Non-pharmacological Interventions Research Articles

Pulmonary hypertension in patients affected by sleep-related breathing disorders: up to date from the literature.

Sleep-related breathing disorders (SBD) are conditions of abnormal and difficult respiration during sleep, including chronic snoring, obstructive sleep apnea (OSA), central sleep apnea (CSA), sleep-related hypoventilation disorders and sleep-related hypoxemia. Some of them have a limited impact on health, but others (e.g., OSA) can have serious consequences, because of their dangerous effects on sleep and the hematic balance of oxygen and carbon dioxide. According to several population-based studies, prevalence of OSA is relatively high, approximately 3-7% for adult males and 2-5% for adult females in the general population. However, methodological differences and difficulties in characterizing this syndrome yielded to variability in estimates. Moreover, it is estimated that only about 40% of patients with OSA are diagnosed, which can lead to underestimation of disease prevalence. OSA is directly correlated with age and male sex and to risk factors such as obesity. Several studies found that OSA is associated with an increased risk of diabetes, some cancer types, cardiovascular and cerebrovascular diseases, such as hypertension, coronary artery disease and stroke. Pulmonary hypertension (PH), a noted cardiovascular disease, is significantly associated with sleep-related breathing disorders and lot of scientific studies published in the literature demonstrated a strong link between these conditions and the development of pulmonary hypertension PH. PH is relatively less common than sleep-related breathing disorders. The purpose of this systematic review is to analyze both the current knowledge around the consequences that SBD may have on pulmonary hemodynamics and the effects resulting from pharmacological and non-pharmacological treatments of SDB on PH.

Mind-body practices for people living with dementia and their family carers: a systematic review.

People with dementia and their family carers may benefit from non-pharmacological interventions, including mind-body (MB-) practices, which can improve physical and mental health by inducing relaxation. This systematic review provides an overview of availability and effects of MB-practices. The authors performed a systematic search in PubMed, Embase, Emcare, Web of Science, Cochrane Library, PsycINFO, China National Knowledge Infrastructure and Academic Search Premier on February 1, 2024. Research papers on MB-practices for people with dementia and/or their family carers in English, Chinese, Japanese, German, French and Dutch were included if a full text was available. Selection of included articles, data extraction and methodological quality assessments were conducted by two researchers. Of the 130 included studies, 100 (77 %) were of high quality. Traditional Chinese Medicine (TCM) and touch interventions for people with dementia, and meditations for family carers resulted in improvements in respectively cognition and neuropsychiatric symptoms, and mental health. Lack of evidence for other MB-practices is related to small numbers of studies, fragmented use of outcome measures and mixed findings. MB-practices showed promising results. We recommend implementation and further research of TCM- and touch interventions for people with dementia as well as meditations for family carers. We suggest a cross-over of the promising results of one group to be studied in the other group.

The Role of the Massage Method with Deep Breathing Relaxation in Reducing the Intensity of Labor Pain: A Randomized Clinical Trial at Mukomuko Regional General Hospital, Indonesia

Labor pain is a significant concern for expectant mothers, often leading to anxiety and potential complications. Non-pharmacological interventions like massage and deep breathing relaxation (DBR) have gained attention as safe and effective pain management options. This randomized clinical trial aimed to investigate the efficacy of combining massage and DBR in reducing labor pain intensity at Mukomuko Regional General Hospital, Indonesia. A randomized controlled trial was conducted with 100 pregnant women experiencing labor pain. Participants were randomly assigned to either the intervention group (massage + DBR) or the control group (standard care). Pain intensity was assessed using the Visual Analog Scale (VAS) before and after the intervention. Data were analyzed using appropriate statistical tests. The intervention group demonstrated a significantly greater reduction in VAS scores compared to the control group (p < 0.05). Participants in the intervention group reported higher satisfaction with pain management and a more positive childbirth experience. In conclusion, the combination of massage and DBR is a safe and effective non-pharmacological intervention for reducing labor pain intensity. This approach can be easily integrated into standard care practices, offering a valuable tool for improving maternal comfort and well-being during childbirth.

