Technology-Enhanced 4Active Intervention Impacting Psychological Well-Being and Physical Activity among Older Adults: A Pilot Study

Background: To increase psychological well-being and physical activity (PA) behaviors, our pilot study used the social ecological model as the framework to design the 4Active intervention, focusing on multicomponent exercise group lessons at the interpersonal level and self exercise enhanced by activity trackers at the individual level. The purpose of this pilot study was to examine the effectiveness of the two-level 4Active intervention in improving psychological well-being and PA participation in older adults living in retirement communities. Methods: Participants were 27 older adults with a mean age of 85.9 ± 9.3 years. Based on the two-arm, quasi-experimental study design, fourteen older adults (2 men, 12 women) living in one retirement community (RC) were assigned into the intervention group receiving the two-level 4Active intervention, whereas 13 older adults (1 man, 12 women) living in another RC were allocated to the active control group receiving group exercise intervention alone for eight weeks. One week before and after the interventions, the participants were pre-tested and post-tested in psychological well-being (i.e., life satisfaction, subjective happiness, positive affect, and negative affect) and weekly PA minutes (i.e., weekly walking, vigorous, moderate, and total PA minutes). The data were analyzed be means of descriptive statistics, independent sample t-tests, and ANCOVA repeated measures. Results: The results of ANCOVA repeated measures indicated that both groups maintained their slightly high or very high levels of life satisfaction, happiness, and positive affect over times. However, the two-level 4Active intervention group showed significant decreases in negative affect (F = 4.78, p = 0.04, η2 = 0.23) and significance increases in weekly moderate PA (F = 10.355, p = 0.004, η2 = 0.310) compared with the active control group over time. Conclusion: It is concluded that engaging in the two-level 4Active intervention including group-based multicomponent exercises and technology-enhanced self-exercises is more effective in decreasing negative affect and increasing weekly moderate PA METS-min in physically and cognitively frail older adults over time, compared with attending the group exercises alone.

The Role of Executive Function in Children’s Mindfulness Experience

Objectives The effects of a 6-week mindfulness program were examined to assess how executive function level played a role in students’ mindful experience. The effects of the mindfulness program were evaluated according to prospective outcomes across students’ level of executive function, in comparison to an active control group. Methods Classrooms were randomly assigned to a mindfulness-based program or a health-based active control group. Pre- and early adolescent students in the 5th to 8th grade (N = 52) from two MindfulMe! program classrooms and two HealthyMe! program classrooms (active control group) completed self-reported pre-test and post-test measures to assess mindful attention awareness, strengths and difficulties, anxious arousal, rumination, and optimism. A composite score was created from student-, teacher-, and parent-reported BRIEF2 screening forms to determine students’ approximate level of executive function prior to the beginning of the program. Results There was a significant decrease in rumination for students in the mindfulness-based intervention when compared to the active controls. Findings suggest executive function predicted an individual’s change score in total difficulties, mindful attention awareness, optimism, and anxious arousal, after participating in a mindfulness-based intervention. Conclusions Mindfulness-based interventions appear to particularly benefit those with higher levels of executive function; however, an active control did not variably impact students according to their level of executive function.

Self-Managed Music-Guided Exercise Intervention Improved Upper and Lower Extremity Muscle Strength for ICU Survivors—A Pilot Randomized Controlled Study

Objective The objective of this study was to evaluate effects of a self-managed music-guided exercise intervention on muscle strength among intensive care unit (ICU) survivors. Methods We used a two-arm randomized-controlled trial. Following ICU discharge, eligible participants were assigned to one of two groups: music group ( n = 13) or active control group ( n = 13). The music group was taught to self-manage upper and lower extremity exercise movements by listening to an individualized music-guided playlist twice daily for 5 days. The active control group was provided an exercise brochure and advised to perform the same exercises at the same intervals. Dynamometers were used to measure muscle strength. T-tests and Weighted GEE models were used for testing the intervention effect between groups. Results Twenty-six subjects were enrolled. The mean age was 62.8 ( SD = 13.8), 53.8% were male, 65.4% were Caucasian, and the mean APACHE severity of illness score was 59 ( SD = 23.4). Reasons for ICU admission were mainly cardiac and medical. The music group showed significant improvements in handgrip, plantar flexion, leg extension, elbow flexion, and shoulder adduction strengths on left and right sides. Additionally, left and right leg extensor and left plantar flexor strengths showed significant post-differences, and small to moderately large effect sizes, between the music group and control group. Conclusion These findings suggest that a music-guided exercise intervention has the potential to improve muscle strength in ICU survivors and prevent further post-ICU deterioration in ICU survivors. Future trials should build upon these preliminary findings.

