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Bennett KJ, Leese J, Davis JC, Eng JJ, Liu-Ambrose T. Exploring the experience of cognitive changes among community-dwelling stroke survivors: a qualitative study. Disabil Rehabil 2024; 46:1870-1877. [PMID: 37212368 DOI: 10.1080/09638288.2023.2210309] [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] [Received: 09/01/2022] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
PURPOSE Cognitive deficits are common among stroke survivors and impact their functional independence. Despite the prevalence of cognitive deficits after stroke, cognitive function is largely overlooked in post-stroke care. The aim of this qualitative study was to explore the experiences of individuals living with post-stroke cognitive changes to understand the impact of these changes on their daily lives. MATERIALS AND METHODS Semi-structured interviews were conducted with a purposeful sample of thirteen community-dwelling adults 50 years and older with chronic stroke who self-identified cognitive changes post-stroke. Interviews were transcribed and an inductive thematic analysis was completed. RESULTS Four key themes were identified: 1) inability to maintain everyday activities; 2) experiencing emotional responses to living with post-stroke cognitive changes; 3) a shrinking social world and; 4) seeking care for cognitive health post-stroke. CONCLUSIONS Post-stroke cognitive changes were described by participants as a driving force behind negative shifts in their daily lives, emotional health, and social connections after stroke. Despite seeking care for their post-stroke cognitive changes, many participants were unable to find support in mainstream healthcare. There is a demonstrated need to further elucidate the gaps in care for post-stroke cognitive deficits and implement community interventions targeting cognitive health post-stroke.
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Affiliation(s)
- Kimberly J Bennett
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
| | - Jenny Leese
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Department of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research at the Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer C Davis
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Applied Health Economics Laboratory, Faculty of Management, University of British Columbia-Okanagan, Kelowna, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, G. F. Strong Rehabilitation Centre, Vancouver, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
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Rice J, Li LC, Davis JC, Pahor M, Madden K, Wei N, Wong H, Skelton DA, McCormick S, Falck RS, Barha CK, Rhodes RE, Loomba S, Sadatsafavi M, Liu-Ambrose T. Supporting physical activity for mobility in older adults with mobility limitations (SuPA Mobility): study protocol for a randomized controlled trial. Trials 2023; 24:769. [PMID: 38017467 PMCID: PMC10685660 DOI: 10.1186/s13063-023-07798-9] [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: 10/06/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Limited mobility in older adults consistently predicts both morbidity and mortality. As individuals age, the rates of mobility disability increase from 1.0% in people aged 15-24 to 20.6% in adults over 65 years of age. Physical activity can effectively improve mobility in older adults, yet many older adults do not engage in sufficient physical activity. Evidence shows that increasing physical activity by 50 min of moderate intensity physical activity in sedentary older adults with mobility limitations can improve mobility and reduce the incidence of mobility disability. To maximize the healthy life span of older adults, it is necessary to find effective and efficient interventions that can be delivered widely to prevent mobility limitations, increase physical activity participation, and improve quality of life in older adults. We propose a randomized controlled trial to assess the effect of a physical activity health coaching intervention on mobility in older adults with mobility limitations. METHODS This randomized controlled trial among 290 (145 per group) community-dwelling older adults with mobility limitations, aged 70-89 years old, will compare the effect of a physical activity health coaching intervention versus a general healthy aging education program on mobility, as assessed with the Short Physical Performance Battery. The physical activity health coaching intervention will be delivered by exercise individuals who are trained in Brief Action Planning. The coaches will use evidence-based behavior change techniques including goal-setting, action planning, self-monitoring, and feedback to improve participation in physical activity by a known dose of 50 min per week. There will be a total of 9 health coaching or education sessions delivered over 26 weeks with a subsequent 26-week follow-up period, wherein both groups will receive the same duration and frequency of study visits and activities. DISCUSSION The consequences of limited mobility pose a significant burden on the quality of life of older adults. Our trial is novel in that it investigates implementing a dose of physical activity that is known to improve mobility in older adults utilizing a health coaching intervention. TRIAL REGISTRATION ClinicalTrials.gov Protocol Registration System: NCT05978336; registered on 28 July 2023.
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Affiliation(s)
- Jordyn Rice
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Linda C Li
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Jennifer C Davis
- University of British Columbia-Okanagan, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Marco Pahor
- University of Florida, Gainesville, FL, 32611, USA
| | - Kenneth Madden
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Nathan Wei
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Hubert Wong
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Dawn A Skelton
- Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, UK
| | - Sioban McCormick
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Ryan S Falck
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Cindy K Barha
- University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Ryan E Rhodes
- University of Victoria, 3800 Finnerty Rd, Victoria, BC, V8P 5C2, Canada
| | - Sohail Loomba
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Mohsen Sadatsafavi
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, 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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Sakakibara BM, Wiley E, Barclay R, Bayley M, Davis JC, Eng JJ, Harris A, Inness EL, MacKay-Lyons M, Monaghan J, Pollock C, Pooyania S, Schneeberg A, Teasell R, Yao J, Tang A. TeleRehabilitation with Aims to Improve Lower extremity recovery in community-dwelling individuals who have had a stroke: protocol for a multisite, parallel group, assessor-blinded, randomised attention-controlled trial. BMJ Open 2023; 13:e076723. [PMID: 37474180 PMCID: PMC10357752 DOI: 10.1136/bmjopen-2023-076723] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Telerehabilitation is an accessible service delivery model that may support innovative lower extremity rehabilitation programmes that extend the stroke recovery continuum into the community. Unfortunately, there is limited evidence on the provision of exercises for lower extremity recovery after stroke delivered using telerehabilitation. In response, we developed the TeleRehabilitation with Aims to Improve Lower extremity recovery poststroke (TRAIL) programme, a 4-week progressive exercise and self-management intervention delivered synchronously using video-conferencing technology. Our primary hypothesis is that individual within 1-year poststroke who participate in TRAIL will experience significantly greater improvements in functional mobility than individuals in an attention-controlled education programme (EDUCATION). METHODS AND ANALYSIS In this multisite, parallel group, assessor-blinded randomised attention-controlled trial, 96 community-living stroke survivors within 1-year poststroke will be recruited from five sites (Vancouver, Winnipeg, Toronto, London and Halifax, Canada) from the CanStroke Recovery Trials Platform which is a network of Canadian hospital sites that are affiliated with academic institutions to facilitate participant recruitment and quality trial practices. Participants will be randomised on a 1:1 basis to TRAIL or EDUCATION. Participants randomised to TRAIL will receive eight telerehabilitation sessions where they will perform exercises and receive self-management support to improve lower extremity recovery from a TRAIL physical therapist. The primary outcome will be measured using the Timed Up and Go. Secondary outcomes include lower extremity muscle strength, functional balance, motor impairment, balance self-efficacy, health-related quality of life and health service use for our economic evaluation. Measurements will be taken at baseline, immediately after the intervention, 3-month and 6-month postintervention. ETHICS AND DISSEMINATION Ethics approval for this research has been obtained by all participating sites. All study participants will provide their informed consent prior to enrolling them in the study. Findings from this trial will be disseminated in peer-reviewed journals and presentations at international scientific meetings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov, NCT04908241.
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Affiliation(s)
- Brodie M Sakakibara
- Department of Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Chronic Disease Prevention and Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Elise Wiley
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ruth Barclay
- College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mark Bayley
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer C Davis
- Faculty of Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Janice J Eng
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Anne Harris
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Elizabeth L Inness
- Mobility Innovations Centre, Toronto Rehabiltiation Institute, Toronto, Ontario, Canada
| | | | - Jennifer Monaghan
- Centre for Chronic Disease Prevention and Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Courtney Pollock
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Sepideh Pooyania
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Schneeberg
- Consultant, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Teasell
- Lawson Health Research Unit, Parkwood Hospital, London, Ontario, Canada
- Physical Medicine and Rehabiliation, University of Western Ontario, London, Ontario, Canada
| | - Jennifer Yao
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Falck RS, Davis JC, Khan KM, Handy TC, Liu-Ambrose T. A Wrinkle in Measuring Time Use for Cognitive Health: How should We Measure Physical Activity, Sedentary Behaviour and Sleep? Am J Lifestyle Med 2023; 17:258-275. [PMID: 36896037 PMCID: PMC9989499 DOI: 10.1177/15598276211031495] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
One new case of dementia is detected every 4 seconds and no effective drug therapy exists. Effective behavioural strategies to promote healthy cognitive ageing are thus essential. Three behaviours related to cognitive health which we all engage in daily are physical activity, sedentary behaviour and sleep. These time-use activity behaviours are linked to cognitive health in a complex and dynamic relationship not yet fully elucidated. Understanding how each of these behaviours is related to each other and cognitive health will help determine the most practical and effective lifestyle strategies for promoting healthy cognitive ageing. In this review, we discuss methods and analytical approaches to best investigate how these time-use activity behaviours are related to cognitive health. We highlight four key recommendations for examining these relationships such that researchers should include measures which (1) are psychometrically appropriate; (2) can specifically answer the research question; (3) include objective and subjective estimates of the behaviour and (4) choose an analytical method for modelling the relationships of time-use activity behaviours with cognitive health which is appropriate for their research question.
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Affiliation(s)
- Ryan S. Falck
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada(RSF, KMK, TLA); Faculty of Management, University of British Columbia–Okanagan, Kelowna, BC, Canada(JCD); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(KMK); Attentional Neuroscience Laboratory, Department of Psychology, Faculty of Arts, University of British Columbia, Vancouver, BC, Canada(TCH)
| | - Jennifer C. Davis
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada(RSF, KMK, TLA); Faculty of Management, University of British Columbia–Okanagan, Kelowna, BC, Canada(JCD); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(KMK); Attentional Neuroscience Laboratory, Department of Psychology, Faculty of Arts, University of British Columbia, Vancouver, BC, Canada(TCH)
| | - Karim M. Khan
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada(RSF, KMK, TLA); Faculty of Management, University of British Columbia–Okanagan, Kelowna, BC, Canada(JCD); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(KMK); Attentional Neuroscience Laboratory, Department of Psychology, Faculty of Arts, University of British Columbia, Vancouver, BC, Canada(TCH)
| | - Todd C. Handy
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada(RSF, KMK, TLA); Faculty of Management, University of British Columbia–Okanagan, Kelowna, BC, Canada(JCD); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(KMK); Attentional Neuroscience Laboratory, Department of Psychology, Faculty of Arts, University of British Columbia, Vancouver, BC, Canada(TCH)
| | - Teresa Liu-Ambrose
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada(RSF, TLA); Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada(RSF, KMK, TLA); Faculty of Management, University of British Columbia–Okanagan, Kelowna, BC, Canada(JCD); Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada(KMK); Attentional Neuroscience Laboratory, Department of Psychology, Faculty of Arts, University of British Columbia, Vancouver, BC, Canada(TCH)
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Jehu DA, Davis JC, Gill J, Oke O, Liu-Ambrose T. The Effect of Exercise on Falls in People Living with Dementia: A Systematic Review. J Alzheimers Dis 2023; 92:1199-1217. [PMID: 36872779 DOI: 10.3233/jad-221038] [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] [Indexed: 03/05/2023]
Abstract
BACKGROUND People living with dementia (PWD) are at a heightened risk for falls. However, the effects of exercise on falls in PWD are unclear. OBJECTIVE To conduct a systematic review of randomized controlled trials (RCTs) examining the efficacy of exercise to reduce falls, recurrent falls, and injurious falls relative to usual care among PWD. METHODS We included peer-reviewed RCTs evaluating any exercise mode on falls and related injuries among medically diagnosed PWD aged ≥55years (international prospective register of systematic reviews (PROSPERO) ID:CRD42021254637). We excluded studies that did not solely involve PWD and were not the primary publication examining falls. We searched the Cochrane Dementia and Cognitive Improvement Group's Specialized Register and grey literature on 08/19/2020 and 04/11/2022; topical categories included dementia, exercise, RCTs, and falls. We evaluated the risk of bias (ROB) using the Cochrane ROB Tool-2 and study quality using the Consolidated Standards of Reporting Trials. RESULTS Twelve studies were included (n = 1,827; age = 81.3±7.0 years; female = 59.3%; Mini-Mental State Examination = 20.1±4.3 points; intervention duration = 27.8±18.5 weeks; adherence = 75.5±16.2%; attrition = 21.0±12.4%). Exercise reduced falls in two studies [Incidence Rate Ratio (IRR) range = 0.16 to 0.66; fall rate range: intervention = 1.35-3.76 falls/year, control = 3.07-12.21 falls/year]; all other studies (n = 10) reported null findings. Exercise did not reduce recurrent falls (n = 0/2) or injurious falls (n = 0/5). The RoB assessment ranged from some concerns (n = 9) to high RoB (n = 3); no studies were powered for falls. The quality of reporting was good (78.8±11.4%). CONCLUSION There was insufficient evidence to suggest that exercise reduces falls, recurrent falls, or injurious falls among PWD. Well-designed studies powered for falls are needed.
