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The aim of this study was to explore if turn duration and the performance of step parameters during segments of the Timed Up and Go (TUG) test with and without cognitive dual-tasking (TUGdt) can discriminate between individuals with different cognitive ability. Participants were divided into groups (dementia = 57, mild cognitive impairment = 126, subjective cognitive impairment = 71, and controls = 50) and performed TUG and TUGdt (naming animals and reciting months in reverse order, respectively). Turn duration and forward and return walk (step parameters) were compared between adjacent groups for all conditions. Results were analyzed with logistic regression models, presented with standardized odds ratios, and generally showed longer turn duration during TUGdt for groups with lower levels of cognitive ability, whereas a small tendency was observed for step length/body height. While these results need to be confirmed, they may indicate the potential of assessing TUG segments, particularly turn duration, to identify risk of cognitive impairment. Trial registration number: NCT05893524.

Background: It is of utmost importance to identify older adults at risk of cognitive impairment at the earliest possible stage. Previous research supports the potential of investigating step parameters and turn duration during Timed Up and Go (TUG) during single and dual-task (TUGdt) conditions to detect subtle impairment. The aim of this study was therefore to investigate the test-retest reliability and measurement error of novel outcomes related to TUG and two TUGdt tests, TUGdt-NA (naming animals) and TUGdt-MB (reciting months in reverse order), in older adults with perceived memory impairment.

Methods: Thirty-four participants (18 women, mean age 76) were included and assessed with TUG, TUGdt-NA and TUGdt-MB on two different occasions, 5–10 days apart. Tests were video recorded for data extraction of spatiotemporal step parameters and turn duration. Reliability of motor and cognitive outcomes were analyzed with intraclass correlations (ICC2.1), standard errors of measurement and minimal detectable change (MDC). The proportional measurement error was presented with MDC%.

Results: The results showed very good reliability (ICC2.1 ≥ 0.85) regarding total completion times, although the measurement error and proportional measurement error (MDC%) was higher during TUGdt conditions than TUG. The reliability of cognitive outcomes during TUGdt favored TUGdt-MB (ICC2.1 ≥ 0.77, MDC% ≤39.8). Step length was the step parameter with highest reliability (ICC2.1 ≥ 0.86) and lowest proportional measurement error (MDC% ≤21.4) across conditions, whereas turn duration showed good reliability during TUG and TUGdt-MB (ICC2.1 ≥ 0.74, MDC%≤38.9).

Conclusion: The results support the potential of including TUG and TUGdt outcomes in cognitive risk evaluations among older adults. Trial Registration Number: Uppsala-Dalarna Dementia and Gait Project | ClinicalTrials.gov, identifier NCT05893524.

Objective: What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers?

Design: A three-round modified e-Delphi study. Participants: Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field.

Methods: A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus.

Results: Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 51 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n = 36; 2) Assessment, n = 39; 3) Management, interventions and prevention n = 40; 4) Communication, therapeutic relationship and person-centred care, n = 17; and 5) Physiotherapists self-management and improvement, n = 5. Conclusions: This e-Delphi study outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians.

Contribution of Paper:

• This e-Delphi study has developed, through expert consensus, the first comprehensive physiotherapy specific core capability framework for providing high-quality care to people with dementia and their families/caregivers.

• The core capability framework can be used by physiotherapists to identify knowledge and/or skill gaps, and by physiotherapy educators to assist with entry-level and post-graduate curriculum development and student/workforce training.

• As physiotherapists play a vital role in working with people with dementia and their caregivers/families, and competencies lie at the heart of effective quality care and service delivery, the newly developed core capability framework serves as basis for broader consultation and input.

Objectives: Fear of falling (FoF) is a common problem among older adults. It can lead to reduced quality of life and less physical activity, which increases fall risk. Earlier work has shown that FoF can be a manifestation of executive dysfunction in adults over 50 years, but studies on people over age 75 years are lacking. Executive functions (EFs) are cognitive functions associated with the frontal lobes and the prefrontal cortex. The aim of this study was to assess associations of EFs and FoF among people aged 80 years or older.

