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Sun Y, Zhang R, Mao Z, Yin J, Zhou Y, Wu Y. Association between Multi-Domain Lifestyle and Objective Cognitive Impairment in Elderly People with SCD and MCI in Chinese Communities. Healthcare (Basel) 2024; 12:1879. [PMID: 39337220 PMCID: PMC11431377 DOI: 10.3390/healthcare12181879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/09/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVES Controlling the lifestyle associated with dementia risk can delay the process of cognitive decline. Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are early states in the development of dementia and are also the window period for early intervention in dementia. The purpose of this study was to explore the association between multi-domain lifestyle and objective cognitive impairment in elderly people with SCD and MCI in Chinese communities and to provide reference for effective implementation of precise health management measures to reduce the risk of dementia. METHODS A total of 265 middle-aged and elderly volunteers recruited from the community were divided into SCD group (107 cases), MCI group (80 cases), and healthy control (HC) group (78 cases). All participants received clinical interview, examination, and cognitive assessments. RESULTS The total Dementia Risk Reduction Lifestyle Scale (DRRLS) scores in the HC, SCD, and MCI groups [110.00 (11.25) vs. 101.00 (10.00) vs. 79.50 (20.75)] exhibited statistically significant differences among them. The total score of the DRRLS showed a significant negative correlation with the Trail-Making Test (TMT), and significant positive correlations with both the Verbal Fluency Test (VFT) and Auditory Verbal Learning Test (AVLT) scores (p < 0.05). After adjusting for confounding factors, such as age and years of education, multiple linear regression analysis revealed several points. In the SCD group, brain-strengthening exercise and interpersonal relationship scores were negatively correlated with TMT scores (β = -11.257, -15.077; all p < 0.05), while health responsibility, smoking control behavior, and interpersonal relationship scores were positively correlated with AVLT scores (β = 0.485, 0.344, and 0.406; all p < 0.05). In the MCI Group, brain-strengthening exercise, brain-healthy diet, and interpersonal relationship were negatively correlated with TMT (β = -22.011, -16.206, -11.696; all p < 0.01), whereas health responsibility, mental activity, smoking control behavior, interpersonal relationship, and stress management were positively correlated with AVLT (β = 0.450, 0.435, 0.308, 0.256, 0.607; all p < 0.05). CONCLUSIONS In Chinese communities, the unhealthy lifestyle of elderly individuals with SCD and MCI is significantly associated with cognitive function impairment. The greater their unhealthy lifestyle habits, the more pronounced the scope and severity of cognitive function impairment becomes. Furthermore, different dimensions of lifestyle have varying impacts on cognitive domains.
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Affiliation(s)
- Yuqin Sun
- Department of Geriatric Psychiatry, the Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi 214151, China
- Department of Nursing, Wuxi Medical College, Jiangnan University, 1800 Li Hu Avenue, Wuxi 214062, China
| | - Ruifen Zhang
- Department of Geriatric Psychiatry, the Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi 214151, China
| | - Zhiqun Mao
- Department of Geriatric Psychiatry, the Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi 214151, China
| | - Jiajun Yin
- Department of Medical Clinical Laboratory, the Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi 214151, China
| | - Yuanyuan Zhou
- Department of Psychotherapy, the Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi 214151, China
| | - Yue Wu
- Department of Geriatric Psychiatry, the Affiliated Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi 214151, China
- Department of Nursing, Wuxi Medical College, Jiangnan University, 1800 Li Hu Avenue, Wuxi 214062, China
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Hadley R, Mathie E, Pike E, Goodman C. Physical Activity Inclusion in Dementia-Friendly Communities: A Mixed Methods Study. J Aging Phys Act 2024; 32:376-386. [PMID: 38281484 DOI: 10.1123/japa.2022-0371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 01/30/2024]
Abstract
Dementia-friendly communities (DFCs) are a policy-endorsed approach to community engagement in England that promotes social inclusion to enable people affected by dementia to live well. Research suggests that physical activity is beneficial in encouraging social connection and improving health. A mixed method sequential study design in England involving a national survey (n = 31) and semistructured interviews (n = 65) in three DFCs was carried out. The aim was to understand how DFCs enable people affected by dementia to participate in physical activities. An evaluation framework for DFCs was used to organize and interpret the data, and analysis was informed by the inclusive (social) citizen lens. Findings showed that DFCs offered a range of adapted dementia-inclusive and dementia-specific activities; however, people were not routinely offered information at time of diagnosis. Local authorities (councils) were key to enable access to information and infrastructure change to support sustainable inclusion within their local community.
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Affiliation(s)
- Rebecca Hadley
- Centre for Applied Clinical, Health and Care Research (CACHE), University of Hertfordshire, Hatfield, United Kingdom
| | - Elspeth Mathie
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, United Kingdom
- NIHR Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
| | - Elizabeth Pike
- Institute of Sport, University of Hertfordshire, Hatfield, United Kingdom
| | - Claire Goodman
- Centre for Research in Public Health and Community Care (CRIPACC), University of Hertfordshire, Hatfield, United Kingdom
- NIHR Applied Research Collaboration (ARC) East of England (EoE), Cambridge, United Kingdom
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Mamayson RF, Lacanaria MGC. Effects of Cognitively Stimulating Activities on the Cognitive Functioning of Older People with Mild Cognitive Impairment: A Meta-analysis. ACTA MEDICA PHILIPPINA 2024; 58:14-23. [PMID: 38846164 PMCID: PMC11151131 DOI: 10.47895/amp.vi0.7162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Background The number of individuals with mild cognitive impairment (MCI), or those people without dementia who are experiencing age-related cognitive decline, has increased in recent years. Conveniently, several interventions to delay cognitive decline exist, where cognitively stimulating activities (CSA) have been receiving too much attention. However, its beneficial effects have not been well established among older people with MCI due to conflicting findings. Objectives This study aimed to assess and summarize the available evidence on the effects of CSA on the overall cognitive functioning of older people with MCI. Specifically, it sought to answer the PICO question, "In older people with MCI, does engagement in cognitively stimulating activities improve cognitive function?" Methods A systematic review and meta-analysis of randomized controlled trials examining the effects of CSA on older people with MCI were conducted. Three studies met the inclusion criteria from the 1,328 records from BioMed Central, CINAHL, Cochrane Library, Health Source: Nursing/Academic Edition, MEDLINE, and PubMed databases and 156 articles from WorldCat, DSpace Saint Louis University, and Google Scholar databases and catalogs. Effect size values were inspected using the random-effects model. Data were summarized as standardized mean difference (SMD) with corresponding 95% confidence intervals in the forest plot. Results This meta-analysis which compared studies that employed similar methodologies, found that CSA has a significant, large effect in improving cognitive functioning among older people with MCI, evidenced by an SMD of 0.798 (95% CI = 0.510-1.085, p = 0.001). While its superiority over other interventions that improve cognitive function was not observed in this study, it was still found that using CSA was helpful in terms of its cost-effectiveness. Also, heterogeneity across studies was non-significant (Cochran's Q = 0.151, df = 2, p = 0.927, I2 = 0.00%). These results mean that clinical heterogeneity was absent even though a diverse range of CSA was employed. Additionally, methodological diversity was not present since there were no variations in the study design and minimal variability in the risk of bias assessment. Conclusion Overall, it is acknowledged that CSA are effective and practical, inexpensive, non-pharmacologic cognitive training approaches to delay cognitive decline among older people with MCI. However, interpreting this study's significant, large effect, and non-significant heterogeneity warrants caution.
