The influence of an 8-week water intervention on executive functioning and mobility in healthy older individuals

Grobler, Syndy (2018-03)

Thesis (MScSportSc)--Stellenbosch University, 2018.

Thesis

ENGLISH ABSTRACT: Background: Inevitable cognitive decline of Executive Function (EF) and Mobility, though quintessential for successful ageing, is already evident in apparently healthy older adults, aged 50 – 64 years. A water training environment might be ideal to simultaneously capitalise on neuroplasticity and Mobility, yet limited research applies. The elderly (≥ 65 years), specific EFs and aspects of Mobility are the focus of research. Aim: Primarily, the influence of a high-intensity, 8-week water-based exercise intervention (WBEI) on EF and Mobility of healthy older adults were investigated. Secondly, it’s influence on Health-related Quality of Life (HRQoL) and Physical Functioning to execute activities of daily living (ADL) pertained. It was hypothesised the WBEI would lead to greater EF and Mobility improvements, compared to non-exercising older adults. Methods: A single-blinded randomised control trial divided forty-one, healthy older adults (50 - 64 years) into a high-intensity WBEI group (Experimental: EXP; 𝑥̅ 55.23 ± 4.37; n = 22) and non-exercising Control (CON) group, attending time-matched-attention (TMA) relaxation and educational activities (𝑥̅ 59.05 ± 4.09; n = 19) with thrice, weekly sessions (45 minutes duration). Pre-and post-tests were completed. The two primary outcome variables were EF and Mobility with outcome measures and tests for EF were: Attention and Working (WM) - Digit Span Forward (DSFW) and -Backward (DSBW); Cognitive flexibility (CF) - Trail Making Test A and B (TMT A and TMT B); Inhibitory control (IC) - Walking Stroop Carpet (WSC). Outcome measures and tests for Mobility: Gait variables (single-task and cognitive dual-task) - the 7-metre instrumented Timed-up and Go (iTUG); Functional Capacity and Gait speed – the Six-minute walk test (6MWT). Secondary variables were as follow: Global Cognition - Montreal Cognitive Assessment (MoCA); Depressive Mood - Patient Health Questionnaire (PHQ-9); Health-related Quality of Life (HRQoL) - Short-Form Health Survey (SF-36) and Physical Function (PF-10). Results: Treatment effects were found for: IC (P = 0.03), Gait speed (P = 0.003), Functional Capacity (P = 0.01), HRQoL (P = 0.04) and Physical Functioning (P = 0.008). Post-hoc analysis indicated improvement (P < 0.05) for both groups on IC for WSC Total duration (TD) on certain congruent, incongruent and average scores of incongruent Conditions. Only the EXP-group improved IC for TD on incongruent Condition 3 (P < 0.0001) and WSC derived scores (P < 0.05). Improved TD on single-task (ST) iTUG (P < 0.05) was found for both groups, yet only for CON group’s TD on dual-task (DT) iTUG (P = 0.03). Gait speed (GS) for iTUG cognitive DT walking improved for the EXP group. Postural transition of Turn-to-sit (TTS) deteriorated (P = 0.01) for the CON group. Post-hoc results for secondary outcome were: Global Cognition (P = 0.0001), visual spatial ability (P = 0.049), memory (P = 0.04), Depressive Mood (P = 0.01), HRQoL (P = 0.0018) and PF-10 (P = 0.006) for the EXP group. With TMT B and ratio scores, CF improved (P < 0.05) for the CON group only but Physical Functioning decreased (P = 0.002). Conclusion: The hypothesis is partially supported with the high-intensity WBEI for older adults, effectivly increasing IC and Mobility, whilst enhancing Cognition and decreasing Depressive Mood, to execute ADL and enhance HRQoL. Training in water might be an ideal environment to address EF- and Mobility decline in older adults.

