Marijke Hopman-Rock

The effects of exercise on cognition in older adults with and without cognitive decline: A systematic review

Objective:To systematically review the effect of physical exercise on cognition in older adults with and without cognitive decline. Data Sources:Randomized controlled trials were identified by literature searches in PubMed, EMBASE, CENTRAL, PsycINFO, and AgeLine. Study Selection:Papers were included on the basis of predefined inclusion criteria. Data Extraction:Data on study population, exercise intervention, and effectiveness were extracted. Two independent reviewers assessed methodological quality. Data Synthesis:Twenty-three studies were included-15 among cognitively healthy subjects and 8 among subjects with cognitive decline. Seven studies were qualified as high-quality studies, 2 in cognitively healthy subjects and 5 in subjects with cognitive decline. In cognitively healthy subjects, significant beneficial intervention effects were observed in 5 studies on information processing, executive function, or memory. Interventions in these studies included aerobic exercise only (n = 2); strength exercise (n = 1); strength and balance exercise (n = 1); or all-round exercise including aerobic, strength, balance and flexibility training (n = 1). In subjects with cognitive decline, 5 studies observed beneficial effects on general cognition, executive functions, and memory. Interventions included aerobic (n = 3) or strength exercise combined with flexibility or balance exercise (n = 2). Conclusions:Beneficial effects of various exercise programs on aspects of cognition have been observed in studies among subjects with and without cognitive decline. The majority of the studies, however, did not find any effect. The small number of included studies; lack of high-quality studies; and the large variability in study populations, exercise protocols, and outcome measures complicate interpretation of the results. More high-quality trials are needed to assess the effects of different types of exercise on cognitive function in older adults with and without cognitive decline.

Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial

Objective: To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment (MCI). Design: Randomised placebo-controlled trial. Setting: General community. Participants: Community-dwelling adults aged 70–80 with MCI. Interventions : The 152 participants were randomly assigned to two interventions: (1) a twice-weekly, group-based, moderate-intensity walking programme (WP, n = 77) or a low-intensity placebo activity programme (n = 75) for one year; and (2) daily vitamin pill containing 5 mg folic acid, 0.4 mg vitamin B-12, 50 mg vitamin B-6 (FA/B12/B6, n = 78) or placebo pill (n = 74) for one year. Outcome measures: Cognitive function, measured with neuropsychological tests at baseline and after six and 12 months. Results: Median session attendance at the exercise programmes (25th–75th percentile) was 63% (2%–81%) and median compliance with taking pills (25th–75th percentile) was 100% (99%–100%). Gender was an effect modifier. Intention-to-treat analysis revealed no main intervention effect for either intervention. In women in the WP, attention (Stroop combination task) improved by 0.3 seconds (p = 0.04) and memory (auditory verbal learning test) by 0.04 words (p = 0.06) with each percentage increase in session attendance. In men attending at least 75% of the sessions, the WP improved memory (β 1.5 (95% CI: 0.1 to 3.0) words). Conclusion: The walking programme and/or FA/B12/B6 supplementation were not effective in improving cognition within one year. The walking programme, however, was efficacious in improving memory in men and memory and attention in women with better adherence. Trial registration: International Standard Randomised Controlled Trial Number Register, 19227688, http://www.controlled-trials.com/isrctn/

