Survivor-perceived motivational facilitators and barriers to participation in cognitive exercise following chronic acquired brain injury

Adherence to cognitive and physical exercise engagement: a challenge to successful dementia risk reduction and prevention efforts

With human life expectancy and proportion of older adults increasing, global use of evidence-supported preventative methods to minimize risk of brain-related disabilities such as Alzheimer's disease and other dementias-as well as interventions to slow rate of disease progression-is important. Sustained engagement in cognitive and physical exercise programs may prevent or delay dementia onset as well as maximize health and function of those with dementia. Despite awareness of the importance of cognitive and physical exercise to brain health, exercise program adherence by older adults is extremely challenging. In this Perspective article, we summarize what is known about contributors to exercise program adherence and strategies to promote it. We discuss our viewpoint on knowledge gaps regarding exercise adherence and research that needs to be conducted. We conclude by proposing a multi-dimensional exercise adherence assessment framework that includes portable neurophysiologic technologies to inform initial design and updating of individualized exercise programs that optimize sustained exercise program engagement and, ultimately, maximize brain health in older adults with and without mild cognitive impairment and dementia.

Exercise for People with Acquired Brain Injury: An ICF Perspective

Exercise is an important element in the process of recovery from an acquired brain injury (ABI). However, specific guidance for exercise prescription and interventions in this population are missed. The aim of this study was to establish the key parameters to design and implement exercise programs based on the International Classification of Functioning, Disability, and Health (ICF) domains. A panel of experts that consisted of 13 professionals from neuro-rehabilitation centers evaluated the key parameters of this original proposal. The Heinemann methodology was used for all qualitative analyses. Additionally, Cronbach’s alpha was applied to the statistical analyses. According to the results, Cronbach’s alpha (0.97) indicated excellent internal consistency, and the experts perceptions ratified the proposed criteria to develop exercise programs for people with ABI. The proposed key parameters for the development of exercise programs for people with ABI based in ICF domains (body functions, activity—participation and environmental factors) bring a new, solid, and innovative tool for methodological design of these programs in sub-acute and chronic rehabilitation settings.

The Importance of Motivation to Older Adult Physical and Cognitive Exercise Program Development, Initiation, and Adherence

Brain health is essential to successful aging, and exercise is essential to brain health. Evidence supports the benefits of regular physical and cognitive exercise in preventing or delaying progressin of mild cognitive impairment and dementia. Despite known benefits, motivation to initiate and adhere to an exercise program can be challenging to older adults. We propose that assessment of motivation in the older adult population be part of individualized physical and cognitive exercise program initial development and ongoing precision health coaching to facilitate initiation of—and adherence to—individualized multi-modal exercise programs and sustained exercise engagement. We suggest one published, physical exercise motivation questionnaire and present a new, psychometrically supported, parallel cognitive exercise questionnaire to do so. Needs for—and implications of—continued exercise motivation research using neurophysiologic and neuropsychologic metrics are discussed.

Acquired Brain Injury Survivor Long-Term Cognitive Exercise Engagement Post-Speech Therapy Discharge

Purpose The purpose of this article is to promote the viewpoint that speech-language pathologists (SLPs) are well positioned to actively encourage individuals with cognitive-communication disorders following acquired brain injury (ABI) to engage in ongoing, long-term, cognitive exercise post-therapy discharge. Method This viewpoint article draws on evidence from the well-researched area of physical exercise, reports findings of early-stage research in the much less studied area of cognitive exercise, and highlights relevant aspects of motivational theory informing exercise participation. Informed by these, an evidence-supported model of cognitive exercise engagement is offered to inform ABI-targeted cognitive wellness empowerment efforts, and a case study illustrates clinical application of the model. Conclusions Exercise provides an opportunity to sustain or improve long-term health, function, and quality of life outcomes. It is within SLP scope of practice to collaborate with family members and other caregivers to empower individuals post-ABI, especially those with decreased self-management skills, to engage in long-term computerized and noncomputerized cognitive exercise following SLP therapy discharge. Ongoing research will further inform the evidence supporting the scholarly opinion presented in this viewpoint.

Cognitive Exercise Self-Efficacy of Community-Dwelling Older Adults: Measurement and Associations with Other Self-Reported Cognitive Exercise Factors

Exercise self-efficacy, the confidence a person has in their ability to develop and meet exercise goals, is key to exercise motivation. The primary objective of this pilot study was to explore associations among cognitive exercise self-efficacy, cognitive exercise frequency, challenge, and enjoyment in older adults. A prospective, cross-sectional, observational study design was used with 133 community-dwelling individuals aged 55 years and older. Respondents completed a cognitive exercise self-efficacy scale and responded to cognitive exercise queries. Individuals who engaged in cognitive exercise demonstrated greater cognitive exercise self-efficacy. Cognitive exercise self-efficacy ratings were significantly different across challenge and enjoyment conditions (Pearson’s χ² test, df = 9, N = 133, χ² = 123.49, p < 0.01), such that the greater the perception of each, the greater the cognitive exercise self-efficacy (p < 0.01). The comparative impact of perceived enjoyment on cognitive exercise self-efficacy was greater than the impact of perceived challenge. Study findings support positive associations among cognitive exercise self-efficacy, cognitive exercise frequency, challenge, and enjoyment. Consideration of these findings may inform design and sustained implementation of motivating cognitive exercise programs to maximize health and quality of life outcomes of healthy and neurologic older adult populations.

Functional Change from Five to Fifteen Years after Traumatic Brain Injury

Few studies have assessed the long-term functional outcomes of traumatic brain injury (TBI) in large, well-characterized samples. Using the Traumatic Brain Injury Model Systems cohort, this study assessed the maintenance of independence between years 5 and 15 post-injury and risk factors for decline. The study sample included 1381 persons with TBI who received inpatient rehabilitation, survived to 15 years post-injury, and were available for data collection at 5 or 10 years and 15 years post-injury. The Functional Independence Measure (FIM) and Disability Rating Scale (DRS) were used to measure functional outcomes. The majority of participants had no changes during the 10-year time frame. For FIM, only 4.4% showed decline in Self-Care, 4.9% declined in Mobility, and 5.9% declined in Cognition. Overall, 10.4% showed decline in one or more FIM subscales. Decline was detected by DRS Level of Function (24% with >1-point change) and Employability (6% with >1-point change). Predictors of decline factors across all measures were age >25 years and, across most measures, having less than or equal to a high school education. Additional predictors of FIM decline included male sex (FIM Mobility and Self-Care) and longer rehabilitation length of stay (FIM Mobility and Cognition). In contrast to studies reporting change in the first 5 years post-TBI inpatient rehabilitation, a majority of those who survive to 15 years do not experience functional decline. Aging and cognitive reserve appear to be more important drivers of loss of function than original severity of the injury. Interventions to identify those at risk for decline may be needed to maintain or enhance functional status as persons age with a TBI.