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Al-Bakry D, Athaide CE, Pathmarajan R, Kuhn T, Middleton LE, Au JS. Short-term vascular responses to spring and fall daylight savings time shifts. Am J Physiol Heart Circ Physiol 2024; 326:H1138-H1145. [PMID: 38426867 DOI: 10.1152/ajpheart.00034.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
Daylight saving time (DST) is a Western biannual time transition, setting the clock back 1 h in the fall and forward 1 h in the spring. There is an epidemiological link between DST and acute myocardial infarction risk in the first week following the spring shift; however, the mechanisms underlying the effect of DST on cardiovascular function remain unclear. The purpose of this study was to explore the short-term cardiovascular changes induced by fall and spring shifts in DST in a convenience sample of healthy adults. We hypothesized that spring, but not fall, DST shifts would acutely increase central pulse wave velocity, the gold standard measurement of central arterial stiffness. Twenty-one individuals (fall: n = 10; spring: n = 11) participated in four visits, occurring 1 wk before and at +1, +3, and +5 days after spring and fall time transitions. Central, brachial, and radial pulse wave velocity as well as carotid augmentation index were assessed with applanation tonometry. Sleep quality and memory function were assessed via questionnaire and the Mnemonic Similarities Task, respectively. Neither fall or spring transition resulted in changes to cardiovascular variables (carotid-femoral pulse wave velocity, carotid-brachial pulse wave velocity, carotid-radial pulse wave velocity, heart rate, mean arterial pressure, or augmentation index), sleep quality, or cognitive function (all P > 0.05). Our findings do not provide evidence that DST shifts influence cardiovascular outcomes in healthy adults. This study emphasizes the need for further research to determine the mechanisms of increased cardiovascular disease risk with DST that help explain epidemiological trends.NEW & NOTEWORTHY The debate of whether to abolish daylight savings time (DST) is, in part, motivated by the population-level increase in all-cause mortality and incidence of cardiovascular events following DST; however, there is an absence of data to support a physiological basis for risk. We found no changes in pulse wave velocity or augmentation index during the subacute window of DST. Large multisite trials are necessary to address the small, but meaningful, effects brought on by a societal event.
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Affiliation(s)
- Dara Al-Bakry
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Chloe E Athaide
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Rishiga Pathmarajan
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Tara Kuhn
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
| | - Jason S Au
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
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Rosenau C, Köhler S, Soons LM, Anstey KJ, Brayne C, Brodaty H, Engedal K, Farina FR, Ganguli M, Livingston G, Lyketsos CG, Mangialasche F, Middleton LE, Rikkert MGMO, Peters R, Sachdev PS, Scarmeas N, Salbæk G, van Boxtel MPJ, Deckers K. Umbrella review and Delphi study on modifiable factors for dementia risk reduction. Alzheimers Dement 2024; 20:2223-2239. [PMID: 38159267 PMCID: PMC10984497 DOI: 10.1002/alz.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 01/03/2024]
Abstract
A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. HIGHLIGHTS: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.
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Affiliation(s)
- Colin Rosenau
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Sebastian Köhler
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Lion M. Soons
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kaarin J. Anstey
- School of PsychologyUniversity of New South WalesKensingtonNew South WalesAustralia
- Neuroscience Research Australia (NeuRA)SydneyNew South WalesAustralia
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
| | - Carol Brayne
- Cambridge Public HealthUniversity of CambridgeCambridgeUK
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Knut Engedal
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
| | - Francesca R. Farina
- Feinberg School of MedicineDepartment of Medical Social SciencesNorthwestern UniversityChicagoIllinoisUSA
| | - Mary Ganguli
- Departments of PsychiatryNeurologyand EpidemiologySchool of Medicine and School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | | | - Constantine G. Lyketsos
- Richman Family Precision Medicine Center of Excellence in Alzheimer's DiseaseJohns Hopkins BayviewJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Francesca Mangialasche
- Division of Clinical GeriatricsDepartment of NeurobiologyCare Sciences and SocietyCenter for Alzheimer ResearchKarolinska InstitutetStockholmSweden
- Theme Inflammation and AgingMedical Unit AgingKarolinska University HospitalStockholmSweden
| | - Laura E. Middleton
- Department of Kinesiology and Health SciencesUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐UW Research Institute for AgingWaterlooOntarioCanada
| | - Marcel G. M. Olde Rikkert
- Department of Geriatric MedicineRadboud University Medical CenterNijmegenthe Netherlands
- Radboudumc Alzheimer CenterDonders Center of Medical NeurosciencesNijmegenthe Netherlands
| | - Ruth Peters
- UNSW Ageing Futures InstituteKensingtonNew South WalesAustralia
- The George Institute for Global HealthNewtownNew South WalesAustralia
- School of Biomedical SciencesUniversity of New South WalesKensingtonNew South WalesAustralia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA)Discipline of Psychiatry and Mental HealthSchool of Clinical MedicineUniversity of New South WalesSydneyNew South WalesAustralia
| | - Nikolaos Scarmeas
- 1st Department of NeurologyAiginition HospitalNational and Kapodistrian University of Athens Medical SchoolAthensGreece
- Department of NeurologyColumbia UniversityNew YorkNew YorkUSA
| | - Geir Salbæk
- Norwegian National Centre for Ageing and HealthVestfold Hospital TrustTønsbergNorway
- Department of Geriatric MedicineOslo University HospitalOsloNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Martin P. J. van Boxtel
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
| | - Kay Deckers
- Alzheimer Centrum LimburgDepartment of Psychiatry and NeuropsychologySchool for Mental Health and Neuroscience (MHeNs)Maastricht UniversityMaastrichtthe Netherlands
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Ripley S, Alizadehsaravi N, Affoo R, Hunter S, Middleton LE, Moody E, Weeks LE, McArthur C. Resident-, family-, and staff-identified goals for rehabilitation of long-term care residents with dementia: a qualitative study. BMC Geriatr 2024; 24:108. [PMID: 38287257 PMCID: PMC10825995 DOI: 10.1186/s12877-024-04674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Long-term care (LTC) residents with dementia can benefit from rehabilitation to improve function and quality of life. However, specific goals for rehabilitation with this population are not always clear. The purpose of this study was to describe the goals for rehabilitation for LTC residents with dementia from the perspective of residents, family, and staff. METHODS This was a phenomenological qualitative study. LTC residents with moderate to severe dementia, family members, and staff were recruited from two LTC homes in Halifax, Nova Scotia. Data were collected through semi-structured interviews and field notes from observations with residents while they were being active within the home. Data were analyzed via the principles of thematic content analysis, mapped onto the International Classification of Functioning, Disability, and Health (ICF) Model, and reported by the participant group (i.e., residents, family, or staff). RESULTS The 15 participants were three female residents aged 82 to 98 years, seven predominantly (86%) female family members aged 56 to 74 years, and five staff members (two females, three males, aged 22 to 55 years) who were physiotherapists, a physiotherapy assistant, a healthcare aide, and a registered licenced practical nurse. Most identified goals fell within the activities and participation constructs of the ICF model and focused on maintaining or improving function, mobility, and quality of life. Specific themes included preventing falls, walking or locomoting, stair climbing, maintaining activities of daily living, engaging in enjoyable exercise, maintaining independence and human connections, keeping busy, leaving the home for activities, and participating in group activities. CONCLUSIONS Rehabilitation goals for LTC residents living with dementia often focus on quality of life and functional activities and participation in LTC and family activities and events. Function and quality of life are interrelated, whereby functional goals influence quality of life. While some goals focus on improvement in function, maintenance or prevention of decline were also key elements. Future work should ensure rehabilitation interventions are developed relative to individually identified goals, and interventional success is measured in relation to the goal.
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Affiliation(s)
- Sara Ripley
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | | | - Rebecca Affoo
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Susan Hunter
- Western University, 1151 Richmond Street, N6A 3K7, London, ON, Canada
| | - Laura E Middleton
- University of Waterloo, 200 University Avenue West, N2L 3G1, Waterloo Ontario, Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Drive, N2J 0E2, Waterloo, ON, Canada
| | - Elaine Moody
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
- Centre of Excellence, Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI, Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Lori E Weeks
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
- Centre of Excellence, Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI, Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Caitlin McArthur
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada.
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Mehrabi S, Drisdelle S, Dutt HR, Middleton LE. "If I want to be able to keep going, I must be active." Exploring older adults' perspectives of remote physical activity supports: a mixed-methods study. Front Public Health 2024; 12:1328492. [PMID: 38327585 PMCID: PMC10847274 DOI: 10.3389/fpubh.2024.1328492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/02/2024] [Indexed: 02/09/2024] Open
Abstract
Introduction Pandemic-related public health restrictions limited older adults' physical activity programs and opportunities. Physical activity supports shifted to remote options, however, information on their adoption and effectiveness is limited. This study aims to describe the remote supports received by older adults and their perceived effectiveness. Additionally, it aims to describe facilitators and barriers to remote supports for physical activity among older adults, particularly those reliant on technology. Methods This study used an explanatory, sequential, mixed-methods design. Community-dwelling older adults (≥ 60 years) were recruited to partake in a web-based survey and an optional semi-structured follow-up interview informed by the COM-B model. Participant characteristics, perceived effectiveness of remote supports, and the presence and severity of barriers were described. Changes in physical activity levels before and during the pandemic were analyzed using the Wilcoxon signed-rank test. Qualitative data underwent inductive thematic analysis. Results Fifty seven older adults (68.3 ± 7.1 years, 43 Female) completed the survey, of which 15 participants (67.4 ± 5.8 years, 12 Female) participated in interviews. The majority were Caucasian, highly educated, and resided in Canada. Total physical activity levels showed no statistically significant change from before to during the pandemic (p = 0.74); however, at-home exercise participation and technology usage increased. Pre-recorded and real-time virtual exercise supports were perceived as most effective. Main barriers included limited contact with exercise professionals, limited access to exercise equipment or space, and decreased mental wellness. Thematic analysis identified five main themes: (i) Enabled by knowledge and resources; (ii) Diverse motivations for physical activity; (iii) Fostering participation through social connection; (iv) Supervision and safety: enabling adherence; and (v) Virtual exercise: a sustainable option with technological considerations. Conclusion Virtual platforms show promise in supporting older adults' physical activity at home, especially for those with limited in-person access. Our study suggests that both real-time and pre-recorded virtual exercise supports are feasible, depending on technological capacity and support. While interactive real-time virtual programs allow interaction with professionals and peers, pre-recorded programs provide timing flexibility. Further research is needed to establish best practices for safe and effective virtual exercise programming, promoting its long-term adoption for supporting a wider range of older adults.