How to undertake a pain assessment for -patients with acute post-operative pain.

Acute post-operative pain is common among patients in secondary care settings, and the alleviation of this pain is a principal responsibility for all healthcare professionals, including nurses. To achieve this, it is essential to regularly undertake comprehensive pain assessments, using validated pain assessment tools, for all patients who have undergone a surgical procedure. Inadequate pain assessment may lead to ineffective or inappropriate pain management, which can adversely affect the patient's recovery and increase their risk of developing chronic pain. •Pain is a subjective experience and therefore requires individualised, comprehensive assessment and management interventions. •The assessment process for patients with acute pain is fundamental to understanding the patient's current status, informing differential diagnoses regarding the underlying cause of the pain, providing appropriate treatment and monitoring, and evaluating the effectiveness of treatment. •Pain assessment should not be undertaken as a one-off care activity; it should be completed whenever a patient reports pain and repeated following pharmacological and/or non-pharmacological interventions. REFLECTIVE ACTIVITY: 'How to' articles can help you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: •How this article might improve your practice when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain. •How you could use this information to educate nursing students or colleagues on the appropriate actions to take when undertaking a comprehensive pain assessment with patients experiencing acute post-operative pain.

PENERAPAN LATIHAN PILATES UNTUK MENGURANGI NYERI MENSTRUASI PADA REMAJA PUTRI

Dysmenorrhea is a disorder of menstrual blood flow or menstrual pain that, if not promptly addressed, can affect an individual's mental and physical functions, necessitating non-pharmacological interventions. One such non-pharmacological therapy is Pilates exercises, which relax contracted muscles and stimulate the hypothalamus to produce endorphins, a natural pain reliever that reduces pain. This community service activity aims to reduce menstrual pain in adolescent girls through Pilates exercise classes held in Dusun Luksongo, Tugurejo Village, Ngasem District, Kediri Regency. The program involves 10 adolescent girls as participants. The methods used include socialization, education, and training in Pilates techniques by a competent instructor. The training includes practical guidance on safe and effective Pilates techniques to reduce menstrual pain and enhance the well-being of the adolescent girls. The results of the service show that out of 10 adolescent girls who participated in the program, 8 girls (80%) reported a decrease in menstrual pain after attending the Pilates sessions, while 2 girls (20%) reported the pain remained the same. No participants reported an increase in pain. These results indicate that the Pilates exercise classes have a significant impact on reducing menstrual pain in adolescent girls, which is an important factor for their well-being. Therefore, the Pilates exercise class program can be considered effective in reducing menstrual pain and improving the physical and psychological health of adolescent girls, as well as strengthening their role in maintaining their own health.

Impact of Preoperative Gum Chewing on Postoperative Anti-Emetic Use in Robot-Assisted Laparoscopic Surgery for Benign Ovarian Masses: A Prospective, Single-Blinded Randomized Controlled Trial

Background and Objectives: Postoperative nausea and vomiting (PONV) is a common issue for females undergoing gynecological surgeries, including those assisted by robotic systems. Despite available prophylactic measures, the incidence of PONV remains high, negatively impacting recovery and increasing healthcare costs. This study evaluates whether preoperative gum chewing reduces the need for anti-emetic drugs in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. Materials and Methods: This prospective, single-blinded, randomized controlled trial enrolled 92 adult females scheduled for robot-assisted laparoscopic surgery to treat benign ovarian mass. Following exclusions, the remaining participants were randomly assigned to either a gum-chewing group or a no-gum-chewing group. The gum-chewing group chewed sugar-free gum for 15 min in the holding area before surgery. The primary outcome measured was the need for anti-emetics to control PONV during the first hour in the post-anesthesia care unit (PACU). Secondary outcomes included the number of anti-emetic requests. No preemptive anti-emetics were administered during surgery. Results: Out of the initial 92 patients, 88 were included in the final analysis, with 44 in each group. The incidence of PONV requiring anti-emetics in the PACU was significantly lower in the gum-chewing group (79.5%) compared to the no-gum-chewing group (95.5%). Additionally, the number of anti-emetic requests was higher in the no-gum-chewing group. No postoperative complications such as tooth or jaw pain/injury or gastric content regurgitation were reported. Conclusions: Preoperative gum chewing for 15 min immediately before surgery significantly reduced the incidence of PONV in females undergoing robot-assisted laparoscopic surgery for benign ovarian mass. This simple, non-pharmacological intervention improved patient comfort and reduced the need for anti-emetic medications without any adverse effects. Further studies are needed to confirm these findings and to develop guidelines for incorporating preoperative gum chewing into clinical practice.

