Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study.

BACKGROUND: Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT). METHODS: Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system. RESULTS: Both the SPPB total score improved significantly (p = < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p = < 0.001), walk ratio (p = 0.011), step length (p = < 0.001), stride length (p = < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible. CONCLUSIONS: SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care. TRIAL REGISTRATION: DRKS00026191.

A comparison between effects of Square-Stepping Exercise and Tai Chi Chuan on functional fitness and fear of falling in older women.

BACKGROUND: It is challenging to find exercise programs that are safe, effective, attractive, and feasible to reduce the risk of falls and fall-related injuries in older adults. AIMS: We compared the effects of SSE (Square-Stepping Exercise) versus TCC (Tai Chi Chuan) on functional fitness and fear of falling in older women aged 60 years and above. METHODS: It was a single blind randomized control trial. We purposefully selected 36 older women (aged 65.2 ± 3.82 years). They were then paired based on the criterion of functional reach test and randomly assigned to two groups (18 people) of TTC and SSE. The exercise program included 8 weeks of three 1-h-session training. We measured functional fitness and fear of falling. Functional fitness was assessed using the following tests: Single Leg-Stance-Eyes Open/Closed, Timed Up and Go, Functional Reach Test, Chair Stand, Arm Curl, and Back Scratch. Fear of falling was assessed using the Falls Efficacy Scale-International. RESULTS: We analyzed the data using repeated measure ANOVA. Within-group comparisons revealed significant improvements for both groups in all nine measures of functional tests as well as fear of falling [Formula: see text]. Interaction comparisons revealed that improvements in measures of functional fitness were greater in the TTC group [Formula: see text]. Nevertheless, the groups were not significantly different in fear of falling [Formula: see text]. CONCLUSION: Our findings showed that both TCC and SSE interventions improved functional fitness and fear of falling. The TCC is more effective than SSE, though the latter is easier to learn and perform.

Group-based exercise and cognitive-physical training in older adults with self-reported cognitive complaints: The Multiple-Modality, Mind-Motor (M4) study protocol.

BACKGROUND: Dementia is associated with cognitive and functional deficits, and poses a significant personal, societal, and economic burden. Directing interventions towards older adults with self-reported cognitive complaints may provide the greatest impact on dementia incidence and prevalence. Risk factors for cognitive and functional deficits are multifactorial in nature; many are cardiovascular disease risk factors and are lifestyle-mediated. Evidence suggests that multiple-modality exercise programs can provide cognitive and functional benefits that extend beyond what can be achieved from cognitive, aerobic, or resistance training alone, and preliminary evidence suggests that novel mind-motor interventions (i.e., Square Stepping Exercise; SSE) can benefit cognition and functional fitness. Nevertheless, it remains unclear whether multiple-modality exercise combined with mind-motor interventions can benefit diverse cognitive and functional outcomes in older adults with cognitive complaints. METHODS/DESIGN: The Multiple-Modality, Mind-Motor (M4) study is a randomized controlled trial investigating the cognitive and functional impact of combined physical and cognitive training among community-dwelling adults with self-reported cognitive complaints who are 55 years of age or older. Participants are randomized to a Multiple-Modality and Mind-Motor (M4) intervention group or a Multiple-Modality (M2) comparison group. Participants exercise for 60 minutes/day, 3-days/week for 24 weeks and are assessed at baseline, 24 weeks and 52 weeks. The primary outcome is global cognitive function at 24 weeks, derived from the Cambridge Brain Sciences computerized cognitive battery. Secondary outcomes are: i) global cognitive function at 52 weeks; ii) domain-specific cognitive function at 24 and 52 weeks; iii) mobility (gait characteristics under single and dual-task conditions and balance); and 3) vascular health (blood pressure and carotid arterial measurements). We will analyze data based on an intent-to-treat approach, using mixed models for repeated measurements. DISCUSSION: The design features of the M4 trial and the methods included to address previous limitations within cognitive and exercise research will be discussed. Results from the M4 trial will provide evidence of combined multiple-modality and cognitive training among older adults with self-reported cognitive complaints on cognitive, mobility-related and vascular outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02136368.