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Affiliation(s)
- Samira Mehrabi
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sara Drisdelle
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Hanna R Dutt
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
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Middleton LE, Pelletier C, Koch M, Norman R, Dupuis S, Astell A, Giangregorio L, Freeman S. Dementia-Inclusive Choices for Exercise Toolkit: Impact on the Knowledge, Perspectives, and Practices of Exercise Providers. J Aging Phys Act 2024:1-10. [PMID: 38262407 DOI: 10.1123/japa.2022-0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/23/2023] [Accepted: 11/14/2023] [Indexed: 01/25/2024]
Abstract
Physical activity improves the well-being of persons living with dementia but few exercise programs include them. The Dementia-Inclusive Choices for Exercise (DICE) toolkit aims to improve exercise providers' understanding of dementia and ability to support persons living with dementia in physical activity. We evaluated the co-designed DICE toolkit with exercise providers using a mixed-methods approach comprising pre/post questionnaires and interviews and reflection diaries. Among 16 participants, self-efficacy for exercise delivery to persons living with dementia and both knowledge and attitudes toward dementia significantly improved. Thematic analysis suggested participants (a) had a deeper understanding of the variability of dementia, (b) were planning for equitable access for persons living with dementia, (c) planned to promote social connection through exercise, and (d) were optimistic for future engagement with persons living with dementia. The DICE toolkit may improve exercise providers' knowledge and confidence to plan proactively to support persons living with dementia in programs and services.
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Affiliation(s)
- Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo,ON, Canada
| | - Chelsea Pelletier
- School of Health Sciences, University of Northern British Columbia, Prince George, BC, Canada
| | - Melissa Koch
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Rebekah Norman
- Recreation and Leisure Studies, University of Waterloo, Waterloo, ON, Canada
| | - Sherry Dupuis
- Schlegel-UW Research Institute for Aging, Waterloo,ON, Canada
- Recreation and Leisure Studies, University of Waterloo, Waterloo, ON, Canada
| | - Arlene Astell
- Department of Psychiatry, University of Toronto, Toronto, ON, USA
| | - Lora Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo,ON, Canada
| | - Shannon Freeman
- Department of Nursing, University of Northern British Columbia, Prince George, BC, Canada
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Basharat A, Mehrabi S, Muñoz JE, Middleton LE, Cao S, Boger J, Barnett-Cowan M. Virtual reality as a tool to explore multisensory processing before and after engagement in physical activity. Front Aging Neurosci 2023; 15:1207651. [PMID: 38020766 PMCID: PMC10652573 DOI: 10.3389/fnagi.2023.1207651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction This pilot study employed a non-randomized control trial design to explore the impact of physical activity within a virtual reality (VR) environment on multisensory processing among community-dwelling older adults. Methods The investigation compared both chronic (over 6 weeks) and acute effects of VR-based physical activity to a reading control group. The evaluation metrics for multisensory processing included audiovisual response time (RT), simultaneity judgments (SJ), sound-induced flash illusion (SIFI), and temporal order judgments (TOJ). A total of 13 older adults were provided with VR headsets featuring custom-designed games, while another 14 older adults were assigned to a reading-based control group. Results Results indicated that acute engagement in physical activity led to higher accuracy in the SIFI task (experimental group: 85.6%; control group: 78.2%; p = 0.037). Additionally, both chronic and acute physical activity resulted in quicker response times (chronic: experimental group = 336.92; control group = 381.31; p = 0.012; acute: experimental group = 333.38; control group = 383.09; p = 0.006). Although the reading group showed a non-significant trend for greater improvement in mean RT, covariate analyses revealed that this discrepancy was due to the older age of the reading group. Discussion The findings suggest that immersive VR has potential utility for enhancing multisensory processing in older adults. However, future studies must rigorously control for participant variables like age and sex to ensure more accurate comparisons between experimental and control conditions.
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Affiliation(s)
- Aysha Basharat
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Samira Mehrabi
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - John E. Muñoz
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | | | - Shi Cao
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, Waterloo, ON, Canada
| | | | - Michael Barnett-Cowan
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
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Middleton LE, Pelletier CA, Koch M, Norman R, Dupuis S, Astell A, Giangregorio LM, Hart F, Heibein W, Hughes C, Johannesson C, Pearce B, Regan K, Rossignoli C, Andrew M, Pettersen JA, Freeman S. The dementia-inclusive choices in exercise project: Using participatory action research to improve physical activity supports for persons with dementia. Dementia (London) 2023; 22:1651-1676. [PMID: 37715689 DOI: 10.1177/14713012231197144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Persons with dementia have the right to equal inclusion in rehabilitation, including physical activity. However, the perspectives of persons with dementia are rarely integrated into decision-making related to physical activity programming, services, and supports. Here, we describe the participatory action research (PAR) approach used to develop the Dementia-Inclusive Choices for Exercise (DICE) toolkit, which aims to increase the quality and number of physical activity opportunities available to persons with dementia. The DICE Research Team included persons with dementia, a family care partner, exercise professionals, community and dementia service providers, health care professionals, and researchers who worked to: 1) Engage/maintain the Research Team; 2) Set/navigate ways of engagement; 3) Understand barriers to physical activity; 4) Prioritize the audience and actions; 5) Develop the toolkit; 6) Conduct usability testing; and 7) Implement and evaluate. Guided by the Behaviour Change Wheel, and informed by interviews, focus groups, and existing research, our PAR Team chose to prioritize training exercise providers; exercise providers can enable exercise for persons with dementia if they understand common changes with dementia and how to support persons with dementia in exercise. The content and format of the toolkit was co-developed: drafted by our Research Team, adapted through a stakeholder workshop, and refined through iterative development and usability testing. The product of our PAR process, the DICE toolkit, includes videos meant to destigmatize dementia, training modules and a training manual for exercise providers, a physical activity handout for persons with dementia, and wallet cards to help persons with dementia communicate their abilities, needs, and preferences. Our usability study indicated that the toolkit could be used by exercise providers and may improve attitudes about dementia. Our vision is that our co-developed DICE toolkit will empower exercise providers to improve physical activity opportunities and support for persons with dementia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Kayla Regan
- University of Waterloo, Waterloo, ON, Canada
| | | | | | | | - Shannon Freeman
- University of Northern British Columbia, Prince George, BC, Canada
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Adjetey C, Davis JC, Falck RS, Best JR, Dao E, Bennett K, Tai D, McGuire K, Eng JJ, Hsiung GYR, Middleton LE, Hall PA, Hu M, Sakakibara BM, Liu-Ambrose T. Economic Evaluation of Exercise or Cognitive and Social Enrichment Activities for Improved Cognition After Stroke. JAMA Netw Open 2023; 6:e2345687. [PMID: 38032638 PMCID: PMC10690466 DOI: 10.1001/jamanetworkopen.2023.45687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Cognitive impairment is prevalent in survivors of stroke, affecting approximately 30% of individuals. Physical exercise and cognitive and social enrichment activities can enhance cognitive function in patients with chronic stroke, but their cost-effectiveness compared with a balance and tone program is uncertain. Objective To conduct a cost-effectiveness and cost-utility analysis of multicomponent exercise or cognitive and social enrichment activities compared with a balance and tone program. Design, Setting, and Participants This economic evaluation used a Canadian health care systems perspective and the Vitality study, a randomized clinical trial aimed at improving cognition after stroke with a 6-month intervention and a subsequent 6-month follow-up (ie, 12 months). The economic evaluation covered the duration of the Vitality trial, between June 6, 2014, and February 26, 2019. Participants were community-dwelling adults aged 55 years and older who experienced a stroke at least 12 months prior to study enrollment in the Vancouver metropolitan area, British Columbia, Canada. Data were analyzed from June 1, 2022, to March 31, 2023. Interventions Participants were randomly assigned to twice-weekly classes for 1 of the 3 groups: multicomponent exercise program, cognitive and social enrichment activities program, or a balance and tone program (control). Main Outcomes and Measures The primary measures for the economic evaluation included cost-effectiveness (incremental costs per mean change in cognitive function, evaluated using the Alzheimer Disease Assessment Scale-Cognitive-Plus), cost-utility (incremental cost per quality-adjusted life-year gained), intervention costs, and health care costs. Since cognitive benefits 6 months after intervention cessation were not observed in the primary randomized clinical trial, an economic evaluation at 12 months was not performed. Results Among 120 participants (mean [SD] age, 71 [9] years; 74 [62%] male), 34 were randomized to the multicomponent exercise program, 34 were randomized to the social and cognitive enrichment activities program, and 52 were randomized to the balance and tone control program. At the end of the 6-month intervention, the cost per mean change in Alzheimer Disease Assessment Scale-Cognitive-Plus score demonstrated that exercise was more effective and costlier compared with the control group in terms of cognitive improvement with an incremental cost-effectiveness ratio of CAD -$8823. The cost per quality-adjusted life-year gained for both interventions was negligible, with exercise less costly (mean [SD] incremental cost, CAD -$32 [$258]) and cognitive and social enrichment more costly than the control group (mean [SD] incremental cost, CAD $1018 [$378]). The balance and tone program had the lowest delivery cost (CAD $777), and the exercise group had the lowest health care resource utilization (mean [SD] $1261 [$1188]) per person. Conclusions and Relevance The findings of this economic evaluation suggest that exercise demonstrated potential for cost-effectiveness to improve cognitive function in older adults with chronic stroke during a 6-month intervention.
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Affiliation(s)
- Cassandra Adjetey
- Faculty of Management, University of British Columbia, Kelowna, Canada
- Applied Health Economics Lab, University of British Columbia, Kelowna, Canada
| | - Jennifer C. Davis
- Faculty of Management, University of British Columbia, Kelowna, Canada
- Applied Health Economics Lab, University of British Columbia, Kelowna, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Ryan S. Falck
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - John R. Best
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Elizabeth Dao
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Kim Bennett
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Daria Tai
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Katherine McGuire
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Janice J. Eng
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Ging-Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Laura E. Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Canada
- Schlegel–UW Research Institute for Aging, Waterloo, Canada
| | - Peter A. Hall
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Min Hu
- Department of Economics, Philosophy and Political Science, University of British Columbia, Kelowna, Canada
| | - Brodie M. Sakakibara
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- Centre for Chronic Disease Prevention and Management, Southern Medical Program, The University of British Columbia, Kelowna, Canada
| | - Teresa Liu-Ambrose
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
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Middleton LE, Freeman S, Pelletier C, Regan K, Donnelly R, Skinner K, Wei C, Rossnagel E, Nasir HJ, Albisser T, Ajwani F, Aziz S, Heibein W, Holmes A, Johannesson C, Romano I, Sanchez L, Butler A, Doggett A, Buchan MC, Keller H. Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned. Res Involv Engagem 2023; 9:87. [PMID: 37775790 PMCID: PMC10542247 DOI: 10.1186/s40900-023-00497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023]
Abstract
Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.
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Affiliation(s)
- Laura E Middleton
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada.
