1Background Children born preterm or with a small-size-for-gestational-age are at increased 2

Objectives To test the effects of walking, light exposure, and a combination intervention (walking plus light plus sleep education) on the sleep of persons with Alzheimer’s disease (AD). Design Randomized, controlled trial with blinded assessors. Setting Independent community living. Participants 132 AD patients and their in-home caregivers. Interventions Participants were randomly assigned to one of three active treatments (walking, light, combination treatment) or contact control. Participants received three or six in-home visits. Measurements Primary outcomes were patient total wake time based on wrist actigraphy, and caregiver ratings of patient sleep quality on the Sleep Disorders Inventory (SDI). Secondary sleep outcomes included additional actigraphic measurements of patient sleep percent, number of awakenings, and total sleep time. Results Patients in walking (p<.05), light (p<.04), and combination treatment (p<.01) had significant improvements in total wake time at post-test (effect size 0.51 – 0.63) compared to control subjects, but no significant improvement on the SDI. Moderate effect size improvements in actigraphic sleep percent were also observed in active treatment subjects. There were no significant differences between active treatment groups, and no group differences for any sleep outcomes at six months. Patients with greater adherence (4+ days/week) to walking and light exposure recommendations had significantly (p<.05) less total wake time and better sleep efficiency at post-test than those with lesser adherence. Conclusion Walking, light exposure and the combination are potentially effective treatments for improving sleep in community-dwelling persons with AD, but consistent adherence to treatment recommendations is required.

These results support the efficacy of ESML support groups for individuals with dementia.

Psychosocial therapy significantly reduced the risk of cardiovascular death in sudden cardiac arrest survivors.

Structural social support, which was measured by reports of living with others and having a caregiver, was respectively associated with higher levels of physical activity and greater participation in pulmonary rehabilitation in adults with COPD. Our findings reinforce the critical importance of the social environment in shaping patients' success with self-care. Clinical Trial registered with clinicaltrials.gov (NCT01074515).