Feasibility of a 6-Month Exercise and Recreation Program to Improve Executive Functioning and Memory in Individuals With Chronic Stroke

Background. Physical activity is beneficial for improving cognitive function in healthy older adults. However, research results on the benefits of physical activity on cognitive performance after stroke are limited. Objective. To determine if a combined exercise and recreation program can improve the executive functioning and memory of individuals with chronic stroke. Methods. In all, 11 ambulatory participants with chronic stroke (mean age 67 ± 10.8 years) participated in a 6-month program of exercise for 2 hours and recreation for 1 hour weekly. Executive functions and memory were assessed at baseline and at 3 and 6 months by a battery of standard neuropsychological tests, including response inhibition, cognitive flexibility, dual task (motor plus cognitive), and memory. Motor ability was also assessed. Nonparametric statistics were used to obtain the differences between the 3 assessments. Results . At baseline, substantial deficits in all aspects of executive functioning were revealed. From baseline to 3 months, the mean improvement was 10% ± 14% for the dual task (Walking While Talking), -3% ± 22% (χ 2 = 2.4; P > .05) for response inhibition (Stroop Test), and 61% ± 69% for memory (Rey Auditory Verbal Learning Test—long delay). From baseline to 6 months, the mean improvement was 7% ± 7.5% for response inhibition (Stroop Test). In addition, knee strength and walking speed improved significantly at 3 months. Conclusions. This pilot study suggests that exercise and recreation may improve memory and executive functions of community-dwelling individuals with stroke. Further studies require a larger sample size and a control group.

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COMPUTERIZED COGNITIVE TRAINING, WITH OR WITHOUT EXERCISE, TO PROMOTE COGNITIVE FUNCTION: A RANDOMIZED TRIAL

Innovation in Aging ◽

10.1093/geroni/igz038.215 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S55-S56

Author(s):

Lisanne F ten Brinke ◽

John R Best ◽

Joey L Chan ◽

Cheyenne Ghag ◽

Kirk I Erickson ◽

...

Keyword(s):

Older Adults ◽

Physical Exercise ◽

Executive Functions ◽

Cognitive Training ◽

Verbal Learning ◽

Stroop Test ◽

Community Dwelling ◽

Computerized Cognitive Training ◽

Improved Performance ◽

At Home

Abstract Given the world’s aging population, it is important to identify strategies that promote healthy cognitive aging. Computerized cognitive training (CCT) may be a promising method to combat cognitive decline in older adults. Moreover, physical exercise immediately prior to CCT might provide additional cognitive benefits. We conducted a randomized controlled trial to examine the effect of a CCT intervention, alone or preceded by physical exercise, on memory and executive functions in older adults. 124 community-dwelling older adults aged 65-85 years were randomly assigned to either 8-weeks of: 1) 3x/week group-based CCT plus 3x/week CCT sessions at home; 2) 3x/week group-based CCT combined with a 15-minute brisk walk (Ex-CCT) plus 3x/week Ex-CCT sessions at home; or 3)3x/week group-based sham exercise and education sessions (CON). At baseline and 8-weeks standard neuropsychological tests of verbal memory and learning and executive functions were administered, including the Rey Auditory Verbal Learning Test (RAVLT), Stroop test, Flanker test, Trail Making Tests (TMT B-A), and Dimensional Change Card Sort (DCCS) Test. At trial completion, there were no differences in RAVLT performance. Compared with CON, FBT and Ex-FBT participants significantly improved performance on the Stroop test (p = .001 and p = .023, respectively). Additionally, those randomized to Ex-CCT improved performance on the Flanker test (p = .002), TMT B-A (p = .047), and the DCCS Test (p = .023) compared with BAT. These findings suggest that an 8-week CCT program could benefit executive functions, and that implementing exercise immediately prior to CCT could provide broader benefits.

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Modifiable factors of vitamin D status among a Brazilian osteoporotic population attended a public outpatient clinic

Arquivos Brasileiros de Endocrinologia & Metabologia ◽

10.1590/0004-2730000003393 ◽

2014 ◽

Vol 58 (5) ◽

pp. 572-582 ◽

Cited By ~ 3

Author(s):

Marília Brasilio Rodrigues Camargo ◽

llda Sizue Kunii ◽

Lilian Fukusima Hayashi ◽

Patrícia Muszkat ◽

Catherine Gusman Anelli ◽

...