Impact of pole dancing on mental wellbeing and sexual self-concept: Protocol for a systematic review and meta-analysis.

Despite the recognized psychological benefits of traditional dance forms, the impact of newer forms, such as pole dancing, on mental well-being and sexual self-concept remains underexplored. This protocol outlines a systematic review and meta-analysis aimed at elucidating the effects of pole dancing, a burgeoning non-pharmacological intervention, on these dimensions of mental health. This systematic review was registered in the PROSPERO. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocol to accomplish the systematic review protocol. This review will systematically search electronic databases, including PubMed, Embase, Web of Science, Medline, and CNKI, for randomized controlled trials (RCTs) assessing the impact of pole dancing on mental well-being and sexual self-concept. Two independent evaluators will screen the literature, extract data, and evaluate study quality and bias. Data synthesis will utilize Stata 14.0 and Revman 5.4, employing random-effects models. The Grading of Recommendations, Development, and Evaluation (GRADE) system will appraise evidence reliability, with subgroup analysis exploring heterogeneity sources. Publication bias will be assessed through funnel plots and Egger's regression tests. This review aims to fill the gap in the current literature by providing a comprehensive evaluation of pole dancing's psychological effects. It is anticipated that this systematic review and meta-analysis will offer valuable insights for health policy and practice, advocating for the inclusion of pole dancing in mental health and sexual well-being interventions. Systematic review registration: PROSPERO CRD42024529369.

Comparative efficacy and safety of non-pharmacological interventions as adjunctive treatment for vascular dementia: a systematic review and network meta-analysis

Comparative efficacy and safety of non-pharmacological interventions as adjunctive treatment for vascular dementia: a systematic review and network meta-analysis

Evaluating research waste and traits among randomized controlled trials of scars over the past 20years: a cross-sectional study.

To analyze the changes in the characteristics of randomized controlled trials (RCTs) in the field of scarring over the last two decades, unveil the components of research waste (RW) within these RCTs, and identify targets for improvement. A search was conducted on ClinicalTrials.gov for RCTs registered from January 2000 to December 2023, using "scar" as the keyword. The search was carried out in January 2024. 391 RCTs were included in this analysis. The global registration of RCTs in scarring has exhibited a consistent increase annually, with the proportion in Asia gradually rising, while the shares in North America and Europe have demonstrated a declining trend. In the analysis of RW, 232 RCTs were included, of which 96 (41.4%) have been published. Among the published RCTs, 56 (58.3%) were evaluated to have sufficient reporting, while 47 RCTs (48.9%) were identified as having avoidable design flaws. Ultimately, 183 RCTs (78.9%) exhibited at least one form of RW. Multicenter design (OR: 3.324, 95%CI: 1.385-7.975, P = 0.018), non-pharmacological interventions (OR: 2.61, 95%CI: 1.253-5.435, P = 0.010), the absence of external funding (OR: 0.325, 95%CI: 0.144-0.732, P = 0.031), and participant numbers exceeding 50 (OR: 3.269, 95%CI: 1.573-6.794, P = 0.002) were identified as independent protective factors against waste. This study delineates the changes in the characteristics of scar RCTs globally over the past two decades, uncovering a substantial burden of RW in scarring research. It provides an evidential reference for more rational planning of future scar-related RCTs and for minimizing RW.

