Browsing by Author "Middleton, Laura"

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The Acute Effect of Exercise Intensity on Cognitive Function
(University of Waterloo, 2016-08-30) Wikkerink, Spencer; Middleton, Laura
Recent research has found that regular exercise has a positive effect on cognitive function. Some studies indicate that even an acute session of exercise has a slight positive effect on cognitive function, though factors moderating this effect have not been thoroughly examined. Exercise intensity and timing of cognitive assessment may have an interactive effect on cognitive changes after exercise. Previous research suggests that moderate intensity exercise has the most consistent benefit to cognitive function. In contrast, studies find positive, negative, or null effects to cognitive function after high intensity exercise, where the timing of the post-exercise assessments may account for the observed differences. Since high-intensity interval training (HIIT) is an increasingly popular form of exercise due to equal or greater cardiovascular adaptation for reduced exercise time, understanding its cognitive effects is of interest. The primary objective of the study was to compare the cognitive effects of an acute bout of HIIT to both moderate intensity continuous training (MCT) and rest. The secondary objective was to compare the timeline of the cognitive effects between these three sessions. Twenty-two participants performed 28.5min of HIIT, MCT, and rest on three separate days, each 2 weeks apart. The rest session was performed first and the subsequent exercise sessions were randomized. Cognitive function was assessed using a modified Flanker task with concurrent electroencephalography (EEG) before and 0, 15, 30, and 45min post-intervention. The hypothesis that cognitive function would improve after MCT and HIIT was not supported. Though there was some variability in cognitive function post-exercise, cognitive function was not significantly different before to after exercise or in comparison to the rest session. However, measures of cognitive function were often better prior to the exercise sessions than before exercise, possibly due to an anticipatory effect prior to exercise or learning carry-over after the rest session, which complicated interpretation of results. Of note, only a small number of prior studies included a baseline assessment of cognitive function in each session. Future research should examine the influence of the anticipation of exercise on cognitive function to better understand whether it is the psychological or physical stress imposed by exercise that enhances cognitive function.
Combined cognitive and exercise training for community-dwelling adults and older adults: A feasibility study
(University of Waterloo, 2020-08-31) Ellis, Courtney; Middleton, Laura
Older adults show cognitive improvements after taking part in exercise training or cognitive training. A number of studies suggest that combining these two types of interventions may lead to greater cognitive gains. However, trials that have done so have occurred in controlled experimental settings, so the effectiveness when translated to real-world settings is unclear. This study evaluated the feasibility of combining a cognitive training regimen (shown efficacious in trials) with a community exercise program for adults and older adults at augmented risk for dementia. The study was conducted in two phases. Phase 1 was a single-arm trial of 3-months of cognitive and exercise training (CET). Phase 2 was a quasi-experimental parallel-group trial where program times (Monday/Wednesday or Tuesday/Thursday) were randomized to either 3-month CET or exercise only (ExO) interventions. Community-dwelling adults and older adults eligible for the study and for the YMCA Move for Health exercise program were recruited. The feasibility outcomes were recruitment rate, study retention, adherence to intervention (attendance and completion of exercise diaries), and participant and instructor program acceptance (based on a satisfaction questionnaire). Exploratory outcomes including cognitive function, physical function, exercise-related self-efficacy and perceived well-being were also measured. Eleven participants were recruited to phase 1 of the study and 32 participants (16/group) were recruited to phase 2 of the study. The study met most a priori feasibility criteria, with the exception of recruitment rate and phase 2 retention. Recruitment rate was 1.8 participants/week in phase 1 and 3.2 participants/week in phase 2, well short of the 6 participants/week target. The most frequent reason for ineligibility was lack of willingness or ability to participate at designated program times. Retention rate was 91% in phase 1 and 72% in phase 2 (69% for CET and 75% ExO) (criterion for success was ≥ 75%). Adherence (attendance) rate was 79% for phase 1 and 73% for phase 2 (73% for CET and for ExO), respectively (criterion for success was ≥ 70%). Participant satisfaction was 4.5 of 5 in phase 1 and in phase 2 (4.5 for CET and 4.4 for ExO). Instructor satisfaction rating was 4.7 for phase 1 and 4.0 for phase 2 (3.9 for CET and 4.1 for ExO instructors) (criterion was ≥ 4 out of 5). No feasibility outcomes differed between the intervention groups. However, participants that were older, had more chronic health conditions, poorer baseline global cognition, and lower baseline physical activity were more likely to withdraw from the study, and had poorer adherence to study protocols, suggesting a need for additional supports for individuals with these traits. In addition, the lowest satisfaction rating was for the difficulty of cognitive and exercise training; for the cognitive training, many of those with high baseline global cognitive function did not feel sufficiently challenged. Though correlations in this small sample were not significant and likely driven by outliers, trends in this study suggest that having fewer chronic conditions may be associated with better cognitive outcomes and should be investigated in a future trial. The results of this study suggest that a pragmatic trial of CET may be feasible in a community setting, provided adjustments to recruitment strategies. This could include opening additional program time-slots, as lack of ability or willingness to participate at the set program time was the primary reason for participants not being recruited.
