TY - JOUR
T1 - An internet-based intervention augmented with a diet and physical activity consultation to decrease the risk of dementia in at-risk adults in a primary care setting
T2 - Pragmatic randomized controlled trial
AU - Anstey, Kaarin J.
AU - Cherbuin, Nicolas
AU - Kim, Sarang
AU - McMaster, Mitchell
AU - D'Este, Catherine
AU - Lautenschlager, Nicola
AU - Rebok, George
AU - McRae, Ian
AU - Torres, Susan J.
AU - Cox, Kay L.
AU - Pond, Constance Dimity
N1 - Funding Information:
The trial protocol for the BBL-GP study is published elsewhere [25]. Briefly, it is a three-arm, pragmatic, single-blind RCT to reduce the risk of cognitive decline in at-risk individuals attending a general practice. The study was conducted within the National Health Co-op (NHC), a bulk billing general practice (ie, patients’ general practitioner [GP] fees are fully funded by a universal health cover Medicare scheme) in Canberra, with 8 clinics drawn from low-and middle-income areas. Canberra has a cold climate and a slightly higher than average level of education compared with the national average in Australia [26]. It also has a lower rate of bulk billing primary care services than any other state or territory in Australia [27]. The NHC had an existing program called the LMP, to which practice physicians referred patients diagnosed with or at-risk of chronic health conditions. To integrate the trial into existing referral pathways at the clinics, the referral criteria for LMP were used as the trial eligibility criteria, and this was managed by the clinic’s LMP coordinator.
Funding Information:
The BBL-GP intervention is a 12-week program that includes (1) 8 web-based electronic learning modules on dementia literacy, risk factors, physical activity, nutrition, health condition management, cognitive activity, social activity, and mood and (2) tailored, face-to-face physical activity and nutrition sessions. BBL-GP participants were required to complete all 8 modules. The dementia literacy and risk factor modules were standardized across participants and were released at the rate of one per week after completion of the prior module, with the same timing for all participants. For the remaining modules, the content was tailored to participants’ individual risk profiles as indicated by the baseline Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF; described below). The tailoring algorithms are included in Multimedia Appendix 1. These modules were also released at the rate of one per week, which was the same for all participants. The same exercise physiologist and 3 dietitians conducted all face-to-face sessions for the BBL-GP participants. The dietitians and exercise physiologist were all staff members within the NHC, but their services for this project were funded by a research grant. Participants at baseline who had unintentional weight loss or weight gain (±5 kg) or scored low on the Australian Recommended Food Score were seen by one of the dietitians (1-hour face-to-face) [25] and reviewed via phone at weeks 4, 12, and 20. Each participant received a single exercise physiology session that involved an evaluation of their current exercise level, fitness, and any preexisting health conditions and the design of a personal exercise program. Although follow-up via phone was planned, this was not conducted. The content of the dietitian’s session was dietary education and advice to assist the participant in adapting their diet to a healthy diet in areas that were identified as unhealthy in the dietary questionnaire. Diet and exercise physiologist sessions varied depending on the participants’ clinical needs and baseline measures. All sessions related to the BBL-GP were provided free of charge to the participants.
Funding Information:
This work was supported by the National Health and Medical Research Council Centre of Research Excellence in Cognitive Health Grant #1100579; KA was funded by the NHMRC Fellowship #1102694, and the development of BBL-GP was funded by the NHMRC Dementia Collaborative Research Centres. This latter funding source had no role in the design, execution, analyses, interpretation of the data, or decision to submit results. The authors would like to thank the NHC and the study participants.
Funding Information:
KA is an adviser for the StaySharp Platform, which is supported by the American Association of Retired Persons. DP has been on the advisory Board for Nutricia, which manufactures a nutritional drink to support early Alzheimers Disease. DP also received payment from a range of primary care providers including Primary Health Networks and the Mental Health Professionals Network, for providing education about dementia. DP also served on the "Silver Book" and "Red Book" advisory boards for the RACGP which provide advice about dementia prevention and management. There are no other declarations of interest.
PY - 2020/9
Y1 - 2020/9
N2 - Background: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. Objective: This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. Methods: A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician–led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). Results: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means −3.86, 95% CI −6.81 to −0.90, P=.01; week 18: difference in means −4.05, 95% CI −6.81 to −1.28, P<.001; week 36: difference in means −4.99, 95% CI −8.04 to −1.94, P<.001; and week 62: difference in means −4.62, 95% CI −7.62 to −1.62, P<.001). Conclusions: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results.
AB - Background: There is a need to develop interventions to reduce the risk of dementia in the community by addressing lifestyle factors and chronic diseases over the adult life course. Objective: This study aims to evaluate a multidomain dementia risk reduction intervention, Body Brain Life in General Practice (BBL-GP), targeting at-risk adults in primary care. Methods: A pragmatic, parallel, three-arm randomized trial involving 125 adults aged 18 years or older (86/125, 68.8% female) with a BMI of ≥25 kg/m2 or a chronic health condition recruited from general practices was conducted. The arms included (1) BBL-GP, a web-based intervention augmented with an in-person diet and physical activity consultation; (2) a single clinician–led group, Lifestyle Modification Program (LMP); and (3) a web-based control. The primary outcome was the Australian National University Alzheimer Disease Risk Index Short Form (ANU-ADRI-SF). Results: Baseline assessments were conducted on 128 participants. A total of 125 participants were randomized to 3 groups (BBL-GP=42, LMP=41, and control=42). At immediate, week 18, week 36, and week 62 follow-ups, the completion rates were 43% (18/42), 57% (24/42), 48% (20/42), and 48% (20/42), respectively, for the BBL-GP group; 71% (29/41), 68% (28/41), 68% (28/41), and 51% (21/41), respectively, for the LMP group; and 62% (26/42), 69% (29/42), 60% (25/42), and 60% (25/42), respectively, for the control group. The primary outcome of the ANU-ADRI-SF score was lower for the BBL-GP group than the control group at all follow-ups. These comparisons were all significant at the 5% level for estimates adjusted for baseline differences (immediate: difference in means −3.86, 95% CI −6.81 to −0.90, P=.01; week 18: difference in means −4.05, 95% CI −6.81 to −1.28, P<.001; week 36: difference in means −4.99, 95% CI −8.04 to −1.94, P<.001; and week 62: difference in means −4.62, 95% CI −7.62 to −1.62, P<.001). Conclusions: A web-based multidomain dementia risk reduction program augmented with allied health consultations administered within the general practice context can reduce dementia risk exposure for at least 15 months. This study was limited by a small sample size, and replication on a larger sample with longer follow-up will strengthen the results.
KW - Dementia prevention & control
KW - Pragmatic clinical trial
KW - Prevention
KW - Primary care
KW - Primary prevention
KW - Risk reduction behavior
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U2 - 10.2196/19431
DO - 10.2196/19431
M3 - Article
C2 - 32969833
AN - SCOPUS:85091662031
VL - 22
JO - Journal of Medical Internet Research
JF - Journal of Medical Internet Research
SN - 1439-4456
IS - 9
M1 - e19431
ER -