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An Exercise Program for Women Who Are Caring for Relatives With Dementia

From the Stanford Center for Research in Disease Prevention (C.M.C., P.O.), Department of Exercise Science, School of Public Health, University of South Carolina, Columbia (S.W.) and Departments of Obstetrics and Gynecology, Stanford University (K.B.), and the Departments of Health Research and Policy and Medicine (A.C.K.), Stanford University School of Medicine, Palo Alto, California.

Address reprint requests to: Dr. Cynthia M. Castro, Stanford Center for Research in Disease Prevention, 730 Welch Road, Suite B, Palo Alto, CA 94304-1583. Email: cynthia.castro{at}stanford.edu

OBJECTIVE: This study describes factors related to retention and adherence to an exercise program for women caregivers.

METHODS: One hundred sedentary women (average age = 62 years) caring for relatives with dementia were randomly assigned to an exercise program or an attention control (nutrition education) condition. Participants in the exercise condition received 12 months of home-based exercise counseling to achieve at least four exercise sessions per week, for at least 30 minutes per session. Adherence was tracked through monthly exercise logs, validated in a subsample by ambulatory heart rate and motion monitors. Participants also completed a psychosocial questionnaire battery at baseline and 12 months after randomization.

RESULTS: Participants achieved a 12-month average exercise adherence rate of 74% (ie, three exercise sessions per week) with an average of 35 minutes per session. At 12 months, the exercise condition demonstrated increased knowledge of the benefits of exercise and increased motivational readiness for exercise compared with the nutrition education condition. Both groups significantly improved in perceived stress, burden, and depression from baseline to posttest. Women who were older, less depressed, and more anxious at baseline showed better program retention, and lower baseline depression was associated with better exercise adherence.

CONCLUSIONS: This study demonstrates the feasibility and success of delivering home-based health promotion counseling for improving physical activity levels in a highly stressed and burdened population. Given the independent risk factors of caregiving and physical inactivity on mortality, programs to improve healthful behaviors are needed to preserve the health of caregivers as they undertake this important familial and societal role.

Key Words: dementia caregivers, • health promotion, • exercise, • retention, • adherence.

Abbreviations: ADLs = activities of daily living;; BDI = Beck Depression Inventory;; IADLs = instrumental activities of daily living;; ISEL = Interpersonal Social Evaluation List;; KR-20 = Kuder-Richardson coefficient;; PSS = Cohen Perceived Stress Scale;; RPE = Rating of Perceived Exertion;; TLC = Teaching Healthy Lifestyles for Caregivers;; TMAS = Taylor Manifest Anxiety Scale.

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