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Background Older people with cognitive impairment (CI) are at high risk for mobility limitations and adverse outcomes after discharge from geriatric rehabilitation settings. The aim was to estimate the effects of a specifically designed home-based physical training and activity promotion program on physical capacity, different aspects of physical activity (PA), and psychosocial status. Methods Patients with mild to moderate CI (Mini-Mental State Examination [MMSE]: 17–26 points) discharged home after rehabilitation were included in this randomized, double-blind, placebo-controlled trial with a 12-week intervention and 12-week follow-up period. The intervention group performed a CI-specific, autonomous, home-based strength, balance, and walking training supported by tailored motivational strategies to foster training adherence and promote PA. The control group participated in an unspecific motor placebo activity. Primary outcomes were physical capacity (Short Physical Performance Battery [SPPB]) and PA (sensor-based activity time). Results Among 118 randomized participants (82.3 ± 6.0 years) with CI (MMSE: 23.3 ± 2.4) and high levels of multimorbidity, those participants undergoing home-based training demonstrated superior outcomes to the control group in SPPB (mean difference between groups 1.9 points; 95% CI: 1.0–2.8; p < .001), with persistent benefits over the follow-up (1.3 points; 95% CI: 0.4–2.2; p < .001). There were no differences in PA across any time points. Among secondary outcomes, fear of falling and activity avoidance behavior were reduced in the intervention group at all time points, life-space mobility improved short-term. Conclusions The results demonstrate clinically important benefits of an individually tailored autonomous physical training and activity promotion program on physical capacity and secondary outcomes in different domains in a vulnerable, multimorbid population. Clinical Trial Registration ISRCTN82378327

Background Community-dwelling older persons with cognitive impairment (CI) following discharge from geriatric rehabilitation are at high risk of losing life-space mobility (LSM). Interventions to improve their LSM are, however, still lacking. The aim of this study was to evaluate the effects of a CI-specific, home-based physical training and activity promotion program on LSM. Methods Older persons with mild-to-moderate CI (Mini-Mental State Examination: 17–26 points) discharged home from rehabilitation were included in this double-blinded, randomized, placebo-controlled trial with a 12-week intervention period and 12-week follow-up period. The intervention group received a CI-specific, home-based strength, balance, and walking training supported by tailored motivational strategies. The control group received a placebo activity. LSM was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment, including a composite score for LSM and 3 subscores for maximal, equipment-assisted, and independent life space. Mixed-model repeated-measures analyses were used. Results One hundred eighteen participants (82.3 ± 6.0 years) with CI (Mini-Mental State Examination: 23.3 ± 2.4) were randomized. After the intervention, the home-based training program resulted in a significant benefit in the Life-Space Assessment in Persons with Cognitive Impairment composite scores (b = 8.15; 95% confidence interval: 2.89–13.41; p = .003) and independent life-space subscores (b = 0.39; 95% confidence interval: 0.00–0.78; p = .048) in the intervention group (n = 63) compared to control group (n = 55). Other subscores and follow-up results were not significantly different. Conclusions The home-based training program improved LSM and independent life space significantly in this vulnerable population. Effects were not sustained over the follow-up. The program may represent a model for improved transition from rehabilitation to the community to prevent high risk of LSM restriction.

The aim of the present study was to examine adherence and acceptance of a home-based program to promote physical activity (PA) in older persons with cognitive impairment (CI) following inpatient rehabilitation. Sixty-three older persons (≥ 65 years) with mild to moderate CI (Mini-Mental State Examination score 17–26), allocated to the intervention group of a randomized, controlled intervention trial underwent a 12-week home-based PA intervention including (1) physical training and outdoor walking to improve functional fitness and (2) motivational strategies (goal-setting, pedometer-based self-monitoring, social support delivered by home visits, phone calls) to promote PA. Training logs were used to assess adherence to physical training, outdoor walking and to motivational strategies (goal-setting, pedometer-based self-monitoring). Acceptance (subjective feasibility and effectiveness) of the program components was assessed by a standardized questionnaire. Mean adherence rates over the intervention period were 63.6% for physical training, 57.9% for outdoor walking, and between 40.1% (achievement of walking goals), and 60.1% (pedometer-based self-monitoring) for motivational strategies. Adherence rates significantly declined from baseline to the end of intervention (T1: 43.4–76.8%, T2: 36.1–51.5%, p values

