Effects of an mHealth Brisk Walking Intervention on Increasing Physical Activity in Older People With Cognitive Frailty: Pilot Randomized Controlled Trial

Development and validation of a risk prediction model for mild cognitive impairment in elderly patients with type 2 diabetes mellitus

BACKGROUND

The prevalence of mild cognitive impairment (MCI) is steadily increasing among elderly people with type 2 diabetes (T2DM). This study aimed to create and validate a predictive model based on a nomogram.

METHODS

This cross-sectional study collected sociodemographic characteristics, T2DM-related factors, depression, and levels of social support from 530 older adults with T2DM. We used LASSO regression and multifactorial logistic regression to determine the predictors of the model. The performance of the nomogram was evaluated using calibration curves, receiver operating characteristics (ROC), and decision curve analysis (DCA).

RESULTS

The nomogram comprised age, smoking, physical activity, social support, depression, living alone, and glycosylated hemoglobin. The AUC for the training and validation sets were 0.914 and 0.859. The DCA showed good clinical applicability.

CONCLUSIONS

This predictive nomogram has satisfactory accuracy and discrimination. Therefore, the nomogram can be intuitively and easily used to detect MCI in elderly adults with T2DM.

Physical activity, sedentary behaviour, and cognitive function among older adults: A bibliometric analysis from 2004 to 2024

Because of population ageing, there will be a vast increase in the prevalence of cognitive decline and dementia. Physical activity and sedentary behaviour have been identified as modifiable lifestyle behaviours associated with these cognitive conditions. Therefore, the aim of this bibliometric analysis is to reveal the knowledge structure of the field of physical activity, sedentary behaviour, and cognitive function among older adults from 2004 to 2024, and to predict emerging research trends. A total of 1290 publications were retrieved from the Web of Science Core Collection. CiteSpace and VOSviewer were applied to conduct performance analysis, science mapping, and enrichment. T. Liu-Ambrose was the most prolific author (39 publications), and the University of British Columbia was the most prolific institution (48 publications). The USA, China, and Canada were the three most productive countries with 392, 174, and 136 publications respectively. Two research trends revealed the knowledge structure of this field, including the shift from evaluating the effectiveness of interventions on cognitive function to evaluating the effectiveness of interventions on other health-related outcomes, as well as an expansion of research on the role of physical activity and sedentary behaviour in the context of healthy ageing. Sleep, sedentary behaviour, and virtual reality may be emerging research trends and may predict directions for future research. Collectively, this bibliometric analysis provides a one-step overview of the knowledge structure in this field for researchers and other stakeholders, as well as a reference for future research.

Enhancing Behavioural Changes: A Narrative Review on the Effectiveness of a Multifactorial APP-Based Intervention Integrating Physical Activity

The rapid evolution of technologies is a key innovation in the organisation and management of physical activities (PA) and sports. The increase in benefits and opportunities related to the adoption of technologies for both the promotion of a healthy lifestyle and the management of chronic diseases is evident. In the field of telehealth, these devices provide personalised recommendations, workout monitoring and injury prevention. The study aimed to provide an overview of the landscape of technology application to PA organised to promote active lifestyles and improve chronic disease management. This review identified specific areas of focus for the selection of articles: the utilisation of mobile APPs and technological devices for enhancing weight loss, improving cardiovascular health, managing diabetes and cancer and preventing osteoporosis and cognitive decline. A multifactorial intervention delivered via mobile APPs, which integrates PA while managing diet or promoting social interaction, is unquestionably more effective than a singular intervention. The main finding related to promoting PA and a healthy lifestyle through app usage is associated with "behaviour change techniques". Even when individuals stop using the APP, they often maintain the structured or suggested lifestyle habits initially provided by the APP. Various concerns regarding the excessive use of APPs need to be addressed.

Effectiveness of a multicomponent exercise intervention in community-dwelling older Chinese people with cognitive frailty: protocol for a mixed-methods research

Aims

To evaluate the effectiveness of a multicomponent exercise intervention and to clarify the underlying mechanisms of the program in community-dwelling older adults with cognitive frailty. Additionally, the perception of participants in the program will be explored.

Design

A mixed-methods design, including a randomized controlled trial and an exploratory qualitative study, was used.

Methods

Each group consists of 41 participants. The experimental group will undergo a 12-week multicomponent exercise intervention, including warm-up, exergaming aerobic exercise, elastic-band resistance exercise, and cool-down. This intervention was developed based on the Health Belief Model (HBM) and Self-Efficacy Model (SEM). The control group will not receive any intervention. Physical frailty and cognitive function will be considered as primary outcomes. Data will be collected both at baseline and at the end of the intervention period. Fisher's exact test, analysis of covariance, and generalized linear models will be conducted to compare mean changes between the two groups. Additionally, the mediation models will be used to examine whether any intervention effects are mediated through exercise self-efficacy.

Discussion

The findings of this study are anticipated to provide valuable insights for healthcare providers, enabling them to learn about effective strategies to enhance exercise adherence and promote improved functionality, independence, and quality of life for older adults with cognitive frailty.Clinical trial registration: [https://clinicaltrials.gov/], identifier [ChiCTR2200058850].

The association of technology acceptance and physical activity on frailty in older adults during the COVID-19 pandemic period

BACKGROUND

Physical activity was known to be the protective factor against frailty. Technology acceptance is associated with behavioural intention to technology usage. Technology has been effective in promoting healthy behaviour of physical activity. The purposes of this study were to examine the association between physical activity and technology acceptance with frailty and examine the moderation effect of technology acceptance on physical activity and frailty. We hypothesize that 1) physical activity and technology acceptance are associated with frailty, and 2) technology acceptance moderates the association of physical activity with frailty.

METHODS

This study employed a cross-sectional design and was conducted in the community settings of Hong Kong in 2021. Eligible participants were old people aged ≥60 and were community-dwelling. Key variables included physical activity measured by Rapid Assessment of Physical Activity (RAPA), social network measured by Lubben Social Network Scale-Six items (LSNS-6); depressive symptoms measured by Patient Health Questionnaire-Nine items (PHQ-9), technology acceptance measured by Senior Technology Acceptance Model-14 items (STAM-14) and frailty measured by Fatigue, Resistance, Ambulation, Illnesses, & Loss of Weight scale (FRAIL). Ordinal logistic regression was employed to test the hypotheses. The moderation effect was examined by introducing an interaction term formed by the multiplication of an independent variable (i.e., physical activity) and a moderating variable (i.e., technology acceptance).

RESULTS

This study recruited 380 eligible participants with a mean age of 66.5 years. Technology acceptance (Beta = - 0.031, p < 0.001, Pseudo-R2 = 0.087) and physical activity (Beta = - 0.182, p = 0.003, Pseudo-R2 = 0.027) were associated with frailty in the unadjusted models. Technology acceptance (Beta = - 0.066, p < 0.001) and physical activity (Beta = - 1.192, p < 0.001) were also associated with frailty in the fully adjusted model (Pseudo-R2 = 0.352). Interaction term formed by the multiplication of technology acceptance and physical activity (Beta = 0.012, p = 0.001) was associated with frailty. Physical activity was significantly associated with frailty in the lower technology acceptance subgroup (Beta = - 0.313, p = 0.002) in the subgroup analysis. However, in the subgroup of higher technology acceptance, the association of physical activity (Beta = 0.104, p = 408) on frailty became positive but not significant.

CONCLUSIONS

This study showed that physical activity and technology acceptance were associated with frailty, and technology acceptance moderated the association of physical activity with frailty. This study recommends engaging older adults in physical activity to combat frailty preferentially in those with a lower level of technology acceptance.

E-Health Interventions for Older Adults With Frailty: A Systematic Review

OBJECTIVE

: To systematically review the efficacy of e-Health interventions on physical performance, activity and quality of life in older adults with sarcopenia or frailty.

METHODS

: A systematic review was conducted by searching the MEDLINE, Embase, Cochrane Library, CINHAL, Web of Science, and the Physiotherapy Evidence Database for experimental studies published in English from 1990 to 2021. E-Health studies investigating physical activity, physical performance, quality of life, and activity of daily living assessment in adults aged ≥65 years with sarcopenia or frailty were selected.

