High-Efficiency Particulate Air Filters for Preventing Wildfire-related Asthma Complications: A Cost-Effectiveness Study.

Rationale: Air pollution caused by wildfire smoke is linked to adverse health outcomes, especially for people living with asthma. Objectives: To evaluate whether government rebates for high-efficiency particulate air (HEPA) filters, which reduce concentrations of smoke particles indoors, are cost effective in managing asthma and preventing exacerbations in British Columbia (BC), Canada. Methods: We used a Markov model to analyze health states for asthma control, exacerbation severity, and death over a retrospective time horizon of 5 years (2018-2022). Concentrations of wildfire smoke-derived particulate matter with an aerodynamic diameter ⩽2.5 µm (PM2.5) from the Canadian Optimized Statistical Smoke Exposure Model and relevant literature informed the model. The base-case analysis assumed continuous use of a HEPA filter. Costs and quality-adjusted life-years (QALYs) resulting from varying rebates were computed for each Health Service Delivery Area (HSDA). Measurements and Main Results: In the base-case analysis, HEPA filter use resulted in increased costs of $83.34 (SE, $1.03) and increased QALYs of 0.0011 (SE, 0.0001) per person. The average incremental cost-effectiveness ratio among BC HSDAs was $74,652/QALY (SE, $3,517), with incremental cost-effectiveness ratios ranging from $40,509 to $89,206 per QALY in HSDAs. Across the province, the intervention was projected to prevent 4,418 exacerbations requiring systemic corticosteroids, 643 emergency department visits, and 425 hospitalizations during the 5-year time horizon. A full rebate was cost effective in 1 of the 16 HSDAs across BC. The probability of cost-effectiveness ranged from 0.1% to 74.8% across HSDAs. A $100 rebate was cost effective in most HSDAs. Conclusions: The cost-effectiveness of HEPA filters in managing wildfire smoke-related asthma issues in BC varies by region. Government rebates up to two-thirds of the filter cost are generally cost effective, with a full rebate being cost effective only in Kootenay Boundary.

Engaging interested parties to optimize wildfire smoke communication in Canada: challenges with initiating change.

Background: In February 2022, an online Wildfire Smoke Communication Workshop series identified priorities and strategies to improve wildfire smoke communication in Canada. We evaluated the engagement methods, the workshop series and workshop summary report, to determine if participants/organizations initiated changes identified in the workshop to optimize wildfire smoke communication plans. Methods: Three evaluation surveys were developed using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework dimensions and PRISM (Practical, Robust, Implementation, and Sustainability Model) contextual domains to measure the engagement impact. Surveys 1, 2, and 3 were disseminated to workshop participants between February 2022 (post-workshop series), May 2022 (pre-wildfire season), and September 2022 (post-wildfire season). Likert survey responses were analyzed descriptively using means and standard deviations. Open-ended written responses were analyzed using deductive reasoning and response proportions. Results: Of 69 workshop participants, 28, 19, and 13 responded to surveys 1, 2, and 3, respectively. Workshop participation helped survey 1 respondents consider optimizing wildfire smoke communication (M = 3.93, SD = 0.88). Workshop participation and the summary report helped survey 2 respondents consider new actions to optimize wildfire smoke communication (M = 3.84, SD = 0.74). The most intended action in survey 2 (68%, n = 13) and the most common action taken in survey 3 (62%, n = 8) was to simplify message content. The primary limitation to optimization was capacity. Conclusion: The engagement methods, particularly the summary report, were beneficial for organizations to take action to optimize wildfire smoke communication in Canada. Future engagement methods should examine persisting system-level issues and capacity limitations as they undermine the ability to optimize wildfire smoke communication in Canada.

Disparities in self-reported healthcare access for airways disease in British Columbia, Canada, during the COVID-19 pandemic. Insights from a survey co-developed with people living with asthma and chronic obstructive pulmonary disease.

