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McArthur C, Alizadehsaravi N, Affoo R, Cooke K, Douglas N, Earl M, Flynn T, Ghanouni P, Hunter S, Kalu M, Middleton L, Moody E, Smith C, Verlinden L, Weeks L. Effectiveness of physical rehabilitation on physical functioning and quality of life for long-term care residents with dementia: a systematic review and meta-analysis. JBI Evid Synth 2024:02174543-990000000-00322. [PMID: 38915237 DOI: 10.11124/jbies-23-00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
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.
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Affiliation(s)
- Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | | | - Rebecca Affoo
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, NS, Canada
| | - Karen Cooke
- Physiotherapy Department, Halifax, NS, Canada
| | - Natalie Douglas
- Deparment of Communicative Disorders, University of Louisiana Lafeyette: Lafeyette, LA, United States
| | - Marie Earl
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | | | - Parisa Ghanouni
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Susan Hunter
- School of Physiotherapy, Western University, London, ON, Canada
| | - Michael Kalu
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Laura Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada
| | - Elaine Moody
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | | | | | - Lori Weeks
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
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Andrews M, Cheema BS, Siette J. Barriers and facilitators to implementation of physical activity programs for individuals with dementia living in aged care homes: A systematic review. Arch Gerontol Geriatr 2024; 126:105535. [PMID: 38936317 DOI: 10.1016/j.archger.2024.105535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 06/10/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES This systematic review aimed to identify barriers and facilitators to the implementation of physical activity programs for residents with dementia in aged care homes. METHODS A search was conducted using the databases Medline, PubMed, PsycINFO, CINAHL, Embase, and ProQuest, and captured articles were assessed for inclusion in the review. Included studies were appraised using the Mixed Methods Appraisal Tool (MMAT). Data extraction was performed for study characteristics, identified barriers and facilitators to physical activity implementation, and synthesised narratively. RESULTS Following full-text screening, 13 articles were included in the review. Reporting quality was high in the majority of studies (69 %). Overall, barriers to implementation of physical activity programs were linked to factors related to the resident or the aged care facility, rather than inherently with the physical activity itself. The most identified barriers were understaffing (62 %), resident fatigue or lack of motivation (46 %), distrust of staff (31 %), and fear of injury (31 %). The most identified facilitators were having a structured physical activity protocol (46 %), opportunities for social interaction (38 %), instructor-led sessions (38 %) and offering an individually tailored program (31 %). CONCLUSIONS Addressing barriers of understaffing and resident fatigue whilst simultaneously offering structured, personalised group physical activity programs led by instructors may help optimise implementation. Future research should focus on developing tailored implementation plans, evaluating their effectiveness and cost-effectiveness, and identifying best practices to support the delivery of physical activity interventions in residential aged care settings. PROSPERO REGISTRATION NUMBER CRD42022372308.
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Affiliation(s)
- Mitchell Andrews
- Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW, 2109, Australia
| | - Birinder S Cheema
- School of Health Sciences, Translational Health Research Institute and the National Institute of Complementary Medicine, Western Sydney University, Penrith, NSW, 2751, Australia
| | - Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Westmead, NSW, 2145, Australia.
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Chow BC, Jiao J, Duong TV, Hassel H, Kwok TCY, Nguyen MH, Liu H. Health literacy mediates the relationships of cognitive and physical functions with health-related quality of life in older adults. Front Public Health 2024; 12:1355392. [PMID: 38550320 PMCID: PMC10976439 DOI: 10.3389/fpubh.2024.1355392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/16/2024] [Indexed: 04/02/2024] Open
Abstract
Background Declining cognitive function (CF) and physical function (PF) relate to poorer health-related quality of life (HRQoL) in older adults. As health literacy (HL) facilitates health information utilization, it may mediate links between functionality and HRQoL appraisals. This study examined HL as an intermediary between joint CF and PF contributions and HRQoL in Hong Kong older adults. Methods 490 older adults aged 50-80 years completed assessments from March to July 2021. Health Literacy Survey Questionnaire Short Form 12 questions (HLS-SF12), Montreal Cognitive Assessment (MoCA), Senior Fitness Test (SFT) and 12-Item Short-Form Health Survey version 2 (SF-12v2) were used to assess HL, CF, PF and HRQoL, respectively. Path analysis tested a model with HL mediating CF/PF predictors and HRQoL outcome. Results Results for direct effects indicated that CF significantly associated with PF (β = 0.115, SE = 0.012, p < 0.001), PF significantly connected to HL (β = 0.101, SE = 0.022, p < 0.001), and HL significantly related to HRQoL (β = 0.457, SE = 0.049, p < 0.001). Meanwhile, PF significantly linked to HRQoL directly (β = 0.156, SE = 0.025, p < 0.001) as well as indirectly (β = 0.046, 95% CI [0.028, 0.067]). Significant mediating effect of HL was found on the relationship of PF and HRQoL. Conclusion Findings confirm CF and PF joint impacts on HL and HRQoL in older adults, elucidating HL's mediating role in translating functionality levels into HRQoL. Fostering enduring health knowledge access may thus buffer effects of age-related declines on well-being. Results can inform interventions leveraging this pathway to promote resilient trajectories.
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Affiliation(s)
- Bik C. Chow
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Jiao Jiao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
- Dr. Stephen Hui Research Centre for Physical Recreation and Wellness, Hong Kong Baptist University, Kowloon Tong, Hong Kong SAR, China
| | - Tuyen V. Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Holger Hassel
- Institute for Applied Health Sciences, Coburg University of Applied Sciences and Arts, Coburg, Germany
- Berlin Institute for Health and Social Affairs, Berlin, Germany
| | - Timothy C. Y. Kwok
- Department of Medicine & Therapeutic and School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Minh H. Nguyen
- International PhD Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huaxuan Liu
- School of Physical Education and Sport Science, Fujian Normal University, Fuzhou, Fujian, China
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Feenstra RW, de Bruin LJE, van Heuvelen MJG. Factors Affecting Physical Activity in People with Dementia: A Systematic Review and Narrative Synthesis. Behav Sci (Basel) 2023; 13:913. [PMID: 37998660 PMCID: PMC10669736 DOI: 10.3390/bs13110913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 11/25/2023] Open
Abstract
Physical activity (PA) has positive effects on the physical and cognitive functioning of people with dementia. Knowledge about what limits and stimulates people with dementia to participate in PA is essential to promote effective PA implementation and enhance PA levels. Previous reviews primarily included opinion-based studies, using data from interviews, focus groups or dyads. By including implementation studies, we aimed to elaborate on previous reviews by identifying new barriers to PA and new facilitators and motivators for PA. We conducted systematic searches in Pubmed, PsychInfo and Web of Science for studies published up to the 21st of September 2021. Search terms were related to the population of people with dementia, PA interventions and implementation outcomes. Studies were included if PA participation was investigated during actual PA implementation. No restrictions were made regarding study design, date of publication, PA type or outcome measures. Studies not implementing PA or not evaluating the implementation were excluded. Based on 13 empirical studies, we identified 35 barriers, 19 facilitators and 12 motivators. Of these, 21 barriers, 11 facilitators and 4 motivators were not identified by previous reviews. New factors are related to the support for people with dementia from informal and formal caregivers, e.g., revealing the importance of a trusting relationship. Furthermore, support for staff from the institution or an external party is needed to overcome doubts about PA, for example, related to safety and effects. New factors also suggested specific recommendations for the content and organization of the PA intervention, for instance, related to how to give instructions. Overall, factors affecting PA identified with opinion-based or implementation studies are complementary. Our extended overview shows the complexity of PA implementation and may help to personalize PA, develop implementation strategies, facilitate actual PA implementation and free up resources needed for effective implementation.
