Deborah Jehu, PhD, is the principal investigator on a project investigating whether six months of exercise plus usual care improves executive function and other health outcomes relative to usual care alone in 42 people living with mild to moderate dementia.
Jehu said individuals living with mild to moderate dementia have problems with decision making as well as other aspects of cognition. The project is targeting executive function because it is important for maintaining independence in activities of daily living, and includes the abilities to make decisions, reason, problem-solve, initiate and maintain tasks, as well as adapt to changing cognitive conditions. It will also focus on secondary outcomes, such as falls, inflammatory blood biomarkers, balance, strength, mood and quality of life.
“Improved executive functioning may be an underlying mechanism by which exercise reduces falls,” Jehu said.
Jehu said 46.8 million individuals worldwide are living with dementia, a number that is expected to reach 131.5 million by 2050. Currently, there are more than 6 million Americans living with dementia.
“We will be examining the effects of the Otago Exercise Program, which is a six-month fall prevention program involving strength and balance training three times per week for 30 minutes and walking for at least 60 minutes per week,” Jehu said. “The program will be led by a physical therapist who will provide individualized and progressive exercise to a group of participants living with dementia.”
The Otago Exercise Program was developed in 1997 by Professor John Campbell and Dr. Clare Robertson at the University of Otago Medical School in New Zealand. It is a strength and balance training program and “is the gold standard for fall prevention,” according to Jehu. It reduces falls by 33% among cognitively intact older adults, but the efficacy of this program on executive function or falls among people living with dementia is not known.
The project will partner with the Georgia War Veterans Nursing Home and potentially other nursing homes. The investigators — Drs. Mark Hamrick, Lufei Young, Richard Sams, Colleen Hergott, Jennifer Waller, Brittany Ange and John Morgan — will randomly assign half of the patients to the Otago Exercise Program plus usual care while the other half will have usual care only.
Jehu said there are about 10 known studies that have examined the effects of exercise on falls in people living with dementia; however, only one study found that exercise reduced falls in this population.
“None of the studies were powered for falls,” Jehu said. “We need more research and larger studies to be done. We may also need to refine the prescription of exercise in this population because people with dementia are cognitively and functionally frail and need a lot of care.”