Effects of adding whole-body vibration to routine day activity program on physical functioning in elderly with mild or moderate dementia: a randomized controlled trial

Effectiveness of exercise programmes in improving physical function and reducing behavioural symptoms of community living older adults with dementia living in Asia, and impact on their informal carers: A systematic review and meta-analysis

Background

There is a growing evidence on the benefits of exercise for older people living with dementia in developed countries. However, cultural, health-care systems and environmental differences may impact on the uptake of exercise and outcomes in different regions of the world.

Objective

This study synthesised the available evidence examining the effectiveness of exercise interventions on improving physical function and reducing behavioural symptoms in community-dwelling older people living with dementia in Asia, and the impact on their informal carers.

Methods

Six databases were searched to November 2021. Randomised controlled trials (RCTs) or quasi-experimental studies evaluating exercise interventions for community-dwelling older people with dementia living in Asia were included. The Cochrane risk-of-bias tool for randomised trials and Downs and Black checklist had been used to assess methodological quality of the studies. Meta-analyses using a fixed effects model assessed the effects of exercise interventions where sufficient data were available. Mean difference (MD) with 95% confidence interval (CI) was used to pool results.

Results

Nine studies (five RCTs) were included (Hong Kong-4, China-1, South Korea-2, Taiwan-1, Indonesia-1). Exercise improved dynamic balance [Functional Reach (2 studies, n = 111 people with dementia), MD = 2 . 61 , 95% CI (1.55, 3.67)], but not for the Berg Balance Scale (MD = 1 . 10 , 95% CI [-2.88, 5.07]), Timed Up and Go (MD =- 3 . 47 , 95% CI [-7.27, 0.33]) and 5 times sit to stand tests (MD =- 1 . 86 , 95% CI [-5.27, 1.54]). Single studies where data could not be pooled showed no effect of exercise on behavioural symptoms or impact on informal carers.

Conclusion

Exercise appeared to have a beneficial effect on improving balance performance among older people with dementia living in Asia, however, this evidence is limited and inconsistent, and should be interpreted with caution. Further high-quality large RCTs are necessary for advancing the evidence base of exercise interventions for this population.

Effects of whole-body vibration training on cognitive function: A systematic review

Background

Whole-body vibration (WBV) training is a novel training method that stimulates the human neuromuscular system by the use of vibration, the frequency and amplitude of which are controlled, thereby inducing adaptive changes in the body. WBV training is widely used as a clinical prevention and rehabilitation tool in physical medicine and neuro-rehabilitation as a clinical prevention and rehabilitation tool.

Objectives

The aim of the present study was to review the effects of WBV on cognitive function, provide an evidence-based foundation for future research on WBV training, and promote additional popularization and use of the methodology in clinical practice.

Methods

A systematic review of articles extracted from the following six databases was conducted: PubMed, Web of Science, China National Knowledge Infrastructure, Embase, Cochrane, and Scopus. A literature search was performed on articles in which the effects of WBV on cognitive function were evaluated.

Results

Initially, a total of 340 studies were initially identified, among which 18 articles that satisfied the inclusion criteria were selected for inclusion in the systematic review. Participants were allocated into two groups: patients with cognitive impairment and healthy individuals. The results demonstrated that WBV was both positive and ineffective in its influence on cognitive function.

Conclusion

The majority of studies suggested that WBV may be a useful strategy for the management of cognitive impairment and should be considered for inclusion in rehabilitation programs. However, the impact of WBV on cognition requires additional, larger, and adequately powered studies.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=376821, identifier CRD42022376821.

Effects of vibration training on quality of life in older adults: a preliminary systematic review and meta-analysis

PURPOSE

Older adults experience reduced quality of life (QOL). Vibration training has been applied in older adults. However, it remains inconclusive whether vibration training improves QOL in this population. This review summarized the effects of vibration training in changing eight domains of the Short Form-36 (SF-36) among older adults.

METHODS

Five randomized controlled trials enrolling 212 participants were included. The mean difference (MD) was calculated as the effect size measurement. Meta-analyses were completed for each of the eight SF-36 domains.

