Barriers and motivators to promotion of physical activity participation for older adults with mild cognitive impairment or dementia: An umbrella review

A Qualitative Study Investigating Health Care Professionals' Views on Barriers to Integrating Physical Activity Into Mild Cognitive Impairment/Dementia Care

This study aimed to investigate health care professionals' (HCPs) views on barriers to integrating physical activity (PA) into mild cognitive impairment/dementia care. Semistructured online interviews form 16 HCPs were completed between November 2022 and December 2022. Data were subjected to thematic analysis and were later mapped deductively to the Theoretical Domains Framework. Four themes were identified: (1) "Dementia-inclusive infrastructure or PA recommendations have not yet been systematically developed and implemented;" (2) "Roles and challenges of the multidisciplinary team;" (3) "HCPs believe that patients' PA participation is influenced by their disease or individual factors;" and (4) "HCPs' thoughts on current practice and opinions." Deductive mapping of these themes revealed that 13 of the 14 Theoretical Domains Framework domains influenced it. Integrating PA into mild cognitive impairment/dementia care is subject to several modifiable determinants. Policymakers should focus on improving the environmental context and resources to encourage PA in mild cognitive impairment/dementia.

Barriers and facilitators to exercise adherence in community-dwelling older adults: A mixed-methods systematic review using the COM-B model and Theoretical Domains Framework

BACKGROUND

Although the health benefits of exercise for older adults are widely recognized, physical inactivity is still common among older adults. Further clarification of the factors affecting exercise adherence is needed to develop more effective exercise interventions in community-dwelling older adults.

OBJECTIVE

The purposes of this study were to identify (1) barriers and facilitators of exercise adherence in community-dwelling older adults and (2) behavior change techniques (BCTs) and implementation strategies that are potentially effective in improving adherence.

METHODS

A total of eight databases were searched: PubMed, Web of Science, EMBASE, CENTRAL, PsycINFO, SPORTDiscus, MEDLINE, and Scopus. Studies published from database inception to April 2023 were searched. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). The Capabilities, Opportunities, Motivations, Behavior (COM-B) model and the Theoretical Domain Framework (TDF) were used to identify potential barriers and facilitators. The BCTs were used to identify potential intervention implementation strategies.

RESULTS

A total of 64 studies were included, including 30 qualitative studies, 12 randomized controlled trials, 12 mixed methods studies, 6 quantitative descriptive studies, and 5 non-randomized trials. 54 factors influencing adherence and 38 potentially effective BCTs were identified from the included studies. The 38 BCTs were further categorized into 8 areas of implementation strategies (tailored exercise program, appropriate exercise environment, multidimensional social support, monitoring and feedback, managing emotional experiences and issues, participants education, enhancing self-efficacy, and exerting participants' autonomy).

CONCLUSION

This study identified 54 influential factors affecting exercise adherence and identified 8 areas of intervention strategies (containing 38 BCTs). Further refinement, evaluation, and validation of these factors and strategies are needed in future studies.

Body Composition, Vascular Health, Cardiorespiratory Fitness, Lung Function, Muscle Architecture, and Physical Activity in People with Young Onset Dementia: A Case-Control Study

BACKGROUND

Body composition, blood pressure, estimated maximal oxygen uptake (VO2max), lung function, physical activity, muscle architecture, and endothelial function had not previously been examined in people with young onset dementia. Therefore, the study measured these variables in a young onset dementia group, compared them to age-matched controls.

METHODS

Estimated VO2max (via the Astrand-Rhyming test), body composition, blood pressure, lung function (via spirometry), muscle architecture (via ultrasonography) and endothelial function (via flow mediated dilation) were assessed. Physical activity was measured using ActiGraph accelerometers for 7 days.

RESULTS

We recruited 33 participants (16 young onset dementia, 17 controls). The young onset dementia group had shorter fascicle lengths of the vastus lateralis, were sedentary for longer over a seven-day period, and completed less moderate-vigorous physical activity than controls (p=0.028, d=0.81; large effect, p=0.029, d=0.54; moderate effect, and p=0.014, d=0.97; large effect, respectively for pairwise comparisons). Pairwise comparisons suggest no differences at the p<0.05 level between young onset dementia and controls for estimated VO2max (despite a moderate effect size [d=0.66]), height, body mass, BMI, blood pressure, light physical activity, lung function, muscle thickness, pennation angle, or endothelial function.

CONCLUSION

This study highlights differences between people with young onset dementia and controls, underscoring the need for multicomponent exercise interventions. Future interventions should target muscle architecture, increase moderate-vigorous physical activity, and reduce sedentariness, with the goal of improving quality of life and promoting functional independence.

Exploring physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity: A qualitative study

AIM

To explore the physical activity experiences of community-dwelling oldest-old adults with chronic multimorbidity.

DESIGN

Descriptive qualitative study.

METHOD

Data collection was conducted through semi-structured interviews with 19 community-dwelling oldest-old adults with chronic multimorbidity. The study was conducted between December 2022 and May 2023. ATLAS.ti software was used for data analysis.

