Mood and behavioral problems are important predictors of quality of life of nursing home residents with moderate to severe dementia: A cross-sectional study.

OBJECTIVES: To examine the predictors associated with quality of life of nursing home residents with dementia, in order to identify which predictors are most important and hold most promise for future intervention studies. METHODS/DESIGN: This cross-sectional analysis of data collected in two intervention trials included 143 participants with moderate to severe dementia who resided in 40 psychogeriatric wards in 13 nursing homes. The outcome measure quality of life was assessed with the Qualidem. Predictors examined were demographic factors, cognition, mood, behavioral problems, and comorbid conditions. RESULTS: Linear mixed regression analyses showed that all nine domains of quality of life showed independent (negative) associations with either depression, agitation, apathy, or a combination of these predictors. Agitation, apathy, depression, and the presence of neurological disease explained 50% of the variance in total quality of life. Male gender, psychiatric/mood disorders, and having one or more comorbid conditions was associated with worse social relations, while the presence of comorbid neurological diseases was associated with more social isolation and a worse care relationship. The presence of endocrine/metabolic disorders and pulmonary disorders was associated with less restless tense behavior. CONCLUSIONS: Different domains of quality of life showed different associations, confirming the multidimensionality of quality of life in nursing home residents with dementia. Quality of life is independently associated with mood and behavioral problems, comorbid conditions, and gender. This knowledge may help to identify older persons at risk of a lower quality of life, and to offer targeted interventions to improve quality of life. TRIAL REGISTRATION: Dutch Trial registration NTR5641.

The Overtraining Syndrome in Soldiers: Insights from the Sports Domain.

INTRODUCTION: Soldiers are exposed to extreme training regimens in order to optimally prepare for real battle. High attrition rates are a known issue during training courses, especially for elite troops. An underlying factor might be the disbalance between stress/strain and recovery. The aim of this review is to give insight in the current knowledge about functional overreaching (FOR), non-FOR (NFOR), and the overtraining syndrome (OTS) in the military. MATERIALS AND METHODS: A systematic literature review was conducted. PubMed, IngentaConnect, Science Direct, and Web of Science were screened for the following keywords and combinations of search terms; military, personnel, OT, soldier. RESULTS: Seven studies investigating the effects of OT during training courses were selected. The definitions used for OT varied widely and there is no systematic use of markers to determine FOR, NFOR, or the OTS in the military. CONCLUSIONS: Much research on NFOR/OTS has been conducted in the sports domain and the military could make use of these insights to promote a more efficient balance between training load and recovery. It is suggested to regularly test soldiers on physical performance, psychomotor speed and mood using ideally a military-specific test or the 1.5-mile run, psychomotor vigilance test and Profile of Mood States. The two-bout exercise test can be used as a specific test if previous testing indicates the development of NFOR/OTS and can be combined with metabolic and immunological testing to exclude pathological causes.

Mental Fatigue and Physical and Cognitive Performance During a 2-Bout Exercise Test.

PURPOSE: The 2-bout exercise protocol has been developed to diagnose nonfunctional overreaching and the "overtraining syndrome." It consists of 2 maximal exercise bouts separated by 4 hours. Mental fatigue negatively influences performance, but the effects of its occurrence during the 2-bout exercise protocol have never been investigated. The aim of this study was to examine whether mental fatigue (induced during the rest period) influences physical and cognitive performance during/after the second exercise bout of the 2-bout exercise protocol. METHODS: Nine healthy, well-trained male cyclists participated in a single-blind, randomized, placebo-controlled crossover study. The intervention consisted of either 1.5-hour rest (control) or performing a computer-based Stroop task to induce mental fatigue. Cognitive (Eriksen Flanker task), physiological (lactate, maximum heart rate, and maximum wattage), and subjective data (mental fatigue-visual analog scale, Profile of Mood States, and rating of perceived exertion) were gathered. RESULTS: Ratings of fatigue, tension, and mental fatigue were affected in the mental fatigue condition (P < .05). Neither physiological nor cognitive differences were found between conditions. Ratings of mental fatigue were already affected after the first maximum exercise test (P < .05). CONCLUSIONS: Neither physical nor cognitive performance was affected by mental fatigue, but subjective ratings did reveal significant differences. It is recommended to exclude mentally challenging tasks during the 2-bout exercise protocol rest period to ascertain unaffected subjective test results. This study should be repeated in athletes diagnosed with nonfunctional overreaching/overtraining syndrome.