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Affiliation(s)
| | | | - Marieke J. G. van Heuvelen
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, P.O. Box 196, 9700 AD Groningen, The Netherlands
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Uysal İ, Başar S, Aysel S, Kalafat D, Büyüksünnetçi AÖ. Aerobic exercise and dual-task training combination is the best combination for improving cognitive status, mobility and physical performance in older adults with mild cognitive impairment. Aging Clin Exp Res 2023; 35:271-281. [PMID: 36550323 DOI: 10.1007/s40520-022-02321-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
AIM The aim of the present study was to investigate the effects of different exercise combinations on cognitive status, muscle strength of lower extremities, mobility, physical performance, mood and quality of life in older adults with mild cognitive impairment (MCI). METHODS A total of 48 older adults with MCI were randomly assigned to four groups: (1) aerobic plus lower extremity strengthening exercises (AG), (2) dual-task training plus lower extremity strengthening exercises (DG), (3) aerobic exercise, dual-task training and lower extremity strengthening exercises (ADG), (4) solely lower extremity strengthening exercises (CG). Patients' cognitive status, lower extremity muscle strength, balance, mobility, activities-specific balance confidence, functional exercise capacity, physical performance, mood and quality of life were evaluated. RESULTS In all three intervention groups, there was a significant improvement in cognitive status, balance, mobility, activities-specific balance confidence, physical performance, mood and quality of life (p < 0.05). The most remarkable change was observed in the ADG on cognitive status, mobility and physical performance parameters (p < 0.05). In addition, the most significant improvement in balance parameters was recorded both in the DG and ADG (p < 0.05). Besides, the highest increase in functional exercise capacity was detected both in the AG and ADG (p < 0.05). On the other hand, both exercise combinations were superior to the control group in terms of improving mood and quality of life (p < 0.05). CONCLUSION The trial results proved that aerobic exercise and dual-task training is the best combination for improving cognitive status, mobility and physical performance in older adults with MCI.
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Affiliation(s)
- İsmail Uysal
- Fethiye Vocational School of Health Services, Department of Elderly Care, Muğla Sıtkı Koçman University, 48330, Fethiye, Muğla, Turkey.
| | - Selda Başar
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Gazi University, Ankara, Turkey
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Yang Y, van Schooten KS, Komisar V, McKay HA, Sims-Gould J, Cheong D, Robinovitch SN. Effects of the Mobility-Fit Physical Activity Program on Strength and Mobility in Older Adults in Assisted Living: A Feasibility Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095453. [PMID: 35564848 PMCID: PMC9102970 DOI: 10.3390/ijerph19095453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Physical activity programs focusing on fall prevention often overlook upper-limb strength, which is important for transferring, balance recovery, and arresting a fall. We developed and evaluated a physical activity program, Mobility-Fit for older adults in Assisted Living (AL) that includes upper-limb strengthening, agility, coordination, and balance exercises. Thirty participants (85 ± 6 years) were recruited from two AL facilities; 15 were assigned to Mobility-Fit (three times/week, 45 min/session for 12 weeks) and 15 maintained usual care. Twenty-two participants (11 in each group) completed the study. We compared outcome changes between groups and interviewed participants and staff to explore the effectiveness and feasibility of the program. Among participants who attended Mobility-Fit, knee extension strength increased by 6%, reaction time decreased by 16%, and five-time sit-to-stand duration decreased by 15%. Conversely, participants in the usual care group had a 6% decrease in handgrip strength. Changes of these outcomes were significantly different between two groups (p < 0.05). Participants enjoyed the program and staff suggested some changes to improve attendance. Our results indicate that Mobility-Fit is feasible to deliver and beneficial for older adults in AL and may guide future clinical trials to evaluate the effectiveness of upper limb strengthening on safe mobility of older adults in care facilities.
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Affiliation(s)
- Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China
- Correspondence: ; Tel.: +852-3943-4001
| | - Kimberley S. van Schooten
- Neuroscience Research Australia, University of New South Wales, Sydney, NSW 2033, Australia;
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2033, Australia
| | - Vicki Komisar
- School of Engineering, The University of British Columbia—Okanagan Campus, Kelowna, BC V1V 1V7, Canada;
| | - Heather A. McKay
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (H.A.M.); (J.S.-G.); (S.N.R.)
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (H.A.M.); (J.S.-G.); (S.N.R.)
| | - Debbie Cheong
- British Columbia Women’s Health Centre, Vancouver, BC V6H 3N1, Canada;
| | - Stephen N. Robinovitch
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (H.A.M.); (J.S.-G.); (S.N.R.)
- Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada
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Galhardas L, Raimundo A, Del Pozo-Cruz J, Marmeleira J. Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5058. [PMID: 35564453 PMCID: PMC9105463 DOI: 10.3390/ijerph19095058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/09/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Luis Galhardas
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais, 7000-727 Évora, Portugal; (A.R.); (J.M.)
- Comprehensive Health Research Centre (CHRC), Palácio do Vimioso, Gabinete 256, Largo Marquês de Marialva, Apart. 94, 7002-554 Évora, Portugal
| | - Armando Raimundo
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais, 7000-727 Évora, Portugal; (A.R.); (J.M.)
- Comprehensive Health Research Centre (CHRC), Palácio do Vimioso, Gabinete 256, Largo Marquês de Marialva, Apart. 94, 7002-554 Évora, Portugal
| | - Jesús Del Pozo-Cruz
- Department of Physical Education and Sports, University of Seville, 41013 Sevilla, Spain;
- Epidemiology of Physical Activity and Fitness across Lifespan Research Group (EPAFit), University of Seville, 41013 Sevilla, Spain
| | - José Marmeleira
- Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Largo dos Colegiais, 7000-727 Évora, Portugal; (A.R.); (J.M.)
- Comprehensive Health Research Centre (CHRC), Palácio do Vimioso, Gabinete 256, Largo Marquês de Marialva, Apart. 94, 7002-554 Évora, Portugal
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Trautwein S. Personen mit Demenz – eine besondere Zielgruppe in der Sportwissenschaft. ZEITSCHRIFT FUR SPORTPSYCHOLOGIE 2022. [DOI: 10.1026/1612-5010/a000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. In sportwissenschaftlichen Studien mit Personen mit Demenz ist es wichtig, die Besonderheiten der Zielgruppe zu berücksichtigen. Bisherige Studien weisen diesbezüglich Limitationen auf. Im Projekt Bewegung gegen Demenz wurde aufbauend auf einer Analyse des Forschungsstandes ein entsprechendes Studiendesign erarbeitet und in einer randomisierten kontrollierten Studie mit 319 Personen mit Demenz eingesetzt. Eine umfassende Betrachtung motorischer Tests unterstreicht die Bedeutung von angepassten Verfahren und gibt erste Empfehlungen. Die Überprüfung eines multimodalen Bewegungsprogrammes zeigt keine statistisch signifikanten Zeit*Gruppen-Effekte auf die motorische Leistung und den Gang. Explorative Analysen decken Unterschiede in der motorischen und kognitiven Ausgangsleistung zwischen Positiv-, Neutral- und Negativ-Respondern auf. Zudem erklären motorische und kognitive Leistungsänderungen bis zu 39.4 % der Varianz der Gangänderung. Die Ergebnisse und das erarbeitete Studiendesign bieten eine Grundlage für zukünftige Studien, verweisen aber gleichzeitig auf weiteren Forschungsbedarf. Außerdem unterstreichen die begrenzte Eignung eines standardisierten Bewegungsprogrammes sowie Hinweise auf zugrundeliegende Mechanismen die Bedeutung der Berücksichtigung des Individuums.
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Affiliation(s)
- Sandra Trautwein
- Institut für Sport und Sportwissenschaft, Karlsruher Institut für Technologie, Karlsruhe, Deutschland
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A Randomized Controlled Feasibility Trial Evaluating a Resistance Training Intervention With Frail Older Adults in Residential Care: The Keeping Active in Residential Elderly Trial. J Aging Phys Act 2021; 30:364-388. [PMID: 34510020 DOI: 10.1123/japa.2021-0130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022]
Abstract
Frailty is associated with negative health outcomes, disability, and mortality. Physical activity is an effective intervention to improve functional health status. However, the effect of resistance training on multidimensional health in frail older adults remains unclear. This randomized controlled trial was conducted in a U.K. residential care home to assess feasibility with limited efficacy testing on health and functional outcomes and to inform a future definitive randomized controlled trial. Eleven frail older adults (>65 years) completed a 6-week machine-based resistance training protocol three times a week. Uptake and retention were greater than 80%. The measures and intervention were found to be acceptable and practicable. The analyses indicated large improvements in functional capacity, frailty, and strength in the intervention group compared with the controls. These findings support the feasibility of a definitive randomized controlled trial and reinforce the value of resistance training in this population. This trial was registered with ClinicalTrials.gov: NCT03141879.