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Affiliation(s)
- Deborah A Jehu
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, GA, USA
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer C Davis
- Applied Health Economics Laboratory, The University of British Columbia -Okanagan, Kelowna, BC, Canada
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, BC, Canada
| | - Jessica Gill
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Olabamibo Oke
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Teresa Liu-Ambrose
- Centre for Aging SMART at Vancouver Coastal Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Falck RS, Best JR, Barha CK, Davis JC, Liu-Ambrose T. Do the relationships of physical activity and total sleep time with cognitive function vary by age and biological sex? A cross-sectional analysis of the Canadian Longitudinal Study on Aging. Maturitas 2022; 166:41-49. [PMID: 36055010 DOI: 10.1016/j.maturitas.2022.08.007] [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: 04/28/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Physical activity (PA) and total sleep time (TST) are each associated with cognition; however, whether these relationships vary by age and biological sex is unclear. We examined the relationships of PA or TST with cognition, and whether age and sex moderated these relationships, using baseline data from the Canadian Longitudinal Study on Aging (CLSA; 2010-2015). STUDY DESIGN A cross-sectional analysis of participants from the Comprehensive cohort of the CLSA with complete PA and sleep data (n = 20,307; age range 45-86 years). MAIN OUTCOME MEASURES PA and TST were measured using the Physical Activity Scale for the Elderly (PASE) and self-reported TST over the past month. Cognition was indexed using a three-factor structural equation model (i.e., memory, executive function, and verbal fluency). RESULTS Non-linear restricted cubic spline models indicated that PA and TST explained statistically significant (p < 0.01) but modest variance of each cognitive domain (<1 % of 23-24 % variance). Age and sex did not moderate associations of PA with any cognitive domain. However, age and sex moderated relationships of TST with cognition, whereby: 1) associations of TST with memory decreased with age for males and females; and 2) males and females had different age-associated relationships of TST with executive function and verbal fluency. CONCLUSIONS PA and TST modestly contribute to multiple domains of cognition across middle and older adulthood. Importantly, the association of PA with cognition does not appear to vary across middle or older adulthood, nor does it vary by biological sex; however, TST appears to have a complex relationship with multiple domains of cognition which is both age- and sex-dependent.
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Affiliation(s)
- Ryan S Falck
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - John R Best
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Cindy K Barha
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada; Applied Health Economics Laboratory, University of British Columbia - Okanagan Campus, Kelowna, BC, Canada; Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan Campus, Kelowna, BC, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.
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8
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Davis JC, Adjetey C. Traversing the Challenges Facing Meaningful Interpretation of Randomized Controlled Trials With Concurrent Economic Evaluations. Arthritis Care Res (Hoboken) 2022; 74:1950-1952. [PMID: 35439349 DOI: 10.1002/acr.24899] [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: 04/04/2022] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Jennifer C Davis
- Applied Health Economics Laboratory, University of British Columbia-Okanagan and Social and Economic Change (SE-Change) Laboratory, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada, and Centre for Hip Health & Mobility, Vancouver, British Columbia, Canada
| | - Cassandra Adjetey
- University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
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Rush KL, Singh S, Seaton CL, Burton L, Li E, Jones C, Davis JC, Hasan K, Kern B, Janke R. Telehealth Use for Enhancing the Health of Rural Older Adults: A Systematic Mixed Studies Review. Gerontologist 2022; 62:e564-e577. [PMID: 34661675 DOI: 10.1093/geront/gnab141] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/18/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Telehealth holds potential for inclusive and cost-saving health care; however, a better understanding of the use and acceptance of telehealth for health promotion among rural older adults is needed. This systematic review aimed to synthesize evidence for telehealth use among rural-living older adults and to explore cost-effectiveness for health systems and patients. RESEARCH DESIGN AND METHODS This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study designs reporting health promotion telehealth interventions with rural-living adults aged 55 and older were eligible for review. Following screening and inclusion, articles were quality-rated and ranked by level of evidence. Data extraction was guided by the Technology Acceptance Model and organized into outcomes related to ease of use, usefulness, intention to use, and usage behavior along with cost-effectiveness. RESULTS Of 2,247 articles screened, 42 were included. Positive findings for the usefulness of telehealth for promoting rural older adults' health were reported in 37 studies. Evidence for ease of use and usage behavior was mixed. Five studies examined intention to continue to use telehealth and in 4 of these, patients preferred telehealth. Telehealth was cost-effective for health care delivery (as a process) compared to face to face. However, findings were mixed for cost-effectiveness with both reports of savings (e.g., reduced travel) and increased costs (e.g., insurance). DISCUSSION AND IMPLICATIONS Telehealth was useful for promoting health among rural-living older adults. Technological supports are needed to improve telehealth ease of use and adherence. Cost-effectiveness of telehealth needs more study, particularly targeting older adults.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Sarah Singh
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Cherisse L Seaton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Lindsay Burton
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Eric Li
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Charlotte Jones
- Faculty of Medicine, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Khalad Hasan
- Department of Computer Science, Mathematics, Physics and Statistics, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Brodie Kern
- School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Robert Janke
- Research and Administration, Library Administration, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
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10
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Falck RS, Percival AG, Tai D, Davis JC. International depiction of the cost of functional independence limitations among older adults living in the community: a systematic review and cost-of-impairment study. BMC Geriatr 2022; 22:815. [PMID: 36273139 PMCID: PMC9587635 DOI: 10.1186/s12877-022-03466-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/08/2021] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Functional independence limitations restrict older adult self-sufficiency and can reduce quality of life. This systematic review and cost of impairment study examined the costs of functional independence limitations among community dwelling older adults to society, the health care system, and the person. METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines this systematic review included community dwelling older adults aged 60 years and older with functional independence limitations. Databases (Cochrane Database of Systematic Reviews, EconLit, NHS EED, Embase, CINAHL, AgeLine, and MEDLINE) were searched between 1990 and June 2020. Two reviewers extracted information on study characteristics and cost outcomes including mean annual costs of functional independence limitations per person for each cost perspective (2020 US prices). Quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS 85 studies were included. The mean annual total costs per person (2020 US prices) were: $27,380.74 (95% CI: [$4075.53, $50,685.96]) for societal, $24,195.52 (95% CI: [$9679.77, $38,711.27]) for health care system, and $7455.49 (95% CI: [$2271.45, $12,639.53]) for personal. Individuals with cognitive markers of functional independence limitations accounts for the largest mean costs per person across all perspectives. Variations across studies included: cost perspective, measures quantifying functional independence limitations, cost items reported, and time horizon. CONCLUSIONS This study sheds light on the importance of targeting cognitive markers of functional independence limitations as they accounted for the greatest costs across all economic perspectives.
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Affiliation(s)
- Ryan S Falck
- University of British Columbia, Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada.,University of British Columbia, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexis G Percival
- Applied Health Economics Laboratory, Faculty of Management, University of British Columbia - Okanagan, 1137 Alumni Avenue, Kelowna, BC, V1V 1V7, Canada
| | - Daria Tai
- University of British Columbia, Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada.,University of British Columbia, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- University of British Columbia, Centre for Hip Health and Mobility, Vancouver, British Columbia, Canada. .,Applied Health Economics Laboratory, Faculty of Management, University of British Columbia - Okanagan, 1137 Alumni Avenue, Kelowna, BC, V1V 1V7, Canada. .,Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada.
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11
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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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12
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Barha CK, Falck RS, Best JR, Nagamatsu LS, Hsiung GYR, Sheel AW, Hsu CL, Kramer AF, Voss MW, Erickson KI, Davis JC, Shoemaker JK, Boyd L, Crockett RA, Ten Brinke L, Bherer L, Singer J, Galea LAM, Jacova C, Bullock A, Grant S, Liu-Ambrose T. Reshaping the path of mild cognitive impairment by refining exercise prescription: a study protocol of a randomized controlled trial to understand the "what," "for whom," and "how" of exercise to promote cognitive function. Trials 2022; 23:766. [PMID: 36085237 PMCID: PMC9462619 DOI: 10.1186/s13063-022-06699-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Targeted exercise training is a promising strategy for promoting cognitive function and preventing dementia in older age. Despite the utility of exercise as an intervention, variation still exists in exercise-induced cognitive gains and questions remain regarding the type of training (i.e., what), as well as moderators (i.e., for whom) and mechanisms (i.e., how) of benefit. Both aerobic training (AT) and resistance training (RT) enhance cognitive function in older adults without cognitive impairment; however, the vast majority of trials have focused exclusively on AT. Thus, more research is needed on RT, as well as on the combination of AT and RT, in older adults with mild cognitive impairment (MCI), a prodromal stage of dementia. Therefore, we aim to conduct a 6-month, 2 × 2 factorial randomized controlled trial in older adults with MCI to assess the individual effects of AT and RT, and the combined effect of AT and RT on cognitive function and to determine the possible underlying biological mechanisms. Methods Two hundred and sixteen community-dwelling adults, aged 65 to 85 years, with MCI from metropolitan Vancouver will be recruited to participate in this study. Randomization will be stratified by biological sex and participants will be randomly allocated to one of the four experimental groups: (1) 4×/week balance and tone (BAT; i.e., active control); (2) combined 2×/week AT + 2×/week RT; (3) 2×/week AT + 2×/week BAT; or (4) 2×/week RT + 2×/week BAT. The primary outcome is cognitive function as measured by the Alzheimer’s Disease Assessment Scale-Cognitive-Plus. Secondary outcomes include cognitive function, health-related quality of life, physical function, actigraphy measures, questionnaires, and falls. Outcomes will be measured at baseline, 6 months (i.e., trial completion), and 18 months (i.e., 12-month follow-up). Discussion Establishing the efficacy of different types and combinations of exercise training to minimize cognitive decline will advance our ability to prescribe exercise as “medicine” to treat MCI and delay the onset and progression of dementia. This trial is extremely timely as cognitive impairment and dementia pose a growing threat to global public health. Trial registration ClinicalTrials.gov NCT02737878. Registered on April 14, 2016.
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Affiliation(s)
- Cindy K Barha
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, 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 (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - John R Best
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada.,Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada
| | - Lindsay S Nagamatsu
- Faculty of Health Sciences, School of Kinesiology, Western University, London, Ontario, Canada.,Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Ging-Yuek Robin Hsiung
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada.,Division of Neurology, UBC, Vancouver, British Columbia, Canada
| | - A William Sheel
- School of Kinesiology, UBC, Vancouver, British Columbia, Canada
| | - Chun Liang Hsu
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Arthur F Kramer
- Department of Psychology, Northeastern University, Boston, MA, USA.,Beckman Institute, University of Illinois, Urbana, IL, USA
| | - Michelle W Voss
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.,Iowa Neuroscience Institute, University of Iowa, IA, Iowa City, USA
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.,Neuroscience Research Institute, AdventHealth, Orlando, FL, USA
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Social and Economic Change Laboratory, Faculty of Management, UBC-Okanagan, Kelowna, Canada
| | - J Kevin Shoemaker
- Faculty of Health Sciences, School of Kinesiology, Western University, London, Ontario, Canada
| | - Lara Boyd
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada
| | - Rachel A Crockett
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Lisanne Ten Brinke
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Louis Bherer
- Department of Medicine, University of Montreal, Montreal, Quebec, Canada.,Research Centre, Montreal Heart Institute, Montreal, Quebec, Canada.,Research Center, Institut Universitaire de Geriatrie de Montréal, Montreal, Quebec, Canada
| | - Joel Singer
- School of Population and Public Health, UBC, Vancouver, British Columbia, Canada.,Providence Healthcare Research Institute, Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Liisa A M Galea
- Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada.,Department of Psychology, UBC, Vancouver, British Columbia, Canada
| | - Claudia Jacova
- School of Graduate Psychology, Pacific University, Hillsboro, OR, USA
| | - Alexis Bullock
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Sofia Grant
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada. .,Djavad Mowafaghian Centre for Brain Health, UBC, Vancouver, British Columbia, Canada. .,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
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13
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Tai D, Falck RS, Davis JC, Vint Z, Liu-Ambrose T. Can exercise training promote better sleep and reduced fatigue in people with chronic stroke? A systematic review. J Sleep Res 2022; 31:e13675. [PMID: 35762096 DOI: 10.1111/jsr.13675] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/23/2022] [Revised: 05/12/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022]
Abstract
Poor sleep and chronic fatigue are common in people with chronic stroke (i.e. ≥ 6 months post-stroke). Exercise training is a viable, low-cost therapy for promoting sleep and reducing fatigue; however, the effects of exercise on sleep and fatigue in people with chronic stroke are unclear. Thus, we conducted a systematic review ascertaining the effects of exercise on sleep and fatigue in people with chronic stroke. We systematically searched EMBASE, MEDLINE, AgeLine, the Cochrane Database of Systematic Reviews, CINAHL, SPORTDiscus, SCOPUS, and reference lists of relevant reviews for articles that examined the effects of exercise on sleep or fatigue in chronic stroke. Search results were limited to adults ≥ 18 years, randomized controlled trials, non-randomized trials, and pre-post studies, which were published in English and examined the effects of exercise on sleep or fatigue in people with chronic stroke. We extracted study characteristics and information on the measurement of sleep and fatigue, and assessed study quality and risk of bias using the CONSORT criteria and Cochrane risk-of-bias tool, respectively. We found two studies that examined the effects of exercise on sleep, and two that examined the effects of exercise on fatigue. All studies reported positive effects of exercise training on sleep and fatigue; however, there were concerns of bias and study quality in all studies. There is preliminary evidence that exercise promotes sleep and reduces fatigue in people with chronic stroke; however, the extent to which exercise impacts these health parameters is unclear.