Cumulative sucrose exposure for repeated procedural pain in preterm neonates and neurodevelopment at 18 months of corrected age: a prospective observational longitudinal study

IntroductionOral sucrose is repeatedly administered to neonates in the neonatal intensive care unit (NICU) to treat pain from commonly performed procedures; however, there is limited evidence on its long-term cumulative...

Evaluating research waste and traits among randomized controlled trials of scars over the past 20years: a cross-sectional study.

To analyze the changes in the characteristics of randomized controlled trials (RCTs) in the field of scarring over the last two decades, unveil the components of research waste (RW) within these RCTs, and identify targets for improvement. A search was conducted on ClinicalTrials.gov for RCTs registered from January 2000 to December 2023, using "scar" as the keyword. The search was carried out in January 2024. 391 RCTs were included in this analysis. The global registration of RCTs in scarring has exhibited a consistent increase annually, with the proportion in Asia gradually rising, while the shares in North America and Europe have demonstrated a declining trend. In the analysis of RW, 232 RCTs were included, of which 96 (41.4%) have been published. Among the published RCTs, 56 (58.3%) were evaluated to have sufficient reporting, while 47 RCTs (48.9%) were identified as having avoidable design flaws. Ultimately, 183 RCTs (78.9%) exhibited at least one form of RW. Multicenter design (OR: 3.324, 95%CI: 1.385-7.975, P = 0.018), non-pharmacological interventions (OR: 2.61, 95%CI: 1.253-5.435, P = 0.010), the absence of external funding (OR: 0.325, 95%CI: 0.144-0.732, P = 0.031), and participant numbers exceeding 50 (OR: 3.269, 95%CI: 1.573-6.794, P = 0.002) were identified as independent protective factors against waste. This study delineates the changes in the characteristics of scar RCTs globally over the past two decades, uncovering a substantial burden of RW in scarring research. It provides an evidential reference for more rational planning of future scar-related RCTs and for minimizing RW.

Cold atmospheric plasma inactivates Aspergillus flavus and Fusarium keratoplasticum biofilms and conidia in vitro.

Introduction. Aspergillus flavus and Fusarium keratoplasticum are common causative pathogens of fungal keratitis (FK), a severe corneal disease associated with significant morbidity and vision loss. Escalating incidence of antifungal resistance to available antifungal drugs poses a major challenge to FK treatment. Cold atmospheric plasma (CAP) is a pioneering nonpharmacologic antimicrobial intervention that has demonstrated potential as a broad-spectrum antifungal treatment.Gap statement. Previous research highlights biofilm-associated resistance as a critical barrier to effective FK treatment. Although CAP has shown promise against various fungal infections, its efficacy against biofilm and conidial forms of FK pathogens remains inadequately explored.Aim. This study aims to investigate the antifungal efficacy of CAP against clinical fungal keratitis isolates of A. flavus and F. keratoplasticum in vitro.Methodology. Power parameters (22-27 kVpp, 300-400 Hz and 20-80 mA) of a dielectric barrier discharge CAP device were optimized for inactivation of A. flavus biofilms. Optimal applied voltage and total current were applied to F. keratoplasticum biofilms and conidial suspensions of A. flavus and F. keratoplasticum. The antifungal effect of CAP treatment was investigated by evaluating fungal viability through means of metabolic activity, c.f.u. enumeration (c.f.u. ml-1) and biofilm formation.Results. For both fungal species, CAP exhibited strong time-dependent inactivation, achieving greater than 80 % reduction in metabolic activity and c.f.u. ml-1 within 300 s or less, and complete inhibition after 600 s of treatment.Conclusion. Our findings indicate that CAP is a promising broad-spectrum antifungal intervention. CAP treatment effectively reduces fungal viability in both biofilm and conidial suspension cultures of A. flavus and F. keratoplasticum, suggesting its potential as an alternative treatment strategy for fungal keratitis.

