Feasibility of Multicomponent Training for People with Moderate to Severe Dementia Living in a Long-Term Care Home: A Social Ethical Approach.

Multicomponent training is recommended for people with dementia living in long-term care homes. Nevertheless, evidence is limited and people with severe dementia are often excluded from trials. Hence, the aim of this study was to investigate (1) the feasibility and (2) the requirements regarding multicomponent training for people with moderate to severe dementia. The study was conducted as an uncontrolled single arm pilot study with a mixed methods approach. Fifteen nursing home residents with a mean age of 82 years (range: 75-90 years; female: 64%) with moderate to severe dementia received 16 weeks of multicomponent training. Feasibility and requirements of the training were assessed by a standardized observation protocol. Eleven participants regularly attended the intervention. The highest active participation was observed during gait exercises (64%), the lowest during strength exercises (33%). It was supportive if exercises were task-specific or related to everyday life. This study confirms that multicomponent training for the target group is (1) feasible and well accepted, and (2) to enhance active participation, individual instructions and the implementation of exercises related to everyday life is required. The effectiveness of the adapted training should be tested in future randomized controlled trials.

A three-armed cognitive-motor exercise intervention to increase spatial orientation and life-space mobility in nursing home residents: study protocol of a randomized controlled trial in the PROfit project.

BACKGROUND: In nursing home residents, the combination of decreasing mobility and declining cognitive abilities, including spatial orientation, often leads to reduced physical activity (PA) and life-space (LS) mobility. As a consequence of sedentary behavior, there is a lack of social interaction and cognitive stimulation, resulting in low quality of life. It has not yet been examined whether cognitive-motor training including spatial cognitive tasks is suitable to improve spatial orientation and, as a consequence, to enlarge LS mobility, and increase well-being and general cognitive-motor functioning. Therefore, the overall goal of this multicentric randomized controlled trial (RCT) is to compare the effect of three different intervention approaches including functional exercise and orientation tasks on PA, LS and spatial orientation in nursing home residents. METHODS: A three-arm single-blinded multicenter RCT with a wait-list control group will be conducted in a sample of 513 individuals (needed according to power analysis) in three different regions in Germany. In each nursing home, one of three different intervention approaches will be delivered to participating residents for 12 weeks, twice a week for 45 min each: The PROfit basic group will perform functional strength, balance, flexibility, and walking exercises always at the same location, whereas the PROfit plus group changes the location three times while performing similar/the same exercises as the PROfit basic group. The PROfit orientation group receives navigation tasks in addition to the relocation during the intervention. Physical and cognitive functioning as well as psychological measures will be assessed in all study groups at baseline. Participants will then be randomized into either the intervention group or the wait-list control group. After 12 weeks, and after 24 weeks the measures will be repeated. DISCUSSION: This study evaluates whether the three different interventions are feasible to reduce the decline of or even improve PA, LS, and spatial orientation in nursing home residents. By adding different training locations in PROfit plus, the program is expected to be superior to PROfit basic in increasing physical and cognitive parameters. Moreover, we expect the PROfit orientation intervention to be most effective in terms of PA, LS, and spatial orientation due to two mechanisms: (1) increased physical and cognitive activity will enhance cognitive-motor capacity and (2) the spatial training will help to build up cognitive strategies to compensate for age-related loss of spatial orientation abilities and related limitations. TRIAL REGISTRATION: The trial was prospectively registered at DRKS.de with registration number DRKS00021423 on April 16, 2020 and was granted permission by the Technical University Berlin local ethics committee (No. GR_14_20191217).

Acute effects of preventive warm-up exercises on modifiable risk factors for anterior cruciate ligament injuries: a three-arm randomized-controlled crossover trial.

BACKGROUND: We aimed to compare the potential acute effects of single bouts of a classic prevention and a risk factor-focus training aiming to target modifiable anterior cruciate ligament (ACL) rupture risk factors and the impact of neuromuscular fatigue on relevant ACL rupture risk factors. METHODS: Two preventive warm-up (standard and ACL rupture risk factor training) and one inactive arm were compared; each of these were followed by a standardized neuromuscular fatigue protocol. The assessments included two Trail making tests (TMT-A; TMT-B, time to complete), drop jump landings (knee separation distance, normalized at hip width), as well as unanticipated counter movement jump landings (time to stabilization and peak ground reaction force). RESULTS: We included 18 participants (25±2years). No differences were found between times and conditions for TMT (P>0.05). A significant time effect occurred in time to stabilization (F=2.6; P<0.05) and a significant time*baseline-value*jumping time interaction was seen in peak ground reaction force (F=3.1; P<0.05). No time effect was found for any knee separation distance (F=.1-2.4; P>0.05); but a significant time*baseline-value*jumping time interaction was seen at initial ground contact (F=2.8; P<0.05), and lowest point (F=4.2; P<0.01). CONCLUSIONS: Risk factor-focus and classic warm-up may not differ in their acute effects on modifiable functional ACL (re-)injury risks factors.