Ground Kayak Paddling Exercise Improves Postural Balance, Muscle Performance, and Cognitive Function in Older Adults with Mild Cognitive Impairment: A Randomized Controlled Trial

Abstract

BackgroundKayaking is an interesting and posturally challenging activity; however, kayaking may be limited by safety issues in older adults. The aim of this study was to determine whether ground kayak paddling (GKP) exercise can improve postural balance, muscle performance, and cognitive function in older adults with mild cognitive impairment.Material/MethodsSixty participants were randomly allocated to a GKP group (n=30; mean age, 74 years) or a control group (n=30; mean age, 74 years). GKP exercise consisted 5 types of exercise protocols, including paddling and multi-directional reaching with repetitive trunk and upper-extremities movements, which was performed for 60 min twice a week for 6 weeks. The outcome measures included the Timed Up and Go Test, the Functional Reach Test, the Berg Balance Scale, the Arm Curl Test, handgrip strength, and the Montreal Cognitive Assessment.ResultsIn this study, adherence to the regimen was 96% in the GKP group. Postural balance, muscle performance, and cognitive function were significantly improved after intervention (p<0.05), and all the values in the GKP group, except for the Berg Balance Scale scores, were significantly decreased or increased compared to the control group. Differences between the 2 groups were Timed Up and Go Test −0.74 s; Functional Reach Test +7.20 cm; Arm Curl Test +5.56 repetitions; right handgrip strength +3.57 kg; left handgrip strength +3.08 kg; and Montreal Cognitive Assessment, +3.46 score (p<0.05).ConclusionsGKP exercise improves the physical and psychological ability of older adults with mild cognitive impairment.

Adherence to exercise interventions in older people with mild cognitive impairment and dementia: A systematic review and meta-analysis

“…hand function and lower extremity strength) Suzuki ( Bossers et al, 2015 ) JP RCT 50 Living in the community; ≥65 years; having a lower memory in the Logical Memory II subtest of the Wechsler memory scale-revised (WMS-LM II) 27;23 76.0 (7.1) Mild cognitive impairment (mean MMSE 26.8 ± 1.8) Cognitive function Tak[75] NL Follow-up to RCT 179 Age between 70 and 80; community dweller; self-reported memory complaints; no report of disability in ADLs; objective memory impairment as measured with a Dutch version of the 10-word learning test; normal cognitive function and absence of dementia as assessed by the Telephone Interview for Cognitive Status; MMSE > 24 101;78 75.1 (2.9) Mild cognitive impairment (mean MMSE 28.3 ± 1.5) Recruitment and adherence to programme Tappen ( Burgener et al, 2008 ) USA Uncontrolled trial 71 Clinical diagnosis of probable AD; MMSE < 23; able to stand and walk with the assistance of one individual and/or an assistive device; physician clearance to participate in the exercise 12;59 87.0 Dementia (mean MMSE 10.8) Functional mobility Taylor ( Cancela et al, 2016 ) AU Uncontrolled trial 42 60 + years; living in the community; clinical diagnosis of dementia (made by a geriatrician or psycho-geriatrician); attending a specialty clinic (e.g. Cognitive Disorders Clinic, Memory Clinic, or Aged Care Clinic) or known to dementia services in the local community; having a carer for a minimum of 3.5 h a week; MMSE > 12/30 20;22 83.0 (7.0) Mild to moderate dementia (mean ACE-R score 58 ± 14) Balance (measured by sway on floor and foam) and affect (measured by the 15-item Geriatric Depression Scale (GDS)) Telenius ( Choi and Lee, 2018 ) NO RCT 170 > 55 years of age; mild or moderate dementia as measured by the Clinical Dementia Rating scale; able to stand up alone or by the help of one person; able to walk 6 m with or without walking aid 45;125 86.7 (7.4) Mild to moderate dementia Balance Teri[33] USA Cross-sectional 30 Meeting the National Institute of Neurologic...…”

“…< 3 or > 3 metabolic equivalents [METs]) Group/Trainer Tappen ( Bossers et al, 2015 ) Thirty minutes of self-paced assisted walking interspersed with rest as needed (with vs. without conversation with supporter) 16 3 Nursing home Individual/ Student researchers Taylor ( Cancela et al, 2016 ) Exercises were predominantly balance focused, but also included strength and/or combined strength-balance exercises, e.g. tandem stance, knee extensions +/− weights, sit-to-stand, step ups on a block, and sidestepping 24 Private home Individual/Carer Telenius ( Choi and Lee, 2018 ) Fifty-to-sixty minute sessions including 5 min warm-up, at least two strengthening exercises for the muscle of lower limb and two balance exercises 12 2 High (i.e. 12 repetitions maximum) Nursing home Group/ Therapist Teri ( Gibson-Moore, 2019 ) Strength training focused on lower-body strengthening including dorsiflexion (“toe lifts”), knee extension and flexion (“knee straightening” and “back knee bends”), plantarflexion (“toe raises”), hip flexors (“marches”), abduction (“side lifts”), and extension (“back leg lifts”).…”

