Physical activity service provision in hospice care: A national mixed-methods study.

BACKGROUND: Physical activity (PA) interventions help people with advanced incurable diseases to manage symptoms and improve their quality of life. However, little is known about the extent to which PA is currently delivered in hospice care in England. OBJECTIVES: To determine the extent of and intervention features of PA service provision in hospice care in England alongside barriers and facilitators to their delivery. METHODS: An embedded mixed-methods design using (1) a nationwide online survey of 70 adult hospices in England and (2) focus groups and individual interviews with health professionals from 18 hospices. Analysis of the data involved applying descriptive statistics to the numeric items and thematic analysis to the open-ended questions. Quantitative and qualitative data were collected and analyzed separately. RESULTS: The majority of responding hospices (n = 47/70, 67%) promoted PA in routine care. Sessions were most often delivered by a physiotherapist (n = 40/47, 85%) using a personalized approach (n = 41/47, 87%) and included resistance/thera bands, Tai Chi/Chi Qong, circuit exercises, and yoga. The following qualitative findings were revealed: (1) variation among hospices in their capacity to deliver PA, (2) a desire to embed a hospice culture of PA, and (3) a need for an organizational commitment to PA service provision. SIGNIFICANCE OF RESULTS: While many hospices in England deliver PA, there is considerable variation in its delivery across sites. Funding and policy action may be needed to support hospices to initiate or scale up services and address inequity in access to high-quality interventions.

Effect of housework on physical activity during transitions to parenthood.

The transition to parenthood is associated with declines in moderate to vigorous physical activity (MVPA) and increases in light PA (LPA). One potential mechanism for this change in PA that occur at the onset of parenthood is housework. We examined housework load and PA levels of three cohorts of couples across 12 months recruited from Victoria, British Columbia, Canada between January 2007 and December 2011. Participants (N = 314; 102 not expecting a child, 136 expecting first-child, 76 expecting second child) completed baseline demographics and 7-day accelerometry, followed by assessments at 6 and 12 months. Hierarchical linear regression assessed the association between PA, housework, and perceptions of partner's workload. New fathers' but not new mothers' housework was positively related to their LPA at 12 months. Perceptions of partners' workload were positively related to new mothers LPA, and negatively related to new fathers MVPA at 12 months. Mediation analysis determined if perceived behavioral control accounts for the relationship between the discrepancy in housework between partners' PA. Results suggest that if a woman perceives their partner to do more housework their own PA increases, whereas for men their PA decreases. These findings highlight the importance of the division of housework on PA for both mothers and fathers.

Development, reliability and validity of the Safe Use of Mobility Aids Checklist (SUMAC) for 4-wheeled walker use in people living with dementia.

BACKGROUND: Balance and gait problems are common and progressive in dementia. Use of a mobility aid provides physical support and confidence. Yet, mobility aid use in people with dementia increases falls three-fold. An assessment tool of mobility aid safety in people with dementia does not currently exist. The objectives of this study were: 1) to develop a tool for the evaluation of physical function and safe use of a 4-wheeled walker in people with dementia, and 2) to evaluate its construct and criterion validity, inter-rater and test-retest reliability and minimal detectable change. METHODS: Healthcare professionals (HCP) experienced in rehabilitation of people with dementia participated in focus groups for item generation of the new tool, The Safe Use of Mobility Aid Checklist (SUMAC). The SUMAC evaluates physical function (PF) and safe use of the equipment (EQ) on nine tasks of daily life. Reliability was evaluated by HCP (n = 5) scored participant videos of people with dementia (n = 10) using a 4-wheeled walker performing the SUMAC. Inter-rater and test-retest reliability was assessed using intra-class correlation coefficients (ICC). Construct validity evaluated scores of the HCPs to a consensus HCP panel using Spearman's rank-order correlations. Criterion validity evaluated SUMAC-PF to the Performance-Oriented Mobility Assessment (POMA) gait subscale using Spearman's rank-order correlations. RESULTS: Three focus groups (n = 17) generated a tool comprised of nine tasks and the components within each task for physical function and safe use. Inter-rater reliability was statistically significant for SUMAC-PF (ICC = 0.92, 95%CI (0.81, 0.98), p < 0.001) and SUMAC-EQ. (ICC = 0.82, 95%CI (0.54, 0.95), p < 0.001). Test-retest reliability was statistically significant for SUMAC-PF (ICC = 0.89, 95%CI (0.81, 0.94), p < 0.001) and SUMAC-EQ. (ICC = 0.88, 95%CI (0.79, 0.93), p < 0.001). As hypothesized, the POMA gait subscale correlated strongly with the SUMAC-PF (rs = 0.84), but not EQ (rs = 0.39). CONCLUSIONS: The focus groups and research team developed a tool of nine tasks with evaluation on physical function and safe use of a 4-wheeled walker for people with dementia. The SUMAC tool has demonstrated content validity for the whole scale and good construct and criterion validity for the SUMAC-PF and SUMAC-EQ. The subscores of the SUMAC demonstrated excellent to good inter-rater and test-retest reliability.