RESULTS

Relative to control groups, vibration training is more effective in improving five QOL domains: physical function (MD = 15.61, p < 0.001), physical role limitations (MD = 12.71, p = 0.001), general health (MD = 10.59, p < 0.001), social function (MD = 11.60, p < 0.001), and vitality (MD = 6.86, p = 0.002). Vibration training may not lead to greater improvements for the other three domains (MD = 0.13-3.25, p values = 0.21-0.96) than the control groups. Vibration training showed a low attrition rate of 7.1%.

CONCLUSION

Vibration training programs may significantly improve five of eight SF-36 QOL domains. While three domains did not demonstrate significant improvements, results were slightly in favor of vibration training compared to the control groups. More rigorous studies are necessary to further confirm the effectiveness of vibration training on QOL in older adults.

Feasible Intervention through Simple Exercise for Risk of Falls in Dementia Patients: A Pilot Study

Physical exercise can help older people maintain capacities such as muscle strength, balance, postural control, bone mass, and functionality in ADL that usually decline with age. Dementia patients can attend day care centers where they participate in activities such as cognitive training, music and art therapy, and physical exercise sessions. This research aimed to determine the effectiveness of simple lower limb strength and single leg stance training, feasible in the facilities of day care centers, to reduce the risk of falls in the elderly with dementia. Twenty patients with dementia were divided into intervention and control groups. They participated in mobility, strength, coordination, and balance exercise sessions for 45-50 min on weekdays for 5 weeks. In addition, the intervention group patients performed simple lower limb strength (sit-to-stands) and single leg stance exercises in every session. Risk of falls was assessed with the Tinetti test and the SPPB. Comparisons of post- and pre-intervention scores for the Tinetti test and SPPB were statistically increased (0.8 ± 0.7, p = 0.03; 1.5 ± 1.3 points, p = 0.02) in intervention patients. Simple lower limb strength and single leg stance exercises feasible to be done in day care facilities are effective tools for reducing the risk of falls in the elderly with dementia.

Potential of Whole-Body Vibration in Parkinson’s Disease: A Systematic Review and Meta-Analysis of Human and Animal Studies

Simple Summary

Exercise has shown to have a positive impact on both motor and non-motor functions in Parkinson’s Disease patients. However, particularly in later stages of the disease, reduced cognitive function and motor capacity may lead to an inability to stay physically active. Therefore, alternative strategies for patients with Parkinson’s Disease are necessary to minimize burden for patients, their families and public health care. Whole-Body Vibration could be such an alternative. Whole-Body Vibration is an exercise or treatment method in which subjects are exposed to a mechanical vibration while sitting, standing or exercising on a vibrating platform. Whole-Body Vibration is currently used for physiotherapy, sports and rehabilitation purposes. Whole-Body Vibration treatment is interesting because it affects both the body and brain. The potential of Whole-Body Vibration for, specifically, Parkinson’s Disease patients should be clarified for further application. For this purpose, we conducted an extensive systematic review of the articles investigating the effects of Whole-Body Vibrations (1) on animals and humans with Parkinson’s Disease and (2) on neuropathological Parkinson’s Disease mechanisms. The results show some potential of Whole-Body Vibration for Parkinson’s Disease patients. The recommendations provided by this review can be used by researchers and rehabilitative practitioners implementing Whole-Body Vibration as a treatment for Parkinson’s Disease patients.

Abstract

(1) Background: When the severity of Parkinson’s Disease (PD) increases, patients often have difficulties in performing exercises. Whole-Body Vibration (WBV) may be a suitable alternative. This systematic review aims to clarify if WBV shows potential as rehabilitative therapy for PD patients. (2) Methods: We searched several databases for controlled trials investigating the effects of WBV (1) on PD populations and (2) PD neuropathological mechanisms. We included both human and animal studies and performed meta-analyses. (3) Results: The studies on PD populations (14 studies) show an overall significant, but small, effect in favor of WBV (Hedges’ g = 0.28), for which the effects on stability (Hedges’ g = 0.39) and balance (Hedges’ g = 0.30) are the most prominent. The studies on the neuropathological mechanisms (18 studies) show WBV effects on neuroinflammation (Hedges’ g = –1.12) and several specific WBV effects on neurotransmitter systems, growth factors, neurogenesis, synaptic plasticity and oxidative stress. (4) Conclusions: The effects of WBV on human PD patients remains inconclusive. Nevertheless, WBV protocols with sufficient duration (≥3 weeks), session frequency (≥3 sessions/week) and vibration frequency (≥20 Hz) show potential as a treatment method, especially for motor function. The potential of WBV for PD patients is confirmed by the effects on the neuropathological mechanisms in mostly non-PD populations. We recommend high-quality future studies on both PD patients and PD mouse models to optimize WBV protocols and to examine the neuropathological mechanisms in PD populations.

