Inpatient cardiac rehabilitation and changes in self-reported health related quality of life – a pilot study

ObjectiveTo assess changes in self-reported health related quality of life (HRQoL) among cardiac patients who participated in an inpatient rehabilitation programme.Patients and methodsMedical Outcomes Study Short Form 36 (SF-36) and the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) was used to assess HRQoL at baseline (T1), after rehabilitation (T2) and 5 months after discharge (T3). The rehabilitation programme consisted of physical exercise, theoretical education, group discussions and individual consultations. Friedman's test with Wilcoxon post-hoc test was used to analyse changes between T1, T2 and T3. Effect size (ES) were calculated.ResultsEighty-nine participants were included (79% male) with mean age of 60.0 ± 8.6 years. All SF-36 and MacNew domains showed significant improvement from T1 to T2 (P < 0.05), and all except the SF-36 domain for emotional role with a moderate to large ES. At T3, change and ES are diminished in all domains, except for the physical and social domains of the MacNew.ConclusionThese findings indicate an improvement in HRQoL over time among cardiac patients attending the rehabilitation programme, particularly so in the domains of physical role and physical function, vitality, bodily pain and emotional-, physical- and social-well-being, all which are important domains for maintaining an active life. Future randomised studies comparing inpatient- and outpatient-programmes with longer follow-up are necessary to ascertain if such improvements persist and if patients are able to change life-style in line with the stated goals of cardiac rehabilitation (CR).     

Efficacy of a progressive resistance exercise program to increase toe flexor strength in older people

BackgroundReduced toe flexor strength is an independent predictor of falls in older people. However it is unknown whether strengthening programs can restore toe flexor strength in older individuals. The aim of this study was to investigate whether a progressive resistance training program, focused specifically on the foot muscles, could improve toe flexor strength in community-dwelling older people.MethodsAfter baseline testing, 85 men and women (age range 60–90 years) were randomized to either a supervised, progressive resistance training (n = 43) or a home-based exercise (n = 42) group for 12 weeks. A further 32 participants were recruited for a control group. The primary outcome measures were hallux and lesser toe flexor strength pre- and post-intervention. Secondary outcome measures were exercise compliance, components of the Foot Health Status Questionnaire and single-leg balance time.FindingsAverage class attendance was 89% with 68 participants from the two intervention groups (80%) completing the follow-up assessments. Participants in the supervised, progressive resistance training group significantly increased their toe strength (up to 36%; P < 0.02), whereas there was no change in toe strength in either the home-based or control groups. This increased toe strength was accompanied by a significant improvement in perceived general foot health and single-leg balance time compared to the other groups (P < 0.05).InterpretationProgressive resistance exercises are a viable intervention to increase toe flexor strength in older adults. A clinical trial is now required to determine whether this intervention can reduce the number of falls suffered by older adults.     

Evaluation of impact-shock on gait after the implementation of two different training programs in older adults

BackgroundGait is negatively affected with increasing age. It is widely accepted that training produces physical-functional improvements in older adults, which can be assessed with numerous physical-functional tests. However, very few studies have been carried out using accelerometry to analyse the training effect on kinetic and kinematic variables in older adults, and there is no one that investigate the effects of two different training programs. Therefore, the aim of this study is to analyse the effects of an interval-walking program and a multicomponent program on the acceleration impacts, shock attenuation, step-length, stride frequency, and gait speed in older adults.Methods23 participants were divided into multicomponent training group [n = 12, 7 female, 71.58 (4.56) years] and interval-walking group [n = 11, 6 female, 69.64 (3.56) years]. We evaluated the participants using three triaxial accelerometers, placing one on the distal end of each tibia and one on the forehead.FindingsAfter 14 weeks' of training, the maximum acceleration values both for the head accelerometer and for the non-dominant tibia, as well as the attenuation in the same leg, increased in the multicomponent training group. The maximum acceleration values for the head and the stride frequency also increased in the interval-walking group. Lower limb strength improved in both groups.InterpretationGiven the benefits we found for each of these programs, we encourage their consideration when planning older adults training programs and suggest that multicomponent programs should be introduced prior to the start of walking-based programs.     

