Relationship between components of leisure physical activity and mortality in Taiwanese older adults. Twelve-week physical and leisure activity programme improved cognitive function in community-dwelling elderly subjects: a randomized controlled trial. Leisure activities and cognitive function in elderly community-dwelling individuals in Japan: a 5-year prospective cohort study. Physical, social and productive leisure activities, cognitive decline and interaction with APOE-epsilon 4 genotype in Chinese older adults. Prospective Associations Between Leisure-Time Physical Activity and Cognitive Performance Among Older Adults Across an 11-Year Period Exercise Is Associated with Reduced Risk for Incident Dementia among Persons 65 Years of Age and Older Protocol for Project FACT: a randomised controlled trial on the effect of a walking program and vitamin B supplementation on the rate of cognitive decline and psychosocial wellbeing in older adults with mild cognitive impairment [ISRCTN19227688] Physical activity, structural brain changes and cognitive decline. The SMART-MR study. A prospective study of physical activity and cognitive decline in elderly women: women who walk. Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. Impact of a physical activity intervention program on cognitive predictors of behaviour among adults at risk of Type 2 diabetes (ProActive randomised controlled trial) Leisure Activities and Risk of Vascular Cognitive Impairment in Older Adults Exercise and well-being: a review of mental and physical health benefits associated with physical activity Process evaluation in an intervention designed to promote physical activity among adults with anxiety disorders: evidence of acceptability and adherence. Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial Leisure activities and the risk of dementia in the elderly. Cost effectiveness of a multi-component school-based physical activity intervention targeting adolescents: the ‘Physical Activity 4 Everyone’ cluster randomized trial ‘Better Health Choices’ by telephone: A feasibility trial of improving diet and physical activity in people diagnosed with psychotic disorders A test of cognitive mediation in a 12-month physical activity workplace intervention: does it explain behaviour change in women? Community-based physical activity as adjunctive smoking cessation treatment: Rationale, design, and baseline data for the Lifestyle Enhancement Program (LEAP) randomized controlled trial Leisure-time physical activity at midlife and the risk of dementia and Alzheimer's disease Promoting Optimal Physical Exercise for Life (PROPEL): aerobic exercise and self-management early after stroke to increase daily physical activity—study protocol for a stepped-wedge randomised trial Work-related physical activity and the risk of dementia and Alzheimer's disease. Harnessing Different Motivational Frames via Mobile Phones to Promote Daily Physical Activity and Reduce Sedentary Behavior in Aging Adults The Effect of the More Active MuMs in Stirling Trial on Body Composition and Psychological Well-Being among Postnatal Women Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory During 16 Weeks Prevention of Dementia: Focus on Lifestyle The positive effect on determinants of physical activity of a tailored, general practice-based physical activity intervention. Cost-effectiveness of a primary care based physical activity intervention in 45-74 year old men and women: a randomised controlled trial. Study of Mental Activity and Regular Training (SMART) in at risk individuals: A randomised double blind, sham controlled, longitudinal trial Complex mental and physical activity in older women and cognitive performance: a 6-month randomized controlled trial. Total daily physical activity and the risk of AD and cognitive decline in older adults
BACKGROUND Whether the major components of leisure physical activity ( number of types , intensity , frequency , and duration ) have independent contribution to mortality reduction and there is a minimum amount of activity beneficial for the elderly remain unclear . METHODS The prospect i ve follow-up study aim ed at examining the relationship between exercise components and total mortality in general elderly population . A total of 2113 persons aged 65 and older participating in 2001 Taiwan National Health Interview Survey were studied . Information regarding leisure physical activity , its energy parameters , other factors at baseline , and vital status at the end of 2003 was analyzed with Cox model . RESULTS A total of 197 deaths occurred during a 2-year follow-up . Regular exercisers reduced 35 % risk of death compared with sedentary individuals after adjustment for covariates . Moreover , exercisers with a weekly amount of energy exceeding 1000 kcal had significant benefit of risk reduction when energy expenditure is considered . There was a significant dose-response relationship between number of activity and the reduction in total mortality . The benefit on mortality reduction among the three components of total energy amount was only observed in intensity . CONCLUSIONS For the amount of energy dedicated to leisure physical activity , older persons are recommended to expend at least 1000 kcal per week through regular exercise for mortality reduction . In addition to energy amount , protection of exercise against death also increases with the number of activities . Among the three components of total amount of energy , only intensity is significantly associated with mortality reduction BACKGROUND Japan is one of the most rapidly ageing societies in the world . A number of municipalities have started services for the prevention of cognitive decline for community-dwelling elderly individuals , but the effectiveness of these services is currently insufficient . Our study explored the efficacy of a comprehensive intervention programme consisting of physical and leisure activities to prevent cognitive decline in community-dwelling elderly subjects . METHOD We administered a 12-week intervention programme consisting of physical and leisure activities aim ed at enhancing participants ' motivation to participate and support one another by providing a pleasant atmosphere , empathetic communication , praise , and errorless support . This programme for the prevention of cognitive decline was conducted as a service by the city of Maebashi . All participants underwent the Five-Cog test , which evaluated the cognitive domains of attention , memory , visuospatial function , language , and reasoning . Executive function was evaluated by the Wechsler Digit Symbol Substitution Test and Yamaguchi Kanji-Symbol Substitution Test . Subjective health status , level of social support , functional capacity , subjective quality of life , and depressive symptoms were assessed with a question naire . Grip strength test , timed up- and -go test , 5-m maximum walking times test , and functional reach test were performed to evaluate physical function . Fifty-two participants were r and omly allocated to  intervention ( n = 26 ) and control ( n = 26 ) groups . Twenty-six participants , aged between 65 - 87 years , received intervention once a week at a community centre . The programme was conducted by health-care professionals , with the help of senior citizen volunteers . RESULTS The intervention group ( n = 19 ) showed significant improvement on the analogy task of the Five-Cog test ( F(1,38 ) = 4.242 , P = 0.046 ) and improved quality of life ( F(1,38 ) = 4.773 , P = 0.035 ) as compared to the control group ( n = 24 ) . CONCLUSION A community-based 12-week intervention programme that aim ed to enhance motivation to participate in activities result ed in improvements in some aspects of cognitive function and quality of life .  Senior citizens who volunteered in the present intervention enabled the smooth implementation of the programme and alleviated the burden on professional staff OBJECTIVE This study aim ed to clarify the longitudinal relationship between leisure activities and cognitive decline  among Japanese community-dwelling older adults , using a 5-year prospect i ve cohort study design . METHODS A total of 567 men and women , aged 70years and over , participated in the study . The  Mini-Mental State Examination was used in baseline and follow-up surveys to assess cognitive function . The change in cognitive function from baseline to follow-up was determined , and cognitive decline over 5years was used as the outcome variable .  