Gait parameters and characteristics associated with increased risk of falls in people with dementia: a systematic review.

BACKGROUND: People with dementia fall twice as often and have more serious fall-related injuries than healthy older adults. While gait impairment as a generic term is understood as a fall risk factor in this population, a clear elaboration of the specific components of gait that are associated with falls risk is needed for knowledge translation to clinical practice and the development of fall prevention strategies for people with dementia. OBJECTIVE: To review gait parameters and characteristics associated with falls in people with dementia. METHODS: Electronic databases CINAHL, EMBASE, MedLine, PsycINFO, and PubMed were searched (from inception to April 2017) to identify prospective cohort studies evaluating the association between gait and falls in people with dementia. RESULTS: Increased double support time variability, use of mobility aids, walking outdoors, higher scores on the Unified Parkinson's Disease Rating Scale, and lower average walking bouts were associated with elevated risk of any fall. Increased double support time and step length variability were associated with recurrent falls. The reviewed articles do not support using the Performance Oriented Mobility Assessment and the Timed Up-and-Go tests to predict any fall in this population. There is limited research on the use of dual-task gait assessments for predicting falls in people with dementia. CONCLUSION: This systematic review shows the specific spatiotemporal gait parameters and features that are associated with falls in people with dementia. Future research is recommended to focus on developing specialized treatment methods for these specific gait impairments in this patient population.

A framework for secondary cognitive and motor tasks in dual-task gait testing in people with mild cognitive impairment.

BACKGROUND: Cognition is a key factor in the regulation of normal walking and dual-task gait assessment is an accepted method to evaluate the relationship. The objective of this study was to create a framework for task complexity of concurrent motor and cognitive tasks with gait in people with mild cognitive impairment (MCI). METHODS: Community-dwelling people with MCI (n = 41, mean age = 76.20 ± 7.65 years) and cognitively normal controls (n = 41, mean age = 72.10 ± 3.80 years) participated in this study. Gait velocity was collected using an instrumented walkway under one single task and six combined tasks of motor and cognitive activities. The cognitive cost was the difference between the single gait task and each of the concurrent motor and cognitive challenges. A repeated two-way measure ANOVA assessed the effect of cognitive group and walking test condition for each gait task test. RESULTS: Gait velocity was significantly slower in the MCI group under all tasks. For both groups, the concurrent motor task of carrying a glass of water conferred a challenge not different from the cognitive task of counting backwards by ones. Performance of the complex cognitive task of serial seven subtractions reduced gait velocity in both groups, but produced a greater change in the MCI group (31.8%). CONCLUSIONS: Not all concurrent tasks challenge cognition-motor interaction equivalently. This study has created a framework of task difficulty which allows for the translation of dual-task test conditions to future research and clinical practice to ensure the accuracy of assessing patient deficits and risk.

