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Physical Activity and Alzheimer's Disease: Measurements, Observations and Subjective Experiences
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Gait disturbances such as slow walking speed and step-to-step variability have been reported among people with mild Alzheimer’s disease (AD) and as risk factors for functional decline, dependency, and falls. Additionally, AD-related emotional reactions and decreased initiative can lead to physical inactivity. The aims of this thesis, therefore, were to explore how the ability to be physically active is affected in the early years of AD, and how people with mild AD and their cohabitants reason about physical activity as part of their everyday life.

To meet the aims, an approach inspired by mixed methods research was used, covering measurements, observations and subjective experiences. Data were collected from different sources in parallel. Participants with mild AD were recruited at the Memory Clinic, Uppsala University Hospital. In Study I, a case study with two couples in which one member had AD, in-depth interviews and participating interviews were performed. Physical activity such as walking was viewed as a meaningful routine improving well-being. Participants were positive about making adjustments to enable physical activity. In Study II, the 25 participants with AD showed a significant lower walking capacity (10 m comfortable walk test, 6-minute walk test, Timed-up-and-Go test) at baseline compared to controls. The decline continued during the subsequent two years. The influence of a cognitive task on walking was distinct, despite this, participants maintained a health-promoting level of physical activity during the two-year study-period. In Study III, gait testing in the motor laboratory of 21 participants with AD showed a marked impact on gait parameters (e.g. slowed speed, decreased step length) by a cognitive task. Additionally, specific dual-task gait disturbances were frequent. In Study IV, in-depth interviews with 14 participants with AD indicated that physical activity was viewed as a meaningful activity, used as a means to maintain well-being and selfhood, and contributed to continuity in life.

In conclusion, walking capacity deteriorates and declines in the early stages of AD. A simple cognitive task can have a substantially negative impact on walking already in mild AD. In contrast, people with AD can also gain “self-promoting benefits” from physical activity beyond the common health-promoting benefits.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 82 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1008
Keyword [en]
Caregiver, continuity theory, dementia, dual-task, gait analysis, in-depth interview, mixed methods research, participant observation, physical capacity, qualitative, selfhood, walking
National Category
Physiotherapy
Research subject
Physiotherapy; Geriatrics
Identifiers
URN: urn:nbn:se:uu:diva-223687ISBN: 978-91-554-8967-0 (print)OAI: oai:DiVA.org:uu-223687DiVA: diva2:713898
Public defence
2014-06-13, Gunnesalen, Akademiska sjukhuset ing 10, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-05-21 Created: 2014-04-23 Last updated: 2014-06-30
List of papers
1. Physical activity and implications on well-being in mild Alzheimer's disease: A qualitative case study on two men with dementia and their spouses
Open this publication in new window or tab >>Physical activity and implications on well-being in mild Alzheimer's disease: A qualitative case study on two men with dementia and their spouses
2010 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 26, no 4, 226-239 p.Article in journal (Refereed) Published
Abstract [en]

To improve the understanding of experiences of people with mild Alzheimer's disease (AD) and their significant others, related to the physical activity of the afflicted persons and its perceived importance. A qualitative case study design was used. The study comprised two men with mild AD and their wives. Data were collected by qualitative interviews and participant observations. Data analysis followed a thematic guideline as described by Braun and Clarke ( 2006 ). Three central themes of experiences related to physical activity in AD were identified: 1) physical activity as health reinforcement; 2) barriers to physical activity; and 3) adaptation strategies. Important motivations for outdoor walks were enjoyable experiences of nature, body movement, and positive attitudes toward physical activity. Several factors were experienced as barriers to physical activity (e.g., tiredness, difficulties in finding one's way, and "peculiar behavior"). Significant others made considerable adjustments in everyday life to enable their partners to retain a physically active lifestyle. The findings indicate that in persons with AD, physical activities such as outdoor walking can play an important part in everyday life by creating meaningful routines and improving experienced well-being and health.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-144803 (URN)10.3109/09593980903423012 (DOI)20397857 (PubMedID)
Available from: 2011-02-02 Created: 2011-02-02 Last updated: 2017-12-11Bibliographically approved
2. Declining Physical Capacity But Maintained Aerobic Activity in Early Alzheimer's Disease
Open this publication in new window or tab >>Declining Physical Capacity But Maintained Aerobic Activity in Early Alzheimer's Disease
2012 (English)In: American Journal of Alzheimer’s Disease and Other Dementia, ISSN 1533-3175, E-ISSN 1938-2731, Vol. 27, no 3, 180-187 p.Article in journal (Refereed) Published
Abstract [en]

