Exercise is medicine, for the body and the brain Nutritional Intervention as a Preventive Approach for Cognitive-Related Outcomes in Cognitively Healthy Older Adults: A Systematic Review. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults? A systematic review protocol Changing everyday memory behaviour in amnestic mild cognitive impairment: A randomised controlled trial A randomised control trial of the cognitive effects of working in a seated as opposed to a standing position in office workers Energy balance-related behaviours associated with overweight and obesity in preschool children: a systematic review of prospective studies. Examining the theory‐effectiveness hypothesis: A systematic review of systematic reviews Higher levels of objectively measured sedentary behavior is associated with worse cognitive ability: Two-year follow-up study in community-dwelling older adults Impact of aerobic exercise on neurobehavioral outcomes. A complex multimodal activity intervention to reduce the risk of dementia in mild cognitive impairment–ThinkingFit: pilot and feasibility study for a randomized controlled trial Knowledge May Not Be the Best Target for Strategies to Influence Evidence-Based Practice: Using Psychological Models to Understand RCT Effects Dietary Factors and Cognitive Decline. Dietary Patterns and Cognitive Health in Older Adults: A Systematic Review. Psychosocial interventions for people with dementia: An overview and commentary on recent developments Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older A behaviour change intervention to reduce sedentary time in people with chronic obstructive pulmonary disease: protocol for a randomised controlled trial. Theoretical exploration of the neural bases of behavioural disinhibition, apathy and executive dysfunction in preclinical Alzheimer's disease in people with Down's syndrome: potential involvement of multiple frontal-subcortical neuronal circuits. Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol Clinical practice with anti-dementia drugs: a revised (second) consensus statement from the British Association for Psychopharmacology Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer’s Disease, and Dementia: From FINGER to World-Wide FINGERS Effectiveness of workplace interventions in rehabilitating musculoskeletal disorders and preventing its consequences among workers with physical and sedentary employment: systematic review protocol Tryptophan depletion impairs stimulus-reward learning while methylphenidate disrupts attentional control in healthy young adults: implications for the monoaminergic basis of impulsive behaviour Determinants of weight loss maintenance: a systematic review.
Cognitive decline is one of the most pressing healthcare issues of the 21st century . Worldwide , one new case of major cognitive decline ( ie , dementia ) is detected every 4 s.1 Given that no effective pharmacological treatment to alter the progress of cognitive decline exists , there is much interest in lifestyle approaches for preventing or treating dementia . Ideally , such strategies should be cost-efficient and widely accessible at a societal level to have the largest benefit for older adults with varying income and functional status levels . One attractive solution that aligns with the above criteria is exercise . However , despite a large and consistent pool of evidence generated over the past five decades linking exercise to improved cognitive functions in older adults,2 there is a reluctance among academics , healthcare practitioners and the public alike to embrace exercise as a prevention and treatment strategy for cognitive decline . For example , the National Institutes of Health ( NIH ) consensus statement from 20103 concedes that there appears to be preliminary data to support the efficacy of exercise in improving cognitive function . However , they caution that there is currently no strong evidence to suggest that modifiable lifestyle factors can alter the trajectory of cognitive decline . Adding fuel to the fire are publications such as a 2013 systematic review of r and omised controlled trials ( RCTs ) ( prior to 31 October 2011 ) reporting ‘ weak ’ evidence for the effects of exercise on cognition.4 We must highlight that the search strategy used in that systematic review failed to capture many pertinent papers providing evidence from RCTs that exercise  promotes cognitive and brain plasticity not only in healthy older adults but also in those with cognitive impairment . Furthermore , there are a number of animal studies that provide insight into the molecular and cellular mechanisms by which exercise  promotes neuroplasticity.5 In a previous commentary , The link diet-cognitive function/dementia has been largely investigated in observational studies ; however , there was a lack of evidence from r and omized clinical trials ( RCTs ) on the prevention of late-life cognitive disorders though dietary intervention in cognitively healthy older adults . In the present article , we systematic ally review ed RCTs published in the last four years ( 2014 - 2017 ) exploring nutritional intervention efficacy in preventing the onset of late-life cognitive disorders and dementia in cognitively healthy subjects aged 60 years and older using different levels of investigation ( i.e. , dietary pattern changes/medical food/nutraceutical supplementation/multidomain approach and dietary macro- and micronutrient approaches ) as well as possible underlying mechanisms of nutritional prevention . From the 35 included RCTs , there was moderate evidence that intervention through dietary pattern changes , medical food/nutraceutical supplementation , and multidomain approach improved specific cognitive domains or cognitive-related blood biomarkers . There was high evidence that protein supplementation improved specific cognitive domains or functional status in prefrail older adults without effect on cognitive function . For fatty acid supplementation , mainly long-chain polyunsaturated fatty acids , there was emerging evidence suggesting an impact of this approach in improving specific cognitive domains , magnetic resonance imaging ( MRI ) findings , and /or cognitive-related biomarkers also in selected subgroups of older subjects , although some results were conflicting . There was convincing evidence of an impact of non-flavonoid polyphenol and flavonoid supplementations in improving specific cognitive domains and /or MRI findings . Finally , there