The Relationship of Explicit-Implicit Evaluative Discrepancy to Exercise Dropout in Middle-Aged Adults.

Discrepancies between automatically activated associations (i.e., implicit evaluations) and explicit evaluations of motives (measured with a questionnaire) could lead to greater information processing to resolve discrepancies or self-regulatory failures that may affect behavior. This research examined the relationship of health and appearance exercise-related explicit-implicit evaluative discrepancies, the interaction between implicit and explicit evaluations, and the combined value of explicit and implicit evaluations (i.e., the summed scores) to dropout from a yearlong exercise program. Participants (N = 253) completed implicit health and appearance measures and explicit health and appearance motives at baseline, prior to starting the exercise program. The sum of implicit and explicit appearance measures was positively related to weeks in the program, and discrepancy between the implicit and explicit health measures was negatively related to length of time in the program. Implicit exercise evaluations and their relationships to oft-cited motives such as appearance and health may inform exercise dropout.

Motivation and Eudaimonic Well-Being in Athletes: A Self-Determination Theory Perspective.

Purpose: Drawing from self-determination theory (SDT), the present study examined the relationship between motivation and eudaimonic well-being in the sport context. Method: The association between motivation and eudaimonic well-being was assessed using a latent variable model through Structural Equation Modeling (SEM). Three hundred ninety-nine athletes (Mage = 25.08, SD = 7.35) from 15 different individual and team sports completed a questionnaire package. Results: Results indicated that integrated and identified regulations positively predicted athletes' eudaimonic well-being. External regulation was also a positive predictor of eudaimonic well-being, while introjected regulation and amotivation negatively predicted athletes' eudaimonic well-being. Finally, athletes' intrinsic motivation did not significantly predict their eudaimonic well-being. Conclusions: Results highlight the complex link between different types of sport motivation and athletes' well-being.

The influence of sleep and movement on mental health and life satisfaction during the transition to parenthood.

OBJECTIVES: This study assessed whether sleep and physical activity impact mental health and life satisfaction across the transition to parenthood. This study assessed the impact of parenthood on mental health of new parents and parents expecting their second child, and whether change in mental health occurred dyadically across couples. DESIGN: Longitudinal 12-month study. PARTICIPANTS: One hundred and fifty-seven couples (N = 314) between the ages of 25 and 40, who were not expecting to have a child (n = 102), expecting their first child (n = 136), or expecting their second child (n = 76) were recruited. MEASUREMENTS: Participants completed measures at baseline, 6 months, and 12 months. Sleep was assessed with how often participants met sleep guidelines (7-9 hours). Physical activity was measured objectively via accelerometers. Mental health was measured using 6 items from the short form-12 Quality of Life Survey. Life satisfaction was assessed with the Satisfaction with Life Scale (5 items). RESULTS: Mental health was not predicted by physical activity but was predicted by sleep. Sleep at 6 months was positively related to mental health at 6 months (ß = 0.156, p < .001), and sleep at 12 months was positively related to mental health at 12 months (ß = 0.170, p < .001). The change in mental health did not occur dyadically: mental health increased for women but not for men across groups. Mental health was positively related to life satisfaction at 6 months (ß = 0.338, p < .001) and 12-months (ß = 0.277, p < .001). CONCLUSIONS: For new and established parents, getting sufficient sleep plays an important role in mental health and, in turn, life satisfaction.

The effect of first-time 4-wheeled walker use on the gait of younger and older adults.

