minutes of brisk walking. Participants were asked to exercise daily if possible. The programme was trialled in an earlier feasibility and safety study with 12 people with dementia and was found to be both feasible and safe. For those in the exercise group, the person with dementia and their carer were both trained in the exercise programme and provided with an exercise manual containing descriptions and illustrations of the exercises as well as safety instructions. During the trial, all participants (treatment and control) received a telephone call at around 2 weeks and again at 2 months to check on their well-being. Those who were exercising were also asked about their progression through the levels of exercising.

Participants (or their carers) provided demographic information at baseline including years of education, smoking and alcohol consumption and an estimate of the number of hours walked per week. Information about age, gender, duration of memory problems and medications was retrieved from the hospital patient record. Participants were assessed on outcome measures at baseline and 4-month follow-up by an assessor blinded as to their allocation to the treatment or control group. Assessments were made of cognitive and physical functioning, ADL, depression and global functional change using standardized assessment scales (detailed elsewhere). Measures of height, weight, waist and hip circumference were taken from which body mass index and waist-to-hip ratio were calculated. In addition, carers completed a self-reported assessment of carer burden.

Outcome assessment tools

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

The following standardized assessments were made at baseline and 4-month follow-up:

  • 1
     Cognitive function: Two tests were used to assess cognitive function. The first was the Alzheimer’s Disease Assessment Scale – Cognitive Sub-Scale (ADAS-Cog), the standard cognitive outcome measure used in clinical trials for patients with mild to moderate Alzheimer’s disease (21). It is scored out of 70, with a higher score indicating greater impairment, and consists of 11 tasks measuring the disturbances of memory, language, praxis, attention and other cognitive abilities. The second measure was the Mini-Mental State Examination, a screening tool for cognitive impairment, scored out of 30, with a higher score indicating better cognitive function (22).
  • 2
     Physical function: Balance, mobility and lower body strength were assessed. Balance was assessed using the Functional Reach test, a measure of maximal forward reach in centimetres (23). Basic functional mobility was assessed using the Timed Up and Go test, which records the time taken (in seconds) to stand up from a standard arm chair, walk 3 m, turn, walk back to the chair and sit down again (24). Lower body strength was measured using the Sit-to-Stand test, which measures the number of chair-rises in a 10-second period (25).
  • 3
     ADL: The Barthel Index of Activities of Daily Living is scored out of 100 and assesses basic self-care and mobility activities with a higher score reflecting greater independence (26). The Instrumental Activities of Daily Living assessment goes beyond basic self-care and evaluates function on tasks including driving, cooking and shopping. It is scored out of 14, with a higher score indicating better function (27).
  • 4
     Depression: The Geriatric Depression Scale – Short Form is a 15-item self-report screening tool commonly used in clinical geriatric practice and research. The maximum score is 15, with a score above 5 suggesting depression (28).
  • 5
     Global change in function: The Clinician’s Interview-Based Impression of Change plus Caregiver Input (CIBIC-plus) is a seven-point scale to assess overall change, where 1 indicates markedly improved relative to baseline, 4 no change, and 7 markedly worse (29).
  • 6
     Carer burden: The Zarit Burden Interview is one of the most widely used scales to determine the degree of burden in caregivers of people with dementia. It is a 22-item self-report questionnaire with a maximum score of 88, where a higher score suggests greater burden (30).

Data analysis

Statistical calculations were performed using Minitab Statistical Software, Release 13 for Windows, 2000 (Minitab Inc., State College, PA, USA). To test for differences between the intervention and control groups on key variables at baseline, chi-squared or independent samples t-test were used. To assess differences in the change over the 4-month period between the two groups, general linear model analysis was used to test the difference in the mean individual change between baseline and follow-up scores for each outcome variable, adjusted for age, sex, years of education and baseline score for that variable. The difference between the exercise and control groups on the CIBIC-plus rating of change was analysed using Kruskall–Wallis test, comparing median change scores at follow-up.

