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Physio findings: moderate to high intensity exercise doesn’t slow cognitive decline

Physiotherapy Journal editor Michele Harms and Caroline White report on recent research.

Physio findings exercise
Moderate to high intensity exercise doesn’t slow the cognitive decline associated with dementia, finds a trial of nearly 500 older people.
 
Recent reviews of trials of exercise training in people with dementia have shown mixed results. The researchers therefore decided to estimate the effect of a moderate to high intensity aerobic and strength exercise training programme on cognitive impairment in 494 people with mild to moderate dementia from across England.
 
Their average age was 77, and they were all living in the community. They were randomly assigned to either a supervised exercise and support programme (329) or to usual care (165). 
 
The exercise programme consisted of group gym sessions lasting 60 to 90 minutes twice a week for four months, plus home exercises for one additional hour each week with ongoing support.
 
The main outcome was an Alzheimer’s disease assessment score (ADAS-cog) at 12 months. Other outcomes included activities of daily living, number of falls, and quality of life.
 
After taking account of potentially influential factors, the researchers found that cognitive impairment declined over the 12-month monitoring period in both groups.
 
Physical fitness improved in the short term among those in the exercise group, but they had higher ADAS-cog scores at 12 months (25.2 vs 23.8) than those in receipt of usual care. But the average difference was small and it wasn’t clear what the clinical relevance of this was.
 
No differences were found in secondary outcomes, or after further analyses to test the strength of the results.
 
The period of structured exercise may have been too short to produce positive benefits, say the researchers, but they conclude that exercise can’t be recommended as a treatment option for cognitive impairment in dementia. 
 
Future trials should explore other forms of exercise: it may be that some types of exercise might worsen cognitive impairment, they say. Lamb S, et al. Dementia And Physical Activity (DAPA) trial of moderate to high intensity exercise training for people with dementia: randomised controlled trial. The BMJ 2018.

Physiotherapy Journal

Physiotherapy editor Michele Harms highlights some ‘in press’ papers here and as a CSP member, you can access the journal free via the CSP website

Getting a handle on reach-to-grasp

Reach-to-grasp is an essential activity of daily living. The authors argue that successful reach-to-grasp requires temporal coordination of transport (reach) and grasp, factors that may not be targeted sufficiently during therapy. This meta-analysis sets out to provide a better understanding of the associated motor deficits in individuals with stroke. They report that this may enable advances in therapy and functional outcomes.
 
The review includes 29 studies involving 460 individuals with stroke and 324 control participants. Perhaps not surprisingly, individuals with stroke exhibited significantly lower peak velocity and greater trunk displacement during reach-to-grasp activities. Although the authors caution a potential risk of bias in the studies, they conclude that individuals with stroke may demonstrate different reach-to-grasp characteristics in the ipsilateral and central workspace, which may need to taken into account during re-training of this activity. Kathryn C. Collins et al Getting a kinematic handle on reach-to-grasp: a meta-analysis.

Ultrasound in thoracic diagnosis

Thoracic ultrasound can be used to examine the pleura, lung parenchyma and diaphragm and promises to be a technique that could be of considerable benefit to physiotherapists. This scoping review aims to clarify how physiotherapists are currently using ultrasound in research and clinical practice. The authors report that there is evidence of efficacy in the diagnosis of conditions like pneumonia, pleural effusion and diaphragmatic dysfunction. They found 26 papers where physiotherapists were part of the study design or the chief investigator. The studies included healthy participants, critical care and COPD patients. This is an emerging skill and its potential for the profession has yet to be realised. S.A. Hayward et al Use of thoracic ultrasound by physiotherapists: a scoping review of the literature. 

Normative values for balance

Papers providing normative data against which clinicians can compare their individual, or group, of patients are particularly useful. This paper provides normative reference values for unipedal balance test time based on the meta-analysis of data from 23 studies. The authors of this paper report that the test has been shown to be reliable, valid and useful in the clinical setting. With this in mind, their next step was to provide normative values in relevant populations. For studies stratified by age and test duration, the authors found weighted mean times ranged from 63 seconds for 60 to 69 year olds, to 10 seconds for individuals who were 80 years and older. They also demonstrated that men matched with women by age group and test duration stood on one foot a mean six seconds longer. Summary tables show unipedal balance time data consolidated via meta-analysis, and a comparison of unipedal balance time data between age groups and men and women. The authors also provide a suggested standardised procedure for conducting the test. Richard W Bohannon et al. Unipedal balance test for older adults: a systematic review and meta-analysis of studies providing normative data.  

Further reading

Comments & conclusions

  • Exercising for at least 30 minutes two to three times a week may be enough to minimise the stiffening of middle sized arteries that comes with age, suggests a study of 102 lifelong exercisers in their 60s. But to prolong the youth of the larger central arteries requires exercising on four to five days of the week, the findings show.The Journal of Physiology 2018
  • Even mild brain trauma may double the risk of developing dementia, suggests research which tracked the brain health of nearly 358,000 US army veterans. In those who had a moderate to severe head injury, the risk was nearly four times higher. JAMA Neurology 2018 
  • In a study of more than 24,000 adults with rheumatoid arthritis, those who were severely obese experienced more rapidly progressing disability than those who were overweight. This wasn’t explained by features of their arthritis, including the amount of inflammation in their joints. Patients who lost weight unintentionally tended to become disabled more quickly, especially those who were already thin. Arthritis Care & Research 2018

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