INTRODUCTION: The 4-wheeled walker is intended to enhance balance and gait for older adults. Yet, some research suggests that walking aids increase falls risk. An understanding of the influence of age with walker use on gait performance is required. OBJECTIVE: To examine the effect of initial 4-wheeled walker use on spatiotemporal gait parameters between younger and older adults. DESIGN: Cross-sectional, repeated-measures. SETTING: Community-dwelling. PARTICIPANTS: Twenty-five younger (age: 26.5 ± 4.1 years) and 24 older (age: 68.5 ± 10.5 years) adults participated. Younger adults were aged 18 to 35 years, whereas older adults were 50 years or older. Included were people not requiring the use of a walking aid, and those able to converse in English. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Gait velocity and stride time variability were recorded using accelerometers. Gait was examined under three conditions: unassisted walking; walking with a 4-wheeled walker; and walking with a 4-wheeled walker while completing a secondary task. Conditions were performed across two walking paths: straight and figure-of-8 Walk Test. Separate mixed-methods analyses of variance (ANOVAs; within-subject: condition/path; between-subject: group) were used for statistical analyses. RESULTS: Velocity was lower when walking using a walker while completing a cognitive task (p < .001), in the figure-of-8 Walk Test (p < .001), and in older adults (p = .001). Stride time variability increased with walking path and condition difficulty (p < .001) for the straight path versus the figure-of-8 Walk Test. CONCLUSIONS: Using a 4-wheeled walker resulted in a slower and more inconsistent gait pattern across both age groups. Walking more complex configurations resulted in the prioritization of gait over the cognitive task while performing the dual-task conditions. No evidence of an age-related difference in the effect of initial walker use on gait was observed. Nonetheless, walkers are cognitively demanding and their introduction should warrant a clinical follow-up.

Understanding the factors influencing physiotherapists' attitudes towards working with people living with dementia.

Background: Research suggests healthcare professionals feel uncomfortable or inadequately prepared to provide care to people living with dementia. Importantly, research on the attitudes of physiotherapists toward people with dementia is limited. The objective was to assess personal, educational, and clinical experiences on physiotherapists' attitudes toward working with people with dementia.Methods: An online survey was completed by registered physiotherapists. Data were collected on their dementia knowledge, confidence, and attitudes. Structural equation modeling (SEM) evaluated the factors associated with attitudes of physiotherapists.Results: A total of 231 physiotherapists completed the survey. Participants' scores on knowledge of dementia were excellent. Interactions with people with dementia were positive (67.4%) and access to rehabilitation was important (70.4%). However, most respondents reported a lack of confidence and strategies to successfully deal with cognitive (42.5%) or behavioral (58.3%) symptoms. In the SEM, only education (p = .048) was significantly related to attitude. Specifically, more education was related to more positive attitudes.Conclusions: Scores on knowledge of dementia were high. Yet, most respondents reported reduced confidence from a lack of skills to manage behavioral or cognitive symptoms associated with dementia. More education related to working with people with dementia was significantly related to positive attitudes among physiotherapists.

The Relationship of Self-efficacy and Explicit and Implicit Associations on the Intention-Behavior Gap.

BACKGROUND: Recent physical activity research is limited by intention-behavior discordance and is beginning to recognize the importance of automatic processes in exercise. The purpose of the current study was to examine the role of multidimensional exercise self-efficacy (SE), explicit-implicit evaluative discrepancies (EIEDs) for health, and appearance on the intention-behavior gap in exercise. METHODS: A total of 141 middle-aged inactive participants (mean age = 46.12 [8.17] y) completed measures of intentions, SE, and explicit and implicit evaluations of exercise outcomes. The participants were classified as inclined actors (n = 107) if they successfully started the exercise program and inclined abstainers (n = 35) if they were not successful. RESULTS: The inclined actors and abstainers did not differ on intentions to exercise; however, the inclined actors had higher coping SE and lower EIEDs for health. In addition, the coping SE (Exp [ß] = 1.03) and EIEDs for health (Exp [ß] = -0.405) were significant predictors of being an inclined actor. CONCLUSIONS: The interaction between explicit and implicit processes in regard to health motives for exercise appears to influence the successful enactment of exercise from positive intentions. As most physical activity promotion strategies focus on health as a reason to be active, the role of implicit and explicit evaluations on behavioral decisions to exercise may inform future interventions.

The Differential Effect of First-Time Single-Point Cane Use between Healthy Young and Older Adults.

