Can PT improve ADLs and Balance in older folks with dementia?

May 2017

Can a 4 month twice a week program led by a physical therapist and consisting of high-intensity functional exercise program improve independence in activities of daily living (ADLs) and balance in older people with dementia? You bet.

A study conducted in Sweden at a residential care facilities, Umeå, with 93 individuals aged 65 and older with a dementia diagnosis, a Mini-Mental State Examination score of 10 or greater, and dependence in ADLs were allocated to the high-intensity functional exercise program, comprising lower limb strength and balance exercises, and 93 to a seated control activity.

Blinded assessors measured ADL independence using the Functional Independence Measure (FIM) and Barthel Index (BI) and balance using the Berg Balance Scale (BBS) at baseline and 4 (directly after intervention completion) and 7 months.
They found significant between-group effect on balance favoring exercise was observed at 4 months (BBS=4.2, 95% CI=1.8-6.6). They concluded that in older people with mild to moderate dementia living in residential care facilities, a 4-month high-intensity functional exercise program administered by a physical therapist appears to slow decline in ADL independence and improve balance.

The exercises had 5 components:

  1. Static and Dynamic Balance in combination with lower extremity strength exercise: Squats in parallel bars, step ups, directional lunges
  2. Dynamic Exercises in Walking: Walking over obstacles, soft surfaces, with multiple turns
  3. Static and Dynamic balance in standing: Trunk rotations, body weight transfer, side steps
  4. Lower extremity strength with continuous balance support: Squat in parallel bars while walking, STS, heel raises
  5. Walking with continuous balance support: Walking various directions, and numerous turns

All exercises can be increased by higher steps, deeper squats, narrowing base, and weighted belts.

Reference:
Toots A, Littbrand H, Lindelöf N, Wiklund R, Holmberg H, Nordström P, et al. Effects of a High-Intensity Functional Exercise Program on Dependence in Activities of Daily Living and Balance in Older Adults with Dementia. Am Geriatr Soc. 2016 Jan;64(1):55-64. doi: 10.1111/jgs.13880. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26782852. Full article available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4722852/.

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