Effects of square-stepping exercise on cognitive functions of older people.

AIM: Cognitive functions can decline with age, and interventions focusing on stimulating them may have positive results. Previous studies have shown that square-stepping exercise (SSE) has a good influence on balance, but this exercise also seems to promote cognitive stimulation. Therefore, the purpose of the present study was to analyse the effect of 16 weeks of SSE on cognitive functions in non-demented community-dwelling older people. METHODS: This was a longitudinal, non-randomized study. Forty-one older adults (60 years and older) were recruited, and 21 participated in the SSE group (practised only SSE sequences) and 20 were in the control group (continued with their activities of daily living). Both groups were evaluated using the Mini-Mental State Examination, the Digit Span test, the Toulouse-Pierón Attention Test and the Modified Card Sorting Test. RESULTS: The SSE group showed a significant improvement in global cognitive status, concentrated attention and mental flexibility after 16 weeks of the SSE intervention. CONCLUSION: Evidence shows that SSE is a physical activity that positively influences cognitive functions in non-demented older people.

Risk Factors of Sports-Related Injury in School-Aged Children and Adolescents: A Retrospective Questionnaire Survey.

Studies conducting quantitative surveys in school-aged children and adolescents help identify sports-related risk factors for acute and overuse injuries are scarce. This study aimed to quantify the risk factors for sports-related injury in school-aged children and adolescents by school categories. University students (n = 484) retrospectively recalled their sports experiences and related injuries in a questionnaire according to the following school categories: lower elementary school (LE), upper elementary school (UE), junior high school (JH), and high school (H). Both sports-related acute and overuse injuries were recorded. After adjusting various covariates, weekly hours in sports were identified as a significant risk factor in LE and UE. The interaction of weekly hours in sports and sports specialization was significant in LE and UE, suggesting that early specialization would be a risk factor in lower school categories. In JH and H, female sex, high-level competition, and injury experienced in a previous school category were significantly related to sports-related injuries. In conclusion, weekly hours in sports, high-level competitions, previous injury experience, and sex were confirmed as risk factors in specific school categories. Most identified risk factors are modifiable, suggesting that sports-related injuries can be prevented in school-aged children and adolescents.

[Reasons for older adults independently continuing exercise after a supervised Square-Stepping Exercise intervention].

OBJECTIVE: Square-Stepping Exercise (SSE), composed of movements similar to walking, involves varied movements in multiple directions and is performed on a thin mat (100 x 250 cm) that is partitioned into 40 squares (25 cm each). We introduced SSE to a group of older adults for three months as a supervised intervention. After this intervention period, the participants continued SSE without supervision for four years. The current study was conducted to determine why the participants independently continued SSE. METHODS: Among 52 older adults who attended the SSE intervention, 40 continued SSE (continued group) and 12 discontinued (discontinued group). Seven in the continued group were excluded from analyses because of low attendance rates. Each of the remainder (n = 33) was independently interviewed and asked why he/she had continued SSE. The average interview time for the continued group was 12 minutes. Twelve in the discontinued group were investigated for exercise habits by postal questionnaire. RESULTS: The participants in the continued group noted two to six reasons for continuation of SSE. After analyzing data inductively, the answers were categorized as follows: (1) friends and social communication; (2) equitable management of group activity; (3) expectation of health from exercise; (4) simple-easy exercise; and (5) family support for exercise. The participants in the discontinued group reported that 89% of them continually did walking, muscular strength exercise, and calisthenics. CONCLUSION: We found that reasons why adoption of SSE as an intervention program for older adults enhance their exercise adherence in the long term.

Sports Specialization and Sports-Related Injuries in Japanese School-Aged Children and Adolescents: A Retrospective Descriptive Study.

