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BackgroundOlder adults, who are living in nursing homes that provide a high level of long-term nursing care, are characterized by multimorbidity and a high prevalence of dependency in activities of daily living. Results of recent studies indicate positive effects of structured exercise programs during long-term care for physical functioning, cognition, and psychosocial well-being. However, for frail elderly the evidence remains inconsistent. There are no evidence-based guidelines for exercises for nursing home residents that consider their individual deficits and capacities. Therefore, high-quality studies are required to examine the efficacy of exercise interventions for this multimorbid target group. The purpose of this study is to determine the feasibility and efficacy of a multicomponent exercise intervention for nursing home residents that aims to improve physical and cognitive functioning as well as quality of life.MethodsA two-arm single-blinded multicenter randomized controlled trial will be conducted, including 48 nursing homes in eight regions of Germany with an estimated sample size of 1120 individuals. Participants will be randomly assigned to either a training or a waiting time control group. For a period of 16 weeks the training group will meet twice a week for group-based sessions (45–60 min each), which will contain exercises to improve physical functioning (strength, endurance, balance, flexibility) and cognitive-motor skills (dual-task). The intervention is organized as a progressive challenge which is successively adapted to the residents’ capacities. Physical functioning, cognitive performance, and quality of life will be assessed in both study groups at baseline (pre-test), after 16-weeks (post-treatment), and after 32-weeks (retention test, intervention group only).DiscussionThis study will provide information about the efficacy of a multicomponent exercise program in nursing homes (performance, recruitment). Results from this trial will contribute to the evidence of multicomponent exercises, which specifically focus on cognitive-motor approaches in the maintenance of mental and physical functioning. In addition, it will help to encourage older adults to actively engage in social life. Furthermore, the findings will lead to recommendations for health promotion interventions for frail nursing home residents.Trial registrationThe trial was prospectively registered at DRKS.de with the registration number DRKS00014957 on October 9, 2018.

Although several studies have shown that dual-tasking (DT) mobility is impaired in Alzheimer's disease, studies on the effects of DT conditions in probable Mild Cognitive Impairment (pMCI) have not yielded unequivocal results. The objectives of the study were to (1) examine the effect of a concurrent task on a complex walking task in adults with cognitive impairment; and (2) determine whether the effect varied with different difficulty levels of the concurrent task. Furthermore, the study was designed to evaluate the Trail-Walking Test (TWT) as a potential detection tool for MCI. We examined DT performance in 42 young adults (mean age 23.9 ± 1.98), and 43 older adults (mean age 68.2 ± 6.42). The MoCA was used to stratify the subjects into those with and without pMCI. DT was assessed using the TWT: participants completed 5 trials each of walking along a fixed pathway, stepping on targets with increasing sequential numbers (i.e., 1-2-…-15), and increasing sequential numbers and letters (i.e., 1-A-2-B-3-…-8). Motor and cognitive DT effects (DTE) were calculated for each task. ROC curves were used to distinguish younger and healthy older adults from older adults with pMCI. The TWT showed excellent test-retest reliability across all conditions and groups (ICC : 0.83–0.97). SEM% was also low (<11%) as was the MDC95% (<30%). Within the DT conditions, the pMCI group showed significantly longer durations for all tasks regardless of the cognitive load compared to the younger and the healthy older adults. The motor DTEs were greatest for the complex condition in older adults with pMCI more so than in comparison with younger and healthy older adults. ROC analyses confirmed that only the tasks with higher cognitive load could differentiate older adults with pMCI from controls (area under the curve >0.7, p < 0.05). The TWT is a reliable DT mobility measure in people with pMCI. However, the condition with high cognitive load is more sensitive than the condition with low cognitive load in identifying pMCI. The TWT-3 thus could serve as a screening tool for early detection of individuals with pMCI. Future studies need to determine the neural correlates for cognitive-motor interference in older adults with pMCI.

