COVEPIC (Cognitive and spOrt Virtual EPIC training) investigating the effects of home-based physical exercise and cognitive training on cognitive and physical functions in community-dwelling older adults: study protocol of a randomized single-blinded clinical trial

Emma Gabrielle Dupuy, Florent Besnier, Christine Gagnon, Thomas Vincent, Catherine-Alexandra Grégoire, Caroll-Ann Blanchette, Kathia Saillant, Nadia Bouabdallaoui, Josep Iglesies-Grau, Marie Payer, Marie-France Marin, Sylvie Belleville, Martin Juneau, Paolo Vitali, Mathieu Gayda, Anil Nigam, Louis Bherer, Emma Gabrielle Dupuy, Florent Besnier, Christine Gagnon, Thomas Vincent, Catherine-Alexandra Grégoire, Caroll-Ann Blanchette, Kathia Saillant, Nadia Bouabdallaoui, Josep Iglesies-Grau, Marie Payer, Marie-France Marin, Sylvie Belleville, Martin Juneau, Paolo Vitali, Mathieu Gayda, Anil Nigam, Louis Bherer

Abstract

Background: In the context of the COVID-19 pandemic, lockdown and social distancing measures are applied to prevent the spread of the virus. It is well known that confinement and social isolation can have a negative impact on physical and mental health, including cognition. Physical activity and cognitive training can help enhance older adults' cognitive and physical health and prevent the negative collateral impacts of social isolation and physical inactivity. The COVEPIC study aims to document the effects of 6 months of home-based physical exercise alone versus home-based physical exercise combined with cognitive training on cognitive and physical functions in adults 50 years and older.

Methods: One hundred twenty-two healthy older adults (> 50 years old) will be recruited from the community and randomized to one of the two arms for 6 months: (1) home-based physical exercises monitoring alone and (2) combined physical exercises monitoring with home-based cognitive training. The primary outcome is cognition, including general functioning (Montreal Cognitive Assessment (MoCA) score), as well as executive functions, processing speed, and episodic memory (composite Z-scores based on validated neuropsychological tests and computerized tasks). The secondary outcome is physical functions, including balance (one-leg stance test), gait and mobility performance (Timed Up and Go, 4-meter walk test), leg muscle strength (5-time sit-to-stand), and estimated cardiorespiratory fitness (Matthews' questionnaire). Exploratory outcomes include mood, anxiety, and health-related quality of life as assessed by self-reported questionnaires (i.e., Geriatric depression scale-30 items, Perceived stress scale, State-trait anxiety inventory-36 items, Perseverative thinking questionnaire, Connor-Davidson Resilience Scale 10, and 12-item Short Form Survey).

Discussion: This trial will document the remote monitoring of home-based physical exercise alone and home-based physical combined with cognitive training to enhance cognitive and physical health of older adults during the COVID-19 pandemic period. Remote interventions represent a promising strategy to help maintain or enhance health and cognition in seniors, and potentially an opportunity to reach older adults in remote areas, where access to such interventions is limited.

Trial registration: Clinical trial Identifier NCT04635462 . COVEPIC was retrospectively registered on November 19, 2020.

Keywords: Aging; COVID; Cognition; Cognitive training; Home-based training; Physical exercise; Remote monitoring.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Study design, remote setting and procedures of the trial, and online data management of the trial

