Dual-Task Training Exercise to Reduce Falls in Older Adults with Mild Cognitive Impairment

项目总结/摘要 非药物干预，如体育锻炼或运动疗法，以防止老年人福尔斯跌倒 患有轻度认知障碍（MCI）的成年人没有效果。我们的长期目标是建立一个安全的 和有效的身心锻炼干预，可以在社区环境中广泛使用， 用于临床实践，以防止社区居住老年人中快速增长的高危人群的福尔斯 关于MCI本提案的目的是评估一种新颖的干预-双任务太极拳： 更好的平衡（双TJQMBB）-这是专门为老年人与MCI，以防止福尔斯。的 这一建议的基本原理是，通过将认知练习与身体（太极拳）相结合， 运动，我们解决受损的平衡和随之而来的注意力（双任务）赤字与 这一人群中跌倒的风险增加。中心假设是，我们的治疗定制和 双任务强化太极拳训练法将比传统太极拳训练法更有效， 防止福尔斯摔倒。中心假设，其前提建立在我们以前的工作和有前途的试点 数据，将通过追求我们的主要目标进行测试，我们将确定6个月的双- TJQMBB干预降低MCI老年人福尔斯发生率的研究我们将解决我们的 主要目的使用创新的电子健康（在线）干预方法，采用3组、单盲、 两种太极拳预防跌倒效果比较的随机对照试验 图4示出了相对于拉伸对照的干预（双TJQMBB、标准TJQMBB）的结果。我们假设， 第6个月，分配到双TJQMBB干预的参与者将显示出显著减少， 福尔斯的发生率（主要结局）和双任务行走以及身体和认知的改善 性能（次要结果）与拉伸对照组相比。该项目有两 次要目的：（1）确定我们的双TJQMBB干预的益处在6- 10年内持续的程度。 干预后一个月的随访，以及（2）检查双TJQMBB培训是否对 降低福尔斯的发生率是通过双任务行走性能的改变来介导的。我们提出的 这项研究意义重大，因为它将填补临床实践中的一个重要空白， 首次将太极拳与认知任务训练相结合的量身定制的跌倒预防干预， 患有MCI的老年人有跌倒和持续认知能力下降的风险。如果证据支持 双重TJQMBB假设，拟议的研究可以（a）对临床实践指南产生快速影响， 跌倒预防领域和（B）具有非常迅速的广泛的积极影响，因为它可以被耦合 标准的TJQMBB计划，该计划已在全国范围内广泛传播。

PROJECT SUMMARY/ABSTRACT Non-pharmacological interventions, such as physical exercise or movement therapies, to prevent falls in older adults with mild cognitive impairment (MCI) have not been effective. Our long-term goal is to establish a safe and efficacious mind-body exercise intervention that can be made widely available in community settings and for clinical practice to prevent falls in a rapidly growing, at-risk population of community-dwelling older adults with MCI. The objective of this proposal is to evaluate a novel intervention—dual-task Tai Ji Quan: Moving for Better Balance (Dual-TJQMBB)—that is specifically tailored for older adults with MCI to prevent falls. The rationale underlying this proposal is that by integrating cognitive exercises with physical (tai ji quan) movements we address the impaired balance and concomitant attention (dual-tasking) deficits associated with the increased risk of falling in this population. The central hypothesis is that our therapeutically tailored and dual-task augmented tai ji quan training approach will be more efficacious than traditional tai ji quan training in preventing falls. The central hypothesis, with its premise established from our prior work and promising pilot data, will be tested by pursuing our Primary Aim in which we will determine the efficacy of a 6-month Dual- TJQMBB intervention in reducing the incidence of falls among older adults with MCI. We will address our Primary Aim using an innovative e-health (online) intervention delivery approach with a 3-arm, single-blind, randomized controlled trial involving a test of the comparative efficacy of the two tai ji quan fall prevention interventions (Dual-TJQMBB, standard TJQMBB) relative to a stretching control. We hypothesize that, by month 6, participants assigned to the Dual-TJQMBB intervention will show a significant reduction in the incidence of falls (primary outcome) and improvement in dual-task walking and physical and cognitive performances (secondary outcomes) compared to those assigned to the stretching control. The project has two secondary aims: (1) to determine how well the benefits of our Dual-TJQMBB intervention persist over a 6- month post-intervention follow-up, and (2) to examine whether the impact of Dual-TJQMBB training on reducing the incidence of falls is mediated by change in dual-task walking performance. Our proposed research is significant because it will fill a vital gap in clinical practice by providing efficacy evidence about a tailored fall prevention intervention that combines tai ji quan with cognitive task training, for the first time, for older adults with MCI who are at risk of falling and continuing cognitive decline. If the evidence supports the Dual-TJQMBB hypothesis, the proposed study can (a) make a rapid impact on clinical practice guidelines in the field of fall prevention and (b) have a widespread positive impact very quickly because it can be coupled with the standard TJQMBB program, which has been broadly disseminated across the country.