Effects of functional physical activity on the maintenance of motor function in Alzheimer's disease

Fajersztajn, Laís; Cordeiro, Renata Cereda; Andreoni, Solange; Garcia, Jacqueline Takayanagi

doi:10.1590/S1980-57642009DN20300013

Abstract

It is widely known that older adults, even frail individuals, can improve their physical function using appropriately targeted exercise. Nevertheless, older adults with Alzheimer's disease (AD) have been excluded from the majority of studies on exercise. The functional-task physical activity program is based on activities of daily living, and may be suited for elderly people with AD because it focuses on the maintenance and stimulation of preserved abilities. In addition, session costs are substantially reduced by adopting a group approach. Furthermore, the group approach may improve the social interaction of the demented patient.

Objectives: To determine whether a functional-task physical activity program in groups can maintain motor function in elderly with AD.

Methods: 10 elderly diagnosed with mild or moderate AD were assigned into one of two groups: subjects with and without intervention. The intervention consisted of a 12-week function-task physical activity program in groups. Measurements: activities of daily living (Katz and Lawton & Brody questionnaires), mobility (Timed Up and Go Test, Timed Up and Go manual Test and Timed Up and Go Cognitive Test), cognition (Mini-Mental State Examination), behavioral disturbances (Neuropsychiatric Inventory I-brief) and functional balance (Berg Balance Scale).

Results: A statistically significant difference between the two groups was found regarding the functional balance mean change measured by Berg scale score (p=0.046). A significant improvement of 1.60 points (95%CI[0.22;2.98]) was observed in the intervention group on this scale, while the non-intervention group showed -0.40 points (95%CI[-1.78;0.98], no change).

Conclusions: It is possible to treat mild and moderate Alzheimer's patients using a group approach. The functional task physical activity program was efficient in functional balance improvement and also appeared to prevent mobility decline.

Key words: motor function; Alzheimer's disease; balance; physical activity; physiotherapy.

Resumo

Apesar dos conhecidos benefícios dos exercícios físicos resistidos em idosos frágeis, os idosos com doença de Alzheimer (DA) vêm sendo excluídos destes estudos. A atividade física funcional, por direcionar os exercícios para atividades comuns no dia a dia, seria adequada a este público, por enfocar a manutenção e a estimulação das capacidades remanescentes. A abordagem em grupo seria adequada tanto para reduzir os custos, quanto para atuar no isolamento social.

Objetivos: Verificar os efeitos da atividade física funcional em grupo sobre a manutenção da função motora do paciente ido so com DA como forma de reabilitação preventiva.

Métodos: 10 idosos com DA leve a moderada alocados em dois grupos: com intervenção (atividades motoras com enfoque funcional durante 12 semanas) e sem intervenção. Foram avaliadas: atividades básicas e instrumentais de vida diária (questionário de Katz e de Lawton & Brody), mobilidade (Timed Up and Go Test, Timed Up and Go Test manual e Timed Up and Go Test cognitivo), cognição (Mini-exame do estado mental) e comportamento (Inventário Neuropsiquiátrico: NPI-Brief). O equilíbrio foi avaliado pela escala Berg de equilíbrio (BBS).

Resultados: Houve diferença estatisticamente significativa entre os dois grupos quanto à mudança média no equilíbrio medido pelo número de pontos na escala de Berg (p=0,046). Um aumento significativo de 1,60 pontos (IC95%[0,22;2,98]) foi observado no grupo com intervenção nessa escala, enquanto que no grupo sem intervenção foi de -0,40 (IC95% [-1,78;0,98], nenhuma mudança).

Conclusões: É possível tratar DA em grupo com estratégias motoras. Essas estratégias se mostraram eficazes na melhora do equilíbrio, sugerindo que a atividade motora pode prevenir o declínio da mobilidade em portadores de DA leve a moderada.

Palavras-chave: função motora; doença de Alzheimer; equilíbrio; atividade física; fisioterapia.

