The effect of Active Plus, a computer-tailored physical activity intervention, on cognitive functioning of elderly people with chronic illness(es) – study protocol for a randomized controlled trial

Bolman

et al. 2020

IJERPH

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eHealth interventions aimed at improving physical activity (PA) can reach large populations with few resources and demands on the population as opposed to centre-based interventions. Active Plus is a proven effective computer-tailored PA intervention for the older adult population focusing on PA in daily life. This manuscript describes the effects of the Active Plus intervention (N = 260) on PA of older adults with chronic illnesses (OACI), compared to a waiting list control group (N = 325). It was part of a larger randomized controlled trial (RCT) on the effects of the Active Plus intervention on cognitive functioning. OACI (≥65 years) with at least one chronic illness were allocated to one of the conditions. Intervention group participants received PA advice. Baseline and follow-up measurements were assessed after 6 and 12 months. Intervention effects on objectively measured light PA (LPA) and moderate-to-vigorous PA (MVPA) min/week were analysed with multilevel linear mixed-effects models adjusted for the clustered design. Intervention effects on self-reported MVPA min/week on common types of PA were analysed with two-part generalized linear mixed-effects models adjusted for the clustered design. The dropout rate was 19.1% after 6 months and 25.1% after 12 months. Analyses showed no effects on objectively measured PA. Active Plus increased the likelihood to perform self-reported cycling and gardening at six months and participants who cycled increased their MVPA min/week of cycling. Twelve months after baseline the intervention increased the likelihood to perform self-reported walking and participants who cycled at 12 months increased their MVPA min/week of cycling. Subgroup analyses showed that more vulnerable participants (higher degree of impairment, age or body mass index) benefitted more from the intervention on especially the lower intensity PA outcomes. In conclusion, Active Plus only increased PA behaviour to a limited extent in OACI 6 and 12 months after baseline measurements. The Active Plus intervention may yet be not effective enough by itself in OACI. A blended approach, where this eHealth intervention and face-to-face contact are combined, is advised to improve the effects of Active Plus on PA in this target group.

“…The study was conducted following the Declaration of Helsinki. An extensive rationale and description of the general study protocol is published elsewhere [45].…”

Section: Study Design Setting and Populationmentioning

confidence: 99%

Section: Intervention Groupmentioning

confidence: 99%

The Effect of Active Plus, a Computer-Tailored Physical Activity Intervention, on the Physical Activity of Older Adults with Chronic Illness(es)—A Cluster Randomized Controlled Trial

Bolman

et al. 2020

IJERPH

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“…To test the actual effects of change in PA on CF, a RCT has to be carried out with at least three groups (LPA intervention, MVPA intervention, control group). As our own Active Plus intervention was mainly aimed at stimulating MVPA, and we only included one experimental group in the RCT [36], we could not test the effects of change in LPA and MVPA on CF separately. In addition, isolating the independent contribution of both PA intensities is di cult.…”

Section: Discussionmentioning

confidence: 99%

“…Demographics and health characteristics were part of the Active Plus and Cognitive Functioning project [36]. As age, gender, educational level, marital status (living together with a spouse or living single), body mass index (BMI), and physical impairment, are known to in uence PA [49] and some also CF [50], these factors assessed at baseline, were taken into account in the current study.…”

Section: Demographic and Health Characteristicsmentioning

confidence: 99%

The Longitudinal Associations Between Change in Physical Activity and Cognitive Functioning in Older Adults With Chronic Illness(es)