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Feasibility and Effectiveness of a Biography-Based Physical Activity Intervention in Institutionalized People With Dementia: Quantitative and Qualitative Results From a Randomized Controlled Trial. J Aging Phys Act 2021; 30:237-251. [PMID: 34426552 DOI: 10.1123/japa.2020-0343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/19/2021] [Accepted: 04/20/2021] [Indexed: 11/18/2022]
Abstract
The objective of this multicenter randomized controlled trial was to evaluate the feasibility and effectiveness of a physical activity intervention for institutionalized people with dementia, individualized by capacity and biography. The intervention group (n = 34; age: mean = 86.09 years; 79.40% female; mean Mini-Mental State Examination value = 18.59) participated in a multicomponent training program, which included daily activities, dancing, gardening, and sports/games, twice weekly for 3 months. The control group (n = 29; age: mean = 86.34 years; 75.90% female; mean Mini-Mental State Examination value = 19.90) received standard care. Feasibility was evaluated by means of focus groups and feedback questionnaires. Functional performance (Short Physical Performance Battery and Timed Up and Go Test), activities of daily living, and gait were outcomes for effectiveness. A high adherence rate (80.46%) and uniformly positive feedback indicate that the piloted training program is feasible. The results show preliminary effectiveness on functional performance (Short Physical Performance Battery mean t0 = 3.15; mean t1 = 4.50; p = .006) and gait (e.g., velocity mean t0 = 46.97; mean t1 = 58.04; p = .007).
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Jenkins E, Koirala B, Rodney T, Lee JW, Cotter VT, Szanton SL, Taylor JL. Home/community-based interventions to improve function in persons with mild cognitive impairment/early dementia. Geriatr Nurs 2021; 42:1109-1124. [PMID: 34280736 DOI: 10.1016/j.gerinurse.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/18/2021] [Accepted: 06/21/2021] [Indexed: 12/18/2022]
Abstract
Persons with mild cognitive impairment/early dementia have a possible 20-year trajectory of disability and dependence with little information on the effectiveness of interventions to improve function. This review investigates the literature of home/community-based interventions for physical and executive function in persons with mild cognitive impairment/early dementia. A 2007-2020 systematic literature search was conducted through PubMed, CINAHL Plus with Full Text and PsycINFO. Of the 1749 articles retrieved, 18 eligible studies were identified and consisted of three types of interventions: cognitive training-only (n = 7), multicomponent (n = 9), and physical activity-only (n = 2). Results showed that the interventions impacting function in persons with cognitive impairment incorporated a visual/written element, technology-based training, caregiver support, and modified duration/increased frequency of interventions. In studies improving function, participants simulated Instrumental Activities of Daily Living. They addressed cognitive function using both objective and subjective cognitive measures. We found gaps in the literature in incorporating race/ethnicity and appropriate socioeconomic status measures.
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Affiliation(s)
- Emerald Jenkins
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA.
| | - Binu Koirala
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA
| | - Tamar Rodney
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA
| | - Ji Won Lee
- Johns Hopkins University School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205 USA
| | - Valerie T Cotter
- Johns Hopkins University School of Nursing, 929 N Wolfe St. Room 403, Baltimore, MD 21205 USA
| | - Sarah L Szanton
- Health Equity and Social Justice Endowed Professor, Director, Center on Innovative Care in Aging, Johns Hopkins School of Nursing, Joint Appointment with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins School of Nursing, 525 North Wolfe Street #424, Baltimore, MD 21205 USA
| | - Janiece L Taylor
- Johns Hopkins University School of Nursing, 525 N. Wolfe St. Room 422, Baltimore, MD 21205 USA
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12
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Wen HJ, Tsai CL. Effects of Acute Aerobic Exercise Combined with Resistance Exercise on Neurocognitive Performance in Obese Women. Brain Sci 2020; 10:brainsci10110767. [PMID: 33105799 PMCID: PMC7690637 DOI: 10.3390/brainsci10110767] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/27/2022] Open
Abstract
To the best of the author’s knowledge, there have been no previous studies conducted on the effects of a combination of acute aerobic and resistance exercise on deficit of inhibitory control in obese individuals. The aim of this study was, thus, to examine the effect of a single bout of such an exercise mode on behavioral and cognitive electrophysiological performance involving cognitive interference inhibition in obese women. After the estimated VO2max and percentage fat (measured with dual-energy X-ray absorptiometry (Hologic, Bedford, MA, USA) were assessed, 32 sedentary obese female adults were randomly assigned to an exercise group (EG) and a control group (CG), with their behavioral performance being recorded with concomitant electrophysiological signals when performing a Stroop task. Then, the EG engaged in 30 min of moderate-intensity aerobic exercise combined with resistance exercise, and the CG rested for a similar duration of time without engaging in any type of exercise. After the interventions, the neurocognitive performance was measured again in the two groups. The results revealed that although acute exercise did not enhance the behavioral indices (e.g., accuracy rates (ARs) and reaction times (RTs)), cognitive electrophysiological signals were improved (e.g., shorter N2 and P3 latencies, smaller N2 amplitudes, and greater P3 amplitudes) in the Stroop task after the exercise intervention in the EG. The findings indicated that a combination of acute moderate-intensity aerobic and resistance exercise may improve the neurophysiological inhibitory control performance of obese women.
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Affiliation(s)
- Huei-Jhen Wen
- Physical Education Center, College of Education and Communication, Tzu Chi University, Hualien 97004, Taiwan
- Sports Medicine Center, Tzu Chi Hospital, Hualien 97004, Taiwan
- Correspondence: (H.-J.W.); (C.-L.T.); Tel.: +886-3-8565-301 (ext. 1217) (H.-J.W.); +886-6-2757-575 (ext. 81809) (C.-L.T.)
| | - Chia-Liang Tsai
- Institution of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan 70101, Taiwan
- Correspondence: (H.-J.W.); (C.-L.T.); Tel.: +886-3-8565-301 (ext. 1217) (H.-J.W.); +886-6-2757-575 (ext. 81809) (C.-L.T.)
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Di Lorito C, Bosco A, Booth V, Goldberg S, Harwood RH, Van der Wardt V. Adherence to exercise interventions in older people with mild cognitive impairment and dementia: A systematic review and meta-analysis. Prev Med Rep 2020; 19:101139. [PMID: 32793408 PMCID: PMC7414005 DOI: 10.1016/j.pmedr.2020.101139] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
Adherence to physical exercise is associated with multiple benefits in people with mild cognitive impairment (MCI) and dementia. Given the gap in research, this systematic literature review aimed to determine in the context of exercise intervention studies for people with MCI and dementia: 1. How adherence is defined, monitored and recorded; 2. Adherence rates; 3. Attrition, compliance and adverse events and 4. Intervention characteristics associated with adherence. Embase, Medline, PsychInfo, SPORTDiscus, AMED, CINAHL and the International Bibliography of Social Sciences were searched in November 2018. The data were analyzed through descriptive and correlation/inferential statistics. Forty-one studies were included, 34 involving participants with dementia (n = 2149) and seven participants with MCI (n = 970). Half of the studies operationally defined adherence. Mean adherence rate was 70% [CI, 69-73%]. Adherence was significantly associated with endurance/resistance training, and interventions not including walking. The review found a lack of consistency around reporting of adherence and of key variables mediating adherence, including compliance, attrition and adverse events. Further research using more reliable measures is needed to confirm whether a correlation exists between length of interventions and adherence in participants with MCI and dementia and to identify the factors or strategies that mediate adherence in this population. Relevant implications for practice include a consideration in the development of new interventions of elements associated with higher adherence in this review, such as endurance/resistance training, and the provision of exercise in group formats.