Objectives To describe life-space mobility and identify its determinants in older persons with cognitive impairment after discharge from geriatric rehabilitation. Methods A cross-sectional study in older community-dwelling persons with mild to moderate cognitive impairment (Mini-Mental State Examination, MMSE: 17–26) following geriatric rehabilitation was conducted. Life-space mobility (LSM) was evaluated by the Life-Space Assessment in Persons with Cognitive Impairment (LSA-CI). Bivariate analyses and multivariate regression analyses were used to investigate associations between LSM and physical, cognitive, psychosocial, environmental, financial and demographic characteristics, and physical activity behavior. Results LSM in 118 older, multimorbid participants (age: 82.3 ± 6.0 years) with cognitive impairment (MMSE score: 23.3 ± 2.4 points) was substantially limited, depending on availability of personal support and equipment. More than 30% of participants were confined to the neighborhood and half of all patients could not leave the bedroom without equipment or assistance. Motor performance, social activities, physical activity, and gender were identified as independent determinants of LSM and explained 42.4% (adjusted R²) of the LSA-CI variance in the regression model. Conclusion The study documents the highly restricted LSM in older persons with CI following geriatric rehabilitation. The identified modifiable determinants of LSM show potential for future interventions to increase LSM in such a vulnerable population at high risk for restrictions in LSM by targeting motor performance, social activities, and physical activity. A gender-specific approach may help to address more advanced restrictions in women.

A version of the Life-Space Assessment in persons with cognitive impairment (LSA-CI) has recently been developed. To establish a cut-off value for the newly developed Life-Space Assessment in persons with cognitive impairment (LSA-CI). In a cross-sectional study including 118 multimorbid, older persons with cognitive impairment, life-space mobility (LSM) was documented by the LSA-CI. The analysis was rationalized by Global Positioning System (GPS)-based measures of spatial distance from home. A receiver-operating characteristic (ROC) curve was created and the cut-off point for the LSA-CI was identified with the Youden’s Index. ROC curve analysis indicated a critical value of 26.75 (within a range of 0–90) to differentiate between low and high LSM with a sensitivity of 78.1% and specificity of 84.2%. Diagnostic interpretation of the ROC curves revealed that low and high LSM groups can be differentiated with the proposed cut-off. The proposed LSA-CI cut-off score can be recommended to tailor clinical interventions and evaluate change over time.

Introduction: There is a substantial lack of home-based exercise programs in the highly vulnerable group of geriatric patients with cognitive impairment (CI) after discharge from ward rehabilitation. Beyond clinical effectiveness, the cost-effectiveness of intervention programs to enhance physical performance is not well investigated in this target group. Objective: The aim of the study was to determine the cost-effectiveness of a 12-week home-based exercise intervention following discharge from ward rehabilitation compared to unspecified flexibility training for geriatric patients with CI from a societal perspective. Methods: This cost-effectiveness study was conducted alongside a randomized placebo-controlled trial. A total of 118 geriatric patients with CI (Mini-Mental State Examination score: 17–26) were randomized either to the intervention group (IG, n = 63) or control group (CG, n = 55). Participants in the IG received a home-based individually tailored exercise program to increase physical performance, while participants in the CG received unspecific flexibility training (placebo control). Healthcare service use, physical performance (Short Physical Performance Battery, SPPB), and quality of life (EQ-5D-3L) were measured over 24 weeks. The net monetary benefit (NMB) approach was applied to calculate incremental cost-effectiveness of the exercise intervention compared to the CG with respect to improvement of (a) physical performance on the SPPB and (b) quality-adjusted life years (QALYs). Results: Physical performance was significantly improved in the IG compared to the CG (mean difference at 24 weeks: 1.3 points; 95% confidence interval [95% CI] = 0.5–2.2; p = 0.003), while health-related quality of life did not significantly differ between the groups at 24 weeks (mean difference: 0.08; 95% CI = −0.05 to 0.21; p = 0.218). Mean costs to implement the home-based exercise intervention were EUR 284 per patient. The probability of a positive incremental NMB of the intervention reached a maximum of 92% at a willingness to pay (WTP) of EUR 500 per point on the SPPB. The probability of cost-utility referring to QALYs was 85% at a WTP of EUR 5,000 per QALY. Conclusion: The home-based exercise intervention demonstrated high probability of cost-effectiveness in terms of improved physical performance in older adults with CI following discharge from ward rehabilitation, but not in terms of quality of life.

This study aimed to identify determinants of quantitative dimensions of physical activity (PA, duration, frequency, and intensity) in community-dwelling, multi-morbid, older persons with cognitive impairment (CI). In addition, qualitative and quantitative aspects of habitual PA have been described. Quantitative PA and qualitative gait characteristics while walking straight and while walking turns were documented by a validated, sensor-based activity monitor. Univariate and multiple linear regression analyses were performed to delineate associations of quantitative PA dimensions with qualitative characteristics of gait performance and further potential influencing factors (motor capacity measures, demographic, and health-related parameters). In 94 multi-morbid, older adults (82.3 &plusmn, 5.9 years) with CI (Mini-Mental State Examination score: 23.3 &plusmn, 2.4), analyses of quantitative and qualitative PA documented highly inactive behavior (89.6% inactivity) and a high incidence of gait deficits, respectively. The multiple regression models (adjusted R&sup2, = 0.395&ndash, 0.679, all p &lt, 0.001) identified specific qualitative gait characteristics as independent determinants for all quantitative PA dimensions, whereas motor capacity was an independent determinant only for the PA dimension duration. Demographic and health-related parameters were not identified as independent determinants. High associations between innovative, qualitative, and established, quantitative PA performances may suggest gait quality as a potential target to increase quantity of PA in multi-morbid, older persons.

