INTRODUÇÃO: Recentemente, videogames interativos (VI) estão sendo utilizados como intervenção cognitiva-motora que associa estímulos motores e cognitivos. Vários estudos mostraram que os VI podem promover melhorias no controle postural, marcha, cognição e independência funcional em idosos e pacientes com doença neurológica. No entanto, ainda não há evidências sobre os efeitos dos VI em idosos frágeis. O objetivo deste estudo foi avaliar a aplicabilidade, a segurança, a aceitabilidade do treinamento com Nintendo Wii Fit Plus® (NWFP) e os resultados funcionais (controle postural, marcha, cognição, humor e medo de cair) em idosos frágeis e pré-frágeis. MÉTODOS: Foi realizado um ensaio clínico randomizado controlado, grupo paralelo, para avaliação da aplicabilidade. Idosos frágeis e pré-frágeis foram atribuídos aleatoriamente ao grupo experimental (GE, n = 15) ou grupo controle (GC, n=15). Os participantes do GE realizaram 14 sessões de treinamento, com duração de 50 minutos cada, duas vezes por semana. Em cada sessão de treinamento, os participantes jogaram cinco dos 10 jogos selecionados, duas tentativas em cada jogo. Os participantes do GC receberam recomendações gerais sobre a importância da atividade física. Todos os participantes foram avaliados por um fisioterapeuta cego em três momentos: antes e depois da intervenção e 30 dias após o término da intervenção (follow-up). Avaliamos a aplicabilidade (pontuação dos participantes nos jogos), aceitabilidade (questionário de satisfação dos jogos), segurança (eventos adversos durante as sessões de treinamento) e desfechos funcionais: (1) controle postural (Mini-BESTest); (2) marcha (Functional Gait Assessment, FGA); (3) cognição (Montreal Cognitive Assessment, MoCA); (4) humor (GDS-15); e (5) medo de cair (FES-I). RESULTADOS: Os participantes do GE melhoraram suas pontuações em todos os 10 jogos, relataram que entenderam os jogos e gostaram de praticá-lo, houve poucos eventos adversos durante o período do estudo. Houve melhora significativa no Mini-BESTest e no FGA no GE quando comparado ao GC (p < 0,05). CONCLUSÃO: O treinamento com NWFP foi aplicável, aceitável e seguro para idosos frágeis e promoveu melhora no controle postural e na marcha. Não houve efeitos sobre a cognição, humor ou medo de cair / BACKGROUND: Recently, interactive video games (IVG) have been used as a cognitive-motor intervention that associates exercises and cognitive stimulation. Several studies have shown that IVG can promote improvement in postural control, gait, cognition, and functional independence in elderly people and patients with neurological disease. However, there is a lack of evidence about the effects of IVG on frail and pre frail elderly. The aim of this study was to evaluate the feasibility, safety, and acceptability of playing Nintendo Wii Fit PlusTM (NWFP) interactive video games, and the functional outcomes (postural control, gait, cognition, mood, and fear of falling) in frail and pre frail older adults. Methods: This study is a randomised controlled, parallel group, feasibility trial. Participants were frail and pre frail older adults randomly assigned to the experimental group (EG, n=15) or control group (CG, n=15). Participants of the EG performed 14 training sessions, lasting 50 minutes each, twice a week. In each training session, participants played five of 10 selected games, with two attempts at each game. Participants of the CG received general advice regarding the importance of physical activity. All participants were assessed by a blinded physical therapist at three moments: before and after intervention, and 30 days after the end of the intervention (follow-up). We assessed the feasibility (score of participants in the games), acceptability (game satisfaction questionnaire), safety (adverse events during training sessions), and functional outcomes: (1) postural control (Mini-BESTest); (2) gait (Functional Gait Assessment); (3) cognition (Montreal Cognitive Assessment); (4) mood (GDS-15); and (5) fear of falling (FES-I). Results: Participants in the EG improved their scores in all of the 10 games, reported to understand and enjoy the tasks of the games, and presented few adverse events during the practice. There was a significant improvement in the Mini-BESTest and Functional Gait Assessment in the EG when compared to the CG (p < 0.05). Conclusion: NWFP was feasible, acceptable, and safe for frail older adults and promoted improvement in postural control and gait. There were no effects on cognition, mood, or fear of falling

