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Effects of a home-based exercise program on mental health for caregivers of relatives with dementia: a randomized controlled trial

Published online by Cambridge University Press:  07 September 2020

Miguel Madruga Open the ORCID record for Miguel Madruga [Opens in a new window] ,
Margarita Gozalo ,
Josué Prieto ,
Paloma Rohlfs Domínguez  and
Narcís Gusi
Miguel Madruga*
Affiliation:
Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
Margarita Gozalo
Affiliation:
Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
Josué Prieto
Affiliation:
University School of Tourism and Education, University of Salamanca, Ávila, Spain
Paloma Rohlfs Domínguez
Affiliation:
Department of Psychology and Anthropology, University of Extremadura, Cáceres, Spain
Narcís Gusi
Affiliation:
Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
*
Correspondence should be addressed to: Miguel Madruga, Faculty of Sport Sciences, Av. de la Universidad S/N, 10071Cáceres, Spain. Phone +34 927257460. Email: miguelmadruga@unex.es.
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Abstract

Objective:

This study was aimed to evaluate the effectiveness of a home-based physical exercise program on participants’ mental health: psychological symptoms, depression, and burden of female informal caregivers.

Design and participants:

In a randomized controlled trial, a sample of 48 female informal primary caregivers completed the entire study, 25 were randomly allocated to the intervention group (IG), and 23 participants to the control group (CG).

Intervention:

Participants in the IG performed two 60-minute-long physical exercise sessions per week (36 weeks) that were supervised by a personal trainer at caregivers’ home during 9 months. The CG continued their habitual leisure-time activities.

Measurements:

Subjective burden was assessed by the Zarit Burden Interview. The risk of depression was measured by the Geriatric Depression Scale Short Form 15-item version, and psychological symptoms were evaluated by the Symptom Check List-90-Revised (SCL-90-R). All participants were evaluated at baseline and at the end of the intervention.

Results:

A promising positive impact of the intervention on caregivers’ subjective burden and risk of depression was found in the IG. In addition, no significant between-group differences were found in any of nine subscales scores of the SCL-90-R. Finally, care recipients’ level of functional independence and area of residence were found to be predictors of the promising positive impact on caregivers’ subjective burden and risk of depression.

Conclusions:

The present home-based physical exercise intervention that was individually implemented has shown promising results to reduce subjective burden and risk of depression in female caregivers of relatives with dementia. However, future research efforts should elucidate both the particular dose of physical exercise and the particular duration of the intervention that are required to obtain the expected significant positive impact. Finally, future inclusion of psychological approaches, besides physical exercise, might help reduce female caregivers’ psychological symptoms.

Keywords

caregiverdementiahome-based interventionmental healthphysical exerciserisk of depressionsubjective burden
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 4: Issue Theme: Caring for Caregivers of People with Dementia , April 2021 , pp. 359 - 372
Copyright
© International Psychogeriatric Association 2020

