# Exercise as it relates to Disease/Improving gait in people with Dementia after resistance & functional training

This is a fact sheet critiquing how resistance and functional training provide improvements in gait characteristics, in people with dementia. This critic has been written as an assignment at the University of Canberra, for the class: Health, Disease & Exercise.
The paper: Schwenk, M. et al (2014) 'Improvements in gait characteristics after intensive resistance and functional training in people with dementia: A randomised controlled trial. BioMed Central vol 14 pp 1–9

## What is Dementia?

Dementia is a combination of multiple disorders effecting the brain; and not one specific disease. It effects cognitive function such as thinking, behaviour and the ability to perform everyday tasks such as walking/gait.

## What is the background to this research?

A decline in mental ability vastly effects one’s ability to walk, or simply called “gait” performance, which therefore reduces the independence and quality of a person’s life, and increases the risk of a fall. There is currently no known cure for dementia due to the many causes and differing severity levels, however multiple studies both past and present have found a relationship between exercise, and that exercise slows down, and prolongs the effects of dementia.
Below is a list of other topics in relation to physical activity interventions and improving gait:
* Reducing the risk of falls in the elderly
* Providing prevention against dementia
* Improving cognitive performance in later years
* Management of chronic disease

## Where is the research from?

The study involved data from sixty-one individuals with a mean age of 81.9 years, with confirmed mild to moderate stage dementia. The participants were all patients undergoing rehabilitation at a geriatric hospital located at the University of Heidelberg, Germany. The lead author; Michael Schwenk, and his colleagues, have previously published successful articles regarding the effects of exercise on dementia patients; however they had not yet completed an article regarding improving gait in dementia patients. This therefore gave the author the opportunity to utilize results found in his previous articles; and apply them to this article with an effective and proven research basis.
The study was conducted through the following universities and institutions:
* Department of Geriatric Research, Bethanien-Hospital/Geriatric Center at the University of Heidelberg, Heidelberg, Germany
* Department of Surgery, Interdisciplinary Consortium on Advanced Motion Performance, College of Medicine, University of Arizona
* Arizona Center on Aging, University of Arizona, Tucson, USA
* Institute of Medical Biometry and Informative, University of Heidelberg, Heidelberg, Germany

## What kind of research was this?

This study was set out as a double-blinded, randomized, controlled intervention trial. This involved 2 groups of participants; an intervention group (IG) and a control group (CG), undertaking supervised treatment, and standard (placebo) treatment respectively. The study compared the results of both groups to each other; in order to understand what type of resistance training was most effective to improve gait in dementia patients.
BEN THERE IS A TABLE FOR THIS SECTION, PLEASE SEE THE WIKIBOOKS SITE TO VIEW
| Advantages | Disadvantages |
| Both groups of participants received some level of treatment | Limitations of external validity – eg. What works in one hospital/area may not be as effective in another & characteristics of the patients can make it hard to compare to external studies |
| Adherence to the intervention was high in both IG and the CG, averaging 93.15% | Time – randomised control trials an take several years to publish, therefore by the time it is published the data may be less relevant |
| Easy comparison of results between groups | |

## What did the research involve?

The research involved German patients from a rehabilitation clinic at a geriatric hospital in Germany. Initially, eight hundred and forty-one patients were admitted and screened for eligibility. As a result of this screening, sixty-one patients (39 female & 22 males) were selected for the study. The sixty-one participants were randomly divided into an Intervention Group (IG) and into a Control Group (CG). The screening reported twenty-four (39.3%) had a possible depressive disorder and that thirty-four (55.7%) reported 1 or more falls in the last year.

## What were the basic results?

The results indicated that out of the sixty-one participants, ten (16.4%) chose not to continue the program after providing their original consent, and two people (3.3%) dropped out during the intervention period. A comparison of the baseline and follow-up assessment provided evidence suggesting significant improvements were obtained for gait speed, cadence, stride length, stride time and double support in the Intervention Group, as compared to the Control Group which did not experience the same level of improvements to these key gait parameters over the 12 week program. The greatest improvement was for gait speed, and the lowest change was with stride length. No improvements were seen in step width, step time variability, and walk-ratio.
The quality of the evidence in this article was found to be accurate and viable, providing positive results; however the opportunity to compare the results to any previous data/articles was not possible; due to research on this topic in the past being scarce. This study can now serve as a suitable paper to be compared to in future research; allowing for more accurate results.
A major limitation was that this study was focused on patients with mild to moderate dementia, therefore these results may not be comparable and applied to the population who have more severe and serious cases of dementia. Despite the study having successfully developed a specific training program with high effectiveness for improvement on gait parameters, the researchers could not eliminate the fact that the time spent exercising by each patient in their group sessions may have differed, and therefore effected the results slightly.
NOTE: PHOTO OF TABLE AT TOP RIGHT SIDE IS SHOWING GAIT PARAMETER RESULTS FOR INTERVENTION GROUP (IG) & CONTROL GROUP (CG). BEFORE DOWNLOADING AS PDF THIS TABLE IS MEANT TO BE IN THE RESULTS AREA, HOWEVER DOWNLOADING AS PDF CHANGES THE LAYOUT