References

    1. Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D, Patel R, et al. COVID-19 and Older Adults: What We Know. J Am Geriatr Soc. 2020;68(5):926–929. doi: 10.1111/jgs.16472.
    1. Zhai F, Shi F, Wang J, Dai C-F, Fan C. Preliminary study on the mechanism underlying the interaction of balance dysfunction and anxiety disorder. Neuroreport. 2019;30(2):53–59. doi: 10.1097/WNR.0000000000000977.
    1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3.
    1. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912–920. doi: 10.1016/S0140-6736(20)30460-8.
    1. Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, Ballard C, Christensen H, Cohen Silver R, Everall I, Ford T, John A, Kabir T, King K, Madan I, Michie S, Przybylski AK, Shafran R, Sweeney A, Worthman CM, Yardley L, Cowan K, Cope C, Hotopf M, Bullmore E. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7(6):547–560. doi: 10.1016/S2215-0366(20)30168-1.
    1. Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends Cogn Sci. 2009;13(10):447–454. doi: 10.1016/j.tics.2009.06.005.
    1. Shankar A, McMunn A, Demakakos P, Hamer M, Steptoe A. Social isolation and loneliness: Prospective associations with functional status in older adults. Heal Psychol. 2017;36(2):179–187. doi: 10.1037/hea0000437.
    1. Jiménez-Pavón D, Carbonell-Baeza A, Lavie CJ. Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Prog Cardiovasc Dis. 2020;63(3):386–388. doi: 10.1016/j.pcad.2020.03.009.
    1. Rodrigues L, Bherer L, Bosquet L, Vrinceanu T, Nadeau S, Lehr L, Bobeuf F, Kergoat MJ, Vu TTM, Berryman N. Effects of an 8-week training cessation period on cognition and functional capacity in older adults. Exp Gerontol. 2020;134:110890. doi: 10.1016/j.exger.2020.110890.
    1. Yamada K, Yamaguchi S, Sato K, Fuji T, Ohe T. The COVID-19 outbreak limits physical activities and increases sedentary behavior: A possible secondary public health crisis for the elderly. J Orthop Sci. 2020;25(6):1093–1094. doi: 10.1016/j.jos.2020.08.004.
    1. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451–1462. doi: 10.1136/bjsports-2020-102955.
    1. Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC. Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev. 2005; 10.1002/14651858.CD004017.pub2.
    1. Borde R, Hortobágyi T, Granacher U. Dose–response relationships of resistance training in healthy old adults: A systematic review and meta-analysis. Sport Med. 2015;45(12):1693–1720. doi: 10.1007/s40279-015-0385-9.
    1. Desjardins-Crépeau L, Berryman N, Fraser SA, Vu TTM, Kergoat MJ, Li KZH, et al. Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults. Clin Interv Aging. 2016;11:1287–1299. doi: 10.2147/CIA.S115711.
    1. Bherer L. Cognitive plasticity in older adults: effects of cognitive training and physical exercise. Ann N Y Acad Sci. 2015;1337(1):1–6. doi: 10.1111/nyas.12682.
    1. Liu-Ambrose T, Nagamatsu LS, Voss MW, Khan KM, Handy TC. Resistance training and functional plasticity of the aging brain: A 12-month randomized controlled trial. Neurobiol Aging. 2012;33(8):1690–1698. doi: 10.1016/j.neurobiolaging.2011.05.010.
    1. Desjardins-Creau L, Berryman N, Minh Vu TT, Villalpando JM, Kergoat MJ, Li KZ, et al. Physical functioning is associated with processing speed and executive functions in community-dwelling older adults. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(6):837–844.
    1. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychol Sci. 2003;14(2):125–130. doi: 10.1111/1467-9280.t01-1-01430.
    1. Bherer L, Erickson KI, Liu-Ambrose T. Physical exercise and brain functions in older adults. J Aging Res. 2013; 10.1155/2013/197326.
    1. Callow DD, Arnold-Nedimala NA, Jordan LS, Pena GS, Won J, Woodard JL, Smith JC. The Mental Health Benefits of Physical Activity in Older Adults Survive the COVID-19 Pandemic. Am J Geriatr Psychiatry. 2020;28(10):1046–1057. doi: 10.1016/j.jagp.2020.06.024.