Effectiveness of home-based electronic cognitive therapy in patients with Alzheimer’s disease dementia: A Feasibility Study (Preprint)

BACKGROUND Can home-based computerized cognitive training programs be a useful tool to sustain cognition and quality of life in patients with Alzheimer’s disease (AD) dementia? Until now, the progressive nature of the disease and the variability in intervention periods has resulted in discrepant findings. We investigated a potential tool to offset the challenges usually found when evaluating the effectiveness of home-based computerized trainings in the AD population. Constant Therapy is a remotely-delivered, cloud-based program developed for patients with speech and cognitive deficits. OBJECTIVE We aimed to assess the feasibility and effectiveness of a 24-week individualized Constant Therapy intervention program in patients with AD in the MCI and mild dementia stages. METHODS Data were collected over a 48-week period. Participants were assigned to either the Constant Therapy or Active Control group. The Constant Therapy group completed an individualized tablet-based training during the first 24 weeks; the second 24 weeks of computerized training were optional. The Active Control group completed paper and pencil games (e.g., sudokus, crosswords) during the first 24 weeks, and then completed the Constant Therapy training during the second 24 weeks. At weeks 0, 24 and 48, participants completed a neuropsychological battery to assess changes in cognition and functioning. In addition, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered every 6 weeks. We measured Constant Therapy rate of adherence and task performance, as well as RBANS scores differences between the Constant Therapy and Active Control groups over the first 24 weeks of training. RESULTS Data for 19 patients were analyzed, with 44% of the Constant Therapy group and 22% of the Active Control group completing the entire 48-week training program. Due to the high drop-out rate, further analysis was only computed for participants who completed 24 weeks of training. The Constant Therapy group spent on average 121 days across the 24 weeks, and an average 27 minutes daily on the app. These participants showed an overall improvement in accuracy and latency in the Constant Therapy tasks scores, as well as specific improvements in the Constant Therapy tasks of visual and auditory memory, attention, and arithmetic. The Constant Therapy group also improved in the RBANS coding subtest compared to the Active Control group. CONCLUSIONS Long term (e.g., 24 weeks) computerized cognitive training using the Constant Therapy platform is feasible in patients with AD in the MCI and mild dementia stages. AD patients showed improvements on the Constant Therapy tasks over the 24 weeks and improved in one of the 12 RBANS subtests. These findings support the need for future research investigating the effects of long term individualized computerized programs as tools to sustain cognitive function and potentially quality of life in patients with AD. CLINICALTRIAL ClinicalTrials.gov NCT02521558

Impact of the MooN Physical Education Program on the Socio-Emotional Competencies of Preadolescents

Few studies have analyzed emotional educational experiences through physical education interventions. The objective of this study was to evaluate the effects on socio-emotional competencies of a physical education intervention (i.e., the MooN program) based on the instructional model known as the sports education model (SEM), compared to a physical education intervention based on the traditional model of direct instruction (TM-DI) in preadolescents. The sample consisted of 170 students between 10 and 13 years old (mean age: M = 10.76; standard deviation: SD = 0.73). Participants were randomly assigned to the experimental group (SEM; n = 87) and the active control group (TM-DI; n = 83). In the experimental group, the SEM-based intervention was applied, while in the active control group, an intervention based on the TM-DI was developed. A quasi-experimental design with repeated pre-test and post-test measures and an active control group was used. The self-efficacy inventory for multiple intelligences (IAMI-40) was used to assess the children’s socio-emotional competencies. The child perfectionism inventory was applied to evaluate the self-demand perfectionist efforts. The results confirmed that the MooN program (SEM intervention) promoted significant improvements in socio-emotional competencies. These findings support the potential of this physical education instructional model as an emotional education pathway for the socio-emotional improvement of preadolescent students.

Evaluating the effects of mindfulness-based stress reduction on cognitive function and quality of life in nondemented older adults : a pilot study.

Adults over the age of 65 years are now the fastest growing segment of the Canadian population. Although individual differences exist, aging is commonly associated with impairments in executive function. The present pilot study investigated the effectiveness of a mindfulness-based stress reduction (MBSR) program on improving executive functioning in older adults, while additionally decreasing perceived stress and improving psychological wellbeing. It was hypothesized that compared with an active control group, the MBSR group would display significant improvements in executive functioning, mood, self-esteem, and perceived stress. Participants were randomly assigned to either MBSR (n=40) or an active control group (n=32). Results suggest that MBSR is associated with significantly enhanced quality of life compared with the control condition. No additional significant results were found. A full-scale study will be necessary to clarify the present results.

Evaluating the effects of mindfulness-based stress reduction on cognitive function and quality of life in nondemented older adults : a pilot study.

Adults over the age of 65 years are now the fastest growing segment of the Canadian population. Although individual differences exist, aging is commonly associated with impairments in executive function. The present pilot study investigated the effectiveness of a mindfulness-based stress reduction (MBSR) program on improving executive functioning in older adults, while additionally decreasing perceived stress and improving psychological wellbeing. It was hypothesized that compared with an active control group, the MBSR group would display significant improvements in executive functioning, mood, self-esteem, and perceived stress. Participants were randomly assigned to either MBSR (n=40) or an active control group (n=32). Results suggest that MBSR is associated with significantly enhanced quality of life compared with the control condition. No additional significant results were found. A full-scale study will be necessary to clarify the present results.

