The goal of this clinical trial is to assess the efficacy of combined aerobic and resistance training in enhancing physical reserve in older adults with physical frailty. Investigator contend that enhanced physical reserve will enable preservation of cognitive and physical function. The main questions aims to answer are: (1) Compared with usual care (i.e., CON), will 3-month aerobic and resistance training (ATRT) improve physical reserve in older adults with physical frailty? (2) Compared with CON, will ATRT lead to changes in the neural network organization? (3) Will improved physical reserve lead to better maintenance of cognitive and physical functioning in spite of presence of white matter hyperintensities (WMH)?
are community-dwelling (i.e., not residing in a nursing home or extended care unit) ;
scored < 9/12 on the SPPB;
scored >18/30 on the MoCA;
are able to walk independently; use of walking aid is acceptable;
diagnosed with dementia or stroke;
self-report engaging in strength and balance training exercises > two-times-per-week in the 3 months prior to screening;
unable to understand, speak, and read Cantonese/Chinese/English proficiently; and
contraindications for MRI such as MRI-incompatible implants.
Parallel
Aerobic and resistance training
BehavioralThe aerobic training sessions will involve standardized sets of stationary training, including on-spot jogging, burpees, aerobic steppers, agility ladders, and non-contact boxing. Each participant will rotate through the stations within the 40-minute training period, with one-minute of rest breaks in-between each station. A 20-point rate-of-perceived exertion will be used to monitor participant status during training with a target rate-of-perceived exertion of 16-17. The resistance training sessions will involve utilizing free weights and resistance bands to stimulate muscle strength. The set of movements include triceps extension, dumbbell bicep curls, seated overhead dumbbell press, bent-over dumbbell row, wall squats, standing calf raises, wall push-ups.
Usual Care
BehavioralParticipant Retention and Care: Investigator will implement strategies to promote participant retention by: (1) conducting monthly phone calls by the project assistant to encourage and motivate participants to stay within the study; (2) discussing participant barriers/distress and developing coping/action plans; (3) providing monthly updates in the form of in-person/online/phone sessions; and (4) offering a comprehensive report on cognitive function, mobility, brain MRI, and monetary compensation for their time upon completion of the study. Investigator will facilitate participant care by recording incidental findings from the MRI and providing clinical assessment data that may be shared with healthcare providers upon request. All personnel on the research team will be trained to detect/assess distress or any possibility of harm and respond appropriately.
30 seconds sit-to-stand test
Mobility
Quantification of physical reserve
Physical reserve will be operationally defined as the unexplained residual variance in 30-second Sit-to-Stand Test after accounting for the effects of age, cognitive capacity, and brain structural integrity.
Alzheimer's Disease Assessment Scale-Cognitive-13
Cognitive capacity will be assessed by the Alzheimer's Disease Assessment Scale-Cognitive-13. It measures memory, language, praxis, attention, and executive function, with scores ranging from 0 to 85; higher scores indicate greater cognitive impairment.
Total hippocampal volume
Total hippocampal volume will be selected to reflect brain structural integrity
Trail Making Test
The Trail Making Test will comprise Part A and Part B. In Part A, participants are instructed to connect numbers in sequential order (e.g., drawing a line from 1 to 2, 2 to 3, 3 to 4, etc.) while being timed. In Part B, participants are instructed to connect, in order, 25 encircled numbers and letters alternately (e.g., 1-A-2-B-3-C) while being timed. A longer time represents worse executive function.
Resting state functional connectivity
Functional MRI will be used to measure resting state functional connectivity
Education
Years of education of participants will be recorded
Physical Activity Scale for the EAlderly
Physical activity will be assessed by the Physical Activity Scale for the Elderly. Higher scores represent better physical activity.
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The Hong Kong Polytechnic University
Lead sponsor
University of British Columbia
Collaborator