The Effects of Exercise Combined with Music on Executive Functioning in Healthy Young Adults
(University of Waterloo, 2022-09-09) Vander Vaart, Jessica; Middleton, Laura
Evidence suggests that both exercise and music improve cognitive functioning. While many individuals listen to music while exercising, whether exercise combined with music produces greater effects on cognitive functioning compared to either method alone is not well understood. This study examined changes in executive functioning (inhibitory control, working memory) in healthy young adults after exercise with music compared to music listening only and exercise only. It was hypothesized that exercise combined with music would show greater improvements in inhibitory control and working memory compared to exercise or music only. Using a repeated measures design, 24 young healthy adults completed three counterbalanced sessions (exercise with music, exercise, and music). Prior to and following the interventions, participants performed assessments for inhibitory control and working memory. The assessments included a Stroop task to assess inhibitory control and a reverse Corsi block task to assess visuospatial working memory. Additionally, affect was assessed pre and post activity using the Physical Activity Affect Scale (PAAS). The data was analyzed using a linear mixed model to compare the effects of exercise with music, music only, and exercise only on cognitive functioning with factors for time (pre/post) and intervention (exercise with music, exercise, music), as well as session number (1, 2,3) to adjust for learning effects within and across sessions. This study found that working memory improved significantly across time however, the magnitude of changes did not differ significantly between the different conditions. Similarly, improvements in positive affect and fatigue were significant across time for all conditions but these changes did not differ significantly between conditions. No significant changes were observed for inhibitory control across time or condition. The results of this study suggest that exercise combined with music does not provide any additive benefit to working memory, inhibitory control, or affect when compared to either exercise or music listening. Instead, it appears that all three conditions (exercise with music, exercise, music listening) resulted in similar changes to components of cognitive functioning and affect across time however, these changes depend on the specific domains assessed.