Case-control study on regular Ba Duan Jin practice for patients with chronic neck pain

PurposeTo observe the long-term effects of regular Ba Duan Jin exercises for patients with chronic neck pain.MethodsParticipants with chronic neck pain were instructed to perform ≥30 min/d of Ba Duan Jin exercises (n = 36) or assigned to a control group (n = 36) for six months. Data from a visual analogue scale, Northwick Park Neck Pain Questionnaire, and the 36-item Short-form Health Survey (SF-36) were collected before, and three and six months after intervention began.ResultsParticipants undergoing Ba Duan Jin exercises achieved significantly greater improvement than the controls in visual analogue scale, Northwick Park Neck Pain Questionnaire and SF-36 health transition scores (all p < 0.05). However, no significant differences were observed in SF-36 physical or mental component summaries.ConclusionRegular Ba Duan Jin practice reduces suffering and pain, and increases health satisfaction in individuals with chronic neck pain.     

Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash

BackgroundHealth-related quality of life (HRQoL) is an important patient-reported outcome that warrants greater attention in individuals who sustained a non-catastrophic injury in a road traffic crash. Additional robust data on HRQoL outcomes after a non-catastrophic injury are needed to effectively identify potential targets for studies of tertiary prevention of poor recovery after a crash.ObjectiveWe assessed the association between non-catastrophic road traffic crash injuries and HRQoL and factors that independently affect long-term HRQoL.MethodsIn this inception cohort study, injured participants (≥ 17 years old) were identified from various sources including hospital emergency departments by a medical examination by a registered healthcare professional in New South Wales (Australia) and followed up after 12 months. HRQoL was measured by the European Quality of Life–5 Dimensions (EQ-5D-3L) and Medical Outcomes Survey Short Form 12 items (SF-12). A range of socio-demographic, pre-injury health, psychological, and injury-related factors were considered potential predictors of HRQoL in regression analyses.ResultsAmong 2019 individuals identified, 1201 (59.5%) were followed up after 12 months. HRQoL significantly improved between baseline and 12-month follow-up: EQ-5D-3L summary score (0.41-unit difference); SF-12 physical component summary score (PCS; 13.6-unit difference) and mental component summary score (MCS; 3.5-unit difference). Over 12 months, HRQoL score was lower for people claiming compensation than others (P < 0.0001). Key predictors of better 12-month EQ-5D-3L summary score and visual analogue scale score for pain were age, not claiming compensation, reduced body mass index, less pain severity, less pain-related disability, and less general psychological distress. Significant predictors of SF-12 PCS score were injury to the neck (P = 0.02) or head or face (P = 0.01), being a driver or passenger at the time of the crash (P < 0.0001), hospital admission (P < 0.0001) and pain severity (P < 0.0001). Baseline variables associated with 12-month SF-12 MCS scores were head or face injury (P = 0.02), pre-injury health (P = 0.04), pre-injury psychological conditions (P = 0.04), trauma-related distress (P = 0.0002) and general psychological distress (P < 0.0001).ConclusionsA wide spectrum of biopsychosocial factors contribute to HRQoL after a road traffic crash injury. These epidemiological data are potentially important because they could identify potential targets for studies of tertiary prevention of persistently poor HRQoL after such an injury.     

Effectiveness of Lafiska exercise on risk of fall,balance, and health status in the elderly

This study aims to investigate the effectiveness of Latihan Fisik Lansia “elderly physical exercise” on the balance status, risk of fall, and health status of institutionalized older adults. A quasi-experimental design was applied measuring pre-test and post-test outcomes in a control group to determine the effectiveness of the intervention in the interventional group. Eighty participants from Panti Sosial Tresna Werdha Budi Mulia 1 Cipayung were divided into an inter-ventional group with 39 older adults (70.3 ± 8.13 years) and a control group with 41 older adults (69.88 ± 8.71 years). Trained facilitators guided the exercise during 16 sessions over eight weeks, each having duration of 50 min, with a small group consisting of 10-12 participants. This study used Morse Fall Scale to measure risk of fall, Berg Balance Scale to measure balance status, and SF-12 to measure health status. Lafiska had an impact on lowering risk of fall, enhancing balance status, and enhancing health status (P value <.0001). Lafiska is a viable exercise option for older adults with independent mobility, as well as older adults with assistive devices.     

