Effects of a Multicomponent Exercise Intervention on Physical and Cognitive Function of Older Adults With Dementia

Physical fitness is going to be measured via the Senior Fitness Test (SFT).This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively), aerobic endurance (2-minute step test), and agility/dynamic balance (8-foot up-and-go test).

Lower body strength was measured using the 30 s chair stand test. Participants were asked to sit in a 43-cm armless chair with their arms crossed at the wrists and held against the chest. The score was the total number of stands executed correctly within 30 s.

Physical fitness is going to be measured via the Senior Fitness Test (SFT).This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively), aerobic endurance (2-minute step test), and agility/dynamic balance (8-foot up-and-go test).

Upper body strength was assessed using the arm curl test. Participants performed as many biceps curls as possible in 30 s, using a dumbbell (3.63 kg and 2.27 kg for men and women, respectively). The score was the total number of hand-weight curls performed through the full range of motion within 30 s.

Physical fitness is going to be measured via the Senior Fitness Test (SFT).This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively), aerobic endurance (2-minute step test), and agility/dynamic balance (8-foot up-and-go test).

Cardiorespiratory fitness was measured using 2-min step test. Participants were asked to raise each knee to a point midway between the patella (kneecap) and iliac crest (top hip bone). The score was the number of times the right knee reaches the required height.

Physical fitness is going to be measured via the Senior Fitness Test (SFT).This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively), aerobic endurance (2-minute step test), and agility/dynamic balance (8-foot up-and-go test).

Participants were asked to as quickly as possible, in a sitting position, stand up, walk 8-foot distance (2,44 meters), turn the cone marker around and return to the seated position. The time, in seconds, necessary to complete this test was registered.

Physical fitness is going to be measured via the Senior Fitness Test (SFT).This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively), aerobic endurance (2-minute step test), and agility/dynamic balance (8-foot up-and-go test).

Upper-body flexibility was measured through the back-scratch test. The participants were asked to, in standing position, place the preferred hand over the same shoulder, reaching down the middle of the back as far as possible - elbow pointed up. Then, the participants were asked to place the other arm around the back of the waist with the palm up and in attempt to touch (or overlap) the extended middle fingers of both hands. The nearest distance (in centimeters) was measured between the tips of the middle fingers (minus or plus, depending if overlapping or not)

Physical fitness is going to be measured via the Senior Fitness Test (SFT).This physical battery includes lower and upper-body strength (30-second chair stand and 30-second arm curl tests, respectively), lower and upper-body flexibility (chair sit-and-reach and back scratch tests, respectively), aerobic endurance (2-minute step test), and agility/dynamic balance (8-foot up-and-go test).

The chair sit-and-reach test was used to assess lower-body flexibility. Participants were asked to sit at the front edge of a chair and with one leg extended (dominant) reach the toward toes as far as possible, bending the upper body forward at the hip joint. The other leg must be bent and slightly off to one side with the foot flat on the floor. The number of centimeters (plus or minus) were registered between the extended fingers (hands overlapping) and the tip of the toe - maintaining the position for at least 2 seconds.

This sub-maximal test with incremental protocol including seven stages and performed on a treadmill. To assess Peak oxygen uptake (VO2 peak), standard an open-circuit spirometer technique (Cosmed K4b2, Cosmed, Rome, Italy) will be used.

The static balance will be measured with the One Leg Balance Test. Participants will be asked to choose a leg to stand on, flex the opposite knee and balance on one leg as long as possible. The time (in seconds) standing unsupported will be recorded.

Handgrip strength will be obtained with a Jamar Plus + Digital hand dynamometer (Sammons Preston Inc., Bolingbrook, Illinois, USA).Measurements will be carried out following the American Society of Hand Therapists recommendations, and each participant will perform three attempts with a pause of 1 min between them. The maximum value, in kilograms of force (kgf), of the three measurements with the dominant hand will be registered.

Appendicular Skeletal Muscle Mass Index (ASMI), which is the sum of muscle masses of the four limbs described as appendicular skeletal muscle mass adjusted for height (kg/m2), will be analyzed with Dual Energy X-ray Absorptiometry (DXA) (Hologic QDR 4500, Explorer model, version 12.4).