BACKGROUND: Walking aids are often introduced to older adults to enable independent mobility. Single-point canes are the most common device used. Benefits are tempered by research suggesting that walking aids increase fall risk. A better understanding of the effect of walking aid use on gait performance is required. OBJECTIVE: To evaluate differences in the effect of initial single-point cane use on gait between younger (YAs) and older adults (OAs). DESIGN: Cross-sectional. SETTING: Community-dwelling. PARTICIPANTS: Twenty-six YAs (mean age ± standard deviation [SD]: 23.7 ± 2.8 years) and 25 OAs (mean age ± SD: 70.8 ± 14.1 years) participated. Inclusion criteria were 18 to 35 years of age for YAs or ≥50 years for OAs, be able to ambulate unassisted, and without any condition affecting mobility. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Gait velocity and stride time variability under different walking path configurations (straight path, Groningen Meander Walking Test, Figure-of-8 Walk Test) and conditions (unassisted walking, walking with a single-point cane, and walking with a single-point cane while completing a cognitive task) were recorded in a laboratory. The arithmetic task of subtracting 1s from 100 was used as the secondary cognitive task. Data analysis included separate three-way mixed analyses of variance (ANOVAs; path/condition/group). RESULTS: There was a statistically significant two-way interaction between walking path and condition for velocity (P < .001, ω2 = 0.03) and stride time variability (P = .032, ω2 = 0.02). In addition, a significant main effect of group was also observed (velocity: P = .004, ω2 = 0.07; stride time variability: P = .001, ω2 = 0.09). CONCLUSIONS: Using a single-point cane decreased velocity and increased stride time variability in both YAs and OAs. However, the cognitive load and effect on gait of initial cane use was not different between age groups. Standardized guidelines aimed at facilitating a client's transition toward the safe use of a walking aid are needed. Future research should evaluate if training can mitigate some of the adverse changes to gait stability observed with initial walking aid use.

The experiences of people with Alzheimer's dementia and their caregivers in acquiring and using a mobility aid: a qualitative study.

PURPOSE: Cognitive deficits and gait and balance problems are progressive in people with Alzheimer's dementia. Yet, mobility aids are associated with an increased falls risk in people with dementia. Our objectives were to identify the perceptions of people living with mild-to-moderate Alzheimer's dementia, and their caregivers, on the use of mobility aids. METHODS: A qualitative study using semi-structured, face-to-face interviews was conducted. Community-dwelling older adults with dementia attending a day hospital program were recruited. Thematic analysis was conducted and the text was coded into broad themes aligned with the research questions. The coded text was examined for patterns and similarities, and grouped to form inductive themes. RESULTS: Twenty-four people (12 living with dementia and their 12 caregivers) participated. Five themes were identified: (1) acknowledgement of need; (2) protecting a sense of self; (3) caregiver oversight and relief of burden; (4) healthcare professional involvement; (5) environment and design of aids. CONCLUSIONS: The findings suggest that people with Alzheimer's dementia and their caregivers regard mobility aid use as increasing independence. There is a role for healthcare professionals to be involved in the prescription, provision and training for use of mobility aids among people living with dementia to ensure uptake and safety.IMPLICATIONS FOR REHABILITATIONMobility aid use is regarded as increasing independence by people with Alzheimer's disease and their caregivers.Falls risk associated with mobility aid use was not well known and caregivers perceived mobility aids as a means to reduce falls.Most people do not see a healthcare professional when they acquire a mobility aid and there is a role for healthcare professionals to be involved in the prescription, provision and training of people living with dementia in the use of mobility aids in order to increase the uptake of aids and their safe use.

Executive function as a mediating factor between visual acuity and postural stability in cognitively healthy adults and adults with Alzheimer's dementia.