was only low evidence suggesting efficacy of intervention with homocysteine-related and antioxidant vitamins in improving cognitive functions , dementia incidence , or cognitive-related biomarkers in cognitively healthy older subjects Introduction Large proportions of the population are not meeting recommended levels of physical activity and have increasingly sedentary lifestyles . Low levels of physical activity are predictive of poor health outcomes and time spent sedentary is related to a host of risk factors independently of physical activity levels . Building an evidence base of the best approaches to intervene in the lifestyles of inactive individuals is crucial in preventing long-term disease , disability and higher mortality rates . Methods and analysis Systematic search es will be conducted on all relevant data bases ( eg , PubMed , Scopus , CINAHL , PsycINFO ) . Studies will be included if they assess interventions aim ed at changing physical activity or sedentary behaviour levels in adults ( over 18 ) who are inactive and do not suffer from chronic conditions . Studies must also be r and omised controlled trials ( RCTs ) , have a primary outcome of physical activity or sedentary behaviour , and measure outcomes at least 6 months after intervention completion . Studies will be coded using the Behaviour Change Technique ( BCT ) taxonomy v1 and Template for Intervention Description and Replication ( TIDieR ) guidelines . 2 review ers will independently screen full-text articles and extract data on study characteristics , participants , BCTs , intervention features and outcome measures . Study quality will also be assessed independently by 2 review ers using the Cochrane risk of bias tool . A meta- analysis will be considered if there is sufficient homogeneity across outcomes . GRADE criteria will be used to assess quality of evidence . Dissemination This will be the first review to systematic ally appraise interventions aim ed at changing the physical activity or sedentary behaviour of inactive individuals using RCT design s with a 6-month follow-up post-intervention . This review will better inform intervention design ers targeting inactive population s and inform the design of a future complex intervention . Review registration number This protocol was registered with the International Prospect i ve Register of Systematic Review s ( PROSPERO ) on 17 October 2014 ( registration number : CRD42014014321 ) One of the defining differences between mild cognitive impairment ( MCI ) and dementia is the degree of independence in everyday activities . Effecting memory-related behavioural change in MCI could help maintain daily function and prolong the time before onset of dependency . However , it is well known that changing previously well-established behaviours is difficult to achieve . We conducted a r and omised controlled trial to evaluate the effectiveness of a multidisciplinary group-based intervention programme in changing everyday memory behaviour in individuals with amnestic MCI . The intervention provided evidence d-based memory training and lifestyle education to optimise memory behaviour .  Fifty-four participants were r and omly assigned to treatment or waitlist-control conditions . Consistent with our primary goal , treatment participants showed an increase in memory- strategy knowledge and use from pre-test to immediate post-test , and these gains were maintained at three-month post-test relative to waitlist controls . There were no group differences in memory beliefs or on laboratory tests of objective memory performance . The increase in memory- strategy knowledge and use was associated with the degree of participation in the programme . Individuals with MCI , therefore , can acquire and maintain knowledge about memory strategies and , importantly , can change their everyday memory behaviour by putting this knowledge into practice . This incorporation of practical memory strategies into daily routines could potentially provide the means for maintaining functional independence by individuals with MCI , an issue to be addressed in future research Abstract Sedentary behaviour is increasing and has been identified as a potential significant health risk , particularly for desk-based employees . The development of sit-st and workstations in the workplace is one approach to reduce sedentary behaviour . However , there is uncertainty about the effects of sit-st and workstations on cognitive functioning .  A sample of 36 university staff participated in a within-subjects r and omised control trial examining the effect of sitting vs. st and ing for one hour per day for five consecutive days on attention , information processing speed , short-term memory , working memory and task efficiency . The results of the study showed no statistically significant difference in cognitive performance or work efficiency between the sitting and st and ing conditions , with all effect sizes being small to very small ( all ds < .2 ) . This result suggests that the use of sit-st and workstations is not associated with a reduction in cognitive performance . Practitioner Summary : Although it has been reported that the use of sit-st and desks may help offset adverse health effects of prolonged sitting , there is scant evidence about changes in productivity . This r and omised control study showed that there was no difference between sitting and st and ing for one hour on cognitive function or task efficiency in university staff The current review aim ed to systematic ally identify dietary , physical activity and sedentary behaviours in preschool children ( 4 - 6 years of age ) that are prospect ively related to overweight or obesity later in childhood . Prospect i ve studies published between January 1990 and June 2010 were selected from search es in PubMed , EMBASE , PsycINFO , CINAHL and Cochrane Library . Studies examining the prospect i ve association between at least one relevant behaviour measured during preschool period ( children aged 4 - 6 years at baseline ) in relation to at least one anthropometric measurement at follow-up ( age < 18 years ) were included . Harvest plots were used to summarize the results and draw conclusions from the evidence . Of the 8,718 retrieved papers , 23 papers reporting on 15 different study sample s were included in this review . Strong evidence was found for an inverse association between total physical activity and overweight . Moderate evidence was observed for a