Keyword(s):

Physical Activity ◽

Vitamin D ◽

Dietary Habits ◽

Vitamin D Supplementation ◽

Community Dwelling ◽

Vitamin D Status ◽

Mineral Density ◽

Cross Sectional ◽

Modifiable Factors ◽

The Mean

Objectives To evaluate the serum 25-hydroxyvitamin D [25(OH)D] concentration in Brazilian osteoporotic patients and the modifiable factors of vitamin D status in this population. Subjects and methods In a cross-sectional study, 363 community-dwelling patients who sought specialized medical care were evaluated between autumn and spring in São Paulo, Brazil. Serum levels of 25(OH)D and parathormone (PTH), biochemical and anthropometric measurements, and bone density scans were obtained. The group was assessed using two questionnaires: one questionnaire covered lifestyle and dietary habits, skin phototype, sun exposure, medical conditions, and levels of vitamin D supplementation (cholecalciferol); the other questionnaire assessed health-related quality-of-life. Logistic regression and a decision tree were used to assess the association between the variables and the adequacy of vitamin D status. Results The mean age of the overall sample was 67.9 ± 8.6 years, and the mean 25(OH)D concentration was 24.8 ng/mL. The prevalence of inadequate vitamin D status was high (73.3%), although 81.5% of the subjects were receiving cholecalciferol (mean dose of 8,169 IU/week). 25(OH)D was positively correlated with femoral neck bone mineral density and negatively correlated with PTH. In the multivariate analysis, the dose of cholecalciferol, engagement in physical activity and the month of the year (September) were associated with improvement in vitamin D status. Conclusions In this osteoporotic population, vitamin D supplementation of 7,000 IU/week is not enough to reach the desired 25(OH)D concentration (≥ 30 ng/mL). Engagement in physical activity and the month of the year are modifiable factors of the vitamin D status in this population.

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Transitioning to a microprocessor-controlled prosthetic knee: Executive functioning during single and dual-task gait

Prosthetics and Orthotics International ◽

10.1177/0309364619892773 ◽

2019 ◽

Vol 44 (1) ◽

pp. 27-35 ◽

Cited By ~ 1

Author(s):

Nerrolyn Ramstrand ◽

David F Rusaw ◽

Saffran Filippa Möller

Keyword(s):

Executive Functioning ◽

Executive Functions ◽

Study Design ◽

Dual Task ◽

Brain Activity ◽

Cognitive Effort ◽

Limb Amputation ◽

Prosthetic Knee ◽

Testing Occasion ◽

Before And After

Background: Walking with a prosthesis requires substantial concentration on behalf of the user and places increased demands on executive functions. Little is known of the effects that prosthetic knee joint prescription may have on executive functioning. Objectives: Evaluate executive functioning in trans-femoral prosthesis users during single and dual-task walking, before and after they transition to a Microprocessor-controlled prosthetic knee unit. Study Design: Multiple case-study design. Methods: Single and dual task gait was evaluated while recording cortical brain activity. Testing occasion 1 occurred prior to participants receiving their microprocessor-controlled prosthetic knee, while testing occasion 2 was conducted a minimum of 8 months after they had been fitted with an microprocessor-controlled prosthetic knee. Results: During single-task level walking and walking while performing a dual-task key finding test, executive functions, measured as the relative haemodynamic response in the frontal cortex, reduced for most, but not all participants after transitioning to an Microprocessor-controlled prosthetic knee. There did not appear to be any difference when participants performed a trail walk test. Conclusions: Results suggest Microprocessor-controlled prosthetic knee prosthetic knees may have a positive effect on executive functioning for some individuals who have undergone a lower-limb amputation. A larger, longitudinal study with careful control of extraneous variables (e.g. age, training) is needed to confirm results and determine causality. Clinical relevance This article provides some evidence to suggest that prosthetic prescription may influence executive functioning and that microprocessor-controlled prosthetic knee mechanisms may reduce cognitive effort when walking.

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Can functional walk tests add value to the prediction of cardiorespiratory fitness after stroke? A prospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0255308 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255308

Author(s):

Mari Gunnes ◽

Inger-Lise Aamot Aksetøy ◽

Turid Follestad ◽

Bent Indredavik ◽

Torunn Askim

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Cardiorespiratory Fitness ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Chronic Stroke ◽

