Efeitos de um programa de telessaúde no nível de atividade física de pessoas idosas com demência e seus cuidadores durante a pandemia da COVID-19: um ensaio clínico randomizado e controlado

Abstract

Considering the increasing prevalence of dementia in older adults and its functional, neuropsychiatric, and psychosocial impacts on affected individuals and caregivers, it becomes relevant to investigate non-pharmacological strategies that are accessible and applicable in different care contexts. Multicomponent physical exercise programs combined with cognitive exercises, delivered via telehealth and using a multidisciplinary approach, may represent a promising alternative for health promotion, functional maintenance, and the reduction of caregiving burden. The main gap is the lack of studies that investigate, in an integrated and multidimensional way, the effects of multicomponent telehealth interventions, combining synchronous and asynchronous strategies, on the caregiver-older adult with dementia dyad, stratified by physical activity level (PAL). Thus, it is hypothesized that physical activity acts as an associated and potentially modifying factor of multidimensional outcomes in the dyad, and that a multicomponent intervention via telehealth may promote better outcomes for both. The overall objective was to investigate the level of physical activity in older adults with dementia and their caregivers, analyzing its associations with variables such as physical activity level, neuropsychiatric disorders and quality of life of older adults with dementia, and stress, burden and quality of life of caregivers, as well as the effects of a multicomponent exercise program via telehealth on the level of physical activity and related outcomes in this dyad. This doctoral thesis comprised three main studies that addressed the theme of telehealth and older adults with dementia and their caregivers during the COVID-19 pandemic. Study I aimed to evaluate the PAL of caregivers of older adults with dementia, considering stress, burden, and quality of life (QoL) during the COVID-19 pandemic. It consisted of a cross-sectional study with 89 caregivers of older adults with dementia who were assessed via Google Meet video call using the following instruments: International Physical Activity Questionnaire – short version (IPAQ); Perceived Stress Scale (PSS) and Zarit Burden Scale (ZARIT); Quality of Life in Alzheimer's Disease (QoL-AD) caregiver version. The results demonstrated a negative correlation between METs-minutes/week and caregiver burden, showing that the higher the PAL, the lower the burden; and a positive correlation between METs-minutes/week and QoL, showing that the higher the PAL, the higher the QoL. No correlation was found between PAL and stress. Furthermore, significant values were found for the model that includes caregiver burden in relation to METs. It was concluded that PAL proved effective in reducing caregiver burden and increasing QoL. Study II aimed to evaluate the associations between cognition, functionality, neuropsychiatric disorders (ND), and QoL with PAL in older adults with dementia. It consisted of a cross-sectional study composed of 80 older adults with dementia. They were assessed using the Clinical Dementia Rating Scale (CDR); the Baecke Physical Activity Questionnaire modified for older adults (BAECKE); and the Quality of Life in Alzheimer's Disease Scale (QoL-AD) older adults version. A 10-item version of the Neuropsychiatric Inventory Questionnaire (NPI – Q10) reported by caregivers in older adults with dementia. The results demonstrated significant correlations between PAL and cognition, QoL, and functionality. No significant correlation was found with ND. It was concluded that in older adults with dementia, higher PA was associated with better cognition, QoL, and functionality. Study III aimed to investigate the effect of a telehealth-based physical and cognitive exercise program intervention on PAL, as the primary outcome, in older adults with dementia. Secondarily, it investigated the effect of a physical and cognitive exercise program intervention, moderated by the initial PAL of older adults with dementia, on ND and QoL, and on caregiver burden, stress, and QoL. This consisted of a Randomized Controlled Clinical Trial, with pre-intervention, post-intervention (three-month) assessments and a three-month follow-up, comprising 80 dyads of older adults with dementia and their caregivers, randomly divided into two groups: Intervention Group (IG) and Control Group (CG). In the IG, older adults with dementia performed a protocol of physical and cognitive exercises through telehealth. Their caregivers received psychoeducation with guidance on dementia and coping with social distancing during COVID-19. The CG received only psychoeducation at the beginning of the proposed period and was questioned monthly about possible clinical events during the research period. The instruments used with the elderly person with dementia were: CDR; BAECKE modified for older adults; QoL-AD, older adults version; 10-item version of the NPI – Q10; The following instruments were applied to caregivers: IPAQ - short version; PSS; ZARIT; QoL-AD - caregiver version. The main results showed that the IG presented significantly higher physical activity levels (PA) than the CG at the 25th, 50th, and 75th percentiles post-intervention (270%, 220%, and 154% increase, respectively) and at follow-up (54% increase). For secondary outcomes, paired comparisons between groups post-intervention showed that, moderated by PAL at baseline, caregiver QoL values were significantly higher in the IG than in the CG. The physical exercise program, delivered via telehealth, was able to increase PAL in older adults with dementia, and these effects were maintained after the intervention and after the follow-up period. The findings reinforce the importance of structured exercise programs as a complementary strategy for care and prevention of functional decline in these populations.