A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial. Effect of a High-Intensity Exercise Program on Physical Function and Mental Health in Nursing Home Residents with Dementia: An Assessor Blinded Randomized Controlled Trial Optimizing function and physical activity among nursing home residents with dementia: testing the impact of function-focused care. Factors Influencing Engagement, Perceived Usefulness and Behavioral Mechanisms Associated with a Text Message Support Program Using a behaviour change techniques taxonomy to identify active ingredients within trials of implementation interventions for diabetes care Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial. Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomised controlled trial Evaluation of exercise on individuals with dementia and their carers: a randomised controlled trial Physical training improves motor performance in people with dementia: a randomized controlled trial. Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: the Maximizing Independence in Dementia (MIND) study. The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9-Week Randomized, Controlled Trial. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. Dual-task performances can be improved in patients with dementia Effects of Exercise on Cognition: The Finnish Alzheimer Disease Exercise Trial: A Randomized, Controlled Trial. Mechanisms by Which Social Support Networks Influence Healthy Aging Among Thai Community-Dwelling Elderly
OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function . METHODS Using a 9-week , parallel , three-group , single-blind , r and omized , controlled trial with a follow-up assessment at week 18 , we assessed 109 patients with dementia ( age 85.5 ± 5.1 years ) in a psycho-geriatric nursing home . Each 9-week intervention consisted of 36 , 30-minute sessions . A combined group ( N = 37 ) received and completed two strength and two walking sessions per week , an aerobic group ( N = 36 ) completed four walking sessions , and a social group ( N = 36 ) completed four social visits per  week . Cognitive and motor functions were assessed at baseline , after the 9-week intervention , and after a consecutive 9 weeks of usual care . RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition , visual memory , verbal memory , executive function , walking endurance , leg muscle strength , and balance . Aerobic versus social group scores were higher for executive function . Follow-up effects reversed toward baseline values . Motor improvement did not significantly mediate cognitive improvement . CONCLUSION Compared with a nonexercise control group , a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia . No mediating effects between improvements in cognitive function via improved motor function were found . Future research into the underlying mechanistic associations is needed Background Dementia is among the leading causes of functional loss and disability in older adults . Research has demonstrated that nursing home patients without dementia can improve their function in activities of daily living , strength , balance and mental well being by physical exercise . The evidence on effect of physical exercise among nursing home patients with dementia is scarce and ambiguous . Thus , the primary objective of this study was to investigate the effect of a high intensity functional exercise program on the performance of balance in nursing home residents with dementia . The secondary objective was to examine the effect of this exercise on muscle strength , mobility , activities of daily living , quality of life and neuropsychiatric symptoms . Design and Methods This single blinded r and omized controlled trial was conducted among 170 persons with dementia living in nursing homes . Mean age was 86.7 years ( SD = 7.4 ) and 74 % were women . The participants were r and omly allocated to an intervention ( n = 87 ) or a control group ( n = 83 ) . The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks . The control condition was leisure activities . Results The intervention group improved the score on Bergs Balance Scale by 2.9 points , which was significantly more than the control group who improved by 1.2 points ( p = 0.02 ) . Having exercised 12 times or more was significantly associated with improved strength after intervention ( p<0.05 ) . The level of apathy was lower in the exercise group after the intervention , compared to the control group ( p = 0.048 ) . Conclusion The results from our study indicate that a high intensity functional exercise program improved balance and muscle strength as well as reduced apathy in nursing home patients with dementia . Trial Registration Clinical Trials.gov PURPOSE OF THE STUDY The purpose of this study was to test the impact of Function-Focused Care for the Cognitively Impaired Intervention on nursing home residents with dementia and the nursing assistants who care for them . DESIGN AND METHODS This was a cluster-r and omized controlled trial using repeated measures . A total of 103 cognitively impaired residents and 77 nursing assistants were recruited from four nursing homes . For residents , outcome measures included function , physical activity ( survey and actigraphy ) , mood , behavior , and adverse events ( falls and hospitalization ) . Main outcome measures for nursing assistants included knowledge , beliefs , and performance of function focused care . RESULTS