RESULTS

: Among the 3,164 identified articles screened, a total of 4 studies complied with the inclusion criteria. The studies were heterogeneous by participant characteristics, type of e-Health intervention, and outcome measurement. Age criteria for participant selection and sex distribution were different between studies. Each study used different criteria for frailty, and no study used sarcopenia as a selection criteria. E-Health interventions were various across studies. Two studies used frailty status as an outcome measure and showed conflicting results. Muscle strength was assessed in 2 studies, and meta-analysis showed statistically significant improvement after intervention (standardized mean difference, 0.51; 95% confidence interval, 0.07-0.94; p=0.80, I2=0%).

CONCLUSION

: This systematic review found insufficient evidence to support the efficacy of e-Health interventions. Nevertheless, the studies included in this review showed positive effects of e-Health interventions on improving muscle strength, physical activity, and quality of life in older adults with frailty.

Health factors associated with cognitive frailty in older adults living in the community

Introduction

This study aims to investigate the health factors associated with cognitive frailty in frail and pre-frail older adults living in the community.

Methods

A total of 233 older adults meeting Fried's criteria for pre-frailty or frailty were included. Cognitive status was evaluated using the Short Portable Mental Status Questionnaire. Health factors encompassed nutritional status (evaluated using the Mini Nutritional Assessment tool, body mass index, and waist, arm, and leg circumferences), physical function (assessed with the Short Physical Performance Battery), quality of life (measured with the total index of the EuroQoL 5-Dimension 5-Level questionnaire - EQoL-Index -, and the Visual-Analogue Scale - QoL-VAS - for today's health state), as well as sleep, physical activity, and inactivity estimated through wrist-worn accelerometers. Multivariable logistic regression analyses were conducted to identify potential predictors of cognitive frailty, considering age as a confounding factor.

Results

Cognitive frail participants exhibited advanced age, heightened self-reported exhaustion, diminished overall physical performance, reduced leg perimeter, decreased engagement in moderate-to-vigorous physical activity, and higher levels of inactivity (all p<0.05). However, after adjusting for age, only QoL-VAS emerged as a cognitive frailty risk factor (Odds ratio: 1.024), while the EQoL-Index, calf perimeter, and levels of moderate-to-vigorous physical activity were identified as protective factors (Odds ratios: 0.025, 0.929, and 0.973, respectively).

Discussion

This study highlights the complex relationship between non-modifiable factors such as age, and modifiable factors including quality of life, nutritional status, and physical activity in the development of cognitive frailty among older adults with a frailty phenotype living in the community.

Management of cognitive frailty: A network meta-analysis of randomized controlled trials

OBJECTIVES

We aimed to compare the effectiveness of interventions in cognitive function and frailty status and rank these interventions.

METHODS

Data Sources-We searched PubMed, Embase, CINAHL, PsycINFO, Web of Science, Cochrane Library, Central Register of Controlled Trials (CENTRAL), CNKI, Wanfang, VIP and Google scholar. Data synthesis-The risk of bias was assessed using the Cochrane risk bias assessment tool. Statistical heterogeneity was assessed using the Chi-square test and quantified by I2 . The results were pooled using the standardized mean difference (SMD). The rank probability for each intervention was calculated using the surface under the cumulative ranking curve (SUCRA). Additionally, the quality of the evidence was evaluated using the GRADE approach.

RESULTS

A total of 10 randomized controlled trials (RCTs) involving 1110 patients were included in our analysis. The network map of cognitive function comprised 9 RCTs with 1347 participants, examining eight different interventions. Nutritional support (SUCRA = 99.9%, SMD = 3.02, 95% CI: 2.53, 3.51) may be the most effective intervention to improve cognitive function. The network map of frailty (including 9 RCTs with 1017 participants and 9 interventions) suggested that multicomponent exercises (SUCRA = 96.4%, SMD = -5.10, 95% CI: -5.96, -4.23) tended to have a greater effect.

CONCLUSIONS

Community-based multicomponent exercises have shown significant benefits for improving cognitive function and frailty status in older adults, with moderate certainty. For hospitalized older patients with Cognitive frailty (CF), current evidence suggests that nutritional support yields the most improvement. Additionally, aerobic exercise and dual-task training have proven effective in managing CF. Further studies are needed to validate these preliminary findings and exploring more accessible and effective physical and cognitive interventions to prevent CF in aging.

The effects of therapeutic virtual reality experience to promote mental well-being in older people living with physical disabilities in long-term care facilities

BACKGROUND

Mental well-being is poor in long-term care facilities (LTCF) residents. Physical disabilities, impaired social engagement, and environmental stress are also common in LTCF which exacerbate the decline of the mental well-being of older people living in LTCF. Protective elements, including nature-based, reminiscence, outdoor, and group activities, are known to be effective to promote the mental well-being of older people living in LTCF. However, limited by their physical disabilities and poor social support, older people living in LTCF are not likely to benefit from these effective measures. Virtual reality has been proven to be feasible to be environmentally unrestricted to providing LTCF residents with all protective elements promoting mental well-being. However, its effects on the mental well-being of LTCF residents living with physical disabilities are unclear.

METHODS

This study employs a single-blinded, two-parallel-group (intervention-to-control group ratio = 1:1), non-inferiority, randomized controlled trial. Eligible participants are aged 60 years or above, LTCF residents, and living with physical disabilities. The study will be conducted in LTCF. In the intervention group, participants will receive a 6-week VR experience program. In the control group, participants will receive the usual care provided by the LTCF. The primary outcome is mental well-being, as measured by World Health Organization Five Well-being Index at the time point of baseline (i.e., week 0) and after completion of the intervention (i.e., week 7). This study aims to recruit a total of 216 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention.

TRIAL REGISTRATION

The trial has been registered at ClinicalTrials.gov (Identifier: NCT05818579 ), Registered on April 5, 2023. The latest version of the protocol was published online on 19 April 2023. All items come from the World Health Organization Trial Registration Data Set. This study has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2023158). The findings will be disseminated in peer-reviewed journals, presented at international and local conferences with related themes, and shared in local media.

The effects of an integrated exercise and cardiovascular health education programme on community-dwelling older adults at risk of atherosclerotic cardiovascular diseases: A study protocol for a randomised controlled trial

BACKGROUND

Although older adults are at an increased risk of atherosclerotic cardiovascular disease (ASCVD), the effect of an integrated exercise and cardiovascular health education programme based on self-efficacy theory has not been well investigated among older adults. This study aims at examining the effect of this programme on community-dwelling older adults at risk of ASCVD concerning physical activity level, exercise self-efficacy and ASCVD risk profile.

METHODS

A parallel two-arm randomised controlled trial with pretest-posttest design will be performed among 190 Chinese community-dwelling adults aged 60 or above in elderly community centres of the Guangdong-Hong Kong-Macao Greater Bay Area. Eligible participants will be randomised by computerised generation. Experimental group will receive a 12-week integrated exercise and cardiovascular health education programme, which comprises a one-hour group-based health education talk conducted at Week 1, a booklet, a lecture video, a tailor-made exercise video, and a booster intervention by text messaging starting from Week 1 to Week 12. Control group will receive placebo intervention including a talk on basic health issues, a lecture video and corresponding leaflet. The outcomes will be investigated through self-report questionnaires and physiological evaluations at baseline, Week 12, Week 24, and Week 36. Physical activity level, exercise self-efficacy and ASCVD risk profile will be assessed, with physical activity level at Week 24 considered the primary outcome. The main intervention effect (group differences on continuous outcome variables) will be examined via Generalized Estimating Equations with identity link.

DISCUSSION

This study findings will provide clues to the effect of the integrated exercise and cardiovascular health education programme, which is theoretically underpinned with self-efficacy theory, in older adults at risk of ASCVD. It will also enhance the quality of community health education by providing insight into the effective teaching strategies targeting older adults.

TRIAL REGISTRATION

This study has been registered on ChinicalTrial.gov (Trial ID: NCT05434273).

The effects of an e-health brisk walking intervention in increasing moderate-to-vigorous physical activity in physically inactive older people with cognitive frailty: study protocol for a randomized controlled trial

BACKGROUND

Cognitive frailty is a risk for many adverse health outcomes that are commonly observed in older people. Physical activity is known to be effective to reserve cognitive frailty but the prevalence of physical inactivity is still high in older people. E-health enhances behavioural change effects through an innovative way to deliver behavioural change methods that can enhance the behavioural change effects. However, its effects on older people with cognitive frailty, its effects compared with conventional behavioural change methods, and the sustainability of the effects are unclear.

