kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2014.14.1.33 kjhp-14-33 Original Article Effects of Multi-Component Exercise and Retraining after Detraining on Functional Fitness and Cognitive Function in Elder People with Mild Dementia HongSeung-youn Division of Silver Industry, Kangnam University, Yongin, Korea ￭ Corresponding author：Seung-youn Hong, PhD, MEd Division of Silver Industry, Kangnam University, 40 Gangnam-ro, Giheung-gu, Yongin 446-702, Korea Tel: +82-31-280-3975, Fax: +82-31-899-7220 E-mail: yoni91@hotmail.com 01 2014 20 01 2014 14 1 33 42 24022014 17032014 Copyright © 2014 The Korean Society of Health Promotion and Disease Prevention 2014 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

With rapid growth in the number of older Koreans and prevalence of dementia, exercise has been emphasized as first, second and third prevention of dementia. A few study, however, investigate effects of detraining and retraining in demented elders. Therefore, the purpose of this study was to investigate the effects of 24 week exercise followed by 12 week detraining and retraining on physical and cognitive function in demented seniors.

 Methods

Thirty-five demented older adults were assigned into exercise and control group. Exercise group performed multi-component exercise, 2 times a week for 24 weeks. After 12 week detraining, subjects were retraining for 12 weeks. Subjects were tested four times on physiological variables, physical function and cognitive function. Ten subjects in exercise group and 6 subjects in control group were remained at final 48 week, and data from them were analyzed.

 Results

There were no significant effects on physiological variable in both groups. However, 24 week exercise improved upper and lower body strength, flexibility, dynamic mobility and physical function. These effects, however, were significantly decreased in 12 week detraining period and increased again after 12 week retraining. There were significance group differences. Cognitive function was improved after 24 week exercise but decreased in detraining and retraining period and no significant difference between groups was shown.

 Conclusions

The present study suggests that positive effects after exercise tend to be reduced once one stops exercise, and be improved again after retraining. Therefore, strategies to encourage demented elders to exercise are needed.