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Affiliation(s)
- Daria Tai
- Aging, Mobility, and Cognitive Neuroscience Laboratory, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Social & Economic Change Laboratory, Faculty of Management, The University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Zackari Vint
- Aging, Mobility, and Cognitive Neuroscience Laboratory, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Balbim GM, Falck RS, Barha CK, Starkey SY, Bullock A, Davis JC, Liu-Ambrose T. Effects of exercise training on the cognitive function of older adults with different types of dementia: a systematic review and meta-analysis. Br J Sports Med 2022; 56:bjsports-2021-104955. [PMID: 35577539 DOI: 10.1136/bjsports-2021-104955] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect of exercise training on the cognitive function of older adults living with different types of dementia, as well as potential moderators of exercise efficacy. DESIGN Systematic review and meta-analysis. DATA SOURCES Cochrane Central, PsycINFO, Embase, Medline and CINAHL. ELIGIBILITY CRITERIA Peer-reviewed, randomised controlled trials, in English (1990-present), which examined the effects of exercise training on the cognitive function of older adults living with dementia. STUDY APPRAISAL AND SYNTHESIS Risk of bias and study quality were assessed (Cochrane Risk of Bias Tool 2.0 and Physiotherapy Evidence Database Scale). We performed random-effects models using robust variance estimation and tested moderators using the approximate Hotelling-Zhang test. RESULTS Twenty-eight studies (n=2158) were included in the qualitative review and 25 in the meta-analysis. For all-cause dementia, a small effect of exercise training on cognitive function was observed (g=0.19; 95% CI 0.05 to 0.33; p=0.009). Type of dementia and exercise training characteristics did not moderate the effects of exercise training on cognitive function (p>0.05). Adherence to the intervention moderated the cognitive outcome effect size such that greater mean adherence was associated with greater cognitive outcome effect sizes (b=0.02; SE=0.01; p=0.005). CONCLUSION Exercise training showed small benefits for the cognitive function of older adults living with all-cause dementia. More research and standardised reporting of exercise training characteristics can strengthen the evidence for what works best for which types of dementia. PROSPERO REGISTRATION NUMBER CRD42020198716.
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Affiliation(s)
- Guilherme Moraes Balbim
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
| | - Ryan S Falck
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- School of Biomedical Engineering, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Cindy K Barha
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samantha Y Starkey
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexis Bullock
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
- Faculty of Management, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, The University of British Columbia, Faculty of Medicine, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Research Institute, Vancouver, British Columbia, Canada
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Davis JC, Li EPH, Butterfield MS, DiLabio GA, Santhagunam N, Marcolin B. Are we failing female and racialized academics? A Canadian national survey examining the impacts of the COVID-19 pandemic on tenure and tenure-track faculty. Gend Work Organ 2022; 29:703-722. [PMID: 35601746 PMCID: PMC9111281 DOI: 10.1111/gwao.12811] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 05/26/2021] [Revised: 12/19/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
The novel coronavirus 2019 (COVID‐19) pandemic caused the abrupt curtailment of on‐campus research activities that amplified impacts experienced by female and racialized faculty. In this mixed‐method study, we systematically and strategically unpack the impact of the shift of academic work environments to remote settings on tenured and tenure‐track faculty in Canada. Our quantitative analysis demonstrated that female and racialized faculty experienced higher levels of stress, social isolation and lower well‐being. Fewer women faculty felt support for health and wellness. Our qualitative data highlighted substantial gender inequities reported by female faculty such as increased caregiving burden that affected their research productivity. The most pronounced impacts were felt among pre‐tenured female faculty. The present study urges university administration to take further action to support female and racialized faculty through substantial organizational change and reform. Given the disproportionate toll that female and racialized faculty experienced, we suggest a novel approach that include three dimensions of change: (1) establishing quantitative metrics to assess and evaluate pandemic‐induced impact on research productivity, health and well‐being, (2) coordinating collaborative responses with faculty unions across the nation to mitigate systemic inequities, and (3) strategically implementing a storytelling approach to amplify the experiences of marginalized populations such as women or racialized faculty and include those experiences as part of recommendations for change.
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Affiliation(s)
- Jennifer C Davis
- Social & Economic Change Laboratory University of British Columbia Kelowna British Columbia Canada.,Centre for Hip Health & Mobility Vancouver British Columbia Canada.,Faculty of Management University of British Columbia-Okanagan Kelowna British Columbia Canada
| | - Eric Ping Hung Li
- Social & Economic Change Laboratory University of British Columbia Kelowna British Columbia Canada.,Faculty of Management University of British Columbia-Okanagan Kelowna British Columbia Canada
| | - Mary Stewart Butterfield
- Social & Economic Change Laboratory University of British Columbia Kelowna British Columbia Canada.,Faculty of Management University of British Columbia-Okanagan Kelowna British Columbia Canada
| | - Gino A DiLabio
- Social & Economic Change Laboratory University of British Columbia Kelowna British Columbia Canada.,Department of Chemistry University of British Columbia Kelowna British Columbia Canada
| | - Nithi Santhagunam
- Social & Economic Change Laboratory University of British Columbia Kelowna British Columbia Canada.,Faculty of Management University of British Columbia-Okanagan Kelowna British Columbia Canada
| | - Barbara Marcolin
- Social & Economic Change Laboratory University of British Columbia Kelowna British Columbia Canada.,Faculty of Management University of British Columbia-Okanagan Kelowna British Columbia Canada
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16
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Davis JC, Hsu CL, Barha C, Jehu DA, Chan P, Ghag C, Jacova P, Adjetey C, Dian L, Parmar N, Madden K, Liu-Ambrose T. Comparing the cost-effectiveness of the Otago Exercise Programme among older women and men: A secondary analysis of a randomized controlled trial. PLoS One 2022; 17:e0267247. [PMID: 35442974 PMCID: PMC9020705 DOI: 10.1371/journal.pone.0267247] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objective Using stratified analyses, we examined the cost-effectiveness of the Otago Exercise Programme (OEP), from a health care system perspective, among older women and men who have previously fallen. Methods This study was a secondary stratified analysis (by women and men), of a 12-month prospective economic evaluation of a randomized clinical trial (OEP compared with usual care). Three hundred and forty four community-dwelling older adults (≥70; 172 OEP (110 women; 62 men), 172 usual care (119 women; 53 men)) who sustained a fall in the past 12 months and received a baseline assessment at the Vancouver Falls Prevention Clinic, Canada were included. A gender by OEP/usual care interaction was examined for the falls incidence rate ratio (IRR). Outcome measures stratified by gender included: falls IRR, incremental cost-per fall prevented (ICER), incremental cost per quality adjusted life year (QALY, ICUR) gained, and mean total health care resource utilization costs. Results Men were frailer than women at baseline. Men incurred higher mean total healthcare costs $6794 (SD: $11906)). There was no significant gender by OEP/usual care interaction on falls IRR. The efficacy of the OEP did not vary by gender. The adjusted IRR for the OEP group demonstrated a 39% (IRR: 0.61, CI: 0.40–0.93) significant reduction in falls among men but not women (32% reduction (IRR: 0.69, CI: 0.47–1.02)). The ICER showed the OEP was effective in preventing falls and less costly for men, while it was costlier for women by $42. The ICUR showed the OEP did not impact quality of life. Conclusion Future studies should explore gender factors (i.e., health seeking behaviours, gender related frailty) that may explain observed variation in the cost-effectiveness of the OEP as a secondary falls prevention strategy. Trial registrations ClinicalTrials.gov Protocol Registration System Identifier: NCT01029171; URL: https://clinicaltrials.gov/ct2/show/NCT01029171 Identifier: NCT00323596; URL: https://clinicaltrials.gov/ct2/show/NCT00323596
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Affiliation(s)
- Jennifer C. Davis
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia, Kelowna, British Columbia, Canada
- * E-mail:
| | - Chun Liang Hsu
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, Massachusetts, United States of America
| | - Cindy Barha
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Deborah A. Jehu
- Interdisciplinary Health Sciences Department, Augusta University, Augusta, Georgia, United States of America
| | - Patrick Chan
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Cheyenne Ghag
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Patrizio Jacova
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Cassandra Adjetey
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia, Kelowna, British Columbia, Canada
| | - Larry Dian
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naaz Parmar
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Madden
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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17
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Falck RS, Best JR, Davis JC, Barha CK, Khan KM, Liu-Ambrose T. Cardiometabolic risk, biological sex, and age do not share an interactive relationship with cognitive function: A cross-sectional analysis of the Canadian Longitudinal Study on Aging. Appl Physiol Nutr Metab 2021; 47:405-414. [PMID: 34898283 DOI: 10.1139/apnm-2021-0227] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
It is unclear whether cardiometabolic risk shares an interactive relationship with age-associated differences in cognition, and whether this relationship varies by biological sex. We conducted a cross-sectional analyses using baseline data from the Canadian Longitudinal Study on Aging (2010-2015) to examine whether: 1) cardiometabolic risk has an interactive relationship with age-associated cognition; and 2) interactive effects are sex-dependent. We measured memory, executive function, and verbal fluency in the Comprehensive cohort (n=25,830; 45-86 years). Each cognitive domain was modeled using restricted cubic splines for age and each cardiometabolic risk factor (HbA1c, HSCRP, TG, and LDL and HDL cholesterol). Sex was included as a predictor in all models. Wald chi-square statistics were used to determine the relative importance of age, cardiometabolic risk, sex, and their interactive effects on cognition. Age was the most important variable in each model (proportion χ2=34-48%). Biological sex was the second most important variable for memory (proportion χ2=26%), but was unimportant for executive function and verbal fluency (proportion χ2=3-5%). Cardiometabolic risk factors were unimportant predictors in each model (proportion χ2=1-3%). Two and three-way interactions between cardiometabolic risk, age, and sex were also unimportant (proportion χ2=0-2%). Thus, cardiometabolic risk factors did not meaningfully account for age-associated differences in cognition, and these associations (or lack thereof) did not vary by sex. Novelty: Males have poorer age-associated cognitive performance than females Females and males differ in cardiometabolic risk across middle and older adulthood Cardiometabolic risk has a small association with age-associated cognition, and there are no sex differences in this relationship.
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Affiliation(s)
- Ryan Stanley Falck
- The University of British Columbia, Physical Therapy, Vancouver, British Columbia, Canada;
| | - John R Best
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada;
| | - Jennifer C Davis
- Univ British Columbia, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada;
| | - Cindy K Barha
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada;
| | - Karim M Khan
- University of British Columbia, Vancouver, British Columbia, Canada;
| | - Teresa Liu-Ambrose
- University of British Columbia, Department of Physical Therapy, Vancouver, Canada.,University of British Columbia, Vancouver, Canada.,University of British Columbia, Vancouver, Canada;
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18
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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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19
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Santhagunam SN, Li EPH, Buschert K, Davis JC. A theoretical framework to improve adherence among older adults to recommendations received at a falls prevention clinic: A narrative review. Appl Nurs Res 2021; 62:151493. [PMID: 34814997 DOI: 10.1016/j.apnr.2021.151493] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Falls impose a prominent public health problem among older adults. Falls are preventable through multi-factorial interventions offered by a Falls Prevention Clinic. Yet, adherence to recommendations is often average or low, particularly for lifestyle recommendations. To achieve full health benefits from such a multifactorial intervention, improving adherence is critical. PURPOSE Our primary objective was to conduct a narrative review to develop a theoretical framework, categorized by intrinsic and extrinsic factors that impact adherence to falls prevention interventions, considering a Falls Prevention Clinic setting. MATERIALS AND METHODS We conducted a comprehensive literature review of all peer-reviewed manuscripts published between 1998 through August 2020 among older adults (i.e., aged 60 years and older) who fall. We used the following search engines: Pubmed, CINAHL, Embase, MedLine, Cochrane and Google Scholar. RESULTS The theoretical framework categorizes two dominate factors (comprised of specific domains) that affect adherence among older adults who fall. Intrinsic factors comprised of three domains included: demographics (age, gender, ethnicity), individual factors (participation, control, behavioural habits) and health factors (physical health, mental state, perceived severity). Extrinsic factors comprised of four domains included: caregiver factors (family dynamics, miscarried helping) medication factors (availability, accessibility, drug handling, reliability), health system (costs, communication, relationship with doctors, attention) and environmental factors (public health policy interventions). Intrinsic factors such as high socioeconomic status, high health literacy, being married and extrinsic factors such as low healthcare cost, better communication and useful policy interventions were associated with greater adherence. CONCLUSION This theoretical model elucidates priority factors to target for promoting adherence to reduce falls, decrease mortality and, lower fall-related healthcare costs.
