A large clinical study to test a specially-designed programme of exercise for people who are in the early stages of dementia is to go ahead after a feasibility trial showed positive results.
The PrAISED (Promoting Activity Independence and Stability in Early Dementia) study is being led by a team of Nottingham-based experts thanks to a £2.8million grant from the National Institute for Health Research (NIHR). The trial is being publicised during Dementia Awareness Week 21st – 27th May 2018 and recruitment will start in September.
People in the early stages of dementia often struggle with everyday activities and are more prone to accidents. Between 60 and 80% of these people are injured in a fall every year and this can speed up the decline in both physical and mental health. Nearly half of broken hips happen in people with dementia so the new study aims to reduce the number of serious injuries by increasing fitness.
The PrAISED intervention is an individually tailored programme of exercise and daily activity aimed at maintaining independence and well-being. It is supported by health professionals and delivered using motivational approaches to support the long-term continuation of activity.
The team of researchers are from the University of Nottingham, Nottingham University Hospitals NHS Trust, the Nottinghamshire Healthcare NHS Foundation Trust, Nottingham Citycare Partnership and Bangor University. With help from Alzheimer’s Research UK, the team will be recruiting at least 400 people with dementia through several trial centres across England.
Leading the study, Professor Rowan Harwood, said: “Originally we were looking at ways of preventing falls, but interviews with patients, carers and professionals suggested that we should focus on promoting activity, independence and well-being rather than focusing solely on the falls themselves. This prompted us to develop a physical activity programme over the past five years that combines balance exercises, advice on undertaking daily activities confidently and safely, and a sensible approach towards what risks are worth taking and what are not.”
One target of the study is all about ‘dual-task’ activities - doing two things at once - which is a particular problem from the earliest stages of dementia, and which may respond to training. The team will carefully focus on individual’s abilities, interests and goals, to make taking part worthwhile for them. They will work with people with mild dementia who are at risk of deterioration and will look for benefits and impact on disability, rate of falling, activity levels, memory and quality of life. The aim is to try to set back the impact of the disease, to help people live well with dementia for longer.
The intervention was tested with a group of 60 people with early dementia in the Nottingham and Derby areas in 2016 and 2017. This safety and feasibility study compared the outcomes of groups of people with early dementia who were given the usual care and advice with the outcomes of those given the new therapy programme. The team analysed how the programme worked in practice, including the role and impact on families, and how it could be incorporated into existing services.
The researchers hope that the PrAISED trial will lead to a reduction in falls, fractures and resulting disability among people with dementia as well as the cost of disease progression with a real prospect of financial savings to the NHS. The exercise programme could form an important addition to the treatments offered to patients and families after a diagnosis of dementia.
This research paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Reference Number RP-PG-0614-20007). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
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