Implementation and effects of Movement-oriented Restorative Care in a nursing home - a quasi-experimental study.

BACKGROUND: The prevalence of dementia is expected to increase rapidly, and institutionalization is a common consequence of the disease. Dependence in activities of daily living (ADL) is a predictor for institutionalization and a determinant for the quality of life (QoL). A promising method to increase functional independence in nursing homes is a restorative care or function focused care (FFC) approach. Movement-oriented restorative care (MRC) is derived from the concept of FFC and restorative care and focuses on the integration of physical activity in the daily lives of nursing home residents with dementia using a multidisciplinary approach. The objective of this study was to assess the effectiveness of MRC in preservation of ADL independence and QoL in nursing home residents with dementia. METHODS: In this quasi-experimental 12-month study, the effects of MRC were compared to care as usual in 61 nursing home residents with moderate to severe dementia. The outcome measures were ADL independence and QoL. These outcomes were measured five times (i.e. at baseline, and after 3, 6, 9, and 12 months). Additionally, data was collected regarding the degree of implementation, and the barriers to the implementation process. The effect of the intervention was analyzed using linear mixed model analyses. RESULTS: There was no significant overall intervention effect on ADL independence and QoL. A significant group-by-time interaction was found for the QoL subscale positive self-image: after a 12 month intervention period, the MRC group scored significantly better than the control group on positive self-image. Regarding the other subscales and the total score of the QoL, as well as ADL, no significant group-by-time interactions were found. CONCLUSIONS: MRC did not demonstrate significant improvements in ADL or QoL. After a 12-month intervention period, residents who received MRC showed higher scores on positive self-image compared to the control group. This study contributes to the limited research regarding the effect of MRC on resident outcomes. Further large-scale studies are recommended. TRIAL REGISTRATION: The trial was retrospectively registered in http://clinicaltrials.gov on February 2, 2017: NCT03001232 .

Refining Selection for Elite Troops by Predicting Military Training Outcome.

INTRODUCTION: Paratrooper training courses are very demanding, leading to a high number of drop-outs, despite existing selection criteria. This study investigated physiological, neuropsychological, and subjective data of completers and drop-outs during paratrooper training to identify potential predictive indices. METHODS: Tested were 24 paratrooper soldiers before (t0), after 8 wk (t1), and at the end of a 12-wk training camp (t2). There were 11 soldiers who completed the course and 13 dropped out. The Training OPtimalisation test (TOPtest) uses two maximum exercise events to assess changes in measured parameters. The TOPtest was administered at t0, t1, and t2; physiological [i.e., adrenocorticotrophic hormone (ACTH), cortisol, heart rate (HR)], neuropsychological (Stroop, Flanker, Go NoGo, Task Switch), and subjective data [Profile of Mood States (POMS)] were collected. Physiological and subjective raw data was gathered pre- and post-test from each of the two maximum exercise tests. The pre/post-test change of each parameter's raw values was calculated as the parameter's reactivity (or delta score). RESULTS: At t0, drop-outs showed a significantly smaller HR reactivity (117.9 ± 14.0 vs.107.7 ± 10.6). Delta scores of tension and fatigue values differed significantly between completers and drop-outs at t0. Completers' physiological reactivity during the TOPtest at t2 (HR: 105.91 ± 13.68 vs. 95.55 ± 10.28) was significantly reduced and became comparable to the drop-outs' reactivity at t0. Delta scores of fatigue and tension values showed a similar pattern. DISCUSSION: Reactivity of HR, tension, and fatigue parameter values were found to have predictive value in identifying completers vs. drop-outs of an elite paratrooper training course.Vrijkotte S, Meeusen R, Roelands B, Kubesch S, Mairesse O, de Schutter G, Pattyn N. Refining selection for elite troops by predicting military training outcome. Aerosp Med Hum Perform. 2017; 88(9):850-857.

