Using Digital Technology to Quantify Habitual Physical Activity in Community Dwellers With Cognitive Impairment: Systematic Review

Abstract

Background Participating in habitual physical activity (HPA) can support people with dementia and mild cognitive impairment (MCI) to maintain functional independence. Digital technology can continuously measure HPA objectively, capturing nuanced measures relating to its volume, intensity, pattern, and variability. Objective To understand HPA participation in people with cognitive impairment, this systematic review aims to (1) identify digital methods and protocols; (2) identify metrics used to assess HPA; (3) describe differences in HPA between people with dementia, MCI, and controls; and (4) make recommendations for measuring and reporting HPA in people with cognitive impairment. Methods Key search terms were input into 6 databases: Scopus, Web of Science, Psych Articles, PsychInfo, MEDLINE, and Embase. Articles were included if they included community dwellers with dementia or MCI, reported HPA metrics derived from digital technology, were published in English, and were peer reviewed. Articles were excluded if they considered populations without dementia or MCI diagnoses, were based in aged care settings, did not concern digitally derived HPA metrics, or were only concerned with physical activity interventions. Key outcomes extracted included the methods and metrics used to assess HPA and differences in HPA outcomes across the cognitive spectrum. Data were synthesized narratively. An adapted version of the National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies was used to assess the quality of articles. Due to significant heterogeneity, a meta-analysis was not feasible. Results A total of 3394 titles were identified, with 33 articles included following the systematic review. The quality assessment suggested that studies were moderate-to-good quality. Accelerometers worn on the wrist or lower back were the most prevalent methods, while metrics relating to volume (eg, daily steps) were most common for measuring HPA. People with dementia had lower volumes, intensities, and variability with different daytime patterns of HPA than controls. Findings in people with MCI varied, but they demonstrated different patterns of HPA compared to controls. Conclusions This review highlights limitations in the current literature, including lack of standardization in methods, protocols, and metrics; limited information on validity and acceptability of methods; lack of longitudinal research; and limited associations between HPA metrics and clinically meaningful outcomes. Limitations of this review include the exclusion of functional physical activity metrics (eg, sitting/standing) and non-English articles. Recommendations from this review include suggestions for measuring and reporting HPA in people with cognitive impairment and for future research including validation of methods, development of a core set of clinically meaningful HPA outcomes, and further investigation of socioecological factors that may influence HPA participation. Trial Registration PROSPERO CRD42020216744; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216744

Associations Between Local Area Deprivation and Physical Activity Participation in People with Cognitive Impairment in the North East of England

“…Finally, we did not consider the effect of dementia disease subtype or level of cognitive impairment on walking behaviors. Previous evidence has suggested that dementia subtypes with significant motor symptoms (e.g., Parkinson’s disease dementia) participate in lower volumes and demonstrate shorter and less variable walking bouts than Alzheimer’s disease [ 10 ], while patterns of walking activity appear affected by level of cognitive impairment [ 9 ]. As such, future research should consider the impact of local area deprivation on walking activity with consideration of dementia disease subtype and cognitive status, with an appropriately powered sample.…”

Wearable Sensors in Other Medical Domains with Application Potential for Orthopedic Trauma Surgery—A Narrative Review

“…Even in patients with mild cognitive impairment (MCI), increasing physical activity can have a positive impact on disease progression [ 66 ]. When examining physical activity, sensor techniques for step counting are currently most commonly used to determine patients’ volume of movement [ 67 ]. In this context, objectifying the diagnosis of multifactorial MCI is challenging, as the differences between temporary pathophysiological disease states and an incipient neuropsychiatric disease cannot be reliably differentiated using established questionnaires.…”

Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study

“…Based on the current literature, ARC residents primarily participate in low volumes of light-intensity walking and show little variation in their walking behaviors [ 8 ]. Based on prevailing gaps in the literature, current recommendations for the assessment of walking behaviors in ARC include the use of validated digital methods that can capture very low volumes of activity, using low cutoff thresholds (eg, any walking activity ≥3 steps), and derive standardized outcomes relating to volume (ie, the amount or duration of walking activity), pattern (ie, the distribution of walking activity across a time period), and variability (ie, changes in walking activities—either within-person or group activities—and over time) of walking behaviors [ 8 9 ].…”

“…For example, we previously found that better physical function was associated with higher walking volumes in ARC residents in intermediate (ie, rest homes) and high-level (ie, hospitals) care, while surprisingly, moderate dementia, mild depression, and pain had no effect on walking volumes [ 10 ]. In contrast, people with mild cognitive impairment in the community show no differences in walking volumes compared to people who undergo normal aging, but they do demonstrate different patterns and greater variability in their walking behaviors [ 9 ]. By looking beyond the volume of walking activities to pattern and variability, we may garner information about people’s routines and the time they spend indoors and outdoors (based on walking bout lengths) [ 8 9 11-14 undefined undefined undefined ]; we can then examine the impact of cognitive and physical impairments on these behaviors [ 14 ].…”