Exercise Slows Physical Decline of Alzheimer's

A guided home exercise program can help slow physical decline and reduce falls in people with Alzheimer's disease, a new study suggests. The study included 210 people. All were living at home with a spouse who took care of them. They were randomly divided into 3 groups. One group did exercises at home twice a week with a physical therapist. Another group exercised in a group setting at a gym. The third group just received usual care and information about exercise. After a year, people in all 3 groups had declines in physical function. But people in the home-exercise group had only half the decline of those who got usual care. They also had only half as many falls. The gym group got stronger but had less benefit than the home-exercise group. Annual health care costs were about $34,000 for the usual-care group, $25,000 for the home-exercise group and $22,000 for the gym group. A decline in hospital trips offset the costs of the exercise programs. The journal JAMA Internal Medicine published the study online. HealthDay News wrote about it April 15.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Dementia is best known for its effects on memory and thinking. But people also lose much of their muscle strength, balance and endurance. These losses make it even more difficult for them to care for themselves and greatly increase their risk of falls.

Getting regular exercise helps prevent memory loss and decreases your risk of developing dementia. But what about people who already have dementia? Can they still derive some benefit?

A study called the Finnish Alzheimer Disease Exercise Trial gives a "thumbs up" to working out. The study included 210 men and women with Alzheimer's disease. All of them were still living at home with a caregiver wife or husband. Researchers divided people into three groups. They received different therapies:

1. Personalized training by a physical therapist twice a week in the home for one year
2. Group exercise classes outside the home twice a week for one year
3. Usual care without specific hands-on exercise coaching

All three groups showed declines in physical function during the year. But people who got the in-home physical therapy had about half the decline of those in usual care. They also fell less often.

People who went to group exercise classes improved their strength. And they had a bit less decline than people who were assigned to usual care.

The researchers suggest the following reasons that home-based physical therapy patients did the best:

• The exercises were designed and modified based on each person's needs.
• People didn't need to leave home, so they were more comfortable.
• They couldn't miss any sessions, since the therapists came to them.
• One-on-one coaching leads to a more intense workout. The therapists can give breaks as needed to allow the person to finish the hour of exercise.
• The physical therapists had special skills to instruct and coach people with dementia.

Less functional decline in the home exercisers led to lower health care costs. These savings offset the expense of personalized physical therapy.

What Changes Can I Make Now?

Too often older people (and many who are really not that old) have the wrong impression that they are past the point where exercise can do them any good. They also might be concerned that exercise will make them worse. That is almost never true with a well-designed exercise program. Such a program is, first of all, safe. It's easy at first, and the challenge increases at a reasonable pace.

For more ideas, check out my column: You're Never Too Old or Too Frail to Exercise.

What Can I Expect Looking to the Future?

The main focus of research on Alzheimer's disease has, of course, been the brain. But meanwhile, this study shows that regular exercise may help many people with the disease slow their functional decline. And this can mean a longer time to remain safely in their own homes.