Effects of Multimodal Exercise With Augmented Reality on Cognition in Community-Dwelling Older Adults

OBJECTIVES

This study aims to investigate the effects of an exercise intervention using multimodal exercise with augmented reality and multimodal exercise-only on cognitive function in older adults living in a community dwelling.

DESIGN

Quasi-experimental research study.

SETTING AND PARTICIPANTS

In this control study, 78 participants were divided into 2 experimental groups (with sessions 3 times a week for 12 weeks) and a control group (CG).

METHODS

EG1 participated in a multimodal exercise-only intervention program, EG2 participated in a multimodal exercise program with augmented reality exergames, and CG continued its usual activities. Participants were assessed at baseline and postintervention after 12 weeks.

RESULTS

Comparison between baseline and postintervention at 12 weeks showed significant improvements in executive functions, verbal fluency, choice reaction time, and dual task in EG1, whereas there were improvements in general cognition, executive functions, verbal fluency, discrimination reaction time, and depression in EG2 (P ≤ .05). The clinical effect sizes of the interventions were large for overall cognition, executive functions, and reaction time on single- and dual-task reaction time in EG1 and for overall cognition, executive functions, and verbal fluency in EG2.

CONCLUSION AND IMPLICATIONS

The intervention programs showed significant improvements in several cognitive domains. The multimodal exercise-only showed improvements in more variables than the multimodal exercise with augmented reality, but the augmented reality group showed greater changes between baseline and postintervention.

Effects of a six-week multimodal training programme on the sprinting ability of adolescent rugby sevens players

This study evaluated the effects of 6-week multimodal training on the sprinting performance and biomechanics of adolescent rugby players. Twenty-four players were assigned to control group (CG) or intervention group (IG). For 6 weeks, CG maintained their training routine, while IG completed a training programme consisting of unresisted sprints, as well as heavy-resisted sprints, running technique drills and lumbopelvic stability. Before and after, sprint performance, horizontal force-velocity profile (FV-h), sprinting kinematics and spatiotemporal data were obtained. After the training, IG reduced the 0-5 m (p = 0.044), 0-10 m (p = 0.046) and 25-30 m (p = 0.035) split times compared with CG. In FV-h, IG displayed a higher maximal theoretical horizontal force (p = 0.035) and ratio of force (p = 0.048) than CG. Regarding kinematic and spatiotemporal variables, only IG improved step length (p < 0.001), step rate (p = 0.005) and distance between knees (p = 0.048) compared with baseline, but there were no between-group differences. Six weeks of multimodal training improved sprinting acceleration and mechanical variables of force application during sprinting of adolescent rugby players. Although IG improved some biomechanical variables compared with baseline, these changes were similar to those observed in CG.

Gait changes after supervised exercise training in patients with symptomatic lower extremity peripheral artery disease

This study aimed to investigate the effects of supervised exercise training (SET) on walking performance and spatiotemporal gait changes in patients with symptomatic lower extremity peripheral artery disease (PAD). In this single-arm prospective nonrandomized cohort study, patients with Fontaine stage II PAD following a 3-month SET program were included. Before and after SET, a constant-load treadmill test was performed to determine the pain-free and maximal walking distances (PFWD and MWD, respectively). During this test, spatiotemporal gait parameters were assessed. The ankle-brachial index (ABI) and toe-brachial index (TBI) were also measured. Twenty-seven patients with PAD (64.0 ± 1.9 y, 74% men) were included. Following SET, the PFWD (+68%; p = 0.001) and MWD (+79%; p ⩽ 0.001) significantly increased. The ABI and TBI did not change significantly. Following SET, the stride duration, stride frequency, stride length, and double support phase duration did not change significantly. In contrast, subphases of stance showed significant changes: the loading response (+8%; p = 0.03) and foot-flat (+2%; p = 0.01) phases were significantly longer, whereas the push-off phase (-7%; p = 0.002) was significantly shorter. A significant positive correlation was found between changes in the foot-flat phase and changes in PFWD (r = 0.43, p = 0.03). A significant negative correlation was found between changes in the push-off phase and changes in PFWD (r = -0.39, p = 0.05). No significant correlations were found between changes in relative durations of the subphases of stance and MWD. These results indicate that changes in temporal gait parameters during the foot contact phase potentially constitute an underlying mechanism of delayed claudication distance in patients with symptomatic PAD.