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Affiliation(s)
- Shree Nithi Santhagunam
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Eric P H Li
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kim Buschert
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Jennifer C Davis
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada; Centre for Hip Health & Mobility, Vancouver, British Columbia, Canada. https://twitter.com/DrJenniferDav1
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20
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Jehu DA, Davis JC, Madden K, Parmar N, Liu-Ambrose T. Minimal Clinically Important Difference of Executive Function Performance in Older Adults Who Fall: A Secondary Analysis of a Randomized Controlled Trial. Gerontology 2021; 68:771-779. [PMID: 34657043 DOI: 10.1159/000518939] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/08/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Executive function is responsive to exercise and predictive of subsequent falls. Minimal clinically important differences (MCIDs) are critical for understanding whether observed changes are meaningful. However, MCIDs of many cognitive measures are not established. We aimed to determine MCIDs of the Digit Symbol Substitution Test ([DSST] processing speed measure), Stroop (inhibition measure), and Trail Making Test B-A (TMT; set-shifting measure), using anchor- and distribution-based approaches in older adults who have fallen and received the Otago Exercise Program (OEP) relative to usual care only (CON). Our secondary aim was to establish construct (convergent and divergent) validity of these measures. METHODS Complete case analyses of cognitive outcomes (DSST, Stroop, TMT, and Montreal Cognitive Assessment [MoCA]) were acquired at baseline and 1 year (NCT01029171; NCT003235960); participants were randomized to the OEP (n = 114/172; Age: 80.6 ± 6.1 years; 64.9% Female) or CON (n = 128/172; Age: 82.3 ± 5.8 years; 71.9% Female)]. The MoCA was used as the anchor. We estimated MCIDs using anchor- and distribution-based approaches. Anchor-based executive function change differences ([CD] 1 year minus baseline) observed in participants with meaningful changes in the MoCA (≥3 or ≤ -3 points) receiving the OEP were subtracted from the CON. An anchor-based receiver operator characteristic (ROC) curve was employed to identify optimal cut-off scores of the 3 executive function measures. The distribution-based approach (DA) accounted for variability in baseline and follow-up data. MCID ranges were estimated using these approaches. We used Spearman's correlations to explore convergent validity between executive function measures and other measures involving the same construct (DSST, Stroop, TMT, MoCA, and Mini-Mental State Examination), and divergent validity between executive function measures and variables reflecting different constructs (Geriatric Depression Scale, Instrumental Activities of Daily Living, sex, and body mass index). RESULTS Based on the 3 approaches, MCID improvement ranges were 3-5 symbols for the DSST (CD = 5; ROC = 2.5; DA = 3.3 symbols), and -11.5 to -26.0 s for the Stroop (CD = -26.0; ROC = -11.5; DA = -20.6 s). MCID decline ranges were -3 to -6 symbols for the DSST (CD = -5.2; ROC = -2.5; DA = -3.3 symbols) and 5.4-30.6 s for the Stroop (CD = 30.6; ROC = 5.4; DA = 20.6 s). MCIDs for the TMT were not meaningful due to high variability (Improvement: CD = -106.6; ROC = -18.4; DA = -69.1 s; Decline: CD = 69.1; ROC = 14.5; DA = 69.1 s). The executive function measures exhibited good convergent (r = -0.22 to r = 0.42) and divergent (r < -0.01 to r = 0.16) validity. CONCLUSIONS These established MCIDs will allow clinicians to interpret meaningful changes in executive function following exercise amongst older adults who have fallen. The DSST, Stroop, and TMT demonstrated good construct validity, supporting their use in comprehensive fall-risk assessments in older adults who fall.
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Affiliation(s)
- Deborah A Jehu
- Interdisciplinary Health Sciences Department, College of Allied Health Sciences, Augusta University, Augusta, Georgia, USA,
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kenneth Madden
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Gerontology and Diabetes Research Laboratory, Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naaz Parmar
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Falck RS, Davis JC, Li L, Stamatakis E, Liu-Ambrose T. Preventing the '24-hour Babel': the need for a consensus on a consistent terminology scheme for physical activity, sedentary behaviour and sleep. Br J Sports Med 2021; 56:367-368. [PMID: 34556466 PMCID: PMC8938678 DOI: 10.1136/bjsports-2021-104487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Ryan S Falck
- Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, The University of British Columbia, Kelowna, British Columbia, Canada
| | - Linda Li
- Department of Physical Therapy, Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuel Stamatakis
- School of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Teresa Liu-Ambrose
- Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
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22
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Liu-Ambrose T, Davis JC, Falck RS, Best JR, Dao E, Vesely K, Ghag C, Rosano C, Hsu CL, Dian L, Cook W, Madden KM, Khan KM. Exercise, Processing Speed, and Subsequent Falls: A Secondary Analysis of a 12-Month Randomized Controlled Trial. J Gerontol A Biol Sci Med Sci 2021; 76:675-682. [PMID: 33225343 DOI: 10.1093/gerona/glaa239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/16/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Strength and balance retraining exercises reduce the rate of subsequent falls in community-dwelling older adults who have previously fallen. Exercise can also improve cognitive function, including processing speed. Given processing speed predicts subsequent falls, we aimed to determine whether improved processing speed mediated the effects of the Otago Exercise Program on the rate of subsequent: (i) total falls, (ii) non-injurious falls, (iii) moderate injurious falls, and (iv) serious injurious falls. METHOD A secondary complete case analysis of a 12-month, single-blind, randomized clinical trial among 256 of 344 adults aged at least 70 years who fell in the previous 12 months. Participants were randomized 1:1 to receive usual care plus the Otago Exercise Program (n = 123) or usual care (n = 133), consisting of fall prevention care provided by a geriatrician. The primary outcome was self-reported number of falls over 12 months (ie, rate of falls). Processing speed was assessed at baseline and at 12 months by the Digit Symbol Substitution Test (DSST). Causal mediation analyses were conducted using quasi-Bayesian estimates and 95% confidence intervals. RESULTS Exercise significantly reduced the rate of subsequent moderate injurious falls (IRR = 0.49; 95% CI: 0.31, 0.77; p = .002) and improved processing speed (estimated mean difference: 1.16 points; 95% CI: 0.11, 2.21). Improved DSST mediated the effect of exercise on the rate of subsequent moderate injurious falls (estimate: -0.06; 95% CI: -0.15, -0.001; p = .036). CONCLUSION Improved processing speed may be a mechanism by which exercise reduces subsequent moderate injurious falls in older adults who fell previously. CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov Protocol Registration System:NCT01029171: https://clinicaltrials.gov/ct2/show/NCT01029171NCT00323596: https://clinicaltrials.gov/ct2/show/NCT00323596.
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Affiliation(s)
- Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Social & Economic Change Laboratory, Faculty of Management, University of British Columbia, Kelowna, Canada
| | - Ryan S Falck
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - John R Best
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Elizabeth Dao
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Kristin Vesely
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Cheyenne Ghag
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Caterina Rosano
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - C L Hsu
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada
| | - Larry Dian
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Wendy Cook
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kenneth M Madden
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, British Columbia, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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23
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Jehu DA, Davis JC, Barha CK, Vesely K, Cheung W, Ghag C, Liu-Ambrose T. Sex Differences in Subsequent Falls and Falls Risk: A Prospective Cohort Study in Older Adults. Gerontology 2021; 68:272-279. [PMID: 34186535 DOI: 10.1159/000516260] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/18/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sex differences for subsequent falls and falls risk factors in community-dwelling older adults who have fallen are unknown. Our aim was to: (1) compare the number of falls between sexes, (2) identify modifiable falls risk factors, and (3) explore the interaction of sex on falls risk factors in older adults who fall. METHODS Four hundred sixty-two community dwellers seeking medical attention after an index fall were recruited from the Vancouver Falls Prevention Clinic and participated in this 12-month prospective cohort study. Ninety-six participants were part of a randomized controlled trial of exercise. Falls were tracked with monthly falls calendars. Demographics, falls risk measures, and the number of subsequent falls were compared between sexes. A principal component analysis (PCA) was employed to reduce the falls risk measures to a smaller set of factors. The PCA factors were used in negative binomial regression models to predict the number of subsequent falls. Age, exposure time (i.e., number of falls monitoring days), and prescribed exercise (yes/no) were used as covariates, and sex (male/female) and PCA factors were used as main effects. The interaction of sex by PCA factor was then included. RESULTS Males fell more over 12 months (males: 2.80 ± 6.86 falls; females: 1.25 ± 2.63 falls) than females, and poorer executive function predicted falls in males. Four PCA factors were defined - impaired cognition and mobility, low mood and self-efficacy, mobility resilience, and perceived poor health - each predicted the number of falls. The sex by mobility resilience interaction suggested that mobility resilience was less protective of falls in males. CONCLUSION Modifiable risk factors related to cognition, physical function, psychological wellbeing, and health status predicted subsequent falls. In males, better mobility was not as protective of falls compared with females. This may be due to males' poorer executive function, contributing to decreased judgement or slowed decision-making during mobility. These results may inform efficacious sex-specific falls prevention strategies.
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Affiliation(s)
- Deborah A Jehu
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - Cindy K Barha
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Kristin Vesely
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Winnie Cheung
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Cheyenne Ghag
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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Falck RS, Davis JC, Best JR, Chan PCY, Li LC, Wyrough AB, Bennett KJ, Backhouse D, Liu-Ambrose T. Effect of a Multimodal Lifestyle Intervention on Sleep and Cognitive Function in Older Adults with Probable Mild Cognitive Impairment and Poor Sleep: A Randomized Clinical Trial. J Alzheimers Dis 2021; 76:179-193. [PMID: 32444553 DOI: 10.3233/jad-200383] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Poor sleep is common among older adults with mild cognitive impairment (MCI) and may contribute to further cognitive decline. Whether multimodal lifestyle intervention that combines bright light therapy (BLT), physical activity (PA), and good sleep hygiene can improve sleep in older adults with MCI and poor sleep is unknown. OBJECTIVE To assess the effect of a multimodal lifestyle intervention on sleep in older adults with probable MCI and poor sleep. METHODS This was a 24-week proof-of-concept randomized trial of 96 community-dwelling older adults aged 65-85 years with probable MCI (<26/30 on the Montreal Cognitive Assessment) and poor sleep (>5 on the Pittsburgh Sleep Quality Index [PSQI]). Participants were allocated to either a multimodal lifestyle intervention (INT); or 2) education + attentional control (CON). INT participants received four once-weekly general sleep hygiene education classes, followed by 20-weeks of: 1) individually-timed BLT; and 2) individually-tailored PA promotion. Our primary outcome was sleep efficiency measured using the MotionWatch8© (MW8). Secondary outcomes were MW8-measured sleep duration, fragmentation index, wake-after-sleep-onset, latency, and PSQI-measured subjective sleep quality. RESULTS There were no significant between-group differences in MW8 measured sleep efficiency at 24-weeks (estimated mean difference [INT -CON]: 1.18%; 95% CI [-0.99, 3.34]), or any other objective-estimate of sleep. However, INT participants reported significantly better subjective sleep quality at 24-weeks (estimated mean difference: -1.39; 95% CI [-2.72, -0.06]) compared to CON. CONCLUSION Among individuals with probable MCI and poor sleep, a multimodal lifestyle intervention improves subjective sleep quality, but not objectively estimated sleep.
