Feasibility, safety, and adherence of a remote physical and cognitive exercise protocol for older women

Peixoto, Cristiane; Matioli, Maria Niures Pimentel dos Santos; Takano, Satiko Andrezza Ferreira; Teixeira, Maurício Silva; Borges Passos Neto, Carlos Eduardo; Dozzi Brucki, Sonia Maria

doi:10.1055/s-0044-1785690

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Original Article • Arq. Neuro-Psiquiatr. 82 (4) • 2024 • https://doi.org/10.1055/s-0044-1785690 copy

Feasibility, safety, and adherence of a remote physical and cognitive exercise protocol for older women

Viabilidade, segurança e aderência de um protocolo remoto de exercícios físicos e cognitivos para mulheres idosas

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Population aging and the consequences of social distancing after the COVID-19 pandemic make it relevant to investigate the feasibility of remote interventions and their potential effects on averting functional decline.

Objective

(1) To investigate the feasibility, safety, and adherence of a remote protocol involving physical and cognitive exercises for older women with normal cognition; (2) to examine its effects on cognitive and well-being variables.

Methods

Twenty-nine women (age ≥ 60 years old) were randomized into experimental group (EG; n = 15) and control group (CG; n = 14). The EG performed a 40-minute session of cognitive and physical exercises, and CG performed a 20-minute stretching session. Both groups performed 20 sessions via videoconference and 20 on YouTube twice a week. The Mini-Mental State Examination, Verbal Fluency Test, Digit Span (direct an inverse order), Geriatric Depression Scale (GDS), and Well-being Index (WHO-5) were applied in pre- and post-interventions by phone.

Results

Overall adherence was 82.25% in EG and 74.29% in CG. The occurrence of adverse events (mild muscle pain) was 33.3% in EG and 21.4% in CG. The EG improved verbal fluency and attention (p ≤ 0.05); both groups had improved depressive symptoms.

Conclusion

The present study met the pre-established criteria for feasibility, safety, and adherence to the remote exercise protocol among older women. The results suggest that a combined protocol has more significant potential to improve cognitive function. Both interventions were beneficial in improving the subjective perception of well-being.

Keywords
Feasibility Studies; Exercise; Telemonitoring; Aged

Variable	Category	Group		p value
Variable	Category	CG (n = 14)	EG (n = 15)	p value
Age	Mean (SD)	66.71 (4.18)	67.8 (4.84)	0.510^† † Mann-Whitney U test.
Age	Median (min-max)	66 (62-75)	67 (60-78)	0.510^† † Mann-Whitney U test.
Level of schooling	Mean (SD)	13 (3.28)	11.73 (4.56)	0.451^† † Mann-Whitney U test.
Level of schooling	Median (min-max)	15 (8-15)	15 (2-15)	0.451^† † Mann-Whitney U test.
Level of physical activity pratice by IPAQ	Active	9 (64.3%)	10 (66.7%)	0.999^* * Fisher's exact test;
	Inactive	3 (21.4%)	4 (26.7%)
	Insufficiently active	2 (14.3%)	1 (6.7%)
MMSE raw scores	Normal	14 (100%)	15 (100%)	NA
Functional activity questionnaire	Mean (SD)	0.14 (0.53)	0.60 (1.59)	0.326^† † Mann-Whitney U test.
Functional activity questionnaire	Median (min-max)	0 (0-2)	0 (0-6)	0.326^† † Mann-Whitney U test.

Variable		Group		p value
Variable		CG (n = 14)	EG (n = 15)	p value
% adverse events GRADE 1		3 (21.4%)	5 (33.3%)	0.682^* * Fisher's exact test;
% adverse events GRADE 2		0 (0%)	1 (6.7%)	0.999^* * Fisher's exact test;
% adverse events GRADE 3-5		0%	0%	NA
% Google Meet adherence (GMA)	Mean (SD)	78.93 (15.46)	83.67 (16.42)	0.404^† † Mann-Whitney U test.
% Google Meet adherence (GMA)	Median (min-max)	80 (55-100)	85 (45-100)	0.404^† † Mann-Whitney U test.
% YouTube adherence (YTA)	Mean (SD)	69.64 (37.89)	80.83 (23.56)	0.450^† † Mann-Whitney U test.
% YouTube adherence (YTA)	Median (min-max)	94 (0-100)	100 (50-100)	0.450^† † Mann-Whitney U test.
% overall Adherence (OA)	Mean (SD)	74.29 (19.6)	82.25 (16.11)	0.213^† † Mann-Whitney U test.
% overall Adherence (OA)	Median (min-max)	80 (35-97.5)	88 (50-100)	0.213^† † Mann-Whitney U test.

Variable	Group	n	Median	Mean	Standard deviation	p value^* * Mann-Whitney U Test.
MMSE PRE	EG	15	20.00	19.93	1.22	0.404
MMSE PRE	CG	14	21.00	20.21	1.48	0.404
MMSE POST	EG	15	20.00	20.00	1.51	0.165
MMSE POST	CG	14	21.00	20.57	1.79	0.165
VFT PRE	EG	15	15.00	14.27	2.37	0.709
VFT PRE	CG	14	14.00	14.86	2.96	0.709
VFT POST	EG	15	17.00	16.60	3.20	0.965
VFT POST	CG	14	17.00	17.14	5.46	0.965
Digit test forward PRE	EG	15	5.00	5.00	0.85	0.214
Digit test forward PRE	CG	14	6.00	5.50	1.34	0.214
Digit test forward POST	EG	15	6.00	5.80	1.21	0.367
Digit test forward POST	CG	14	6.50	6.21	0.97	0.367
Digit test backward PRE	EG	15	4.00	3.93	1.49	0.095
Digit test backward PRE	CG	14	4.50	4.93	1.59	0.095
Digit test backward POST	EG	15	5.00	5.13	1.36	0.751
Digit test backward POST	CG	14	5.00	5.00	1.57	0.751
GDS PRE	EG	15	2.00	4.20	4.23	0.741
GDS PRE	CG	14	3.00	3.71	2.92	0.741
GDS POST	EG	15	1.00	2.67	3.24	0.624
GDS POST	CG	14	1.50	2.71	3.15	0.624
WHO-5 PRE	EG	15	16.00	14.60	6.82	0.63
WHO-5 PRE	CG	14	17.00	15.71	4.46	0.63
WHO-5 POST	EG	15	18.00	16.60	6.05	0.81
WHO-5 POST	CG	14	18.00	17.21	5.47	0.81

	MMSE		VFT		Digit test forward		Digit test backward		GDS		WHO-5
	PRE	POST	PRE	POST	PRE	POST	PRE	POST	PRE	POST	PRE	POST
EG (median)	20	20	15	17	5	6	4	5	2	1	16	18
p value	0.66		0.025		0.028		0.011		0.021		0.032
CG (median)	21	21	14	17	6	6	4	5	3	2	17	18
p value	0.546		0.257		0.083		0.807		0.005		0.081

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[1] Address for correspondence Cristiane Peixoto (email: Cristiane.peixoto@gmail.com)