Leisure activities ( hobby , social activity , and physical activity )  were assessed at baseline and used as independent variables . Age , gender , number of years of education , presence of chronic diseases , instrumental activities of daily living , depressive symptoms , smoking , hearing deficits , and level of cognitive function at baseline were used as covariates . RESULTS Multivariate logistic regression analysis , adjusted for potential confounders , showed that non-participation in a hobby  was significantly and independently associated with cognitive decline ( odds ratio : 1.87 , 95 % confidence interval : 1.16 - 3.02 , p<0.01 ) . There were no significant relationships between social activity , physical activity and cognitive decline . CONCLUSIONS Our study found a longitudinal inverse relationship between hobby participation and cognitive decline among elderly Japanese community-dwelling individuals , suggesting that engaging in a hobby in later life can contribute to preserving cognitive function BACKGROUND We evaluated the combined and differential effects of physical , social and productive activities on  cognitive decline  and whether they were modified by the presence of the APOE-epsilon 4 allele . METHODS In a prospect i ve cohort study of 1635 community-dwelling Chinese older adults aged 55 or older participating in the ongoing Singapore Longitudinal Aging Study , physical , social and productive leisure activities were assessed at baseline , and cognitive decline ( at least one point drop ) in MMSE scores between baseline and follow-up after one year . RESULTS Cognitive decline was observed in 30 % of the respondents . Controlling for age , gender , education and other risk factors , odds ratios ( ORs ) were significantly reduced in those with medium ( OR : 0.60 , 95 % CI : 0.45 - 0.79 ) and high activity levels ( OR : 0.62 , 95 % CI : 0.46 - 0.84 ) . A stronger association was shown for productive activity ( OR = 0.36 ) , than for physical ( OR = 0.78 ) and social activities ( OR = 0.85 ) . These associations showed statistically significant interactions with APOE genotype , being more pronounced in those with the APOE-epsilon 4 allele . CONCLUSION Increased leisure activity  , especially productive activities  more than  physical or social activities  , was associated with a lowered risk of cognitive decline . APOE-epsilon 4 genotype individuals appeared to be more vulnerable to the effects of low and high levels of leisure activities Background Few studies have explored the relations between naturally occurring changes in physical activity and cognitive performance in later life . This study examined prospect i ve associations between changes in physical activity and cognitive performance in a population -based sample of Taiwanese older adults during an 11-year period . Methods Analyses were based on nationally representative data from the Taiwan Health and Living Status of the Elderly Survey collected in 1996 , 1999 , 2003 , and 2007 . Data from a fixed cohort of 1160 participants who were aged 67 years or older in 1996 and followed for 11 years were included .  Cognitive performance ( outcome ) was assessed using 5 questions from the Short Portable Mental Status Question naire . Physical activity ( exposure ) was self-reported as number of sessions per week . The latent growth model was used to examine associations between changes in physical activity and cognitive performance after controlling for sociodemographic variables , lifestyle behaviors , and health status . Results With multivariate adjustment , higher initial levels of physical activity were significantly associated with better initial cognitive performance ( st and ardized coefficient β = 0.17 ) . A higher level of physical activity  at baseline ( 1996 ) was significantly related to slower decline in cognitive performance , as compared with a lower level of activity ( β = 0.22 ) . The association between changes in physical activity and changes in cognitive performance was stronger ( β = 0.36 ) than the previous 2 associations . The effect remained after excluding participants with cognitive decline before baseline . Conclusions Physical activity in later life is associated with slower age-related cognitive decline Context Some studies suggest that people with high levels of physical activity are less likely to develop dementia . Content All 1740 participants in this cohort study were 65 years of age or older and were cognitively intact at baseline . Over 6.2 years , the rate of dementia was 13.0 per 1000 person-years in those who exercised 3 or more times per week and 19.7 per 1000 person-years in those who exercised less than 3 times per week . Limitations The only measure of exercise intensity was self-reported frequency . The cohort was largely white and well-educated . Implication s This study adds to the evidence that regular exercise is associated with a lower risk for dementia . However , the existing evidence does not prove that regular exercise is associated with a lower dementia risk . The Editors Alzheimer disease and other dementing illnesses are major sources of morbidity and mortality ( 1 - 3 ) that affect millions of persons in the increasingly aging society of the United States . Research design ed to discover strategies to delay onset and progression of these potentially devastating illnesses is ongoing worldwide . Effective prevention strategies would result in substantial benefits through improved quality of life , prolonged independent life expectancy , and reduced economic cost and social burdens .  Regular physical exercise is an important element in overall health promotion ( 4 ) and might also be an effective strategy to delay onset of dementia ( 5 ) . A biological basis for how physical exercise might preserve brain function includes improved cerebral blood flow and oxygen delivery ( 6 ) and inducing fibroblast growth factor in the hippocampus ( 7 ) . More recent evidence suggests that reduced loss of hippocampal brain tissue in the aging brain is related to level of physical fitness ( 8) . Evidence from some longitudinal studies and r and omized trials suggests that physical exercise enhances cognitive function in older adults ( 9 - 15 ) , whereas other studies have failed to observe the benefits of physical exercise in preserving cognitive function ( 16 - 19 ) . Many people regard Alzheimer disease as one of the most dreaded consequences of aging . If regular physical exercise were shown to be effective in reducing the risk or delaying the onset of dementing illnesses , it would be another compelling reason to promote physical exercise . Few population -based longitudinal studies have examined the role of physical exercise on the risk for dementia in elderly persons . One recent longitudinal study showed that physical exercise was associated with decreased risk for decline in cognitive function ( odds ratio [ OR ] , 0.58 ) , Alzheimer disease ( OR , 0.50 ) , and any dementia ( OR , 0.63 ) ( 11 ) , whereas another longitudinal study showed no association between physical exercise and dementia ( 16 ) . More recent studies showed that walking was associated with a reduced risk for dementia and Alzheimer disease in a cohort of Japanese-American men ( 20 ) and that engaging in more diverse physical activities was associated with a reduced risk for dementia in the Cardiovascular Health Study ( 21 ) . The purpose of this study was 2-fold : 1 ) to determine whether regular exercise is associated with a reduced risk for incidence of dementia ( in particular , Alzheimer disease ) in a cohort followed biennially over 6 years and 2 ) to examine whether the association of physical exercise with incident dementia is modulated by other potential risk factors , such as depression , cardiovascular and cerebrovascular disease , diabetes , apolipoprotein E 4 allele , cognitive function , physical function , self-rated health , and lifestyle characteristics . Methods Study Sample The Adult Changes in Thought ( ACT ) study is a population -based , longitudinal study of aging and dementia . The ACT study was design ed to determine the incidence of Alzheimer disease , other types of dementia , and cognitive impairment as well as to determine risk factors for these conditions . The details of the ACT study have been described elsewhere ( 22 , 23 ) . Briefly , a r and om sample of 6782 individuals was drawn from Seattle-area members of Group Health Cooperative ( GHC ) , a consumer-governed health maintenance organization . The participants were 65 years of age and older when the study began in 1994 to 1996 . Those who had an existing diagnosis of dementia , were current residents of a nursing home , or were participating in other studies were ineligible ( n= 1360 ) . Of 5422 eligible persons , 2581 participated and 2841 declined participation . Age , sex , and ethnicity of the remaining 2581 participants did not differ significantly from those who were excluded . Nonresponse has been described elsewhere ( 22 ) . Declining to participate was more common among the oldest age group ( > 85 years ) , women , and African-American and minority groups ( 22 ) . Additional details regarding the incident rates of dementia and Alzheimer disease from the ACT study have been published elsewhere and are consistent with rates reported in U.S. and European cohort studies ( 22 ) . The institutional review boards of the University of Washington and Group Health Cooperative approved the ACT study . Participants received the  Cognitive Ability