positive association between television viewing and overweight . Because of the heterogeneity in the assessed dietary behaviours , insufficient evidence was found for an association between  dietary intake or specific dietary behaviours and overweight . These results suggest that interventions aim ing to prevent overweight among preschool children should focus on promotion of total physical activity and limitation of screen time and that further research is needed to establish whether and which dietary behaviours are important for obesity prevention in this age group . However , despite the lack of evidence for dietary behaviours from the present review , future interventions may already target specific dietary behaviours that are highly prevalent and for which there a clear rationale as well as preliminary evidence that these behaviours are associated with overweight PURPOSE Health interventions based on theory may be more effective than those that are not . This review of review s synthesizes all published r and omized controlled trial ( RCT ) meta-analytic evidence from the last decade to examine whether theory-based interventions were found to be associated with more effective  adult health behaviour change interventions . METHODS Systematic review s including meta-analyses were identified by search ing Medline , CINAHL , PsycINFO , and CDSR . A narrative synthesis was used to summarize and analyse the evidence . Only review s including RCTs of health behaviour change interventions with adults aged 18 + published from 2007 to 2017 were included . RESULTS Of 8,659 articles , nine systematic review s met inclusion criteria . The majority of review s ( n = 8) suggested no increased effectiveness for theory-based compared to non-theory-based interventions for effectiveness of outcomes relating to health behaviour . Less than half of the RCTs included in the review s reported the use of theory ( 85/183 ) . Two review s suggested interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Method ological and reporting issues limit the conclusions . CONCLUSIONS Theory-based interventions as currently operationalized in systematic review s were not found to be more effective than non-theory-based interventions . Method ological and reporting issues at study and review level may not reflect the true utility of theory use within health behaviour interventions . The promotion of theory use may benefit from using a multifaceted argument , rather than a narrow focus of increased effectiveness . Statement of contribution What is already known on this subject ? Theory use is regularly promoted by cl aim ing that it will lead to more effective behaviour change interventions . Theory use has been frequently linked to effectiveness within systematic review s of behaviour change interventions . The theory-effectiveness hypothesis has not been systematic ally examined at the systematic review level . What does this study add ? Theory use as operationalized by systematic review authors was not associated with increased effectiveness within systematic review s examining r and omized controlled trials of behaviour change interventions in adults . Interventions based on control theory , motivational interviewing , or self-determination theory were associated with greater effectiveness for physical activity and /or dietary interventions and outcomes . Theory use should be promoted using a multifaceted argument , and assertions for increased effectiveness of theory-based interventions should only be used in domains where specific evidence exists to support this cl aim Background : A number of cross‐sectional studies have suggested that higher levels of  sedentary behavior ( SB ) are associated with worse cognitive abilities  in older age . There is a paucity of longitudinal studies investigating this relationship utilizing objective ly assessed SB . This study investigated the relationship between objective ly assessed SB and future cognitive abilities in a cohort of older adults . Methods : A longitudinal study over 22.12 ± 1.46 months including 285 community‐dwelling older adults across 14 regions in Taiwan was undertaken . Cognitive ability was ascertained using a Chinese version of the Ascertain Dementia 8‐item Question naire ( AD8 ) and SB captured by 7 days accelerometer data . Multivariable negative binomial regression models adjusted for confounders were undertaken . Results : 274 community‐dwelling older adults finished the study ( age = 74.6 ± 6.2 , % female = 54.4 % ) . At baseline , 20.1 % ( n = 55 ) , 48.5 % ( n = 133 ) and 31.4 % ( n = 86 ) of the sample engaged in high ( 11 + h ) , medium ( 7–10.99 h ) and low ( < 7 h ) of SB respectively . In the fully adjusted model , higher levels of SB were associated with an increased risk of worse cognitive ability at follow up ( adjusted rate ratio (ARR)1.09 ( 95%CI:1.00–1.19 ) ) , with the strongest relationship evident in those engaging in over 11 h of SB ( ARR 2.27 ( 95%CI:1.24–4.16 ) ) . The relationship remained evident after adjusting for depressive symptoms and physical activity . Conclusion : Our data suggests that objective ly assessed SB , particularly when over 11 h a day , is independently associated with worse cognitive ability over a two year period . Our data adds to the pressing reasons to reduced SB in older age . HighlightsFirst prospect i ve study to investigate objective  ly sedentary behavior ( SB ) and cognition in older adults . Higher levels of objective SB were independently associated with worse cognitive ability over two years . This relationship was most pronounced in older people spending over 11 h a day being sedentary Numerous studies have examined the relationship between physical activity and cognitive function , demonstrating that greater physical activity is associated with lower incidence of cognitive impairment in later life . Due to an increasingly large number of older adults at risk for cognitive impairment , the relationship between physical activity and cognition has garnered increasing public health relevance and multiple r and omized trials have demonstrated that exercise interventions among sedentary adults improve cognitive performance in multiple domains of function . This article will examine the relationship between physical activity and cognitive function by review ing several different areas of literature , including the prevalence of cognitive impairment , assessment methods , observational studies examining physical