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada.
| | - Shannon Freeman
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Chelsea Pelletier
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Kayla Regan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Rachael Donnelly
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Kelly Skinner
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Cindy Wei
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Emma Rossnagel
- University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Huda Jamal Nasir
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Tracie Albisser
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Fatim Ajwani
- University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Sana Aziz
- Alzheimer Society of B.C., 828 W 8Th Ave Suite 300, Vancouver, BC, V5Z 1E2, Canada
| | - William Heibein
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Ann Holmes
- Active Health Solutions, 150 - 556 North Nechako Road, Prince George, BC, V2K 1A1, Canada
| | - Carole Johannesson
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Isabella Romano
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Louisa Sanchez
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Alexandra Butler
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Amanda Doggett
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - M Claire Buchan
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
| | - Heather Keller
- University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L3G1, Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Dr, Waterloo, ON, N2J 0E2, Canada
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Montero-Odasso M, Zou G, Speechley M, Almeida QJ, Liu-Ambrose T, Middleton LE, Camicioli R, Bray NW, Li KZH, Fraser S, Pieruccini-Faria F, Berryman N, Lussier M, Shoemaker JK, Son S, Bherer L. Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2324465. [PMID: 37471089 DOI: 10.1001/jamanetworkopen.2023.24465] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
Importance Exercise, cognitive training, and vitamin D may enhance cognition in older adults with mild cognitive impairment (MCI). Objective To determine whether aerobic-resistance exercises would improve cognition relative to an active control and if a multidomain intervention including exercises, computerized cognitive training, and vitamin D supplementation would show greater improvements than exercise alone. Design, Setting, and Participants This randomized clinical trial (the SYNERGIC Study) was a multisite, double-masked, fractional factorial trial that evaluated the effects of aerobic-resistance exercise, computerized cognitive training, and vitamin D on cognition. Eligible participants were between ages 65 and 84 years with MCI enrolled from September 19, 2016, to April 7, 2020. Data were analyzed from February 2021 to December 2022. Interventions Participants were randomized to 5 study arms and treated for 20 weeks: arm 1 (multidomain intervention with exercise, cognitive training, and vitamin D), arm 2 (exercise, cognitive training, and placebo vitamin D), arm 3 (exercise, sham cognitive training, and vitamin D), arm 4 (exercise, sham cognitive training, and placebo vitamin D), and arm 5 (control group with balance-toning exercise, sham cognitive training, and placebo vitamin D). The vitamin D regimen was a 10 000 IU dose 3 times weekly. Main Outcomes and Measures Primary outcomes were changes in ADAS-Cog-13 and Plus variant at 6 months. Results Among 175 randomized participants (mean [SD] age, 73.1 [6.6] years; 86 [49.1%] women), 144 (82%) completed the intervention and 133 (76%) completed the follow-up (month 12). At 6 months, all active arms (ie, arms 1 through 4) with aerobic-resistance exercise regardless of the addition of cognitive training or vitamin D, improved ADAS-Cog-13 when compared with control (mean difference, -1.79 points; 95% CI, -3.27 to -0.31 points; P = .02; d = 0.64). Compared with exercise alone (arms 3 and 4), exercise and cognitive training (arms 1 and 2) improved the ADAS-Cog-13 (mean difference, -1.45 points; 95% CI, -2.70 to -0.21 points; P = .02; d = 0.39). No significant improvement was found with vitamin D. Finally, the multidomain intervention (arm 1) improved the ADAS-Cog-13 score significantly compared with control (mean difference, -2.64 points; 95% CI, -4.42 to -0.80 points; P = .005; d = 0.71). Changes in ADAS-Cog-Plus were not significant. Conclusions and Relevance In this clinical trial, older adults with MCI receiving aerobic-resistance exercises with sequential computerized cognitive training significantly improved cognition, although some results were inconsistent. Vitamin D supplementation had no effect. Our findings suggest that this multidomain intervention may improve cognition and potentially delay dementia onset in MCI. Trial Registration ClinicalTrials.gov Identifier: NCT02808676.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Department of Medicine, Division of Geriatric, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Guangyong Zou
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
- Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Quincy J Almeida
- Carespace Health & Wellness, Waterloo, Ontario, Canada
- Movement Disorders Research & Rehabilitation Centre, Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, Alberta, Canada
| | - Nick W Bray
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Karen Z H Li
- PERFORM Centre and Department of Psychology, Concordia University, Montréal, Quebec, Canada
| | - Sarah Fraser
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ontario, Canada
| | | | - Nicolas Berryman
- Département des sciences de l'activité physique Université du Québec à Montréal, Montréal, Quebec, Canada
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
| | - Maxime Lussier
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
- Integrated Health and Social Services University Network for South-Central Montreal, Montreal, Quebec, Canada
| | - J Kevin Shoemaker
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Surim Son
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Louis Bherer
- Research Centre, Institut Universitaire de Gériatrie de Montréal, Montréal, Quebec, Canada
- Research Centre, Montreal Heart Institute, and Department of Medicine, University of Montréal, Montréal, Quebec, Canada
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Bray NW, Pieruccini-Faria F, Witt ST, Bartha R, Doherty TJ, Nagamatsu LS, Almeida QJ, Liu-Ambrose T, Middleton LE, Bherer L, Montero-Odasso M. Combining exercise with cognitive training and vitamin D 3 to improve functional brain connectivity (FBC) in older adults with mild cognitive impairment (MCI). Results from the SYNERGIC trial. GeroScience 2023:10.1007/s11357-023-00805-6. [PMID: 37162700 PMCID: PMC10170058 DOI: 10.1007/s11357-023-00805-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023] Open
Abstract
Changes in functional brain connectivity (FBC) may indicate how lifestyle modifications can prevent the progression to dementia; FBC identifies areas that are spatially separate but temporally synchronized in their activation and is altered in those with mild cognitive impairment (MCI), a prodromal state between healthy cognitive aging and dementia. Participants with MCI were randomly assigned to one of five study arms. Three times per week for 20-weeks, participants performed 30-min of (control) cognitive training, followed by 60-min of (control) physical exercise. Additionally, a vitamin D3 (10,000 IU/pill) or a placebo capsule was ingested three times per week for 20-weeks. Using the CONN toolbox, we measured FBC change (Post-Pre) across four statistical models that collapsed for and/or included some or all study arms. We conducted Pearson correlations between FBC change and changes in physical and cognitive functioning. Our sample included 120 participants (mean age: 73.89 ± 6.50). Compared to the pure control, physical exercise (model one; p-False Discovery Rate (FDR) < 0.01 & < 0.05) with cognitive training (model two; p-FDR = < 0.001), and all three interventions combined (model four; p-FDR = < 0.01) demonstrated an increase in FBC between regions of the Default-Mode Network (i.e., hippocampus and angular gyrus). After controlling for false discovery rate, there were no significant correlations between change in connectivity and change in cognitive or physical function. Physical exercise alone appears to be as efficacious as combined interventional strategies in altering FBC, but implications for behavioral outcomes remain unclear.
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Affiliation(s)
- Nick W Bray
- Cumming School of Medicine, Department of Physiology & Pharmacology, University of Calgary, Calgary, AB, T2N 1N4, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, T2N 1N4, Canada.
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, 550 Wellington Road, Room A3-116, London, ON, N6C-0A7, Canada.
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, 550 Wellington Road, Room A3-116, London, ON, N6C-0A7, Canada
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A-5C1, Canada
| | - Suzanne T Witt
- BrainsCAN, Western University, London, ON, N6A-3K7, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A-5C1, Canada
- Robarts Research Institute, Western University, London, ON, N6A-5B7, Canada
| | - Timothy J Doherty
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A-5C1, Canada
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A-5C1, Canada
| | - Lindsay S Nagamatsu
- Faculty of Health Sciences, School of Kinesiology, Western University, London, ON, N6G-2V4, Canada
| | - Quincy J Almeida
- Faculty of Science, Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON, N2L-3C5, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, V6T-1Z3, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L-3G1, Canada
| | - Louis Bherer
- Department of Medicine, University of Montréal, Montréal, QC, H3T-1J4, Canada
- Research Centre, Montreal Heart Institute, Montréal, QC, H1T-1C8, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, 550 Wellington Road, Room A3-116, London, ON, N6C-0A7, Canada.
- Department of Medicine, Division of Geriatric Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A-5C1, Canada.
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, N6A-5C1, Canada.
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12
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Montero‐Odasso M, Almeida QJ, Burhan AM, Camicioli R, Li K, Liu‐Ambrose T, Middleton LE, Doyon J, Fraser S, Hunter SW, McIlroy B, Morais JA, Pieruccini‐Faria F, Shoemaker K, Speechley MR, Vasudev A, Zou GY, Berryman N, Lussier M, Vanderhaeghe L, Bherer L. The SYNERGIC Trial: A Randomized Controlled Trial Assessing Multimodal Interventions to Improve Cognition in Mild Cognitive Impairment in Older Adults. Alzheimers Dement 2022. [DOI: 10.1002/alz.061616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - Amer M. Burhan
- Ontario Shores Centre for Mental Health Sciences Whitby ON Canada
| | | | - Karen Li
- Concordia University Montreal QC Canada
| | | | | | - Julien Doyon
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal (CRIUGM) Montreal QC Canada
| | | | | | | | - José A Morais
- McGill University Montreal QC Canada
- McGill University Health Centre Montreal QC Canada
| | - Frederico Pieruccini‐Faria
- Gait and Brain Laboratory, Parkwood Institute London ON Canada
- Gait & Brain Lab; Lawson Research Institute; Schulich School of Medicine& Dentistry, Division of Geriatric Medicine, Western University London ON Canada
| | | | | | - Akshya Vasudev
- University of Western Ontario; Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario London ON Canada
| | - G Y Zou
- University of Wester Ontario London ON Canada
| | | | - Maxime Lussier
- University of Montreal Montreal QC Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM) Montreal QC Canada
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Liu-Ambrose T, Falck RS, Dao E, Best JR, Davis JC, Bennett K, Hall PA, Hsiung GYR, Middleton LE, Goldsmith CH, Graf P, Eng JJ. Effect of Exercise Training or Complex Mental and Social Activities on Cognitive Function in Adults With Chronic Stroke: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2236510. [PMID: 36227593 PMCID: PMC9561961 DOI: 10.1001/jamanetworkopen.2022.36510] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE A stroke doubles one's risk for dementia. How to promote cognitive function among persons with chronic stroke is unclear. OBJECTIVE To evaluate the effect of exercise (EX) or cognitive and social enrichment activities (ENRICH) on cognitive function in adults with chronic stroke. DESIGN, SETTING, AND PARTICIPANTS This was a 3-group parallel, single-blinded, single-site, proof-of-concept randomized clinical trial at a research center in Vancouver, British Columbia, Canada. Participants included community-dwelling adults with chronic stroke, aged 55 years and older, able to walk 6 meters, and without dementia. The trial included a 6-month intervention and a 6-month follow-up. Randomization occurred from June 6, 2014, to February 26, 2019. Measurement occurred at baseline, 6 months, and 12 months. Data were analyzed from January to November 2021. INTERVENTIONS Participants were randomly allocated to twice-weekly supervised classes of: (1) EX, a multicomponent exercise program; (2) ENRICH, a program of cognitive and social enrichment activities; or (3) balance and tone (BAT), a control group that included stretches and light-intensity exercises. MAIN OUTCOMES AND MEASURES The primary outcome was the Alzheimer Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus), which included the 13-item ADAS-Cog, Trail Making Test Parts A and B, Digit Span Forward and Backward, Animal Fluency, and Vegetable Fluency. RESULTS One-hundred and twenty participants, with a mean (range) of 1.2 (1-4) strokes, a mean (SD) of 66.5 (53.8) months since the most recent stroke, mean (SD) baseline age of 70 (8) years, mean (SD) baseline ADAS-Cog-Plus of 0.22 (0.81), and 74 (62%) male participants, were randomized to EX (34 participants), ENRICH (34 participants), or BAT (52 participants). Seventeen withdrew during the 6-month intervention and another 7 during the 6-month follow-up. Including all 120 participants, at the end of the 6-month intervention, EX significantly improved ADAS-Cog-Plus performance compared with BAT (estimated mean difference: -0.24; 95% CI, -0.43 to -0.04; P = .02). This difference did not persist at the 6-month follow-up (estimated mean difference: -0.08; 95% CI, -0.29 to 0.12; P = .43). For the 13-item ADAS-Cog, the EX group improved by 5.65 points over the 6-month intervention (95% CI, 2.74 to 8.57 points; P < .001), exceeding the minimally clinical difference of 3.0 points. CONCLUSIONS AND RELEVANCE These findings suggest that exercise can induce clinically important improvements in cognitive function in adults with chronic stroke. Future studies need to replicate current findings and to understand training parameters, moderators, and mediators to maximize benefits. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01916486.