There were significant improvements in the amount and intensity of physical activity ( by survey and actigraphy ) and physical function in the treatment group . In addition , there was a significant decrease in the number of residents who fell during the treatment period with those in the treatment sites having fewer falls ( 28 % vs. 50 % in the control group ) . Nursing assistants were also observed to be providing a greater percentage of function focused care during resident care interactions in the treatment group at 6 months following the completion of baseline measures . IMPLICATION S This study provides some evidence that nursing home residents with severe cognitive impairment can safely and successfully be engaged in physical and functional activities Introduction Many studies have now demonstrated the efficacy of text messaging in positively changing behaviours . We aim ed to identify features and factors that explain the effectiveness of a successful text messaging program in terms of user engagement , perceived usefulness , behavior change and program delivery preferences . Methods Mixed methods qualitative design combining four data sources ; ( i ) analytic data extracted directly from the software system , ( ii ) participant survey , ( iii ) focus groups to identify barriers and enablers to implementation and mechanisms of effect and ( iv ) recruitment screening logs and text message responses to examine engagement . This evaluation was conducted within the TEXT ME trial — a parallel design , single-blind r and omized controlled trial ( RCT ) of 710 patients with coronary heart disease ( CHD ) . Qualitative data were interpreted using inductive thematic analysis . Results 307/352 ( 87 % response rate ) of recruited patients with CHD completed the program evaluation survey at six months and 25 participated in a focus group . Factors increasing engagement included ( i ) ability to save and share messages , ( ii ) having the support of providers and family , ( iii ) a feeling of support through participation in the program , ( iv ) the program being initiated close to the time of a cardiovascular event , ( v ) personalization of the messages , ( vi ) opportunity for initial face-to-face contact with a provider and ( vii ) that program and content was perceived to be from a credible source . Clear themes relating to program delivery were that diet and physical activity messages were most valued , four messages per week was ideal and most participants felt program duration should be provided for at least for six months or longer . Conclusions This study provides context and insight into the factors influencing consumer engagement with a text message program aim ed at improving health-related behavior . The study suggests program components that may enhance potential success but will require integration at the development stage to optimize up-scaling . Trial Registration Australia and New Zeal and Clinical Trials Registry , ACTRN12611000161921 Background Method ological guidelines for intervention reporting emphasise describing intervention content in detail . Despite this , systematic review s of quality improvement ( QI ) implementation interventions continue to be limited by a lack of clarity and detail regarding the intervention content being evaluated . We aim ed to apply the recently developed Behaviour Change Techniques Taxonomy version 1 ( BCTTv1 ) to trials of implementation interventions for managing diabetes to assess the capacity and utility of this taxonomy for characterising active ingredients . Methods Three psychologists independently coded a r and om sample of 23 trials of healthcare system , provider- and /or patient-focused implementation interventions from a systematic review that included 142 such studies . Intervention content was coded using the BCTTv1 , which describes 93 behaviour change techniques ( BCTs ) grouped within 16 categories . We supplemented the generic coding instructions within the BCTTv1 with decision rules and examples from this literature . Results Less than a quarter of possible BCTs within the BCTTv1 were identified . For implementation interventions targeting providers , the most commonly identified BCTs included the following : adding objects to the environment , prompts/cues , instruction on how to perform the behaviour , credible source , goal setting ( outcome ) , feedback on outcome of behaviour , and social support ( practical ) . For implementation interventions also targeting patients , the most commonly identified BCTs included the following : prompts/cues , instruction on how to perform the behaviour , information about health consequences , restructuring the social environment , adding objects to the environment , social support ( practical ) , and goal setting ( behaviour ) . The BCTTv1 mapped well onto implementation interventions directly targeting clinicians and patients and could also be used to examine the impact of system-level interventions on clinician and patient behaviour . Conclusions The BCTTv1 can be used to characterise the active ingredients in trials of implementation interventions and provides specificity of content beyond what is given by broader intervention labels . Identification of BCTs may provide a more helpful means of accumulating knowledge on the content used in trials of implementation interventions , which may help to better inform replication efforts . In addition , prospect i ve use