Screening Instrument ( CASI ) ( 24 ) as initial screening for cognitive function and were interviewed with structured question naires to obtain data , including demographic characteristics , medical history , memory and general functioning , and potential epidemiologic risk factors . Persons scoring 86 or higher on the CASI were entered directly into the ACT cohort as being cognitively intact . ( The CASI scores range from 0 to 100 ; a score of 86 corresponds to a Mini-Mental State Examination score of 25 to 26 . ) Persons with a score lower than 86 had additional medical record review and st and ardized clinical and neuropsychological evaluation for dementia . Persons who did not meet established criteria for dementia ( 25 ) were included in the ACT cohort . The current study sample was selected from the 2581 ACT participants to examine the temporal relationship of physical exercise preceding development of dementia . By design , we selected the 1895 persons whose CASI scores were above the 25th percentileCASI scores 91 to 100 . We excluded 686 persons whose CASI scores were in the lowest quartileCASI scores 62 to 90because the lowest quartile group might include persons who had mild cognitive impairment or impending dementia ( 26 ) . We did not collect information about the history of exercise before the participants entered the study . Therefore , in the group with low CASI scores , we could not be certain whether a reported low level of physical exercise preceded the development of dementia or was a consequence of the development of cognitive impairment or dementia . Of 1895 participants selected , 155 withdrew after the baseline visit and did not have a follow-up examination and were thus excluded from the analyses , leaving the analytic sample of 1740 persons . Incident Dementia We conducted biennial examinations to identify cases of incident dementia , when participants were rescreened with the CASI . Those who scored 86 or higher on the CASI remained in the ACT cohort . Scores on the CASI that were less than 86 at follow-up prompted a full st and ardized clinical examination . The results of rescreening by the CASI and by the clinical and neuropsychological examinations were review ed at a consensus diagnosis conference that included at least the examining physician , a neuropsychologist , another study physician , and the study nurse . Persons who did not meet the criteria for dementia were considered as not having dementia and were followed in the ACT cohort ( 22 , 23 ) . Persons who met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition ( DSM-IV ) , criteria ( 25 ) for dementia were considered to have incident dementia . Dementia type was determined by the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer 's Disease and Related Disorders Association ( NINCDS-ADRDA ) criteria ( 27 ) for Alzheimer disease and by the DSM-IV criteria ( 25 ) for other types of dementia . Level of physical activity was not considered at the consensus conference . Physical Exercise Physical exercise was assessed at baseline by asking participants the number of days per week they did each of the following activities for at least 15 minutes at a time during the past year : walking , hiking , bicycling , aerobics or calisthenics , swimming , water aerobics , weight training or stretching , or other exercise . The frequency of exercise was calculated by the times per week that participants engaged in any of these forms of exercise . In this study , persons who exercised at least 3 times a week , above the lowest quartile , were classified as exercising regularly . Baseline Variables as Potential Confounders Numerous factors may influence the relationship between exercise and risk for dementia , including physical functioning , cognitive function , depression , health conditions , and lifestyle characteristics . Physical function was assessed by a performance-based physical function ( PPF ) test ( 23 ) , which consisted of 4 performance tests : 10-foot timed walk , time to st and from a seated position in a chair to a st and ing position 5 times , balance test , and grip strength in the dominant h and . Each test was scored from 0 to 4 points . The final PPF score was the sum of the scores for the 4 performance tests and ranged from 0 to 16 ; higher scores indicated better physical function . Details of the PPF test have been reported elsewhere ( 23 ) . Cognitive function was assessed by using the CASI , which provides quantitative assessment of attention , concentration , orientation , short-term memory , long-term memory , language ability , visual construction , list-generating fluency , abstract ion , and judgment ( 24 ) . At baseline , depression was measured by using the 11-item Center for Epidemiologic Studies Depression ( CES-D ) scale ( 28 ) . The CES-D scores ranged from 0 to 33 , with higher scores Background the prevalence of individuals with cognitive decline is increasing since the number of elderly adults is growing considerably . The literature provides promising results on the beneficial effect of exercise and vitamin supplementation on cognitive function both in cognitively healthy as well as in the demented elderly . Methods / Design the design is a two-by-two factorial r and omised controlled trial . The study population consists of independently living elderly , between 70 and 80 years old , with mild cognitive impairment ( MCI ) . In the RCT the effect of two interventions , a walking program and vitamin supplementation , is examined . The walking program ( WP ) is a group-based program aim ed at improving cardiovascular endurance ; frequency two lessons a week ; lesson duration one hour ; program duration one year . Non-walking groups receive a placebo activity program ( PAP ) ( i.e. low intensive non-aerobic group exercises , like stretching ) with the same frequency , lesson and program duration . Vitamin supplementation consists of a single daily vitamin supplement containing 50 mg B6 , 5 mg folic acid and 0,4 mg B12 for one year . Subjects not receiving vitamin supplements are daily taking an identically looking placebo pill , also for a year . Participants are r and omised to four groups 1 ) WP and vitamin supplements ; 2 ) WP and placebo supplements ; 3 ) PAP and vitamin supplements ; 4 ) PAP and placebo supplements . Primary outcome measures are measures of cognitive function . Secondary outcomes include psychosocial wellbeing , physical activity , cardiovascular endurance and blood vitamin levels . Discussion no large intervention study has been conducted yet on the effect of physical activity and vitamin supplementation in a population -based sample of adults with MCI . The objective of the present article is to describe the design of a r and omised controlled trial examining the effect of a walking program and vitamin B supplementation on the rate of cognitive decline in older adults with MCI OBJECTIVE We aim ed to examine the cross-sectional and prospect i ve relationship between leisure time physical activity , brain MRI abnormalities and cognitive performance in patients with vascular disease . METHODS Within the SMART-MR study , 1.5 T MRI of the brain and neuropsychological examinations were performed at baseline ( n = 1232 ) and after 3.9 ± 0.4 years follow-up ( n = 663 ) . Automatic brain segmentation was used to quantify intracranial ( ICV ) , total brain , ventricular , and white matter lesion ( WML ) volumes . Brain infa rcts were rated visually . Level of physical activity was expressed in metabolic equivalents ( MET ) hours p/week . With linear regression analysis we examined associations of level of physical activity with brain MRI measures and with cognitive performance , adjusted for potential confounders . For the association with brain infa rcts relative risks ( RR ) were calculated with Poisson regression . RESULTS At baseline , an increase in physical activity of one SD ( 39.7 METh/w ) was significantly associated with larger total brain volume ( B = 0.20 % of ICV ; 95 % CI 0.06 ; 0.33 % ) . A trend was found for the association of physical activity with smaller ventricular volume ( B = -0.04 % of ICV ; 95 % CI -0.09 ; 0.02 % ) and with a decreased risk for brain infa rcts ( RR = 0.91 , 95 % CI : 0.82 - 1.02 ) . No association was found with smaller WML volume ( B = -0.02 % of ICV ; 95 % CI -0.07 ; 0.04 % ) . No associations with change in brain structures over time were observed . Also , no associations  between physical activity and cognitive performance or cognitive decline were found . CONCLUSION These data suggest that leisure time physical activity does not have a significant contribution in preventing or slowing down brain abnormalities and cognitive decline in this cohort of middle-aged individuals already burdened with vascular disease BACKGROUND Several studies have suggested that physical activity is positively associated with cognitive function in elderly persons . Evidence about this association has been limited by the cross-sectional design of most studies and by the frequent lack of adjustment for potential confounding variables . We determined whether physical activity is associated with cognitive decline in a prospect i ve study of older women . METHODS We studied 5925 predominantly white community-dwelling women ( aged > or = 65 years ) who were recruited at 4 clinical centers and were without baseline cognitive impairment or physical limitations . We measured cognitive performance using a modified  Mini-Mental State Examination  at baseline and 6 to 8 years later .  