Multimodal Supervised Exercise Significantly Improves Walking Performances Without Changing Hemodynamic Parameters in Patients With Symptomatic Lower Extremity Peripheral Artery Disease

We evaluated the outcome of multimodal supervised exercise training (SET) on walking performances and different hemodynamic parameters (ankle/toe-brachial index [ABI/TBI], and transcutaneous oxygen pressure [TcPO₂]) in patients with symptomatic lower extremity peripheral artery disease (PAD). Whether hemodynamic parameters predict walking performances at baseline and following SET was also investigated. Fontaine stage II PAD's patients following a 3-month SET were retrospectively included. Hemodynamic parameters and walking performances (pain-free [PFWD], maximal [MWD], and 6-minute [6MWD] walking distance) were measured in each patient. Eighty-five symptomatic PAD patients were included. Following SET, PFWD, MWD, and 6MWD significantly increased (+142%, +94%, +14%; respectively; P ≤ .001). Toe-brachial index significantly increased (MD: 0.04 ± 0.01; P = .02), whereas ABI and TcPO₂ did not change significantly. At baseline, patients with higher TBI and TcPO₂ performed significantly better (PFWD: β = 0.25, P = .01 for TBI; PFWD: β = 0.30, P = .005, and MWD: β = 0.22, P = .04, for TcPO₂). No significant relationship was observed at baseline between ABI and walking performances. Baseline values of hemodynamic parameters did not significantly correlate with changes in walking performances. Multimodal SET significantly improves walking performances. Following SET, no significant changes in ABI and TcPO₂ were observed. Toe-brachial index values significantly improved after SET. However, this increase was very modest and its clinical relevance remains questionable. Although baseline TBI and supine TcPO₂ values predict baseline walking performances, no association was found between baseline hemodynamic parameters and changes in walking performances following SET.

Effects of functional training and 2 interdisciplinary interventions on maximal oxygen uptake and weight loss of women with obesity: a randomized clinical trial

Our aim was to analyze and compare functional training, interdisciplinary therapy, and interdisciplinary education on cardiorespiratory fitness (CF) and anthropometric characteristics of women with obesity. Forty-four women (age = 39.7 ± 5.9 years, body mass index (BMI) = 35.5 ± 2.8 kg/m²) completed 30 weeks of intervention randomly assigned to 3 groups: functional training (FT) (n = 14), interdisciplinary therapy (IT) (n = 19), and interdisciplinary education (IE) (n = 11). The FT group participated in the training program (3/week), the IT group received the same training intervention plus nutrition (1/week) and psychology advice (1/week) and physical therapy (1/week). The IE group participated in interdisciplinary lectures on topics related to health promotion (1/month). CF (ergospirometry), anthropometry, and body composition (electrical bioimpedance) were measured pre-intervention (Pre) and post-intervention (Post). CF increased (p ≤ 0.05) significantly (Pre vs. Post) in the FT (7.5%) and IT (10.8%) groups, but not in the IE group (1.8%). Body mass (BM), BMI, relative fat mass, and waist circumference significantly (p ≤ 0.05) decreased (Pre vs. Post) in IT (-4.4%, -4.4%, -2.3%, and -5.1%, respectively). The IE group showed a significant decrease in BM (-3.7%), BMI (-3.7%), and waist circumference (-3.5%), whereas the FT group promoted significant decrease in waist circumference (-3.4%). In conclusion, functional training increased CF but only interdisciplinary interventions improved the anthropometric profile of women with obesity. Novelty Interdisciplinary therapy provided more comprehensive adaptations in women with obesity, including morphological variables and CF. Functional training increased CF but reduced only abdominal obesity. Interdisciplinary education provided benefits on morphological variables, but it does not increase CF.

Physiological and Fitness Adaptations after Eight Weeks of High-Intensity Functional Training in Physically Inactive Adults

The purpose of this study was to characterize high-intensity functional training (HIFT) in physically inactive adults. Four men and 10 women who were inexperienced with HIFT and not performing regular physical activity performed HIFT 3 days/week for 8 weeks. Health and fitness measures were assessed before and after the intervention. Resting heart rate (73 ± 12 vs. 68 ± 11 bpm) and resting diastolic blood pressure (71 ± 7 vs. 65 ± 6 mmHg) were reduced, while resting systolic blood pressure remained unchanged. Absolute VO_2max (2.53 ± 0.68 vs. 2.69 ± 0.66 L/min) and relative VO_2max (32.51 ± 8.84 vs. 34.31 ± 8.63 mL/kg/min) were improved. Lean body mass (48.20 ± 13.37 vs. 49.26 ± 13.81 kg) was increased, but fat mass was unchanged. Performance on the leg press (164.61 ± 54.35 vs. 201.62 ± 67.50 kg), bench press (39.12 ± 20.15 vs. 46.43 ± 21.18 kg), YMCA bench press (26 ± 13 vs. 37 ± 16 reps), one-minute sit-up (25 ± 9 vs. 32 ± 10 reps), and sit-and-reach (30.36 ± 11.36 vs. 32.14 ± 9.66 cm) were all increased. High-intensity functional training may be useful for improving health-related physical fitness parameters in physically inactive adults.

