Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned.

Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.

The dementia-inclusive choices in exercise project: Using participatory action research to improve physical activity supports for persons with dementia.

Persons with dementia have the right to equal inclusion in rehabilitation, including physical activity. However, the perspectives of persons with dementia are rarely integrated into decision-making related to physical activity programming, services, and supports. Here, we describe the participatory action research (PAR) approach used to develop the Dementia-Inclusive Choices for Exercise (DICE) toolkit, which aims to increase the quality and number of physical activity opportunities available to persons with dementia. The DICE Research Team included persons with dementia, a family care partner, exercise professionals, community and dementia service providers, health care professionals, and researchers who worked to: 1) Engage/maintain the Research Team; 2) Set/navigate ways of engagement; 3) Understand barriers to physical activity; 4) Prioritize the audience and actions; 5) Develop the toolkit; 6) Conduct usability testing; and 7) Implement and evaluate. Guided by the Behaviour Change Wheel, and informed by interviews, focus groups, and existing research, our PAR Team chose to prioritize training exercise providers; exercise providers can enable exercise for persons with dementia if they understand common changes with dementia and how to support persons with dementia in exercise. The content and format of the toolkit was co-developed: drafted by our Research Team, adapted through a stakeholder workshop, and refined through iterative development and usability testing. The product of our PAR process, the DICE toolkit, includes videos meant to destigmatize dementia, training modules and a training manual for exercise providers, a physical activity handout for persons with dementia, and wallet cards to help persons with dementia communicate their abilities, needs, and preferences. Our usability study indicated that the toolkit could be used by exercise providers and may improve attitudes about dementia. Our vision is that our co-developed DICE toolkit will empower exercise providers to improve physical activity opportunities and support for persons with dementia.

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.

Changes in cognitive control and mood across repeated exercise sessions.

Acute exercise elicits benefits to cognition and mood. The consistency and accumulation of benefits across exercise sessions remains unclear. This exploratory study evaluated the reproducibility and accumulation of changes in cognitive control and mood across multiple exercise sessions. Thirty young healthy adults (18-35 years) were recruited to exercise (N = 14; age: 21.71 [SD = 1.64]; 57% female) or control (N = 16; age: 22.25 [SD = 3.68]; 56% female) groups. Participants attended six sessions over 2 weeks (EX = 20-min mod-intensity cycling; CO = 20-min reading). Cognitive control was assessed using a Flanker task (accuracy-adjusted response time, RTLISAS ) pre-/post-intervention. Mood was reported 5×/day on exercise and non-exercise days (pre, post, 11:30 am, 3 pm, and 8 pm) using the Bond-Lader VAS. Cognitive control and mood improved acutely (within session) following exercise compared with control (F(1, 592) = 6.11, p = .0137; F(1, 305.93) = 38.68, p < .0001; F(1, 307.06) = 13.69, p = .0003) and were consistent across sessions. Cognitive control also improved across sessions in both groups (F(5, 282.22) = 11.06, p < .0001). These results suggest that: (1) acute effects of exercise on cognition and mood are consistent across multiple sessions; (2) the Flanker task learning effects continue over many trials/sessions; and (3) accumulated mood effects require further investigation. Future studies should further explore the connection between acute exercise exposures and accumulated cognitive benefits.

Perceptions of Social Media Use to Augment Health Care Among Adolescents and Young Adults With Cystic Fibrosis: Survey Study.

BACKGROUND: For individuals with cystic fibrosis (CF), adolescence and young adulthood are times of significant vulnerability and have been associated with clinical and psychosocial challenges. Social media may offer innovative care delivery solutions to address these challenges. OBJECTIVE: This study explored motivations and attitudes regarding current social media use and preferences for a social media platform in a sample of adolescents and young adults (AYA) with CF. METHODS: A cross-sectional survey was administered to 50 AYA with CF followed at a large pediatric-adult CF center. The survey included questions regarding social media platform utilization, attitudes toward general and CF-specific online activities, and preferences for a CF-specific care delivery platform. RESULTS: YouTube, Snapchat, and Instagram were the most commonly used social media platforms. AYA with CF do not report routinely using social media for health-related information acquisition, social support, or help with adherence. However, their perceptions of social media utilization and preferences for platform development suggest interest in doing so in the future. CONCLUSIONS: AYA with CF use social media and expressed interest in the development of a social media platform. Platform development will allow for gaps in health care delivery to be addressed by improving social support and adherence while augmenting current methods of health information acquisition.

Dementia- and mild cognitive impairment-inclusive exercise: Perceptions, experiences, and needs of community exercise providers.