Although early sports specialization is associated with sports-related injuries, relevant quantitative studies on young non-elite athletes, the majority of sports participants, are scarce. We described sports specialization time points and the characteristics of sports-related injuries. Undergraduate students at a university in Japan (n = 830) recalled their history of sports participation from elementary to high school and sports-related injuries in a self-administered questionnaire. Of 570 valid respondents, 486 (85%) engaged in sports at least once. Significantly more respondents played multiple sports in upper elementary school (30%) than in other school categories (1-23%). In junior high and high schools, 90% and 99% played only one sport, respectively. Of the 486 respondents who played sports, 263 (54%) had experienced acute or overuse injuries. The proportion of injured participants significantly differed by school category: lower elementary school (4%), upper elementary school (21%), junior high (35%), and high school (41%). The proportions of acute or overuse injuries in males were higher than those in females. In conclusion, this study clarified a slight variation in sports items, particularly in junior high and high schools, which demonstrates 13 years as the age of beginning specialization in a single sport. More than half of the non-elite athletes experienced sports-related injuries. Injuries were frequently observed in males and those in junior high and high schools.

Double-task exercise programmes to strengthen cognitive and vascular health in older adults at risk of cognitive decline: protocol for a randomised clinical trial.

INTRODUCTION: Cognitive and physical declines are frequent causes of disability among older adults (OAs) in Mexico that imposes significant burden on the health system and OAs' families. Programmes to prevent or delay OAs' cognitive and physical decline are scarce. METHODS AND ANALYSIS: A double-blind randomised clinical trial will be conducted. The study will aim to evaluate two 24-week double-task (aerobic and cognitive) square-stepping exercise programmes for OAs at risk of cognitive decline-one programme with and another without caregiver participation-and to compare these with an aerobic-balance-stretching exercise programme (control group). 300 OAs (100 per group) affiliated with the Mexican Institute of Social Security (IMSS) between 60 and 65 years of age with self-reported cognitive concerns will participate. They will be stratified by education level and randomly allocated to the groups. The intervention will last 24 weeks, and the effect of each programme will be evaluated 12, 24 and 52 weeks after the intervention. Participants' demographic and clinical characteristics will be collected at baseline. The outcomes will include: (1) general cognitive function; (2) specific cognitive functions; (3) dual-task gait; (4) blood pressure; (5) carotid intima-media thickness; (6) OAs' health-related quality of life; and (7) caregiver burden. The effects of the interventions on each outcome variable will be examined using a repeated-measures analysis of variance (ANOVA), with study groups as the between-subjects variable and time as the within-subject variable. ETHICS AND DISSEMINATION: The study was approved by the IMSS Ethics and Research Committees (registration number: 2018-785-095). All participants will sign a consent form prior to their participation. The study results will be disseminated to the IMSS authorities, healthcare providers and the research community. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT04068376).

Innovative Exercise as an Intervention for Older Adults with Knee Osteoarthritis: A Pilot Feasibility Study.

ABSTRACTExercise has potential to mitigate morbidity in knee osteoarthritis (OA). Participants with knee OA were randomized to a Square-stepping Exercise (SSE) group (2x/week for 24 weeks) or a control group. We assessed the feasibility of SSE and its effectiveness on symptoms (WOMAC), balance (Fullerton), mobility, and walking speed at 12 and 24 weeks. The SSE group had a 49.3% attendance rate and trended toward improvement in the 30-second chair stand at 12 (F = 1.8, p = .12, ηp2 = 0.16), and 24 weeks, (F = 3.4, p = .09, ηp2 = 0.18), and walking speed at 24 weeks, compared to controls. There were no differences in symptoms or balance. The low attendance and recruitment demonstrated limited feasibility of SSE in adults with knee OA. Trends suggest the potential for SSE to improve lower extremity functional fitness and walking speed. SSE should be further studied for effectiveness on symptoms and balance, in addition to improving feasibility.

Square-stepping exercise and fall risk factors in older adults: a single-blind, randomized controlled trial.

