Exercise or Social Intervention for Nursing Home Residents with Dementia: A Pilot Randomized, Controlled Trial
Exercise or Social Intervention for Nursing Home Residents with Dementia: A Pilot Randomized, Controlled Trial
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DOI：
10.1111/jgs.14947
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发表时间：
2017-09-01
影响因子：
6.3
通讯作者：
Rolland, Yves
中科院分区：
文献类型：
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作者：
de Souto Barreto, Philipe;Cesari, Matteo;Rolland, Yves
目的比较运动和结构化非身体干预对养老院(NH)痴呆症患者日常生活活动能力(ADL)及身体和认知功能的影响。设计整群随机先导对照试验。设置7名法国NH参与者生活在NH中的PWD。测量NH被随机分为运动组(4个NHS，n=47)或结构化社会活动组(3个NHS，n=50)，进行为期24周的干预，每周两次，每次60分钟。主要终点是ADL表现(阿尔茨海默病合作研究严重阿尔茨海默病日常生活活动量表(ADCS-ADL-SEV)；范围0-54，越高越好)；次要终点是总体认知功能(简易精神状态检查(MMSE))和基于表现的身体功能测试(短身体表现电池(SPPB)，通常步速)。结果91名参与者至少有一次基线后ADL评估进入效果分析。在性别、神经精神症状和营养状况方面，各组在基线方面存在差异。校正基线差异的多水平分析发现，锻炼和社会活动(逐个时间的互动)的效果没有显著差异，6个月时调整后的平均差异ADCS-ADL-SEV为1.9分，MMSE为0.55分，SPPB为0.6分，0.05m/S有利于锻炼。不良事件在不同组之间没有差异，除了社会活动组比运动组摔倒更多。结论需要一项更大、更长的试验来确定运动是否比制度化残疾人的物理干预具有更大的健康益处。
ObjectivesTo compare the effects of exercise with those of a structured nonphysical intervention on ability to perform activities of daily living (ADLs) and physical and cognitive function of persons with dementia (PWDs) living in nursing homes (NH).DesignCluster-randomized pilot-controlled trial.SettingSeven French NHs.ParticipantsPWDs living in NHs.MeasurementsNHs were randomized to an exercise group (4 NHs, n=47) or structured social activity group (3 NHs, n=50) for a 24-week intervention performed twice per week for 60minutes per session. The main endpoint was ADL performance (Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer's Disease Scale (ADCS-ADL-sev); range 0-54, higher is better); secondary endpoints were overall cognitive function (Mini-Mental State Examination (MMSE)) and performance-based tests of physical function (Short Physical Performance Battery (SPPB), usual gait speed).ResultsNinety-one participants with at least one postbaseline ADL assessment were included in efficacy analysis. Groups differed at baseline in terms of sex, neuropsychiatric symptoms, and nutritional status. Multilevel analysis adjusted for baseline differences between groups found no significant difference between effects of exercise and social activity (group-by-time interaction), with adjusted mean differences at 6months of 1.9 points for ADCS-ADL-sev and 0.55 points for MMSE favoring social activity and 0.6 points for SPPB and 0.05m/s favoring exercise. Adverse events did not differ between groups, except that the social activity group had more falls than the exercise group.ConclusionA larger, longer trial is required to determine whether exercise has greater health benefits thannonphysical interventions for institutionalized PWDs.