activity and cognition , and intervention studies . The present review is intended to provide a historical tutorial of existing literature linking  physical activity , exercise , and cognitive function among both healthy and clinical population Background Dementia affects 35 million people worldwide and is currently incurable . Many cases may be preventable because regular participation in physical , mental and social leisure activities during middle age is associated with up to 47 % dementia risk reduction . However , the majority of middle-aged adults are not active enough . MCI is therefore a clear target for activity interventions aim ed at reducing dementia risk . An active lifestyle during middle age reduces dementia risk but it remains to be determined if increased activity reduces dementia risk when MCI is already evident . Before this can be investigated conclusively , complex multimodal activity programmes are required that ( 1 ) combine multiple health promoting activities , ( 2 ) engage people with MCI , and ( 3 ) result in sufficient adherence rates . Methods We design ed the ThinkingFit programme to engage  people with MCI  in a complex intervention comprised of three activity components : physical activity , group-based cognitive stimulation ( GCST ) and individual cognitive stimulation ( ICST ) . Engagement and adherence was promoted by applying specific psychological techniques to enhance behavioural flexibility in an early pre-phase and during the course of the intervention . To pilot the intervention , participants served as their own controls during a 6- to 12-week run-in period , which was followed by 12 weeks of activity intervention . Results Out of 212 MCI patients screened , 163 were eligible , 70 consented and 67 completed the intervention ( mean age 74 years ) .  Activity adherence rates were high : physical activity = 71 % ; GCST = 83 % ; ICST = 67 % . Significant treatment effects ( p < .05 ) were evident on physical health outcomes ( decreased BMI and systolic blood pressure , [ pre/post values of 26.3/25.9 kg/m2 and 145/136 mmHg respectively ] ) , fitness ( decreased resting and recovery heart rate [ 68/65 bpm and 75/69 bpm ] ) , and cognition ( improved working memory [ 5.3/6.3 items ] ) . Conclusions We found satisfactory recruitment , retention and engagement rates , coupled with significant treatment effects in elderly MCI patients . It appears feasible to conduct r and omized controlled trials of the dementia prevention potential of complex multimodal activity programmes like ThinkingFit . Trial registration Clinical Trials.gov registration nr : NCT01603862 ; date : 17/5/2012 Background Interventions to enhance the implementation of evidence -based practice have a varied success rate . This may be due to a lack of underst and ing of the mechanism by which interventions achieve results . Purpose Use psychological models to further an underst and ing of trial effects by piggy-backing on a r and omised controlled trial testing 2 interventions ( Audit & Feedback and Computer-aided Learning ) in relation to evidence -based third molar management . Method All participants of the parent trial ( 64 General Dental Practitioners across Scotl and ) , regardless of intervention group , were invited to complete a question naire assessing knowledge and predictive measures from Theory of Planned Behaviour and Social Cognitive Theory . The main outcome was evidence -based extracting behaviour derived from patient records . Results Neither intervention significantly influenced behaviour in the parent trial . This study revealed that the interventions did enhance knowledge , but knowledge did not predict extraction behaviour . However , the interventions did not influence variables that did predict extraction behaviour ( attitude , perceived behavioural control , self-efficacy ) . Results suggest both interventions failed because neither influenced possible mediating beliefs for the target behavior . Conclusion Using psychology models eluci date d intervention effects and allowed the identification of factors associated with evidence based practice , providing the basis for improving future intervention design Cognitive decline is an increasingly important public health problem , with more than 100 million adults worldwide projected to develop dementia by 2050 . Accordingly , there has been an increased interest in preventive strategies that diminish this risk . It has been recognized that lifestyle factors including dietary patterns , may be important in the prevention of cognitive decline and dementia in later life . Several dietary components have been examined , including antioxidants , fatty acids , and B vitamins . In addition , whole dietary eating plans , including the Mediterranean diet ( MeDi ) , and the Dietary Approaches to Stop Hypertension ( DASH ) diet , with and without weight loss , have become areas of increasing interest . Although prospect i ve epidemiological studies have observed that antioxidants , fatty acids , and B vitamins are associated with better cognitive functioning , r and omized clinical trials have generally failed to confirm the value of any specific dietary component in improving neurocognition . Several r and omized trials have examined the impact of changing ' whole ' diets on cognitive outcomes . The MeDi and DASH diets offer promising preliminary results , but data are limited and more research in this area is needed While the role of diet and nutrition in cognitive health and prevention of dementia  in older adults has attracted much attention , the efficacy of different dietary patterns remains uncertain . Previous review s have mainly focused on the Mediterranean diet , but either omitted other dietary patterns , lacked more recent studies , were based on cross-sectional studies , or combined older and younger population s. We followed PRISMA guidelines , and examined the efficacy of current research from r and omized controlled trials and cohort studies on the effects of different dietary patterns . We review ed the Mediterranean diet , Dietary Approach to Stop Hypertension ( DASH ) diet , the Mediterranean-DASH diet Intervention for Neurodegenerative Delay ( MIND ) diet , Anti-inflammatory diet , Healthy diet recommended by guidelines via dietary index , or Prudent healthy diets generated via statistical approaches , and their impact on cognitive health among older adults . Of 38 studies , the Mediterranean diet was the most investigated