of a behaviour change techniques taxonomy for developing and reporting intervention content would further aid in building a cumulative science of effective implementation interventions Background Research indicates that exercise can have a positive effect on both physical and mental health in nursing home patients with dementia , however the lasting effect is rarely studied . In a previously published article we investigated the immediate effect of a 12 weeks functional exercise program on physical function and mental health in nursing home residents with dementia . In this paper we studied the long-term effect of this exercise program . We explored the differences between the exercise and control group from baseline to 6 months follow-up and during the detraining period from month 3 to 6 . Methods A single blind , r and omized controlled trial was conducted and a total of 170 nursing home residents with dementia were included . The participants were r and omly allocated to an intervention ( n = 87 ) or a control group ( n = 83 ) . The intervention consisted of intensive strengthening and balance exercises in small groups twice a week for 12 weeks . The control condition was leisure activities . Thirty participants were lost between baseline and six-month follow-up . Linear mixed model analyses for repeated measurements were used to investigate the effect of exercise after detraining period . Results The exercise group improved their scores on Berg Balance Scale from baseline to 6 months follow-up by 2.7 points in average . The control group deteriorated in the same period and the difference between groups was statistically significant ( p = 0.031 ) . The exercise group also scored better on NPI agitation sub-score after 6 months ( p = 0.045 ) . Conclusion The results demonstrate long-time positive effects of a high intensity functional exercise program on balance and indicate a positive effect on agitation , after an intervention period of 12 weeks followed by a detraining period of 12 weeks . Identifier at Clinical Trials.gov : IMPORTANCE Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease ( AD ) . OBJECTIVES To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services . DESIGN A r and omized controlled trial . SETTING AND PARTICIPANTS A total of 210 home-dwelling patients with AD living with their spousal caregiver . INTERVENTIONS The 3 trial arms included ( 1 ) group-based exercise ( GE ; 4-hour sessions with approximately 1-hour training ) and ( 2 ) tailored home-based exercise ( HE ; 1-hour training ) , both twice a week for 1 year , and ( 3 ) a control group ( CG ) receiving the usual community care . MAIN OUTCOME MEASURES The Functional Independence Measure ( FIM ) , the Short Physical Performance Battery , and information on the use and costs of social and health care services . RESULTS All groups deteriorated in functioning during the year after r and omization , but deterioration was significantly faster in the CG than in the HE or GE group at 6 ( P = .003 ) and 12 ( P = .015 ) months . The FIM changes at 12 months were -7.1 ( 95 % CI , -3.7 to -10.5 ) , -10.3 ( 95 % CI , -6.7 to -13.9 ) , and -14.4 ( 95 % CI , -10.9 to -18.0 ) in the HE group , GE group , and CG , respectively . The HE and GE groups had significantly fewer falls than the CG during the follow-up year . The total costs of health and social services for the HE patient-caregiver dyads ( in US dollars per dyad per year ) were $ 25,112 ( 95 % CI , $ 17,642 to $ 32,581 ) ( P = .13 for comparison with the CG ) , $ 22,066 in the GE group ( $ 15,931 to $ 28,199 ; P = .03 vs CG ) , and $ 34,121 ( $ 24,559 to $ 43,681 ) in the CG . CONCLUSIONS AND RELEVANCE An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects . TRIAL REGISTRATION anzctr.org.au Identifier : ACTRN12608000037303 Background Preventing and rehabilitating gait disorders in people with dementia during early disease stage is of high importance for staying independent and ambulating safely . However , the evidence gathered in r and omized controlled trials ( RCTs ) on the effectiveness of exercise training for improving spatio-temporal gait parameters in people with dementia is scarce . The aim of the present study was to determine whether a specific , st and ardized training regimen can improve gait characteristics in people with dementia . Methods Sixty-one individuals ( mean age : 81.9 years ) with confirmed mild to moderate stage dementia took part in a 3-month double-blinded outpatient RCT . Subjects in the intervention group ( IG ) received supervised , progressive resistance and functional group training for 3 months ( 2 times per week for two hours ) specifically developed for people with dementia . Subjects in the control group ( CG ) conducted a low-intensity motor placebo activity program .  