UA Study Shows Intensive Exercise Training Program for Dementia Patients Improves Care in Clinical Setting

By Jo Marie Barkley, Department of Surgery | January 8, 2014

Rehabilitation of basic functional tasks, such as rising from a chair or walking, reduces fall risk, prevents loss of independence and increases mobility-related quality of life in patients with dementia.

A high intensity, tailored exercise program might benefit patients with dementia more than a traditional rehabilitation program, according to new UA research.

A high intensity, tailored exercise program might benefit patients with dementia more than a traditional rehabilitation program, according to new UA research.
A study by researchers at the University of Arizona Department of Surgery, published in the Journal of Alzheimer’s Disease, showed that an innovative, customized exercise program applied to clinical practice substantially improved care for dementia patients.

The UA study combined high-intensity strength and functional exercises with specifically designed strategies for patients with dementia to promote exercise training in a hospital setting. The new exercise program was implemented in a hospital rehabilitation unit and compared with a usual-care rehabilitation program.

“Rehabilitation of basic functional tasks, such as the ability to rise from a chair or walking, is of utmost importance to reduce fall risk, prevent loss of independence and increase mobility-related quality of life in patients with dementia,” said Michael Schwenk, lead author of the paper and a research associate with the UA Interdisciplinary Consortium on Advanced Motion Performanc, or iCAMPHowever, there has been a lack of evidence whether patients with dementia can benefit from more intensive rehabilitation exercise programs.”

In addition to cognitive deficits, people with dementia experience declining basic motor performances, such as walking, during the course of the disease. Motor deficits worsen by the reduced physical activity and increase the fall rate in these patients, causing an additional disability burden. Based on motor and cognitive deficits, people with dementia have a threefold risk of falling compared with those without cognitive impairment, Schwenk said.

Results of the UA study showed that the higher-intensity, tailored exercise program greatly increased the benefits of functional performances in patients with dementia as compared with the traditional rehabilitation program. The patients who received the novel intensive training improved substantially in basic motor functions, such as lower-extremity muscle strength and postural balance, which are linked to the high fall risk in this population.

“Improvement in lower extremity strength was four times higher in the group that received the new training program compared to the group that received usual rehabilitation care only,” said Schwenk. “Results indicate that medium to high training adherence can be achieved in the majority of geriatric inpatients despite cognitive impairment and acute functional impairment.”

Several studies have identified cognitive impairment as a negative predictor for functional rehabilitation outcomes and that memory loss, language impairments or lack of motivation may be barriers for effective rehabilitation. Schwenk said geriatricians and therapists struggle with which type of exercise and what level of intensity is appropriate for these patients, and that little guidance is available as to which exercise program is the most suitable. Specific exercise programs incorporating strategies to promote exercise training in patients with dementia have not been adequately developed, he said.

“The UA study provides important insight as to how geriatric rehabilitation exercise programs in patients with dementia can be adjusted and rendered more effective,” Schwenk said. “Current findings may help to establish specifically designed rehabilitation exercise programs for patients with dementia and may provide guidance to clinicians as to which rehabilitation protocols are the most effective.”

Schwenk, who also is a member of the UA’s Arizona Center on Aging, collaborated on the study with a multidisciplinary team that included Bijan Najafi, iCAMP director, UA associate professor of surgery and engineering, and member of the Arizona Center on Aging, the UA Arthritis Center and the UA Cancer Center; Jane Mohler, iCAMP clinical adviser, associate director of the Arizona Center on Aging and associate professor of medicine with co-appointments in the UA colleges of Nursing and Pharmacy and the UA Mel and Enid Zuckerman College of Public Health; Ilona Dutzi, William Micol and Klaus Hauer, all with the Department of Geriatric Research, Bethanien-Hospital/Geriatric Centre at the University of Heidelberg, Germany; and Stefan Englert, with the Institute of Medical Biometry and Informatics, University of Heidelberg, Germany.