The Influence of Social Engagement on Exercise-Associated Cognitive and Affective Changes in Older Adult Women
(University of Waterloo, 2019-08-20) Nieman, Teran; Middleton, Laura
Single bouts of aerobic exercise appear to elicit improvements in cognition and affect among older adults, which are dependent on exercise dose (intensity, duration). Social engagement, not typically considered in exercise prescription but often included in exercise delivery, may also influence these outcomes. This study examined the effects of social exercise and solo exercise versus a control on affect and cognition among older adult women. Thirty healthy older adult women were recruited to this study. In a repeated-measures design, participants each completed three sessions: 1) social exercise: moderate intensity treadmill walking with concurrent conversation with another participant; 2) solo exercise: moderate intensity treadmill walking alone; and 3) active control seated and listening to an informative podcast. Order of conditions was counterbalanced. Executive function was assessed immediately before and 10 minutes after each intervention using a modified Eriksen Flanker task. Response time (RT), accuracy, and inverse efficiency score (IES) were calculated from Flanker data. Affect was assessed using the Physical Activity Affect Scale (PAAS) immediately before and after each intervention and at 3-hour intervals throughout the day of intervention and the following day. PAAS subfactors of positive affect, negative affect, tranquility, and fatigue were used in analysis. To better examine variability in RT response to exercise, individual participant response times across conditions and time were examined and used to group participants in an exploratory analysis. Four groupings emerged: 1) Consistent Responders; 2) Social Responders; 3) Solo Responders; 4) Non-Responders. Differences in personality, activity levels, conversation characteristics, sleep, and energy expenditure were examined between groups. Results show higher accuracy in exercise conditions than control, but with no change in RT over time or conditions. There was significantly lower IES in the social condition compared to control, but no difference between exercise conditions. Responder groups varied by personality, exercise history, and social engagement characteristics such that consistent and social responders tended to be more extroverted, agreeable, and conscientious than other groups. Social conversation quality and quantity was also higher among these groups, while contribution to the conversation was lowest. Subjective physical activity levels were highest in the non-responder group. Acute improvements in affect (denoted by higher positive affect and reduced negative affect) occurred following social exercise, but not solo exercise or control. This reduction in negative affect remained until 6h-post social exercise, however positive affect decreased over this time. Overall, results provide only weak support for enhanced executive functions following exercise or social exercise. However, social engagement during exercise may lead to affective improvements, which may be sustained up to 6h-post intervention.
The Magnitude and Time Course Effects of an Acute Bout of Moderate Intensity Resistance Training on Cognitive Function
(University of Waterloo, 2016-05-19) Vonk, Matthew; Middleton, Laura
Resistance training (RT) is a common form of physical activity that forms a core part of physical activity recommendations. RT has well-documented benefits to metabolic and musculoskeletal health. Emerging research also suggests that RT, when performed over a period of time, is associated with improvements in cognitive function. More recently, studies have examined the acute effect of RT on cognitive function, as characterized by behavioural and electroencephalography (EEG) measures. Studies to date have predominantly demonstrated acute benefits to behavioural measures of executive function after RT in older, untrained populations. Only one study also used concurrent EEG to examine underlying cortical changes in a young adult population. Results from this study suggest that an acute moderate intensity RT session promotes faster responses and increased P300 (P3) amplitude. The purpose of this thesis was to specifically examine the effects of acute moderate intensity RT on response inhibition among young adults, when compared to non-exercise rest and loadless (LL) movement controls. The first objective was to determine if acute RT altered cortical processing, as measured by P3 amplitude and latency during a modified Stroop task. The second objective was to investigate whether acute RT influences behavioural measures of response time and accuracy during a modified Stroop task. The final objective was to examine the time course of effects up to 40min after the intervention. Twenty-two physically active young adults performed three sessions: rest, LL activity (simulated RT), and moderate intensity RT over a 5-week period. The rest session was always performed first and the LL and RT sessions were then performed in randomized order. A modified Stroop task was performed before the intervention and again 10, 20, 30, and 40min post-intervention with concurrent EEG. Outcomes (Stroop task response time and accuracy, P3 amplitude and latency) were analyzed with mixed effects linear regression models. Changes in cognitive function, as characterized by behavioural and EEG measures, were similar after RT, LL, and rest for most measures. P3 amplitudes increased over time, for the rest session only (p<0.0041). There were no differences between RT and LL activity. The reason for the lack of effects, in contrast to most prior studies, is unclear. However, it is possible that the lack of effects may be due to the simpler response inhibition task, the shorter rest during the RT session, or the lack of randomization of the rest session. Future research should further investigate the relative effects of RT, LL movement, and rest on cognitive function, with a fully randomized design. Studies should also investigate underlying mechanisms and relative differences between these conditions to better understand the influence of movement and exertion on cognitive function.