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References

Alfakhri, A. S. et al. (2018). Depression among caregivers of patients with dementia. Inquiry, 55, 46958017750432. doi: 10.1177/0046958017750432.Google ScholarPubMed
Alonso, A., Garrido, A., Díaz, A., Casquero, R. and Riera, M. (2004). Perfil y sobrecarga de los cuidadores de pacientes con demencia incluidos en el programa ALOIS. Revista de Atención Primaria, 33, 61–68.CrossRefGoogle Scholar
Alzheimer’s Disease International (2016). World Alzheimer Report 2016. Improving healthcare for people living with dementia: coverage, Quality and costs now and in the future. London: Alzheimer’s Disease International.Google Scholar
Badia, X., Lara, N. and Roset, M. (2004). Quality of life, time commiment and burden perceived by the principal informal caregiver of Alzheimer’s patients. Revista de Atención Primaria, 34, 170–177. doi: 10.1016/S0212-6567(04)78904-0.Google Scholar
Birkenhäger-Gillesse, E., Kollen, B., Zuidema, S. and Achterberg, W. (2018). The “more at home with dementia” program: a randomized controlled study protocol to determine how caregiver training affects the well-being of patients and caregivers. BMC Geriatrics, 18, 252–259. doi: 10.1186/s12877-018-0948-3.CrossRefGoogle ScholarPubMed
Brodaty, H. and Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217–228.Google ScholarPubMed
Burns, E., Fleming, R., Wagstaff, D., Goodwin, J., Hirschman, R. and Greenberg, J. (2002). Affective and Behavioral Stress Outcomes in Alzheimer’s Caregivers. Journal of Applied Biobehavioral Research, 7, 65–74.CrossRefGoogle Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. doi: 10.1037//0033-2909.112.1.155.CrossRefGoogle ScholarPubMed
Connell, C. M. and Janevic, M. R. (2009). Effects of a telephone-based exercise intervention for dementia caregiving wives: a randomized controlled trial. Journal of Applied Gerontology, 28, 171–194. doi: 10.1177/0733464808326951.CrossRefGoogle ScholarPubMed
Craft, L. (2005). Exercise and clinical depression: examining two psychological mechanisms. Psychology and Sport and Exercise, 6, 151–171.CrossRefGoogle Scholar
Cuthbert, C. A. et al. (2018). The effects of exercise on physical and psychological outcomes in cancer caregivers: results from the RECHARGE randomized controlled trial. Annals of Behavioral Medicine, 52, 645–661. doi: 10.1093/abm/kax040.CrossRefGoogle ScholarPubMed
Chan, W. C., Lautenschlager, N., Dow, B., Ma, S. L., Wong, C. S. and Lam, L. C. (2016). A home-based exercise intervention for caregivers of persons with dementia: study protocol for a randomised controlled trial. Trials, 17, 460. doi: 10.1186/s13063-016-1582-z.CrossRefGoogle ScholarPubMed
Chiao, C. Y., Wu, H. S. and Hsiao, C. Y. (2015). Caregiver burden for informal caregivers of patients with dementia: a systematic review. International Nursing Review, 62, 340–350. doi: 10.1111/inr.12194.CrossRefGoogle ScholarPubMed
Del Rio Lozano, M., Garcia-Calvente, M. D. M., Calle-Romero, J., Machon-Sobrado, M. and Larranaga-Padilla, I. (2017). Health-related quality of life in Spanish informal caregivers: gender differences and support received. Quality of Life Research, 26, 3227–3238. doi: 10.1007/s11136-017-1678-2.CrossRefGoogle ScholarPubMed
Delgado, E., Suárez, O., De Dios, R., Valdespino, I., Sousa, Y. and Braña, G. (2014). Características y factores relacionados con sobrecarga en una muestra de cuidadores principales de pacientes ancianos con demencia. SEMERGEN, 40, 8.Google Scholar
Derogatis, L. (1977). SCL-90-R, Administration, Scoring and Procedures Manual I for the Revised Version of the SCL-90. Baltimore: Johns Hopkins University Press Google Scholar
Domingues, N. S., Verreault, P. and Hudon, C. (2018). Reducing burden for caregivers of older adults with mild cognitive impairment: a systematic review. American Journal of Alzheimer’s Disease & Other Dementias, 33, 401–414. doi: 10.1177/1533317518788151.CrossRefGoogle ScholarPubMed