Tactile Low Frequency Vibration in Dementia Management: A Scoping Review

The prevalence of dementia is increasing with the ever-growing population of older adults. Non-pharmacological, music-based interventions, including sensory stimulation, were reported by the Lancet Commission in 2020 to be the first-choice approach for managing the behavioural and psychological symptoms of dementia. Low frequency sinusoidal vibration interventions, related to music interventions through their core characteristics, may offer relief for these symptoms. Despite increasing attention on the effectiveness of auditory music interventions and music therapy for managing dementia, this has not included low frequency vibration. This scoping review, following the JBI methodology guidelines, was conducted to investigate participants’ responses to both sound and mechanical vibration, the characteristics of the delivered interventions, methodological challenges, and the specifics of the research experiments reported. An extensive search was conducted in BMC, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE (OvidSP), Pedro, ProQuest Central, PsycINFO, Scopus, and Web of Science. Current Controlled Trials, Clinical Trials, and Google Scholar were also searched as well as a hand search in relevant journals. Studies on adults with all types of dementia, investigating tactile low frequency sound or mechanical vibration in any context were considered. Data from eight full-length studies (three RCTs, two quasi-experimental, two case reports, and one qualitative) were extracted using the data extraction table developed by the authors and were included in the analysis and critical appraisal. Issues in quality related to, for example, control groups and blinding. Few studies addressed participants’ subjective responses to the interventions. Reporting on the intervention characteristics was unclear. It appeared more frequent sessions led to better outcomes and home-based interventions potentially addressing the issue of access and feasibility. Future research should include neuroimaging to measure and confirm the hypothesised mechanism of cerebral coherence. Standardised reporting of intervention characteristics is also needed to ensure replicability of the experiments. Higher quality research is needed to investigate the impact and effect of low frequency vibration for the symptoms of dementia and compare outcomes in meta-syntheses.

Comparative efficacy of various exercise interventions on cognitive function in patients with mild cognitive impairment or dementia: A systematic review and network meta-analysis

BACKGROUND

Exercise is a promising nonpharmacological therapy for cognitive dysfunction, but it is unclear which type of exercise is most effective. The objective of this study was to compare and rank the effectiveness of various exercise interventions on cognitive function in patients with mild cognitive impairment (MCI) or dementia and to examine the effects of exercise on the symptoms relevant to cognitive impairment.

METHODS

We searched PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, SPORTDiscus, and PsycInfo through September 2019 and included randomized controlled trials that examined the effectiveness of exercise interventions in patients with MCI or dementia. Primary outcomes included global cognition, executive cognition, and memory cognition. Secondary outcomes included activities of daily living, neuropsychiatric symptoms, and quality of life. Pairwise analyses and network meta-analyses were performed using a random effects model.

RESULTS

A total of 73 articles from 71 trials with 5606 participants were included. All types of exercise were effective in increasing or maintaining global cognition, and resistance exercise had the highest probability of being the most effective intervention in slowing the decrease in global cognition (standard mean difference (SMD) = 1.05, 95% confidence interval (95%CI): 0.56-1.54), executive function (SMD = 0.85, 95%CI: 0.21-1.49), and memory function (SMD = 0.32, 95%CI: 0.01-0.63) in patients with cognitive dysfunction. Subgroup analyses for patients with MCI revealed different effects, and multicomponent exercise was most likely to be the optimal exercise therapy for preventing the decline of global cognition (SMD = 0.99, 95%CI: 0.44-1.54) and executive function (SMD = 0.72, 95%CI: 0.06-1.38). However, only resistance exercise showed significant effects on memory function for patients with MCI (SMD = 0.35, 95%CI: 0.01-0.69). Exercise interventions also showed various effects on the secondary outcomes.

