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      A Novel Exercise for Enhancing Visuospatial Ability in Older Adults with Frailty: Development, Feasibility, and Effectiveness

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          Abstract

          We aimed to develop a novel exercise to improve visuospatial ability and evaluate its feasibility and effectiveness in older adults with frailty. A non-randomized preliminary trial was conducted between June 2014 and March 2015. We recruited 35 adults with frailty (24 women), aged 66–92 years. Participants were assigned to either locomotive- or visuospatial-exercise groups. All participants exercised under the supervision of physiotherapists for 90 min/week for 12 weeks. The visuospatial exercise participants used cubes with six colored patterns and were instructed to “reproduce the same colored pattern as shown in the photo”, using the cubes. In the locomotive exercise group, lower extremity functional training was provided. Rates of retention and attendance measured feasibility. Most participants completed the intervention (77.3%, locomotive; 84.6%, visuospatial) and had good attendance (83.8%, locomotive; 90.7%, visuospatial). Mini-mental state examination (MMSE), clock drawing test (CDT), and seven physical performance tests were conducted before and after interventions. The improvement in the MMSE score, qualitative analysis of CDT, grip strength, and sit and reach assessments were significantly greater in the visuospatial exercise group than in the locomotive exercise group. The cube exercise might be a feasible exercise program to potentially improve visuospatial ability and global cognition in older adults with frailty.

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          Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability.

          Functional assessment is an important part of the evaluation of elderly persons. We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons. This prospective cohort study included men and women 71 years of age or older who were living in the community, who reported no disability in the activities of daily living, and who reported that they were able to walk one-half mile (0.8 km) and climb stairs without assistance. The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later. The tests included an assessment of standing balance, a timed 8-ft (2.4-m) walk at a normal pace, and a timed test of five repetitions of rising from a chair and sitting down. Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up, lower scores on the base-line performance tests were associated with a statistically significant, graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up. After adjustment for age, sex, and the presence of chronic disease, those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores, and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability. Among nondisabled older persons living in the community, objective measures of lower-extremity function were highly predictive of subsequent disability. Measures of physical performance may identify older persons with a preclinical stage of disability who may benefit from interventions to prevent the development of frank disability.
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            Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia: A meta-analysis

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              A Randomized Controlled Trial of Multicomponent Exercise in Older Adults with Mild Cognitive Impairment

              Background To examine the effect of multicomponent exercise program on memory function in older adults with mild cognitive impairment (MCI), and identify biomarkers associated with improvement of cognitive functions. Methodology/Principal Findings Subjects were 100 older adults (mean age, 75 years) with MCI. The subjects were classified to an amnestic MCI group (n = 50) with neuroimaging measures, and other MCI group (n = 50) before the randomization. Subjects in each group were randomized to either a multicomponent exercise or an education control group using a ratio of 1∶1. The exercise group exercised for 90 min/d, 2 d/wk, 40 times for 6 months. The exercise program was conducted under multitask conditions to stimulate attention and memory. The control group attended two education classes. A repeated-measures ANOVA revealed that no group × time interactions on the cognitive tests and brain atrophy in MCI patients. A sub-analysis of amnestic MCI patients for group × time interactions revealed that the exercise group exhibited significantly better Mini-Mental State Examination (p = .04) and logical memory scores (p = .04), and reducing whole brain cortical atrophy (p<.05) compared to the control group. Low total cholesterol levels before the intervention were associated with an improvement of logical memory scores (p<.05), and a higher level of brain-derived neurotrophic factor was significantly related to improved ADAS-cog scores (p<.05). Conclusions/Significance The results suggested that an exercise intervention is beneficial for improving logical memory and maintaining general cognitive function and reducing whole brain cortical atrophy in older adults with amnestic MCI. Low total cholesterol and higher brain-derived neurotrophic factor may predict improvement of cognitive functions in older adults with MCI. Further studies are required to determine the positive effects of exercise on cognitive function in older adults with MCI. Trial Registration UMIN-CTR UMIN000003662 ctr.cgi?function = brows&action = brows&type = summary&recptno = R000004436&language = J.
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                Author and article information

                Journal
                Geriatrics (Basel)
                Geriatrics (Basel)
                geriatrics
                Geriatrics
                MDPI
                2308-3417
                03 May 2020
                June 2020
                : 5
                : 2
                : 29
                Affiliations
                [1 ]Dementia Medical Center, University of Tsukuba Hospital, Tsukuba 3058575, Japan
                [2 ]Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo 1730015, Japan; hiroyuki.sasai@ 123456gmail.com
                [3 ]Upten Health Support, Tsukuba 3050047, Japan; yabushita-noriko@ 123456upten.jp
                [4 ]School of Health and Physical Education, University of Tsukuba, Tsukuba 3058577, Japan; keito19920904@ 123456gmail.com
                [5 ]Department of Occupational Therapy, Ibaraki Prefectural University of Health Sciences, Ami 3000394, Japan; hotta@ 123456ipu.ac.jp (K.H.); yoshihiko.fujita@ 123456gmail.com (Y.F.)
                [6 ]Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba 3058577, Japan; kth3442@ 123456gmail.com
                [7 ]Faculty of Human Sciences, Shimane University, Matsue 6900823, Japan; tsujimoto@ 123456hmn.shimane-u.ac.jp
                [8 ]Faculty of Medicine, University of Tsukuba, Tsukuba 3058575, Japan; 4632tetsu@ 123456md.tsukuba.ac.jp
                [9 ]Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 3058577, Japan; tanaka.kiyoji.ft@ 123456u.tsukuba.ac.jp
                Author notes
                [* ]Correspondence: miyuki.nemoto@ 123456md.tsukuba.ac.jp ; Tel.: +81-29-853-8069
                Author information
                https://orcid.org/0000-0002-1969-5098
                https://orcid.org/0000-0001-8120-6163
                Article
                geriatrics-05-00029
                10.3390/geriatrics5020029
                7345634
                32375239
                2af2689f-1d51-456b-8bd7-a040897ae91c
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 26 February 2020
                : 02 May 2020
                Categories
                Article

                cube exercise,visuospatial ability,frailty
                cube exercise, visuospatial ability, frailty

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