Effect of Exercise on Negative Affect in Residents in Special Care Units With Moderate to Severe Dementia

Abstract

Approximately 35% of individuals with dementia exhibit depression and/or anxiety symptoms, often manifested by symptoms of negative affect. Exercise has been associated with improved affect but has not been demonstrated to improve affect in residents of secured dementia units in long-term care facilities. This pilot study determined whether moderate-intensity, chair-based exercise was associated with changes in negative affect in residents in secured units. The sample included 36 patients from 2 nursing homes who participated in a 12-week, 30-minute moderate-intensity group exercise program thrice weekly. Affect, measured by the Philadelphia Geriatric Center Apparent Affect Rating Scale, was assessed at weeks 3 and 12, before and after each exercise session. Paired t tests assessed the immediate effect of exercise (before/after a session) and the long-term effect of exercise (study initiation/12 wk) on patients' affect ratings. The mean age was 85 years (SD=5.5), with 86% female, and 97% white. At week 3, anxiety was significantly lower immediately after the exercise session when adjusted for level of participation (P=0.02) compared with immediately before the exercise session, indicating immediate changes in affect. Anxiety and depression were significantly reduced at week 12, when compared with week 3, after adjusting for level of participation (P=0.01; P=0.03), indicating long-term effects of the exercise intervention. The study revealed the feasibility of conducting a moderate-intensity exercise program and the potential for exercise as a nonpharmacologic intervention for reducing symptoms of negative affect and depression in this vulnerable population.

The effect of exercise on behavioral and psychological symptoms of dementia: towards a research agenda

“…In depression, Aman and Thomas (2009) found no improvements in depressed mood after three weeks of engaging in exercise and a pilot study by Steinberg et al (2009) found evidence of higher depression scores and poorer quality of life after 12 weeks of daily aerobic exercise. Edwards et al (2008) failed to find a short-term effect of exercise, although after a 12-week period a significant effect was evident. Indeed, after a longer duration, significant effects accruing from exercise appear more likely.…”

“…Indeed, there is some evidence that physical activity can help to reduce aggressive behaviors in people with dementia. Although Edwards et al (2008) found no effect of chair-based exercise in reducing levels of agitation after 12 weeks, Aman and Thomas (2009) training, and Volicer et al (2006) found that meaningful exercise (i.e. exercise designed to meet the interest, physical, mental, and psychosocial wellbeing of each resident) reduced agitation after seven months.…”

“…Of the individual studies, most took place within care homes (Hokkanen et al, 2003;Volicer et al, 2006;Edwards et al, 2008;Aman and Thomas, 2009). Steinberg et al (2009), however, carried out their intervention outside the care home setting where participants exercised within their own home.…”

Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial

“…For instance, some studies report the greatest benefits after multicomponent exercise interventions (e.g., combined strength and aerobic exercises) [32,42], while other studies consider aerobic exercise to be the driving force for improvements in cognition, physical functions, mood, and behavioral problems [1,2,12]. Regarding the duration, there is some evidence that short-term exercise interventions (< 12 weeks) are more likely to benefit mood and behavioral problems [9], while other studies report benefits on these outcomes only after 12 weeks of exercise [36,50]. Despite the heterogeneity, there is some consensus that the largest improvements in function are found after multicomponent interventions with a duration of at least 12 weeks, with larger effect sizes (ES) found in interven-…”

The Intensity of Chair-Assisted Exercises in Cognitively Healthy Older Adults

“…A widely applied type of physical activity for the oldest age group in, for example, long-term care is a group activity that is performed on and behind a chair (chair-assisted exercises) to guarantee safety (Edwards, Gardiner, Ritchie, Baldwin, & Sands, 2008), as older people may have balance problems (Deandrea et al, 2010). For many other daily activities the intensity is known (Ainsworth et al, 2000), but it is unclear whether chair-assisted exercise for older adults is of (at least) moderate intensity-the recommended intensity level for healthy aging.…”