METHODS

This study employs a single-blinded, two-parallel-group, non-inferiority, randomized controlled trial design with a 1:1 group allocation ratio. Eligible participants are aged 60 years or above, have cognitive frailty and physical inactivity, and possess a smartphone for more than six months. The study will be conducted in community settings. In the intervention group, participants will receive a 2-week brisk-walking training followed by a 12-week e-health intervention. In the control group, participants will receive a 2-week brisk-walking training followed by a 12-week conventional behavioural change intervention. The primary outcome is minutes of moderate-to-vigorous physical activity (MVPA). This study aims to recruit a total of 184 participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention.

ETHICS AND DISSEMINATION

The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) on 7th March 2023, https://clinicaltrials.gov/ct2/show/NCT05758740 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022136). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields.

TRIAL REGISTRATION

The trial has been registered at ClinicalTrials.gov (Identifier: NCT05758740) and all items come from the World Health Organization Trial Registration Data Set. The latest version of the protocol was published online on 7th March 2023.

The effects of Digital Buddy programme on older adults' mental well-being: study protocol for a multi-centre, cluster randomized controlled trial

INTRODUCTION

Mental well-being is associated with many mental health symptoms, including depression and health-related quality of life. Digital divide could impact mental health, particularly during the COVID-19 pandemic. Information and communication technology (ICT)-based tools and interventions could effectively provide social support. Intergenerational mentoring between college students and older adults could promote eHealth literacy and self-efficacy, and it is advocated to bridge the digital divide for older adults. However, the effectiveness of an intervention which employs ICT-based tools and intergenerational mentoring strategies (i.e. Digital Buddy) on mental well-being is unclear.

METHODS

This study will employ a multi-centre, cluster-randomized, two-parallel-group, noninferiority, controlled trial design with a 1:1 group allocation ratio. In the intervention group, a Digital Buddy (i.e. a young volunteer) is assigned to a group of older adults in a 1:10 ratio. A series of training sessions for a minimum of 23 h will be provided to the older adults by Digital Buddy, who will also follow through the intervention period with the older participants. The training contents include ICT and mental health care knowledge and skills. The whole intervention period will last for 6 months between 14 sessions. In the control group, participants will receive the usual care. The primary outcome measure is mental well-being. We aim to recruit 292 older participants. Generalized estimating equations (GEE) will be used to examine the effects of the intervention.

ETHICS AND DISSEMINATION

This trial has been registered at ClinicalTrials.gov (NCT05553730) on 23 September 2022, https://clinicaltrials.gov/ct2/show/NCT05553730 , and all items come from the World Health Organization Trial Registration Data Set. It has been approved by the Research Ethics Committee of Tung Wah College, Hong Kong (reference number: REC2022143). The findings will be disseminated in peer-reviewed journals and presented at international conferences relevant to the subject fields.

Effectiveness of online-based cognitive intervention in community-dwelling older adults with cognitive dysfunction: A systematic review and meta-analysis

BACKGROUND

Mild cognitive impairment (MCI) or mild dementia imposes a substantial burden on patients, families, and social systems. For MCI or mild dementia patient, cognitive training is required to prevent progression to dementia. With advances in digital health, cognitive interventions using information and communication technology (ICT) have become essential for maintaining independence and functioning in dementia patients.

OBJECTIVES

This study aimed to examine the effectiveness of an ICT-based cognitive intervention in community-dwelling older adults with MCI or mild dementia.

METHODS

A literature search was performed in four databases: Ovid-Medline, Ovid-EMBASE, Cochrane Library, and CINAHL. We selected studies published up to April 15, 2021, on topics related to cognitive interventions using ICT in older adults with MCI or mild dementia.

RESULTS

Forty-four studies were included in the analysis. Our meta-analysis showed that ICT-based cognitive interventions significantly improved the Mini-Mental State Examination score in the intervention group compared with that in the control group. Additionally, cognitive training using ICT was significantly effective for a period of more than 30 min, more than 6 weeks, and multi-domain content. Moreover, a significant reduction in depression was found in the intervention group compared with that in the control group.

CONCLUSIONS

ICT-based cognitive intervention had a positive effect on cognitive function, depression, and quality of life in older adults with MCI or mild dementia. Application of ICT-based cognitive training to community-dwelling older adults with MCI or mild dementia should be expanded, and nurses should play a pivotal role in mediating between these older adults.

The influence of health information attention and app usage frequency of older adults on persuasive strategies in mHealth education apps

With the development of mobile communication technology, persuasive technology is widely used in mobile health. Using personalized persuasive strategies in mobile health education (MHE) apps can effectively improve users’ health literacy and health behaviors. The transtheoretical model explains the process of user behavior change. Different usage frequency of the app reflects changes in user behavior. However, few studies have examined how the perceived importance of persuasive strategies among older adults changes with increasing use frequency. In this study, we analyzed the sensitivity of 111 older adults in China to persuasive strategies in MHE apps. Thirteen persuasive strategies were selected for this study. A repeated measure analysis of variance (RM-ANOVA) was used to demonstrate the influence of gender, health information attention and frequency of use on the sensitivity of perceived persuasive strategies among older adults. The results revealed older adults with a high usage frequency of health apps were more receptive to persuasive strategies, especially in social comparison strategy. This result may help developers consider factors such as the frequency of use by older users when designing personalized persuasive strategies for MHE apps.

Effects of a Home-Based Physical Training and Activity Promotion Program in Community-Dwelling Older Persons with Cognitive Impairment after Discharge from Rehabilitation: A Randomized Controlled Trial

BACKGROUND

Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status.

METHODS

Patients with mild to moderate CI (Mini-Mental State Examination [MMSE]: 17-26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance, and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time).

RESULTS

Among 118 randomized participants (82.3 ± 6.0 years) with CI (MMSE: 23.3 ± 2.4) and high levels of multimorbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95% CI: 1.0-2.8; p < .001), with persistent benefits over the follow-up (1.3 points; 95% CI: 0.4-2.2; p < .001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term.

CONCLUSIONS

The results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multimorbid population.

CLINICAL TRIAL REGISTRATION

ISRCTN82378327.

Effectiveness of interventions in older adults with cognitive frailty: a systematic review and meta-analysis of randomised controlled trials

BACKGROUND

interventions targeting older adults with cognitive frailty have grown rapidly in recent years with inconsistent findings. However, there is no meta-analysis that has synthesised pooled estimates.

OBJECTIVE

to synthesise the pooled effect of current targeted interventions in older people with cognitive frailty.

METHODS

we conducted a systematic search in PubMed, Embase, Web of Science, the Cochrane Library, the JBI database and three Chinese databases (CNKI, Wan-Fang and VIP) for literature from the inception of the database until 8 March 2022. The mean difference or standardised mean difference with 95% CIs was calculated. The methodological quality was assessed by the Cochrane RoB 2.0. The certainty of evidence was assessed using the GRADE criteria.

RESULTS

thirteen randomised controlled trials with a total of 1,089 participants were included. The results of the meta-analysis showed that older adults with cognitive frailty in the intervention groups had significant improvement in frailty score [MD = -1.67, 95% CI (-2.39, -0.95), P < 0.00001, I2 = 97%], global cognitive function [MD = 3.38, 95% CI (1.90, 4.85), P < 0.00001, I2 = 93%], mobility [MD = -0.96, 95% CI (-1.27, -1.66), P < 0.00001, I2 = 0%], muscle strength [SMD = 0.75, 95% CI (0.09, 1.41), P = 0.03, I2 = 85%] and nutritional status [MNA:MD = 5.64, 95% CI (3.99, 7.29), P < 0.00001, I2 = 89%; ALB: MD = 3.23, 95% CI (0.76, 5.71), P = 0.01, I2 = 93%; PALB: MD = 54.52, 95% CI (25.26, 83.77), P = 0.0003, I2 = 96%; TRF: MD = 0.64, 95% CI (0.22, 1.06), P = 0.003, I2 = 97%]. The overall certainty of the evidence ranged from low to moderate.

CONCLUSIONS

interventions targeting older adults with cognitive frailty are effective in improving physical frailty, global cognitive function, physical function and nutritional status with low to moderate certainty. More research is still needed in the future to further enrich the evidence in these fields.

PROSPERO NUMBER

CRD42022318758.

