Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: a single blinded randomized controlled trial

Effectiveness of physical rehabilitation on physical functioning and quality of life for long-term care residents with dementia: a systematic review and meta-analysis

OBJECTIVE

The objective of this review was to evaluate the effectiveness of physical rehabilitation versus non-rehabilitation comparators on physical functioning and quality of life for long-term care (LTC) residents with dementia.

INTRODUCTION

LTC residents living with dementia often have impaired physical functioning and quality of life. Physical rehabilitation can improve physical functioning and quality of life for individuals living with dementia; however, many LTC residents with dementia do not receive physical rehabilitation and providers are unsure what interventions to employ. A synthesis of studies examining physical rehabilitation will help guide practice in the LTC sector where most residents live with dementia. Previous syntheses have focused on all residents in LTC, specific professions, interventions, or people with dementia in the community. Our review focuses on LTC residents with dementia and a broader definition of physical rehabilitation.

INCLUSION CRITERIA

This review includes studies that evaluate physical rehabilitation in comparison with non-rehabilitation controls among LTC residents with any severity of dementia. We included studies that measure the effect on activities of daily living, performance-based physical functioning, and self- or proxy-rated quality of life.

METHODS

Searches were conducted in APA PsycINFO (EBSCOhost), CINAHL (EBSCOhost), PubMed (National Library of Medicine), Embase, Scopus, and the Cochrane CENTRAL database with no date or language limitations. Two independent reviews assessed the studies against the inclusion criteria. Two independent reviewers extracted data and conducted a quality assessment using a structured extraction form. Certainty of evidence was ascertained using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Where possible, studies were pooled in meta-analyses; otherwise, a narrative synthesis was performed.

RESULTS

Thirty-three studies were included (n = 3072 participants); 27 were randomized control trials and the remaining 6 were non-randomized trials. The overall risk of bias of the included studies was low to unclear. Many of the included studies focused on increasing activity or walking, while few were individually tailored or at an intensity appropriate to induce therapeutic effects on physical function. Physical function was also measured via several outcome measures, limiting our ability to pool results. There was low certainty evidence that physical rehabilitation improved activities of daily living (12 RCTs, 1348 participants, SMD 0.78; 95% CI 0.27 to 1.30) and the Short Physical Performance Battery Score (3 RCTs, 258 participants, MD 3.01 points; 95% CI 1.37 to 4.66) compared with non-rehabilitation interventions. There was low to moderate certainty evidence that physical rehabilitation demonstrated no change in the 30-Second Sit to Stand Test (2 RCTs, 293 participants, MD 0.79 repetitions; 95% CI -0.45 to 2.03), 6-Minute Walk Test (4 RCTs, 363 participants, MD 17.32 meters; 95% CI -29.41 to 64.05), gait speed (4 RCTs, 400 participants, MD 0.10 meters/seconds; 95% CI -0.02 to 0.22), Timed Up and Go Test (3 studies, 275 participants, MD -2.89 seconds; 95% CI -6.62 to 0.84), or quality of life (4 RCTs, 419 participants, SMD 0.20; 95% CI -0.08 to 0.47).

CONCLUSIONS

This review demonstrates that physical rehabilitation may improve activities of daily living for LTC residents living with dementia, though the evidence is of low certainty. The effect of physical rehabilitation on specific functional tasks, like gait speed and quality of life, are less clear. Future research should examine the effects of individualized, progressive interventions on outcome measures that reflect the capacity and preferences of LTC residents with more advanced dementia.

REVIEW REGISTRATION

PROSPERO CRD42022308444.

Enhancing Minds in Motion® as a virtual program delivery model for people living with dementia and their care partners

The Alzheimer Society of Ontario's Minds in Motion (MiM) program improves physical function and well-being of people living with dementia (PLWD) and their care partners (CP) (Regan et al., 2019). With the COVID-19 pandemic, there was an urgent need to transition to a virtual MiM that was similarly safe and effective. The purpose of this mixed methods study is to describe the standardized, virtual MiM and evaluate its acceptability, and impact on quality of life, and physical and cognitive activity of participants. Survey of ad hoc virtual MiM practices and a literature review informed the design of the standardized MiM program: 8 weeks of weekly 90-minute sessions that included 45-minutes of physical activity and 45-minutes of cognitive stimulation in each session. Participants completed a standardized, virtual MiM at one of 6 participating Alzheimer Societies in Ontario, as well as assessments of quality of life, physical and cognitive activity, and program satisfaction pre- and post-program. In all, 111 PLWD and 90 CP participated in the evaluation (average age of 74.6±9.4 years, 61.2% had a college/university degree or greater, 80.6% were married, 48.6% of PLWD and 75.6% of CP were women). No adverse events occurred. MiM participants rated the program highly (average score of 4.5/5). PLWD reported improved quality of life post-MiM (p = <0.01). Altogether, participants reported increased physical activity levels (p = <0.01) and cognitive activity levels (p = <0.01). The virtual MiM program is acceptable, safe, and effective at improving quality of life, cognitive and physical activity levels for PLWD, and cognitive and physical activity levels among CP.

Characteristics and effects of physical exercise programs for older adults during the COVID-19 pandemic: an integrative review

Objective: To evaluate the characteristics of physical exercise programs for older adults and their effects during the COVID-19 pandemic. Methods: An integrative review was conducted between January and March 2022. A search was conducted in MEDLINE via PubMed, Lilacs via BVS, PEDro, and Cochrane Library. Experimental articles (randomized clinical trials, non-randomized trials, or quasi-experimental studies) published from 2019 to 2021, with no language restriction, and that used physical exercise programs for older adults (> 60 years) in their intervention were included. The studies were selected by reading the title, abstract, and full text. The selected articles had their results extracted using an online form, tabulated using an electronic spreadsheet, and analyzed qualitatively and quantitatively. Results: 113 studies were identified; 7 met the eligibility criteria and were included in the review, all randomized controlled trials. The multi-component exercise programs were more frequent (resistance, balance, flexibility, and aerobic), delivered remotely and performed 2 to 7 times a week, lasting between 30 and 50 minutes. Significant effects were observed on physical function, body composition, blood triglycerides, the incidence of falls, physical activity, and functional capacity. Conclusions: The physical exercise programs used during the COVID-19 pandemic showed promising results for older adults. The programs proved to be a viable alternative for maintaining the physical, mental, and cognitive functions of older adults in times of public calamity.

Exercise program for the management of anxiety and depression in adults and elderly subjects: Is it applicable to patients with post-covid-19 condition? A systematic review and meta-analysis

The Coronavirus Disease 2019 (Covid-19) pandemic had dramatic effect on mental health, causing long-term psychiatricmorbidity. At present, there are no randomized trials reporting the effect of physical exercise on individuals with post- Covid-19 condition are available. The aim of this review was to summarize the evidence regarding the evidence on exercise as a treatment for anxiety and depression symptoms secondary to chronic diseases, which may be generalized to individuals suffering from the post- Covid-19 condition. Trials were included if they reported the effects of physical exercise programs on anxiety or depression symptoms in adults, either healthy or affected by chronic diseases. Outcomes were changes of anxiety or depression severity after an exercise-based intervention. Of the 2161 RCTs identified, eight out of 15 studies were included. Exercise was associated with greater improvements of depressive (SMD = -0.169; 95 % CI -0.302 at -0.003; p = 0.013) and anxiety symptoms (SMD = -0.263, 95 % CI -0.418 at -0.109; p = 0.001), compared with control interventions. Supervised exercise programs were effective against symptoms of anxiety or depression among individuals with chronich illnesses. Pending specific clinical trials, exercise may be considered for adoption among patients with the post Covid-19 condition.

