Multicomponent exercise to improve motor functions, cognition and well-being for nursing home residents who are unable to walk - A randomized controlled trial

The effect of recreational games on happiness, life satisfaction, loneliness, and somatisation in elderly individuals: a non-randomized controlled trial

BACKGROUND

Participation in recreational activities supports continuity of activity and psychological well-being in old age. Games are one of these recreational activities. This study aims to measure the influence of recreational games on somatisation, loneliness, happiness and life satisfaction among elderly individuals.

METHODS

This non-randomized quasi-experimental study involved 80 individuals from two nursing homes, allocated to intervention (n = 40) and control (n = 40) groups. Participants, aged 65 or older, met cognitive eligibility criteria based on the Standardized Mini-Mental State Examination. The intervention group selected 4 games (hot-and-cold, word challenge, bingo, matching pairs) from a set of 15 and played twice weekly for two months in smaller groups. The control group maintained their usual leisure activities. Data were collected using the Oxford Happiness Questionnaire Short Form, Satisfaction with Life Scale, De Jong Gierveld Loneliness Scale, and Symptom Checklist-90-Revised Somatization Subscale at baseline, 1 week, and 1 month post-intervention.

RESULTS

The intervention group (IG) showed significant improvements compared to the control group (CG). Happiness (η² = 0.93) and life satisfaction (η² = 0.92) increased significantly in the IG (p < 0.0001), with higher scores than the CG in both the post-test (r ≈ -0.246 to -0.212, p < 0.05) and follow-up (r ≈ -0.273 to -0.309, p < 0.01). Loneliness, including emotional and social loneliness, decreased significantly in the IG (η² = 0.94, p < 0.0001), with greater reductions than the CG in the post-test and follow-up (r ≈ -0.503 to -0.593, p < 0.0001). Somatization did not change significantly within the IG but showed a reduction compared to the CG in the post-test and follow-up (r ≈ -0.226 to -0.280, p < 0.05).

CONCLUSIONS

Recreational games may give psychological benefits to older adults. Yet, results of the study need to be interpreted with caution and need to be replicated.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06505070 (retrospectively registered, Protocol ID: Duzce-U-merve0003, Last Update Posted: 2024-08-02). https://ctv.veeva.com/study/the-effect-of-recreational-games-on-happiness-life-satisfaction-loneliness-and-somatisation-in-el?comeFrom=study-search .

Lifestyle interventions for dementia risk reduction: A review on the role of physical activity and diet in Western and Asian Countries

Dementia, is a critical global public health challenge with no effective pharmacological treatments. Recent research highlights the significant role of lifestyle interventions, particularly physical activity and dietary habits, in mitigating cognitive decline among the elderly and preventing the progression to dementia in individuals with Mild Cognitive Impairment (MCI). This comprehensive review explores the impact of physical exercise and dietary approaches on cognitive health, comparing strategies adopted in Western and Asian countries. Physical activity, including aerobic, resistance, balance training, and dual-task exercises, has been shown to enhance neurogenesis, improve cerebral blood flow, and delay cognitive decline. In Western countries, structured regimens such as the Mediterranean (MedDiet) and MIND diets are prominent, while Asian countries often integrate traditional mind-body practices like Tai Chi and culturally relevant diets rich in antioxidants and polyphenols. Although both regions recognize the importance of lifestyle changes in reducing dementia risk, their approaches differ significantly, shaped by cultural norms and dietary preferences. This review underscores the need for culturally tailored public health strategies to promote cognitive health globally, highlighting the importance of individualized approaches in MCI and dementia prevention.

[DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research]

The DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research summarizes, for the first time, the highly interdisciplinary and interprofessional field of physical activity-based health care in the German healthcare system. In addition to providing a conceptual framework and definition of key measures and concepts in physical activity-related health care research, existing research gaps and needs are identified, and methods for advancing this relatively young field of research are described. A particular focus of this study is the relevant outcome parameters and their standardized assessment using established and valid measurement tools. The memorandum aims to establish a general understanding of the complex subject of promoting physical activity and sports therapy in the context of healthcare, to give an impulse to new research initiatives, and to integrate the currently available strong evidence on the effectiveness of physical activity and exercise into healthcare.

Enhancing physical activity and augmenting upper limb function in sedentary stroke survivors: the transformative impact of chair transitions

In post-stroke individuals with walking difficulties, prolonged sitting can lead to increased mortality. Interventions targeting increased physical activity for these individuals are limited. Consequently, many such stroke survivors become reliant on wheelchairs, leading to prolonged inactivity. This report highlights a case where a chronic stroke patient, with walking challenges, was transitioned from a wheelchair to regular chair sitting by nursing staff in a facility lacking specialised rehabilitation professionals. This simple act of transitioning from a wheelchair to a chair during daily routines led to improvements in the patient's physical activity and upper limb functionality and reduced the need for help during meals.

Alexa, let's train now! - A systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive aging

BACKGROUND

There is mounting evidence that regular physical activity is an important prerequisite for healthy cognitive aging. Consequently, the finding that almost one-third of the adult population does not reach the recommended level of regular physical activity calls for further public health actions. In this context, digital and home-based physical training interventions might be a promising alternative to center-based intervention programs. Thus, this systematic review aimed to summarize the current state of the literature on the effects of digital and home-based physical training interventions on adult cognitive performance.

METHODS

In this pre-registered systematic review (PROSPERO; ID: CRD42022320031), 5 electronic databases (PubMed, Web of Science, PsycInfo, SPORTDiscus, and Cochrane Library) were searched by 2 independent researchers (FH and PT) to identify eligible studies investigating the effects of digital and home-based physical training interventions on cognitive performance in adults. The systematic literature search yielded 8258 records (extra 17 records from other sources), of which 27 controlled trials were considered relevant. Two reviewers (FH and PT) independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale).

RESULTS

Of the 27 reviewed studies, 15 reported positive effects on cognitive and motor-cognitive outcomes (i.e., performance improvements in measures of executive functions, working memory, and choice stepping reaction test), and a considerable heterogeneity concerning study-related, population-related, and intervention-related characteristics was noticed. A more detailed analysis suggests that, in particular, interventions using online classes and technology-based exercise devices (i.e., step-based exergames) can improve cognitive performance in healthy older adults. Approximately one-half of the reviewed studies were rated as having a high risk of bias with respect to completion adherence (≤85%) and monitoring of the level of regular physical activity in the control group.

CONCLUSION

The current state of evidence concerning the effectiveness of digital and home-based physical training interventions is mixed overall, though there is limited evidence that specific types of digital and home-based physical training interventions (e.g., online classes and step-based exergames) can be an effective strategy for improving cognitive performance in older adults. However, due to the limited number of available studies, future high-quality studies are needed to buttress this assumption empirically and to allow for more solid and nuanced conclusions.

The Perspective of Rehabilitation Nurses on Physical Exercise in the Rehabilitation of Older People in the Community: A Qualitative Study

In the face of an increasingly aging population, nurses have to design and implement programs aimed at the elderly in order to keep them healthy and maintain their quality of life. Structured physical exercise and overall physical activity play a major role in maintaining an active lifestyle, improving health, preventing disease, and helping to maintain older people's quality of life. To investigate the importance of implementing physical exercise programs for the older person in the community, taking into account the perspective of the rehabilitation nurse specialist, this is a qualitative, exploratory, and descriptive study with nine rehabilitation nurses from various regions of Portugal who have experience of implementing physical exercise programs with the elderly. This study used semi-structured interviews, one of the most common data collection procedures in social and health research. Content analysis was used to analyze the data. The study received a positive opinion from the Ethics Committee. The participants' perspectives focused on the following subjects: "Physical exercise program for the elderly in the community", "Importance of physical exercise in the rehabilitation of the elderly in the community", "People's adherence to the programs", "Gains in health resulting from the implementation of these strategies" and "Gains from group activities". A set of indicators emerged from the analysis. Nurses recognize the importance of using structured physical exercise programs adjusted to the rehabilitation of the older person, with gains in promoting active and healthy aging.

A Chair-Based Music-Kinetic Combined Exercise Program as an Alternative Approach for Increasing Health, Functional Capacity, and Physical Fitness Indices in Middle-Aged Pre-Menopausal Women

Lately, chairs have been widely used as a cheap, easily accessible, safe, and effective training means in different settings (e.g., in gyms, the house, workplaces, and in rehabilitation). This study investigated the effectiveness of a 10-week chair-based music-kinetic integrated combined exercise program on health, functional capacity, and physical fitness indicators of middle-aged pre-menopausal women. A total of 40 healthy women (40-53 years) were assigned to two groups: exercise (EG) and control (CG). The EG followed a 10-week (3 times/weekly; 30 training sessions) chair-based exercise program including aerobic dance, flexibility, coordination, and strength exercises with body weight or auxiliary means. Selected indicators of health, functional capacity, and physical fitness were evaluated before and after the 10 weeks. Following the program, the EG significantly reduced their body fat (-2.5%), blood pressure (by -4.5 to -5.5%), the time during the timed up-and-go (TUG) test (by -10.27%), heart rate (by -6.35 to -13.78%), and the rate of perceived exertion (by -24.45 to -25.88%), while increasing respiratory function (3.5-4%), flexibility (12.17%), balance (50.38-51.07%), maximal handgrip strength (10-12.17%), and endurance strength (43.87-55.91%). The chair-based combined music-kinetic exercise program was effective and could be safely used in different settings to improve health, functional capacity, and physical fitness in middle-aged women.

