Feasibility of a Small Group Otago Exercise Program for Older Adults Living with Dementia

Feasibility and Acceptance of a Remotely Supervised Home-Based Group Mobility Exercise for Older Adults Using a Mobile Robotic Telepresence: A Pilot Study

BACKGROUND/OBJECTIVES

 Mobile robotic telepresence could be used to remotely supervise physical activity programs. Our study aims to explore the feasibility, acceptance, and usability of a physical activity program offered synchronously via a mobile robotic telepresence platform.

METHODS

 For this interventional study, five Cutii robots were made available in two residences for older adults in Quebec. Participants received the exercise program, two sessions per week for 4-6 weeks, delivered remotely via the robot. The following feasibility indicators were collected during the study, as recommended by Thabane et al.: process, resources, management, and intervention. Acceptance and usability of the technology were measured using the extended version of the Unified Theory of Acceptance and Use of Technology-based questionnaire and the System Usability Scale, respectively.

RESULTS

 Eighty percent of participants completed the protocol, and 58% of participants attended 80% of the sessions. Various technical problems (internet connection and technology issues) limited the usability and acceptance of the technology.

CONCLUSION

 The results revealed that the program was feasible according to the process, management, and intervention indicators but unsatisfactory in terms of resources. For some participants, minor modifications were needed to improve technology support and facilitate connection to the mobile robotic telepresence. Further studies will need to focus on the evaluation of the effectiveness of this type of intervention.

IMPLICATIONS

These results emphasize the importance of continuing research evaluating the opportunities provided by new technologies to enhance older adults' engagement in physical activity and inform clinicians and policymakers to improve future services in this domain.

The Effectiveness of an Exercise Program on Muscle Strength and Range of Motion on Upper Limbs, Functional Ability and Depression at Early Stage of Dementia

Background: Dementia involves the loss of cognitive abilities and represents a decline from the prior level of function, which impairs functional abilities in day-to-day life. The purpose of the present study is to examine the effectiveness of an exercise program on the muscle strength and range of motion of the upper limbs, the functional status, and the depression of elderly people with early stage dementia. Methods: The sample consisted of 60 elderly people with early stage dementia who were randomly divided into a control and an experimental group of 30 participants each. The experimental group received a 12-week Otago exercise program with 45 min duration of each session. The control group received usual care without doing exercise. The outcome measures of muscle strength and range of motion of the upper limbs, the functional status, and the depression were assessed by valid instruments and tests at the beginning and at the end of the intervention program. Repeated measures one-way ANOVA and Mann-Whitney tests examined the differences between the two groups at the end of the 12-week exercise program. Results: Statistically significant differences were found between the experimental and control groups in the entire outcome measures (functional ability F = 9.35 p < 0.05; muscle strength right hand F = 32.33, p < 0.05 left hand U = 95.50 p < 0.01; e.g., range of motion shoulder extension U = 104.00 p < 0.01), except depression. Conclusions: Both muscle strength and range of motion of the upper limbs, as well as the functional ability, were improved by the exercise program. Further research is needed to investigate the present results, in particular to explore the long-term cognitive, behavioral, and functional status outcomes of exercise in the early stages of dementia.

Effects of Otago Exercise Program on postural control ability in elders living in the nursing home: A systematic review and meta-analysis

BACKGROUND

Losing postural control ability and related injuries are of particular concern for elders living in the nursing home (NH). The Otago Exercise Program (OEP) is a multimodal exercise training program initially designed as an individually tailored home exercise for community-dwelling elders, but whether its movement characteristics and exercise intensity meet NH elders' needs still needs to be clarified. This study aimed to determine the effects of the OEP in enhancing postural control ability among elders in the NH.

METHODS

A systematic literature search of English language databases (Cochrane Library, PubMed, EMBASE, CINAHL, and Web of Science) and Chinese language databases (China National Knowledge Infrastructure, Wanfang, and Chongqing VIP) until 15 April 2022 were performed by 2 reviewers on searching randomized controlled trial (RCT) and non-RCT. A meta-analysis was performed using Review Manager 5.3 software. Continuous data were expressed as mean difference (MD) with 95% confidence intervals (95% CI). Dichotomous data were presented as risk ratios (RRs) with 95% CI. Study methodological quality was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions for RCTs and Risk Of Bias In Non-randomized Studies-of Interventions for non-RCTs by 3 reviewers.