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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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Barisch-Fritz B, Bezold J, Scharpf A, Trautwein S, Krell-Roesch J, Woll A. A New Approach to Individualize Physical Activity Interventions for Individuals With Dementia: Cluster Analysis Based on Physical and Cognitive Performance. J Geriatr Phys Ther 2023:00139143-990000000-00038. [PMID: 37820354 DOI: 10.1519/jpt.0000000000000396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND PURPOSE Physical activity (PA) can have a beneficial effect on cognitive and physical performance in individuals with dementia (IWD), including those residing in nursing homes. However, PA interventions in nursing homes are usually delivered using a group setting, which may limit the effectiveness of the intervention due to the heterogenous nature of IWD. Therefore, the purpose of this study was to identify clusters based on cognitive and physical performance values, which could be used to improve individualization of PA interventions. METHODS Based on the cognitive and physical performance variables of 230 IWD, a cluster analysis was conducted. Global cognition (Mini-Mental State Examination), mobility (6-Meter Walking Test), balance (Frailty and Injuries: Cooperative Studies of Intervention Techniques-subtest-4), and strength and function of lower extremities (30-Second Chair-Stand Test) were assessed, and values were used to perform a hierarchical cluster analysis with Ward's method. Differences in physical and cognitive performance as well as other secondary outcomes (age, sex, body mass index, use of walking aids, diagnosis and etiology of dementia, number of medications, and Cumulative Illness Rating Scale) were tested using 1-factorial analyses of variance. RESULTS AND DISCUSSION Out of 230 data sets, 3-cluster solutions were identified with similar cluster sizes of 73 to 79. The silhouette coefficients for all calculated clusters ranged between 0.15 and 0.34. The cluster solutions were discussed in the context of cognitive and physical functions as well as training modalities and opportunities. The 4-cluster solution appears to be best suited for providing or developing an individualized PA intervention. CONCLUSIONS The identified clusters of the 4-cluster solution may be used in future research to improve individualization of dementia-specific PA interventions. By assigning IWD to these clusters, more homogenous groups with regard to cognitive and physical performance can be formed. This allows for more individualized PA interventions and may result in a higher effectiveness, particularly in nursing homes. Our findings are relevant for therapists and nursing staff who design or deliver PA interventions in nursing homes or similar settings.
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Affiliation(s)
- Bettina Barisch-Fritz
- Karlsruhe Institute of Technology, Institute of Sports and Sports Science, Karlsruhe, Germany
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de Rondão CA, Mota MP, Esteves D. Physical activity interventions in older adults with a cognitive impairment: A critical review of reviews. Aging Med (Milton) 2023; 6:290-306. [PMID: 37711255 PMCID: PMC10498829 DOI: 10.1002/agm2.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 09/16/2023] Open
Abstract
This critical review explores the review material on physical activity combined with cognitive stimulation interventions in older adults with cognitive impairment and/or dementia. A critical, systematic, review of the review method was used, considering four electronic databases: WEB OF SCIENCE, SCOPUS, MEDLINE, and the COCHRANE ELECTRONIC LIBRARY. The search terms "exercise," "physical activity," "cognitive impairment," "dementia," and "systematic review" were used. All available reviews were marked against predetermined inclusion and exclusion criteria. There were 32 reviews that met the inclusion criteria. A combination of various types of training and aerobic exercises were the most frequently reported interventions; meanwhile, dual task training programs (combining physical exercise with cognitive stimulation), functional training programs along with exercises combination, aerobic exercise as well as strength, stretching, or balance workouts were also reported. The evidence is compelling; exercise can improve physical health by ensuring cognitive, psychological, and behavioral benefits. Overall, exercise can improve the physical and mental health of people living with dementia: there is sufficient evidence to recommend multimodal exercise.
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Affiliation(s)
| | - Maria Paula Mota
- University of Trás‐os Montes e Alto DouroVila RealPortugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD)Vila RealPortugal
| | - Dulce Esteves
- University Beira InteriorCovilhãPortugal
- Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD)Vila RealPortugal
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Krafft J, Barisch-Fritz B, Krell-Roesch J, Trautwein S, Scharpf A, Woll A. A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study. JMIR Aging 2023; 6:e46480. [PMID: 37606974 PMCID: PMC10481225 DOI: 10.2196/46480] [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: 03/07/2023] [Revised: 06/26/2023] [Accepted: 07/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. OBJECTIVE This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. METHODS Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. RESULTS A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as "good." The main usability issues concerned navigation logic and comprehensibility of app content. CONCLUSIONS The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ≥50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study.
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Affiliation(s)
- Jelena Krafft
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Bettina Barisch-Fritz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sandra Trautwein
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Andrea Scharpf
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Rojas-Valverde D, Bonilla DA, Gómez-Miranda LM, Calleja-Núñez JJ, Arias N, Martínez-Guardado I. Examining the Interaction between Exercise, Gut Microbiota, and Neurodegeneration: Future Research Directions. Biomedicines 2023; 11:2267. [PMID: 37626763 PMCID: PMC10452292 DOI: 10.3390/biomedicines11082267] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Physical activity has been demonstrated to have a significant impact on gut microbial diversity and function. Emerging research has revealed certain aspects of the complex interactions between the gut, exercise, microbiota, and neurodegenerative diseases, suggesting that changes in gut microbial diversity and metabolic function may have an impact on the onset and progression of neurological conditions. This study aimed to review the current literature from several databases until 1 June 2023 (PubMed/MEDLINE, Web of Science, and Google Scholar) on the interplay between the gut, physical exercise, microbiota, and neurodegeneration. We summarized the roles of exercise and gut microbiota on neurodegeneration and identified the ways in which these are all connected. The gut-brain axis is a complex and multifaceted network that has gained considerable attention in recent years. Research indicates that gut microbiota plays vital roles in metabolic shifts during physiological or pathophysiological conditions in neurodegenerative diseases; therefore, they are closely related to maintaining overall health and well-being. Similarly, exercise has shown positive effects on brain health and cognitive function, which may reduce/delay the onset of severe neurological disorders. Exercise has been associated with various neurochemical changes, including alterations in cortisol levels, increased production of endorphins, endocannabinoids like anandamide, as well as higher levels of serotonin and dopamine. These changes have been linked to mood improvements, enhanced sleep quality, better motor control, and cognitive enhancements resulting from exercise-induced effects. However, further clinical research is necessary to evaluate changes in bacteria taxa along with age- and sex-based differences.
