Physical activity and its relationship to burden and health concerns in family caregivers of people with dementia
Leandro da Silva-Sauer
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Search for more papers by this authorRicardo Basso Garcia
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Search for more papers by this authorÉgina Karoline Gonçalves Fonsêca
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Department of Neuroscience, University of São Paulo, Ribeirão Preto, Brazil
Search for more papers by this authorCorresponding Author
Bernardino Fernández-Calvo
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Department of Psychology, Faculty of Educational Sciences and Psychology, University of Córdoba, Córdoba, Spain
Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
Correspondence: Bernardino Fernández-Calvo, Facultad de Ciencias de la Educación y Psicología. Departamento de Psicología. C/San Alberto Magno s/n, 14071 Córdoba, Spain. Email: [email protected]
Search for more papers by this authorLeandro da Silva-Sauer
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Search for more papers by this authorRicardo Basso Garcia
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Search for more papers by this authorÉgina Karoline Gonçalves Fonsêca
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Department of Neuroscience, University of São Paulo, Ribeirão Preto, Brazil
Search for more papers by this authorCorresponding Author
Bernardino Fernández-Calvo
Laboratory of Ageing and Neurodegenerative Disorder, Department of Psychology, Federal University of Paraíba, João Pessoa, Brazil
Department of Psychology, Faculty of Educational Sciences and Psychology, University of Córdoba, Córdoba, Spain
Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
Correspondence: Bernardino Fernández-Calvo, Facultad de Ciencias de la Educación y Psicología. Departamento de Psicología. C/San Alberto Magno s/n, 14071 Córdoba, Spain. Email: [email protected]
Search for more papers by this authorAbstract
Background
Caring for people with dementia (PwD) usually triggers stress and leads to mental and somatic health complaints (SHCs). Physical activity (PA) can provide burden relief in PwD caregivers, but it is not clear whether PA habits would contribute to reducing SHCs. This study aims to analyze the effect of PA on the relationship between burden and SHCs in a sample of family caregivers of PwD.
Methods
One hundred and fifty-seven caregivers of PwD reported their PA habits, and completed the Giessen's Subjective Health Complaints Questionnaire (GBB-8) and the Zarit Burden Interview (ZBI). The relationship between PA habits, burden of care (ZBI), and SHCs (B-GBB-8 scale) was examined. Subsequently, the moderating effect of PA habits on the relationship between burden and SHCs was tested.
Results
PA habit was inversely associated with ZBI (rbp = −0.242) and GBB-8 scores (rbp (Gastrointestinal) = −0.174; rbp (Musculoskeletal) = −0.195; rbp (Exhaustion) = −0.247; rbp (Cardiovascular) = −0.250; and rbp (Overall) = −0.257, respectively), whereas moderate positive correlations were found between ZBI and GBB-8 scores (r (Gastrointestinal) = 0.483; r (Musculoskeletal) = 0.536; r (Exhaustion) = 0.542; r (Cardiovascular) = 0.438; and r (Overall) = 0.598, respectively). The interaction effect of PA habit and burden was significant for the overall SHCs (b = −0.11; P < 0.05) and cardiovascular complaints (b = −0.06; P < 0.05). However, the association between burden and SHCs was significant (P < 0.001) only for sedentary caregivers.
Conclusion
These findings indicate that maintaining an active lifestyle through regular PA could potentially help alleviate the adverse effects of caregiver burden on somatic health among caregivers of PwD. Encouraging and endorsing PA interventions for informal caregivers might yield substantial advantages for their health and general well-being.
Conflict of Interest
The authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association, 2000.
- 2Wang Q, Sheng Y, Wu F, Zhang Y, Xu X. Effect of different sources support on adaptation in families of patient with moderate-to-severe dementia in China. Am J Alzheimers Dis Other Demen 2019; 34: 361–375. https://doi.org/10.1177/1533317519855154.
- 3Schulz R, Martire LM. Family caregiving of persons with dementia: prevalence, health effects, and support strategies. Am J Geriatr Psychiatry 2004; 12: 240–249. https://doi.org/10.1097/00019442-200405000-00002.
- 4Zarit SH, Orry NK, Zarit JM. The hidden victims of Alzheimer's disease. In: Families under stress. New York: NY University Press, 1985.
- 5Pearlin LI, Mullan JT, Semple SJ, Skaff MM. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist 1990; 30: 583–594. https://doi.org/10.1093/geront/30.5.583.
- 6Schulz R, Williamson GM. The measurement of caregiver outcomes in Alzheimer disease research. Alzheimer Dis Assoc Disord 1997; 11: 117–124.
- 7Jütten LH, Mark RE, Sitskoorn MM. Empathy in informal dementia caregivers and its relationship with depression, anxiety, and burden. Int J Clin Health Psychol 2019; 19: 12–21. https://doi.org/10.1016/j.ijchp.2018.07.004.
