Poor physical fitness is independently associated with mild cognitive impairment in elderly Koreans

Community-based exercise program, self-reported health-related symptoms, and quality of life in persons with traumatic brain injury 45 + years old

BACKGROUND

Individuals with moderate to severe traumatic brain injury (msTBI) have reported a lack of motivation, lack of time, and fatigue as perceived barriers to exercise.

OBJECTIVE

To evaluate the effects of an exercise program on self-reported health-related symptoms and quality of life in persons 45-years and older with msTBI.

METHODS

Post-hoc analysis of a prospective community-based 12-week exercise program of 20 adults, age 45-80 years, with msTBI. Ten were in aerobic exercise training (AET) program and 10 in a stretching and toning (SAT) program. The AET group was instructed to exercise based on their estimated maximal heart rate (HR) for 150 minutes weekly. The SAT group was to stretch for the same target time without significantly increasing HR or level of exertion. Outcome measures were Traumatic Brain Injury Quality of Life (TBI-QOL) for global, cognitive, emotional, and social health, Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, and Pittsburgh Sleep Quality Index (PSQI) for sleep quality.

RESULTS

AET was associated with improved self-reported cognitive health and sleep compared to SAT. Moderate to large, positive effect sizes were also observed in the AET group in the QOL categories of global, emotional, and social health, and depressive symptoms.

CONCLUSIONS

This study offers preliminary evidence that AET may improve health-related QOL, especially for cognition and sleep, in middle-aged and older adults with msTBI.

Cognitive ability and motor performances in the elderly

Background/Aim. Aging entails a wide range of cognitive processes that are not independent of one another. It leads to changes in physical-motor characteristics and sometimes to disability. The aim of this study was to examine the association between multiple cognitive performances in elderly subjects and their physical-motor abilities. Method. The study included 98 elderly participants (60+) (16 males and 82 females). Cognitive abilities were assessed by the Montreal Cognitive Assessment (MoCA)/Serbian version, and physical measures were assessed by the Senior Fitness Test with its five subtests, supplemented by the Walking Speed Test. Results. Several MoCA items demonstrated relatively low variability, i.e., they proved to be too easy for most of the participants. The participants exhibited the lowest performance on the memory relating to other domains, followed by executive functions, visuospatial skills, attention, concentration, and working memory domains, with the highest performance on temporal and spatial orientation relating to other domains. Executive functions and language correlated most significantly with physical strength. Agility and dynamic balance, lower- and upper-body strength, and aerobic endurance correlated moderately and positively. Conclusion. This study underlines the positive correlation between physical fitness and cognitive level in the elderly and emphasizes the importance of physical fitness for cognitive functions, especially those of executive type in elderly subjects. Clinicians should consider the association between cognitive function and physical-motor performances when dealing with functioning improvement in the elderly. The importance of designing the most efficient exercise pro-grams to achieve maximal somatic and cognitive effects is emphasized.

Self-Efficacy, Exercise Anticipation and Physical Activity in Elderly: Using Bayesian Networks to Elucidate Complex Relationships

AIM

To explore the correlation of exercise anticipation, self-efficacy and lower limb function in the elderly, and identify active predictors of exercise. The time up and go (TUG) has been used to access basic mobility skills, as well as strength, balance and agility, which is used in a range of population.

METHODS

A cross-sectional survey approach was employed in this study, assessing the functional relationship of the level of exercise anticipation, modified gait efficacy scale (mGES), self-efficacy for exercise scale (SEE), perceived efficacy of patient-physician interactions (PEPPI-10), behavioral regulation in exercise questionnaire (BREQ), and the time up and go (TUG) and International Physical Activity Questionnaire (IPAQ). Consequently, we constructed the Bayesian network model utilizing Genie 2.3, in order to effectively determine clear negative and positive correlations.