Effectiveness of non-pharmacological therapies on cognitive function in patients with dementia-A network meta-analysis of randomized controlled trials

Objective

Non-pharmacological therapies (NPTs) have received increasing attention from researchers as a category of treatment to improve cognitive impairment in patients with dementia because of their fewer side effects. In this study, photobiomodulation (PBM), enriched environment (EE), exercise therapy (ET), computerized cognitive training (CCT), and cognitive stimulation therapy (CST) were selected to compare the effects of NPTs that improve dementia by quantifying information from randomized controlled trials (RCTs).

Methods

We did a systematic review and network meta-analysis. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure Database, Wan Fang Database, Chinese Biomedical Literature Database, Web of Science, and VIP Database from the time of database creation to 1 August 2022. Two investigators independently screened the literature, extracted information, and assessed the RCTs' quality with the Cochrane Collaboration Network Risk of Bias 2.0. Network meta-analysis was performed using R language (X64 version 4.1.3) and STATA 17.0.

Results

We identified 1,268 citations and of these included 38 trials comprising 3,412 participants. For improving dementia, the results of the network meta-analysis showed that compared with the control group (CON), PBM (SMD = 0.90, 95% CI: 0.43-1.37), EE (SMD = 0.71, 95% CI: 0.02-1.41), ET (SMD = 0.42, 95% CI: 0.16-0.68), and CST (SMD = 0.36, 95% CI: 0.11-0.62) were significantly different (P < 0.05); There was no significant difference in CCT (SMD = 0.41, 95% CI: -0.07-0.88) (P > 0.05). The ranked results showed that PBM has more potential to be the best intervention (P = 0.90). In addition, there was a significant difference between PBM and CST in improving cognitive function (SMD = 0.54, 95% CI: 0.00; 1.08, P < 0.05).

Conclusion

In this study, NPTs have excellent potential to improve cognition in people with dementia, and PBM may have more significant benefits in improving cognition than the other four NPTs.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022363746.

The Impact of Physical Exercises with Elements of Dance Movement Therapy on Anthropometric Parameters and Physical Fitness among Functionally Limited Older Nursing Home Residents

Changes in the composition of the body mass of functionally limited older patients may contribute to a decrease in functional fitness and the development of chronic diseases. This research aimed to assess the differences in anthropometric parameters and physical fitness of older patients, over the age of 65, in a 12-week clinical intervention study. Method: The study participants were nursing home inhabitants aged 65-85 who were functionally limited. Persons meeting the inclusion criteria were assigned to one of the three groups: Group 1-basic exercises/BE group (n = 56); Group 2-physical exercises with elements of dancing/PED group (n = 57); Group 3-control group/CO group (n = 56) routine care. The data were collected at the beginning of the study and at the 12-week mark. The outcome was observed for hand grip strength (HGS), arm curl test (ACT), Barthel Index (BI), Berg Balance Scale (BBS), triceps skin fold (TSF), waist-to-hip-ratio (WHR), and arm muscle area (AMA). Results: The study included 98 women and 71 men. The average age of the participants was 74.40 years. The analysis of the effects of the 12-week exercise program showed the greatest changes in HGS, ACT, and BI in the exercise groups, especially in the PED group compared to the BE group. Statistically significant differences in the examined parameters of the PED vs. BE vs. CO groups were demonstrated in favour of the exercising groups. In conclusion, a 12-week program of group physical exercises, both PED and BE, improves physical fitness indicators and anthropometric indicators.

A Comparative Study of Inhibition Function between High-Intensity Interval Training and Moderate-Intensity Continuous Training in Healthy People: A Systematic Review with Meta-Analysis

Meta-analysis was used to compare the effects of two interventions, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), on inhibition in executive function in healthy people, providing some theoretical basis for exercise practice and health interventions. We searched the PubMed, Science Direct, Web Of science, Cochrane, and CNKI databases for relevant articles on the inhibition function effects of HIIT and MICT in healthy populations for the period of library construction to 15 September 2022. The basic information of the screened literature was organized and summarized using Excel. Statistical analysis of the correct rate and response time indicators of the inhibition function in the HIIT and MICT groups was performed using Review Manager 5.3 analysis software. A total of 285 subjects from 8 studies were included in this study, the number of HIIT subjects was 142, the number of MICT subjects was 143, including teenagers, young adults, and the elderly. Eight studies included response time, and four included correct rate and response time. The standardized mean difference (SMD) for correct rate inhibition function in the HIIT and MICT groups was 0.14, 95% CI (-0.18, 0.47), SMD at response time was 0.03, 95% CI (-0.20, 0.27). In addition, no significant differences were found between the two exercise modalities in either the intervention period or the population receiving the intervention. Both HIIT and MICT could improve inhibition function in healthy people, but there was no significant difference in the improvement effect between them. It is hoped that this study can provide some references for people's choice of health intervention methods and clinical practice.

Nonpharmacological approaches reduce symptoms of depression in dementia: A systematic review and meta-analysis

BACKGROUND

Depression is a common psychological symptom associated with dementia. Pharmacological approaches are often used despite two large negative trials of efficacy. This meta-analysis examines nonpharmacological (i.e., psychosocial) approaches for symptoms of depression in people living with dementia and reports statistical and clinical significance.

METHODS

Relevant studies published between 2012 and 2020 were sourced by searching electronic databases: MEDLINE, EMBASE, PsychINFO, Social Work Abstracts and the Cochrane Central Register of Controlled Trials. Studies were assessed for methodological quality. Random-effects meta-analysis was performed to calculate a pooled effect size (ES) and 95% confidence intervals (CI).

RESULTS

Overall, 37 nonpharmacological studies were identified including 2,636 participants. The mean quality rating was high (12/14, SD=1.4). Meta-analysis revealed that nonpharmacological approaches were significantly associated with reduced symptoms of depression with a medium effect size (ES=-0.53, 95%CI [-0.72, -0.33], p < 0.0001). There was considerable heterogeneity between studies. Meta-regression revealed this was not driven by intervention type or setting (residential versus community).

CONCLUSIONS

Nonpharmacological approaches such as reminiscence, cognitive stimulation/ rehabilitation, therapeutic, music-based approaches and education/ training, have the potential to reduce symptoms of depression in dementia.

Effects of Chronic Physical Exercise or Multicomponent Exercise Programs on the Mental Health and Cognition of Older Adults Living in a Nursing Home: A Systematic Review of Studies From the Past 10 Years

Some nursing homes for the elderly provide holistic care that integrates several interventions, including physical exercise. The aim of this systematic review is to summarize the effects of physical exercise or multicomponent exercise programs on the mental health (wellbeing, anxiety and depression) and cognitive functions of older adults with/without dementia who live in a nursing home and do/do not require wheelchair assistance. To this end, PubMed, PsycInfo and Web of Science are using to identify clinical trials and randomized controlled studies conducted during the period January 2011 to December 2021 to examine the progression of research in this field over the past ten years. In total, 2597 articles are identifying and 21 are including in the systematic review. After selecting articles according to the PRISMA standards, the data extraction and methodological quality assessment of the eligible studies are performing individually by two reviewers and then pooled together. The synthesis of the studies shows that physical exercise or multicomponent exercise programs have a beneficial effect on mental health and cognitive functions. However, this effect is more common among older adults without dementia, compared to their counterparts who have dementia or use wheelchairs. The explanatory mechanisms, lack of benefits from physical exercise and the need to standardize methods are discussing in this regard. Finally, future studies must examine the effects of an innovative and adaptive physical activity program on the mental health and cognitive functions of older adults living in nursing homes.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

The Effects of High-Intensity Functional Training on Cognition in Older Adults with Cognitive Impairment: A Systematic Review

