Effect of aerobic training versus brain gym exercises to improve global cognition and quality of life in elderly - a randomised clinical trial protocol

Introduction

With more than 0.26 billion elderly people, Asia is the region with the largest proportion of the world's elderly population.¹ It is anticipated that the aggregate number of people older than 65 years will spike upto1.5 billion in the next three decades, which is almost double.² From a physiological perspective, aging is linked to the accumulation of an array of tissue damage over time. As a result, physical and mental abilities gradually deteriorate, disease risk increases, and eventually, death occurs. These changes are neither linear nor consistent, and they only tangentially correspond to an individual's age expressed in years. Aging features the beginning of various complex health disorders like Alzheimer’s disease, dementia, diabetes, hypertension, etc that can further lead to many secondary problems.³ The implications are more pronounced if these extra years are primarily marked by declines in physical and mental capacity.⁴

As we grow older, our physical and mental abilities deteriorate, making us more likely to contract diseases associated with getting older. An aging body's physical degeneration manifests as a reduction in the strength of the muscles resulting in improper balance and gait abnormalities.⁵ These impairments raise the risk of falling in combination with their diminished cognitive abilities. A fall occurs on average once a year for more than 30% of people who are 65 or older, which is the traditional age at which someone is considered elderly. It is essential to lower the risk of falling among this population to stop further effects from occurring because of such events. The reduction of bodily functions that has a detrimental effect on balance control is meant to be accelerated by inactivity. Thus, it has been demonstrated that engaging in physical activity can mitigate this occurrence.⁶

Exercising has a significant positive impact on cardiovascular health as well as mental and cognitive health, making it the most efficient long-term vaso-protective non-pharmacological treatment. It has been illustrated to foster vascular plasticity.⁷ Exercising daily lowers blood pressure and lipid levels, prevents metabolic syndromes, and has favorable effects on inflammatory markers and endothelial functions, all of which have been linked to an elevated probability of Alzheimer's disease. Additionally, studies in recent literature demonstrate that aerobic exercise can increase the volume of the hippocampus, which can stimulate neurological development and raise the complexity of dendritic networks.

This increase in volume results in better memory performance. As a result, physical therapy may be neuroprotective, and beginning an exercise program later in life is not pointless for increasing brain volume or improving cognition. In addition to improving task performance, aerobic exercise increases regional blood flow in several relevant brain structures, particularly in the hippocampus, in response to cognitive tasks. Even in the presence of cognitive impairment, cognitive training, and physical activity have been found to be effective ways to enhance cognitive function in older people.

Yet another advancement to these various physical therapy techniques is the brain gymnasium or brain gym exercises.⁸ Brain gym can reawaken the human reticular activating system, which serves as an alertness center. It gives the necessary stimulus to the corpus callosum, which maintains numerous two-way neural connections between the cortical regions of both hemispheres of the brain, including the hippocampus and amygdala. The hippocampus links specific memory components stored in various brain regions and serves as a cross-reference system for consolidation. This affects variations in neuronal memory and boosts nucleic acid.⁹ Exercises like brain gymnastics help the body's electromagnetic energy travel throughout the body by reactivating neural pathways that link the brain and body. All mental and physical events undergo electrical and chemical changes, which are supported by this movement.¹⁰

Thus, this study aims to investigate how aerobic exercise and brain gym activities for the elderly affect their overall quality of life by measuring improvements in their cardiovascular health and cognitive function.

Protocol

All participants will have provided written informed consent prior to the study's execution. The participants will be chosen from the Community Physiotherapy OPD at Acharya Vinobha Bhave Hospital Sawangi (Meghe) at Wardha, Maharashtra, following approval from the institutional ethics committee of Datta Meghe Institute of Higher Education and Research. Participants in the study will be split into two groups. Group-A (Aerobic training group) and Group B (Brain gym exercise group) by randomization for 1:1 allocation with intent to treat purpose. The participants will be screened as per inclusion and exclusion followed by randomization using a computer-generated list. Allocation will be done by sequentially numbered opaque sealed envelopes. Allocation and participant enrolment will be done by the primary investigator. The inclusion and exclusion criteria for selection will be based on the cut-off values at baseline parameters when engaging participants. Throughout the six-month recruitment phase, a second source of recruitment will be used if more study participants are needed. To compare improvements in the Montreal Cognitive Assessment (MoCA), Lawton-Brody Instrumental Activities of Daily Living (IADL), Older People’s Quality of Life Questionnaire (OPQOL-35), Modified Falls Efficacy Scale (MFES) and The Borg Rating of Perceived Exertion (RPE) scale, Group-A will receive aerobic training and Group-B will receive brain gym exercises. Participants will be enrolled and evaluated at several intervals, including the first visit and second visit for subject enrolment and screening respectively, baseline, four weeks, and two weeks after treatment for follow-up, when primary and secondary parameters will be measured (Figure 1).

Figure 1. Flowchart of the procedure.

Outcome measures

Discussion

One of the major demographic shifts brought on by higher living standards is the aging of the population. Age-related health and social issues have been highlighted by some contemporary research conducted in India, that revealed a significant portion of elderly people were out of work, were either completely or partially dependent on others, and exhibited a variety of health-related issues that can be shaped by alteration in the lifestyle.¹⁶ The World Health Organisation, in conjunction with the Indian Government, conducted a cross-sectional, community-based study of the elderly population 60 years and older at 10 different sites in various states and union territories of India in light of the growing burden of geriatric health in the country.¹⁷

Enumeration from the Government of India shows that cardiovascular diseases are responsible for one-third of deaths among the elderly. Mortality due to respiratory disorders makes up 10% of the total, while infections like tuberculosis make up the remaining 10%. Neoplasm makes up 6% of elderly mortality, while assault, intoxication, and accidents account for less than 4% of cases. Rates of nutritional, metabolic, gastrointestinal, and genito-urinary infections are more or less comparable. Other psychological issues, such as dementia, mood disorders, depression, etc., are also quite widespread in elderly people.¹⁸ With an in-depth examination of the socioeconomic and health issues that India's elderly population is dealing with, this particular study intends to improve global cognition, increase exercise tolerance, reduce the risk of falls, and enhance the quality of life in older adults. To explore the effect of aerobic training and brain gym exercises on the Montreal Cognitive Assessment (MoCA), Rating of Perceived Exertion (RPE) scale, Modified Falls Efficacy Scale (MFES), Lawton-Brody Instrumental Activities of Daily Living (IADL) and Older People’s Quality of Life Questionnaire (OPQOL-35), participants between the age group of 60-80 years will be part of the study. The data analysis shall be recorded at baseline and after the session and contamination of groups shall be prevented to ensure accurate results.