Download 21.Timothy CY, Kwok.Effectiveness of coordination exercise in

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1 Name of the Candidate
and Address
SMRUTI SANGAMNERKAR
SRINIVAS COLLEGE OF
PHYSIOTHERAPY,
PANDESHWARA,
MANGALORE-575001
2 Name of the Institute
SRINIVAS COLLEGE OF
PHYSIOTHERAPY, MANGALORE.
3 Course of Study and
Subject
MASTER OF PHYSIOTHERAPY
(MPT)
2 YEARS DEGREE COURSE.
“NEUROLOGICAL AND
PSYCHOSOMATIC DISORDERS”.
4 Date of Admission
25/5/2011.
To Course
5 Title of the Topic
“EFFECT OF COORDINATION
EXERCISES AND STRENGTH
TRAINING IN IMPROVING
COGNITION IN ELDERLY
POPULATION- A RANDOMIZED
CONTROL TRIAL.”
1
6 Brief resume of the intended work:
6.1 Need for the study:
Aging involves gradual progressive and spontaneous
deterioration of most physiological functions.1Many studies on
the process of aging have revealed decline in numerous
sensory and motor functions in elderly1.The aging process is
accompanied by deterioration of cognitive functions such as
memory,attention,
reaction
time,
and
speed
of
informationprocessing.2
Exercise has multiple positive effects in older adults.3
Physical exercise is associated with decreased risk of
dementia and Alzheimer disease.4 Regular physical activity
could represent an important and potent protective factor for
cognitive decline and dementia in elderly persons.
5
Regular exercise that focuses on functional fitness,
such as walking, has been associated with significant
reductions in the levels of dependence and disability in older
adults.
6,7
The
relationship
among
physical
fitness
levels,
specifically aerobic fitness, cognition, and physical health in
older adults, is well established.8,9
Physical
improve,
or
exercise
atleast
and
resistance
maintain
health,
training
may
physical
and
psychological well-being and cognitive functioning in elderly
people.
The
benefits
consistently
shown
improvement
of
for
of
physical
objective
cardiorespiratory
2
exercise
health
have
measures
fitness,
been
e.g.
favourable
physiological
changes such as lower serum cholesterol
concentrations and increase in bone density.10
Cognition refers to all mental process, by which the
sensory inputs are transformed, reduced, elaborated, stored,
recovered and used, and this covers memory, attention,
reasoning, creativity and problem solving.11
Poor cognitive function is a predictor of mortality at
all ages and as such can be seen as a marker of general health
status.12
Subjective
complaints
about
cognitive
capacity
increase with age and an objective decline in cognitive
performance accelerates around the age of 50.13
There is also empirical support for exercise improving
physical fitness,behavior,cognition,14,15 communication, and
functioning in older people with cognitive impairments.16
The benefits for older people who regularly participate
in endurance, balance and resistance training programmes
are vast. Such health benefits include improved muscle mass,
arterial
compliance,
energy
metabolism,
cardiovascular
fitness, muscle strength, overall functional capacity, and the
maintenance or even enhancement of cognitive function.17
Coordination or coordinated movement is the ability to
execute
smooth,
accurate,
controlled
motor
response.18
Coordinated movements are characterized by appropriate
speed, distance, direction, timing and muscular tension.In
addition, they involve appropriate synergistic influences, easy
reversal between opposing muscle groups, and proximal
fixation to allow distal motion or maintanance of posture.19
Exercise has been shown to possitively affect cognitive
3
performance. Henning Budde, Claudia Voelcker- Rehage did a
study to know the effect of coordination exercises on cognition,
in which 115 healthy adolescents were included in the study.
The results of the study revealed that Coordination exercises
improve cognition which could be because of enhanced
neuronal connection between the cerebellum and the frontal
cortex.20
No study has been done to measure the effectiveness
of coordination exercises and strength training in cognition
improvement. This study is an attempt to know whether
Coordination exercises and Strength training will improve the
cognition of elderly individuals who have impaired cognition.
