The presence of mild cognitive impairment (MCI) in older adults increases their fall risk. While physical exercise is effective in reducing falls rate and risk of falls, and cognitive training in improving cognitive functioning in healthy older adults, their effectiveness in preventing falls and reducing risks of falls in MCI when administered simultaneously is not yet established. Therefore, this study aims to determine the effectiveness of combined physical and cognitive training in preventing falls and decreasing risks of falls among community-dwelling older persons with MCI.
This is a single-blind, multicentre, randomized controlled trial. At least ninety-three community-dwelling older adults with MCI aged 60 or above will be recruited. They will be randomly allocated into four groups: Physical Training alone (PT), Cognitive Training alone (CT), combined Physical And Cognitive Training (PACT) and Waitlist Group (WG). The PT group will perform exercises (flexibility, endurance, strengthening, and balance training) for 60–90 min three times per week for 12 weeks. The CT group will be involved in a paper-based training focusing on orientation, memory, attention and executive functioning for 60–90 min per session, once a week for 12 weeks. The PACT group will undergo cognitive training incorporated in physical exercise for 60–90 min three times per week for 12 weeks. The WG will receive the intervention, combined physical and cognitive training, at a later date. Assessors blinded to participant allocation will conduct pre-intervention, post-intervention, and 6-month follow-up assessments. The primary outcome measure will be falls rate. The secondary outcome measures will be Physiologic Profile Assessment and Falls Risk for Older Persons in the Community, and assessments that evaluate cognitive, physical and psychological factors related to falls.
Considering the possible physical, social, financial and psychological consequences of a fall, we hope to provide insights on the effectiveness of combining physical and cognitive training on falls and fall-related factors for older adults with MCI. It is projected that the combined interventions will lead to significantly lower falls rate and reduced risk of falls compared to using single or no intervention.
ClinicalTrials.gov NCT03167840. Registered on May 30, 2017.
Sherrington C, Michaleff ZA, Fairhall N, Paul SS, Tiedemann A, Whitney J, et al. Exercise to prevent falls in older adults: An updated systematic review and meta-analysis. Br J Sports Med. 2016; https://doi.org/10.1136/bjsports-2016-096547.
Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:Cd007146.
Power V, Clifford AM. Characteristics of optimum falls prevention exercise programmes for community-dwelling older adults using the FITT principle. Eur Rev Aging Phys Act. 2013;10:95–106. CrossRef
Zheng G, Xia R, Zhou W, Tao J, Chen L. Aerobic exercise ameliorates cognitive function in older adults with mild cognitive impairment: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med. 2016. https://doi.org/10.1136/bjsports-2016-09719.
Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer's or vascular type: a review. Alzheimers Res Ther. 2013. https://doi.org/10.1186/alzrt189.
Liu XY, Li L, Xiao JQ, He CZ, Lyu XL, Gao L, et al. Cognitive training in older adults with mild cognitive impairment. Biomed Environ Sci. 2016;29:356–64. PubMed
Fabel K, Wolf SA, Ehninger D, Babu H, Leal-Galicia P, Kempermann G. Additive effects of physical exercise and environmental enrichment on adult hippocampal neurogenesis in mice. Front Neurosci. 2009. https://doi.org/10.3389/neuro.22.002.2009.
Train the Brain Consortium. Randomized trial on the effects of a combined physical/cognitive training in aged MCI subjects: The Train the Brain study. Sci Rep. 2017. https://doi.org/10.1038/srep39471.
Reuter I, Mehnert S, Sammer G, Oechsner M, Engelhardt M. Efficacy of a multimodal cognitive rehabilitation including psychomotor and endurance training in Parkinson's disease. J Aging Res. 2012. https://doi.org/10.1155/2012/235765.
Kounti F, Bakoglidou E, Agogiatou C, Lombardo E, Serper LL, Tsolaki M. RHEA,* a nonpharmacological cognitive training intervention in patients with mild cognitive impairment. Top Geriatr Rehabil. 2011;27:289–300. CrossRef
Suzuki T, Shimada H, Makizako H, Doi T, Yoshida D, Ito K, et al. A randomized controlled trial of multicomponent exercise in older adults with mild cognitive impairment. PLoS ONE. 2013. https://doi.org/10.1371/journal.pone.0061483.
Fiatarone Singh MA, Gates N, Saigal N, Wilson GC, Meiklejohn J, Brodaty H, et al. The study of mental and resistance training (SMART) study-resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial. JAMDA. 2014;15:873–80. PubMed
Lam LC, Chan WC, Leung T, Fung AW, Leung EM. Would older adults with mild cognitive impairment adhere to and benefit from a structured lifestyle activity intervention to enhance cognition?: A cluster randomized controlled trial. PLoS One. 2015. https://doi.org/10.1371/journal.pone.0118173.
Vojtkofsky T, Feldman RG. Keep your brain stronger for longer: 201 brain exercises for people with mild cognitive impairment. New York: The Experiment, LLC; 2015.
Freiberger E, Häberle L, Spirduso WW, Rixt Zijlstra GA. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc. 2012;60:437–46. CrossRefPubMed
Sampaio NR, Rosa NMDB, Godoy APS, Pereira DS, Hicks C, Lord SR, et al. Reliability evaluation of the physiological profile assessment to assess fall risk in older people. Gerontol Geriatr Res. 2014;3:179–82.
Lord SR, Menz HB, Tiedemann A. A physiological profile approach to falls risk assessment and prevention. Phys Ther. 2003;83:237–52. PubMed
Smith T, Gildeh N, Holmes C. The Montreal cognitive assessment: validity and utility in a memory clinic setting. Can J Psychiatr. 2007;52:329–32. CrossRef
Bohannon RW, Schaubert K. Long-term reliability of the timed up-and-go test among community-dwelling elders. J Phys Ther Sci. 2005;17:93–6. CrossRef
Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the timed up & go test. Phys Ther. 2000;80:896–903. PubMed
Hauer K, Yardley L, Beyer N, Kempen G, Dias N, Campbell M, et al. Validation of the falls efficacy scale and falls efficacy scale international in geriatric patients with and without cognitive impairment: results of self-report and interview-based questionnaires. Gerontology. 2010;56:190–9. CrossRefPubMed
Reker GT, Wong PTP. Psychological and physical well-being in the elderly: the perceived well-being scale (PWB). Can J Aging. 1984;3:23–32. CrossRef
van Reenen M, Janssen B. EQ-5D-5L user guide: basic information on how to use the EQ-5D-5L instrument. The Netherlands: EuroQol Research Foundation; 2015.
Schoene D, Valenzuela T, Lord SR, de Bruin ED. The effect of interactive cognitive-motor training in reducing fall risk in older people: a systematic review. BMC Geriatr. 2014. https://doi.org/10.1186/1471-2318-14-107.
Vetter NJ, Ford D. Anxiety and depression scores in elderly fallers. Int J Geriatr Psychiatry. 1989;4:159–63. CrossRef
Chan WC, Yeung JW, Wong CS, Lam LC, Chung KF, Luk JK, et al. Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis. JAMDA. 2015;16:149–54. PubMed
- Falls prevention through physical and cognitive training (falls PACT) in older adults with mild cognitive impairment: a randomized controlled trial protocol
Donald S. Lipardo
William W. N. Tsang
- BioMed Central
Neu im Fachgebiet Innere Medizin
Meistgelesene Bücher aus der Inneren Medizin
Mail Icon II