July 19, 2013

Alzheimer’s is a disease that robs the mind and memory. It also takes a physical toll, including decreased mobility and a predisposition to falls, which can lead to broken hips and the subsequent need for institutional care. Now, a new study shows that a home exercise program can provide a cost-effective solution for improving the physical frailty that often arises in those with Alzheimer’s disease.

For the study, researchers at the University of Helsiniki in Finland enrolled 210 men and women with Alzheimer’s who were living at home and being cared for by their spouses. The patient and caregiver pairs were randomly divided into three groups.

One of the groups received a one-hour training session on how to do exercises that were tailored to improve physical abilities in people with Alzheimer’s, followed by group exercise classes twice a week over the next year at a day care center that were supervised by physiotherapists who specialized in dementia care. Another group received training, followed by exercise classes twice a week at home that were supervised by a visiting physiotherapist. The third group received the usual community care, which included written advice on nutrition and exercise, and served as controls.

The exercise program was individually tailored to each participant and consisted of endurance, balance, and strength training exercises. Exercises included some combination of climbing stairs, balance training, walking and outdoor activities. Various kinds of equipment were also used to enhance the training, such as exercise bikes, ankle or hand weights, balls, canes and balance pillows. The program also included “brain training” exercises designed to challenge the mind, such as having patients complete two tasks at once. Spouse caregivers could participate, or use the time for their own activities. Sessions were fairly intensive and lasted, on average, for about an hour.

After six months, and again after a year, the researchers found that all three groups showed some deterioration in physical functioning. But deterioration was faster in the control group than in the home-based exercise or group exercise groups.

Those in one of the exercise groups had significantly fewer falls than those in the control groups. Falls are a major cause of disability in the elderly, including older people with dementia, and are a major reason why older people must go to the hospital. In someone with Alzheimer’s, a hospital stay is particularly likely to lead to disorientation and further disability.

The researchers also calculated the costs for health and social services during the study period. They found that the typical patient in the control group cost $34,121 during the year. Patients who did exercise were much less costly on average: $22,066 for those participating in group exercise, and $25,112 per person in the home exercise group. So, overall costs in the exercise groups were lower even though trained exercise physiologists were employed to supervise the exercise sessions.

The authors note that a home-exercise program may be particularly useful, since people with Alzheimer’s do not have to travel to do them and may therefore be likely to participate. Those in the group exercise program were more likely to bow out than those in the home exercise group.

Getting exercise also led to modest improvements in day-to-day activities like getting dressed, walking and eating. Any improvements in these activities can allow people with Alzheimer’s to remain at home longer and delay the need to enter a nursing home.

By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: JAMA Internal Medicine. Kaisu H. Pitk MD, PhD, Minna M. P MD, PhD, Marja-Liisa Laakkonen MD, PhD, et al: Effects of the Finnish Alzheimer Disease Exercise Trial (FINALEX): A Randomized Controlled Trial. A. Mark Clarfield, MD,; Tzvi Dwolatzky, MD: “Exercise in Alzheimer’s Disease: Comment.”
Published online April 15, 2013.