Recruitment of a multi‐site randomized controlled trial of aerobic exercise for older adults with amnestic mild cognitive impairment: The EXERT trial

Abstract

Introduction:Effective strategies to recruit older adults with mild cognitive impairment (MCI) into nonpharmacological intervention trials are lacking.Methods: Recruitment for EXERT, a multisite randomized controlled 18-month trial examining the effects of aerobic exercise on cognitive trajectory in adults with amnestic MCI, involved a diverse portfolio of strategies to enroll 296 participants.Results: Recruitment occurred September 2016 through March 2020 and was initially slow. After mass mailings of 490,323 age-and geo-targeted infographic postcards and brochures, recruitment rates increased substantially, peaking at 16 randomizations/month in early 2020. Mass mailings accounted for 52% of randomized participants, whereas 25% were recruited from memory clinic rosters, electronic health records, and national and local registries. Other sources included news broadcasts, public service announcements (PSA), local advertising, and community presentations.

T2 Protect AD: Achieving a rapid recruitment timeline in a multisite clinical trial for individuals with mild to moderate Alzheimer's disease

“…While mass mailings have been used for recruitment into AD prevention trials and brain health registries, our findings suggest that mass mailings may be ineffective for recruitment into pharmacologic trials of mild to moderate AD 13–16 . Mass mailings accounted for more than half of participants randomized into EXERT, whereas 25% were recruited from existing lists of eligible patients from participating sites 11 . This underscores the need to publish AD trial recruitment metrics to inform the evidence base around best practices for recruitment.…”

“…Similar to EXERT, we found that major reasons for screen failure in T2 Protect AD were similar across racial and ethnic groups. 11 Thus, enrollment of underrepresented populations into future AD clinical trials will require concerted and targeted recruitment strategies.…”

“…In contrast, a recent National Institute on Aging (NIA)-funded trial of aerobic exercise conducted by ADCS among individuals with amnestic mild cognitive impairment (MCI; the EXERT trial) achieved a minority participation rate of 13.2%, largely due to a concerted effort by the ADCS recruitment team that involved the development of culturally appropriate and sensitive multimedia messaging, geo-targeting of mass mailings of postcards and brochures in areas with demographic diversity, and prioritization of underrepresented minorities for screening and clinic appointments. 11 As an NIA-funded trial, EXERT had specific minority recruitment goals. Similar to EXERT, we found that major reasons for screen failure in T2 Protect AD were similar across racial and ethnic groups.…”

Telephone and Smartphone-Based Interventions for Cognitive and Cardio-Metabolic Health in Middle-Aged and Older Adults: A Systematic Review

“…Digital tools (eg emails, social media advertisements) are effective for recruiting older participants 66 even those with mild cognitive impairment. 67 However, it is indispensable to take into account limitations, barriers and needs of the target population to better adapt devices and interventions. 68 , 69 One of the main barriers to older people using mobile technology and devices should be as simple as possible and if applicable, easy to wear.…”

Designing Infographics: Visual Representations for Enhancing Education, Communication, and Scientific Research

“…As a teaching tool, infographics enhance engagement, memory retention, recall, comprehension, and development of communication skills. 7 8 In the current climate of the coronavirus pandemic, infographics have been increasingly employed for patient education. For example, infographics were used to promote the goal of “flattening the curve” by encouraging hygienic practices such as handwashing and appropriate mask-wearing and providing information on local public health guidelines.…”