BACKGROUND: Falls in older adults, notably those with Alzheimer's dementia (AD), are prevalent. Vision and balance impairments are prominent falls risk factors in older adults. However, recent literature in the cognitively impaired suggests that executive function (EF) is important for falls risk assessments. The study objectives were to: 1) to compare balance among people with AD, healthy older adults (OA), and healthy young adults (YA) and 2) to quantify the interaction of visual acuity and EF on postural stability. METHODS: We recruited 165 individuals (51 YA, 48 OA, and 66 AD). Trail Making Tests (A and B) quantified EF and the Colenbrander mixed contrast chart measured high and low contrast visual acuity. Accelerometers recorded postural sway during the Modified Test for Sensory Integration. A two-way repeated measures ANOVA examined postural sway differences across groups. Mediation analysis quantified the association of EF in the relationship between contrast sensitivity and postural sway. RESULTS: Significant EF and visual acuity between-group differences were observed (p < 0.001). For postural sway, a significant interaction existed between group and balance condition (p < 0.001). In general, EF was a significant mediator between visual acuity and postural sway. Visual acuity, EF and postural sway was worse with increased age, particularly in the AD group. CONCLUSIONS: Mediation analysis revealed that individuals with poorer visual acuity had poorer EF, and those with poorer executive function had poorer balance control. These results highlight the importance of assessing not only vision and balance but also EF, especially in older individuals living with AD.

Effect of dual-tasking on walking and cognitive demands in adults with Alzheimer's dementia experienced in using a 4-wheeled walker.

BACKGROUND: Learning to walk with a 4-wheeled walker increases cognitive demands in people with Alzheimer's dementia (AD). However, it is expected that experience will offset the increased cognitive demand. Current research has not yet evaluated gait in people with AD experienced in using a 4-wheeled walker under complex gait situations. RESEARCH QUESTION: What is the effect of dual-task testing on the spatial-temporal gait parameters and cognitive performance of people with AD experienced with a 4-wheeled walker? METHODS: Twenty-three adults with mild to moderate AD (87.4 ±â€¯6.2 years, 48 % female) and at least 6 months of walker use experience participated. Three walking configurations: 1) straight path (SP), 2) Groningen Meander Walking Test (GMWT), and 3) Figure of 8 path (F8) were tested under two walking conditions: 1) single-task (walking with aid) and 2) dual-task (walking with aid and completing a cognitive task). Tri-axial accelerometers collected velocity, cadence and stride time variability (STV). Gait and cognitive task cost were the percentage difference between single-task and dual-task conditions. Two-way repeated measures ANOVAs were used to answer the study question. RESULTS: A significant interaction between walking configuration and condition was found for velocity (p = 0.002, ω2 = 0.36), cadence (p = 0.04, ω2 = 0.15) and STV (p < 0.001, ω2 = 0.53). Velocity and cadence decreased and STV increased with increasing walking configuration complexity and upon dual-tasking. Dual-task gait and cognitive task cost deteriorated in all walking configurations, but gait was prioritized in the GMWT and F8 configurations. Despite familiarity, experienced walker users with AD exhibit impaired gait when walking in complex situations which increases falls risk. Upon dual-task, individuals with AD self-prioritized a posture-first strategy in complex configurations. SIGNIFICANCE: Dual-task testing in experienced users results in slower walking, fewer steps and increased STV, which increases falls risk in people with mild to moderate AD and becomes most pronounced in complex environments.

Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer's Disease: Part I - Cane.

BACKGROUND: People with Alzheimer's disease (AD) exhibit balance and walking impairments that increase falls risk. Prescription of a mobility aid is done to improve stability, yet also requires increased cognitive resources. Single-point canes require unique motor sequencing for safe use. The effect of learning to use a single-point cane has not been evaluated in people with AD. OBJECTIVES: In people with AD and healthy adult controls: 1) examine changes in gait while using a cane under various walking conditions; and 2) determine the cognitive and gait costs associated with concurrent cane walking while multi-tasking. METHODS: Seventeen participants with AD (age 82.1±5.6 years) and 25 healthy controls (age 70.8±14.1 years) walked using a single-point cane in a straight (6 meter) and a complex (Figure of 8) path under three conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). Velocity and stride time variability were recorded with accelerometers. RESULTS: Gait velocity significantly slowed for both groups in all conditions and stride time variability was greater in the AD group. Overall, multi-tasking produced a decrease in gait and cognitive demands for both groups, with more people with AD self-prioritizing the cognitive task over the gait task. CONCLUSION: Learning to use a cane demands cognitive resources that lead to detrimental changes in velocity and stride time variability. This was most pronounced in people with mild to moderate AD. Future research needs to investigate the effects of mobility aid training on gait performance.