The aim of the study was to investigate the biometrical quality of a newly developed activity monitor (uSense) to document established physical activity (PA) parameters as well as innovative qualitative and quantitative gait characteristics for habitual activity behavior in multi-morbid, older adults. Validity, test-retest reliability, and feasibility of established (including activity counts, MET-Intensities, number/duration of gait episodes/steps) as well as newly developed gait characteristics, which have not been documented before for habitual assessment (including number, velocity, duration of turnings, various parameters for gait symmetry/ regularity), have been analyzed for multimorbid, geriatric patients with cognitive impairment (n=110) discharged from ward-based rehabilitation. On average, Spearman correlations of established and innovative uSense parameters with clinically relevant parameters were high for motor performances (range for rhos: 0.02 – 0.63) and life space (0.01 – 0.59) and low to moderate for cognitive status (0.01 – 0.25), and age (0.01 – 0.30), indicating moderate to good construct validity. Concurrent validity was high as PA parameters measured by the U-Sense monitor showed consistently high correlation with equivalent parameters measured by another well-established ambulatory motion sensor (PAMSysTM) (0.59 – 0.91). Moderate to excellent test-retest reliability was shown for all uSense parameters (ICC: 0.68–0.97) and good feasibility could be shown, as 85.5% of all measurements were completed without failure. The uSense monitor allows documentation of established and innovative qualitative-quantitative parameters for habitual PA behavior which have so far only been assessed in laboratory settings in multi-morbid, cognitively impaired, older adults with moderate to good validity and high test-retest reliability.

Background Geriatric patients with cognitive impairment (CI) show an increased risk for a negative rehabilitation outcome and reduced functional recovery following inpatient rehabilitation. Despite this obvious demand, evidence-based training programs at the transition from rehabilitation to the home environments are lacking. The aim of this study is to evaluate the efficacy of a feasible and cost-effective home-based training program to improve motor performance and to promote physical activity, specifically-tailored for post-ward geriatric patients with CI. Methods A sample of 101 geriatric patients with mild to moderate stage CI following ward-based rehabilitation will be recruited for a blinded, randomized controlled trial with two arms. The intervention group will conduct a 12 week home-based training, consisting of (1) Exercises to improve strength/power, and postural control; (2) Individual walking trails to enhance physical activity; (3) Implementation of patient-specific motivational strategies to promote behavioral changes. The control group will conduct 12 weeks of unspecific flexibility exercise. Both groups will complete a baseline measurement before starting the program, at the end of the intervention, and after 24 weeks for follow-up. Sensor-based as well as questionnaire-based measures will be applied to comprehensively assess intervention effects. Primary outcomes document motor performance, assessed by the Short Physical Performance Battery, and level of physical activity (PA), as assessed by duration of active episodes (i.e., sum of standing and walking). Secondary outcomes include various medical, psycho-social, various PA and motor outcomes, including sensor-based assessment as well as cost effectiveness. Discussion Our study is among the first to provide home-based training in geriatric patients with CI at the transition from a rehabilitation unit to the home environment. The program offers several unique approaches, e.g., a comprehensive and innovative assessment strategy and the integration of individually-tailored motivational strategies. We expect the program to be safe and feasible in geriatric patients with CI with the potential to enhance the sustainability of geriatric rehabilitation programs in patients with CI. Trial registration International Standard Randomized Controlled Trial (# ISRCTN82378327 ). Registered: August 10, 2015.

INFLUENCES OF A 7-WEEK-HIKE ON THE AWARENESS / ATTENTION OF BREAST CANCER PATIENTSBreast cancer with its intensive medical therapy has a generalized and lasting influence on the concerning patient. Negative psychological effects can be observed still many years after diagnosis. These include depressions and the closely connected missing ability to focus the attention on the present. Fears and concerns shape the emotions of the female patients over many years. The present project sets at this problem. In April/May 2008, 12 women, in the condition after breast cancer, hiked the Camino de Santiago, a route distance of 815 km, for seven weeks. The questionnaire Mindfulness Attention Awareness Scale (MAAS) was filled out on the days − 2 (2 days before takeoff), 18, 36 and 54 (4 days after return) in order to examine the influences of a long hike on the attention. The results showed clearly positive changes on the focussing of attention during the hike. The participants showed a significant (p = 0,012) improvement in controlling the attention on the present. The small patient number and the missing control group permit only a limited conclusion of the study. Besides, this study is probably the first study, which observed the influence of physical activities with cancer patients in aftercare on the attention. Nevertheless, the results give cause for motivation to let further studies follow on this new field of activity.