# Exercise as it relates to Disease/The Potential for Dementia Prevention utilising Multimodal Activity Intervention in the Mildly Cognitively Impaired

For some of us the ageing process will involve the reduction and/or loss of cognition. This critique examines the feasibility of using the 'ThinkingFit' program to slow the progress of cognitive impairment as we age. This fact sheet has been prepared by student 3079063 as part of the Health, Disease and Exercise Unit, University of Canberra.
The paper: A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment-ThinkingFit: pilot and feasibility study for a randomised controlled trial. BMS Psychiatry. 2014; 14:129.

## What Is The Background To This Research?

Dementia is a collective term used for a number of chronic conditions that effect the functioning of the brain. Over time, increasing declines occur in brain function, affecting memory, problem solving ability, and emotional, social and behavioural issues. Dementia is a terminal condition with an estimated 47.5 million people worldwide living with dementia, including 353,800 Australian’s.
Approximately half of all dementia cases can be attributed to physical inactivity, cognitive inactivity, obesity, diabetes and hypertension. The risk of developing dementia later in life can be reduced significantly with regular engagement in physical, social and mental activities during mid-life.
Research suggests there is a greater likelihood for dementia to progress from a state of mild cognitive impairment (MCI) compared to progression from a non-impaired healthy baseline. The progressive nature of dementia potentially offers opportunity for individuals suffering MCI to benefit from programmes that regularly engage physical, mental and social activity.

## Where is the research from?

This study was carried out in England with support and sponsorship from North Essex Partnership University NHS Foundation Trust and the UK Dementia and Neurodegenerative Diseases Research Network. Some authors were employees of the Foundation, while others have academic appointments at the University College London, the University of Hertfordshire, and the Istanbul Bilgi University, Istanbul, Turkey. There were no competing interests arising from this research.

## What kind of research was this?

This study was an open label pilot and feasibility study testing the design of a specific programme as an effective multimodal intervention for improving dementia risk outcomes. Dependent upon the engagement and adherence outcomes, intentions were for the design to be used in future randomised control trials.
An open label study is a type of clinical study where participants and researchers are aware which treatment is being administered. In this study participants worked under the guidance of researchers and support staff.

## What did the research involve?

A rigorous selection process sourced participants from local memory clinics. Experts conducted MCI diagnosis, and considerations were given to safety and physical activity risk.
The study involved a 12 week control period, in which a 4 week preparation phase was undertaken followed by a 12 week intervention period. Four weeks prior to the end of the control period “Do Something Different” (DSD) activities were introduced to increase activity adherence prospects. During the intervention period subjects participated in regular (minimum 3 times per week) moderate intensity physical activity, weekly group based cognitive stimulation training (GCST), and regular (three times per week) individual cognitive stimulation training (ICST). Physical, neuropsychological and quality of life measures were taken at the commencement of the control period and repeated after 6–12 weeks of control treatment, and after 12 weeks of the intervention treatment.
Researches sought to address limitations of previous research design which included adherence and maintenance factors, drop out due to falls and/or adverse events, and inaccuracy of self-reporting physical activity data. They achieved this by facilitating behavioural change; improving motivation through group association, enjoyment and engagement; and using skilled support staff for supervision of physical activities and collection of heart rate data during physical activity.
The improvements seen in cognitive measures in this study may have been directly impacted by the DSD activity, however, the exposure to this activity was short, and more likely contributed to the high adherence rates of the intervention.

## What were the basic results?

Intervention activity adherence rates were high, providing a strong case for future multimodal interventions of this design for MCI sufferers.
| Activity | % Adherence |
| DSD activity | 83% |
| Physical activity | 71% |
| GCST activity | 83% |
| ICST activity | 67% |
Table 1: Adherence rates
The results of the study demonstrated:
* Elderly patients with MCI were able to safely engage in a complex activity intervention,
* High adherence rates for activity are possible in elderly patients with previously low levels of physical activity,
* Improvements occurred in physical fitness, and
* Cognitive outcomes either remained stable during the control period and improved following the intervention, or deteriorated during the control period and remained stable or improved following the intervention.
Even during a relatively brief period of multimodal activity, improvements in cognitive outcomes for MCI patients were achieved and measures of physical health and cardiovascular fitness improved.