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Affiliation(s)
- Daniel Rojas-Valverde
- Nucleus of Studies for High Performance and Health (CIDISAD-NARS), School of Human Movement Sciences and Quality of Life (CIEMHCAVI), National University, Heredia 86-3000, Costa Rica
- Sports Injury Clinic (Rehab & Readapt), School of Human Movement Sciences and Quality of Life (CIEMHCAVI), National University, Heredia 86-3000, Costa Rica
| | - Diego A. Bonilla
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia;
- Research Group in Biochemistry and Molecular Biology, Faculty of Sciences and Education, Universidad Distrital Francisco José de Caldas, Bogotá 110311, Colombia
- Research Group in Physical Activity, Sports and Health Sciences (GICAFS), Universidad de Córdoba, Montería 230002, Colombia
- Sport Genomics Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Luis M. Gómez-Miranda
- Sports Faculty, Autonomous University of Baja California, Tijuana 22615, Mexico; (L.M.G.-M.); (J.J.C.-N.)
| | - Juan J. Calleja-Núñez
- Sports Faculty, Autonomous University of Baja California, Tijuana 22615, Mexico; (L.M.G.-M.); (J.J.C.-N.)
| | - Natalia Arias
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, C/del Hostal, 28248 Madrid, Spain;
| | - Ismael Martínez-Guardado
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, C/del Hostal, 28248 Madrid, Spain;
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Ammar A, Trabelsi K, Glenn JM. Editorial: ICT-based training intervention for healthy aging: ITIHA. Front Physiol 2022; 13:1067462. [DOI: 10.3389/fphys.2022.1067462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
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Barisch-Fritz B, Bezold J, Scharpf A, Trautwein S, Krell-Roesch J, Woll A. ICT-Based Individualized Training of Institutionalized Individuals With Dementia. Evaluation of Usability and Trends Toward the Effectiveness of the InCoPE-App. Front Physiol 2022; 13:921105. [PMID: 35874545 PMCID: PMC9304760 DOI: 10.3389/fphys.2022.921105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/27/2022] [Indexed: 01/10/2023] Open
Abstract
Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants (n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App.
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Affiliation(s)
- Bettina Barisch-Fritz
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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Park HJ, Oh DW, Kang TW. Music-Based Sling Exercise for Cognition and Function of Older Adults with Dementia. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2022. [DOI: 10.1080/02703181.2022.2091722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Hyun-Ju Park
- Dr Ara Pilaes Lab, Seo-gu, Daejeon, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Tae-Woo Kang
- Department of Physical Therapy, College of Health and Welfare, Woosuk University, Wanju_Gun, Jeollabuk-do, Republic of Korea
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Effects of Exercise Training on the Autonomic Nervous System with a Focus on Anti-Inflammatory and Antioxidants Effects. Antioxidants (Basel) 2022; 11:antiox11020350. [PMID: 35204231 PMCID: PMC8868289 DOI: 10.3390/antiox11020350] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/01/2023] Open
Abstract
Studies show that the autonomic nervous system (ANS) has an important impact on health in general. In response to environmental demands, homeostatic processes are often compromised, therefore determining an increase in the sympathetic nervous system (SNS)’s functions and a decrease in the parasympathetic nervous system (PNS)’s functions. In modern societies, chronic stress associated with an unhealthy lifestyle contributes to ANS dysfunction. In this review, we provide a brief introduction to the ANS network, its connections to the HPA axis and its stress responses and give an overview of the critical implications of ANS in health and disease—focused specifically on the immune system, cardiovascular, oxidative stress and metabolic dysregulation. The hypothalamic–pituitary–adrenal axis (HPA), the SNS and more recently the PNS have been identified as regulating the immune system. The HPA axis and PNS have anti-inflammatory effects and the SNS has been shown to have both pro- and anti-inflammatory effects. The positive impact of physical exercise (PE) is well known and has been studied by many researchers, but its negative impact has been less studied. Depending on the type, duration and individual characteristics of the person doing the exercise (age, gender, disease status, etc.), PE can be considered a physiological stressor. The negative impact of PE seems to be connected with the oxidative stress induced by effort.
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Liu Q, Vaci N, Koychev I, Kormilitzin A, Li Z, Cipriani A, Nevado-Holgado A. Personalised treatment for cognitive impairment in dementia: development and validation of an artificial intelligence model. BMC Med 2022; 20:45. [PMID: 35101059 PMCID: PMC8805393 DOI: 10.1186/s12916-022-02250-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 01/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Donepezil, galantamine, rivastigmine and memantine are potentially effective interventions for cognitive impairment in dementia, but the use of these drugs has not been personalised to individual patients yet. We examined whether artificial intelligence-based recommendations can identify the best treatment using routinely collected patient-level information. METHODS Six thousand eight hundred four patients aged 59-102 years with a diagnosis of dementia from two National Health Service (NHS) Foundation Trusts in the UK were used for model training/internal validation and external validation, respectively. A personalised prescription model based on the Recurrent Neural Network machine learning architecture was developed to predict the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores post-drug initiation. The drug that resulted in the smallest decline in cognitive scores between prescription and the next visit was selected as the treatment of choice. Change of cognitive scores up to 2 years after treatment initiation was compared for model evaluation. RESULTS Overall, 1343 patients with MMSE scores were identified for internal validation and 285 [21.22%] took the drug recommended. After 2 years, the reduction of mean [standard deviation] MMSE score in this group was significantly smaller than the remaining 1058 [78.78%] patients (0.60 [0.26] vs 2.80 [0.28]; P = 0.02). In the external validation cohort (N = 1772), 222 [12.53%] patients took the drug recommended and reported a smaller MMSE reduction compared to the 1550 [87.47%] patients who did not (1.01 [0.49] vs 4.23 [0.60]; P = 0.01). A similar performance gap was seen when testing the model on patients prescribed with AChEIs only. CONCLUSIONS It was possible to identify the most effective drug for the real-world treatment of cognitive impairment in dementia at an individual patient level. Routine care patients whose prescribed medications were the best fit according to the model had better cognitive performance after 2 years.
