# Exercise as it relates to Disease/Music-based Exercise for Dementia Patients

This is a fact sheet and critical analysis of the journal article "Cognitive and behavioural effects of music based exercises in patients with Dementia" by Van de Winckel, Feys, De Weerdt, & Dom, 2004.

## Background to the research
### Dementia

Dementia is a disease categorised by the degradation of brain function. It affects multiple aspects of brain function including cognition, behaviour, memory, language, and perception. Dementia includes over 100 different diseases that all involve the impairment of brain function. While the various types and severities of dementia determine the individuals experience, Dementia comes on gradually, gets increasingly worse over time and is typically irreversible. Dementia is a leading cause of death in Australia and is most prevalent in women over the age of 65, though is common in both men and women and can be of early onset. Research in the field is extensive, with many studies focusing on the effects of exercise on both prevention and treatment of Dementia.

## Where is the research from?

Ann Van de Winckel, Hilde Feys, Willy de Weerdt and René Dom conducted the trial in the Public Psychiatric Hospital at Rekem, Limburg, Belgium.

## Type of Research

This study was a randomised controlled trial. Data was collected through two different cognitive screening tests and one behavioural screening test. Participants completed these tests before the experimental period, 6 weeks in, and then immediately following the end of the experimental period (after three months). The size of the study was small with only 25 participants, all of which were full time residents in the hospital in Belgium.

## What did the research involve?

The study involved 25 participants, 15 dementia patients randomly assigned to an exercise group and 10 to a control group. Both were conducted over 3 months and both spent 30 minutes per day in music therapy, however only the 15 exercise participants combined exercise and music-therapy. The 10 control patients had a therapy session where they could talk to a therapist. The 15 exercise patients also saw the therapist but sat in a circle and mimicked movements to music. The movements focused on upper and lower body strengthening, balance, trunk stability and flexibility. Before the study started the patients completed a Mini Mental State Examination (MMSE) and to qualify for the study needed to achieve a score lower than 24/30. They also completed the Amsterdam Dementia Screening Test 6 (ASD-6) and an abbreviated version of the Stockton Geriatric Rating Scale (BOP). To determine the results of the study, the original scores from the 3 tests were compared against scores from the six week mark and scores from the end of the experimental period.

## Results

The results showed an increase in the scores of the MMSA and the ASD-6 from the exercise group, however the changes of the abbreviated Stockton Geriatric Rating Scale (BOP) were not large enough to be significant. The control group showed improvements in the MMSA score at the six week mark however declined after this time to a score that was only slightly higher than the original score. The results of the ASD-6 and the BOP were not significant. The researchers interpreted this increase in scores as a success, proving that music based exercise helps to improve cognition and behaviour in dementia patients.

## Conclusion based on research/results

Based on the results of this study, one can assume that music based exercise prescription is an effective way to treat and prevent dementia.
While the researchers saw this study as a success, as it proved their hypothesis that music based exercise interventions would be effective for dementia patients, they only compared the results to one control group who did no exercise. There was no measure to see if music based exercise is better than exercise alone. Because of this, it is not clear if exercise or music or both are the major effector in the protocol for the prevention and treatment of dementia.
In a 2011 study, the effects of physical exercise, at various stages in life, on the prevention and treatment of dementia and brain ageing was measured over a 12 month period. The effects were remeasured at 6 months and again at 12 months and the results showed that the participants who engaged in physical exercise had better cognitive scores than the participants who were sedentary.
In 2012, a meta-analysis looked at the effects of music therapy on dementia patients. The results of the meta-analysis are consistent with the results of the original study in that there were improvements in anxiety, confidence, and behavioural symptoms in dementia patients over periods of three months or more.
Combining the results of each of the three studies mentioned indicates that both exercise and music-therapy, together and separately, are effective in the prevention and treatment of dementia, though further research in the field, particularly over longer periods of time and across larger sample sizes, will provide more insight and evidence of the effects.

## Practical Advice and Further Reading

Dementia is such a devastating disease effecting thousands of people every year. For this reason, it is important to continue research in the area of treatment and prevention as there is no cure for the disease. From this study and from others like it, we are able to draw the conclusion that exercise, in this case music based exercise, is an effective strategy to help reduce the effects of dementia. Having said this, it is essential to be cleared by a medical professional before undertaking any exercise program.
For more information, support or to donate to dementia resources:

##### Ozcare Dementia Support

http://www.dementiasupport.com.au/

##### Alzheimer's Australia

https://www.fightdementia.org.au/

## References

* 1 2 3 4 5 Van de Winckel, A., Feys, H., De Weerdt, W., & Dow, R. (2004). Cognitive and behavioural effects of music-based exercises in patients with dementia. Clinical Rehabilitation, 18, 253-260. doi:10.1191/0269215504cr750oa
* ↑ Australian Government, Australian Institute of Health and Welfare. (2012). Dementia in Australia. Cat. no. AGE 70. Canberra: AIHW
* ↑ Ahlskog, J.E., Geda, Y.E., Graff-Radford, N.R. & Peterson, R.C. (2011). Physical Exercise as a Preventative or Disease-Modifying Treatment of Dementia and Brain Aging. Mayo Clinic Proc. 86(9): 876-884.
* ↑ Ueda, T., Suzukamo, Y., Sato, M. & Izumi, S. (2012). Effects of music therapy on behavioural and psychological symptoms of dementia: A systematic review and meta-analysis. Ageing Research Reviews. 12: 628-641