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Affiliation(s)
- Claudio Di Lorito
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Alessandro Bosco
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham NG7 2TU, United Kingdom
| | - Vicky Booth
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Sarah Goldberg
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Rowan H. Harwood
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, United Kingdom
| | - Veronika Van der Wardt
- Wissenschaftliche Mitarbeiterin, Zentrum für Methodenwissenschaften und Gesundheitsforschung Abteilung für Allgemeinmedizin, Präventive und Rehabilitative Medizin, Philipps-Universität Marburg Karl-von-Frisch-Straße 4, 35032 Marburg, Germany
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14
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van der Wardt V, Hancox J, Pollock K, Logan P, Vedhara K, Harwood RH. Physical activity engagement strategies in people with mild cognitive impairment or dementia - a focus group study. Aging Ment Health 2020; 24:1326-1333. [PMID: 30957521 DOI: 10.1080/13607863.2019.1590308] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: This focus group study aimed to explore how to motivate people with mild cognitive impairment (MCI) or dementia and their carers to engage in exercise and physical activity.Methods: Four focus groups were conducted with six people with MCI or dementia, three carers and four clinicians (nurse, occupational therapist, physiotherapists). A thematic analysis of the data was undertaken.Results: Five main themes were identified: 'memory problems', 'self-motivation', 'external motivation', 'design of activities' and 'barriers'. Participants viewed exercise positively but emphasised that it needed to fit into their daily routine. Goal-setting was seen as helpful by some participants but others saw this as a source of potential failure. Enjoyment was seen as key to engagement.Conclusion: Exercise and physical activity interventions need an individualised approach to engage people with MCI or dementia, with a positive emphasis on enjoyment. Goal-setting should be used with caution in this group of people.
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Affiliation(s)
- Veronika van der Wardt
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Jennie Hancox
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | - Kristian Pollock
- Division of Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Pip Logan
- Division of Rehabilitation and Ageing, University of Nottingham School of Medicine, Nottingham, UK
| | | | - Rowan H Harwood
- Division of Primary Care, University of Nottingham School of Medicine, Nottingham, UK
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15
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Recreational Therapy to Promote Mobility in Long-Term Care: A Scoping Review. J Aging Phys Act 2020; 29:142-161. [PMID: 32723928 DOI: 10.1123/japa.2019-0345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 03/29/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022]
Abstract
The objective of this study was to explore and synthesize evidence on the effectiveness and implementation of recreational therapy programs to enhance mobility outcomes (e.g., balance, functional performance, fall incidence) for older adults in long-term care. The authors conducted a scoping review of 66 studies following the PRISMA guidelines. Two independent reviewers evaluated each article, and a third reviewer resolved discrepancies. Randomized controlled studies provided strong to moderate evidence that tai chi programs, walking, dancing, and ball games improve flexibility, functional mobility, and balance. Studies assessing program implementation highlighted that program delivery was facilitated by clear instruction, encouragement, attendance documentation, and minimal equipment. This review elucidated the benefit of recreational therapy programs on mobility. It also identified the need for customized programs based on individuals' interests and their physical and mental abilities. These findings and recommendations will assist practitioners in designing effective and feasible recreational therapy programs for long-term care.
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Trautwein S, Barisch-Fritz B, Scharpf A, Ringhof S, Stein T, Krell-Roesch J, Woll A. Effects of a 16-week multimodal exercise program on gait performance in individuals with dementia: a multicenter randomized controlled trial. BMC Geriatr 2020; 20:245. [PMID: 32677897 PMCID: PMC7364487 DOI: 10.1186/s12877-020-01635-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background There is a high prevalence of gait impairments in individuals with dementia (IWD). Gait impairments are associated with increased risk of falls, disability, and economic burden for health care systems. Only few studies have investigated the effectiveness of physical activity on gait performance in IWD, reporting promising but inconsistent results. Thus, this study aimed to investigate the effectiveness of a multimodal exercise program (MEP) on gait performance in IWD. Methods In this parallel-group randomized controlled trial, we enrolled 319 IWD of mild to moderate severity, living in care facilities, aged ≥ 65 years, and being able to walk at least 10 m. The control group (n = 118) received conventional treatment, whereas the intervention group (n = 201) additionally participated in a 16-week MEP specifically tailored to IWD. We examined the effects of the MEP on spatiotemporal gait parameters and dual task costs by using the gait analysis system GAITRite. Additionally, we compared characteristics between positive, non-, and negative responders, and investigated the impact of changes in underlying motor and cognitive performance in the intervention group by conducting multiple regression analyses. Results Two-factor analyses of variance with repeated measurements did not reveal any statistically significant time*group effects on either spatiotemporal gait parameters or dual task costs. Differences in baseline gait performance, mobility, lower limb strength, and severity of cognitive impairments were observed between positive, non-, and negative responders. Positive responders were characterized by lower motor performance compared to negative and non-responders, while non-responders showed better cognitive performance than negative responders. Changes in lower limb strength and function, mobility, executive function, attention, and working memory explained up to 39.4% of the variance of changes in gait performance. Conclusions The effectiveness of a standardized MEP on gait performance in IWD was limited, probably due to insufficient intensity and amount of specific walking tasks as well as the large heterogeneity of the sample. However, additional analyses revealed prerequisites of individual characteristics and impacts of changes in underlying motor and cognitive performance. Considering such factors may improve the effectiveness of a physical activity intervention among IWD. Trial registration DRKS00010538 (German Clinical Trial Register, date of registration: 01 June 2016, retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do).
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Affiliation(s)
- Sandra Trautwein
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | - Bettina Barisch-Fritz
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Andrea Scharpf
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Steffen Ringhof
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.,Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Thorsten Stein
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Janina Krell-Roesch
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.,Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Alexander Woll
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
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17
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Takechi H, Yamamoto F, Matsunagaa S, Yoshino H, Suzuki Y. A Systematic Review of Multimodal Non-Pharmacological Interventions for Cognitive Function in Older People with Dementia in Nursing Homes. Dement Geriatr Cogn Disord 2020; 48:1-16. [PMID: 31634894 PMCID: PMC7212693 DOI: 10.1159/000503445] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/17/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Multimodal non-pharmacological interventions (MNPIs) have been reported to be effective in improving the cognitive function. Therefore, it is necessary to study these interventions in older people with dementia (PWD) in nursing homes (NHs). AIMS This study aimed to investigate the effects, contents, frequency, duration, length, and form of MNPIs on the global and specific cognitive functions of PWD in NHs through a systematic review, and to consider what kind of intervention design is most effective. METHODS A systematic search of peer-reviewed literature published between January 2008 and October 2018 was performed on the PubMed, Cochrane Library, Web of Science and CINAHL databases. RESULTS Six randomized controlled trials (RCTs) and one non-RCTs were extracted from electronic databases, and a review was carried out. CONCLUSION Our review suggests that MNPIs may improve the global, executive function and memory of PWD in NHs. The combination of exercise, cognitive training and activities of daily living, and intervention at least 3 times a week over at least 8 weeks with, at least 30 min per session using the integrated form is recommended for improving the global and specific cognitive functions of PWD in NHs.
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Affiliation(s)
- Hajime Takechi
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Toyoake, Japan,*Hajime Takechi, MD, PhD, Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutukake, Aichi, Toyoake 470-1192 (Japan),
| | | | - Shinji Matsunagaa
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Yoshino
- Department of Geriatrics and Cognitive Disorders, Fujita Health University School of Medicine, Toyoake, Japan
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18
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McGough EL, Lin SY, Belza B, Becofsky KM, Jones DL, Liu M, Wilcox S, Logsdon RG. A Scoping Review of Physical Performance Outcome Measures Used in Exercise Interventions for Older Adults With Alzheimer Disease and Related Dementias. J Geriatr Phys Ther 2020; 42:28-47. [PMID: 29210934 DOI: 10.1519/jpt.0000000000000159] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance. METHODS A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties. RESULTS AND DISCUSSION A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD. CONCLUSIONS The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.