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Affiliation(s)
- Qiang Liu
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Nemanja Vaci
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Ivan Koychev
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Andrey Kormilitzin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Institute of Mathematics, University of Oxford, Oxford, UK
| | - Zhenpeng Li
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Alejo Nevado-Holgado
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Akrivia Health, Oxford, UK
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14
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Barisch-Fritz B, Bezold J, Scharpf A, Trautwein S, Krell-Roesch J, Woll A. InCoPE-App: Study protocol to examine usability and effectiveness of an individualized, tablet-based multidomain exercise program for institutionalized people with dementia delivered by nursing assistants. (Preprint). JMIR Res Protoc 2022; 11:e36247. [PMID: 36156463 PMCID: PMC9555322 DOI: 10.2196/36247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic’s impact. Objective Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program. Methods We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program. Results Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants. Conclusions To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic. Trial Registration German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024069 International Registered Report Identifier (IRRID) DERR1-10.2196/36247
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Affiliation(s)
- Bettina Barisch-Fritz
- Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Jelena Bezold
- Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Andrea Scharpf
- Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Sandra Trautwein
- Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Alexander Woll
- Institue of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
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15
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Bezold J, Trautwein S, Barisch-Fritz B, Scharpf A, Krell-Roesch J, Nigg CR, Woll A. Effects of a 16-week multimodal exercise program on activities of daily living in institutionalized individuals with dementia. GERMAN JOURNAL OF EXERCISE AND SPORT RESEARCH 2021. [DOI: 10.1007/s12662-021-00760-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractWe aimed to examine the effects of a 16-week multimodal exercise program (MEP) on activities of daily living (ADL) in individuals with dementia (IWD). Furthermore, we investigated the participants’ individual response to the MEP and whether baseline cognitive and motor performance explain ADL performance. We conducted a multicenter randomized controlled trial (RCT) involving 319 participants aged ≥ 65 years with mild to moderate dementia. ADL were assessed at baseline and after the 16-week intervention using the Barthel Index (BI), the Erlangen Test of Activities of Daily Living (E-ADL) and the 7‑item Physical Performance Test (PPT-7). We additionally assessed cognitive and motor performance using standardized and validated assessments. Intervention effects were examined through two-factor analysis of variance with repeated measurements applying a per protocol and an intention-to-treat analysis. We compared baseline cognitive and motor performance between positive-responders (positive-R), non-responders (non-R), and negative-responders (negative-R) and examined cognitive and motor performance as potential cofounders of ADL by conducting multiple regression analyses. There were no significant time×group effects on ADL. Between 20 and 32% of participants responded positively to the intervention, i.e., improved ADL performance from baseline to follow-up. Positive-R had worse baseline motor performance compared to non-R. Cognitive and motor performance explained up to 51.4% of variance in ADL. The MEP had no significant overall effect on ADL in IWD. This may be related to insufficient exercise intensity. However, our results indicate that the response to the MEP depends on individual prerequisites which should thus be considered in further research on individual exercise approaches.
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16
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Abstract
Dementia is an eurodegenerative disorder, which causes significant disability, especially among the elderly population worldwide. The affected person shows a progressive cognitive decline, which interferes with the independence in performing the activities of daily living. Other than the cognitive domain, the patient tends to have neuropsychiatric, behavioral, sensorimotor, speech, and language-related issues. It is expected that the global burden of the disease will rise with more people entering the geriatric age group. By 2050 close, to 140 million people will be living with one or the other type of dementia. Alzheimer's disease contributes to more than 60% of cases worldwide, followed by vascular dementia. Pharmacotherapy has a limited role to play in the treatment, and at present, no drug is available, which can halt or reverse the progress of the disease. World Health Organization has mandated rehabilitation as a core recommendation in the global action plan on the public health response to dementia. Rehabilitation services are widely recognized as a practical framework to maximize independence and community participation in dementia care. The rehabilitation program is customized to achieve the desired goals, as each person has different experiences, preferences, motivations, strengths, and requirements based on type, course, and severity of the illness. It is an interdisciplinary-team approach with the involvement of several health care professionals. This article reviews the existing literature and outlines the effective rehabilitation strategies concisely in dementia care.
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Affiliation(s)
- Anupam Gupta
- Dept. of Neurological Rehabilitation, NIMHANS, Bangalore, Karnataka, India
| | - Naveen B. Prakash
- Dept. of Neurological Rehabilitation, NIMHANS, Bangalore, Karnataka, India
| | - Gourav Sannyasi
- Dept. of Neurological Rehabilitation, NIMHANS, Bangalore, Karnataka, India
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17
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Netz Y, Yekutieli Z, Arnon M, Argov E, Tchelet K, Benmoha E, Jacobs JM. Personalized Exercise Programs Based upon Remote Assessment of Motor Fitness: A Pilot Study among Healthy People Aged 65 Years and Older. Gerontology 2021; 68:465-479. [PMID: 34515118 DOI: 10.1159/000517918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The World Health Organization has recently updated exercise guidelines for people aged >65 years, emphasizing the inclusion of multiple fitness components. However, without adequate recognition of individual differences, these guidelines may be applied using an approach that "one-size-fits-all." Within the shifting paradigm toward an increasingly personalized approach to medicine and health, it is apparent that fitness components display a significant age-related increase in variability. Therefore, it is both logical and necessary to perform an accurate individualized assessment of multiple fitness components prior to optimal prescription for a personalized exercise program. OBJECTIVE The aim of the study was to test the feasibility and effectiveness of a novel tool able to remotely assess balance, flexibility, and strength using smartphone sensors (accelerometer/gyroscope), and subsequently deliver personalized exercise programs via the smartphone. METHODS We enrolled 52 healthy volunteers (34 females) aged 65+ years, with normal cognition and low fall risk. Baseline data from remote smartphone fitness assessment were analyzed to generate 42 fitness digital markers (DMs), used to guide personalized exercise programs (×5/week for 6 weeks) delivered via smartphone. Programs included graded exercises for upper/lower body, flexibility, strength, and balance (dynamic, static, and vestibular). Participants were retested after 6 weeks. RESULTS Average age was 74.7 ± 6.4 years; adherence was 3.6 ± 1.7 exercise sessions/week. Significant improvement for pre-/posttesting was observed for 10/12 DMs of strength/flexibility for upper/lower body (sit-to-stand repetitions/duration; arm-lift duration; torso rotation; and arm extension/flexion). Balance improved significantly for 6/10 measures of tandem stance, with consistent (nonsignificant) trends observed across 20 balance DMs of tandem walk and 1 leg stance. Balance tended to improve among the 37 participants exercising ≥3/week. DISCUSSION These preliminary results provide a proof of concept, with high adherence and improved fitness confirming the benefits of remote fitness assessment for guiding home personalized exercise programs among healthy adults aged >65 years. Further examination of the application within a randomized control study is necessary, comparing the personalized exercise program to general guidelines among healthy older adults, as well as specific populations, such as those with frailty, deconditioning, cognitive, or functional impairment. The study tool offers the opportunity to collect big data, including additional variables, with subsequent utilization of artificial intelligence to optimize the personalized exercise program.
