Keeping the beat: use of rhythmic music during exercise activities for the elderly with dementia

Perceived Quality of Online Music Therapy Sessions by Older Adults Aging at Home

Online delivery is new to the field of music therapy (MT). This research investigated older adults' perceived quality of MT online by certified music therapists. In this feasibility study, applying both process and outcome assessments, nine older adults volunteered to participate. Zoom was used, and a virtual music therapy (VMT) kit was developed as a resource. Surveys and observed technical difficulties revealed that perceived quality varied slightly by level of technical difficulty experienced; however, overall mean perceived quality was 7.2 out of 9. Post-study interviews revealed three main themes: (a) individual experiences with VMT, (b) individuals' suggestions for further development of VMT sessions, and (c) individuals' personal outcomes from VMT sessions. Participants reported overall positive experiences with VMT. Despite a slight decline in perceived quality when more technical difficulties were present, each participant reported a desire for more sessions, and they would recommend it to others.

Utilising Emotion Monitoring for Developing Music Interventions for People with Dementia: A State-of-the-Art Review

The demand for smart solutions to support people with dementia (PwD) is increasing. These solutions are expected to assist PwD with their emotional, physical, and social well-being. At the moment, state-of-the-art works allow for the monitoring of physical well-being; however, not much attention is delineated for monitoring the emotional and social well-being of PwD. Research on emotion monitoring can be combined with research on the effects of music on PwD given its promising effects. More specifically, knowledge of the emotional state allows for music intervention to alleviate negative emotions by eliciting positive emotions in PwD. In this direction, the paper conducts a state-of-the-art review on two aspects: (i) the effect of music on PwD and (ii) both wearable and non-wearable sensing systems for emotional state monitoring. After outlining the application of musical interventions for PwD, including emotion monitoring sensors and algorithms, multiple challenges are identified. The main findings include a need for rigorous research approaches for the development of adaptable solutions that can tackle dynamic changes caused by the diminishing cognitive abilities of PwD with a focus on privacy and adoption aspects. By addressing these requirements, advancements can be made in harnessing music and emotion monitoring for PwD, thereby facilitating the creation of more resilient and scalable solutions to aid caregivers and PwD.

Spectro-temporal acoustic elements of music interact in an integrated way to modulate emotional responses in pigs

Music is a complex stimulus, with various spectro-temporal acoustic elements determining one of the most important attributes of music, the ability to elicit emotions. Effects of various musical acoustic elements on emotions in non-human animals have not been studied with an integrated approach. However, this knowledge is important to design music to provide environmental enrichment for non-human species. Thirty-nine instrumental musical pieces were composed and used to determine effects of various acoustic parameters on emotional responses in farm pigs. Video recordings (n = 50) of pigs in the nursery phase (7-9 week old) were gathered and emotional responses induced by stimuli were evaluated with Qualitative Behavioral Assessment (QBA). Non-parametric statistical models (Generalized Additive Models, Decision Trees, Random Forests, and XGBoost) were applied and compared to evaluate relationships between acoustic parameters and pigs' observed emotional responses. We concluded that musical structure affected emotional responses of pigs. The valence of modulated emotions depended on integrated and simultaneous interactions of various spectral and temporal structural components of music that can be readily modified. This new knowledge supports design of musical stimuli to be used as environmental enrichment for non-human animals.

Exploring the use of music to promote physical activity: From the viewpoint of psychological hedonism

Despite the global efforts to encourage people to regularly participate in physical activity (PA) at moderate-to-vigorous intensity, an inadequate number of adults and adolescents worldwide meet the recommended dose of PA. A major challenge to promoting PA is that sedentary or low-active people experience negative shifts in affective valence (feeling bad versus good) in response to moderate-to-vigorous intensity PA. Interestingly, empirical data indicate that listening to music during acute bouts of PA positively alters affective valence (feeling good versus bad), reduces perceived exertion, and improves physical performance and oxygen utilization efficiency. From the viewpoint of the ancient principle of psychological hedonism - humans have ultimate desires to obtain pleasure and avoid displeasure - we elaborate on three putative mechanisms underlying the affective and ergogenic effects of music on acute bouts of PA: (1) musical pleasure and reward, (2) rhythmic entrainment, and (3) sensory distraction from physical exertion. Given that a positive shift in affective valence during an acute bout of PA is associated with more PA in the future, an important question arises as to whether the affective effect of music on acute PA can be carried over to promote long-term PA. Although this research question seems intuitive, to our knowledge, it has been scarcely investigated. We propose a theoretical model of Music as an Affective Stimulant to Physical Activity (MASPA) to further explain the putative mechanisms underlying the use of music to promote long-term PA. We believe there have been important gaps in music-based interventions in terms of the rationale supporting various components of the intervention and the efficacy of these interventions to promote long-term PA. Our specification of relevant mechanisms and proposal of a new theoretical model may advance our understanding of the optimal use of music as an affective, ergogenic, and sensory stimulant for PA promotion. Future directions are suggested to address the gaps in the literature.

