Exercise shores up the caregivers

Most mornings, Mardi Barrett Brick would wake up before her husband, who suffered from Alzheimer’s disease. She moved quietly to the other end of the couple’s mobile home to play favorite up-tempo songs by the Glenn Miller Orchestra or Duke Ellington.

Then she danced for at least 30 minutes a day four to five times per week. No partner necessary.

“I took a modern dance class in college,” said Brick, 77. “We had to make up our own steps and moves.”

Her husband, Chalo Barrett, died in 2000 at age 72. Brick said the regular dance sessions were “a lifesaver for me.” Chalo was diagnosed in 1994, and each year presented a heightened challenge for Brick as a caregiver.

“I wasn’t taking care of myself,” Brick recalled. “I was feeling awfully overburdened. I was depressed. I wasn’t yelling, `Help!,’ or ready to bail out. But I wasn’t enjoying life.”

One of Brick’s friends recognized the quiet desperation and dulled zest that can only be natural for a caregiver who is tending to a loved one with diminishing mental capabilities 24 hours/seven days per week. She pointed Brick to a newspaper advertisement in the San Jose Mercury News. Stanford University was recruiting participants for a study about caregivers and exercise.

“I live in Santa Cruz, so it was fortunate my friend noticed the ad,” said Brick, who recently married a widower she met as part of an Alzheimer’s Association support group.

Brick answered the ad in early 1999, becoming one of the first recruits in a study with results published in the June issue of Psychosomatic Medicine. The Stanford researchers found that following a regular exercise program improved physical health, including less pain and better sleep. Mental outlook improved significantly with reduced amounts of stress, depression and perceived burden.

Perhaps most impressive was that 74 percent of the caregivers continued exercising at least three times per week for a full year. These were all caregivers providing assistance, at an average of 70 hours weekly, to loved ones with some form of dementia. No caregiving situation is simple or easy, but experts recognize dementia as consistently difficult for those doing the caring.

“The exercise rate of the general population is not very high,” said Cynthia M. Castro, a clinical psychologist at the Stanford Center for Research in Disease Prevention and lead author of the study. “So we are pleased with the adherence levels of these caregivers. “

The study of 100 women in the San Francisco region was designed to examine whether a home-based exercise-counseling program could improve the physical and mental health of the caregivers. Half of the caregivers were assigned to the home-based exercise, while the other 50 received nutrition counseling but no exercise instruction.

Castro said the lifestyles, schedules and burdens of the caregivers were paramount in developing the study.

“Rather than require these women to leave home, making arrangements for someone else to watch their husband or father, we decided to bring the exercise to them,” Castro said.

Each of the women in the experimental group met with an exercise counselor for a one-on-one session that included a treadmill stress test. Participants were phoned once a month to discuss progress. The women recorded their exercise activities in a monthly diary, providing material for the next month’s phone call.

“I was glad to be part of the exercise group,” Brick said. “When I sat down with the woman from the study, she asked me what sort of exercise I liked. I told her that I love to dance. She looked a bit surprised; maybe she thought I was going to say golf or tennis. But she said, `That will work.'”

Brick learned during the treadmill stress test to make sure she danced at a proper target heart rate. Many other participants walked for exercise, on treadmills or outside. Exercise intensity should equal “a brisk walk or more vigorous,” Castro said.

One finding surprised Castro and her colleagues, spurring ideas about future research projects and caregiver interventions: The women in the “control” group receiving regular nutrition counseling also significantly improved mental outlook in the form of less stress, depression and perceived burden. These participants didn’t improve their exercise habits, cardiovascular health or sleep patterns, but they were better off a year later than typical caregivers in their situations.

“We didn’t expect the same psychological effect in the nutrition group,” Castro said. “It is likely there was a positive outcome for the caregivers talking to a health educator on a regular basis, even just by telephone. It can help more than we realize. That suggests some highly effective yet inexpensive ways [including phone or Internet contact] to support caregivers.”