 Dementia Aged Exercise References National Health Insurance Services Fight with dementia 2013 Costa PT WIlliams TF Somerfield M Recognition and initial assessment of Alzheimer's diease and related dementias. Clinical practice guidelines no 19 Rockville US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research 1996 Colcombe S Kramer AF Fitness effects on the cognitive function of older adults Psychological Science 200314 2 12530 Munoz VM van Kan GA Cantet C Cortes F Ousset PJ Rolland Y Gait and balance impairments in Alzheimer disease patients Alzheimer Dis Assoc Disord 201024 1 7984 Rolland Y Pillard F Klapouszczak A Reynish E Thomas D Andrieu S Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial J Am Geriatr Soc 200755 2 15865 Kwak YS Um SY Son TG Kim DJ Effect of regular exercise on senile dementia patients Int J Sports Med 200829 6 4714 Williams CL Tappen RM Exercise training for depressed older adults with Alzheimer's disease Aging and Mental Health 200812 1 7280 Dishman RK Exercise adherence: its impact on public health Human Kinetics;1988. Cohen J Statistical power analysis for the behavioral sciences Psychology Press;1988. Heyn P Abreu BC Ottenbacher KJ The effects of exercise training on elderly persons with cognitive impairment and dementia: a metaanalysis Arch Phys Med Rehabil 200485 10 1694704 Rikli RE Jones CJ Senior fitness test manual Champaign, Ill; Leeds Human Kinetics 2001 xiv, 161 p. Cho BL Physical performance measures in the elderly Korean J Fam Med 200324 8 68995 http://www.komci.org/CedRef Full.php?ArticleID=1001KJFM%2F2003.24.8.689. Hong S An investigation of the validity of thirty-second chair stand test as a measure of lower body strength in Korean older adults International Journal of Human Movement Science 20126 1 1728 Van Pelt RE Evans EM Schechtman KB Ehsani AA Kohrt WM Contribution of total and regional fat mass to risk for cardiovascular disease in older women American Journal of Physiology, Endocrinology and Metabolism 2002282 E10238 Whitmer RA Gustafson DR Barrett-Connor E Haan MN Gunderson EP Yaffe K Central obesity and increased risk of dementia more than three decades later Neurology 200871 14 105764 Fratiglioni L Launer LJ Andersen K Breteler MM Copeland JR Dartigues JF Incidence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group Neurology 200054 11 Suppl 5 S105 Andersen CK Wittrup-Jensen KU Lolk A Andersen K Kragh-S⊘rensen P Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia Health and Quality of Life Outcomes 20042 1 528 Bullock R Hammond G Realistic expectations: the management of severe Alzheimer disease Alzheimer Dis Assoc Disord 200317 S805 Kovach CR Henschel H Planning activities for patients with dementia: a descriptive study of therapeutic activities on special care units J Gerontol Nurs 199622 9 338 Lee S Lee J The study on health-related physical fitness and bone mineral density in the elderly dementia and mild cognitive impairment Korean Journal of Sports Sccience 201120 4 78998 Dvorak RV Poehlman ET Appendicular skeletal muscle mass, physical activity, and cognitive status in patients with Alzheimer's disease Neurology 199851 5 138690 Um S Kwak Y The effects of regular exercise on cognitive function and blood Lipid in woman patient with senile dementia Korean Journal of Sports Science 200415 1 5765 http://www.papersearch.net/view/detail.asp?detail_key=1m200283 Brill PA Drimmer AM Morgan LA Gordon NF The feasibility of conducting strength and flexibility programs for elderly nursing home residents with dementia Gerontologist 199535 2 2636 Winters KM Snow CM Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women J Bone Miner Res 200015 12 2495503 Son H The Effects of exercise program on activities of daily living and balance in elderly with dementia. [dissertation] Daegu Daegu University 2007 Park H The effects of in-facility exercise program on fall-related fitness and cognitive function in elderly with dementia J Korean Soc Living Environ Sys 201017 1 7785 van Gelder BM Tijhuis MAR Kalmijn S Giampaoli S Nissinen A Kromhout D Physical activity in relation to cognitive decline in elderly men Neurology 200463 12 231621 Lautenschlager NT Cox KL Flicker L Foster JK van Bockxmeer FM Xiao J Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease JAMA 2008300 9 102737 Figures and Tables

Time 1, time 2, time 3, and time 4 indicate baseline, after 24 week exercise, after 12 week detraining, and after 12 week retraining respectively.

Time 1, time 2, time 3, and time 4 indicate baseline, after 24 week exercise, after 12 week detraining, and after 12 week retraining respectively. Abbreviations: 244 TUG, 244 cm time to up and go test; SPPB, short physical performance battery; EG, exercise group; CG, control group. 244 TUG was significantly decreased from time 1 to time 4, and SPPB was significantly increased from time 1 to time 4. Wilcox signed rank test was used for assessing their statistical differences.

General characteristics of subjectsa

Variables Categories EG (n=10) CG (n=6) χ2 or U Pb
Gender Male 4 (40.0) 2 (33.3) 0.071 0.608
  Female 6 (60.0) 4 (66.7)    
Age, y   77.10±6.56 77.87±50.32 68.500 0.723
Weight, kg   58.33±11.52 50.79±6.90 50.000 0.149
BMI, kg/m2   23.53±3.33 22.14±2.36 42.500 0.166
FFM, kg   38.76±5.22 33.41±6.04 12.000 0.064
Fat, %   32.44±7.43 25.23±7.97 39.500 0.115

Abbreviations: EG, exercise group; CG, control group; BMI, body mass index; FFM, fat free mass.

Values are presented as N (%) or mean±SD unless otherwise indicated.

Calculated by χ2 test or Mann-Whitney U test.

