Exercise Helps Alzheimer’s Patients Remain Independent Longer

By: Dr. Pascale Michelon

Physical exercise can benefit people with Alzheimer’s disease. A study reports that a bi-weekly hour of physical training can help them remain independent longer. The slower decline in activities of daily living was accompanied by less falls, and this at no overall increase in social and health care costs.

The mental symptoms of Alzheimer’s disease, such as major memory lapses or space and time disorientation, can be striking. These are the ones that everybody have heard of. But physical symptoms are also part of the disease. As it progresses, the brain’s control over muscles deteriorates and people can experience stiffness, un-coordination, or tremor. This physical disability, added to the mental disability, prevents patients from being able to accomplish activities of daily living such as brushing their teeth, dress or climb stairs.

A recent study looked at 210 people with moderate to severe Alzheimer’s disease who still lived at home with their spouse. For one year, one third participated in a group-based exercise program, one third in a home-based exercise program, and one third received usual care but did not participate in any organized physical training.

Both exercise programs required 1h-training sessions twice a week and were conducted by physical therapists. The home training was tailored to each patient’s problems with function and mobility. The group training aimed at improving endurance, balance and strength.

The researchers measured the effect of the exercise programs on mobility as well as on functional independence (i.e., how well people can cope with daily living activities). The use and cost of social and health care services was also examined.

Although all participants showed functional decline over the course of the 1 year study, the decline was slower in people who were exercising regularly. This was true as soon as 6 months after the beginning of the exercise program. The same people also had fewer falls.

The stronger and most significant effects of physical training were observed in people who exercised at home. This is probably because people in the group exercise program tended to skip more sessions.

The total cost of health and social services was lower for participants who exercised. Even the cost of bi-weekly private sessions with a therapist was offset by how much was saved on medical bills.

This study is one of the few showing that an intervention can help people already far into the disease. Improving physical functions and independence can be crucial in avoiding nursing home. It also dramatically improves quality of life.

One wishes that the study had also measured the participants’ mental functioning over the year. Given the well-known impact of physical exercise on brain functions it would have been interesting to see whether the patients in the study also experienced a slower mental decline. As of now it is not clear how physical exercise helped the patients in their activities of daily living: Was it because they were more able physically or mentally?

References: Pitkälä HK, et al. (2013). Effects of the Finnish Alzheimer disease exercise trial (FINALEX): A randomized controlled trial. JAMA Intern Med; DOI: 10.1001/jamainternmed.2013.359.

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