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Affiliation(s)
- Ryan S Falck
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada
| | - John R Best
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick C Y Chan
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Arthritis Research Canada, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne B Wyrough
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly J Bennett
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Backhouse
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute. University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Liu-Ambrose T, Dao E, Crockett RA, Barha CK, Falck RS, Best JR, Hsiung GYR, Field TS, Madden KM, Alkeridy WA, Boa Sorte Silva NC, Davis JC, Ten Brinke LF, Doherty S, Tam RC. Reshaping the path of vascular cognitive impairment with resistance training: a study protocol for a randomized controlled trial. Trials 2021; 22:217. [PMID: 33736706 PMCID: PMC7971404 DOI: 10.1186/s13063-021-05156-1] [Citation(s) in RCA: 4] [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: 11/16/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Subcortical ischemic vascular cognitive impairment (SIVCI) is the most common form of vascular cognitive impairment. Importantly, SIVCI is considered the most treatable form of cognitive impairment in older adults, due to its modifiable risk factors such as hypertension, diabetes mellitus, and hypercholesterolemia. Exercise training is a promising intervention to delay the progression of SIVCI, as it actively targets these cardiometabolic risk factors. Despite the demonstrated benefits of resistance training on cognitive function and emerging evidence suggesting resistance training may reduce the progression of white matter hyperintensities (WMHs), research on SIVCI has predominantly focused on the use of aerobic exercise. Thus, the primary aim of this proof-of-concept randomized controlled trial is to investigate the efficacy of a 12-month, twice-weekly progressive resistance training program on cognitive function and WMH progression in adults with SIVCI. We will also assess the efficiency of the intervention. Methods Eighty-eight community-dwelling adults, aged > 55 years, with SIVCI from metropolitan Vancouver will be recruited to participate in this study. SIVCI will be determined by the presence of cognitive impairment (Montreal Cognitive Assessment < 26) and cerebral small vessel disease using computed tomography or magnetic resonance imaging. Participants will be randomly allocated to a twice-weekly exercise program of (1) progressive resistance training or (2) balance and tone training (i.e., active control). The primary outcomes are cognitive function measured by the Alzheimer’s Disease Assessment Scale-Cognitive-Plus (ADAS-Cog-13 with additional cognitive tests) and WMH progression. Discussion The burden of SIVCI is immense, and to our knowledge, this will be the first study to quantify the effect of progressive resistance training on cognitive function and WMH progression among adults with SIVCI. Slowing the rate of cognitive decline and WMH progression could preserve functional independence and quality of life. This could lead to reduced health care costs and avoidance of early institutional care. Trial registration ClinicalTrials.gov NCT02669394. Registered on February 1, 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05156-1.
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Affiliation(s)
- Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada. .,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada. .,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - Elizabeth Dao
- Department of Radiology, UBC, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - Rachel A Crockett
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Cindy K Barha
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, 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 (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, 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 (UBC), Vancouver, British Columbia, Canada.,Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada.,Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada.,Department of Psychiatry, UBC, Vancouver, British Columbia, Canada
| | - Ging-Yeuk R Hsiung
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Division of Neurology, UBC, Vancouver, British Columbia, Canada
| | - Thalia S Field
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Division of Neurology, UBC, Vancouver, British Columbia, Canada.,Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Kenneth M Madden
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Division of Geriatric Medicine, Department of Medicine, UBC, Vancouver, British Columbia, Canada
| | - Walid A Alkeridy
- Division of Neurology, UBC, Vancouver, British Columbia, Canada.,Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Narlon C Boa Sorte Silva
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.,Social and Economic Change Laboratory, Faculty of Management, UBC-Okanagan, Kelowna, British Columbia, Canada
| | - Lisanne F Ten Brinke
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Stephanie Doherty
- Department of Physical Therapy, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Roger C Tam
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada.,Department of Radiology, UBC, Vancouver, British Columbia, Canada.,School of Biomedical Engineering, UBC, Vancouver, British Columbia, Canada
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Davis JC, Rhodes RE, Khan KM, Mansournia MA, Khosravi A, Chan P, Zhao M, Jehu DA, Liu-Ambrose T. Cognitive Function and Functional Mobility Predict Exercise Adherence in Older Adults Who Fall. Gerontology 2021; 67:350-356. [PMID: 33631742 DOI: 10.1159/000513452] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Strength and balance exercises prevent falls. Yet, exercise adherence is often low. To maximize the benefit of exercise on falls prevention, we aimed to identify baseline cognitive and mobility factors that predict adherence to the Otago Exercise Program (OEP) - a home-based exercise program proven to prevent falls. METHODS We conducted a secondary longitudinal analysis of data from a randomized clinical trial (RCT) (OEP compared with usual care) among 172 participants who were assigned to the OEP intervention of the RCT. Adherence to the OEP was calculated as a percent score (i.e., [frequency of strength and balance retraining session per week/3 strength and balance retraining sessions per week] × 100). Executive function (i.e., mental flexibility) was measured using the Trail Making Tests (Part A and B: TMT B - TMT A) and the Digit Symbol Substitution Test (DSST). Short-term memory and encoding was measured using the Verbal Digits Forward test. Executive function (i.e., inhibition and working memory) was measured using the Stroop Color-Word Test and the Verbal Digits Forward minus Verbal Digits Backward test. Mobility was assessed using the Short Performance Physical Battery and the Timed Up and Go test. We used general estimation equations analysis to determine the predictors of adherence to the OEP. RESULTS Better set shifting (β = -0.06, z = -2.43, [SE = 0.02] p = 0.018] predicted greater OEP adherence. Greater attention and short-term memory (β = -6.99, z = -2.37 [SE = 2.95]) predicted poorer OEP adherence. Response inhibition, processing speed, working memory, and mobility assessed by the SPPB were not associated with adherence. Poorer baseline Timed Up and Go (β = 1.48 z = 1.94, [SE = 0.76]; p < 0.001), predicted better OEP adherence. CONCLUSION Specific cognitive processes (i.e., executive function of set shifting, attention, and short-term memory) and functional mobility predicted exercise adherence. Further research needs to explore the pathways that explain why better attention and short-term memory predicted lower adherence and why poorer functional mobility led to better OEP adherence.
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Affiliation(s)
- Jennifer C Davis
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada, .,Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada,
| | - Ryan E Rhodes
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Behavioural Medicine Laboratory, School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Karim M Khan
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Khosravi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Patrick Chan
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Zhao
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Deborah A Jehu
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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27
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Falck RS, Crockett RA, Davis JC, Khan KM, Liu-Ambrose T. Shining the Light on the MotionWatch8 Light Sensor for Sleep and Aging Research: What Can We Measure and What Are We Missing? J Alzheimers Dis Rep 2021; 5:55-63. [PMID: 33681717 PMCID: PMC7903008 DOI: 10.3233/adr-200242] [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] [Indexed: 01/17/2023] Open
Abstract
Background Poor sleep is common among older adults at risk for dementia and may be due to circadian dysregulation. Light is the most important external stimulus to the circadian clock and bright light therapy (BLT) has been used for >20 years to help realign circadian rhythms. However, the ability of field methods (e.g., actigraphy) to accurately determine the type and intensity of light is unknown. Objective We examined the ability of the MotionWatch8 (MW8) light sensor to determine: 1) light versus dark, 2) electrical light versus daylight, and 3) device-based BLT versus light which was not BLT. Methods We tested the MW8 under 17 daily light scenarios. Light exposure data was collected for 5 minutes during each scenario. Concurrently, we measured light exposure using the LT40 Light Meter, a sensitive measure of light intensity. We then developed individual cut-points using receiver operator characteristics analyses to determine optimal MW8 cut-points for 1) light versus dark; 2) electrical light versus daylight; and 3) light from a BLT box versus light which was not BLT. Bland-Altman plots tested the precision of the MW8 compared to the LT40. Results The MW8 accurately discriminated light versus dark (>32 lux), and electrical light versus daylight (<323 lux). However, the MW8 had poor accuracy for 1) discriminating BLT from light which was not BLT; and 2) low precision compared to the LT40. Conclusion The MW8 appears to be able to discern light versus dark and electrical light versus daylight; however, there remains a need for accurate field methods capable of measuring light exposure.
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Affiliation(s)
- Ryan S Falck
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Rachel A Crockett
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer C Davis
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.,Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, BC, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.,Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
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28
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van Schooten KS, Taylor ME, Close JCT, Davis JC, Paul SS, Canning CG, Latt MD, Hoang P, Kochan NA, Sachdev PS, Brodaty H, Dean CM, Hulzinga F, Lord SR, Delbaere K. Sensorimotor, Cognitive, and Affective Functions Contribute to the Prediction of Falls in Old Age and Neurologic Disorders: An Observational Study. Arch Phys Med Rehabil 2020; 102:874-880. [PMID: 33253696 DOI: 10.1016/j.apmr.2020.10.134] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether impairments across cognitive and affective domains provide additional information to sensorimotor deficits for fall prediction among various populations. DESIGN We pooled data from 5 studies for this observational analysis of prospective falls. SETTING Community or low-level care facility. PARTICIPANTS Older people (N=1090; 74.0±9.4y; 579 female); 500 neurologically intact (NI) older people and 3 groups with neurologic disorders (cognitive impairment, n=174; multiple sclerosis (MS), n=111; Parkinson disease, n=305). INTERVENTIONS None. MAIN OUTCOME MEASURES Sensorimotor function was assessed with the Physiological Profile Assessment, cognitive function with tests of executive function, affect with questionnaires of depression, and concern about falling with falls efficacy questionnaires. These variables were associated with fall incidence rates, obtained prospectively over 6-12 months. RESULTS Poorer sensorimotor function was associated with falls (incidence rate ratio [95% CI], 1.46 [1.28-1.66]). Impaired executive function was the strongest predictor of falls overall (2.91 [2.27-3.73]), followed by depressive symptoms (2.07 [1.56-2.75]) and concern about falling (2.02 [1.61-2.55]). Associations were similar among groups, except for a weaker relationship with executive impairment in NI persons and a stronger relationship with concern about falling in persons with MS. Multivariable analyses showed that executive impairment, poorer sensorimotor performance, depressive symptoms, and concern about falling were independently associated with falls. CONCLUSIONS Deficits in cognition (executive function) and affect (depressive symptoms) and concern about falling are as important as sensorimotor function for fall prediction. These domains should be included in fall risk assessments for older people and clinical groups.
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Affiliation(s)
- Kimberley S van Schooten
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Morag E Taylor
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, Australia
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Serena S Paul
- Faculty of Health Sciences, University of Sydney, Sydney Lidcombe, Sydney, New South Wales, Australia
| | - Colleen G Canning
- Faculty of Health Sciences, University of Sydney, Sydney Lidcombe, Sydney, New South Wales, Australia
| | - Mark D Latt
- Geriatric Medicine Department, University of Sydney, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| | - Phu Hoang
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, New South Wales, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Dementia Centre for Research Collaboration, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Catherine M Dean
- Department of Health Professions, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, Sydney, New South Wales, Australia
| | - Femke Hulzinga
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; Department of Rehabilitation Sciences, Biomedical Sciences Group, KU Leuven University, Leuven, Belgium
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
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29
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Jehu DA, Davis JC, Falck RS, Bennett KJ, Tai D, Souza MF, Cavalcante BR, Zhao M, Liu-Ambrose T. Risk factors for recurrent falls in older adults: A systematic review with meta-analysis. Maturitas 2020; 144:23-28. [PMID: 33358204 DOI: 10.1016/j.maturitas.2020.10.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [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: 08/19/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 01/05/2023]
Abstract
Older adults who fall recurrently (i.e., 2 or more falls/year) are at risk of functional decline and mortality. Understanding which risk factors for recurrent falls are most important will inform secondary fall prevention strategies that can reduce recurrent falls risk. Thus, we conducted a systematic review with meta-analysis to determine the relative risk of recurrent falls for different types of falls risk factors. MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched on April 25, 2019 (Prospero Registration: CRD42019118888). We included peer-reviewed prospective studies which examined risk factors that contributed to recurrent falls in adults aged ≥ 60 years. Using the falls risk classification system of Lord and colleagues, we classified each risk factor into one of the following domains: 1) balance and mobility; 2) environmental; 3) psychological; 4) medical; 5) medication; 6) sensory and neuromuscular; or 7) sociodemographic. We calculated the summary relative risk (RR) for each domain and evaluated the risk of bias and quality of reporting. Twenty-two studies were included in this systematic review and meta-analysis. Four domains predicted recurrent falls: balance and mobility (RR:1.32;95 % CI:[1.10, 1.59]), medication (RR:1.53;95 % CI:[1.11, 2.10]), psychological (RR:1.35;95 % CI:[1.03, 1.78]), and sensory and neuromuscular (RR:1.51;95 % CI:[1.18, 1.92]). Each of these four domains can be viewed as a marker of frailty. The risk of bias was low, and the study quality was high (minimum:19/22). Older adults with markers of frailty are up to 53 % more likely to experience recurrent falls. Strategies that identify and resolve frailty markers should be a frontline approach to preventing recurrent falls.
