Sport and Exercise Science, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia.
Exercise and Sport Science, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia.
BMC Geriatr. 2022 Aug 9;22(1):650. doi: 10.1186/s12877-022-03347-2.
Lewy body dementia (LBD) is an aggressive type of dementia of rapid, fluctuating disease trajectory, higher incidence of adverse events, and poorer functional independence than observed in Alzheimer's disease dementia. Non-pharmacological treatments such as progressive, high-intensity exercise are effective in other neurological cohorts but have been scarcely evaluated in LBD.
The Promoting Independence in Lewy Body Dementia through Exercise (PRIDE) trial was a non-randomised, non-blinded, crossover pilot trial involving older adults with LBD consisting of a baseline assessment, an 8-week wait-list, and an 8-week exercise intervention. The aims of this study were to evaluate the determinants of the primary outcome functional independence, as measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale, and the feasibility and preliminary efficacy of an exercise intervention on this outcome. Additionally, important clinical characteristics were evaluated to explore associations and treatment targets. The exercise intervention was supervised, clinic-based, high-intensity progressive resistance training (PRT), challenging balance, and functional exercises, 3 days/week.
Nine participants completed the baseline cross-sectional study, of which five had a diagnosis of Parkinson's disease dementia (PDD), and four dementia with Lewy Bodies (DLB). Six completed the exercise intervention (three PDD, three DLB). The cohort was diverse, ranging from mild to severe dementia and living in various residential settings. Greater functional independence at baseline was significantly associated with better physical function, balance, cognition, quality of life, muscle mass ratio, walking endurance, faster walking speed and cadence, and lower dementia severity (p < 0.05). Participants declined by clinically meaningful amounts in functional independence, cognition, physical function, muscle mass, and weight over the wait-list period (p < 0.05). Following exercise, participants improved by clinically meaningful amounts in functional independence, cognition, physical function, and strength (p < 0.05). Progressive, high intensity exercise was well-tolerated (> 80% adherence), and only one minor exercise-related adverse event occurred.
PRIDE is the first exercise trial conducted specifically within individuals diagnosed with LBD, and provides important insight for the design of larger, randomized trials for further evaluation of progressive, high-intensity exercise as a valuable treatment in LBD.
The PRIDE trial protocol has previously been prospectively registered (08/04/2016, ANZCTR: ACTRN12616000466448).
路易体痴呆（LBD）是一种快速、波动的疾病轨迹的侵袭性痴呆，与阿尔茨海默病痴呆相比，其不良事件发生率更高，功能独立性更差。非药物治疗，如渐进式、高强度的运动，在其他神经科人群中是有效的，但在 LBD 中很少被评估。
通过运动促进路易体痴呆患者的独立性（PRIDE）试验是一项非随机、非盲、交叉试验，涉及到由基线评估、8 周等待期和 8 周运动干预组成的 LBD 老年患者。本研究的目的是评估主要结局（运动障碍协会统一帕金森病评定量表评估的功能独立性）的决定因素，以及运动干预对该结局的可行性和初步疗效。此外，还评估了重要的临床特征，以探索相关性和治疗靶点。运动干预是在诊所进行的，监督下进行的，包括高强度的渐进式阻力训练（PRT）、平衡挑战和功能训练，每周 3 天。
9 名参与者完成了基线横断面研究，其中 5 名患有帕金森病痴呆（PDD），4 名患有路易体痴呆（DLB）。6 名参与者完成了运动干预（3 名 PDD，3 名 DLB）。该队列的多样性很大，从轻度到重度痴呆，居住在各种居住环境中。基线时的功能独立性越高，身体功能、平衡、认知、生活质量、肌肉质量比、步行耐力、行走速度和步频越快，痴呆严重程度越低（p<0.05）。参与者在等待期内的功能独立性、认知、身体功能、肌肉质量和体重都有显著的临床意义的下降（p<0.05）。运动后，参与者的功能独立性、认知、身体功能和力量都有显著的临床意义的改善（p<0.05）。渐进式、高强度的运动是可以耐受的（>80%的依从性），只有 1 例与运动相关的轻微不良事件发生。
PRIDE 是专门针对 LBD 患者进行的首次运动试验，为更大规模、随机试验的设计提供了重要的见解，以进一步评估渐进式、高强度运动作为 LBD 有价值的治疗方法。
PRIDE 试验方案已预先注册（2016 年 8 月 4 日，ANZCTR：ACTRN12616000466448）。
