Fit & Active Seniors Trial

Study Overview
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Brief Summary
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The investigators propose to test the hypothesis that a six-month intervention of combined fitness and cognitive training in the form of dancing will have a significant positive effect on a variety of executive control and memory processes as well as brain structure and function as compared to a non-aerobic strength and balance control/comparison group. Additionally, these two groups will be compared to walking groups in which one of the walking groups will also be provided with a daily, liquid, milk-based nutritional supplement.

Detailed Description
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Our previous trial (known as HALT, Healthy Active Lifestyle Trial) suggests that improvements in aerobic fitness have beneficial effects on cognitive function that are rather specific. That is, improvements in aerobic fitness appear to result in improvements in executive control processes such as scheduling, planning, coordination, inhibition, and working memory - some of the very cognitive abilities most affected during aging. Indeed, executive control processes and the prefrontal and frontal regions which support them have shown substantial and disproportionate age-related declines. The main hypothesis that the investigators test in the present project is that such deficits may be particularly benefited by improvements in aerobic fitness combined with cognitive training in the form of dance. Additionally, we will compare the outcomes of these interventions with an aerobic condition (walking) group and an aerobic condition (walking) group that also is provided with a daily nutritional supplement (walking + nutrition). The investigators will examine the relationship between aerobic fitness, physical activity, cognitive status, and brain function with this six-month aerobic training intervention study. The investigators will collect psychosocial data and functional fitness data to assess other relevant changes in psychological and physical function brought about by exercise training. Healthy, non-active older adults (60 to 79 years of age) will be recruited from the local community. Half One quarter of the older adults will be randomly assigned to an aerobic/cognitive combination group (dance), one quarter will be while the remaining half of the older adults will be randomly assigned to a non-aerobic control group (stretching, strengthening, and stability), one quarter will be assigned to the walking group, and one quarter will be assigned to the walking + nutrition group. The exercise interventions will be conducted by trained exercise staff. The participants will be assessed before and after the intervention (6 months). Assessments will include (a) cardiorespiratory testing, (b) physical activity monitoring (c) performance on neurocognitive tests of executive and non-executive function (d) measures of brain activation (fMRI) during cognitive tasks in a 3.0 tesla MRI system (e) a battery of psychosocial questionnaires (f) functional performance measures and (g) a mock street walking task.

Official Title
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Influence of Fitness on Brain and Cognition II

Conditions
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Aging

Intervention / Treatment
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* Behavioral: Dance Group
* Behavioral: Strength, Stretching, Stability
* Behavioral: Walking
* Behavioral: Walking + Nutrition


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 60-79 years of age Low-active: zero to two days of physical activity (> 30 minutes per day) per week in previous six months. Personal physician's examination and/or consent to participate in testing and exercise intervention Successful completion of graded exercise test without evidence of cardiac abnormalities or responses which are likely to be exacerbated by exercise. This decision will be made by the attending cardiologist. Adequate responses to the Telephone Interview of Cognitive Status (TICS-M) questionnaire Corrected (near and far) acuity of 20/40 or better in both eyes and no diagnosis of color-blindedness Initial depression score on GDS-15 (Geriatric Depression Scale) below clinical level (> 10) No presence of implanted devices or metallic bodies above the waist No history of brain surgery that involved removal of brain tissue Right-handed No history of stroke or Transient ischemic attack(TIA) Intention to remain in the local area for the duration of the intervention or testing period English fluency Exclusion Criteria: Below 60 years of age or above 80 years of age at beginning of intervention Self-reported regular physical activity of more than 2 times per week in last six months Non-consent of physician Evidence of abnormal cardiac responses or conditions during graded exercise testing Inadequate responses to the Telephone Interview of Cognitive Status (TICS-M) questionnaire (<20) Uncorrectable (near and far) acuity of greater than 20/40 in either eye and/or color-blindness Depression score on GDS-15 indicative of clinical depression (≤ 10) Presence of any implanted devices above the waist i.e. cardiac pacemaker or auto-defibrillators; neural pacemaker; aneurysm clips in the Central Nervous System(CNS); cochlear implant; metallic bodies in the eye or CNS; any form of wires or metal devices that may concentrate radiofrequency fields History of brain surgery that involved removal of brain tissue Left-handed History of Stroke or TIA Intent to move or be away from the area for an extended period of time (i.e. > 3 weeks) during the intervention or testing period Inability to communicate effectively in English

