Abstract
BackgroundWorldwide, 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.MethodsThis 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.DiscussionThere 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).
Highlights
Worldwide, almost 50million people lived with dementia in 2016
Methods & design This is a pragmatic, randomized, parallel group trial to explore the relative effectiveness of two exercise delivery options (CB versus HB) among 60 people with mild cognitive impairment (MCI) and mild dementia
This study will examine the effects of CB versus HB exercise on physical activity as well as cost, cognitive function, physical function and health, functional ability, apathy and depressive symptoms, and quality of life among people diagnosed with MCI or mild dementia
Summary
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. [2] Convergent evidence from cohort studies, clinical trials, and animal models supports exercise as an intervention to improve cognitive function among older adults with and without cognitive impairment, [3] though more rigorous randomized controlled trials are still needed. [6] A meta-analysis of exercise trials among people with cognitive impairment confirmed that exercise programs as short as 3 months improved daily function and physical function among this group. Even with the substantial associated benefits, many older adults remain inactive, [15, 16] and people with mild cognitive impairment (MCI) and dementia are more sedentary than their peers. Despite substantial support for exercise as a therapy for people with MCI or dementia, we have a poor understanding of the best strategies to increase exercise levels in this group. A recent review highlighted the need to identify effective exercise delivery options specific to people with MCI and dementia. [22]
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