Training and retention effects of paced and music-synchronised walking exercises on pre-older females: an interventional study

BACKGROUND

Physical activity at pre-older ages (55-64 years) can greatly affect one's physical fitness, health, physical-activity behaviour, and quality of life at older ages. The objective of this study was to conduct a 24-week walking-exercise programme among sedentary pre-older females and investigate the influence of different walking cadences on cardiorespiratory fitness and associated biomarkers.

METHODS

A total of 78 pre-older sedentary female participants were recruited and randomly assigned to normal (n = 36), paced (n = 15), music-synchronised (n = 15) walking, and no-exercise control (n = 12) groups, respectively. The normal, paced, and music-synchronised walking groups walked at a cadence of 120 steps/min, 125 steps/min, and 120-128 steps/min, respectively, under supervised conditions. Anthropometric characteristics, step length, nutrient intake, blood pressure and composition, and cardiorespiratory fitness were measured at baseline, the 12th week of the programme, the 24th week of the programme (completion), and after a 12-week retention period, which began immediately upon completion of the programme and did not feature any supervised exercises.

RESULTS

All walking conditions improved high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, step length, maximum oxygen consumption (VO₂max), and oxidative capacity at anaerobic threshold (all P < 0.001); however, after the 12-week retention period only the training effects of HDL-C (P < 0.05) and VO₂max (P < 0.05) remained robust. Additionally, music-synchronised walking was found to reduce the fat ratio (P = 0.031), while paced walking was found to reduce body mass (P = 0.049).

CONCLUSIONS

The significant pre-post changes in health-related outcomes across the 24-week walking intervention, including improved blood composition, longer step length, and better cardiorespiratory capacity, show that this intervention is promising for improving health and fitness. When, during the retention period, the participants resumed their usual lifestyles without supervised exercise, most physiological biomarkers deteriorated. Thus, for sedentary middle-aged females, persistent behavioural change is necessary to retain the health benefits of physical exercise.

Using digital technology to quantify habitual physical activity in community-dwellers with cognitive impairment: A systematic review (Preprint)

BACKGROUND

Participating in habitual physical activity (HPA) can support people with dementia and mild cognitive impairment (MCI) to maintain functional independence. Digital technology can continuously measure HPA objectively, capturing nuanced measures relating to its volume, intensity, pattern, and variability.

OBJECTIVE

To understand HPA participation in people with cognitive impairment, this systematic review aims to (1) identify digital methods and protocols; (2) identify metrics used to assess HPA; (3) describe differences in HPA between people with dementia, MCI, and controls; and (4) make recommendations for measuring and reporting HPA in people with cognitive impairment.

METHODS

Key search terms were input into 6 databases: Scopus, Web of Science, Psych Articles, PsychInfo, MEDLINE, and Embase. Articles were included if they included community dwellers with dementia or MCI, reported HPA metrics derived from digital technology, were published in English, and were peer reviewed. Articles were excluded if they considered populations without dementia or MCI diagnoses, were based in aged care settings, did not concern digitally derived HPA metrics, or were only concerned with physical activity interventions. Key outcomes extracted included the methods and metrics used to assess HPA and differences in HPA outcomes across the cognitive spectrum. Data were synthesized narratively. An adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess the quality of articles. Due to significant heterogeneity, a meta-analysis was not feasible.

RESULTS

A total of 3394 titles were identified, with 33 articles included following the systematic review. The quality assessment suggested that studies were moderate-to-good quality. Accelerometers worn on the wrist or lower back were the most prevalent methods, while metrics relating to volume (eg, daily steps) were most common for measuring HPA. People with dementia had lower volumes, intensities, and variability with different daytime patterns of HPA than controls. Findings in people with MCI varied, but they demonstrated different patterns of HPA compared to controls.

CONCLUSIONS

This review highlights limitations in the current literature, including lack of standardization in methods, protocols, and metrics; limited information on validity and acceptability of methods; lack of longitudinal research; and limited associations between HPA metrics and clinically meaningful outcomes. Limitations of this review include the exclusion of functional physical activity metrics (eg, sitting/standing) and non-English articles. Recommendations from this review include suggestions for measuring and reporting HPA in people with cognitive impairment and for future research including validation of methods, development of a core set of clinically meaningful HPA outcomes, and further investigation of socioecological factors that may influence HPA participation.

TRIAL REGISTRATION

PROSPERO CRD42020216744; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216744  .

Effects of telehealth intervention for people with dementia and their carers: A systematic review and meta-analysis of randomized controlled studies

PURPOSE

Interventions delivered using telehealth modalities are becoming standard practice with patient populations around the world, partly because of innovation necessitated by the COVID-19 pandemic and partly due to improved infrastructure and comfort of providers, patients, and families, through technology. Though increasingly utilized, the effectiveness of telehealth interventions with families with dementia remains unclear. This gives rise to the need for investigation to develop telehealth interventions that are evidence based and not merely convenient tools. This current study is designed to systematically examine the impact and effectiveness of telehealth-delivered psychoeducational and behavioral interventions among persons with dementia and their caregivers.

DESIGN

The design combines systematic review and meta-analysis.

METHODS

A total of eight databases were electronically accessed and searched as of November 16, 2021. Experimental studies identifying the results of telehealth interventions for persons with dementia and associated caregivers published in English have been reviewed in this study. Standardized mean differences (SMD) offering 95% confidence intervals (CI) were developed to pool the effect size using a random effects model (in this case, Stata 16.0). The Revised Cochrane Risk-of-Bias Tool for Randomized Trials (RoB-2) was used to analyze the study's methodological soundness.

FINDINGS

Nineteen cases met the eligibility criteria (including 1379 persons with dementia and 1339 caregivers). Overall, telehealth interventions demonstrated effects in the expected directions on depression (SMD -0.63; 95% degree of confidence intervals (CI) -0.88 to -0.38, p < 0.001); and caregivers' perceived competency (SMD 0.27; 95% CI -0.05 to 0.50, p = 0.02). There were, however, no statistically significant effects observed on cognitive function or multiple aspects of quality of life for subjects.

CONCLUSIONS

Telehealth interventions appear to effect a reduction in depression among persons diagnosed with dementia while improving the perceived competency of caregivers.

CLINICAL RELEVANCE

The study's results could be used as evidence of the effectiveness of using telehealth for persons with dementia and their caregivers, including contextualizing where they are used (i.e., long-term care facilities, private homes, etc.), understanding the mechanisms in play (including intervention delivery and systems), and isolating and identifying mediating influences.

Exercise interventions for older people with cognitive frailty-a scoping review

Background

As the global population ages, the issue of frailty in older people is gaining international attention. As one of the major subtypes of frailty, cognitive frailty is a heterogeneous clinical manifestation characterised by the co-existence of physical decline and cognitive impairment. The occurrence of cognitive frailty increases the risk of adverse health outcomes in older people, affecting their daily functioning and quality of life. However, cognitive frailty is a reversible state, and many interventions have been explored, with exercise interventions playing an important role in the non-pharmacological management of cognitive frailty. This study describes and summarises current exercise interventions for older people with cognitive frailty (including parameters such as mode, frequency and duration of exercise) and identifies the limitations of existing studies to inform future exercise interventions for older people with cognitive frailty.

Methods

Using a scoping review approach, Chinese and English literature published in PubMed, Web of Science, Cochrane Library, Embase, China Knowledge Network, Wanfang Database, China Biomedical Literature Database (SinoMed) and Vipshop from April 2013, when the definition of cognitive frailty first appeared, to August 2021 was searched to select studies related to exercise interventions for this group, extract information from the included literature, and summarise and report the findings.

Results

Nine RCT trial studies and one quasi-experiment study were included, for a total of 10 articles. The exercise modalities involved walking, brisk walking, Otago exercise, resistance exercise, balance training, flexibility training and Baduanjin, etc.; the intensity of exercise was based on individualised guidance and graded exercise intensity; the frequency of exercise was mostly 3–4 times/week; the duration of exercise was mostly 30–60 min/time; compared to the control group, the included studies showed statistically significant improvements in cognitive function, frailty status, and depression with the exercise intervention.

Conclusion

There is a paucity of evidence on exercise interventions for older people with cognitive frailty. The evidence provided in this study suggests that exercise interventions may be beneficial for older people with cognitive frailty. However, the existing studies suffer from small sample sizes, short intervention periods, inadequate monitoring of the entire exercise process, and non-uniformity in the assessment of exercise effects. More randomized controlled trials should be conducted in the future to explore the most effective, low-cost and simple interventions to meet the needs of the older people with cognitive frailty.

