Narlon Cassio Boa Sorte Silva

Combined Dual-Task Gait Training and Aerobic Exercise to Improve Cognition, Mobility, and Vascular Health in Community-Dwelling Older Adults at Risk for Future Cognitive Decline1

This 6-month experimental case series study investigated the effects of a dual-task gait training and aerobic exercise intervention on cognition, mobility, and cardiovascular health in community-dwelling older adults without dementia. Participants exercised 40 min/day, 3 days/week for 26 weeks on a Biodex GaitTrainer2 treadmill. Participants were assessed at baseline (V0), interim (V1: 12-weeks), intervention endpoint (V2: 26-weeks), and study endpoint (V3: 52-weeks). The study outcomes included: cognition [executive function (EF), processing speed, verbal fluency, and memory]; mobility: usual & dual-task gait (speed, step length, and stride time variability); and vascular health: ambulatory blood pressure, carotid arterial compliance, and intima-media thickness (cIMT). Fifty-six participants [age: 70(6) years; 61% female] were included in this study. Significant improvements following the exercise program (V2) were observed in cognition: EF (p = 0.002), processing speed (p < 0.001), verbal fluency [digit symbol coding (p < 0.001), phonemic verbal fluency (p < 0.001)], and memory [immediate recall (p < 0.001) and delayed recall (p < 0.001)]; mobility: usual & dual-task gait speed (p = 0.002 and p < 0.001, respectively) and step length (p = 0.001 and p = 0.003, respectively); and vascular health: cIMT (p = 0.002). No changes were seen in the remaining outcomes. In conclusion, 26 weeks of dual-task gait training and aerobic exercise improved performance on a number of cognitive outcomes, while increasing usual & dual-task gait speed and step length in a sample of older adults without dementia.

Multiple-modality exercise and mind-motor training to improve cardiovascular health and fitness in older adults at risk for cognitive impairment: A randomized controlled trial.

BACKGROUND The effects of multiple-modality exercise on arterial stiffening and cardiovascular fitness has not been fully explored. OBJECTIVES To explore the influence of a 24-week multiple-modality exercise program associated with a mind-motor training in cardiovascular health and fitness in community-dwelling older adults, compared to multiple-modality exercise (M2) alone. METHODS Participants (n=127, aged 67.5 [7.3] years, 71% females) were randomized to either M4 or M2 groups. Both groups received multiple-modality exercise intervention (60min/day, 3days/week for 24-weeks); however, the M4 group underwent additional 15min of mind-motor training, whereas the M2 group received 15min of balance training. Participants were assessed at 24-weeks and after a 28-week non-contact follow-up (52-weeks). RESULTS at 52-weeks, the M4 group demonstrated a greater VO2max (ml/kg/min) compared to the M2 group (mean difference: 2.39, 95% CI: 0. 61 to 4.16, p=0.009). Within-group analysis indicated that the M4 group demonstrated a positive change in VO2max at 24-weeks (mean change: 1.93, 95% CI: 0.82 to 3.05, p=0.001) and 52-weeks (4.02, 95% CI: 2.71 to 5.32, p=0.001). Similarly, the M2 group increased VO2max at 24-weeks (2.28, 95% CI: 1.23 to 3.32, p<0.001) and 52-weeks (1.63, 95% CI: 0.43 to 2.83, p=0.008). Additionally, the M2 group decreased 24h SBP (mmHg) at 24-weeks (-2.31, 95% CI: -4.61 to -0.01, p=0.049); whereas the M4 group improved 24h DBP (-1.6, 95% CI: -3.03 to -0.17, p=0.028) at 52-weeks. CONCLUSION Mind-motor training associated with multiple-modality exercise can positively impact cardiovascular fitness to the same extent as multiple-modality exercise alone.

Multiple-modality exercise and mind-motor training to improve mobility in older adults: A randomized controlled trial

Objective: To investigate the effects of multiple‐modality exercise with or without additional mind‐motor training on mobility outcomes in older adults with subjective cognitive complaints. Methods: This was a 24‐week randomized controlled trial with a 28‐week no‐contact follow‐up. Community‐dwelling older adults underwent a thrice ‐weekly, Multiple‐Modality exercise and Mind‐Motor (M4) training or Multiple‐Modality (M2) exercise with an active control intervention (balance, range of motion and breathing exercises). Study outcomes included differences between groups at 24 weeks and after the no‐contact follow‐up (i.e., 52 weeks) in usual and dual‐task (DT, i.e., serial sevens [S7] and phonemic verbal fluency [VF] tasks) gait velocity, step length and cycle time variability, as well as DT cognitive accuracy. Results: 127 participants (mean age 67.5 [7.3] years, 71% women) were randomized to either M2 (n = 64) or M4 (n = 63) groups. Participants were assessed at baseline, intervention endpoint (24 weeks), and study endpoint (52 weeks). At 24 weeks, the M2 group demonstrated greater improvements in usual gait velocity, usual step length, and DT gait velocity (VF) compared to the M4 group, and no between‐ or within‐group changes in DT accuracy were observed. At 52 weeks, the M2 group retained the gains in gait velocity and step length, whereas the M4 group demonstrated trends for improvement (p = 0.052) in DT cognitive accuracy (VF). Conclusions: Our results suggest that additional mind‐motor training was not effective to improve mobility outcomes. In fact, participants in the active control group experienced greater benefits as a result of the intervention. HighlightsDeficits in cognitive function are associated with mobility impairment.We applied multiple‐modality exercise plus mind‐motor training to improve mobility in high‐functioning older adults.We targeted community‐dwelling older adults with subjective cognitive complaints.Multiple‐modality exercise with mind‐motor training did not affect mobility outcomes.More research is warranted in individuals at risk for cognitive and mobility impairment.

