IMPLEMENTATION OF AN EVIDENCE-BASED, MULTIMODAL PHYSICAL ACTIVITY INTERVENTION FOR THE PREVENTION OF DEMENTIA IN LOCAL PRACTICE – GESTALT
Streber A., Rutten A.
Friedrich-Alexander-University Erlangen-Nuremberg, Institute of Sport Science and Sport, Germany
Relevance of the research. The promotion of physical activity is one of the key priorities of dementia prevention. Research results indicate that ongoing, lifelong, moderate-intensity physical exercise (Ahlskog et al., 2011) and varying leisure time activities (Podewils et al., 2005), as well as active and socially integrated lifestyles in late life (Fratiglioni et al., 2004), may have the potential to prevent dementia. The combination of physical with cognitive stimulation might provide complementary contributions necessary for improving brain functions (Hötting, Röder, 2013).
Based on these findings the program GESTALT – an evidence-based physical activity program for dementia prevention – aims at raising the quality and quantity of physical activities of participants (ages 65‒75) at risk of dementia. The same-named project GESTALT aimed to investigate if, and under which circumstances the GESTALT program could be implemented into and sustained in the daily routines of prevention providers and reach relevant target groups for dementia prevention.
Research methods and organization. The GESTALT project used a cooperative planning process (Rütten, Gelius, 2013) as a participatory method to bring together scientists, local policy makers, preventive services providers and (later) members of the target group to plan and carry out the GESTALT program. I. a. cognitive functions and physical activity were measured in a pre-post design with a follow up measurement after six months (Streber et al., 2014).
The GESTALT program included two accompanying modules: 1) exercise program and 2) telephone support (Rütten, 2011). Qualified physical activity instructors were trained to implement GESTALT and were given a written instructors manual. The six-month exercise program (twice a week, 90 minutes) was divided into three areas: “dance & move to music”, “sports & games” and “physical activity in daily routines ‒ walking”. All areas of the program systematically integrated cognitive aspects and emotional/social aspects into physical stimulation. The scientific project management implemented the telephone support. Coaching sessions occurred seven times. The focus of the coaching was to maintain physical activity after the completion of the intervention through supporting the integration of movement into the daily routines of participants as well as raising perceptions of possibilities to be physically active in their neighbourhoods.
Results and discussion. GESTALT was highly accepted by the participants (n = 75, 90 % had risk factors for dementia). 60 % of the participants were practicing additional physical activity at the time of follow-up (six months after the end of the intervention). There were improvements in cognitive performance with respect to short-term and working memory (Streber et al., 2014). With regard to the context, 14 local partners were recruited for cooperative planning. Out of those, 5 organizations implemented the GESTALT program and 4 providers decided to adapt and reoffer the program after the end of the 1st round of implementation. Due to participant request all 5 organizations implemented steady follow-up GESTALT offers. The cooperative planning group built partnerships that facilitated public relations activities and acquisition of political support, leading to sustainable funding under the responsibility of the municipality.
Conclusions. The GESTALT project – including the GESTALT program – was successfully piloted in Erlangen/Germany by FAU. The pilot study showed how systematically established cooperation between scientists and different stakeholders and institutions from prevention practice and policies (cooperative planning), lay the foundation for sustainable implementation of an evidence-based program for the prevention of dementia. Participants profited from the program through improvements in cognitive functions and physical activity levels.