with evidence supporting protection against cognitive decline among older adults . Evidence from other dietary patterns such as the MIND , DASH , Anti-inflammatory , and Prudent healthy diets was more limited but showed promising results , especially for those at risk of cardiovascular disease . Overall , this review found positive effects of dietary patterns including the Mediterranean , DASH , MIND , and Anti-inflammatory diets on cognitive health outcomes in older adults . These dietary patterns are plant-based , rich in poly- and mono-unsaturated fatty acids with lower consumption of processed foods . Better underst and ing of the underlying mechanisms and effectiveness is needed to develop comprehensive and practical dietary recommendations against age-related cognitive decline among older adult An influential review in 2010 concluded that non-pharmacological multi-component interventions have positive effects on cognitive functioning , activities of daily living , behaviour and mood of people with dementia . Our aim here is to provide an up-to- date overview of research into psychosocial interventions and their impact on psychosocial outcomes . We focused on r and omised controlled trials , controlled studies and review s published between October 2008 and August 2015 , since the earlier review . The search of PsychInfo , Medline and the Cochrane data base of systematic review s yielded 61 relevant articles , organised into four themes echoing key phases of the care pathway : Living at home with dementia ( five review s , eight studies ) , carer interventions ( three review s , four studies ) , interventions in residential care ( 16 review s , 12 studies ) and end-of-life care ( three review s , two studies ) , along with an additional group spanning community and institutional setting s ( six review s , two studies ) . Community findings suggested that appointment of dementia specialists and attention to case management can produce positive outcomes ;  physical therapies , cognitive training and modified cognitive behaviour therapy also had a range of benefits . There was more limited evidence of positive benefits for people with dementia through interventions with family carers . Thirty-two articles focused on the management of ‘ behavioural symptoms ’ through a range of interventions all of which had some evidence of benefit . Also a range of multi-component and specific interventions had benefits for cognitive , emotional and behavioural well-being of people with dementia in residential setting s , as well as for quality of life . Overall , interventions tended to be short term with impact only measured in the short term . We recommend further research on interventions to promote living well in the community post-diagnosis and to address end-of-life care . Development of psychosocial interventions would benefit from moving beyond the focus on control of behaviours to focus on wider aspects of life for people with dementia Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores INTRODUCTION Replacing sedentary behaviour with light intensity physical activity ( ie , activities classified as less than three metabolic equivalents , such as slow-paced walking ) may be a more realistic strategy for reducing cardiometabolic risk in people with chronic obstructive pulmonary disease than only aim ing to increase levels of moderate-vigorous intensity physical activity . Behaviour change interventions to reduce sedentary behaviour in people with chronic obstructive pulmonary disease have not yet been developed or tested . RESEARCH QUESTIONS Is a 6-week behaviour change intervention effective and feasible in reducing sedentary time in people with chronic obstructive pulmonary disease ? DESIGN This study will be a multi-centre , r and omised , controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis , comparing a 6-week behaviour change intervention aim ed at reducing sedentary time with a sham intervention in people with chronic obstructive pulmonary disease . PARTICIPANTS AND SETTING Seventy participants will be recruited from the waiting lists for pulmonary rehabilitation programs at Royal Prince Alfred Hospital and Prince of Wales Hospital , Sydney , Australia . INTERVENTION The behaviour change intervention aims to reduce sedentary time through a process of guided goal setting with participants to achieve two target behaviours : ( 1 ) replace sitting and lying down with light-intensity physical activity where possible , and ( 2 ) st and up and move for 2minutes after 30minutes of continuous sedentary time . Three face-to-face sessions and three phone sessions will be held with a physiotherapist over the 6-week intervention period . The ' capability ' , ' opportunity ' , ' motivation ' and ' behaviour ' ( COM-B ) model will be applied to each participant to determine which components of behaviour ( capability , opportunity or motivation ) need to change in order to reduce sedentary time . Based on this ' behavioural diagnosis ' , the Behaviour Change Wheel will be used to systematic ally select appropriate behaviour change techniques to assist participants in achieving their weekly goals . Behaviour change techniques will include providing information about the health consequences of sedentary behaviour , self-monitoring and review of weekly goals , problem-solving of barriers to achieving weekly goals , and providing feedback on sedentary time using the Jawbone UP3 activity monitor . CONTROL The sham intervention will consist of weekly phone calls for 6 weeks , to enquire whether the participants ' health status has changed over the intervention period ( eg , hospitalised for an acute exacerbation ) . No instructions regarding physical activity or exercise will be given . MEASUREMENTS Outcomes will be assessed at baseline , at the end of the 6-week intervention period , and at the 3-month follow-up . Primary outcome measures will be : ( 1 ) total sedentary time , including the pattern of accumulation of sedentary time , assessed by the activPAL3 activity monitor , and ( 2 ) feasibility of the intervention assessed by uptake and retention of participants , participant compliance , self-reported achievement of weekly goals , and adverse events . Secondary outcome measures will include functional exercise capacity , health-related quality of life , domain-specific and behaviour-specific sedentary time , patient activation , and anxiety and depression .  