Supporting Aging Through Green Exercise (SAGE) (SAGE)

Supporting Aging Through Green Exercise (SAGE): Comparing the Cognitive Effects of Outdoor Versus Indoor Exercise Among Older Adults With Mild Cognitive Impairment

Aerobic exercise is an evidence-based approach to mitigate cognitive decline in older adults with mild cognitive impairment (MCI). Emerging evidence suggests that the cognitive benefits of exercise may be enhanced when performed in outdoor, natural settings, as compared to indoor or built settings. Thus, the investigators aim to compare the effects of outdoor versus indoor walking programs on cognitive function among older adults with MCI. Secondary outcomes are motor function, emotional well-being, health-related behaviours, and quality of life. Participants will be randomly assigned to a 12--week, 3x/week program of either outdoor walking on forest trails or indoor walking on a treadmill. A 3-month followup will also be completed after trial completion.

Study Overview

• Status: Completed
• Conditions: Aging; Mild Cognitive Impairment
• Intervention / Treatment: Other: Aerobic Exercise Indoors; Other: Aerobic Exercise Outdoors

Detailed Description

Study Design: A 12-week, single-blinded, trial with two experimental arms. Participants will be randomized (1:1) to either outdoor walking (OP) or indoor walking or cycling (IP). Measurement will occur in person at baseline and at trial completion. Additionally, follow-up measurement of questionnaire-based outcomes will occur via email or phone at 3 months following trial completion. Outcome assessors will be trained by the research team and blinded to group allocation of the participants.

Participants: 68 community-dwelling adults aged 65-80 years old with probable MCI and in sufficient health to participate in aerobic exercise of moderate intensity

Interventional Arms: All participants will receive three group-based training sessions per week for 12 weeks, under the supervision of instructors with a relevant background and first aid certification. Each session will consist of 10 min of warm-up, 40 min of aerobic exercise, and 10 min of cool-down. For both OP and IP, aerobic exercise will be progressive and of moderate intensity. During training, each participant will wear a heart rate monitor and will be asked to work initially at approximately 45% of their heart rate reserve (HRR) and gradually progress to reach the target of 70% of HRR over the 12-week study period. Participants will also subjectively monitor workout intensity using the 20-point Borg's Rating of Perceived Exertion. OP participants will walk or jog a pre-determined route in trails of an urban forest (Pacific Spirit Park). IP participants will walk or jog on treadmills in the Exercise Prescription Suite of the Centre for Hip Health and Mobility (CHHM). Both OP and IP training groups will have a participant to instructor ratio of 3:1. To promote adherence to the exercise program, sessions will be offered at times that are convenient for each individual participant. Protocols will be adjusted as necessary to align with COVID-19 guidelines.

Measurement of descriptors and outcomes: Standardized protocols will be developed and study personnel will be trained. Assessors will be blinded to treatment allocation. We will measure descriptors and outcomes at baseline and at trial completion. Each measurement session will be 2 hours in duration. For these measurements, participants will complete a session of behavioural and clinical testing at the VCH Research Pavilion and the CHHM. To account for time-of-day effects, each participant's session start time will be the same at both timepoints, and the order of the assessments will be the same for all participants.

• Study Type: Interventional
• Enrollment (Actual): 72
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V5Z1M9
      • University of British Columbia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 65 years to 80 years (Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. achieve a score ≥18/30 and ≤24/30 on the Montreal Cognitive Assessment
2. have subjective cognitive impairment based on interview
3. have no significant impairment in daily function, as determined by a score ≥6/8 on the Lawton and Brody Instrumental Activities of Daily Living Scale
4. no diagnosis of dementia
5. aged 65 to 80 years old
6. live independently in their own home
7. live in the Greater Vancouver area
8. read, write, and speak English with acceptable visual and auditory acuity
9. are cleared to start a supervised exercise programme based on the Physical Activity Readiness Questionnaire for Everyone
10. able to walk independently
11. able to provide informed consent

Exclusion Criteria:

1. participating in regular moderate to vigorous intensity aerobic exercise in the last 3 months
2. planning to enroll in a concurrent exercise or drug trial targeting cognitive function
3. diagnosed with a neurological, cerebrovascular, or psychiatric disease, or other chronic medical condition requiring intensive treatment and monitoring
4. have major impairments in eyesight, hearing or motor movements
5. have clinically significant neuropathy or musculoskeletal or joint disease
6. have a recent traumatic brain injury, including concussions
7. are currently using prescribed cognitive intervention or electromagnetic stimulation
8. at the time of recruit, indicate they recently (within the last 2 months) or will start taking drugs that significantly alter cognition, movement, or affect, such as cholinesterase inhibitors, anticholinergics, hormone replacement therapy, or antidepressants

