title: Evaluation of a hospital-based day-structuring exercise programme on exacerbated behavioural and psychological symptoms in dementia--the exercise carrousel: study protocol for a randomised controlled trial.
abstract: BACKGROUND
  Conceptual reviews and observational studies describe a link between physical inactivity and behavioural disturbances in people with dementia. Consequently, treatment of these symptoms requires physical activation and pharmacological or physical immobilization should be avoided. The few trials that have been conducted in inpatient dementia care to investigate the effects of exercise on behavioural and psychological symptoms revealed inconsistent results. Due to a lack of evidence, there is a paucity of recommendations for physical activation in this stage of care. Therefore, this trial seeks to investigate the effects of a day-structuring exercise programme on behavioural and psychological symptoms as well as on circadian rhythms of patients with dementia, hospitalized because of their behavioural and psychological disturbances.
  
  
  METHODS
  A single-centre randomised controlled trial will be conducted in three special dementia care units of an old age psychiatry hospital. Enrolled patients will receive either a 2-week exercise programme, or a 2-week social stimulation programme in addition to usual care. Due to the provision of four day-structuring exercise-sessions in the course of an intervention day, the exercise programme for the study group is called exercise-carrousel. Baseline and post-intervention assessment for the primary outcome variable - the overall effects on behavioural and psychological symptoms--will be measured by the Alzheimer's disease Cooperative Study-Clinical Global Impression of Change. The following objectives are set up as secondary outcomes: dimensions of the behavioural and psychological symptoms of dementia (BPSD) and caregiver burden, routine and on-demand psychotropic medication, patients' motor behaviour, diurnal cortisol-levels from saliva probes and brain-derived neurotrophic factor-levels from blood serum.
  
  
  CONCLUSIONS
  In order to be regarded as an important treatment option for behavioural and psychological symptoms, physical activation in inpatient hospital dementia care requires more evidence and appropriate recommendations. Respecting hospital routines and the intra-daily variability of the patients' motivation and behavioural disturbances in the provision of exercise sessions could lead to higher exercise adherence and better effects on patients' behavioural and psychological symptoms than former trials have presented. The concealment of allocation throughout the trial and the rating of individual exercise exertion present the key challenges and main limitations of this trial.
  
  
  BACKGROUND
  DRKS00006740 (German Clinical Trial Register, date of registration: 28 October 2014).
authors.affiliation: Institute of Movement and Sport Gerontology, German Sport University, Cologne, 50993, Germany. T.Fleiner@dshs-koeln.de.|Department of Old Age Psychiatry, LVR-Klinik Köln, Köln, 51109, Germany. T.Fleiner@dshs-koeln.de.
authors.forename: Tim
authors.initials: T
authors.lastname: Fleiner
authors.affiliation: Institute of Movement and Sport Gerontology, German Sport University, Cologne, 50993, Germany. Zijlstra@dshs-koeln.de.
authors.forename: Wiebren
authors.initials: W
authors.lastname: Zijlstra
authors.affiliation: Department of Old Age Psychiatry, LVR-Klinik Köln, Köln, 51109, Germany. Hannah.Dauth@lvr.de.
authors.forename: Hannah
authors.initials: H
authors.lastname: Dauth
authors.affiliation: Department of Old Age Psychiatry, LVR-Klinik Köln, Köln, 51109, Germany. Peter.Haeussermann@lvr.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Haussermann
mesh_terms: D000203:Activities of Daily Living; D000204:Activity Cycles; D000367:Age Factors; D002985:Clinical Protocols; D003704:Dementia / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D005852:Geriatric Psychiatry; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011788:Quality of Life; D012107:Research Design; D057185:Sedentary Behavior; D013997:Time Factors; D016896:Treatment Outcome