BACKGROUND: Decreased fitness of the lower extremities is a potentially modifiable fall risk factor. This study aimed to compare two exercise programs--square-stepping exercise (SSE), which is a low-cost indoor program, and walking--for improving the fitness of the lower extremities. METHODS: We randomly allocated 68 community-dwelling older adults (age 65-74 years) to either the SSE or walking group (W group). During the 12-week regimen, the SSE group participated in 70-minute exercise sessions conducted twice a week at a local health center, and the W group participated in outdoor supervised walking sessions conducted weekly. The W group was instructed to increase the number of daily steps. Prior to and after the program, we obtained information on 11 physical performance tests for known fall risk factors and 3 self-reported scales. The fall incidence was followed-up for 8 months. RESULTS: At 12 weeks postregimen, significant differences were observed between the two exercise groups with respect to leg power (1 item), balance (2 items), agility (2 items), reaction time (2 items), and a self-reported scale (1 item); the SSE group demonstrated a marked improvement in the above-mentioned items with Group x Time interactions. Significant time effects were observed in the tests involving chair stands, functional reach, and standing up from a lying-down position without Group x Time interactions. During the follow-up period, the fall rates per person-year in the SSE and W groups were 23.4% and 33.3%, respectively (p =.31). CONCLUSION: Although further studies are required, SSE is apparently more effective than walking in reducing fall risk factors, and it appears that it may be recommended as a health promotion exercise in older adults.

Effects of aerobic training and recreational activities in patients with chronic obstructive pulmonary disease.

The purpose of this study was to evaluate whether strength or recreational activities are a useful addition to aerobic training in patients with chronic obstructive pulmonary disease (COPD). Thirty-three patients with moderate to severe COPD were randomly assigned to 12 weeks of aerobic combined with strength training (AERO+ST) or combined with recreational activities (AERO+RA). The AERO regimen consisted of three weekly 20-min walking exercise sessions; the ST regimen included three series of 10 repetitions of four exercises; and the RA regimen consisted of training using exercise balls to perform smoothly for instrumental activity of daily living. Baseline and after-training measurements of peripheral muscular strength and endurance, cardio respiratory fitness, and 6-min walking distance were obtained, whereas quality of life was assessed with the Short Form 36 questionnaire. Change in grip strength showed a significant difference between the AERO+ST group (8.3+/-6.7%) and the control group (-1.3+/-10.5%), and AERO+RA group (-4.7+/-5.6%) (P<0.05). A significant increase was found in percentage change in peak (.)V(O2) between the AERO+ST group (5.1+/-11.8%) and the control group (-9.2+/-8.6%) (P<0.05). In the health-related quality of life scores, there was a significant difference in mean percentage change in physical functioning between the AERO+ST group (7.9+/-24.4%) and the control group (-14.8+/-19.1%) (P<0.05). A significant difference was found in mean percentage change in social functioning between the AERO+RA group (9.4+/-20.0%) and the control group (-14.9+/-23.2%) (P<0.05). A significant difference in mean percentage change in mental health was also found between the AERO+RA group (12.2+/-12.4%) and the control group (-5.0+/-7.8%) (P<0.05). It is preferable to introduce various forms of exercise that use different muscles involving the whole body, such as recreational activities, as they are an appropriate approach to stimulating physical activity and to improving functional fitness gradually while improving health-related quality of life, though it is necessary to practice exercises for maintenance and improvement in patients with COPD.

Performance improvement via bagging in probabilistic prediction of chaotic time series using similarity of attractors and LOOCV predictable horizon.

Recently, we have presented a method of probabilistic prediction of chaotic time series. The method employs learning machines involving strong learners capable of making predictions with desirably long predictable horizons, where, however, usual ensemble mean for making representative prediction is not effective when there are predictions with shorter predictable horizons. Thus, the method selects a representative prediction from the predictions generated by a number of learning machines involving strong learners as follows: first, it obtains plausible predictions holding large similarity of attractors with the training time series and then selects the representative prediction with the largest predictable horizon estimated via LOOCV (leave-one-out cross-validation). The method is also capable of providing average and/or safe estimation of predictable horizon of the representative prediction. We have used CAN2s (competitive associative nets) for learning piecewise linear approximation of nonlinear function as strong learners in our previous study, and this paper employs bagging (bootstrap aggregating) to improve the performance, which enables us to analyze the validity and the effectiveness of the method.

Home-based, square-stepping exercise program among older adults with multiple sclerosis: results of a feasibility randomized controlled study.