Validity and Reproducibility of Motion Sensors in Youth: A Systematic Update

PURPOSE To review recently published studies on the reproducibility, validity, and feasibility of motion sensors used to assess physical activity in healthy children and adolescents (2-18 yr). METHODS On October 2004, a systematic literature search in PubMed, EMBASE, and PsycINFO was performed. This search has been updated on October 2007. In this update, the clinimetric quality of three pedometers (Digi-Walker, Walk4Life, and Sun TrekLINQ) and nine accelerometers (ActiGraph, BioTrainer, StepWatch Activity Monitor, Actiwatch, Actical, Tritrac-R3D, RT3, ActivTracer, and Mini-Motionlogger) has been evaluated and compared using a checklist. RESULTS Thirty-two recently published clinimetric studies have been reviewed. All 12 motion sensors have been validated in youth in one or more studies. There is strong evidence for moderate validity of the StepWatch in children and adolescents (4-18 yr) and moderate to good validity of the ActiGraph in preschool children and young children (2-8 yr). There is less evidence for the reproducibility and feasibility of the 12 motion sensors. Strong evidence exists for good reproducibility of the ActiGraph in preschool children (2-4 yr). CONCLUSION Compared to the review performed in 2004, there is increased evidence for the clinimetric quality of pedometers and accelerometers in youth. Most motion sensors seem reproducible, valid, and feasible in assessing physical activity in youth.

Prevention of onset and progression of basic ADL disability by physical activity in community dwelling older adults: A meta-analysis

PURPOSE Physical activity (PA) is an important behavior when it comes to preventing or slowing down disablement caused by aging and chronic diseases. It remains unclear whether PA can directly prevent or reduce disability in activities of daily living (ADL). This article presents a meta-analysis of the association between PA and the incidence and progression of basic ADL disability (BADL). METHODS Electronic literature search and cross-referencing of prospective longitudinal studies of PA and BADL in community dwelling older adults (50+) with baseline and follow-up measurements, multivariate analysis and reporting a point estimate for the association. RESULTS Compared with a low PA, a medium/high PA level reduced the risk of incident BADL disability by 0.51 (95% CI: 0.38, 0.68; p<001), based on nine longitudinal studies involving 17,000 participants followed up for 3-10 years. This result was independent of age, length of follow-up, study quality, and differences in demographics, health status, functional limitations, and lifestyle. The risk of progression of BADL disability in older adults with a medium/high PA level compared with those with a low PA level was 0.55 (95% CI: 0.42, 0.71; p<001), based on four studies involving 8500 participants. DISCUSSION This is the first meta-analysis to show that being physically active prevents and slows down the disablement process in aging or diseased populations, positioning PA as the most effective preventive strategy in preventing and reducing disability, independence and health care cost in aging societies.

Determinants of activity-friendly neighborhoods for children: results from the SPACE study

Purpose. To examine the association between childrens physical activity and factors of the built environment. Design. Cross-sectional study. Setting. Ten neighborhoods in six cities in the Netherlands. Subjects. Four hundred twenty-two children (age range, 6–11 years; 49% male). Measures. Physical activity diary, neighborhood observations, and anthropometric measures. Analysis. Univariate and multivariate linear regression analyses. Results. According to univariate analyses adjusted for age, sex, body mass index, and highest level of maternal education, physical activity (≥ 3 metabolic equivalents) was significantly (p < .05) associated with the proportion of green space, with the residential density, with the general impression of activity-friendliness of the neighborhood, and with the frequency of certain types of residences (e.g., terraced houses), sports fields, water, dog waste, heavy traffic, and safe walking and cycling conditions (e.g., cycle tracks and 30-km speed zones) in the neighborhood. According to adjusted multivariate analyses, physical activity was best predicted by the frequency of parallel parking spaces in the neighborhood and by the general impression of activity-friendliness of the neighborhood (R2 = 0.193). Conclusions. Childrens physical activity is associated with certain modifiable factors of the built environment. Longitudinal studies should examine whether there is a causal relationship.

Quality of life in elderly subjects with pain in the hip or knee

This study examines the quality of life (QOL) of community living elderly people aged 55-74 with chronic, episodic or sporadic pain in the hip or knee and of a reference group without pain (total n=306). Firstly, it was hypothesized that the experienced QOL is lower in people with more chronic pain. Secondly, the potential mediating and moderating roles of disability and of coping with problems in general on the relationship between pain chronicity and QOL were assessed. A Visual Analogue Scale was used to assess global QOL. Physical as well as psychosocial disability was assessed with the Sickness Impact Profile (SIP). Coping with problems in general was assessed with the Utrecht Coping List. As expected, a significantly lower QOL was found in people with more chronic pain (p=0.045). The difference in QOL between the group with chronic pain and a reference group without pain was 10%. A multivariate regression model showed that physical and especially psychosocial disability are mediators in the relationship between pain chronicity and QOL and that ‘seeking social support’ as a coping style is a more important predictor of the experienced QOL than either pain chronicity or physical disability. No moderating role of the style of coping with problems was found.