CONCLUSION

Resistance exercise has the highest probability of being the optimal exercise type for slowing cognitive decline in patients with cognitive dysfunction, especially in patients with dementia. Multicomponent exercise tends to be most effective in protecting global cognition and executive function in patients with MCI.

Multi-mechanical waves against Alzheimer's disease pathology: a systematic review

Alzheimer’s disease (AD) is the most common cause of dementia, affecting approximately 40 million people worldwide. The ineffectiveness of the available pharmacological treatments against AD has fostered researchers to focus on alternative strategies to overcome this challenge. Mechanical vibrations delivered in different stimulation modes have been associated with marked improvements in cognitive and physical performance in both demented and non-demented elderly. Some of the mechanical-based stimulation modalities in efforts are earlier whole-body vibration, transcranial ultrasound stimulation with microbubble injection, and more recently, auditory stimulation. However, there is a huge variety of treatment specifications, and in many cases, conflicting results are reported. In this review, a search on Scopus, PubMed, and Web of Science databases was performed, resulting in 37 papers . These studies suggest that mechanical vibrations delivered through different stimulation modes are effective in attenuating many parameters of AD pathology including functional connectivity and neuronal circuit integrity deficits in the brains of AD patients, as well as in subjects with cognitive decline and non-demented older adults. Despite the evolving preclinical and clinical evidence on these therapeutic modalities, their translation into clinical practice is not consolidated yet. Thus, this comprehensive and critical systematic review aims to address the most important gaps in the reviewed protocols and propose optimal regimens for future clinical application.

Favorable Effects of 24-Week Whole-Body Vibration on Glycemic Control and Comprehensive Diabetes Therapy in Elderly Patients with Type 2 Diabetes

BACKGROUND

Elderly patients with type 2 diabetes (T2DM) are vulnerable to treatment-inducible hypoglycemia, falls, and depressive symptoms. Although it is challenging for elderly patients to adhere to regular exercise, its positive effect on functional ability, glycemic control, and mental wellness offers comprehensive diabetes treatment. In the present study, we aimed to investigate a novel exercise approach for the elderly, focusing on whole-body vibration (WBV).

METHODS

This retrospective cohort study was conducted in a primary-care setting at a medical fitness center affiliated with the incorporated medical institution of THY (TOTAL HEALTH YARD). Fourteen (WBV group) and 12 (control group) elderly patients with T2DM undergoing and not undergoing our WBV program, respectively, for > 6 months were analyzed. Primary endpoints were the functional ability changes, evaluated by Timed Up and Go (TUG), Sit-to-Stand test (SST), gait length, and grip test. Secondary endpoints were global glycemic control and questionnaires, namely the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Geriatric Depression Scale (GDS). All records of exercise adherence and any adverse events were followed.

RESULTS

Significant improvements in TUG and SST were found only in the WBV group [TUG: 7.1 ± 0.9, 7.1 ± 0.8 to 7.0 ± 1.0, 6.6 ± 0.9 (s), P = 0.63, 0.01; SST: 10.4 ± 1.9, 11.3 ± 2.4 to 9.7 ± 2.3, 9.5 ± 2.1 (s), P = 0.62, P < 0.01, control vs. WBV group, respectively]. The WBV group demonstrated significant improvement of hemoglobin A1C levels (7.2 ± 0.8 to 6.9 ± 0.5, P < 0.01) and DTSQ and GDS scores, while the control group did not. There were no hypoglycemic events during the study. The WBV program adherence was 93.3 ± 8.0%.

CONCLUSION

We demonstrated the favorable effect of WBV training on balance, diabetes treatment, and mood. Therefore, WBV training can be proposed as comprehensive therapy in a safe manner and potentially has a positive effect on health-related quality of life in elderly patients with T2DM.

