Abstract
BackgroundFalls represent a major health problem for older adults with cognitive impairment, and the effects of exercise for fall reduction are understudied in this population. This pilot randomized controlled trial evaluated the feasibility, safety, and exploratory effectiveness of a Dalcroze eurhythmics program and a home exercise program designed for fall prevention in older adults with mild cognitive impairment (MCI) or early dementia.MethodsFor this three-arm, single-blind, 12-month randomized controlled pilot trial, we recruited community-dwelling women and men age 65 years and older with MCI or early dementia through participating memory clinics in Zurich, Switzerland. Participants were randomly assigned to a Dalcroze eurhythmics group program, a simple home exercise program (SHEP), or a non-exercise control group. All participants received 800 IU of vitamin D3 per day. The main objective of the study was to test the feasibility of recruitment and safety of the interventions. Additional outcomes included fall rate, gait performance, and cognitive function.ResultsOver 12 months, 221 older adults were contacted and 159 (72%) were screened via telephone. Following screening, 12% (19/159) met the inclusion criteria and were willing to participate. One participant withdrew at the end of the baseline visit and 18 were randomized to Dalcroze eurhythmics (n = 7), SHEP (n = 5), or control (n = 6). Adherence was similarly low in the Dalcroze eurhythmics group (56%) and in the SHEP group (62%; p = 0.82). Regarding safety and pilot clinical endpoints, there were no differences between groups.ConclusionThe MOVE for your MIND pilot study showed that recruitment of older adults with MCI or early dementia for long-term exercise interventions is challenging. While there were no safety concerns, adherence to both exercise programs was low.Trial registrationClinicalTrials.gov, NCT02279316. Registered on 31 October 2014
Highlights
Falls represent a major health problem for older adults with cognitive impairment, and the effects of exercise for fall reduction are understudied in this population
The MOVE for your MIND pilot study showed that recruitment of older adults with mild cognitive impairment (MCI) or early dementia for long-term exercise interventions is challenging
Older adults with mild cognitive impairment (MCI) or dementia have a twofold higher risk of falling and are twice as likely to experience severe consequences such as fractures and loss of autonomy compared to cognitively healthy peers [1, 6]
Summary
Falls represent a major health problem for older adults with cognitive impairment, and the effects of exercise for fall reduction are understudied in this population. Major risk factors include older age, gait and balance impairment, and reduced cognitive function [4, 5] Regarding the latter, older adults with mild cognitive impairment (MCI) or dementia have a twofold higher risk of falling and are twice as likely to experience severe consequences such as fractures and loss of autonomy compared to cognitively healthy peers [1, 6]. Exercise is among the most effective strategies for fall prevention, independent of whether it is performed in a group setting or at home [7, 8] Both settings have been demonstrated to be safe and feasible in older adults with cognitive impairment or dementia [9,10,11]. Results from meta-analyses on the effect of exercise on fall reduction among older adults with impaired cognitive function are inconclusive, indicating that the beneficial effect of certain exercise programs might not translate to this population [12,13,14]
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