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Affiliation(s)
- Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S. Falck
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Dao
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John R. Best
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Jennifer C. Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Management, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kim Bennett
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Peter A. Hall
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Ging-Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
- Clinic for Alzheimer Disease and Related Disorders, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura E. Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Charles H. Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter Graf
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Bechard LE, McGilton KS, Middleton LE, Chertkow H, Sivananthan S, Bethell J. Engaging People With Lived Experience of Dementia in Research: Perspectives From a Multi-disciplinary Research Network. Can Geriatr J 2022; 25:254-261. [PMID: 36117740 PMCID: PMC9427184 DOI: 10.5770/cgj.25.583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Patient and public involvement/engagement in research on dementia is not new, but it is becoming increasingly common. The objective of this study was to describe researchers’ knowledge, attitudes, and activities related to engaging people with lived experience of dementia in research, and how these differ by research theme. Methods Data were from an online, anonymous survey of researchers within the Canadian Consortium on Neurodegeneration in Aging. Results Of the 84 researchers who completed the survey (response rate: 27%), 89% agreed they understood the meaning of engaging people with lived experience in research, although this was lower among biomedical researchers. Almost all (93%) agreed that people with lived experience could contribute meaningfully to research, and nearly two-thirds were already incorporating engagement in their research. Some engagement practices reported differed by research theme. Irrespective of the type of research they conduct, researchers were most often motivated by improving the relevance and quality of their research. Conclusions These findings support an optimistic outlook for engaging people with lived experience of dementia in research, but identify differences across research themes. Understanding approaches to incorporate, evaluate, and adapt engagement activities across research disciplines are needed to enable researchers, as well as others involved in research, to develop and target strategies for patient and public involvement/engagement in research on dementia.
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Santos WMD, Sardeli AV, Moraes DFG, Venturini MLF, Santos LDC, Cavaglieri CR, Middleton LE, Chacon-Mikahil MPT. Função cognitiva após exercícios aeróbicos com e sem restrição do fluxo sanguíneo em adultos mais velhos. Conexões 2022. [DOI: 10.20396/conex.v20i00.8666856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
As perdas cognitivas tipicamente experimentadas com o envelhecimento podem ser atenuadas por exercícios aeróbicos (EA) regulares. EA também induz melhora aguda da função cognitiva em idosos; no entanto, não está claro qual protocolo de EA é mais eficaz. A prática de EA com restrição de fluxo sanguíneo (RFS) agrega outros benefícios à saúde do idoso, como melhorias na aptidão aeróbia, aumento da massa e força muscular. Assim, objetivamos comparar protocolos de EA com e sem RFS na função cognitiva de idosos. Vinte e um idosos realizaram o teste de Stroop antes e após três sessões de EA em medida repetida, desenho cruzado: EA com alta carga (70% VO2máx), EA com baixa carga (40% VO2máx) e EA com RFS (40% VO2máx e 50% do RFS). Não houve efeito significativo das sessões experimentais na função cognitiva. Talvez, as cargas aplicadas não tenham sido adequadas para estimular melhorias na função cognitiva, visto que as cargas moderadas têm sido mais eficientes para aumentar o fluxo sanguíneo cerebral, entre outros mecanismos fisiológicos englobados. Além disso, observamos respostas bastante heterogêneas entre indivíduos e sessões, sugerindo que pesquisas futuras são necessárias para melhor compreensão desse fenômeno.
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Muñoz J, Mehrabi S, Li Y, Basharat A, Middleton LE, Cao S, Barnett-Cowan M, Boger J. Immersive Virtual Reality Exergames for Persons Living With Dementia: User-Centered Design Study as a Multistakeholder Team During the COVID-19 Pandemic. JMIR Serious Games 2022; 10:e29987. [PMID: 35044320 PMCID: PMC8772876 DOI: 10.2196/29987] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/24/2021] [Accepted: 09/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Advancements in supporting personalized health care and well-being using virtual reality (VR) have created opportunities to use immersive games to support a healthy lifestyle for persons living with dementia and mild cognitive impairment (MCI). Collaboratively designing exercise video games (exergames) as a multistakeholder team is fundamental to creating games that are attractive, effective, and accessible. OBJECTIVE This research extensively explores the use of human-centered design methods that involve persons living with dementia in long-term care facilitates, exercise professionals, content developers, game designers, and researchers in the creation of VR exergames targeting physical activity promotion for persons living with dementia/MCI. METHODS Conceptualization, collaborative design, and playtesting activities were carried out to design VR exergames to engage persons living with dementia in exercises to promote upper limb flexibility, strength, and aerobic endurance. We involved a total of 7 persons living with dementia/MCI, 5 exercise professionals, 5 community-dwelling older adults, a VR company for content creation, and a multidisciplinary research team with game designers, engineers, and kinesiology experts. RESULTS An immersive VR exergame called Seas the Day was jointly designed and developed and it is freely available to be played in state-of-the-art VR headsets (Oculus Quest 1, 2). A model for the triadic interaction (health care institution, industry partner, academia) is also presented to illustrate how different stakeholders contribute to the design of VR exergames that consider/complement complex needs, preferences, and motivators of an underrepresented group of end users. CONCLUSIONS This study provides evidence that a collaborative multistakeholder design results in more tailored and context-aware VR games for persons living with dementia. The insights and lessons learned from this research can be used by others to co-design games, including remote engagement techniques that were used during the COVID-19 pandemic.
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Affiliation(s)
- John Muñoz
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Samira Mehrabi
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Yirou Li
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Aysha Basharat
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura E Middleton
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Shi Cao
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Michael Barnett-Cowan
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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Mehrabi S, Muñoz JE, Basharat A, Li Y, Middleton LE, Cao S, Barnett-Cowan M, Boger J. Seas the day: Co-designing immersive virtual reality exergames with exercise professionals and people living with dementia. Alzheimers Dement 2022; 17 Suppl 11:e051278. [PMID: 34971033 DOI: 10.1002/alz.051278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Physical activity (PA) is associated with physical and cognitive benefits among people living with dementia or mild cognitive impairment (PLWD/MCI) and is a meaningful activity that can improve their confidence in everyday life. Exercising in virtual reality environments (VR Exergame) is becoming an increasingly feasible and enjoyable way to promote PA and well-being in PLWD/MCI. Although co-design can significantly improve the design of technology, it is rarely done with PLWD/MCI. This study uses participatory design methods and collaborative approaches to involve key stakeholders to develop and test a VR Exergame "Seas the Day", a novel solution targeting PLWD/MCI well-being. METHODS A multi-stage, user-centered co-design approach was used to custom-build VR Exergames tailored to the unique needs and abilities of PLWD/MCI based on a first generation of the prototype that was previously developed and tested with PLWD/MCI. This paper describes the next iteration of the prototype. Processes included concept ideation and brainstorming activities, iterative prototyping, and playtesting/input/feedback sessions with key stakeholders (PLWD/MCI, exercise professionals, engineers, VR game designers, content developers). RESULTS The multidisciplinary and collaborative design process occurred over 15 months (overlapping with COVID-19 pandemic) with 7 PLWD/MCI (6 females; M=81.3 years) and 9 exercise professionals (7 females; M=38.1 years) to date. The game was designed to target movements identified by exercise professionals and researchers (aerobic exercises, range of motion, seated-balance, quick response to stimuli) and is structured in three exercise stages (warm-up, conditioning, cool-down). To ensure safety of participants while using VR headsets, only seated upper-limb exercises were targeted. Stakeholder feedback regarding game mechanics, aesthetics, and visual/auditory cues were gathered during brainstorming and playtesting sessions and implemented into specific game-related scenarios (tai-chi, rowing, fishing). CONCLUSION We presented the process, outcomes, and challenges of adopting a participatory/collaborative approach with multiple stakeholder groups to co-design VR Exergames tailored to PLWD/MCI. Next steps will include a mixed-method evaluation of the VR Exergames among community-dwelling older adults and PLWD/MCI in retirement communities and long-term care to evaluate: i) feasibility and acceptability of use, ii) game user experience, iii) barriers/facilitators to uptake of VR Exergames; and iv) inform/validate VR Exergames gameplay metrics reflective of cognitive and motor performance.