PURPOSE: For persons who are at risk for, or living with, dementia exercise is recommended, yet many become or remain inactive. Exercise providers play a vital role in promoting and facilitating exercise in these groups by recognizing and being responsive to the needs of persons with mild cognitive impairment (MCI) or dementia in exercise programming. The objective of this study was to explore the experiences, perceptions, and needs of community exercise providers regarding dementia. MATERIALS & METHODS: Five focus groups were held with community exercise providers (n = 30) who deliver exercise to older adults (≥55 years) in municipal, non-profit, for profit, or academic settings. RESULTS: Three themes were developed: (1) Unique experiences and diverse perceptions: suggests unique personal experiences with MCI and dementia inform distinct perceptions of dementia; (2) Dementia-Inclusive Practices: learning as you go and adapting for the individual: reflects exercise providers' approaches to recognizing and accommodating individuals' unique abilities and preferences; (3) Training and Best Practices, with Flexibility: identifies exercise providers' desires for MCI- and dementia-specific knowledge and training strategies, which need to recognize dementia heterogeneity between and within persons over time. CONCLUSIONS: These findings highlight a willingness of exercise providers to support dementia-inclusive exercise, but recognize they have minimal training and lack educational resources to do so. Formal training resources may enhance exercise accessibility and participation for persons with MCI or dementia.

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.

Effects of an Exercise and Mental Activity Program for People With Dementia and Their Care Partners.

Exercise and mental stimulation may improve cognition, physical function, and well-being of people with dementia (PWD) and older adults more generally. This study evaluated changes in physical function, physical activity, exercise self-efficacy, and mental well-being with participation in Minds in Motion®, a weekly exercise and mental stimulation program for PWD (n = 343) and care partners (n = 318). Most physical function measures improved among PWD and care partners (endurance, upper and lower body strength, upper body flexibility; ps ≤ .009). Participants also reported a significant increase in weekly frequency, duration, and intensity of physical activity (ps < .001) and in mental well-being (p < .001). Exercise self-efficacy did not change (p = .16). These results suggest that Minds in Motion® yields improvements in physical function, which may translate into better functional abilities for PWD and improved ability for their partners to care for people living with dementia.

Centre- versus home-based exercise among people with mci and mild dementia: study protocol for a randomized parallel-group trial.

BACKGROUND: Worldwide, almost 50million people lived with dementia in 2016. A cure or disease modifying pharmaceutical treatment for dementia remains elusive so alternative therapies are of critical importance. Mounting evidence supports exercise in the prevention and therapy of dementia. However, the cognitive, physical, and psychological challenges common to dementia along with a poor understanding and accommodation of dementia in the community are major barriers to exercise. Consequently, effective delivery options need to be identified. The primary objective of this study is to compare the effectiveness of center-based (CB) exercise versus home-based (HB) exercise for achievement of physical activity guidelines among people with MCI or mild dementia. METHODS: This is a randomized parallel-group trial comparing the effects of CB and HB exercise adherence among community-dwelling adults ≥50 years with a clinical diagnosis of MCI or mild dementia. Participants will be randomized to either CB or HB exercise. The CB group will meet weekly for small group exercise and will be prescribed additional exercise to be completed independently. Participants in the HB group will be given a physical activity prescription to be completed independently in the community. Participants in HB will also be contacted by phone monthly to adjust exercise prescriptions. The primary outcome will be achievement of exercise guidelines (150 min/wk. of moderate activity) assessed using an activity monitor. Secondary objectives will evaluate cost-effectiveness and the influence of individual and environmental factors on the primary outcome. Tertiary outcomes include physical function, cognition, mood, and quality of life. DISCUSSION: There is scant research to indicate the most effective way to deliver exercise to people with MCI and mild dementia, which is needed specifically because these groups face significant barriers to exercise. To capitalize on the benefits of exercise, feasible exercise delivery options need to be identified. The results of this study will directly complement ongoing clinical trials and will be essential to implementing exercise recommendations specific to the prevention and therapy of dementia in a feasible and cost-effective manner when they emerge. TRIAL REGISTRATION: Clinicatrials.gov ; Identifier: NCT02774720 (version updated December 12, 2016).

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.

Changes in Physical Activity and Function with Transition to Retirement Living: A Pilot Study.

This pilot study examined changes in physical activity and function among older adults moving from community dwellings to retirement living. Twelve community-dwelling older adults, recruited from the wait-lists of two retirement living facilities, were assessed prior to and following the transition to retirement living. Physical activity was assessed using an Actigraph (GT3X+) activity monitor; physical activity by type was reported with the CHAMPS activity questionnaire. Physical function was assessed using the Senior Fitness Test. Objectively monitored total physical activity decreased after the transition to retirement living (p = 0.02). Reports of physical activity by type indicated that only activities of daily living decreased (p < 0.01) although intentional exercise increased (p < 0.03) with the transition. Endurance and strength also improved (p < 0.05 and p < 0.04). Pilot results indicate that possible physical benefits accrue from retirement living, although efforts to reduce sedentary time are needed.