RESULTS

This investigation incorporated a total of 285 patients. The results of Spearman's correlation analysis indicated that the TUG effectively correlated with age (r = 0.158, P < 0.01), drinking (r=-0.362, P < 0.01), mGES (r=-0.254, P < 0.01), PEPPI (r=-0.329, P < 0.01), SEE (r =-0.408, P < 0.01), BREQ (r = 0.676, P < 0.01), EA (r =-0.688, P < 0.01) and IPAQ (r =-0.742, P < 0.01). TUG can be used as the direct influencing factor of IPA, and five nodes in the model can be considered the primary indirect influencing factors of TUG, such as drinking, EA, age, sex and mGES in Bayesian network. The sensitivity analysis of the model confirmed that TUG (0.059), drinking (0.087), EA (0.335), age (0.080), sex (0.164), mGES (0.028) and hypertension (0.030) can become the sensitivity evaluation indicators of IPAQ in the elderly community population, in which the area under the ROC curve (AUC) was 59.6% (2207/3705), indicating a suitable prediction performance.

CONCLUSION

Exercise anticipation and life behavior habit can effectively predict physical activity capability in the elderly. These findings can help clinicians establish effective intervention to improve the physical activity regularly of the elderly.

Functional objective parameters which may discriminate patients with mild cognitive impairment from cognitively healthy individuals: a systematic review and meta-analysis using an instrumented kinematic assessment

BACKGROUND

a systematic review in 2015 showed kinematic gait and balance parameters which can discriminate patients with mild cognitive impairment (MCI) from cognitively healthy individuals.

OBJECTIVE

this systematic review and meta-analysis aims to summarise and synthesise the evidence published after the previous review about the functional objective parameters obtained by an instrumented kinematic assessment which could discriminate patients with MCI from cognitively healthy individuals, as well as to assess the level of evidence per outcome.

METHODS

major electronic databases were searched from inception to August 2019 for cross-sectional studies published after 2015 examining kinematic gait and balance parameters, which may discriminate patients with MCI from cognitively healthy individuals. Meta-analysis was carried out for each parameter reported in two or more studies.

RESULTS

Ten cross-sectional studies with a total of 1,405 patients with MCI and 2,277 cognitively healthy individuals were included. Eight of the included studies reported a low risk of bias. Patients with MCI showed a slower gait speed than cognitively healthy individuals. Thus, single-task gait speed (d = -0.44, 95%CI [-0.60 to -0.28]; P < 0.001), gait speed at fast pace (d = -0.48, 95%CI [-0.72 to -0.24]; P < 0.001) and arithmetic dual-task gait speed (d = -1.20, 95%CI [-2.12 to -0.28]; P = 0.01) were the functional objective parameters which best discriminated both groups.

CONCLUSION

the present review shows kinematic gait parameters which may discriminate patients with MCI from cognitively healthy individuals. Most of the included studies reported a low risk of bias, but the grading of recommendations assessment, development and evaluation criteria showed a low level of evidence per outcome.

Relationship Between Physical Performance and Mild Cognitive Impairment in Chinese Community-Dwelling Older Adults

Objective

This study aimed to examine the relationship between physical performance and mild cognitive impairment (MCI) in Chinese older adults.

Methods

The sample comprised 956 relatively healthy and aged ≥65 years old Chinese community-dwelling participants (mean age, 72.56 ± 5.43 years; 56.8% female), which did not include those with dementia, severe cognitive impairment, mental illness etc. The Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were used for the initial classification of patients with MCI. Physical performance was measured via hand grip, Timed Up and Go Test (TUGT), and 4-m walking speed.

Results

The physical performance (grip strength, TUGT, and 4-m walking speed) correlated with MCI. The grip strength [odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.93–0.99] and 4-m walking speed (OR = 0.25, 95% CI = 0.10–0.64) correlated negatively with MCI, while TUGT (OR = 1.08, 95% CI = 1.03–1.13) and MCI correlated positively.

Conclusion

The physical performance (grip strength, TUGT, and 4-m walking speed) correlated with MCI. Further analysis showed that the grip strength was associated with overall cognition, time orientation, recall, and language, while TUGT and 4-m walking speed were associated with overall cognition and various cognitive domains, except recall.