    1. Foster C, Richards J, Thorogood M, Hillsdon M. Remote and web 2.0 interventions for promoting physical activity. Cochrane Database Syst Rev. 2013; 10.1002/14651858.CD010395.pub2.
    1. Geraedts H, Zijlstra A, Bulstra SK, Stevens M, Zijlstra W. Effects of remote feedback in home-based physical activity interventions for older adults: A systematic review. Patient Educ Couns. 2013;91(1):14–24. doi: 10.1016/j.pec.2012.10.018.
    1. Ball K, Berch DB, Helmers KF, et al. Effects of cognitive training interventions with older adults: A randomized controlled trial. JAMA. 2002;288:2271–2281. doi: 10.1001/jama.288.18.2271.
    1. Li KZ, Roudaia E, Lussier M, et al. Benefits of cognitive dual-task training on balance performance in healthy older adults. J Gerontol A Biol Sci Med Sci. 2010;65:1344–1352. doi: 10.1093/gerona/glq151.
    1. Marusic U, Verghese J, Mahoney JR. Cognitive-Based Interventions to Improve Mobility: A Systematic Review and Meta-analysis. J AmMed Dir Assoc. 2018;19(6):484–491. doi: 10.1016/j.jamda.2018.02.002.
    1. Bherer L, Gagnon C, Langeard A, Lussier M, Desjardins-Crépeau L, Berryman N, et al. Synergistic Effects of Cognitive Training and Physical Exercise on Dual-Task Performance in Older Adults. J Gerontol Ser B. 2020; 10.1093/geronb/gbaa124.
    1. Montero-Odasso M, Almeida QJ, Burhan AM, Camicioli R, Doyon J, Fraser S, et al. SYNERGIC TRIAL (SYNchronizing Exercises, Remedies in Gait and Cognition) a multi-Centre randomized controlled double blind trial to improve gait and cognition in mild cognitive impairment. BMC Geriatr. 2018;18(1):1-15.
    1. Chan A-W, Tetzlaff JM, Gøtzsche PC, Altman DG, Mann H, Berlin J, Dickersin K, Hróbjartsson A, Schulz KF, Parulekar WR, Krleža-Jerić K, Laupacis A, Moher D. SPIRIT 2013 Explanation and Elaboration: Guidance for protocols of clinical trials. BMJ. 2013;346(jan08 15):e7586. doi: 10.1136/bmj.e7586.
    1. Roccaforte WH, Burke WJ, Bayer BL, Wengel SP. Validation of a Telephone Version of the Mini-Mental State Examination. J Am Geriatr Soc. 1992;40(7):697–702. doi: 10.1111/j.1532-5415.1992.tb01962.x.
    1. Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee MC, Chan HT, Tsao CK, Tsai SP, Wu X. Minimum amount of physical activity for reduced mortality and extended life expectancy: A prospective cohort study. Lancet. 2011;378(9798):1244–1253. doi: 10.1016/S0140-6736(11)60749-6.
    1. Lambourne K, Tomporowski P. The effect of exercise-induced arousal on cognitive task performance: A meta-regression analysis. Brain Res (Elsevier). 2010;1341:12–24.
    1. Lussier M, Saillant K, Vrinceanu T, Hudon C, Bherer L. Normative Data for a Tablet-Based Dual-Task Assessment in Healthy Older Adults. Arch Clin Neuropsychol. 2020; 10.1093/arclin/acaa121.
    1. Saillant K, Langeard A, Kaushal N, Vu TTM, Pothier K, Langlois F, Nigam A, Juneau M, Bherer L. Statin use moderates the beneficial effects of aerobic exercise on older adults' performances on the Stroop test: A subanalysis. Exp Gerontol. 2021;147:111277. doi: 10.1016/j.exger.2021.111277.
    1. Boujut A, Verty LV, Maltezos S, Lussier M, Mellah S, Bherer L, Belleville S. Effects of Computerized Updating and Inhibition Training in Older Adults: The ACTOP Three-Arm Randomized Double-Blind Controlled Trial. Front Neurol. 2020;11:606873. doi: 10.3389/fneur.2020.606873.
    1. Ranganath C, Rainer G. Cognitive neuroscience: Neural mechanisms for detecting and remembering novel events. Nat Rev Neurosci. 2003;4(3):193–202. doi: 10.1038/nrn1052.
    1. Belleville S, Hudon C, Bier N, Brodeur C, Gilbert B, Grenier S, Ouellet MC, Viscogliosi C, Gauthier S. MEMO+: Efficacy, Durability and Effect of Cognitive Training and Psychosocial Intervention in Individuals with Mild Cognitive Impairment. J Am Geriatr Soc. 2018;66(4):655–663. doi: 10.1111/jgs.15192.
    1. Pendlebury ST, Welch SJV, Cuthbertson FC, Mariz J, Mehta Z, Rothwell PM. Telephone assessment of cognition after transient ischemic attack and stroke: Modified telephone interview of cognitive status and telephone montreal cognitive assessment versus face-to-face montreal cognitive assessment and neuropsychological battery. Stroke. 2013;44(1):227–229. doi: 10.1161/STROKEAHA.112.673384.