(1) Background: High-Intensity Functional Training (HIFT) is a new exercise modality that emphasizes multi-joint functional movements adaptable to any fitness level and promotes greater muscle recruitment. Previous studies have evaluated the positive effects of HIFT on mental and cognitive health but have not evaluated it in older people. This study aims to conduct a systematic review of randomized controlled trials assessing the effects of HIFT on general cognition in older adults with cognitive impairment. (2) Methods: Following the PRISMA 2020 guideline, articles that did a high-intensity functional physical exercise intervention on cognitive performance in older adults with mild to moderate cognitive impairment (MMSE > 10) or dementia, aged 55 years or older, published between 2011 and 2021 in five different electronic databases: PubMed, Web of Science, Scopus, CINAHL, and Cochrane plus were included. (3) Results: 7 articles were included, all having general cognition as their primary outcome. All assessed general cognition using the Mini-Mental State Examination, the ADAS-Cog, or both. All studies had at least one HIFT experimental group with a frequency of 2 sessions per week and a variable duration between protocols of 12, 13, 16, and 26 weeks. Two articles showed that a progressive HIFT program improves general cognition, four articles showed no significant changes within or between groups and one article concluded that a HIFT intervention does not slow cognitive decline. (4) Conclusions: Evidence exists of the benefits of HIFT on general cognition in older adults with cognitive impairment, assessed using the MMSE, the ADAS-cog, or both. Two articles that showed improvement in cognitive function used progressive HIFT with 80% RM at 6, 12, and 1 weeks; however, in the other articles, due to the heterogeneity of intervention protocols, measurement time points, and control group activities, mixed results were evidenced

Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis

BACKGROUND

Exercise is a promising nonpharmacological therapy for cognitive dysfunction, but it is unclear which type of exercise is most effective. The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment (MCI) or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.

METHODS

We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia. Primary outcomes included global cognition, executive cognition, and memory cognition. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, and quality of life. Pairwise analyses and network meta-analyses were performed using a random effects model.

RESULTS

A total of 73 articles from 71 trials with 5606 participants were included. All types of exercise were effective in increasing or maintaining global cognition, and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition (standard mean difference (SMD) = 1.05, 95% confidence interval (95%CI): 0.56-1.54), executive function (SMD = 0.85, 95%CI: 0.21-1.49), and memory function (SMD = 0.32, 95%CI: 0.01-0.63) in patients with cognitive dysfunction. Subgroup analyses for patients with MCI revealed different effects, and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition (SMD = 0.99, 95%CI: 0.44-1.54) and executive function (SMD = 0.72, 95%CI: 0.06-1.38). However, only resistance exercise showed significant effects on memory function for patients with MCI (SMD = 0.35, 95%CI: 0.01-0.69). Exercise interventions also showed various effects on the secondary outcomes.

CONCLUSION

Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive decline in patients with cognitive dysfunction, especially in patients with dementia. Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.

Re-thinking reablement strategies for older adults in residential aged care: a scoping review

BACKGROUND

The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness).

METHOD

This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored.

RESULTS

Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness.

CONCLUSIONS

There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted.

TRIAL REGISTRATION

Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).

Implementation of an integrative movement program for residents with dementia in a VA nursing home

BACKGROUND

Preventing Loss of Independence through Exercise (PLIÉ) is an integrative group movement program developed for adults with mild-to-moderate dementia attending day programs. However, many older adults with dementia ultimately require assistance with their activities of daily living and become residents in nursing homes or other long-term care facilities with their complex comorbidities and unique needs. We conducted a post-implementation evaluation of PLIÉ at a San Francisco Veterans Affairs (VA) nursing home to assess reach and effectiveness among residents, staff, and family members who participated in ≥ 1 PLIÉ class from 9/2018 to 6/2019.

METHODS

Post-implementation number of classes offered and mean attendance; anonymous satisfaction surveys (5-point Likert scales); qualitative content analysis of open-ended survey responses and clinical progress notes.

RESULTS

Forty-five PLIÉ classes were offered over 9 months. Residents attended an average of 13 ± 12 classes with an average class size of 14 residents, 4 staff members, and 2 family members. Most survey respondents rated the program overall as "very good" or "excellent" (100 % residents, n = 15; 87 % staff, n = 14; 100 % family members, n = 8). Respondents reported improvements in themselves and/or others in four domains: (1) physical, (2) psychological, (3) social, and (4) cognitive. Physical improvements among veterans included mobility, strength, and energy. Psychological improvements included feelings of happiness/well-being, enjoyment, and self-empowerment. Social improvements included connection, social skills, and social support. Cognitive improvements included engagement, communication ability, and focus/attention. Responses were similar among resident, staff, and family member surveys and clinical progress notes. Participants frequently reported improvements in multiple domains (e.g., "The veterans are more alert and engaged, many are smiling and laughing."). Negative comments were primarily related to logistics, suggesting that the class occur more frequently.

CONCLUSIONS

PLIÉ was successfully implemented in a VA nursing home with high attendance and satisfaction among residents, staff, and family members. Participants reported clinically meaningful physical, psychological, social, and cognitive benefits. Other long-term care facilities could potentially benefit from implementing PLIÉ to increase quality of life in residents with dementia.

Assessing the Outcome of Rehabilitation after Hip Fracture with a Wearable Device-A Study Protocol for a Randomized Control Trial in Community Healthcare

BACKGROUND

The increase of the aging population is a challenge to society, as age is related to dependence. Injuries such as hip fractures cause morbidity, loss of independent life, and mortality. The purpose of this protocol is to describe a randomized control trial, with three intervention arms, aiming at investigating if there are any differences in outcomes after hip fracture between different rehabilitation interventions including (1) High-Intensity Functional Exercise (HIFE), (2) HIFE with the addition of continuous measures of movement and body positions with a wearable device, or (3) standard rehabilitation. A secondary aim is to evaluate physiotherapists' satisfaction with using the wearable device in rehabilitation.

METHOD

Patients with hip fracture that require rehabilitation at home will be invited to participate and randomly assigned to one intervention arm. The primary outcome is balance, measured by postural sway using an Inertial Measurement Unit and by Functional Balance test for Geriatric patients. Secondary outcomes are functional independence in everyday activities, measured with the Barthel Index, and health-related quality of life measured with EuroQol 5 Dimension questionnaire and EuroQol Visual Analogue Scale for health and user satisfaction measured by the User Satisfaction Evaluation Questionnaire.

DISCUSSION

This study protocol is the first step in securing the research process before performing a full randomized controlled trial. The next step will be a pilot- and feasibility study.

Models of provider care in long-term care: A rapid scoping review

INTRODUCTION

One of the current challenges in long-term care homes (LTCH) is to identify the optimal model of care, which may include specialty physicians, nursing staff, person support workers, among others. There is currently no consensus on the complement or scope of care delivered by these providers, nor is there a repository of studies that evaluate the various models of care. We conducted a rapid scoping review to identify and map what care provider models and interventions in LTCH have been evaluated to improve quality of life, quality of care, and health outcomes of residents.

METHODS

We conducted this review over 10-weeks of English language, peer-reviewed studies published from 2010 onward. Search strategies for databases (e.g., MEDLINE) were run on July 9, 2020. Studies that evaluated models of provider care (e.g., direct patient care), or interventions delivered to facility, staff, and residents of LTCH were included. Study selection was performed independently, in duplicate. Mapping was performed by two reviewers, and data were extracted by one reviewer, with partial verification by a second reviewer.

RESULTS

A total of 7,574 citations were screened based on the title/abstract, 836 were reviewed at full text, and 366 studies were included. Studies were classified according to two main categories: healthcare service delivery (n = 92) and implementation strategies (n = 274). The condition/ focus of the intervention was used to further classify the interventions into subcategories. The complex nature of the interventions may have led to a study being classified in more than one category/subcategory.

CONCLUSION

Many healthcare service interventions have been evaluated in the literature in the last decade. Well represented interventions (e.g., dementia care, exercise/mobility, optimal/appropriate medication) may present opportunities for future systematic reviews. Areas with less research (e.g., hearing care, vision care, foot care) have the potential to have an impact on balance, falls, subsequent acute care hospitalization.