There is very little known about exercise rehabilitation approaches for older adults with multiple sclerosis (MS), yet this growing segment of the MS population experiences declines in cognition and mobility associated with disease progression and aging. We conducted a RCT examining the feasibility of a 12-week, home-based Square-Stepping Exercise (SSE) program in older adults with MS. Older adults with MS (N = 26) with mild-to-moderate levels of disability were recruited and randomized into the intervention (i.e., SSE) or a minimal activity, attention-control conditions. Participants in the SSE condition received a mat for home-based practice of the step patterns, an instruction manual, and a logbook along with a pedometer for monitoring compliance. Both conditions received weekly Skype™ calls and had biweekly meetings with an exercise trainer. Feasibility was assessed based on process, resource, management and scientific outcomes. Regarding scientific outcomes, participants in both conditions completed in-lab assessments before and after the 12-week period. Twenty-five participants completed the study (96%) and the total cost of the study was $13,387.00 USD. Pedometer data demonstrated good compliance with the SSE intervention condition. Effect sizes calculated for all treatment outcomes ranged from small-to-moderate for both mobility and cognitive variables between the intervention and attention-control conditions, thereby providing preliminary evidence that participation in the SSE program may improve cognition and mobility function. The results support the feasibility, acceptability, and possible efficacy of a home-based SSE intervention for older adults with MS.

Results From a Feasibility Study of Square-Stepping Exercise in Older Adults With Type 2 Diabetes and Self-Reported Cognitive Complaints to Improve Global Cognitive Functioning.

OBJECTIVES: Adults with type 2 diabetes mellitus have an increased risk for dementia. Therefore, we proposed an intervention called the Square-stepping exercise (SSE) program to mitigate this risk. Our primary aim was to determine the feasibility of SSE in adults with type 2 diabetes and self-reported cognitive complaints. Our secondary aim was to determine whether 24 weeks of SSE improved cognition. Our tertiary aim was to determine whether SSE improved antisaccade reaction time, which is a measure of executive-related oculomotor control. METHODS: Adults >49 years with type 2 diabetes and self-reported cognitive complaints were randomized to an SSE group (2×/week for 24 weeks of SSE) or a control group. Feasibility was assessed by recruitment and attendance. Participants were assessed at baseline, after 12 weeks and after 24 weeks for global cognitive function, memory, planning, reasoning and concentration via a computer-based cognitive battery (Cambridge Brain Sciences) and antisaccade reaction time (at baseline and 24 weeks). RESULTS: Participants in the SSE group were (mean [SD]): 65.9 (5.2) years old; 33% female; body mass index 33.3 kg/m2 (4.8) (n=12). Participants in the control group were 71.2 (6.9) years old; 31% female; body mass index 31.9 kg/m2 (4.6) (n=13). Over 24 weeks, attendance was 70.2% (SD 17.2) for 4/12 participants. There were 4 withdrawals and 1 adverse event. There were no differences in global cognitive functioning. The SSE group improved in planning domain change scores between 12 and 24 weeks (F=5.8, p=0.03, ηp2=0.28) compared to controls. In the SSE group, we found a nonsignificant improvement in antisaccade reaction time of 38 ms (SD 16), n=2, compared to 9 ms (SD 45) in the control group, n=8. CONCLUSIONS: SSE should be evaluated further to improve its feasibility in older adults with type 2 diabetes. This study provides preliminary evidence that SSE improves executive function in adults with type 2 diabetes and self-reported cognitive complaints.

Cognitive changes following multiple-modality exercise and mind-motor training in older adults with subjective cognitive complaints: The M4 study.

BACKGROUND: We investigated the effects of multiple-modality exercise with additional mind-motor training on cognition in community-dwelling older adults with subjective cognitive complaints. METHODS: Participants (n = 127, mean age 67.5 [7.3] years, 71% women) were randomized to receive 45 minutes of multiple-modality exercise with additional 15 minutes of either mind-motor training (M4, n = 63) or control (balance, range of motion and breathing exercises [M2, n = 64]). In total, both groups exercised 60 minutes/day, 3 days/week, for 24 weeks. Standardized global cognitive functioning (GCF), concentration, reasoning, planning, and memory were assessed at 24 weeks and after a 28-week no-contact follow-up. RESULTS: There were no significant differences in the study primary outcomes. The M4 group, however, showed trends for greater improvements in GCF and memory (both, P = .07) compared to the M2 group at 24 weeks. Significant differences between group in GCF (P = .03) and memory (P = .02) were observed after the 28-week no-contact follow-up favouring the M4 group. DISCUSSION: Additional mind-motor training did not impart immediate greater benefits to cognition among the study participants.