RESULTS

Nine studies with 546 participants were included in this review. Two hundred and sixty-nine participants received OEP, and 277 only had conventional exercise training. Compared to the conventional exercise training group, the NH elders in the OEP group have considerably decreased in fall risk (MD = -0.84; 95% CI = -1.17, -0.51; P < .00001) and positively increased in postural balance (MD = 5.55; 95% CI = 3.60, 7.50; P < .00001), functional mobility in short-distance (MD = -6.39; 95% CI = -8.07, -4.70; P < .00001), lower-limb muscle strength (MD = 4.32; 95% CI = 3.71, 4.93; P < .00001), and health status (risk ratio = 0.35; 95% CI = 0.18, 0.66; P = .001).

CONCLUSIONS

Current evidence suggests that OEP is practical and feasible in NH. The nursing personnel can receive sufficient support for maintaining and enhancing these elders' postural control ability, especially during the COVID-19 pandemic.

The effectiveness of mental imagery on motor, cognitive and emotional status of older people with early-stage dementia: A study protocol

Dementia involves the loss of cognitive abilities and represents a decline from the prior level of function which impairs functional abilities in day-to-day life. No previous experimental research has been done to assess mental imagery (MI) effectiveness in the motor, cognitive and emotional status of individuals with early-stage dementia. One hundred and forty older individuals with early-stage dementia from the Day Care Centre of the Alzheimer Association in Athens will take part in this study. The sample will be randomly divided into three groups: MI and physical exercise (intervention group), only physical exercise (1^st control group), and neither MI nor physical exercise (2^nd control group). Assessment will be obtained one week prior to the program, in the middle of the program (6^th week of the intervention program) and after the end of the program (13^th week of the intervention program). Participants of the intervention group will perform a 30-minute MI programme after the end of every physiotherapy session. Reliable and valid instruments will be used to assess the primary outcomes, i.e., balance and functional status as well as the secondary outcomes i.e., cognitive ability, emotional state and quality of life. The two-way Mixed ANOVA with factors 'intervention' (between groups) and 'time' (within group) will be used as a statistical analysis. Approvals of clinical trial protocol: a) UNIWA Research Committee study protocol approval: 93292 - 26/10/2021. b) ClinicalTrials.gov: ID NCT05232526.

The Effect of Exercise on Falls in People Living with Dementia: A Systematic Review

BACKGROUND

People living with dementia (PWD) are at a heightened risk for falls. However, the effects of exercise on falls in PWD are unclear.

OBJECTIVE

To conduct a systematic review of randomized controlled trials (RCTs) examining the efficacy of exercise to reduce falls, recurrent falls, and injurious falls relative to usual care among PWD.

METHODS

We included peer-reviewed RCTs evaluating any exercise mode on falls and related injuries among medically diagnosed PWD aged ≥55years (international prospective register of systematic reviews (PROSPERO) ID:CRD42021254637). We excluded studies that did not solely involve PWD and were not the primary publication examining falls. We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register and grey literature on 08/19/2020 and 04/11/2022; topical categories included dementia, exercise, RCTs, and falls. We evaluated the risk of bias (ROB) using the Cochrane ROB Tool-2 and study quality using the Consolidated Standards of Reporting Trials.

RESULTS

Twelve studies were included (n = 1,827; age = 81.3±7.0 years; female = 59.3%; Mini-Mental State Examination = 20.1±4.3 points; intervention duration = 27.8±18.5 weeks; adherence = 75.5±16.2%; attrition = 21.0±12.4%). Exercise reduced falls in two studies [Incidence Rate Ratio (IRR) range = 0.16 to 0.66; fall rate range: intervention = 1.35-3.76 falls/year, control = 3.07-12.21 falls/year]; all other studies (n = 10) reported null findings. Exercise did not reduce recurrent falls (n = 0/2) or injurious falls (n = 0/5). The RoB assessment ranged from some concerns (n = 9) to high RoB (n = 3); no studies were powered for falls. The quality of reporting was good (78.8±11.4%).

CONCLUSION

There was insufficient evidence to suggest that exercise reduces falls, recurrent falls, or injurious falls among PWD. Well-designed studies powered for falls are needed.