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Affiliation(s)
- D A Jehu
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - J C Davis
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada.
| | - R S Falck
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - K J Bennett
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - D Tai
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - M F Souza
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Universidade Federal do Vale do São Francisco, UNIVASF, Clinical Exercise Lab, LABEC, Department of Physical Education, Petrolina, PE, Brazil.
| | - B R Cavalcante
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Associated Graduate Program in Physical Education, University of Pernambuco, Recife, Brazil.
| | - M Zhao
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
| | - T Liu-Ambrose
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
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Martin Ginis KA, van der Scheer JW, Todd KR, Davis JC, Gaudet S, Hoekstra F, Karim ME, Kramer JLK, Little JP, Singer J, Townson A, West CR. A pragmatic randomized controlled trial testing the effects of the international scientific SCI exercise guidelines on SCI chronic pain: protocol for the EPIC-SCI trial. Spinal Cord 2020; 58:746-754. [PMID: 32409778 DOI: 10.1038/s41393-020-0478-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Protocol for a pragmatic randomized controlled trial (the Exercise guideline Promotion and Implementation in Chronic SCI [EPIC-SCI] Trial). PRIMARY OBJECTIVES To test if home-/community-based exercise, prescribed according to the international SCI exercise guidelines, significantly reduces chronic bodily pain in adults with SCI. SECONDARY OBJECTIVES To investigate: (1) the effects of exercise on musculoskeletal and neuropathic chronic pain; (2) if reduced inflammation and increased descending inhibitory control are viable pathways by which exercise reduces pain; (3) the effects of chronic pain reductions on subjective well-being; and (4) efficiency of a home-/community-based exercise intervention. SETTING Exercise in home-/community-based settings; assessments in university-based laboratories in British Columbia, Canada. METHOD Eighty-four adults with chronic SCI, reporting chronic musculoskeletal or neuropathic pain, and not meeting the current SCI exercise guidelines, will be recruited and randomized to a 6-month Exercise or Wait-List Control condition. Exercise will occur in home/community settings and will be supported through behavioral counseling. All measures will be taken at baseline, 3-months and 6-months. Analyses will consist of linear mixed effect models, multiple regression analyses and a cost-utility analysis. The economic evaluation will examine the incremental costs and health benefits generated by the intervention compared with usual care. ETHICS AND DISSEMINATION The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-01650). Using an integrated knowledge translation approach, stakeholders will be engaged throughout the trial and will co-create and disseminate evidence-based recommendations and messages regarding the use of exercise to manage SCI chronic pain.
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Affiliation(s)
- Kathleen A Martin Ginis
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada.
| | - Jan W van der Scheer
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Kendra R Todd
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Jennifer C Davis
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Social & Economic Change Laboratory, Faculty of Management; Centre for Hip Health and Mobility, University of British Columbia, Kelowna, BC, Canada
| | - Sonja Gaudet
- Spinal Cord Injury British Columbia, Vancouver, BC, Canada
- The Thompson Okanagan Tourism Association; Canadian Paralympic Committee Alumni/3 X Paralympic Gold Medalist, Vernon, BC, Canada
| | - Femke Hoekstra
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health and Centre for Health Evaluation and Outcome Sciences, Providence Health Care, University of British Columbia, Vancouver, BC, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Jonathan Peter Little
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Joel Singer
- School of Population and Public Health, UBC; Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Andrea Townson
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Christopher R West
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
- Department of Cell & Physiological Sciences, Faculty of Medicine, Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
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Davis JC, Khan KM, Hsu CL, Chan P, Cook WL, Dian L, Liu-Ambrose T. Action Seniors! Cost-Effectiveness Analysis of a Secondary Falls Prevention Strategy Among Community-Dwelling Older Fallers. J Am Geriatr Soc 2020; 68:1988-1997. [PMID: 32472567 DOI: 10.1111/jgs.16476] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The Otago Exercise Program (OEP) has demonstrated cost-effectiveness for the primary prevention of falls in a general community setting. The cost-effectiveness of exercise as a secondary falls prevention (ie, preventing falls among those who have already fallen) strategy remains unknown. The primary objective was to estimate the cost-effectiveness (incremental cost-effectiveness/utility ratio) of the OEP from a healthcare system perspective. DESIGN A concurrent 12-month prospective economic evaluation conducted alongside the Action Seniors! randomized critical trial (OEP compared with usual care). SETTING Vancouver Falls Prevention Clinic (Vancouver, BC, Canada; http://www.fallsclinic.ca). PARTICIPANTS A total of 344 community-dwelling older adults, aged 70 years and older, who attended a geriatrician-led Falls Prevention Clinic in Vancouver, after sustaining a fall in the previous 12 months. MEASUREMENTS Main outcome measures included: incidence rate ratio for falls, healthcare costs, incremental cost per fall prevented, and incremental cost per quality-adjusted life year (QALY) gained. RESULTS The OEP costs $393 CAD per participant to implement. The incremental cost per fall prevented resulted in a savings of $2 CAD. The incremental cost per QALY gained (where QALYs were estimated using the Euro-Qol 5D three-level version [EQ-5D-3L]) indicated the OEP was less effective than usual care. The incremental cost per QALY gained (where QALYs were estimated using the Short Form 6D [SF-6D]) indicated the OEP was more effective and less costly than usual care. The incremental QALYs estimated using the EQ-5D-3L and the SF-6D were not clinically significant and close to zero, indicating no change in quality of life. CONCLUSION Compared with usual care, healthcare system costs are saved and falls are prevented when older fallers who attend a geriatrician-led falls clinic are allocated to, and provided, the physiotherapist-guided exercise-based falls prevention program (the OEP).
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Affiliation(s)
- Jennifer C Davis
- Social and Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chun Liang Hsu
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Patrick Chan
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy L Cook
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry Dian
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.,Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
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Abstract
INTRODUCTION Older adults who fall recurrently (i.e., >1 fall/year) are at risk for functional decline and mortality. Key risk factors for recurrent falls in community-dwelling older adults are not well established due to methodological limitations, such as recall bias. A better understanding of the risk factors for recurrent falls will aid in refining clinical practice guidelines for secondary fall prevention strategies. The primary objective of this systematic review with meta-analysis is to examine the risk factors for recurrent falls in prospective studies among community-dwelling older adults. METHODS AND ANALYSIS A comprehensive search for articles indexed in MEDLINE, EMBASE, PsycINFO and CINAHL databases as well as grey literature was conducted on April 25, 2019. We will use MeSH and keyword search terms around the following topics: falls, recurrence, fall-risk, ageing and prospective studies. Prospective studies with monthly falls monitoring for 12 months, investigating risk factors for recurrent falls in older adults will be included. One author will complete the search. Two authors will remove duplicates and screen the titles and abstracts for their potential inclusion against the eligibility criteria. Two authors will screen the full texts and extract the data using a piloted extraction sheet. Included studies will be evaluated for the risk of bias with the Joanna Briggs Institute Prevalence Critical Appraisal tools. The quality of reporting will be determined with the Strengthening the Reporting of OBservational studies in Epidemiology. The data extraction will include study characteristics as well as sociodemographic, balance and mobility, sensory and neuromuscular, psychological, medical, medication and environmental factors. The results will be presented via figures, summary tables, meta-analysis (when possible) and narrative summaries. ETHICS AND DISSEMINATION No ethics approval will be required. Findings will be disseminated through publication and media. PROSPERO REGISTRATION NUMBER CRD42019118888; Pre-results.
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Affiliation(s)
- Deborah A Jehu
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, 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
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Bjerk M, Brovold T, Davis JC, Skelton DA, Bergland A. Health-related quality of life in home care recipients after a falls prevention intervention: a 6-month follow-up. Eur J Public Health 2020; 30:64-69. [PMID: 31169888 DOI: 10.1093/eurpub/ckz106] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Falls in older adults are an increasingly important public health concern due to the expanding older population and contribute considerably to the global burden of disease. Home care recipients have a high incidence of falls and a low level of health-related quality of life (HRQOL). In this understudied group of older adults, exercise interventions could prevent falls, promote HRQOL and enable healthy ageing in the longer term. METHODS The study is a single-blinded parallel-group randomized controlled trial, lasting 3 months with a follow-up at 6 months, conducted in primary care. The objective was to explore the effects of a falls prevention exercise programme post-intervention at a 6-month follow-up in home care recipients 67+ years with a history of falls. The Otago Exercise Programme lasting 3 months was performed. The primary outcome was HRQOL measured by the Short Form 36 Health Survey (SF-36). Linear mixed regression models and structural equation models were employed. RESULTS At 6-month follow-up, the intervention group scored significantly higher on SF-36's physical component summary compared with the controls; 3.0 points, 95% confidence interval (CI) = 0.4, 5.6. This effect was mediated by an increased probability of maintaining exercise in the post-intervention period; odds ratio = 2.3 (CI = 1.1, 5.1). Exercising was associated with a 7.1-point increase in physical component summary (CI = 3.2, 10.9). CONCLUSION A falls prevention exercise programme can improve physical HRQOL in home care recipients post-intervention. The exercise programme also led to longer-term changes in exercise behaviour mediating this effect.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Therese Brovold
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia, Vancouver, BC, Canada
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
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Tai D, Li E, Liu-Ambrose T, Bansback N, Sadatsafavi M, Davis JC. Patient-Reported Outcome Measures (PROMs) to Support Adherence to Falls Prevention Clinic Recommendations: A Qualitative Study. Patient Prefer Adherence 2020; 14:2105-2121. [PMID: 33154634 PMCID: PMC7608137 DOI: 10.2147/ppa.s269202] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/27/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE We examined how patient-reported outcome measures (PROMs) support patients' adherence to fall prevention recommendations in a novel primary care setting - the Falls Prevention Clinic. PATIENTS AND METHODS Using a patient-oriented qualitative study design, we recruited patient partners to our study team to assist in developing focus group prompts. A trained facilitator conducted five semi-structured interviews with a total of 21 Falls Prevention Clinic participants. A trained facilitator prompted participants about: their views on the EuroQol 5 domain - 5 level (EQ-5D-5L) PROM, their preferences for PROM administration and feedback, the presentation of PROM questionnaire data, the use of comparative data and the EQ-5D-5L in improving adherence to recommendations, and other information they would need to improve adherence. Participants' responses were coded according to three stages of qualitative analysis: open, axial and selective coding using an iterative and comparative approach. RESULTS "Opportunity" and "Development" emerged as higher-level themes for the participants' perspectives on how the EQ-5D-5L may be helpful for their appointments. "Frequency" described how often the participants believed the EQ-5D-5L should be administered and feedback provided. "Challenges", "Benefits", "Patients' Understanding", "Relevance of Data", and "Usefulness of Data" provided insight on how PROMs data presentation was viewed by patients. "Performance", "Resources", "Knowledge", "Role in Behaviour Change" highlighted the participants' ideas for the role of the EQ-5D-5L and additional information in supporting their adherence to falls prevention recommendations. Participants emphasized that patients would value further support information to facilitate their adherence. CONCLUSION This patient-oriented qualitative study, among individuals at high risk of future falls, sheds light on the importance of timely, understandable feedback, integrated with other clinical feedback in supporting adherence.
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Affiliation(s)
- Daria Tai
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia – Okanagan, Kelowna, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Li
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia – Okanagan, Kelowna, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia – Vancouver, Vancouver, British Columbia, Canada
- Centre for Health Evaluation & Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia – Vancouver, Vancouver, British Columbia, Canada
- Collaboration for Outcomes Research and Evaluation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Social & Economic Change Laboratory, Faculty of Management, University of British Columbia – Okanagan, Kelowna, British Columbia, Canada
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Correspondence: Jennifer C Davis Faculty of Management, The University of British Columbia – Okanagan, 1137 Alumni Avenue, Kelowna, BCV1V 1V7, CanadaTel +1 250 807 9507 Email
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Jehu DA, Davis JC, Velsey K, Cheung W, Liu-Ambrose T. ABILITY OF THE PHYSIOLOGICAL PROFILE ASSESSMENT TO CLASSIFY FALLER TYPE: A PROSPECTIVE COHORT STUDY. Innov Aging 2019. [PMCID: PMC6840300 DOI: 10.1093/geroni/igz038.1757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Accurately identifying older adults who will experience subsequent falls is important for the provision of secondary fall prevention. The purpose of this study was to determine the accuracy of the Physiological Profile Assessment (PPA) – a valid and reliable fall-risk assessment [1] – in predicting subsequent falls over a 12-month period in older adults who sought for medical attention after an index fall. Seven hundred thirty-seven community-dwelling adults, aged 70 years and older, who were seen at the Vancouver General Hospital Fall Prevention Clinic, completed the PPA at their initial visit. Falls over the subsequent 12 months were tracked prospectively via monthly falls calendars. All individuals received geriatric care at baseline. Binary logistic regressions were performed to determine the accuracy of classifying two prospective faller types: 1) no additional falls; 2) one or more additional fall(s). Baseline PPA, age, and sex were entered as independent variables. During the 12 month observation period, 345 participants had no additional falls (Age:81.3±6.6yrs;Female=251) and 392 fell one or more times (Age:82.3±6.5yrs;Female=230). The classification accuracy was 51.3% for those who had no additional falls and 64.8% for those with one or more additional fall(s) (Overall:58.5%;χ2=29.0;PPA:β=-0.21;Age:β=-0.01;Sex:β=-60). The PPA was not able to accurately differentiate between those who did and did not subsequently fall. Fall-risk assessment sensitivity and specificity should be improved in older adults seeking medical attention following an index fall to inform secondary fall prevention. [1] Lord SR, et al., 2003. Phys Ther.