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Affiliation(s)
| | | | | | - Yiru Li
- University of Waterloo, Waterloo, ON, Canada
| | | | - Shi Cao
- University of Waterloo, Waterloo, ON, Canada
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Middleton LE, Keller H, McAiney CA, Bechard LE, Wei C, Koch M, Heibein W, Roth G, Schneider L, Shoemaker D, Shoemaker M. Co‐design of the DELIGHT (Dementia Lifestyle Interventions for Growing Healthy Together) program for persons living with dementia and care partners. Alzheimers Dement 2021. [DOI: 10.1002/alz.053193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Carrie A McAiney
- University of Waterloo Waterloo ON Canada
- Schlegel‐UW Research Institute for Aging Waterloo ON Canada
| | | | - Cindy Wei
- University of Waterloo Waterloo ON Canada
| | | | | | - Gail Roth
- Alzheimer Society of Waterloo‐Wellington Kitchener ON Canada
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Bechard LE, Wei C, Tupling O, Keller H, McAiney CA, Middleton LE. Evaluating the co‐design of a program to supporting living well with dementia. Alzheimers Dement 2021. [DOI: 10.1002/alz.052077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Cindy Wei
- University of Waterloo Waterloo ON Canada
| | | | | | - Carrie A McAiney
- University of Waterloo Waterloo ON Canada
- Schlegel‐UW Research Institute for Aging Waterloo ON Canada
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20
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Montero‐Odasso M, Jarrett P, Handrigan G, Chamard‐Witkowski L, Bouchard DR, Tranchant CC, Yetman L, Belleville S, Chertkow H, Feldman H, Nygaard HB, Almeida QJ, Bherer L, Liu‐Ambrose T, Middleton LE, Speechley MR, Kamkar N, McGibbon CA. The SYNERGIC RCTs from Can Thumbs Up: Canadian experience in migrating lifestyle interventions to an @Home‐based program to enhance cognition. Alzheimers Dement 2021. [DOI: 10.1002/alz.055806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Manuel Montero‐Odasso
- Parkwood Institute London ON Canada
- Schulich School of Medicine& Dentistry, Division of Geriatric Medicine ,Western University London ON Canada
| | | | | | - Ludivine Chamard‐Witkowski
- Dr. Georges L. Dumont University Hospital, Vitalité Health Network, Centre de Formation Médicale du Nouveau‐Brunswick Moncton NB Canada
| | | | - Carole C Tranchant
- Faculty of Health Sciences and Community Services, Université de Moncton Moncton NB Canada
| | | | | | | | - Howard Feldman
- Alzheimer's Disease Cooperative Study, University of California San Diego La Jolla CA USA
| | | | | | | | - Teresa Liu‐Ambrose
- University of British Columbia Vancouver BC Canada
- Djavad Mowafaghian Centre for Brain Health Vancouver BC Canada
| | | | | | | | - Chris A McGibbon
- Faculty of Kinesiology, University of New Brunswick Fredericton NB Canada
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21
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Middleton LE, Koch M, Freeman S, Pelletier C, Bechard LE, Mohamed S, Heibein W, Johannesson C, Dupuis SL, Astell AJ, Giangregorio L, Regan K. Using participatory research to co‐create the dementia‐inclusive choices for exercise toolkit. Alzheimers Dement 2021. [DOI: 10.1002/alz.053215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Shannon Freeman
- University of Northern British Columbia Prince George BC Canada
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22
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Liu‐Ambrose T, Falck RS, Best JR, Hsiung GR, Middleton LE, Hall PA, Davis JC, Eng JJ. Exercise training improves cognition in chronic stroke: A 6‐month randomized controlled trial. Alzheimers Dement 2021. [DOI: 10.1002/alz.052952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Teresa Liu‐Ambrose
- University of British Columbia Vancouver BC Canada
- Djavad Mowafaghian Centre for Brain Health Vancouver BC Canada
| | - Ryan S Falck
- University of British Columbia Vancouver BC Canada
- Djavad Mowafaghian Centre for Brain Health Vancouver BC Canada
| | - John R Best
- University of British Columbia Vancouver BC Canada
- Djavad Mowafaghian Centre for Brain Health Vancouver BC Canada
| | - Ging‐Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, University of British Colombia Vancouver BC Canada
- Vancouver Coastal Health Research Institute Vancouver BC Canada
| | | | | | - Jennifer C Davis
- Department of Management Kelowna BC Canada
- University of British Columbia, Okanagan Vancouver BC Canada
| | - Janice J Eng
- University of British Columbia Vancouver BC Canada
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23
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Mehrabi S, Muñoz JE, Basharat A, Boger J, Cao S, Barnett-Cowan M, Middleton LE. Immersive virtual reality exergames to promote well-being of community-dwelling older adults: a mixed-methods pilot study protocol (Preprint). JMIR Res Protoc 2021; 11:e32955. [PMID: 35700014 PMCID: PMC9237784 DOI: 10.2196/32955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/21/2022] [Accepted: 04/21/2022] [Indexed: 01/26/2023] Open
Abstract
Background Despite the proven benefits of exercise in older adults, challenges such as access and motivation can deter their engagement. Interactive virtual reality (VR) games combined with exercise (exergames) are a plausible strategy to encourage physical activity among this population. However, there has been little research on the feasibility, acceptability, and potential benefits of deploying at-home VR exergames among community-dwelling older adults. Objective The objectives of this study are to estimate the feasibility, usability, and acceptability of a co-designed VR exergame in community-dwelling older adults; examine intervention feasibility and assessment protocols for a future large-scale trial; and provide pilot data on outcomes of interest (physical activity, exercise self-efficacy, mood, cognition, perception, and gameplay metrics). Methods The study will be a remote, 6-week intervention comprising an experimental and a control group. A sample of at least 12 community-dwelling older adults (with no or mild cognitive impairment) will be recruited for each group. Both groups will follow the same study procedures and assessment methods. However, the experimental group will engage with a co-designed VR exergame (Seas The Day) thrice weekly for approximately 20 minutes using the Oculus Quest 2 (Facebook Reality Labs) VR headset. The control group will read (instead of playing Seas The Day) thrice weekly for approximately 20 minutes over the 6-week period. A mixed methods evaluation will be used. Changes in physical activity, exercise self-efficacy, mood, cognition, and perception will be compared before and after acute data as well as before and after the 6 weeks between the experimental (exergaming) and control (reading) groups. Qualitative data from postintervention focus groups or interviews and informal notes and reports from all participants will be analyzed to assess the feasibility of the study protocol. Qualitative data from the experimental group will also be analyzed to assess the feasibility, usability, and acceptability of at-home VR exergames and explore perceived facilitators of and barriers to uptaking VR systems among community-dwelling older adults. Results The screening and recruitment process for the experimental group started in May 2021, and the data collection process will be completed by September 2021. The timeline of the recruitment process for the control group is September 2021 to December 2021. We anticipate an estimated adherence rate of ≥80%. Challenges associated with VR technology and the complexity of remote assessments are expected. Conclusions This pilot study will provide important information on the feasibility, acceptability, and usability of a custom-made VR exergaming intervention to promote older adults’ well-being. Findings from this study will be useful to inform the methodology, design, study procedures, and assessment protocol for future large-scale trials of VR exergames with older adults as well as deepen the understanding of remote deployment and at-home use of VR for exercise in older adults. International Registered Report Identifier (IRRID) DERR1-10.2196/32955
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Affiliation(s)
- Samira Mehrabi
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - John E Muñoz
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Aysha Basharat
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jennifer Boger
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
| | - Shi Cao
- Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | | | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
- Research Institute for Aging, Waterloo, ON, Canada
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Nieman T, Bergelt M, Clancy J, Regan K, Hobson N, Dos Santos A, Middleton LE. Changes in cognitive control and mood across repeated exercise sessions. Appl Psychol Health Well Being 2021; 13:853-870. [PMID: 34196482 PMCID: PMC9291128 DOI: 10.1111/aphw.12275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 03/02/2021] [Accepted: 03/22/2021] [Indexed: 11/28/2022]
Abstract
Acute exercise elicits benefits to cognition and mood. The consistency and accumulation of benefits across exercise sessions remains unclear. This exploratory study evaluated the reproducibility and accumulation of changes in cognitive control and mood across multiple exercise sessions. Thirty young healthy adults (18-35 years) were recruited to exercise (N = 14; age: 21.71 [SD = 1.64]; 57% female) or control (N = 16; age: 22.25 [SD = 3.68]; 56% female) groups. Participants attended six sessions over 2 weeks (EX = 20-min mod-intensity cycling; CO = 20-min reading). Cognitive control was assessed using a Flanker task (accuracy-adjusted response time, RTLISAS ) pre-/post-intervention. Mood was reported 5×/day on exercise and non-exercise days (pre, post, 11:30 am, 3 pm, and 8 pm) using the Bond-Lader VAS. Cognitive control and mood improved acutely (within session) following exercise compared with control (F(1, 592) = 6.11, p = .0137; F(1, 305.93) = 38.68, p < .0001; F(1, 307.06) = 13.69, p = .0003) and were consistent across sessions. Cognitive control also improved across sessions in both groups (F(5, 282.22) = 11.06, p < .0001). These results suggest that: (1) acute effects of exercise on cognition and mood are consistent across multiple sessions; (2) the Flanker task learning effects continue over many trials/sessions; and (3) accumulated mood effects require further investigation. Future studies should further explore the connection between acute exercise exposures and accumulated cognitive benefits.
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Affiliation(s)
| | | | | | - Kayla Regan
- The University of Waterloo, Waterloo, ON, Canada
| | - Nic Hobson
- The University of Waterloo, Waterloo, ON, Canada
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25
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Bechard LE, Bergelt M, Neudorf B, DeSouza TC, Middleton LE. Using the Health Belief Model to Understand Age Differences in Perceptions and Responses to the COVID-19 Pandemic. Front Psychol 2021; 12:609893. [PMID: 33935865 PMCID: PMC8082183 DOI: 10.3389/fpsyg.2021.609893] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
COVID-19 severity and mortality risk are greater for older adults whereas economic impact is deeper for younger adults. Using the Health Belief Model (HBM) as a framework, this study used a web-based survey to examine how perceived COVID-19 susceptibility and severity and perceived efficacy of recommended health behaviors varied by age group and were related to the adoption of health behaviors. Proportional odds logistic regression was used to examine the relationship between age group and perceived COVID-19 susceptibility, severity, impact, and health behavior efficacy and adoption. Structural equation modeling based on HBM constructs examined the relationships between health beliefs and behaviors. Data from 820 participants (Ontario, Canada) were analyzed (age: 42.7, 16.2 years; 79% women). Middle-aged and older adults reported greater concerns about the personal risk of hospitalization and mortality, economic impact, and social impact of COVID-19 than young adults. Middle-aged adults also reported greatest concern for other age groups. Adoption and perceived efficacy of health behaviors was similar across age groups with few exceptions. Both middle-aged and older-adults were more likely to perceive their own and each other's age groups as responding adequately to COVID-19 compared to young adults. Structural equation modeling indicated perceived benefits of health behaviors were the primary driver of behavior uptake, with socioeconomic factors and perceived severity and susceptibility indirectly associated with uptake through their influence on perceived benefits. Overall, these results suggest adoption of health behaviors is very high with few differences between age groups, despite differences in perceived impact of COVID-19. Public health communications should focus on the benefits of health behaviors to drive adoption.
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Affiliation(s)
- Lauren E Bechard
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | | | - Bobby Neudorf
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Tamara C DeSouza
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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26
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Bergelt M, Fung Yuan V, O’Brien R, Middleton LE, Martins dos Santos W. Moderate aerobic exercise, but not anticipation of exercise, improves cognitive control. PLoS One 2020; 15:e0242270. [PMID: 33186396 PMCID: PMC7665798 DOI: 10.1371/journal.pone.0242270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Evidence suggests a single bout of exercise can improve cognitive control. However, many studies only include assessments after exercise. It is unclear whether exercise changes as a result, or in anticipation, of exercise. OBJECTIVE To examine changes in cognitive control due to moderate aerobic exercise, and anticipation of such exercise. METHODS Thirty-one young healthy adults (mean age 22 years; 55% women) completed three conditions (randomized order): 1) exercise (participants anticipated and completed exercise); 2) anticipation (participants anticipated exercise but completed rest); and 3) rest (participants anticipated and completed rest). Cognitive control was assessed with a modified Flanker task at three timepoints: (1) early (20 min pre-intervention, pre-reveal in anticipation session); (2) pre-intervention (after reveal); and (3) post-intervention. An accuracy-weighted response time (RTLISAS) was the primary outcome, analyzed with a linear mixed effects modeling approach. RESULTS There was an interaction between condition and time (p = 0.003) and between session and time (p = 0.015). RTLISAS was better post-exercise than post-rest and post-deception, but was similar across conditions at other timepoints. RTLISAS improved across time in session 1 and session 2, but did not improve over time in session 3. There were also main effects of condition (p = 0.024), session (p = 0.005), time (p<0.001), and congruency (p<0.001). CONCLUSIONS Cognitive control improved after moderate aerobic exercise, but not in anticipation of exercise. Improvements on a Flanker task were also observed across sessions and time, indicative of a learning effect that should be considered in study design and analyses.