Tactile Low Frequency Vibration in Dementia Management: A Scoping Review Protocol

Dementia is a growing issue in modern society. Non-pharmacological interventions such as music are suggested as the primary methods for symptom management. Therapeutic potential may also be found in sound/mechanical low frequency vibrations (LFV) that share the core characteristics of music, but these are lesser understood. The aim of the proposed scoping review is to explore the responses of persons with dementia to LFV, e.g., vibroacoustic therapy or whole-body vibration. The scoping review will follow the Joanna Briggs Institute methodology guidelines. An extensive search in BMC, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, ERIC, MEDLINE (OvidSP), Pedro, ProQuest Central, PsycINFO, Scopus, Web of Science, and grey literature sources in Clinical Trials, Current Controlled Trials, Google Scholar, and manual search of relevant journals is planned to find all relevant research papers. The paper selection, full-text assessment, and data extraction will be performed by two independent reviewers. Participants' responses to the interventions and the experiment designs, including methodological challenges, will be analysed and compared. Results may highlight potential gaps in reporting and comparing sound and mechanical vibration approaches and promote better understanding of their potential for managing the symptoms of dementia. Furthermore, the possible relationships between LFV and music-based interventions may become clearer.

Physical Activity and Trajectory of Cognitive Change in Older Persons: Mayo Clinic Study of Aging

BACKGROUND

Little is known about the association between physical activity (PA) and cognitive trajectories in older adults.

OBJECTIVE

To examine the association between PA and change in memory, language, attention, visuospatial skills, and global cognition, and a potential impact of sex or Apolipoprotein E (APOE) ɛ4 status.

METHODS

Longitudinal study derived from the population-based Mayo Clinic Study of Aging, including 2,060 cognitively unimpaired males and females aged ≥70 years. Engagement in midlife (ages 50-65) and late-life (last year) PA was assessed using a questionnaire. Neuropsychological testing was done every 15 months (mean follow-up 5.8 years). We ran linear mixed-effect models to examine whether mid- or late-life PA at three intensities (mild, moderate, vigorous) was associated with cognitive z-scores.

RESULTS

Light intensity midlife PA was associated with less decline in memory function compared to the no-PA reference group (time x light PA; estimate [standard error] 0.047 [0.016], p = 0.004). Vigorous late-life PA was associated with less decline in language (0.033 [0.015], p = 0.030), attention (0.032 [0.017], p = 0.050), and global cognition (0.039 [0.016], p = 0.012). Females who were physically inactive in midlife experienced more pronounced cognitive decline than females physically active in midlife and males regardless of PA (p-values for time interaction terms with midlife PA levels and sex were all p < 0.05 for global cognition). APOE ɛ4 carriership did not moderate the association between PA and cognition.

CONCLUSION

Engaging in PA, particularly of vigorous intensity in late-life, was associated with less pronounced decline in global and domain-specific cognition. This association may differ by sex.

Acute Effects of Whole-Body Vibration on Peripheral Blood Flow, Vibrotactile Perception and Balance in Older Adults

Background: Non-invasive application of whole-body vibration (WBV) has the potential for inducing improvements in impaired peripheral circulation, cutaneous sensation and balance among older adults. However, relevant studies have frequently applied high magnitudes of vibration and show conflicting and inconclusive results. Therefore, we attempted to ascertain the acute responses in those parameters from exposure of thirty older subjects to WBV of three different magnitudes, defined according to ISO 2631-1 (1997). Methods: Each subject randomly underwent four sessions of intervention (three bouts of 1 min exposure with 1 min between-bout rests): WBV at 15, 20, or 25 Hz with a peak-to-peak displacement of 4 mm, or control condition. Results: Both during and after intervention, dorsal foot skin blood flow increased significantly under 20 and 25 Hz exposure conditions with greater responses under the latter condition, the magnitude of which slightly exceeded the recommended value. Plantar vibrotactile perception showed significant increases after WBV exposure with overall greater responses under higher frequencies of vibration. In contrast, no WBV-induced change in balance was observed. Conclusions: WBV at 20 Hz with a magnitude within the recommended limit can be effective in inducing enhancements in peripheral blood flow; however, the same magnitude of vibration seems insufficient in improving balance among older adults.

