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

doi:10.1111/jgs.13880

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

J Am Geriatr Soc. 2016 Jan;64(1):55-64. doi: 10.1111/jgs.13880.

Authors

Annika Toots^{1

2}, Håkan Littbrand^{1

2}, Nina Lindelöf^{1

2}, Robert Wiklund^{1

2}, Henrik Holmberg³, Peter Nordström², Lillemor Lundin-Olsson¹, Yngve Gustafson², Erik Rosendahl^{1

2}

Affiliations

¹ Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
² Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
³ Department of Community Medicine and Rehabilitation, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.

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.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living*
Aged
Aged, 80 and over
Dementia / physiopathology
Dementia / rehabilitation*
Exercise / physiology*
Exercise Therapy / methods*
Female
Follow-Up Studies
Humans
Male
Motor Activity / physiology*
Postural Balance / physiology*
Time Factors
Treatment Outcome