Reducing Sedentary Time in Patients With Mild Cognitive Impairment: The Take a STAND for Health Study

Reducing Sedentary Time in Patients With Mild Cognitive Impairment: The Take a STAND for Health Study

Reducing Sedentary Time in Patients With Mild Cognitive Impairment: The Take a STAND for Health Study TS4H-MCI

This research program aims to comprehensively investigate the clinical, physiological, metabolic, and molecular effects of reducing sedentary behavior in patients with mild cognitive impairment. A 4-month parallel-group randomized controlled trial will be conducted aiming to investigate the feasibility and efficacy of a newly developed personalized intervention focused on replacing sedentary time with light-(or very light-) intensity physical activity in patients with mild cognitive impairment. Additionally, a sub-sample of patients will complete a randomised cross-over study aiming to unravel potential mechanisms underlying the metabolic, physiological and molecular effects of breaking up sedentary time with light-intensity physical activity versus carrying out the minimum amount of daily exercise at once and then remaining sedentary versus simply remaining sedentary throughout all sessions, in a well-controlled laboratorial condition.

A 4-month parallel-group randomised controlled trial will be performed, in which patients with mild cognitive impairment will be assessed at baseline (PRE) and after 4 months (POST). Moreover, a sub-sample of patients will perform a randomised crossover trial at baseline (PRE). Patients will complete three experimental sessions in a random manner, as follows: Prolonged sitting (SIT), in which participants engaged in prolonged sitting throughout an 5-h period and were instructed to minimize excessive movement; Exercise followed by prolonged sitting (EX), in which participants performed a 30-min moderate-to-vigorous exercise bout on a treadmill, subsequently, participants engaged in prolonged sitting as described for SIT; Light-intensity breaks (BR), in which participants completed a 3-min bout of light-intensity walking every 30 min of sitting throughout the experimental period.

A newly developed personalized intervention focused on replacing sedentary time with light-(or very light-) intensity physical activity

The control group will receive regular medical care and advice on healthy lifestyle, including physical activity and healthy eating recommendations

The Take a STAND for health is a newly developed 4-month goal-setting intervention aimed at reducing sedentary behavior

Questionnaire to be completed by the patient. Final score 0 to 30, lower scores indicate worse cognitive performance

Cognitive decline assessed by the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE)

Questionnaire to be completed by the caregiver. 26 Likert scale questions. Higher scores indicate worse cognitive performance

Questionnaire to be completed by the patient and the caregiver. Final scores classify memory complaints as absent, mild, moderate or accentuated

Functional impairments in activities of daily living assessed by the Functional Activities Questionnaire (FAQ)

Questionnaire to be completed by the caregiver. Final score 0 to 30, higher scores indicate greater functional dependency

Questionnaire to be completed by the patient. Final score 0 to 20, higher scores indicate greater anxiety symptoms

Questionnaire to be completed by the patient. Final score 0 to 15, higher scores indicate greater depression symptoms

Reliable online system that assesses verbal learning capacity, executive function, processing speed, attention capacity, reaction time, and operational memory. Final score will be generated automatically by the system

The following sequences will be obtained: 1 - sagittal 3D T1; 2 - axial T2 fast spin echo (FSE); 3 - axial fluid-attenuated inversion recovery (FLAIR); 4 - coronal T2 spectral presaturation with inversion recovery (SPIR); 5 - coronal T2 aligned with hippocampus; 6 - SENSE diffusion

Positron emission computed tomography with 18F-fluordesoxyglucose (PET-18FDG) using the Biograph, CTI/Siemens, Knowville, EUA

Tomographic sections will be acquired for 15 minutes with a 256x256 matrix, zoom 2.5, resulting in pixels of size 1.04 mm (voxel of 1.04 mm3). The images will be reconstructed using the ordered subset expectation maximization (OSEM) iterative method, with six iterations and 16 subsets, and smoothed with a 5 mm Gaussian filter. The data will be corrected for scattering, attenuation and decay

Patients will wear a mask connected to a unidirectional valve with a Douglas bag (with 5% CO2). Evaluations will include: partial pressure of carbon dioxide at the end of expiration (PetO2, PetCO2) (Metalyzer model III b/breath-by-breath, CORTEX, Germany) and O2 saturation (SpO2; Nellcor, Medtronic Corporation, USA). Blood flow and diameter of the internal carotid artery will be assessed using a Doppler ultrasound (Logiq E, General Electric, Milwaukee, USA) connected to a linear transducer (12L-RS - 5.0-13.0 MHz). Cerebrovascular reactivity will be assessed by responses of arterial diameter, blood flow and shear rate to CO2 inhalation (reactivity = peak - baseline). A software with automatic detection of the artery walls will be used (Cardiovascular Suite, Quipu®, Pisa, Italy). Blood flow will be calculated (Flow = Vm x πr2 x 60). The shear rate will be calculated using the following formula: Shear rate = 8 x Vm / diameter

Patient will have three 5-second trials, with 1-minute interval between trials. Best score will be considered handgrip strength

Inclusion Criteria: Middle-aged and older adults with mild cognitive impairment confirmed by a team of neurologists from the CEREDIC HC-FMUSP Exclusion Criteria: Patients who spend less than 8 hours per day in sedentary time Patients who are physically active (more than 150 min/week of moderate physical activity, or more than 75 min/week of vigorous activity) Patients who are functional illiterates Patients with history or clinical diagnosis of neurological diseases Patients with severe psychiatric symptoms Patients taking antidepressants Patients with visual and/or hearing impairments that prevent participation