Background: Executive functions (EFs) not only play an important role in shaping adolescent's goal-directed, future-oriented cognitive skills under relatively abstract, non-affective conditions (Cool EF), but also under motivationally significant, affective conditions (Hot EF). Empirical evidence suggest a link between EF, exercise and physical activity, specifically elite adult athletes appear to outperform amateur athletes in Cool EF; however, no previous studies have examined the relationship between Hot and Cool EFs and impulsivity during the developmentally sensitive period of adolescence comparing different types of sport (open-vs. closed-skills), and levels (elite athletes vs. amateurs). Methods: A total 86 boys and girls between 13 and 15 years of age (mean: 14.0, SD: 0.79) from different sports (track-and-field; team handball) were recruited. Participants were further divided into two groups: (a) 40 elite, and (b) 46 amateur athletes. They completed four Cool EF tasks including Trail-Making Test, Trail-Walking-Test, Flanker task, n-back-task, and one Hot EF task on Game of Dice task. Data on subjective impulsivity (UPPS Impulsive Behavior Scale; Barratt Impulsiveness Scale-15) was also collected. Results: There was a significant overall effect for expertise in favor of elite athletes (Wilks' Lambda = 0.61, F(14,69) = 3.19, p = 0.001,η 2 p = 0.393), but no overall main effect for type of sport or an interaction for expertise by type of sport. Specifically, elite athletes showed significantly better performances on dual tasks. For Hot EF, there were no main effects for type of sport, expertise level, training experience or training duration. We also found positive correlations among Cool EF and impulsivity measures, and between Hot EF and Impulsivity, but no significant relationship between Cool and Hot EF. Conclusion: The current understanding of the decisive cognitive abilities does not correspond to sporting reality, so that the tests frequently used are not sensitive enough to distinguish between elite and amateur athletes or different sports. However, it should also be remembered that the factors underlying complex sporting performance are multidimensional and are obviously difficult to trace back to selected partial

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The evidence supporting the effects of age on the ability to coordinate a motor and a cognitive task show inconsistent results in children and adolescents, where the Dual-Task Effects (DTE) – if computed at all – range from either being lower or comparable or higher in younger children than in older children, adolescents and adults. A feasible reason for the variability in such findings is the wide range of cognitive tasks (and to some extend of motor tasks) used to study Cognitive-Motor Interference (CMI). Our study aims at determining the differences in CMI when performing cognitive tasks targeting different cognitive functions at varying walking pathways. 69 children and adolescents (boys, n = 45; girls, n = 24; mean age, 11.5 ± 1.50 years) completed higher-level executive function tasks (2-Back, Serial Subtraction, Auditory Stroop, Clock Task, TMT-B) in comparison to non-executive distracter tasks [Motor Response Task (MRT), TMT-A] to assess relative effects on gait during straight vs. repeated Change of Direction (COD) walking. DT during COD walking was assessed using the Trail-Walking-Test (TWT). The motor and cognitive DTE were calculated for each task. There were significant differences between 5th and 8th graders on single gait speed on the straight (p = 0.016) and the COD pathway (p = 0.023), but not on any of the DT conditions. The calculation of DTEs revealed that motor DTEs were lowest for the MRT and highest for the TWT in the numbers/letters condition (p < 0.05 for all comparisons). In contrast, there were cognitive benefits for the higher-order cognitive tasks on the straight pathways, but cognitive costs for both DT conditions on the COD pathway (p < 0.01 for all comparisons). Our findings demonstrate that DT changes in walking when completing a secondary task that involve higher-level cognition are attributable to more than low-level divided attention or motor response processes. These results specifically show the direct competition for higher-level executive function resources important for walking, and are in agreement with previous studies supporting the cognitive-motor link in relation to gait in children. This might be in line with the idea that younger children may not have adequate cognitive resources.

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IntroductionNursing staff is burdened by high workload and stress. Furthermore, heavy lifting, as well as transferring nursing home residents, cause lumbar tissue damage and back pain. Exercise intervention studies to reduce work-related problems are rare and the evidence for efficacy of studies among nurses is limited. Studies including targeted analysis of requirements are necessary to generate effective recommendations and tailored interventions for health promotion programmes. The purpose of this multicentred intervention study is to identify work-related problems, to implement health promotion programmes and to evaluate their effectiveness.Methods and analysisA randomised controlled trial will be conducted, including a total of 48 nursing home facilities in eight regions of Germany with an estimated sample size of 700 nurses. Standardised ergonomics and posture training (10 weeks, once a week for 20–30 min) and subsequently, back-fitness training (12 weeks, once a week for 45–60 min) will be administered. Following the implementation of standardised health promotion programmes, further demand-oriented interventions can be implemented. The perceived exposure to work-related demands, work-related pain in different parts of the body, health-related quality of life, perceived stress, work-related patterns of behaviour and experience, presentism behaviour, work environment as well as general needs and barriers to health promotion, will be assessed at baseline (pre-test), at 10 weeks (post-test, after ergonomics training), at 22 weeks (post-test, after back-fitness training) and at 34 weeks of the programme (follow-up).Ethics and disseminationThe study was reviewed and approved by the local ethics committee of the University of Hamburg (AZ: 2018_168). The results of the study will be published in open-access and international journals. Furthermore, the results will be presented in the participating nursing homes and at national and international conferences.Trial registration numberDRKS.de (DRKS00015241).