Contacts

Jo Marie Barkley
Department of Surgery
520-626-7219
jgellerm@email.arizona.edu

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TGen, Nemucore and Barrow team up under $3M Ivy Foundation grant

Ivy Foundation awards $3 million grant, supporting brain cancer research in Arizona

 

The Ben & Catherine Ivy Foundation announced a $3 million grant to the Translational Genomics Research Institute (TGen), Nemucore Medical Innovations Inc., and Barrow Neurological Institute at St. Joseph’s Hospital and Medical Center to help fund significant brain tumor research in Arizona. ( Dateline:  December 18, 2013)

 

The collaboration of TGen, Nemucore and Barrow will pursue ways to optimize targeted therapies delivered by nanotechnology systems to treat glioblastoma, the most common and most aggressive form of malignant brain tumors.

 

This project is a primary example of translational research, moving laboratory findings as soon as practicable to patient care. Laboratory success should result in eventual follow-on efforts in the biomanufacturing of personalized medicine and implementation of new therapies in clinical trials.

 

“We are excited about this innovative approach to research, especially the collaboration between two major Arizona institutions: TGen and Barrow,” said Catherine Ivy, Founder and President of the Ivy Foundation. “Knowing there is a tangible way to develop therapies specific to the needs of patients will enhance the care and treatment of every brain tumor patient—and that is priceless.”

 

One of the goals of this Ivy Foundation grant is to enable TGen, Nemucore and Barrow to collaboratively align their findings toward the goal of creating new medications that can bridge the body’s blood-brain barrier, which in the past has hampered the successful implementation of intravenous brain-cancer drugs.

 

Each of the collaborators is a leader in their respective fields:

•TGen’s genomic sequencing—in which all 3 billion base-pair letters of human DNA are spelled out, in order—can be used to create molecular profiles of patients and match specific therapies to diseases, providing the promise of better clinical results while minimizing side effects.

•Nemucore specializes in the development of life-saving cancer nanomedicines, in which drugs are packaged in ways that evade cancer defenses, delivering medications that can knockout tumors.

•Barrow, which is internationally known for its treatment of neurological disorders and treats one of the highest volumes of brain tumors in the United States, will conduct preclinical work to design nanomedicines for better access to the tumor, and will also provide the setting for clinical trials, in which patients are the first to benefit from new therapies.

 

“Working with the research team from the outset of the study will be helpful. We can advise them on methods or components as they develop novel formulations suitable for crossing the blood-brain barrier,” said Dr. Tim Coleman, CEO of Nemucore. “Without this type of integrated approach it would take much longer to translate these individualized investigational therapies to the clinic.”

 

Based on the research findings, the team would work with a strategic manufacturing partner, Blue Ocean Biomanufacturing, to develop methods to manufacture personalized medicine for the treatment of glioblastoma.

 

Coleman also is CEO of Blue Ocean, which is developing a cutting edge, fully flexible manufacturing facility in Peoria, Arizona. With a focus on small-batch pharmaceuticals and personalized medicine, Blue Ocean will advance breakthrough technologies for producing biopharmaceuticals with reasonable economics. This revolutionary technology will make it possible to use the genetics of a single patient’s tumor to customize and produce the medicine specific to them.

 

“Barrow’s collaboration with TGen and Nemucore is unique in that we will develop novel drug delivery technology that fully spans basic academic science through bench top translation and manufacturing,” says Dr. Rachael Sirianni, assistant professor at the Barrow Brain Tumor Research Center. “Our first and foremost goal is to improve the prospects for patients diagnosed with glioblastoma, and to translate our academic science into safe and effective therapies. This innovative partnership between our respective institutions and the funding provided by the Ivy Foundation will make it possible to bring forward academic research to benefit patients at Barrow and elsewhere.”

 

“This grant is a tremendous step in changing the way medicine is developed in Arizona,” said Dr. Michael Berens, TGen Deputy Director for Research Resources and Director of TGen’s Cancer and Cell Biology Division. “This project should enable us to develop treatments that will bridge the blood-brain barrier. I wholeheartedly thank the Ivy Foundation for their continuing support of the work we are doing to find new and effective treatments for the patients afflicted with this most aggressive form of cancer.”

 

Provided by The Translational Genomics Research Institute