The longitudinal influences on physical capacity and habitual aerobic activity level in the early stages of Alzheimer's disease (AD) are unclear. Therefore, changes in physical capacity and aerobic activity level were evaluated. Twenty-five individuals with AD were assessed annually for 2 years, by 10-m walk test, 6-minute walk test, and timed up-and-go (TUG) single/dual tasks. Habitual aerobic activity was assessed by diary registrations. The AD group showed a lower physical capacity than controls at baseline but comparable levels of aerobic activity. During the follow-up period, physical capacity declined in the AD group, but the aerobic activity levels changed only marginally. Our results show that in the early stages of AD, people are capable of maintaining health-promoting aerobic activity levels, despite a decline in their physical capacity. Additionally, it appears that cognitive dysfunction contributes to an impaired physical capacity. The TUG tasks might, therefore, be useful for detecting early signs of cognitive impairment.

Keyword
dementia, longitudinal, physical activity, timed up-and-go, walking
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-175200 (URN)10.1177/1533317512442996 (DOI)000303831300007 ()22573284 (PubMedID)
Available from: 2012-06-07 Created: 2012-06-04 Last updated: 2017-12-07Bibliographically approved
3. A longitudinal study of gait function and characteristics of gait disturbances in individuals with Alzheimer's disease
Open this publication in new window or tab >>A longitudinal study of gait function and characteristics of gait disturbances in individuals with Alzheimer's disease
2014 (English)In: Gait & Posture, ISSN 0966-6362, E-ISSN 1879-2219, Vol. 39, no 4, 1022-1027 p.Article in journal (Refereed) Published
Abstract [en]

Walking in daily life places high demands on the interplay between cognitive and motor functions. A well-functioning dual-tasking ability is thus essential for walking safely. The aims were to study longitudinal changes in gait function during single- and dual-tasking over a period of two years among people with initially mild AD (n = 21). Data were collected on three occasions, twelve months apart. An optical motion capture system was used for three-dimensional gait analysis. Gait parameters were examined at comfortable gait speed during single-tasking, dual-tasking naming names, and naming animals. The dual-task cost for gait speed was pronounced at baseline (names 26%, animals 35%), and remained so during the study period. A significant (p < 0.05) longitudinal decline in gait speed and step length during single- and dual-tasking was observed, whereas double support time, step width and step height showed inconsistent results. Systematic visual examination of the motion capture files revealed that dual-tasking frequently resulted in gait disturbances. Three main characteristics of such disturbances were identified: Temporal disturbance, Spatial disturbance and Instability in single stance. These aberrant gait performances may affect gait stability and increase the risk of falling. Furthermore, the observed gait disturbances can contribute to understanding and explaining previous reported gait variability among individuals with AD. However, the role that dual-task testing and aberrant dual-task gait performance play in the identification of individuals with early signs of cognitive impairment and in predicting fall risk in AD remains to be studied.

National Category
Physiotherapy Control Engineering
Identifiers
urn:nbn:se:uu:diva-223680 (URN)10.1016/j.gaitpost.2013.12.026 (DOI)000333801400004 ()
Available from: 2014-04-23 Created: 2014-04-23 Last updated: 2017-12-05Bibliographically approved
4. Maintained well-being and selfhood through physical activity: the meanings that people with Alzheimer's disease attach to being active
Open this publication in new window or tab >>Maintained well-being and selfhood through physical activity: the meanings that people with Alzheimer's disease attach to being active
(English)Manuscript (preprint) (Other academic)
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-223686 (URN)
Available from: 2014-04-23 Created: 2014-04-23 Last updated: 2014-06-30

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