Study protocol of a randomized intervention study to explore effects of a pure physical training and a mind-body exercise on cognitive executive function in independent living adults age 65-85.

BACKGROUND: Decline in cognitive function associated with aging is one of the greatest concerns of older adults and often leads to a significant burden for individuals, families, and the health care system. Executive functions are most susceptible to age-related decline. Despite the well-known benefits of regular exercise on cognitive health, older adults tend to be less physically active than other age groups. Thus, there is a need to identify strategies that attract older adults and can enhance cognitive vitality. AIMS: This article describes the protocol of a study designed to evaluate whether two interventions, a pure physical exercise and a mind-body exercise, can improve cognitive executive function in independent-living older adults. In addition, the study will explore barriers/facilitators related to adherence. METHODS: After baseline assessment, participants will be randomly assigned to one of three groups (strength training, Awareness Through Movement®, or a control group). Participants of the two active groups will attend the interventions for 12 weeks. The control group continues with the usual everyday life. Assessments will include three measures of executive function of the NIH Toolbox, and are administered at baseline, post-intervention and at 3-month follow-up. The primary outcomes are the changes in cognitive executive function performances. Secondary outcomes include adherence, self-efficacy for exercise, symptoms of depression, mindfulness and enjoyment. Attendance will be used as a measure of adherence. DISCUSSION AND CONCLUSION: If successful, the interventions could provide low-cost strategies for older adults to maintain cognitive vitality and has the potential to impact current exercise guidelines.

Memphis FitKids: implementing a mobile-friendly web-based application to enhance parents' participation in improving child health.

BACKGROUND: Child obesity is a major public health challenge, increasing the risk of chronic medical conditions such as type 2 diabetes, metabolic syndrome, and hypertension. Among U.S. states, Tennessee has one of the highest rates of child obesity. Emerging communication technologies can help to deliver highly disseminable population-level interventions to improve health behavior. The aim of this paper is to report the implementation and the evaluation of the reach of Memphis FitKids, a web-based application, intended to promote healthy behaviors for families and children. METHODS: A community-level demonstration project, Memphis FitKids, was developed and implemented in Tennessee's Greater Memphis Area. This application ( www.memphisfitkids.org ) was designed for parents to assess their children's obesity risk through determinants such as weight, diet, physical activity, screen time, and sleep adequacy. A built-in "FitCheck" tool used this collected information to create a report with tailored recommendations on how to make healthy changes. A Geographic Information Systems component was implemented to suggest low-cost neighborhood resources that support a healthy lifestyle. A social marketing framework was used to develop and implement FitKids, and a Community Advisory Board with representatives from community partners (e.g., the YMCA of Memphis, the Pink Palace Family of Museums, and the Memphis Public Library) supported the implementation of the project. Five kiosks distributed in the community served as public access points to provide a broad reach across socioeconomic strata. Presentations at community events and the use of Facebook facilitated the promotion of FitKids. Website traffic and Facebook usage were evaluated with Google Analytics and Facebook Insights, respectively. RESULTS: In Tennessee, 33,505 users completed 38,429 FitCheck sessions between July 2014 and December 2016. Among these, 6763 sessions were completed at the five kiosks in the community. FitKids was presented at 112 community events and the social media posts reached 23,767 unique Facebook users. CONCLUSIONS: The Memphis FitKids demonstration project showed that web-based health tools may be a viable strategy to increase access to information about healthy weight and lifestyle options for families. Mobile-friendly web-based applications like Memphis FitKids may also serve health professionals in their efforts to support their clients in adopting healthy behaviors.

The Feldenkrais Method(®) can enhance cognitive function in independent living older adults: A case-series.

Poor cognitive health a major concern of aging individuals, can compromise independent living. More than 16 million people in the United States are affected by cognitive impairment. We have studied the effects of the Feldenkrais Method(®) on cognitive function. In this case series with three participants cognitive function was assessed with the Trail Making Test A and B at baseline and after the Feldenkrais intervention. All participants improved performance on Trail Making Test A and B after completing the Feldenkrais intervention indicating that Feldenkrais lessons may offset age-related decline in cognitive function. The results of this case series warrant larger scale studies on cognitive outcomes of Feldenkrais interventions in clinical and non-clinical populations.

Case Report: Outcomes of Feldenkrais Movements on Self-reported Cognitive Decline in Older Adults.

UNLABELLED: Context • A lack of cognitive health can limit a person's well-being and may compromise independent living. The potential for cognitive decline is a major concern for aging individuals. Regular physical activity has been shown to improve cognitive processes. However, functional limitations frequently prevent older adults from participating in conventional exercise programs. Given the gentle nature of mind-body exercises, interventions such as the Feldenkrais may provide an alternative. Objective • The study intended to investigate whether Feldenkrais lessons can offset cognitive decline among older adults. DESIGN: The study was a case series with 2 participants. Setting • The study took place in the wellness center of a retirement community. Participants • Participants were 2 female residents in the community, with self-reported cognitive challenges. Intervention • The Feldenkrais method awareness through movement (ATM) was used. The lessons were based on common Feldenkrais themes, such as the relationship between eye organization and body movement, coordination of muscles, breathing, and an exploration of the participants' habits. Outcome Measures • The Trail Making Test A (TMT-A) and Trail Making Tests B (TMT-B) were used to measure cognitive function at baseline and after the Feldenkrais intervention. Results • Both participants improved their performance on the TMT-A and TMT-B after completing the Feldenkrais intervention. Neither of the 2 participants reported any adverse events related to the lessons. Conclusion • The beneficial results warrant further research into the efficacy of Feldenkrais as complementary, alternative therapy for preserving cognitive function on a larger scale and in populations with diagnosed cognitive impairments.

