Multimodal Exercise Effect on Brain Dynamics, Cognitive Functioning and Physical Fitness

Study Overview
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Brief Summary
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The aim of present study is to analyze the effect of a multimodal exercise program on brain dynamics, cognitive functioning and physical fitness in community-dwelling older adults This experimental study is a controlled trial. Participants will be allocated to two groups: experimental group (who attend the multimodal exercise program) and control group (who maintain usual activity). The multimodal exercise program will run for 12 weeks (3 sessions / week of 60 minutes). Participants will be assessed 1) at baseline and at 2) at 12 weeks.

Detailed Description
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Aging is associated with a decline in cognitive functioning (CF), which influence negatively the motor capacities of older adults (1). Differences on dynamic brain, namely reductions in structural and functional connectivity contribute to cognitive decline. However, efficient communications between brain regions works like a prerequisite for CF (2,3). Programs targeting cognitive functioning improvement evidenced the importance of the information processing speed (IPS). However, IPS may not be the only factor conditioning the relationship between CF and gait in the older people, especially in locomotive tasks that require attention (4). According to Lezak et al. (5), the performance in each area of CF decreases with aging, and the most significant decline is reported on the performance of complex attentional tasks such as selective or divided attention. Recent studies focusing cognitive or physical fitness programs, have been shown that dual-task (DT) performance, particularly involving walking while performing a task with cognitive interference, predicts the risk of frailty, disability and mortality in older people (6,7). According Bahureksa, et al. (8), for balance maintenance is needed to incorporate and decipher the sensorimotor information through CF. On the other hand, exercise programs reported as effective strategies for agility, muscle strength and body composition improvement (9, 10). However, no studies were found focusing the effect and benefits of a multimodal exercise program privileging IPS on brain electrical activity, CF and functional fitness in community-dwelling older adults. This multimodal exercise program, privileging information processing speed and comprising sensorimotor and neurocognitive exercises, may revert the process of loss and decline on brain dynamics, CF and physical fitness in community-dwelling older adults.

Official Title
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The Effect of a Multimodal Exercise Program on Brain Dynamics, Cognitive Functioning and Physical Fitness in Community-dwelling Older Adults

Conditions
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Community-dwelling Older Adults

Intervention / Treatment
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* Other: Multimodal exercise program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male or female participants aged ≥65 years; Community-dwelling older adults living independently; Exclusion Criteria: Presence of cognitive impairment (Mini-Mental State Examination) (11); Presence of motor impairment compromising the program participation; Presence of neurological problems or diseases compromising the program participation;

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Multimodal exercise program<br>The experimental group intervention will attend the multimodal exercise program. The program integrates 3 sessions / week of 60 minutes on alternated days. The multimodal exercise program includes exercises promoting simultaneous motor and cognitive stimulation. | Other: Multimodal exercise program<br>* Each session includes: beginning ritual (5 min), warm-up (15 min), main section comprising the multimodal exercises (30 min), cool-down (5 min), and finishing ritual (5 min). At the initial stage, the activation of different muscle groups will be performed. The main section (multimodal exercises) will be focused on the specific objectives through sensorimotor and neurocognitive activities and will privilege IPS. This section includes periods ranging 10-15 min of exercises mainly focused on motor stimulation - physical fitness (strength, balance and agility) - alternating with exercises mainly focused on cognitive stimulation - CF (planning ability, solving-problems, IPS, attention and DT performance). At the cool-down the participants will normalize their physiological parameters. Finally, at the finishing ritual the participants sign an attendance sheet regarding the session, including perceived exertion (Borg Scale) and satisfaction (Caregiver Treatment Satisfaction questionnaire).<br>|
| No Intervention: Control Group<br>Usual care. After the study, it will be offered the opportunity to integrate a similar exercise program for the control group (CG) participants. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from Baseline, between and within groups comparison | Dynamic Brain Outcome Measure - Electroencephalographic evaluation to assess frequency analyses in the alpha, theta and beta power spectrum | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Cognitive Functioning Outcome Measure - Tower of London test, ranging from 0 (worst) to 36 (best), to assess problem-solving ability (n) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Cognitive Functioning Outcome Measure - Tower of London test to assess planning and execution time (s) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Cognitive Functioning Outcome Measure - Useful Field of View Assessment, ranging from 17 (best) to 500 (worst), to evaluate processing speed, selective and divided attention (ms) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Physical Fitness Outcome Measure - Timed Up and Go test (single and dual-task version) to assess agility and dual-task performance (s) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Physical Fitness Outcome Measure - The Ten Step Test to assess agility (s) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Physical Fitness Outcome Measure - Senior Fitness Test (30-Second Chair Stand) to assess lower body strength (resistance) (n) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Physical Fitness Outcome Measure - Short Physical Performance Battery (Chair Stand Test) to assess lower body strength (power) (n) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Physical Fitness Outcome Measure - Fullerton Advanced Balance Scale (modified version), ranging from 0 (worst) to 16 (best) points, to assess balance | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Body Composition Outcome Measure - Bioimpedance analyzer (Tanita® MC-780) to assess body fat mass (%) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Body Composition Outcome Measure - Bioimpedance analyzer (Tanita® MC-780) to assess body lean mass (%) | 0, 3 months | 
| Change from Baseline, between and within groups comparison | Body Composition Outcome Measure - Bioimpedance analyzer (Tanita® MC-780) to assess body water (%) | 0, 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Older adults, Multimodal exercise program, Brain dynamics, Cognitive functioning, Physical fitness