Effects of Walking on Sundown Syndrome and Sleep Quality in community dwelling people with Alzheimer’s disease

• Main Authors: Yen-HuaShih, 施燕華
• Other Authors: Jing-Jy Wang
• Format: Others
• Language: en_US
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/99wgfw

博士 === 國立成功大學 === 護理學系 === 106 === Background: Sundown syndrome and sleep quality are important care issues for both people with dementia (PwD) and caregivers. Studies have indicated that disturbances of the circadian rhythm and sleep-wake rhythm a common occurrence in PwD and related to sundown syndrome and sleep quality. Walking is a safe and simple physical activity for most PwD. Many studies illustrated that physical exercise could affect agitation and sleep quality due to the regulation of circadian rhythm and sleep-wake rhythm, yet no research has ever explored the different effect of different long-term walking periods on sundown syndrome and sleep quality. Purposes: The aims of this study were thus to examine the effects of walking on sundown syndrome and sleep quality in community dwelling people with Alzheimer’s disease, and determine whether different walking time periods show different effects on sundown syndrome and sleep quality in community dwelling people with Alzheimer’s disease. Design: A quasi-experimental and longitudinal study design with four measurements were conducted. Methods: 60 PwD who were recruited from dementia out-patient clinics of several hospitals and long-term care resource management centers in southern Taiwan, were equally assigned to either the control, morning or afternoon walking group according to their wishes for a six month intervention consisting of an average of 120 minutes walking per week, accompanied by their caregivers. 46 PwD completed the study at the end point. The Chinese version of the Cohen-Mansfield Agitation Inventory, Community form (CMAI-C) was used to assess sundown syndrome and the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI) was used to measure sleep quality. Four measurements were conducted at the pre-test and three post-tests at 8th, 16th and 24th week. The Generalized estimating equation (GEE) was mainly performed for the longitudinal data analysis. Results: An average 90.2% of the three groups finished the intervention with four adverse events reported in PwD. After walking for 8 weeks, the scores of the CMAI decreased significantly in the morning walking group (Wald X2= 7.91, p= .048) compared to the pre-test. Different groups presented different effects. The CMAI scores significantly decreased after 16 weeks walking in the afternoon (Wald X2=14.64, p=0.001) and after 24 weeks in the morning and afternoon walking groups (Wald X2= 15.08, p= .001) compared to the control group. However, there was no significant group difference between the morning and afternoon walking groups during the 24-week walking intervention. Regarding sleep quality, there was a significant effect on the CPSQI score after walking for 16 weeks in the afternoon walking group (Wald X2= 11.03, p= .012). Surprisingly, there was a significant difference in the sleep quality at 16 weeks in the control group compared to the pre-test (Wald X2= 14.91, p= .02). The group difference after 8 weeks walking in sleep quality improved significantly in the morning walking group than in the control and afternoon walking groups (Wald X2=11.33, p=0.003). However, no difference in sleep quality was found between the morning and afternoon walking groups. Conclusions: The different effects between the three groups showed at 16-week and 24-week measurements. After 16 weeks walking in the afternoon group, sundown syndrome improved and after continuously walking for 24 weeks, sundown syndrome improved continually. Sundown syndrome also gradually improved after a longer walking time in the morning group; however there was no different effect between the two walking groups. The results indicated that either morning or afternoon walking was effective for improving sundown syndrome, and the longer the walking time was, the more sundown syndrome improved. Regarding sleep quality, only at 8 weeks did the significant difference among groups show that sleep quality in the morning walking group was better than in the afternoon walking and non-walking group. This study suggests that continued morning or afternoon walking could have a beneficial effect on sundown syndrome; shorter morning walking could improve sleep quality. In addition, the participation rate in the two walking groups was good in this study, this further indicates that walking is a concrete, feasible and effective intervention to improve sundown syndrome and promote sleep quality.