Effects of a 12-week program of Tai Chi exercise on the kidney disease quality of life and physical functioning of patients with end-stage renal disease on hemodialysis

BackgroundPrevious studies have shown that exercise training in patients with end-stage renal disease could improve their physical functioning and quality of life. Nevertheless, few studies have evaluated the effects of Tai Chi exercise in patients on hemodialysis.ObjectiveTo investigate the effects of a Tai Chi exercise intervention on the quality of life and physical functioning in end-stage renal disease patients on hemodialysis.DesignA pre-post experimental design.SettingPatients, aged 20 years or older, on hemodialysis recruited from the hemodialysis unit at a medical center in central Taiwan were assigned, based on their own preference, to either a control group (n = 25) or an intervention group (n = 21).InterventionA weekly one-hour short-form Yang style Tai Chi session for a total of 12 weeks.Main outcome measuresPhysical functioning and Kidney Disease Quality of Life (KDQOL) at the baseline and at the end of the intervention.ResultsThe least square means of repetition of sit-to-stand cycles in one minute (STS-60), 6-min walk test, and gait speed test were significantly improved in the intervention group. In addition, the least square means of the five different dimensions of the KDQOL were all significantly higher in the intervention group, except the SF-12 physical health score.ConclusionsImprovements in the kidney disease quality of life and physical functioning were observed in Taiwanese patients on hemodialysis with a 12-week Tai Chi exercise intervention.     

Pain Neuroscience Education in cancer survivors with persistent pain: A pilot study

PurposeTo describe the Pilot Study: Pain Neuroscience Education in Cancer Survivors and describe the innovative educational component of Pain Neuroscience Education (PNE).DesignQuasi experimental design.MethodThe PNE program, encompassing a one-on-one education session and an information leaflet was given to 30 cancer survivors. At baseline and two weeks after the PNE, participants were asked to fill out following outcome measures; pain intensity, pain catastrophizing, and HRQoL.FindingsFollowing PNE, a significant decrease on pain intensity (p = 0.001), on the SF-36 subscale pain (p = 0.003) and for the following PCS subscales: Helplessness (p < 0.001), Rumination (p = 0.002) and Total score (p < 0.001) was found compared to baseline.ConclusionsAlthough the current results need to be verified in a larger randomized, controlled trial, preliminary evidence shows a decrease in pain intensity and pain catastrophizing following PNE in cancer survivors with persistent pain.     

Impact of Intensive Lifestyle Intervention on Depression and Health-Related Quality of Life in Type 2 Diabetes: The Look AHEAD Trial

OBJECTIVE

We examined the effects of an intensive lifestyle intervention (ILI), compared with a diabetes support and education (DSE) control intervention, on long-term changes in depression symptoms, antidepressant medication (ADM) use, and health-related quality of life (HRQoL) in overweight/obese individuals with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Look AHEAD was a multisite randomized controlled trial of 5,145 overweight/obese participants assigned to ILI (designed to produce weight loss) or DSE and followed for a median of 9.6 years. The Beck Depression Inventory (BDI) was administered at baseline, annually at years 1–4, and again at year 8. Mean BDI scores and incidence of BDI scores ≥10, indicative of likely mild or greater depression, were examined. Annually through year 10, participants reported their ADM use and completed the Medical Outcomes Study Short Form 36 (SF-36) questionnaire, which yields physical component summary (PCS) and mental component summary (MCS) scores.

RESULTS

ILI significantly reduced the incidence of mild or greater depression symptoms (BDI scores ≥10) compared with DSE (hazard ratio [HR] = 0.85; 95% CI 0.75–0.97; P = 0.0145). Although SF-36 PCS scores worsened over time in both groups, ILI participants reported better physical function than DSE throughout the first 8 years (all P values <0.01). There were no significant differences between treatment arms in the proportion of participants who used ADMs or in SF-36 MCS scores.

CONCLUSIONS

ILI for overweight/obese patients with type 2 diabetes may reduce the risk of developing clinically significant symptoms of depression and preserve physical HRQoL. These findings should be considered when evaluating the potential benefits of ILIs.     