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 79 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Dance<br>Participants will be instructed in various forms of dances such as ballroom, swing, waltz, folk, and English country. | Behavioral: Dance Group<br>* Participants will be instructed and learn various forms of dance (i.e. English country, folk, ballroom) and will be led by trained dance instructors and exercise specialists. Participants will for one-hour sessions and meet three times per week for six months.<br>* Other names: Fit & Active Seniors Trial;|
| Active Comparator: Strengthening, Stability, Stretching<br>Participants will be instructed in various forms of strength, stretching (flexibility) and stability (balance)exercises. | Behavioral: Strength, Stretching, Stability<br>* Exercises focusing on strength, flexibility and balance will be performed at one-hour sessions held three times per week for six months. Classes are led by trained exercise specialists.<br>* Other names: Fit & Active Seniors Trial;|
| Experimental: Walking<br>Participants in this moderate aerobic conditioning exercise program will be instructed in a walking program that focuses on having them walk within their target heart rate. | Behavioral: Walking<br>* Participants in this moderate aerobic conditioning exercise program will be instructed in a walking program that focuses on having them walk within their target heart rate. They will be provided with heart rate monitors and pedometers for accurate record keeping. They will meet three times per week for one hour for six months. Warm up and cool down stretches will be a part of each walking session and sessions will be monitored and led by trained exercise specialists.<br>|
| Experimental: Walking + Nutritional Supplement<br>Participants in this moderate aerobic conditioning exercise program will be instructed in a walking program that focuses on having them walk within their target heart rate. These participants will also be provided with a daily nutritionally balanced liquid, milk-based formula. | Behavioral: Walking<br>* Participants in this moderate aerobic conditioning exercise program will be instructed in a walking program that focuses on having them walk within their target heart rate. They will be provided with heart rate monitors and pedometers for accurate record keeping. They will meet three times per week for one hour for six months. Warm up and cool down stretches will be a part of each walking session and sessions will be monitored and led by trained exercise specialists.<br>Behavioral: Walking + Nutrition<br>* Participants in this moderate aerobic conditioning exercise program will be instructed in a walking program that focuses on having them walk within their target heart rate. They will be provided with heart rate monitors and pedometers for accurate record keeping. They will meet three times per week for one hour for six months. Warm up and cool down stretches will be a part of each walking session and sessions will be monitored and led by trained exercise specialists. These participants will also be provided with a daily nutritionally balanced liquid, milk-based supplement formula.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline to month six in brain structure and function | Participants will undergo a neuropsychological battery of tasks assessing memory, attention and decision-making at baseline and month six. They will also undergo an fMRI during which images of brain structure and function (completing tasks during image collection) will be compared from baseline to month six. | Baseline and six months | 
| Change from baseline to month six in cardiorespiratory fitness | We will conduct graded maximal exercise treadmill test measuring peak oxygen consumption at baseline and six months. | Baseline and six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline to month six: Quality of life | We will assess multiple indicators of Quality of Life such as: depression; physical and mental health status; satisfaction with life; etc. | Baseline and six months | 
| Change from baseline to month six: Self-efficacy | We will examine the extent to which self-efficacy (e.g. barriers, adherence, function) changes as a function of participation in regular group physical activity training. | Baseline, three weeks and six months | 
| Program adherence over six month intervention | We will monitor attendance during the six-month intervention(program meets three days per week). | Six months | 
| Change from baseline to month six: Physical function | We will conduct functional fitness testing including tests of balance, strength, mobility and flexibility at baseline and six months. | Baseline and six months | 
| Change from baseline to month six: Psychosocial Outcomes | We will assess changes in psychosocial function (e.g. self-esteem; social support; anxiety) by written questionnaires. | Baseline and six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Executive function, Aging, Physical activity