Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany.
BMC Geriatr. 2020 Jul 16;20(1):245. doi: 10.1186/s12877-020-01635-3.
There is a high prevalence of gait impairments in individuals with dementia (IWD). Gait impairments are associated with increased risk of falls, disability, and economic burden for health care systems. Only few studies have investigated the effectiveness of physical activity on gait performance in IWD, reporting promising but inconsistent results. Thus, this study aimed to investigate the effectiveness of a multimodal exercise program (MEP) on gait performance in IWD.
In this parallel-group randomized controlled trial, we enrolled 319 IWD of mild to moderate severity, living in care facilities, aged ≥ 65 years, and being able to walk at least 10 m. The control group (n = 118) received conventional treatment, whereas the intervention group (n = 201) additionally participated in a 16-week MEP specifically tailored to IWD. We examined the effects of the MEP on spatiotemporal gait parameters and dual task costs by using the gait analysis system GAITRite. Additionally, we compared characteristics between positive, non-, and negative responders, and investigated the impact of changes in underlying motor and cognitive performance in the intervention group by conducting multiple regression analyses.
Two-factor analyses of variance with repeated measurements did not reveal any statistically significant time*group effects on either spatiotemporal gait parameters or dual task costs. Differences in baseline gait performance, mobility, lower limb strength, and severity of cognitive impairments were observed between positive, non-, and negative responders. Positive responders were characterized by lower motor performance compared to negative and non-responders, while non-responders showed better cognitive performance than negative responders. Changes in lower limb strength and function, mobility, executive function, attention, and working memory explained up to 39.4% of the variance of changes in gait performance.
The effectiveness of a standardized MEP on gait performance in IWD was limited, probably due to insufficient intensity and amount of specific walking tasks as well as the large heterogeneity of the sample. However, additional analyses revealed prerequisites of individual characteristics and impacts of changes in underlying motor and cognitive performance. Considering such factors may improve the effectiveness of a physical activity intervention among IWD.
DRKS00010538 (German Clinical Trial Register, date of registration: 01 June 2016, retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do ).
痴呆症患者（IWD）普遍存在步态障碍。步态障碍与跌倒风险增加、残疾和医疗保健系统经济负担增加有关。只有少数研究调查了身体活动对 IWD 步态表现的有效性，报告结果喜忧参半。因此，本研究旨在调查多模式运动方案（MEP）对 IWD 步态表现的有效性。
在这项平行组随机对照试验中，我们招募了 319 名轻度至中度严重程度的 IWD，居住在护理机构中，年龄≥65 岁，能够至少行走 10 米。对照组（n=118）接受常规治疗，而干预组（n=201）则另外参加了专门针对 IWD 的 16 周 MEP。我们使用步态分析系统 GAITRite 检查 MEP 对时空步态参数和双重任务成本的影响。此外，我们比较了积极、非和消极反应者之间的特征，并通过进行多元回归分析，研究了干预组中潜在运动和认知表现变化的影响。
重复测量的两因素方差分析未显示时空步态参数或双重任务成本的任何具有统计学意义的时间*组效应。积极、非和消极反应者之间在基线步态表现、移动性、下肢力量和认知障碍严重程度方面存在差异。与非反应者和消极反应者相比，积极反应者的运动表现较低，而与消极反应者相比，非反应者的认知表现较好。下肢力量和功能、移动性、执行功能、注意力和工作记忆的变化解释了步态表现变化的 39.4%。
标准化 MEP 对 IWD 步态表现的有效性有限，可能是由于特定行走任务的强度和数量不足以及样本的高度异质性所致。然而，额外的分析揭示了个体特征的先决条件和潜在运动和认知表现变化的影响。考虑到这些因素可能会提高 IWD 身体活动干预的有效性。
DRKS00010538（德国临床试验注册处，注册日期：2016 年 6 月 1 日，回溯性注册，https://www.drks.de/drks_web/setLocale_EN.do）。