    1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–699. doi: 10.1111/j.1532-5415.2005.53221.x.
    1. Lezak MD, Howieson DB, Loring DW. Neuropsychological Assessment. Oxford University Press; 2012.
    1. Besnier F, Bérubé B, Gagnon C, Olmand M, Ribeiro PAB, Nigam A, et al. Cardiorespiratory fitness mediates cognitive performance in chronic heart failure patients and heart transplant recipients. Int J Environ Res Public Health. 2020;17(22):1–14. doi: 10.3390/ijerph17228591.
    1. McComb E, Tuokko H, Brewster P, Chou PHB, Kolitz K, Crossley M, Simard M. Mental Alternation Test: Administration mode, age, and practice effects. J Clin Exp Neuropsychol. 2011;33(2):234–241. doi: 10.1080/13803395.2010.509916.
    1. Delis D, Kaplan E, Kramer J. The Delis-Kaplan Executive Function System: Technical Manual. San Antonio: The Psychological Corporation, editor; 2001.
    1. Wechsler D. WAIS-IV Wechsler Adult Intelligence Scale. San Antonio: NCS Pearson; 2008.
    1. Esther S, Elisabeth MS, Sherman A. Compendium of Neuropsychological Tests. Oxford University Press; 2006.
    1. Parks AC, Davis J, Spresser CD, Stroescu I, Ecklund-Johnson E. Validity of In-Home Teleneuropsychological Testing in the Wake of COVID-19. Arch Clin Neuropsychol. 2021;00:1–10.
    1. Montero-Odasso M, Almeida QJ, Bherer L, Burhan AM, Camicioli R, Doyon J, Fraser S, Muir-Hunter S, Li KZH, Liu-Ambrose T, McIlroy W, Middleton L, Morais JA, Sakurai R, Speechley M, Vasudev A, Beauchet O, Hausdorff JM, Rosano C, Studenski S, Verghese J, Canadian Gait and Cognition Network Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA) J Gerontol A Biol Sci Med Sci. 2019;74(6):897–909. doi: 10.1093/gerona/gly148.
    1. Madhavan S, Sivaramakrishnan A, Bowden MG, Chumbler NR, Field-Fote EC, Kesar TM. Commentary: Remote assessments of gait and balance - Implications for research during and beyond Covid-19. Top Stroke Rehabil. 2021;1–8.
    1. Matthews CE, Heil DP, Freedson PS, Pastides H. Classification of cardiorespiratory fitness without exercise testing. Med Sci Sports Exerc. 1999;31(3):486–493. doi: 10.1097/00005768-199903000-00019.
    1. Brink TL, Yesavage JA, Lum O, Heersema PH, Adey M, Rose TL. Screening tests for geriatric depression. Clin Gerontol. 1982;1(1):37–43. doi: 10.1300/J018v01n01_06.
    1. Spielberger CD, Gorsuch RL, Lushene RE. Manual for the State-Trait Anxiety Inventory. Consulting Psychologists; 1970.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–396. doi: 10.2307/2136404.
    1. Ehring T, Zetsche U, Weidacker K, Wahl K, Schönfeld S, Ehlers A. The Perseverative Thinking Questionnaire (PTQ): Validation of a content-independent measure of repetitive negative thinking. J Behav Ther Exp Psychiatry. 2011;42(2):225–232. doi: 10.1016/j.jbtep.2010.12.003.
    1. Connor KM, Davidson JRT. Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC) Depress Anxiety. 2003;18(2):76–82. doi: 10.1002/da.10113.
    1. Ware JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220–233. doi: 10.1097/00005650-199603000-00003.
    1. Richard L, Gauvin L, Gosselin C, Laforest S. Staying connected: Neighbourhood correlates of social participation among older adults living in an urban environment in Montréal, Québec. Health Promot Int. 2009;24(1):46–57. doi: 10.1093/heapro/dan039.
    1. Lubben J, Gironda M. Social networks and social exclusion: Sociological and policy perspectives. 2004. Measuring social networks and assessing their benefits; pp. 20–34.
    1. Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Thurtell MJ, Bruce BB, Rye DB, Newman NJ, Biousse V. The Berlin questionnaire screens for obstructive sleep apnea in idiopathic intracranial hypertension. J Neuro-Ophthalmology. 2011;31(4):316–319. doi: 10.1097/WNO.0b013e31821a4d54.