The effects of interventions to enhance cognitive and physical functions in older people with cognitive frailty: a systematic review and meta-analysis

Introduction

Cognitive frailty is the co-existence of mild cognitive impairment and physical frailty that increases the risk of adverse health outcomes. The existing systematic reviews on cognitive frailty in the literature have focused only on identifying associated factors and adverse outcomes, and their relationship with frailty and cognition. This study aimed to examine the effects of interventions on cognitive functions, frailty, and physical functions and provide an overview of intervention components used in older people with cognitive frailty.

Methods

This is a systematic review and meta-analysis. Medline, PubMed, CINAHL, Embase, PsycINFO, and Cochrane were searched for publishing during 2013–2021. Studies were selected based on the following eligibility criteria: 1) older people (age ≥ 60 years), 2) cognitive frailty, 3) outcomes on frailty or cognition or physical function, and 4) randomized controlled trial with any type of intervention. The Physiotherapy Evidence Database (PEDro) scale was used to rate the quality of the included studies. The review protocol was registered with PROSPERO (CRD42021251321).

Results

Two thousand five hundred six studies were identified, 9 were eligible, and 8 were included in the meta-analysis. The standardized mean difference (Hedges G) between groups of cognitive functions was 0.95, frailty status was 0, physical function in walking was -1.67, and the physical function in core strength assessment was 3.39. Physical activity appeared as an essential component in all interventions for older people with cognitive frailty.

Discussion

All interventions include physical activity as one of the components. Other components include cognitive training, nutrition education, behavioural intervention, mind–body intervention, psychosocial support, and virtual reality. The interventions are effective to promote cognitive and physical functions, but not physical frailty.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-022-00299-9.

Global Research on Cognitive Frailty: A Bibliometric and Visual Analysis of Papers Published during 2013–2021

This study analyzed the current status, hotspots, and emerging trends of global research on cognitive frailty, in order to provide new research ideas for researchers. Articles and reviews related to cognitive frailty, published from 2013 to 2021, were retrieved from the Web of Science Core Collection (WoSCC) database on 26 November 2021. CiteSpace 5.8.R3 was employed for data analyses. A total of 2077 publications were included. There has been a rapid growth of publications on cognitive frailty research since 2016. The United States, Italy, England, and Australia have been the leading research centers of cognitive frailty; however, China has also recently focused on this topic. The National Center for Geriatrics and Gerontology, and Shimada H. were found to be the most prolific institution and author, respectively. Co-citation analysis identified 16 clusters, of which the largest was cognitive frailty. The keywords which occurred most frequently were “older adult”, followed by “cognitive impairment”, “frailty”, “risk”, “dementia”, “prevalence”, “mortality”, “health”, and “Alzheimer’s disease”. Burst keyword detection revealed a rising interest in cognitive frailty models. By analyzing these publications from recent years, this study provides a comprehensive analysis of cognitive frailty research.

A systematic literature review and meta-analysis on digital health interventions for people living with dementia and Mild Cognitive Impairment

OBJECTIVES

Digital health interventions enable services to support people living with dementia and Mild Cognitive Impairment (MCI) remotely. This literature review gathers evidence on the effectiveness of digital health interventions on physical, cognitive, behavioural and psychological outcomes, and Activities of Daily Living in people living with dementia and MCI.

METHODS/DESIGN

Searches, using nine databases, were run in November 2021. Two authors carried out study selection/appraisal using the Critical Appraisal Skills Programme checklist. Study characteristics were extracted through the Cochrane handbook for systematic reviews of interventions data extraction form. Data on digital health interventions were extracted through the template for intervention description and replication (TIDieR) checklist and guide. Intervention effectiveness was determined through effect sizes. Meta-analyses were performed to pool data on intervention effectiveness.

RESULTS

Twenty studies were included in the review, with a diverse range of interventions, modes of delivery, activities, duration, length, frequency, and intensity. Compared to controls, the interventions produced a moderate effect on cognitive abilities (SMD = 0.36; 95% CI = -0.03 to 0.76; I2  = 61%), and a negative moderate effect on basic ADLs (SMD = -0.40; 95% CI = -0.86 to 0.05; I2  = 69%). Stepping exergames generated the largest effect sizes on physical and cognitive abilities. Supervised training produced larger effect sizes than unsupervised interventions.

CONCLUSION

Supervised intervention delivery is linked to greatest benefits. A mix of remote and face-to-face delivery could maximise benefits and optimise costs. Accessibility, acceptability and sustainability of digital interventions for end-users must be pre-requisites for the development of future successful services.

A Scoping Review for Usage of Telerehabilitation among Older Adults with Mild Cognitive Impairment or Cognitive Frailty

Older adults are vulnerable towards cognitive frailty that can lead to adverse health outcomes and telerehabilitation appears to be a potential platform to reverse cognitive frailty among older adults. The aim of this coping review is to identify the usage of telerehabilitation and its common platform of delivery among older adults with mild cognitive impairment (MCI) or cognitive frailty (CF). Articles published from January 2015 until October 2020 were selected. Out of the 1738 articles retrieved, six studies were identified. Two articles were randomized controlled trials, one was a pilot study and three were qualitative studies. The outcome suggests that telerehabilitation may improve the quality of life among participants as well as it can be a useful and supportive digital platform for health care. Some types of technologies commonly used were smartphones or telephones with internet, television-based assistive integrated technology, mobile application and videoconference. Telerehabilitation utilization in managing cognitive frailty among older adults is still limited and more research is required to evaluate its feasibility and acceptability. Although telerehabilitation appears to be implemented among older adults with MCI and CF, some social support is still required to improve the adherence and effectiveness of telerehabilitation. Future research should focus on the evaluation of acceptance and participants’ existing knowledge towards telerehabilitation to achieve its target.

The Determinants of Walking Behavior before and during COVID-19 in Middle-East and North Africa: Evidence from Tabriz, Iran

To support the global strategy to raise public health through walking among adults, we added the evidence on predictors of walking behavior in the Middle East and North Africa (MENA) region by emphasizing the mediator—COVID-19. During the COVID-19 outbreak, public restrictions to encompass the spread of the disease have disrupted normal daily lifestyles, including physical activity and sedentary behavior. It was proposed that tremendous changes have occurred on predictors of physical activity in general and walking behavior in particular for three types of walking, including commute, non-commute, and social walking compared to pre-COVID-19 time. This study aimed to identify the determinants of the walking types mentioned above, including subjective and objective variables before COVID-19, and compare them during the COVID-19 period in a sample from Iran, which has not yet been addressed in previous research. Adults (N = 603) finalized an online survey between June 5 and July 15, 2021. This group reported their individual/socioeconomic locations (e.g., home/work) and perception features before and during COVID-19. The paper developed six Binary Logistic (BL) regression models, with two models for each walking type (commute, non-commute, and social walking). For commute trips before COVID-19, the findings showed that factors including BMI, residential duration, p. (perceived) neighborhood type, p. distance to public transport stations and job/university places, p. sidewalks quality, p. facilities attractiveness, p. existence of shortcut routes, commute distance, building density and distance to public transport were correlated with commute walking. At the same time, such associations were not observed for BMI, p. distance to public transport and job/university places, p. facilities attractiveness, building density, and distance to public transport during COVID-19. The variables include age, possession of a driving license, number of family members, p. neighborhood type, p. distance to grocery, restaurant, parking, and mall, p. existence of sidewalks, land-use mix, and distance to public transport indicated correlations with non-commute before COVID-19. However, p. distance to groceries and malls and the p. existence of sidewalks did not correlate with non-commute walking during COVID-19. Ultimately for social walking, age and income variables, and the considerable proportions of subjective variables (e.g., p. distance to services/land-uses, security, etc.), health status and building density were correlated with social walking before COVID-19. Nevertheless, most of the mentioned variables did not explicitly correlate with social walking during COVID-19. As for the implication of our study, apparently, special actions will be needed by urban authorities to encourage adults to enhance their walkability levels by fully considering both objective and subjective indicators and walking types, which will result in healthier lifestyles.

