Effects of Multi-Component Exercise and Retraining after Detraining on Functional Fitness and Cognitive Function in Elder People with Mild Dementia

Article information

Korean J Health Promot. 2014;14(1):33-42

Publication date (electronic) : 2014 January 20

doi : https://doi.org/10.15384/kjhp.2014.14.1.33

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

Received 2014 February 24; Accepted 2014 March 17.

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.

Keywords: Dementia; Aged; Exercise

Fig. 1.

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.

Fig. 2.

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.

Table 1.

General characteristics of subjects^a

Table 2.

General characteristics of dropout vs. no dropout

Table 3.

Homogeneity test for functional fitness and cognitive function of subjects^a

Table 4.

Changes of physiological variables after exercise training, detraining and retraining^a

Table 5.

Changes of physical and cognitive function after exercise training, detraining and retraining^a

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Fig. 1.

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.

Fig. 2.

Table 1.

General characteristics of subjects^a

Variables	Categories	EG (n=10)	CG (n=6)	χ² or U	P^b
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.

Table 2.

General characteristics of dropout vs. no dropout

Variables	Categories	Dropout (n=19)	No Dropout (n=16)	χ² or U	P^b
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.

Table 3.

Homogeneity test for functional fitness and cognitive function of subjects^a

Variables	EG (n=10)	CG (n=6)	U	P^b
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.

Table 4.

Changes of physiological variables after exercise training, detraining and retraining^a

Variables	Group	Time 1^b	Time 2^c	Time 3^d	Time 4^e	χ²	Post	U or F
Variables	Group	(a)	(b)	(c)	(d)	(P)^f	hoc^g	(P)^h
Weight, kg	EG (n=10) CG (n=6)	58.33±11.52 50.79±6.90	59.76±10.04 53.14±6.73	61.49±9.24 53.40±9.17	62.44±9.34 53.17±9.52	5.962 (0.113) 8.478 (0.037)	NA a<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±7.97 32.44±7.43	27.05±9.10 33.02±7.28	23.67±13.45 34.32±6.68	24.80±13.81 35.25±5.87	0.724 (0.868) 4.067 (0.254)	NA NA	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.

Table 5.

Changes of physical and cognitive function after exercise training, detraining and retraining^a

Variables	Group	Time 1^b	Time 2^c	Time 3^d	Time 4^e	χ²	Post hoc^g	U or F
Variables	Group	(a)	(b)	(c)	(d)	(P)^f	Post hoc^g	(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, d b>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, d b>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.