The impact of physical exercises with elements of dance movement therapy on the upper limb grip strength and functional performance of elderly wheelchair users living in nursing homes - a randomized control trial

INTRODUCTION

Over the last few decades, the quality of care and the quality of life of nursing home (NH) residents have significantly improved, but insufficient physical activity and social involvement still represent substantial challenges in modern nursing facilities. The main aim of this research was to assess the influence of physical exercises with dance movement therapy (DMT) elements on strength and other fitness components of the upper limbs and the overall functional performance of NH residents in wheelchairs compared to standard exercise programmes and usual care.

METHOD

The study participants were persons aged 68-85 who lived in NH and used manual wheelchairs as a primary means of mobility. Individuals meeting the inclusion criteria were assigned to one of the three groups: Group 1, basic exercise/BE group (n = 55); group 2, physical exercises with elements of dance movement therapy/PED group (n = 55); and group 3, control group, usual care/CO group (n = 55). The intervention for both exercising groups consisted of a 30-min session, two times a week, for 12 weeks in total. Outcome assessments were performed at baseline, 12 weeks after baseline (immediately after the intervention) and 24 weeks after baseline (12 weeks after the intervention). The main outcome was observed for hand grip strength (HGS), while secondary outcomes for box and block test (BBT), arm curl test (ACT), back scratch test (BS), chair sit-and-reach (CSR), peak expiratory flow (PEF), Barthel Index (BI), Berg Balance Scale (BBS) and the range of motion of the shoulder.

RESULTS

Prior to the start of the exercise programmes, all the tested groups were homogeneous. After 12 weeks the PED group presented higher statistically significant scores in HGSL, BBT, ACT, BS, CSR, BI, BBS: p < 0.001 and HGSR: p = 0.01, compared to the BE group. After 24 weeks from the beginning of the intervention the comparison between the PED group and the BE group showed statistically significant differences (p < 0.001) in favour of PED group in almost all areas: HGSR, HGSL, BBT: ACT, PEF, BS, CSR, BI. After 12 and 24 weeks both intervention groups performed better than the CO in all measures except for Katz ADL and shoulder extension.

CONCLUSION

Twelve weeks of physical exercises had beneficial effects on the strength and fitness of the upper limbs and overall functional performance in both exercise groups. This study demonstrated that group performing physical exercises with elements of DMT obtained statistically better scores in the majority of analysed domains than other groups.

TRIAL REGISTRATION

The study was registered in the Sri Lanka Clinical Trials Registry (Registration Number - SLCTR/2018/014 - Date of Registration 16/05/2018. Accessed on https://slctr.lk/trials/1045 ).

Loss of benefits after cessation of exercise interventions in nursing home residents: randomized controlled trial follow-up

Exercise interventions improve physical fitness, cognitive and affective function, and quality of life among nursing home residents. However, little is known regarding the consequences of cessation of activity, or detraining. We analyzed physical fitness, physical activity level, cognitive function, quality of life, and loneliness during a 6-month observational follow-up after a 6-month randomized controlled trial in which nursing home residents performed either routine activities (control group) or group-based exercise (intervention group). The intervention group showed an important decline in most physical fitness and cognitive function parameters after a 6-month detraining period. These results highlight the importance of recreation as part of residents' care needs, and exercise should therefore be implemented continuously.

Can cognitive-motor training improve physical functioning and psychosocial wellbeing in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project

BACKGROUND

A multi-component training program holds promises for the elderly, but still has to be tested on its feasibility and effect in nursing homes.

AIMS

The aim of this study was (1) to design a multi-component training program which improves physical functioning and psychosocial wellbeing and (2) to evaluate the feasibility of this intervention in nursing home residents.

METHODS

This study is a two-arm, stratified-randomized controlled feasibility trail. Twenty-four nursing home residents (aged 83.7 ± 6.4, 21 women) were divided into an intervention and a waiting-list control group. The intervention group completed a multi-component training (including dual-task, dynamic balance, endurance and strength exercises) for 16 weeks (twice per week for 45-60 min). Primary outcomes were lower extremity functionality (SPPB), gait performance (GAITRite), health-related quality of life (SF-12) as well as life satisfaction (SWLS).

RESULTS

Life satisfaction (SWLS) and physical functioning (SPPB) increased in the intervention group after training whereas the control group showed a decrease. Gait parameters could only be analyzed for n = 5 participants of the intervention group and n = 2 of the control group and showed no time differences for the intervention group. The mean number of participants was 12.5 ± 1.9 per session (attendance ranged between 66% and 90%).

CONCLUSION

A multi-component training seems (1) to lead to clinically relevant improvements in physical functioning as well as in psychosocial wellbeing and (2) to be feasible and well accepted in nursing home residents. Nevertheless, the complexity and progression of the program as well as the testing protocol have to be adapted. Further research should test the effectiveness of this adapted program in a larger sample size.

Comparing the care environment at farm-based and regular day care for people with dementia in Norway-An observational study

People with dementia should be able to live in the community, and day care services are recommended as a means for people to live in their own homes for as long as possible. In this study we wanted to compare the quality of care at one type of small-scale day care situated at community farms to regular day care provided in connection with residential care facilities for elderly people. A total of 42 participants from 10 farm-based day care offers and 46 participants from seven regular day care offers were included. A qualitative observational design using the validated Maastricht Electronic Daily Life Observation tool was used. The data were collected between March and June 2018. Ecological momentary assessments of the activities taking place, level of engagement, physical effort, location, social interaction and mood were conducted while the participants attended their day care offer. The results showed that familiar daily activities were common at farm-based day care, and a linear mixed model analysis showed that farm-based day care attendees used more physical effort, spent more time outdoors, had more social interaction and experienced more positive mood compared to regular day care attendees. These findings contribute with valuable information about care provided at different types of day care services, and indicate that farm-based day care has more activities with the potential to meet the social and activity needs of people with dementia compared to regular day care. There are two main implication of this study. First, regular day care services should focus on including more familiar daily activities found to be important for attendees' sense of identity and feelings of contributing. Second, regular day care services should utilise the potential of available outdoor areas as time spent outdoors has been found to facilitate physical activity, relaxation, health and well-being.

[Physical activity and activities of daily living of nursing homes residents: A systematic review and meta-analysis]

BACKGROUND

Interventions to promote physical activity in nursing homes are among the priorities of German long-term care insurance funds. We summarized the evidence on the effectiveness of such interventions.

METHODS

We conducted a systematic literature search in five electronic databases in November 2019, which was complemented by searching reference lists and trials registries. Eligible studies included individually (RCTs) or cluster randomized trials or non-randomized comparative studies that investigated the effectiveness of interventions to promote physical activity in nursing home residents and their impact on the ability to perform activities of daily living. Results were synthesized using random effects meta-analysis.

RESULTS

Meta-analysis of 19 included studies with high risk of bias showed a small yet statistically significant effect on activities of daily living (SMD = 0.40, 95 % CI 0.08-0.72); heterogeneity was substantial (I² = 77 %, p < 0.0001). Sensitivity analysis excluding two non-randomized comparative studies did not alter the results (SMD = 0.40, 95 % CI 0.03-0.76). The effect attenuated but was still statistically significant in a meta-analysis which excluded five studies that were largely responsible for the heterogeneity (SMD = 0.27, 95 % CI 0.12-0.43, I²=34 %, p = 0.10). Subgroup analyses did not demonstrate any statistically significant results in favour of physical activity.

DISCUSSION

We found evidence for a beneficial effect on activities of daily living in favour of interventions that aim to promote physical activity. Due to the high overall risk of bias and substantial heterogeneity of the included studies the results should be interpreted with caution, though.

CONCLUSION

Methodologically sound studies are needed to strengthen the evidence base on the topic.

Pain-Reducing Effects of Physical Therapist-Delivered Interventions: A Systematic Review of Randomized Trials Among Older Adults With Dementia

BACKGROUND AND PURPOSE

Pain is common among older adults with dementia. There are nonpharmacological options for managing pain in this population. However, the effects of physical therapist-delivered interventions have not been summarized. The purpose of this systematic review was to summarize the literature on physical therapist-delivered interventions in randomized trials for reducing pain among older adults with dementia.