Physical activity  was measured by self-reported blocks ( 1 block approximately 160 m ) walked per week and by total kilocalories ( energy ) expended per week in recreation , blocks walked , and stairs climbed . Cognitive decline was defined as a 3-point decline or greater on repeated modified Mini-Mental State Examination . RESULTS Women with a greater physical activity level at baseline were less likely to experience cognitive decline during the 6 to 8 years of follow-up : cognitive decline occurred in 17 % , 18 % , 22 % , and 24 % of those in the highest , third , second , and lowest quartile of blocks walked per week ( P < .001 for trend ) . Almost identical results were obtained by quartile of total kilocalories expended per week . After adjustment for age , educational level , comorbid conditions , smoking status , estrogen use , and functional limitation , women in the highest quartile remained less likely than women in the lowest quartile to develop cognitive decline ( for blocks walked : odds ratio , 0.66 [ 95 % confidence interval , 0.54 - 0.82 ] ; for total kilocalories : odds ratio , 0.74 [ 95 % confidence interval , 0.60 - 0.90 ] ) . CONCLUSIONS Women with higher levels of baseline physical activity were less likely to develop cognitive decline . This association was not explained by differences in baseline function or health status . This finding supports the hypothesis that physical activity prevents cognitive decline in older community-dwelling women BACKGROUND Little information has been published on the impact of antihypertensive medications on quality of life in older persons . Particular concern has existed that lowering systolic blood pressure in older persons might have adverse consequences on cognition , mood , or leisure activities . METHODS A multicenter double-blind r and omized controlled trial was conducted over an average of 5 years ' followup involving 16 academic clinical trial clinics . Participants consisted of 4736 persons ( 1.06 % ) selected from 447,921 screenees aged 60 years and older . Systolic blood pressure at baseline ranged from 160 to 219 mm Hg , while diastolic blood pressure was less than 90 mm Hg . Participants were r and omized to active antihypertensive drug therapy  or matching placebo . Active treatment consisted of 12.5 to 25 mg of chlorthalidone for step 1 , while step 2 consisted of 25 to 50 mg of atenolol . If atenolol was contraindicated , 0.05 to 0.10 mg of reserpine could be used for the second-step drug . The impact of drug treatment on measures of cognitive , emotional , and physical function and leisure activities was assessed . RESULTS Our analyses demonstrate that active treatment of isolated systolic hypertension in the Systolic Hypertension in the Elderly Program cohort had no measured negative effects and , for some measures , a slight positive effect on cognitive , physical , and leisure function . The positive findings in favor of the treatment group were small . There was no effect on measures related to emotional state . Measures of cognitive and emotional function were stable in both groups for the duration of the study . Both treatment groups showed a modest trend toward deterioration of some measures of physical and leisure function over the study period . CONCLUSIONS The overall study cohort exhibited decline over time in activities of daily living , particularly the more strenuous ones , and some decline in certain leisure activities . However , mood , cognitive function , basic self-care , and moderate leisure activity were remarkably stable for both the active and the placebo groups throughout the entire study . Results of this study support the inference that medical treatment of isolated systolic hypertension does not cause deterioration in measures of cognition , emotional state , physical function , or leisure activities Background In the ProActive Trial an intensive theory-based intervention program was no more effective than theory-based brief advice in increasing objective ly measured physical activity among adults at risk of Type 2 diabetes . We aim ed to illuminate these findings by assessing whether the intervention program changed cognitions about increasing activity , defined by the Theory of Planned Behaviour , in ways consistent with the theory . Methods N = 365 sedentary participants aged 30–50 years with a parental history of Type 2 diabetes were r and omised to brief advice alone or to brief advice plus the intervention program delivered face-to-face or by telephone . Question naires at baseline , 6 and 12 months assessed cognitions about becoming more physically active . Analysis of covariance was used to test intervention impact . Bootstrapping was used to test multiple mediation of intervention impact . Results At 6 months , combined intervention groups ( face-to-face and telephone ) reported that they found increasing activity more enjoyable ( affective attitude , d = .25 ) , and they perceived more instrumental benefits ( e.g. , improving health ) ( d = .23 ) and more control ( d = .32 ) over increasing activity than participants receiving brief advice alone . Stronger intentions ( d = .50 ) in the intervention groups than the brief advice group at 6 months were partially explained by affective attitude and perceived control . At 12 months , intervention groups perceived more positive instrumental ( d = .21 ) and affective benefits ( d = .29 ) than brief advice participants . The intervention did not change perceived social pressure to increase activity . Conclusion Lack of effect of the intervention program on physical activity over and above brief advice was consistent with limited and mostly small short-term effects on cognitions . Targeting affective benefits ( e.g. , enjoyment , social interaction ) and addressing barriers to physical activity may strengthen intentions , but stronger intentions did not result in more behaviour change . More powerful interventions which induce large changes in TPB cognitions may be needed . Other interventions deserving further evaluation include theory-based brief advice , intensive measurement of physical and psychological factors , and monitoring of physical activity . Future research should consider a wider range of mediators of physical activity change , assess participants ' use of self-regulatory strategies taught in the intervention , and conduct experimental studies or statistical modelling prior to trial evaluation . IS RCT N61323766 ` ` Vascular cognitive impairment ' ' refers to cognitive impairment caused or associated with vascular risk factors , and encompasses a cognitive spectrum ranging from mild cognitive impairment to dementia . We examined the association of leisure activity participation to risk of developing VCI in the Bronx aging study . Over 21 years , 71 of the 401 participants who were free of dementia or VCI at entry developed VCI ( 49 participants with VCI without dementia ) . We derived  Cognitive and Physical Activity Scales  based on frequency of leisure activity participation . A 1-point increase on the Cognitive , but not Physical Activity Scale , was associated with lower risk of VCI ( hazard ratio 0.931 , 95 % confidence interval [ CI ] 0.895 - 0.970 ) in Cox analysis .  Participation in cognitive but not physical leisure activities  is associated with lower risk of VCI with or without dementia . Prospect i ve studies and clinical trials are needed to define the causal role of  cognitive leisure activities in influencing vascular risk for cognitive decline Purpose of review This review highlights recent work evaluating the relationship between exercise , physical activity and physical and mental health . Both cross-sectional and longitudinal studies , as well as r and omized clinical trials , are included . Special attention is given to physical conditions , including obesity , cancer , cardiovascular disease and sexual dysfunction . Furthermore , studies relating physical activity to depression and other mood states are review ed . The studies include diverse ethnic population s , including men and women , as well as several age groups ( e.g. adolescents , middle-aged and older adults ) . Recent findings Results of the studies continue to support a growing literature suggesting that exercise , physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes . Generally , participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions . Similarly , participants in r and omized clinical trials of physical-activity interventions show better health outcomes , including better general and health-related quality of life , better functional capacity and better mood states . Summary The studies have several implication s for clinical practice and research . Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes . Therefore , assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several population s. Several limitations were noted , particularly in research involving r and omized clinical trials . These trials tend to involve limited sample sizes with short follow-up periods , thus limiting the clinical implication s of the benefits associated with physical activity . Abbreviations CAD : coronary artery disease ; COPD : chronic obstructive pulmonary disease ; CRP : cardiac rehabilitation program ; CVD : cardiovascular disease ; GMCB : group-mediated cognitive – behavioural ; HRQOL : health-related quality of life ISSUE ADDRESSED To assess the adherence and acceptability of a physical activity program delivered as an adjunct to the usual cognitive behavioural group therapy ( CBGT ) for adults with anxiety disorders . METHODS Seventy-three participants with either a generalised anxiety disorder , social phobia or panic disorder were r and omised to either exercise-enhanced CBGT ( CBGT+EX ) or the usual CBGT plus nutrition education ( CBGT+ED ) group .  Physical activity , stress , anxiety , depression were assessed at baseline ; session attendance , compliance and satisfaction were assessed during the eight-week intervention . RESULTS Forty-five per cent of participants achieved the recommended levels of physical activity for health at baseline . The proportions of participants attending group meetings declined over time across both groups . In the intervention groups ( CBGT+EX ) , a slightly higher proportion of participants attended the CBGT session than the physical activity sessions . Individuals with social phobia were significantly more likely than those with panic or generalised anxiety disorder to adhere to the physical activity program . Among the remaining adherers , most reported satisfaction with their skills development and better underst and ing of the benefits of physical activity . CONCLUSIONS Time constraints and participants viewing physical activities as irrelevant or detracting them from their psychological treatment are potential factors contributing to low adherence and present as challenges in implementing a physical activity program as adjunctive to psychological treatment . Process evaluation data helped profile participants who adhered or not adhered to the physical activity program and will inform future physical activity promotion to individuals with anxiety disorders Background / Aims : There is no consensus regarding the optimal nonpharmacological intervention to slow down dementia-related decline . We examined whether physical stimulation interventions were effective in reducing cognitive , physical , mood , and behavioral decline in nursing home residents with dementia . Methods : Eighty-seven nursing home residents with dementia were r and omly assigned to 3 physical activity interventions : activities of daily living ( ADL ) training , multicomponent exercise training , or combined multicomponent exercise and ADL training . Outcomes were measured at baseline , and after 3 and 6 months . Results : A 6-month ADL training benefitted executive functions , physical endurance , and depression among men . Exercise training benefitted only grip strength of participants with mild-to-moderate cognitive impairment . A combined training benefitted functional mobility compared to ADL training , depressive symptoms and agitation compared to exercise training , and physical endurance compared to no physical stimulation . Conclusions : ADL training appears to be effective for nursing home residents with moderately severe dementia . It remains unclear whether exercise training is an effective type of stimulation BACKGROUND Participation in leisure activities has been associated with a lower risk of dementia .  It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the pre clinical phase of dementia . METHODS We examined the relation between leisure activities and the risk of dementia in a prospect i ve cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line . We examined the frequency of participation in leisure activities at enrollment and derived  cognitive-activity and physical-activity scales in which the units of measure were activity-days per week . Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities , with adjustment for age , sex , educational level , presence or absence of chronic medical illnesses , and base-line cognitive status . RESULTS Over a median follow-up period of 5.1 years ,  dementia  developed in 124 subjects ( Alzheimer 's disease in 61 subjects , vascular dementia in 30 , mixed dementia in 25 , and other types of dementia in 8) . Among leisure activities , reading , playing board games , playing musical instruments , and dancing were associated with a reduced risk of dementia . A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia ( hazard ratio , 0.93 [ 95 percent confidence interval , 0.90 to 0.97 ] ) , but a one-point increment in the physical-activity score was not ( hazard ratio , 1.00 ) . The association with the cognitive-activity score persisted after the exclusion of the subjects with possible pre clinical dementia at base line . Results were similar for Alzheimer 's disease and vascular dementia . In linear mixed models , increased participation in cognitive activities at base line was associated with reduced rates of decline in memory . CONCLUSIONS Participation in leisure activities is associated with a reduced risk of dementia , even after adjustment for base-line cognitive status and after the exclusion of subjects with possible pre clinical dementia . Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia Abstract Background Few school-based interventions have been successful in reducing physical activity decline and preventing overweight and obesity in adolescent population s. As a result , few cost effectiveness analyses have been reported . The aim of this paper is to report the cost and cost effectiveness of the Physical Activity 4 Everyone ( PA4E1 ) intervention which was a multi-component intervention implemented in secondary schools located in low-income communities .  Cost effectiveness was assessed using both the physical activity and weight status trial outcomes . Methods Intervention and Study Design : The PA4E1 cluster r and omised controlled trial was implemented in 10 Australian secondary schools ( 5 intervention : 5 control ) and consisted of intervention schools receiving seven physical activity promotion strategies and six additional strategies that supported school implementation of the intervention components . Costs associated with physical activity strategies , and intervention implementation strategies within the five intervention schools were estimated and compared to the costs of usual physical activity practice s of schools in the control group . The total cost of implementing the intervention was estimated from a societal perspective , based on the number of enrolled students in the target grade at the start of the intervention ( Grade 7 , n = 837 ) . Economic Outcomes : The economic analysis outcomes were cost and incremental cost effectiveness ratios for the following : minutes of moderate-to-vigorous physical activity ( MVPA ) per day gained , MET hours gained per person/day ; Body Mass Index ( BMI ) unit avoided ; and 10 % reduction in BMI z-score . Results The intervention cost AUD $ 329,952 over 24 months , or AUD$394 per student in the intervention group . This result ed in a cost effectiveness ratio of AUD$56 ( $ 35–$147 ) per additional minute of MVPA , AUD$1 ( $ 0.6–$2.7 ) per MET hour gained per person per day , AUD$1408 ( $ 788–$6,570 ) per BMI unit avoided , and AUD$563 ( $ 282–$3,942 ) per 10 % reduction in BMI z-score . Conclusion PA4E1 is a cost effective intervention for increasing the physical activity levels and reducing unhealthy weight gain in adolescence , a period in which physical activity typically declines . Additional modelling could explore the potential economic impact of the intervention on morbidity and mortality . Trial registration Australian New Zeal and Clinical Trials Registry ACTRN12612000382875 The study objective was to evaluate the feasibility of a telephone delivered intervention consisting of motivational interviewing and cognitive behavioural strategies aim ed at improving diet and physical activity in people diagnosed with psychotic disorders . Twenty participants diagnosed with a non-acute psychotic disorder were recruited . The intervention consisted of eight telephone delivered sessions targeting fruit and vegetable ( F&V ) consumption and leisure screen time , as well as smoking and alcohol use ( as appropriate ) . F&V frequency and variety , and overall diet quality ( measured by the Australian Recommended Food Score , ARFS ) , leisure screen time , overall sitting and walking time , smoking , alcohol consumption , mood , quality of life , and global functioning were examined before and 4-weeks post-treatment . Nineteen participants ( 95 % ) completed all intervention sessions , and 17 ( 85 % ) completed follow-up assessment s. Significant increases from baseline to post-treatment were seen in ARFS fruit , vegetable and overall diet quality scores , quality of life and global functioning . Significant reductions in leisure screen time and overall sitting time were also seen . Results indicated that a telephone delivered intervention targeting key cardiovascular disease risk behaviours appears to be feasible and relatively effective in the short-term for people diagnosed with psychosis . A r and omized controlled trial is warranted to replicate and extend these findings Background Attempts to demonstrate the efficacy of interventions aim ed at increasing  physical activity ( PA )  have been mixed . Further , studies are seldom design ed in a manner that facilitates the underst and ing of how or why a treatment is effective or ineffective and PA intervention design s should be guided by a heavier reliance upon behavioral theory . The use of a mediating variable framework offers a systematic method ological approach to testing the role of theory , and could also identify the effectiveness of specific intervention components . The primary purpose of this paper was to test the mediating role that cognitive constructs may have played in regards to the positive effect that a workplace behavioral intervention had on leisure-time PA for women . A subsidiary purpose was to examine the cross-sectional relationships of these cognitive constructs with PA behavior . Methods The Physical Activity Workplace Study was a r and omized controlled trial which compared the effects of stage-matched and st and ard print material s upon self-reported leisure-time PA , within a workplace sample at 6 and 12-months . In this secondary analysis we examined the mediation effects of 14 psychosocial constructs across 3 major social-cognitive theories which were operationalized for the intervention material s and measured at baseline , 6 and 12-months . We examined change in PA and change in the psychological constructs employing a mediation strategy proposed by Baron and Kenny for : ( 1 ) the first 6-months ( i.e. , initial change ) , ( 2 ) the second 6-months ( i.e. , delayed change ) , and ( 3 ) the entire 12-months ( overall change ) of the study on 323 women ( n = 213 control/st and ard material s group ; n = 110 stage-matched material s group ) . Results Of the 14 constructs and 42 tests ( including initial , delayed and overall change ) two positive results were identified ( i.e. , overall change in pros , initial change in experiential powerful intervention approaches processes ) , with very small effect sizes . However , these mediating results were eliminated after adjusting for the multiple statistical tests . Conclusions The intervention did not change these mediators in any substantive way , and show a similar pattern to prior research where interventions generally do not result in a change in mediation of behavior change . It is important to report mediation results in r and omized controlled trials whether the findings are null or positive . Future studies may wish to focus on more detailed dose-response issues between mediators and behavior , the inclusion of moderators that could affect individual change , or different mediator constructs at higher levels of measurement specificity . Continued work on innovative and more powerful PA intervention approaches are needed Despite advances in behavioral and pharmacological treatment for tobacco use and dependence , quit rates remain suboptimal . Increasing physical activity has shown some promise as a strategy for improving cessation outcomes . However , initial efficacy studies focused on intensive , highly structured exercise programs that may not be applicable to the general population of smokers . We describe the rationale and study design and report baseline participant characteristics from the Lifestyle Enhancement Program ( LEAP ) , a two-group , r and omized controlled trial . Adult smokers who engaged in low levels of leisure time physical activity were r and omly assigned to treatment conditions consisting of an individualized physical activity intervention delivered by health fitness instructors in community-based exercise facilities or an equal contact wellness control . All participants received st and ard cognitive behavioral smoking cessation counseling combined with nicotine replacement therapy . The primary outcomes are seven-day point prevalence abstinence at seven weeks , six- and 12 months . Secondary outcomes include self-reported physical activity , dietary intake , body mass index , waist circumference , percent body fat , and nicotine withdrawal symptoms .  Participants consist of 392 sedentary smokers ( mean [ st and ard deviation ] age = 44.6 [ 10.2 ] = years ; 62 % female ; 31 % African American ) . Results reported here provide information regarding experiences recruiting smokers willing to change multiple health behaviors including smoking and physical activity BACKGROUND Physical activity may help maintain cognitive function and decrease dementia risk , but epidemiological findings remain controversial . The aim of our study was to investigate the association between leisure-time physical activity at midlife and the subsequent development of dementia and Alzheimer 's disease ( AD ) . METHODS Participants were r and omly selected from the survivors of a population -based cohort previously surveyed in 1972 , 1977 , 1982 , or 1987 . 1449 persons ( 72.5 % ) age 65 - 79 years participated in the re-examination in 1998 ( mean follow-up , 21 years ) . 117 persons had dementia and 76 had AD .  Multiple logistic regression methods were used to analyse the association between leisure-time physical activity and dementia or AD . FINDINGS Leisure-time physical activity at midlife at least twice a week was associated with a reduced risk of dementia and AD ( odds ratio [ OR ] 0.48 [ 95 % CI 0.25 - 0.91 ] and 0.38 [ 0.17 - 0.85 ] , respectively ) , even after adjustments for age , sex , education , follow-up time , locomotor disorders , APOE genotype , vascular disorders , smoking , and alcohol drinking . The associations were more pronounced among the APOE epsilon4 carriers . INTERPRETATION Leisure-time physical activity at midlife is associated with a decreased risk of dementia and AD later in life . Regular physical activity may reduce the risk or delay the onset of dementia and AD , especially among genetically susceptible individuals Introduction Physical exercise after stroke is essential for improving recovery and general health , and reducing future stroke risk . However , people with stroke are not sufficiently active on return to the community after rehabilitation . We developed the Promoting Optimal Physical Exercise for Life ( PROPEL ) programme , which combines exercise with self-management strategies within rehabilitation to promote ongoing physical activity in the community after rehabilitation . This study aims to evaluate the effect of PROPEL on long-term participation in  exercise  after discharge from stroke rehabilitation . We hypothesise that individuals who complete PROPEL will be more likely to meet recommended frequency , duration and intensity of exercise compared with individuals who do not complete the programme up to 6 months post discharge from stroke rehabilitation . Methods and analysis Individuals undergoing outpatient stroke rehabilitation at one of six hospitals will be recruited ( target n=192 total ) . A stepped-wedge design will be employed ; that is , the PROPEL intervention ( group exercise plus self-management ) will be ‘ rolled out ’ to each site at a r and om time within the study period . Prior to roll-out of the PROPEL intervention , sites will complete the control intervention ( group aerobic exercise only ) . Participation in physical activity for 6 months post discharge will be measured via activity and heart rate monitors , and st and ardised physical activity question naire . Adherence to exercise guidelines will be evaluated by ( 1 ) number of ‘ active minutes ’ per week ( from the activity monitor ) , ( 2 ) amount of time per week when heart rate is within a target range ( ie , 55%–80 % of age-predicted maximum ) and ( 3 ) amount of time per week completing ‘ moderate ’ or ‘ strenuous ’ physical activities ( from the question naire ) . We will compare the proportion of active and inactive individuals at 6 months post intervention using mixed-model logistic regression , with fixed effects of time and phase and r and om effect of cluster ( site ) . Ethics and dissemination To date , research ethics approval has been received from five of the six sites , with conditional