Dyadic Group Exercises for Persons with Memory Deficits and Care Partners: Mixed-Method Findings from the Paired Preventing Loss of Independence through Exercise (PLIÉ) Randomized Trial

Article type: Research Article

Authors: Mehling, Wolf E.^{a; b; c; *} | Scott, Travis M.^{d; e} | Duffy, James^{f; g} | Whitmer, Rachel A.^{g; h} | Chesney, Margaret A.^b | Boscardin, W. John^{c; j; k} | Barnes, Deborah E.^{c; f; k; *}

Affiliations: [a] University of California San Francisco, Department of Family and Community Medicine, San Francisco, CA, USA | [b] University of California San Francisco, Osher Center for Integrative Medicine, San Francisco, CA, USA | [c] San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA | [d] Veterans Affairs Palo Alto Sierra Pacific Mental Illness Research, Education, & Clinical Center, Palo Alto, CA, USA | [e] Stanford School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, CA, USA | [f] University of California San Francisco, Department of Psychiatry, San Francisco, CA, USA | [g] Kaiser Permanente Medical Center, Oakland, CA, USA | [h] Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA | [i] University of California Davis, Department of Public Health Sciences, Davis, CA, USA | [j] University of California San Francisco, Department of Medicine, San Francisco, CA, USA | [k] University of California San Francisco, Department of Epidemiology and Biostatistics, San Francisco, CA, USA

Correspondence: [*] Correspondence to: Wolf E. Mehling, MD, Department of Family and Community Medicine, Osher Center for Integrative Medicine, University of California San Francisco, 1545 Divisadero St, 4th floor, San Francisco, CA 94115, USA. Tel.: +1 415 353 9506; E-mail: Wolf.Mehling@ucsf.edu and Deborah E. Barnes, PhD, MPH, UCSF Weill Institute for Neurosciences, Departments of Psychiatry and Epidemiology & Biostatistics, University of California, San Francisco San Francisco VA Medical Center, 4150 Clement Street, 151R, San Francisco, CA 94121, USA. Tel.: +1 415 221 4810 ext. 24221; Fax: +1 415 750 6669; E-mails: deborah.barnes@ucsf.edu or deborah.barnes4@va.gov

Abstract: Background:Non-pharmacological therapies for persons with dementia (PWD) are needed. Objective:To develop and test the Paired Preventing Loss of Independence through Exercise (PLIÉ) program, an integrative group movement program for PWD and care partners (CPs). Methods:Participants were randomized to immediate or delayed start to Paired PLIÉ in community-based classes (1 hour, 2 days/week, 12 weeks, 3 home visits). Co-primary outcomes included standard measures of cognition, physical function,and quality of life (PWD) and caregiver burden (CPs) assessed by blinded assessors, analyzed using linear mixed models to calculate effect sizes for outcome changes during Paired PLIÉ, controlling for randomization group. Anonymous satisfaction surveys included satisfaction ratings and thematic analysis of open-ended responses. Results:Thirty dyads enrolled, 24 (80%) completed. PWD (mean age 80; 55% female) experienced significant improvement in self-rated quality of life (Effect Size+0.23; p = 0.016) when participating in Paired PLIÉ, while CPs experienced a non-significant increase in burden (–0.23, p = 0.079). Changes in physical and cognitive function in PWD were not significant. All CPs returning the satisfaction survey (n = 20) reported being moderately-to-highly satisfied with the program. Thematic analyses identified physical (e.g., sit-to-stand, more energy), emotional (enjoyment), and social benefits (peer-to-peer interaction) for PWD and CPs; challenges were primarily related to getting to the in-person classes. Conclusion:Paired PLIÉ is a promising integrative group movement program that warrants further study. It is feasible and may improve self-rated quality of life in PWD. Although CPs may experience increased burden due to logistical challenges, most reported high satisfaction and physical, emotional, and social benefits.

Keywords: Alzheimer’s disease, caregiver, dementia, exercise, quality of life

DOI: 10.3233/JAD-200713

Journal: Journal of Alzheimer's Disease, vol. 78, no. 4, pp. 1689-1706, 2020