The Relationship on Exercise Anticipation, Function and Self-efficacy in Patients After Knee Surgeries Over Six Months: An Observational Study

AIM

To explore the association between the exercise anticipation, function and self-efficacy in patients after knee surgeries over six months and to identify the predictors for rehabilitation.

METHODS

This observational study used the cross-sectional survey method and was divided into two stages: (1) designing the experimental video materials and answer cards about exercise anticipation, and (2) analyzing the correlation of the level of exercise anticipation, knee function, modified gait efficacy scale (mGES), self-efficacy for rehabilitation outcome scale (SER), self-efficacy for exercise scale (SEE), time up and go task (TUG) and knee joint angle in walking. We used IBM SPSS modeler 18.0 software for establishing the Bayesian network data mining model, which can identify strong positive and negative associations.

RESULTS

A total of 110 patients were included in this study. Our research confirmed that the exercise anticipation score exhibited the significant correlation with SER (r=0.552, P<0.01), SEE (r=0.457, P<0.01), TUG (r=-0.419, P<0.01) and knee joint angle in walking (r=-0.342, P<0.01). There is only one parent node of exercise expectation, that is, rehabilitation self-efficacy, which shows that the rehabilitation self-efficacy of patients after knee surgery is directly related to their ability to judge exercise expectation. Meanwhile this study verified the model results, and the area under the ROC curve (AUC) is 0.572 (755/1320), indicating that the prediction performance is acceptable.

CONCLUSION

This preliminary study confirmed that improving the exercise anticipation and rehabilitation self-efficacy is an important method of enhancing the knee function in patients after knee surgeries over six months. In the future, the long-term effect of the exercise anticipation and self-efficacy should be researched.

Functional parameters indicative of mild cognitive impairment: a systematic review using instrumented kinematic assessment

BACKGROUND

Patients with mild cognitive impairment (MCI) experience alterations of functional parameters, such as an impaired balance or gait. The current systematic review set out to investigate whether functional objective performance may predict a future risk of MCI; to compare functional objective parameters in patients with MCI and a control group; and to assess changes in these parameters after different physical activity interventions.

METHODS

Electronic databases, including PubMed, AMED, CINAHL, EMBASE, PEDro and Web of Science as well as grey literature databases, were searched from inception to February 2020. Cohort studies and Randomized Controlled Trials (RCTs) were included. The risk of bias of the included studies was assessed independently by reviewers using quality assessment checklists. The level of evidence per outcome was assessed using the GRADE criteria.

RESULTS

Seventeen studies met inclusion criteria including patients with MCI. Results from RCTs suggested that gait speed, gait variability and balance may be improved by different physical activity interventions. Cohort studies showed that slower gait speed, above all, under Dual Task (DT) conditions, was the main impaired parameter in patients with MCI in comparison with a Control Gorup. Furthermore, cohort studies suggested that gait variability could predict an incident MCI. Although most of included cohort studies reported low risk of bias, RCTs showed an unclear risk of bias.

CONCLUSIONS

Studies suggest that gait variability may predict an incident MCI. Moreover, different gait parameters, above all under DT conditions, could be impaired in patients with MCI. These parameters could be improved by some physical activity interventions. Although cohort studies reported low risk of bias, RCTs showed an unclear risk of bias and GRADE criteria showed a low level of evidence per outcome, so further studies are required to refute our findings.

PROSPERO

CRD42019119180.