Semi-structured interviews will be conducted with participants who receive the behaviour change intervention to explore acceptability and satisfaction with the different components of the intervention . ANALYSIS Analysis of covariance ( ANCOVA ) will be used to calculate between-group comparisons of total sedentary time and the number of bouts of sedentary time>30minutes after adjusting baseline values . Uncertainty about the size of the mean between-group differences will be quantified with 95 % CI . Within-group comparisons will be examined using paired t-tests and described as mean differences with 95 % CIs . Secondary outcome measures will be analysed similarly . The feasibility measures will be analysed descriptively . Semi-structured interviews will be conducted until data saturation is achieved and there are no new emerging themes . De-identified interview transcripts will be coded independently by two research ers and analysed alongside data collection using the COM-B model as a thematic framework . DISCUSSION / SIGNIFICANCE If behaviour change interventions are found to be an effective and feasible method for reducing sedentary time , such interventions may be used to reduce cardiometabolic risk in people with chronic obstructive pulmonary disease . An approach that emphasises participation in light-intensity physical activity may increase the confidence and willingness of people with chronic obstructive pulmonary disease to engage in more intense physical activity , and may serve as an intermediate goal to increase uptake of pulmonary rehabilitation BACKGROUND Recent research has suggested a specific impairment in frontal-lobe functioning in the pre clinical stages of Alzheimer 's disease ( AD ) in people with Down 's syndrome ( DS ) , characterised by prominent changes in personality or behaviour . The aim of the current paper is to explore whether particular kinds of change ( namely executive dysfunction ( EDF ) , disinhibition and apathy ) , associated in the literature with disruption of different underlying frontal-subcortical circuits , are a ) more or less frequently reported than others and b ) related to poor performance on tasks involving different cognitive processes . METHOD Seventy-eight participants ( mean age 47 years , range 36 - 72 ) with DS and mild to moderate intellectual disability ( based on ICD-10 criteria ) , without a diagnosis of dementia of Alzheimer 's type ( DAT ) or other psychiatric disorders , were selected from a larger sample of older adults with DS ( n = 122 ) . Dementia diagnosis was based on the CAMDEX informant interview , conducted with each participant 's main carer . Informant-reported changes in personality/behaviour and memory were recorded . Participants were scored based on symptoms falling into three behavioural domains and completed five executive function ( EF ) tasks , six memory tasks ( two of which also had a strong executive component ) and the BPVS ( as a measure of general intellectual ability ) . Multiple regression analyses were conducted to determine the degree to which the behavioural variables of ' EDF ' , ' disinhibition ' and ' apathy ' , along with informant-reported memory decline and antidepressant medication use , predicted performance on the cognitive tasks ( whilst controlling for the effects of age and general intellectual ability ) . RESULTS Strikingly , disinhibited behaviour was reported for 95.7 % of participants with one or more behavioural change ( n = 47 ) compared to 57.4 % with reported apathy and 36.2 % with reported EDF . ' Disinhibition ' score significantly predicted performance on three EF tasks ( design ed to measure planning , response inhibition and working memory ) and an object memory task , ( also thought to place high dem and s on working memory ) , while ' apathy ' score significantly predicted performance on two different tasks , those measuring spatial reversal and prospect i ve memory ( p < 0.05 ) . Informant reported memory decline was associated only with performance on a delayed recall task while antidepressant medication use was associated with better performance on a working memory task ( p < 0.05 ) . CONCLUSION Observed dissociation between performance on cognitive tasks associated with reported apathy and disinhibition is in keeping with proposed differences underlying neural circuitry and supports the involvement of multiple frontal-subcortical circuits in the early stages of DAT in DS . However , the prominence of disinhibition in the behavioural profile ( which more closely resembles that of disinhibited subtype of DFT than that of AD in the general population ) leads us to postulate that the serotonergically mediated orbitofrontal circuit may be disproportionately affected . A speculative theory is developed regarding the biological basis for observed changes and discussion is focused on how this underst and ing may aid us in the development of treatments directly targeting underlying abnormalities Background Meeting the needs of the growing number of older people is a challenge for health and social care services . Home-based interventions aim ing to modify health-related behaviours of frail older people have the potential to improve functioning and well-being . Previous review s have focused on whether such interventions are effective , rather than what might make them effective . Recent advances in behavioural science make possible the identification of potential ‘ active ingredients ’ of effective interventions , such as component behaviour change techniques ( BCTs ) , and intended intervention functions ( IFs ; e.g. to educate , to impart skills ) . This paper reports a protocol for a systematic review that seeks to ( a ) identify health behaviour change interventions for older frail people , ( b ) describe the content of these interventions , and ( c ) explore links between intervention content and effectiveness . The protocol is reported in accordance with Preferred Reporting Items for Systematic Review s and Meta-Analyses Protocol s ( PRISMA -P ) 2015 guidelines . Methods / design Studies will be identified through a systematic search of 15 electronic data bases , supplemented by citation tracking . Studies will be retained for review where they report r and omised controlled trials focusing on home-based health promotion delivered by a health professional for frail older people in community setting s , written in English , and either published from 1980 onwards , or , for registered trials only , unpublished but