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Affiliation(s)
- Yael Netz
- The Academic College at Wingate, Netanya, Israel
| | | | - Michal Arnon
- The Academic College at Wingate, Netanya, Israel
| | - Esther Argov
- The Academic College at Wingate, Netanya, Israel
| | | | - Eti Benmoha
- The Academic College at Wingate, Netanya, Israel
| | - Jeremy M Jacobs
- Department of Geriatric Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Abstract
The beneficial effects of exercise on the brain are well known. In general, exercise offers an effective way to improve cognitive function in all ages, particularly in the elderly, who are considered the most vulnerable to neurodegenerative disorders. In this regard, myokines, hormones secreted by muscle in response to exercise, have recently gained attention as beneficial mediators. Irisin is a novel exercise-induced myokine, that modulates several bodily processes, such as glucose homeostasis, and reduces systemic inflammation. Irisin is cleaved from fibronectin type III domain containing 5 (FNDC5), a transmembrane precursor protein expressed in muscle under the control of peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α). The FNDC5/irisin system is also expressed in the hippocampus, where it stimulates the expression of the neurotrophin brain-derived neurotrophic factor in this area that is associated with learning and memory. In this review, we aimed to discuss the role of irisin as a key mediator of the beneficial effects of exercise on synaptic plasticity and memory in the elderly, suggesting its roles within the main promoters of the beneficial effects of exercise on the brain.
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19
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Ammar A, Boukhris O, Halfpaap N, Labott BK, Langhans C, Herold F, Grässler B, Müller P, Trabelsi K, Chtourou H, Zmijewski P, Driss T, Glenn JM, Müller NG, Hoekelmann A. Four Weeks of Detraining Induced by COVID-19 Reverse Cardiac Improvements from Eight Weeks of Fitness-Dance Training in Older Adults with Mild Cognitive Impairment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5930. [PMID: 34073051 PMCID: PMC8198940 DOI: 10.3390/ijerph18115930] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/13/2022]
Abstract
Physical training is considered as a low-cost intervention to generate cardioprotective benefits and to promote physical and mental health, while reducing the severity of acute respiratory infection symptoms in older adults. However, lockdown measures during COVID-19 have limited people's opportunity to exercise regularly. The aim of this study was to investigate the effect of eight weeks of Fitness and Dance training, followed by four weeks of COVID-19-induced detraining, on cardiac adaptations and physical performance indicators in older adults with mild cognitive impairment (MCI). Twelve older adults (6 males and 6 females) with MCI (age, 73 ± 4.4 y; body mass, 75.3 ± 6.4 kg; height, 172 ± 8 cm; MMSE score: 24-27) participated in eight weeks of a combined Fitness-Dance training intervention (two sessions/week) followed by four weeks of training cessation induced by COVID-19 lockdowns. Wireless Polar Team Pro and Polar heart rate sensors (H10) were used to monitor covered distance, speed, heart rate (HR min, avg and max), time in HR zone 1 to 5, strenuousness (load score), beat-to-beat interval (max RR and avg RR) and heart rate variability (HRV-RMSSD). One-way ANOVA was used to analyze the data of the three test sessions (T1: first training session, T2: last training session of the eight-week training program, and T3: first training session after the four-week training cessation). Statistical analysis showed that eight weeks of combined Fitness-Dance training induced beneficial cardiac adaptations by decreasing HR (HR min, HR avg and HR max) with p < 0.001, ES = 0.5-0.6 and Δ = -7 to-9 bpm, and increasing HRV related responses (max and avg RR and RMSSD), with p < 0.01 and ES = 0.4. Consequently, participants spent more time in comfortable HR zones (e.g., p < 0.0005; ES = 0.7; Δ = 25% for HR zone 1) and showed reduced strenuousness (p = 0.02, Δ = -15% for load score), despite the higher covered total distance and average speed (p < 0.01; ES = 0.4). However, these changes were reversed after only four weeks of COVID-19 induced detraining, with values of all parameters returning to their baseline levels. In conclusion, eight weeks of combined Fitness-Dance training seems to be an efficient strategy to promote cardioprotective benefits in older adults with MCI. Importantly, to maintain these health benefits, training has to be continued and detraining periods should be reduced. During a pandemic, home-based exercise programs may provide an effective and efficient alternative of physical training.
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Affiliation(s)
- Achraf Ammar
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, 92000 Nanterre, France;
| | - Omar Boukhris
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis 1003, Tunisia; (O.B.); (H.C.)
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia;
| | - Nicole Halfpaap
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Berit Kristin Labott
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Corinna Langhans
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Fabian Herold
- German Center for Neurodegenerative Diseases (DZNE), 39104 Magdeburg, Germany; (F.H.); (P.M.); (N.G.M.)
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Bernhard Grässler
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
| | - Patrick Müller
- German Center for Neurodegenerative Diseases (DZNE), 39104 Magdeburg, Germany; (F.H.); (P.M.); (N.G.M.)
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia;
- Research Laboratory, Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax 3000, Tunisia
| | - Hamdi Chtourou
- Physical Activity, Sport, and Health, UR18JS01, National Observatory of Sport, Tunis 1003, Tunisia; (O.B.); (H.C.)
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax 3000, Tunisia;
| | - Piotr Zmijewski
- Jozef Pilsudski University of Physical Education in Warsaw, 00-809 Warsaw, Poland;
| | - Tarak Driss
- Interdisciplinary Laboratory in Neurosciences, Physiology and Psychology: Physical Activity, Health and Learning (LINP2), UFR STAPS, UPL, Paris Nanterre University, 92000 Nanterre, France;
| | - Jordan M. Glenn
- Exercise Science Research Center, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR 72701, USA;
- Neurotrack Technologies, 399 Bradford St, Redwood City, CA 94063, USA
| | - Notger G. Müller
- German Center for Neurodegenerative Diseases (DZNE), 39104 Magdeburg, Germany; (F.H.); (P.M.); (N.G.M.)
- Department of Neurology, Medical Faculty, Otto von Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Brenneckestraße 6, 39118 Magdeburg, Germany
| | - Anita Hoekelmann
- Institute of Sport Science, Otto-von-Guericke University, 39106 Magdeburg, Germany; (N.H.); (B.K.L.); (C.L.); (B.G.); (A.H.)