METHODS

A systematic search of MEDLINE/PubMed, CINAHL, PsycINFO, and Web of Science was conducted for randomized trials of pain management in individuals 60 years or older with medically diagnosed dementia of any severity. Included studies addressed the effects of nonpharmacological physical therapist-delivered interventions on pain outcomes. Pain outcomes included patient or caregiver self-report, observational or interactive measures. Independent reviewers extracted relevant data and assessed methodological quality using the PEDro scale.

RESULTS AND DISCUSSION

Three studies (total = 222 participants; mean age range = 82.2-84.0 years; 178 [80.2%] females) met inclusion criteria. PEDro scores ranged from 4 to 8/10. Interventions included passive movement and massage. Pain outcomes included the observational measures Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), Pain in Advanced Dementia (PAINAD), and Doloplus-2 Scale. Passive movement did not show better results when compared with no treatment, while massage showed pain-reducing effects in 1 study compared with no treatment.

CONCLUSIONS

The evidence supporting pain-reducing physical therapy interventions for patients with dementia is limited. There is a clear gap in knowledge related to evidence-based physical therapy for managing pain in this population. Future studies should examine active physical therapist-delivered interventions and utilize interactive pain measures.

High-intensity exercise programs in people with dementia — a systematic review and meta-analysis

Dementia is a syndrome characterized by a progressive deterioration of cognitive and physical functions. The aim of this systematic review was to investigate the effects of high-intensity exercise training (HIT) programs on cognitive and mental health, physical performance, activities of daily living (ADLs) and quality of life (QoL) in people with dementia. A systematic literature search for randomized controlled trials was performed until July 2019. We calculated mean difference (MD) or standardized MD (SMD) and the 95% confidence interval (CI), and assessed heterogeneity using I2 statistic. Nine studies from three large-scale research projects which were based on the high-intensity functional exercise (HIFE) program incorporating strength, balance and mobility exercises of the lower limbs, including 456 participants (85.5 ± 7.0 years), were considered. There was an overall good study quality (mean PEDro score = 7.6 ± 0.7). Compared to seated control activities, strength and balance HIT resulted in statistically significant but small positive effects on balance performance (MD = 2.31, 95% CI = 0.44–4.17, p = 0.02; I2 = 73%) and on the abilities to independently perform ADLs (SMD = 0.28, 95% CI = 0.12–0.44, p = 0.0006; I2 = 0%). No differences were found in cognitive function, depressive symptoms and QoL. The qualitative analyses yielded sporadic beneficial results (mobility, psychological well-being and apathetic behaviour) in favour of HIT. There is only limited evidence for an intensity-related dose–response relationship. Further well-designed studies are needed to identify the best exercise type for different types and stages of dementia.

Balance and gait performance in older adults with early-stage cognitive impairment

BACKGROUND

People with cognitive impairment are susceptible to fall. Previous studies regarding balance and gait enrolled patients with various severity of dementia. Quantification of the balance and gait performance of people with cognitive impairment may help identify their postural instability and fall risks.

AIM

We investigated the differences in balance and gait among older adults with preserved cognition, amnestic mild cognitive impairment, and mild dementia due to Alzheimer's disease.

DESIGN

Prospective observational study.

SETTING

Outpatient department of neurology or psychology.

POPULATION

Older adults (aged ≥65 years) with independent gait were evaluated using the Mini-Mental State Examination and Clinical Dementia Rating scale. People with other neurological or musculoskeletal disorders were excluded.

METHODS

Participants were classified into three groups: 30 healthy controls, 30 mild cognitive impairment and 30 mild dementia. Balance were evaluated through functional test (Berg Balance Scale [BBS]) and laboratory test (posturography). Gait was assessed by wearable device. Muscle strength and mass were measured through grip force, calf circumstance, and body composition.

RESULTS

The BBS (P=0.04), posturography of fall risk index (FR, P=0.01) and sensory integration indices in eyes open and firm surface (EOFIS, P=0.009), eyes open and foam surface (EOFOS, P=0.003) were substantially different among three groups. EOFIS and EOFOS indices of balance in mild dementia were significantly worse than in MCI. The gait speed (P=0.04) and stride length (P=0.04) were significantly different among three groups. The post-hoc analyses revealed that all above balance and gait indices in subjects with cognitive impairments were significantly worse than in healthy controls. The grip force, calf circumstance and body composition-muscle mass did not significantly differ among three groups.

CONCLUSIONS

It is a piece of evidence that cognitive dysfunction, even in early stage of memory decline, may have some bad impact on balance and gait regardless of the effect of musculoskeletal problems.

CLINICAL REHABILITATION IMPACT

Understanding the difference of specific indices of balance and gait among different severity of cognitive impairments and healthy controls could help to develop better balance-oriented rehabilitation programs in older adults at early-stage cognitive impairment.

High-intensity functional exercise in older adults with dementia: A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate the efficacy of high-intensity functional exercise among older adults with dementia.

METHODS

In this systematic review and meta-analysis of randomized controlled trials, we collected articles published before August 2020 from PubMed, Embase, and the Cochrane Library to evaluate the effect of high-intensity functional exercise on older adults with dementia. Primary outcomes included improvements in balance function and gait performance (speed, cadence, and stride length). The secondary outcomes included lower limb strength, activities of daily living, psychiatric well-being, depression, and cognition. Furthermore, we performed subgroup analysis with two high-intensity functional exercise programs: the Umeå program and Hauer's program.

RESULTS

We identified 15 articles describing six trials including older adults with dementia undergoing high-intensity functional exercise or control activity. The meta-analysis indicated that high-intensity functional exercise, both in Hauer's program and in the Umeå program, significantly improved balance function (pooled standardized mean difference 0.57, 95% confidence interval 0.31-0.83). Hauer's program significantly improved gait speed, cadence, stride length, and lower limb strength. Beneficial effects on speed, cadence, and lower limb strength were retained for several months. The Umeå program facilitated activities of daily living and psychiatric well-being, with effects on activities of daily living lasting several months. In the only eligible trial, no effects on cognition were observed. Adverse effects of high-intensity functional exercise were minimal to none.

CONCLUSIONS

High-intensity functional exercise is generally safe and is recommended for older individuals with mild or moderate dementia to provide benefits in motor performance and daily functioning.

From evidence to practice: Developing best practice guidelines for the delivery of activities to people living with moderate to advanced dementia using a pragmatic observational study

The benefits of physical activities for those living with moderate to advanced dementia are well documented and include improved well-being and quality of life. What is less well known is how best to deliver such activities to make them meaningful for those taking part and, more generally, how to develop good practice guidance for working with this group. This article reports on an observational study of a physical activity programme in a residential care setting, Mobile Me, and on the process used to develop good practice guidance from it, which included input from a range of stakeholders. Learnings from this study conclude that changes in delivery and setting can contribute to a difference in the quality of the experience for participants and their levels of well-being during sessions. The findings from the study were consolidated into four themes for disseminating best practice: promoting the right atmosphere, environment, communication, and adaptations. These form part of a new multimedia best practice guide for delivering physical activities to those living with moderate to advanced dementia.

Physical activity in people with dementia attending farm-based dementia day care - a comparative actigraphy study

BACKGROUND

Despite public focus on the importance of physical activity and findings showing the benefits of such activity, research has shown that people with dementia are less physically active and have more sedentary behaviour compared to others in similar age groups. In Norway, there is a focus on day care services as a means to allow people with dementia to experience social, physical and cultural activities. Farm based services have been highlighted as an innovative and customized day care service, but little research has been done on physical activity and such services. This study therefor aims to investigate the potential of farm-based day care services as services that can promote physical activity for people with dementia.

METHODS

Actigraphy data from people with dementia attending farm-based day care services (n = 29) and people with dementia attending regular day care services (n = 107) was used to assess levels of physical activity in each group and to compare the two groups.