Ethical considerations

The study was approved by the Human Research Ethics Committee (Tasmania) Network and informed consent was provided by all participants and/or their carers. The use of a randomized control group, receiving usual treatment only, raised ethical issues which were carefully considered in the design of the study. Even though exercise has not been established to be effective in the treatment of Alzheimer’s disease, it is well accepted that it is generally beneficial and it was considered unethical not to offer all participants and their carers the opportunity to be trained in the exercise programme. Accordingly, those allocated to the control group were offered training in the exercise programme at the conclusion of the study.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

Sixteen men and 24 women diagnosed with Alzheimer’s disease participated in the study. They were all living in their own home, with a mean age of 74.1 years (range 51–89 years) and a mean Mini Mental State Examination score of 22.0 (range 10–28). Twenty-five (63%) were taking cholinesterase inhibitor medication for Alzheimer’s disease. For their carers, the mean carer burden score was 26.5 (range 0–52), indicating mild to moderate burden on average. As Table 1 shows, there were no differences between the treatment and control groups on key baseline variables including age, years of education, Mini Mental State Examination score, hours walked per week, body mass index or carer burden.

Table 1.   Participant baseline characteristics (mean, range unless otherwise stated)
CharacteristicTreatment (exercise) (n = 20)Controls (n = 20)p-value*
  1. *Calculated using chi-square or independent samples t-test.

Men/women (n)11/95/150.053
Age (years)73.5 (51–83)74.7 (58–89)0.662
Years of education10.1 (6–17)10.3 (7–17)0.795
Duration of memory problems (years)4.2 (0.5–10)3.8 (0.5–10)0.598
Cholinesterase inhibitor (n, %)12 (60%)13 (65%)0.744
Mini mental state examination (/30)22.9 (13–28)21.0 (10–28)0.298
Walking (hours/week)2.2 (0–7)1.8 (0–14)0.643
BMI (kg/m2)24.5 (19.9–32.5)25.4 (17.6–37.0)0.509
Geriatric depression scale (/15)2.6 (0–7)2.3 (0–5)0.468
Zarit carer burden (/88)22.6 (0–52)29.9 (4–52)0.237

At 4-month follow-up, patients who exercised (compared with controls) had improved overall with median CIBIC-Plus global ratings of ‘minimally improved’ for the exercise group vs. ‘minimally worse’ for the controls (p < 0.001). Moreover, improvement in the exercise group over the 4-month period, calculated as the difference in the mean change at follow-up compared with controls, was seen in nearly all functional domains. For cognitive function, the exercise group, compared with controls, had increased Mini Mental State Examination scores by 2.6 points (p = 0.001) and decreased ADAS-Cog scores by 7.1 (p = 0.001), where a lower score reflects better function for the latter. Physical function was also improved for the group who exercised, compared with controls, reflected in: better balance (Functional Reach increased by 4.2 cm, p = 0.032); improved mobility (2.9 seconds faster on Timed Up and Go, p = 0.004); and increased lower body strength (2.7 additional sit-to-stands in 10 seconds, p < 0.001). Independence in ADL scores improved for the exercise group, compared with controls, with an increase of 2.6 points on the Barthel Index of ADL (p = 0.047) and an increase of 1.6 points on Instrumental ADL (p = 0.007). Table 2 presents these results in more detail, with the analyses adjusted for confounding factors.

Table 2.   Outcome measures: baseline, follow-up and change scores (mean and SD unless otherwise specified)
Outcome measureTreatment (n = 20)Controls (n = 20)Mean change at follow-up*
BaselineFollow-upBaselineFollow-upTreatmentControlsp-value**
  1. ADL, activities of daily living.

  2. *Mean (SE) of the individual differences between baseline and follow-up scores adjusted for age, sex, years of education and baseline score for that variable.

  3. **Calculated using GLM adjusted as above.

  4. aLower value indicates better function.