Community Dwelling ◽

Functional Dependency ◽

Daily Physical Activity ◽

Walk Tests

Background Cardiorespiratory fitness is often impaired following stroke, and peak oxygen consumption (VO2peak) is an important prognostic value of all-cause mortality. The primary objective was to investigate whether functional walk tests assessed in the subacute phase after stroke added value in predicting VO2peak in chronic stroke, in addition to age, sex and functional dependency. Secondary objectives were to investigate associations between daily physical activity and functional walk tests, and with VO2peak in chronic stroke. Methods This prospective cohort study included eligible participants originally included in the randomized controlled trial Life After Stroke. Functional walk tests, i.e., six-minute walk test (6MWT) and maximal gait speed, were assessed at inclusion and 18 months later. VO2peak [ml/kg/min] was assessed by a cardiopulmonary exercise test on a treadmill 20 months after inclusion. Daily physical activity was measured by a uniaxial accelerometer (activPAL) at 18-month follow-up. Results Ninety-two community-dwelling individuals, with a mean (SD) age of 69.2 (10.6) years and 33 (35.9%) women, were included 3 months after stroke onset. Eighty-three (90.2%) participants had a modified Rankin Scale (mRS) score of 1 or 2, indicating functional independence. An overall assessment of four prediction models indicated the combination of age, sex, mRS and 6MWT as predictors to be the best fitted model in predicting VO2peak (adjusted R2 = 0.612). Secondary results showed statistically significant, but not clinically significant, associations between daily physical activity and functional walk tests, and with VO2peak. Conclusions 6MWT add significant value to the prediction of mean VO2peak in the chronic phase in mild strokes, in combination with age, sex and functional dependency. This prediction model may facilitate clinical decisions and rehabilitation strategies for mildly affected stroke survivors in risk of low levels of VO2peak. Future studies should validate the model in various stages after stroke and in patients moderately and severely affected.

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THE COYOACAN COHORT STUDY: DESIGN, METHODOLOGY, AND PARTICIPANTS’ CHARACTERISTICS OF A MEXICAN STUDY ON NUTRITIONAL AND PSYCHOSOCIAL MARKERS OF FRAILTY

Journal of Frailty & Aging ◽

10.14283/jfa.2013.11 ◽

2013 ◽

pp. 1-9

Author(s):

L. RUIZ-ARREGUI ◽

J.A. ÁVILA-FUNES ◽

H. AMIEVA ◽

S.A. BORGES-YÁÑEZ ◽

A. VILLA-ROMERO ◽

...

Keyword(s):

Physical Activity ◽

The Elderly ◽

Biological Data ◽

Community Dwelling ◽

Face To Face ◽

Clinical Evaluations ◽

Increased Risk ◽

Cohort Study Design ◽

The Mean

Background:“Frailty” has emerged as a condition associated with an increased risk of functionaldecline among the elderly, which may be differentiated from aging, disability, and co-morbidities. Objective: TheMexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly hasemerged to help answer many questions about frailty among the older adults. This report presents the design ofthe study and baseline data of its participants. Design: The “Coyoacan cohort” is a longitudinal observationalstudy developed in Mexico City. Participants:A representative sample of 1,294 non-institutionalized men andwomen aged 70 years and older were randomly recruited to undergo a face-to-face interview and acomprehensive geriatric assessment (including clinical evaluations and blood samples) between 2008 and 2009.Measurements:Data collected included socio-demographic and economic characteristics, medical history, oralhealth, drug use, cognitive function and mood, nutritional status, physical performance and functional status,physical activity, quality of life, social networks, and biological data. Frailty was defined as the presence of ≥3 ofthe following components: slowness, poor muscle strength, low physical activity, exhaustion and unintentionalweight loss. Results: A total of 1,124 participants completed the interview. The mean age was 79.5 ± 7.1 years,and 55.9% were female. Nine hundred and forty-five subjects completed the clinical evaluation and 743 bloodsamples were collected. The baseline prevalence of frailty was 14.1%. Conclusions:Understanding the medical,biological, and environmental factors that contribute to the phenomenon of frailty is the goal of the currentresearch in the field.

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A 9-Week Jaques-Dalcroze Eurhythmics Intervention Improves Single and Dual-Task Gait Speed in Community-Dwelling Older People

Journal of Physical Activity and Health ◽

10.1123/jpah.2017-0416 ◽

2017 ◽

Vol 14 (9) ◽

pp. 740-744 ◽

Cited By ~ 4

Author(s):

Lisa Ferguson-Stegall ◽

Mandy Vang ◽

Anthony S. Wolfe ◽

Kathy M. Thomsen

Keyword(s):

