Cerga-Pashoja, A;
(2016)
Evaluation of Exercise on Individuals with Behavioural and Psychological Symptoms of Dementia and Their Carers: A Randomized Controlled Trial.
Doctoral thesis , UCL (University College London).
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Abstract
There are over 840,000 people in the UK with dementia, most of whom will experience Behavioural and Psychological Symptoms of Dementia (BPSD). Treatment options for BPSD are limited and often they have been managed with anti-psychotic medication, which increase mortality and the risk of stroke in people with dementia. Consequently, it is imperative to evaluate the impact that non-pharmacological interventions such as physical exercise have on BPSD. This research seeks to address this matter by: exploring the current state of knowledge through a literature review; designing a simple, measurable and safe physical intervention for BPSD; devising, carrying out and reporting findings on a methodologically robust trial of exercise; and discussing its impact and future directions. A rapid appraisal of the literature showed that exercise programmes for people with dementia have often been poorly conceptualised and research methods had significant limitations; this was addressed with the design of EVIDEM-E. EVIDEM-E was a pragmatic, randomised, parallel group, single-blind, controlled trial that evaluated the effectiveness of exercise (planned walking) on the BPSD symptoms of 131 dyads (individuals with dementia and their carers). Physical exercise was delivered as an individually tailored regime of walking designed to become progressively intensive. Regular walking did not produce a statistically significant reduction in BPSD. This exercise, however, attenuated carer burden significantly. It is not clear whether this was because of the exercise per se, increased psychosocial interaction between carer and person with dementia, or a Hawthorne effect. Further research should focus on the mechanisms by which exercise may affect carers’ burden and whether reducing carer burden has long-term effects.
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