General characteristics of dropout vs. no dropout

Variables Categories Dropout (n=19) No Dropout (n=16) χ2 or U Pb
Gender Male 6 (42.9) 8 (38.1) 0.079 0.526
  Female 8 (57.1) 13 (61.9)    
Age, y 80.40±6.62 77.87±8.96 49.00 0.160
Weight, kg 49.29±12.11 55.32±9.97 53.00 0.165
BMI, kg/m2 20.69±3.67 22.72±2.87 40.00 0.213
FFM, kg 33.71±7.34 32.80±6.08 47.00 0.320
Body fat, % 26.26±9.28 29.56±8.23 50.00 0.548
Chair stand 4.71±3.20 7.97±4.60 20.50 0.021
Arm curl 11.83±7.18 10.38±7.18 88.50 0.732
One leg stand 1.99±1.72 4.81±6.44 69.00 0.188
SPPB 4.50±2.07 6.31±2.92 24.50 0.112
MMSE-K 16.80±7.85 16.25±5.36 26.50 0.721

Abbreviations: BMI, body mass index; FFM, fat free mass; SPPB, short physical performance battery; MMSE-K, Korean version of mini mental state examination.

Values are presented as N (%) or mean±SD unless otherwise indicated.

Calculated by χ2 test or Mann-Whitney U test.

Homogeneity test for functional fitness and cognitive function of subjectsa

Variables EG (n=10) CG (n=6) U Pb
Chair stand, times/30 sec 8.20±3.22 7.58±5.76 45.500 0.337
Arm curl, times/30 sec 10.20±5.88 10.69±6.16 63.500 0.926
Grip strength, kg 15.72±6.61 13.54±7.24 47.000 0.242
Lower flexibility, cm –9.0±10.69 –14.95±9.78 32.500 0.184
One leg stand, sec 5.23±5.27 3.75±6.58 31.500 0.034
244 TUG, sec 16.59±7.91 15.75±7.55 41.000 0.744
SPPB, score 7.00±2.26 5.18±3.12 29.500 0.070
MMSE-K 18.90±5.84 12.86±4.22 14.500 0.045

Abbreviations: EG, exercise group; CG, control group; 244 TUG, 244 cm time to up and go test; SPPB, short physical performance battery MMSE-K, Korean version of mini mental state examination.

Values are presented as mean±SD unless otherwise indicated.

Calculated by Mann-Whitney U test.

Changes of physiological variables after exercise training, detraining and retraininga

Variables Group Time 1b Time 2c Time 3d Time 4e χ2 Post U or F
(a) (b) (c) (d) (P)f hocg (P)h
Weight, kg EG (n=10)CG (n=6) 58.33±11.5250.79±6.90 59.76±10.0453.14±6.73 61.49±9.2453.40±9.17 62.44±9.3453.17±9.52 5.962 (0.113)8.478 (0.037) NAa<b 18.500 (0.281)
BMI, kg/m2 EG (n=10) 23.53±3.33 24.21±2.76 24.70±2.54 25.27±2.57 5.771 (0.134) NA 21.000 (0.463)
  CG (n=6) 22.14±2.44 23.43±2.31 23.75±3.19 24.05±4.05 7.271 (0.640) NA  
FFM, kg EG (n=10) 38.76±5.22 39.63±5.68 39.65±5.38 39.99±5.82 5.250 (0.154) NA 11.500 (0.054)
  CG (n=6) 33.41±6.04 34.09±6.83 33.77±6.80 33.84±5.28 1.174 (0.759) NA  
Body fat, % EG (n=10)CG (n=6) 25.23±7.9732.44±7.43 27.05±9.1033.02±7.28 23.67±13.4534.32±6.68 24.80±13.8135.25±5.87 0.724 (0.868)4.067 (0.254) NANA 24.000 (0.694)
BMR, kcal EG (n=10) 1,186±159.59 1,204±157.79 1,218±156.16 1,226±164.28 6.910 (0.075) NA 11.5000 (0.054)
  CG (n=6) 1,235±114.85 1,228±133.85 1,067±498.60 1,065±450.28 1.000 (0.801) NA  

Abbreviations: EG, exercise group; CG, control group; BMI, body mass index; FFM, fat free mass; BMR, basal metabolic rate.

Values are presented as mean±SD unless otherwise indicated.

