| Background:Currently,the aging of the population is severe worldwide.The prevalence of dementia is increasing,and the care and financial burden are heavy.Because research progess of effective treatments for dementia is slow,the stage of predementia has drawn more and more attention.Mild cognitive impairment(MCI)is a stage of pre-dementia,and people with MCI are more likely to develop dementia than older adults with normal cognition,but they can also remain stable MCI or return to normal cognition.MCI is an appropriate and necessary stage for intervention.Mind-body exercise,which involves both physical activity and mental health,has the potential to improve MCI.Although some scholars have conducted mind-body exercises such as Qigong,yoga and dance in older adults with MCI,due to inconsistent research conclusions,mindbody exercises have not been widely promoted in the population with MCI as effective interventions.Therefore,it is of great significance to explore a scientific and effective mind-body exercise suitable for the promotion in Chinese older adults with MCI.Objectives:Based on the theoretical rehabilitation model of MCI,this study aimed to explore a scientific and effective mind-body exercise which is suitable for Chinese older adults with MCI,evaluate its effectiveness on older adults with MCI in the pension institutions,and explore the relevant mechanisms of the effect.(1)Based on evidence-based nursing,this study aimed to explore a scientific and effective mind-body exercise which is easily popularized in Chinese older adults with MCI.(2)Through field investigation,this study aimed to identify the influencing factors of MCI in older adults living in the pension institutions,and analyze the correlation between exercise habits and these influencing factors,so as to lay a foundation for the controlling of the confounding factors and the selection of outcome measures(modifiable risk and protective factors for MCI)at the evaluation stage.(3)Through intervention,this study aimed to test the effect of mind-body exercise on older adults with MCI living in the pension institutions,and explore the related mechanism by which the mind-body exercise affects the cognitive function of participants with MCI.(4)Through understanding of the participants' experience,this study aimed to verify the feasibility of the mind-body exercise in older adults with MCI living in the pension institutions,explore the benefits of the mind-body exercise comprehensively,and analyze the influencing factors of participants' adherence,so as to further improve the intervention schemes and lay a foundation for the extensive promotion of the mindbody exercise.Methods:(1)Effects of mind-body exercise on older adults with cognitive impairment: a systematic review and meta-analysis.9 databases were systematically searched for control studies examing the intervention effect of mind-body exercises on population with cognitive impairment.Publication date was limited to March 29,2018.A randomeffects model was used to calculate the pooled standard mean difference(SMD)and95% confidence interval(CI)to evaluate the intervention effect.Subgroup analyses were performed based on the level of cognitive impairment and types of exercise,to determine 1)the effects of mind-body exercise on cognitive function in older adults with cognitive impairment,MCI or dementia;2)the effects of different types of mindbody exercise on cognitive function in older adults with cognitive impairment.(2)A study on the association paths between exercise habits and mild cognitive impairment of older adults living in the pension institutions.Convenience sampling was used to select four pension institutions in Changchun,China,and 338 older adults with MCI/normal cognition were included.Data including demographic characteristics,frailty status,depression,sleep quality,social support and cognitive status were collected.Independent sample t test/rank sum test/chi-square test and logistic regression were used to analyze the influence factors of MCI;WLSMV and bootstrapping with2000 resamples were used to analyze the correlation paths between exercise habits and MCI;so as to determine the confounding factors and some outcome measures at the evaluation stage.(3)A study on the effect and related mechanism of mind-body exercise on older adults with mild cognitive impairment living in the pension institutions.Convenience sampling was used to select a large pension institution in Changchun,China,and 66 older adults with MCI were included.Participants were assigned to the intervention group(n = 33)or the control group(n = 33)according to their residential floor.The intervention group underwent a 12-week adapted version of Jiamusi happy dance aerobics routine,and the frequency was three sessions per week,40 min per session.The control group maintained usual lifestyle.Participants' global cognition,frailty status,depression,sleep quality and quality of life were assessed at baseline,week 6and week 12.Generalized estimating equations(GEE)was used to evaluate the difference in outcome changes between the intervention group and the control group during the intervention period,so as to test the effect of mind-body exercise on older adults with MCI living in the pension institutions.Path analysis was conducted to explore the possible mechanisms by which dance intervention affected the global cognition of participants with MCI,and ML and bootstrapping with 2000 resamples were used.All the analyses were conducted based on the intention-to-treat principle.