Methods: This cross-sectional study was based on data from the Northern Sweden Silver-MONICA study and included 434 participants aged 80 years or older. EFs were assessed with the Frontal Assessment Battery (FAB) and FoF with the Falls Self-Efficacy Scale–International (FES-I). Multivariable linear regression analysis was used to examine associations among EF, FoF, and a comprehensive set of adjustment factors. Pearson correlation analysis was used to evaluate associations of FES-I and the subitems of the FAB.

Results: EFs as measured by FAB were inversely associated with FoF (β = -0.23; 95% confidence interval, -0.42 to -0.03; p = 0.021), even after comprehensive adjustments. The FAB subitems measuring lexical fluency, inhibitory control, sustained attention, self-organization, motor programming, and planning also were inversely associated with FoF.

Conclusions: Lower EF is associated with higher FoF among people aged 80 years or older. This information is important for treating and preventing FoF in this population.

Background: Falls among older adults are a significant public health issue due to their high incidence, severe consequences, and substantial economic impact. Exercise programs incorporating balance and functional exercises have been shown to reduce fall rates, but adherence and scaling up the interventions remain challenges. Digital technology offers a promising avenue to deliver this type of exercise, potentially improving exercise adherence and enabling self-management of exercise in the aging population.

Objective: This study aims to assess the effectiveness of the Safe Step app, a self-managed, unsupervised, home-based digital exercise program, in reducing fall rates or fall risk in community-dwelling older adults. Additional aims were to describe fall-related injuries in both the exercise and control groups, study attrition, and adherence to the Safe Step exercise program.

Methods: Community-dwelling individuals, aged 70 years or older, who had experienced falls or a decline in balance in the past year were randomized to either an exercise group using the Safe Step app combined with educational videos, or a control group receiving educational videos alone. Both interventions lasted for 1 year. Information regarding fall events was self-reported monthly through questionnaires. Exercise adherence was monitored through questionnaires every third month. Negative binomial and logistic regression estimated the incidence rate ratio of fall rate and the risk ratio (RR) of experiencing falls, respectively. Fall-related injuries, study attrition, and exercise adherence were reported descriptively. Results: In total, 1628 people were enrolled in the study, 79% were women, and the mean age was 75.8 (SD 4.4) years (range 70-94 years). The intention-to-treat analysis showed no significant difference in fall rates between the exercise and control groups after 12 months (2.21 falls per person-year in the exercise group and 2.41 in the control group; incidence rate ratio 0.92, 95% CI 0.76-1.11; P=.37). The risk of experiencing at least 1 fall was significantly lower (11%) in the exercise group compared to the control group (53% vs 59.6%; RR 0.89, 95% CI 0.80-0.99; P=.03). No differences were observed regarding the risk of 2 or more falls (34.1% in the exercise group, 37.1% in the control group; RR 0.92, 95% CI 0.79-1.06; P=.23). Injurious fall rates were similar between the exercise and control group. During the trial, 161 (20%) participants from the exercise group and 63 (8%) from the control group formally withdrew. The proportion of exercise group participants meeting the 90-minute weekly exercise goal was 12.7%, 13.4%, 8.6%, and 9.1% at 3, 6, 9, and 12 months, respectively.

Conclusions: Access to a self-managed unsupervised digital exercise program can be an effective component of a primary fall prevention strategy for community-dwelling older adults. Further research is needed to explore the mediating factors that influence the outcomes and develop strategies that enhance adherence for optimal impact in this population.

Background: Identifying cognitive impairment at an early stage is important to enable preventive treatment and lifestyle changes. As gait deviations precede cognitive impairment, the aim of this study was to investigate if step parameters during different Timed Up and Go (TUG) conditions could discriminate between people with different cognitive ability.