Exploration of combined physical activity and music for patients with Alzheimer’s disease: A systematic review

Objective

Alzheimer’s disease (AD) can be treated in different ways, one of which is combined physical activity and music intervention, which is a non-pharmacological one. This study provided a thorough systematic review on the application of combined physical activity and music intervention in patients with AD.

Method

Online sources, such as PubMed, Web of Science, SAGE Premier, EBSCO, and Cochrane, published from January 2002 to March 2022 were searched for articles. Reviewer screened articles on inclusion criteria and identified relevant studies. 200 studies were selected as potentially relevant; of these, eight met all the inclusion criteria.

Results

The systemic review looked at eight studies, two of which had high methodological quality and six were of moderate quality. Various types of research were included: randomized controlled tails, single-subject study, crossover study, and case report. Music intervention was conducted during an exercise program in six studies. A cognitive stimulation was applied with music therapy and physical activities among two studies. The physical activities or movements included balance training, stretching, strengthening, and different sports activities. Outcome assessment, including the Barthel index in two studies and the functional independence measure, was conducted to evaluate the daily functional score. Mental health was evaluated by Mini-Mental State Examination in three studies.

Conclusion

Combined physical activity and music intervention are beneficial and improve the cognition, function and well-being of patients with AD. Supporting combined physical and music intervention will play a key role in helping clinical guidelines for both physical therapists and music therapists.

Immediate physiological effects of listening to music before physical exercise in institutionalized older people with dementia

ABSTRACT The evolution of dementia is strongly related to cognitive, motor, and functional changes and to the presence of cardiovascular diseases. Disturbances vary according to phase of dementia and can limit instrumental and basic activities of daily living. The aim of this study was to analyze the immediate physiological effects of listening to music before physical exercise in institutionalized older people with moderate to advanced dementia. A randomized trial was conducted with 18 institutionalized older people with dementia (mean age was 79 years old, 52.6% were female), who were divided into a Training with Music Group (TWMG) and a Training without Music Group (TWtMG). The evaluation included heart rate (HR), blood pressure (BP) and HR variability (HRV). The assessment was conducted in a closed environment or in places with minimal visual and auditory stimulation. The TWMG was submitted to stimuli with music for 15 minutes and physical exercises for 30 minutes to improve/maintain their global mobility. The TWtMG performed the same physical exercises, however without music before physical exercise. The interventions lasted 12 weeks, and were performed individually once a week. In the TWMG, we observe a decrease in diastolic BP in the third session. In the sixth week, the HR increased after the session in both groups. TWMG improved HRV in the third session, with a difference between groups only after the session. After the sixth session, HRV values improved in both groups. In conclusion, listening to music before physical exercise is associated with positive effects in people with dementia, as it tends to maintain and improve physiological factors.

Patterns of enhancement in paretic shoulder kinematics after stroke with musical cueing

Musical cueing has been widely utilised in post-stroke motor rehabilitation; however, the kinematic evidence on the effects of musical cueing is sparse. Further, the element-specific effects of musical cueing on upper-limb movements have rarely been investigated. This study aimed to kinematically quantify the effects of no auditory, rhythmic auditory, and melodic auditory cueing on shoulder abduction, holding, and adduction in patients who had experienced hemiparetic stroke. Kinematic data were obtained using inertial measurement units embedded in wearable bands. During the holding phase, melodic auditory cueing significantly increased the minimum Euler angle and decreased the range of motion compared with the other types of cueing. Further, the root mean square error in the angle measurements was significantly smaller and the duration of movement execution was significantly shorter during the holding phase when melodic auditory cueing was provided than when the other types of cueing were used. These findings indicated the important role of melodic auditory cueing for enhancing movement positioning, variability, and endurance. This study provides the first kinematic evidence on the effects of melodic auditory cueing on kinematic enhancement, thus suggesting the potential use of pitch-related elements in psychomotor rehabilitation.

Effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia: Pilot study

AIM

Determine the effects of listening to music and practicing physical exercise on functional and cognitive aspects in institutionalized older adults with dementia.

METHODS

A randomized clinical pilot trial was conducted involving 17 institutionalized older adults with moderate to advanced dementia. The participants were allocated to two groups: training with music (TWM) and training without music (TWtM). The TWtM group performed light exercises with a focus on mobility. The TWM group was initially submitted to a cognitive stimulus with music, followed by the same exercises as those performed in the TWtM Group. Sessions were held once a week for 12 weeks. Functional and cognitive assessments were performed at baseline and after the 12-week intervention.

RESULTS

No significant differences in functional or cognitive performance were found between groups or evaluation times. Both groups maintained their performances after 12 weeks.

CONCLUSIONS

Listening to music combined with physical exercise training did not exert an effect on functional or cognitive performance in institutionalized older adults with moderate to advanced dementia.

The impact of environmental factors on persons with dementia attending recreational groups

OBJECTIVES

The Comprehensive Process Model of Group Engagement posits that personal factors (eg, cognitive function), stimulus factors (eg, group activity content and group size), and environmental factors (eg, light and noise) impact the response to group activities. This paper reports the impact of environmental and group characteristics on engagement, mood, and sleepiness of persons with dementia attending group activities.

METHODS/DESIGN

The sample included 69 nursing home residents. Environmental contexts of activities included time of day, location, noise, light, and temperature. Outcome variables captured engagement, mood, and sleepiness, observed during 20 group activity sessions. Mixed model analyses were used to examine the impact of environmental and group attributes on the outcome variables.

RESULTS

Background noise and time of day significantly affected outcome variables after controlling for participants' cognitive functioning and group topic. Background noise was related with decreased engagement and increased sleepiness. Activities conducted before noon were associated with increased sleepiness. Group size did not affect the outcome variables. There was little variation concerning temperature and light.

CONCLUSIONS

These findings have implications for architectural and ongoing planning. The methodology presents a model for continuous quality improvement. The main components of the Comprehensive Process Model of Group Engagement significantly impacted group activity engagement.

Home-Based Gait Training Using Rhythmic Auditory Cues in Alzheimer's Disease: Feasibility and Outcomes

Background/Purpose: Although gait disorders occur early in the course of Alzheimer's disease (AD) and increase the risk of falling, methods to improve walking in the home setting are poorly understood. This study aimed to determine the feasibility of a home-based gait training program using rhythmic auditory cues for individuals living with mild to moderately severe AD.

Methods: Participants had probable AD with no other major conditions affecting locomotion. The intervention consisted of eight progressively modified 45-min gait training sessions delivered during home visits over 4 weeks. Experienced physiotherapists provided the therapy that incorporated rhythmic music cues for a range of locomotor tasks and ambulatory activities. On the days when the physiotherapist did not attend, participants independently performed a seated music listening activity. Walking speed, cadence, stride length, double limb support duration, and gait variability (coefficient of variation) were measured using an 8-m GAITRite® computerized walkway immediately before and after the physiotherapy intervention. Participant satisfaction was also assessed using a purpose-designed questionnaire.

Results: Eleven (median age, 77.0 years; median ACE III score, 66/100; 3 females and 8 males) community-dwelling adults living with AD participated. Wilcoxon signed rank tests revealed statistically significant increases in gait speed following the home-based physiotherapy intervention (baseline = 117.5 cm/s, post-intervention = 129.9 cm/s, z = −2.40, p < 0.05). Stride length also improved (baseline = 121.8 cm, post-intervention = 135.6 cm, z = −2.67, p < 0.05). There was no significant change in gait variability. The program was found to be feasible and safe, with no attrition. Participant satisfaction with the home-based music-cued gait training was high, and there were no adverse events.

Conclusion: A progressively modified gait training program using rhythmic auditory cues delivered at home was feasible, safe, and enjoyable. Music-cued gait training can help to reduce the rate of decline in gait stride length and speed in some individuals living with AD.

Trial Registration:http://www.anzctr.org.au/Default.aspx, ACTRN12616000851460.

Universal Trial Number: U1111-1184-5735.

