Supporting Aging Through Green Exercise (SAGE)
Condition: Mild Cognitive Impairment; Aging
MeSH terms: Cognitive Dysfunction
Study type: Interventional

Summary: 
      Aerobic exercise is an evidence-based approach to mitigate cognitive decline in older adults
      with mild cognitive impairment (MCI). Emerging evidence suggests that the cognitive benefits
      of exercise may be enhanced when performed in outdoor, natural settings, as compared to
      indoor or built settings. Thus, the investigators aim to compare the effects of outdoor
      versus indoor walking programs on cognitive function among older adults with MCI. Secondary
      outcomes are motor function, emotional well-being, health-related behaviours, and quality of
      life. Participants will be randomly assigned to a 12--week, 3x/week program of either outdoor
      walking on forest trails or indoor walking on a treadmill. A 3-month followup will also be
      completed after trial completion.
    

Detailed description: 
      Study Design: A 12-week, single-blinded, trial with two experimental arms. Participants will
      be randomized (1:1) to either outdoor walking (OP) or indoor walking or cycling (IP).
      Measurement will occur in person at baseline and at trial completion. Additionally, follow-up
      measurement of questionnaire-based outcomes will occur via email or phone at 3 months
      following trial completion. Outcome assessors will be trained by the research team and
      blinded to group allocation of the participants.

      Participants: 68 community-dwelling adults aged 65-80 years old with probable MCI and in
      sufficient health to participate in aerobic exercise of moderate intensity

      Interventional Arms: All participants will receive three group-based training sessions per
      week for 12 weeks, under the supervision of instructors with a relevant background and first
      aid certification. Each session will consist of 10 min of warm-up, 40 min of aerobic
      exercise, and 10 min of cool-down. For both OP and IP, aerobic exercise will be progressive
      and of moderate intensity. During training, each participant will wear a heart rate monitor
      and will be asked to work initially at approximately 45% of their heart rate reserve (HRR)
      and gradually progress to reach the target of 70% of HRR over the 12-week study period.
      Participants will also subjectively monitor workout intensity using the 20-point Borg's
      Rating of Perceived Exertion. OP participants will walk or jog a pre-determined route in
      trails of an urban forest (Pacific Spirit Park). IP participants will walk or jog on
      treadmills in the Exercise Prescription Suite of the Centre for Hip Health and Mobility
      (CHHM). Both OP and IP training groups will have a participant to instructor ratio of 3:1. To
      promote adherence to the exercise program, sessions will be offered at times that are
      convenient for each individual participant. Protocols will be adjusted as necessary to align
      with COVID-19 guidelines.

      Measurement of descriptors and outcomes: Standardized protocols will be developed and study
      personnel will be trained. Assessors will be blinded to treatment allocation. We will measure
      descriptors and outcomes at baseline and at trial completion. Each measurement session will
      be 2 hours in duration. For these measurements, participants will complete a session of
      behavioural and clinical testing at the VCH Research Pavilion and the CHHM. To account for
      time-of-day effects, each participant's session start time will be the same at both
      timepoints, and the order of the assessments will be the same for all participants.
    

Intervention name(s): Aerobic Exercise Indoors; Aerobic Exercise Outdoors
Intervention type(s): Other; Other
Intervention description(s): Each session will consist of 10 min of warm-up, 40 min of aerobic exercise, and 10 min of cool-down. Aerobic exercise will be progressive and of moderate intensity. During training, each participant will wear a heart rate monitor and will be asked to work initially at approximately 45% of his/her target heart rate (i.e., heart rate reserve (HRR)) and gradually progress to reach the target of 70% of HRR over the 12-week study period. Participants will also subjectively monitor workout intensity using the 20-point Borg's Rating of Perceived Exertion. Participants will walk or jog on treadmills or cycle on stationary bikes in the Exercise Prescription Suite of the Centre for Hip Health and Mobility.; Each session will consist of 10 min of warm-up, 40 min of aerobic exercise, and 10 min of cool-down. Aerobic exercise will be progressive and of moderate intensity. During training, each participant will wear a heart rate monitor and will be asked to work initially at approximately 45% of his/her target heart rate (i.e., heart rate reserve (HRR)) and gradually progress to reach the target of 70% of HRR over the 12-week study period. Participants will also subjectively monitor workout intensity using the 20-point Borg's Rating of Perceived Exertion. Participants will walk or jog pre-determined routes in trails of an urban forest (Pacific Spirit Park)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention
Keywords: green space; cognitive function; aerobic exercise