## How did the researchers interpret the results?

The researchers determined that a 12-week exercise program, focusing on resistance and functional training, improved many relevant temporal gait parameters in patients with mild to moderate cases of confirmed dementia. Importantly, the researchers concluded that the most important parameters to have been improved were stride length and double support; as they serve as predictive indicators of fall risk in the elderly; therefore reducing the risk of a fall in these participants. Interestingly, no significant changes were found in step width, step time variability and walk-ratio, in both groups; perhaps suggesting a different approach is required to improve these parameters.

## What conclusions can we take from this research?

This research provides an understanding and justification that a combination of resistance and functional training, can improve gait performance in dementia patients. Gait/walking is a key form of independence in any human, especially an elderly person in a diseased state, therefore it is a vital factor to improve. Previous studies which had used just functional training such as walking, did not report improvements in gait speed, due to the lack of resistance involved. Furthermore, a study utilising only resistance training, but no functional training also resulted in limited effect on gait. With a comparison between past studies and this paper, it should be understood that a combination of both resistance and functional training are essential to improve gait in mild to moderate cases of dementia.

## What are some implications of this research?

Through this study the researchers were able to understand that intensive exercise training is a feasible method for improving gait performance in dementia patients; and therefore their quality of life. However further research is needed to identify exercises to improve parameters such a step width, step variability and walk-ratio, and also to determine an effective approach to improving gait in people with more serious cases of dementia.
Through the process of critiquing this article; it should be understood that if a person with mild to moderate dementia completes functional and resistance training, they will see some form of improvement in gait. This paper provides the necessary recommendations for improving gait through exercise (and should be applied to patients in the real world), and therefore the quality of life in individuals with mild to moderate dementia.

## Further reading

For information regarding Dementia and the benefits which exercise can have on gait, follow the links below:
General Dementia Information: https://www.fightdementia.org.au/about-dementia/what-is-dementia
Signs & Symptoms: http://www.helpguide.org/articles/alzheimers-dementia/understanding-dementia.htm
Caring for someone with Dementia: http://www.myagedcare.gov.au/caring-someone-particular-need/caring-someone-dementia
Improving Gait: http://www.nchpad.org/504/2394/Exercises~to~Improve~Gait~Abnormalities

## References

* 1 2 3 4 5 6 7 8 9 Schwenk, M. et al (2014) 'Improvements in gait characteristics after intensive resistance and functional training in people with dementia: A randomised controlled trial. BioMed Central vol 14 pp 1-9
* ↑ Barnes, D. (2015). Preventing loss of independence through exercise (PLIE): a pilot clinical trial in order adults with dementia. 10 (2), 11-15
* ↑ Fox, B. (2015). Exercise, Dementia and Physical Function. 47, 334-336
* ↑ Esther, S. (2006). Interventions that target multiple risk factors and known fallers seem to be effective in reducing falls in elderly people.53(3), 240-241
* ↑ Karlsson, M., Magnusson, H., von Schewelov, T., & Rosengren, B. (2013). Prevention of fallsin the elderly - a review.24(3), 747-762
* ↑ van Baal, P., Hoogendoorn, M., & Fischer, A. (2016). Preventing dementia by promoting physical activity and the long-term impact on health and social care expenditures.85(4), 78-83
* ↑ Miller, D. (2012). Measuring the impact of exercise on cognitive aging: Methodological issues.33(3), 622-626
* ↑ Zisser, H. et al. (2011). Exercise and diabetes.65(2), 71-75
* ↑ Visovsky, C., & Dvorak, C. (2005). Exercise and cancer recovery.10(2), 46-53.
* ↑ Morton, A., & Fitch, K. (2011). Australian association for exercise and sports science position statement on exercise and asthma.14(4), 304-308
* ↑ O'Brien, M. (2001). Exercise and osteoporosis.170(1), 202-210
* ↑ Dungey, M., Hull, K., & Smith, A. (2013). Inflammatory factors and exercise in chronic kidney disease.34(5), 143
* ↑ Cott CA, Dawson P, Sidani S, Wells D: The effects of a walking/talking program on communication, ambulation, and functional status in residents with Alzheimer disease. Alzheimer Dis Assoc Disord 2002, 16(2):81–87
* ↑ Blankevoort CG, van Heuvelen MJ, Boersma F, Luning H, de Jong J, Scherder EJ: Review of effects of physical activity on strength, balance, mobility and ADL performance in elderly subjects with dementia. Dement Geriatr Cogn Disord 2010, 30(5):392–402