approval granted by the sixth site . Results will be disseminated directly to study participants at the end of the trial , and to other stake holders via publication in a peer- review ed journal . Trial registration number NCT02951338 ; Pre- results BACKGROUND Leisure-time physical activity has been related with a reduced risk of  dementia and Alzheimer 's disease ( AD ) . The effects of occupational and commuting physical activity ( physical activity at work and on the way to work ) on cognitive health are still unclear . This study aim ed to clarify the association between work-related physical activity and dementia/AD . METHODS Participants of the Cardiovascular Risk Factors , Aging , and Dementia ( CAIDE ) study were derived from r and om , population -based sample s previously studied in a survey carried out in 1972 , 1977 , 1982 , or 1987 . After an average follow-up of 21 years , 1449 individuals ( 73 % ) aged 65 to 79 years participated in the re-examination in 1998 . RESULTS Neither occupational [ Odds Ratio ( OR ) 1.45 ; 95 % Confidence Intervals ( CI ) 0.66 - 3.17 ] nor  commuting physical activity  ( OR 0.46 ; 95 % CI 0.10 - 2.17 ) were associated with the risk of dementia or AD after adjustments for age , sex , education , follow-up time , locomotor symptoms , main occupation during life , income at midlife , leisure-time physical activity , other subtype of work-related physical activity , ApoE genotype , vascular disorders and the smoking status . There were also no interactions between work-related physical activity and the ApoE epsilon4 genotype , leisure-time physical activity or sex . CONCLUSIONS In this study , work-related physical activity was not found to be sufficient to protect against dementia and AD later in life . The lack of effect might be partly due to a residual confounding . Nevertheless , physical activity during leisure-time may be beneficial even for people who are physically active at work or when commuting Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors . Despite an explosion of mobile phone applications aim ed at physical activity and other health behaviors , few have been based on theoretically derived constructs and empirical evidence . Eighty adults ages 45 years and older who were insufficiently physically active , engaged in prolonged daily sitting , and were new to smartphone technology , participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence . An “ analytically ” framed custom application focused on personalized goal setting , self-monitoring , and active problem solving around barriers to behavior change . A “ socially ” framed custom application focused on social comparisons , norms , and support . An “ affectively ” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar , whose movements and behaviors reflected the physical activity and sedentary levels of the user . To explore the applications ' initial efficacy in changing regular physical activity and leisure-time sitting , behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity question naire and the Australian sedentary behavior question naire . User acceptability of and satisfaction with the applications was explored via a post-intervention user survey . The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period . Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology . Preliminary data exploring sustained use of the applications across a longer time period yielded promising results . The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors Introduction . Physical activity is important for health and well-being ; however , rates of postnatal physical activity can be low . This paper reports the secondary outcomes of a trial aim ed at increasing physical activity among postnatal women . Methods . More Active MuMs in Stirling ( MAMMiS ) was a r and omised controlled trial testing the effect of physical activity consultation and pram walking group intervention among inactive postnatal women . Data were collected on postnatal weight , body composition , general well-being , and fatigue . Participants were also interviewed regarding motivations and perceived benefits of participating in the trial . Results . There was no significant effect of the intervention on any weight/body composition outcome or on general well-being at three or six months of follow-up . There was a significant but inconsistent difference in fatigue between groups . Qualitative data highlighted a number of perceived benefits to weight , body composition , and particularly well-being ( including improved fatigue ) which were not borne out by objective data . Discussion . The MAMMiS study found no impact of the physical activity intervention on body composition and psychological well-being and indicates that further research is required to identify successful approaches to increase physical activity and improve health and well-being among postnatal women Background Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior . A secondary benefit of these devices is the opportunity for investigators to objective ly track adherence to physical activity goals across weeks or even months , rather than relying on self-report or a small number of accelerometry wear periods . The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research , but few studies have been published in this rapidly developing area . Objective The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention , as measured by the Fitbit tracker . Methods Participants were 25 overweight or obese , postmenopausal women enrolled in the intervention arm of a r and omized controlled physical activity intervention trial . Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website . The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity ( MVPA ) and 10,000 steps/day ; however , goals were set individually for each participant and up date d at Week 4 based on progress . Adherence data were collected by the Fitbit and aggregated by Fitabase . Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16 . Results The median participant logged 10 hours or more/day of Fitbit  wear on 95 % of the 112 intervention days , with no significant decline in wear over the study period . Participants averaged 7540 ( SD 2373 ) steps/day and 82 minutes/week ( SD 43 ) of accumulated “ fairly active ” and “ very active ” minutes during the intervention . At Week 4 , 80 % ( 20/25 ) of women chose to maintain/increase their individual MVPA goal and 72 % ( 18/25 ) of participants chose to maintain/increase their step goal . Physical activity levels were relatively stable after peaking at 3 weeks , with only small declines of 8 % for steps ( P=.06 ) and 14 % for MVPA ( P=.05 ) by 16 weeks . Conclusions These data indicate that a sophisticated , direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks . Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention . Trial Registration Clinical trials.gov NCT01837147 ; http:// clinical trials.gov/ct2/show/NCT01837147 ( Archived by WebCite at http://www.webcitation.org/6d0VeQpvB The objective of this paper is to summarize current knowledge on the possible advantages of lifestyle interventions , with particular attention to physical fitness , cognitive activity , leisure and social activity as well as nutrition . There is a large amount of published papers providing partial evidence and asserting the need for immediate , appropriate preventive lifestyle measures against dementia and AD development . Nevertheless , there are currently great difficulties in drafting effective guidelines in this field . This depends mainly upon lack of r and omized controlled trials assessing benefits versus risks of particular lifestyle interventions strategies . However , due to the rapid increase of dementia burden , lifestyle factors and their amelioration should be already made part of decision making in light of their health-maintaining effects while awaiting for results of well- design ed large prospect i ve cohort studies in dementia PACE ( Physician-based Assessment and Counseling for Exercise ) is an individualized theory-based minimal intervention strategy aim ed at the enhancement of regular physical activity . The aim of this study was to evaluate the effectiveness of a PACE intervention applied by general practitioners ( GPs ) on potential determinants of physical activity . A r and omized controlled trial was conducted in 29 general practice s with the following inclusion criteria for patients : aged between 18 and 70 years , diagnosed with hypertension , hypercholesterolemia and /or non-insulin-dependent diabetes mellitus , and not in maintenance stage for regular physical activity . The intervention consisted of two visits with the GP and two telephone booster calls by a physical activity counselor . Determinants of physical activity were assessed with question naires at baseline , and at 8-week ( short ) , 6-month ( medium ) and 1-year ( long ) follow-up . A significant positive effect was observed on self-efficacy , and on the