Design and Validation of Rule-Based Expert System by Using Kinect V2 for Real-Time Athlete Support

In sports and rehabilitation processes where isotonic movements such as bodybuilding are performed, it is vital for individuals to be able to correct the wrong movements instantly by monitoring the trainings simultaneously, and to be able to train healthily and away from the risks of injury. For this purpose, we designed a new real-time athlete support system using Kinect V2 and Expert System. Lateral raise (LR) and dumbbell shoulder press (DSP) movements were selected as examples to be modeled in the system. Kinect V2 was used to obtain angle and distance changes in the shoulder, elbow, wrist, hip, knee, and ankle during movements in these movement models designed. For the rule base of Expert System developed according to these models, a 28-state rule table was designed, and 12 main rules were determined that could be used for both actions. In the sample trainings, it was observed that the decisions made by the system had 89% accuracy in DSP training and 82% accuracy in LR training. In addition, the developed system has been tested by 10 participants (25.8 ± 5.47 years; 74.69 ± 14.81 kg; 173.5 ± 9.52 cm) in DSP and LR training for four weeks. At the end of this period and according to the results of paired t-test analysis (p < 0.05) starting from the first week, it was observed that the participants trained more accurately and that they enhanced their motions by 58.08 ± 11.32% in LR training and 54.84 ± 12.72% in DSP training.

Associations between the dopamine D4 receptor gene polymorphisms and personality traits in elite athletes

Personality traits and temperament may affect sports performance. Previous studies suggest that dopamine may play an important role in behavior regulation and physical exercise performance. The aim of this study is to determine associations between dopamine D4 receptor gene (DRD4 Ex3) polymorphisms and personality traits (such as neuroticism, extraversion, openness, agreeability and conscientiousness) in elite combat athletes. A total of 302 physically active, unrelated, self-reported Caucasian participants were recruited for this study. The participants consisted of 200 elite male combat athletes and 102 healthy male participants (control group). For personality trait measurements, the NEO Five-Factor Personality Inventory (NEO-FFI) and the State-Trait Anxiety Inventory questionnaires were used. For the genetic assays, blood was collected and all samples were genotyped using the real-time PCR method. A 2 x 3 factorial ANOVA revealed statistically significant differences on the Openness NEO Five Factor Inventory scale for both examined factors, i.e. sport status and genetics DTD4 Ex3. Combat athletes achieved higher scores on the Conscientiousness NEO-FFI scale when compared to controls (7.18 vs 5.98). On the other hand, combat athletes scored lower on the Openness scale in comparison with control group (4.42 vs. 4.63). Subjects with the DRD4 Ex3 s/s genotype had lower results on the openness scale in comparison with participants with the DRD4 Ex3 s/1 genotype (4.01 vs. 4.57) and higher DRD4 Ex3 1/1 genotype (4,01 vs. 3,50). In conclusion, we found an association between the dopamine D4 receptor gene in variable number tandem repeat (VNTR) polymorphisms and athletic status for two NEO-FFI factors: Openness and Conscientiousness. The DRD4 exon 3 polymorphism may be associated with the selected personality traits in combat athletes, thereby modulating athletes’ predisposition to participate in high risk sports.

Relationships between socio-clinico-demographic factors and global cognitive function in the oldest old living in the Tokyo Metropolitan area: Reanalysis of the Tokyo Oldest Old Survey on Total Health (TOOTH)

BACKGROUND

Despite a steady increase in life expectancy, a few studies have investigated cross-sectional correlates and longitudinal predictors of cognitive function, a core domain of the successful aging, among socio-clinico-demographic factors in the oldest-old exclusively.

OBJECTIVES

The aims of this study were to examine socio-clinico-demographic characteristics associated with global cognition and its changes in the oldest-old.

METHODS

We reanalyzed a dataset of cognitively preserved community-dwelling subjects aged 85 years and older in the Tokyo Oldest Old Survey on Total Health, a 6-year longitudinal observational study. This study consisted of (1) baseline cross-sectional analyses examining correlates of global cognition (n = 248) among socio-clinico-demographic factors and (2) longitudinal analyses examining baseline predictors for changes of global cognition in 3-year follow-up (n = 195). The Mini-Mental State Examination was used as a screening test to assess global cognition.

RESULTS

At baseline, higher weights were related to higher cognitive function in the oldest-old. The baseline predictors of global cognitive decline in 3-year follow-up were higher global cognition, shorter education period, and lower sociocultural activities and lower instrumental activity of daily living, in this order.