Effect of Learning to Use a Mobility Aid on Gait and Cognitive Demands in People with Mild to Moderate Alzheimer's Disease: Part II - 4-Wheeled Walker.

BACKGROUND: Cognitive deficits and gait problems are common and progressive in Alzheimer's disease (AD). Prescription of a 4-wheeled walker is a common intervention to improve stability and independence, yet can be associated with an increased falls risk. OBJECTIVES: 1) To examine changes in spatial-temporal gait parameters while using a 4-wheeled walker under different walking conditions, and 2) to determine the cognitive and gait task costs of walking with the aid in adults with AD and healthy older adults. METHODS: Twenty participants with AD (age 79.1±7.1 years) and 22 controls (age 68.5±10.7 years) walked using a 4-wheeled walker in a straight (6 m) and Figure of 8 path under three task conditions: single-task (no aid), dual-task (walking with aid), and multi-task (walking with aid while counting backwards by ones). RESULTS: Gait velocity was statistically slower in adults with AD than the controls across all conditions (all p values <0.025). Stride time variability was significantly different between groups for straight path single task (p = 0.045), straight path multi-task (p = 0.031), and Figure of 8 multi-task (0.036). Gait and cognitive task costs increased while multi-tasking, with performance decrement greater for people with AD. None of the people with AD self-prioritized gait over the cognitive task while walking in a straight path, yet 75% were able to shift prioritization to gait in the complex walking path. CONCLUSION: Learning to use a 4-wheeled walker is cognitively demanding and any additional tasks increases the demands, further adversely affecting gait. The increased cognitive demands result in a decrease in gait velocity that is greatest in adults with AD. Future research needs to investigate the effects of mobility aid training on gait performance.

The effect of walking path configuration on gait in adults with Alzheimer's dementia.

BACKGROUND: Walking is a cognition intensive activity and impaired walking is associated with an increased fall risk in people with Alzheimer's dementia (AD). Walking in a curved path configuration increases complexity of the task, reflects real-life environments and situations when falls occur. The effect of walking path task complexity has not been evaluated in people with AD. RESEARCH QUESTION: The purpose was 1) to assess the utility of a curved path walking task to detect differences in gait performance between people with AD and healthy controls and 2) to assess the relationship of cognitive function to gait performance on straight path and curved path walking. METHODS: Participants with AD (n = 14, mean age ±â€¯SD = 73.08 ±â€¯9.22) and age and sex matched controls (n = 14, mean age = 72.86 ±â€¯9.53) were recruited. Time to complete a 6-meter straight path and a curved path (Figure of 8 Test) walking task was recorded. Steps taken, accuracy and qualitative measures of smoothness were rated for curved-path walking. Measures of global cognition (MMSE, MoCA) and executive function (Trail making A and B, Digit Span forwards and backwards) were assessed. RESULTS: Gait was significantly slower in people with AD for both the straight-path (AD = 6.05 ±â€¯1.26 s, Control = 5.09 ±â€¯0.76 s, p = 0.02) and curved-path walking (AD = 11.25 ±â€¯4.87 s, Control = 8.28 ±â€¯2.44 s, p =  0.05). In addition, smoothness scores were significantly lower for people with AD (AD = 1.93±1.26; Control = 3.00±0.00, p = 0.004). SIGNIFICANCE: Walking in a curved path resulted in a significant deterioration in gait quality in the people with AD. Executive function was related only to curved path walking, in which lower executive function scores were associated with longer time to walk.