Home-based exercise training following ward-based rehabilitation in geriatric patients with cognitive impairment

INTERVENTION: Patients are randomly assigned to one of the two study groups (intervention group and control group): Intervention group: Patients take part in a standardized 12‐weeks home training program, including exercises to promote balance, strength and physical functioning (i.e., walking, stairs, sit‐to‐stand transfer) and the identification of individually‐tailored walking courses. The motivational approach of the study is based on the Theory of Planned Behavior, by providing knowledge about the benefits of physical activity, increasing patients’ self‐efficacy, setting individual goals, and encouraging patients to translate their intentions into behavioral changes (including the identification of potential barriers). Participants identify their individual abilities and their desire for improvements in: 1. Key motor qualifications (i.e., standing, walking, sit‐to‐stand transfer) 2. Indoor activities (i.e., bathing, house cleaning) 3. Outdoor activities (i.e., shopping, medical appointments, socializing). Subsequently, one or two individual goals are defined and implemented into the training intervention. The home training program is specifically‐tailored for elderly patients with mild to moderate cognitive impairments. It has been shown to be feasible and effective in multi‐morbid, frail older adults and includes six exercises covering balance and strength‐related aspects of motor performance. The exercises are explained and regularly reviewed by a sports scientist and illustrated at the patient’s home using a large poster. Also, pictures and a brief comprehensive description of key elements for each exercise are provided. Furthermore, participants in the intervention group will be encouraged to walk regularly. The sports scientist specifies a walking trail for each participant, including individual goals (i.e., going to a bakery or a supermarket). Participants and instructor specify when and where the walking exercises take place and who is available to assist (i.e., relat CONDITION: Moderate cognitive impairment ; Mental and Behavioural Disorders ; Moderate cognitive impairment PRIMARY OUTCOME: 1. Physical and functional performance is measured using the Short Physical Performance Battery and Timed Up & Go at baseline, 3 months and 6 months; 2. Physical activity (duration, intensity, and frequency of lying, sitting, standing, and walking) is be recorded using tri‐axial accelerometers for 48 consecutive hours at baseline, 3 months and 6 months INCLUSION CRITERIA: 1. Geriatric patients following ward‐based rehabilitation 2. Cognitive impairment defined as a Mini‐Mental State Examination (MMSE) score of 17‐26 3. Aged 65 years or over 4. Ability to independently walk 4 meters 5. Residence = 30 kilometers away from study center 6. No simultaneous participation in other studies 7. Telephone contact possible 8. Capacity to give written informed consent SECONDARY OUTCOME: 1. Life space is measured using a Global Positioning System device recording participants’ locations (Qstarz International Co., Ltd., Taiwan) over a period of 48 hours. Data registered include distance and time spent in various activities (i.e., walking, standing, in a vehicle). Subjects’ life space will also be measured with the UAB Study of Aging Life‐Space Assessment. The LSA will retrospectively assess the frequency of in‐ and outdoor activities over a period of one week at baseline, 3 months and 6 months; 2. Psycho‐social parameters are measured at baseline, 3 months and 6 months; 2.1. Fear of falling is measured using the short version of the falls efficacy scale (FES‐I); 2.2. Fall‐related activity avoidance is assessed using the Fear of Falling Avoidance‐Behavior Questionnaire (FFABQ); 2.3. Quality of life is measured using the EuroQol health status questionnaire (EQ‐5D); 2.4. Apathy is measured using the Apathy Evaluation Scale (AES); 2.5. Social support is assessed using the German questionnaire "Soziale Situation" developed by Nikolaus et al.; 3. Cognitive performance (i.e., working memory) is measured using a sub‐scale of the Wechsler Adult Intelligence Scale [WAIS] at at baseline, 3 months and 6 months; 4. Costs of the intervention are measured using the Questionnaire for Health‐Related Resource Use in an Elderly Population (FIMA) at baseline, 3 months and 6 months