completed with results obtainable from authors . Interventions will be coded for their content ( BCTs , IFs ) and for evidence of effectiveness ( outcome data relating to behavioural and health outcomes ) . Analyses will describe characteristics of all interventions . Interventions for which effectiveness data are available will be categorised into those showing evidence of effectiveness versus those showing no such evidence . The potential for each intervention characteristic to contribute to change in behaviour or health outcomes will be estimated by calculating the percentage of all interventions featuring those characteristics that have shown effectiveness . Discussion Results will reveal the strategies that have been drawn on within home-based interventions to modify the health behaviours of frail older people , and highlight those more associated with positive changes in behaviour and health . Findings from this review will provide a useful basis for underst and ing , developing , and implementing behaviour change interventions in this field . Systematic review registration PROSPERO The British Association for Psychopharmacology ( BAP ) coordinated a meeting of experts to review and revise its first ( 2006 ) Guidelines for clinical practice with  anti-dementia drugs .  As before , levels of evidence were rated using accepted st and ards which were then translated into grade s of recommendation A to D , with A having the strongest evidence base ( from r and omized controlled trials ) and D the weakest ( case studies or expert opinion ) . Current clinical diagnostic criteria for dementia have sufficient accuracy to be applied in clinical practice ( B ) and brain imaging can improve diagnostic accuracy ( B ) . Cholinesterase inhibitors ( donepezil , rivastigmine , and galantamine ) are effective for mild to moderate Alzheimer ’s disease ( A ) and memantine for moderate to severe Alzheimer ’s disease ( A ) . Until further evidence is available other drugs , including statins , anti-inflammatory drugs , vitamin E and Ginkgo biloba , can not be recommended either for the treatment or prevention of Alzheimer ’s disease ( A ) . Neither cholinesterase inhibitors nor memantine are effective in those with mild cognitive impairment ( A ) . Cholinesterase inhibitors are not effective in frontotemporal dementia and may cause agitation ( A ) , though selective serotonin reuptake inhibitors may help behavioural ( but not cognitive ) features ( B ) . Cholinesterase inhibitors should be used for the treatment of people with Lewy body dementias ( Parkinson ’s disease dementia and dementia with Lewy bodies ( DLB ) ) , especially for neuropsychiatric symptoms ( A ) . Cholinesterase inhibitors and memantine can produce cognitive improvements in DLB ( A ) . There is no clear evidence that any intervention can prevent or delay the onset of dementia . Although the consensus statement focuses on medication , psychological interventions can be effective in addition to pharmacotherapy , both for cognitive and non-cognitive symptoms . Many novel pharmacological approaches involving strategies to reduce amyloid and /or tau deposition are in progress . Although results of pivotal studies are awaited , results to date have been equivocal and no disease-modifying agents are either licensed or can be currently recommended for clinical use Alzheimer ’s disease ( AD ) and dementia are a global public health priority , and prevention has been highlighted as a pivotal component in managing the dementia epidemic . Modifiable risk factors of dementia and AD include lifestyle-related factors , vascular and metabolic disorders , and psychosocial factors . R and omized controlled clinical trials ( RCTs ) are needed to clarify whether modifying such factors can prevent or postpone cognitive impairment  and dementia in older adults . Given the complex , multifactorial , and heterogeneous nature of late-onset AD and dementia , interventions targeting several risk factors and mechanisms simultaneously may be required for optimal preventive effects . The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability ( FINGER ) is the first large , long-term RCT to demonstrate that a multidomain lifestyle-based intervention ameliorating vascular and lifestyle-related risk factors can preserve cognitive functioning and reduce the risk of cognitive decline among older adults at increased risk of dementia . To investigate the multidomain intervention in other population s and diverse cultural and geographical setting s , the World-Wide FINGERS ( WW-FINGERS ) network was recently launched ( https://alz.org/wwfingers ) . Within this network , new FINGER-type trials with shared core methodology , but local culture and context -specific adaptations , will be conducted in several countries . The WW-FINGERS initiative facilitates international collaborations , provides a platform for testing multidomain strategies to prevent cognitive impairment and dementia , and aims at generating high- quality scientific evidence to support public health and clinical decision-making . Furthermore , the WW-FINGERS network can support the implementation of preventive strategies and translation of research findings into practice Background Musculoskeletal disorders ( MSDs ) are the leading cause of work disability and sickness absence worldwide . The prevalence of MSDs increases with age , consequently challenging sustainable employability among the growing ageing workforce . Knowledge of feasible and efficient workplace-based interventions to rehabilitate MSD or prevent its consequences is therefore warranted . This systematic review will evaluate the effectiveness of workplace-based interventions on MSDs and its consequences among adult workers with physical and sedentary work tasks , respectively . Methods We will search the following bibliographic data bases : PubMed ( including the data base ‘ MEDLINE ’ ) and Web of Science Core Collection ( including the data bases ‘ Science Citation Index Exp and ed ’ , ‘ Social Sciences Citation Index ’ and ‘ Arts & Humanities Citation Index ’ ) . Manual search es will also be performed . We will include r and omised controlled trials ( RCTs ) and non- RCTs reported in English in which ( 1 ) participants are adult workers with MSD , ( 2 ) interventions are aim ing at rehabilitating pain symptoms of MSD or preventing the consequences of MSD and ( 3 ) interventions are initiated and /or carried out at the workplace . The review will