Patients' perspectives on the impact of the COVID-19 pandemic on their access to asthma and COPD healthcare could inform better, more equitable care delivery. We demonstrate this topic using British Columbia (BC), Canada, where the impact of the pandemic has not been described. We co-designed a cross-sectional survey with patient partners and administered it to a convenience sample of people living with asthma and COPD in BC between September 2020 and March 2021. We aimed to understand how access to healthcare for these conditions was affected during the pandemic. The survey asked respondents to report their characteristics, access to healthcare for asthma and COPD, types of services they found disrupted and telehealth (telephone or video appointment) use during the pandemic. We analysed 433 responses and found that access to healthcare for asthma and COPD was lower during the pandemic than pre-pandemic (p < 0.001). Specialty care services were most frequently reported as disrupted, while primary care, home care and diagnostics were least disrupted. Multivariable logistic regression revealed that access during the pandemic was positively associated with self-assessed financial ability (OR = 22.0, 95% CI: 7.0 - 84.0, p < 0.001, reference is disagreeing with having financial ability) and living in medium-sized urban areas (OR = 2.3, 95% CI: 1.0 - 5.2, p = 0.04, reference is rural areas). These disparities in access should be validated post-pandemic to confirm whether they still persist. They also indicate the continued relevance of exploring approaches for more equitable healthcare.

Advocating for Implementation of the Global Action Plan on Physical Activity: Challenges and Support Requirements.

BACKGROUND: There is limited understanding of the challenges experienced and supports required to aid effective advocacy of the Global Action Plan on Physical Activity (GAPPA). The purpose of this study was to assess the challenges experienced and supports needed to advocate for the GAPPA across countries of different income levels. METHODS: Stakeholders working in an area related to the promotion of physical activity were invited to complete an online survey. The survey assessed current awareness and engagement with the GAPPA, factors related to advocacy, and the perceived challenges and supports related to advocacy for implementation of the GAPPA. Closed questions were analyzed in SPSS, with a Pearson's chi-square test used to assess differences between country income level. Open questions were analyzed using inductive thematic analysis. RESULTS: Participants (n = 518) from 81 countries completed the survey. Significant differences were observed between country income level for awareness of the GAPPA and perceived country engagement with the GAPPA. Challenges related to advocacy included a lack of support and engagement, resources, priority, awareness, advocacy education and training, accessibility, and local application. Supports needed for future advocacy included guidance and support, cooperation and alliance, advocacy education and training, and advocacy resources. CONCLUSIONS: Although stakeholders from different country income levels experience similar advocacy challenges and required supports, how countries experience these can be distinct. This research has highlighted some specific ways in which those involved in the promotion of physical activity can be supported to scale up advocacy for the GAPPA. When implementing such supports, consideration of regional, geographic, and cultural barriers and opportunities is important to ensure they are effective and equitable.

Physical activity RX: development and implementation of physical activity counselling and prescription learning objectives for Canadian medical school curriculum.

Physical activity is an important component of health and well-being, and is effective in the prevention, management, and treatment of numerous non-communicable chronic diseases. Despite the known health benefits of physical activity in all populations, most Canadians do not meet physical activity recommendations. Physicians play a key role in assessing, counselling, and prescribing physical activity. Unfortunately, many barriers, including the lack of adequate education and training, prevent physicians from promoting this essential health behaviour. To support Canadian medical schools in physical activity curriculum development, a team of researchers, physicians, and exercise physiologists collaborated to develop a key set of learning objectives deemed essential to physician education in physical activity counselling and prescription. This commentary will review the newly developed Canadian Physical Activity Counselling Learning Objectives and give case examples of three Canadian medical schools that have implemented these learning objectives.

L'activité physique est une composante importante de la santé et du bien-être, et elle est efficace dans la prévention, la prise en charge et le traitement de nombreuses maladies chroniques non transmissibles. Malgré les bienfaits qu'on lui reconnaît pour la santé des populations, la plupart des Canadiens ne suivent pas les recommandations en matière d'exercice. Les médecins jouent un rôle clé dans l'évaluation, le counseling et la prescription de l'activité physique, mais de nombreux obstacles, dont le manque de formation adéquate, les empêchent de promouvoir cette habitude de vie essentielle pour la santé. Afin d'aider les facultés de médecine canadiennes dans l'élaboration de leur cursus sur l'activité physique, une équipe composée de chercheurs, de médecins et de physiologistes de l'exercice a collaboré à la définition d'un ensemble d'objectifs d'apprentissage jugés indispensables à la formation des médecins pour qu'ils puissent offrir des conseils sur l'activité physique et la prescrire. Ce commentaire passe en revue les nouveaux objectifs d'apprentissage en matière de counseling en activité physique et donne des exemples de cas de trois facultés de médecine canadiennes qui ont mis en œuvre ces objectifs d'apprentissage.

Public Health Messaging for Wildfire Smoke: Cast a Wide Net.