Does Multicomponent Training Improve Cognitive Function in Older Adults Without Cognitive Impairment? A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVES

To carry out a systematic review and meta-analysis to verify the effects of multicomponent training on the cognitive function of older adults without cognitive impairment.

DESIGN

Systematic review and meta-analysis.

SETTING AND PARTICIPANTS

Adults aged 60 years and older.

METHODS

The searches were accomplished through MEDLINE (via PubMed), EMBASE, Cochrane Library, Web of Science, SCOPUS, LILACS, and Google Scholar databases. We performed the searches up to November 18, 2022. The study included only randomized controlled trials and older adults without any cognitive impairment (dementia, Alzheimer's, mild cognitive impairment, neurologic diseases). Risk of Bias 2 tool and PEDro scale was performed.

RESULTS

Ten randomized controlled trials were included in the systematic review, of which 6 (involving 166 participants) were compiled in the meta-analysis of random effects models. The Mini-Mental State Examination and Montreal Cognitive Assessment were used to assess global cognitive function. The Trail-Making Test (TMT) (A and B domains) was performed by 4 studies. Compared with the control group, multicomponent training increases the global cognitive function (standardized mean difference = 0.58, 95% CI: 0.34-0.81, I² = 11%; P < .001). Regarding TMT-A and TMT-B, multicomponent training decreases the time performed in the tests (TMT-A: mean difference = -6.70, 95% CI: -10.19 to -3.21; I² = 51%; P = .0002) (TMT-B: mean difference = -8.80, 95% CI: -17.59 to -0.01; I² = 69%; P = .05). The PEDro scale for the studies in our review ranged from 7 to 8 (mean = 7.4 ± 0.5), meaning good methodologic quality, and most studies were judged as at least low in terms of risk of bias.

CONCLUSION AND IMPLICATIONS

Multicomponent training improves cognitive function in older adults without cognitive impairment. Therefore, a possible protective effect of multicomponent training for cognitive function in older adults is suggested.

Changes in Selected Cognitive and Motor Skills as Well as the Quality of Life After a 24-Week Multidimensional Music-Based Exercise Program in People With Dementia

The loss of independence is one of the greatest consequences of dementia. Multidimensional music-based exercise programs could counteract. The present study investigates the effects of such a program on people with dementia and bases on a 24-week intervention with three measurement time points. Sixty-nine people with dementia were randomly assigned to the intervention (n = 43) and control group (n = 26). The following outcome parameters were measured: leg strength, gait, grip strength, balance, reaction time, selected cognitive abilities, and quality of life. A mixed ANOVA with repeated measurement showed significant interaction effects between group and time. After 24-weeks in contrast to the control group the intervention group significantly improved in leg strength (P = .001), balance (P = .001), gait (P = .001), grip strength (right P = .002, left P = .011), reaction time (P = .003), global cognition (P = .039), verbal fluency (P = .002), attention (P = .013) and quality of life (P = .011). In conclusion, the program enhanced selected cognitive and motor skills and quality of life.

Strategies to improve health status among adults with multimorbidity: A scoping review

Although public health and medical care advancements have enabled an increased lifespan among many populations around the world, there is an ongoing need to enhance the health span of adults and older adults. Due to the increasingly substantial prevalence of multiple chronic conditions, also known as multimorbidity, this scoping review aims to identify and describe the current literature on programs or interventions to improve the health status of and to prevent further chronic conditions among adults and older adults who are already living with multimorbidity. Of the 2898 articles identified from a search of PubMed and Embase, 72 underwent full-text screening and 14 were included in the review. A total of 8 articles included both adult and older adult participants, while 6 articles involved only participants who were older adults. The articles reported a variety of settings, components and key outcomes, and reported varying degrees of success in improving the health status of the participants. Some of the interventions were tailored to a specific population such as individuals receiving home care services, nursing home residents or individuals who were living with obesity along with multiple co-occurring conditions. While many interventions involved dimensions of physical activity and healthy eating to improve health status, many interventions also utilized a combination of components to enhance the impact of the initiative. Overall, this scoping review highlights the literature and the continued need for multifaceted research that can help inform future programs and policies to support individuals living with multimorbidity.

