Thomson W. L. Wong

Effect of Low-intensity Exercise on Physical and Cognitive Health in Older Adults: a Systematic Review

BackgroundIt is well known that physical exercise is important to promote physical and cognitive health in older population. However, inconsistent research findings were shown regarding exercise intensity, particularly on whether low-intensity exercise (1.5 metabolic equivalent tasks (METs) to 3.0 METs) can improve physical and cognitive health of older adults. This systematic review aimed to fill this research gap. The objective of this study is to conduct a systematic review of the effectiveness of low-intensity exercise interventions on physical and cognitive health of older adults.MethodsPublished research was identified in various databases including CINAHL, MEDLINE, PEDro, PubMed, Science Direct, SPORTDiscus, and Web of Science. Research studies published from January 01, 1994 to February 01, 2015 were selected for examination. Studies were included if they were published in an academic peer-reviewed journal, published in English, conducted as randomized controlled trial (RCT) or quasi-experimental studies with appropriate comparison groups, targeted participants aged 65 or above, and prescribed with low-intensity exercise in at least one study arm. Two reviewers independently extracted the data (study, design, participants, intervention, and results) and assessed the quality of the selected studies. Fifteen studies met the inclusion criteria. Quality index ranged from 15 to 18 mean = 18.3 with a full score of 28, indicating a moderate quality. Most of the outcomes reported in these studied were lower limb muscle strength (n = 9), balancing (n = 7), flexibility (n = 4), and depressive symptoms (n = 3).ResultsOut of the 15 selected studies, 11 reported improvement in flexibility, balancing, lower limb muscle strength, or depressive symptoms by low-intensity exercises.ConclusionsThe current literature suggests the effectiveness of low-intensity exercise on improved physical and cognitive health for older adults. It may be a desired intensity level in promoting health among older adults with better compliance, lower risk of injuries, and long-term sustainability.

Movement specific reinvestment and allocation of attention by older adults during walking.

Abstract Older repeat fallers have previously been shown to have a higher propensity to consciously monitor and control their movements (i.e. reinvestment) than non-fallers, yet to direct their attention equally between their limb movements and the external environment during locomotion (Wong et al. in J Am Geriatr Soc 57: 920–922, 2009). Whether increased attention to their movements is a result of falling or originates from a prior inclination to reinvest remains unclear. In order to better understand the interaction between reinvestment and attention during locomotion, this study examined the allocation of attention by older adults who had not fallen but displayed a high or low inclination for reinvestment. Twenty-eight low and twenty-eight high reinvestors were required to perform 30 walking trials. Their allocation of attention during walking was evaluated by asking tone-related attentional focus questions shortly after finishing each walking trial. High reinvestors were found to be more aware of their limb movements and less aware of the external environment. Low reinvestors, on the contrary, were more aware of the surrounding environment and less aware of their movement mechanics. Given that focusing internally to body movements has been proposed to utilise working memory capacity, the ability of high reinvestors to pick up all the environmental information necessary for successful locomotion might be compromised and requires further examination.

Examining motor learning in older adults using analogy instruction

Objective: Previous studies have reported that analogy promotes stable motor performance under cognitively demanding situations such as stress and fatigue. However, it is unclear whether analogy is useful for motor learning among older adults, or whether the benefits of motor learning by analogy can be generalized to older adults. The present study examined these questions. Methods and design: Groups of young and older table tennis novices learnt to perform a forehand topspin stroke in table tennis, receiving either analogy instruction or a set of explicit instructions. Afterwards, participants were asked to perform a motor task in three testing situations: dual‐task, immediate retention and skill consolidation. Motor performance was assessed using a validated scoring system. Results: Motor performance induced by analogy instruction was comparable to that induced by explicit instruction in both young and older adults. In addition, similar to young adults, the older analogy‐instructed participants demonstrated more robust motor performance than their explicitly instructed counterparts in dual‐task, immediate retention and skill consolidation testing situations. Conclusions: Analogy instruction aided older adults in acquiring new motor skills, and the benefits of analogy to reduce the cognitive demand of motor learning can be generalized to the older population. HighlightsWe examine the feasibility of analogy instruction in motor learning by older adults.We compare the effectiveness of analogy instruction in motor learning between older adults and young adults.Analogy instruction is effective for motor learning by older adults.Analogy instructed motor skill is more durable than explicitly instructed motor skill in both young and older adults.Fewer working memory resources may be required to process analogy instructions than explicit instructions.