The effect of aerobic and resistance exercise training on the health related quality of life,physical function,and muscle strength among hemodialysis patients with Type 2 diabetes

IntroductionDiabetic patients who undergo hemodialysis commonly suffer from reduction of both exercise capacity and muscle strength. These factors may have a negative effect on health related quality of life (HRQoL) and physical function. We investigated the effect of aerobic and resistance exercise training on the HRQoL, physical function, and muscle strength among hemodialysis patients with Type 2 diabetes.MethodsTwenty-eight diabetic patients who were on hemodialysis in the Milad Hospital (Tehran, Iran) were recruited for the study. Subjects were randomized into control (n = 13) and exercise training groups (n = 15). The exercise training group performed combined aerobic and resistance exercise training at moderate intensity (11–15/20 on the Borg scale) during hemodialysis treatment, 3 times a week for 8 weeks. The primary outcomes consisted of physical function measured by a 6-min walk test (6MWT), HR-QoL measured by the Short Form Health Survey (SF-36), and lower limb muscle strength measured using a hand-held Digital Dynamometer.ResultsThe 6MWT distance increased significantly in the exercise training group (36%). Bilateral hip flexor strength (right, 24.5%; left, 30.4%) and abductor strength (right, 27.6%; left, 25.2%) decreased significantly in the non-exercising control group but no significant change was found in the exercise group (P > 0.05). There were no significant changes in any of the 8 generic subscales of HR-QoL neither in the exercise training group nor controls following an 8- week study.Conclusions8 weeks of combined aerobic-resistance exercise training among diabetic hemodialysis patients seem to be effective in improvement of physical function and lower limb muscle strength.     

Health-related quality of life and its predictors among outpatients with coronary heart disease in Singapore

Aims and BackgroundCoronary heart disease (CHD) is a major cause of death and disability and negatively impacts on patients' health-related quality of life (HRQoL). This study aimed to explore HRQoL and identify its predictors among outpatients with CHD in Singapore.MethodsA correlational study was conducted with a convenience sample of 106 outpatients with CHD recruited from a public hospital. HRQoL outcomes were measured using the Short Form-12 Health Survey (SF-12), Medical Outcomes Study Social Support Survey (MOS-SSS) and Hospital Anxiety and Depression Scale (HADS).ResultsPatients reported a generally high level of HRQoL as assessed by SF-12. Those aged over 65 years reported significantly higher mental health and those who were married had higher levels of education or income reported significantly higher physical health. There were significant negative correlations between physical and mental health and anxiety and depression (p < .05). Perceived social support was negatively correlated with anxiety and depression and positively correlated with mental health. Education level and depression significantly predicted physical health, while age, anxiety and depression predicted mental health.ConclusionAnxiety, depression, age and education are significant predictors of HRQoL in this patient population and should be assessed routinely and, where appropriate, addressed through individually-tailored interventions.     

Efectividad de los ejercicios de equilibrio entre los adultos mayores en Depok,Indonesia

ObjectiveFalls are a serious problem for older adults. Balance impairment is one of the most significant reasons why adults fall from a standing position. This study aims to investigate the effect of an eight-week postural balance exercise intended to reduce the risk of falls among older adults in a community in Depok City, Indonesia.MethodThis quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group of 30 respondents and a control group of a further 30 respondents. The sample was selected using multistage random sampling. The data were analyzed using a t-test.ResultsThe balance exercise significantly affected the respondents’ postural balance and reduced their risk of falling. There were significant differences between the two groups (intervention group and control group) in postural balance (p < 0.001) and the risk of suffering a fall (p = 0.023).ConclusiónBalance exercises can be utilized as one of the preventive efforts to maintain postural balance and reduce the risk of falls among older adults. Future studies may consider the variation of age to more accurately determine the effectiveness of this balance exercise.     

IMPROVE,a community-based exercise intervention versus support group to improve functional and health outcomes among older African American and non-Hispanic White breast cancer survivors from diverse socioeconomic backgrounds: Rationale,design and methods

