Assessing cardiorespiratory capacity in older adults with major depression and Alzheimer disease

Exploring the Lived Experiences of Physical Activity in Community-Dwelling Adults Living With Dementia and Their Carers

People living with dementia have the same right to well-being as anyone else, including physical activity. Yet, physical activity levels among people with dementia are lower than in the general population, and while the physical activity health benefits are well established, little is known about how people living with dementia experience physical activity. To explore these physical activity experiences, we visited six community settings in one English county and conducted informal interviews with 18 people who were either living with dementia and community dwelling (n = 4), caring for or who had cared for someone with dementia (n = 10), or providing a support service for people living with dementia and their carers (n = 4). Findings highlight both the challenges and facilitators presented by organized groups, service provider skills and qualities, and environmental factors. Additionally, these factors were influential in shaping the physical activity experience of people living with dementia. The findings may be relevant for people providing or planning support services, commissioners, policymakers, and researchers.

Physical Activity Patterns Within Dementia Care Dyads

Previous research has explored the physical activity habits of people with dementia and their family carers separately, with little consideration of how physical habits are associated within dyads. In this observational study, we sought to explore the relationship between people with dementia and their carers' physical activity, at a group level and at a dyadic level. Twenty-six participant dyads (persons with dementia and their carer spouses) were asked to wear an accelerometer for 30 days continuously. Comparisons were made at a group level and a dyadic level. People with dementia did not participate in significantly more moderate to vigorous physical activity (M = 15.44 min/day; SD = 14.40) compared with carers (M = 17.95 min/day; SD = 17.01). Within dyads, there were moderately strong associations between daily moderate to vigorous physical activity (r = .48-.54), but not with overall activity levels (r = .24). Despite physical activity habits remaining relatively low within people with dementia and carers, respectively, moderate to vigorous physical activity levels appear to be correlated within dyads. Understanding mutual influence on physical activity levels within dyads is an important pathway to promote an active lifestyle.

Barriers, motivators and facilitators of physical activity in people with dementia and their family carers in England: dyadic interviews

INTRODUCTION

Physical activity may have a number of physical and mental health benefits for people with dementia and their carers. However, there is limited evidence about factors that influence physical activity participation in these groups. This study therefore looks at the barriers, facilitators and motivators of physical activity in people with dementia, from both the perspective of the person with dementia and their carer.

METHOD

Thirty participants (15 sets of community-dwelling people with dementia and their family carers) were recruited from the South East of England. The participants took part in semi-structured dyadic interviews about their views of physical activity. Interviews were analysed using inductive thematic analysis at an individual level and comparisons were made between the groups.

RESULTS

Common motivator themes across persons with dementia and family carers were emotional and physical wellbeing, and social connectedness. Physical health was seen as a common barrier in both groups. Physical activity in the person with dementia was encouraged and supported by the family carer. For the carer, their caring role, and limited time acted as barriers to their participation.

CONCLUSION

Themes such as social connectedness, positive emotion and health were seen as key motivators to physical activity, which indicate that people with dementia and carers use physical activity as a means to maintain and improve their quality of life. Supporting family members to better facilitate such activities could encourage physical activity in people with dementia.

Types of leisure time physical activities (LTPA) of community-dwelling persons who have been screened positive for dementia

Background

To (a) describe the pattern of leisure time physical activities (LTPA) in community-dwelling persons who have been screened positive for dementia and (b) determine the health-related and sociodemographic factors associated with LTPA.

Methods

Data of the general practitioner-based, randomized, controlled intervention trial, DelpHi-MV (Dementia: life- and person-centered help in Mecklenburg-Western Pomerania) were used. Patients aged 70 years or older, who lived at home and had a DemTect< 9 were informed about the study by their General practitioners and invited to participate. Data from 436 participants with complete baseline data were used. Standardized, computer-assisted assessments were made during face-to-face interviews at the participants’ homes.

Results

Two hundred thirty-eight patients (54.6%) carried out LTPA (men 58.4%, women 51.8%). Physically active patients mentioned one to two different activities; diversity of LTPA was higher for men than for women. The most-frequently mentioned types of activity were gardening (35.3%), cycling (24.1%) and mobility training (12.4%); there was only a statistically significant difference between men and women in cycling, χ²(1) = 21.47, p < .001. The odds of LTPA increased with increasing quality of life (OR = 2.41), lower impairments in activities of daily living (OR = 0.85), and living in a rural environment (OR = 2.02).

Conclusions

Our findings suggest that people who have been screened positive for dementia living in a rural area are more likely to be active than people living in an urban area. Following studies should investigate whether this difference has an effect on the progression of dementia.

Trial registration

ClinicalTrial.gov Identifier NCT01401582.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02201-1.

Two-Minute Step Test of Exercise Capacity: Systematic Review of Procedures, Performance, and Clinimetric Properties

BACKGROUND AND PURPOSE

The 2-minute step test (TMST) is one of many alternatives for measuring exercise capacity. First introduced in 1999 as part of the Senior Fitness Test, the TMST has the advantage of requiring limited space, only a few minutes' time, and no expensive equipment. These advantages notwithstanding, the test must be clinimetrically sound if it is to be recommended. We sought therefore to summarize the literature addressing TMST performance and measurement properties.

