Feasibility of a Memory Clinic-Based Physical Activity Prescription Program

Abstract

Background Effective programs for promoting physical activity are needed for those with cognitive impairment. Objective To test the feasibility of mobile Health (mHealth) technology-supported physical activity prescription from a tertiary care memory clinic. Methods This feasibility study was designed as a 16-week randomized, crossover trial of a physical activity prescription: 8 weeks of intervention, 8 weeks of baseline or maintenance phase data collection. We recruited 2 cohorts: 21 individuals with Alzheimer-related cognitive impairment (mean age 72.3 (5.2), 9 females), and 9 individuals with normal cognition (mean age 69.6 (5.8), 8 females). We gave each cohort an mHealth accelerometer-based physical activity prescription to double number of steps taken. Our primary outcomes were feasibility and safety. Our secondary outcomes were change in weekly steps taken, Dementia Quality of Life Scale, Self-efficacy Scale, 6-minute Walk, mini-Physical Performance Test. Results Set-up and use of the device was not a barrier to participation. However, only 62% of participants with cognitive impairment completed the intervention. The cohort with cognitive impairment did not change their weekly step count above Week 1. All participants in the cohort with normal cognition were able to set up and use their device and increased their weekly step count above Week 1. There were no differences between Week 1 and Week 8 for any secondary measures in either cohort. Conclusions Setup and daily use of mHealth technology appears to be feasible for a person with cognitive impairment with the help of a partner, but increasing daily step counts over 8 weeks was not achieved. Future work needs to assess alternative activity prescription goals or additional support for patients and their partners.

Categorizing Health Outcomes and Efficacy of mHealth Apps for Persons With Cognitive Impairment: A Systematic Review

“…The one exercise intervention that met inclusion criteria selected health outcomes of quality of life, self-efficacy, change in weekly steps taken, the 6-minute walk time, and the Mini-Physical Performance Test. None of these outcomes improved with the exercise intervention [ 54 ].…”

“…Vidoni et al [ 54 ] sought to improve the health of persons with dementia by prescribing physical activity in conjunction with using a wearable mHealth device (Fitbit) in a tertiary medical clinic setting. The wearable device was an accelerometer that measured steps taken and communicated with the mHealth app installed on either a mobile device or computer.…”

“…Normal controls improved on their baseline weekly steps taken, whereas those with cognitive impairment did not. Only 62% of those with cognitive impairment completed the intervention [ 54 ].…”

Adherence support strategies for exercise interventions in people with mild cognitive impairment and dementia: A systematic review

“…; 2 of the 6 communities also offered a structured walking programme 2–3 times a wkIndividual and situational factors influencing physical activityGroup setting, reminders from staff and through centrally located bulletin board, planning of exercise to fit into daily routine, tailoring and supervision discussedAdherence: n/aEvaluation: focus groups: group setting desirable as it also provided the opportunity to socialize; planning exercise and using reminders seen as important; individualized home exercise and supervision with a motivational leader desirable; most preferred type of exercise was walkingFairhall et al (2012), AustraliaRCTCommunity setting; intervention group: n  = 120; mean age = 83.4 (SD = 5.8); 67% women; mean MMSE = 26.6 (SD = 2.6)12 months multifactorial interdisciplinary and individually tailored intervention targeting frailty. This included 10 home based 45–60 min physiotherapy sessionsMobility related disability in terms of satisfaction and performanceGoal setting and ongoing review of goals by PT for mobility goals; assessment of barriers to goal attainment; PT identified barriers and organized additional services to help overcome barriers; components to achieve goals were practiced at home, then in target environment with decreasing degree of assistanceAdherence: median global level of adherence as estimated by the physiotherapists: 25%–50% of intervention program;Evaluation: percentage of participants completing goal focused aspect of intervention: 50%; physiotherapist organized additional services depending on barriers such as provision, modification or advice about equipment (for 40% of participants), referral to services for care of older people (for 41% of participants) or to medical care (for 30% of participants)Lindelof et al (2012), SwedenQualitative, InterviewsResidential care setting; total n  = 9; mean age = 89 (73–91); 66% women; MMSE 23 (Phillips and Flesner, 2013, Cox et al, 2013, Resnick et al, 2009, Rosenberg et al, 2012, Wu et al, 2015, Frederiksen et al, 2014, Olsen et al, 2015, Vidoni et al, 2016, Fairhall et al, 2012, Kerse et al, 2008, Lindelof et al, 2012, Smith et al, 2017); 3 diagnosed with dementia3 months of high intensity group based exercise intervention with 5 sessions lasting 45 min each held in every 2 week period prior to the interviewsViews on participating in the exercise, motivation; experience of positive and negative effects of the exerciseSupport from exercise supervisor (close supervision for exercises by 2 PTs); group setting;Adherence: n/aEvaluation: interviews: supervisors were perceived as confidence inspiring and encouraging and therefore seen as exercise facilitators; group exercise provided opportunity to socialize, which subsequently increased self-confidence – created a “sense of togetherness”Rosenberg et al (2012), USAFeasibility study using a single cohort designRetirement facility setting, total n  = 87; mean age = 84.1 (range 69–98); 76% women; included pe...…”

Can consumer wearable activity tracker-based interventions improve physical activity and cardiometabolic health in patients with chronic diseases? A systematic review and meta-analysis of randomised controlled trials

“…Only eight studies blinded the outcome assessors, whereas the majority of the studies did not adequately report blinding of the outcome assessors (n = 22). Most of the studies provided complete outcome data (n = 31), whereas three studies had a high risk of attrition bias [38,54,60] due to incomplete outcome data and only one study reported insufficient information [48].…”