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Affiliation(s)
- Deborah A Jehu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Kristin Velsey
- University of British Columbia, Vancouver, Canada, Canada
| | - Winnie Cheung
- University of British Columbia, Vancouver, British Columbia, Canada
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Falck RS, Best JR, Davis JC, Chan P, Backhouse D, Landry GJ, Liu-Ambrose T. MULTIMODAL PERSONALIZED CHRONOTHERAPY IMPROVES SLEEP IN ADULTS WITH MILD COGNITIVE IMPAIRMENT: A RANDOMIZED TRIAL. Innov Aging 2019. [PMCID: PMC6840131 DOI: 10.1093/geroni/igz038.1342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Poor sleep is common among older adults with Mild Cognitive Impairment (MCI) and may contribute to their increased risk for dementia. Chronotherapy is a set of intervention strategies which can improve sleep quality by strengthening the entrainment of the biological clock to the solar light-dark cycle, and includes strategies such as: 1) bright light therapy (BLT); 2) physical activity (PA); and 3) good sleep hygiene. Thus, in this 24-week randomized controlled trial (RCT; NCT02926157), we aimed to examine the efficacy of a multimodal, personalized chronotherapy intervention to improve sleep quality among older adults with MCI. Ninety-six older adults (65+ years) with MCI were randomized to either: 1) a multimodal personalized chronotherapy group (INT); or 2) a waitlist-plus-education control group (CON). Participants allocated to the INT received four once-weekly, general sleep hygiene education classes, followed by 20 weeks of 1) individually-timed BLT; and 2) bi-weekly, individually-tailored PA counselling in conjunction with receiving a consumer-available PA tracker (Fitbit® FlexTM). We found a significant group x time interaction for objectively measured sleep fragmentation (5.01; p< 0.01) and also for Pittsburgh Sleep Quality Index (PSQI) score (p= 0.03), such that the INT: 1) maintained sleep fragmentation while CON worsened at 12 weeks (p< 0.01); and 2) had improved PSQI score compared to CON at both 12 weeks (p< 0.01) and 24 weeks (p= 0.04). Our results provide novel evidence that a multimodal personalized chronotherapy approach may promote both objective and subjective aspects of sleep quality in older adults with MCI.
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Affiliation(s)
- Ryan S Falck
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Best
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - Patrick Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Backhouse
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Glenn J Landry
- University of British Columbia, Vancouver, British Columbia, Canada
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Liu-Ambrose T, Davis JC, Best JR, Dian L, Cook W, Madden K, Hsu CL, Khan KM. EFFECT OF A HOME-BASED EXERCISE PROGRAM ON SUBSEQUENT FALLS IN SENIORS AFTER A FALL: A RANDOMIZED CLINICAL TRIAL. Innov Aging 2019. [PMCID: PMC6840924 DOI: 10.1093/geroni/igz038.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
We assessed the efficacy of the home-based Otago Exercise Program (OEP) as a secondary falls prevention strategy in seniors referred to a falls prevention clinic after an index fall. We conducted a 12-month randomized controlled trial of 344 adults, aged 70 years and older, with = or > 1 fall resulting in medical attention in the prior 12 months. Participants were randomized to OEP or standard of care (CON). The OEP is a home-based strength and balance training program delivered by a physical therapist. All participants received AGS Guideline Care for falls prevention from a geriatrician. Differences in falls rate was tested with a negative binomial regression model. The rate of falls was lower in the OEP group vs the CON group (incident rate ratio [IRR] = 0.64, 95% CI 0.46 to 0.90). The estimated incidence rate of falls per person-year was 1.4 (95% CI 0.1 to 2.0) in the OEP group and 2.1 (95% CI 0.1 to 3.2) in the CON group, with an absolute incidence rate difference of 0.74 (95% CI 0.04 to 1.78) falls per person-year. DSST performance also increased in the OEP group by a mean change of 1.1 points (95% CI 0.02 to 2.1) vs the CON group. Improved DSST was associated with fewer falls (IRR = 0.80, 95% CI 0.68 to 0.95). These findings support the use of the OEP for secondary falls prevention.
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Affiliation(s)
| | - Jennifer C Davis
- University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
| | - John R Best
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry Dian
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, British Columbia, Canada
| | - Wendy Cook
- Division of Geriatric Medicine, University of British Columbia, Vancouver, Canada
| | - Kenneth Madden
- Gerontology and Diabetes Laboratory, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chun Liang Hsu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim M Khan
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, Canada
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Bennett K, Crockett RA, Brinke LFT, Davis JC, Liu-Ambrose T. QUADRICEPS STRENGTH IS ASSOCIATED WITH COGNITION IN OLDER ADULTS WITH CHRONIC STROKE. Innov Aging 2019. [PMCID: PMC6841579 DOI: 10.1093/geroni/igz038.2431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Individuals who have suffered a stroke are at risk for developing cognitive impairment and dementia. Thus, it is important to identify modifiable risk factor for cognitive decline in this population. Among older adults without a history of stroke, greater muscle strength is associated with better cognitive function. Whether this relationship also exist in older adults with a history of stroke is not known. Thus, we aimed to examine whether cognition, as measured by both the Montreal Cognitive Assessment (MoCA) and the 13-item Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-Cog 13), is associated with lower extremity muscle strength in adults with chronic stroke (> 1 year post stroke). Ninety-one community-dwelling adults, aged 55 years and older, with chronic stroke were included in this analysis. Isometric strength of the quadriceps was measured bilaterally in kilograms. Two linear regression models were constructed to determine the independent association of quadriceps strength (mean kilograms of both legs) with: 1) MoCA; and 2) ADAS-Cog 13, after controlling for age, sex, and mood. Mean quadriceps strength was independently associated with both MoCA and ADAS-Cog scores, after accounting for age, sex, and mood. Specifically, quadriceps strength explained an additional 5.6% of the variable in MoCA scores; total variance explained by the model was 12.0%. For ADAS-Cog 13, quadriceps strength explained an additional 5.4% of the variance; total variance explained by the model was 16.5%. Our current cross-sectional results suggest that the maintenance of muscle strength may be important for cognitive health in older adults who have suffered a stroke.
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Affiliation(s)
| | | | | | - Jennifer C Davis
- University of British Columbia - Okanagan Campus, Kelowna, British Columbia, Canada
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Affiliation(s)
- Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | | | - Karim M Khan
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, Canada
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Bjerk M, Brovold T, Davis JC, Bergland A. Evaluating a falls prevention intervention in older home care recipients: a comparison of SF-6D and EQ-5D. Qual Life Res 2019; 28:3187-3195. [PMID: 31364036 DOI: 10.1007/s11136-019-02258-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Health-related quality of life (HRQOL) is an important outcome in economic evaluations of health care interventions for older adults. The aim of this study was to compare two commonly used preference-based utility measures, SF-6D and EQ-5D, to provide knowledge on their applicability when evaluating falls prevention interventions in primary health care. METHODS The study is a secondary analysis of longitudinal data from a randomised controlled trial, which included 155 older home care recipients participating in a falls prevention intervention in Norway. HRQOL was measured by SF-6D and EQ-5D. Physical function was measured by Berg Balance Scale, 4-m walk test, 30-s sit-to-stand and Falls Efficacy Scale International. Assessments were performed at baseline, 3 months and 6 months. The agreement between SF-6D and EQ-5D was examined using Bland-Altman plots and Spearman correlations. Elasticities from regression analysis were employed to compare the instruments' responsiveness. RESULTS SF-6D and EQ-5D were strongly correlated (0.71), but there were differences in the instruments' agreement and domains of HRQOL covered. Participants with a higher mean HRQOL and/or better physical function scored generally higher on EQ-5D. Participants with a lower mean HRQOL and/or poorer physical function achieved a relatively higher score on SF-6D. EQ-5D was more responsive to changes in physical function compared to SF-6D. CONCLUSIONS SF-6D and EQ-5D have both similarities and differences regarding sensitivity, domains covered and responsiveness to changes when evaluating a falls prevention intervention. Selecting the appropriate instrument depends on the characteristics of the participants and the intervention being evaluated.
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Affiliation(s)
- Maria Bjerk
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway.
| | - Therese Brovold
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia Okanagan, Kelowna, Canada
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, PO Box 4, St. Olavs Plass, 0130, Oslo, Norway
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Davis JC, Falck RS, Best JR, Chan P, Doherty S, Liu-Ambrose T. Examining the Inter-relations of Depression, Physical Function, and Cognition with Subjective Sleep Parameters among Stroke Survivors: A Cross-sectional Analysis. J Stroke Cerebrovasc Dis 2019; 28:2115-2123. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 12/28/2022] Open
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Falck RS, Best JR, Davis JC, Liu-Ambrose T. The Independent Associations of Physical Activity and Sleep with Cognitive Function in Older Adults. J Alzheimers Dis 2019; 63:1469-1484. [PMID: 29782311 DOI: 10.3233/jad-170936] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Current evidence suggests physical activity (PA) and sleep are important for cognitive health; however, few studies examining the role of PA and sleep for cognitive health have measured these behaviors objectively. OBJECTIVE We cross-sectionally examined whether 1) higher PA is associated with better cognitive performance independently of sleep quality; 2) higher sleep quality is associated with better cognitive performance independently of PA; and 3) whether higher PA is associated with better sleep quality. METHODS We measured PA, subjective sleep quality using the Pittsburgh Sleep Quality Index (PSQI), and objective sleep quality (i.e., fragmentation, efficiency, duration, and latency) using the MotionWatch8© in community-dwelling adults (N = 137; aged 55+). Cognitive function was indexed using the Alzheimer's Disease Assessment Scale-Plus. Correlation analyses were performed to determine relationships between PA, sleep quality, and cognitive function. We then used latent variable modelling to examine the relationships of PA with cognitive function independently of sleep quality, sleep quality with cognitive function independently of PA, and PA with sleep quality. RESULTS We found greater PA was associated with better cognitive performance independently of 1) PSQI (β= -0.03; p < 0.01); 2) sleep fragmentation (β= -0.02; p < 0.01); 3) sleep duration (β= -0.02; p < 0.01); and 4) sleep latency (β= -0.02; p < 0.01). In addition, better sleep efficiency was associated with better cognitive performance independently of PA (β= -0.01; p = 0.04). We did not find any associations between PA and sleep quality. CONCLUSIONS PA is associated with better cognitive performance independently of sleep quality, and sleep efficiency is associated with better cognitive performance independently of PA. However, PA is not associated with sleep quality and thus PA and sleep quality may be related to cognitive performance through independent mechanisms.
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Affiliation(s)
- Ryan S Falck
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, 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, Vancouver, BC, Canada
| | - Jennifer C Davis
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- University of British Columbia, Faculty of Medicine, Aging, Mobility and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, Vancouver, BC, Canada.,Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute and University of British Columbia, Vancouver, BC, Canada
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Liu-Ambrose T, Davis JC, Best JR, Dian L, Madden K, Cook W, Hsu CL, Khan KM. Effect of a Home-Based Exercise Program on Subsequent Falls Among Community-Dwelling High-Risk Older Adults After a Fall: A Randomized Clinical Trial. JAMA 2019; 321:2092-2100. [PMID: 31162569 PMCID: PMC6549299 DOI: 10.1001/jama.2019.5795] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown. OBJECTIVE To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall. DESIGN, SETTING, AND PARTICIPANTS A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the past 12 months and were recruited from a fall prevention clinic. INTERVENTIONS Participants were randomized to receive usual care plus a home-based strength and balance retraining exercise program delivered by a physical therapist (intervention group; n = 173) or usual care, consisting of fall prevention care provided by a geriatrician (usual care group; n = 172). Both were provided for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was self-reported number of falls over 12 months. Adverse event data were collected in the exercise group only and consisted of falls, injuries, or muscle soreness related to the exercise intervention. RESULTS Among 345 randomized patients (mean age, 81.6 [SD, 6.1] years; 67% women), 296 (86%) completed the trial. During a mean follow-up of 338 (SD, 81) days, a total of 236 falls occurred among 172 participants in the exercise group vs 366 falls among 172 participants in the usual care group. Estimated incidence rates of falls per person-year were 1.4 (95% CI, 0.1-2.0) vs 2.1 (95% CI, 0.1-3.2), respectively. The absolute difference in fall incidence was 0.74 (95% CI, 0.04-1.78; P = .006) falls per person-year and the incident rate ratio was 0.64 (95% CI, 0.46-0.90; P = .009). No adverse events related to the intervention were reported. CONCLUSIONS AND RELEVANCE Among older adults receiving care at a fall prevention clinic after a fall, a home-based strength and balance retraining exercise program significantly reduced the rate of subsequent falls compared with usual care provided by a geriatrician. These findings support the use of this home-based exercise program for secondary fall prevention but require replication in other clinical settings. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01029171; NCT00323596.