6.2 Review of literature :
1.T Seng CN, Gau BS (2011) did a study on the effectiveness
on improving cognitive function in older people and concluded
that an exercise regimen of 6 weeks and at least 3 times per
week for 60 minutes had a positive effect on cognition24.
2.Timothy CY, Kwok (2011) did a prospective study on the
effectiveness of coordination exercises in improving cognition
in older adults.The findings demonstrate that low physical
level exercise is beneficial for cognitive function and helps
maintain the physical mobility of the elderly21.
3.Claudia VR, Ben G(2011) did a study on how
4
Cardiovascular and Coordination Training Differentially
Improve Cognitive Performance and Neural Processing in Older
Adults which quotes that besides cardiovascular training also
other types of physical activity improve cognition of older
adults25.
4.Anderson H C, Nimon JP (2010) did a study on Cognitive
health benefits of strengthening exercise for communitydwelling older adults.They concluded that there are possitive
effects of strength training on cognition26.
5.Patricia H, Beatriz C.A(2004) did a study on the effects of
exercise training on elderly persons with
cognitive impairment and dementia: a meta-analysis, from
which he concluded that exercise training increases fitness,
physical function, cognitive function, and possitive behavior in
people with dementia and related cognitive impairments27.
6.Pasquauna PC, Walter J, Perrig(1998) conducted the study
on the effects of resistance training on well-being and memory
in elderly volunteers concluding that resistance training
lessens the anxiety and self-attentivenes and improves muscle
strength and they found possitive corelation between cognition
and physical fitness10.
7.Molloy DW, Beerschoten (1988) did a study on acute
effects of exercise on neuropsychological function in elderly
subjects. He concluded that elderly patients who have taken
5
part in exercise programs have shown improvement in mental
function14.
8.John WJ (1977) BioPsychoSocial Assessment Tools for the
Elderly - Assessment Summary Sheet. In Cognitive Capacity
Screening Exam, the Pearson correlation was 0.92 (kappa
0.62).
Had a sensitivity of 84% and a specificity of 94% using
a cutting-point of 19 or 2023.
9.Marshal M, Molloy(1975) reported inter-rater reliability of
0.69 and 0.78. In a sample of 15 neurological inpatients,
inter-rater reliability gave a Pearson correlation of 0.95 and a
Kendall coefficient of 0.63. The concurrent validity of
0.78
with the WAIS Verbal IQ scale and 0.66 with the WAIS
Performance scale22.
6.3 Objectives of the study
 To
know
the
effect
of
co-ordination
exercises
in
improving cognition in elderly population.
 To know the effect of strength training in improving
cognition in elderly population.
 To compare the effectiveness of strength training and
co-ordination exercises in improving cognition in elderly
population.
6
6.4 Hypothesis:
ExperimentalHypothesis:
1.coordination
exercises
will
be
effective
in
improving
cognition.
2.Strength training will be effective in improving cognition.
3.There will be significant difference beween effect of strength
training
and
co-ordination
exercises
on
cognition
improvement.
Null Hypothesis:
1.Co-ordination
exercises
will
not
be
effective
in
improving cognition.
2.Strength training will not be effective in improving
cognition.
3.There will be no significant difference beween effect of
strength training and co-ordination exercises on cognition
improvement.
7 Materials and Method:
7.1 Source of data:
The participants who are willing to participate in the
study and meeting the selection criteria will be included from
the society and old age homes in karnataka.
7
7.2 Method of collection of data:
Sample size: 15 patients will be included in each group.
Study duration : The study would be conducted for 8 weeks.
The intervention will be given on 2nd, 4th, 6th and 8th week. The
treatment session would last for 40 minutes, twice a week.
Sampling: Purposive sampling.
Procedure: The participants who meet the inclusion criteria
will be randomly allocated to following groups to receive
intervention.