Cognitive Changes Following Multiple-Modality Exercise And Mind-Motor Training In Older Adults With Subjective Cognitive Complaints: The M4 Study

Background We investigated the effects of multiple-modality exercise with additional mind-motor training on cognition in community-dwelling older adults with subjective cognitive complaints. Methods Participants (n = 127, mean age 67.5 [7.3] years, 71% women) were randomized to receive 45 minutes of multiple-modality exercise with additional 15 minutes of either mind-motor training (M4, n = 63) or control (balance, range of motion and breathing exercises [M2, n = 64]). In total, both groups exercised 60 minutes/day, 3 days/week, for 24 weeks. Standardized global cognitive functioning (GCF), concentration, reasoning, planning, and memory were assessed at 24 weeks and after a 28-week no-contact follow-up. Results There were no significant differences in the study primary outcomes. The M4 group, however, showed trends for greater improvements in GCF and memory (both, P = .07) compared to the M2 group at 24 weeks. Significant differences between group in GCF (P = .03) and memory (P = .02) were observed after the 28-week no-contact follow-up favouring the M4 group. Discussion Additional mind-motor training did not impart immediate greater benefits to cognition among the study participants.

The Impact of Blood Pressure Dipping Status on Cognition, Mobility, and Cardiovascular Health in Older Adults Following an Exercise Program:

Objectives: To determine whether a dual-task gait and aerobic exercise intervention differentially impacted older adults with normal blood pressure (BP) dipping status (dippers) compared to those with nondipping status (nondippers). Methods: This study was a secondary analysis involving participants (mean age = 70.3 years, 61% women) who attended a laboratory-based exercise intervention over a 6-month period (40 min/day and 3 days/week). Participants were assessed in measures of cognition, mobility, and cardiovascular health at baseline, 3, 6, and 12 months (after a 6-month no-contact follow-up). Results: We observed improvements in cognition in both groups at 6 and 12 months, although no between-group differences were seen. Nondippers demonstrated superior improvements in usual gait velocity and step length after the exercise intervention compared to dippers. Dippers reduced daytime systolic BP at 6 and 12 months to a greater extent than nondippers. Discussion: BP dipping status at baseline did not influence exercise benefits to cognition but did mediate changes in mobility and cardiovascular health.

DOES A 6-MONTH DUAL-TASK GAIT AND AEROBIC EXERCISE INTERVENTION DIFFERENTIALLY IMPACT OLDER ADULTS WITH NORMAL VERSUS NON-NORMAL BLOOD PRESSURE DIPPING STATUS?

Abbreviatio MMSE, Mini Assessment; C Data prese applicable. Cognition, z scores Global cognitive function .22 (.7) –.17 (.7) .075 Executive function .17 (.8) –.13 (.9) .423 Processing speed .23 (1) –.19 (.9) .121 Memory .28 (.8) –.22 (.9) .124 AEROBIC EXERCISE INTERVENTION DIFFERENTIALLY IMPACT OLDER ADULTS WITH NORMALVERSUS NONNORMAL BLOOD PRESSURE DIPPING STATUS? Verbal fluency .18 (.8) –.15 (.8) .179 Mobility Usual gait velocity, cm/s 117.7 (18) 106.7 (18.5) .013* Usual step length, cm 63.7 (6.1) 61.3 (7.8) .152 Usual gait variability, CoV, % 2.6 (4.5) 2.3(1.1) .69 DT gait velocity, cm/s 96.8 (23.4) 85.8 (9.4) .146 DT step length, cm 59.5 (6.8) 56.2 (9.4) .193 DT gait variabilitv, CoV, % 7.4 (8.5) 6.2 (4.8) .547

THE EFFICACY OF A MULTI-MODALITY EXERCISE PROGRAM COMBINED WITH MIND-MOTOR TASK TRAINING FOR OLDER ADULTS AT RISK OF COGNITIVE IMPAIRMENT ON USUAL AND DUAL-TASK GAIT: A RANDOMIZED CONTROLLED TRIAL

were found between the 3 risk groups. When obesity and hypertension were excluded from the index in late life, the risk for dementia increased as the index became higher (HR1⁄41.08, 1.021.15, p1⁄40.013) and individuals in the high-risk group had an increased risk for dementia compared to those in the low-risk group (HR1⁄41.26, 1.04-1.52, p1⁄40.018; Table 1). Conclusions: Our findings indicate that the LIBRA index might be a useful tool in midlife and, when adjusted, also in late life to identify individuals for primary prevention interventions of dementia and monitor individuals’ risk-change over time.