Sustained Military Operations and Cognitive Performance.

INTRODUCTION: Cognitive performance is crucial during military operations. It is suggested that impaired cognitive performance accounts for most of the accidents during training courses and actual battle. There is a need to define when soldiers' operational readiness becomes impaired. The objective of this systematic review was to investigate the effects of sustained military operations (SUSOPS) on vigilance, reaction time, working memory, and reasoning in order to select good indicators for performance impairment. METHODS: A systematic literature search was performed using publicly accessible databases (IngentaConnect, PubMed, Science Direct, and Defense Technical Information Center online) that were screened until July 2015. Keywords were military, sustained operations, (cognitive) performance, soldier, and training. RESULTS: Only 7 out of 589 studies met the inclusion criteria. Selected studies were difficult to compare due to different methodologies, cognitive tasks, and military courses. Vigilance, reaction time, and working memory were affected after only a few hours, showing severe impairment. They are linearly related to military stress up to 80 h of SUSOPS. These three indicators needed little recovery time to return to baseline levels. After more than 80 h of SUSOPS, no significant impairments of those indicators were observed. Reasoning becomes impaired after high stress levels of relatively short duration and can remain affected after more than 80 h of SUSOPS. DISCUSSION: Vigilance, reaction time, and working memory are affected after only a few hours while little recovery time is needed. For reasoning to return to baseline values, longer recovery is needed than the time available during SUSOPS. Vrijkotte S, Roelands B, Meeusen R, Pattyn N. Sustained military operations and cognitive performance. Aerosp Med Hum Perform. 2016; 87(8):718-727.

The implementation of the functional task exercise programme for elderly people living at home.

BACKGROUND: The Functional Task Exercise programme is an evidence-based exercise programme for elderly people living at home. It enhances physical capacity with sustainable effects. FTE is provided by physiotherapists and remedial therapists. Although the intervention was found to be effective in a Randomised Controlled Trial, we may not assume that therapists will automatically supply the programme or that elderly people will automatically join the programme. This study protocol focuses on identifying determinants of implementation, developing implementation strategies and studying the effects of the implementation in daily practice. METHODS/DESIGN: Phase 1: The systematic identification of determinants of the implementation of FTE among therapists and the elderly. A questionnaire study was conducted in a random sample of 100 therapists, and interviews took place with 23 therapists and 8 elderly people (aged 66 to 80 years). The determinants were broken down into four categories: the characteristics of the environment, the organisation, the therapists, and the training programme.Phase 2: Developing and applying strategies adapted to the determinants identified. Fifteen physiotherapists will be trained to provide FTE and to recruit elderly people living at home. The therapists will then deliver the 12-week programme to two groups of elderly, each consisting of six to twelve people aged 70 years or older.Phase 3: Study of implementation and the impact. To study the actual use of FTE: 1) therapists record information about the selection of participants and how they apply the key features of FTE, 2) the participating elderly will keep an exercise logbook, 3) telephone interviews will take place with the therapists and the elderly and there will be on-site visits. The effects on the elderly people will be studied using: 1) the Patient-Specific Questionnaire, the Timed Up and Go test and a two performance tests. All tests will be performed at the start of the FTE programme, half way through, and at the end of the programme. DISCUSSION: The number of older people will increase in many countries in the years to come and so the project outcomes will be of interest to policy-makers, insurance companies, health-care professionals and implementation researchers.