adhere to the ‘ Preferred Reporting Items for Systematic review s and Meta-Analyses ’ ( PRISMA ) guidelines for reporting systematic review s and the Institute for Work and Health ( IWH ) guidelines for workplace-based interventions . For the primary evaluation of the review , the quality assessment and evidence synthesis will conform to the IWH guidelines . Secondary evaluation will include a meta- analysis ( unless the included studies do not allow this due to heterogeneity ) and employ the risk of bias domains recommended by Cochrane along with the Grading of Recommendations , Assessment , Development and Evaluations ( GRADE ) approach on the studies with pain intensity as an outcome . Discussion This systematic review will provide knowledge on effective workplace-based interventions among physical and sedentary workers with MSD . RCTs are considered the most powerful experimental design in clinical trials , but solely including these may be too restrictive to underst and effective workplace-based interventions where r and omised and carefully controlled trials ( RCTs ) are not always possible . In order to maximize practical relevance , the selection process will , therefore , include both RCTs and non- RCTs and the quality assessment and evidence synthesis will conform to IWH guidelines focusing on developing practical guidelines for stakeholders . The result of this work will form the basis for industry-specific evidence -based recommendations on effective workplace-based interventions for rehabilitation of MSDs and its consequences that will later be operationalised into concrete and user-friendly practical tools for workplaces . Systematic review registration International Prospect i ve Register of Systematic Review s ( PROSPERO ) number CRD42018116752 Abstract Rationale : Altered serotonergic and dopaminergic function have been widely implicated in behavioural disorders associated with impulsivity and risk-taking . However , little research has addressed the specific cognitive consequences of changed monoaminergic function that might contribute to the production of impulsive behaviour . Objectives and methods : We compared the effects of rapid plasma tryptophan depletion , acute doses of the mixed indirect catecholamine agonist , methylpheni date ( 40 mg ) , and acute doses of the α1/α2 agonist , clonidine ( 1.5 µg/kg ) , on aspects of visual discrimination learning involving either acquisition of altered stimulus-reward associations ( i.e. updating the affective valence of exteroceptive stimuli ) or the control of attention towards relevant as opposed to irrelevant stimulus dimensions . Results : Relative to subjects who received placebo , subjects with reduced tryptophan exhibited a deficit in the ability to learn changed stimulus-reward associations , but were still able to shift an acquired attentional set away from a now-irrelevant stimulus dimension towards a newly relevant dimension . By contrast , subjects who received methylpheni date were able to learn effectively about changing stimulus-reward associations , but showed an enhanced ability to shift an attentional bias , in combination with slowed response times .  Subjects who received clonidine showed neither of these changes . Conclusions : These results suggest that reduction in central serotonin leads to altered neuromodulation of the cortical and subcortical regions ( e.g. orbitofrontal cortex , striatum and anterior temporal structures ) that mediate important aspects of associative learning whereby exteroceptive stimuli acquire altered incentive motivational value . On the other h and , facilitation of catecholamine neurotransmitters may disrupt the allocation of attention between relevant and irrelevant features of the environment , perhaps through altered modulation of the dorsolateral prefrontal cortex . The implication s of these results for underst and ing the differential neuromodulation of cognitive functions are discussed BACKGROUND Discerning the determinants of weight loss maintenance is important in the planning of future interventions and policies regarding overweight and obesity . We have therefore systematic ally synthesized recent literature on determinants of weight loss maintenance for individuals with overweight and obesity . METHODS With the use of the Preferred Reporting Items for Systematic Review s and Meta-Analyses statement , prospect i ve studies were identified from search es in PubMed and PsycINFO from 2006 to 2016 . We included articles investigating adults with overweight and obesity undergoing weight loss without surgery or medication .  Included articles were scored on their method ological quality , and a best- evidence synthesis was applied to summarize the results . RESULTS Our search result ed in 8,222 articles of which 67 articles were selected . In total , 124 determinants were identified of which 5 were demographic , 59 were behavioural , 51 were psychological/cognitive and 9 were social and physical environmental determinants . We found consistent evidence that demographic determinants were not predictive of weight loss maintenance . Behavioural and cognitive determinants that promote a reduction in energy intake , an increase in energy expenditure and monitoring of this balance are predictive determinants . CONCLUSION This review identifies key determinants in weight loss maintenance . However , more research regarding cognitive and environmental determinants of weight loss maintenance is needed to advance our knowledge on determinants of weight loss maintenance
Summary Sedentary behaviour is associated with lower cognitive performance , although the attributable risk of sedentary time to all-cause dementia incidence is unclear .
Our systematic review provides evidence that limiting sedentary time and concomitantly engaging in regular moderate-to-vigorous physical activity may best promote healthy cognitive ageing
Aim The increasing rate of all-cause dementia worldwide and the lack of effective pharmaceutical treatments emphasise the value of lifestyle approaches as prevention strategies .
Emerging evidence suggests sedentary behaviour is associated with impaired cognitive function .
A better underst and ing of this association would significantly add to our knowledge of how to best promote healthy cognitive ageing .
Thus , we conducted a systematic review ascertaining the contribution of sedentary behaviour towards associated changes in cognitive function over the adult lifespan .