Unique Exercise Program May Be Best Treatment for Those with Dementia
A novel exercise program known as Preventing Loss of Independence through Exercise (PLIÉ), has been demonstrated to hold possibly important benefits for those that suffer from dementia. Most forms of dementia, including dementia of the Alzheimer's type, are usually treated with medications to help slow the progression of the disease. However, many older adults suffering from dementia fail to demonstrate consistent and predictable results from the medications and some often fail to tolerate the medications.
Traditional exercise programs have often been targeted toward improving a person's physical health and functional level of existence. Those with dementia often can benefit from the physical improvements that exercise offer, especially in helping to improve their physical health that is frequently in decline. However, PLIÉ combines physical exercise that emphasizes functional movements with mindful body awareness to not only enhance a person's physical health, but also direct efforts toward maintaining a person's cognitive level of functioning as well.
Dr. Deborah Barnes from the University of California, San Francisco explained the results of her work with PLIÉ, and the results she has obtained from her research to those attending the 65th annual meeting of the American Academy of Neurology. Barnes states that the program "combines the best elements of eastern and western exercise traditions including yoga, tai chi, Feldenkrais, physical therapy, occupational therapy, mindfulness, and dance movement therapy." (1)
PLIÉ was especially focused on the maintaining and enhancing procedural memory, which is the more implicit memory that we use that helps to automatically and often habitually guide our daily movements and actions. Furthermore, conscious concentration or what Barnes referred to as techniques to increase awareness by focusing on "being in the moment" were used to help enhance one's cognitive abilities while engaging in the functional levels of exercise. Moreover, the exercise programs with those that suffered from dementia were often conducted within a circle. This helped to enhance the socially interactive features of the exercise group, allowing many of the individuals to communicate and interact freely with each other.
The results of the individuals that participated in PLIÉ were compared with those who had dementia but were given the traditional or usual care (UC). The study was small so the results have to be looked at cautiously. There were only six participants in the PLIÉ group and five in the UC group. The study ran for a period of 18 weeks. Pre- and post-intervention data were collected using the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-Cog), the Quality of Life in Alzheimer's Disease (QoL-AD), and the Short Physical Performance Battery (SPPB). Furthermore, caregivers were examined as well and their outcomes were measured as well.
The participants in the study, both those that had dementia and those who were caregivers, where closely matched on baseline characteristics and overall were quite similar on these characteristics. Briefly speaking, what stood out in the study was a noted improvement in ADAS-Cog scores (-4.6) in the intervention group, while the UC group experienced a worsening in their condition (2.4), for an effect size of 0.76. Dr. Barnes states that "This is substantially higher than what is usually seen with dementia medications, which is usually on the order of around 0.2 standard deviations." (1) Furthermore, the results were also positive for the caregivers as well. The investigators reported improvements in caregiver burden and caregiver distress scores as well.
As has been mentioned, one has to look at the results cautiously at this point due to the small number of participants that were studied. Nevertheless, one has to be optimistic, albeit cautiously optimistic, over the results that were obtained and further study in this area is definitely needed. Given that the treatment is much more holistic, being targeted toward not just enhancing the patient's physical health, but also enhancing their cognitive performance as well, it definitely needs to be looked at favorably for the greater depth and breadth of treatment intervention it can offer those with this debilitating condition.
Furthermore, since pharmacological interventions can often lead to serious side-effects, be quite expensive, and often provide very specific and limited treatment without the greater salubrious effects that this program has to offer, this in itself should be an impetus for much more research to be undertaken in this area. Since pharmacological therapy has not been the panacea that many have hoped for in addressing the problem of dementia, at least up to this point in time, providing an alternative form of treatment that is less passive and more dynamic, targeting the total organism in its treatment modality, and offering a more pervasive level of health enhancement for the person suffering from dementia may be a very productive avenue to entertain until better and more curative forms of therapeutic intervention exist.
1. Cassels, C. Novel Exercise Program May Trump Meds for Dementia. Medscape News. http://www.medscape.com/viewarticle/781607?src=wnl_edit_specol&uac=87637DR
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