Un programme d’APA améliore l’autonomie dans la maladie d’Alzheimer

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A clinical trial evaluating the efficacy of a tailored physical activity program (APA) Mobility base of people with Alzheimer’s disease.

An American randomized controlled trial of Roach and his colleagues, published in the Journal of Geriatric Physical Therapy in 2011, compares the efficacy of a 4 month program of adapted physical activity (APA) based mobility program assisted walking and talking in people with Alzheimer’s disease. The results show that the APA program improves the ability to perform position transfers while this capacity continues to decline in the other two groups.

The Study Rationale

13.2 million Americans will have Alzheimer’s disease in 2050. These dementia need assistance to perform basic activities of daily living such as dressing, bathing and walking. They require ongoing support from their relatives that goes beyond their personal limits. The more the person is physically dependent and the risk of depression in the caregiver is high. The care in an institution is often the only solution when the physical level of dependence of the patient exceeds the caregiver support capability.

The alteration of the physical strength, range of motion and balance is correlated to the difficulties with the activities of daily living. There is strong evidence about the effectiveness of adapted physical activity programs (APA) focused on the strength, flexibility, balance and walking speed of the elderly. However, the content of such a program for people with Alzheimer’s disease should be clarified and evaluated scientifically.

The Question

A program of adapted physical activities mobilizing the strength, flexibility, balance and endurance he improves more basic mobility of people with Alzheimer’s disease than a walking program?

The Protocol

The randomized controlled trial of Roach and colleagues evaluated the effectiveness of a specific APA program based on mobility. The study focused on 82 older adults with Alzheimer’s disease (moderate to severe stage). All participants live in an institution of long-term care. They are dependent in at least one of the following: bed mobility, transfer positions or representation, balance and ability to walk with or without need of assistance. Participants were randomly placed in either the group with specific APA program or in the group with supervised walking program or in the control group. The main measures included limiting core activities: bed mobility, transfers and walking (Acute Care Index of Function) and functional mobility (6 minute walk test). Participants assessed early intervention and late response at 16 weeks.

The tested Non-Pharmacological Intervention (NPI)

The Adapted Physical Activity program (APA) includes 5 sessions per week for 16 weeks. The program aims to slow the decline and improve the ability to perform activities requiring basic mobility. For example, the balance in a sitting position and standing position, the transfer from the sitting position to the standing position. The program includes four components: strength, flexibility, balance and endurance. Exercise duration was 15 minutes at the start of the program and has increased up to 30 minutes late intervention. The program was conducted by a nurse or a family member under the professional supervision of the Adapted Physical Activity (APA). The exercises muscle strengthening and flexibility were designed to strengthen the muscles of the trunk and lower limbs. For this, the eccentric and concentric exercises were conducted. The muscle groups involved in the exercises are the same as those asked to perform a sit-stand transfer or vice versa. Another series of exercises was based on balance and weight transfer. The participant placed his hands on the shoulders of the person who assisted and the latter placed his hands on the walking belt around the waist of the participant. They then moved to the left, right, backward and forward. The assistance provided by the speaker was gradually reduced and the resistance was increased proportionally to the improvement of the participant in its ability to achieve the financial year.

An important criterion in this population teaching is repetition, the simplicity and familiarity of the exercises.

Main Results

The results show an improvement in transfer capacity to intervene for the group benefiting from the APA program specific to the two other groups. However, bed mobility and functional mobility are unchanged end of the procedure for the three groups.

What it means for Patients

A 4-month APA program based on strength, flexibility, balance and endurance improves the ability to effect change position from sitting to standing and vice versa. But, it improves mobility in bed and functional mobility.

What it means for Healthcare Professionals

Regular walking is not sufficient to reduce the decline in the mobility of people with Alzheimer’s disease. An APA program of four months seeking strength, flexibility, balance and endurance should be implemented in patients in institutions to improve their transfer capacity.

What it means for Researchers

The clinical trial was designed to assess the effectiveness of a tailored physical activity program (APA) based on the mobility of patients with Alzheimer’s disease. Future studies will need to replicate this study on a larger number of participants.

What it means for Policymakers

This trial provides evidence that a suitable program of physical activity (APA) is more effective than walking program in improving physical autonomy of people with Alzheimer’s disease.

The reference

Dzator JA, Hendrie D, Burke V, Gianguilio N, Gillam HF, Beilin LJ, Houghton S (2004). A randomized trial of interactive group sessions achieved greater improvements in nutrition and physical activity at a tiny increase in cost. Journal of Clinical Epidemiology, 57, 610-619.

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To reference this Blog en Sante © article

Ninot G (2016). An Adapted Physical Activity (APA) program improves the autonomy of people with Alzheimer’s disease sufferers. Blog en Sante, A86.

© Copyright 2016 Grégory Ninot. All rights reserved.