Farran, C. J. et al. (2016a). Effect of moderate to vigorous physical activity intervention on improving dementia family caregiver physical function: a randomized controlled trial. The Journal of Alzheimer Disease & Parkinsonism, 6. doi: 10.4172/2161-0460.1000253.CrossRefGoogle ScholarPubMed
Farran, C. J. et al. (2016b). Impact of an individualized physical activity intervention on improving mental health outcomes in family caregivers of persons with dementia: a randomized controlled trial. AIMS Medical Science, 3, 15–31. doi: 10.3934/medsci.2016.1.15.CrossRefGoogle ScholarPubMed
Feast, A., Orrell, M., Russell, I., Charlesworth, G. and Moniz-Cook, E. (2017). The contribution of caregiver psychosocial factors to distress associated with behavioural and psychological symptoms in dementia. International Journal of Geriatric Psychiatry, 32, 76–85. doi: 10.1002/gps.4447.CrossRefGoogle ScholarPubMed
Fusar-Poli, P., et al. (2020). What is good mental health? A scoping review. European Neuropsychopharmacology, 31, 33–46. doi: 10.1016/j.euroneuro.2019.12.105.CrossRefGoogle ScholarPubMed
Garzón-Maldonado, F., Gutiérrez-Bedmar, M., García-Casares, N., Pérez-Errázquin, F., Gallardo-Tur, A. and Martínez-Valle, M. (2016). Calidad de vida relacionada con la salud en cuidadores de pacientes con enfermedad de Alzheimer. Neurología, 32, 508–515. doi: 10.1016/j.nrl.2016.02.023.CrossRefGoogle Scholar
Gaugler, J. and Kane, R. (2015). A Perfect Storm? The Future of Family Caregiving. Family Caregiving in the New Normal. San Diego: Elsevier.Google Scholar
Gitlin, L. N., Marx, K., Stanley, I. H. and Hodgson, N. (2015). Translating evidence-based dementia caregiving interventions into practice: state-of-the-science and next steps. Gerontologist, 55, 210–226. doi: 10.1093/geront/gnu123.CrossRefGoogle ScholarPubMed
González-De Paz, L., Real, J., Borrás-Santos, A., Martínez-Sánchez, J. M., Rodrigo-Baños, V. and Dolores Navarro-Rubio, M. (2016). Associations between informal care, disease, and risk factors: a Spanish country-wide population-based study. Journal of Public Health Policy, 37, 173–189. doi: 10.1057/jphp.2016.3.CrossRefGoogle ScholarPubMed
Goy, E., Kansagara, D. and Freeman, M. 2010. A Systematic Evidence Review of Interventions for Non-professional Caregivers of Individuals with Dementia. Washington, DC: Department of Veterans Affairs.Google ScholarPubMed
Haines, K. J., Denehy, L., Skinner, E. H., Warrillow, S. and Berney, S. (2015). Psychosocial outcomes in informal caregivers of the critically ill: a systematic review. Critical Care Medicine, 43, 1112–1120. doi: 10.1097/CCM.0000000000000865.CrossRefGoogle ScholarPubMed
Hill, K., Smith, R., Fearn, M., Rydberg, M. and Oliphant, R. (2007). Physical and psychological outcomes of a supported physical activity program for older carers. Journal of Aging and Physical Activity, 15, 257–271.CrossRefGoogle ScholarPubMed
Hirano, A., Suzuki, Y., Kuzuya, M., Onishi, J., Ban, N. and Umegaki, H. (2011). Influence of regular exercise on subjective sense of burden and physical symptoms in community-dwelling caregivers of dementia patients: a randomized controlled trial. Archives of Gerontology and Geriatrics, 53, e158–e163. doi: 10.1016/j.archger.2010.08.004.CrossRefGoogle ScholarPubMed
Jackson, G. and Browne, D. (2017). Supporting carers of people with dementia: what is effective? BJPsych Advances, 23, 179–189.CrossRefGoogle Scholar
Kaddour, L., Kishita, N. and Schaller, A. (2019). A meta-analysis of low-intensity cognitive behavioral therapy-based interventions for dementia caregivers. International Psychogeriatrics, 31, 961–976. doi: 10.1017/S1041610218001436.CrossRefGoogle Scholar
King, A. C., Baumann, K., O’sullivan, P., Wilcox, S. and Castro, C. (2002). Effects of moderate-intensity exercise on physiological, behavioural and emotional responses to family caregiving: a randomized controlled trial. Journal of Gerontology, 57A, 26–36.Google Scholar
Kuo, L. M. et al. (2013). A home-based training program improves Taiwanese family caregivers’ quality of life and decreases their risk for depression: a randomized controlled trial. International Journal of Geriatric Psychiatry, 28, 504–513. doi: 10.1002/gps.3853.CrossRefGoogle ScholarPubMed
