Context Exercise training for patients with Alzheimer disease combined with
teaching caregivers how to manage behavioral problems may help decrease the
frailty and behavioral impairment that are often prevalent in patients with
Objective To determine whether a home-based exercise program combined with caregiver
training in behavioral management techniques would reduce functional dependence
and delay institutionalization among patients with Alzheimer disease.
Design, Setting, and Patients Randomized controlled trial of 153 community-dwelling patients meeting
National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer
Disease and Related Disorders Association criteria for Alzheimer disease,
conducted between June 1994 and April 1999.
Interventions Patient-caregiver dyads were randomly assigned to the combined exercise
and caregiver training progam, Reducing Disability in Alzheimer Disease (RDAD),
or to routine medical care (RMC). The RDAD program was conducted in the patients'
home over 3 months.
Main Outcome Measures Physical health and function (36-item Short-Form Health Survey's [SF-36]
physical functioning and physical role functioning subscales and Sickness
Impact Profile's Mobility subscale), and affective status (Hamilton Depression
Rating Scale and Cornell Depression Scale for Depression in Dementia).
Results At 3 months, in comparison with the routine care patients, more patients
in the RDAD group exercised at least 60 min/wk (odds ratio [OR], 2.82; 95%
confidence interval [CI], 1.25-6.39; P = .01) and
had fewer days of restricted activity (OR, 3.10; 95% CI, 1.08-8.95; P<.001). Patients in the RDAD group also had improved
scores for physical role functioning compared with worse scores for patients
in the RMC group (mean difference, 19.29; 95% CI, 8.75-29.83; P<.001). Patients in the RDAD group had improved Cornell Depression
Scale for Depression in Dementia scores while the patients in the RMC group
had worse scores (mean difference, −1.03; 95% CI, −0.17 to −1.91; P = .02). At 2 years, the RDAD patients continued to have
better physical role functioning scores than the RMC patients (mean difference,
10.89; 95% CI, 3.62-18.16; P = .003) and showed a
trend (19% vs 50%) for less institutionalization due to behavioral disturbance.
For patients with higher depression scores at baseline, those in the RDAD
group improved significantly more at 3 months on the Hamilton Depression Rating
Scale (mean difference, 2.21; 95% CI, 0.22-4.20; P =
.04) and maintained that improvement at 24 months (mean difference, 2.14;
95% CI, 0.14-4.17; P = .04).
Conclusion Exercise training combined with teaching caregivers behavioral management
techniques improved physical health and depression in patients with Alzheimer