METHODS

Relevant literature was identified by searches of 3 electronic databases (PubMed, Scopus, and Cumulative Index of Nursing and Allied Health) and hand searches. Inclusion of an article required that it described use of the TMST of Rikli and Jones and that it focused on adults. Articles published in a language other than English were excluded. Studies were abstracted for information on participants, TMST description, and findings.

RESULTS AND DISCUSSION

Thirty articles were deemed appropriate based on inclusion and exclusion criteria. The participants in the studies included community-dwelling healthy older adults and adults with assorted pathologies. Studies described varied methods of conducting the TMST. Among tests in which steps for one side were counted over a full 2 minutes, the mean number of steps among populations ranged from 29.1 for patients with chronic stroke to 110.8 for older osteoporotic women. Numerous reviewed studies provide support for the validity of the TMST. Only one study addressed reliability and none focused on responsiveness. Normative data have been proffered.

CONCLUSIONS

The TMST has been widely used since first introduced, albeit not always as originally described. There is considerable evidence for the validity of the test, but its reliability and responsiveness are not yet firmly established.

Use of Physical Activity Questionnaires in People With Dementia: A Scoping Review

Physical activity questionnaires are an important means to assess habitual physical activity. It remains unclear what questionnaires are used and whether they are appropriate for people with dementia who have impaired information recall but are also often largely sedentary. This scoping review aimed to identify and quantify the use of physical activity questionnaires within a dementia population. Eighteen studies met the inclusion criteria for this review. The majority of studies used questionnaires that were validated for use within an older adult population (e.g., Modified Baecke Questionnaire for the Elderly), though none had specifically been validated for use in people with dementia. Interestingly, just over half of the studies (N = 10, 55.6%) adapted the questionnaires from the original validated version by allowing a proxy to provide input to the responses. Future research needs to robustly validate the use of proxy-report measures of physical activity in people with dementia.

Association among 2-min step test, functional level and diagnosis of dementia

Aerobic capacity declines significantly throughout life, beginning at the age of 30 years and accelerating from 60 years, where a decline of 17% per decade is expected thereafter.

Objective

To investigate the association between aerobic capacity and a diagnosis of mild cognitive impairment (MCI), mild AD or moderate AD in older adults, considering the risk classification of functional loss of the Step test.

Methods

In this cross-sectional study, 93 patients (age >60 years) were evaluated (Healthy=36; MCI=18, AD=39). The step test was used to assess aerobic capacity, while overall cognitive status was measured using the MMSE. The groups were divided according to the risk classifications of functional loss into below or above the standard cut-off point for aerobic capacity.

Results

Subjects in the functional loss risk group were approximately ten to fourteen times more likely to be diagnosed with mild (OR:10.7; p=0.001) or moderate (OR.=14.7; p=0.002) AD than their fitter counterparts. Low aerobic fitness was also associated with the MCI condition (OR=4.5; p=0.05), but only after controlling for educational level, age and sex. In the overall sample (N=93), there was an association between aerobic capacity and MMSE performance (R²=0.35; p<0.001) after controlling for confounding variables.

Conclusion

low aerobic capacity was associated with cognitive decline, and older adults at risk of functional loss on the STEP test had greater chance of being diagnosed with MCI or AD after controlling for age, sex and education.

Physical activity and sedentary behavior in people with major depressive disorder: A systematic review and meta-analysis

BACKGROUND

Low levels of physical activity (PA) and sedentary behavior (SB) are independent risk factors for cardiovascular disease and premature mortality in people with major depressive disorder (MDD).

AIMS

Investigate levels of PA and SB and their predictors in people with MDD.

METHODS

Electronic databases were searched from inception till 04/2016 for articles measuring PA and SB with a self-report questionnaire (SRQ) or objective measure (e.g. accelerometer) in people with MDD. Random-effects meta-analyses and meta-regression analyses were conducted.

RESULTS

Twenty-four eligible studies were identified including 2901 people with MDD (78.4% female, mean age=54 years; range: 21-77 years). People with MDD spent 126.0min (95%CI=91.9-160.1) per day engaging in all types of PA and spent 8.5hours (95%CI=7.51-9.62) during their waking day being sedentary. Compared to controls, people with MDD spent less time in total PA (SMD=-0.25, 95%CI=-0.03 to 0.15) and moderate to vigorous PA (SMD=-0.30, 95%CI=-0.40 to 0.21) and engaged in higher levels of SB (SMD=0.09, 95%CI=0.01-0.18). The proportion of people with MDD not meeting the recommended PA guidelines was 67.8% (n=13 studies), which was higher in studies relying on objective versus self-report measures (85.7% v 62.1%, p=0.04). People with MDD were more likely than controls to not meeting the recommended PA guidelines (OR = 1.50, 95%CI = 1.10–2.10).

LIMITATIONS

Heterogeneity was evident in most analyses.

CONCLUSIONS

Adults with MDD engage in low levels of PA and high levels of SB. PA and SB are independent predictors of mortality, therefore, future lifestyle interventions targeting both the prevention of SB and adoption and maintenance of PA are warranted.