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Affiliation(s)
| | - Vanessa Fung Yuan
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
- Department of Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Richard O’Brien
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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27
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Bechard LE, McDougall A, Mitchell C, Regan K, Bergelt M, Dupuis S, Giangregorio L, Freeman S, Middleton LE. Dementia- and mild cognitive impairment-inclusive exercise: Perceptions, experiences, and needs of community exercise providers. PLoS One 2020; 15:e0238187. [PMID: 32898193 PMCID: PMC7478809 DOI: 10.1371/journal.pone.0238187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/11/2020] [Indexed: 01/05/2023] Open
Abstract
PURPOSE For persons who are at risk for, or living with, dementia exercise is recommended, yet many become or remain inactive. Exercise providers play a vital role in promoting and facilitating exercise in these groups by recognizing and being responsive to the needs of persons with mild cognitive impairment (MCI) or dementia in exercise programming. The objective of this study was to explore the experiences, perceptions, and needs of community exercise providers regarding dementia. MATERIALS & METHODS Five focus groups were held with community exercise providers (n = 30) who deliver exercise to older adults (≥55 years) in municipal, non-profit, for profit, or academic settings. RESULTS Three themes were developed: (1) Unique experiences and diverse perceptions: suggests unique personal experiences with MCI and dementia inform distinct perceptions of dementia; (2) Dementia-Inclusive Practices: learning as you go and adapting for the individual: reflects exercise providers' approaches to recognizing and accommodating individuals' unique abilities and preferences; (3) Training and Best Practices, with Flexibility: identifies exercise providers' desires for MCI- and dementia-specific knowledge and training strategies, which need to recognize dementia heterogeneity between and within persons over time. CONCLUSIONS These findings highlight a willingness of exercise providers to support dementia-inclusive exercise, but recognize they have minimal training and lack educational resources to do so. Formal training resources may enhance exercise accessibility and participation for persons with MCI or dementia.
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Affiliation(s)
- Lauren E. Bechard
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
- * E-mail:
| | - Aidan McDougall
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
| | - Cheyenne Mitchell
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
| | - Kayla Regan
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
| | - Maximillian Bergelt
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
| | - Sherry Dupuis
- Department of Recreation and Leisure Studies, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
| | - Lora Giangregorio
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
| | - Shannon Freeman
- University of Northern British Columbia School of Nursing, Prince George, British Columbia, Canada
| | - Laura E. Middleton
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Waterloo, Ontario, Canada
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Wu SA, Morrison‐Koechl J, Slaughter SE, Middleton LE, Carrier N, McAiney C, Lengyel C, Keller H. Family member eating assistance and food intake in long‐term care: A secondary data analysis of the M3 Study. J Adv Nurs 2020; 76:2933-2944. [DOI: 10.1111/jan.14480] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/15/2020] [Accepted: 06/15/2020] [Indexed: 12/16/2022]
Affiliation(s)
| | | | | | | | | | - Carrie McAiney
- University of Waterloo Waterloo ON Canada
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo ON Canada
| | | | - Heather Keller
- University of Waterloo Waterloo ON Canada
- Schlegel‐University of Waterloo Research Institute for Aging Waterloo ON Canada
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29
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Middleton LE. Altering Dementia Risk: Can Fitness Overcome Obesity in Relation to Cognition? Can J Cardiol 2020; 36:1703-1705. [PMID: 32619449 DOI: 10.1016/j.cjca.2020.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
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Anstey KJ, Peters R, Zheng L, Barnes DE, Brayne C, Brodaty H, Chalmers J, Clare L, Dixon RA, Dodge H, Lautenschlager NT, Middleton LE, Qiu C, Rees G, Shahar S, Yaffe K. Future Directions for Dementia Risk Reduction and Prevention Research: An International Research Network on Dementia Prevention Consensus. J Alzheimers Dis 2020; 78:3-12. [PMID: 32925063 PMCID: PMC7609069 DOI: 10.3233/jad-200674] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 12/26/2022]
Abstract
In the past decade a large body of evidence has accumulated on risk factors for dementia, primarily from Europe and North America. Drawing on recent integrative reviews and a consensus workshop, the International Research Network on Dementia Prevention developed a consensus statement on priorities for future research. Significant gaps in geographical location, representativeness, diversity, duration, mechanisms, and research on combinations of risk factors were identified. Future research to inform dementia risk reduction should fill gaps in the evidence base, take a life-course, multi-domain approach, and inform population health approaches that improve the brain-health of whole communities.
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Affiliation(s)
- Kaarin J. Anstey
- UNSW Aging Futures Institute, School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
| | - Ruth Peters
- UNSW Aging Futures Institute, School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
| | - Lidan Zheng
- UNSW Aging Futures Institute, School of Psychology, University of New South Wales, Sydney, NSW, Australia
- Neuroscience Research Australia (NeuRA), Randwick, NSW, Australia
| | - Deborah E. Barnes
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Forvie Site, Cambridge, UK
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - John Chalmers
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Linda Clare
- College of Medicine and Health, University of Exeter, St Luke’s Campus, Exeter, UK
| | - Roger A. Dixon
- Neuroscience and Mental Health Institute, Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Hiroko Dodge
- Layton Aging and Alzheimer’s Disease Center, Department of Neurology, Oregon Health & Science University, Portland, OR, USA
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
- Michigan Alzheimer’s Disease Center, University of Michigan, Ann Arbor, MI, USA
| | - Nicola T. Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia
- NorthWestern Mental Health, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Laura E. Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Chengxuan Qiu
- Aging Research Center and Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
| | - Glenn Rees
- Alzheimer’s Disease International, London, UK
| | - Suzana Shahar
- Center for Healthy Ageing & Wellness, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Kristine Yaffe
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Falck RS, Best JR, Davis J, Eng JJ, Middleton LE, Hall PA, Liu-Ambrose T. P4-434: SLEEP AND COGNITIVE FUNCTION IN CHRONIC STROKE: A COMPARATIVE CROSS-SECTIONAL STUDY. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ryan S. Falck
- University of British Columbia; Vancouver BC Canada
- Djavad Mowafaghian Center for Brain Health; Vancouver BC Canada
| | - John R. Best
- University of British Columbia; Vancouver BC Canada
- Djavad Mowafaghian Centre for Brain Health; Vancouver BC Canada
- Centre for Hip Health and Mobility; Vancouver BC Canada
| | - Jennifer Davis
- Department of Management; Kelowna BC Canada
- University of British Columbia; Okanagan, Vancouver BC Canada
| | | | | | | | - Teresa Liu-Ambrose
- University of British Columbia; Vancouver BC Canada
- Djavad Mowafaghian Centre for Brain Health; Vancouver BC Canada
- Centre for Hip Health and Mobility; Vancouver BC Canada
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Middleton LE, Black SE, Herrmann N, Oh PI, Regan K, Bechard L, Lanctot KL. P4-387: CENTRE VERSUS HOME-BASED EXERCISE (CHEX) STUDY: A RANDOMIZED PARALLEL-GROUP TRIAL. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Sandra E. Black
- Hurvitz Brain Sciences Research Program; Sunnybrook Research Institute; Toronto ON Canada
- Sunnybrook Research Institute; Toronto ON Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute; Toronto ON Canada
- University of Toronto; Toronto ON Canada
- Neuropsychopharmacology Research Group; Toronto ON Canada
| | - Paul I. Oh
- Sunnybrook Health Sciences Centre; Toronto ON Canada
- University Health Network Toronto Rehabilitation Institute; Toronto ON Canada
| | | | | | - Krista L. Lanctot
- Sunnybrook Research Institute; Toronto ON Canada
- University of Toronto; Toronto ON Canada
- Neuropsychopharmacology Research Group; Toronto ON Canada
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Falck RS, Best JR, Davis JC, Eng JJ, Middleton LE, Hall PA, Liu-Ambrose T. Sleep and cognitive function in chronic stroke: a comparative cross-sectional study. Sleep 2019; 42:5364812. [DOI: 10.1093/sleep/zsz040] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/10/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Ryan S Falck
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - John R Best
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
| | - Jennifer C Davis
- University of British Columbia-Okanagan Campus, Faculty of Management, Kelowna, BC, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Faculty of Medicine, Neurorehabilitation Research Program, GFS Rehabilitation Centre, Vancouver, BC, Canada
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Peter A Hall
- University of Waterloo, School of Public Health and Health Systems, Waterloo, ON, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health and Centre for Hip Health and Mobility, Vancouver, BC, Canada
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Torres NF, Chibi B, Middleton LE, Solomon VP, Mashamba-Thompson TP. Evidence of factors influencing self-medication with antibiotics in low and middle-income countries: a systematic scoping review. Public Health 2019; 168:92-101. [PMID: 30716570 DOI: 10.1016/j.puhe.2018.11.018] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Self-medication with antibiotics (SMA) is a practice of global concern with a higher incidence within the low- and middle-income countries (LMICs). Despite worldwide efforts to control and promote the rational use of antibiotics, the continuing practice of SMA systematically exposes individuals and communities to the risk of antibiotic resistance and a host of other antibiotic side-effects. This systematic scoping review maps evidence on the factors influencing SMA in these settings. STUDY DESIGN Systematic scoping review. METHODS The search strategy involved electronic databases including PubMed, Web of science, Science Direct, EBSCOhost, Google Scholar, BioMed Central, and the World Health Organization Library. PRISMA P guidelines and Arksey and O'Malley's framework were used. Thematic analysis was used to identify the factors that influence the practices of SMA in LMICs. The Mixed Method Appraisal Tool (MMAT), version 2011, was used to assess the quality of the included primary studies. RESULTS Fifteen studies met the inclusion criteria. Studies included participants from the following LMICs: Guatemala, India, Indonesia, Kenya, Laos, Nepal, Nigeria, Pakistan, Sri Lanka, and Yemen. The findings of the review emphasized a considerable high prevalence of SMA, ranging from 8.1% to 93%, with an association with the level of education, monthly income, and gender of participants. Accessibility, affordability, and conditions of health facilities, as well as the health-seeking behavior, are factors that influence SMA in LMICs. Health conditions such as a sore throat, common cold, cough, headache, toothache, flu-like symptoms, pain relief, fever, runny nose, toothache, upper respiratory tract infections, and urinary tract infection were the major complaints that led to the practices of SMA. CONCLUSIONS There is a considerable level of research evidence predominantly in some LMICs from Asia, with less evidence from African LMICs. Sociocultural determinants of health associated with the structure and conditions of health system as well as the health-seeking behavior are the main factors influencing SMA. Contextual and comprehensive studies on the factors influencing the non-prescribed use of antibiotics are needed to enable evidence-based strategies to correctly address the utilization of antibiotics and contain the problem of antimicrobial resistance, especially within the LMICs. PROSPERO REGISTRATION CRD42017072954.
