The featured paper is ‘Exercise Interventions for Dementia and Cognitive Impairment: The Seattle Protocols’ by Teri and colleagues and freely available here. The paper is a brief one which introduces a system of programs for engaging people with cognitive impairment in the community in exercise and are referred to as the Seattle Protocols. The authors identify four goals for the Protocols:- ‘identifying, intiating and maintaining participation in enjoyable physical exercise’, managing obstacles to exercise using behavioural and problem-solving approaches, using ‘interpersonal support’ and focusing on activities which are readily available in the community. The authors refer the interested reader to another paper for consideration of the basis of the Protocols and state that they will be dealing with the application of the protocols in this article. Nevertheless they do cover material relevant to the theory and evidence base later in the paper.
The authors then describe the approach as using a model in which exercise is considered as a series of behaviours. The person with cognitive impairment is encouraged to shape their behaviours into the pattern needed for exercise. If the person is unable to initiate or maintain this, then the same approach is used with the support of the carer. The authors describe the exercises as those that maintain ‘strength and mobility’ and are designed to facilitate daily tasks as well as balancing and endurance exercises. The authors have been creative in making the exercises more enjoyable thus ensuring an intrinsic reward is associated with the activities. The authors also work with the carer in the problem solving exercises.
The authors then cover some of the empirical evidence. They look at the Reducing Disability In Alzheimer’s Disease (RDAD) Study an RCT involving 153 people with Alzheimer’s Disease (AD) assigned to a protocol or treatment as usual and followed-up over 24 months. This study showed a number of benefits in terms of measures of exercise or activity and also depression scores. The Nighttime Insomnia Treatment and Education in Alzheimer Disease study (NITE-AD) is then covered in which 36 people with AD were evaluated over a 6-month period. Compared to a control group, those that engaged in the exercise program again had better scores on the depression scale and also on activity measures. Finally the Resources and Activities for Life Long Independence (RALLI) study are considered. In this study, cognitively intact exercise partners accompanied people with Mild Cognitive Impairment to the exercise classes while they were learning the exercises. Cues were used in the person’s home. 34 people were enrolled into the study and there were no dropouts! There were more impressive results when at 6-month follow-up, 82% of the subjects had exercises at least once in the preceding week, a significant increase over baseline. There were a number of improvements on outcome measures including a mean increase of 1.2 points on the MMSE although this was significant at the 6% level.
This is a brief paper which provides useful information on the Seattle Protocols and it will be very interesting to follow the further developments of these protocols which already have a supporting evidence base.
STT2 (Could be considered for incorporation into policy)
Steps To Treatment (STT)
STT = Steps To Treatment. An estimate of the number of steps between the results and translation into practice i.e. treatment. This is an opinion. A policy statement would have a value of 1 as this a guide for practice whereas a speculative model would get a much higher score as there are more steps between statement of the model and treatment (which would involve testing the model, informing treatment approaches and trialling these approaches for instance).
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