Wildfire smoke events are increasing in British Columbia (BC), Canada and environmental and public health agencies are responsible for communicating the health-related risks and mitigation strategies. To evaluate and identify opportunities for improving public communications about wildfire smoke and associated health risks we collaborated with end-users and developed a 32-question online survey. The survey was deployed province-wide from 29 September to 31 December 2020 following a severe wildfire smoke episode, which impacted large parts of BC. Using a convenience sample, we disseminated the survey through email lists, radio advertisements, a provincial research platform, and snowball methods. There were 757 respondents, who were generally representative of provincial demographics. Respondents indicated that they receive wildfire smoke messages from diverse sources, including: websites, social media, radio, and television. Radio was identified as the most important source of information for populations that may have increased exposure or health risks, including Indigenous respondents and those working in the trades. Respondents with lower educational attainment expressed that messaging should be simplified. Environmental and public health agencies should continue to share wildfire smoke messages using diverse methods, ideally tailoring the messages and methods to specific populations at risk for exposure and health effects.

Effect of an Ultra-Endurance Event on Cardiovascular Function and Cognitive Performance in Marathon Runners.

Background: Ultra-marathon running participation has become increasingly more popular in recent years; however, there is inconclusive evidence concerning the effects of participation on cognition and cardiovascular function. The purpose of this study was to examine alterations in cardiovascular function and cognitive performance and their association in ultra-marathon runners prior to and following an ultra-endurance event. Methods: In total, 24 runners (19 males and 5 females) participated in an ultra-marathon race (FatDog120) held in British Columbia, Canada. Participants competed in varying races distances [48 km (n = 2), 80 km (n = 7), 113 km (n = 3), and 193 km (n = 12)]. Cognition was assessed prior to and upon race completion using simple reaction time, choice reaction time, discrimination reaction time, and recognition memory (% correct). Cardiovascular function was assessed prior to and upon race completion using radial applanation tonometry for diastolic pulse contour examination. Results: Cognitive performance displayed significantly (p < 0.001) slower reaction times post-race for simple (30.2%), discrimination (22.7%), and choice reaction time (30.5%), as well as a significant (p < 0.05) reduction in memory test performance (-8.2%). A significant association between systemic vascular resistance and choice reaction time was observed post-race (r = 0.41, p < 0.05). Significant changes in post-race cardiovascular function were observed in resting heart rate (31.5%), cardiac output (27.5%), mean arterial blood pressure (-5.6%), total systemic resistance (-17.6%), systolic blood pressure (-7.0%), pulse pressure (-11.2%), and rate pressure product (22.4%). There was evidence of enhanced cardiovascular function being associated with improved cognitive performance before and after the ultra-endurance event. Conclusion: Ultra endurance running is associated with marked impairments in cognitive performance that are associated (at least in part) with changes in cardiovascular function in healthy adults.

Better Together: Launching and Nurturing a Community Stakeholder Committee to Enhance Care and Research for Asthma and COPD.

Partnering with patients and community stakeholders to identify, design, undertake, and evaluate research is increasingly common. We describe our experience with creating and developing an ongoing Community Stakeholder Committee to guide lung health research for disease prevention and health care improvement. This committee is central to the integrated knowledge translation approach of Legacy for Airway Health, which is dedicated to preventing and improving care for lung diseases. Patient Engagement in Research (PEIR) aims to improve the relevance, quality, and implementation of research activities. Meaningful patient and community engagement in research remains challenging to enact. The committee was established in October 2019, just before the COVID-19 pandemic, and quickly adapted from in-person to virtual engagement activities. This change led to an increased focus on relationship-building and mutual support alongside other research and training activities. We conducted a baseline evaluation survey after 1 year (October 2020), using a modified version of the Patient Engagement in Research Scale (PEIRS-22). Whereas individual scores suggested varied levels of meaningful engagement within the committee, overall results indicated strong personal relationships and a sense of feeling valued and respected, as well as a desire for increased opportunities to contribute to research within the program. Overall, this experience offers lessons learned about the importance of spending time and effort to build relationships, particularly in a virtual context, and shows that meaningful engagement can be achieved even when personal contact is limited. These efforts are illustrated in successful grant applications, research involvement, and stronger personal relationships.

Association between physical activity level and cardiovascular risk factors in adolescents living with type 1 diabetes mellitus: a cross-sectional study.

BACKGROUND: Type 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM. METHODS: This cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses. RESULTS: Results were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25-75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1, p = 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1, p = 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1 p = 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1, p = 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1, p = 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs, p = 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00-124.14) vs (53.19 (35.68-63.16) min, p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74-16.22) vs 8.56 (6.18-10.12) %, p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (ß = 0.29, p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (ß = - 0.001, p = 0.018, model R2 = 0.205) and METs (ß = - 0.359, p = 0.015, model R2 = 0.208), and positively associated with time spent in sedentary behaviour (ß = 0.002, p = 0.041, model R2 = 0.156) in persons living with T1DM. CONCLUSIONS: Chinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.