Sarcopenia and its association with objectively measured life-space mobility and moderate-to-vigorous physical activity in the oldest-old amid the COVID-19 pandemic when a physical distancing policy is in force

Introduction

The oldest-old are highly vulnerable to sarcopenia. Physical distancing remains a common and effective infection-control policy to minimize the risk of COVID-19 transmission during the pandemic. Sarcopenia is known to be associated with impaired immunity. Moderate-to-vigorous physical activity (MVPA) and life-space mobility (LSM) are potential strategies for minimizing the risk of sarcopenia. However, a physical distancing policy might jeopardize the practice of MVPA and LSM. The purposes of this study were to identify the prevalence of sarcopenia and examine the association between MVPA and LSM with sarcopenia in the community-dwelling oldest-old during the COVID-19 pandemic.

Methods

This study employed a cross-sectional and observational design. The study was conducted in 10 community centres for older people in Hong Kong during the period of the COVID-19 pandemic (September to December 2020). Eligible participants were the oldest-old people aged ≥85 years, who were community-dwelling and had no overt symptoms of cognitive impairment or depression. Key variables included sarcopenia as measured by SARC-F, LSM as measured by a GPS built into smartphones, and MVPA as measured by a wrist-worn ActiGraph GT3X+. Variables were described by mean and frequency. A multiple linear regression was employed to test the hypotheses. The dependent variable was sarcopenia and the independent variables included LSM and MVPA.

Results

This study recruited 151 eligible participants. Their mean age was 89.8 years and the majority of them were female (n = 93/151, 61.6%). The prevalence of sarcopenia was 24.5% (n = 37/151) with a margin of error of 6.86%. MVPA was negatively associated with sarcopenia in older people (β = − 0.002, SE = 0.001, p = 0.029). However, LSM was not associated with sarcopenia.

Conclusion

The prevalence of sarcopenia in the community-dwelling oldest-old population is high. MVPA is negatively associated with sarcopenia. LSM is unrelated to sarcopenia. Sarcopenia should be recognized and the oldest-old with sarcopenia should be accorded priority treatment during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02861-7.

A systematic review and meta-analysis on cognitive frailty in community-dwelling older adults: risk and associated factors

OBJECTIVES

To identify which factors are associated with cognitive frailty (CF), as well as the impact of CF on the incidence of dementia and mortality.

METHODS

A systematic review with meta-analysis was carried out using papers that enrolled a total of 75,379 participants and were published up to January 2020.

RESULTS

Of the 558 identified records, 28 studies met the inclusion criteria and were included in the review. The meta-analysis of cross-sectional studies showed that CF has a significant association of having an older age and a history of falls. In longitudinal studies, the analysis showed a significant increase in risk of mortality and dementia for those with CF.

DISCUSSION

This is the first systematic review and meta-analysis on CF, which addressed a wide variety of factors associated with the theme and which pointed out some as a potential target for prevention or management with different interventions or treatments, showing the clinical importance of its identification in the most vulnerable and susceptible groups.

Differences in the Correlation between the Built Environment and Walking, Moderate, and Vigorous Physical Activity among the Elderly in Low- and High-Income Areas

Studies have proved that activity and fitness behaviors are closely related to the quality of life and health status of the elderly. However, different intensities of physical activity (PA)—walking, moderate PA, and vigorous PA—have different correlations with the built environment (BE). This study combines the high and low socioeconomic status (SES) of Guangzhou to establish two types of BE models. The physical activity time of 600 elderly people was collected from questionnaires. Through ArcGIS software, 300 m, 500 m, 800 m, and 1000 m buffer zones were identified, and the land use diversity, street design, population density, distance to destination, distance to public transportation—the five Ds of the BE—were measured. SPSS software was adopted to analyze the correlation between the BE and PA. Results: The PA of people living in low-SES areas was more dependent on the BE, whereas the correlation may be limited in high SES areas. Moreover, in low SES areas, walking was negatively correlated with street connectivity; moderate PA was positively correlated with street connectivity and the shortest distance to the subway station, but negatively correlated with the density of entertainment points of interest (POIs). Studying the relevant factors of the environment can propose better strategies to improve the initiative of the elderly to engage in PA.

Cognitive Frailty: An Update

This review article provides an update of the empirical research on cognitive fragility conducted in the last four years. The studies retrieved were classified in four different categories. The first category includes articles relating cognitive frailty to cognitive reserve and which continue to highlight the importance of educational level. The second category includes recent research on cognitive fragility biomarkers, involving neuroimaging, metabolism and, in a novel way, microbiota. The third category includes research on how cognitive frailty is related to motor development and physical functioning, exploring e.g. the use of technology to study motor markers of cognitive frailty. Finally, in the fourth category, research clarifying the difference between reversible frailty and potentially reversible cognitive frailty has led to new interventions aimed at reducing cognitive frailty and preventing negative health outcomes. Interventions based on physical activity and multicomponent interventions are particularly emphasized. In addition, recent research explores the long-term effects of dual interventions in older adults living in nursing homes. In summary, research on cognitive frailty has increased in recent years, and applied aspects have gained importance.

Perception of E-health Technology Scale in Chinese Brief (PETS-C Brief): Translation, item reduction, and psychometric testing

Introduction

Perception of e-health is a broad concept involving many aspects of values and thoughts related to e-health. It is an important precursor to using e-health technologies to promote health. The purpose of this study is to validate an instrument for measuring perceptions of e-health technology among healthcare professionals.

Methods

This methodological study was conducted in China. We based on an existing instrument to develop a new instrument (i.e. PETS-C Brief). In phase 1, we modified and translated the existing instrument into Chinese. Subsequently, we employed the modified and translated instrument to conduct a cross-sectional survey. In phase 2, we randomly selected data from 400 participants to run an exploratory factor analysis and item analysis to reduce the number of items and develop factors. In phase 3, we employed the data from the remaining participants to run a confirmatory factor analysis to confirm the instrument structure.

Results

In phase 1, the modified and translated instrument showed good content and face validities (S-CVI = 0.96, mean comprehensibility = 93.5%). 1338 participants completed the survey. In phase 2, the number of items was reduced from 40 to 19, which demonstrated a 4-factor model. In phase 3, the goodness-of-fit of the 4-factor PETS-C Brief was shown to be acceptable (χ²/d.f. = 6.40, CFI = 0.93, RMR = 0.40, NFI = 0.92, RMSEA = 0.076, IFI = 0.93).

Discussion

This study suggests using this instrument to survey perceptions of e-health technology in Chinese people. Future studies should examine its other important psychometric properties, including convergent/discriminant and predictive validity on behaviors using e-health technology.

An update on cognitive frailty: Its definition, impact, associated factors and underlying mechanisms, and interventions

Since the concept and operational definition of "cognitive frailty" (simultaneous presence of physical frailty and cognitive impairment without concurrent dementia) were proposed by the International Academy of Nutrition and Aging and the International Association of Gerontology and Geriatrics, cognitive frailty has been widely investigated. This review is intended to address the operational definition of cognitive frailty, its consequences, contributing factors and underlying mechanisms, as well as interventions for cognitive frailty. Although the definitions and assessments of cognitive frailty vary among researchers, older adults with both physical frailty and cognitive impairment are shown to be at higher risk of adverse health outcomes, including death, disability, hospitalization and incident dementia, than those with either condition alone. While the underlying mechanisms of cognitive frailty are still unclear, factors shown to be associated with cognitive frailty include sociodemographic factors, social status, nutritional status, geriatric syndrome, physical and cognitive activities, functional status, comorbidities, medication use, gut-derived metabolites and structural changes in the brain. Accumulating evidence indicates the need for comprehensive geriatric assessment that helps identify the possible causes of cognitive frailty and develop a multimodal individualized intervention to prevent adverse health outcomes for older adults with cognitive frailty. Further studies are required to clarify the mechanisms through which physical frailty and cognitive impairment interact to accelerate adverse health outcomes, particularly cognitive outcomes. In addition, for older adults with cognitive frailty, an effective flow diagram from primary screening through comprehensive assessment to multidimensional intervention needs to be developed for future implementation in both clinical and community settings. Geriatr Gerontol Int 2021; ••: ••-••.

Conversational Agent for Healthy Lifestyle Behavior Change: Web-Based Feasibility Study

BACKGROUND

The rising incidence of chronic diseases is a growing concern, especially in Singapore, which is one of the high-income countries with the highest prevalence of diabetes. Interventions that promote healthy lifestyle behavior changes have been proven to be effective in reducing the progression of prediabetes to diabetes, but their in-person delivery may not be feasible on a large scale. Novel technologies such as conversational agents are a potential alternative for delivering behavioral interventions that promote healthy lifestyle behavior changes to the public.

