Discussion
cognitive impairment
This study provides preliminary evidence that a simple homebased, twice daily exercise snacking programme appears to be acceptable to pre-frail older adult memory clinic attendees. Qualitative data from 15 of the 18 completers suggested that the simplicity of the exercises, and the short, simple to do nature of exercise snacking is a useful feature of this programme, with many non-exercising participants seeing value of continued practice of these exercises. Participants generally found the exercise snacking programme easy to implement, not burdensome, and worthwhile, and for participants who returned follow-up data we observed potential improvements in basic tests of physical function and single leg balance.Together, these findings offer encouragement for the utility of exercise snacking as an intervention for inactive, older adult, memory clinic attendees, with a large effect size for improvement in the SPPB (Self-reported adherence to the exercise snacking intervention was higher than in other exercise studies in people with cognitive impairment (80% of all participants who completed follow up assessment in the present study compared to typical adherence rates around 70%) [Based on our data, exercise snacking may be of particular benefit for those who express common barriers to engagement with more comprehensive exercise provision or formats (such as group-based classes and intensive instructor led interventions), and certainly act as a gateway programme to improve baseline strength and balance and self-efficacy for regular exercise. The process outcomes displayed in Table The results indicate several aspects of the protocol and intervention that warrant further consideration prior to full scale testing to improve acceptability, such as the need to develop adaptations of the snacking exercises to make them easier or more challenging as required, or making the logging and performance of exercise snacks simpler and more habitual (Table Consistent with the other evaluations of exercise snacking in general non-patient populations [There are also several limitations with the study design that warrant consideration. It should be emphasised that the single-group design and lack of a non-exercise control group means that we cannot conclusively state the observed improvements in physical function were a product of the exercise snacking intervention. Whilst the SPPB and TUG are well established with reported reference ranges, the 60-second strength and balance tests used in the present study lack data on their validity and reliability. Furthermore, the present study lacks mechanistic data to explain what physiological adaptations might have contributed to a change in function, for example improved maximum force or power generating capacity [Considering the findings of this study in light of these limitations, we conclude that the utilisation of a simple exercise snacking intervention could be an acceptable and beneficial way to improve the physical function of pre-frail memory clinic patients and warrants further evaluation to establish the efficacy of this approach. Whilst our data demonstrate an encouraging pattern of overall improvement in functional tests, this is not a robust study design to demonstrate efficacy of the intervention and further research employing a randomised controlled trial study design is required. Nonetheless, these initial findings suggest the exercise snacking format is acceptable, low burden, and engaging in this target population.