Recommended motor assessments based on psychometric properties in individuals with dementia: a systematic review

Background

Motor assessments are important to determine effectiveness of physical activity in individuals with dementia (IWD). However, inappropriate and non-standardised assessments without sound psychometric properties have been used. This systematic review aims to examine psychometric properties of motor assessments in IWD combined with frequency of use and effect sizes and to provide recommendations based on observed findings.We performed a two-stage systematic literature search using Pubmed, Web of Science, Cochrane Library, ALOIS, and Scopus (inception - July/September 2018, English and German). The first search purposed to identify motor assessments used in randomised controlled trials assessing effectiveness of physical activity in IWD and to display their frequency of use and effect sizes. The second search focused on psychometric properties considering influence of severity and aetiology of dementia and cueing on test-retest reliability. Two reviewers independently extracted and analysed findings of eligible studies in a narrative synthesis.

Results

Literature searches identified 46 randomised controlled trials and 21 psychometric property studies. While insufficient information was available for validity, we observed sufficient inter-rater and relative test-retest reliability but unacceptable absolute test-retest reliability for most assessments. Combining these findings with frequency of use and effect sizes, we recommend Functional Reach Test, Groningen Meander Walking Test (time), Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up & Go Test, instrumented gait analysis (spatiotemporal parameters), Sit-to-Stand assessments (repetitions> 1), and 6-min walk test. It is important to consider that severity and aetiology of dementia and cueing influenced test-retest reliability of some assessments.

Conclusion

This review establishes an important foundation for future investigations. Sufficient relative reliability supports the conclusiveness of recommended assessments at group level, while unacceptable absolute reliability advices caution in assessing intra-individual changes. Moreover, influences on test-retest reliability suggest tailoring assessments and instructions to IWD and applying cueing only where it is inevitable. Considering heterogeneity of included studies and insufficient examination in various areas, these recommendations are not comprehensive. Further research, especially on validity and influences on test-retest reliability, as well as standardisation and development of tailored assessments for IWD is crucial.This systematic review was registered in PROSPERO (CRD42018105399).

The optimal treatment for improving cognitive function in elder people with mild cognitive impairment incorporating Bayesian network meta-analysis and systematic review

It's widely acknowledged that, as a neurodegenerative aging disease representing an intermediate stage between cognitive intactness and Alzheimer's disease (AD), Mild cognitive impairment (MCI) poses an excessive burden on patients' well-being, family members, health-care providers as well as the whole society. This study focuses on three cognitive interventions proposed by Clare and Woods, which are, Cognitive stimulation (CS), Cognitive training (CT) and Cognitive rehabilitation (CR). Our Network meta-analysis (NMA) aims to compar them with one another to determine the optimal cognitive intervention for elderly adults with MCI in improving their cognitive function. We applied extensive strategies to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs) which scrupulously compared any two of the three cognitive interventions with one another or any one of the three with a control group as the placebo or non-active group in treating elder patients with MCI in accordance with Petersen's criteria. Our NMA of cognitive interventions for patients diagnosed with MCI appraised the relative effectiveness of cognitive interventions across trials simultaneously. Our study attempts to summarize available data to suggest that CS (Mean difference [MD] = 0.95, 95% confidence interval [CI]:0.27, 1.70) and CT (MD = 0.70, [CI]:0.11,1.30) were significantly beneficial to MCI patients for improving their cognition status while CR (MD = 0.59, [CI]:-0.30,1.50) scored lowest. Our study suggested CS was most likely to be the best intervention for improving the cognitive function of MCI patients.

Interventions to Improve Gait in Older Adults with Cognitive Impairment: A Systematic Review

OBJECTIVES

To review intervention programs that measure gait to investigate what features of the intervention may contribute to improving gait in older adults with cognitive impairment or dementia.

DESIGN

Systematic review using Medline, Cinahl, Scopus, PsychInfo, Amed, Embase, Web of Science, and PubMed for original research published in English between January 1, 2000, and July 23, 2018, to identify interventional controlled trials. Narrative synthesis was undertaken.

