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The latest evidence for practice

Una Adderley
Community Tissue
Viability Prescribing

Could exercise slow decline for patients with Alzheimer's disease?

The incidence of Alzheimer's disease is steadily increasing, and with no sight of a potential cure, interventions that slow the progress of the disease are urgently required.
This French randomised controlled trial sought to discover whether an exercise programme could slow the decline of the ability to undertake activities of daily living for patients with Alzheimer's disease living in nursing homes. A total of 134 patients aged between 62 and 103 years from five different nursing homes participated in the trial. All the participants were able to transfer from a chair and walk at least six metres without human assistance.
The participants were randomly divided into two groups. Those in the exercise group participated in individualised aerobic, strength, flexibility and balance training (including walking). The exercise sessions lasted one hour and occurred twice a week with at least two days between sessions. The second group received normal care. After 12 months the exercise group participants showed less decline in their abilities to undertake activities of daily living, but there was no difference between the two groups regarding the incidence of falls or deaths. 
A commentary notes that adherence to the exercise programme was low, but that exercise adherence was closely related to ess deterioration in activities of daily living. Therefore it suggests that further research should focus on exploring the barriers to adherence for this group of patients and an evaluation of cost-effectiveness.

Rolland Y, Pillard F, Klapouszczak A, et al. Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial. J Am Geriatr Soc 2007;55:158-65.

Forbes DA. Evid Based Nurs 2007;10:89

How can we help obese children lose weight?

Worryingly, Great Britain is raising a generation of overweight children that may have a shorter life expectancy than their parents. This English qualitative study sought to discover what obese children saw as the levers (facilitators) and barriers to weight loss. Six girls and 14 boys who were clinically obese and attending an NHS-funded weight loss programme took part in individual 20 minute interviews and follow-up focus groups that addressed initial awareness of weight problems, the process of behavioural change, previous attempts to lose weight, reasons for losing weight, and facilitators and barriers to weight loss. 
Bullying was identified as a prompt to change. All the participants had experienced bullying and some suggested that bullying was "normal" behaviour. Other reasons prompting change were the wish to "fit in" and to improve physical abilities. Only two children mentioned future health. Bullying was also identified as the means by which most children recognised their obesity, but the influence of a significant person, often their mother, was the more common driving force behind deciding to lose weight.
The participants were aware of the necessary sacrifices involved in weight loss, but perceived advice from dietitians as a barrier to dealing with the problem. The real challenge was seen not in deciding to lose weight, but in maintaining weight loss action. Continual support was viewed as essential and children reported that motivation was affected by low levels of confidence and self-esteem as well as some factors that were outside their control, such as access to sports facilities and the cost of "healthy" school meals.
A commentary suggests that targeting parents may be very important in weight loss programmes.

Murtagh J, Dixey R, Rudolf M. A qualitative investigation into the levers and barriers to weight loss in children: opinions of obese children. Arch Dis Child 2006;91:920-3.

MacDonald M. Evid Based Nurs 2007;10:92.