Dissemination of an evidence-based program to reduce fear of falling, South Carolina, 2006-2009.

INTRODUCTION: Falls among older adults are a serious public health issue, and fear of falling can limit mobility, which in turn increases fall risk. A Matter of Balance/Volunteer Lay Leader Model is an evidence-based program designed to address fear of falling. The objective of this study was to describe implementation, dissemination, and outcomes of this program in 3 regions of South Carolina with a predominantly African American and largely underserved population. METHODS: We developed partnerships throughout the state, organized master and lay leader trainings, and documented numbers of lay leaders, programs offered, demographic characteristics of participants, program fidelity, and attendance. Outcome measures were self-reported confidence to prevent and manage falls and a quantitative measure of functional mobility. Both measures were assessed at baseline and after program completion. RESULTS: Older adults (N = 235) attended 18 classes at 16 sites. Barriers to implementation were program teams' limited familiarity with the concept of evidence-based programs and the importance of adhering to program content. Facilitators were state-level leadership and a history of state, regional, and local groups collaborating successfully on other projects. Outcomes indicated greater confidence in managing falls and carrying out activities of daily living. Mobility improved significantly, suggesting a reduced risk for falls. CONCLUSION: Evidence-based programs such as A Matter of Balance/Volunteer Lay Leader Model can be successfully disseminated in underserved areas. Outcomes indicate that participation in fall prevention programs can benefit groups of predominantly African American older adults.

Development of a community-based fall prevention program: Stay In Balance.

BACKGROUND: Falls and fall-related injuries are critical issues for older adults; evidence indicates that multidimensional interventions that address modifiable risk factors can be successful in reducing falls. Few evidence-based fall prevention interventions exist due, in part, to complex issues associated with development and implementation. There is a need for a variety of such programs from which older adults may choose. We describe steps, outcomes, and issues involved in developing/implementing an evidenced-based fall prevention program in community settings. METHODS: The Stay In Balance program (SIB), developed by a team of professionals, local service providers and active older adults, was carried out with total of 135 older adults in several steps: developing objectives and program content, laboratory-based randomized controlled trial (RCT), pilot program in the community, community-based RCT, and implementation at 2 community sites. RESULTS: Each step in development provided useful and different insights into needed changes in program content, equipment, support materials, training, and appropriate outcome measures. CONCLUSION: Development of an evidenced-based fall prevention program requires a long term commitment on the part of all partners, University personnel, local service providers, and older adult participants; funding is also critical.

The relationships among gait and mobility under single and dual task conditions in community-dwelling older adults.

AIMS: The purpose of this study was to examine relationships among gait and mobility under single and dual task conditions in older adults. METHODS: Community-dwelling older adults (n=41, mean age=75) completed mobility and gait tasks. Mobility was assessed with the Timed-Up-and-Go (TUG). Select gait parameters were examined while individuals walked at their preferred speed across the GAITRite electronic walkway. Two age groups were studied (younger age group=65-75; older age group=76+). Multiple linear regression analyses were used to examine the relationship between gait and mobility under single vs dual conditions. RESULTS: Older adults required more time to complete the TUG when concurrently performing a second cognitive task (10.84 sec vs 15.77 sec). In addition, one or more gait characteristic such as stride length, cadence and stance explained (a) a high percentage of variance in mobility performance under single task conditions (TUG 74%) and (b) a smaller portion of variance in mobility performance under dual task conditions (TUGc 25%). No salient age group differences were observed in TUG performance, but gait characteristics accounted for a larger portion of variance in TUGc performance (46%) for the older age group (mean age=81) than for the younger age group (mean age=69; TUGc 18%).

Effects of Feldenkrais exercises on balance, mobility, balance confidence, and gait performance in community-dwelling adults age 65 and older.

BACKGROUND: Falls and fall-related injuries are a major public health concern, a financial challenge for health care providers, and critical issues for older adults. Poor balance and limited mobility are major risk factors for falls. OBJECTIVE: The purpose of this study was to examine effects of Feldenkrais exercises in improving balance, mobility, and balance confidence in older adults. METHODS: Participants (N = 47, mean age 75.6) were randomly assigned to a Feldenkrais group (FG, n = 25) or to a control group (CG, n = 22). The FG group attended a 5-week Feldenkrais program, 60 minutes three times per week, while the CG group was a waitlist control. The outcome measures were balance (tandem stance), mobility (Timed Up and Go), gait characteristics (GAITRite Walkway System), balance confidence (Balance Confidence Scale; ABC), and fear of falling (Falls Efficacy Scale). Pre- and post-tests were conducted. RESULTS: After completion of the program, balance (p = 0.030) and mobility (p = 0.042) increased while fear of falling (p = 0.042) decreased significantly for the FG group. No other significant changes were observed. However, participants of the FG group showed improvements in balance confidence (p = 0.054) and mobility while performing concurrently a cognitive task (p = 0.067). CONCLUSIONS: These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility, and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults. A long-term follow-up study of balance and mobility is warranted. Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes.

Functional status assessment for community long-term care: preliminary observations.

The Community Long-Term Care (CLTC) program in South Carolina offers services to nursing home eligible persons that allow them to remain at home and receive help with activities of daily living. Variation in the ways potential clients are evaluated often produces inconsistent eligibility determinations. We developed a simple, objective assessment tool to complement CLTC evaluations. A conceptual framework, based on Nagi's model of disablement, was tested on community-dwelling healthy older adults and CLTC clients. Three simple physiologic tasks assessing mobility, functional leg strength, and manual dexterity discriminated between community-dwelling older adults and CLTC clients, classifying them with 80% to 90% accuracy.