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Exergaming to reduce frailty in older people with dementia

Does it promote physical activity and help limiting frailty?

People with dementia are known to be frailer when compared to healthy aged individuals. Indeed, dementia is an obstacle to physical activity, leading to sedentary lifestyle, risk of sarcopenia, loss of mass and therefore frailty.

Frailty is described as a state of decreased reserves of several physiological systems, with a limited capacity to withstand stressors. Aged people get more vulnerable and less able to adapt to troubles or health issues, which increases the risk for developing dementia.

While dementia and frailty are conditions found in older adults, many studies have already highlighted the benefits of physical activity in such context on cognition, physical and daily functioning or well-being.

Adherence to the proposed exercise programme is definitely one of the key elements needed to promote physical activity. According to previous studies, exergaming has proven to be effective for people with dementia as it enhances patients' participation, while positively influencing balance, dual-task performance and psychomotor speed.

The present study focuses on the effects of exergaming on frailty but also on other aspects such as physical functioning, physical activity and activities of daily living (ADL) in older people suffering from dementia.

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.

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