RESULTS

Three main themes with their respective sub-themes and units of meaning were developed from the data analysis: (1) motivational factors for engaging in physical activity; (2) fear of getting hurt during physical activity and (3) confidence in being physically active.

CONCLUSION

Motivation, kinesiophobia and confidence are three core elements that influence the experience of physical activity in oldest-old adults with chronic multimorbidity. Interventions tailored to meet the needs of the oldest-old adults are important for promotion and development of active ageing.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses and other healthcare professionals should design, implement and evaluate interventions that aim to increase oldest-old adults' motivation and confidence, while decreasing their fear to engage in physical activity.

IMPACT

This study provides insights into the way community-dwelling oldest-old adults with chronic multimorbidity experience physical activity in their daily lives. Our findings suggest that motivation, kinesiophobia and confidence are key factors for oldest-old adults to engage in physical activity. These findings could contribute to the design and implementation of interventions that specifically aim at raising the physical activity levels of community-dwelling oldest-old adults with chronic multimorbidity.

REPORTING METHOD

The study findings are reported according to the COREQ guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Commentary on: physical activity and exercise for mild cognitive impairment and dementia: a collaborative international guideline

Physical inactivity is an important, but potentially reversible risk factor for dementia and mild cognitive impairment (MCI). There is literature about physical activity and exercise for the prevention and management of dementia and MCI, but this had not been previously synthesized into specific guidelines about this topic. A recent guideline on physical activity and exercise in MCI and dementia was published, authored by several international societies, including lay representatives. In this commentary, we discuss the implications of this guidance for healthcare professionals, caregivers, and lay representatives involved in the care of people with MCI and dementia.The guidelines highlight the importance of physical activity and exercise in cognitively healthy persons and for dementia and MCI, at different stages of these conditions. For primary prevention of dementia, physical activity may be suggested in cognitively healthy persons. In people with MCI, mind-body interventions, such as yoga, have the greatest evidence, whilst the role of physical activity and exercise requires more evidence from high-quality randomized controlled trials. In people living with moderately severe dementia, exercise may be useful for maintaining physical and cognitive function. There are benefits of physical activity and exercise separate from their impact on cognitive outcomes. The guidelines also proposed some questions for future research. In conclusion, there is limited evidence on the beneficial role of physical activity and exercise in preserving cognitive functions in subjects with normal cognition, MCI or dementia. The guidelines support the promotion of physical activity based on the beneficial effects on almost all facets of health.

Physical activity trajectories and their associations with health outcomes in older adults with mild cognitive impairment or dementia: a national cohort study

BACKGROUND

Physical activity (PA) is a promising non-pharmacological intervention for this population. However, few studies have investigated their PA trajectories, influencing factors, and their relationship with health outcomes.

AIMS

The aim was to identify latent trajectories in PA and their determinants in older adults with mild cognitive impairment (MCI) or dementia, as well as to assess the associations between PA trajectories and health outcomes based on the capability-opportunity-motivation behavior model.

METHODS

This is a cohort study. Data were obtained from a national cohort study and included participants aged 60 years and older with MCI or dementia. PA trajectories were identified using group-based trajectory modelling. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Linear regression models were used to assess the associations between PA trajectories and health outcomes. This study adhered to the STROBE checklist for reporting.

RESULTS

Three distinct PA trajectories were identified: high-decreasing and rebound class (9.34%), moderate-decreasing class (10.31%), and low-increasing class (80.34%). The logistic regression showed that age, sex, education level, body mass index, residence, depressive symptoms, mobility activities of daily life score, frequency of social activities score were PA predictors. Adjusting for sociodemographic variables, only the high-decreasing and rebound class remained significantly associated with worse self-rated health.

DISCUSSION

This study revealed three PA trajectories among older adults with MCI/dementia. Besides sociodemographic variables, addressing physical function and mental health, providing social support are vital for promoting PA in this population.

Determinants of physical activity behavior among older adults with subjective cognitive decline based on the capability, opportunity, motivation, and behavior model: mediating and moderating effects

Background

PA is vital for secondary prevention in older adults with subjective cognitive decline (SCD), but their physical activity (PA) levels are low, and the underlying interaction pathways among associated factors are poorly understood. This study aims to identify mediating and moderating effects of determinants on PA behavior in older adults with SCD using the capability, opportunity, motivation, and behavior model.

Methods

Following the STROBE checklist, we conducted a cross-sectional survey among 289 older adults with SCD. Path regression, mediation effects, and moderation effects were used to explore the associated factors of PA behavior and the associations among these variables.

Results

The prevalence of physical inactivity among older adults with SCD was high (40.3%). The path model fit indices were χ2/df = 1.145, GFI = 0.968, CFI = 0.988, and RMSEA = 0.022. Path regression revealed that frailty, physical and social support, PA motivation, and fall history had significant direct association with PA behavior. PA motivation not only partially mediates between frailty and PA behavior but also partially mediates between physical and social support and PA behavior. Additionally, fall history moderated the relationship between frailty and PA behavior.

Conclusion

PA behavior in older adults with SCD requires improvement. Healthcare professionals should devise more effective interventions to boost PA behavior by enhancing motivation. Screening for frailty and addressing fall history, while providing sufficient physical and social support, is crucial.