Physical Activity ◽

Older People ◽

Dual Task ◽

Gait Speed ◽

Fall Risk ◽

Preliminary Investigation ◽

Community Dwelling ◽

Health Concern ◽

Short Term ◽

Movement Training

Background:Falls are a major public health concern among older adults, and most occur while walking, especially under dualtask conditions. Jaques-Dalcroze eurhythmics (JDE) is a music-based movement training program that emphasizes multitask coordinated movement. A previous 6-mo JDE study in older people demonstrated improved gait and balance; however, the effects of short-term JDE interventions on fall risk-related outcomes are largely unknown. We conducted a preliminary investigation on whether a 9-week JDE intervention improved gait and stability in a community-dwelling older cohort, hypothesizing that improvements would occur in all outcome measures.Methods:Nine participants (78.9 ± 12.3 y) completed the supervised JDE intervention (once/week for 60 min). Gait speed was determined by the 6-m timed walk test (6MTW); dual-task gait speed was determined by another 6MTW while counting backward from 50 aloud; and coordinated stability was assessed using a Swaymeter-like device.Results:Gait speed (0.92 ± 0.11 vs 1.04 ± 0.12 m/sec, P = .04) and dual-task gait speed (0.77 ± 0.09 vs 0.92 ± 0.11 m/sec, P = .0005) significantly improved.Conclusions:This novel intervention is an effective short-term physical activity option for those that plan physical activity or fall-risk reduction programs for the older people.

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Texting Older Sisters to Step (TOSS) Using Fitbits to Promote Physical Activity: A Feasibility Study

Innovation in Aging ◽

10.1093/geroni/igab046.3256 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 905-905

Author(s):

Pamela Bowen ◽

William Opoku-Agyeman ◽

Veronica Mixon ◽

Olivia Affuso ◽

Olivio Clay

Keyword(s):

Physical Activity ◽

Black Women ◽

Low Cost ◽

Text Message ◽

Public Health Problem ◽

Community Dwelling ◽

Self Monitoring ◽

The Mean ◽

Control Evaluation ◽

Group Averaging

Abstract Black women are disproportionately diagnosed with obesity (BMI ≥ 30 kg/m2). Obesity is a preventable but complex, public health problem that is multifaceted, chronic, and approximately 58% of Black women 60 years and older are classified as obese, compared to 38% of their White counterparts. This 12 week, pre/post, 2-group study aimed to determine if a peer-informed physical activity (PA) intervention with peer support would be feasible among community- dwelling, obese, older Black women to promote regular PA. Forty-eight potential participants were screened, 24 categorized as obese were enrolled and completed the study. The mean age was 64 (SD 3.0) years. Steps were measured by a Fitbit-Inspire with data successfully collected on 98% of days with the treatment group averaging a daily increase of 700-steps more than the control. Evaluation of intervention’s acceptability revealed that 100% enjoyed the study and using the Fitbit device. Text message readability was 100% and 95% said the study was motivational. Additionally, 8.3% said daily prompts were too frequent, 12% indicated that future studies should include additional social support, and 88% did not comment on the Fitbit community option for support, suggesting that this feature was not practical. Findings demonstrated that this intervention meets the criteria of being scalable, low cost, feasible, and acceptable for the older Black women. Using self-monitoring techniques in combination with at least one other behavioral strategy, such as our TOSS messages (cues for motivation) as the delivery channel for health promotion messages are a promising approach to increase PA behaviors.

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Abstract 38: Prospective Study of Midlife Sedentary Behavior, Physical Activity, and Cognitive Function: The CARDIA Study

Circulation ◽

10.1161/circ.141.suppl_1.38 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Cited By ~ 1

Author(s):

Kara M Whitaker ◽

Kelley Pettee Gabriel ◽

Baojiang Chen ◽

Monica Ahrens ◽

Barbara Sternfeld ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Function ◽