Mini Mental State Examination (/30)22.9 (5.0)23.9 (5.0)21.0 (6.3)19.0 (7.7)1.0 (1.4)−1.6 (0.5)0.001
ADAS-Cog (/70)a22.7 (9.7)18.5 (9.8)26.6 (16.6)30.6 (17.9)−4.9 (1.1)2.1 (1.4)0.001
Functional reach (cm)27.6 (7.4)30.6 (7.0)24.0 (6.4)22.1 (7.9)2.3 (1.1)−1.9 (1.3)0.032
Timed up and go (seconds)a9.7 (3.7)9.1 (3.8)11.1 (3.3)12.8 (4.1)−0.9 (0.5)2.0 (0.7)0.004
Sit-to-stand (number)9.2 (2.5)10.8 (2.0)8.5 (2.9)7.2 (3.2)1.7 (0.4)−1.0 (0.4)<0.001
Barthel index of ADL (/100)99.5 (1.5)99.6 (1.2)98.4 (5.4)94.2 (12.6)−0.4 (0.8)−3.0 (0.9)0.047
Instrumental ADL (/14)10.6 (4.1)11.0 (4.1)8.6 (4.2)7.6 (4.5)0.5 (0.3)−1.1 (0.4)0.007
Geriatric depression scale (/15)a2.6 (1.7)2.0 (1.5)2.3 (1.4)2.3 (1.4)−0.5 (0.2)0.2 (0.3)0.071
Waist/hip ratioa0.90 (0.09)0.89 (0.09)0.88 (0.05)0.88 (0.05)−0.01 (0.01)0.02 (0.01)0.023
Body mass index (kg/m2)a24.5 (3.7)24.4 (3.6)25.4 (5.1)25.6 (5.0)−0.2 (0.2)0.0 (0.2)0.473
Zarit carer burden (/88)a22.6 (14.3)18.2 (13.2)29.9 (16.2)33.5 (17.0)−2.8 (2.3)1.0 (2.3)0.313

As Table 2 shows, on secondary outcome measures the exercise group, compared with controls, had reduced waist-to-hip ratio by 0.03 (p = 0.023) but there was no difference in body mass index. There was a trend to improvement for those who exercised on measures of depression and carer burden, but these changes were not statistically significant.

There were also other, unexpected, gains for those in the exercise group. The intent of the study was for carers in the exercise group to act as ‘personal trainers’ for the person with dementia. For many carers, this worked best by them actually exercising themselves alongside the person with dementia, bringing unanticipated benefits. First, many carers reported how much they enjoyed doing something positive with the person with dementia, rather than the usual daily routine of personal care tasks, constant reminders and friction. Second, while no specific measures were taken of carer health, many reported that they were feeling much better overall after 4 months of exercising. The regular walking in the local neighbourhood appeared to be a particularly enjoyable aspect of the exercise programme, bringing opportunities to socialize with the local community as well as the benefits of physical activity.

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

The results of this study suggest that a community-based exercise programme specifically developed for people with dementia is effective in improving functional ability across a number of domains, including cognition, physical function and ADL. While previous studies have reported associations between exercise and improved function in one or two specific domains in people with dementia, this is the first study (to our knowledge) to demonstrate improvement across multiple functional domains in a randomized controlled trial in a community setting. This is important, as dementia is usually associated with the progressive decline of cognitive and physical function along with increasing dependence in ADL, cumulatively contributing to increased care needs and carer burden. Moreover, given that the amount of time needed for care giving increases as the severity of dementia increases (31), a slowing of overall functional decline is critical in supporting both the person with dementia and their informal carers in the community.

The improvement in ADL for those who exercised reported in this study is of particular significance, given that ADL ability has been identified as the strongest predictor of informal care hours for community-dwelling patients with dementia (32). For people with dementia, an association between exercise and improvement in ADL has been reported in previous trials in residential care facilities. Rolland et al. (11) found that a twice-weekly group exercise programme slowed deterioration in the ability to perform ADL in a 12-month randomized controlled trial involving 134 nursing home residents with mild to severe dementia. Unlike the current study, however, they did not find an association with measures of physical function (apart from improved walking speed), nor on behaviour or depression. This may have been because of the advanced dementia of their participants or the lack of frequency of the exercise programme. Improvement in ADL (in the areas of self-help and sociability) was also reported in those who participated in a 12-week, thrice weekly group exercise programme in a randomized controlled trial involving 75 nursing home residents with dementia (33). In addition, they also reported a slowing in global cognitive decline (measured by clock-drawing). This current study confirms this finding regarding cognition but goes even further, demonstrating that those who exercised had significantly improved cognitive function across multiple cognitive domains using two well-established measures of cognitive impairment (ADAS-Cog and MMSE).