Effects of exercise frequency on functional fitness in older adult women.

This study evaluated the effects of exercise frequency on functional fitness in older women participating in a 12-week exercise program. Participants (67.8+/-4.6 years) were divided into three different exercise groups (I, II, and III; n=34) and a control group (Group C; n=11). Group I participated in a 90-min exercise program once a week, for 12 weeks, while Group II attended it twice a week, and Group III attended three times a week. The exercise program consisted of a 10-min warm-up, 20 min of walking, 30 min of recreational activities, 20 min of resistance training, and a 10-min cool-down. The following items were measured before and after the program: muscular strength, muscular endurance, dynamic balance, coordination, and cardiorespiratory fitness (6-min walking distance). Comparisons of baseline and post-intervention measures showed significantly greater improvements in body weight, coordination, and cardiorespiratory fitness for Group III compared to the other groups (p<0.05). In addition, the greatest improvements in body fat, muscular endurance, and dynamic balance were also observed in Group III (p<0.05). However, no significant differences were found in muscular strength. Older women who participate in an exercise program three times a week gain greater functional fitness benefits than those who exercise less frequently. In order to improve functional fitness in older women, an exercise frequency of at least three times each week should be recommended.

Feasibility study design and methods for a home-based, square-stepping exercise program among older adults with multiple sclerosis: The SSE-MS project.

We propose a randomized controlled trial (RCT) examining the feasibility of square-stepping exercise (SSE) delivered as a home-based program for older adults with multiple sclerosis (MS). We will assess feasibility in the four domains of process, resources, management and scientific outcomes. The trial will recruit older adults (aged 60 years and older) with mild-to-moderate MS-related disability who will be randomized into intervention or attention control conditions. Participants will complete assessments before and after completion of the conditions delivered over a 12-week period. Participants in the intervention group will have biweekly meetings with an exercise trainer in the Exercise Neuroscience Research Laboratory and receive verbal and visual instruction on step patterns for the SSE program. Participants will receive a mat for home-based practice of the step patterns, an instruction manual, and a logbook and pedometer for monitoring compliance. Compliance will be further monitored through weekly scheduled Skype calls. This feasibility study will inform future phase II and III RCTs that determine the actual efficacy and effectiveness of a home-based exercise program for older adults with MS.

HealtheBrain: an innovative smartphone application to improve cognitive function in older adults.

BACKGROUND: Exercise-based interventions have shown promise in slowing cognitive decline, however there is limited evidence for scalability. Our previous research has linked a novel visuospatial memory exercise intervention, incorporating patterned walking or square-stepping exercise (SSE) with significant improvements in executive function and memory among older adults with normal cognition as well as those with subjective cognitive complaints (SCC) and mild cognitive impairment (MCI). The aim of the current study was to determine the feasibility and utility of the HealtheBrain smartphone app to deliver SSE outside the laboratory among older adults with and without cognitive impairment. METHODS: Previous healthy research subjects with and without SCC or MCI, who had previous exposure to SSE, and who owned or had access to an iPhone of iPad, were recruited to download the HealtheBrain app and use it up to 3 weeks. There were no restrictions on the number of times subjects could use the app. A 15-question survey was developed to assess feasibility and utility of the HealtheBrain app and completed online following the brief exposure period. RESULTS: Of 135 people who were identified, 95 were contacted between September 2014 to August 2015, 27 downloaded the HealtheBrain app on their iPhone or iPad from the App Store and 19 completed the questionnaire. Subjects (n=19) were an average age of 68.3±5.4; 74% female and had 15.5±2.8 years of education (84% post-secondary education), a mean Mini Mental State examination score of 29.1 (SD 1.2) out of 30 and Montreal Cognitive Assessment score of 26.3 (SD 1.9) out of 30. Subjects used the HealtheBrain app 1-7 days per week, mostly at home. Of possible stages of progression, subjects mainly used the stage 1 and 2 beginner patterns. Subjects reported perceived and technical challenges registering horizontal step patterns associated with stage 2 and greater progression. Sixty percent found the app was easy to use or similar to what they experienced with SSE in the laboratory setting. Most said they would continue to use the HealtheBrain app and would recommend it to friends and family. CONCLUSIONS: The HealtheBrain app was feasible in providing SSE to older adults with the appropriate smartphone device outside the laboratory setting. Challenges were identified with perceived capture of higher levels of SSE stages that used horizontal step patterns. This as well as technical issues with horizontal step patterns will be addressed by newer GPS technology in current smartphone devices. Most subjects stated they would continue to use the HealtheBrain app and refer to their friends and family. We believe that our findings in a representative cohort support the HealtheBrain app as a scalable intervention to promote cognitive health in older adults.