    1. Gilsing A, Mayhew A, Payette H, Shatenstein B, Kirkpatrick S, Amog K, Wolfson C, Kirkland S, Griffith L, Raina P. Validity and Reliability of a Short Diet Questionnaire to Estimate Dietary Intake in Older Adults in a Subsample of the Canadian Longitudinal Study on Aging. Nutrients. 2018;10(10):1522. doi: 10.3390/nu10101522.
    1. Rami L, Valls-Pedret C, Bartrés-Faz D, Caprile C, Solé-Padullés C, Castellví M, et al. Cognitive reserve questionnaire. Scores obtained in a healthy elderly population and in one with Alzheimer's disease. Rev Neurol. 2011;52(4):195–201.
    1. Belleville S, LeBlanc AC, Kergoat M, Calon F, Gaudreau P, Hébert SS, et al. The Consortium for the early identification of Alzheimer’s disease–Quebec (CIMA-Q) Alzheimers Dement Diagnosis Assess Dis Monit. 2019;11(1):787–796.
    1. Washburn RA, Smith KW, Jette AM, Janney CA. The physical activity scale for the elderly (PASE): Development and evaluation. J Clin Epidemiol. 1993;46(2):153–162. doi: 10.1016/0895-4356(93)90053-4.
    1. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24(1):1–8. doi: 10.1016/0005-7967(86)90143-9.
    1. Buhr K, Dugas MJ. The intolerance of uncertainty scale: Psychometric properties of the English version. Behav Res Ther. 2002;40(8):931–945. doi: 10.1016/S0005-7967(01)00092-4.
    1. Duncan LA, Schaller M, Park JH. Perceived vulnerability to disease: Development and validation of a 15-item self-report instrument. Pers Individ Differences. 2009;47(6):541–546. doi: 10.1016/j.paid.2009.05.001.
    1. Bem SL. The measurement of psychological androgyny. J Consult Clin Psychol. 1974;42(2):155–162. doi: 10.1037/h0036215.
    1. Langlois F, Vu TTM, Chasse K, Dupuis G, Kergoat M-J, Bherer L. Benefits of Physical Exercise Training on Cognition and Quality of Life in Frail Older Adults. J Gerontol Ser B Psychol Sci Soc Sci. 2013;68(3):400–404.
    1. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, et al. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(Suppl.9):498–504. doi: 10.1097/00005768-200009001-00009.
    1. Loprinzi PD, Edwards MK, Crush E, Ikuta T, Del Arco A. Dose–Response Association Between Physical Activity and Cognitive Function in a National Sample of Older Adults. Am J Heal Promot. 2018;32(3):554–560. doi: 10.1177/0890117116689732.
    1. ICMJE. Recommendations Defining the Role of Authors and Contributors. . Accessed 27 July 2021.
    1. Narici M, De Vito G, Franchi M, Paoli A, Moro T, Marcolin G, et al. Impact of sedentarism due to the COVID-19 home confinement on neuromuscular, cardiovascular and metabolic health: Physiological and pathophysiological implications and recommendations for physical and nutritional countermeasures. Eur J Sport Sci. 2021;21(4):614-35.
    1. Simonsick EM, Guralnik JM, Volpato S, Balfour J, Fried LP. Just get out the door! Importance of walking outside the home for maintaining mobility: Findings from the Women's Health and Aging Study. J Am Geriatr Soc. 2005;53(2):198–203. doi: 10.1111/j.1532-5415.2005.53103.x.
    1. Lampit A, Hallock H, Valenzuela M. Computerized Cognitive Training in Cognitively Healthy Older Adults: A Systematic Review and Meta-Analysis of Effect Modifiers. PLoS Med. 2014;11(11):e1001756. doi: 10.1371/journal.pmed.1001756.
    1. Castonguay N, Lussier M, Bugaiska A, Lord C, Bherer L. Executive functions in men and postmenopausal women. J Clin Exp Neuropsychol. 2015;37(2):193–208. doi: 10.1080/13803395.2014.1000267.
    1. Barha CK, Davis JC, Falck RS, Nagamatsu LS, Liu-Ambrose T. Sex differences in exercise efficacy to improve cognition: A systematic review and meta-analysis of randomized controlled trials in older humans. Front Neuroendocrinol. 2017;46:71–85. doi: 10.1016/j.yfrne.2017.04.002.
    1. Peterman JE, Harber MP, Imboden MT, Whaley MH, Fleenor BS, Myers J, Arena R, Finch WH, Kaminsky LA. Accuracy of Nonexercise Prediction Equations for Assessing Longitudinal Changes to Cardiorespiratory Fitness in Apparently Healthy Adults: BALL ST Cohort. J Am Heart Assoc. 2020;9(11):e015117. doi: 10.1161/JAHA.119.015117.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe