Multidisciplinary Therapy Coaching Program For Individuals With Huntington's Disease

This is a single-blind (assessor blinded to group allocation), two arm (multidisciplinary therapy coaching program versus lifestyle guidance), randomised controlled trial. This trial will examine the feasibility, safety and therapeutic effects of a multidisciplinary therapy coaching program, compared to lifestyle guidance, for individuals with premanifest and manifest Huntington's disease. Participants will be randomly assigned to receive the multidisciplinary therapy coaching program or lifestyle guidance by an independent statistician. Participants in both groups will receive 12 months of treatment (multidisciplinary therapy coaching program/lifestyle guidance). Multidisciplinary Therapy Coaching Program The multidisciplinary therapy coaching intervention will be designed by an interdisciplinary team of specialists comprising exercise physiologists, neuroscientists, occupational therapists and physiotherapists. The intervention will encompass cardiorespiratory and resistance exercise training, cognitive training and sleep hygiene two exercise training sessions per week and two computerised cognitive training sessions per week at home. Participants will also be asked to maintain good sleep hygiene throughout the study as indicated by the sleep resources provided. To maximise participant adherence and clinical benefits the multidisciplinary therapy coaching program will be structured into distinct cycles comprising of active, tapering and rest weeks. Six cycles, each eight weeks in duration, will be delivered during the intervention period. The intervention will be delivered by trained multidisciplinary therapy coaches (exercise physiologists). Participants will be contacted by a coach on two separate occasions, at the beginning and midway point (4 weeks) of each cycle. The implementation and progress of the program for that cycle as well as the barriers to training and goals for the upcoming cycle will be discussed. Cardiorespiratory (e.g., swimming, walking, running) and Resistance Exercise Training (e.g., chest press, upright rows) The exercise training component of the intervention will comprise individualised (i.e., adjusted to cardiorespiratory fitness [percentage of predicted heart rate max: 220-participant age]), block periodised (i.e., systematically organised exercise variation [volume, intensity and use of specific exercises] into mesocycles [eight week blocks]), progressive and autoregulated (i.e., the volume and intensity of training will be adjusted based on the training response and well-being of patients on training days [i.e., muscle soreness and motivation]) aerobic and resistance exercise training. The intervention will comprise six training blocks that are eight weeks in duration. Each training block will comprise of a training phase (weeks 1-6), detraining/deloading phase (week 7) and rest phase (week 8). An additional rest phase (1 week) will be provided every 16 weeks. Participants will be asked to complete two 45 minute exercise training sessions per week. The intervention will be delivered in the home environment via telehealth applications (Microsoft Teams). The intensity of exercise during training sessions will be prescribed by percentage of predicted heart rate max (cardiorespiratory) and repetitions in reserve (resistance). The exercise program will be monitored by exercise physiologists and an occupational therapist to ensure that participants reach their target rate of perceived exertion (RPE). Cognitive Training The cognitive training program will consist of computerised cognitive training. Computerised cognitive training will be undertaken using NeuroNation software. The prescription and dose of computerised cognitive training are informed by previous work and target a number of cognitive domains including working memory, executive control, divided attention and response inhibition, which are compromised early in HD. Training performance will be automatically recorded by the computerised cognitive training software. Cognitive training will be undertaken twice weekly for 45 minutes. Sleep Hygiene: The sleep hygiene intervention will comprise expert recommendations on healthy sleep habits (Morton et al 2013). Participants will also be provided with and encouraged to follow sleep hygiene guidelines as formulated in the Principles and Practice of Sleep Medicine. Participants will receive tailored advice from their coach for thirty minutes (via telehealth) at the start of each block on how to integrate sleep hygiene practices into their sleep routine. Adherence will be evaluated via an intervention diary. Participants will be asked to tick each sleep health recommendation that they adhered to on a weekly basis.