Maximizing Cochlear Implant Outcomes with Short-Term Aural Rehabilitation

Background Increasing numbers of adults are receiving cochlear implants (CIs) and many achieve high levels of speech perception and improved quality of life. However, a proportion of implant recipients still struggle due to limited speech recognition and/or greater communication demands in their daily lives. For these individuals a program of aural rehabilitation (AR) has the potential to improve outcomes. Purpose The study investigated the effects of a short-term AR intervention on speech recognition, functional communication, and psychosocial outcomes in post lingually deafened adult CI users. Research Design The experimental design was a multisite clinical study with participants randomized to either an AR treatment or active control group. Each group completed 6 weekly 90-minute individual treatment sessions. Assessments were completed pretreatment, 1 week and 2 months post-treatment. Study Sample Twenty-five post lingually deafened adult CI recipients participated. AR group: mean age 66.2 (48–80); nine females, four males; months postactivation 7.7 (3–16); mean years severe to profound deafness 18.4 (2–40). Active control group: mean age 62.8 (47–85); eight females, four males; months postactivation 7.0 (3–13); mean years severe to profound deafness 18.8 (1–55). Intervention The AR protocol consisted of auditory training (words, sentences, speech tracking), and psychosocial counseling (informational and communication strategies). Active control group participants engaged in cognitive stimulation activities (e.g., crosswords, sudoku, etc.). Data Collection and Analysis Repeated measures ANOVA or analysis of variance, MANOVA or multivariate analysis of variance, and planned contrasts were used to compare group performance on the following measures: CasperSent; Hearing Handicap Inventory; Nijmegen Cochlear Implant Questionnaire; Client Oriented Scale of Improvement; Glasgow Benefit Inventory. Results The AR group showed statistically significant improvements on speech recognition performance, psychosocial function, and communication goals with no significant improvement seen in the control group. The two groups were statistically equivalent on all outcome measures at preassessment. The robust improvements for the AR group were maintained at 2 months post-treatment. Conclusion Results of this clinical study provide evidence that a short-term AR intervention protocol can maximize outcomes for adult post lingually deafened CI users. The impact of this brief multidimensional AR intervention to extend CI benefit is compelling, and may serve as a template for best practices with adult CI users.

Acute kidney injury is associated with subtle but quantifiable neurocognitive impairments

Background Acute kidney injury (AKI) is associated with long-term morbidity and mortality. The effects of AKI on neurocognitive functioning remain unknown. Our objective was to quantify neurocognitive impairment after an episode of AKI. Methods Survivors of AKI were compared to age-matched controls, as well as a convenience sample of patients matched for cardiovascular risk factors with normal kidney function (active control group). Patients with AKI completed two assessments, while the active control group completed one assessment. The assessment included a standardized test: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and a robotic assessment: Kinarm. Results The cohort consisted of 21 patients with AKI, 16 of whom completed both assessments, and 21 active control patients. The majority of patients with AKI had Kidney Disease Improving Global Outcomes stage 3 AKI (86%), 57% received dialysis, and 43% recovered to ≤ 25% of their baseline serum creatinine by their first assessment. Compared to the RBANS, which detected little impairment, the Kinarm categorized patients as impaired in visuomotor (10/21, 48%), attention (10/20, 50%), and executive tasks (11/21, 52%) compared to healthy controls. Additionally, patients with AKI performed significantly worse in attention and visuomotor domains when compared to the active controls. Neurocognitive performance was generally not impacted by the need for dialysis or whether kidney function recovered. Conclusion Robotic technology identified quantifiable neurocognitive impairment in survivors of AKI. Deficits were noted particularly in attention, visuomotor, and executive domains. Further investigation into the downstream health consequences of these neurocognitive impairments is warranted.

EXPRESS: Training executive functions using an adaptive procedure over 21-days (ten training sessions) and an active control group

The degree to which executive function (EF) abilities (including working memory (WM), inhibitory control (IC), and cognitive flexibility (CF)) can be enhanced through training is an important question, however research in this area is inconsistent. Previous cognitive training studies largely agree that training leads to improvements in the trained task, but the generalizability of this improvement to other related tasks remains controversial. In this paper, we present a pre-registered experiment that used an adaptive training procedure to examine whether EFs can be enhanced through cognitive training, and directly compared the efficacy and generalisability across sub-components of EF using training programs that target WM, IC or CF vs. an active control group. Participants (n=160) first completed a battery of tasks that assessed EFs, then were randomly assigned to one of four training groups, and completed an adaptive procedure over 21 days (10 training sessions) that targeted a specific sub-component of EF (or was comparatively engaging and challenging, but did not train a specific EF). At post-test, participants returned to the lab to repeat the battery of EF tasks. Results revealed robust direct training effects (i.e. on trained task), but limited evidence to support near (i.e. same EF, different task) and far (i.e. different EF and task) transfer effects. Where indirect training benefits emerged, the effects were more readily attributable to the overlapping training/assessment task routines, rather than more general enhancements to the underlying cognitive processes or neural circuits.