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Affiliation(s)
- Ellen L McGough
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Shih-Yin Lin
- School of Nursing, University of Washington, Seattle, Washington
| | - Basia Belza
- School of Nursing, University of Washington, Seattle, Washington.,Health Promotion Research Center, University of Washington, Seattle, Washington
| | - Katie M Becofsky
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Dina L Jones
- Department of Orthopaedics, Division of Physical Therapy, and Injury Control Research Center, West Virginia University, Morgantown, West Virginia
| | - Minhui Liu
- School of Nursing, University of Washington, Seattle, Washington.,Center for Innovative Care in Aging School of Nursing, Johns Hopkins University, Baltimore, Maryland
| | - Sara Wilcox
- Department of Exercise Science and Prevention Research Center, University of South Columbia, South Carolina
| | - Rebecca G Logsdon
- School of Nursing, University of Washington, Seattle, Washington.,Health Promotion Research Center, University of Washington, Seattle, Washington
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19
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[Effectiveness of interventions to strengthen cognitive resources in nursing home residents : A systematic review and network meta-analysis]. Z Gerontol Geriatr 2019; 53:778-787. [PMID: 31720830 DOI: 10.1007/s00391-019-01654-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
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.
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Heesterbeek M, van der Zee EA, van Heuvelen MJG. Feasibility of Three Novel Forms of Passive Exercise in a Multisensory Environment in Vulnerable Institutionalized Older Adults with Dementia. J Alzheimers Dis 2019; 70:681-690. [PMID: 31256137 PMCID: PMC6700638 DOI: 10.3233/jad-190309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasing physical activity levels in patients with dementia can reduce pathology severity and progression of the disease. However, physical activity programs can be challenging to adhere to for this vulnerable population. Three novel forms of passive exercise in a multisensory environment may be feasible alternatives for patients who can no longer be involved in physical activity. OBJECTIVE To determine the feasibility of three different forms of passive exercise in a multisensory environment in inactive institutionalized older adults with dementia. METHODS 120 patients with dementia participated in this single blind randomized controlled trial (64.5% female, age 85.3±6.8 years Mini-Mental State Examination range 0-29). Ninety participants were randomly assigned to one of the three intervention groups: Therapeutic Motion Simulation (TMSim), Whole Body Vibration (WBV), and TMSim + WBV. Participants received 6 weeks of passive exercise, 4 sessions a week, 4 (WBV) to 12 (TMSim and TMSim + WBV) minutes per session. Feasibility of the novel forms of passive exercise was evaluated based on attendance, compliance, (proxy) experience scores, adverse events and drop-out rates. RESULTS On average 87.9% of the offered intervention sessions were attended. All three forms of passive exercise were well appreciated by the participants (7.3 on a scale from 0 to 10). Intervention related drop-out rates were reasonable (12.2%) and no serious adverse events occurred. CONCLUSION The novel passive exercise interventions TMSim, WBV, and TMSim + WBV are feasible to apply in patients at all stages of dementia. More research is needed to establish effectiveness of passive exercise to limit adverse effects of dementia.
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Affiliation(s)
- Marelle Heesterbeek
- Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, The Netherlands
| | - Eddy Anton van der Zee
- Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences (GELIFES), University of Groningen, Groningen, The Netherlands
| | - Marieke Joan Gerda van Heuvelen
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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21
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Fien S, Henwood T, Climstein M, Rathbone E, Keogh JWL. Exploring the feasibility, sustainability and the benefits of the GrACE + GAIT exercise programme in the residential aged care setting. PeerJ 2019; 7:e6973. [PMID: 31198633 PMCID: PMC6555397 DOI: 10.7717/peerj.6973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/16/2019] [Indexed: 12/15/2022] Open
Abstract
Background The feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort. Methods A quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance. Results Twenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s). Discussion The GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents.
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Affiliation(s)
- Samantha Fien
- School of Health, Medical and Applied Sciences, CQUniversity, Mackay, Queensland, Australia.,Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Tim Henwood
- Southern Cross Care, North Plympton, South Australia, Australia
| | - Mike Climstein
- School of Health and Human Sciences, Southern Cross University, Gold Coast, Queensland, Australia.,Water Based Research Unit, Bond University, Robina, Queensland, Australia.,Physical Activity, Lifestyle, Ageing and Wellbeing Faculty Research Group, University of Sydney, Sydney, New South Wales, Australia
| | - Evelyne Rathbone
- Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Justin W L Keogh
- Health Science and Medicine, Bond University, Robina, Queensland, Australia.,Human Potential Centre, Auckland University of Technology, Auckland, New Zealand.,Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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22
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Trautwein S, Barisch-Fritz B, Scharpf A, Bossers W, Meinzer M, Steib S, Stein T, Bös K, Stahn A, Niessner C, Altmann S, Wittelsberger R, Woll A. Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel - a qualitative approach. Eur Rev Aging Phys Act 2019; 16:5. [PMID: 31015865 PMCID: PMC6463628 DOI: 10.1186/s11556-019-0212-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/31/2019] [Indexed: 12/02/2022] Open
Abstract
Background Recommendations for assessing motor performance in individuals with dementia (IWD) are rare, and most existing assessment tools previously applied in IWD were initially developed for healthy older adults. However, IWD and their healthy counterparts differ in motor and cognitive capabilities, which needs to be considered when designing studies for this population. This article aims to give recommendations for motor assessments for IWD and to promote standardisation based on a structured discussion of identified assessment tools used in previous trials. Methods Appropriateness and standardisation of previously applied motor assessments for IWD were intensively discussed using a qualitative approach during an expert panel. Furthermore, the use of external cues and walking aids, as well as psychometric properties were considered. Starting with a comprehensive overview of current research practice, the discussion was gradually specified and resulted in the elaboration of specific recommendations. Results The superior discussion emphasised the need for tailoring motor assessments to specific characteristics of IWD and attaching importance to standardised assessment procedures. Specific recommendations include the use of sequential approaches, which incorporate a gradual increase of complexity from simple to more difficult tasks, a selection of motor assessments showing sufficient relative reliability and appropriateness for IWD, as well as allowing external cues and walking aids when restricted to repeated instructions and commonly used devices, respectively. Conclusions These are the first recommendations for assessing motor performance in IWD based on a comprehensive qualitative approach. Due to limited evidence, it was not possible to address all existing questions. It is therefore important to evaluate these recommendations in studies with IWD. Besides tailoring and evaluating available assessments, future research should focus on developing specific tools for IWD. Moreover, further progress in standardisation is necessary to enhance comparability between different trials. This article provides initial approaches for overcoming existing limitations in trials with IWD by giving recommendations and identifying future research questions, and therefore contributes to enhancing evidence regarding efficacy and effectiveness of physical activity interventions.
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Affiliation(s)
- Sandra Trautwein
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Bettina Barisch-Fritz
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Andrea Scharpf
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Willem Bossers
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcus Meinzer
- 3Centre for Clinical Research, University of Queensland, Brisbane, Australia.,4Department of Neurology, Greifswald University Medicine, Greifswald, Germany
| | - Simon Steib
- 5Department of Sport Science and Sport, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Thorsten Stein
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Klaus Bös
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Stahn
- 6Unit of Experimental Psychiatry, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA.,Institute of Physiology, Charité - Universitätsmedizin Berlin, a corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Niessner
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Stefan Altmann
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Rita Wittelsberger
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Woll
- 1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
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Hsiao CY, Tsai AY, Chen KM, Yao CT. Applicability of an elastic band exercise program to wheelchair-bound older adults with and without dementia: A self-rating survey. Geriatr Gerontol Int 2018; 19:103-107. [PMID: 30556233 DOI: 10.1111/ggi.13560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 08/26/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
AIM To investigate the perceptions of wheelchair-bound older adults with and without dementia toward the Wheelchair-bound Senior Elastic Band exercise program, and to compare the differences of their perceptions to the program. METHODS A descriptive and comparative design was applied. Data were derived from the experimental groups of two cluster-randomized controlled trials. A total of 133 participants from eight long-term care facilities were recruited: dementia trial (four facilities, n = 73) and non-dementia trial (four facilities, n = 60). All participants received the Wheelchair-bound Senior Elastic Band exercises, which included three phases of warm-up, aerobic motion and harmonic stretching, three times per week, 40 min per session for 6 months. The self-rating survey using the criteria of simplicity, safety, appropriateness and helpfulness was applied to rate the program through face-to-face individual interviews at the end of the study. RESULTS Wheelchair-bound older adults with or without dementia have positive perceptions of the Wheelchair-bound Senior Elastic Band exercise program with regard to its simplicity, safety, appropriateness and helpfulness after 6 months of practice (mean scores ranged 8.75-9.59). No significant differences were found between groups on self-rating of the program in most of the criteria. CONCLUSIONS Older adults with dementia might be able to express their perceptions toward the exercise program through the self-rating survey, as did the participants without dementia. The participants' perceptions provide direct feedback for modifying, improving and sustaining the long-term implementation of the program. Geriatr Gerontol Int 2019; 19: 103-107.
