Efeito do exercício em casa versus presencial na aptidão física e funcionalidade de idosos com doença de Alzheimer: um ensaio clínico randomizado controlado

Abstract

Introduction: Alzheimer’s disease (AD) progressively impairs cognition and functionality in older adults. Non-pharmacological strategies, such as supervised physical exercise, have proven effective in maintaining functional independence. Telerehabilitation has emerged as a promising alternative, especially in contexts with logistical and access barriers. Objective: To evaluate the effects of a supervised multicomponent exercise program delivered via telerehabilitation on the functionality and balance of older adults with AD, in comparison to face-to-face supervision and a control group. Methods: A randomized clinical trial was conducted with 35 older adults diagnosed with mild to moderate AD, allocated into three groups: telerehabilitation (TG, n=10), face-to-face supervision (FFSG, n=12), and control (CG, n=13). The intervention lasted 12 weeks, with two weekly sessions of multicomponent exercises. The following outcomes were assessed: postural balance (force platform), functional mobility (TUG), lower limb strength (sit-to-stand test), and functionality (DAD Scale). Statistical analysis was performed using generalized estimating equations (p<0.05). Results: The TG showed a significant improvement in lower limb strength (FFSG: 10±4reps pre and 10±4reps post; TG: 7±3reps pre and 9±3reps post; CG: 8±3reps pre and 9±3reps post; group: p=0.083; time: p=0.012; interaction: p=0.039). The FFSG group showed an increase in postural sway with eyes open (FFSG: 60±16.9cm pre and 75.3±6.9cm post; TG: 65.9±19.6cm pre and 77±8.3cm post; CG: 72.8±22.6cm pre and 62.5±20.3cm post; group: p=0.728; time: p=0.098; interaction: p=0.003) and with eyes closed (FFSG: 71.7±23.5cm pre and 95.3±19.8cm post; TG: 83.6±34.2cm pre and 77.3±15.4 cm post; CG: 89±33.4cm pre and 75.5±19.1cm post; group: p=0.965; time: p=0.794; interaction: p<0.001), indicating a decline in balance. All other tests showed maintenance of the variables assessed. Conclusion: Telerehabilitation proved effective in improving muscle strength and maintaining balance, agility, handgrip strength, and functionality, representing a viable and accessible alternative for older adults with AD.