High Intensity Interval Training Leads to Similar Inflammatory Activation as Seen With Traditional Training in Chronic Heart Failure.

BACKGROUND: Inflammatory activation has been associated with the severity and progression of chronic heart failure (CHF). Although cardiac rehabilitation is an important therapy, acute bouts of exercise may lead to increases in pro-inflammatory cytokines with exercise intensity mediating these changes. OBJECTIVE: To evaluate the acute inflammatory response in patients living with CHF during a randomized trial following Steady State (SS) or High Intensity Interval (HIIT) training. METHODS: Patients living with CHF (n = 14) were stratified (for body mass and aerobic power) and randomized into SS and HIIT cycle exercise. The HIIT exercise training involved 2 min work:recovery phases at 90:40% heart rate reserve. The SS exercise training involved continuous exercise at 65% of heart rate reserve (matched total work). Acute inflammatory markers were evaluated (via ELISA) at baseline, immediately following the bout, and at 6, 24, and 48 h post-exercise. RESULTS: There was limited differences in the changes in inflammatory biomarkers across time between the HIIT and SS groups. Both groups experienced a significant (p < 0.05) change in Interleukin-6 immediately post-exercise. CONCLUSIONS: A single bout of HIIT or SS does not result in excessive inflammatory activation in CHF patients. Acute HIIT and SS result in similar changes in inflammatory markers. These findings have important implications for exercise training and rehabilitation programs in persons living with CHF.

A Systematic Review of the Short-Term Health Effects of Air Pollution in Persons Living with Coronary Heart Disease.

Persons living with chronic medical conditions (such as coronary artery disease (CAD)) are thought to be at increased risk when exposed to air pollution. This systematic review critically evaluated the short-term health effects of air pollution in persons living with CAD. Original research articles were retrieved systematically through searching electronic databases (e.g., Medical Literature Analysis and Retrieval System Online (MEDLINE)), cross-referencing, and the authors' knowledge. From 2884 individual citations, 26 eligible articles were identified. The majority of the investigations (18 of 22 (82%)) revealed a negative relationship between air pollutants and cardiac function or overall health. Heart rate variability (HRV) was the primary cardiovascular outcome measure, with 10 out of 13 studies reporting at least one index of HRV being significantly affected by air pollutants. However, there was some inconsistency in the relationship between HRV and air pollutants, mediated (at least in part) by the confounding effects of beta-blocker medications. In conclusion, there is strong evidence that air pollution can have adverse effects on cardiovascular function in persons living with CAD. All persons living with CAD should be educated on how to monitor air quality, should recognize the potential risks of excessive exposure to air pollution, and be aware of strategies to mitigate these risks. Persons living with CAD should minimize their exposure to air pollution by limiting outdoor physical activity participation when the forecast air quality health index indicates increased air pollution (i.e., an increased risk).

Innovative Exercise as an Intervention for Older Adults with Knee Osteoarthritis: A Pilot Feasibility Study.

ABSTRACTExercise has potential to mitigate morbidity in knee osteoarthritis (OA). Participants with knee OA were randomized to a Square-stepping Exercise (SSE) group (2x/week for 24 weeks) or a control group. We assessed the feasibility of SSE and its effectiveness on symptoms (WOMAC), balance (Fullerton), mobility, and walking speed at 12 and 24 weeks. The SSE group had a 49.3% attendance rate and trended toward improvement in the 30-second chair stand at 12 (F = 1.8, p = .12, ηp2 = 0.16), and 24 weeks, (F = 3.4, p = .09, ηp2 = 0.18), and walking speed at 24 weeks, compared to controls. There were no differences in symptoms or balance. The low attendance and recruitment demonstrated limited feasibility of SSE in adults with knee OA. Trends suggest the potential for SSE to improve lower extremity functional fitness and walking speed. SSE should be further studied for effectiveness on symptoms and balance, in addition to improving feasibility.

Results From a Feasibility Study of Square-Stepping Exercise in Older Adults With Type 2 Diabetes and Self-Reported Cognitive Complaints to Improve Global Cognitive Functioning.