Sedentary Behavior ◽

Repeated Measures ◽

Adult Population ◽

Verbal Learning ◽

Stroop Test ◽

Digit Symbol Substitution Test ◽

Beneficial Effects ◽

Intensity Physical Activity

Introduction: Evidence suggests moderate to vigorous intensity physical activity (MVPA) has beneficial effects on various domains of cognitive function; however, less than half of adults meet MVPA guidelines. Alternate approaches, such as reducing sedentary behavior (SED) with concurrent increases in light-intensity physical activity (LPA) may resonate more strongly with the adult population. Objective: To determine if accelerometer measured SED, LPA, and MVPA at ages 38-50 years is prospectively associated with measures of cognitive function. Methods: We studied 1,842 Black and White men and women enrolled in CARDIA who participated in the year 20 (2005-06) and year 25 (2010-11) and/or year 30 (2015-16) exams. SED, LPA, and MVPA were measured by the ActiGraph 7164 accelerometer at year 20. Cognitive function tests at the year 25 and 30 exams included the Rey Auditory Verbal Learning Test (RAVLT, memory), Digit Symbol Substitution Test (DSST, processing speed), and Stroop Test (executive function). Compositional isotemporal substitution analysis examined associations of SED, LPA, and MVPA at year 20 with repeated measures (unstructured covariance) of the cognitive function raw test scores at years 25 and 30. Results: In men, substituting 30 minutes of SED with 30 minutes of LPA was associated with a decrease in the RAVLT (-0.05) and DSST (-0.76), and increase in Stroop (0.45) scores, indicating worse performance (see Table ). Substituting SED or LPA with MVPA was associated with an increase in RAVLT (0.15, 0.20) and DSST (1.21, 2.00), and decrease in Stroop (-0.68, -1.17) scores, respectively, indicating better performance. In women, who had higher cognitive function scores than men, substituting SED or LPA with MVPA was associated with worse performance on the Stroop test (0.70, 0.63), contrary to our hypothesis. Conclusions: Statistical substitution of time from lower-intensity activities (SED or LPA) with MVPA, but not SED with LPA, resulted in better cognitive performance in men, but not women, over 10 years.

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Dual-Task Gait Performance Among Community-Dwelling Senior Women: The Role of Balance Confidence and Executive Functions

The Journals of Gerontology Series A ◽

10.1093/gerona/glp063 ◽

2009 ◽

Vol 64A (9) ◽

pp. 975-982 ◽

Cited By ~ 41

Author(s):

T. Liu-Ambrose ◽

L. A. Katarynych ◽

M. C. Ashe ◽

L. S. Nagamatsu ◽

C. L. Hsu

Keyword(s):

Executive Functions ◽

Dual Task ◽

Community Dwelling ◽

Gait Performance ◽

Balance Confidence ◽

Senior Women

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Latent Profile Analysis of Cognition in a Non-Demented Diverse Cohort: A Focus on Modifiable Cardiovascular and Lifestyle Factors

Journal of Alzheimer s Disease ◽

10.3233/jad-210110 ◽

2021 ◽

pp. 1-14

Author(s):

Melissa Lamar ◽

Deborah Drabick ◽

Elizabeth A. Boots ◽

Puja Agarwal ◽

Sheina Emrani ◽

...

Keyword(s):

Physical Activity ◽

Executive Functioning ◽

Mediterranean Diet ◽

Cognitive Aging ◽

Latent Profile Analysis ◽

Vigorous Physical Activity ◽

Community Dwelling ◽

Blood Levels ◽

Modifiable Factors ◽

Latent Profile

Background: Cognitively-defined subgroups are well-documented within neurodegeneration. Objective: We examined such profiles in diverse non-demented older adults and considered how resulting subgroups relate to modifiable factors associated with neurodegeneration. Methods: 121 non-demented (MMSE = 28.62) diverse (46%non-Latino Black, 40%non-Latino White, 15%Latino) community-dwelling adults (age = 67.7 years) completed cognitive, cardiovascular, physical activity, and diet evaluations. Latent profile analyses (LPA) employed six cognitive scores (letter fluency, letter-number sequencing, confrontational naming, ‘animal’ fluency, list-learning delayed recall, and recognition discriminability) to characterize cognitively-defined subgroups. Differences between resulting subgroups on cardiovascular (composite scores of overall health; specific health components including fasting blood levels) and lifestyle (sedentary behavior; moderate-to-vigorous physical activity; Mediterranean diet consumption) factors were examined using ANCOVAs adjusting for relevant confounders. Results: Based on sample means across cognitive scores, LPA resulted in the following cognitive subgroups: 1) high-average cognition, 55%non-Latino White and 64%female participants; 2) average cognition, 58%non-Latino Black and 68%male participants; 3) lower memory, 58%non-Latino Black participants; and 4) lower executive functioning, 70%Latinos. The high-average subgroup reported significantly higher Mediterranean diet consumption than the average subgroup (p = 0.001). The lower executive functioning group had higher fasting glucose and hemoglobin A1c than all other subgroups (p-values<0.001). Conclusion: LPA revealed two average subgroups reflecting level differences in cognition previously reported between non-Latino White and Black adults, and two lower cognition subgroups in domains similar to those documented in neurodegeneration. These subgroups, and their differences, suggest the importance of considering social determinants of health in cognitive aging and modifiable risk.

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