Integrated physical and cognitive training intervention to reverse cognitive frailty among community dwelling older adults

BRIEF NAME: WE RISE Project - Warga Emas Robust mInd and muscle Exercise Program. (Warga Emas means older adults in the Malay Language) WHY: The co-existence of both frailty and cognitive impairment has been termed as ‘Cognitive frailty’ and has been identified as one of the main precursors to dementia. In a recent study in Singapore, older adults with pre-frailty and frailty coupled with cognitive impairment were found to be at a higher risk of having functional disability, poor quality of life and increased mortality. This study will the first of its kind to provide a modality which could potentially reverse cognitive frailty, as compared to the ‘usual care’ management practice for older adults. There is a need to develop and implement an intervention package which is cost- effective, integrated and applies interdisciplinary approaches for successful outcomes. This intervention can be packaged and delivered by interdisciplinary trainers to be implemented in health care service provider centers. Not only will this intervention package optimize the cost of geriatric healthcare, it is also sustainable, and it aims to enrich the lives of the ageing population. WHAT: This is a intervention study which mainly focuses on the domains of physical exercise and cognitive stimulation with the aim of potentially reversing cognitive frailty among community dwelling older adults. Group 1: Intervention Group Intervention group will be receiving 12 weeks of exercise-based programme in combination with cognitive stimulation training. Materials used during intervention include weight-cuffs, chairs, basketballs, cognitive stimulating games and stationary. The exercises included in this study were effective evidence based exercises for older adult from systematic reviews. The intervention session comprise of the following: 1. Warm up & Dynamic Stretching – 10 minutes 2. Dance Aerobics – 15 minutes 3. Progressive resistance training – 20 minutes - weight cuffs were used for progressive resistance training in addition to body weight exercises. - 1st to 4th week = 0.5kg - 5th to 8th week = 1.0kg - 9th to 12th week = 2.0kg Repetitions were increased from 8 to 10 repetitions/ 3 sets per session. 4. Balance & Coordination Training – 20 minutes Level 1 • Weight shifting • Single leg stand • Semi tandem stand • Tandem stand • Side walking • Frontward/backward walking • Passing ball around in a circle • Ball dribbling/catching • Single direction ball throwing (partner activity) • Hand-eye coordination training Level 2 • Weight shifting • Single leg stand without support • Semi tandem stand • Tandem stand & walk • Side walking with a turn • Frontward/backward walking with a turn • Heel & tiptoe walk • Ball throwing/catching in different directions in a circle • Slalom walking with a ball • Messy walking around obstacles • Dribbling/catching with one hand • Hand-eye coordination training Level 3 • Weight Shifting • Single leg stand eyes open/eyes closed • Semi tandem stand • Tandem stand • Tandem walk with ball • Dribble/throw upwards ball and catch • Side walking with a turn with ball • Heel & tiptoe walk with a turn with ball • Frontward/backward walking with a turn with ball • Throwing & catching ball in different directions while rotating in circle • Messy walking while picking up objects • Slalom walking while carrying a tray of cups • Hand-eye coordination training 5. Cognitive Stimulation Activities – 20 minutes Cognitive stimulation will include the following: -Jigsaw Puzzle - Visuospatial Reasoning & Working memory -Sorting Games - Executive Function & Cognitive Flexibility -Spot the difference - Attention & Processing Speed -Maze games - Problem Solving Skills -Recall Activity - Short Term Memory -Memory Card Games - Reaction Time,Attention,Processing Speed -Colouring Games - Concentration & Matrix Reasoning Group 2: Control Group (Active) Receiving usual care as provided by the older adult activity centers. WHO PROVIDED: Physiotherapist with post graduate qualification in community based geriatric health. HOW: Intervention was executed in the form of face to face group sessions. WHERE: In selected Older Adult Activity Centres within the states of Kuala Lumpur and Selangor in Peninsular Malaysia. Selection of centres were made based on the density of registered members at the activity centres. These centres have hall spaces which are used for the intervention. WHEN AND HOW MUCH: This intervention will be carried out across the span of 6 months. First 3 months (week 1 to 12) will be the intervention phase and the last 3 months (week 13 to 24) will be the self-administered health empowerment Intervention consists of 2 sessions per week for a period of 90 minutes per session. (total 24 sessions in 12 weeks). Frequency: 2 sessions/week Intensity: 65 to 80% of maximum heart rate. Time: 85 to 90 minutes Type: Combination of Aerobic, resistance and balance training. TAILORING This was a group targeted program, not tailored to the individual. No specific adherence strategies applied, however attendance will be monitored for every session conducted. Motivation and enjoyment are also part of promoting adherence to the intervention program.