Preventing Loss of Independence through Exercise (PLIÉ): A Pilot Trial in Older Adults with Subjective Memory Decline and Mild Cognitive Impairment

Linda L Chao; Jennifer A Lee; Steven Martinez; Cody Barlow; Margaret A Chesney; Wolf E Mehling; Deborah E Barnes

doi:10.3233/JAD-210159

Preventing Loss of Independence through Exercise (PLIÉ): A Pilot Trial in Older Adults with Subjective Memory Decline and Mild Cognitive Impairment

J Alzheimers Dis. 2021;82(4):1543-1557. doi: 10.3233/JAD-210159.

Authors

Linda L Chao^{1

2

3}, Jennifer A Lee¹, Steven Martinez¹, Cody Barlow¹, Margaret A Chesney^{4

5}, Wolf E Mehling^{4

6}, Deborah E Barnes^{1

3

7}

Affiliations

¹ San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.
² Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA.
³ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.
⁴ Osher Center for Integrative Medicine, University of California, San Francisco, CA, USA.
⁵ Department of Medicine, University of California, San Francisco, CA, USA.
⁶ Department of Family and Community Medicine, University of California, San Francisco, CA, USA.
⁷ Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.

Abstract

Background: Preventing Loss of Independence through Exercise (PLIÉ) is a group movement program initially developed for people with mild-to-moderate dementia that integrates principles from several well-established traditions to specifically address the needs of people with cognitive impairment.

Objective: To investigate whether PLIÉ would benefit cognitive and behavioral outcomes and functional brain connectivity in older adults with milder forms of cognitive impairment.

Methods: Participants (≥55 y) with subjective memory decline (SMD) or mild cognitive impairment (MCI) were assessed with tests of cognitive and physical function, self-report questionnaires, and resting state functional magnetic resonance imaging (rs-fMRI) on a 3 Tesla scanner before and after participating in twice weekly PLIÉ classes for 12 weeks at the San Francisco Veterans Affairs Medical Center.

Results: Eighteen participants completed the pre-post intervention pilot trial. We observed significant improvements on the Alzheimer's Disease Assessment Scale cognitive subscale (ADAS-cog; effect size 0.34, p = 0.002) and enhanced functional connections between the medial prefrontal cortex (mPFC) and other nodes of the default mode network (DMN) after PLIÉ. Improvements (i.e., lower scores) on ADAS-cog were significantly correlated with enhanced functional connectivity between the mPFC and left lateral parietal cortex (Spearman's ρ= -0.74, p = 0.001) and between the mPFC and right hippocampus (Spearman's ρ= -0.83, p = 0.001). After completing PLIÉ, participants reported significant reductions in feelings of social isolation and improvements in well-being and interoceptive self-regulation.

Conclusion: These preliminary findings of post-PLIÉ improvements in DMN functional connectivity, cognition, interoceptive self-regulation, well-being and reduced feelings of social isolation warrant larger randomized, controlled trials of PLIÉ in older adults with SMD and MCI.

Keywords: Aging; cognitive dysfunction; exercise therapy; memory disorders; mild cognitive impairment; mind-body therapies; self-report.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Aged
Brain / pathology*
California
Cognitive Dysfunction* / psychology
Cognitive Dysfunction* / therapy
Exercise / psychology
Exercise Therapy*
Female
Humans
Image Processing, Computer-Assisted / statistics & numerical data*
Independent Living*
Magnetic Resonance Imaging
Male
Mind-Body Therapies
Neuropsychological Tests / statistics & numerical data
Pilot Projects
Self Report
Surveys and Questionnaires