The Effects of Intuitive Movement Reembodiment on the Quality of Life of Older Adults With Dementia: A Pilot Study

BACKGROUND

The creative use of reminiscent music and natural movements were reported to have positive effects on the well-being of older adults with cognitive impairment.

OBJECTIVES

To explore the effects of the intuitive movement reembodiment (IMR) program on the quality of life (QoL) of older adults with dementia.

METHODS

Data collected from 22 participants were analyzed: group 1 (mild dementia), group 2 (moderate dementia), group 3 (advanced dementia). All study groups participated in 10 weekly sessions. Self-reported QoL ratings were gathered through using the World Health Organisation (WHO)-5 questionnaire, alongside qualitative evidence recorded through onsite observation.

RESULTS

Statistically significant improvement in QoL was demonstrated after session 6. The qualitative analysis showed that the IMR sessions provided a sense of humor, imagination, and intuition that motivated the participants to dance and interact with joy.

CONCLUSION

These preliminary positive findings need to be replicated in a larger randomized controlled trial.

Therapeutic Dancing for Frail Older People in Residential Aged Care: A Thematic Analysis of Barriers and Facilitators to Implementation

Background

Adults who live in residential aged care can have reduced participation in physical activities and sit for prolonged periods. Therapeutic dancing aims to optimize movement, creative expression, well-being, and social interaction.

Objectives

To investigate the benefits, challenges, and facilitators to implementing therapeutic dancing in residential aged care.

Methods

Thematic analysis of semistructured interviews of residential aged care staff and therapists. Interviews were digitally audio-recorded and thematically analyzed. Findings: Four main themes were identified: (a) despite frailty, dancing classes afforded motor and nonmotor benefits, (b) music and dance genre selections were key to success, (c) the skills of the dance instructor were associated with successful outcomes, and (d) there were modifiable and nonmodifiable facilitators and barriers to implementation.

Conclusion

Enablers included support from management, resident supervision, age-appropriate music with a strong rhythmical beat, and a dance instructor skilled in comprehensive care. Barriers included multimorbidity, frailty, severe cognitive impairment, and funding.

A physical exercise program using music-supported video-based training in older adults in nursing homes suffering from dementia: a feasibility study

BACKGROUND

Motivation towards an exercise program is higher in a small group setting in comparison to individual therapy. Due to attentional problems, group exercises are difficult for people with Alzheimer disease (AD). This study evaluates the feasibility of a music-supported video-based group exercise program in older adults suffering from AD.

METHODS

Five participants with moderate AD were recruited from a nursing home. A progressive physical exercise program using a video-based training with musical accompaniment was performed and digitally recorded to investigate the adherence and performed accuracy of the exercises.

RESULTS

The overall participation during the exercises was 84.1%. The quality of the performance was for all exercises above the cut-off scores.

CONCLUSION

A music-supported video-based group exercise program is feasible in persons with AD. The participants were motivated and the expectations towards the program increased over time. Music seemed an important factor for attention in participants with AD.

The Value of Exercise Rehabilitation Program Accompanied by Experiential Music for Recovery of Cognitive and Motor Skills in Stroke Patients

BACKGROUND

The aim of this study was to systematically assess the effects of exercise rehabilitation program accompanied by experiential music for clinical recovery.

METHODS

This was a prospective randomized study with 65 stroke survivor patients. All cases underwent a neuropsychological assessment first as a prescreening test, during the admission at the Rehabilitation center (baseline), and 6 months poststroke. All patients received standard treatment for stroke in terms of medical care and rehabilitation. Additionally, all patients were separated into 2 Groups: a music Group (daily listening to experiential/traditional music), and a control Group (CG) with no experiential/traditional music therapy (standard care only). Computed tomography perfusion and full neurological examination including GCS were assessment. As Recovery was defined the improvement of cognitive and motor skills of the limb in the affected site, with an increase of muscle strength at least by 1/5 and with emotional progress.

RESULTS

Statistically significant differences were found between the Group CG and the rest of the patients in respect of Lesion size (P = .001) and CBF in affected area (P = .001). Μultivariate analysis revealed that only Group and Lesion size were independent predictors for Recovery (odd ratio [OR][95%confidence interval]) .11(.001-.133) and .798(.668-.954) respectively.

CONCLUSION

The findings of this study suggest that the music-based exercise program has a positive effect on mood profile in stroke patients and Recovery rate is higher when exercise rehabilitation program was accompanied by an enriched sound environment with experiential music.

Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.

Does physical exercise improve ADL capacities in people over 65 years with moderate or severe dementia hospitalized in an acute psychiatric setting? A multisite randomized clinical trial

BACKGROUND

Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward.

METHODS

A multicenter clinical trial was conducted in five Swiss and Belgian psychiatric hospitals. Participants were randomly allocated to either an experimental group (EG) or a control group (CG). Members of the EG received 20 physical exercise sessions (strengthening, balance, and walking) over a four-week period while members of the CG participated in social interaction sessions of equivalent duration and frequency, but without physical exercise. The effect of exercise on ADL was measured by comparing scores of the Barthel Index and the Functional Independence Measure in the EG and CG before and after the intervention, and two weeks later.

RESULTS

Hundred and sixty patients completed the program. Characteristics of participants of both groups were similar at the inception of the study. The mean ADL score of EG decreased slightly over time, whereas that of the CG significantly decreased compared to initial scores. Overall differences between groups were not significant; however, significant differences were found for mobility-related items.

CONCLUSIONS

ADL scores in elderly with moderate to severe dementia deteriorate during acute psychiatric hospitalization. An exercise program delays the loss of mobility but does not have a significant impact on overall ADL scores.

Cognitive and behavioural effects of music-based exercises in patients with dementia

Objective: To evaluate the effect of a musical exercise programme on mood state and cognitive function in women with dementia.

Design: Randomized controlled trial.

Setting: Public Psychiatric Hospital Rekem, Belgium.

Patients: Twenty-five patients with dementia.

Interventions: Fifteen patients attended exercise training for three months, which consisted of daily physical exercises supported by music for 30 min/session. They were compared with a group of 10 control patients, who received an equal amount of attention through daily conversation.

Main measures: The effect on cognition was measured by the Mini-Mental State Examination (MMSE) and the Amsterdam Dementia Screening Test 6 (ADS 6). Behaviour was evaluated with the abbreviated Stockton Geriatric Rating Scale (BOP scale). The assessments were made before, after six weeks of intervention and immediately after the three-month experimental period.

Results: The exercise group showed a significant improvement in cognition. This was documented by an increased MMSE mean score of 12.87-15.53, and by a higher median score, rising from 10 to 14 points, on the subset ‘fluency’ (ADS 6 test). The control group showed no significant improvement, either on the MMSE (mean score of 10.80 -11.00) or on the fluency subtest of the ADS 6 (median scores were 6.5-7 points). The effects on behavioural changes were not significant.

Conclusion: The present study suggests a beneficial effect of cognition using a music-based exercise programme in a group of patients with moderate to severe dementia. Further studies are needed to confirm these findings.

A systematic review of strategies to foster activity engagement in persons with dementia

Dementia is a growing public health issue. Activity, a positive therapeutic modality, has potential to enhance quality of life and reduce behavioral symptoms in persons with dementia--outcomes eluding pharmacological treatments. However, it is unclear how to effectively engage persons with dementia in activities for them to derive desired benefits. We present a systematic review of 28 studies involving 50 tests of different ways of modifying activities to enhance engagement and reduce behavioral and psychological symptoms for this group. Of 50 tests, 22 (44%) evaluated changes to objects and properties (e.g., introducing activities with intrinsic interest), 6 (12%) evaluated changes to space demands (e.g., lighting, noise levels), 8 (16%) evaluated changes to social demands (e.g., prompts, praise), and 14 (28%) combined two or more activity modifications. No modifications were made to the sequence and timing of activities. Although modifications to objects and properties were the most common, outcomes for engagement and behaviors were mixed. Modifications to space and social demands were less frequently tested, but consistently yielded positive outcomes. No modifications resulted in negative behavioral outcomes or decreased engagement. Methodological strengths of studies included direct observation of outcomes and fidelity assessments. Few studies however involved persons with dementia at home. Our review revealed a growing evidentiary base for different modifications to foster engagement in activities and reduce behavioral and psychological symptoms. Future studies should evaluate how contextual factors (e.g., physical environment, activity type) and caregiver ability to employ activity modifications affect engagement.