RESULTS

People attending farm-based day care had significantly higher levels of moderate activity, approximately 23 min each day, compared with persons attending ordinary day care (p = 0.048). Time spent in sedentary or light activity were similar for both groups. For the group attending farm-based day care services, days at the service, were significantly associated with less time spent in sedentary activity (p = 0.012) and more time spent in light (p < 0.001) and moderate activity (p = 0.032), and in taking more steps (p = 0.005) compared to days not at the service.

CONCLUSION

The findings indicate that participants in farm-based day care for people with dementia have higher levels of physical activity compared to ordinary day care and that farm-based day care increases levels of physical activity for its attendees. Farm based day care services has the potential to help their participants reach or maintain recommended levels of physical activity. Further research is needed to investigate what facilitates this increase in activity and how such knowledge could be used in all types of day care services.

Effects of low- and high-intensity physical exercise on physical and cognitive function in older persons with dementia: a randomized controlled trial

BACKGROUND

Potential moderators such as exercise intensity or apolipoprotein-E4 (ApoE4) carriership may determine the magnitude of exercise effects on physical and cognitive functions in patients with dementia (PwD). We determined the effects of a 24-week aerobic and strength training program with a low- and high-intensity phase on physical and cognitive function.

METHODS

In an assessor-blinded randomized trial, 91 PwD (all-cause dementia, recruited from daycare and residential care facilities, age 82.3 ± 7.0 years, 59 women, Mini-Mental State Examination 20.2 ± 4.4) were allocated to the exercise or control group. In the exercise group, PwD participated in a walking and lower limb strength training program with 12 weeks low- and 12 weeks high-intensity training offered three times/week. Attention-matched control participants performed flexibility exercises and recreational activities. We assessed adherence, compliance, and exercise intensity for each session. We assessed physical (endurance, gait speed, mobility, balance, leg strength) and cognitive (verbal memory, visual memory, executive function, inhibitory control, psychomotor speed) functions with performance-based tests at baseline and after 6, 12, 18, 24, and 36 weeks (follow-up). ApoE4 carriership was determined post-intervention.

RESULTS

Sixty-nine PwD were analyzed. Their mean attendance was ~ 60% during the study period. There were no significant effects of the exercise vs. control intervention on endurance, mobility, balance, and leg strength in favor of the exercise group (Cohen's d = 0.13-0.18). Gait speed significantly improved with ~ 0.05 m/s after the high-intensity phase for exercise participants (Cohen's d = 0.41) but declined at follow-up. There were no significant effects of the exercise vs. control intervention on any of the cognitive measures (Cohen's d ~ - 0.04). ApoE4 carriership did not significantly moderate exercise effects on physical or cognitive function.

CONCLUSIONS

Exercise was superior to control activities for gait speed in our sample of PwD. However, the training effect provided no protection for mobility loss after detraining (follow-up). There were no beneficial effects of the exercise vs. control group on cognitive function. Exercise intensity moderated the effects of exercise on gait speed. ApoE4 carriership moderated the effect of exercise on global cognition only (trend level).

TRIAL REGISTRATION

Netherlands Trial Register, NTR5035. Registered on 2 March 2015.

It’s Not Just Physical: Exercise Physiologist-Led Exercise Program Promotes Functional and Psychosocial Health Outcomes in Aged Care

Regular physical activity has multiple benefits for older adults, including improved physical, cognitive, and psychosocial health. This exploratory study investigated the benefits of a 12-week exercise program for older adults (n = 11 control and n = 13 intervention) living in a residential aged care facility in Perth, Western Australia. The program, prescribed and delivered by an accredited exercise physiologist, aimed to maintain or improve participants’ physical capacity. It comprised one-on-one exercise sessions (1 hr × 2 days/week × 12 weeks), involving a components-approach intervention. Physical performance measures (balance, strength, flexibility, and mobility) were assessed preintervention and postintervention. Qualitative interviews postintervention with residents participating in the exercise intervention, and with family members, staff, and research team members, explored barriers and enablers to participation and perceived psychosocial outcomes. Findings indicate the program provided physical benefits and enhanced social engagement for participants, illustrating the value of providing exercise physiology services in the aged care sector.

Physical exercise attenuates cognitive decline and reduces behavioural problems in people with mild cognitive impairment and dementia: a systematic review

QUESTIONS

What is the effect of physical exercise on cognitive decline and behavioural problems in people with mild cognitive impairment (MCI) or dementia? What is the effect of physical exercise on particular domains of cognitive function? How do training protocols and patients' characteristics influence the outcomes?

DESIGN

Systematic review and meta-analysis of randomised trials.

PARTICIPANTS

People with MCI or dementia as their primary diagnosis.

INTERVENTION

Physical exercise.

OUTCOME MEASURES

Cognitive function including global cognition, memory, executive function, reasoning, attention, language, and behavioural problems.

RESULTS

Forty-six trials involving 5099 participants were included in this review. Meta-analysis of the data estimated that aerobic exercise reduced the decline in global cognition, with a standardised mean difference (SMD) of 0.44, 95% CI 0.27 to 0.61, I² = 69%. For individual cognitive functions, meta-analysis estimated that exercise lessened working memory decline (SMD 0.28, 95% CI 0.04 to 0.52, I² = 40%). The estimated mean effect on reducing the decline in language function was favourable (SMD 0.17), but this estimate had substantial uncertainty (95% CI -0.03 to 0.36, I² = 67%). The effects of exercise on other cognitive functions were unclear. Exercise also reduced behavioural problems (SMD 0.36, 95% CI 0.07 to 0.64, I² = 81%).

CONCLUSION

Physical exercise can reduce global cognitive decline and lessen behavioural problems in people with MCI or dementia. Its benefits on cognitive function can be primarily attributed to its effects on working memory. Aerobic exercise at moderate intensity or above and a total training duration of > 24 hours can lead to a more pronounced effect on global cognition.

A multicomponent exercise intervention to improve physical functioning, cognition and psychosocial well-being in elderly nursing home residents: a study protocol of a randomized controlled trial in the PROCARE (prevention and occupational health in long-term care) project

BACKGROUND

Older adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life.

METHODS

A two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45-60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents' capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only).

DISCUSSION

This study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents.

TRIAL REGISTRATION

The trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

[Effectiveness of interventions to strengthen cognitive resources in nursing home residents : A systematic review and network meta-analysis]

BACKGROUND

Strengthening cognitive resources of residents in nursing homes is an important goal of preventive activities. The aim of this systematic review was to answer the question which intervention is most effective for nursing home residents to strengthen their cognitive resources.

METHOD

A systematic literature search was carried out in the Cochrane Library and the MEDLINE (PubMed), Embase, CINAHL, PsycINFO and PEDro databases. Reference lists of publications classified as relevant were checked and trial registries were searched. The literature selection, data extraction and assessment of the study quality were carried out by two reviewers independently. A frequentist network meta-analysis was conducted using a random effects model.

RESULTS

A total of 29 studies with 1816 participants were included. Both physical activity (standardized mean difference [SMD] = 0.70, 95%-confidence interval [CI] 0.35-1.06, p < 0.001) and cognitive activity (SMD = 0.61, 95%-CI 0.22-1.01, p < 0.01) were statistically significantly superior in strengthening cognitive resources compared to usual care. Physical and cognitive activities did not differ statistically significantly from each other. In addition, neither physical activity nor cognitive activity showed statistically significantly better cognitive resources in nursing home residents compared to social activities.

CONCLUSION

The findings imply that physical activity as well as cognitive activity could be effective to strengthen cognitive resources of nursing home residents. Considering the low-quality of available evidence, performance of high-quality studies is essential in order to verify the robustness of the statistical results.