- 8Liu S, Li C, Shi Z et al. Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer's disease caregivers in China. J Clin Nurs 2017; 26: 1291–1300. https://doi.org/10.1111/jocn.13601.
- 9Dassel KB, Carr DC. Does dementia caregiving accelerate frailty? Findings from the health and retirement study. Gerontologist 2016; 56: 444–450. https://doi.org/10.1093/geront/gnu078.
- 10Mausbach BT, Aschbacher K, Patterson TL et al. Effects of placement and bereavement on psychological well-being and cardiovascular risk in Alzheimer's caregivers: a longitudinal analysis. J Psychosom Res 2007; 62: 439–445. https://doi.org/10.1016/j.jpsychores.2006.10.011.
- 11Schulz R, Beach SR, Czaja SJ, Martire LM, Monin JK. Family caregiving for older adults. Annu Rev Psychol 2020; 71: 635–659. https://doi.org/10.1146/annurev-psych-010419-050754.
- 12Ruisoto P, Contador I, Fernández-Calvo B, Palenzuela D, Ramos F. Exploring the association between optimism and quality of life among informal caregivers of persons with dementia. Int Psychogeriatr 2019; 31: 309–315. https://doi.org/10.1017/S104161021800090X.
- 13Serra L, Contador I, Fernández-Calvo B et al. Resilience and social support as protective factors against abuse of patients with dementia: a study on family caregivers. Int J Geriatr Psychiatry 2018; 33: 1132–1138. https://doi.org/10.1002/gps.4905.
- 14O'Dwyer ST, Moyle W, Zimmer-Gembeck M, De Leo D. Suicidal ideation in family carers of people with dementia: a pilot study. Int J Geriatr Psychiatry 2013; 28: 1182–1188. https://doi.org/10.1002/gps.3941.
- 15Kellner R. Psychosomatic Syndromes and Somatic Symptoms. Washington D.C.: American Psychiatric Press Inc, 1991.
- 16Kliem S, Lohmann A, Klatt T et al. Brief assessment of subjective health complaints: development, validation and population norms of a brief form of the Giessen subjective complaints list (GBB-8). J Psychosom Res 2017; 95: 33–43. https://doi.org/10.1016/j.jpsychores.2017.02.003.
- 17Koh K. Stress and Somatic Symptoms: Biopsychosociospiritual Perspectives. Switzerland: Springer Nature, 2018. https://doi.org/10.1007/978-3-030-02783-4_5.
10.1007/978-3-030-02783-4 Google Scholar
- 18Gierk B, Kohlmann S, Kroenke K et al. The somatic symptom scale–8 (SSS-8): a brief measure of somatic symptom burden. JAMA Intern Med 2014; 174: 399–407. https://doi.org/10.1001/jamainternmed.2013.12179.
- 19Creed FH, Davies I, Jackson J et al. The epidemiology of multiple somatic symptoms. J Psychosom Res 2012; 72: 311–317. https://doi.org/10.1016/j.jpsychores.2012.01.009.
- 20Baumgarten M, Hanley JA, Infante-Rivard C, Battista RN, Becker R, Gauthier S. Health of family members caring for elderly persons with dementia: a longitudinal study. Ann Intern Med 1994; 120: 126–132. https://doi.org/10.7326/0003-4819-120-2-199401150-00005.
- 21Gräsel E. Somatic symptoms and caregiving strain among family caregivers of older patients with progressive nursing needs. Arch Gerontol Geriatr 1995; 21: 253–266. https://doi.org/10.1016/0167-4943(95)00660-D.
- 22Park SS. Caregivers' mental health and somatic symptoms during COVID-19. J Gerontol B Psychol Sci Soc Sci 2021; 76: e235–e240. https://doi.org/10.1093/geronb/gbaa121.
- 23Badia LX, Suriñach LN, Gamisans RM. Calidad de Vida, tiempo de dedicación y carga percibida por el cuidador principal informal del enfermo de Alzheimer [quality of life, time commitment and burden perceived by the principal informal caregiver of Alzheimer's patients]. Aten Primaria 2004; 34: 170–177. Spanish. https://doi.org/10.1016/S0212-6567(04)78904-0.
- 24Roca RM, Úbeda Bonet I, Fuentelsaz Gallego C et al. Impacto del hecho de cuidar en la salud de los cuidadores familiares. [impact of caring on the health of family carers]. Aten Primaria 2000; 26: 217–223. https://doi.org/10.1016/S0212-6567(00)78650-1.
- 25Dubbert PM. Physical activity and exercise: recent advances and current challenges. J Consult Clin Psychol 2002; 70: 526–536. https://doi.org/10.1037/0022-006X.70.3.526.
- 26Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ 2006; 174: 801–809. https://doi.org/10.1503/cmaj.051351.