Methods: Participants (N = 304) were divided into the following groups: (1) controls, n = 50, mean age:73, 44% women; (2) Subjective cognitive Impairment (SCI), n = 71, mean age:67, 45% women; (3) Mild Cognitive Impairment (MCI), n = 126, mean age: 73, 42% women; and (4) dementia disorders, n = 57, mean age: 78, 51% women. Participants conducted TUG and two motor-cognitive TUG-conditions: TUG while naming animals (TUGdt-NA) and reciting months in reverse order (TUGdt-MB). Tests were video recorded for data extraction of valid spatiotemporal parameters: step length, step width, step duration, single step duration and double step duration. Step length was investigated with the step length/body height ratio (step length divided by body height). Logistic regression models (adjusted for age, sex and education) investigated associations between step parameters and dichotomous variables of groups adjacent in cognitive ability: dementia disorders vs. MCI, MCI vs. SCI, and SCI vs. controls. Results were presented as standardized odds ratios (sORs), with 95% confidence intervals (CI95) and p-values (significance level: p < 0.05). The areas under the Receiver Operating Characteristic curves were presented for the step parameters/conditions with the highest sORs and, where relevant, optimal cutoff values were calculated.

Results: Step length showed greatest overall ability to significantly discriminate between adjacent groups (sOR ≤. 67, CI95:.45-.99, p = ≤. 047) during all group comparisons/conditions except three. The highest sOR for step-length was obtained when discriminating between SCI vs controls during TUGdt-MB (sOR =.51, CI95:.29-.87, p =.014), whereby the area under the curve was calculated (c-statistics =.700). The optimal cut-off indicated a step length of less than 32.9% (CI95 = 22.1–43.0) of body height to identify SCI compared with controls.

Conclusions: The results indicate that step length may be important to assess during TUG, for discrimination between groups with different cognitive ability; and that the presented cut-off has potential to aid early detection of cognitive impairment.

Trial registration number: NCT05893524 (retrospectively registered 08/06/23).

Background: Physical activity and exercise are promoted worldwide as effective interventions for healthy ageing. Various exercise initiatives have been developed and evaluated for their efficacy and effectiveness among older populations. However, a deeper understanding of participants’ experiences with these initiatives is crucial to foster long-term activity and exercise among older persons.

Methods: A constructivist grounded theory study was conducted to explore the experiences of older persons participating in a supervised group supramaximal high-intensity training (HIT) programme. Four focus groups were held, involving 28 persons aged 65 to 78. The focus groups were analysed inductively, followed by an iterative process of abstraction, abduction, and theory generation using a constant comparative method. A conceptual framework comprising three theoretical concepts—stereotype embodiment, ageist practices, and self-efficacy—was employed during the abductive phase as an analytical lens.

Results: The core category of our grounded theory, Negotiating a physically active life in tune with ageing, encapsulates the complex processes and actions influencing older persons as they engage in physical activities in their daily lives and in relation to HIT. This core category was created from the conceptual framework and the four categories: Grit in the moment and overall life, Empowered by the training group, Navigating one’s physically active self, and Committing to exercise for duty and pleasure. Participants reported feeling invigorated by the exercise, enjoying the challenge, and valuing the group setup for its social connectedness and structure. The generated theory illustrates how participants’ engagement with physical activity and exercise is shaped by various perspectives accumulated over their lifespan. The findings provide a plausible explanation of how participation in HIT groups can challenge negative age stereotypes and ageist practices while enhancing self-efficacy for high-intensity exercise.

Conclusions: Our grounded theory underscores that physical activity and exercise should be regarded as multifaceted processes, which must be considered when promoting physical activity initiatives for older persons. By considering the older person and societal norms and values, we can gather knowledge to design physical exercise interventions that are not only effective but also enjoyable and capable of transforming how individuals perceive themselves as exercising persons.