Trials of exercise interventions for community-dwelling people with dementia have been few, with mixed results. This present study confirms some of the findings of previous studies in terms of improved physical function with exercise. Just as this study found improvement in physical function (including balance, mobility and lower-body strength) in those who exercised, a randomized controlled trial of a combined exercise and caregiver training programme with 153 community-dwelling patients with Alzheimer’s disease demonstrated improvement on carer-reported measures of physical function (8). However, the intervention in that study comprised exercise training combined with caregiver behavioural management techniques and, as the researchers note, they did not investigate the relative efficacy of exercise or behavioural management. In that study, participants in the intervention group also fared better than controls on the number of restricted activity days and measures of depression. The depression finding was partly confirmed in this current study, where there was a trend towards improvement in depression for those who exercised. This is certainly consistent with research with general older populations, where the link between exercise and improved depressive symptoms is well established (16). A recent trial of a home-based exercise intervention programme to improve the functional performance of 27 home-dwelling patients with Alzheimer’s disease had less positive results (12). Participants were randomized to either an exercise intervention programme delivered by their caregivers or a home safety assessment control. The exercise programme was similar to the one in this current trial, with balance and strength training combined with brisk walking. The study was unable to demonstrate a clear benefit from exercise, but did report that patients in the exercise group demonstrated a trend for improved functional performance on measures of hand function and lower extremity strength. No benefits were seen on other measures, but this may have been because of the small sample size.

Carer burden was an issue for many of the carers in this current study, with their average burden at baseline in the ‘mild to moderate’ range. This is consistent with previous studies, where carers of people with dementia (compared with noncarers) report higher levels of stress, depression and anxiety symptoms, and lower levels of subjective well-being and self-efficacy (34). Carer burden impacts on the ongoing ability of informal carers to provide care for the person with dementia in the community, but the impact of caring may go even further than this with a recent study suggesting that caring for someone with dementia may be associated with an increased risk of dementia for the carer themselves, because of the chronic and severe stress of dementia care (35). While our study did not find that participation in the exercise programme significantly reduced carer burden, there was anecdotal evidence from carers of improved well-being following their participation in the programme. This would be worthy of further investigation in a future study targeting carer health and well-being.

There are a number of limitations to this research. From this study, it is not possible to establish whether it was the physical exercise programme itself or the social aspects of the intervention that led to improved function. This is important as there is evidence to suggest that social interventions may be effective in reducing some of the symptoms of dementia (36). Further studies utilizing control interventions with a comparable social component would help to clarify this issue. A second limitation is that the study was not double blinded. While the outcome assessor was blinded, participants and their carers knew if they were in the intervention (exercise) group or not, and this may have led to an expectation of improvement amongst those who exercised and an expectation of decline in those who did not. Again, a control intervention would assist to overcome this in future studies. Finally, the intervention and follow-up periods were short (4 months). It would be interesting to conduct an extended trial with longer follow-up to see whether the short-term benefits were maintained.

Conclusion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

This study suggests that participation in a community-based home exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimer’s disease. Improving functional ability in people with dementia has great potential to benefit not only the person with dementia, but also their informal carers and wider health and aged care systems. With the number of people with dementia increasing and few treatments available, the development and testing of such interventions is now critical. Further research into the role of exercise as an intervention for people with dementia is now required, with larger trials over a longer time period which also assess the impact on carer health and well-being.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

The authors would like to thank the participants and their carers for their time and goodwill in assisting with the study. Thanks also to staff from the Allied Health Department and Northern Tasmanian Pathology Services, Launceston General Hospital and special thanks to Melody West, who coordinated the study.

Author Contributions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

Anthea Vreugdenhil was involved in the study conception/design, data collection/analysis, drafting of manuscript and supervision. John Cannell was involved in the study conception/design, technical support and critical revisions for important intellectual content. Andrew Davies was involved in the study conception/design and data collection. George Razay was involved in the study conception/design, data analysis and critical revisions for important intellectual content.

Funding

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References

This study was funded by the Clifford Craig Medical Research Trust and the Tasmanian Community Fund.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Outcome assessment tools
  6. Results
  7. Discussion
  8. Conclusion
  9. Acknowledgements
  10. Author Contributions
  11. Funding
  12. References
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