Group-based exercise combined with dual-task training improves gait but not vascular health in active older adults without dementia.

BACKGROUND: Gait abnormalities and vascular disease risk factors are associated with cognitive impairment in aging. OBJECTIVE: To determine the impact of group-based exercise and dual-task training on gait and vascular health, in active community-dwelling older adults without dementia. METHODS: Participants [n=44, mean (SD) age: 73.5 (7.2) years, 68% female] were randomized to either intervention (exercise+dual-task; EDT) or control (exercise only; EO). Each week, for 26 weeks, both groups accumulated 50 or 75 min of aerobic exercise from group-based classes and 45 min of beginner-level square stepping exercise (SSE). Participants accumulating only 50 min of aerobic exercise were instructed to participate in an additional 25 min each week outside of class. The EDT group also answered cognitively challenging questions while performing SSE (i.e., dual-task training). The effect of the interventions on gait and vascular health was compared between groups using linear mixed effects models. RESULTS: At 26 weeks, the EDT group demonstrated increased dual-task (DT) gait velocity [difference between groups in mean change from baseline (95% CI): 0.29 m/s (0.16-0.43), p<0.001], DT step length [5.72 cm (2.19-9.24), p =0.002], and carotid intima-media thickness [0.10mm (0.003-0.20), p=0.04], as well as reduced DT stride time variability [8.31 coefficient of variation percentage points (-12.92 to -3.70), p<0.001], when compared to the EO group. CONCLUSIONS: Group-based exercise combined with dual-task training can improve DT gait characteristics in active older adults without dementia.

The Healthy Mind, Healthy Mobility Trial: A Novel Exercise Program for Older Adults.

BACKGROUND: More evidence is needed to conclude that a specific program of exercise and/or cognitive training warrants prescription for the prevention of cognitive decline. We examined the effect of a group-based standard exercise program for older adults, with and without dual-task training, on cognitive function in older adults without dementia. METHODS: We conducted a proof-of-concept, single-blinded, 26-wk randomized controlled trial whereby participants recruited from preexisting exercise classes at the Canadian Centre for Activity and Aging in London, Ontario, were randomized to the intervention group (exercise + dual-task [EDT]) or the control group (exercise only [EO]). Each week (2 or 3 d · wk(-1)), both groups accumulated a minimum of 50 min of aerobic exercise (target 75 min) from standard group classes and completed 45 min of beginner-level square-stepping exercise. The EDT group was also required to answer cognitively challenging questions while doing beginner-level square-stepping exercise (i.e., dual-task training). The effect of interventions on standardized global cognitive function (GCF) scores at 26 wk was compared between the groups using the linear mixed effects model approach. RESULTS: Participants (n = 44; 68% female; mean [SD] age: 73.5 [7.2] yr) had on average, objective evidence of cognitive impairment (Montreal Cognitive Assessment scores, mean [SD]: 24.9 [1.9]) but not dementia (Mini-Mental State Examination scores, mean [SD]: 28.8 [1.2]). After 26 wk, the EDT group showed greater improvement in GCF scores compared with the EO group (difference between groups in mean change [95% CI]: 0.20 SD [0.01-0.39], P = 0.04). CONCLUSIONS: A 26-wk group-based exercise program combined with dual-task training improved GCF in community-dwelling older adults without dementia.