- 27Cuthbert CA, King-Shier K, Ruether D, Tapp DM, Culos-Reed SN. What is the state of the science on physical activity interventions for family caregivers? A systematic review and RE-AIM evaluation. J Phys Act Health 2017; 14: 578–595. https://doi.org/10.1123/jpah.2016-0280.
- 28Lambert SD, Duncan LR, Kapellas S et al. A descriptive systematic review of physical activity interventions for caregivers: effects on caregivers' and care recipients' psychosocial outcomes, physical activity levels, and physical health. Ann Behav Med 2016; 50: 907–919. https://doi.org/10.1007/s12160-016-9819-3.
- 29Loi SM, Dow B, Ames D et al. Physical activity in caregivers: what are the psychological benefits? Arch Gerontol Geriatr 2014; 59: 204–210. https://doi.org/10.1016/j.archger.2014.04.001.
- 30Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380: 219–229. https://doi.org/10.1016/S0140-6736(12)61031-9.
- 31Piercy KL, Troiano RP, Ballard RM et al. The physical activity guidelines for Americans. JAMA 2018; 320: 2020–2028. https://doi.org/10.1001/jama.2018.14854.
- 32Lowery D, Cerga-Pashoja A, Iliffe S et al. The effect of exercise on behavioral and psychological symptoms of dementia: the EVIDEM-E randomised controlled clinical trial. Int J Geriatr Psychiatry 2014; 29: 819–827. https://doi.org/10.1002/gps.4062.
- 33Ablin JN, Clauw DJ, Lyden AK et al. Effects of sleep restriction and exercise deprivation on somatic symptoms and mood in healthy adults. Clin Exp Rheumatol 2013; 31: S53–S59.
- 34Capistrant BD. Caregiving for older adults and the Caregivers' health: an epidemiologic review. Curr Epidemiol Rep 2016; 3: 72–80. https://doi.org/10.1007/s40471-016-0064-x.
10.1007/s40471-016-0064-x Google Scholar
- 35Zigmond AS, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x.
- 36Hayes AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach, 2nd edn. New York: The Guilford Press, 2018.
- 37 IBM Corp. IBM SPSS Statistics for Windows, V. 25.0. Armonk, NY: IBM Corp; Released 2017.
- 38Farran CJ, Staffileno BA, Gilley DW et al. A lifestyle physical activity intervention for caregivers of persons with Alzheimer's disease. Am J Alzheimers Dis Other Demen 2008; 23: 132–142.
- 39Marquez DX, Bustamante EE, Kozey-Keadle S, Kraemer J, Carrion I. Physical activity and psychosocial and mental health of older caregivers and non-caregivers. Geriatr Nurs 2012; 33: 358–365. https://doi.org/10.1016/j.gerinurse.2012.03.003.
- 40von Känel R, Mausbach BT, Dimsdale JE et al. Regular physical activity moderates cardiometabolic risk in Alzheimer's caregivers. Med Sci Sports Exerc 2011; 43: 181–189. https://doi.org/10.1249/MSS.0b013e3181e6d478.
- 41Hirano A, Suzuki Y, Kuzuya M, Onishi J, Ban N, Umegaki H. Influence of regular exercise on subjective sense of burden and physical symptoms in community-dwelling caregivers of dementia patients: a randomized controlled trial. Arch Gerontol Geriatr 2011; 53: e158–e163. https://doi.org/10.1016/j.archger.2010.08.004.
- 42Orgeta V, Miranda-Castillo C. Does physical activity reduce burden in carers of people with dementia? A literature review. Int J Geriatr Psychiatry 2014; 29: 771–783. https://doi.org/10.1002/gps.4060.
- 43Beesley VL, Price MA, Webb PM. Loss of lifestyle: health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer. Support Care Cancer 2011; 19: 1949–1956. https://doi.org/10.1007/s00520-010-1035-2.
- 44Hill K, Smith R, Fearn M, Rydberg M, Oliphant R. Physical and psychological outcomes of a supported physical activity program for older carers. J Aging Phys Act 2007; 15: 257–271.
- 45Gomes GAO, Luchesi BM, Gratão ACM et al. Prevalence of physical inactivity and associated factors among older caregivers of older adults. J Aging Health 2019; 31: 793–813. https://doi.org/10.1177/0898264318756422.
- 46Jowsey T, McRae I, Gillespie J, Banfield M, Yen L. Time to care? Health of informal older carers and time spent on health related activities: an Australian survey. BMC Public Health 2013; 13: 374. https://doi.org/10.1186/1471-2458-13-374.
- 47McEwen BS, Stellar E. Stress and the individual: mechanisms leading to disease. Arch Intern Med 1993; 153: 2093–2101. https://doi.org/10.1001/archinte.1993.00410180039004.