OBJECTIVES: Adults with type 2 diabetes mellitus have an increased risk for dementia. Therefore, we proposed an intervention called the Square-stepping exercise (SSE) program to mitigate this risk. Our primary aim was to determine the feasibility of SSE in adults with type 2 diabetes and self-reported cognitive complaints. Our secondary aim was to determine whether 24 weeks of SSE improved cognition. Our tertiary aim was to determine whether SSE improved antisaccade reaction time, which is a measure of executive-related oculomotor control. METHODS: Adults >49 years with type 2 diabetes and self-reported cognitive complaints were randomized to an SSE group (2×/week for 24 weeks of SSE) or a control group. Feasibility was assessed by recruitment and attendance. Participants were assessed at baseline, after 12 weeks and after 24 weeks for global cognitive function, memory, planning, reasoning and concentration via a computer-based cognitive battery (Cambridge Brain Sciences) and antisaccade reaction time (at baseline and 24 weeks). RESULTS: Participants in the SSE group were (mean [SD]): 65.9 (5.2) years old; 33% female; body mass index 33.3 kg/m2 (4.8) (n=12). Participants in the control group were 71.2 (6.9) years old; 31% female; body mass index 31.9 kg/m2 (4.6) (n=13). Over 24 weeks, attendance was 70.2% (SD 17.2) for 4/12 participants. There were 4 withdrawals and 1 adverse event. There were no differences in global cognitive functioning. The SSE group improved in planning domain change scores between 12 and 24 weeks (F=5.8, p=0.03, ηp2=0.28) compared to controls. In the SSE group, we found a nonsignificant improvement in antisaccade reaction time of 38 ms (SD 16), n=2, compared to 9 ms (SD 45) in the control group, n=8. CONCLUSIONS: SSE should be evaluated further to improve its feasibility in older adults with type 2 diabetes. This study provides preliminary evidence that SSE improves executive function in adults with type 2 diabetes and self-reported cognitive complaints.

Commentary on: "Effects of Regular Physical Activity on the Cognitive Performance of Type 2 Diabetic Patients: A Systematic Review" by Podolski et al. (Metab Syndr Relat Disord 2017;15:481-493).

Type 2 diabetes mellitus (T2DM) imparts an increased risk for cognitive decline, specifically executive function, which is important to maintain for diabetes self-management. There is evidence to suggest that exercise improves cognition in healthy older adults; however, the literature in adults with T2DM is lacking. This commentary is in complement to Podolski et al.'s systematic review evaluating the effects of physical activity on cognitive function in adults with T2DM. We have included eight additional studies and further highlight their conclusions on the heterogeneity of the literature thus far. Three current issues with the literature are as follows: (1) variability in interventions (e.g., aerobic, resistance, lifestyle, and yoga), (2) variability in cognitive outcome measures, and (3) lack of detailed description of the population studied, for example, baseline glycated hemoglobin (A1C) values. Overall, making it difficult to compare these studies and draw final conclusions. Thus, the efficacy for exercise to improve cognition in adults with T2DM is not yet well understood. Potential ways to mitigate these limitations could be for future studies that (1) use robust methodology whenever possible, that is, randomized controlled trials, (2) to follow current guideline-derived exercise recommendations for adults with T2DM, and (3) utilize cognitive outcome measures that are consistent across studies. The hope is that these consistencies in turn will help to determine the efficacy of exercise on cognitive function in adults with T2DM and therefore, allow national organizations to develop recommendations and guidelines for healthcare practitioners to follow.

HealtheBrain: an innovative smartphone application to improve cognitive function in older adults.