Treatment of type 2 diabetes and stress using neuro-emotional technique: case report

This case report presents a novel, non-pharmacological treatment of Type 2 Diabetes in a 46-year-old male, demonstrating improvements in blood chemistry and psychometric markers after 8 treatments using a Mind-Body Intervention (MBI) called Neuro-Emotional Technique (NET). The patient presented with a diagnosis of Type 2 Diabetes (T2D), pain, psychosocial indicators of stress and anxiety, and a score of 4 on the ACE-Q (Adverse Childhood Experiences Questionnaire) that is consistent with a predisposition to chronic disease and autoimmune disorders. Glucose levels for this patient were above normal levels (typically between 10-15mmol/L where optimal range is between 4-10mmol/L) for at least two months prior to the 4-week NET intervention period, despite the standard use of conventional antidiabetic medications (insulin injections). The patient exhibited numerous indictors of chronic stress that were hypothesised to be underlying his medical diagnosis and a series of 8 NET treatments over a period of 4 weeks was recommended. Psychometric tests and glucose measurements were recorded at baseline (prior to treatment), 4 weeks (at the conclusion of treatment) and at 8 weeks (4 weeks following the conclusion of treatment). Results show that glucose levels were reduced, and self-reported measures of depression, anxiety, stress, distress and pain all decreased from high and extreme levels to within normal ranges after 4 weeks, with ongoing improvement at 8 weeks. McEwen described the concept of allostatic load and the disruptive effects that cumulative stress can have on both mental and physical health. It is hypothesized that NET reduces allostatic load thereby fortifying homeostasis and the salutogenic stress response mechanisms involved in recovery from chronic illness, possibly via the Psycho-Immune-Neuroendocrine (PINE) network. Further studies with larger sample sizes are required to establish whether these results could be extrapolated to a wider population, however the results of this case suggest that it may be beneficial to consider co-management of T2D with an MBI such as NET.

Reduced Blood Glucose Levels in Diabetic Patients After Using a Combination of Progressive Muscle Relaxation (Pro-Mure) and Slow Deep Breathing Exercises (SD-Bex)

Background: One of the causes of diabetes mellitus is a person's lifestyle, namely their level of physical inactivity. So, to avoid complications, persons with diabetes mellitus require both pharmaceutical and non-pharmacological treatments to lower blood glucose values. Finding out if people with diabetes mellitus might reduce their blood glucose levels by combining a technique that involved slow deep breathing and progressive muscular relaxation was the primary goal of the research. Methods: This study is quasi-experimental because it uses a control group design with pre- and post-tests. The number of respondents is 34, and the method of sampling is purposive sampling. Twenty to twenty-five minutes of a combination of progressive muscle relaxation (Pro-Mure) and slow deep breathing exercises (SD-Bex) were administered to the experimental group, while the control group received the usual course of intervention. Values of blood glucose levels were the dependent variable. With a p-value of less than 0.05, the study used the Wilcoxon Signed Rank Test to compare outcomes before and after treatment and the Mann-Whitney test to compare the experimental group to the control group. Results: We found that the intervention group's blood glucose value was 0.001 and the control group's was 0.025. A p-value of 0.001 was found on the value of blood glucose levels between the experimental group and the control group as a result of the study utilising the Mann-Whitney test. Conclusion: Those suffering from diabetes mellitus can find relief from their symptoms by combining the techniques of Progressive Muscle Relaxation with Slow Deep Breathing. Additionally, the method is simple to apply.