Vestibular Physical Therapy in Individuals With Cognitive Impairment: A Theoretical Framework

Falls are a major health care concern in individuals with Alzheimer disease (AD) and their caregivers. Vestibular impairment is a known risk factor for falls, and individuals with AD have been shown to have an increased prevalence of vestibular loss compared with age-matched controls. Vestibular physical therapy (VPT) is effective in improving balance and reducing fall risk in cognitively-intact persons with vestibular impairment. However, the effectiveness of VPT in improving balance and reducing falls in individuals with AD who have vestibular loss has never been explored. SUMMARY OF KEY POINTS:: In this article, we apply prevailing ideas about rehabilitation and motor learning in individuals with cognitive impairment (IwCI) to VPT. RECOMMENDATIONS FOR CLINICAL PRACTICE:: We propose a modification of current evidence-based VPT protocols for IwCI using the strength-based theoretical framework that emphasizes the motor learning abilities of IwCI. In addition, we highlight the importance of establishing an excellent rapport with IwCI, and present key strategies for optimizing the therapeutic relationship. In ongoing work, we are assessing the efficacy of this modified VPT protocol in IwCI to improve balance and reduce falls.

Six-month observational follow-up on activities of daily living in people with dementia living in nursing homes after a 6-month group based on either exercise or social activities

BACKGROUND

Studies have demonstrated changes in activities of daily living after an exercise intervention in people with dementia (PWD) living in nursing homes (NH). However, some discrepancies are shown during follow-up.

AIMS

Our objective was to measure activities of daily living (ADL) performance during a 6-month observational follow-up after a 6-month exercise or social activity intervention in PWD living in NH.

METHODS

After cluster randomisation, 91 PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). After the intervention, 85 PWD were assessed for post-intervention follow-up. Instrumental and basic activities of daily living (IADL, ADL) were measured at 6-month observational follow-up after the intervention using the Alzheimer's Disease Cooperative Study Activities of Daily Living Inventory for Severe Alzheimer's Disease (ADCS-ADL-sev) scale (scores ranging from 0 to 51, higher is better).

RESULTS

Compared to participants in the social activity, those who participated to the exercise intervention had a significant decrease of their ADCS-ADL-sev score (between-group adjusted mean difference: 4.6 points, p = 0.001) with IADL having the most decrease (2.8 points, p = 0.004).

DISCUSSION

Unexpectedly, exercisers declined sharply in the performance of ADLs and IADLs, whereas participants in the social intervention group maintained their levels. The potential mechanisms to explain these findings remain still to be elucidated.

Effect of Exercise on Behavioral Symptoms and Pain in Patients With Dementia Living in Nursing Homes

OBJECTIVES

Examine the effects of a 6-month exercise intervention on neuropsychiatric symptoms, pain, and medication consumption in older people with dementia (PWD) living in nursing homes (NH).

METHODS

Ninety-one older PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). Neuropsychiatric symptoms were measured by the neuropsychiatric inventory (NPI), pain was assessed using the Algoplus scale, and dementia-related drug prescriptions were obtained for all participants.

RESULTS

Between-group analysis found a nonsignificant difference that could be of clinical relevance: a 4-point difference in the NPI and 1.3-point difference in the reduction of the number of medications favoring exercisers. No significant differences were found for pain, and a trend was found for an increase in medication consumption in the social group.

CONCLUSION

Exercise effects did not differ from social intervention effects on neuropsychiatric symptoms, pain, and medication consumption in older PWD living in NH.

Dose-response relationship between exercise and cognitive function in older adults with and without cognitive impairment: A systematic review and meta-analysis

This systematic review and meta-analysis examined the dose-response relationship between exercise and cognitive function in older adults with and without cognitive impairments. We included single-modality randomized controlled aerobic, anaerobic, multicomponent or psychomotor exercise trials that quantified training frequency, session and program duration and specified intensity quantitatively or qualitatively. We defined total exercise duration in minutes as the product of program duration, session duration, and frequency. For each study, we grouped test-specific Hedges' d (n = 163) and Cohen's d (n = 23) effect sizes in the domains Global cognition, Executive function and Memory. We used multilevel mixed-effects models to investigate dose-related predictors of exercise effects. In healthy older adults (n = 23 studies), there was a small positive effect of exercise on executive function (d = 0.27) and memory (d = 0.24), but dose-parameters did not predict the magnitude of effect sizes. In older adults with cognitive impairments (n = 13 studies), exercise had a moderate positive effect on global cognition (d = 0.37). For older adults with cognitive impairments, we found evidence for exercise programs with a short session duration and high frequency to predict higher effect sizes (d = 0.43-0.50). In healthy older adults, dose-parameters did not predict the magnitude of exercise effects on cognition. For older adults with cognitive impairments, exercise programs with shorter session duration and higher frequency may generate the best cognitive results. Studies are needed in which different exercise doses are directly compared among randomized subjects or conditions.

On the Run for Hippocampal Plasticity

Accumulating research in rodents and humans indicates that exercise benefits brain function and may prevent or delay onset of neurodegenerative conditions. In particular, exercise modifies the structure and function of the hippocampus, a brain area important for learning and memory. This review addresses the central and peripheral mechanisms underlying the beneficial effects of exercise on the hippocampus. We focus on running-induced changes in adult hippocampal neurogenesis, neural circuitry, neurotrophins, synaptic plasticity, neurotransmitters, and vasculature. The role of peripheral factors in hippocampal plasticity is also highlighted. We discuss recent evidence that systemic factors released from peripheral organs such as muscle (myokines), liver (hepatokines), and adipose tissue (adipokines) during exercise contribute to hippocampal neurotrophin and neurogenesis levels, and memory function. A comprehensive understanding of the body-brain axis is needed to elucidate how exercise improves hippocampal plasticity and cognition.

Systematic review of the efficacy of non-pharmacological interventions in people with Lewy body dementia

ABSTRACTBackground:Pharmacological interventions for Lewy body dementia (LBD), especially for its non-cognitive symptoms, are limited in their efficacy and tolerability. Clinicians are often uncertain about non-pharmacological interventions and their efficacy in managing cognitive and non-cognitive symptoms of LBD. Therefore, we aimed to systematically review the existing literature on non-pharmacological interventions for people with LBD.

METHODS

We carried out a systematic search using six databases. All human studies examining impact of any non-pharmacological intervention on LBD were assessed for cognitive, physical, psychiatric, and quality-of-life outcomes. Study quality was assessed by Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the CARE criteria checklist.

RESULTS

Prevailing evidence supporting the efficacy of non-pharmacological interventions is weak. We screened 1,647 papers. Fifteen studies (n = 61) including 11 case reports were found eligible for this systematic review. Interventions and reported outcomes were heterogeneous. Deep brain stimulation of the nucleus basalis of Meynert reportedly conferred cognitive benefit. Electroconvulsive therapy and repetitive transcranial magnetic stimulation have been reported to ameliorate depressive symptoms. Transcranial direct current stimulation was observed to improve attention. Exercise-based interventions reportedly improve various clinically important outcomes. Spaced retrieval memory training and environmental intervention for "mirror sign" have also been reported.

CONCLUSIONS

Several non-pharmacological interventions have been studied in LBD. Although evidence supporting their efficacy is not robust, prevailing preliminary evidence and limitations of available pharmacological interventions indicate the need to consider appropriate non-pharmacological interventions, while planning comprehensive care of LBD patients. Larger trials evaluating the efficacy of non-pharmacological interventions for LBD are needed.

Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review

QUESTION

Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training?

DESIGN

Systematic review with meta-analysis of randomised trials.

PARTICIPANTS

People with mild cognitive impairment or dementia as the primary diagnosis.

INTERVENTION

Physical exercise.

OUTCOME MEASURES

Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls.

RESULTS

Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact.

CONCLUSION

People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15].

