Stanford researchers help caregivers find relief in home-based exercise program

STANFORD, Calif. - Taking care of a loved one with dementia can be emotionally draining and physically taxing, so it's no surprise that caregivers have higher rates of depression, anxiety, sleep problems, elevated blood pressure and compromised immunity. But a study by researchers at Stanford University Medical Center shows that a home-based exercise program can yield significant mental and physical benefits for caregivers, including increased physical fitness and strength, better sleep, and decreased depression, anxiety and pain.

Lead author Cynthia M. Castro, PhD, research associate at the Stanford Center for Research in Disease Prevention, explained that 'despite the burdens of caring for their loved ones, our research showed that these people are really interested in taking care of their own health, which is important to make sure they can continue fulfilling this crucial role.' The study appears in the June issue of Psychosomatic Medicine.

More than five million Americans provide in-home, unpaid care for family members with dementia, saving the health-care system an estimated $34,500 annually per caregiver. That number is expected to increase as the nation's elderly population expands.

Castro and her colleagues recruited 51 women, age 50 or over, each caring for a demented relative living with her at home. The women did not engage in regular physical activity and provided an average of 70 hours of care per week.

Each participant received an in-person counseling session with a health educator, who provided instruction on developing a weekly schedule of up to four 30- to 40-minute sessions of moderate-intensity, home-based exercise.

During the following 12 months, participants received periodic phone calls from the counselor, who asked about the participant's activity level and schedule and provided guidance and referrals as needed. The caregivers kept weekly activity logs, which they sent to their counselor.

Among the study's most surprising results was the high retention rate (only six of the 51 women dropped out of the program by the end of the year) and the participants' strong commitment to the program. Despite the significant time commitment and the emotional stress of their caregiving responsibilities, the participants completed 70 percent of their prescribed exercise sessions each month on average.

The participants' high level of participation shows the effectiveness of home-based programs featuring regular phone contact with a counselor, Castro said. 'This kind of approach has a lot to offer,' she added. 'It's convenient, it fits in with their schedule, and it doesn't require them to leave home.'

In surveys conducted at the end of the study, participants said they felt better physically and mentally. They reported increased strength and fitness, decreased pain and better sleep, as well as decreased stress and depression.

Linda Flores, one of the participants, said the exercise program was 'one of the things that kept me sane' during the two years she took care of her mother (now deceased), who had Alzheimer's disease. 'It was a taxing, painful experience,' she said of seeing her mother, a retired teacher, lose her memory and grasp on reality - asking the same questions over and over, trying to leave the house in the middle of the night, and repeatedly emptying the linen closet.

Flores started out walking a few times a week, then built up to running and working out at a gym. 'When I'd exercise, I'd come back feeling invigorated and like I could go on one more day,' she said. 'It really helped alleviate the stress.' As the program went on, Flores said, she felt healthier overall and paid more attention to her diet.

Castro's team also worked with a similar group of 49 caregivers who participated in an at-home nutrition-counseling program instead of the exercise program. While researchers expected the nutrition group to experience less physical benefit, they were surprised to find that participants in this group stuck to their program just as much and experienced similar improvements in psychological well-being. Castro thinks the frequent, supportive contact with a counselor - a feature of both groups - likely accounted for these improvements.

'Just being involved in a program and knowing someone is checking in with you and cares about your health may be enough to produce significant psychological benefit,' she said.

Castro hopes the findings will spur the creation of similar home-based health promotion programs by agencies serving dementia patients and families. 'As the number of people with dementia increases, the number of family caregivers will also grow, so programs like this are going to be really important,' she said. 'Caregivers need to find ways to take care of their own health so they can take care of someone else.'