Accepted for/Published in: JMIR Rehabilitation and Assistive Technologies
Date Submitted: May 13, 2024
Open Peer Review Period: May 13, 2024 - Jul 8, 2024
Date Accepted: Nov 12, 2024
(closed for review but you can still tweet)
The effect of the Mediterranean diet integrated GAmified HOme-based COgnitive-Nutritional (GAHOCON) training programme for older people with cognitive frailty: A pilot randomized controlled trial
ABSTRACT
Background:
Cognitive frailty is known to be associated with nutrition and cognitive training. However, effective treatments engaging older people with cognitive frailty to the Mediterranean diet and cognitive training are lacking.
Objective:
This study examined the feasibility and preliminary effects of GAHOCON on older people with cognitive frailty on Mediterranean diet knowledge, Mediterranean diet adherence, cognitive functions, physical frailty, grip strength, walking speed, memory, and body composition.
Methods:
This study employed a two-centred, assessor-blinded, two-parallel-group, non-inferiority, and randomized controlled trial. Eligible participants were those who were aged ≥60 years, were community-dwelling, lived with cognitive frailty, and had poor Mediterranean diet adherence. Eligible participants were randomly allocated to two groups in a 1:1 intervention-to-control group ratio. In the intervention group, participants received 4-week centre-based training (health education) and 8-week home-based training (GAHOCON). In the control group, participants only received 4-week centre-based training and 8-week self-revision of health educational materials at home. Participants’ time spent and levels of difficulty accomplished weekly on GACOCON were measured as feasibility markers during the intervention period. Outcomes included Mediterranean diet knowledge, Mediterranean diet adherence, cognitive functions, physical frailty, grip strength, walking speed, memory, and body composition. Data were collected at baseline (T0) and the week post-intervention (T1). Wilcoxon Signed Rank test was employed to examine the within-group effects for outcome variables of the two groups separately.
Results:
25 participants were recruited. 13 and 12 participants were allocated to the intervention and control groups respectively. The median accumulative minutes adhered to GAHOCON training increased from 117 minutes to 926 minutes. The median level of difficulty accomplished for Game 1 increased from level 14 to level 20, while that for Game 2 increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=-0.606, p=0.036). Significant improvements in Mediterranean diet adherence (r=-0.728, p=0.009), cognitive function (r=-0.752, p=0.007), and physical frailty (r=-0.668, p=0.016), and walking speed (r=-0.587, p=0.034) were observed in the intervention group but not in the control group.
Conclusions:
GAHOCON is feasible in engaging older people with cognitive frailty to attend the intervention regularly. Preliminary evidence also showed that it could retain Mediterranean diet knowledge after nutritional education, improve adherence to the Mediterranean diet, and improve global cognitive function, physical frailty, and walking speed. However, the difficulty of the later levels of Game 1 might be too high. Further studies should adjust the level of difficulty of Game 1. Trials with a large sample and a longer follow-up period are needed to confirm its effects. Clinical Trial: ClinicalTrials.gov ID: NCT05207930
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