A philosophical defense of the idea that we can hold each other in personhood: intercorporeal personhood in dementia care

Since John Locke, regnant conceptions of personhood in Western philosophy have focused on individual capabilities for complex forms of consciousness that involve cognition such as the capability to remember past events and one's own past actions, to think about and identify oneself as oneself, and/or to reason. Conceptions of personhood such as Locke's qualify as cognition-oriented, and they often fail to acknowledge the role of embodiment for personhood. This article offers an alternative conception of personhood from within the tradition of phenomenology of the body. The article presents a phenomenological analysis of joint musical activity in dementia care and outlines an intercorporeal conception of personhood based on this analysis. It also provides a philosophical basis for the idea that others can hold us in personhood, and it questions a strict one-body-one-person logic that has pertained in much personhood debate.

Music, Exercise Performance, and Adherence in Clinical Populations and in the Elderly: A Review

The purpose of this study was to review a series of studies (n = 20) examining the effects of adding music to exercise programs in clinical populations and in the elderly. We found that the addition of music can (a) improve exercise capacity and increase patients’ motivation to participate in cardiac and pulmonary exercise rehabilitation programs; (b) lead to improved balance, greater ability to perform activities of daily living, and improved life satisfaction in elderly individuals; (c) enhance adherence and function of individuals suffering from neurological diseases such as Alzheimer’s and Parkinson’s; and (d) sustain these benefits if continued on a long-term basis. Based on the reviewed studies, a number of methodological concerns were presented, among them the choice of music style. One of the practical implications suggested for clinicians and practitioners was that the type of music should be individualized based on each patient’s musical preferences.

Physical activity and Alzheimer's disease: from prevention to therapeutic perspectives

A number of factors, including physical activity, may contribute to prevention of cognitive decline and delay the onset of dementia. In addition to its convincing multiple benefits, an increasing body of evidence suggests that an active life has a protective effect on brain functioning in elders. Physical activity may also slow down the course of Alzheimer's disease. These hypotheses have led to increasing research in this specific area during the past decade. This review systematically analyzes the current literature on Alzheimer's disease and the effect of physical activity. Epidemiological studies, short-term randomized controlled trials (RCTs) in nondemented participants, and biological research suggest that physical activity improves cognitive function in older subjects. The limitations of these works are discussed. No RCTs have yet demonstrated that regular physical activity prevents dementia. Additional challenging clinical interventional studies are needed to demonstrate this relationship, but accumulating evidence from biological research is available. Defining the optimal preventive and therapeutic strategies in terms of type, duration, and intensity of physical activity remain an open question. In the future, the prevention of Alzheimer's disease may be based on rules governing lifestyle habits such as diet, cognitive activity, and physical activity.

Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial

OBJECTIVES

To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD).

DESIGN

Randomized, controlled trial.

SETTING

Five nursing homes.

PARTICIPANTS

One hundred thirty-four ambulatory patients with mild to severe AD.

INTERVENTION

Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months.

MEASUREMENTS

ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis.

RESULTS

ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred.

CONCLUSION

A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.

Assessment of active music participation as an indication of subsequent music making engagement for persons with midstage dementia

Persons with midstage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types--rhythm playing, exercising with music, and singing. Activity staff with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staff, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.

The effect of a multisensory exercise program on engagement, behavior, and selected physiological indexes in persons with dementia

A multisensory exercise approach that evokes the stimulation and use of various senses, such as combining physical and cognitive stimuli, can assist in the management of persons with Alzheimer's disease (AD). The objective of this study was to evaluate the outcomes of a multisensory exercise program on cognitive function (engagement), behavior (mood), and physiological indices (blood pressure, resting heart rate, and weight) in 13 nursing home residents diagnosed with moderate to severe AD. A one-group pretest/post-test, quasi-experimental design was used. The program combined a variety of sensory stimulations, integrating storytelling and imaging strategies. Results showed an improvement in resting heart rate, overall mood, and in engagement of physical activity. The findings suggest that a multisensory exercise approach can be beneficial for individuals with AD.

The effects of music therapy on engagement in family caregiver and care receiver couples with dementia

The purpose of this study was to examine the effects of caregiver-implemented music applications on engagement with their care receivers. Eight couples participated individually in a series of sessions, where a music therapist trained and cued the caregivers to implement a music application of choice. Changes in engagement frequency over a series of five sessions was highly statistically significant. The authors conclude that music therapy applications are effective in increasing mutual engagement in caregiving and care receiving couples with dementia, and that caregivers can effectively facilitate the engagement using music. Furthermore, once the engagement is established, it carries over into visitation without music.