Bolman

et al. 2021

Preprint

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Background Regular physical activity (PA) is potentially beneficial for age-related cognitive decline. Although moderate-to-vigorous physical activity (MVPA) is mostly advised, older adults with chronic illnesses (OACI) might benefit more from light physical activity (LPA), as they suffer from mobility problems, pain and fatigue, limiting high intensity PA. Therefore, the longitudinal association between change in respectively LPA and MVPA on the one hand and the change in cognitive functioning (CF) on the other hand is investigated in OACI.Methods In total 432 OACI (≥65 years) with at least one chronic illness participated in this longitudinal observational study. Longitudinal associations between accelerometer assessed change in PA (LPA and MVPA) and change in CF, measured with an objective validated neuropsychological test battery were tested with multivariate linear regressions.Results An increase in LPA between baseline and six months follow-up was significantly associated with improved short-term verbal memory and inhibition over the first six months. In addition, the change score in LPA over the first six months was predictive for the change score in short-term verbal memory over 12 months. Furthermore, an increase in MVPA between baseline and six months follow-up was significantly associated with a decrease in longer-term verbal memory scores over the same six month period. Conclusions Increase in LPA over the first six months is associated with better short-term verbal memory scores over the same period and this is extended to better short-term verbal memory scores over the whole year. Increase in LPA over the first six months is also associated with better inhibition scores over the same period, however this doesn’t seem to extend to the long run (i.e change in inhibition in 12 months). Remarkably, an increase in MVPA over the first six months was associated with a decrease in longer-term verbal memory scores over the same six month period. Thus, for OACI who experience issues with being sufficiently active this seems good news as LPA is more achievable for them to improve CF than MVPA. Trial Registration Netherlands Trial Register NL6005; Date of Registration 21-03-2017; https://www.trialregister.nl/trial/6005

“…The study was conducted following the Declaration of Helsinki. A comprehensive rationale and description of the study protocol is published elsewhere [34].…”

Section: Study Design Setting and Populationmentioning

confidence: 99%

A randomized controlled trial into the cognitive effects of a computer-tailored physical activity intervention in older adults with chronic disease(s)

Coumans

et al. 2021

Eur Rev Aging Phys Act

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Background Cognitive functioning (CF) is important for wellbeing and an independent life. However, older adults with chronic diseases are at a higher risk of poorer CF levels. Although, research suggests that physical activity (PA) could play an essential role in maintaining good CF, older adults with chronic diseases have low levels of PA. PA interventions to prevent cognitive decline for this specific group exist. Yet, until now these interventions focused on a single specific chronic disease. Active Plus is a proven effective computer-tailored PA stimulating intervention focused on increasing PA in daily life for the older adult population suffering from a broad range of chronic diseases. This study tests the cognitive effects of Active Plus in older adults with chronic diseases. Methods In this RCT older adults with at least one chronic disease (≥65 years) were allocated to the intervention group (N = 260, mean age = 74.2) or waiting list control group (N = 325, mean age = 74.5). In total, intervention group participants received three times computer-tailored PA stimulating advice within four months (i.e., at baseline, after two months, and after three to four months). The online and print delivered advice were tailored to the specific needs and wishes of the participant and focused on incorporating PA in daily life. Baseline and follow-up measurements of the CF verbal memory (Verbal Learning Test), shifting (Trailmaking Test), inhibition (Stop-signal Task) and processing speed (Letter Digit Substitution Test) were assessed after six and 12 months. Intervention effects were analyzed with multilevel linear mixed-effects models adjusted for the clustered design and confounding variables. Results The dropout rate was 19.1% after 6 months and 25.1% after 12 months. Although both conditions improved on all verbal memory outcomes after 6 months, and all CF outcomes except inhibition after 12 months, no intervention effects were found, not even in subgroups (p > .05). Conclusions To our knowledge this is the first study to test the cognitive effects of a computer-tailored PA stimulating intervention in older adults suffering from a broad range of chronic diseases. The effects of the Active Plus intervention were not strong enough to improve CF or prevent cognitive decline. A blended approach, in which this computer-tailored intervention is combined with a face-to-face PA intervention and / or cognitive training, might be a good suggestion to increase the effects of Active Plus on PA and CF in older adults with chronic diseases. Trial registration Netherlands Trial Register NL6005; Date of Registration 03-21-2017; https://www.trialregister.nl/trial/6005