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Affiliation(s)
- Chih-Yin Hsiao
- Center for Long-term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Athena Yijung Tsai
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- Department of Medical Research, College of Nursing, Kaohsiung Medical University, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ching-Teng Yao
- Master Program of Long-Term Care in Aging, Kaohsiung Medical University, Kaohsiung, Taiwan
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Zhang W, Low LF, Gwynn JD, Clemson L. Interventions to Improve Gait in Older Adults with Cognitive Impairment: A Systematic Review. J Am Geriatr Soc 2018; 67:381-391. [PMID: 30506754 DOI: 10.1111/jgs.15660] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/01/2018] [Accepted: 09/16/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To review intervention programs that measure gait to investigate what features of the intervention may contribute to improving gait in older adults with cognitive impairment or dementia. DESIGN Systematic review using Medline, Cinahl, Scopus, PsychInfo, Amed, Embase, Web of Science, and PubMed for original research published in English between January 1, 2000, and July 23, 2018, to identify interventional controlled trials. Narrative synthesis was undertaken. RESULTS Of 6,379 citations, 36 articles met inclusion criteria. Interventions were categorized as medication or medical devices (8 studies), exercise (19 studies), and exercise plus cognitive training (9 studies). Antidementia medication may improve gait variability in people with Alzheimer's disease. Exercise programs focusing on strength and balance training, especially when combined with functional mobility training, improve gait in people with mild cognitive impairment or dementia. Exercise plus cognitive training programs combining strength and balance training, functional mobility training, and training on attention and executive function also improve gait. CONLUSION Physical and cognitive factors affect gait performance, and both should be addressed in intervention programs. Physical exercises including functional mobility training, especially walking, have better results than physical programs with only static, resistance, and flexibility training. Cognitive intervention should be concomitant with physical exercises rather than separate, with a focus on attention and executive function. Combining physical training with cognitive training in a functional context may assist older adults with cognitive impairment generalize from training to everyday activity. J Am Geriatr Soc 67:381-391, 2019.
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Affiliation(s)
- Weihong Zhang
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia.,Wolper Jewish Hospital, Sydney, New South Wales, Australia
| | - Lee-Fay Low
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | - Josephine Diana Gwynn
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
| | - Lindy Clemson
- University of Sydney, Faculty of Health Sciences, Sydney, New South Wales, Australia
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25
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Feasibility of a machine vs free weight strength training program and its effects on physical performance in nursing home residents: a pilot study. Aging Clin Exp Res 2018; 30:819-828. [PMID: 28980220 DOI: 10.1007/s40520-017-0830-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 08/31/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Resistance training holds promise for nursing home residents to prevent further disabilities, falls, and fractures. Free weight as well as machine training may offer an efficient option to improve physical performance, but the feasibility of these training regimes among elderly who require continuous institutional care is still open. AIMS (1) To examine the feasibility of a 3-month machine vs. free weight strength training program in institutionalized older adults, and (2) to determine the effects on physical performance. METHODS This study is a two-arm, single-blind, randomized controlled feasibility study within a nursing home. 45 institutionalized elderly men and women (aged 83.8 ± 8.0, 12 men, 33 women) were randomly divided into two groups. The two groups completed either a free weight (FWT) or machine training (MT) for 12 weeks, twice per week, 45-60 min per session, in an individually supervised format. Performance was assessed with the 11-step stair-climbing test, 10-m walk test, Timed Up and Go Test (TUG), 30-s Chair Rising Test (CRT), grip strength, body mass index. RESULTS Indices of feasibility showed a recruitment and adherence rate of 53.6 and 87.5%, respectively. 35.6% of the participants dropped out after several weeks for personal reasons, illness, medical visits, or hospital stays. After the program no significant differences on motor performance were found between MT and FWT. However, there were significant improvements for both training groups on the TUG and the CRT. CONCLUSIONS The present pilot study showed that it is feasible to conduct a strength training program in institutionalized participants. The more robust changes in motor function could serve as a basis for large randomized clinical trials.
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Feasibility, Safety, and Preliminary Effectiveness of a Home-Based Self-Managed High-Intensity Interval Training Program Offered to Long-Term Manual Wheelchair Users. Rehabil Res Pract 2018; 2018:8209360. [PMID: 29888007 PMCID: PMC5985105 DOI: 10.1155/2018/8209360] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/14/2018] [Accepted: 04/04/2018] [Indexed: 01/17/2023] Open
Abstract
Objectives To investigate and compare the feasibility, safety, and preliminary effectiveness of home-based self-managed manual wheelchair high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) programs. Methods Eleven manual wheelchair users were randomly assigned to the HIIT (n = 6) or the MICT group (n = 5). Both six-week programs consisted of three 40-minute propulsion training sessions per week. The HIIT group alternated between 30 s high-intensity intervals and 60 s low-intensity intervals, whereas the MICT group maintained a constant moderate intensity. Cardiorespiratory fitness, upper limb strength, and shoulder pain were measured before and after the programs. Participants completed a questionnaire on the programs that explored general areas of feasibility. Results The answers to the questionnaire demonstrated that both training programs were feasible in the community. No severe adverse events occurred, although some participants experienced increased shoulder pain during HIIT. Neither program yielded a significant change in cardiorespiratory fitness or upper limb strength. However, both groups reported moderate to significant subjective improvement. Conclusion Home-based wheelchair HIIT appears feasible and safe although potential development of shoulder pain remains a concern and should be addressed with a future preventive shoulder exercise program. Some recommendations have been proposed for a larger study aiming to strengthen evidence regarding the feasibility, safety, and effectiveness of HIIT.