Body mass (kg), fat-free mass (kg) and fact mass (kg) will be analyzed with Dual Energy X-ray Absorptiometry (DXA) (Hologic QDR 4500, Explorer model, version 12.4)

To evaluate independence on performing basic activities of daily living, ranging from 0-100 and with higher scores representing increased functionality.

Assessment of instrumental activities of daily life. It evaluates the following categories and subcategories: A. Ability to Use Telephone; B. Shopping; C.Food Preparation; D.Housekeeping; E. Laundry; F. Mode of Transportation; G. Responsibility for Own Medications; H. Ability to Handle Finances. Range 0-8. Lower scores are indicative of increased difficulties to independently perform instrumental activities.

The Mini Mental State Examination (MMSE) a widely used test of cognitive function among older adults will be used and consists of a 30-item instrument (with higher scores indicating better cognitive performance) that is organized in six cognitive domains - orientation, retention, attention and calculation, delayed recall, language, and visuo-constructive ability.

The executive functions will be assessed with the Trail Making Test part A - attention, visual scanning, speed of eye-hand coordination, and information processing; and part B - working memory and the ability to switch between different stimuli. Time and number of errors will be registered.

NPI is used to determine the frequency and severity of behavioral and psychological symptoms of dementia (BPSD) with a total score ranging from zero to 144 points with high scores corresponding to worsening of BPSD.

The QoL-AD will be used to measure the dementia participants' quality of life. The questionnaire includes 13 items such as physical health, energy, mood, memory, family, marriage, friends, and ability to do things for fun. The QoL-AD provides the participant and the caregiver reports of the participant's QoL and is scored on a 4-point Likert-type scale ranging from 1 to 4 (excellent), with total scores ranging between 13 and 52 point, and higher scores indicating better quality of life.

The Care-related Quality of Life instrument (CarerQol) will be used to address subjective burden (CarerQol-7D). The subjective burden is measured in seven dimensions: fulfillment, relational problems, mental health, daily activities problems, physical health and support. Total CarerQol-7D score ranges from 0 to 14 points with higher scores indicating better caregiving situation.

The Care-related Quality of Life instrument (CarerQol) will be used to address caregivers' well-being (CarerQol-VAS), using a visual analogue scale to ask about happiness between 0 (completely unhappy) and 10 (completely happy).

Determination of TG (mg/dL), TC (mg/dL),LDL-C (mg/dL), HDL-C (mg/dL) concentrations in plasma.

Determination of HbA1c(μg/mL) concentrations in blood.

Plasma IL-6 (pg/ml), IL-8 (pg/ml), IL-10 (pg/ml) concentrations will be measured using V-PLEX Human Biomarker 40-Plex Kit pro-inflammatory.

Plasma CRP (μg/mL) and TNF-alfa (μg/mL) concentrations will be measured using V-PLEX Human Biomarker 40-Plex Kit pro-inflammatory.

BDNF (pg/ml), VEGF (pg/ml), sICAM-1 (pg/ml), sVCAM-1 (pg/ml), MMP-9 (pg/ml) concentrations will be analysed using the ELISA method (enzyme-linked immunosorbent assay).

Plasma IGF-1 (ng/ml) concentrations will be measured by the DiaSorin using a LIAISON ® kit and analysed by CLIA method.

Systolic and Diastolic Blood Pressure (mmHg) will be measured using a digital sphygmomanometer.

Arterial stiffness is going to be measured as carotid-femoral pulse wave velocity (cfPWV) using applanation tonometry (SphygmoCor, AtCor Medical, Australia). Procedures will follow international guidelines. In brief, sequential and consecutive carotid and femoral pressure waves are going to be registered together with the electrocardiogram, which will serve as a reference to calculate the transit time between the recording's sites. The distance traveled by the pressure wave will be the direct distance between the recording points at the femoral and carotid arteries, corrected by the factor 0.8. The value of cfPWV is going to be calculated as the direct distance (in meters) divided by the transit time (in seconds). All measurements will be performed in duplicate by the same trained researcher.