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Affiliation(s)
- N F Torres
- Instituto Superior de Ciências de Saúde - ISCISA, Maputo, Mozambique; School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa.
| | - B Chibi
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa; Human Sciences Research Council, Durban, South Africa
| | - L E Middleton
- School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - V P Solomon
- School of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - T P Mashamba-Thompson
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
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Montero-Odasso M, Almeida QJ, Camicioli R, Li K, Liu-Ambrose T, Middleton LE, Bherer L. O3‐05‐06: SYNERGIC TRIAL: MULTIMODAL INTERVENTION TO PREVENT AND MANAGE MILD COGNITIVE IMPAIRMENT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | - Karen Li
- Concordia UniversityMontrealQCCanada
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Middleton LE, Regan K, Black SE, Herrmann N, Oh PI, Bechard L, Lanctot KL. P1‐581: HOW DO WE BEST DELIVER EXERCISE TO PEOPLE WITH MCI AND DEMENTIA? A RANDOMIZED PARALLEL‐GROUP TRIAL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Sandra E. Black
- Sunnybrook Research InstituteUniversity of TorontoTorontoONCanada
| | | | - Paul I. Oh
- Sunnybrook Health Sciences CentreTorontoONCanada
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Cullen S, Montero-Odasso M, Bherer L, Almeida Q, Fraser S, Muir-Hunter S, Li K, Liu-Ambrose T, McGibbon CA, McIlroy W, Middleton LE, Sarquis-Adamson Y, Beauchet O, McFadyen BJ, Morais JA, Camicioli R. Guidelines for Gait Assessments in the Canadian Consortium on Neurodegeneration in Aging (CCNA). Can Geriatr J 2018; 21:157-165. [PMID: 29977431 PMCID: PMC6028168 DOI: 10.5770/cgj.21.298] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Motor and cognitive impairments are common among older adults and often co-exist, increasing their risk of dementia, falls, and fractures. Gait performance is an accepted indicator of global health and it has been proposed as a valid motor marker to detect older adults at risk of developing mobility and cognitive declines including future falls and incident dementia. Our goal was to provide a gait assessment protocol to be used for clinical and research purposes. Methods Based on a consensus that identified common evaluations to assess motor–cognitive interactions in community-dwelling older individuals, a protocol on how to evaluate gait in older adults for the Canadian Consortium on Neurodegeneration in Aging (CCNA) was developed. Results The CCNA gait assessment includes preferred and fast pace gait, and dual-task gait that comprises walking while performing three cognitively demanding tasks: counting backwards by ones, counting backwards by sevens, and naming animals. This gait protocol can be implemented using an electronic-walkway, as well as by using a regular stopwatch. The latter approach provides a simple manner to evaluate quantitative gait performance in clinics. Conclusions Establishing a standardized gait assessment protocol will help to assess motor–cognitive interactions in aging and neurodegeneration, to compare results across studies, and to feasibly implement and translate gait testing in clinics for detecting impending cognitive and mobility decline.
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Affiliation(s)
- Stephanie Cullen
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada.,Schulich School of Medicine and Dentistry, Department of Medicine (Geriatrics) and Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - Louis Bherer
- Department of Medicine, Montreal Heart Institute and Institut Universitaire de Gériatrie de Montréal, University of Montreal, Montreal, QC, Canada
| | - Quincy Almeida
- The Sun Life Financial Movement Disorders Research and Rehabilitation Centre, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Sarah Fraser
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Susan Muir-Hunter
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada.,Faculty of Health Sciences, School of Physiotherapy, University of Western Ontario, London, ON, Canada
| | - Karen Li
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Chris A McGibbon
- Faculty of Kinesiology and Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - William McIlroy
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Laura E Middleton
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Yanina Sarquis-Adamson
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Olivier Beauchet
- Department of Medicine, Divisions of Geriatrics and Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Bradford J McFadyen
- Rehabilitation Department, Université Laval, and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec, QC, Canada
| | - José A Morais
- Department of Medicine, Divisions of Geriatrics and Experimental Medicine, McGill University, Montreal, QC, Canada
| | - Richard Camicioli
- Department of Medicine, Division of Neurology, University of Alberta, Edmonton, AB, Canada
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38
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Best JR, Eng JJ, Davis JC, Hsiung R, Hall PA, Middleton LE, Graf P, Goldsmith CH, Liu-Ambrose T. Study protocol for Vitality: a proof-of-concept randomised controlled trial of exercise training or complex mental and social activities to promote cognition in adults with chronic stroke. BMJ Open 2018; 8:e021490. [PMID: 29550783 PMCID: PMC5875626 DOI: 10.1136/bmjopen-2018-021490] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Cerebrovascular disease-such as stroke-is the second most common cause of dementia (ie, vascular dementia). Specifically, a stroke increases one's risk for dementia by a factor of two. Thus, stroke survivors represent a target population in need of intervention strategies to promote cognitive function and prevent dementia. The current standard of care in stroke rehabilitation does not adequately address the significant cognitive consequences of stroke, especially for those who are in the chronic phase (ie, >12 months since an index stroke). Two potential intervention strategies are: (1) exercise training and (2) cognitive and social enrichment activities. METHODS AND ANALYSIS The aim of this proof-of-concept randomised controlled trial is to determine whether a 6-month targeted exercise training programme or a 6-month cognitive and social enrichment programme can efficaciously and efficiently improve cognitive function in older adults with chronic stroke compared with a 6-month stretch and tone programme (ie, control). The primary measurement periods will be baseline, month 6 (postintervention) and month 12 (6-month follow-up). The primary outcome measure will be performance on the Alzheimer's Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-Plus), a global measure of cognitive performance using multidimensional item response theory to summarise scores from the 13-item ADAS-Cog and other standard cognitive assessments. The primary analysis will compare changes in ADAS-Cog-Plus performance from baseline to month 6. Proof-of-concept outcomes relating to intervention feasibility will be analysed descriptively. The economic evaluation will examine the incremental costs and health outcome benefits generated by both interventions versus the control. ETHICS AND DISSEMINATION Ethical approval has been obtained from the University of British Columbia's Clinical Research Ethics Board (H13-00715, 26 July 2013). Any modifications to the protocol will require a formal amendment to the protocol and approval by the Research Ethics Board. Outcomes of this randomised controlled trial and the statistical code to generate those outcomes will be disseminated through publication in peer-reviewed journals as well as conference presentations. TRIAL REGISTRATION NUMBER NCT01916486.
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Affiliation(s)
- John R Best
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Faculty of Management, University of British Columbia, Kelowna, British Columbia, Canada
| | - Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
- Clinic for Alzheimer Disease and Related Disorders, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Peter A Hall
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Peter Graf
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles H Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Middleton LE, Black SE, Herrmann N, Oh PI, Regan K, Lanctot KL. Centre- versus home-based exercise among people with mci and mild dementia: study protocol for a randomized parallel-group trial. BMC Geriatr 2018; 18:27. [PMID: 29370756 PMCID: PMC5785893 DOI: 10.1186/s12877-017-0684-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background Worldwide, almost 50million people lived with dementia in 2016. A cure or disease modifying pharmaceutical treatment for dementia remains elusive so alternative therapies are of critical importance. Mounting evidence supports exercise in the prevention and therapy of dementia. However, the cognitive, physical, and psychological challenges common to dementia along with a poor understanding and accommodation of dementia in the community are major barriers to exercise. Consequently, effective delivery options need to be identified. The primary objective of this study is to compare the effectiveness of center-based (CB) exercise versus home-based (HB) exercise for achievement of physical activity guidelines among people with MCI or mild dementia. Methods This is a randomized parallel-group trial comparing the effects of CB and HB exercise adherence among community-dwelling adults ≥50 years with a clinical diagnosis of MCI or mild dementia. Participants will be randomized to either CB or HB exercise. The CB group will meet weekly for small group exercise and will be prescribed additional exercise to be completed independently. Participants in the HB group will be given a physical activity prescription to be completed independently in the community. Participants in HB will also be contacted by phone monthly to adjust exercise prescriptions. The primary outcome will be achievement of exercise guidelines (150 min/wk. of moderate activity) assessed using an activity monitor. Secondary objectives will evaluate cost-effectiveness and the influence of individual and environmental factors on the primary outcome. Tertiary outcomes include physical function, cognition, mood, and quality of life. Discussion There is scant research to indicate the most effective way to deliver exercise to people with MCI and mild dementia, which is needed specifically because these groups face significant barriers to exercise. To capitalize on the benefits of exercise, feasible exercise delivery options need to be identified. The results of this study will directly complement ongoing clinical trials and will be essential to implementing exercise recommendations specific to the prevention and therapy of dementia in a feasible and cost-effective manner when they emerge. Trial registration. Clinicatrials.gov; Identifier: NCT02774720 (version updated December 12, 2016).
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Affiliation(s)
- Laura E Middleton
- University of Waterloo, 200 University Ave W (BMH 1114), Waterloo, ON, N2L 3G1, Canada.
| | - Sandra E Black
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Nathan Herrmann
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Paul I Oh
- University Health Network, 347 Rumsey Rd, Toronto, ON, M4G 2V6, Canada
| | - Kayla Regan
- University of Waterloo, 200 University Ave W (BMH 1114), Waterloo, ON, N2L 3G1, Canada
| | - Krista L Lanctot
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
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Middleton LE, Ventura MI, Santos-Modesitt W, Poelke G, Yaffe K, Barnes DE. The Mental Activity and eXercise (MAX) trial: Effects on physical function and quality of life among older adults with cognitive complaints. Contemp Clin Trials 2017; 64:161-166. [PMID: 29066293 DOI: 10.1016/j.cct.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 10/14/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Older adults with cognitive complaints are vulnerable to dementia, physical impairments, and poor quality of life. Exercise and mental activity may improve physical function and health-related quality of life (HRQOL) but combinations have not been investigated systematically. The Mental Activity and eXercise (MAX) trial found that mental activity plus exercise over 12weeks improved cognitive function (primary outcome) in sedentary older adults with cognitive complaints. OBJECTIVE To investigate the effects of combinations of two mental activity and exercise programs on physical function and HRQOL (secondary outcomes). METHODS Participants (n=126, age 73±6years, 65% women) were randomized to 12weeks of exercise (aerobic exercise or stretching/toning, 3×60min/week) plus mental activity (computer-based cognitive training or educational DVDs, 3×60min/week) using a factorial design. Assessments included the Senior Fitness Test (physical function), Short Form-12 physical and mental sub-scales (HRQOL), and CHAMPS questionnaire (physical activity). RESULTS There were no differences between groups at baseline (p>0.05). We observed improvements over time in most physical function measures [chair stands (p-for-time=0.001), arm curls (p-for-time<0.001), step test (p-for-time=0.003), sit & reach (p-for-time=0.01), and back scratch (p-for-time=0.04)] and in physical HRQOL (p-for-time=0.04). There were no differences in change between groups (group∗time p>0.05). Changes in most physical function measures and physical HRQOL correlated with physical activity changes. CONCLUSION Combined mental activity and exercise interventions of various types can improve both physical function and physical HRQOL among sedentary older adults with cognitive complaints. Exercise control group design should be carefully considered as even light exercise may induce benefits in vulnerable older adults.
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Affiliation(s)
| | - Maria I Ventura
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | | | - Gina Poelke
- Department of Clinical Psychology, Notre Dame de Namur University, USA
| | - Kristine Yaffe
- Department of Psychiatry, University of California San Francisco, USA; Department of Psychiatry, San Francisco Veterans Affairs Medical Centre, USA; Department of Medicine, University of California San Francisco, USA; Department of Neurology, University of California San Francisco, USA
| | - Deborah E Barnes
- Department of Psychiatry, University of California San Francisco, USA; Department of Psychiatry, San Francisco Veterans Affairs Medical Centre, USA.