BackgroundAfrican Americans (AA) and socioeconomic status (SES) disadvantaged older breast cancer survivors (BCS) are more likely to experience poor functional and health outcomes. However, few studies have evaluated the putative beneficial effects of exercise on these outcomes in older racial minority and SES-disadvantaged BCS.MethodsThis is a mixed-methods study that includes a randomized-controlled trial, “IMPROVE”, to evaluate a group-based exercise intervention compared to a support group program in older BCS, followed by post-intervention semi-structured interviews to evaluate the intervention. The trial aims to recruit 220 BCS with 55 in each of four strata defined by race (AA versus Non-Hispanic Whites) and SES (disadvantaged vs. non-disadvantaged). Participants are ≥65 years old and within five years of treatment completion for stage I-III breast cancer. Participants are randomized to a 52-week, three sessions/week, one-hour/session, moderate intensity aerobic and resistance group exercise intervention, (n = 110) or a 52-week, one hour/week, support group intervention [attention-control arm], (n = 110). The first 20 weeks of both programs are supervised and the last 32 weeks, unsupervised. The primary outcome is the change in Short Physical Performance Battery (SPPB) Scores at 20 weeks from baseline, between the two arms. Secondary outcomes include change in SPPB scores at 52 weeks, change in body composition and biomarkers, at 20 and 52 weeks from baseline, between arms.DiscussionResults of the trial may contribute to a better understanding of factors associated with recruitment, and acceptability, and will inform future exercise programs to optimally improve health outcomes for older BCS.     

The Benefits of a Therapeutic Exercise and Educational Intervention Program on Central Sensitization Symptoms and Pain-Related Fear Avoidance in Breast Cancer Survivors

BackgroundCentral sensitization symptoms and pain-related fear avoidance are two common problems in breast cancer survivors. Non-pharmacologic interventions such as therapeutic exercise and patient education can be effective in this population.AimsThis study aimed to: (1) analyze the benefits of a therapeutic exercise and educational program on central sensitization symptoms and pain-related fear avoidance in breast cancer survivors, and (2) explore the association between pain-related fear avoidance and central sensitization symptoms.DesignA single group pre–post intervention study was conducted.MethodsPatients were recruited from the service of Medical Oncology of the University Clinical Hospital Virgen de la Victoria, in Málaga (Spain). The intervention consisted of a therapeutic exercise and educational program that lasted 12 weeks, twice a week, for 1 hour. Two instruments were used: the Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale.ResultsA total of 82 breast cancer survivors participated in the study. Pre–post change on Central Sensitization Inventory was statistically significant (p = .007). There was a trend towards a significant difference for the Spanish Fear Avoidance Components Scale (p = .062). There was a statistically significant correlation between pain-related fear avoidance and central sensitization symptoms (r = 0.536, p < .001).ConclusionsThe current study has provided preliminary evidence on the benefits of this intervention in pain-related fear avoidance and central sensitization symptoms in breast cancer survivors. The Spanish version of the Central Sensitization Inventory and the Spanish Fear Avoidance Components Scale demonstrated responsiveness to change.     

Effectiveness of simulation learning program for mastering public health nursing skills to enhance strength of community: A quasi-experimental design

PurposeThe purpose of this study is to develop a simulation learning program for mastering public health nursing skills to enhance strength of community, and to verify its effectiveness.MethodsThe program is one-day session to master the skills from three exercises. This study adopts a quasi-experimental design. We selected unbiased 34 participants in intervention group and 30 participants in control group, and conducted self-administered questionnaire surveys at three points in time: pre, post 1 and post 2. Three tools were used to measure the required outcome. For the outcome evaluation, we calculated the changes in the mean value of each tool between pre and post 1 and between pre and post 2, and compared them between the two groups.ResultsThe change of intervention group in the total score at the post 1 stage from the pre stage was significantly higher than control group regarding each of the scales (P < .05).ConclusionsThe program was found to be effective in upgrading the skills of less-experienced public health nurses to enhance strength of community.     

Effect of exergaming versus combined exercise on cognitive function and brain activation in frail older adults: A randomised controlled trial

