A Dyadic Approach for a Remote Physical Activity Intervention in Adults with Alzheimer's Disease and their Caregivers

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Project Summary/Abstract Adults with Alzheimer’s disease (AD) and their caregivers represent a sizeable and underserved segment of the population with low levels of moderate physical activity (MPA). Available evidence suggests that regular MPA can improve mobility, performance of activities of daily living, general cognition, and balance in adults with AD. Additionally, MPA may reduce the risk of development of AD and improve health and well-being in caregivers. However, options for increased MPA in community dwelling adults with AD and their caregivers are limited. No trials have been designed specifically to examine strategies to increase long-term (≥12 mos.) daily MPA in this group. The significant barriers associated with current options (medical clinic, community site, home visits, caregiver delivered), including the time and cost associated with travel to clinic or community site, expense associated with individual home visits and the additional burden of caregiver directed exercise reduce the potential of these approaches to result in sustained improvements in MPA. An intervention delivered remotely via real-time video conferencing to groups of adults with AD and their caregivers in their homes (RGV), represents a potentially effective approach for increasing MPA in this group. This approach eliminates the need for transportation to a medical clinic or other community facility, and offers the potential for peer support and socialization, which may be important for initiation and maintenance of MPA. We propose to compare the effectiveness of the RVG approach with usual care, enhanced with caregiver support (EUC), for increasing MPA in 100 community dwelling adults with mild to moderate AD and their caregiver (dyads). Participants in both arms will be provided with an iPad® for intervention delivery, Fitbit for self-monitoring MPA, and will be asked to complete a 150 min of total MPA/wk. Dyads in both arms will be provided with written materials regarding exercise and physical activity from the National Institute on Aging, and will be asked to complete brief (15-20 min) FaceTime® meetings (0-6 mos.= 2/mo.; 7-12 mos.= 1/mo.;, 13-18 mos. =0/mo.) with the heath coach to discuss progress, provide support and receive additional guidance on increasing/maintaining MPA. Dyads in the RGV arm will be asked to complete group (5-8 dyads) exercise (aerobic, resistance, balance/coordination) delivered by a trained health coach via Zoom® software on an iPad®. Group sessions (45-min) will be held 3 d/wk. during mos. 0-6, 1 d/wk. during mos. 7-12, and will be discontinued during the no-contract period (mos.13-18). Dyads in the EUC arm, will be provided with a recommended exercise plan to complete own their own. Our primary aim is to compare total MPA (min/wk.) between the RGV and EUC arms in adults with AD and their caregiver across 6 mos. Secondarily we will compare total MPA and other outcomes, e.g., cognitive function, activities of daily living, caregiver burden etc. between the RGV and EUC arms across 18 mos.