Effects of a 16-week multimodal exercise program on activities of daily living in institutionalized individuals with dementia

Abstract

We aimed to examine the effects of a 16-week multimodal exercise program (MEP) on activities of daily living (ADL) in individuals with dementia (IWD). Furthermore, we investigated the participants’ individual response to the MEP and whether baseline cognitive and motor performance explain ADL performance. We conducted a multicenter randomized controlled trial (RCT) involving 319 participants aged ≥ 65 years with mild to moderate dementia. ADL were assessed at baseline and after the 16-week intervention using the Barthel Index (BI), the Erlangen Test of Activities of Daily Living (E-ADL) and the 7‑item Physical Performance Test (PPT-7). We additionally assessed cognitive and motor performance using standardized and validated assessments. Intervention effects were examined through two-factor analysis of variance with repeated measurements applying a per protocol and an intention-to-treat analysis. We compared baseline cognitive and motor performance between positive-responders (positive-R), non-responders (non-R), and negative-responders (negative-R) and examined cognitive and motor performance as potential cofounders of ADL by conducting multiple regression analyses. There were no significant time×group effects on ADL. Between 20 and 32% of participants responded positively to the intervention, i.e., improved ADL performance from baseline to follow-up. Positive-R had worse baseline motor performance compared to non-R. Cognitive and motor performance explained up to 51.4% of variance in ADL. The MEP had no significant overall effect on ADL in IWD. This may be related to insufficient exercise intensity. However, our results indicate that the response to the MEP depends on individual prerequisites which should thus be considered in further research on individual exercise approaches.

Strength gains after 12 weeks of resistance training correlate with neurochemical markers of brain health in older adults: a randomized control 1H-MRS study

“…These reduced NAA levels could reflect impaired functional network integrity in SM1 which supports bimanual coordination domain of motor control [ 8 ]. Another study observed that participants that responded to 16 weeks of a multimodal exercise program had worse baseline motor performance than non-responders [ 89 ]. Taken together, lower SM1 tNAA/tCr in our study’s responders might be indicatory of their lower motor control integrity or other deficits which possibly made them more receptive to the motor task (i.e., resistance training intervention in our study).…”

A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study

“…The InCoPE-App is a tablet-based app aimed at assisting nursing home staff in delivering tailored cognitive and physical exercise training for individuals with dementia in a nursing home setting. The content of the InCoPE-App is based on previous studies of our research group on PA for individuals with dementia [8][9][10]. The goal of this study was to evaluate the usability of the InCoPE-App with possible end users, that is, nursing home staff, using a mixed methods approach in a laboratory setting.…”

“…Thus, a one-size-fits-all PA approach may fall short [7]. In addition, individual vulnerabilities and needs of individuals with dementia may need to be considered when designing, planning, and conducting PA interventions [8][9][10].…”

Exercise and physical activity for health promotion and rehabilitation in community dwelling very old adults or nursing home residents

“…Another program with the aim to increase activities of daily living in individuals with dementia was conducted by Bezold et al (2021) and is reported in this issue. In their 16-week multimodal intervention within a multicenter randomized controlled trial involving 319 participants aged ≥65 years with mild to moderate dementia, they investigated the participants' individual response to the exercise program and whether baseline cognitive and motor performance explain activities of daily living performance.…”

“…Instead, we present a variety of studies: Regarding the "pathways" above, four papers relate to (1) physical activity and tailored exercises to increase different outcomes of cognitive and motor fitness, three papers to (2) social engagement, psychosocial parameters, and mental health and three papers to (3) cognitive stimulation, which is also associated withphysical and global functioning. Most of the papers relate to preparation (Fricke et al, 2021;Wolter et al, 2021;Prinz et al, 2021) and conduction (Hezel et al, 2021;Bezold et al, 2021) of specified interventions. Two papers deal with the development and validation of instruments (Klotzbier et al, 2021;Schott et al, 2021).…”