There would be three groups, i.e, one experimental
group which would receive coordination exercises, the second
experimental group would receive strength training. And the
control group would receive the combination of coordination
exercises and strength training.
Outcome measures :
Mini Mental State Examination (MMSE)22
Mini mental state examination designed to give a practical
clinical assessment of change in cognitive status in geriatric
inpatients .It covers the person's orientation to time and place,
recall ability, short-term memory, and arithmetic ability.It may
8
be used as a screening test for cognitive loss or as a brief
bedside cognitive assessment.It includes components like
orientation, registration, attention and calculation, recall and
language.
 The scoring is done according to performance.
 For each correct answer 1 mark and for wrong answer 0
mark will be given.
 The maximum score of MMSE is 30.
 Interpretation: Higher score shows good cognition of
subjects. The cutoff score for MMSE is 23.
 Time: Time to complete the test will be 10-15 minutes.
Cognitive capacity screening exam23
 It includes components like, judgment, mental speed,
and sustained effort.
 The scoring is done according to the performance.
 For every correct answer score the question as 1.
 The maximum score will be 30.
 If the score is less than 20, diminished cognitive capacity
is suspected.
Materials to be used:
 MMSE- Pen, pencil, watch, recording sheet.
 CCSE- pen, pencil, recording sheet.
Inclusion Criteria
 Sixty years
and above
elderly people who can
ambulate with and without walking aids.
9
 Both males and females will be included.
 Participants should able to understand the commands
properly.MMSE- less than 24.
Exclusion Criteria
 Neurological disorder leading to balance impairment.
 Musculoskeletal disorders.
 Uncontrolled hypertension.
 Severe ankle edema.
 Limb length discrepancy.
Statistical analysis:
Study design: A RANDOMIZED CONTROL TRIAL.
The participants who meet the inclusion criteria will be
randomly allocated to 3 groups to receive intervention.
1.experimental group-strengh training
2.experimental group-coordination exercises
3.control group- coordination exercises and strength training.
TEST:
1. Repeated measures ANOVA- will be used to find out
signifanct difference among three treatment group.in which
participants will be randomly allocated.
7.3
Does
the
study
require
10
any
investigations
or
interventions to be conducted on patients or other
humans or animals? If so please describe briefly.
YES.
This study will assess cognition by using MMSE and
CCSE in elderly population.
7.4 Has ethical clearance been obtained from your
institution in case of 7.3?
YES.
Consent has been taken from the Institute’s ethical
committee.
8 List of references:
1.Anne Shumway Cook, Marjorie H Woollacott. Normal
postural control. Anne Shumway Cook. Motor Control Theory
and
Practical
Applications.
2nd
edition.
Pennsylvania,
Lippincott Williams and Wilkins, 2001;164-6.
2.Van boxtel Mental Health and Physical Activity 2008; 62–68.
3.Kleyman P.Toward healthy aging 2010: meeting the national
agenda. Aging Today 2002;23(5):7-10.
4.Yonas E. Geda, Rosebud O. Roberts. Physical Exercise,
Aging, and Mild Cognitive Impairment A Population-Based
Study. Arch Neurol. 2010;67(1):80-6.
5. Laurin D. Physical activity and risk of cognitive impairment
and dementia in elderly persons. Arch Neurol. 2001;58(3):49804.
6.Singh
MA.
Exercise
comes
11
of
age:
rationale
and
recommendations for a geriatric exercise prescription. J
Gerontol A Biol Med Sci. 2002;57:262-82.
7.Yaffe K, Barnes D, Nevitt M, Lui LY, Covinsky K. A
prospective study of physical activity and cognitive decline in
elderly
women:women
who
walk.
Arch
Intern
Med.
2001;161:1703-8
8.Powell RR. Effects of exercise on mental functioning. J
Sports Med. 1975;15:125-31
9.Spirduso W. Physical dimensions of aging. Champaign:
HumanKinetics.1995.