Built environmental correlates of walking and cycling in dutch urban children: Results from the SPACE study

This study examined built environmental correlates of children’s walking and cycling behavior. Four hundred and forty-eight children from 10 Dutch neighborhoods completed a seven-day physical activity diary in which the number of walking and cycling trips for transportation, to school, and for recreation were assessed. The associations between observed built environmental characteristics and children’s walking and cycling behavior were examined with multivariate linear regression analyses. The results showed that built environmental correlates of children’s walking and cycling behavior differ by purpose and by commuting mode implying a behavior-specific approach for interventions and for future, preferably prospective, studies.

Performance-based physical function in older community-dwelling persons: a systematic review of instruments

BACKGROUND Identification of older persons at risk for the loss of independence, onset of (co)-morbidity or functional limitations through screening/assessment is of interest for the public health-care system. To date several different measurement instruments for overall physical function are frequently used in practice, but little information about their psychometric properties is available. Objectives and METHODS Our aim was to assess instruments with an overall score related to functional status and/or physical performance on content and psychometric properties. Electronic databases (Medline, EMBASE, AMED, Cochrane Library and CINAHL) were searched, using MeSH terms and relevant keywords. Studies, published in English, were included if their primary or secondary purpose was to evaluate the measurement properties of measurement instruments for overall physical function in community-dwelling older persons aged 60 years and older. Reliability, validity, responsiveness and practicability were evaluated, adhering to a specified protocol. RESULTS In total 78 articles describing 12 different functional assessment instruments were included and data extracted. Seven instruments, including their modified versions, were evaluated for reliability. Nine instruments, including their modified versions, were evaluated with regard to validity. CONCLUSION In conclusion, the Short Physical Performance Battery can be recommended most highly in terms of validity, reliability and responsiveness, followed by the Physical Performance Test and Continuous Scale Physical Functional Performance.

The effects of a psychomotor activation programme for use in groups of cognitively impaired people in homes for the elderly.

To test the effects of the Psychomotor Activation Programme (PAP) on the behaviour and cognition of demented elderly people.

Once a week is not enough: Effects of a widely implemented group based exercise programme for older adults; a randomised controlled trial

Objectives: To determine the effects of gymnastics on the health related quality of life (HRQoL) and functional status of independently living people, aged 65 to 80 years. Gymnastics formed part of the More Exercise for Seniors (MBvO in Dutch) programme, a group based exercise programme for older adults in the Netherlands. It has been widely implemented since 1980. Design: Randomised controlled trial with pretest and post-test measurements. Intervention: The exercise programme given by experienced instructors lasted 10 weeks and was given weekly (MBvO1; n = 125, six groups) or twice weekly (MBvO2; n = 68, six groups). The control group (n = 193) was offered a health education programme. Setting: Community dwelling of older people, with a comparatively low level of fitness as assessed with the Groningen Fitness test for the Elderly. Results: No significant effects were found on the HRQoL (Vitality Plus Scale, TAAQoL, and RAND-36) and the functional status (Physical Performance Test and the Groningen Activity Restriction Scale). The MBvO2 group, with a low level of physical activity at baseline, showed the only improvement found on the Vitality Plus Scale (F = 4.53; p = 0.01). Conclusions: MBvO gymnastics once a week did not provide benefits in HRQoL and functional status after 10 weeks. However, participants with a low level of physical activity may benefit from MBvO gymnastics if they participate twice a week. To improve the health of the general public, sedentary older adults should be recruited and encouraged to combine MBvO with the health enhancing physical activity guidelines.