Shellington Erin M, Felfeli Tina, Shigematsu Ryosuke, Gill Dawn P, Petrella Robert J
Faculty of Health Sciences, University of Western Ontario, London, ON, Canada.
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Mhealth. 2017 May 5;3:17. doi: 10.21037/mhealth.2017.04.05. eCollection 2017.
Exercise-based interventions have shown promise in slowing cognitive decline, however there is limited evidence for scalability. Our previous research has linked a novel visuospatial memory exercise intervention, incorporating patterned walking or square-stepping exercise (SSE) with significant improvements in executive function and memory among older adults with normal cognition as well as those with subjective cognitive complaints (SCC) and mild cognitive impairment (MCI). The aim of the current study was to determine the feasibility and utility of the HealthBrain smartphone app to deliver SSE outside the laboratory among older adults with and without cognitive impairment.
Previous healthy research subjects with and without SCC or MCI, who had previous exposure to SSE, and who owned or had access to an iPhone of iPad, were recruited to download the HealthBrain app and use it up to 3 weeks. There were no restrictions on the number of times subjects could use the app. A 15-question survey was developed to assess feasibility and utility of the HealthBrain app and completed online following the brief exposure period.
Of 135 people who were identified, 95 were contacted between September 2014 to August 2015, 27 downloaded the HealthBrain app on their iPhone or iPad from the App Store and 19 completed the questionnaire. Subjects (n=19) were an average age of 68.3±5.4; 74% female and had 15.5±2.8 years of education (84% post-secondary education), a mean Mini Mental State examination score of 29.1 (SD 1.2) out of 30 and Montreal Cognitive Assessment score of 26.3 (SD 1.9) out of 30. Subjects used the HealthBrain app 1-7 days per week, mostly at home. Of possible stages of progression, subjects mainly used the stage 1 and 2 beginner patterns. Subjects reported perceived and technical challenges registering horizontal step patterns associated with stage 2 and greater progression. Sixty percent found the app was easy to use or similar to what they experienced with SSE in the laboratory setting. Most said they would continue to use the HealthBrain app and would recommend it to friends and family.
The HealthBrain app was feasible in providing SSE to older adults with the appropriate smartphone device outside the laboratory setting. Challenges were identified with perceived capture of higher levels of SSE stages that used horizontal step patterns. This as well as technical issues with horizontal step patterns will be addressed by newer GPS technology in current smartphone devices. Most subjects stated they would continue to use the HealthBrain app and refer to their friends and family. We believe that our findings in a representative cohort support the HealthBrain app as a scalable intervention to promote cognitive health in older adults.
基于运动的干预措施在减缓认知衰退方面已显示出前景，但关于其可扩展性的证据有限。我们之前的研究将一种新颖的视觉空间记忆运动干预措施，即结合有图案的行走或方形步运动（SSE），与认知正常的老年人以及有主观认知抱怨（SCC）和轻度认知障碍（MCI）的老年人的执行功能和记忆的显著改善联系起来。本研究的目的是确定HealthBrain智能手机应用程序在有和没有认知障碍的老年人中在实验室外提供SSE的可行性和实用性。
招募之前接触过SSE、有或可以使用iPhone或iPad的有和没有SCC或MCI的健康研究对象，下载HealthBrain应用程序并使用长达3周。对受试者使用应用程序的次数没有限制。开发了一项包含15个问题的调查，以评估HealthBrain应用程序的可行性和实用性，并在短暂接触期后在线完成。
在确定的135人中，2014年9月至2015年8月期间联系了95人，其中27人从应用商店在其iPhone或iPad上下载了HealthBrain应用程序，19人完成了问卷调查。受试者（n = 19）的平均年龄为68.3±5.4岁；74%为女性，受教育年限为15.5±2.8年（84%为高等教育），简易精神状态检查表平均得分为29.1（标准差1.2）（满分30分），蒙特利尔认知评估量表得分为26.3（标准差1.9）（满分30分）。受试者每周使用HealthBrain应用程序1 - 7天，主要是在家中使用。在可能的进展阶段中，受试者主要使用第1和第2阶段的初学者模式。受试者报告了在记录与第2阶段及更高进展相关的水平步模式时存在感知和技术挑战。60%的人发现该应用程序易于使用或与他们在实验室环境中进行SSE的体验相似。大多数人表示他们会继续使用HealthBrain应用程序，并会推荐给朋友和家人。
HealthBrain应用程序在实验室外为配备适当智能手机设备的老年人提供SSE是可行的。在感知捕捉使用水平步模式的更高水平的SSE阶段方面发现了挑战。当前智能手机设备中更新的GPS技术将解决这一问题以及水平步模式的技术问题。大多数受试者表示他们会继续使用HealthBrain应用程序并推荐给朋友和家人。我们相信我们在一个代表性队列中的研究结果支持将HealthBrain应用程序作为一种可扩展的干预措施，以促进老年人的认知健康。