Analogy motor learning by young children: a study of rope skipping

Abstract Research in psychology suggests that provision of an instruction by analogy can enhance acquisition and understanding of knowledge. Limited research has been conducted to test this proposition in motor learning by children. The purpose of the present study was to examine the feasibility of analogy instructions in motor skill acquisition by children. Thirty-two children were randomly assigned to one of the two instruction protocols: analogy and explicit instruction protocols for a two-week rope skipping training. Each participant completed a pretest (Lesson 1), three practice sessions (Lesson 2–4), a posttest and a secondary task test (Lesson 5). Children in the analogy protocol displayed better rope skip performance than those in the explicit instruction protocol (p < .001). Moreover, a cognitive secondary task test indicated that children in the analogy protocol performed more effectively, whereas children in the explicit protocol displayed decrements in performance. Analogy learning may aid children to acquire complex motor skills, and have potential benefits related to reduced cognitive processing requirements.

Instructions influence response to the Chinese version of the Movement-Specific Reinvestment Scale in community-dwelling older adults

To examine whether differences emerged when the Chinese version of the Movement‐Specific Reinvestment Scale (MSRS‐C) was administered to community‐dwelling older adults with instructions to respond in the context of “general” movements, walking, using chopsticks or dressing. Furthermore, the difference between the six‐point Likert scale and four‐point Likert scale response formats of the MSRS‐C was investigated.

Psychophysical effects of subtle modification of the built environment: a quasi-experimental field study

BACKGROUND Chinas rapid urban growth is associated with an increasingly unhealthy population. Urban planners can design cities to promote healthy lifestyles, but to re-engineer the existing built environment is no simple task. We assessed whether a simple modification of the built environment was associated with altered perceptions of, and ambulation in, that environment. METHODS We adjusted a single-rail stair banister (length 3 m, height 1 m) in an urban area of Hong Kong, China, to increase or decrease the convergence angle with the stairs by 10% (plus or minus 1·91°). When positioned conventionally, the banister was parallel to the stairs (2·19 m width, 26·5° incline). 92 participants (mean age 19·71 years [SD 0·79], 54 male and 38 female) who were unaware that the banister diverged from (n=32), converged with (n=30), or was parallel to the stairs (n=30), visually estimated the angle of incline of the stairs from the top by rotating a disk to match the slant of the staircase. Walking speed (metres per second) was video-recorded surreptitiously as a sub-sample of the participants (n=36) approached the stairs with the banister in each position. Data were analysed using one-way analysis of variance followed by Bonferroni comparisons. Ethics approval was obtained from the University of Hong Kong Research Ethics Committee, and participants provided written informed consent to participate. FINDINGS Visual estimations differed between the groups (F2,89=6·62, p=0·002, η2=0·13); estimates of angle were smaller when the banister converged with the stairs (mean 32·53° [SD 8·39]) than when it diverged (39·69° [9·0]; p=0·007) or was parallel (39·88° [8·92]; p=0·006). Walking speeds in the final three strides preceding transition to stair descent also differed (F2,70=3·11, p=0·05, ηp2=0·08) with mean walking speed slower when the banister diverged (mean 1·24 m per s [SD 0·26]) than when it converged (1·36 m per s [0·19]; p=0·046). INTERPRETATION Modification of the angle of a stair banister was associated with differences in perception of the steepness of stairs and in walking behavior during approach to the stairs. Problems associated with rapid urban development, including falls in older people and physical inactivity, are high on the health agenda of the Chinese government. Future work should examine whether stairs that appear less steep are more readily climbed, thus promoting physical activity, and whether stepping parameters are improved, thus promoting fewer falls. FUNDING None.