Lamotte, G., Shah, R. C., Lazarov, O. and Corcos, D. M. (2017). Exercise training for persons with Alzheimer’s disease and caregivers: a review of dyadic exercise interventions. Journal of Motor Behavior, 49, 365–377. doi: 10.1080/00222895.2016.1241739.CrossRefGoogle ScholarPubMed
Lee, M., Ryoo, J. H., Crowder, J., Byon, H. D. and Wiiliams, I. C. (2020). A systematic review and meta-analysis on effective interventions for health-related quality of life among caregivers of people with dementia. Journal of Advanced Nursing, 76, 475–489. doi: 10.1111/jan.14262.CrossRefGoogle ScholarPubMed
Lopez, J. and Crespo, M. (2008). Analysis of the efficacy of a psychotherapeutic program to improve the emotional status of caregivers of elderly dependent relatives. Aging and Mental Health, 12, 451–461.CrossRefGoogle ScholarPubMed
Lowery, D. et al. (2014). The effect of exercise on behavioural and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. International Journal of Geriatric Psychiatry, 29, 819–827. doi: 10.1002/gps.4062.CrossRefGoogle ScholarPubMed
Madruga, M., Prieto, J., Rohlfs, P. and Gusi, N. (2020). Cost-effectiveness and effects of a home-based exercise intervention for female caregivers of relatives with dementia: study protocol for a randomized controlled trial. Healthcare (Basel), 8. doi: 10.3390/healthcare8010054.Google ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Marquez-Gonzalez, M., Losada-Baltar, A., Izal, M., Perez-Rojo, G. and Montorio, I. (2007). Modification of dysfunctional thoughts about caregiving in dementia family caregivers: description and outcomes of an Intervention Program. Aging & Mental Health, 616–625. doi: 10.1080/13607860701368455.CrossRefGoogle Scholar
Mbakile-Mahlanza, L., Van der Ploeg, E., Busija, L., Camp, C., Walker, H. and O’Connor, D. (2020). A cluster-randomized crossover trial of Montessori activities delivered by family carers to nursing home residents with behavioral and psychological symptoms of dementia. International Psychogeriatrics, 32, 347–358. doi: 10.1017/S1041610219001819.CrossRefGoogle ScholarPubMed
Mitsonis, C., Voussoura, E., Dimopoulos, N., Psarra, V., Kararizou, E., Latzouraki, E., et al. (2012). Factors associated with caregiver psychological distress in chronic schizophrenia. Social Psychiatry and Psychiatric Epidemiology, 47, 331–337. doi: 10.1007/s00127-010-0325-9.CrossRefGoogle ScholarPubMed
Orgeta, V. and Miranda-Castillo, C. (2014). Does physical activity reduce burden in carers of people with dementia? A literature review. International Journal of Geriatric Psychiatry, 29, 771–783.CrossRefGoogle ScholarPubMed
Pérez-Fuentes, M., Gázquez, J., Ruiz, M. and Molero, M. (2017). Inventory of overburden in Alzheimer’s patient family caregiver with no specialized training. International Journal of Clinical and Health Psychology, 17, 56–64. doi: 10.1016/j.ijchp.2016.09.004.CrossRefGoogle ScholarPubMed
Ploeg, J. et al. (2017). Web-based interventions to improve mental health, general caregiving outcomes, and general health for informal caregivers of adults with chronic conditions living in the community: rapid evidence review. Journal of Medical Internet Research, 19, e263. doi: 10.2196/jmir.7564.CrossRefGoogle ScholarPubMed
Pot, A. M., Deeg, J. H. and Van Dyck, R. (1997). Psychological well-being of informal caregiver in elderly people with dementia: changes over time. Aging & Mental Health, 1, 261–268.CrossRefGoogle Scholar
Prick, A. E., De Lange, J., Scherder, E. and Pot, A. M. (2011). Home-based exercise and support programme for people with dementia and their caregivers: study protocol of a randomised controlled trial. BMC Public Health, 11, 894. doi: 10.1186/1471-2458-11-894.CrossRefGoogle ScholarPubMed
Prick, A. E., De Lange, J., Twisk, J. and Pot, A. M. (2015). The effects of a multi-component dyadic intervention on the psychological distress of family caregivers providing care to people with dementia: a randomized controlled trial. International Psychogeriatrics, 27, 2031–2044. doi: 10.1017/S104161021500071X.CrossRefGoogle ScholarPubMed