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Keogh JW, Grigg J, Vertullo CJ. Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial. PeerJ 2018; 6:e4738. [PMID: 29761054 PMCID: PMC5949056 DOI: 10.7717/peerj.4738] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 04/19/2018] [Indexed: 01/22/2023] Open
Abstract
Background Knee osteoarthritis (OA) patients often suffer joint pain and stiffness, which contributes to negative changes in body composition, strength, physical performance (function), physical activity and health-related quality of life. To reduce these symptoms and side effects of knee OA, moderate-intensity continuous training (MICT) cycling is often recommended. While resistance training is considered the optimal form of training to improve sarcopenic outcomes, it imposes higher joint loads and requires supervision, either initially or continuously by trained exercise professionals. Therefore, this pilot study sought to gain some insight into the feasibility and potential benefits of high-intensity interval training (HIIT) cycling as an alternative exercise option to MICT cycling for individuals with knee OA. Methods Twenty-seven middle-aged and older adults with knee OA were randomly allocated to either MICT or HIIT, with both programs involving four unsupervised home-based cycling sessions (∼25 min per session) each week for eight weeks. Feasibility was assessed by enrolment rate, withdrawal rate, exercise adherence and number of adverse effects. Efficacy was assessed by health-related quality of life (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index), physical function (Timed Up and Go (TUG), Sit to Stand (STS) and preferred gait speed) and body composition (body mass, BMI, body fat percentage and muscle mass). Results Twenty-seven of the interested 50 potential participants (54%) enrolled in the study, with 17 of the 27 participants completing the trial (withdrawal rate of 37%); with the primary withdrawal reasons being unrelated injuries or illness or family related issues. Of the 17 participants who completed the trial, exercise adherence was very high (HIIT 94%; MICT 88%). While only three individuals (one in the MICT and two in the HIIT group) reported adverse events, a total of 28 adverse events were reported, with 24 of these attributed to one HIIT participant. Pre–post-test analyses indicated both groups significantly improved their WOMAC scores, with the HIIT group also significantly improving in the TUG and STS. The only significant between-group difference was observed in the TUG, whereby the HIIT group improved significantly more than the MICT group. No significant changes were observed in the Lequesne index, gait speed or body composition for either group. Discussion An unsupervised home-based HIIT cycle program appears somewhat feasible for middle-aged and older adults with knee OA and may produce similar improvements in health-related quality of life but greater improvements in physical function than MICT. These results need to be confirmed in larger randomised controlled trials to better elucidate the potential for HIIT to improve outcomes for those with knee OA. Additional research needs to identify and modify the potential barriers affecting the initiation and adherence to home-based HIIT cycling exercise programs by individuals with knee OA.
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Affiliation(s)
- Justin W Keogh
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Human Potential Centre, Auckland University of Technology, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Josephine Grigg
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Christopher J Vertullo
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia.,Knee Research Australia, Gold Coast, QLD, Australia
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Abstract
Dementia is a syndrome seen most commonly in older people and characterized by a decline in cognitive performance which impacts on the person's ability to function. There are approximately 47 million people worldwide with dementia and there are 10 million new cases every year. It is a major cause of disability and dependence and impacts on the physical, psychologic, and social well-being of families and carers. Alzheimer's disease is the most common form of dementia. Gait and balance impairments are common in people with dementia and contribute to the significantly elevated risk of falls. Older people with dementia are at increased risk of injury, institutionalization, hospitalization, morbidity, and death after a fall. There is preliminary evidence, predominantly from relatively small studies, that falls and disability can be prevented in this population. However, more good-quality research is needed, both to provide some certainty around the existing evidence base as well as to explore alternate approaches to prevention, including combined cognitive-motor training and cognitive pharmacotherapy.
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Affiliation(s)
- Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
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Körperliche Aktivität zur Stärkung kognitiver Ressourcen. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2017. [DOI: 10.1007/s11553-017-0612-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Bossers WJR, van der Woude LHV, Boersma F, Hortobágyi T, Scherder EJA, van Heuvelen MJG. Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9-Week Randomized, Controlled Trial. J Am Geriatr Soc 2017; 64:1258-66. [PMID: 27321604 DOI: 10.1111/jgs.14160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare the effects of two exercise programs on proxy- and performance-based measures of activities of daily living (ADLs) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia. DESIGN A parallel, three-group, single-blind, randomized, controlled trial. SETTING Psychogeriatric wards. PARTICIPANTS Individuals with dementia (mean age 85.6 ± 5.1). INTERVENTIONS Each 9-week intervention consisted of thirty-six 30-minute sessions. A combined group (n = 35) participated in two strength and two walking sessions, an aerobic group (n = 35) participated in four walking sessions, and a social control group (n = 35) participated in four nonexercise social visits per week. The social group was used as a reference for the mediation analysis, which was performed in the combined and aerobic groups. MEASUREMENTS ADLs were assessed using the Katz index (proxy-reported ADL performance), Erlangen-ADL test (E-ADL) (instrumental ADL performance), and 7-item Physical Performance Test (PPT-7) (physical ADL performance). RESULTS There was a group effect for Katz index (P = .02), E-ADL (P < .001), and PPT-7 (P = .003). Differences from baseline to after the intervention were similar in the combined and aerobic groups. Exercise-induced changes in global cognition mediated changes in Katz index (95% confidence interval (CI) = 0.05-0.41), leg muscle strength mediated changes in E-ADL (95% CI = 0.03-0.43), and leg muscle strength (95% CI = 0.01-0.36) and walking endurance (95% CI = 0.01-0.43) mediated changes in PPT-7 only in the combined group. CONCLUSION Physical exercise can improve ADL levels in individuals with dementia, but improvements are small and seem independent of exercise type. Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic-only exercise to effectively target ADL dysfunction in individuals with dementia. Future research is warranted to justify these exercise-specific findings.
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Affiliation(s)
- Willem J R Bossers
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Froukje Boersma
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tibor Hortobágyi
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik J A Scherder
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, the Netherlands
| | - Marieke J G van Heuvelen
- Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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31
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Kim CJ, Park J, Kang SW, Schlenk EA. Factors affecting aging cognitive function among community-dwelling older adults. Int J Nurs Pract 2017. [PMID: 28621053 DOI: 10.1111/ijn.12567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The study purpose was to determine factors affecting aging cognitive function of 3,645 community-dwelling older adults in Korea. METHODS The Hasegawa Dementia Scale assessed aging cognitive function, blood analyses and anthropometrics assessed cardio-metabolic risk factors, and the Geriatric Depression Scale Short Form Korean Version assessed depressive symptoms. RESULTS Participants with poor aging cognitive function were more likely to be in the late age group (≥75 y) and currently smoking and have a medical history of stroke, high body mass index, and high level of depressive symptoms; they were also less likely to engage in regular meals and physical activities. CONCLUSION Regular meals and physical activities may be primary factors for clinical assessment to identify older adults at risk for aging cognitive function. With aging, depressive symptoms and other unhealthy lifestyle behaviours should be managed to prevent cognitive function disorders.
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Affiliation(s)
- Chun-Ja Kim
- College of Nursing, Institute of Nursing Science, Ajou University, Suwon, South Korea
| | - JeeWon Park
- College of Nursing, Institute of Nursing Science, Ajou University, Suwon, South Korea
| | - Se-Won Kang
- Department of Nursing, Dongseo University, Busan, South Korea
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van der Wardt V, Hancox J, Gondek D, Logan P, Nair RD, Pollock K, Harwood R. Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review. Prev Med Rep 2017; 7:38-45. [PMID: 28593121 PMCID: PMC5447393 DOI: 10.1016/j.pmedr.2017.05.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/15/2017] [Indexed: 02/02/2023] Open
Abstract
Exercise-based therapy may improve health status for people with Mild Cognitive Impairment (MCI) or dementia but cannot work without adherence, which has proven difficult. This review aimed to evaluate strategies to support adherence among people with MCI or Dementia and was completed in Nottingham/UK in 2017. A narrative synthesis was used to investigate the effectiveness or usefulness of adherence support strategies. Fifteen adherence support strategies were used including theoretical underpinning (programmes based on behavior change theories), individual tailoring, worksheets and exercise booklets, goal setting, phone calls or reminders, newsletters, support to overcome exercise barriers, information, adaptation periods, individual supervision, support for clinicians, group setting, music, accelerometers/pedometers and emphasis on enjoyable activities. Music was the only strategy that was investigated in a comparative design but was found to be effective only for those who were generally interested in participating in activities. A wide range of adherence support strategies are being included in exercise interventions for people with MCI or dementia, but the evidence regarding their effectiveness is limited.