Graduation date: 2004

The main purposes of this thesis were to evaluate a high-intensity functional weight-bearing exercise pro­gramme, regarding its applicability (attendance, achieved intensity, adverse events) as well as its effect on physical functions and activities of daily living (ADL) among older people living in residential care facilities, with a special focus on people with dementia. Furthermore, a main purpose was to systematically review the applicability and effects of physical exercise on physical functions, cognitive functions, and ADL among people with dementia. A high-intensity functional weight-bearing exercise programme that includes lower-limb strength and balance exercises in standing and walking, was evaluated in a randomised controlled trial among 191 older people, dependent in ADL, living in residential care facilities, and with a Mini-Mental State Examination (MMSE) score of ten or more. One hundred (52.4%) of the participants had dementia. Participants were randomised to an exercise programme or a control activity, consisting of 29 supervised sessions over 3 months, as well as to an intake of a protein-enriched energy supplement or a placebo drink immediately after each session. The effect on physical functions was evaluated using the Berg Balance Scale, usual and maximum gait speed, and one-repetition maximum in a leg press machine measuring lower-limb strength. The effect on ADL was evaluated using the Barthel Index. These outcome measures were followed up at 3 and 6 months by blinded assessors and analysed using the intention-to-treat principle. The evaluation of the applicability of the high-intensity functional weight-bearing exercise programme showed that there was a high rate of attendance, a relatively high achieved intensity in the exercises, and all except two adverse events were assessed as minor or temporary and none led to manifest injury or disease. No statistically significant differences were observed in applicability when comparing participants with dementia and participants without dementia. In addition, the applicability of the programme was not associated with the participants’ cognitive function. Significant long-term effects of the exercise programme were seen regarding functional balance, gait ability and lower-limb strength in comparison with the control activity. The intake of the protein-enriched energy supplement did not increase the effect of the training. Age, sex, depression, dementia disorder, nutritional status, and level of functional balance capacity did not influence the effect on functional balance of the high-intensity functional weight-bearing exercise programme. There were no significant differences between the groups regarding overall ADL performance. Analyses for each item revealed that a significantly smaller proportion of participants in the exercise group had deteriorated regarding indoor mobility at 3 and 6 months. For people with dementia, there was a significant difference in overall ADL performance in favour of the exercise group at 3 months, but not at 6 months. In a systematic review, randomised controlled trials, evaluating the effects of physical exercise among people with dementia, were identified according to pre-defined inclusion criteria. Two reviewers independently extracted predetermined data and assessed methodological quality. Ten studies were included in the review and the majority of the participants were older people with Alzheimer’s disease living in residential care facilities. Four studies reached “moderate” methodological quality and six “low”. The results showed that among older people with Alzheimer’s disease in residential care facilities, combined functional weight-bearing exercise over 12 months at an intended moderate intensity seems applicable for use regarding attendance and adverse events and there is some evidence that the exercise improves walking performance and reduces ADL decline. Furthermore, there is some evidence that walking exercise over 16 weeks performed individually, where the participant walks as far as possible during the session, reduces decline in walking performance, but adverse events need to be evaluated. In conclusion, among older people who are dependent in ADL, living in residential care facilities, and have an MMSE score of 10 or more, a high-intensity functional weight-bearing exercise programme is applicable for use and has positive long-term effects on functional balance, gait ability, and lower-limb strength and seems to reduce ADL decline related to indoor mobility. An intake of a protein-enriched energy supplement immediately after the exercise does not appear to increase the effect of the training. In people with dementia, the exercise programme may prevent decline in overall ADL performance, but continuous training may be needed to maintain that effect. The positive results regarding applicability and effects of combined functional weight-bearing exercise among people with dementia is confirmed when the scientific literature is systematically reviewed. It seems to be important that exercise interventions among people with dementia last for at least a few months and that the exercises are task-specific and intended to challenge the individual’s physical capacity. Whether physical exercise can improve cognitive functions among people with dementia remains unclear. There is a need for more exercise studies of high methodological quality among people with dementia disorders.

published_or_final_version / Gerontology / Master / Master of Social Sciences

No description available.

The association of functional status with fat-free mass (FFM) was examined cross-sectionally in a sample of 30 frail elderly women $(81.5 pm 7$ years) to evaluate potential outcome indicators for nutritional interventions. FFM, determined using multi-frequency bioelectrical impedance analysis, was lower in this frail group than in previous reports for "younger" elderly females. All measures of muscle strength (handgrip, biceps, quadriceps) were significantly correlated with FFM $ rm (r ge 0.45, p le 0.02),$ while the measures of global function (Timed "Up & Go" Test and walking speed) as well as self-perceived health were not. The measures of muscle strength and global function were found to have good reliability based on measurements taken on two occasions separated by one week $ rm (ICC ge 0.80).$

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Thesis (M.Sc.). / Written for the School of Physical and Occupational Therapy. Title from title page of PDF (viewed 2008/07/29). Includes bibliographical references.

Thèse (M.Ps.) -- Université du Québec à Chicoutimi, programme extensionné de l'Université du Québec à Trois-Rivières, 2003. / La p. de t. porte en outre : Mémoire présenté à l'Université du Québec à Chicoutimi comme exigence partielle de la maîtrise en psychologie offerte à l'Université du Québec à Chicoutimi en vertu d'un protocole d'entente avec l'Université du Québec à Trois-Rivières. Comprend des réf. bibliogr. : f. [102]-115. Document électronique également accessible en format PDF.