Schwenk Michael, Zieschang Tania, Englert Stefan, Grewal Gurtej, Najafi Bijan, Hauer Klaus
Department of Geriatric Research, Bethanien-Hospital/ Geriatric Center at the University of Heidelberg, Heidelberg, Germany.
BMC Geriatr. 2014 Jun 12;14:73. doi: 10.1186/1471-2318-14-73.
Preventing and rehabilitating gait disorders in people with dementia during early disease stage is of high importance for staying independent and ambulating safely. However, the evidence gathered in randomized controlled trials (RCTs) on the effectiveness of exercise training for improving spatio-temporal gait parameters in people with dementia is scarce. The aim of the present study was to determine whether a specific, standardized training regimen can improve gait characteristics in people with dementia.
Sixty-one individuals (mean age: 81.9 years) with confirmed mild to moderate stage dementia took part in a 3-month double-blinded outpatient RCT. Subjects in the intervention group (IG) received supervised, progressive resistance and functional group training for 3 months (2 times per week for two hours) specifically developed for people with dementia. Subjects in the control group (CG) conducted a low-intensity motor placebo activity program. Gait characteristics were measured before and after the intervention period using a computerized gait analysis system (GAITRite®).
Adherence to the intervention was excellent, averaging 91.9% in the IG and 94.4% in the CG. The exercise training significantly improved gait speed (P < 0.001), cadence (P = 0.002), stride length (P = 0.008), stride time (P = 0.001), and double support (P = 0.001) in the IG compared to the CG. Effect sizes were large for all gait parameters that improved significantly (Cohen's d: 0.80-1.27). No improvements were found for step width (P = 0.999), step time variability (P = 0.425) and Walk-Ratio (P = 0.554). Interestingly, low baseline motor status, but not cognitive status, predicted positive training response (relative change in gait speed from baseline).
The intensive, dementia-adjusted training was feasible and improved clinically meaningful gait variables in people with dementia. The exercise program may represent a model for preventing and rehabilitating gait deficits in the target group. Further research is required for improving specific gait characteristics such as gait variability in people with dementia.
ISRCTN49243245.
在疾病早期预防和康复痴呆症患者的步态障碍对于保持独立和安全行走至关重要。然而，关于运动训练对改善痴呆症患者时空步态参数有效性的随机对照试验（RCT）所收集的证据很少。本研究的目的是确定一种特定的、标准化的训练方案是否能改善痴呆症患者的步态特征。
61名确诊为轻度至中度痴呆的个体（平均年龄：81.9岁）参加了一项为期3个月的双盲门诊RCT。干预组（IG）的受试者接受了专门为痴呆症患者制定的3个月监督下的渐进性阻力和功能组训练（每周2次，每次2小时）。对照组（CG）的受试者进行了低强度运动安慰剂活动计划。在干预期前后使用计算机化步态分析系统（GAITRite®）测量步态特征。
干预的依从性很好，IG平均为91.9%，CG平均为94.4%。与CG相比，运动训练显著改善了IG的步态速度（P < 0.001）、步频（P = 0.002）、步长（P = 0.008）、步幅时间（P = 0.001）和双支撑时间（P = 0.001）。所有显著改善的步态参数的效应量都很大（科恩d值：0.80 - 1.27）。步宽（P = 0.999）、步幅时间变异性（P = 0.425）和步行比率（P = 0.554）没有改善。有趣的是，低基线运动状态而非认知状态预测了积极的训练反应（步态速度相对于基线的相对变化）。
强化的、针对痴呆症调整的训练是可行的，并改善了痴呆症患者具有临床意义的步态变量。该运动计划可能代表了预防和康复目标群体步态缺陷的一种模式。需要进一步研究以改善痴呆症患者的特定步态特征，如步态变异性。
ISRCTN49243245。