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Affiliation(s)
- Teresa Liu-Ambrose
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Jennifer C. Davis
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Faculty of Management, University of British Columbia–Okanagan, Kelowna, Canada
| | - John R. Best
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Larry Dian
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kenneth Madden
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Wendy Cook
- Department of Medicine, Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Chun Liang Hsu
- Aging, Mobility, and Cognitive Neuroscience Lab, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Karim M. Khan
- Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Harris HM, Eans SO, Ganno ML, Davis JC, Dooley CT, McLaughlin JP, Nefzi A. Antinociceptive activity of thiazole-containing cyclized DAMGO and Leu-(Met) enkephalin analogs. Org Biomol Chem 2019; 17:5305-5315. [PMID: 31094391 DOI: 10.1039/c9ob00882a] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Numerous studies demonstrate the promise of opioid peptides as analgesics, but poor oral bioavailability has limited their therapeutic development. This study sought to increase the oral bioavailability of opioid peptides by cyclization, using Hantzsch-based macrocyclization strategies to produce two new series of cyclized DAMGO and Leu/Met-enkephalin analogs. Opioid receptor affinity and selectivity for compounds in each series were assessed in vitro with radioligand competition binding assays. Compounds demonstrated modest affinity but high selectivity for the mu, delta, and kappa opioid receptors (MOR, DOR and KOR), while selectivity for mu opioid receptors varied by structure. Antinociceptive activity of each compound was initially screened in vivo following intracerebroventricular (i.c.v.) administration and testing in the mouse 55 °C warm-water tail-withdrawal test. The four most active compounds were then evaluated for dose- and time-dependent antinociception, and opioid receptor selectivity in vivo. Cyclic compounds 1924-10, 1936-1, 1936-7, and 1936-9 produced robust and long- lasting antinociception with ED50 values ranging from 0.32-0.75 nmol following i.c.v. administration mediated primarily by mu- and delta-opioid receptor agonism. Compounds 1924-10, 1936-1 and 1936-9 further displayed significant time-dependent antinociception after oral (10 mg kg-1, p.o.) administration. A higher oral dose (30 mg kg-1. p.o.) of all four cyclic peptides also reduced centrally-mediated respiration, suggesting successful penitration into the CNS. Overall, these data suggest cyclized opioid peptides synthesized by a Hantzsch-based macrocyclization strategy can retain opioid agonist activity to produce potent antinociception in vivo while conveying improved bioavailability following oral administration.
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Affiliation(s)
- Hannah M Harris
- University of Florida Department of Pharmacodynamics, Gainesville, FL, USA
| | - Shainnel O Eans
- University of Florida Department of Pharmacodynamics, Gainesville, FL, USA
| | - Michelle L Ganno
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, FL, USA.
| | - Jennifer C Davis
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, FL, USA.
| | - Colette T Dooley
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, FL, USA.
| | - Jay P McLaughlin
- University of Florida Department of Pharmacodynamics, Gainesville, FL, USA
| | - Adel Nefzi
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, FL, USA.
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Al Tunaiji H, Davis JC, Mansournia MA, Khan KM. Population attributable fraction of leading non-communicable cardiovascular diseases due to leisure-time physical inactivity: a systematic review. BMJ Open Sport Exerc Med 2019; 5:e000512. [PMID: 31191969 PMCID: PMC6539142 DOI: 10.1136/bmjsem-2019-000512] [Citation(s) in RCA: 8] [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] [Accepted: 03/12/2019] [Indexed: 12/18/2022] Open
Abstract
Objective The aim of this systematic review was to investigate the methods used for estimating the population attributable fraction (PAF) to leisure-time physical inactivity (PI) of coronary artery diseases, hypertension and stroke in order to provide the best available estimate for PAF. Design Systematic review. Data sources Four electronic databases (MEDLINE/PubMed, EMBASE, SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to August 2018. Eligibility criteria for selecting studies This review included prospective cohort studies, with men and women aged ≥18 years old, investigating the PAF attributable to leisure-time PI related to coronary artery diseases, hypertension and stroke. Results The PAF estimates of the three studies included were 13% (3%–22%) for ‘stage-1 hypertension’ subtype incidence due to ‘non-regular exercise’; 25% (10.4%–35.8%) for ‘stage-2 hypertension’ subtype incidence due to ‘activity of daily living’ and ‘vigorous-intensity sports’; and 8.5% (1.7%–16.7%) for ‘total: fatal and non-fatal’ cardiovascular events of ‘incidence and mortality’ endpoints due to non-accumulation of 550 kcal/week (subsets not specified). Conclusions The PAF estimate exhibited a protective dose–response relationship between hypertension and an increased amount of energy expenditure of leisure-time PI. In order to enhance accuracy of PAF estimates, the following steps are recommended: (1) to clearly define and state the working definition of leisure-time PI and dose using a reliable and valid objective measurement tool; (2) use a clear definition of outcome subtypes and endpoints using reliable and valid objective measures; and (3) estimate PAF using modelling techniques based on prospective data and ensuring to report 95% CI.
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Affiliation(s)
- Hashel Al Tunaiji
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada.,Sport Medicine & Sciences Unit, Zayed Military Hospital, Abu Dhabi, United Arab Emirates
| | - Jennifer C Davis
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Karim M Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada
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Falck RS, Davis JC, Best JR, Crockett RA, Liu-Ambrose T. Impact of exercise training on physical and cognitive function among older adults: a systematic review and meta-analysis. Neurobiol Aging 2019; 79:119-130. [PMID: 31051329 DOI: 10.1016/j.neurobiolaging.2019.03.007] [Citation(s) in RCA: 196] [Impact Index Per Article: 39.2] [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: 07/11/2018] [Revised: 03/03/2019] [Accepted: 03/16/2019] [Indexed: 01/01/2023]
Abstract
Exercise plays a key role in healthy aging by promoting both physical and cognitive function. Physical function and cognitive function appear to be interrelated and may share common mechanisms. Thus, exercise-induced improvements in physical function and cognitive function may co-occur and be associated with each other. However, no systematic review has specifically assessed and compared the effects of exercise on both physical function and cognitive function in older adults, and the association between changes in both outcomes after exercise training. Thus, we conducted a systematic review and meta-analysis (N = 48 studies) among older adults (60+ years). These data suggest exercise training has a significant benefit for both physical function (g = 0.39; p < 0.001) and cognitive function (g = 0.24; p < 0.001). At the study level, there was a positive correlation between the size of the exercise-induced effect on physical function and on cognitive function (b = 0.41; p = 0.002). Our results indicate exercise improves both physical and cognitive function, reiterating the notion that exercise is a panacea for aging well.
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Affiliation(s)
- Ryan S Falck
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jennifer C Davis
- Faculty of Management, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| | - John R Best
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Rachel A Crockett
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada; Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, 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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Davis JC, Dian L, Parmar N, Madden K, Khan KM, Chan W, Cheung W, Rogers J, Liu-Ambrose T. Geriatrician-led evidence-based Falls Prevention Clinic: a prospective 12-month feasibility and acceptability cohort study among older adults. BMJ Open 2018; 8:e020576. [PMID: 30518579 PMCID: PMC6286621 DOI: 10.1136/bmjopen-2017-020576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE We assessed the feasibility and acceptability of delivering a geriatrician-led evidence-based Falls Prevention Clinic to older adults with a history of falls. DESIGN 12-month prospective cohort study. SETTING Vancouver Falls Prevention Clinic, Vancouver, British Columbia, Canada (www.fallsclinic.ca). PARTICIPANTS 188 community-dwelling older adults aged ≥70 years who received a baseline assessment at the Vancouver Falls Prevention Clinic due to having had at least one fall resulting in medical attention in the previous 12 months. Fifty-six per cent of participants were also participating in a randomised controlled trial. MEASUREMENTS Feasibility was ascertained by measuring demand (clinic attendance). Acceptability was measured by compliance with recommendations, completion of monthly fall calendars and patient experience. RESULTS The attendance was 65% of those eligible and invited. This indicates feasibility for demand. 155 received at least one of the following clinical management recommendations from four domains (compliance reported in %): (1) medication changes (78%); (2) exercise prescription (58%); (3) referrals to other healthcare professionals (78%); and/or (4) lifestyle modifications (35%) excluding exercise. Overall compliance to all recommendations was 69%. Patient experience was related to factors impacting patient perceived physical benefit and attributes influencing patient satisfaction. CONCLUSION This study demonstrated the feasibility and acceptability of a multifactorial intervention approach based on best available evidence-based medicine.
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Affiliation(s)
- Jennifer C Davis
- Faculty of Management, University of British Columbia, Vancouver, British Columbia, Canada
| | - Larry Dian
- Center for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Geriatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naaz Parmar
- Division of Geriatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Madden
- Division of Geriatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim M Khan
- Center for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wency Chan
- Center for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health , Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Winnie Cheung
- Center for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health , Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Rogers
- Center for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Teresa Liu-Ambrose
- Center for Hip Health and Mobility, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health , Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Al-Ali H, Debevec G, Santos RG, Houghten RA, Davis JC, Nefzi A, Lemmon VP, Bixby JL, Giulianotti MA. Scaffold Ranking and Positional Scanning Identify Novel Neurite Outgrowth Promoters with Nanomolar Potency. ACS Med Chem Lett 2018; 9:1057-1062. [PMID: 30344917 DOI: 10.1021/acsmedchemlett.8b00425] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/24/2018] [Indexed: 12/12/2022] Open
Abstract
Central nervous system (CNS) neurons typically fail to regrow their axons after injury. Injuries or neuropathies that damage CNS axons and disrupt neuronal circuitry often result in permanent functional deficits. Axon regeneration is therefore an intensely pursued therapeutic strategy for numerous CNS disorders. Phenotypic screens utilizing primary neurons have proven successful at identifying agents that promote axon regeneration in vivo. Here, we report the screening of mixture-based combinatorial small molecule libraries in a phenotypic assay utilizing primary CNS neurons and the discovery of neurite outgrowth promoters with low nanomolar potency.
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Affiliation(s)
| | - Ginamarie Debevec
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida 34987, United States
| | - Radleigh G. Santos
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida 34987, United States
| | - Richard A. Houghten
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida 34987, United States
| | - Jennifer C. Davis
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida 34987, United States
| | - Adel Nefzi
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida 34987, United States
| | | | | | - Marc A. Giulianotti
- Torrey Pines Institute for Molecular Studies, Port St. Lucie, Florida 34987, United States
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Falck RS, Davis JC, Best JR, Li LC, Chan PCY, Wyrough AB, Landry GJ, Liu-Ambrose T. Buying time: a proof-of-concept randomized controlled trial to improve sleep quality and cognitive function among older adults with mild cognitive impairment. Trials 2018; 19:445. [PMID: 30119694 PMCID: PMC6098594 DOI: 10.1186/s13063-018-2837-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 02/01/2018] [Accepted: 08/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current evidence suggests that good quality sleep is associated with preserved cognitive function and reduced dementia risk in older adults. Sleep complaints are especially common among older adults with mild cognitive impairment (MCI), and this may contribute to their increased risk for progression to dementia. Thus, improving their sleep may be important for maintaining their cognitive health. Chronotherapy is a set of intervention strategies that can improve sleep quality through strengthening the entrainment of the biological clock to the solar light-dark cycle, and includes strategies such as (1) bright light therapy (BLT); (2) physical activity (PA); and (3) good sleep hygiene. Of these strategies, BLT is the most potent and is based on providing individualized timing to entrain circadian rhythms. Thus, a personalized chronotherapy intervention of individually timed BLT and individually tailored PA promotion, in conjunction with general sleep hygiene education may promote older adult sleep quality. We therefore aim to carry out a proof-of-concept randomized controlled trial (RCT) to examine the efficacy of such a personalized chronotherapy intervention to improve sleep quality among older adults with MCI. METHODS/DESIGN This was a 24-week RCT of a personalized chronotherapy intervention aimed to primarily improve sleep quality as measured by the MotionWatch8©. Participants in the personalized chronotherapy group (INT) will receive four once-weekly, general sleep hygiene education classes, followed by 20 weeks of (1) individually timed BLT and (2) bi-weekly, individually tailored PA counseling phone calls in conjunction with receiving a consumer-available PA tracker-the Fitbit® Flex™. Ninety-six adults (aged 65-85 years) classified as having MCI (i.e., Mini-Mental State Exam (MMSE) ≥ 24; Montreal Cognitive Assessment (MoCA) ≤ 26; without dementia or significant functional impairment) will be randomized to either INT or a waitlist control group (CON). DISCUSSION The results of this trial will help determine if a personalized chronotherapy intervention that includes individually timed BLT and individually tailored PA promotion, along with general sleep hygiene education can promote sleep quality among older adults at increased risk for dementia. Our results will help inform best practices for promoting sleep quality among older adults with MCI. TRIAL REGISTRATION ClinicalTrials.gov , NCT02926157 . Registered on 6 October 2016.
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Affiliation(s)
- Ryan S Falck
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer C Davis
- Department of Management, University of British Columbia - Okanagan Campus, Kelowna, BC, Canada
| | - John R Best
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, Arthritis Research Canada, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patrick C Y Chan
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anne B Wyrough
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Glenn J Landry
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Aging, Mobility and Cognitive Neuroscience Laboratory, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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