Cognitive Impairment
Conditions
Keywords
Aerobic exercise, Cognition, Dual Task, Gait Training, Group-based exercise, Older adults
Brief summary
The investigators proposed research will establish whether combining aerobic exercise with cognitive challenges is feasible and effective in community dwelling older adults with early signs of cognitive impairment.
Detailed description
To determine the effects of dual-task aerobic exercise training on community dwelling older adults with early signs of cognitive impairment. We will compare an exercise intervention (E-I) versus an exercise control (E-C) group. Each week, both groups will accumulate a minimum of 120 minutes of exercise (target 150 minutes) from community-based group classes (50 minutes of aerobic exercise) and also complete 45 minutes of beginner-level Square Stepping Exercise (SSE). The E-I group will also answer cognitively challenging questions while doing SSE (dual-task training). This study will determine whether a combined multiple modality (primary component being aerobic exercise) and dual-task exercise program is both feasible and effective for improving cognitive and mobility status, as well as vascular compliance, in older adults who may be at risk for cognitive and mobility decline.
Interventions
BEHAVIORALExercise Intervention
Goal of 150 minutes of structured exercise/week; minimum of 120 minutes from CCAA classes/week. The 75-minute class includes: 5-minute warm-up; 25 minutes of AE (70-85% maximum heart rate); 5-minute cool-down; 20 minutes of strength training; 5 minutes of core strengthening; 5 minutes of balance training; and 10 minutes of stretching. The 60-minute program is identical except: 15 minutes total for all strength training (including core) and 5 minutes of stretching. Following CCAA classes, participants continue with dual-task gait training where they are required to walk on a special mat with a designated walking pattern (beginner level Square Stepping Exercise) while answering cognitively challenging questions.
BEHAVIORALExercise Control
Goal of 150 minutes of structured exercise/week; minimum of 120 minutes from CCAA classes/week. The 75-minute class includes: 5-minute warm-up; 25 minutes of AE (70-85% maximum heart rate); 5-minute cool-down; 20 minutes of strength training; 5 minutes of core strengthening; 5 minutes of balance training; and 10 minutes of stretching. The 60-minute program is identical except: 15 minutes total for all strength training (including core) and 5 minutes of stretching. Following CCAA classes, participants continue with gait training where they are required to walk on a special mat with a designated walking pattern (beginner level Square Stepping Exercise). This will not include any dual-task challenges.
Sponsors
University of Western Ontario, Canada
Canadian Institutes of Health Research (CIHR)
Parkwood Hospital, London, Ontario
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
55 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
* Male/Female 55-90 years old. * Montreal Cognitive Assessment score ≤27 * Preserved Instrumental Activities of Daily Living (based on Lawton-Brody Instrumental Activities of Daily Living Sale)
Exclusion criteria
* Dementia (i.e., Mini-Mental Examination score \<24 or self-reported physician diagnosis) * Major Depression (\>=16 on the Center for Epidemiologic Studies - Depression Scale combined with clinical judgment by primary study physician) * Other neurological or psychiatric disorders * Recent history of severe cardiovascular conditions * Significant orthopedic conditions * Have blood pressure \>180/100 mmHg or \<100/60 mmHg * Unable to comprehend questionnaire material/study procedures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Global cognitive functioning | 26 weeks | Four standardized domain-specific composite scores were averaged to create this standardized global cognitive functioning score (incorporates executive function, processing speed, verbal learning and memory, and verbal fluency. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global cognitive functioning | 12 & 52 weeks | Four standardized domain-specific composite scores were averaged to create this standardized global cognitive functioning score (incorporates executive function, processing speed, verbal learning and memory, and verbal fluency. |
| Executive Function/Mental Flexibility | 12, 26, and 52 weeks | Standardized scores from seconds to complete Trail Making Test Part A and Trail Making Test Part B averaged to create this standardized composite score |
| Processing Speed | 12, 26 and 52 weeks | Standardized score from the Digit-Symbol Substitution Test (total correct responses) |
| Verbal Learning and Memory | 12, 26 and 52 weeks | Standardized scores from Auditory Verbal Learning Test (number of words learned and number of words recalled) were averaged to create this standardized composite score |
| Verbal Fluency | 12, 26 and 52 weeks | Standardized scores from semantic (number of animals) and phonemic (number of words starting with C) were averaged to create this standardized composite score |
| Gait variability (step length) under dual-task conditions | 12, 26 and 52 weeks | Gait variability is the stride-to-stride fluctuations of the way someone walks and will be calculated as coefficient of variation of step length (SD/mean x 100). Measured with GAITRite system. |
| Gait variability (step length) under single-task conditions | 12, 26 and 52 weeks | Gait variability is the stride-to-stride fluctuations of the way someone walks and will be calculated as coefficient of variation of step length (SD/mean x 100). Measured with GAITRite system. |
| Gait speed under dual-task conditions | 12, 26 and 52 weeks | Average walking speed measured with GAITRite system |
| Gait speed under single-task conditions | 12, 26 and 52 weeks | Average walking speed measured with GAITRite system |
| Double support (seconds and % gait cycle time) under dual-task conditions | 12, 26 and 52 weeks | Initial double support occurs from heel contact of one footfall to toe-off of the opposite footfall. Terminal double support occurs from opposite footfall heel strike to support footfall toe-off.Total double support is the sum of the initial double support added to the terminal double support. It is measured in seconds (sec) and also expressed as a percent of the Gait Cycle time for the same foot. Measured with GAITRite system |
| Double support (seconds and % gait cycle time) under single-task conditions | 12, 26 and 52 weeks | Initial double support occurs from heel contact of one footfall to toe-off of the opposite footfall. Terminal double support occurs from opposite footfall heel strike to support footfall toe-off.Total double support is the sum of the initial double support added to the terminal double support. It is measured in seconds (sec) and also expressed as a percent of the Gait Cycle time for the same foot. Measured with GAITRite system |
| Step length under dual-task conditions | 12, 26 and 52 weeks | Mean step length measured with GAITRite system |
| Step length under single-task conditions | 12, 26 and 52 weeks | Mean step length measured with GAITRite system |
| Carotid artery compliance | 12, 26 and 52 weeks | Measured from non-invasive vascular assessment with B-mode Ultrasound over the carotid artery (in the neck) |
| Carotid artery Intima-media thickness (IMT) | 12, 26 and 52 weeks | Measured from non-invasive vascular assessment with B-mode Ultrasound over the carotid artery (in the neck) |
| Ambulatory systolic blood pressure | 12, 26 and 52 weeks | Average systolic blood pressure over a 24-hour time frame |
| Clinic systolic blood pressure | 12, 26 and 52 weeks | Average systolic blood pressure from final 2 (out of 3) readings |
| Ambulatory diastolic blood pressure | 12, 26 and 52 weeks | Average diastolic blood pressure over a 24-hour time frame |
| Clinic diastolic blood pressure | 12, 26 and 52 weeks | Average diastolic blood pressure from final 2 (out of 3) readings |
| Total balance score | 12, 26, and 52 weeks | Total balance score calculated from the Fullerton Advanced Balance Scale |
| Total Falls Self-Efficacy score | 12, 26, and 52 weeks | Total falls self-efficiacy score calculated from the Falls Self-Efficacy International (FES-I) scale |
Countries
Canada
Outcome results
None listed