Intensive Multimodal Training to Improve Gait Resistance, Mobility, Balance and Cognitive Function in Persons With Multiple Sclerosis: A Pilot Randomized Controlled Trial

Introduction: Persons with multiple sclerosis (MS) have deficits in many aspects of physical and cognitive functioning that can impact on mobility and participation in daily life. The effect of a 4 week intensive multimodal treadmill training on functional mobility, balance, executive functions and participation in persons with MS with moderate to severe disability was investigated.

Methods: Thirty eight persons with MS admitted to a rehabilitation center participated in a two arm randomized 2:1 controlled trial. Participants in the experimental group received supervised intensive treadmill training including cognitive and motor dual tasks (DT-group, N = 26), 5 sessions per week and a control group received the same amount of supervised strength training (S-group, N = 12). The participants were assessed before and after the rehabilitation period with the 2 Minutes Walking Test (2MWT), speed and, static and dynamic balance measures, the Frontal Assessment Battery and the Short Form-12 questionnaire. The main hypothesis was related to the superiority of the treadmill intervention based on a greater proportion of people making a clinically relevant gain (15% increase on 2MWT) in gait resistance following treatment. ANCOVA (Analysis of covariance) models adjusting for baseline measurement of the respective outcome variable, as well as sex and age, were used to evaluate differences in efficacy for all variables. P was set at 0.05.

Results: Nineteen out of 26 persons in the DT-group made a clinically relevant gain and two out of 12 in the S-Group (P = 0.001). The DT-group improved more in gait resistance, speed and mobility (P < 0.01). Balance and executive functions instead improved moderately in both groups following training while perception of health remained similar in both groups.

Conclusion: A four week multimodal training on treadmill was highly effective in augmenting gait resistance and mobility in moderately to severely affected persons with MS.

Physical exercise and functional fitness in independently living vs institutionalized elderly women: a comparison of 60- to 79-year-old city dwellers

Purpose

To compare functional fitness (FF) levels among independent-living (IL) and day care (DC) elderly women of different age groups and to analyze changes in FF after 8 months of participation in an exercise program intervention for the IL elderly women.

Materials and methods

A total of 674 elderly women were divided into four IL groups with age in the range of 60–64 years (IL60–64, n=149), 65–69 years (IL65–69, n=138), 70–74 years (IL70–74, n=135), and 75–79 years (IL75–79, n=83), and four DC groups with age in the range of 60–64 years (DC60–64, n=35), 65–69 years (DC65–69, n=34), 70–74 years (DC70–74, n=47), and 75–79 years (DC75–79, n=53). The intervention consisted of a multimodal exercise training, 3 days per week for 8 months. Senior Fitness Test battery performances were obtained at baseline and after 8-month intervention.

Results

Significant differences were identified between all IL groups and DC groups in all FF tests (P<0.001), except between IL70–74 and DC70–74 in the chair sit-and-reach. Analysis of covariance (ANCOVA) identified significant improvements in all FF tests between pre- and posttests in the IL groups (P<0.001), except in the chair sit-and-reach for the IL70–74. ANCOVA also showed a significant declining performance in all FF tests for DC groups (P<0.001), except in the chair sit-and-reach for the DC70–74 and DC75–79.

Conclusion

IL women are more fit than institutionalized DC elderly women. The multimodal training was effective in improving all FF components related to daily living activities, in all age groups. In contrast, institutionalized elderly showed a clear tendency to worsen their FF over the time.

Evaluating the relationship between change in performance on training tasks and on untrained outcomes

Training interventions for older adults are designed to remediate performance on trained tasks and to generalize, or transfer, to untrained tasks. Evidence for transfer is typically based on the trained group showing greater improvement than controls on untrained tasks, or on a correlation between gains in training and in transfer tasks. However, this ignores potential correlational relationships between trained and untrained tasks that exist before training. By accounting for crossed (trained and untrained) and lagged (pre-training and post-training) and cross-lagged relationships between trained and untrained scores in structural equation models, the training-transfer gain relationship can be independently estimated. Transfer is confirmed if only the trained but not control participants' gain correlation is significant. Modeling data from the Improvement in Memory with Plasticity-based Adaptive Cognitive Training (IMPACT) study (Smith et al., 2009), transfer from speeded auditory discrimination and syllable span to list and text memory and to working memory was demonstrated in 487 adults aged 65-93. Evaluation of age, sex, and education on pretest scores and on change did not alter this. The overlap of the training with transfer measures was also investigated to evaluate the hypothesis that performance gains in a non-verbal speeded auditory discrimination task may be associated with gains on fewer tasks than gains in a verbal working memory task. Gains in speeded processing were associated with gains on one list memory measure. Syllable span gains were associated with improvement in difficult list recall, story recall, and working memory factor scores. Findings confirmed that more overlap with task demands was associated with gains to more of the tasks assessed, suggesting that transfer effects are related to task overlap in multimodal training.