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Tsolaki
1. Physical activities and Cognitive function Magda Tsolaki, MD, PhD Neuropsychiatrist Professor of Aristotle University of Thessaloniki Chair of Greek Alzheimer Federation www.alzheimer-hellas.gr
13. Alzheimer Disease Progression Deterioration Time in years From S GAUTHIER 1996 Clinical Phase ? Mood disturbances Cognitive impairments Impaired activities of daily living ADL Behavioural disturbances Motor disorders
29. Authors Year Participants Intervention Results Molloy et al 1988 N= 15, MMSE: 24 1 st group : mild aerobic exercise 45΄/ once a week for two weeks 2 nd group : no intervention Improvement in verbal fluency Mulrow et al 1994 N= 194, MMSE: 21 1 st group ασκήσεις ενδυνάμωσης, ισορροπίας, κινητικότητας. 2 η ομάδα: φιλικές επισκέψεις. 45΄/ 3 φορές την εβδομάδα/ 16 εβδομάδες Moderate motor improvement Baum et al 2003 N= 20 MMSE: 21 1 η ομάδα: εύρος κινητικότητας καθισμένου 2 η ομάδα: ψυχαγωγικές δραστηριότητες 60΄/ 3 φορές την εβδομάδα/ 6 μήνες Improvement in physical status and MMSE Stevens et al 2006 N= 75 MMSE: 9 - 23 1 η ομάδα: σωματική άσκηση 2 η ομάδα: κοινωνικές επισκέψεις 30΄/ 3 φορές την εβδομάδα/ 12 εβδομάδες 2 η ομάδα: καμία παρέμβαση Delay of cognitive and physical deterioration
64. OUR EXPERIENCE EFFECTS OF AN EXERCISE INTERVENTION ON COGNITIVE FUNCTION OF ALZHEIMER’S DISEASE PATIENTS C.A. Mouzakidis, M.Tsolaki
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68. NS = non-significant Soda Pop Test 12 16.50 ( ± 11.79) 13.20 ( ± 11.20) NS Finger Dexterity 12 29.75 ( ± 31.00) 25.85 ( ± 23.26) NS Hand Tapping 12 62.00 ( ± 19.00) 70.00 ( ± 11.67) NS Reaction Time (cm) 12 38.50 (±15.51) 29.70 (±13.75) p = 0.001 Repetitive Arm and Hand Movements Right Hand 12 3.21 (±0.97) 2.75 (±0.74) p = 0.001 Left Hand 12 3.44(±0.97) 3.00 (±0.78) p = 0.010 Grip Test (kg) Right Hand 12 27.58 (±6.37) 30.00 (±7.29) p = 0.007 Left Hand 12 24.33 (±7.40) 26.50 (±8.10) p = 0.007 Sequential Arm and Hand Movements 12 1.75 (±2.05) 0.83 (±2.00) p = 0.050 Reeling String on a Stick 11 17.17 (±11.93) 15.22 (±11.00) p = 0.001 Bounce a Ball 12 2.17 ( ± 2.21) 1.08 ( ± 2.06) NS Throw a B all to a target 12 2.08 (±1.24) 0.92 (±1.24) p = 0.004 Bowling 12 2.17 ( ± 2.33) 3.50 ( ± 2.71) NS Gait Control 11 0.45 ( ± 1.21) 0.09 ( ± 0.30) NS Static Balance 12 25.17 (±22.61) 33.81 (±23.57) p = 0.008 Step Into and Out of a Hoop 12 0.83 ( ± 1.64) 1.58 ( ± 2.35) NS Sit and Reach Test 12 49.25 (±13.50) 52.17 (±15.35) p = 0.006 Agility 12 7.00 ( ± 4.26) 8.25 ( ± 5.67) NS
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71. ΝΟΣΟΣ ALZHEIMER Μάγδα Τσολάκη, MD, PhD Νευρολόγος-Ψυχίατρος, Θεολόγος, Αναπληρώτρια Καθηγήτρια, Α.Π.Θ. Πρόεδρος της Ελληνικής Ομοσπονδίας Νόσου Alzheimer
79. Expected Results pre post Cognitive Function Theory Expected Results Results from Konstanz: 10 weeks physical training 2 x 45 min/week Hertzog et al., 2009 LLM Control 2011
Physical activity, cognitive functioning, and aging. Both cross-sectional and prospective cohort studies have linked participation in regular physical activity with a reduced risk for dementia or cognitive decline in older adults. Examples include the Study of Osteoporotic Fractures (268), which reported that activity level was linked to changes in Mini-Mental Status Examination scores, and the Canadian Study of Health and Aging, which demonstrated that physical activity was associated with lower risk of cognitive impairment and dementia (138). It also seems that decreases in physical mobility are linked to cognitive decline (127). The InCHIANTI study reported an association between physical mobility, specifically walking speed and ability to walk 1 km, with signs of neurological disease (65). Similarly, the Oregon Brain Aging Study reported an association between walking speed and onset of cognitive impairment (147) Finally, the MacArthur Research Network on Successful Aging Community Study reported associations between declines in cognitive performance and routine physical tasks including measures of grip strength and mobility (i.e., walking speed, chair stands) (238). Experimental trials of exercise interventions in older adults demonstrate that acute exposure to a single bout of aerobic exercise can result in short-term improvements in memory, attention, and reaction time (39), but more importantly, participation in both AET and RET alone, and in combination, leads to sustained improvements in cognitive performance, particularly for executive control tasks (39). Several studies have compared the individual and combined effects of physical and mental exercise interventions (61,177). These studies found cognitive benefits to be larger with the combined cognitive and aerobic training paradigms. The mechanism for the relationship between physical activity and exercise and cognitive functioning is not well understood; however, several researchers have suggested that enhanced blood flow, increased brain volume, elevations in brain-derived neurotrophic factor, and improvements in neurotransmitter systems and IGF-1 function may occur in response to behavioral and aerobic training (40,134).
The battery of psychomotor measures included simple and complex tasks which assess flexibility, strength of upper limbs, agility, dynamic balance, eye-hand coordination, reaction time, orientation, dexterity, balance, hand rapid movements, neuromuscular coordination and attention (Mouzakidis, 1998)
In the main exercise period ( 45 minutes), were chosen exercise routines that improve flexibility, strength of upper and lower limbs, endurance, dexterity, balance, agility, speed, attention and accuracy, co-ordination, orientation, memory, self-control, and co-operation among the patients. The exercise routines were flexible. They could be modified to the needs and the abilities of a patient without causing any feelings of discomfort to the rest of the team. There was a combination of standing and sitting exercises with one or two sets and five repetitions, which they were increasing gradually to 8 or 10 according to the level of the patients. The instructions were simple and rhythmic. The physical educator was using the same words and the same presentation for a specific exercise routine. To those who faced some difficulties to follow an exercise routine it was given one-on-one help. Furthermore, accordingly to the difficulty of the exercise routine, the physical educator provided the patients with encouragement, feedback, and reinforcement.
Paired Samples t-tests revealed that the patients of the experimental group managed to maintain their cognitive abilities ( t (11) = 0.692, p = 0.504), while the patients of the control group deteriorated ( t (11) = 3.570, p = 0.004).
Paired samples t tests indicated that the participants improved their performance in 8 out of 16 psychomotor measures, ie., reaction time, repetitive arm and hand movements , handgrip strength, sequential arm and hand movements , reeling string on a stick , throwing a b all , static balance, and in sit and reach . Mean scores, standard deviations, p values, and within-group pre-test to post-test comparisons for all psychomotor measures appear in Table 4 .