Perceived Barriers to Exercise among Older Adults with MCI and Early Dementia
(University of Waterloo, 2017-09-08) Hobson, Nicholas; Middleton, Laura
Increasing evidence suggests that exercise can benefit physical and cognitive function among older adults with mild cognitive impairment (MCI) and early dementia (MCI/dementia). Unfortunately, many older adults with MCI/dementia are not sufficiently active to achieve these benefits. Older adults with MCI/dementia experience barriers to exercise, some of which may be shared with older adults in general. There are likely to also be factors unique to their condition. Further, the social-ecological model (SEM) suggests that characteristics of the social and physical environmental factors may interact with individual factors and play important and dynamic roles in influencing health behaviours, including exercise. The objective of this study was to explore and characterize the perceived barriers, motivators, and facilitators to exercise among community-dwelling older adults with MCI/dementia guided by the SEM as a framework, from the perspectives of both older adults with MCI/dementia and their care partners. Additional objectives were to explore the perceived acceptability of exercise options among older adults with MCI/dementia and their care partners and to explore the supports and accommodations that may be needed to create inclusive conditions for persons with MCI/dementia to participate in community-based exercise programs. Ten older adults with MCI/dementia and 7 care partners were conveniently recruited to the study. Perspectives, experiences, and opinions of both persons with MCI/dementia and their care partners regarding exercise among persons with MCI/dementia were gathered qualitatively through four focus group discussions. Focus groups ranged in size from 3 to 6 participants. Pairs of focus groups, one for each participant group, ran simultaneously with a separate moderating team for each group. Group discussions were audio-recorded, transcribed verbatim, and reviewed to ensure consistency. Data analysis followed the general inductive thematic approach outlined by Braun and Clarke (2006). Thematic analysis revealed a complex and dynamic interplay between factors across levels of the SEM influencing exercise behaviour among persons with MCI/dementia. Key themes indicate that persons with MCI/dementia and their care partners viewed exercise as a positive, meaningful, and beneficial activity that had physical, mental, and social benefits. However, several barriers to exercise participation emerged including low intrinsic motivation, physical and mental health challenges and stigma against dementia. Despite challenges to engage in exercise, external support at the individual and community level could help overcome barriers. Low motivation to exercise among persons with MCI/dementia could be mediated by encouragement from their care partners and availability of enjoyable, social exercise opportunities. By providing transportation and acting as an exercise companion, the care partners could also help the person with MCI/dementia’s physical and cognitive limitations. Further, access to exercise opportunities that meet the individual physical and mental needs of the person with MCI/dementia could reduce the negative impact of physical and mental challenges experienced by persons with MCI/dementia on exercise engagement. The results suggest that increasing availability of preferred exercise opportunities, such as walking outdoors and exercise in social settings with others with whom they identify, is likely a worthwhile venture that may motivate and enable exercise among persons with dementia. Future research should determine and assess strategies to augment motivators and facilitators to exercise and reduce barriers, especially at the social and community-levels. Results should, however, be interpreted with caution as this study included primarily active participants from a single region and future studies should specifically target persons with MCI/dementia who are sedentary and from broad social and geographical environmental, as the factors that influence exercise are likely to be different.