CONCLUSIONS

The present study suggests that it is crucial to attain higher education during early life and avoid leanness or obesity, participate in sociocultural cognitive activities during late life, and maintain instrumental activity of daily living to preserve optimal cognitive function in the oldest-old, which will facilitate developing prevention strategies for cognitive decline and promoting successful aging in this increasing population.

Relationships between functional fitness and cognitive impairment in Chinese community-dwelling older adults: a cross-sectional study

OBJECTIVE

The aim of this study was to investigate the associations between each functional fitness (FF) domain and cognitive impairment (CI) in Chinese community-dwelling older adults.

DESIGN

A community-based, cross-sectional study was conducted.

SETTING

Participants were selected by multistage stratified random sampling in Wuhan City, Hubei Province, Central China, during December 2015-May 2016.

PARTICIPANTS

A total of 2096 (1031 male and 1065 female) adults older than 65 years were included in our study. Exclusion criteria were age <65 years, losing self-living ability, previously diagnosed with dementia by a neurological physician, severe physical pain, congestive heart failure, dizziness and uncontrolled hypertension (exceeding 160/100 mm Hg).

PRIMARY AND SECONDARY OUTCOME MEASURES

The Senior Fitness Test and the Mini-Mental State Examination were used to measure FF (including 30 s chair stand, 30 s arm curl, 2 min step, 8 foot up-and-go, chair sit-and-reach and back scratch) and screen CI, respectively. Activities of daily living and instrumental activities of daily living questionnaires were administered to evaluate functional status (FS).

RESULTS

32.16% were classified as the CI group. The results showed that the CI group had significantly lower frequency of 30 s chair stand, 30 s arm curl and 2 min step, and longer time to complete the 8 foot up-and-go, shorter chair sit-and-reach and back scratch distance than the non-CI adults (p<0.05). Except for back scratch, older adults with moderate and high levels of FF were less likely to have CI than those with low levels, adjusted by sociodemographics, chronic disease, health condition, health behaviour and FS (p<0.05).

CONCLUSIONS

The relationship between FF and CI was independent of FS decline in Chinese community-dwelling older people.

Sex differentials in relationships between functional fitness and cognitive performance in older adults: a canonical correlation analysis

This study aimed to explore the sex differentials in correlations between functional fitness (FF) and cognitive impairment (CI) in older adults without dementia. A community-based cross-sectional study was conducted using 2096 adults more than 65 years of age. The Senior Fitness test and Mini-mental State Examination (MMSE) were used to measure FF and cognitive performance. Canonical correlation analysis (CCA) was performed to evaluate the relationships between FF and MMSE. Our results confirmed the relationships between FF and CI, furthermore FF and MMSE were significantly different between men and women (P < 0.05). CCA results showed overall FF was positively correlated with overall MMSE in both men (canonical coefficient = 0.37, P < 0.0001) and women (first canonical coefficient = 0.42, P < 0.0001; second canonical coefficient = 0.17, P = 0.004). Among men, 30s-arm curl and language were most highly correlated with FF and MMSE, respectively. Whereas among women, 30s-arm curl and eight-foot up-and-go were most highly correlated with FF, and orientation and recall were most highly correlated with MMSE. In conclusion, there was a sex difference in the relationships between FF and MMSE, which facilitated generating insight into cognitive performance improvement from the perspective of FF enhancement by sex. Prospective studies are needed to explore the causality between FF and cognitive performance.

Cardiorespiratory Fitness and White Matter Neuronal Fiber Integrity in Mild Cognitive Impairment

BACKGROUND

Mounting evidence showed the self-reported levels of physical activity are positively associated with white matter (WM) integrity and cognitive performance in normal adults and patients with mild cognitive impairment (MCI). However, the objective measure of cardiorespiratory fitness (CRF) was not used in these studies.

OBJECTIVE

To determine the associations of CRF measured by maximal oxygen uptake (VO2max) with WM fiber integrity and neurocognitive performance in older adults with MCI.

