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Keeping Elderly With Mild Cognitive Impairment Physically Active: Determinants of Maintenance

Erwin Tak, Physical Activity and Health, TNO Quality of Life; Jannique G.Z. Van Uffelen, Body@Work, Research Center,TNO-VUmc, Amsterdam/Department of Public and Occupational Health/ EMGO Institute, VUmc, Amsterdam/TNO Quality of Life, Physical Activity and Health, The Netherlands; Marijke J.M. China A Paw, Willem Van Mechelen, Department of Public and Occupational Health/ EMGO Institute, VUmc, Amsterdam/Body@Work, Research Center,TNO-VUmc, Amsterdam; Marijke Hopman-Rock, TNO Quality of Life, Department of Physical Activity and Health, Leiden, The Netherlands/Body@Work, Research Center,TNO-VUmc, Amsterdam

Objective: The FACT study (Folate physical Activity Cognition Trial) was designed to evaluate the effect of physical exercise (i.e., moderate intensive walking) and vitamin B supplementation in adults with mild cognitive impairment, compared with placebo pills and a low-intensity placebo activity program. The duration of the intervention was 12 months. Six months after the end of the intervention a follow-up was carried out to determine 1) level of maintenance of physical activity (PA; i.e., daily general PA and specific intervention activity) and 2) which determinants influence maintenance of PA.

Methods: Measurements at baseline in subjects who finished the FACT study (N = 138): background (sex, age, education, marital status), level of cognitive function (MMSE), and PA (Longitudinal Aging Study Amsterdam physical activity Questionnaire: LAPAQ, measures daily PA during the past 2 weeks). Participants were contacted at 6 months follow-up for a telephone interview concerning their current daily physical activity level, barriers for PA, lapses in PA during the intervention period, and satisfaction with the intervention. A regression analysis was carried out to evaluate the contribution of personal (demographic, cognitive) and program-related (quality) aspects to maintenance at follow-up.

Results: 134 follow-up interviews were conducted (1 died, 3 could not be contacted): 41% female, 25% lived alone. Average MMSE score at baseline was 28.4 (SD 1.4; range 24-30), indicating reasonable cognitive functioning as expected in an MCI population. About 1/3 of participants had lapses during the intervention period but completed the program (most stated reasons for lapses: holidays, illnesses, physical complaints, and other activities), 1/3 had no lapses and completed the program, and 1/3 dropped out during the intervention. At the end of the study about 25% continued with the walking or placebo activity, 14% expressed intention to start again, and about 61% had no intention at all to continue (most stated reasons: lack of time, injury, health complaints, practical limitations of activity [location, time of day] and advice of physician). Having dropped out (p < .001) and a lower level of adherence (p < .001) during the intervention were associated with discontinuing the program after the intervention ended. Participants who continued rated several quality aspects higher (guidance, contents, intensity, cost, and progress; p < .5) but did not show a higher general satisfaction (p = .174).

Conclusions: It can be concluded that maintenance of PA after exercise programs end is difficult, especially for dropouts and participants with low adherence. Possible improvements include quality aspects such as contents, intensity, and guidance.


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