Author: Parial, Laurence Lloyd Bundalian
Title: Effects of dual-task Zumba gold (DTZ) on the cognition of community-dwelling people with mild cognitive impairment : a pilot randomized controlled trial
Advisors: Leung, Angela (SN)
Kor, Patrick (SN)
Lam, Simon (SN)
Degree: Ph.D.
Year: 2022
Award: FHSS Faculty Distinguished Thesis Award (2021/22)
Subject: Mild cognitive impairment
Mind and body
Health promotion
Hong Kong Polytechnic University -- Dissertations
Department: School of Nursing
Pages: xx, 381 pages : color illustrations
Language: English
Abstract: Background: Mild cognitive impairment (MCI) significantly increases the risk of dementia, making cognitive health promotion a crucial aim for affected individuals. While physical and cognitive activities may benefit people with MCI, evidence suggests that combining these two approaches (e.g., dual-task training) could facilitate greater cognitive outcomes. With the increasing global prevalence of cognitive decline, especially in developing countries, it is crucial to explore interventions that could be readily accessed by community-dwelling people with MCI. A cognitively-enriched aerobic dance intervention has the potential to promote dual-task training and may benefit people with MCI. However, there is limited information on the feasibility and efficacy of this approach among people with MCI.
Objectives: This study aimed to develop a dual-task Zumba Gold (DTZ) intervention to improve the cognition of community-dwelling people with MCI; and assess its feasibility and preliminary efficacy among people with MCI in the Philippines.
Methods: The study is comprised of three phases: (1) development and refinement of the DTZ intervention; (2) feasibility testing of the DTZ protocol; and (3) preliminary examination of the efficacy of DTZ. Phase 1 involved a comprehensive literature review integrating the current evidence about aerobic dancing and dual-task training on people with MCI (Phase 1a). This was followed by focus groups/individual interviews among 44 older adults to facilitate protocol refinement (Phase 1b). Phase 2 included a mixed-methods feasibility study, wherein DTZ was implemented on ten people with MCI. Phase 3 involved a parallel-group, single-blinded, pilot randomized controlled trial (RCT) of 60 participants with MCI allocated to the intervention (DTZ for 12 weeks at 3x/week) or control group (12-week physical activity with health education). The preliminary efficacy of DTZ intervention was assessed at baseline (T0), immediate post-intervention (T1), and six weeks follow-up (T2) through the following outcomes: global cognition (primary outcome), memory, executive function, quality of life, depressive symptoms, mobility, and body measures (secondary outcomes). Generalized estimating equations were utilized to evaluate the changes in the clinical outcomes across the three time points. Post-intervention qualitative interviews were also conducted with 13 DTZ participants, and findings were analyzed via content analysis.
Results: The literature review (Phase 1a) indicated that dancing might positively impact the cognition of people with MCI, although the cognitive benefits of aerobic dancing were lesser compared to traditional partnered dances. Another review showed that dual-task interventions could be an effective approach for enhancing the cognitive performance of people with MCI, although previous programs commonly required exercise equipment or technological resources. Findings of these reviews further guided the development of the initial protocol. Meanwhile, Phase 1b indicated that community-dwelling older adults perceived dual-task training in Zumba as an innovative approach, although appropriate strategies should be in place to address potential challenges. These findings facilitated the refinement of the DTZ protocol. Phase 2 results suggested that DTZ was feasible and acceptable among the participants with MCI, with good program retention (90%) and attendance (90.3%) and without reported adverse events. Qualitative findings also showed participants reporting intervention acceptability. In the pilot RCT, the intervention group had significant improvements in global cognition (p < 0.001), executive function (p < 0.001), immediate recall (p < 0.001), delayed recall (p = 0.003), quality of life (p = 0.027), and mobility (p = 0.005) at T1 and T2, compared to the control group. Particularly, DTZ facilitated moderate to large changes in global cognition (d = 0.75 - 0.78), delayed recall (d = 0.66 - 0.71), and quality of life (d = 0.59 - 0.63); while immediate recall (d = 0.50 - 0.54), executive function (d = 0.28 - 0.33), and mobility (d = 0.53- 0.56) had small to moderate improvements. However, there were no significant improvements in working memory, depressive symptoms, blood pressure, waist circumference, and body mass index were not significant. In the post-intervention interviews, participants affirmed that DTZ is a feasible program in the community. Nevertheless, some of them expressed challenges in performing dual-task exercises at the beginning of the program. They also suggested some recommendations for its future implementation.
Conclusion: Dual-task Zumba Gold is a feasible and acceptable program for people with MCI, which seemed to enhance global cognition and other subdomains (executive function, immediate/delayed recall), mobility, and quality of life. The current results support the investigation of DTZ using a full-scale trial to investigate its effects on the larger MCI population.
Significance of the study: This is the first study to develop a dual-task aerobic dance intervention and provide preliminary evidence of its positive effects on the cognition of people with MCI. Enriching the Zumba Gold program with mental exercises is an innovative strategy to stimulate physical and cognitive activities in people with MCI. Since the Zumba Gold program is established in many countries, expanding it to a multicomponent cognitive intervention may benefit a large number of older people across various settings. Notably, DTZ has the potential to be integrated in communities as a practical and sustainable means for dementia risk reduction among people with MCI.
Rights: All rights reserved
Access: open access

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