BACKGROUND: Exercise-based interventions have shown promise in slowing cognitive decline, however there is limited evidence for scalability. Our previous research has linked a novel visuospatial memory exercise intervention, incorporating patterned walking or square-stepping exercise (SSE) with significant improvements in executive function and memory among older adults with normal cognition as well as those with subjective cognitive complaints (SCC) and mild cognitive impairment (MCI). The aim of the current study was to determine the feasibility and utility of the HealtheBrain smartphone app to deliver SSE outside the laboratory among older adults with and without cognitive impairment. METHODS: Previous healthy research subjects with and without SCC or MCI, who had previous exposure to SSE, and who owned or had access to an iPhone of iPad, were recruited to download the HealtheBrain app and use it up to 3 weeks. There were no restrictions on the number of times subjects could use the app. A 15-question survey was developed to assess feasibility and utility of the HealtheBrain app and completed online following the brief exposure period. RESULTS: Of 135 people who were identified, 95 were contacted between September 2014 to August 2015, 27 downloaded the HealtheBrain app on their iPhone or iPad from the App Store and 19 completed the questionnaire. Subjects (n=19) were an average age of 68.3±5.4; 74% female and had 15.5±2.8 years of education (84% post-secondary education), a mean Mini Mental State examination score of 29.1 (SD 1.2) out of 30 and Montreal Cognitive Assessment score of 26.3 (SD 1.9) out of 30. Subjects used the HealtheBrain app 1-7 days per week, mostly at home. Of possible stages of progression, subjects mainly used the stage 1 and 2 beginner patterns. Subjects reported perceived and technical challenges registering horizontal step patterns associated with stage 2 and greater progression. Sixty percent found the app was easy to use or similar to what they experienced with SSE in the laboratory setting. Most said they would continue to use the HealtheBrain app and would recommend it to friends and family. CONCLUSIONS: The HealtheBrain app was feasible in providing SSE to older adults with the appropriate smartphone device outside the laboratory setting. Challenges were identified with perceived capture of higher levels of SSE stages that used horizontal step patterns. This as well as technical issues with horizontal step patterns will be addressed by newer GPS technology in current smartphone devices. Most subjects stated they would continue to use the HealtheBrain app and refer to their friends and family. We believe that our findings in a representative cohort support the HealtheBrain app as a scalable intervention to promote cognitive health in older adults.

Long-Term Maintenance of Executive-Related Oculomotor Improvements in Older Adults with Self-Reported Cognitive Complaints Following a 24-Week Multiple Modality Exercise Program.

Adults (≥55 years) with self-reported cognitive complaints (sCC) were randomized to: multiple-modality exercise (M2), or multiple-modality plus mind-motor exercise (M4), for 24-weeks. Participants (n = 58) were assessed on antisaccade reaction time (RT) to examine executive-related oculomotor control and self-reported physical activity (PA) at pre-intervention (V0), post-intervention (V1), and 52-weeks follow-up (V2). We previously reported significant improvements in antisaccade RT of 23 ms at V1, in both groups. We now report maintenance of antisaccade RT improvement from V1 to V2, t(57) = 0.8, p = 0.45, and improved PA from V1 to V2, t(56) = -2.4, p = 0.02. Improvements in executive-related oculomotor control attained at V1 were maintained at V2.

Group-based exercise and cognitive-physical training in older adults with self-reported cognitive complaints: The Multiple-Modality, Mind-Motor (M4) study protocol.

BACKGROUND: Dementia is associated with cognitive and functional deficits, and poses a significant personal, societal, and economic burden. Directing interventions towards older adults with self-reported cognitive complaints may provide the greatest impact on dementia incidence and prevalence. Risk factors for cognitive and functional deficits are multifactorial in nature; many are cardiovascular disease risk factors and are lifestyle-mediated. Evidence suggests that multiple-modality exercise programs can provide cognitive and functional benefits that extend beyond what can be achieved from cognitive, aerobic, or resistance training alone, and preliminary evidence suggests that novel mind-motor interventions (i.e., Square Stepping Exercise; SSE) can benefit cognition and functional fitness. Nevertheless, it remains unclear whether multiple-modality exercise combined with mind-motor interventions can benefit diverse cognitive and functional outcomes in older adults with cognitive complaints. METHODS/DESIGN: The Multiple-Modality, Mind-Motor (M4) study is a randomized controlled trial investigating the cognitive and functional impact of combined physical and cognitive training among community-dwelling adults with self-reported cognitive complaints who are 55 years of age or older. Participants are randomized to a Multiple-Modality and Mind-Motor (M4) intervention group or a Multiple-Modality (M2) comparison group. Participants exercise for 60 minutes/day, 3-days/week for 24 weeks and are assessed at baseline, 24 weeks and 52 weeks. The primary outcome is global cognitive function at 24 weeks, derived from the Cambridge Brain Sciences computerized cognitive battery. Secondary outcomes are: i) global cognitive function at 52 weeks; ii) domain-specific cognitive function at 24 and 52 weeks; iii) mobility (gait characteristics under single and dual-task conditions and balance); and 3) vascular health (blood pressure and carotid arterial measurements). We will analyze data based on an intent-to-treat approach, using mixed models for repeated measurements. DISCUSSION: The design features of the M4 trial and the methods included to address previous limitations within cognitive and exercise research will be discussed. Results from the M4 trial will provide evidence of combined multiple-modality and cognitive training among older adults with self-reported cognitive complaints on cognitive, mobility-related and vascular outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02136368.