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Affiliation(s)
- Veronika van der Wardt
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Jennie Hancox
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Dawid Gondek
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Roshan das Nair
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Kristian Pollock
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Rowan Harwood
- Nottingham University Hospital NHS Trust, Nottingham NG7 2UH, United Kingdom
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Van Roie E, Martien S, Hurkmans E, Pelssers J, Seghers J, Boen F, Delecluse C. Ergometer-cycling with strict versus minimal contact supervision among the oldest adults: A cluster-randomised controlled trial. Arch Gerontol Geriatr 2017; 70:112-122. [DOI: 10.1016/j.archger.2017.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 10/20/2022]
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Keogh JWL, Grigg J, Vertullo CJ. Is Home-Based, High-Intensity Interval Training Cycling Feasible and Safe for Patients With Knee Osteoarthritis?: Study Protocol for a Randomized Pilot Study. Orthop J Sports Med 2017; 5:2325967117694334. [PMID: 28451599 PMCID: PMC5400173 DOI: 10.1177/2325967117694334] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: Osteoarthritis (OA) is a degenerative joint disease affecting the knee joint of many middle-aged and older adults. As OA symptoms typically involve knee pain and stiffness, individuals with knee OA are often insufficiently physically active, have low levels of physical function, and are at increased risk of other comorbidities and reduced quality of life. While moderate-intensity continuous training (MICT) cycling is often recommended, little is known about the feasibility, safety, and benefits of high-intensity interval training (HIIT) cycling for this population, even though the feasibility, safety, and benefits of HIIT have been demonstrated in other chronic disease groups. Purpose: The primary objective of this pilot study was to examine the feasibility and safety of home-based HIIT and MICT cycling in middle-aged and older adults with knee OA. A secondary objective was to gain some insight into the relative efficacy of HIIT and MICT for improving health status (pain, stiffness, and disability), muscle function, and body composition in this population. This study protocol is being published separately to allow a detailed description of the research methods, explain the rationale for choosing the methodological details, and to stimulate consideration of the best means to simulate a research protocol that is relevant to a real-life treatment environment. Study Design: Randomized pilot study protocol. Methods: This trial sought to recruit 40 middle-aged and older adults with knee OA. Participants were randomly allocated to either continuous (MICT) or HIIT home-based cycle training programs, with both programs requiring the performance of 4 cycling sessions (approximately 25 minutes per session) each week. Participants were measured at baseline and postintervention (8 weeks). Feasibility and safety were assessed by adherence rate, dropout rate, and number of adverse events. The relative efficacy of the cycling programs was investigated by 2 knee OA health status questionnaires (Western Ontario and McMaster Universities Osteoarthritis Index scale[WOMAC] and the Lequesne Index) as well as the timed up and go, sit to stand, preferred gait speed, and body composition. Discussion: This pilot study appears to be the first study assessing the feasibility and safety of a home-based HIIT training program for middle-aged and older adults with knee OA. As HIIT has been demonstrated to be more effective than MICT for improving aspects of health status, body composition, and/or muscular function in other chronic disease groups, the current study has the potential to improve patient outcomes and inform the design of future randomized controlled trials.
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Affiliation(s)
- Justin W L Keogh
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia.,Human Potential Centre, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Josephine Grigg
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia
| | - Christopher J Vertullo
- Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia.,Knee Research Australia, Gold Coast, Australia
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35
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Fien S, Henwood T, Climstein M, Keogh JWL. Feasibility and benefits of group-based exercise in residential aged care adults: a pilot study for the GrACE programme. PeerJ 2016; 4:e2018. [PMID: 27231652 PMCID: PMC4878364 DOI: 10.7717/peerj.2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/17/2016] [Indexed: 11/20/2022] Open
Abstract
The objective of the study was to examine the feasibility and benefits of a group resistance training exercise programme for improving muscle function in institutionalised older adults. A feasibility and acceptability study was designed for a residential aged care (RAC) facility, based on the Gold Coast, Australia. Thirty-seven adults, mean age 86.8 ± 6.1 years (30 females) living in a RAC facility. Participants were allocated into an exercise (n = 20) or control (n = 17) group. The exercise group, the Group Aged Care Exercise (GrACE) programme, performed 12 weeks of twice weekly resistance exercises. Feasibility was measured via recruitment rate, measurement (physiological and surveys) completion rate, loss-to-follow-up, exercise session adherence, adverse events, and ratings of burden and acceptability. Muscle function was assessed using gait speed, sit-to-stand and handgrip strength assessments. All intervention participants completed pre- and post-assessments, and the exercise intervention, with 85% (n = 17) of the group attending ≥ 18 of the 24 sessions and 15% (n = 3) attending all sessions. Acceptability was 100% with exercise participants, and staff who had been involved with the programme strongly agreed that the participants "Benefited from the programme." There were no adverse events reported by any participants during the exercise sessions. When compared to the control group, the exercise group experienced significant improvements in gait speed (F(4.078) = 8.265, p = 0.007), sit to stand performance (F(3.24) = 11.033, p = 0.002) and handgrip strength (F(3.697) = 26.359, p < 0.001). Resistance training via the GrACE programme is feasible, safe and significantly improves gait speed, sit-to-stand performance and handgrip strength in RAC adults.
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Affiliation(s)
- Samantha Fien
- Health Science and Medicine, Bond University , Robina , Australia
| | - Timothy Henwood
- Health Science and Medicine, Bond University, Robina, Australia; School of Human Movement & Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Mike Climstein
- Exercise, Health and Performance Faculty Research Group, University of Sydney , Sydney, NSW , Australia
| | - Justin William Leslie Keogh
- Health Science and Medicine, Bond University, Robina, Australia; Human Potential Centre, Auckland University of Technology, Auckland, New Zealand; Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Sunshine Coast, Australia
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A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial. Am J Geriatr Psychiatry 2015; 23:1106-16. [PMID: 25648055 DOI: 10.1016/j.jagp.2014.12.191] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 12/17/2014] [Accepted: 12/25/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare training and follow-up effects of combined aerobic and strength training versus aerobic-only training on cognitive and motor function in institutionalized patients with dementia and to explore whether improved motor function mediates improved cognitive function. METHODS Using a 9-week, parallel, three-group, single-blind, randomized, controlled trial with a follow-up assessment at week 18, we assessed 109 patients with dementia (age 85.5 ± 5.1 years) in a psycho-geriatric nursing home. Each 9-week intervention consisted of 36, 30-minute sessions. A combined group (N = 37) received and completed two strength and two walking sessions per week, an aerobic group (N = 36) completed four walking sessions, and a social group (N = 36) completed four social visits per week. Cognitive and motor functions were assessed at baseline, after the 9-week intervention, and after a consecutive 9 weeks of usual care. RESULTS Baseline corrected post-test scores in the combined versus the social group were higher for global cognition, visual memory, verbal memory, executive function, walking endurance, leg muscle strength, and balance. Aerobic versus social group scores were higher for executive function. Follow-up effects reversed toward baseline values. Motor improvement did not significantly mediate cognitive improvement. CONCLUSION Compared with a nonexercise control group, a combination of aerobic and strength training is more effective than aerobic-only training in slowing cognitive and motor decline in patients with dementia. No mediating effects between improvements in cognitive function via improved motor function were found. Future research into the underlying mechanistic associations is needed.
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Yi SJ, Kim JS. The effects of respiratory muscle strengthening exercise using a sling on the amount of respiration. J Phys Ther Sci 2015; 27:2121-4. [PMID: 26311937 PMCID: PMC4540831 DOI: 10.1589/jpts.27.2121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/24/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to present aerobic exercise that can be performed together with respiratory muscle strength training and examine whether the vital capacity of individuals can be enhanced when respiratory muscle strength training is conducted together with aerobic exercise. [Subjects and Methods] The subjects were 10 male students and 8 female students. The sling exercise method was used to conduct three types of training to strengthen the muscles around the shoulder joints. A maximal respiratory quotient measurement device was used to measure the vital capacity of the subjects five times. [Results] There was a significant difference in each respiratory training time point compared with before the performance of respiratory training. [Conclusion] This study presented respiratory muscle strength training using a sling as a training method for respiratory training.
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Affiliation(s)
- Seung-Ju Yi
- Department of Physical Therapy, Andong Science College, Republic of Korea
| | - Jin-Seop Kim
- Department of Physical Therapy, Sunmoon University, Republic of Korea
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Henwood T, Neville C, Baguley C, Clifton K, Beattie E. Physical and functional implications of aquatic exercise for nursing home residents with dementia. Geriatr Nurs 2015; 36:35-9. [DOI: 10.1016/j.gerinurse.2014.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/08/2014] [Accepted: 10/13/2014] [Indexed: 12/19/2022]
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