OBJECTIVE

The aim of this study is to assess the feasibility and acceptability of using a conversational agent promoting healthy lifestyle behavior changes in the general population in Singapore.

METHODS

We performed a web-based, single-arm feasibility study. The participants were recruited through Facebook over 4 weeks. The Facebook Messenger conversational agent was used to deliver the intervention. The conversations focused on diet, exercise, sleep, and stress and aimed to promote healthy lifestyle behavior changes and improve the participants' knowledge of diabetes. Messages were sent to the participants four times a week (once for each of the 4 topics of focus) for 4 weeks. We assessed the feasibility of recruitment, defined as at least 75% (150/200) of our target sample of 200 participants in 4 weeks, as well as retention, defined as 33% (66/200) of the recruited sample completing the study. We also assessed the participants' satisfaction with, and usability of, the conversational agent. In addition, we performed baseline and follow-up assessments of quality of life, diabetes knowledge and risk perception, diet, exercise, sleep, and stress.

RESULTS

We recruited 37.5% (75/200) of the target sample size in 1 month. Of the 75 eligible participants, 60 (80%) provided digital informed consent and completed baseline assessments. Of these 60 participants, 56 (93%) followed the study through till completion. Retention was high at 93% (56/60), along with engagement, denoted by 50% (30/60) of the participants communicating with the conversational agent at each interaction. Acceptability, usability, and satisfaction were generally high. Preliminary efficacy of the intervention showed no definitive improvements in health-related behavior.

CONCLUSIONS

The delivery of a conversational agent for healthy lifestyle behavior change through Facebook Messenger was feasible and acceptable. We were unable to recruit our planned sample solely using the free options in Facebook. However, participant retention and conversational agent engagement rates were high. Our findings provide important insights to inform the design of a future randomized controlled trial.

Validity of mHealth devices for counting steps in individuals with Parkinson's disease

BACKGROUND

Step quantification is a good way to characterize the mobility and functional status of individuals with some functional disorder. Therefore, a validation study may lead to the feasibility of devices to stimulate an increase in the number of steps and physical activity level of individuals with Parkinson's Disease (PD).

AIM

To investigate the validity of mHealth devices to estimate the number of steps in individuals with PD and compare the estimate with a standard criterion measure.

METHOD

An observational study in a university laboratory with 34 individuals with idiopathic PD. The number of steps was measured using mHealth devices (Google Fit, Health, STEPZ, Pacer, and Fitbit INC®), and compared against a criterionstandard measure during the Two-Minute Walk Test using habitual speed.

RESULTS

Our sample was 82% men with a Hoehn and Yahr mean of 2.3 ± 1.3 and mean walking speed of 1.2 ± 0.2 m/s. Positive and statistically significant associations were found between Google Fit (r = 0.92; p < 0.01), STEPZ (r = 0.91; p < 0.01), Pacer (r = 0.77; p < 0.01), Health (r = 0.54; p < 0.01), and Fitbit Inc® (r = 0.82; p < 0.01) with the criterion-standard measure.

CONCLUSIONS

GoogleFit, STEPZ, Fitbit Inc.®, Pacer, and Health are valid instruments to measure the number of steps over a given period of time with moderate to high correlation with the criterion-standard in individuals with PD. This result shows that technology such as smartphone applications and activity monitor can be used to assess the number of steps in individuals with PD, and allows the possibility of using this technology for assessment and intervention purposes.

Mobile health applications for older adults: a systematic review of interface and persuasive feature design

OBJECTIVE

Mobile-based interventions have the potential to promote healthy aging among older adults. However, the adoption and use of mobile health applications are often low due to inappropriate designs. The aim of this systematic review is to identify, synthesize, and report interface and persuasive feature design recommendations of mobile health applications for elderly users to facilitate adoption and improve health-related outcomes.

MATERIALS AND METHODS

We searched PubMed, Embase, PsycINFO, CINAHL, and Scopus databases to identify studies that discussed and evaluated elderly-friendly interface and persuasive feature designs of mobile health applications using an elderly cohort.

RESULTS

We included 74 studies in our analysis. Our analysis revealed a total of 9 elderly-friendly interface design recommendations: 3 recommendations were targeted at perceptual capabilities of elderly users, 2 at motor coordination problems, and 4 at cognitive and memory deterioration. We also compiled and reported 5 categories of persuasive features: reminders, social features, game elements, personalized interventions, and health education.

DISCUSSION

Only 5 studies included design elements that were based on theories. Moreover, the majority of the included studies evaluated the application as a whole without examining end-user perceptions and the effectiveness of each single design feature. Finally, most studies had methodological limitations, and better research designs are needed to quantify the effectiveness of the application designs rigorously.

CONCLUSIONS

This review synthesizes elderly-friendly interface and persuasive feature design recommendations for mobile health applications from the existing literature and provides recommendations for future research in this area and guidelines for designers.

Enhancing the Physical Activity Levels of Frail Older Adults with a Wearable Activity Tracker-Based Exercise Intervention: A Pilot Cluster Randomized Controlled Trial

A wearable activity tracker (WAT) incorporated with behavioral change techniques (BCTs) increases physical activity in younger adults; however, its effectiveness with frail older adults is unknown. The feasibility and preliminary effects of a WAT-based exercise intervention to increase physical activity levels in frail older adults was investigated in this pilot study involving 40 community-dwelling frail older adults. The experimental group received a 14-week WAT-based group exercise intervention and a 3-month follow-up, while the control group only received similar physical training and all BCTs. The recruitment rate was 93%, and the average attendance rate was 85.2% and 82.2% in the WAT and control groups, respectively, establishing feasibility. Adherence to wearing the WAT was 94.2% and 92% during the intervention and follow-up periods, respectively. A significant interaction effect between time and group was found in all physical assessments, possibly lasting for 3 months post-intervention. However, no significant difference between groups was observed in any daily activity level by the ActiGraph measurement. The majority of the WAT group's ActiGraph measurements reverted to baseline levels at the 1-month follow-up. Thus, the WAT-based exercise program has potential for employment among community-dwelling frail older adults, but sustaining the effects after the intervention remains a major challenge.

Normative wrist-worn accelerometer values for self-paced walking and running: a walk in the park

This study aimed to a) determine whether wrist acceleration varies by accelerometer brand, wear location, and age for self-paced "slow", "normal" and "brisk" walking; b) develop normative acceleration values for self-paced walking and running for adults. One-hundred-and-three adults (40-79 years) completed self-paced "slow", "normal" and "brisk" walks, while wearing three accelerometers (GENEActiv, Axivity, ActiGraph) on each wrist. A sub-sample (n = 22) completed a self-paced run. Generalized estimating equations established differences by accelerometer brand, wrist, and age-group (walking only, 40-49, 50-59, 60-69, 70-79 years) for self-paced walking and running. Brand*wrist interactions showed ActiGraph dominant wrist values were ~10% lower than GENEActiv/Axivity values for walking and running, and non-dominant ActiGraph values were ~5% lower for running only (p < 0.001). Acceleration during brisk walking was lower in those aged 70-79 (p < 0.05). Normative acceleration values (non-dominant wrist, all brands; dominant wrist GENEActiv/Axivity) for slow and normal walking were 140 mg and 210 mg. Brisk walking, values were 350 mg in those aged 40-69 years, but 270 mg in those aged 70-79 years. Accelerations >600 mg approximated running. These values facilitate user-friendly interpretation of accelerometer-determined physical activity in large cohort and epidemiological datasets.

An mHealth-Facilitated Personalized Intervention for Physical Activity and Sleep in Community-Dwelling Older Adults

This randomized controlled pilot trial tested the preliminary effect of a 24-week mHealth-facilitated, personalized intervention on physical activity (PA) and sleep in 21 community-dwelling older adults. The intervention included a personalized exercise prescription, training, goal setting, and financial incentives. mHealth strategies, including self-monitoring, motivational messages, activity reminders, and phone coaching, were used to facilitate PA participation. PA and sleep were measured using actigraphy and questionnaires at baseline and 8-, 16-, and 24-week visits. Participants in the intervention group had lower objective PA levels at 24 weeks than at 8 and 16 weeks, although levels of PA remained higher than at baseline. Compared with the control group, the intervention increased PA at 8, 16, and 24 weeks; improved subjective sleep quality at 16 and 24 weeks; and increased actigraphy-measured sleep duration and sleep efficiency at 24 weeks. mHealth PA interventions may benefit PA and sleep in older adults. Strategies for maintaining long-term PA behavioral changes are needed.

Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial

BACKGROUND

Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments.

OBJECTIVE

We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty.

METHODS

A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ≥60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed.

RESULTS

Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=-2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=-1.19, P=.24). The reduction in physical frailty in the intervention group (Z=-1.73, P=.08) was similar to that in the control group (Z=-1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=-0.16, P=.11) and greater in the control group (Z=-2.52, P=.01). The recruitment rate was acceptable (17/33, 52%). Both groups had a 100% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group.

CONCLUSIONS

This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216.

The Use of Samsung Health and ECG M-Trace Base II Applications for the Assessment of Exercise Tolerance in the Secondary Prevention in Patients after Ischemic Stroke

Background and objectives: The aim of the study was to use the mobile application Samsung Health for the assessment of parameters of exercise tolerance and the ECG (electrocardiogram) M-Trace Base II for the assessment of cardiological parameters. Materials and Methods: The measurements were conducted during rest and after performing SMWT (Six Minute Walk Test) and SCT (Stair Climb Test) in 26 patients after ischemic stroke (IS) and 26 healthy individuals. Results: In the SMWT, the post-stroke group (SG) walked a shorter distance (p < 0.001), achieving lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p = 0.002). In the SCT, SG achieved a lower mean gait velocity (p < 0.001) and lower maximum gait velocity (p < 0.001) when compared to the control group (CG). In SG, myocardial ischemia in ECG was noted in four patients after SMWT and in three patients following SCT. Both in SG and in CG the increase in SBP (systolic blood pressure) value measured after SMWT and SCT compared to at rest (p < 0.001) was observed. In SG, in the compared ratios rest to SMWT and SCT as well as SMWT to SCT, there was an increase in HR (heart rate) (p < 0.001). Conclusions: ECG M-Trace Base II and Samsung Health are mobile applications that can assess cardiological parameters and exercise tolerance parameters in patients after IS, so they can be used to plan the intensity of exercise in rehabilitation programs.

Digital inequalities in health information seeking behaviors and experiences in the age of web 2.0: A population-based study in Hong Kong

BACKGROUND

Inequalities in health information seeking behaviors (HISBs) using mass media and internet websites (web 1.0) are well documented. Little is known about web 2.0 such as social networking sites (SNS) and instant messaging (IM) and experiences of HISBs.

METHODS

We surveyed representative Hong Kong Chinese adults (N = 10143, 54.9% female; 72.3% aged 25-64 years) on frequency of HISBs using traditional sources, internet websites, SNS (e.g., Facebook, Twitter), and IM (e.g., WhatsApp, WeChat) and experiences measured using Information Seeking Experience Scale. Adjusted prevalence ratios (aPRs) for HISBs and experiences by sociodemographic and health-related characteristics were yielded using multivariable Poisson regression with robust variance estimators. aPRs for experiences by HISBs using internet websites, SNS, and IM adjusting for sociodemographic and health-related characteristics were also yielded.

RESULTS

Being female, higher educational attainment, not smoking, and being physically active were associated with HISBs using any source (all P<0.05). Older age had decreased aPRs for HISBs using traditional sources (P for trend = 0.03), internet websites (P for trend<0.001), and SNS (P for trend<0.001) but not for IM (aged 45-64 years: aPR = 1.48, 95% CI 1.07, 2.03). Lower educational attainment and income were associated with negative experiences including feelings of effort and difficulties in understanding the information (all P for trend<0.05). Older age had increased aPRs for difficulties in understanding the information (P for trend = 0.003). Compared with internet websites, HISBs using IM was associated with feelings of frustration (aPR = 1.39, 95% CI 1.08, 1.79), difficulties in understanding the information (aPR = 1.36, 95% CI 1.12, 1.65), and quality concern (aPR = 1.20, 95% CI 1.08, 1.32).

CONCLUSIONS

We identified correlates of web-based health information seeking and experiences in Hong Kong Chinese adults. Providing greater access to and improved information environment of web 2.0 to the target groups may help address digital inequalities.

Measurement of Human Walking Movements by Using a Mobile Health App: Motion Sensor Data Analysis

Background

This study presents a new approach to measure and analyze the walking balance of humans by collecting motion sensor data in a smartphone.

Objective

We aimed to develop a mobile health (mHealth) app that can measure the walking movements of human individuals and analyze the differences in the walking movements of different individuals based on their health conditions. A smartphone’s motion sensors were used to measure the walking movements and analyze the rotation matrix data by calculating the variation of each xyz rotation, which shows the variables in walking-related movement data over time.

Methods

Data were collected from 3 participants, that is, 2 healthy individuals (1 female and 1 male) and 1 male with back pain. The participant with back pain injured his back during strenuous exercise but he did not have any issues in walking. The participants wore the smartphone in the middle of their waistline (as the center of gravity) while walking. They were instructed to walk straight at their own pace in an indoor hallway of a building. The walked a distance of approximately 400 feet. They walked for 2-3 minutes in a straight line and then returned to the starting location. A rotation vector in the smartphone, calculated by the rotation matrix, was used to measure the pitch, roll, and yaw angles of the human body while walking. Each xyz-rotation vector datum was recalculated to find the variation in each participant’s walking movement.

Results

The male participant with back pain showed a diminished level of walking balance with a wider range of xyz-axis variations in the rotations compared to those of the healthy participants. The standard deviation in the xyz-axis of the male participant with back pain was larger than that of the healthy male participant. Moreover, the participant with back pain had the widest combined range of right-to-left and forward-to-backward motions. The healthy male participant showed smaller standard deviation while walking than the male participant with back pain and the female healthy participant, indicating that the healthy male participant had a well-balanced walking movement. The walking movement of the female healthy participant showed symmetry in the left-to-right (x-axis) and up-to-down (y-axis) motions in the x-y variations of rotation vectors, indicating that she had lesser bias in gait than the others.

Conclusions

This study shows that our mHealth app based on smartphone sensors and rotation vectors can measure the variations in the walking movements of different individuals. Further studies are needed to measure and compare walking movements by age, gender, as well as types of health problems or disease. This app can help in finding differences in gait in people with diseases that affect gait.

A validation study of the use of smartphones and wrist-worn ActiGraphs to measure physical activity at different levels of intensity and step rates in older people

BACKGROUND

Physical activity promotes healthy ageing in older people. Accurate measurement of physical activity in free-living environment is important in evaluating physical activity interventions.

RESEARCH QUESTION

What is the criterion validity of 1)an ActiGraph to identify physical activity at different intensity levels and 2)an ActiGraph and a smartphone to measure step rate?

METHODS

Community-dwelling older people aged≥60 were recruited. The index tests were using ActiGraph worn in different positions (i.e.,both wrists and hip) to measure physical activity intensity and step rate and using smartphone (i.e., Samsung J2 pro and Google Fit) worn in different positions (i.e.,trousers pocket and waist pouch) to measure the step rate. The reference standards were using indirect calorimetry (i.e.,CosMedK4b 2) to measure physical activity intensity and using direct observation for step rate. Subjects were exposed in different physical activity intensity levels (i.e.,sedentary:MET < 1.5,light: MET = 1.5-2.99, moderate:MET = 3.0-6.0, vigorous:MET>6) and step rates through walking on a treadmill at different speeds (i.e.,2-8 km) for approximately 30 min. Spearman's rho, ROC analysis, and percentage error were employed to report the criterion validity.

RESULTS

31 participants completed the tests. ActiGraphs worn in different body positions could significantly differentiate physical activity intensity at the levels of "light- or-above" (VM cut-off = 279.5-1959.1,AUC = 0.932-0.954), "moderate-or-above" (VM cut- off = 1051.0-4212.9,AUC = 0.918-0.932), and "vigorous" (VM cut-off = 3335.4-5093.0, AUC = 0.890-0.907) well with different cut-off points identified. The step rate measured by direct observation correlated significantly with ActiGraph and smartphone (rho = 0.415-0.791). Both ActiGraph and smartphone at different positions generally underestimated the step rate (%error= -20.5,-30.3).

SIGNIFICANCE

A wrist-worn ActiGraph can accurately identify different physical activity intensity levels in older people, but lower cut-off points in older people should be adopted. To measure step rate, a hip-mounted ActiGraph is preferable than a wrist- worn one. A smartphone employing Google Fit generally underestimates step rate but it gives a relatively more accurate estimation of step rate when the older people walk at a speed of 4-8 km/h.