Feasibility and acceptability of a multicomponent lifestyle intervention program on changes in functional ability, cognition and quality of life in community dwelling older adults at risk of functional decline: A Pilot Study

The 12-week intervention program will be carried out once a week following a comprehensive geriatric assessment in a small group of 6-8 participants using the existing outpatient service facilities and staffing at an outpatient rehabilitation facility. 3x45-minute components will be included in each week's program. It will start with 45-minute individualised exercises consisting aerobic exercise (e.g. cycling, brisk walking), strength exercise (e.g. weights, squats) and balance exercises (Figure 8 walking, tandem stance/walking) in a circus style supervised by physiotherapists, followed by 45-minute computer-based cognitive training using a well-established program - BrainHQ (https://www.brainhq.com). The cognitive training session will be facilitated by occupational therapist(s) and laptops and iPads will be provided from the rehab facility or the participants may bring their own devices if they would prefer. A variety of cognitive domains will be trained which include attention (e.g. tracing objects), processing speed (e.g. spot the differences), memory (e.g. remembering spoken information, visual memory), problem solving (e.g. processing changing rules) and visuospatial/orientation (e.g. image rotation, sensing directions), with facilitated discussions on generalisation of the skills to everyday activities. The third 45-minute component of the program will consist of a series of topics including nutrition and diet education and tailored advice delivered by a dietitian, education on maintaining brain health and functional abilities delivered by an occupational therapist, education on promoting social interaction, stress management and mindfulness practice delivered by a social worker, and yoga delivered by a qualified yoga teacher. As the age of the participants ranges from 65 to above 80 years, they may have multiple comorbidities (e.g. osteoarthritis, chronic pain, cardiopulmonary conditions, etc.) and their physical abilities and restrictions of physical activities may vary significantly, a tailored exercise program will be established for each participant based on their baseline assessment by a physiotherapist. This individualised program will be performed during the weekly exercise sessions and will be printed out in a user-friendly format and included in the purpose-designed Home Program Journal. All participants will be required to continue practising all components of the program at home 3 times a week (at least a total of 2.25 hours of exercises and 2.25 hours of cognitive training, and at least 5 minutes each day on mindfulness practice). They are required to record activities performed on a purpose-designed Home Program Journal, which will be reviewed by relevant staff and feedback will be provided during the period of the program. Attendance will be checked each week of the program with a maximum of 3 non-attendance. A follow-up phone call (or in-person follow-up, depending on participants’ preferences) at 3 months post program completion will be conducted to evaluate the sustainability of lifestyle changes (e.g. increased physical and cognitive activities, continuing healthy eating and mindfulness practice, etc.) as a result of the lasting impact of the intervention program.