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Hughes TF, Liu A, Jacobsen E, Rosano C, Berman SB, Chang CCH, Ganguli M. Exercise and the Risk of Mild Cognitive Impairment: Does the Effect Depend on Vascular Factors? Alzheimer Dis Assoc Disord 2021; 35:30-35. [PMID: 32960854 PMCID: PMC9350907 DOI: 10.1097/wad.0000000000000410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/21/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although exercise is associated with a lower risk for mild cognitive impairment (MCI), it is unclear whether its protective effect depends on the presence or absence of vascular factors. METHODS In an exploratory study of data from a population-based cohort, 1254 participants aged 65+ years were followed for 10 years for incident MCI. The main effect of baseline total minutes of exercise per week (0 vs. 1 to 149 vs. 150+), and its interaction with several vascular factors, on risk for incident MCI was examined using Cox proportional hazards regression models, adjusting for demographics. RESULTS Compared with no exercise, 1 to 149 minutes [hazard ratio (HR)=0.90; 95% confidence interval (95% CI), 0.69-1.16] and 150 or more minutes per week (HR=0.84; 95% CI, 0.66-1.07) of exercise lowered risk for incident MCI in a dose-dependent manner. The majority of interactions were not statistically significant, but risk reduction effect sizes of <0.75 suggested that exercise may have stronger effects among those without high cholesterol, never smoking, and not currently consuming alcohol; also, those with arrhythmia, coronary artery disease, and heart failure. Overall, there was a pattern of exercise being associated with lower MCI risk among those without vascular factors. CONCLUSIONS Spending more time engaging in exercise each week may offer protection against MCI in late life, with some variation among those with different vascular conditions and risk factors. Our findings may help target subgroups for exercise recommendations and interventions, and also generate hypotheses to test regarding underlying mechanisms.
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Affiliation(s)
- Tiffany F. Hughes
- Youngstown State University, Youngstown, OH, United States of America
| | - Anran Liu
- University of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, United States of America
| | - Erin Jacobsen
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, United States of America
| | - Caterina Rosano
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United State of America
| | - Sarah B. Berman
- University of Pittsburgh, School of Medicine, Department of Neurology, Pittsburgh, PA, United States of America
| | - Chung-Chou H. Chang
- University of Pittsburgh, Graduate School of Public Health, Department of Biostatistics, Pittsburgh, PA, United States of America
- University of Pittsburgh, School of Medicine, Department of Medicine, Pittsburgh, PA, United States of America
| | - Mary Ganguli
- University of Pittsburgh, School of Medicine, Department of Psychiatry, Pittsburgh, PA, United States of America
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, Pittsburgh, PA, United State of America
- University of Pittsburgh, School of Medicine, Department of Neurology, Pittsburgh, PA, United States of America
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Zarco EPT, Aquino M, Petrizzo J, Wygand J, McGorry A. Perceived Benefits of a Guided Exercise Program Among Older Adults. Gerontol Geriatr Med 2021; 7:23337214211060147. [PMID: 35071693 PMCID: PMC8766912 DOI: 10.1177/23337214211060147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Michele Aquino
- Health and Sport Sciences, Adelphi University, Garden City, NY, USA
| | - John Petrizzo
- Health and Sport Sciences, Adelphi University, Garden City, NY, USA
| | - John Wygand
- Health and Sport Sciences, Adelphi University, Garden City, NY, USA
| | - Amy McGorry
- Health Sciences, Long Island University, Brookville, NY, USA
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de Azevedo KPM, de Oliveira VH, de Medeiros GCBS, Mata ÁNDS, García DÁ, Martínez DG, Leitão JC, Knackfuss MI, Piuvezam G. The Effects of Exercise on BDNF Levels in Adolescents: A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176056. [PMID: 32825341 PMCID: PMC7503913 DOI: 10.3390/ijerph17176056] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/04/2020] [Accepted: 07/10/2020] [Indexed: 12/25/2022]
Abstract
The aim of this study was to analyze the evidence available in the literature about the effects of exercise on brain-derived neurotrophic factor levels in adolescents. The literature searches were conducted in PubMed, Embase, Scopus, ScienceDirect, Web of Science, SportDiscus, the Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL. Randomized controlled trials and non-randomized controlled trials performed with adolescents (10–19 years) who underwent different exercise programs and who evaluated BDNF levels before and after the intervention were included. We included six studies, four RCTs and two non-RCTs in the systematic review with a total of 407 adolescents. In two randomized trials and one non-RCT, the intervention groups showed significant improvements in BDNF levels compared with the control group. The results presented in the meta-analysis indicate that despite the positive effect in favor of the intervention, there were no significant differences (standardized mean difference 0.28 ng/mL, 95% confidence interval −0.28 to 0.85; p = 0.32, I² = 0%). The results presented in our review indicate that aerobic exercise programs practiced in moderate- or high-intensity are promising strategies to increase BDNF levels in adolescents. However, further studies are required to support this finding.
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Affiliation(s)
- Kesley Pablo Morais de Azevedo
- Post-Graduate Program in Public Health, Federal University of Rio Grande do Norte, 59078-970 Natal, Brazil; (V.H.d.O.); (G.C.B.S.d.M.); (Á.N.d.S.M.); (G.P.)
- Correspondence: ; Tel.: +55-084-98738-1422
| | - Victor Hugo de Oliveira
- Post-Graduate Program in Public Health, Federal University of Rio Grande do Norte, 59078-970 Natal, Brazil; (V.H.d.O.); (G.C.B.S.d.M.); (Á.N.d.S.M.); (G.P.)
| | | | - Ádala Nayana de Sousa Mata
- Post-Graduate Program in Public Health, Federal University of Rio Grande do Norte, 59078-970 Natal, Brazil; (V.H.d.O.); (G.C.B.S.d.M.); (Á.N.d.S.M.); (G.P.)
| | - Daniel Ángel García
- Department of Sociosanitary Sciences, University of Murcia, 30100 Murcia, Spain;
| | | | - José Carlos Leitão
- Center for Research in Sport, Health and Human Development, University of Trás-os-Montes and Alto Douro, 5001-801 Vila Real, Portugal;
| | - Maria Irany Knackfuss
- Post-Graduate Program in Health and Society, State University of Rio Grande do Norte (UERN), 59610-210 Mossoró, Brazil;
| | - Grasiela Piuvezam
- Post-Graduate Program in Public Health, Federal University of Rio Grande do Norte, 59078-970 Natal, Brazil; (V.H.d.O.); (G.C.B.S.d.M.); (Á.N.d.S.M.); (G.P.)
