The Applicability of a High-Intensity Functional Exercise Program Among Older People With Dementia Living in Nursing Homes.
Anna Sondell, Erik Rosendahl, Yngve Gustafson and 2 others
PMID 29851748WHAT IT FOUND
Older adults with mild to moderate dementia in nursing homes attended a high-intensity exercise program at a median rate of 82.5%.
Most achieved moderate to high intensity. Adverse events were minor and temporary. People with non-Alzheimer's dementia exercised with higher strength intensity than those with Alzheimer's.
Key findings
01The overall attendance rate was 73.4%, with a median individual attendance rate of 82.5%, showing no significant difference between Alzheimer's and non-Alzheimer's groups.
02All recorded adverse events were minor or temporary, mostly musculoskeletal pain or soreness, occurring in 16.3% of attended sessions.
03Participants with non-Alzheimer's dementia achieved high-intensity strength exercises significantly more often than those with Alzheimer's dementia (53.8% vs 34.9% of sessions).
STILL TO COME
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What it does not show
The study excluded people with severe dementia (MMSE <10) and those who could not rise from a chair with minimal assistance, so results do not apply to more dependent residents. Exercise intensity was rated by physiotherapists using observational scales that were not tested for reliability. Adverse events were only recorded during exercise sessions, not between them, so delayed pain or other issues may have been missed. The non-Alzheimer's group was heterogeneous, combining vascular, mixed, Lewy body, frontotemporal, and Parkinson's dementia, which may mask specific subtype effects. Only half of the participants met the recommendation of exercising at least twice per week, indicating that the program frequency may be insufficient for some. Two authors developed the program and receive royalties on the equipment used, which is a potential conflict of interest.
Declared interests
H.L. and N.L. developed the High-Intensity Functional Exercise program and receive royalties on the weighted belt used in the study. All other authors declared no conflicts of interest.
The easy way to misread this
Do not assume that high-intensity exercise is equally effective for all dementia types. Participants with Alzheimer's disease achieved high-intensity strength exercises in significantly fewer sessions (34.9%) than those with non-Alzheimer's dementia (53.8%), suggesting that intensity targets may need to be adjusted downward or approached more gradually for Alzheimer's patients.