Rodriguez-Sanchez, E. et al. (2013). Effects of a psychological intervention in a primary health care center for caregivers of dependent relatives: a randomized trial. Gerontologist, 53, 397–406. doi: 10.1093/geront/gns086.CrossRefGoogle Scholar
Sacristan, J., Oliva, J., Del Llano, J., Prieto, L. and Pinto, J. (2002). What is an efficient health technology in Spain? Gaceta Sanitaria, 16, 334–343.Google ScholarPubMed
Shim, S. H., Kang, H. S., Kim, J. H. and Kim, D. K. (2016). Factors associated with caregiver burden in dementia: 1-year follow-up study. Psychiatry Investigation, 13, 43–49. doi: 10.4306/pi.2016.13.1.43.CrossRefGoogle ScholarPubMed
Shua-Haim, J. R., Haim, T., Shi, Y., Kuo, Y. H. and Smith, J. M. (2001). Depression among Alzheimer’s caregivers: identifying risk factors. American Journal of Alzheimer’s Disease & Other Dementias, 16, 353–359.CrossRefGoogle ScholarPubMed
Sorensen, S., Pinquart, M. and Duberstein, P. (2002). How effective are interventions with caregivers? An updated meta-analysis. Gerontologist, 42, 356–372.CrossRefGoogle ScholarPubMed
Stella, F., Canonici, A. P., Gobbi, S., Galduroz, R. F., Cacao Jde, C. and Gobbi, L. T. (2011). Attenuation of neuropsychiatric symptoms and caregiver burden in Alzheimer’s disease by motor intervention: a controlled trial. Clinics (Sao Paulo), 66, 1353–1360.CrossRefGoogle ScholarPubMed
Thomas, S., Reading, J. and Shephard, R. J. (1992). Revision of the Physical Activity Readiness Questionnaire (PAR-Q). Canadian Journal of Sport Sciences, 17, 338–345.Google Scholar
Turró-Garriga, O., Soler-Cors, O., Garre-Olmo, J., López-Pousa, S., Vilalta-Franch, J. and Monserrat-Vila, S. (2008). Distribución factorial de la carga en cuidadores de pacinetes con enfermedad de Alzheimer. Revista de Neurología, 46, 582–588.CrossRefGoogle Scholar
Vandepitte, S., Van Den Noortgate, N., Putman, K., Verhaeghe, S. and Annemans, L. (2016a). Effectiveness and cost-effectiveness of an in-home respite care program in supporting informal caregivers of people with dementia: design of a comparative study. BMC Geriatrics, 16, 207. doi: 10.1186/s12877-016-0373-4.CrossRefGoogle ScholarPubMed
Vandepitte, S., Van Den Noortgate, N., Putman, K., Verhaeghe, S., Faes, K. and Annemans, L. (2016b). Effectiveness of supporting informal caregivers of people with dementia: a systematic review of randomized and non-randomized controlled trials. Journal of Alzheimer’s Disease, 52, 929–965. doi: 10.3233/JAD-151011.CrossRefGoogle ScholarPubMed
Viñas-Díez, V., Conde-Sala, J. L., Turró-Garriga, O., Gascón-Bayarri, J. and Reñé-Ramírez, R., R. (2019). Síntomas depresivos y sobrecarga en los familiares cuidadores en la enfermedad de Alzheimer: un modelo de ecuaciones estructurales. Revista de Neurología, 69, 11–17. doi: 10.33588/rn.6901.2018504.CrossRefGoogle Scholar
Werner, P. (2019). Reflections on quality of care for persons with dementia: Moving toward an integrated, comprehensive approach. International Psychogeriatrics, 31, 307–308. doi: 10.1017/S1041610219000346.CrossRefGoogle ScholarPubMed
World Health Organization (2004). Promoting mental health : concepts, emerging evidence, practice : summary report. Geneva: World Health Organization, Victorian Health Promotion Foundation and The University of Melbourne.Google Scholar
Yesavage, J., Brink, T. L., Rose, T. L. and Lum, O. (1983). Development and validation of a geriatric depression scale: a preliminary report. Journal of Psychiatry Research, 17, 37–49.CrossRefGoogle Scholar
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655. doi: 10.1093/geront/20.6.649.CrossRefGoogle ScholarPubMed
Zijlstra, T. R., Braakman-Jansen, L. M., Taal, E., Rasker, J. J. and Van De Laar, M. A. (2007). Cost-effectiveness of Spa treatment for fibromyalgia: general health improvement is not for free. Rheumatology (Oxford), 46, 1454–1459. doi: 10.1093/rheumatology/kem157.CrossRefGoogle Scholar