Lifestyle Empowerment for Alzheimer’s Prevention (LEAP! Rx) week 12 outcomes

Abstract

AbstractBackgroundClinicians have few tools to incorporate physical activity into clinical care to capitalize on the benefits of exercise for Alzheimer’s prevention. Barriers limit older adults from initiating and maintaining exercise recommendations. We tested the efficacy of an exercise and healthy lifestyle program, LEAP! Rx, in physician‐referred patients vs. self‐referred patients (typical referral method). Physician referrals occurred via electronic prescription embedded in the electronic health record. The program included 12 weeks of regular supervised exercise at a network of YMCAs, followed by 40 weeks of intermittent supervised exercise. Participants were offered monthly Alzheimer’s prevention classes (diet, cognitive engagement, stress reduction).MethodAn RCT tested efficacy of LEAP! Rx for gains in cardiorespiratory fitness and reduced disease markers. Participants (age 65+) were randomized to the Intervention Group (n = 110) or a Control Group (n = 110). 54% were referred by physicians, 46% were self‐referred. During the pandemic, exercise coaching was moved online. We analyzed increases in cardiorespiratory fitness (VO2max) and changes in insulin resistance, body composition, and lipids between baseline and week 12.ResultAnalyses are based on 179 participants’ data at week 12. The intervention group increased 3.6% in cardiorespiratory fitness (VO2max ml/kg/min) vs. 1.0% in Controls (non‐significant trend, t = 1.66, p = .098). The intervention group reduced fat mass by 2.0% vs. 0.7% in Controls (non‐significant trend, t = 0.163, p = .105). Self‐referred participants increased 4.7% in VO2max (p = .007) vs. 2.0% in physician‐referred (p = 0.20). Both referral groups had reductions in fat mass (p<.05). Adherence was lower in physician‐referred (fewer aerobic goals met (p = .038), more weeks of pandemic‐related gym closures (p<.001)). Physician‐referred had more participants identifying as Black and Latino/a (22%) vs. self‐referred (8%).ConclusionAlthough outcomes improved across 12 weeks, we found no significant differences between intervention and control groups. A potential explanation is differences between physician‐referred and self‐referred groups. Our unique physician referral method resulted in a more racially/ethnically diverse sample. However, the physician‐referred group had fewer VO2 gains, likely due to greater pandemic‐related adherence disruption. When week 52 is complete, we will investigate feasibility and acceptability of the referring physicians’ role and analysis of actigraphy data to clarify mechanisms of differential benefits.