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      Double-task exercise programmes to strengthen cognitive and vascular health in older adults at risk of cognitive decline: protocol for a randomised clinical trial

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          Abstract

          Introduction

          Cognitive and physical declines are frequent causes of disability among older adults (OAs) in Mexico that imposes significant burden on the health system and OAs’ families. Programmes to prevent or delay OAs’ cognitive and physical decline are scarce.

          Methods and analysis

          A double-blind randomised clinical trial will be conducted. The study will aim to evaluate two 24-week double-task (aerobic and cognitive) square-stepping exercise programmes for OAs at risk of cognitive decline—one programme with and another without caregiver participation—and to compare these with an aerobic-balance-stretching exercise programme (control group). 300 OAs (100 per group) affiliated with the Mexican Institute of Social Security (IMSS) between 60 and 65 years of age with self-reported cognitive concerns will participate. They will be stratified by education level and randomly allocated to the groups. The intervention will last 24 weeks, and the effect of each programme will be evaluated 12, 24 and 52 weeks after the intervention. Participants’ demographic and clinical characteristics will be collected at baseline. The outcomes will include: (1) general cognitive function; (2) specific cognitive functions; (3) dual-task gait; (4) blood pressure; (5) carotid intima–media thickness; (6) OAs’ health-related quality of life; and (7) caregiver burden. The effects of the interventions on each outcome variable will be examined using a repeated-measures analysis of variance (ANOVA), with study groups as the between-subjects variable and time as the within-subject variable.

          Ethics and dissemination

          The study was approved by the IMSS Ethics and Research Committees (registration number: 2018-785-095). All participants will sign a consent form prior to their participation. The study results will be disseminated to the IMSS authorities, healthcare providers and the research community.

          Trial registration number

          ClinicalTrials.gov (NCT04068376).

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          Most cited references52

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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            Long-term effects of cognitive training on everyday functional outcomes in older adults.

            Cognitive training has been shown to improve cognitive abilities in older adults but the effects of cognitive training on everyday function have not been demonstrated. To determine the effects of cognitive training on daily function and durability of training on cognitive abilities. Five-year follow-up of a randomized controlled single-blind trial with 4 treatment groups. A volunteer sample of 2832 persons (mean age, 73.6 years; 26% black), living independently in 6 US cities, was recruited from senior housing, community centers, and hospitals and clinics. The study was conducted between April 1998 and December 2004. Five-year follow-up was completed in 67% of the sample. Ten-session training for memory (verbal episodic memory), reasoning (inductive reasoning), or speed of processing (visual search and identification); 4-session booster training at 11 and 35 months after training in a random sample of those who completed training. Self-reported and performance-based measures of daily function and cognitive abilities. The reasoning group reported significantly less difficulty in the instrumental activities of daily living (IADL) than the control group (effect size, 0.29; 99% confidence interval [CI], 0.03-0.55). Neither speed of processing training (effect size, 0.26; 99% CI, -0.002 to 0.51) nor memory training (effect size, 0.20; 99% CI, -0.06 to 0.46) had a significant effect on IADL. The booster training for the speed of processing group, but not for the other 2 groups, showed a significant effect on the performance-based functional measure of everyday speed of processing (effect size, 0.30; 99% CI, 0.08-0.52). No booster effects were seen for any of the groups for everyday problem-solving or self-reported difficulty in IADL. Each intervention maintained effects on its specific targeted cognitive ability through 5 years (memory: effect size, 0.23 [99% CI, 0.11-0.35]; reasoning: effect size, 0.26 [99% CI, 0.17-0.35]; speed of processing: effect size, 0.76 [99% CI, 0.62-0.90]). Booster training produced additional improvement with the reasoning intervention for reasoning performance (effect size, 0.28; 99% CI, 0.12-0.43) and the speed of processing intervention for speed of processing performance (effect size, 0.85; 99% CI, 0.61-1.09). Reasoning training resulted in less functional decline in self-reported IADL. Compared with the control group, cognitive training resulted in improved cognitive abilities specific to the abilities trained that continued 5 years after the initiation of the intervention. clinicaltrials.gov Identifier: NCT00298558.
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              Fitness effects on the cognitive function of older adults: A Meta-Analytic study

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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2020
                30 December 2020
                : 10
                : 12
                : e039723
                Affiliations
                [1 ]departmentEpidemiology and Health Services Research Unit CMN Siglo XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [2 ]departmentMedical Research Unit in Nutrition, Pediatrics Hospital, National Medical Center Century XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [3 ]departmentSchool of Rehabilitation Sciences, Faculty of Health Sciences , McMaster University , Hamilton, Ontario, Canada
                [4 ]departmentRehabilitation Service, Specialty Hospital, National Medical Center Century XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [5 ]departmentCardiology Service, Specialty Hospital, National Medical Center Century XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [6 ]departmentImage Service, Specialty Hospital, National Medical Center Century XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [7 ]departmentContinuous Admission Service, Specialty Hospital, National Medical Center Century XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [8 ]departmentDivision of Occupational Risk Prevention. Occupational Health Coordination , Mexican Institute of Social Security , Mexico City, Mexico
                [9 ]departmentMedical Research Unit in Neurological Diseases, National Medical Center Century XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [10 ]departmentResearch Unit in Endocrine Diseases, National Medical Center Century XXI , Mexican Institute of Social Security , Mexico City, Mexico
                [11 ]departmentCoordination of Health Education , Mexican Institute of Social Security , Mexico City, Mexico
                [12 ]departmentAragón School of Higher Education , National Autonomous University of Mexico , Mexico City, Mexico
                [13 ]departmentFaculty of Education , Mie University , Tsu, Mie, Japan
                Author notes
                [Correspondence to ] Dr Svetlana V Doubova; svetlana.doubova@ 123456gmail.com
                Author information
                http://orcid.org/0000-0002-0521-7095
                Article
                bmjopen-2020-039723
                10.1136/bmjopen-2020-039723
                7780518
                33380479
                f7551172-afcc-4cba-b7f3-ef348f40448a
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 27 April 2020
                : 18 November 2020
                : 26 November 2020
                Categories
                Geriatric Medicine
                1506
                1698
                Protocol
                Custom metadata
                unlocked

                Medicine
                geriatric medicine,mental health,preventive medicine
                Medicine
                geriatric medicine, mental health, preventive medicine

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