Effectiveness of a 16-Week Multimodal Exercise Program on Individuals With Dementia: Study Protocol for a Multicenter Randomized Controlled Trial

Trautwein, Sandra; Scharpf, Andrea; Barisch‐Fritz, Bettina; Niermann, Christina; Wöll, Alexander

doi:10.2196/resprot.6792

Cited by 22 publications

(30 citation statements)

References 80 publications

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“…A major strength of the expert panel was the comprehensive and thorough analysis of the appropriateness of motor assessments considering specific characteristics of IWD. Following the expert panel, the recommended assessments were applied in a trial of our own with IWD in mild to moderate stages of the disease [ 67 ] and demonstrated feasibility. This is in line with previous investigations successfully utilising these assessments or determining their reliability.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel – a qualitative approach

Trautwein

Barisch‐Fritz

Scharpf

et al. 2019

Eur Rev Aging Phys Act

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Background Recommendations for assessing motor performance in individuals with dementia (IWD) are rare, and most existing assessment tools previously applied in IWD were initially developed for healthy older adults. However, IWD and their healthy counterparts differ in motor and cognitive capabilities, which needs to be considered when designing studies for this population. This article aims to give recommendations for motor assessments for IWD and to promote standardisation based on a structured discussion of identified assessment tools used in previous trials. Methods Appropriateness and standardisation of previously applied motor assessments for IWD were intensively discussed using a qualitative approach during an expert panel. Furthermore, the use of external cues and walking aids, as well as psychometric properties were considered. Starting with a comprehensive overview of current research practice, the discussion was gradually specified and resulted in the elaboration of specific recommendations. Results The superior discussion emphasised the need for tailoring motor assessments to specific characteristics of IWD and attaching importance to standardised assessment procedures. Specific recommendations include the use of sequential approaches, which incorporate a gradual increase of complexity from simple to more difficult tasks, a selection of motor assessments showing sufficient relative reliability and appropriateness for IWD, as well as allowing external cues and walking aids when restricted to repeated instructions and commonly used devices, respectively. Conclusions These are the first recommendations for assessing motor performance in IWD based on a comprehensive qualitative approach. Due to limited evidence, it was not possible to address all existing questions. It is therefore important to evaluate these recommendations in studies with IWD. Besides tailoring and evaluating available assessments, future research should focus on developing specific tools for IWD. Moreover, further progress in standardisation is necessary to enhance comparability between different trials. This article provides initial approaches for overcoming existing limitations in trials with IWD by giving recommendations and identifying future research questions, and therefore contributes to enhancing evidence regarding efficacy and effectiveness of physical activity interventions.

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Section: Discussionmentioning

confidence: 99%

Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel – a qualitative approach

Trautwein

Barisch‐Fritz

Scharpf

et al. 2019

Eur Rev Aging Phys Act

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“…Researchers have studied the effects of different physical activities such as aerobic, cycling, and gait training with people with MCI, and in general, the results showed beneficial effects in maintaining both physical and cognitive capabilities [19,22]. While exercise is beneficial, age-related changes often result in decreased physical activity for older adults, particularly those with MCI where changes in cognition create additional challenges [5,15].…”

Section: Introductionmentioning

confidence: 99%

Participatory Design of a Virtual Reality Exercise for People with Mild Cognitive Impairment

Eisapour

Cao

Domenicucci³

et al. 2018

Extended Abstracts of the 2018 CHI Conference on Human Factors in Computing Systems

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This case study describes the creation of a headmounted display virtual reality exergame program for promoting physical exercise for people with mild cognitive impairment (MCI), namely people with earlystage dementia. We engaged in an iterative participatory design process with kinesiologists, recreational therapists, and people with MCI prior to pilot-testing a prototype program with three persons with MCI. The test participants engaged in the exergame, were able to do the exercises, and their feedback was very positive. Engaging with professionals and people with dementia throughout the design process was very beneficial to creating a usable and engaging design as well as identifying areas that could be further improved. In conclusion, the approach illustrated through this case study resulted a new way for older adults with MCI to engage in physical activities that is fun and tailored to their abilities. The next phase in our research is to evaluate the exergame against comparable human-guided movements.

