Increasing Physical Activity in Persons With Dementia: A Randomized Controlled Trial

in Journal of Aging and Physical Activity
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This study investigated the effectivity and sustainability of a physical activity (PA) promotion and motor training programs and analyzed predictors for PA changes in persons with dementia. A total of 122 participants with mild-to-moderate dementia were randomized to the intervention program designed for persons with dementia (intervention group) or a motor placebo activity (control group). The primary outcome was the Physical Activity Questionnaire for the Elderly assessed at the baseline, after the 3-month intervention, and at a 3-month follow-up. The PA promotion program significantly increased PA in the intervention group compared with the control group during the training intervention phase. Both groups showed an increase in habitual PA when intervention-induced activities were excluded. PA was sustainably increased in both groups at follow-up. Low baseline PA was predictive for increased PA after the intervention and low baseline PA, high motor performance, and low comorbidity for increased PA at follow-up.

Pomiersky, Abel, Werner, Lacroix, and Hauer are with the Department of Geriatric Research, Agaplesion Bethanien Hospital, Geriatric Center at the University of Heidelberg, Heidelberg, Germany. Pomiersky and Schäufele are with the Faculty of Social Work, University of Applied Sciences Mannheim, Mannheim, Germany. Pfeiffer is with the Department of Clinical Gerontology and Geriatric Rehabilitation, Robert-Bosch-Hospital Stuttgart, Stuttgart, Germany.

Hauer (khauer@bethanien-heidelberg.de) is corresponding author.
  • Allan, L., McKeith, I., Ballard, C., & Kenny, R.A. (2006). The prevalence of autonomic symptoms in dementia and their association with physical activity, activities of daily living and quality of life. Dementia and Geriatric Cognitive Disorders, 22(3), 230237. doi:10.1159/000094971

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bandura, A. (2012). Self-efficacy: The exercise of control. New York, NY: Freeman.

  • Bayles, K.A., Tomoeda, C.K., & Trosset, M.W. (1992). Relation of linguistic communication abilities of Alzheimer’s patients to stage of disease. Brain and Language, 42(4), 454472. doi:10.1016/0093-934X(92)90079-T

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Campbell, M.J., Julious, S.A., & Altman, D.G. (1995). Estimating sample sizes for binary, ordered categorical, and continuous outcomes in two group comparisons. British Medical Journal (Clinical Research Edition), 311(7013), 11451148. doi:10.1136/bmj.311.7013.1145

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cedervall, Y., & Åberg, A.C. (2010). Physical activity and implications on well-being in mild Alzheimer’s disease: A qualitative case study on two men with dementia and their spouses. Physiotherapy Theory and Practice, 26(4), 226239. doi:10.3109/09593980903423012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chodzko-Zajko, W.J., Proctor, D.N., Fiatarone Singh, M.A., Minson, C.T., Nigg, C.R., Salem, G.J., & Skinner, J.S. (2009). American College of Sports Medicine position stand. Exercise and physical activity for older adults. Medicine & Science in Sports & Exercise, 41(7), 15101530. doi:10.1249/MSS.0b013e3181a0c95c

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chudyk, A.M., McKay, H.A., Winters, M., Sims-Gould, J., & Ashe, M.C. (2017). Neighborhood walkability, physical activity, and walking for transportation: A cross-sectional study of older adults living on low income. BMC Geriatrics, 17(1), 82. doi:10.1186/s12877-017-0469-5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum.

  • David, R., Mulin, E., Friedman, L., Le Duff, F., Cygankiewicz, E., Deschaux, O., . . . Zeitzer, J.M. (2012). Decreased daytime motor activity associated with apathy in Alzheimer disease: An actigraphic study. The American Journal of Geriatric Psychiatry, 20(9), 806814. doi:10.1097/JGP.0b013e31823038af