Gait characteristics were measured before and after the intervention period using a computerized gait analysis system ( GAITRite ® ) . Results Adherence to the intervention was excellent , averaging 91.9 % in the IG and 94.4 % in the CG . The exercise training significantly improved gait speed ( P < 0.001 ) , cadence ( P = 0.002 ) , stride length ( P = 0.008 ) , stride time ( P = 0.001 ) , and double support ( P = 0.001 ) in the IG compared to the CG . Effect sizes were large for all gait parameters that improved significantly ( Cohen ’s d : 0.80 - 1.27 ) . No improvements were found for step width ( P = 0.999 ) , step time variability ( P = 0.425 ) and Walk-Ratio ( P = 0.554 ) . Interestingly , low baseline motor status , but not cognitive status , predicted positive training response ( relative change in gait speed from baseline ) . Conclusion The intensive , dementia-adjusted training was feasible and improved clinical ly meaningful gait variables in people with dementia . The exercise program may represent a model for preventing and rehabilitating gait deficits in the target group . Further research is required for improving specific gait characteristics such as gait variability in people with dementia . Trial registration IS RCT Background Almost all of the 820,000 people in the UK with dementia will experience Behavioural and Psychological Symptoms of Dementia ( BPSD ) . However , research has traditionally focused on treating cognitive symptoms , thus neglecting core clinical symptoms that often have a more profound impact on living with dementia . Recent evidence ( Kales et al , 2007 ; Ballard et al , 2009 ) indicates that the popular approach to managing BPSD - prescription of anti-psychotic medication - can increase mortality and the risk of stroke in people with dementia as well as impair quality of life and accelerate cognitive decline . Consequently , there is a need to evaluate the impact that non-pharmacological interventions have on BPSD ; we believe physical exercise is a particularly promising approach . Methods / Design We will carry out a pragmatic , r and omised , single-blind controlled trial to evaluate the effectiveness of exercise ( planned walking )  on the behavioural and psychological symptoms of individuals with dementia . We aim to recruit 146 people with dementia and their carers to be r and omized into two groups ; one will be trained in a structured , tailored walking programme , while the other will continue with treatment as usual . The primary outcome ( BPSD ) will be assessed with the Neuropsychiatric Inventory ( NPI ) along with relevant secondary outcomes at baseline , 6 and 12 weeks . Discussion Design ing this study has been challenging both ethically and method ologically . In particular to design an intervention that is simple , measurable , safe , non-invasive and enjoyable has been testing and has required a lot of thought . Throughout the design , we have attempted to balance method ological rigour with study feasibility . We will discuss the challenges that were faced and overcome in this paper . Trial Registration IS RCT OBJECTIVES To determine whether a specific , st and ardized training regimen can improve muscle strength and physical functioning in people with dementia . DESIGN Double-blinded , r and omized , controlled trial with 3-month intervention and 3-month follow-up period in 2006 to 2009 . SETTING Outpatient geriatric rehabilitation . PARTICIPANTS Individuals with confirmed mild to moderate dementia , no severe somatic or psychological disease , and ability to walk 10 m. Most participants were still living independently with or without supportive care . INTERVENTION Supervised , progressive resistance and functional group training for 3 months specifically developed for people with dementia ( intervention , n = 62 ) compared with a low-intensity motor placebo activity ( control , n = 60 ) . MEASUREMENTS Primary outcome measures were one-repetition maximum in a leg press device for maximal strength and duration of the five-chair-st and test for functional performance . Secondary outcome measures were assessed for a number of established parameters for maximal strength , physical function , and physical activity . RESULTS Training significantly improved both primary outcomes ( percentage change from baseline : maximal strength , intervention group ( IG ) : + 51.5 ± 41.5 kg vs control group ( CG ) : -1.0 ± 28.9 kg , P < .001 ; functional performance , IG : -25.9 ± 15.1 seconds vs CG : + 11.3 ± 60.4 seconds , P < .001 ) . Secondary analysis confirmed effects for all strength and functional parameters . Training gains were partly sustained during follow-up . Low baseline performance on motor tasks but not cognitive impairment predicted positive training response . Physical activity increased significantly during the intervention ( P < .001 ) . CONCLUSION The intensive , dementia-adjusted training was feasible and substantially improved motor performance in frail , older people with dementia and may represent a model for structured rehabilitation or outpatient training OBJECTIVE To determine the feasibility and efficacy of a home-based exercise intervention program to improve the functional performance of patients with Alzheimer 's Disease ( AD ) . METHODS Twenty-seven home-dwelling patients with AD were r and omized to either an exercise intervention program delivered by their caregivers or a home safety assessment control .  