## What conclusions can we take from this research?

This preliminary research into the efficacy of a specifically designed protocol has produced very promising results for improving dementia risk factors in patients who already suffer MCI.
This study supports and extends existing research by demonstrating that engagement in a combination of regular physical activity, mental stimulation and social interaction, with professional support can slow the progression of the MCI, thus reducing the risk of dementia. In addition, the design of the programme complimented the intervention outcome with high levels of adherence in each activity. These findings strongly support the establishment of randomised control trials and subsequent long term implementation of the intervention for the benefit of MCI sufferers.
Although the multimodal intervention in this study was resource intensive and costly, it was considered that, in comparison to the compounding future costs of healthcare related to this condition, the intervention expense was relatively small.
The intervention in this study is a relatively safe proposal, which improved quality of life and functional ability for the individual without the use of pharmacology.

## Practical advice

Making changes to our lifestyle in mid-life to incorporate regular moderate intensity exercise, mental stimulation and social engagement can provide protection from numerous later in life health complications, including the prevention of dementia.
It is never too late to start exercising the body and the mind.

## Further information/resources

Links to further information on the topic of exercise, lifestyle and dementia appear below:
* Alzheimer's Disease International: http://www.alz.co.uk/
* Alzheimer's Australia: https://www.fightdementia.org.au/
* Research in the role of nutrition and the prevention of dementia: Swaminathan, A., & Jicha, G. A. (2014). Nutrition and prevention of Alzheimer’s dementia. Frontiers in Aging Neuroscience, 6, 282.

## Reference List

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Dannhauser, M. Cleverley, M., Whitfield, T.J., Fletcher, B., Stevens, T., & Walker, Z. (2014). A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment-ThinkingFit: pilot and feasibility study for a randomised control trial. BMC Psychiatry, 14, 129
* ↑ Abbey, J. (2013). Wrestling with dementia and death (Alzheimer's Australia Paper 34). Australia.
* 1 2 World Health Organisation. (2015). 10 facts on dementia [cited 2016 09 27. Available from: http://www.who.int/features/factfiles/dementia.
* ↑ Alzheimer's Australia (2016). Health Professional’s Introduction Fact Sheet. Retrieved from Alzheimer’s Australia website: https://www.fightdementia.org.au.
* ↑ Barnes, D. E., & Yaffe, K. (2011). The projected effect of risk factor reduction on alzheimer’s disease prevalence. Lancet Neurol, 10(9), 819-828
* ↑ Hamer, M., & Childa, Y. (2009). Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med, 39(1), 3-11
* ↑ Karp, A., Paillard-Borg, S., Wang, H., Silverstein, M., Winbald, B., Fratiglioni, L. (2006). Mental, physical and social components in leisure activities equally contribute to decrease dementia risk. Dement Geriatr Cogn Discord, 21(2), 65-73
* ↑ Mitchell, A.J., Shiri-Feshki, M. (2009). Rate of progression of mild cognitive impairment to dementia-meta-analysis of 41 robust inception cohort studies. Acta Psychiatrica Scandinavcia, 119(4), 252-265
* ↑ Tak, E.C., van Uffelen, J. G., Paw, M. J., van Mechelen, W., Hopman-Rock, M. (2012). Adherence to exercise programs and determinants of maintenance in older adults with mild cognitive impairment. Journal of Aging Physiology Act, 20(1), 32-46.
* ↑ Bossers, W., van der Woude, L., Boersma, F., Horotobágyi, T., Scherder, E., van Heuvelen, M. (2015). A 9-Week Aerobic and Strength Training Program Improves Cognitive and Motor Function in Patients with Dementia: A Randomized, Controlled Trial. The American Journal of Geriatric Psychiatry, 23(11),1106-16.