10.Pasquauna perrig-chiello, walter j, Perrig. The effect of
resistance training on well being and memory in elderly
volunteers.1998; 27: 469-75.
11.Neisser, Uric. Cognitive Psychology. Grolier Multimedia
Encylopedia. 2009.
12.Archana Singh-Manoux, PhD, Melvyn Hillsdon Effects of
Physical Activity on Cognitive Functioningin Middle Age:
Evidence From the Whitehall II Prospective Cohort Study
2005;95:2252-8.
13.Angevaren M, Aufdemkampe G, Verhaar HJJ Physical
activity and enhanced fitness to improve cognitive function in
older people without known cognitive impairment 2008:(2).
14.Molloy DW, Richardson LD, Crilly RG. The effects of a
threemonth exercise program on neuropsychological function
in elderly institutionalized women: a randomized controlled
trial. Age Ageing 1988;17:303-10.
15.McMurdo ME, Rennie L. A controlled trial of exercise by
residents of old people’s home. Age Ageing 1993;22:11-5.
12
16.Brill PA, Probst JC, Greenhouse DL, Schell B, Macera
CA.Clinical feasibility of free-weight strength training program
for older adults. J Am Board Fam Pract 1998;11:445-51.
17.Colcombe. Fitness effects on the cognitive function of older
adults: a meta-analytic study. 2003;14(2):125-30.
18.Susan O Sullivan. Physical rehabilitation. Thomas J.
Schmitz. Coordination assessment. (4):157.
19.Ghez C , Gordon J .voluntary movement. In Kandel ER.
Essentials of neuroscience and behaviour.Appleton and Lange.
Norwalk CT.1995;529.
20.Henning Budde, Claudia Voelcker-Rehage, Acute
coordinative exercise improves attentional performance in
adolescents 2008;441: 219-23.
21.Timothy CY, Kwok.Effectiveness of coordination exercise in
improving cognitive function in older adults: a prospective
study 2011;6:261–67.
22.Mini Mental State Examination
http://lifemanagement.com/nextsteps/Mini_Mental_Status_E
xam.pdf.
23.Cognitive capacity screening exam file:///H:/CCSE.html
24.T Seng CN, Gau BS Lou MF. The effectiveness of exercise
on improving cognitive function in older people: a systematic
review. J Nurs Res 2011; 19(2):119-31.
25.
Claudia
Staudinger.
Voelcker-Rehage, Ben
Cardiovascular
and
Godde
and
Coordination
Ursula
Training
Differentially Improve Cognitive Performance and Neural
Processing in Older Adults. Front Hum Neurosci. 2011; 5: 26.
26. Anderson-Hanley C, Nimon JP, Westen SC 2010. Cognitive
13
health benefits of strengthening exercise for community
dwelling
older
adult.
j Clin
Exp
Neuropsychol. 2010
Nov;32(9):996-1001.
27. Patricia Heyn, Beatriz C. Abreu, Kenneth J. Ottenbacher.
The Effects of Exercise Training on Elderly Persons With
Cognitive Impairment and Dementia: A Meta-Analysis. Arch
Phys Med Rehabil. 2004;85.
14
9
Signature of the Candidate
10 Remarks of the Guide
11 Name & Designation of:
11.1 Guide
DR. S.BALASUBRAMANIAM
Associate
Professor
in
Physiotherapy.
11.2 Signature
11.3 Co-Guide (If Any)
DR. SAHANA S
Assisstant
professor
Physiotherapy.
in
11.4 Signature
DR. T.JOSELEY SUNDERRAJ
PANDIAN
Associate
Professor
in
Physiotherapy
and
P.G.
Coordinator.
11.5 Head of the
Department
11.6 Signature
12 12.1 Remarks of Chairman
and Principal
12.2 Signature
15
DR. RAMPRASAD M.
Principal and Professor in
Physiotherapy.
Accepted by scientific and
ethical committee reviewers.