AFRIKAANSE OPSOMMING: Agtergrond: Normale veroudering lei tot ‘n afname in noodsaaklike Uitvoerende Funksie(EF) en Mobiliteit, reeds sigbaar in oënskynlik gesonde, ouer volwassene (50 – 64 jaar). ‘n Water-gebaseerde oefenprogram (WBEI) kan ‘n ideale omgewing bied vir gelyktydige bevordering van neuroplastisiteit en Mobiliteit. Navorsing oor waterintervensies is beperk en gerig op bejaardes (≥ 65 jaar). Doel: Die primêre doel was ondersoek oor die invloed van ‘n 8-weke, hoë-intensiteit WBEI vir ouer volwassenes op EF en Mobiliteit, terwyl die sekondêre doel ‘n ondersoek was oor invloed op gesondheidsverwante lewenskwaliteit (HRQoL) en Fisiese Funksionaliteit (PF-10) vir uitvoering van daaglikse aktiwiteite (ADL). Dis gehipotetiseer dat die WBEI EF en Mobiliteit sal verbeter inteenstelling met die groep sonder oefeninge. Metodes: Een-en-veertig gesonde ouer volwassenes (ouderdom: 50 – 64 jaar) is ewekansig toegewys aan twee groepe, met beide hoof-navorser en deelnemers blind gelaat. Die Eksperimentele groep (‘EXP group’; 𝑥̅ 55.23 ± 4.37; n = 22) het aan ‘n 8-weke, hoë-intensiteit WBEI deelgeneem, teenoor die Kontrole groep (‘CON group’; 𝑥̅ 59.05 ± 4.09; n = 19) se ontspannings- en opvoedkundige aktiwiteite. Alle sessies was drie keer per week vir 45minute. Voor- en na-toetsing is vir beide groepe uitgevoer. Twee primêre uitkomste EF en Mobiliteit, geld. Uitvoerende funksie is as volg gemeet: Aandag en Werksgeheue (WM) met die ‘Digit Span Forward (DSFW)’ en -‘Backward (DSBW)’; Kognitiewe buigsaamheid (CF) met die ‘Trail Making Test A and B (TMT A and B)’; Inhibitiewe beheer (IC) deur die ‘Walking Stroop Carpet (WSC)’. Mobiliteit is op grond van verkose loopgang-veranderlikes tydens beide enkel-taak (‘single-task’) en kognitiewe dubbel-taakuitvoering (‘cognitive dual-task’) gemeet deur die 7-meter ‘instrumented Timed-up and Go (iTUG)’- toets. Funksionele Kapasiteit, sowel as spoed tydens loopgang, is bepaal met die ‘Six-minute walk test (6MWT)’. Die sekondêre veranderlikes en meetmiddels was as volg: Globale Kognisie - ‘Montreal Cognitive Assessment (MoCA)’, Depressiewe gemoed - Pasiënt-gesondheidsvraelys (‘PHQ-9’), gesondheidsverwante lewenskwaliteit (HRQoL) - Verkorte Gesondheidsvraelys (SF-36), asook Fisieke Funksionering in uitvoering van ADL - Fisieke Funksioneringsvraelys (PF-10). Resultate: Behandelingseffekte is as volg verkry: IC (P = 0.03), versnelde loopgang (GS) (P = 0.003), Funksionele Kapasiteit (P = 0.01), HRQoL (P = 0.04), sowel as PF-10 (P = 0.006). Post-hoc analise toon beide groepe verbeter IC vir WSC Totale tydsduur (TD) op onderskeie kongruente, inkongruente, en gemiddelde tellings van inkongruente Kondisies (P < 0.05). Verbetering in IC vir TD tydens die inkongruente Kondisie 3 (P < 0.0001), asook afgeleide WSC-tellings (P < 0.05) is gevind vir die EXP-groep. Beide groepe toon korter tydsduur vir TD tydens die enkel-taak (ST) loopgang iTUG – toets (P < 0.05). Slegs die CON groep verbeter beduidend (P = 0.03) in TD met die kognitiewe dubbel-taak (DT) tydens die iTUG, waarteenoor slegs die EXP groep hul GS tydens die kognitiewe DT in hierdie toets verbeter (P < 0.05). Draai-tot-sit (‘Turn-to-sit: TTS’) verswak vir die CON groep, by voltooing van die ST loopgang (P = 0.01). Post-hoc analise vir sekondêre uiteenkomste is as volg gekry vir die EXP groep: Globale Kognisie (P = 0.0001), visuele ruimtelike vermoë (P = 0.049), geheue (P = 0.04), gemoedsverbetering (P = 0.01), HRQoL (P = 0.0018), asook PF-10 (P = 0.006). Kognitiewe buigsaamheid soos gemeet deur die TMT B, asook verhoudingstellings, het slegs vir die CON-groep (P < 0.05) verbeter maar die CON groep het beduidend (P = 0.002) verswak in PF-10 tellings. Gevolgtrekking: Gedeeltelike ondersteuning van die hipotese, bevestig dat die hoë-intensiteit WBEI gemik op ouer volwassenes, effektief is in die verbetering van IC en Mobiliteit, asook Globale Kognisie en Depressiewe gemoed. Verbeterde uitvoering van ADL en verhoogde HRQoL is tot gevolg. Water bied ‘n ideale oefeningsomgewing, waardeur die afname in EF en Mobiliteit van die ouer volwassene aangespreek kan word.

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