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Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial.

ABSTRACT: The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.Residents (n?=?186) with a diagnosis of dementia, age???65?years, Mini-Mental State Examination score???10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45?min every other weekday for 4?months. The 15-item Geriatric Depression Scale (GDS) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were administered by blinded assessors at baseline, 4, and 7?months.No difference between the exercise and control activity was found in GDS or MADRS score at 4 or 7?months. Among participants with GDS scores???5, reductions in GDS score were observed in the exercise and control groups at 4?months (-1.58, P?=?0.001 and -1.54, P?=?0.004) and 7?months (-1.25, P?=?0.01 and -1.45, P?=?0.007). Among participants with MADRS scores???7, a reduction in MADRS score was observed at 4?months in the control group (-2.80, P?=?0.009) and at 7?months in the exercise and control groups (-3.17, P?=?0.003 and -3.34, P?=?0.002).A 4-month high-intensity functional exercise program has no superior effect on depressive symptoms relative to a control activity among older people with dementia living in residential care facilities. Exercise and non-exercise group activities may reduce high levels of depressive symptoms.

SUBMITTER: Bostrom G

PROVIDER: S-EPMC5215547 | biostudies-other | 2016 Aug

REPOSITORIES: biostudies-other

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Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial.

Boström Gustaf G Conradsson Mia M Hörnsten Carl C Rosendahl Erik E Lindelöf Nina N Holmberg Henrik H Nordström Peter P Gustafson Yngve Y Littbrand Håkan H

International journal of geriatric psychiatry 20151207 8

<h4>Objectives</h4>The aim of this study is to evaluate the effect of a high-intensity functional exercise program on depressive symptoms among older care facility residents with dementia.<h4>Methods</h4>Residents (n = 186) with a diagnosis of dementia, age ≥ 65 years, Mini-Mental State Examination score ≥ 10, and dependence in activities of daily living were included. Participants were randomized to a high-intensity functional exercise program or a non-exercise control activity conducted 45 min ...[more]

PMID: 26644304

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Project description:BackgroundThe effects of exercise frequency and intensity on alleviating depressive symptoms in older adults with insomnia are unclear.PurposeThe purpose of this study was to investigate the influence of different exercise frequencies and intensities on prescribed aerobic-type physical activity (i.e., 75 min of vigorous-intensity exercise or 150 min of moderate-intensity exercise weekly) for reducing depressive symptoms in older adults living with insomnia, as recommended by the WHO.DesignThis study is a randomized, controlled, assessor-blinded trial.SettingThis study is conducted at a single research site in Hong Kong.ParticipantsThis study includes older adults aged 50 years or above with depressive symptoms and insomnia.InterventionParticipants were randomly assigned in a 1:1:1:1:1 ratio to the following groups: attention control (CON), moderate walking once weekly (MOD × 1/week), moderate walking thrice weekly (MOD × 3/week), vigorous walking once weekly (VIG × 1/week), and vigorous walking thrice weekly (VIG × 3/week). The total weekly exercise volumes among the walking groups were matched to the minimum recommended physical activity volume.MeasurementsDepression, anxiety, self-perceived sleep quality, insomnia severity, actigraphy-assessed 7-day sleep data, 7-day sleep diary, cardiorespiratory fitness, adherence, and habitual physical activity were examined at baseline and after 12 weeks of intervention.ResultsBoth MOD × 3/week and VIG × 3/week groups demonstrated reduced depression (Hospital Anxiety and Depression Scale [HADS] - Depression: MOD × 3/wk: -68.6%; VIG × 3/week: -67.4%) and anxiety levels (HADS - Anxiety: MOD × 3/week: -54.3%; VIG × 3/week: -59.8%) compared with CON (both p < 0.01). Self-perceived sleep quality was improved in MOD × 3/week (-31.4% of the Pittsburgh Sleep Quality Index [PSQI]), VIG × 1/week (-34.1% of PSQI), and VIG × 3/week (-38.3% of PSQI), but not in MOD × 1/week, when compared with CON (p < 0.05). No serious adverse events were observed in this study.ConclusionThe effects of walking training on reducing depressive symptoms appeared to be dependent on exercise frequency. Our findings suggest that three sessions of walking per week at either moderate or vigorous-intensity effectively alleviate depressive symptoms in older adults with insomnia. Additional research is needed to further verify the effects of exercise frequency on depression.Clinical trial registration[ClinicalTrials.gov], identifier [NCT04354922].

Project description:ObjectiveTo estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment and other outcomes in people with mild to moderate dementia.DesignMulticentre, pragmatic, investigator masked, randomised controlled trial.SettingNational Health Service primary care, community and memory services, dementia research registers, and voluntary sector providers in 15 English regions.Participants494 people with dementia: 329 were assigned to an aerobic and strength exercise programme and 165 were assigned to usual care. Random allocation was 2:1 in favour of the exercise arm.InterventionsUsual care plus four months of supervised exercise and support for ongoing physical activity, or usual care only. Interventions were delivered in community gym facilities and NHS premises.Main outcome measuresThe primary outcome was score on the Alzheimer's disease assessment scale-cognitive subscale (ADAS-cog) at 12 months. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, health related quality of life, and carer quality of life and burden. Physical fitness (including the six minute walk test) was measured in the exercise arm during the intervention.ResultsThe average age of participants was 77 (SD 7.9) years and 301/494 (61%) were men. By 12 months the mean ADAS-cog score had increased to 25.2 (SD 12.3) in the exercise arm and 23.8 (SD 10.4) in the usual care arm (adjusted between group difference -1.4, 95% confidence interval -2.6 to -0.2, P=0.03). This indicates greater cognitive impairment in the exercise group, although the average difference is small and clinical relevance uncertain. No differences were found in secondary outcomes or preplanned subgroup analyses by dementia type (Alzheimer's disease or other), severity of cognitive impairment, sex, and mobility. Compliance with exercise was good. Over 65% of participants (214/329) attended more than three quarters of scheduled sessions. Six minute walking distance improved over six weeks (mean change 18.1 m, 95% confidence interval 11.6 m to 24.6 m).ConclusionA moderate to high intensity aerobic and strength exercise training programme does not slow cognitive impairment in people with mild to moderate dementia. The exercise training programme improved physical fitness, but there were no noticeable improvements in other clinical outcomes.Trial registrationCurrent Controlled Trials ISRCTN10416500.

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Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial.

Publications

Effects of a high-intensity functional exercise program on depressive symptoms among people with dementia in residential care: a randomized controlled trial.

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