BackgroundCognitive impairment is prevalent among frail older adults. Traditional exercise and exergaming positively affect cognition in healthy older people. However, few studies have investigated the effects of exergaming on cognition and brain activation in frail older adults.ObjectiveThis study compared the effect of Kinect based exergaming (EXER) and combined physical exercise (CPE) training on cognitive function and brain activation in frail older adults in Taiwan. We hypothesised that EXER would be superior to CPE in this population.MethodsWe randomised 46 community-dwelling frail older adults to the EXER or CPE group for 36 sessions (three 60-min training sessions per week) over 12 weeks. Outcome measures for cognitive function included global cognition measured by the Montreal Cognitive Assessment, executive function measured by the Executive Interview 25, verbal memory measured by the Chinese version of the California Verbal Learning Test, attention measured by the Stroop Colour and Word Test and Trail Making Test (part B), and working memory measured by spatial n-back tests. Prefrontal cortex activation during the global cognition test was documented with functional near-infrared spectroscopy (fNIRS).ResultsBoth groups improved significantly in global cognition (P < 0.05), executive function (P < 0.05), and attention (P < 0.05) after the 12-week intervention. The group × time interaction indicated that EXER training significantly enhanced global cognition more than CPE training (F(1,44) = 5.277, P = 0.026). Moreover, only the EXER group showed significant improvements in verbal (P < 0.05) and working (P < 0.05) memory after the intervention. The fNIRS hemodynamics data revealed decreased activation in prefrontal cortices of both groups (P < 0.05) during the post-training cognitive assessment, thereby suggesting greater neural efficiency; however, we found no significant group difference.ConclusionIn frail older adults, exergaming and CPE could improve cognitive function, most likely by increasing neural efficiency. Moreover, exergaming may be superior to CPE, particularly in improving global cognition.     

Influence of intermittent pneumatic compression on foot sensation and balance control in chemotherapy-induced peripheral neuropathy patients

BackgroundChemotherapy-induced peripheral neuropathy, a side effect of cancer treatment, presents several issues to patients, including reduced sensation and increased fall risk. Previously, massage therapy has been shown to improve chemotherapy-induced peripheral neuropathy symptoms, possibly through increased blood flow. A custom built intermittent pneumatic compression device, previously shown to increase lower leg blood flow, was tested as a plausible treatment modality.MethodsSeven cancer survivors suffering from chemotherapy-induced peripheral neuropathy were recruited. Foot sensation (Semmes-Weinstein test) as well as static (dual and tandem stance) and dynamic (timed-up-and-go) balance control tests were performed both pre and post a 5-min intermittent pneumatic compression intervention. Self-reported feedback was provided by participants following testing and 24-h later.FindingsFive participants reported positive changes in their feet immediately following intermittent pneumatic compression treatment while four of those participants reported positive changes up to 24 h after intervention. Foot sensation was unchanged regardless of location tested (P ≥ 0.23). Postural sway path length and sway area were unchanged following intervention during dual stance (P ≥ 0.14), but path length was significantly reduced (~19.9%) following intervention during tandem stance (P = 0.033). Timed-up-and-go duration was also significantly reduced (~7.0%, P = 0.012).InterpretationOverall, these findings demonstrate that intermittent pneumatic compression may be a plausible treatment modality for improving self-reported foot sensation as well as static and dynamic balance control. As a pilot study, this study provides sufficient context for further research exploring the efficacy of intermittent pneumatic compression as a treatment using a randomized control trial design.     

The effect of a multicomponent intervention to promote community activity on cognitive function in older adults with mild cognitive impairment: A randomized controlled trial

ObjectivesThis study aimed to examine the effectiveness of a multicomponent intervention combining physical, cognitive, and social activities developed to promote community activity in improving cognitive function in older adults with mild cognitive impairment (MCI).DesignSingle-blind randomized controlled trial.SettingA total of 83 Japanese older adults with MCI participated in the study from April to September 2017.InterventionsParticipants were randomly assigned to either the multicomponent intervention group (n = 41), attending 90-minute physical, cognitive, or social activity sessions using community resources twice weekly, or the health education control group (n = 42).OutcomesThe primary outcomes were cognitive functions, and the secondary outcomes were grip strength, walking speed, depressive symptoms, physical activities, number of outdoor activities, and conversation time.ResultsAnalysis using linear mixed models revealed significantly greater improvements in the intervention group in spatial working memory (p = 0.024) following intervention compared with the control group. Time spent in moderate-to-vigorous physical activity (p = 0.048) and step count (p = 0.059) decreased from the baseline post-intervention in the control group, whereas the baseline was maintained in the intervention group. No significant between-group differences were found post-intervention in the other primary and secondary outcomes.ConclusionsThis study showed that a 24-week multicomponent intervention program was effective in improving spatial working memory and maintaining physical activity in older adults with MCI. A follow-up investigation is required to determine whether continuation of physical, cognitive, and social activity can prevent dementia or reverse MCI in older adults.