The present study is based on a three-armed randomised controlled trial which basically compared aerobic training, exergame training and an active control intervention.
A total of 115 individuals suffering from mild to moderate dementia (mean Mini-Mental State Examination score: 22.9) with an average age of 79.2 years old were included. They were all randomised within one of the three following groups and attended the corresponding programme three times a week for twelve weeks:
- Exergame group: aerobic bicycle training with stationary bike connected to a video screen displaying a route and digital environment while performing cognitive tasks
- Aerobic group: cycling between 30 to 50 minutes on stationary bike with no video connected
- Control group: relaxation and flexibility
The main outcome measure was the level of frailty, assessed through the Evaluative Frailty Index for Physical activity (EFIP), both at baseline and after the whole intervention. Differences between each group were assessed using covariance. Other indicators such as the Physical Activity Scale for the Elderly (PASES – level of physical activity) and the Katz Index (for ADL) were also analysed.
Although not significant, a trend towards higher adherence in the Exergame group was found in comparison to the aerobic group. This may be a tool to encourage older patients with dementia to be physically active.
Moreover, after twelve weeks, the EFIP score was significantly decreased in the Exergame group when compared to the control group (significant change applying specifically and only on the physical items of the index). This is of great clinical importance, as limiting frailty may help in limiting further health issues.
No significant differences were found between groups in either the Katz Index or the PASE.
> From: Karssemeijer, J Am Med Dir Assoc 20 (2019) 1502-1508 . All rights reserved to Elsevier Inc. Click here for the online summary.
Expert opinion
It is interesting to note that frailty did not decrease significantly in the aerobic group. No obvious reasons were found by the authors.
However, they highlighted the benefits of exergame in terms of adherence. This is of particular importance for a population such as older people with dementia who often display a lack of compliance to exercise interventions, even though these are on the basis of fighting frailty.
Despite the large sample involved in this study and the high level of adherence during the whole intervention, results may not be generalizable, because only mobile and motivated older people with mild to moderate dementia were enrolled. Moreover, reliability and validity of the EFIP to measure frailty have not been assessed yet for individuals suffering from dementia.
