Supervised exercise to reduce agitation in severely cognitively impaired persons.
BACKGROUND
Several studies have shown an improvement in depression, activities of daily living, and agitation in cognitively impaired subjects who undergo a long-term exercise program. These studies have not considered the short-term effects of exercise.


OBJECTIVE
The purpose of this study was to investigate the short-term effects of a limited, supervised exercise program on agitation, depression, and activities of daily living in cognitively impaired patients residing in the special needs unit of a nursing home.


METHODS
This study was a prospective comparative study. A 3-week exercise program was implemented at the special needs units of 2 nursing homes. The exercise program involved 30 minutes of exercise (15 minutes of aerobic and 15 minutes of resistance), 3 days per week. There were 50 residents in this study (76% female, 24% male) and they had a mean age of 79.2 +/- 9.7 years. The subjects had a mean SLUMS (Saint Louis Mental Status Examination) score of 1.5 +/- 2.1 (SLUM score range 0-30, 30 meaning full cognitive faculty). Each subject had his or her depression, agitation, activities of daily living, and 6-meter walk time measured before and after the 3-week exercise program. The Cornell Scale for Depression, Pittsburgh Agitation Scale (PAS)/Cohen-Mansfield Agitation Inventory, and ADCS-ADL (Alzheimer's disease cooperative study-activities of daily living) were used to measure depression, agitation, and activities of daily living, respectively. Multiple paired t tests were calculated for each outcome measurement.


RESULTS
The post-study scales showed an improvement in the 6-meter walk test and, using the PAS (0-16, 0 meaning no agitation), an improvement in agitation. The improvement in agitation in the entire population was P less than .05; mean PAS pre-study scores were 5.8 +/- 4.8 and mean PAS poststudy scores were 4.5 +/- 3.7 . Among the patients with PAS Pre-Exercise Program Scores greater than 3, thus categorized as agitated, there was a greater decrease in agitation; PAS Pre-Study Scores were 9.1 +/- 3.4 and PAS Study Scores were 6.1 +/- 3.4 (P < .001). There was also an improvement in 6-meter walk times; pre-study times were 12.5 +/- 5.2 and post-exercise program times were 10.1 +/- 4.4 (P < .001).


CONCLUSIONS
There was an improvement in agitation scores and the 6-meter walk times in the subjects after their engagement in the 3-week exercise program. Further study is needed in order to expand on these results.
Aman
Edris
E
Division of Geriatric Medicine, Saint Louis University School of Medicine, St. Louis, MO 63104, USA. eaman@slu.edu
Thomas
David R
DR
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000503:physiopathology / Q000628:therapy*; D003863:Depression / Q000503:physiopathology / Q000628:therapy; D015444:Exercise; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008923:Missouri; D009735:Nursing Homes; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000503:physiopathology*; D012720:Severity of Illness Index; D013997:Time Factors