Moving Beyond Medication: Harnessing the Power of Physical Therapy and Dance Therapy in Parkinson's Disease Management

Introduction Parkinson's disease (PD) poses significant challenges due to its complex array of motor and non-motor symptoms, impacting patients' quality of life. While traditional pharmacological treatments focus on motor symptoms, non-pharmacological interventions, including physical and dance therapy, offer alternative approaches. Aim of the Study This study aims to evaluate the therapeutic potential of physical and dance therapy, including tango, in managing motor symptoms and improving overall well-being in individuals with PD. It seeks to compare these interventions with traditional treatments and explore their efficacy. State of Knowledge Parkinson's disease management involves a combination of pharmacological and non-pharmacological approaches. Traditional treatments target motor symptoms but have limitations. Non-pharmacological interventions, such as deep brain stimulation and physical therapy, complement traditional treatments. Dance therapy, including tango, shows promise in improving motor function and quality of life. Conclusions Physical and dance therapy, including tango, offer promising avenues for managing motor symptoms and enhancing quality of life in PD patients. While traditional treatments remain essential, non-pharmacological interventions provide valuable alternatives. Further research is needed to refine intervention parameters and compare their effectiveness comprehensively. Overall, these therapies present holistic approaches to PD management, addressing both motor and non-motor symptoms for improved patient outcomes.

Treatment of chronic kidney disease in older populations.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Bridging the gap: facilitating the use of rheumatology research results in clinical practice with hybrid implementation effectiveness studies

The implementation of proven effective pharmacological and non-pharmacological interventions into routine rheumatology practice is a lengthy and complex process. Bridging this gap between research and practice is crucial. Hybrid implementation...

Cognition and Activity of Daily Living Function in people with Parkinson's disease.

The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.

Treatment of chronic kidney disease in older populations.

As the world population ages, an expected increase in the prevalence of chronic kidney disease (CKD) among older individuals will pose a considerable challenge for health care systems in terms of resource allocation for disease management. Treatment strategies for older patients with CKD should ideally align with those applied to the general population, focusing on minimizing cardiovascular events and reducing the risk of progression to kidney failure. Emerging therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, hold promise for the effective management of CKD in older individuals. In addition, non-pharmacological interventions such as nutritional and exercise therapies have a crucial role. These interventions enhance the effects of pharmacotherapy and, importantly, contribute to the maintenance of cognitive function and overall quality of life. Various factors beyond age and cognitive function must be taken into account when considering kidney replacement therapy for patients with kidney failure. Importantly, all treatment options, including dialysis, transplantation and conservative management approaches, should be tailored to the individual through patient-centred decision-making. The dynamic integration of digital technologies into medical practice has the potential to transform the management of CKD in the aging population.

Cognition and Activity of Daily Living Function in people with Parkinson's disease.

The ability to perform activities of daily living (ADL) function is a multifaceted construct that reflects functionality in different daily life situations. The loss of ADL function due to cognitive impairment is the core feature for the diagnosis of Parkinson's disease dementia (PDD). In contrast to Alzheimer's disease, ADL impairment in PD can be compromised by various factors, including motor and non-motor aspects. This narrative review summarizes the current state of knowledge on the association of cognition and ADL function in people with PD and introduces the concept of "cognitive ADL" impairment for those problems in everyday life that are associated with cognitive deterioration as their primary cause. Assessment of cognitive ADL impairment is challenging because self-ratings, informant-ratings, and performance-based assessments seldomly differentiate between "cognitive" and "motor" aspects of ADL. ADL function in PD is related to multiple cognitive domains, with attention, executive function, and memory being particularly relevant. Cognitive ADL impairment is characterized by behavioral anomalies such as trial-and-error behavior or task step omissions, and is associated with lower engagement in everyday behaviors, as suggested by physical activity levels and prolonged sedentary behavior. First evidence shows that physical and multi-domain interventions may improve ADL function, in general, but the evidence is confounded by motor aspects. Large multicenter randomized controlled trials with cognitive ADL function as primary outcome are needed to investigate which pharmacological and non-pharmacological interventions can effectively prevent or delay deterioration of cognitive ADL function, and ultimately the progression and conversion to PDD.