# Exercise as it relates to Disease/Multi-component exercise in patients with dementia

This is an analysis of the journal article "A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial" by Bossers et al (2014)

### What is the background to this research?

Dementia is an increasingly common form of mental illness stemming primarily from genetic, age and lifestyle factors. Dementia is described as a collection of disorders effecting the brain, leading to a progressive decline in cognitive and motor function. There is currently no cure for dementia, due to the abundance of causes rendering the situation difficult to ascertain a definitive solution. Pharmaceutical companies have been leading the way with drugs attempting to slow the progressive functional decline. However, recent studies have shown similar slowing effects through the use of multicomponent exercise.

### Where was this research from?

This study was undertaken in the following departments of these universities:
* The University Medical Centre in Groningen, Netherlands.
* The University of Groningen in Groningen, Netherlands
** Department of General Practice
** Department of Elderly Care Medicine
** Center for Rehabilitation
** Center for Human Movement Sciences
* The VU University in Amsterdam, Netherlands
** Department of Clinical Neuropsychology

### What kind of research was this?

This study was a parallel, three group, single blind, randomized, controlled trial conducted over nine weeks. The study was set this way as it allowed researchers to assess the different treatment methods with no crossover results from the other test groups, which maximised accuracy.

### What did the research involve?

The 495 subjects were screened initially to meet the following factors:
* Aged over 70
* Diagnosis of dementia from a specialist in the area
* No other major health problems that would make the study methods unsafe
Of the 495 initial participants, only 132 were found suitable for the study and baseline measures were taken. A Mini-Mental State Examination (MMSE) was established and helped researchers to split the subjects into three groups with each adhering to a different exercise program:
* Multi-component group
** This group was prescribed a program containing both Resistance training and Aerobic training
* Aerobic Group
** This group was prescribed Aerobic exercise only
* Social group
** This group was prescribed Social and intellectual engagement
Results were after the nine weeks of prescription concluded as well as follow up testing 18 weeks after the baseline testing.

### What were the basic results?

The MMSE test determines what the level of cognitive impairment an individual has and can thus be used to determine their risk factor of developing dementia. The test is scored out of 30 with the normal range being a score of between 24-30, 20-23 is categorised as mild cognitive impairment or the early stages of dementia, whilst scores of 10-19 and 0-9 are categorised as moderate and severe dementia respectively. Therefore the researchers were looking for as high a score as possible within the groups being assessed. With this being said the Multi-component exercise group posted the highest mean increases in global cognition increasing their MMSE score to 17.16 (±4.33) from their initial score of 15.81 (±4.3). The aerobic group showed minimal increases going from 15.22 (±4.79) to 15.5 (±5.51) and the social group posted lower scores after their nine week testing going from 15.89 (±4.2) to 15.17 (±4.48). The follow up testing that occurred 18 weeks post commencement provided some interesting results however with the aerobic and social groups dropping to scores below their initial testing with scores of 14.62 (±5.61) and 13.88 (±5.73) respectively. The multi-component group was the only group to maintain a higher score 18 weeks post commencement with a mean score of 15.91 (±4.6)

### How did the researchers interpret the results?

The researchers have determined that a multi-component exercise prescription slows the cognitive and motor functional decline when compared to the non-exercise control group. Whilst it may slow the decline of cognitive function there were only minimal increases in cognitive function indicating that further study into the area needs to be conducted before any definitive conclusions can be drawn. The researchers believe that the positive results from the multi-component exercise can be attributed to the insulin-like growth factor 1 (IGF-1) produced by resistance training that slows the deterioration of the brain. IGF-1 has been proven in other studies to promote "neural growth, survival and differentiation whilst improving cognitive performance".

### What conclusions should be taken away from this research?

The study has shown research still needs to be conducted into the area of exercise to aid in dementia slowing thought the area is promising. As well as aiding in dementia exercise including a resistance training component would improve overall quality of life with executive function improving leading to improved limb strength which in turn reduces fall risk as well as better circulation due to the increase in blood flow. There were several limitations to this study; being the first study of its kind to use trainer based RPE instead of RPE from the patients. It also only provides results on dementia patients who are mobile and motivated to use exercise as an aid.

### What are the implications of this research?

This research has shown that physical activity interventions of any kind provide benefits to the everyday lives of older adults as well as reducing the progression of dementia though exercising on a multi-component plan provides the best results. There are many different physiological pathways that could be researched in the future which may provide alternatives to the more common pharmaceutical methods of treatment currently employed

## Further reading

For further information on Dementia and it's relationship with physical activity read below:
* Dementia Overview: http://apps.who.int/iris/bitstream/10665/75263/1/9789241564458_eng.pdf
* Early Signs and Symptoms of Dementia: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Dementia_-_early_signs?open
* Activities for People with Dementia: https://fightdementia.org.au/national/support-and-services/carers/activities-for-people-with-dementia
* Brain Health: http://yourbrainmatters.org.au/sites/default/files/YBM%20Paper%2036_webfinal_0.pdf

### References

* 1 2 3 4 5 6 7 Bossers W, van der Woude L, Boersma F, Horotobágyi T, Scherder E, van Heuvelen M. A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial. The American Journal of Geriatric Psychiatry 2015.
* 1 2 3 Liu-Ambrose T, Donaldson M. Exercise and cognition in older adults: Is there a role for resistance training programmes?. British Journal of Sports Medicine 2015; 43(1): p. 25-27
* 1 2 Brodaty H, Burns K. Nonpharmacological management of apathy in dementia: a systematic review. The American Journal of Geriatric Psychiatry 2012; 20(1):p549-564
* 1 2 3 Forte R, Boreham C, Costa Leite J, De Vito G, Brenna L, Gibney E, Pesce C. Enhancing cognitive functioning in the elderly: multicomponent vs resistance training. The Journal of Clinical Intervention in Ageing. 2013; 8(1): p.19-27
* ↑ Richens A. Proof of efficacy trials: cross-over versus parallel-group. Journal of Epilepsy Research. 2001; 45(3): p. 43-47
* ↑ Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A. Mapping Scores Onto Stages: Mini-Mental State Examination and Clinical Dementia Rating. The American Journal of Geriatric Psychiatry. 2006; 14(2): p.139-144
* 1 2 Kwak Y, Um S, Son T, Kim D. Effect of regular exercise on senile dementia patients. The International Journal of Sports Medicine. 2008; 29(6): p. 471-474.
* 1 2 Colcombe s, Kramer A. Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychological Science. 2003; 14(2): p.125-130.
* ↑ Wiesmann M, Kiliaan A, Claassen J. Vascular aspects of cognitive impairment and dementia. Journal of Cerebral Blood Flow and Metabolism. 2013; 33(11): p.1696-1706.
* ↑ Nelson M, Rejeski W, Blair S, Duncan P, King A, Macera C, Castaneda-Sceppa C. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise. 2007; 39(8(: p.1435-1445.