Physical exercise shows positive effects on cognitive functions such as working memory (WM) for older adults; however, large individual differences in response exist and the underlying mechanisms are not well understood. We tested the hypothesis that exercise-induced changes in cardiorespiratory fitness and leg strength would improve WM-related brain activity, which subsequently would improve WM performance. This study was based on the Umeå HIT study, a randomized controlled trial assessing the effects of watt-controlled supramaximal high-intensity interval training (HIT) versus moderate-intensity training for nonexercising older adults (N=68). A subsample (n=43, 66 to 79 years, 56% females) underwent task-based functional magnetic resonance imaging, testing WM. The outcomes of interest were change in WM performance, WM task activation, cardiorespiratory fitness, and leg strength. For WM performance, we found no significant between-group difference in change; however, there was a significant within-group increase for HIT in WM composites. For HIT, changes in leg strength significantly predicted increased right dorsolateral prefrontal cortex activation, which in turn predicted improved in-scanner WM task performance. Cardiorespiratory fitness did not predict WM-related functional change. These results indicate a specific physiological ingredient, namely leg strength gains, that is a potential mechanism in exercise-induced prefrontal activation and WM performance increases.

This analysis of secondary outcomes investigated the applicability of supramaximal high-intensity interval training (HIT) with individually prescribed external intensity performed on stationary bicycles. Sixty-eight participants with a median (min; max) age of 69 (66; 79), at the time not engaged in regular exercise were randomized to 25 twice-weekly sessions of supramaximal HIT (20-min session with 10 × 6-s intervals) or moderate-intensity training (MIT, 40-min session with 3 × 8-min intervals). The primary aim was outcomes on applicability regarding; adherence to prescribed external interval intensity, participant reported positive and negative events, ratings of perceived exertion (RPE 6–20), and affective state (Feeling Scale, FS -5–5). A secondary aim was to investigate change in exercise-related self-efficacy (Exercise Self-Efficacy Scale) and motivation (Behavioural Regulations in Exercise Questionnaire-2). Total adherence to the prescribed external interval intensity was [median (min; max)] 89 % (56; 100 %) in supramaximal HIT, and 100 % (95; 100 %) in MIT. The supramaximal HIT group reported 60 % of the positive (112 of 186) and 36 % of the negative (52 of 146) events. At the end of the training period, the median (min; max) session RPE was 15 (12; 17) for supramaximal HIT and 14 (9; 15) for MIT. As for FS, the median last within-session rating was 3 (−1; 5) for supramaximal HIT and 3 (1; 5) for MIT. Exercise-related motivation increased (mean difference in Relative Autonomy Index score = 1.54, 95 % CI [0.69; 2.40]), while self-efficacy did not change (mean difference = 0.55, 95 % CI [-0.75; 1.82]), regardless of group. This study provide support for supramaximal HIT in supervised group settings for older adults.

Falls are the most common cause of injury in older people, with consequences for the individual and society. With an increasing population of older people, falls and related costs are expected to increase. It is crucial to identify scalable and cost-effective interventions and subsequently reduce fall-related costs. The aim was to evaluate the cost-effectiveness of the Safe Step digital fall preventive exercise intervention over a period of 12 years and, in addition, to evaluate the impact of increased recruitment cost and decreased intervention effect. The intervention was evaluated in an observational study in a municipality context targeting community-dwelling older people of age 70 +. A Markov model with five states was used to model the cost-effectiveness of the Safe Step intervention and evaluate quality-adjusted life years (QALYs) and fall-related costs from a societal perspective. By using data from a meta-analysis as basis for the estimated intervention effect, the Safe Step intervention was compared with a no-intervention alternative. The results showed that the Safe Step intervention dominated no intervention. In the sensitivity analysis with the most conservative estimate of intervention effect, the ICER was €7 616 per QALY gained. Hence, Safe Step showed to be a cost-saving fall preventive intervention in older people at risk of falling and potentially cost-effective even with a low estimated intervention effect. Future studies on efficacy of fall preventive digital interventions will contribute in precising effect estimates and enhance the validity of these cost-effectiveness results.