Time 1 indicates baseline.

Time 2 indicates after 24 week exercise.

Time 3 indicates after 12 week detraining.

Time 4 indicates after 12 week retraining.

Assessed by Friedman test.

Assessed by Wilcox signed rank test.

Assessed by ANCOVA.

Changes of physical and cognitive function after exercise training, detraining and retraininga

Variables Group Time 1b Time 2c Time 3d Time 4e χ2 Post hocg U or F
(a) (b) (c) (d) (P)f (P)h
Chair stand, times/30 sec EG (n=10) 8.20±3.22 14.73±5.22 10.80±2.39 14.55±5.83 15.468 (0.001) a<b, c, db>c, c<d 12.000(0.042)
  CG (n=6) 7.58±5.76 9.99±4.58 9.43±2.67 9.01±4.01 3.316 (0.345) NA  
Arm curl, times/30 sec EG (n=10) 10.20±5.88 23.45±4.27 18.20±5.00 22.33±5.05 18.494 (<0.001) a<b, c, db>c, c<d 2.000(0.011)
  CG (n=6) 10.69±6.16 15.00±6.93 16.13±7.79 12.5±4.65 4.385 (0.223) NA  
Grip strength, kg EG (n=10) 15.72±6.61 17.92±7.59 16.32±6.20 16.88±6.92 1.557 (0.669) NA 26.000 (0.270)
  CG (n=6) 13.54±7.24 11.90±5.17 14.60±5.91 13.88±6.23 2.233 (0.392) NA  
Lower flexibility, cm EG (n=10) –9.0±10.69 –2.75±9.19 –5.48±6.17 –0.39±6.08 8.616 (0.035) a<b, d b<d 22.000 (0.065)
  CG (n=6) –14.95±9.78 –18.00±15.10 –15.25±16.67 –16.43±17.16 3.011 (0.392) NA  
One leg stand, sec EG (n=10) 5.23±5.27 7.89±6.14 5.83±4.58 5.35±4.06 11.157 (0.011) a<b, b<c, b<d 0.938 (0.399)
  CG (n=6) 3.75±6.58 4.79±4.16 3.91±5.66 3.36±1.34 1.345 (0.719) NA  
244 TUG, sec EG (n=10) 16.59±7.91 10.96±4.14 13.17±4.28 12.27±4.71 8.760 (0.033) a>b, d b<c 26.500 (0.080)
  CG (n=6) 15.75±7.55 15.44±5.94 16.81±6.08 16.85±6.14 0.652 (0.884) NA  
SPPB, score EG (n=10) 7.00±2.26 10.82±1.60 9.60±1.35 10.22±1.86 14.373 (0.002) a<b, c, d 9.000 (0.008)
  CG (n=6) 5.18±3.12 7.63±2.98 6.91±2.25 5.42±3.58 7.965 (0.047) a<b, b>d  
2 min steps, steps EG (n=10) 51.50±31.44 85.80±22.79 71.90±28.76 101.00±19.78 15.068 (0.002) a<b, d a<d 7.000 (0.106)
  CG (n=6) 44.20±51.54 42.83±33.91 26.25±18.23 44.00±46.07 0.214 (0.975) NA  
MMSE-K EG (n=10) 18.90±5.84 20.5±6.00 19.89±5.09 18.89±4.49 7.135 (0.049) a<b, b>d 0.080 (0.779)
  CG (n=6) 12.86±4.22 11.38±7.15 9.33±6.02 10.67±6.14 2.379 (0.497) NA  

Abbreviations: EG, exercise group; CG, control group; 244 TUG, 244 cm time to up and go test; SPPB, short physical performance battery; MMSE-K, Korean version of mini mental state examination.

Values are presented as mean±SD unless otherwise indicated.

Time 1 indicates baseline.

Time 2 indicates after 24 week exercise.

Time 3 indicates after 12 week detraining

Time 4 indicates after 12 week retraining.

Assessed by Friedman test.

Assessed by Wilcox signed rank test.

Assessed by ANCOVA.