METHODS

Eighty-one participants (age = 65±7 years, 43 women), including 26 cognitively normal older adults and 55 amnestic MCI patients, underwent VO2max test to measure CRF, diffusion tensor imaging (DTI) to assess WM fiber integrity, and neurocognitive assessment focused on memory and executive function. DTI data were analyzed by the tract-based spatial statistics and region-of-interest approach.

RESULTS

Cognitively normal older adults and MCI patients were not different in global WM fiber integrity and VO2max. VO2max was associated positively with DTI metrics of fractional anisotropy in ∼54% WM fiber tracts, and negatively with mean and radial diffusivities in ∼46% and ∼56% of the WM fiber tracts. The associations of VO2max with DTI metrics remained statistically significant after adjustment of age, sex, body mass index, WM lesion burden, and MCI status. The DTI metrics obtained from the area that correlated to VO2max were associated with executive function performance in MCI patients.

CONCLUSIONS

Higher levels of CRF are associated with better WM fiber integrity, which in turn is correlated with better executive function performance in MCI patients.

'Timed Up and Go' test: Age, gender and cognitive impairment stratified normative values of older adults

Aims

The aim of this study was to establish ‘Timed up and Go’ test (TUG) normative data among community dwelling older adults stratified based on cognitive status, gender and age groups.

Methods

A total of 2084 community dwelling older adults from wave I and II were recruited through a multistage random sampling method. TUG was performed using the standard protocol and scores were then stratified based on with and without mild cognitive impairment (MCI), gender and in a 5-year age groups ranging from ages of 60’s to 80’s.

Results

529(16%) participants were identified to have MCI. Past history of falls and medical history of hypertension, heart disease, joint pain, hearing and vision problem, and urinary incontinence were found to have influenced TUG performance. Cognitive status as a mediator, predicted TUG performance even when both gender and age were controlled for (B 0.24, 95% CI (0.02–0.47), β 0.03, t 2.10, p = 0.36). Further descriptive analysis showed, participants with MCI, women and older in age took a longer time to complete TUG, as compared to men with MCI across all age groups with exceptions for some age groups.

Conclusion

These results suggested that MCI needs to be taken into consideration when testing older adults using TUG, besides age and gender factors. Data using fast speed TUG may be required among older adults with and without MCI for further understanding.

Blood pressure, heart rate and perceived enjoyment after small-sided soccer games and repeated sprint in untrained healthy adolescents

The purpose of this study was to examine systolic (SBP) and diastolic blood pressure (DBP), heart rate (HR), rating of perceived exertion (RPE) and perceived enjoyment responses to a repeated-sprint training session (RST) compared to a small-sided soccer game session (SSG) in untrained adolescents. Twelve healthy post-pubertal adolescent males (age 15.8±0.6 years, body mass 59.1±3.7 kg, height 1.7±0.1m) performed RST and SSG sessions in a randomized and counterbalanced order. Blood pressure and HR were measured at rest and at 10, 20 and 30 minutes after interventions, and RPE and enjoyment were assessed. RST and SSG elicited similar exercise HR (74.0% vs. 73.7% of HR peak during RST and SSG respectively, P>0.05). There was no significant change in SBP or DBP after the 2 interventions (all P>0.05, ES<0.5) with a trend to a decrease in SBP after SSG at 30 min after intervention (moderate effect, ES=0.6). Pearson’s correlation analysis revealed a significant and large correlation between baseline BP values and magnitude of decline after both RST and SSG. Heart rate during recovery was higher compared with baseline at all times after both sessions (all P<0.05), with HR values significantly lower after SSG versus RST at 30 min after interventions (82.3±3.2 versus 92.4±3.2 beats/min, respectively, P=0.04). RPE was significantly lower (P=0.02, ES=1.1) after SSG than after RST, without significant differences in enjoyment. In conclusion, repeated sprint and small-sided games elicited similar exercise intensity without a significant difference in perceived enjoyment. Post-exercise hypotension after the two forms of training may depend on resting BP of subjects.