Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation among Older People with Dementia in Nursing Homes?

Effect of Adding Motorized Cycle Ergometer Over Exercise Training on Balance in Older Adults with Dementia: A Randomized Controlled Trial

BACKGROUND

Falls secondary to balance disturbances have been considered as a burden on health systems in people with dementia aged above 65. Exercise has been increasingly recommended to address such problem and the main challenges being the commitment and supervision of training. The study's aim was to investigate the effect of adding motorized cycle ergometer (MCE) on high intensity functional exercise (HIFE) training on balance and cognition in older adults with dementia.

METHODS

Sixty participants over the age of 65 were randomly allocated into 3 groups, Mo, Ex, and MoEx undergoing, respectively, 50 minutes MCE, HIFE, or combination of both. Sessions were done 3 times per week for 12 weeks. Outcome measures taken before and after study period were Berg Balance Scale (BBS), timed up and go test (TUG), and Mini Mental State Exam (MMSE).

RESULTS

All groups showed significant improvement in BBS scores but not on TUG or MMSE scores. Between group analysis showed no privilege of any used training methods over the other for all measures taken.

CONCLUSIONS

Training with HIFE, MCE, or combination of both is effective in improving balance but not cognition. However, MCE can be an alternative to supervised exercise training in addressing balance.

Type D personality, cognitive illness perception, depression, approach coping, and self-management among older adults in long-term care hospitals: Structural equation modeling

This study aimed to construct a structural equation model to explore the relationship between Type D personality, cognitive illness perception, depression, approach-coping, and self-management. The study was conducted at two long-term care hospitals with 300 or more beds in Korea. Participants were 287 older patients from whom data were collected from February 17 to March 10, 2021, using a structured questionnaire comprising items on the following variables: Type D personality, cognitive illness perception, depression, approach coping, and self-management. Type D personality (β=-.601, p=.001), cognitive illness perception (β =.692, p <.001), depression (β =-.204, p =.011), and approach-coping (β =.326, p <.001) explained 78.8% of the total variance of self-management, highlighting their impact on how patients accept and manage a disease and their relevance to the self-management of older adults in long-term care hospitals.

Physical exercise and goal attainment after shunt surgery in idiopathic normal pressure hydrocephalus: a randomised clinical trial

Background

Rehabilitation in iNPH is suggested to be an important factor to improve patients’ functions but there are lack of clinical trials evaluating the effect of rehabilitation interventions after shunt surgery in iNPH. The objective of this study was to evaluate the effect of a physical exercise programme and goal attainment for patients with idiopathic normal pressure hydrocephalus (iNPH) after surgery compared to a control group.

Methods

This was a dual centre randomised controlled trial with assessor blinding, intention-to-treat (ITT) and per protocol (PP) analysis. Individuals diagnosed with iNPH scheduled to undergo shunt surgery at the Linköping University Hospital in Linköping and Sahlgrenska University Hospital in Gothenburg, Sweden were consecutively eligible for inclusion. Inclusion was conducted between January 2016 and June 2018. The patients were randomised 1:1 using sequentially numbered sealed envelopes to receive either written exercise information (control group) or written information and an additional supervised high-intensity, functional exercise programme (HIFE) executed twice weekly over 12 weeks (exercise group). Preoperatively, the patients set individual goals. The primary outcome was change from baseline in the total iNPH scale score at the post-intervention follow-up. Secondary outcomes were goal attainment, and change in the separate scores of gait, balance, neuropsychology and continence and in the total score after 6 months.

Results

In total, 127 participants were randomised to the exercise group (n = 62) and to the control group (n = 65). In the ITT population (exercise group, n = 50; control group, n = 59), there were no between-group differences in the primary outcome, but the attrition rate in the exercise group was high. The exercise group improved more than the control group in the balance domain scores after 6 months. Post-intervention, the PP exercise population achieved their set goals to a greater extent than the controls.

Conclusions

An additional effect of the 12-week HIFE-programme on the overall improvement according to the iNPH-scale after shunt surgery in iNPH was not shown. This could be due to high attrition rate. However, the long-term effect on balance and higher goal achievement indicate beneficial influences of supervised physical exercise.

Trial registration clinicaltrials.gov, NCT02659111. Registered 20 January 2016, https://clinicaltrials.gov/ct2/show/NCT02659111

Supplementary Information

The online version contains supplementary material available at 10.1186/s12987-021-00287-8.