use of cognitive and behavioral processes of change , at both short- and medium-term follow-up . The intervention respondents also perceived fewer barriers for regular physical activity at short-term and used behavioral processes of change more at long-term follow-up . No intervention effect was observed for perceived benefits of physical activity . In conclusion , this GP-based PACE intervention result ed in positive changes in potential determinants of physical activity OBJECTIVE To assess the cost-effectiveness of a primary care based intervention aim ed at increasing levels of physical activity in inactive people aged 45 - 74 . METHODS A total of 714 inactive people aged 45 - 74 , taken from two west London general practice s , were r and omised into two groups . Intervention subjects were invited to a consultation with an exercise development officer , and offered a personalised 10 week programme to increase their level of regular physical activity , combining leisure centre and home based activities . Control subjects were sent information on local leisure centres . All subjects were followed up at eight months . RESULTS There was a net 10.6 % ( 95 % confidence interval 4.5 to 16.9 % ) reduction in the proportion of people classified as sedentary in the intervention group compared with the control group , eight months after the intervention . The intervention group also reported an increase in the mean number of episodes of physical activity per week , as compared with the control group ( an additional 1.52 episodes ( 95 % confidence interval 1.14 to 1.95 ) ) . The cost of moving a person out of the sedentary group was shown to be less than 650 Pounds . The cost of moving someone to the now commonly recommended level was estimated at almost 2500 Pounds . CONCLUSIONS Moderate physical activity can be successfully encouraged in previously sedentary men and women aged 45 - 74 through a primary care based intervention . The process of recruitment was the most important variable cost . A high uptake rate would maximise cost-effectiveness , and sensitivity analysis suggests that unit costs could be halved with a more effective recruitment strategy Background The extent to which mental and physical exercise may slow cognitive decline in adults with early signs of cognitive impairment is unknown . This article provides the rationale and methodology of the first trial to investigate the isolated and combined effects of cognitive training ( CT ) and progressive resistance training ( PRT ) on general cognitive function and functional independence in older adults with early cognitive impairment : Study of Mental and Regular Training ( SMART ) . Our secondary aim is to quantify the differential adaptations to these interventions in terms of brain morphology and function , cardiovascular and metabolic function , exercise capacity , psychological state and body composition , to identify the potential mechanisms of benefit and broader health status effects . Methods SMART is a double-blind r and omized , double sham-controlled trial . One hundred and thirty-two community-dwelling volunteers will be recruited . Primary inclusion criteria are : at risk for cognitive decline as defined by neuropsychology assessment , low physical activity levels , stable disease , and age over 55 years . The two active interventions are computerized CT and whole body , high intensity PRT . The two sham interventions are educational videos and seated calisthenics . Participants are r and omized into 1 of 4 supervised training groups ( 2 d/wk × 6 mo ) in a fully factorial design . Primary outcomes measured at baseline , 6 , and 18 months are the Alzheimer 's Disease Assessment Scale ( ADAS-Cog ) , neuropsychological test scores , and Bayer Informant Instrumental Activities of Daily Living ( B-IADLs ) . Secondary outcomes are psychological well-being , quality of life , cardiovascular and musculoskeletal function , body composition , insulin resistance , systemic inflammation and anabolic/neurotrophic hormones , and brain morphology and function via Magnetic Resonance Imaging ( MRI ) and Spectroscopy ( fMRS ) . Discussion SMART will provide a novel evaluation of the immediate and long term benefits of CT , PRT , and combined CT and PRT on global cognitive function and brain morphology , as well as potential underlying mechanisms of adaptation in older adults at risk of further cognitive decline . Trial Registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) : BACKGROUND Several reports suggest beneficial impacts of either physical or mental activity on cognitive function  in old age . However , the differential effects of complex mental and physical activities on cognitive performance in humans remain to be clarified . METHODS This r and omized controlled trial evaluates a cognitive and a physical st and ardized 6-month activity intervention ( 3 x 1.5 h/wk ) conducted in Berlin ( Germany ) . Two hundred fifty nine healthy women aged 70 - 93 years were r and omized to a computer course ( n = 92 ) , an exercise course ( n = 91 ) , or a control group ( n = 76 ) , of whom 230 completed the 6-month assessment . Group differences in change over a period of 6 months in episodic memory ( story recall , possible range , 0 - 21 ; word recall , possible range , 0 - 16 ) , executive control ( working memory , ie , time quotient of Trail Making Tests B/A ) , and verbal fluency were evaluated by analyses of covariance ( intention to treat ) adjusting for baseline , fluid intelligence , and educational level . RESULTS In contrast to the control group , both the exercise group , DeltaM ( SD ) = 2.09 ( 2.66 ) , p < .001 , and the computer group , DeltaM ( SD ) = 1.89 ( 2.88 ) , p < .001 , showed improved delayed story recall . They maintained performance in delayed word recall and working memory ( time measure ) as opposed to the control group that showed a decline , DeltaM ( SD ) = -0.91 ( 2.15 ) , p = .001 , and DeltaM ( SD ) = 0.24 ( 0.68 ) , p = .04 , respectively . CONCLUSIONS In healthy older women , participation in new stimulating activities contributes to cognitive fitness and might delay cognitive decline .  Exercise and computer classes seem to generate equivalent beneficial effects Objective : Studies examining the link between objective measures of total daily physical activity and incident Alzheimer disease ( AD ) are lacking . We tested the hypothesis that an objective measure of total daily physical activity predicts incident AD and cognitive decline . Methods : Total daily exercise and nonexercise physical activity was measured continuously for up to 10 days with actigraphy ( Actical ® ; Philips Healthcare , Bend , OR ) from 716 older individuals without dementia participating in the Rush Memory and Aging Project , a prospect i ve , observational cohort study . All participants underwent structured annual clinical examination including a battery of 19 cognitive tests . Results : During an average follow-up of about 4 years , 71 subjects developed clinical AD . In a Cox proportional hazards model adjusting for age , sex , and education , total daily physical activity was associated with incident AD ( hazard ratio = 0.477 ; 95 % confidence interval 0.273–0.832 ) . The association remained after adjusting for self-report physical , social , and cognitive activities , as well as current level of motor function , depressive symptoms , chronic health conditions , and APOE allele status . In a linear mixed-effect model , the  level of total daily physical activity  was associated with the rate of global cognitive decline ( estimate 0.033 , SE 0.012 , p = 0.007 ) . Conclusions : A higher level of total daily physical activity  is associated with a reduced risk of AD
In this review we found that exercise interventions ( or lifestyle activities ) that improved cardiorespiratory exercise capacity showed the most positive impact on physical health .
CONCLUSIONS Findings suggest that programs should facilitate and support women to participate in regular exercise by embedding physical activity programs in public health initiatives , by developing home-based exercise programs that require few re sources and by creating interventions that can incorporate physical activity within a healthy lifestyle .
The review also suggests that clinicians should consider prescribing exercise in a tailored manner for older women to ensure that it is of a high enough intensity to obtain the positive sustained effects of exercise
BACKGROUND Participation in regular physical activity is among the most promising and cost effective strategies to reduce physical and cognitive decline and premature death .
However , confusion remains about the amount , frequency , and duration of physical activity that is likely to provide maximum benefit as well as the way in which interventions should be delivered .
AIMS This paper aim ed to review research on the impact of leisure-time and general physical activity levels on physical and cognitive decline in postmenopausal women .