Experiences of older people with dementia participating in a high-intensity functional exercise program in nursing homes: "While it's tough, it's useful"

The objective of the study was to describe the views and experiences of participation in a high-intensity functional exercise (HIFE) program among older people with dementia in nursing homes. The study design was a qualitative interview study with 21 participants (15 women), aged 74-96, and with a Mini-Mental State Examination score of 10-23 at study start. The HIFE-program comprises exercises performed in functional weight-bearing positions and including movements used in everyday tasks. The exercise was individually designed, supervised in small groups in the nursing homes and performed during four months. Interviews were performed directly after exercise sessions and field notes about the sessions were recorded. Qualitative content analysis was used for analyses. The analysis revealed four themes: Exercise is challenging but achievable; Exercise gives pleasure and strength; Exercise evokes body memories; and Togetherness gives comfort, joy, and encouragement. The intense and tailored exercise, adapted to each participant, was perceived as challenging but achievable, and gave pleasure and improvements in mental and bodily strength. Memories of previous physical activities aroused and participants rediscovered bodily capabilities. Importance of individualized and supervised exercise in small groups was emphasized and created feelings of encouragement, safety, and coherence. The findings from the interviews reinforces the positive meaning of intense exercise to older people with moderate to severe dementia in nursing homes. The participants were able to safely adhere to and understand the necessity of the exercise. Providers of exercise should consider the aspects valued by participants, e.g. supervision, individualization, small groups, encouragement, and that exercise involved joy and rediscovery of body competencies.

Systematic review of behaviour change techniques to promote participation in physical activity among people with dementia

PURPOSE

The objective of this study was to systematically review the evidence for the potential promise of behaviour change techniques (BCTs) to increase physical activity among people with dementia (PWD).

METHODS

PsychINFO, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched 01/01/2000-01/12/2016. Randomized controlled/quasi-randomized trials were included if they recruited people diagnosed/suspected to have dementia, used at least one BCT in the intervention arm, and had at least one follow-up measure of physical activity/adherence. Studies were appraised using the Cochrane Collaboration Risk of Bias Tool, and BCTs were coded using Michie et al., 2013, Annals of Behavioral Medicine, 46, 81. taxonomy. Intervention findings were narratively synthesized as either 'very promising', 'quite promising', or 'non-promising', and BCTs were judged as having potential promise if they featured in at least twice as many very/quite promising than non-promising interventions (as per Gardner et al., 2016, Health Psychology Review, 10, 89).

RESULTS

Nineteen articles from nine trials reported physical activity findings on behavioural outcomes (two very promising, one quite promising, and two non-promising) or intervention adherence (one quite promising and four non-promising). Thirteen BCTs were used across the interventions. While no BCT had potential promise to increase intervention adherence, three BCTs had potential promise for improving physical activity behaviour outcomes: goal setting (behaviour), social support (unspecified), and using a credible source.

CONCLUSIONS

Three BCTs have potential promise for use in future interventions to increase physical activity among PWD. Statement of contribution What is already known on this subject? While physical activity is a key lifestyle factor to enhance and maintain health and wellbeing amongst the general population, adults rarely participate in sufficient levels to obtain these benefits. Systematic reviews suggest that specific behaviour change techniques can increase physical activity, although one review suggested that self-regulatory techniques may be counterproductive when promoting physical activity among older people. Until now, no systematic review has been conducted to assess which behaviour change techniques may be associated with greater participation in physical activity among people with dementia. What does this study add? Interventions showed mixed promise for increasing physical activity and little effect on participant adherence. Goal setting (behaviour), social support (unspecified), and using a credible source are promising approaches. No technique showed promise for increasing adherence to physical activity interventions among people with dementia.

[Interventions for promoting physical activity in nursing homes : Systematic review of the effectiveness of universal prevention]

BACKGROUND

Among residents of nursing homes, physical activity might be beneficial in maintaining health-related quality of life because impairment is caused in particular by functional decline. The aim is the evaluation of the effectiveness of universal preventive interventions directed at increasing physical activity on activities of daily living in nursing home residents.

MATERIAL AND METHODS

Relevant studies were identified through database searching in MEDLINE, the Cochrane library, EMBASE, CINAHL, PsycINFO and PEDro. Two review authors independently selected articles, assessed the risk of bias and extracted data. Results were combined in random effects meta-analyses.

RESULTS

By including 14 primary studies, nursing home residents participating in physical activities showed a statistically significant greater physical functioning compared to controls (standardized mean difference [SMD] = 0.48, 95% confidence interval [95% CI] 0.26-0.71, p < 0.0001). Subgroup analyses suggest that especially nursing home residents with severe physical and cognitive impairment might benefit from participation in physical activities. Results after non-training periods substantiate the necessity of a sustained implementation. Due to the high risk of bias in included studies, the results must be interpreted with caution.

CONCLUSION

Physical activity for nursing home residents can be effective. Considering the low-quality evidence, performance of high-quality studies is essential in order to verify the statistical results.

Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis

BACKGROUND

Previous reviews and meta-analyses demonstrated effects of cognitive interventions in dementia, but none specifically considered residents with dementia in long-term care (LTC) facilities.

OBJECTIVE

To analyse the efficacy of cognitive interventions in institutionalised individuals with dementia.

METHODS

After identifying 27 articles, a systematic review was performed. A meta-analysis was calculated for 15 studies of the randomized controlled trials regarding effects on relevant outcomes. Fixed-effects meta-analyses were conducted using standardized mean differences (SMD) of changes from baseline pooled using the inverse variance method.

RESULTS

When comparing cognitive interventions to passive control groups, the meta-analysis revealed significant moderate effects on global cognition (SMD=0.47, 95% CI 0.27-0.67), autobiographical memory (0.67, 0.02-1.31), and behavioral and psychological symptoms in dementia (BPSD; 0.71, 0.06-1.36). Significant small effects were detected for quality of life (QoL; 0.37, 0.05-0.70). Moderate effects on activities of daily living (0.28; -0.02 to 0.58) failed to reach significance; no effects were found on depression (0.22; -0.08 to 0.51). Significant moderate effects of global cognition (0.55; 0.22-0.89) and depression (0.64; 0.21-1.07) were also found for cognitive interventions contrasting active control groups. No harmful events related to the participation in the interventions were observed.

CONCLUSION

Cognitive interventions are safe and effective for residents with dementia in LTC. However, while it seems clear that cognitive benefits can specifially be assigned to these forms of intervention, further research is necessary to clarify whether the effects on BPSD and QoL reflect unspecific changes due to additional attention. Furthermore, future studies will have to determine which intervention type yields the largest benefits.

Informed Consent to Research with Cognitively Impaired Adults: Transdisciplinary Challenges and Opportunities

Due to issues related to informed research consent, older adults with cognitive impairments are often excluded from high-quality studies that are not directly related to cognitive impairment, which has led to a dearth of evidence for this population. The challenges to including cognitively impaired older adults in research and the implications of their exclusion are a transdisciplinary issue. The ethical challenges and logistical barriers to conducting research with cognitively impaired older adults are addressed from the perspectives of three different fields-social work, emergency medicine, and orthopaedic surgery. Issues related to funding, study design, intervention components, and outcomes are discussed through the unique experiences of three different providers. A fourth perspective-medical research ethics-provides alternatives to exclusion when conducting research with cognitively impaired older adults such as timing, corrective feedback and plain language, and capacity assessment and proxy appointments. Given the increasing aging population and the lack of evidence on cognitively impaired older adults, it is critical that researchers, funders, and institutional review boards not be dissuaded from including this population in research studies.

Physical Fitness in Older People Recently Diagnosed with Cognitive Impairment Compared to Older People Recently Discharged from Hospital

BACKGROUND/AIMS

There is evidence of an association between cognitive function and physical fitness. The aim of this study was to compare physical fitness in patients with cognitive impairment with a group of older people recently discharged from hospital.

METHODS

A cross-sectional study with 98 patients recently diagnosed with cognitive impairment and 115 patients recently discharged from hospital. Associations between the study group variable and different components in the Senior fitness test were examined, controlling for demographic factors and comorbidity.

RESULTS

The group recently diagnosed with cognitive impairment indicated poorer results on three of six physical fitness components (p < 0.05).

CONCLUSION

Older adults with cognitive impairment are in need of individually tailored physical activity programs to increase the level of physical fitness.