“…Flexibility training focusing on the back, shoulders, hips, hamstrings, gastrocnemius/soleus/achilles, neck, and hand. Endurance including brisk walking 12 Private home Individual/Carer Thomas ( Choi and Lee, 2018 ) Resistance training sessions using Thera Band, comprising: a brief warmup, and 12 exercises to target the hip flexors, hip extensors, hip abductors, hip adductors, knee flexors, knee extensors, ankle dorsi-flexors, and ankle plantar-flexors 6 3 Moderate Community Individual/Trainer Too ts(2014) Functional exercises (exercises performed in functional, weight-bearing positions similar to those used in everyday situations, such as rising from a chair, stepping up, trunk rotation while standing, and walking) aimed to improve lower limb strength, balance, and mobility 16 2.5 High (i.e. 8- to 12-repetition maximum) Nursing home Group/Therapist Van Uffelen ( Edwards et al, 2008 ) Outdoors walking sessions including a warm-up, moderate-intensity walking exercises and cool-down 48 2 Moderate (i.e.…”

“…Four serious adverse events related to study, including one hospitalization, two injurious falls, and one case of worsening hip pain) Lowery ( Teri et al, 1998 ) 15; 11; (nine withdrew, four lost to follow up, two died) 8; 6; (unrelated to study, including six falls and two deaths) Pitkälä ( Blankevoort et al, 2010 ) 56; 27; (17 deaths, 18 admissions to nursing homes, 13 self-withdrawals, 8 deterioration of health) 491; average: two per person; (96 hospital admissions, 365 falls, 17 deaths, 13 fractures) Prick ( Sobol et al, 2016 ) 46; 41; (16 carer burden, 13 participant burden, 6 deaths, 6 admissions to nursing homes, 4 carer health) Six; 5; (deaths unrelated to study) 16 Rolland ( Yágüez et al, 2011 ) 24; 18; (15 deaths, 8 changes of institutions, one self-withdrawal) 297; average: two per person; (275 falls, 15 deaths, seven fractures, and five falls, the latter occurred during exercise) Santana-Sosa ( Binder, 1995 ) None; 0 None; 0 Schwenk ( Lautenschlager et al, 2008 , Bossers et al, 2014 , Bossers et al, 2015 , Brill et al, 1995 , Burgener et al, 2008 , Cancela et al, 2016 , Choi and Lee, 2018 ) 12; 20; (seven lack of motivation, three deaths, two serious adverse event) 5; 8; (unrelated to study, of which three deaths) Sobol ( Nyman and Victor, 2011 ) 11; 5; (four medical illness, four self-withdrawal, two dementia progression, one family illness) 1; 1; (serious adverse event - atrial fibrillation - possibly related to the study). Unspecified number of musculoskeletal problems and dizziness /faintness, half related to the study 80 Steinberg ( Murray et al, 2013 ) 7; 26 (one death, one Syncopal episode, one fractured metatarsal, one transient ischemic attack, one wrist pain, one ganglion cyst, one light-headed post-phlebotomy) Suzuki ( Bossers et al, 2015 ) 3; 6; (one medical illness, one refusal and one did not give reasons) Tak ( ...…”

Postural Control Dysfunction and Balance Rehabilitation in Older Adults with Mild Cognitive Impairment

“…There were a total of 16 original RCTs [ 39 , 40 , 41 , 42 , 43 , 44 , 46 , 47 , 49 , 50 , 53 , 54 , 56 , 57 , 58 , 59 ]; five studies [ 45 , 48 , 51 , 52 , 55 ] were secondary reports of the 16 RCTs ( Table 1 ). Therefore, in the following sections, the study percentages demonstrating study outcomes and results ( Section 3.1.7 and Section 3.2 ) were taken out of the 21 studies, while the study percentages describing other study characteristics ( Section 3.1.3 , Section 3.1.4 , Section 3.1.5 , Section 3.1.6 and Section 3.1.8 ) were taken out of the 16 original RCTs.…”