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Aerobic Exercise Indoors; Each session will consist of 10 min of warm-up, 40 min of aerobic exercise, and 10 min of cool-down. Aerobic exercise will be progressive and of moderate intensity. During training, each participant will wear a heart rate monitor and will be asked to work initially at approximately 45% of his/her target heart rate (i.e., heart rate reserve (HRR)) and gradually progress to reach the target of 70% of HRR over the 12-week study period. Participants will also subjectively monitor workout intensity using the 20-point Borg's Rating of Perceived Exertion. Participants will walk or jog on treadmills or cycle on stationary bikes in the Exercise Prescription Suite of the Centre for Hip Health and Mobility.	Other: Aerobic Exercise Indoors; Each session will consist of 10 min of warm-up, 40 min of aerobic exercise, and 10 min of cool-down. Aerobic exercise will be progressive and of moderate intensity. During training, each participant will wear a heart rate monitor and will be asked to work initially at approximately 45% of his/her target heart rate (i.e., heart rate reserve (HRR)) and gradually progress to reach the target of 70% of HRR over the 12-week study period. Participants will also subjectively monitor workout intensity using the 20-point Borg's Rating of Perceived Exertion. Participants will walk or jog on treadmills or cycle on stationary bikes in the Exercise Prescription Suite of the Centre for Hip Health and Mobility.
Experimental: Aerobic Exercise Outdoors; Each session will consist of 10 min of warm-up, 40 min of aerobic exercise, and 10 min of cool-down. Aerobic exercise will be progressive and of moderate intensity. During training, each participant will wear a heart rate monitor and will be asked to work initially at approximately 45% of his/her target heart rate (i.e., heart rate reserve (HRR)) and gradually progress to reach the target of 70% of HRR over the 12-week study period. Participants will also subjectively monitor workout intensity using the 20-point Borg's Rating of Perceived Exertion. participants will walk or jog pre-determined routes in trails of an urban forest (Pacific Spirit Park).	Other: Aerobic Exercise Outdoors; Each session will consist of 10 min of warm-up, 40 min of aerobic exercise, and 10 min of cool-down. Aerobic exercise will be progressive and of moderate intensity. During training, each participant will wear a heart rate monitor and will be asked to work initially at approximately 45% of his/her target heart rate (i.e., heart rate reserve (HRR)) and gradually progress to reach the target of 70% of HRR over the 12-week study period. Participants will also subjectively monitor workout intensity using the 20-point Borg's Rating of Perceived Exertion. Participants will walk or jog pre-determined routes in trails of an urban forest (Pacific Spirit Park)

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Digits Span Forwards and Backwards	This is a measure of working memory.	Baseline to 12 weeks
Change in List Sorting Performance	This is a measure of working memory	Baseline to 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Digit Symbol Substitute Test	A measure of processing speed and executive functions.	Baseline to 12 weeks
Change in the Short Physical Performance Battery	A measure of balance and mobility	Baseline to 12 weeks
Change in Timed Up and Go Test	A measure of general mobility	Baseline to 12 weeks
Change in State-Trait Anxiety Inventory	A measure of anxiety	Baseline to 12 weeks and 6 months
Change in Centre for Epidemiological Studies Depression Scale	A measure of depressive symptoms	Baseline to 12 weeks and 6 months
Change in Blood Pressure	Systolic and diastolic blood pressure	Baseline to 12 weeks
Change in sensor measured sleep	Using MotionWatch 8 to measure sleep quality	Baseline to 12 weeks
Change in sensor measured physical activity	Using MotionWatch 8 to measure levels and amount of physical activity	Baseline to 12 weeks
Change in Physical Activity Scale for the Elderly	A self-report measure of physical activity, higher scores indicate higher activity	Baseline to 12 weeks and 6 months
Change in Pittsburgh Sleep Quality Index	A self-report measure of sleep quality, higher scores indicate poorer sleep quality	Baseline to 12 weeks and 6 months
Change in ICEpop CAPability measure for Older people (ICECAP-O)	A measure of quality of life, higher values indicate better quality of life	Baseline to 12 weeks and 6 months
5-level EuroQoL 5-dimension (EQ-5D-5L) questionnaire	A measure of quality of life, higher values indicate better quality of life	Baseline to 12 weeks and 6 months
Change in NIH Toolbox Cognitive Battery Performance	Measures different cognitive domains, with a focus on executive functions	Baseline to 12 weeks
Change in gait speed, derived from Short Physical Performance Battery	A measure of walking speed.	Baseline to 12 weeks.
Changes in hemodynamics of the brain as measured by fNIRS during the N-Back Task	A measure of brain function.	Baseline to 12 weeks.
Changes in Feeling Scale	Measure of affective valence	Baseline to 12 weeks.
Changes in Exercise Enjoyment Scale	An affective measure	Baseline to 12 weeks.
Changes in Felt Arousal Scale	Measure of affective activation	Baseline to 12 weeks

Collaborators and Investigators

• Sponsor: University of British Columbia
• Investigators: Principal Investigator: Teresa Liu-Ambrose, PhD, University of British Columbia; Principal Investigator: Matthew Noseworthy, BSc, University of British Columbia

Study record dates

Study Major Dates

• Study Start (Actual): January 19, 2022
• Primary Completion (Actual): July 10, 2023
• Study Completion (Actual): November 27, 2023

Study Registration Dates

• First Submitted: September 1, 2021
• First Submitted That Met QC Criteria: September 1, 2021
• First Posted (Actual): September 5, 2021

Study Record Updates

• Last Update Posted (Estimated): January 29, 2024
• Last Update Submitted That Met QC Criteria: January 25, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: cognitive function; aerobic exercise; green space
• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: H21-00406

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No