Exercise May Help People With Alzheimer's Avoid Nursing Homes

 Regular exercise slows disability and prevents falls in 

patients with Alzheimer's disease without increasing overall 

costs, according to a new study .

The findings suggest that exercise, particularly when tailored 

to an individual's needs and performed at home, may help 

Alzheimer's patients maintain their independence and delay 

the move to a nursing home.

"This is an important study,"a said . "If we could ever deliver 

exercise for people with dementia in their homes, I think we 

could accomplish very substantial benefits for patients and 

reduce costs, which is a very big deal ... in health care these 

days." 

Mental changes are the first wrenching signs of Alzheimer's 

disease, and they often are the symptoms that get the most 

attention. But physical declines are also a part the disease. 

Over time, muscles become stiff and uncoordinated, or may 

start to tremor. Alzheimer's patients may lose the ability to 

brush their teeth, climb stairs, and dress, feed and bathe 

themselves.

"These people are at very high risk of disability. That's one of 

the reasons they end up in institutional care," said a study 

author . "They need so much help that their caregivers often 

get very tired, and after a few years they will end up in 

institutional care, which is very expensive and often not the 

wish of the patients nor the caregivers."

For the study, the researchers chose more than 200 patients 

with moderate to severe Alzheimer's disease who were living 

at home with a caregiver and showing signs of physical 

decline. The patients were randomly assigned to one of three 

groups: home exercise, group exercise at a day care centre  

or a control group.

Those in the home-exercise group got visits from a physical 

therapist for one hour twice a week. The physical therapists 

specialized in dementia care, and they tailored these 

sessions to each patient's problems with function and 

mobility.

Patients in the group-exercise classes travelled to an adult 

care centre twice a week, where two physical therapists 

guided them through exercises to improve endurance, 

balance, strength and mental function.

The patients in the usual-care group were followed by the 

study nurses and were given advice on nutrition and exercise.

After one year, all the groups saw declines in physical 

function, but the groups that exercised regularly fared better 

than those who got usual care. Those in the home-exercise 

group did the best. Their physical function declined about half 

as much as that of the control group. Importantly, they also 

had half as many falls as those who got usual care.

Group exercisers showed some signs of better health -- their strength improved over the course of the year -- but those results were not statistically significant. And although the study found an association between exercise and better health among Alzheimer's patients, it didn't prove a cause-and-effect relationship.

The researchers think one reason the group exercisers didn't see bigger benefits was because they were more likely to skip their sessions than those who exercised at home.

"When the taxi came to the person's home to take them to the group-based exercise, they could say often, 'Today I'm tired; I'm not coming,'" . "When there's a person coming to your home and telling you, 'Let's do a little bit today,' it's much easier to say yes than it is to go outside your home."

During the year they exercised, patients in the home group had fewer hospital admissions and about half as many falls as those in the control group. The money they saved on medical bills more than offset the cost of regular private sessions with a physical therapist. The average annual cost of caring for a patient in the home-exercise group was about $25,000, but it was about $34,000 for patients who received only usual care. The annual cost for group-exercise patients was even lower, at about $22,000.

Another expert who was not involved in the study praised the research and said it offered a practical blueprint to improve the lives of patients and families affected by Alzheimer's disease.

"If you can do something that can improve their physical functioning and mobility and help them stay home and not actually cost anything -- or be cost neutral -- I think you can make a huge potential impact on a family's quality of life," said a Dr.