The Feasibility and Perceived Impact of the DEmentia Lifestyle Intervention for Getting Healthy Together (DELIGHT) Program for People Living with Dementia and their Care Partners
(University of Waterloo, 2024-10-30) Tupling, Olivia; Middleton, Laura
Improving supports to enhance quality of life for people living with dementia is a priority of research and practice. Multimodal lifestyle interventions that include components such as physical activity, nutrition, and social activity may help support quality of life and function for people living with dementia and their care partners. The DEmentia Lifestyle Intervention Program for Getting Healthy Together (DELIGHT) was co-designed by people with dementia, care partners, community stakeholders, and researchers with the goal of promoting ‘living well’ with dementia. The DELIGHT program incorporates exercise and shared learning on topics related to health and wellbeing (healthy eating, physical activity, social support, mental wellbeing, sleep). The aim here was to assess the feasibility and perceived impact of the 8-week in-person DELIGHT program. Feasibility was evaluated through recruitment rate (target: 6 per month), attendance (target: 75% of sessions), retention (target: 80% of participants who started the program complete post-program assessments), and program acceptability. Perceived impact and challenges and were also assessed through semi-structured interviews with participants, study leaders, and volunteers. Interview transcripts were analyzed using inductive thematic analysis to identify and describe experience with, and impact of, the DELIGHT program. A separate deductive content analysis was used to identify issues related to feasibility (challenges and recommendations). Exploratory effectiveness outcomes included quality of life, physical activity, balance confidence, exercise self-efficacy, nutrition risk, social connectedness, social isolation, balance, strength, and fitness. Quantitative and qualitative results were compared to support a richer interpretation of the programs impact on participants. Seventeen participants completed the DELIGHT program, recruited at an average of 4.25 participants/month, which was lower than our feasibility target. All participants completed the program with an average attendance of 89.7% and 16 (94%) completed post-program evaluation. All (100%) of participants (n=16) and volunteers/study personnel (n=7) described enjoying their participation in the DELIGHT program and reported that they would be interested in participating again. Four themes related to the impact of and satisfaction with the DELIGHT program were identified from interviews. Making the most of today for tomorrow describes the immediate and lasting emotional and physical benefits of the program and the empowerment participants felt over their health, inspiring lifestyle changes. These aligned with group average improvement on assessments of physical function and physical activity. Broadening perspectives and taking action describes how participants and volunteers challenged stigma, providing hope and inspiring action to continue the conversation. Connecting and caring describes the feelings of comfort and belonging among participants and volunteers, inspiring participants to engage and go outside their comfort zone. These aligned with the group average improvement of social connection and maintained low levels of loneliness. Learning together and sharing knowledge describes how participants and volunteers learned from each other’s unique knowledge and perspectives, and the paramount value of learning from experience. All themes generally suggest that DELIGHT supported participants in improving wellbeing however, quantitative measures of quality of life showed a decrease of one point in average scores. Results indicate DELIGHT is a feasible lifestyle intervention for people living with dementia and their care partners with promise for supporting wellbeing but more time may be required to recruit to the program. Further large-scale evaluation is warranted to examine the effectiveness of DELIGHT. In addition, adaptation of DELIGHT for specific ethno-cultural groups should be explored.
Understanding the impact related to lifestyle interventinos for people with dementia: A systematic review protocol
(Public Library of Science (PLOS), 2024) Middleton, Laura; Vucea-Tirabassi, Vanessa; Liu, Grace; Bethell, Jennifer; Cooke, Heather; Keller, Heather; Liu-Ambrose, Teresa; O'Connell, Megan E.; Stapleton, Jackie; Waldron, Ingrid; Wu, Sarah; Yous, Marie-Lee; Aiken, Christine; Heibein, William; Norman, Myrna; McAiney, Carrie
There is growing evidence to suggest that lifestyle initiatives promote brain health and reduce dementia risk. However, there is comparatively limited research focused on lifestyle interventions among people living with dementia. Most recent systematic reviews of lifestyle interventions among people living with dementia centre on the impact of exercise on cognition; yet, functional abilities and quality of life are most consistently prioritized by people living with dementia, care partners, and healthcare professionals. There is insufficient evidence to inform guidelines on effective lifestyle interventions, programs, resources, and policies for people living with dementia. To address this knowledge gap, the objective of this study is to perform a systematic review to understand the impact of lifestyle interventions among people living with dementia. The specific research questions are: "What is the effectiveness of physical activity interventions on improving functional abilities and quality of life among community-dwelling people living with dementia?", "What is the effectiveness of healthy eating/nutrition on improving nutritional status or quality of life among community-dwelling people living with dementia?" and "Does the effectiveness of interventions vary depending on the components (single or multi), setting (in-home or community centre, geography), program structure, mode of delivery, dosage, and participant characteristics (sex/gender, ethno-cultural or language group, race, dementia type)?" The results from this review will inform recommendations of lifestyle interventions and their delivery among people living with dementia in the community. Trial registration: Systematic review registration PROSPERO #CRD42024509408.