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Denkinger, M.D., Lukas, A., Nikolaus, T., & Hauer, K (2015). Factors associated with fear of falling and associated activity restriction in community-dwelling older adults: A systematic review. The American Journal of Geriatric Psychiatry, 23(1), 7286. doi:10.1016/j.jagp.2014.03.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dewing, J. (2008). Personhood and dementia: Revisiting Tom Kitwood’s ideas. International Journal of Older People Nursing, 3(1), 313. doi:10.1111/j.1748-3743.2007.00103.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Egerton, T., Paterson, K., & Helbostad, J.L. (2017). The association between gait characteristics and ambulatory physical activity in older people: A cross-sectional and longitudinal observational study using Generation 100 data. Journal of Aging and Physical Activity, 25(1), 1019. doi:10.1123/japa.2015-0252

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Eggermont, L.H.P., Blankevoort, C.G., & Scherder, E.J.A. (2010). Walking and night-time restlessness in mild-to-moderate dementia: A randomized controlled trial. Age and Ageing, 39(6), 746749. doi:10.1093/ageing/afq115

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189198. doi:10.1016/0022-3956(75)90026-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Forbes, D., Forbes, S.C., Blake, C.M., Thiessen, E.J., & Forbes, S. (2015). Exercise programs for people with dementia. The Cochrane Database of Systematic Reviews 4(12), CD006489. doi:10.1002/14651858.CD006489.pub4

    • Search Google Scholar
    • Export Citation
  • Freds, S., Cohen, D., Eisdorfer, C., Paveza, G., Gorelick, P., Luchins, D.J., . . . Semla, T. (1992). Functional status and clinical findings in patients with Alzheimer’s disease. Journal of Gerontology, 47(6), M177M182. doi:10.1093/geronj/47.6.M177

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Groot, C., Hooghiemstra, A.M., Raijmakers, P.G., van Berckel, B.N., Scheltens, P., Scherder, E.J., . . . Ossenkoppele, R. (2016). The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials. Ageing Research Reviews, 25 1323. doi:10.1016/j.arr.2015.11.005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hauer, K., Lord, S.R., Lindemann, U., Lamb, S.E., Aminian, K., & Schwenk, M. (2011). Assessment of physical activity in older people with and without cognitive impairment. Journal of Aging and Physical Activity, 19(4), 347372. doi:10.1123/japa.19.4.347

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hauer, K., Rost, B., Rütschle, K., Opitz, H., Specht, N., Bärtsch, P., . . . Schlierf, G. (2001). Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. Journal of the American Geriatrics Society, 49(1), 1020. doi:10.1046/j.1532-5415.2001.49004.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hauer, K., Schwenk, M., Zieschang, T., Essig, M., Becker, C., & Oster, P. (2012). Physical training improves motor performance in people with dementia: A randomized controlled trial. Journal of the American Geriatrics Society, 60(1), 815. doi:10.1111/j.1532-5415.2011.03778.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hauer, K., Ullrich, P., Dutzi, I., Beurskens, R., Kern, S., Bauer, J., & Schwenk, M. (2017). Effects of standardized home training in patients with cognitive impairment following geriatric rehabilitation: A randomized controlled pilot study. Gerontology, 63(6), 495506. doi:10.1159/000478263

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hauer, K., Yardley, L., Beyer, N., Kempen, G., Dias, N., Campbell, M., . . . Todd, C. (2010). Validation of the Falls Efficacy Scale and Falls Efficacy Scale International in geriatric patients with and without cognitive impairment: Results of self-report and interview-based questionnaires. Gerontology, 56(2), 190199. doi:10.1159/000236027

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hoffmann, F., Kaduszkiewicz, H., Glaeske, G., van den Bussche, H., & Koller, D. (2014). Prevalence of dementia in nursing home and community-dwelling older adults in Germany. Aging Clinical and Experimental Research, 26(5), 555559. doi:10.1007/s40520-014-0210-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hüger, D., Zieschang, T., Schwenk, M., Oster, P., Becker, C., & Hauer, K. (2009). Designing studies on the effectiveness of physical training in patients with cognitive impairment. Zeitschrift für Gerontologie und Geriatrie, 42(1), 1119. doi:10.1007/s00391-008-0529-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jansen, C.-P., Claßen, K., Wahl, H.-W., & Hauer, K. (2015). Effects of interventions on physical activity in nursing home residents. European Journal of Ageing, 12(3), 261271. doi:10.1007/s10433-015-0344-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kitwood, T. (1990). The dialectics of dementia: With particular reference to Alzheimer’s disease. Ageing and Society, 10(02), 177196. doi:10.1017/S0144686X00008060

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lechowski, L., Benoit, M., Chassagne, P., Vedel, I., Tortrat, D., Teillet, L., & Vellas, B. (2009). Persistent apathy in Alzheimer’s disease as an independent factor of rapid functional decline: The REAL longitudinal cohort study. International Journal of Geriatric Psychiatry, 24(4), 341346. doi:10.1002/gps.2125

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lyketsos, C.G., Lopez, O., Jones, B., Fitzpatrick, A.L., Breitner, J., & DeKosky, S. (2002). Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment. The Journal of the American Medical Association, 288(12), 14751483. doi:10.1001/jama.288.12.1475

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mahoney, F.I., & Barthel, D.W. (1965). Functional evaluation: The Barthel Index. Maryland State Medical Journal, 14 6165.

  • Malthouse, R., & Fox, F. (2014). Exploring experiences of physical activity among people with Alzheimer’s disease and their spouse carers: A qualitative study. Physiotherapy, 100(2), 169175. doi:10.1016/j.physio.2013.10.002

    • Crossref
    • Search Google Scholar
    • Export Citation
  • May, K., & Hittner, J.B. (2003). On the relation between power and reliability of difference scores. Perceptual and Motor Skills, 97(3), 905908. doi:10.2466/pms.2003.97.3.905

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McAuley, E., Szabo, A., Gothe, N., & Olson, E.A. (2011). Self-efficacy: Implications for physical activity, function, and functional limitations in older adults. American Journal of Lifestyle Medicine, 5(4), 361369. doi:10.1177/1559827610392704

    • Crossref
    • Search Google Scholar
    • Export Citation
  • McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E.M. (1984). Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology, 34(7), 939944. doi:10.1212/WNL.34.7.939

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Mega, M.S., Cummings, J.L., Fiorello, T., & Gornbein, J. (1996). The spectrum of behavioral changes in Alzheimer’s disease. Neurology, 46(1), 130135. doi:10.1212/WNL.46.1.130

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Meijer, E.P., Westerterp, K.P., & Verstappen, F.T.J. (1999). Effect of exercise training on total daily physical activity in elderly humans. European Journal of Applied Physiology and Occupational Physiology, 80(1), 1621. doi:10.1007/s004210050552

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Oddy, R. (1987). Promoting mobility in patients with dementia: Some suggested strategies for physiotherapists. Physiotherapy Practice, 3(1), 1827. doi:10.3109/09593988709044164

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Olanrewaju, O., Kelly, S., Cowan, A., Brayne, C., & Lafortune, L. (2016). Physical activity in community dwelling older people: A systematic review of reviews of interventions and context. PLoS One, 11(12), e0168614. doi:10.1371/journal.pone.0168614

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Olsen, C.F., Telenius, E.W., Engedal, K., & Bergland, A. (2015). Increased self-efficacy: The experience of high-intensity exercise of nursing home residents with dementia—A qualitative study. BMC Health Services Research, 15 379. doi:10.1186/s12913-015-1041-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Parmelee, P.A., Thuras, P.D., Katz, I.R., & Lawton, M.P. (1995). Validation of the Cumulative Illness Rating Scale in a geriatric residential population. Journal of the American Geriatrics Society, 43(2), 130137. doi:10.1111/j.1532-5415.1995.tb06377.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Podsiadlo, D., & Richardson, S. (1991). The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142148. doi:10.1111/j.1532-5415.1991.tb01616.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rapp, K., Becker, C., Cameron, I.D., König, H.-H., & Büchele, G. (2012). Epidemiology of falls in residential aged care: Analysis of more than 70, 000 falls from residents of Bavarian nursing homes. Journal of the American Medical Directors Association, 13(2), 187.e1187.e6. doi:10.1016/j.jamda.2011.06.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Regan, K., White, F., Harvey, D., & Middleton, L.E. (2018). Effects of an exercise and mental activity program for people with dementia and their care partners. Journal of Aging and Physical Activity, 27(2), 276283. doi:10.1123/japa.2017-0300