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Robertson AD, Marzolini S, Middleton LE, Basile VS, Oh PI, MacIntosh BJ. Exercise Training Increases Parietal Lobe Cerebral Blood Flow in Chronic Stroke: An Observational Study. Front Aging Neurosci 2017; 9:318. [PMID: 29033829 PMCID: PMC5626868 DOI: 10.3389/fnagi.2017.00318] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 09/15/2017] [Indexed: 02/01/2023] Open
Abstract
Exercise is increasingly recommended as an essential component of stroke rehabilitation, yet uncertainty remains with respect to its direct effect on the cerebral vasculature. The current study first demonstrated the repeatability of pseudo-continuous arterial spin labeling (ASL) magnetic resonance imaging (MRI) in older adults with stroke, and then investigated the change in cerebrovascular function following a 6-month cardiovascular rehabilitation program. In the repeatability study, 12 participants at least 3 months post-stroke underwent two ASL imaging scans 1 month apart. In the prospective observational study, eight individuals underwent ASL imaging and aerobic fitness testing before and after a 6-month cardiovascular rehabilitation program. Cerebral blood flow (CBF) and the spatial coefficient of variation of CBF (sCoV) were quantified to characterize tissue-level perfusion and large cerebral artery transit time properties, respectively. In repeat scanning, intraclass correlation (ICC) indicated moderate test-retest reliability for global gray matter CBF (ICC = 0.73) and excellent reliability for sCoV (ICC = 0.94). In the observational study, gray matter CBF increased after training (baseline: 40 ± 13 vs. 6-month: 46 ± 12 ml·100 g−1·min−1, P = 0.036). The greatest change occurred in the parietal lobe (+18 ± 12%). Gray matter sCoV, however, did not change following training (P = 0.31). This study provides preliminary evidence that exercise-based rehabilitation in chronic stroke enhances tissue-level perfusion, without changing the relative hemodynamic properties of the large cerebral arteries.
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Affiliation(s)
- Andrew D Robertson
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Hurvitz Brain Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Susan Marzolini
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Toronto Rehab, University Health Network, Toronto, ON, Canada
| | - Laura E Middleton
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | | | - Paul I Oh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Toronto Rehab, University Health Network, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
| | - Bradley J MacIntosh
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Ottawa, ON, Canada.,Hurvitz Brain Sciences, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
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Beyer KB, Sage MD, Staines WR, Middleton LE, McIlroy WE. A single aerobic exercise session accelerates movement execution but not central processing. Neuroscience 2017; 346:149-159. [DOI: 10.1016/j.neuroscience.2017.01.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 01/07/2017] [Accepted: 01/11/2017] [Indexed: 11/17/2022]
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Middleton LE, Hobson N, Lanctot KL, Herrmann N, Oh PI, Black SE. P2‐403: Targeting MCI with Cardiac Rehabilitation Exercise: A Feasibility Study. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Krista L. Lanctot
- University of TorontoTorontoON Canada
- Sunnybrook Research InstituteTorontoON Canada
- Neuropsychopharmacology Research GroupTorontoON Canada
- Sunnybrook Health Sciences CentreTorontoON Canada
| | - Nathan Herrmann
- University of TorontoTorontoON Canada
- Sunnybrook Research InstituteTorontoON Canada
- Neuropsychopharmacology Research GroupTorontoON Canada
- Sunnybrook Health Sciences CentreTorontoON Canada
| | - Paul I. Oh
- Sunnybrook Health Sciences CentreTorontoON Canada
- University Health Network Toronto Rehabilitation InstituteTorontoON Canada
| | - Sandra E. Black
- Sunnybrook Research InstituteTorontoON Canada
- Sunnybrook Health Sciences CentreTorontoON Canada
- Faculty of Medicine University of TorontoTorontoON Canada
- LC Campbell Cognitive Neurology Research Unit Sunnybrook Health Sciences CentreTorontoON Canada
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Regan K, Middleton LE, White F. O3‐07‐06: Evaluation of the Minds in Motion
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Program: Physical, Mood, and Knowledge Outcomes. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Background Indigenous peoples in Canada have higher prevalence of modifiable risk factors for Alzheimer’s disease (AD). The relative importance of these risk factors on AD risk management is poorly understood. Methods Relative risks from literature and prevalence of risk factors from Statistics Canada or the First Nations Regional Health Survey were used to determine projected population attributable risk (PAR) associated with modifiable risk factors for AD (low education and vascular risk factors) among on- and off-reserve Indigenous and non-Indigenous people in Canada using the Levin formula. Results Physical inactivity had the highest PAR for AD among Indigenous and non-Indigenous peoples in Canada (32.5% [10.1%–51.1%] and 30.5% [9.2%–48.8%] respectively). The PAR for most modifiable risk factors was higher among Indigenous peoples in Canada, particularly among on-reserve groups. The greatest differences in PAR were for low educational attainment and smoking, which were approximately 10% higher among Indigenous peoples in Canada. The combined PAR for AD for all six modifiable risk factors was 79.6% among on-reserve Indigenous, 74.9% among off-reserve Indigenous, and 67.1% among non-Indigenous peoples in Canada. (All differences significant to p < .001.) Conclusions Modifiable risk factors are responsible for the most AD cases among Indigenous peoples in Canada. Further research is necessary to determine the prevalence of AD and the impact of risk factor modification among Indigenous peoples in Canada.
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Affiliation(s)
| | - Deborah E Barnes
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA; ; Department of Psychiatry, San Francisco Veterans' Affairs Medical Centre, San Francisco, CA, USA
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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Intzandt B, Black SE, Lanctôt KL, Herrmann N, Oh P, Middleton LE. Is Cardiac Rehabilitation Exercise Feasible for People with Mild Cognitive Impairment? Can Geriatr J 2015; 18:65-72. [PMID: 26180562 PMCID: PMC4487738 DOI: 10.5770/cgj.18.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Exercise is a promising strategy to prevent dementia, but no clinically supervised exercise program is widely available to people with mild cognitive impairment (MCI). The objective was to survey health professionals to assess the feasibility of using cardiac rehabilitation exercise programs for MCI populations. Methods We distributed surveys to: 1) health professionals working in cardiac rehabilitation exercise programs (36/72 responded); and 2) physicians who treat MCI (22/32 responded). Questions addressed clinician and clinic characteristics and feasibility of referring and accommodating people with MCI. Results Most cardiac rehabilitation exercise programs currently treat people with MCI (61.1%). Nearly all were willing and able to accept people with MCI and comorbid vascular risk (91.7%), though only a minority could accept MCI without vascular risk (16.7%). Although most physicians recommend exercise to people with MCI (63.6%), few referred patients with MCI to programs or people to guide exercise (27.3%). However, all physicians (100%) would refer patients with MCI to a cardiac rehabilitation exercise program. Conclusions Our study supports cardiac rehabilitation exercise programs as a feasible model of exercise for patients with MCI with vascular risk. Patients with and without vascular risk could likely be accommodated if program mandates were expanded.
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Affiliation(s)
| | - Sandra E Black
- Division of Cognitive Neurology, Sunnybrook Health Sciences Centre, Toronto; ; Brain Sciences Research Program, Sunnybrook Research Institute; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Department of Medicine (Neurology), University of Toronto
| | - Krista L Lanctôt
- Brain Sciences Research Program, Sunnybrook Research Institute; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Neuropsychopharmacology Research Group, Sunnybrook Research Institute; ; Department of Psychiatry, Sunnybrook Health Sciences Centre; ; Department of Psychiatry, University of Toronto
| | - Nathan Herrmann
- Brain Sciences Research Program, Sunnybrook Research Institute; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Neuropsychopharmacology Research Group, Sunnybrook Research Institute; ; Department of Psychiatry, Sunnybrook Health Sciences Centre; ; Department of Psychiatry, University of Toronto
| | - Paul Oh
- Canadian Partnership for Stroke Recovery (Sunnybrook Site); ; Cardiac Rehab and Secondary Prevention Program, Toronto Rehabilitation Institute, University Health Network; ; Clinical Pharmacology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo; ; Canadian Partnership for Stroke Recovery (Sunnybrook Site)
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Fraser KS, Heckman GA, McKelvie RS, Harkness K, Middleton LE, Hughson RL. Cerebral Hypoperfusion Is Exaggerated With an Upright Posture in Heart Failure. JACC: Heart Failure 2015; 3:168-75. [DOI: 10.1016/j.jchf.2014.07.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/21/2014] [Accepted: 07/28/2014] [Indexed: 11/16/2022]
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Sage M, Middleton LE, Tang A, Sibley KM, Brooks D, McIlroy W. Validity of Rating of Perceived Exertion Ranges in Individuals in the Subacute Stage of Stroke Recovery. Top Stroke Rehabil 2015; 20:519-27. [DOI: 10.1310/tsr2006-519] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brown C, Fraser JE, Inness EL, Wong JS, Middleton LE, Poon V, McIlroy WE, Mansfield A. Does Participation in Standardized Aerobic Fitness Training During Inpatient Stroke Rehabilitation Promote Engagement in Aerobic Exercise After Discharge? A Cohort Study. Top Stroke Rehabil 2015; 21 Suppl 1:S42-51. [DOI: 10.1310/tsr21s1-s42] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Thacker JS, Middleton LE, McIlroy WE, Staines WR. The influence of an acute bout of aerobic exercise on cortical contributions to motor preparation and execution. Physiol Rep 2014; 2:2/10/e12178. [PMID: 25355852 PMCID: PMC4254103 DOI: 10.14814/phy2.12178] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Increasing evidence supports the use of physical activity for modifying brain activity and overall neurological health. Specifically, aerobic exercise appears to have a positive effect on cognitive function, which some have suggested to be a result of increasing levels of arousal. However, the role of aerobic exercise on movement-related cortical activity is less clear. We tested the hypothesis that (1) an acute bout of exercise modulates excitability within motor areas and (2) transient effects would be sustained as long as sympathetic drive remained elevated (indicated by heart rate). In experiment 1, participants performed unimanual self-paced wrist extension movements before and after a 20-min, moderate intensity aerobic exercise intervention on a recumbent cycle ergometer. After the cessation of exercise, Bereitschaftspotentials (BP), representative cortical markers for motor preparation, were recorded immediately postexercise (Post) and following a return to baseline heart rate (Post[Rest]). Electroencephalography (EEG) was used to measure the BP time-locked to onset of muscle activity and separated into three main components: early, late and reafferent potentials. In experiment 2, two additional time points postexercise were added to the original protocol following the Post[Rest] condition. Early BP but not late BP was influenced by aerobic exercise, evidenced by an earlier onset, indicative of a regionally selective effect across BP generators. Moreover, this effect was sustained for up to an hour following exercise cessation and this effect was following a return to baseline heart rate. These data demonstrate that acute aerobic exercise may alter and possibly enhance the cortical substrates required for the preparation of movement.
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Affiliation(s)
- Jonathan S Thacker
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Laura E Middleton
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - William E McIlroy
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - W Richard Staines
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
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