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References

¹ Ramos LR, Montaño MBMM. Distúrbios da memória e demência no idoso. Rev Bras Med 2005;62:29-37.
² Bottino CMC, Carvalho IAM, Alvarez AMMA, et al. Reabilitação cognitiva em pacientes com doença de Alzheimer: relato de trabalho em equipe multidisciplinar. Arq Neuropsiquiatr 2002;60:70-79.
³ Wang L, Larson EB, Bowen JD, VanBelle G. Performance-based physical function and future dementia in older people. Arch Intern Med 2006;166:1115-1120.
⁴ Pettersson AF, Olsson E, Wahlund LO. Motor function in subjects with mild cognitive impairment and early Alzheimer's disease. Dement Geriatr Cogn Disord 2005;19:299-304.
⁵ Pettersson AF, Engardt M, Wahlund L. Activity level and balance in subjects with mild Alzheimer's disease. Dement Geriatr Cogn Disord 2002;13:213-216.
⁶ Franssen EH, Souren LEM, Torossian CL, Reisberg B. Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer's disease. JAGS 1999;47:463-469.
⁷ Alexander NB, Mollo JM, Giordani B, et al. Maintenance of balance, gait patterns, and obstacle clearance in Alzheimer's disease. Neurology 1995;45:908-914.
⁸ Kluger A, Gianutsos JG, Golomb J. Patterns of motor impairment in normal aging, mild cognitive decline, and early Alzheimer disease. J Gerontol B Psychol Sci Soc Sci 1997;52:P28-39.
⁹ Waite LM, Broe GA, Grayson DA, Creasey H. Motor function and disability in the dementias. Int J Geriatr Psychiatry 2000;15:897-903.
¹⁰ Nakamura T, Meguro K, Yamazaki H, et al. Postural and gait disturbances correlated with decreased frontal cerebral blood flow in Alzheimer disease. Alzheimer Dis Assoc Disord 1997;11:132-139.
¹¹ Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA 2003;290:2015-2022.
¹² Tappen RM, Roach KE, Applegate B, Stowell P. Effect of a combined walking and conversation intervention on functional mobility of nursing home residents with Alzheimer disease. Alzheimer Dis Assoc Disord 2000;14:196-201.
¹³ Heyn P, Abreu BC, Ottembacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil 2004;85:1694-1704.
¹⁴ de Vreede PL, Samson MM, van Meeteren NL, Duursma SA, Verhaar HJ. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized controlled trial. JAGS 2005;53:2-10.
¹⁵ Barnett A, Smith B, Lord SR, Wiluams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomized controlled trial. Age Ageing 2003;32:407-414.
¹⁶ Teri L, McCurry SM, Buchner DM, et al. Exercise and activity level in Alzheimer's disease: a potential treatment focus. J Rehabil Res Develop 1998;35:411-419.
¹⁷ Thomas VS, Hageman A. A preliminary study on the reability of physical performance measures in older day-care center clients with dementia. Int Psychogeriatr 2002;14:17-23.
¹⁸ De Vreese LP, Neri M, Fiovaranti M, Belloi L, Zanetti O. Memory rehabilitation in Alzheimer's disease: a review of progress. Int J Geriatr Psychiatry 2001;16:794-809.
¹⁹ American Psychiatric Association (APA). Committee on nomenclature and statistics diagnostic and statistic manual of mental disorders. 4th ed. Washington (DC);1994:142-143.
²⁰ Bertolucci P, Brucki S, Campacci SR, Juliano Y. The Mini-Mental State Examination in a general population: impact of educational status. Arq Neuropsiquiatr 1994;52:1-7
²¹ Morris J. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.
²² Montaño, MBMM, Ramos LR. Validade da versão em português da Clinical Dementia Rating. Rev Saude Publica 2005;39:912-917.
²³ Katz S, Downs TD, Cash HR, Grotz RC. Progress in the development of the index of ADL. Gerontologist 1970;1:20-30.
²⁴ Lawton MP, Brody EM. Assessment of older people: self maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.
²⁵ Ávila R. Resultados da reabilitação neuropsicológica em paciente com doença de Alzheimer leve. Rev Psiq Clin 2003; 30:139-146.
²⁶ Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992;83(Suppl 2):S7-11.
²⁷ Myamoto ST, Lombardi JI, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg Balance Scale. Braz J Med Biol Res 2004;37:1411-1421.
²⁸ Podsiadlo D, Richardson S. The Timed "Up & Go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142-148.
²⁹ Lundin-Olsson L, Nyberg L, Gustafson MD. Attention, frailty, and falls: the effect of a manual task on basic mobility. J Am Geriatr Soc 1998;46:758-761.
³⁰ Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed Up & Go test. Phys Ther 2000;80:896-903
³¹ Kaufer DI, Cummings JL, Ketchel P, Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci 2000;12:2.
³² Cummings JL, Mega M, Gray K, Rosemberg-Thompson S, Carusi DA, Gornbein J. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
³³ Ramos LR, Simões EJ, Abert MS. Dependence in activities of daily living and cognitive impairments strongly predict mortality in older urban residents in Brazil: a 2-year follow-up. JAGS 2001;49:1168-1175.
³⁴ Hepbum K, Lewis M. Effective dementia care: lessons from a family caregiver training program. Home Healthcare Consultant 2002;9:10-17.
³⁵ National Institute on Aging National Institutes of Health. Alzheimer's disease: Unraveling the Mystery. http://www.ttmed.com/dementia/pdf/unraveling.pdf
» http://www.ttmed.com/dementia/pdf/unraveling.pdf
³⁶ Herrera EJ, Caramelli P, Silveira ASB, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
³⁷ Cott CA, Dawson P, Sidani S, Wells D. The Effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease. Alzheimer Dis Assoc Disord 2002;16:81-87.