RESULTS

Of 6,379 citations, 36 articles met inclusion criteria. Interventions were categorized as medication or medical devices (8 studies), exercise (19 studies), and exercise plus cognitive training (9 studies). Antidementia medication may improve gait variability in people with Alzheimer's disease. Exercise programs focusing on strength and balance training, especially when combined with functional mobility training, improve gait in people with mild cognitive impairment or dementia. Exercise plus cognitive training programs combining strength and balance training, functional mobility training, and training on attention and executive function also improve gait.

CONLUSION

Physical and cognitive factors affect gait performance, and both should be addressed in intervention programs. Physical exercises including functional mobility training, especially walking, have better results than physical programs with only static, resistance, and flexibility training. Cognitive intervention should be concomitant with physical exercises rather than separate, with a focus on attention and executive function. Combining physical training with cognitive training in a functional context may assist older adults with cognitive impairment generalize from training to everyday activity. J Am Geriatr Soc 67:381-391, 2019.

Beneficial Effects of Whole Body Vibration on Brain Functions in Mice and Humans

The biological consequences of mechanical whole body vibration (WBV) on the brain are not well documented. The aim of the current study was to further investigate the effects of a 5-week WBV intervention on brain functions. Mice (C57Bl/6J males, age 15 weeks) were exposed to 30 Hz WBV sessions (10 minutes per day, 5 days per week, for a period of 5 weeks; n = 10). Controls received the same intervention without the actual vibration (n = 10). Humans (both genders, age ranging from 44-99 years) were also exposed to daily sessions of 30 Hz WBV (4 minutes per day, 4 days per week, for a period of 5 weeks; n = 18). Controls received the same protocol using a 1 Hz protocol (n = 16). Positron emission tomography imaging was performed in the mice, and revealed that glucose uptake was not changed as a consequence of the 5-week WBV intervention. Whole body vibration did, however, improve motor performance and reduced arousal-induced home cage activity. Cognitive tests in humans revealed a selective improvement in the Stroop Color-Word test. Taken together, it is concluded that WBV is a safe intervention to improve brain functioning, although the subtle effects suggest that the protocol is as yet suboptimal.

Comparison of multiple interventions for older adults with Alzheimer disease or mild cognitive impairment: A PRISMA-compliant network meta-analysis

BACKGROUND

The increasing prevalence of Alzheimer disease (AD) emphasizes the need for effective treatments. Both pharmacological therapies such as nutrition therapy (NT) and nonpharmacologic therapies including traditional treatment or personalized treatment (e.g., physical exercise, music therapy, computerized cognitive training) have been approved for the treatment of AD or mild cognitive impairment (MCI) in numerous areas.

METHODS

The aim of this study was to compare 4 types of interventions, physical exercise (PE), music therapy (MT), computerized cognitive training (CCT), and NT, in older adults with mild to moderate AD or MCI and identify the most effective intervention for their cognitive function. We used a system of search strategies to identify relevant studies and include randomized controlled trials (RCTs), placebo-controlled trials evaluating the efficacy and safety of 4 interventions in patients with AD or MCI. We updated the relevant studies which were published before March 2017 as a full-text article. Using Bayesian network meta-analysis (NMA), we ranked cognitive ability based objectively on Mini-Mental State Examination (MMSE), and assessed neuropsychiatric symptoms based on Neuropsychiatric Inventory (NPI). Pairwise and network meta-analyses were sequentially performed for efficacy and safety of intervention compared to control group through RCTs included.

RESULTS

We included 17 RCTs. Fifteen trials (n = 1747) were pooled for cognition and no obvious heterogeneity was found (I = 21.7%, P = .212) in NMA, the mean difference (MD) of PE (MD = 2.1, confidence interval [CI]: 0.44-3.8) revealed that PE was significantly efficacious in the treatment group in terms of MMSE. Five trials (n = 660) assessed neuropsychiatric symptoms with an obvious heterogeneity (I = 61.6%, P = .034), the MD of CCT (MD = -7.7, CI: -14 to -2.4), revealing that CCT was significantly efficacious in NPI.

CONCLUSIONS

As the first NMA comparing different interventions for AD and MCI, our study suggests that PE and CCT might have a significant improvement in cognition and neuropsychiatric symptoms respectively. Moreover, nonpharmacological therapies might be better than pharmacological therapies.