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Mahalakshmi B, Maurya N, Lee SD, Bharath Kumar V. Possible Neuroprotective Mechanisms of Physical Exercise in Neurodegeneration. Int J Mol Sci 2020; 21:ijms21165895. [PMID: 32824367 PMCID: PMC7460620 DOI: 10.3390/ijms21165895] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 12/22/2022] Open
Abstract
Physical exercise (PE) improves physical performance, mental status, general health, and well-being. It does so by affecting many mechanisms at the cellular and molecular level. PE is beneficial for people suffering from neuro-degenerative diseases because it improves the production of neurotrophic factors, neurotransmitters, and hormones. PE promotes neuronal survival and neuroplasticity and also optimizes neuroendocrine and physiological responses to psychosocial and physical stress. PE sensitizes the parasympathetic nervous system (PNS), Autonomic Nervous System (ANS) and central nervous system (CNS) by promoting many processes such as synaptic plasticity, neurogenesis, angiogenesis, and autophagy. Overall, it carries out many protective and preventive activities such as improvements in memory, cognition, sleep and mood; growth of new blood vessels in nervous system; and the reduction of stress, anxiety, neuro-inflammation, and insulin resistance. In the present work, the protective effects of PE were overviewed. Suitable examples from the current research work in this context are also given in the article.
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Affiliation(s)
- B. Mahalakshmi
- Institute of Research and Development, Duy Tan University, Da Nang 550000, Vietnam;
| | - Nancy Maurya
- Department of Botany, Government Science College, Pandhurna, Chhindwara, Madhya Pradesh 480334, India;
| | - Shin-Da Lee
- Department of Physical Therapy, Asia University, Taichung 41354, Taiwan
- Department of Physical Therapy Graduate Institute of Rehabilitation Science, China Medical University, Taichung 40402, Taiwan
- Correspondence: (S.-D.L.); (V.B.K.); Tel.: +886-4-22053366 (ext. 7300) (S.-D.L.); +886-4-2332-3456 (ext. 6352 or 6353) (V.B.K.); Fax: 886-4-22065051 (S.-D.L.); +886-4-23305834 (V.B.K.)
| | - V. Bharath Kumar
- Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 41354, Taiwan
- Correspondence: (S.-D.L.); (V.B.K.); Tel.: +886-4-22053366 (ext. 7300) (S.-D.L.); +886-4-2332-3456 (ext. 6352 or 6353) (V.B.K.); Fax: 886-4-22065051 (S.-D.L.); +886-4-23305834 (V.B.K.)
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Wollesen B, Wildbredt A, van Schooten KS, Lim ML, Delbaere K. The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis. Eur Rev Aging Phys Act 2020; 17:9. [PMID: 32636957 PMCID: PMC7333372 DOI: 10.1186/s11556-020-00240-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ageing is associated with physical and cognitive decline, affecting independence and quality of life in older people. Recent studies show that in particular executive functions are important for daily-life function and mobility. This systematic review investigated the effectiveness of cognitive-motor training including exergaming on executive function (EF, set-shifting, working memory, inhibitory control) in healthy older people. Methods An electronic database search for randomised controlled trials (RCT), controlled clinical trials (CCT) and parallel group trials was performed using MEDLINE, EMBASE, and PsychINFO following PRISMA guidelines. Inclusion criteria were: (1) community-dwelling participants > 60 years without a medical condition or medical treatment, (2) reporting at least one cognitive-motor intervention while standing or walking, (3) use of dual-task interventions using traditional methods or modern technology to deliver a cognitive-motor task, (4) inclusion of at least one cognitive outcome. The PEDro scale was used for quality assessment. Results A total of 1557 studies were retrieved, of which 25 studies were included in this review. Eleven studies used a technology-based dual-task intervention, while 14 trials conducted a general cognitive-motor training. The age range of the cohort was 69 to 87 years. The interventions demonstrated positive effects on global cognitive function [mean difference 0.6, 95% CI 0.29–0.90] and inhibitory control [mean difference 0.61, 95% CI 0.28–0.94]. Effects were heterogeneous (I2 range: 60–95) and did not remain after a sensitivity analysis. Processing speed and dual-task costs also improved, but meta-analysis was not possible. Conclusion Cognitive-motor and technology-based interventions had a positive impact on some cognitive functions. Dual-task interventions led to improvements of domains related global cognitive functions and inhibitory control. Likewise, technology-based exergame interventions improved functions related to processing speed, attentional and inhibitory control. Training interventions with a certain level of exercise load such as progression in difficulty and task specificity were more effective to gain task-related adaptations on cognitive functions.
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Affiliation(s)
- Bettina Wollesen
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany.,Biological Psychology and Neuroergonomics, Technical University of Berlin, Fasanenstr. 1, D-10623 Berlin, Germany
| | - Alicia Wildbredt
- Department of Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Kimberley S van Schooten
- Neuroscience Research Australia, Sydney, New South Wales Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales Australia
| | - Mei Ling Lim
- Neuroscience Research Australia, Sydney, New South Wales Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales Australia
| | - Kim Delbaere
- Neuroscience Research Australia, Sydney, New South Wales Australia.,School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales Australia
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25
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Miglinas M, Cesniene U, Janusaite MM, Vinikovas A. Cerebrovascular Disease and Cognition in Chronic Kidney Disease Patients. Front Cardiovasc Med 2020; 7:96. [PMID: 32582768 PMCID: PMC7283453 DOI: 10.3389/fcvm.2020.00096] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 05/06/2020] [Indexed: 12/16/2022] Open
Abstract
Chronic kidney disease (CKD) affects both brain structure and function. Patients with CKD have a higher risk of both ischemic and hemorrhagic strokes. Age, prior disease history, hypertension, diabetes, atrial fibrillation, smoking, diet, obesity, and sedimentary lifestyle are most common risk factors. Renal-specific pathophysiologic derangements, such as oxidative stress, chronic inflammation, endothelial dysfunction, vascular calcification, anemia, gut dysbiosis, and uremic toxins are important mediators. Dialysis initiation constitutes the highest stroke risk period. CKD significantly worsens stroke outcomes. It is essential to understand the risks and benefits of established stroke therapeutics in patients with CKD, especially in those on dialysis. Subclinical cerebrovascular disease, such as of silent brain infarction, white matter lesions, cerebral microbleeds, and cerebral atrophy are more prevalent with declining renal function. This may lead to functional brain damage manifesting as cognitive impairment. Cognitive dysfunction has been linked to poor compliance with medications, and is associated with greater morbidity and mortality. Thus, understanding the interaction between renal impairment and brain is important in to minimize the risk of neurologic injury in patients with CKD. This article reviews the link between chronic kidney disease and brain abnormalities associated with CKD in detail.
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Affiliation(s)
- Marius Miglinas
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Ugne Cesniene
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Marta Monika Janusaite
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Arturas Vinikovas
- Nephrology and Kidney Transplantation Unit, Nephrology Center, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Lewis K, Livsey L, Naughton RJ, Burton K. Exercise and dementia: what should we be recommending? QUALITY IN AGEING AND OLDER ADULTS 2020. [DOI: 10.1108/qaoa-10-2019-0053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose
Exercise has the potential to provide benefits for people living with dementia, yet the balance of evidence is uncertain. This paper aims to provide an evidence synthesis to determine whether exercise improves their health and well-being and what exercise should be recommended.