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stessman, J., Hammerman-Rozenberg, R., Cohen, A., Ein-Mor, E., & Jacobs, J.M. (2009). Physical activity, function, and longevity among the very old. Archives of Internal Medicine, 169(16), 14761483. doi:10.1001/archinternmed.2009.248

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Stubbs, B., Eggermont, L., Soundy, A., Probst, M., Vandenbulcke, M., & Vancampfort, D. (2014). What are the factors associated with physical activity (PA) participation in community dwelling adults with dementia? A systematic review of PA correlates. Archives of Gerontology and Geriatrics, 59(2), 195203. doi:10.1016/j.archger.2014.06.006

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Suttanon, P., Hill, K.D., Said, C.M., Williams, S.B., Byrne, K.N., LoGiudice, D., . . . Dodd, K.J. (2013). Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer’s disease: A pilot randomized controlled trial. Clinical Rehabilitation, 27(5), 427438. doi:10.1177/0269215512460877

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Teri, L., Logsdon, R.G., & McCurry, S.M. (2008). Exercise interventions for dementia and cognitive impairment: The Seattle Protocols. The Journal of Nutrition, Health & Aging, 12(6), 391394. doi:10.1007/BF02982672

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Thomas, D.R., & Zumbo, B.D. (2012). Difference scores from the point of view of reliability and repeated-measures ANOVA: In defense of difference scores for data analysis. Educational and Psychological Measurement, 72(1), 3743. doi:10.1177/0013164411409929

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tinetti, M.E. (1986). Performance-oriented assessment of mobility problems in elderly patients. Journal of the American Geriatrics Society, 34(2), 119126. doi:10.1111/j.1532-5415.1986.tb05480.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Trafimow, D. (2015). A defense against the alleged unreliability of difference scores. Cogent Mathematics, 2(1), 1064626. doi:10.1080/23311835.2015.1064626

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Voorrips, L.E., Ravelli, A.C.J., Dongelmans, P.C.A., Deurenberg, P., & van Staveren, W.A. (1991). A physical activity questionnaire for the elderly. Medicine & Science in Sports & Exercise, 23(8), 974979. doi:10.1249/00005768-199108000-00015

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wei, L.J. (1977). A class of designs for sequential clinical trials. Journal of the American Statistical Association, 72(385), 382386. doi:10.1080/01621459.1977.10481005

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Westerterp, K.R. (2000). Daily physical activity and ageing. Current Opinion in Clinical Nutrition and Metabolic Care, 3(6), 485488. doi:10.1097/00075197-200011000-00011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Xue, Q., Bandeen-Roche, K., Mielenz, T.J., Seplaki, C.L., Szanton, S.L., Thorpe, R.J., . . . Fried, L.P. (2012). Patterns of 12-year change in physical activity levels in community-dwelling older women: Can modest levels of physical activity help older women live longer? American Journal of Epidemiology, 176(6), 534543. doi:10.1093/aje/kws125

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M., & Leirer, V.O. (1982). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 3749. doi:10.1016/0022-3956(82)90033-4

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yu, F., & Kolanowski, A. (2009). Facilitating aerobic exercise training in older adults with Alzheimer’s disease. Geriatric Nursing, 30(4), 250259. doi:10.1016/j.gerinurse.2008.11.001

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Yu, F., Leon, A.S., Bliss, D., Dysken, M., Savik, K., & Wyman, J.F. (2011). Aerobic training for older men with Alzheimer’s disease: Individual examples of progression. Research in Gerontological Nursing, 4(4), 243250. doi:10.3928/19404921-20110303-01

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Zieschang, T., Schwenk, M., Becker, C., Uhlmann, L., Oster, P., & Hauer, K. (2017). Falls and physical activity in persons with mild to moderate dementia participating in an intensive motor training: Randomized controlled trial. Alzheimer Disease and Associated Disorders, 31(4), 307314. doi:10.1097/WAD.0000000000000201

    • Crossref
    • Search Google Scholar
    • Export Citation
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