Efficacy of therapeutic exercise on activities of daily living and cognitive function among older residents in long-term care facilities: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

This study aimed to systematically analyze the efficacy of therapeutic exercise on activities of daily living (ADL) and cognitive function among older residents in long-term care facilities.

DATA SOURCES

PubMed, Cochrane Central of Register Trials, Physiotherapy Evidence Database, OTseeker, and Ichushi-Web were searched from inception until December 2018.

STUDY SELECTION

Databases were searched to identify randomized controlled trials (RCTs) of therapeutic exercise for long-term care facility residents aged 60 years and older, focusing on ADL and cognitive function as outcomes.

DATA EXTRACTION

Two independent reviewers extracted the key information from each eligible study. Two reviewers independently screened and assessed all studies for eligibility, extracting information on study participants, details of interventions, outcome characteristics, and significant outcomes. Any discrepancies were resolved by a third reviewer.

DATA SYNTHESIS

A total of 11 RCTs with 1,280 participants were eligible for analyses. Therapeutic exercise had a significant benefit on ADL (standard mean difference [SMD] = 0. 22, 95% confidence interval [CI]: 0.02, 0.42, p = 0.03)]. Subgroup analyses indicated that interventions were conducted ≥ 3 days per week [SMD = 0.42, 95% CI 0.02, 0.82, p = 0.04]. For cognitive function, group exercise and ≥ 3 days/week of intervention had a significant benefit (group exercise: mean difference [MD] = 3.36, 95% CI 0.91, 5.80, p = 0.007; ≥ 3 days/week of intervention: MD = 2.28, 95% CI 0.07, 4.49, p = 0.04).

CONCLUSIONS

Therapeutic exercise conducted 3 or more days per week may be effective for improving ADL and cognitive function among older residents in long-term care facilities. This meta-analysis suggested that group exercise for cognitive functions was effective. However, the effective method of intervention delivery for ADL was unclear.

Effectiveness and Acceptability of e- and m-Health Interventions to Promote Physical Activity and Prevent Falls in Nursing Homes—A Systematic Review

Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and hospitalization in older adults, PA promotion and fall prevention are important measures, especially in nursing homes (NH). With advances in information and communication technology, e- and m-health solutions have been developed to positively influence various health-related factors. To date, only little research exists on the implementation of these technologies to promote health in NH. Therefore, the objective of this systematic review was to provide an overview of the effectiveness, acceptability, and feasibility of e- and m-health interventions aimed at promoting PA and preventing falls in NH. Additionally, the effectiveness of such interventions regarding the secondary outcomes physical function, cognitive function, neuropsychiatric symptoms, and psychosocial status was examined. A systematic literature search was performed in five databases and studies published until 15 November 2021, were considered for inclusion. All studies that examined the effectiveness and/or the acceptability and feasibility of e- or m-health interventions in promoting PA and preventing falls in NH, without restriction on language or date of publication, were included in the final synthesis. Of the 1,358 records retrieved, 28 studies were included in this systematic review. Twenty-four studies contained digital exergaming as an intervention or as a part of the intervention, the four additional studies on e-health interventions only examined a small number of outcomes. No m-health intervention study was identified. Data synthesis indicates that exergaming may be effective in reducing the number of falls and fall risk in NH residents. Several significant improvements were also reported regarding secondary outcomes albeit not consistent across studies. No conclusion can be drawn about the effects of exergaming and other e-health interventions on PA, as data is scarce. E-health interventions were mostly reported as feasible and well accepted by NH residents. However, these findings may not be applicable to NH residents with advanced physical and/or cognitive impairments, since they were excluded in many studies. Therefore, more research examining other digital solutions besides exergaming to promote PA in this specific population is critical.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42021289488

Effects of Chronic Physical Exercise or Multicomponent Exercise Programs on the Mental Health and Cognition of Older Adults Living in a Nursing Home: A Systematic Review of Studies From the Past 10 Years