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“…For this manuscript, we followed the guidelines and recommendations of the Consolidated Standards of Reporting Trials statements [ 51 , 52 ]. The reader is referred to the published study protocol for a detailed description of the study design and methods [ 53 ]. The following sections will only provide a brief summary of study methods.…”

Section: Methodsmentioning

confidence: 99%

“…This allocation ratio accounts for assumed higher dropout quotes and insufficient adherence to the MEP in the IG. The randomization was carried out separately for each of the 36 care facilities that served as recruitment sites, and minimization considered age, sex, Mini-Mental State Examination (MMSE) score and performance in the modified 30-s chair stand test (30s CST) of participants (for details please refer to our study protocol [ 53 ]). If possible, we blinded investigators who examined gait, motor, and cognitive performance to group allocation, i.e., the investigators did not know whether a participant was part of the IG or CG in order to ensure objectivity of testing.…”

Section: Methodsmentioning

confidence: 99%

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Effects of a 16-week multimodal exercise program on gait performance in individuals with dementia: a multicenter randomized controlled trial

et al. 2020

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Background There is a high prevalence of gait impairments in individuals with dementia (IWD). Gait impairments are associated with increased risk of falls, disability, and economic burden for health care systems. Only few studies have investigated the effectiveness of physical activity on gait performance in IWD, reporting promising but inconsistent results. Thus, this study aimed to investigate the effectiveness of a multimodal exercise program (MEP) on gait performance in IWD. Methods In this parallel-group randomized controlled trial, we enrolled 319 IWD of mild to moderate severity, living in care facilities, aged ≥ 65 years, and being able to walk at least 10 m. The control group ( n = 118) received conventional treatment, whereas the intervention group ( n = 201) additionally participated in a 16-week MEP specifically tailored to IWD. We examined the effects of the MEP on spatiotemporal gait parameters and dual task costs by using the gait analysis system GAITRite. Additionally, we compared characteristics between positive, non-, and negative responders, and investigated the impact of changes in underlying motor and cognitive performance in the intervention group by conducting multiple regression analyses. Results Two-factor analyses of variance with repeated measurements did not reveal any statistically significant time*group effects on either spatiotemporal gait parameters or dual task costs. Differences in baseline gait performance, mobility, lower limb strength, and severity of cognitive impairments were observed between positive, non-, and negative responders. Positive responders were characterized by lower motor performance compared to negative and non-responders, while non-responders showed better cognitive performance than negative responders. Changes in lower limb strength and function, mobility, executive function, attention, and working memory explained up to 39.4% of the variance of changes in gait performance. Conclusions The effectiveness of a standardized MEP on gait performance in IWD was limited, probably due to insufficient intensity and amount of specific walking tasks as well as the large heterogeneity of the sample. However, additional analyses revealed prerequisites of individual characteristics and impacts of changes in underlying motor and cognitive performance. Considering such factors may improve the effectiveness of a physical activity intervention among IWD. Trial registration DRKS00010538 (German Clinical Trial Register, date of registration: 01 June 2016, retrospectively registered, https://www.drks.de/drks_web/setLocale_EN.do ).

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Effectiveness of a 16-Week Multimodal Exercise Program on Individuals With Dementia: Study Protocol for a Multicenter Randomized Controlled Trial

Cited by 22 publications

References 80 publications

Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel – a qualitative approach

Recommendations for assessing motor performance in individuals with dementia: suggestions of an expert panel – a qualitative approach

Participatory Design of a Virtual Reality Exercise for People with Mild Cognitive Impairment

Effects of a 16-week multimodal exercise program on gait performance in individuals with dementia: a multicenter randomized controlled trial

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