- 48von Känel R, Dimsdale JE, Mills PJ et al. Effect of Alzheimer caregiving stress and age on frailty markers interleukin-6, C-reactive protein, and D-dimer. J Gerontol A Biol Sci Med Sci 2006; 61: 963–969. https://doi.org/10.1093/gerona/61.9.963.
- 49Kiecolt-Glaser JK, Dura JR, Speicher CE, Trask OJ, Glaser R. Spousal caregivers of dementia victims: longitudinal changes in immunity and health. Psychosom Med 1991; 53: 345–362. https://doi.org/10.1097/00006842-199107000-0000.
- 50Glaser R, Kiecolt-Glaser JK. Chronic stress modulates the virus-specific immune response to latent herpes simplex virus type 1. Ann Behav Med 1997; 19: 78–82. https://doi.org/10.1007/BF02883323.
- 51Roepke SK, Mausbach BT, Patterson TL et al. Effects of Alzheimer caregiving on Allostatic load. J Health Psychol 2011; 16: 58–69. https://doi.org/10.1177/1359105310369188.
- 52Kiecolt-Glaser JK, Marucha PT, Mercado AM, Malarkey WB, Glaser R. Slowing of wound healing by psychological stress. Lancet 1995; 346: 1194–1196. https://doi.org/10.1016/S0140-6736(95)92899-5.
- 53Kim JH, Knight BG. Effects of caregiver status, coping styles, and social support on the physical health of Korean American caregivers. Gerontologist 2008; 48: 287–299. https://doi.org/10.1093/geront/48.3.287.
- 54Vara-García C, Romero-Moreno R, Von Känel R et al. Associations between pleasant events, activity restriction, stressors, and blood pressure in caregivers of persons with dementia. Int Psychogeriatr 2021; 34: 1–11. https://doi.org/10.1017/S1041610221000715.
- 55Shaw WS, Patterson TL, Ziegler MG, Dimsdale JE, Semple SJ, Grant I. Accelerated risk of hypertensive blood pressure recordings among Alzheimer caregivers. J Psychosom Res 1999; 46: 215–227. https://doi.org/10.1016/S0022-3999(98)00084-1.
- 56Capistrant BD, Moon JR, Berkman LF, Glymour MM. Current and long-term spousal caregiving and onset of cardiovascular disease. J Epidemiol Community Health 2012; 66: 951–956. https://doi.org/10.1136/jech-2011-200040.
- 57Nayor M, Chernofsky A, Spartano NL et al. Physical activity and fitness in the community: the Framingham heart study. Eur Heart J 2021; 42: ehab580. https://doi.org/10.1093/eurheartj/ehab580.
- 58Beach SR, Schulz R, Yee JL, Jackson S. Negative and positive health effects of caring for a disabled spouse: longitudinal findings from the caregiver health effects study. Psychol Aging 2000; 15: 259–271. https://doi.org/10.1037//0882-7974.15.2.259.
- 59Unger ES, Grabowski DC, Chen JT, Berkman LF. Association between new-onset Medicaid home care and family Caregivers' health. JAMA Health Forum 2021; 2: e212671. https://doi.org/10.1001/jamahealthforum.2021.2671.
- 60Lackland DT, Voeks JH. Metabolic syndrome and hypertension: regular exercise as part of lifestyle management. Curr Hypertens Rep 2014; 16: 492. https://doi.org/10.1007/s11906-014-0492-2.
- 61Palatini P, Bratti P, Palomba D, Saladini F, Zanatta N, Maraglino G. Regular physical activity attenuates the blood pressure response to public speaking and delays the development of hypertension. J Hypertens 2010; 28: 1186–1193. https://doi.org/10.1097/HJH.0b013e328338a8e7.
- 62Beutel ME, Wiltink J, Schwarz R, Weidner W, Brähler E. Complaints of the ageing male based on a representative community study. Eur Urol 2002; 41: 85–93. https://doi.org/10.1016/S0302-2838(01)00003-3.
- 63Ramirez FD, Chen Y, Di Santo P, Simard T, Motazedian P, Hibbert B. Association between self-reported potentially modifiable cardiac risk factors and perceived need to improve physical health: a population-based study. J Am Heart Assoc 2017; 6: e005491. https://doi.org/10.1161/JAHA.117.005491.
- 64Sousa M, Santos R, Turró-Garriga O, Dias R, Dourado M, Conde-Sala J. Factors associated with caregiver burden: comparative study between Brazilian and Spanish caregivers of patients with Alzheimer's disease (AD). Int Psychogeriatr 2016; 28: 1363–1374. https://doi.org/10.1017/S1041610216000508.
- 65Truzzi A, Valente L, Ulstein I, Engelhardt E, Laks J, Engedal K. Burnout in familial caregivers of patients with dementia. Braz J Psychiatry 2012; 34: 405–412. https://doi.org/10.1016/j.rbp.2012.02.006.