Design/methodology/approach
Structured search for existing literature reviews on exercise for dementia. Relevant articles were selected and critically appraised against systematic criteria. The findings from 15 high quality reviews were collated by using a best evidence synthesis approach.
Findings
The evidence is convincing for improving physical health, promising for cognitive benefits, mixed for psychological benefits and limited for behavioural outcomes. No evidence of harm was found. Overall, exercise can improve physical and mental health for people living with dementia: there is sufficient evidence to recommend multimodal exercise.
Social implications
The potential beneficial outcomes are of significant importance both for people with dementia and their caregivers. In the absence of more specific findings, the current recommendation for older adults in general is pragmatically justified – some activity is better than none, more activity provides greater benefits. Adding social interaction may be important for psychological and behavioural outcomes.
Originality/value
To the best of the authors’ knowledge, this paper is the first to encapsulate the literature to date on exercise for dementia. Combining the findings from previous reviews enabled a novel synthesis across the range of relevant interventions and outcomes.
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Müller P, Duderstadt Y, Lessmann V, Müller NG. Lactate and BDNF: Key Mediators of Exercise Induced Neuroplasticity? J Clin Med 2020; 9:jcm9041136. [PMID: 32326586 PMCID: PMC7230639 DOI: 10.3390/jcm9041136] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/07/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023] Open
Abstract
Accumulating evidence from animal and human studies supports the notion that physical exercise can enhance neuroplasticity and thus reduce the risk of several neurodegenerative diseases (e.g., dementia). However, the underlying neurobiological mechanisms of exercise induced neuroplasticity are still largely unknown. One potential mediator of exercise effects is the neurotrophin BDNF, which enhances neuroplasticity via different pathways (e.g., synaptogenesis, neurogenesis, long-term potentiation). Current research has shown that (i) increased peripheral lactate levels (following high intensity exercise) are associated with increased peripheral BDNF levels, (ii) lactate infusion at rest can increase peripheral and central BDNF levels and (iii) lactate plays a very complex role in the brain’s metabolism. In this review, we summarize the role and relationship of lactate and BDNF in exercise induced neuroplasticity.
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Affiliation(s)
- Patrick Müller
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany; (Y.D.); (N.G.M.)
- Medical Faculty, Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
- Correspondence:
| | - Yves Duderstadt
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany; (Y.D.); (N.G.M.)
| | - Volkmar Lessmann
- Medical Faculty, Institute of Physiology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany;
- Center for Behavioral Brain Sciences (CBBS), Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Notger G. Müller
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Leipziger Str. 44, 39120 Magdeburg, Germany; (Y.D.); (N.G.M.)
- Medical Faculty, Department of Neurology, Otto-von-Guericke University, Leipziger Str. 44, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Leipziger Str. 44, 39120 Magdeburg, Germany
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Abstract
In this paper, we present in depth the hardware components of a low-cost cognitive assistant. The aim is to detect the performance and the emotional state that elderly people present when performing exercises. Physical and cognitive exercises are a proven way of keeping elderly people active, healthy, and happy. Our goal is to bring to people that are at their homes (or in unsupervised places) an assistant that motivates them to perform exercises and, concurrently, monitor them, observing their physical and emotional responses. We focus on the hardware parts and the deep learning models so that they can be reproduced by others. The platform is being tested at an elderly people care facility, and validation is in process.
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Smith PJ. Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition. Brain Plast 2019; 5:3-38. [PMID: 31970058 PMCID: PMC6971820 DOI: 10.3233/bpl-190083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) represent an increasingly urgent public health concern, with an increasing number of baby boomers now at risk. Due to a lack of efficacious therapies among symptomatic older adults, an increasing emphasis has been placed on preventive measures that can curb or even prevent ADRD development among middle-aged adults. Lifestyle modification using aerobic exercise and dietary modification represents one of the primary treatment modalities used to mitigate ADRD risk, with an increasing number of trials demonstrating that exercise and dietary change, individually and together, improve neurocognitive performance among middle-aged and older adults. Despite several optimistic findings, examination of treatment changes across lifestyle interventions reveals a variable pattern of improvements, with large individual differences across trials. The present review attempts to synthesize available literature linking lifestyle modification to neurocognitive changes, outline putative mechanisms of treatment improvement, and discuss discrepant trial findings. In addition, previous mechanistic assumptions linking lifestyle to neurocognition are discussed, with a focus on potential solutions to improve our understanding of individual neurocognitive differences in response to lifestyle modification. Specific recommendations include integration of contemporary causal inference approaches for analyzing parallel mechanistic pathways and treatment-exposure interactions. Methodological recommendations include trial multiphase optimization strategy (MOST) design approaches that leverage individual differences for improved treatment outcomes.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences (Primary), Duke University Medical Center, NC, USA
- Department of Medicine (Secondary), Duke University Medical Center, NC, USA
- Department of Population Health Sciences (Secondary), Duke University, NC, USA
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Gronwald T, Budde H. Commentary: Physical Exercise as Personalized Medicine for Dementia Prevention? Front Physiol 2019; 10:1358. [PMID: 31736780 PMCID: PMC6834542 DOI: 10.3389/fphys.2019.01358] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Thomas Gronwald
- Department of Performance, Neuroscience, Therapy and Health, Faculty of Health Sciences, Medical School Hamburg, University of Applied Science and Medical University, Hamburg, Germany
| | - Henning Budde
- Faculty of Human Sciences, Medical School Hamburg, University of Applied Science and Medical University, Hamburg, Germany
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Inter-Individual Differences in Cognitive Response to a Single Bout of Physical Exercise-A Randomized Controlled Cross-Over Study. J Clin Med 2019; 8:jcm8081101. [PMID: 31349593 PMCID: PMC6723732 DOI: 10.3390/jcm8081101] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/12/2022] Open
Abstract
Recent reviews have shown that acute exercise can improve cognitive functions, especially executive functions. However, a closer look at the included studies revealed a wide inter-individual variability in the effects of exercise on cognition. Therefore, thirty-nine healthy adults (age: 19–30 years) were analyzed in a randomized, controlled cross-over study with two exercise groups (n = 13 each) and a sedentary control group (n = 13). The exercise conditions included moderate (30 min at 40–59% VO2max) and high intensity interval (five × 2 min at 90% VO2max with 3 min active recovery at 40% VO2max) treadmill exercise. The main outcome assessed was cognitive performance (attention, inhibitory control, cognitive flexibility) and underlying inter-individual variability in young adults. On the group level no significant group or group × time interaction effects were observed. Using a median split, we found significant differences between low and high cognitive performers regarding cognitive function following moderate and high intensity interval treadmill exercise. Furthermore, using a pre-determined threshold we could identify responders and non-responders to acute exercise. Therefore, future research should consider individual performance requirements.
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