Some nursing homes for the elderly provide holistic care that integrates several interventions, including physical exercise. The aim of this systematic review is to summarize the effects of physical exercise or multicomponent exercise programs on the mental health (wellbeing, anxiety and depression) and cognitive functions of older adults with/without dementia who live in a nursing home and do/do not require wheelchair assistance. To this end, PubMed, PsycInfo and Web of Science are using to identify clinical trials and randomized controlled studies conducted during the period January 2011 to December 2021 to examine the progression of research in this field over the past ten years. In total, 2597 articles are identifying and 21 are including in the systematic review. After selecting articles according to the PRISMA standards, the data extraction and methodological quality assessment of the eligible studies are performing individually by two reviewers and then pooled together. The synthesis of the studies shows that physical exercise or multicomponent exercise programs have a beneficial effect on mental health and cognitive functions. However, this effect is more common among older adults without dementia, compared to their counterparts who have dementia or use wheelchairs. The explanatory mechanisms, lack of benefits from physical exercise and the need to standardize methods are discussing in this regard. Finally, future studies must examine the effects of an innovative and adaptive physical activity program on the mental health and cognitive functions of older adults living in nursing homes.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

Influence of a multidimensional music-based exercise program on selected cognitive and motor skills in dementia patients—a pilot study

One of the most common causes of needing care in old age is dementia. In order to enjoy a pleasant retirement for people with dementia, it is essential for them to maintain their independence. Studies have shown that a combination of physical activity and music has positive effects on dementia patients. Therefore, this study aimed to investigate the feasibility of implementing a multidimensional music-based exercise program for dementia patients and the effects on an intervention group (IG) compared to a control group (CG, usual care). The study design was based on a 12-week intervention with two (IG/CG) by two (pretest/posttest) parallel groups and block randomization with unequal group sizes. Participants had to be able to move independently or with a walker and not have severe cardiovascular disease or cardiac arrhythmias. Fifty-three blinded dementia patients (age: 83.63 ± 6.03 years) from inpatient facilities participated in the study and were assigned from the exercise instructors to IG (n = 34) and CG (n = 19). The primary outcomes were feasibility (Observation sheet), modified Chair Rising test, Timed Up and Go test, hand dynamometer test, FICSIT‑4 (Frailty and Injuries: Cooperative Studies of Intervention Techniques), and drop bar test. Secondary endpoints included: verbal fluency (“animals”), the Mini-Mental State Examination, memory, Trail Making Test A, and Qualidem. Forty-nine subjects were analyzed (IG = 32; CG = 17). There were significant differences between the groups in the modified Chair Rising test (p = 0.033), FICSIT‑4 (p = 0.035), and Timed Up and Go test (p = 0.005) at posttest, which showed improved performance of the IG compared to the CG. The IG additionally showed improvements in the modified Chair Rising test (p = 0.000), drop bar test (p = 0.033), hand dynamometer test (p = 0.001), Timed Up and Go test (p = 0.000), verbal fluency (p = 0.002) and Trail Making Test A (p = 0.04) after 12 weeks. There were no adverse events or side effects. The multidimensional music-based exercise program could be performed by the dementia patients and was well received. The improved functional mobility could contribute to a lower risk of falls and thus maintain independence. For the follow-up study, the number of subjects, randomization, and parameters should be considered.

Requirements of a cognitive-motor spatial orientation training for nursing home residents: an iterative feasibility study

A sedentary lifestyle in nursing home residents is often accompanied with reduced life space mobility and in turn affects satisfaction with life. One of the reasons for this may be limited ability to find one’s way around the care facility and its environment. However, spatial orientation exercises might reduce these problems if they are integrated into an adequate cognitive-motor training. Therefore, we integrated six novel and target group-specific spatial orientation exercises into an established multicomponent cognitive-motor group training for nursing home residents and evaluated its feasibility. Forty nursing home residents (mean age: 87.3 ± 7 years) participated in the spatial orientation cognitive motor training (45–60 min, twice a week over a period of 12 weeks). The main outcomes included the feasibility criteria (adherence, completion time, acceptance, instructions, motor performance, materials/set up, complexity) and first measurements of mobility and satisfaction with life (SPPB [Short Physical Performance Battery], SWLS [Satisfaction with Life Scale]). Adherence increased over time. The increase was associated with the adaptions and modifications of the spatial orientation exercises that were made to meet the participants’ requirements. A positive trend was discerned for mobility and life satisfaction, comparing pre- and posttraining data. In summary, the feasibility analysis revealed that future interventions should consider that (a) instructions of demanding spatial tasks should be accompanied by an example task, (b) trainers should be encouraged to adjust task complexity and materials on an individual basis, (c) acceptance of the training should be promoted among nursing staff, and (d) surroundings with as little disturbance as possible should be selected for training.