(4)A qualitative study on the experience of older adults with mild cognitive impairment living in the pension institutions participating in a mind-body exercise intervention.Purposive sampling was used to select participants from 31 older adults completing the 12-week square dancing program,and we conducted individual semistructured interviews to them.The sample size was determined by data saturation.The interview guideline mainly involved reasons of initial participation,facilitators of and barriers to adherence,as well as the physical,psychological,social,cognitive and other specific experiences.The data were analyzed using qualitive content analysis.Results:(1)Effects of mind-body exercise on older adults with cognitive impairment: a systematic review and meta-analysis.A total of 19 articles/18 studies were included,and data from 15 of them could be pooled.Mind-body exercise had a moderate to large positive effect on global cognition and memory in older adults with cognitive impairment.Subgroup analyses showed that mind-body exercise was effective for the global cognition of older adults with MCI,and both dance and qigong were effective for the global cognition and memory of older adults with cognitive impairment.(2)A study on the association paths between exercise habits and mild cognitive impairment of older adults living in the pension institutions.There were significant differences in age,education level,occupation type,monthly pension,number of comorbidities,exercise habits,preference for calligraphy and painting,listening to music,drinking tea or coffee,frailty status,depression,sleep quality and social support between the older adults with MCI and those with normal cognition.Age,education level,exercise habits,frailty,depression and sleep quality were independent influencing factors for MCI.The association pathways model between exercise habits and MCI showed that exercise habits were not only directly associated with a reduced risk of MCI,but also indirectly associated with a reduced risk of MCI through lower levels of depression and frailty,respectively.The mediating effect of depression could be achieved alone or in combination with sleep quality or frailty.(3)A study on the effect and related mechanism of mind-body exercise on older adults with mild cognitive impairment living in the pension institutions.Square dancing had no significant effect on the global cognition and frailty in older adults with MCI at week 6,but had significant positive effect during week 6 ? week 12.While,the positive effects on depression,sleep quality and quality of life were significant at week 6,and the effects increased significantly during week 6 ? week 12.Analysis of the influence mechanism of the square dancing on the cognitive function in older adults with MCI showed that depression mediated entirely the relationship between square dancing intervention and the global cognition,that is,square dancing intervention improved the global cognition in older adults with MCI by reducing the depression.(4)A qualitative study on the experience of older adults with mild cognitive impairment living in the pension institutions participating in a mind-body exercise intervention.Three main categories were eventually generated,including benefits associated with exercise,facilitators of adherence,and barriers to adherence.Benefits associated with exercise involved multiple aspects,including physical benefits,psychosocial benefits,social benefits and cognitive benefits,among which psychosocial benefits played an important role.A good spirit contributed to physical health.A good mood contributed to better cognition and sleep quality.Good social interaction was closely associated with a good mood.Activity features,meeting expectations,staff supervision and guidance,young staff and understanding and support for the staff were facilitators of adherence.Forgetfulness was a particular barrier to adherence for participants with cognitive impairment.For some older adults,40 minutes of each session in the beginning may be too long.Conclusions:(1)Mind-body exercise could effectively improve the cognition in older adults with cognitive impairment(including MCI and dementia).Safe and effective mindbody interventions mainly involved dance and qigong.Since dance is easier,more interesting and involves more social interaction,we believe that it may be more suitable to be promoted in older adults with MCI.(2)Independent influencing factors for MCI in older adults living in the pension institutions included age,education level,depression,frailty,sleep quality and exercise habits.Exercise habits were directly associated with MCI diagnosis,and could also be indirectly associated with MCI diagnosis through depression / frailty / depression and frailty / depression and sleep quality.(3)The square dancing mind-body exercise was safe and effective for the older adults with MCI living in the pension institutions.A 12-week square dancing intervention could effectively improve the global cognition,depression,sleep quality,frailty and quality of life in older adults with MCI.Square dancing improved the global cognition by alleviating depressive symptoms in older adults with MCI.(4)The square dancing mind-body exercise was effective and feasible for the older adults with MCI living in the pension institutions.In the future promotion process,attention should be paid to strengthening the facilitators of and barriers to adherence,so as to improve the program and its implementation. |
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