Effects of 6-Month Multimodal Physical Exercise Program on Bone Mineral Density, Fall Risk, Balance, and Gait in Patients with Alzheimer’s Disease: A Controlled Clinical Trial

Abstract

We aimed to determine the short- and medium-term effects of a multimodal physical exercise program (MPEP) on bone health status, fall risk, balance, and gait in patients with Alzheimer’s disease. A single-blinded, controlled clinical trial was performed where 72 subjects were allocated in a 3:1 ratio to an intervention group (IG; n = 53) and control group (CG; n = 19), where the IG’s subjects were admitted to live in a State Reference Center of Alzheimer’s disease, which offers the targeted exercise program, while the CG’s subjects resided in independent living. A multidisciplinary health team assessed all patients before allocation, and dependent outcomes were again assessed at one, three, and six months. During the study, falls were recorded, and in all evaluations, bone mineral density was measured using a calcaneal quantitative ultrasound densitometer; balance and gait were measured using the performance-oriented mobility assessment (POMA), the timed up and go test (TUG), the one-leg balance test (OLB), and the functional reach test (FR). There were no differences between groups at baseline for all outcome measures. The prevalence of falls was significantly lower in the IG (15.09%) than in the CG (42.11%) (χ2 = 5.904; p = 0.015). We also found that there was a significant time*group interaction, with a post hoc Šidák test finding significant differences of improved physical function, especially in gait, for the IG, as assessed by POMA-Total, POMA-Gait, and TUG with a large effect size (ƞ2p = 0.185–0.201). In balance, we found significant differences between groups, regardless of time, and a medium effect size as assessed by POMA-Balance and the OLB (ƞ2p = 0.091–0.104). Clinically relevant effects were observed, although without significant differences in bone health, with a slowing of bone loss. These results show that a multimodal physical exercise program reduces fall risk and produces an improvement in gait, balance, and bone mineral density in the short and medium term in institutionalized patients with Alzheimer’s disease.

Contribution of a multicomponent intervention on functional capacity and independence on activities of daily living in individuals with neurocognitive disorder

“…Therefore, results from TUG analyzes supports the effectiveness of this intervention by improving the mobility of individuals with NCD, or at least, by minimizing its decline. Similar results were reported by other authors [ 51 – 53 ]. Lam et al’s (2018) [ 14 ] systematic review study with meta-analysis of randomized trials, regarding the effects of exercise on physical functioning and quality of life in individuals with minor and major NCD, revealed strong evidence supporting the exercise in improving TUG and walking speed.…”

Intervenções para prevenção de quedas em idosos na Atenção Primária: revisão sistemática

“…Os benefícios destas intervenções assemelham-se a um ensaio clínico realizado na Nova Zelândia com 72 idosos de idade média de 78 anos, em tratamento para Alzheimer, que participaram de um programa de exercício físico multimodal e obtiveram redução no risco de queda e melhora na marcha, equilíbrio e densidade mineral ósseo a curto e médio prazo. (35,36) Nas intervenções de multicomponentes, verificaram-se diferentes tipos de abordagens, porém com semelhança entre elas. A atividade física foi usada na maioria dos estudos, (15,(17)(18)(19)(20) seguida pela monitorização por intervenção telefônica (15,16,18,19) e avaliação de riscos intrínsecos e/ou extrínsecos para ocorrência de quedas.…”

Exercise Training Prevents the Loss of Wall Thickness and Lowers Expression of Alzheimer’s Related Proteins in 3xTg Mouse Jejunum

“…The beneficial effects of chronic exercise training on brain neurodegeneration in humans and murine models of AD are well-documented. However, there is an increasing number of studies supporting the claim that exercise also favorably prevents the AD-related decline of other physiological systems, including those of cardiovascular and cerebrovascular [ 46 ], cardiorespiratory [ 47 ], and musculoskeletal [ 48 , 49 ] systems.…”