Research project The aim of the study was to evaluate effects of a high-intensity functional exercise program in people with dementia. Among the outcomes of interest were activities of daily living (ADL), falls, cognitive and physical function, and depressive symptoms.
Dementia is very common among older people; one out of three aged 85 or over has a dementia disease. Dementia leads to deteriorations in cognitive and physical functions, which contribute to an increased risk of dependency in activities of daily living (ADL) and falls. Previous research had shown that for older people without cognitive impairment, physical and cognitive functions are improved by exercise. This study evaluated whether these exercise effects also exist for people with dementia.
FORTE- Swedish Research Council for Health, Working Life and Welfare
County Council of Västerbotten (“Central ALF-Grants”)
Promobilia Foundation
Vårdal Foundation
Swedish Society of Medicine
Swedish Alzheimer Foundation
Swedish Dementia Association
Ragnhild and Einar Lundström’s Memorial Foundation
Dementia is very common among older people; one out of three aged 85 or over has a dementia disease. The prevalence will increase dramatically in the future. Dementia leads to deteriorations in cognitive and physical functions, which contribute to an increased risk of dependency in activities of daily living (ADL) and falls.
The aim of the UMDEX study was to evaluate effects of a high-intensity functional exercise program in older people with dementia. Among the outcomes of interest were activities of daily living (ADL), falls, cognitive and physical function, and depressive symptoms.
186 older people with a diagnosed dementia and living in residential care facilities were included. Participants were cluster-randomized in small groups to an exercise programme (The High-Intensity Functional Exercise, HIFE, Program) or to a control activity. The exercise and control activity were held five times each 14 days for 4 months, in total 40 sessions. Outcomes were assessed at baseline, 4, and 7 months by persons blinded to group allocation. The study protocol (ISRCTN31767087) is published at the Current Controlled Trials (http://www.controlled-trials.com/ ).
Both activities were feasible. Attendance and motivation were high in both groups, with only some minor and temporary adverse events. According to the HIFE Program, the exercise should be adapted for each participant and the intensity should be as high as possible. To achieve that the Physiotherapist, who led the exercise session, stressed that a continuous iterative process of building on existing knowledge, sharing and reflecting, being alert to any alterations needed for individuals that day, communication skills (both with residents and staff) are needed. In addition, building a relationship and trust with residents are all important for effective delivery of high intensity functional exercise to older people living with dementia in care settings.
The results from the UMDEX Study showed for example that exercise slowed decline in ADL independence and improved balance when compared to the control group, both at 4 months (directly after the intervention period) and at 7 months, albeit only in participants with non-Alzheimer’s dementia. Participants in both the exercise and control groups with higher levels of depressive symptoms at baseline showed significant reductions in depressive symptoms at 4 and 7 months. Regarding falls, no difference in fall rate between groups at 6 or 12 months were found. Participants in the exercise group were less likely to sustain moderate/serious fall-related injuries at 12-month follow-up. According to interviews with participants in the exercise group the intense exercise was perceived as challenging but achievable since it was individually tailored and adapted. Participants described that exercising gave them pleasure, brought improvements in mental and bodily strength, awakened memories of previous physical activities and that they rediscovered bodily capabilities.