Publication Dates

Publication in this collection
Jul-Sep 2008

History

Received
22 Oct 2007
Accepted
20 June 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹ Ramos LR, Montaño MBMM. Distúrbios da memória e demência no idoso. Rev Bras Med 2005;62:29-37.

[2] ² Bottino CMC, Carvalho IAM, Alvarez AMMA, et al. Reabilitação cognitiva em pacientes com doença de Alzheimer: relato de trabalho em equipe multidisciplinar. Arq Neuropsiquiatr 2002;60:70-79.

[3] ³ Wang L, Larson EB, Bowen JD, VanBelle G. Performance-based physical function and future dementia in older people. Arch Intern Med 2006;166:1115-1120.

[4] ⁴ Pettersson AF, Olsson E, Wahlund LO. Motor function in subjects with mild cognitive impairment and early Alzheimer's disease. Dement Geriatr Cogn Disord 2005;19:299-304.

[5] ⁵ Pettersson AF, Engardt M, Wahlund L. Activity level and balance in subjects with mild Alzheimer's disease. Dement Geriatr Cogn Disord 2002;13:213-216.

[6] ⁶ Franssen EH, Souren LEM, Torossian CL, Reisberg B. Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer's disease. JAGS 1999;47:463-469.

[7] ⁷ Alexander NB, Mollo JM, Giordani B, et al. Maintenance of balance, gait patterns, and obstacle clearance in Alzheimer's disease. Neurology 1995;45:908-914.

[8] ⁸ Kluger A, Gianutsos JG, Golomb J. Patterns of motor impairment in normal aging, mild cognitive decline, and early Alzheimer disease. J Gerontol B Psychol Sci Soc Sci 1997;52:P28-39.

[9] ⁹ Waite LM, Broe GA, Grayson DA, Creasey H. Motor function and disability in the dementias. Int J Geriatr Psychiatry 2000;15:897-903.

[10] ¹⁰ Nakamura T, Meguro K, Yamazaki H, et al. Postural and gait disturbances correlated with decreased frontal cerebral blood flow in Alzheimer disease. Alzheimer Dis Assoc Disord 1997;11:132-139.

[11] ¹¹ Teri L, Gibbons LE, McCurry SM, et al. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. JAMA 2003;290:2015-2022.

[12] ¹² Tappen RM, Roach KE, Applegate B, Stowell P. Effect of a combined walking and conversation intervention on functional mobility of nursing home residents with Alzheimer disease. Alzheimer Dis Assoc Disord 2000;14:196-201.