Measures of functional performance ( primary ) , cognition , neuropsychiatric symptoms , quality of life and caregiver burden ( secondary ) were obtained at baseline and at 6 and 12 weeks following r and omization . For each outcome measure , intent-to-treat analyses using linear r and om effects models were performed . Feasibility and adverse events were also assessed . RESULTS Adherence to the exercise program was good . On the primary outcomes ( functional performance ) patients in the exercise group demonstrated a trend for improved performance on measures of h and function and lower extremity strength . On secondary outcome measures , trends toward worse depression and lower quality of life ratings were noted . CONCLUSIONS The physical exercise intervention developed for the study , delivered by caregivers to home-dwelling patients with AD , was feasible and was associated with a trend for improved functional performance in this group of frail patients . Given the limited efficacy to date of pharmacotherapies for AD , further study of exercise intervention , in a variety of care setting , is warranted OBJECTIVE The objective of this study is to evaluate the effectiveness of a simple  dyadic ( person with dementia and their main carer ) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia . METHOD A two arm , pragmatic , r and omised , controlled , single-blind , parallel-group trial of a dyadic exercise regimen ( individually tailored walking regimen design ed to become progressively intensive and last between 20 - 30 min , at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following : clinical ly significant behavioural and psychological symptoms , a carer willing and able to co-participate in the exercise regimen , and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study . RESULTS One hundred and thirty-one dyads were recruited to this study . There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not ( adjusted difference in means ( intervention minus control ) = -1.53 , p = 0.6 , 95 % CI [ -7.37 , 4.32 ] ) . There was a significant between-group difference in caregiver 's burden as measured by the Zarit Caregiver Burden Inventory at week 12 ( OR = 0.18 , p = 0.01 , CI [ 0.05 , 0.69 ] ) favouring the exercise group . CONCLUSIONS This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia , but did seem to attenuate caregiver burden . Further study to improve exercise uptake are needed OBJECTIVES To compare the effects of two exercise programs on proxy- and performance-based measures of activities of daily living ( ADLs ) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia . DESIGN A parallel , three-group , single-blind , r and omized , controlled trial . SETTING Psychogeriatric wards . PARTICIPANTS Individuals with dementia ( mean age 85.6 ± 5.1 ) . INTERVENTIONS Each 9-week intervention consisted of thirty-six 30-minute sessions . A combined group ( n = 35 ) participated in two strength and two walking sessions , an aerobic group ( n = 35 ) participated in four walking sessions , and a social control group ( n = 35 ) participated in four nonexercise social visits per week . The social group was used as a reference for the mediation analysis , which was performed in the combined and aerobic groups . MEASUREMENTS ADLs were assessed using the Katz index ( proxy-reported ADL performance ) , Erlangen-ADL test ( E-ADL ) ( instrumental ADL performance ) , and 7-item Physical Performance Test ( PPT-7 ) ( physical ADL performance ) . RESULTS There was a group effect for Katz index ( P = .02 ) , E-ADL ( P < .001 ) , and PPT-7 ( P = .003 ) . Differences from baseline to after the intervention were similar in the combined and aerobic groups . Exercise-induced changes in global cognition mediated changes in Katz index ( 95 % confidence interval ( CI ) = 0.05 - 0.41 ) , leg muscle strength mediated changes in E-ADL ( 95 % CI = 0.03 - 0.43 ) , and leg muscle strength ( 95 % CI = 0.01 - 0.36 ) and walking endurance ( 95 % CI = 0.01 - 0.43 ) mediated changes in PPT-7 only in the combined group . CONCLUSION Physical exercise can improve ADL levels in individuals with dementia , but improvements are small and seem independent of exercise type . Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic-only exercise to effectively target ADL dysfunction in individuals with dementia . Future research is warranted to justify these exercise-specific findings CONTEXT Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease . OBJECTIVE To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease , conducted between June 1994 and April 1999 . INTERVENTIONS Patient-caregiver dyads were r and omly assigned to the combined exercise and caregiver training program , Reducing Disability in Alzheimer Disease ( RDAD ) , or to routine medical care ( RMC ) . The RDAD program was conducted in the patients ' home over 3 months . MAIN OUTCOME MEASURES Physical health and function ( 36-item Short-Form Health Survey 's [ SF-36 ] physical functioning and physical role functioning subscales and Sickness Impact Profile 's Mobility subscale ) , and affective status ( Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia ) . RESULTS At 3 months , in comparison with the routine care patients , more patients in the RDAD group exercised at least 60 min/wk ( odds ratio [ OR ] , 2.82 ; 95 % confidence interval [ CI ] , 1.25 - 6.39 ; P = .01 ) and had fewer days of restricted activity ( OR , 3.10 ; 95 % CI , 1.08 - 8.95 ; P<.001 ) . Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group ( mean difference , 19.29 ; 95 % CI , 8.75 - 29.83 ; P<.001 ) . Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores ( mean difference , -1.03 ; 95 % CI , -0.17 to -1.91 ; P = .02 ) . At 2 years , the RDAD patients continued to have better physical role functioning scores than the RMC patients ( mean difference , 10.89 ; 95 % CI , 3.62 - 18.16 ; P = .003 ) and showed a trend ( 19 % vs 50 % ) for less institutionalization due to behavioral disturbance . For patients with higher depression scores at baseline , those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale ( mean difference , 2.21 ; 95 % CI , 0.22 - 4.20 ; P = .04 ) and maintained that improvement at 24 months ( mean difference , 2.14 ; 95 % CI , 0.14 - 4.17 ; P = .04 ) . CONCLUSION Exercise training combined with teaching caregivers behavioral management techniques  improved physical health and depression in patients with Alzheimer disease Background : Deficits in attention-related cognitive performance measured as dual-task performance represent early markers of dementia and are associated with motor deficits and increased risk of falling . The purpose of this study was to examine the effect of a specific dual-task training in patients with mild to moderate dementia . Methods : Sixty-one geriatric patients with confirmed dementia took part in a 12-week r and omized , controlled trial . Subjects in the intervention group ( IG ) underwent dual-task – based exercise training . The control group ( CG ) performed unspecific low-intensity exercise .  Motor performance ( gait speed , cadence , stride length , stride time , single support ) and cognitive performance ( serial 2 forward calculation [ S2 ] , serial 3 backward calculation [ S3 ] ) were examined as single and dual tasks . Decrease in performance during dual tasks compared to single task expressed as motor , cognitive , and combined motor/cognitive dual-task cost ( DTC ) was calculated before and after intervention . Primary outcome was defined as DTC for gait speed under complex S3 conditions . Results : Specific training significantly improved dual-task performance under complex S3 conditions compared to the CG ( reduction of DTC : gait speed 21.7 % IG , 2.6 % CG , p < 0.001 ; other gait variables : 8.7 % to 41.1 % IG , −0.9 % to 8.1 % CG , p ≤ 0.001 to 0.056 ; combined motor/cognitive : 20.6 % IG , 2.2 % CG , p = 0.026 ) . No significant effects were found under less challenging dual-task S2 conditions or for cognitive dual-task S3 performance . Conclusions : The specific exercise program was effective to improve dual-task performance in patients with dementia . Classification of evidence : This study provides Class II evidence that specific dual-task training  improves dual-task performance during walking under complex S3 conditions in geriatric patients with mild to moderate dementia OBJECTIVES To examine whether a regular , long-term exercise program performed by individuals with Alzheimer 's disease ( AD ) at home or as group-based exercise at an adult daycare center has beneficial effects on cognition ; to examine secondary outcomes of a trial that has been published earlier . DESIGN R and omized , controlled trial . SETTING Community . PARTICIPANTS Community-dwelling dyads ( N = 210 ) of individuals with AD and their spousal caregivers r and omized into three groups . INTERVENTION Two types of intervention comprising customized home-based exercise ( HE ) and group-based exercise ( GE ) , each twice a week for 1 year , were compared with a control group ( CG ) receiving usual community care . MEASUREMENTS Cognitive function was measured using the Clock Drawing Test ( CDT ) , Verbal Fluency ( VF ) , Clinical Dementia Rating ( CDR ) , and Mini-Mental State Examination ( MMSE ) at baseline and 3 , 6 , and 12 months of follow-up . RESULTS Executive function , measured using CDT , improved in the HE group , and changes in the score were significantly better than those of the CG at 12 months ( adjusted for age , sex , and CDR , P = .03 ) . All groups deteriorated in VF and MMSE score during the intervention , and no significant differences between the groups were detected at 12-month follow-up when analyses were adjusted for age , sex , and CDR . CONCLUSION Regular , long-term , customized HE improved the executive function of community-dwelling older people with memory disorders , but the effects were mild and were not observed in other domains of cognition Objective : To examine the relationships among family , friendship networks and supports , health-promoting behaviors , and healthy aging . Method : A sample of 469 Thai elderly persons was recruited using multistage r and om sampling . A structural equation model based on Berkman ’s conceptual model was performed . Results : Family networks did not directly influence health-promoting behaviors but rather had an indirect effect through family support . Friendship networks had both a significant direct effect on the elderly health-promoting behaviors and an indirect effect via friendship support . Interestingly , friendships had both direct and indirect influences on family support to the elderly . Health-promoting behaviors had a powerful influence on healthy aging and play a significant role in mediating the relationship between family and friendship supports and healthy aging . Discussion : Findings demonstrate the importance of family and friendship roles on health-promoting behaviors and healthy aging . Intervention programs should be design ed to include a collaborative approach involving family members and friends
PURPOSE The objective of this study was to systematic ally review the evidence for the potential promise of behaviour change techniques ( BCTs ) to increase physical activity  among people with dementia ( PWD ) .
While physical activity is a key lifestyle factor to enhance and maintain health and wellbeing amongst the general population , adults rarely participate in sufficient levels to obtain these benefits .