Factors influencing participation in physical activity for persons living with dementia in rural and northern communities in Canada: a qualitative study.

OBJECTIVE: In recognition that engagement in physical activities for persons living with dementia can be challenging in rural and northern communities, the objective of this study was to explore the factors influencing physical activity participation among persons living with dementia in rural/northern communities and to identify the locally-driven mitigation strategies participants used to address barriers to physical activity. SETTING: Interviews and focus groups were conducted in two locations in northern British Columbia, Canada including a rural community (<10 000 persons) and a medium-sized geographically isolated city (<80 000 persons). Both communities are located at substantial distances (>700 km) from larger urban centres. PARTICIPANTS: Twenty-nine individuals participated including healthcare providers (n=8), community exercise professionals (n=12), persons living with dementia (n=4) and care partners (n=5). RESULTS: Rural and northern contextual factors including aspects of the built and natural environment were the main drivers of physical activity for persons living with dementia. Limited capacity in the health system to support physical activity due to a lack of referrals, poor communication mechanisms and limited resources for programming created challenges for physical activity participation. At the community level, local champions filled gaps in physical activity programming by leveraging informal networks to organise opportunities. Programme-level factors included a lack of consistency in staff, and challenges defining programme scope given limited population size and the fear of stigma for persons living with dementia. CONCLUSIONS: Environmental context and limited access to specialised programming affect the opportunities for persons living with dementia to engage in physical activities. Rural and northern communities showed resiliency in providing physical activity opportunities yet remained fragile due to human resource challenges. Without reliable resources and sustained support from the health system, local champions remain vulnerable to burnout. Enhancing support for local champions may provide greater stability and support to physical activity promotion in rural and northern communities.

Protocol for SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home): feasibility of a home-based double-blind randomised controlled trial to improve gait and cognition in individuals at risk for dementia.

INTRODUCTION: Physical exercise and cognitive training have the potential to enhance cognitive function and mobility in older adults at risk of Alzheimer's disease and related dementia (ADRD), but little is known about the feasibility of delivering multidomain interventions in home settings of older adults at risk of ADRD. This study aims to assess the feasibility of home-based delivery of exercise and cognitive interventions, and to evaluate the relationship between participants' intervention preferences and their subsequent adherence. Secondary objectives include the effect of the interventions on ADRD risk factors, including frailty, mobility, sleep, diet and psychological health. METHODS AND ANALYSIS: The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) feasibility trial is a randomised control trial that follows a 2×2 factorial design, with a 16-week home-based intervention programme (3 sessions per week) of physical exercises and cognitive training. Participants will be randomised in blocks of four to one of the following four arms: (1) combined exercise (aerobic and resistance)+cognitive training (NEUROPEAK); (2) combined exercise+control cognitive training (web searching); (3) control exercise (balance and toning)+cognitive training; and (4) control exercise+control cognitive training. SYNERGIC@Home will be implemented through video conferencing. Baseline and post-intervention assessments at 4-month and 10-month follow-up will include measures of cognition, frailty, mobility, sleep, diet and psychological health. Primary feasibility outcome is adherence to the interventions. Primary analytic outcome is the relationship between pre-allocation preference for a given intervention and subsequent adherence to the allocated intervention. A series of secondary analytic outcomes examining the potential effect of the individual and combined interventions on cognitive, mobility and general well-being will be measured at baseline and follow-up. ETHICS AND DISSEMINATION: Ethics approval was granted by the relevant research ethics boards. Findings of the study will be presented to stakeholders and published in peer-reviewed journals and at provincial, national and international conferences. TRIAL REGISTRATION NUMBER: NCT04997681, Pre-results.

Similar changes in executive function after moderate resistance training and loadless movement.

Growing evidence suggests that physical exercise may improve cognitive function in the short- and long-term. Aerobic exercise has been studied most extensively. Preliminary work suggests that resistance training also improves cognitive function, particularly executive function. Conversely, most studies found little dose-effect by intensity. Consequently, cognitive benefits may be elicited, at least in part, by the movement rather than the physical exertion of resistance training. The objective here was to examine and compare acute changes in executive function after resistance training and a loadless movement control among young, healthy adults. Twenty-two young healthy adults (mean age 23.4 years [2.4]; 50% female) completed three conditions, a baseline condition and two experimental conditions (moderate intensity resistance training, loadless movement control). Participants completed a computerized modified Stroop task with concurrent electroencephalography (EEG) before and 10, 20, 30, and 40min after each intervention. Outcomes (incongruent and congruent response time, accuracy, EEG P3 amplitude and latency) were analyzed using mixed linear regression models (factors: condition, time, condition*time). There was a main effect of time for Stroop response time (F4,84 = 3.94, p = 0.006 and F4,84 = 10.27, p<0.0001 respectively) and incongruent and congruent P3 amplitude (F4,76 = 4.40, p = 0.003 and F4,76 = 5.09, p = 0.001 respectively). Post-hoc analyses indicated that both incongruent and congruent P3 amplitude were elevated at time points up to and including 40min after the interventions (compared to pre-intervention, p<0.05). Both incongruent and congruent response times were faster at 10min post-intervention than pre-intervention (p<0.04). There was no main effect of condition or interaction between condition and time for either outcome (p≥0.53). Similar improvements in executive function were observed after loadless movement and resistance training, suggesting that movement is at least partially responsible for the benefits to executive function. Future research should continue to probe the influence of movement versus physical exertion in resistance training by including a movement and non-movement control.

The Acute Effects of Aerobic Exercise on Cognitive Control among People with Chronic Stroke.

BACKGROUND: Over half of stroke survivors have cognitive impairment, which impedes rehabilitation and functional recovery. Evidence suggests a single session of aerobic exercise improves cognitive functions among healthy adults. Whether this holds true for stroke survivors is unclear. The objective of this study was to examine whether one session of moderate-intensity aerobic exercise improves the cognitive control and attention of stroke survivors. METHODS: Nine people with chronic stroke (≥6 months poststroke) performed a modified Eriksen Flanker task with concurrent electroencephalography (EEG) before and immediately, 20 minutes, and 40 minutes after 20 minutes of moderate-intensity exercise and after 20 minutes of rest. The sessions were in randomized order. Accuracy and response time were recorded for congruent and incongruent stimuli. Differences in accuracy, response time, and event-related potentials (P300, reflective of decision making) were analyzed using repeated measures analysis of variance. RESULTS: Improvements in EEG measures were noted after exercise. P300 amplitude at Fz was greater 40 minutes after exercise compared with after rest (P = .007). P300 latency was also shorter at 20 minutes after exercise compared with after rest for both congruent (465.8 milliseconds versus 500.0 milliseconds; P = .02) and incongruent (468.0 milliseconds versus 532.0 milliseconds; P = .003) conditions at the central electrode on the lesional side. Differences in behavioral performance after exercise were not significant. CONCLUSIONS: Preliminary results suggest that aerobic exercise improves cortical processes underlying cognitive control and attention 20-40 minutes postexercise. Future research should confirm results in a larger sample and examine whether attention-demanding rehabilitation in this window has improved outcomes.