[13] ¹³ Heyn P, Abreu BC, Ottembacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Arch Phys Med Rehabil 2004;85:1694-1704.

[14] ¹⁴ de Vreede PL, Samson MM, van Meeteren NL, Duursma SA, Verhaar HJ. Functional-task exercise versus resistance strength exercise to improve daily function in older women: a randomized controlled trial. JAGS 2005;53:2-10.

[15] ¹⁵ Barnett A, Smith B, Lord SR, Wiluams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomized controlled trial. Age Ageing 2003;32:407-414.

[16] ¹⁶ Teri L, McCurry SM, Buchner DM, et al. Exercise and activity level in Alzheimer's disease: a potential treatment focus. J Rehabil Res Develop 1998;35:411-419.

[17] ¹⁷ Thomas VS, Hageman A. A preliminary study on the reability of physical performance measures in older day-care center clients with dementia. Int Psychogeriatr 2002;14:17-23.

[18] ¹⁸ De Vreese LP, Neri M, Fiovaranti M, Belloi L, Zanetti O. Memory rehabilitation in Alzheimer's disease: a review of progress. Int J Geriatr Psychiatry 2001;16:794-809.

[19] ¹⁹ American Psychiatric Association (APA). Committee on nomenclature and statistics diagnostic and statistic manual of mental disorders. 4th ed. Washington (DC);1994:142-143.

[20] ²⁰ Bertolucci P, Brucki S, Campacci SR, Juliano Y. The Mini-Mental State Examination in a general population: impact of educational status. Arq Neuropsiquiatr 1994;52:1-7

[21] ²¹ Morris J. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414.

[22] ²² Montaño, MBMM, Ramos LR. Validade da versão em português da Clinical Dementia Rating. Rev Saude Publica 2005;39:912-917.

[23] ²³ Katz S, Downs TD, Cash HR, Grotz RC. Progress in the development of the index of ADL. Gerontologist 1970;1:20-30.

[24] ²⁴ Lawton MP, Brody EM. Assessment of older people: self maintaining and instrumental activities of daily living. Gerontologist 1969;9:179-186.

[25] ²⁵ Ávila R. Resultados da reabilitação neuropsicológica em paciente com doença de Alzheimer leve. Rev Psiq Clin 2003; 30:139-146.

[26] ²⁶ Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992;83(Suppl 2):S7-11.

[27] ²⁷ Myamoto ST, Lombardi JI, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg Balance Scale. Braz J Med Biol Res 2004;37:1411-1421.

[28] ²⁸ Podsiadlo D, Richardson S. The Timed "Up & Go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991;39:142-148.

[29] ²⁹ Lundin-Olsson L, Nyberg L, Gustafson MD. Attention, frailty, and falls: the effect of a manual task on basic mobility. J Am Geriatr Soc 1998;46:758-761.

[30] ³⁰ Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed Up & Go test. Phys Ther 2000;80:896-903

[31] ³¹ Kaufer DI, Cummings JL, Ketchel P, Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci 2000;12:2.

[32] ³² Cummings JL, Mega M, Gray K, Rosemberg-Thompson S, Carusi DA, Gornbein J. The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[33] ³³ Ramos LR, Simões EJ, Abert MS. Dependence in activities of daily living and cognitive impairments strongly predict mortality in older urban residents in Brazil: a 2-year follow-up. JAGS 2001;49:1168-1175.

[34] ³⁴ Hepbum K, Lewis M. Effective dementia care: lessons from a family caregiver training program. Home Healthcare Consultant 2002;9:10-17.

[35] ³⁵ National Institute on Aging National Institutes of Health. Alzheimer's disease: Unraveling the Mystery. http://www.ttmed.com/dementia/pdf/unraveling.pdf
» http://www.ttmed.com/dementia/pdf/unraveling.pdf

[36] ³⁶ Herrera EJ, Caramelli P, Silveira ASB, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[37] ³⁷ Cott CA, Dawson P, Sidani S, Wells D. The Effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease. Alzheimer Dis Assoc Disord 2002;16:81-87.