This study determined the effectiveness of a 12-week cycle of Ruesi Dadton (RSD) among older adults with mild cognitive impairment (MCI), for improving cognitive and physical performance. Seventy-six participants were included and were divided equally into two groups. A group performed RSD exercise for 60 min, 3 times/wk for 12 weeks, and the control group did not perform RSD exercise. The primary endpoint was cognitive function, as assessed by the Montreal cognitive assessment (MoCA), Mini-Mental State Examination, verbal fluency (VF) test, and trail making test parts A and B (TMT-A and TMT-B). The secondary endpoints were the Timed Up and Go (TUG) test, handgrip, and gait speed results, which were used to evaluate the physical function. There were significant differences in the TMT-B and handgrip scores (
Mild cognitive impairment (MCI) can be indicative of Alzheimer disease (AD) or other forms of dementia. During a follow-up of patients with MCI, progression of MCI to dementia occurred in 29% of participants, of which 81% was thought to be caused by underlying AD (
Molecular inflammation leading to functional decline and pathological aging such as that accompanying dementia can be modulated by calorie restriction and exercise (
Mind-body exercises are beneficial to persons with MCI (
This randomized controlled trial blinded assessors into RSD and control groups.
The participants were recruited at Huadon Health Promoting Hospital, Ubon Ratchathani Province, Thailand, between June and July 2020. A total of 274 individuals aged 50–80 years were included and grouped according to their ability to read and write (
A sample size program was used to calculate the number of participants using T statistics to generate the following two-tailed values: α=0.05; β=0.2; q1=0.5; q0=0.500; E=0.66; and S=1 (
A random allocation of participants in each group was operated by randomized block sizes stratified for age and years of formal education. The first criterion for stratification was advanced age because of its association with MCI (
This trial adopted a single-blinded assessment owing to the nature of experimental protocol; thus, the participants were aware of their group allocation. The data were collected by assessors who were blinded to the group allocation; group numbers were not indicated on participant forms.
Eligible participants were enrolled in the study after screening, and baseline characteristics were recorded. Before the intervention, both groups were provided with information regarding MCI and dementia prevention by the neurologist. The RSD group participated in 2 days of RSD exercise practice; afterward, they started performing RSD exercise using an instruction video for 12 weeks (60 min/session, 3 times/wk). Two Thai medicine instructors led RSD practices for over a period of 2 days; the first day involved breathing exercises and movement corrections, while the second day emphasised deep breathing and breath-holding with slow movements while performing RSD. The researcher (PK) thoroughly supervised the said program. The video included 15 postures with 10 repetitions for each posture according to the performance guidelines of the Thai Ministry of Public Health (
The RSD interventions were conducted after completion of all measurements at baseline. RSD videos, exercise models before a class, supervisor guidance, and 2–4 supervisor assistants were involved in the morning program between 8:00 and 10:00 a.m.
The MoCA and MMSE global cognitive tests were used for screening; individuals with MCI with scores of ≥24 and <25 were asked to participate in the study (
Balance, strength, and speed were measured using the Timed Up and Go (TUG) test, digital hand dynamometer (EH101; Camry, Guangdong, China), and walking speed, respectively, and were analyzed to determine physical function. The TUG test was used to evaluate agility and dynamic balance from sitting to standing, walking a distance of 3 m, turning around, and sitting in the same place. To measure handgrip strength, the participants sat face-to-face with the physical therapist and flexed their elbows at 90° with mild wrist extension in a neutral position. The participants were subsequently instructed to squeeze the handle of the dynamometer for 5 sec and, followed by a 2-min rest. Walking speed was measured using a 10-m normal walking speed (NWS) and 5-m high walking speed (HWS) tests conducted by three assessors (an instructor, a timer, and a signal starter).
Data were analyzed using IBM SPSS Statistics ver. 24.0 (IBM Co., Armonk, NY, USA). Descriptive statistics of the frequency, percentage, mean, and standard deviation were used to analyze the data of the RSD and control groups. Comparisons of differences between the groups were performed using chi-square and Fisher exact tests for nominal scales, and the Mann–Whitney
Seventy-one (RSD group, n=35; control group, n=36) participants were assessed during the analysis. Significant differences were not observed in terms of age, education, BMI, waist circumference, occupation, and illness history of the participants; however, sex was significant (
MoCA scores were significantly improved in both the RSD and control groups at
When the results between the two groups were compared, significant differences in TMT-B (
Changes in the MoCA scores based on the physical function were evaluated (
This study suggests that a 12-week RSD exercise program can induce significant improvements in physical function and reduce cognitive decline. The duration of this study was based on the suggestion of the World Health Organization that older adults (≥65 years) should perform at least 150 min of moderate exercise every week (
For cognition, evaluation of the MoCA scores indicated significant improvements in both groups; this can be attributed to various factors. For example, some MoCA questions (such as subtract 7 from 100) were difficult to answer for a few individuals. Another reason was high sensitivity of the questionnaire, which may have increased the scores (
RSD exercise can induce as much improvement in cognition, and executive and memory functions as shown by any other mind-body intervention. The results of the TUG, handgrip strength, and gait speed tests had varying consistency that depended on the duration, movement, posture, and intensity of the mind-body intervention. The TUG test showed significant improvements in the RSD group but not in the control group (
Significant differences in handgrip strength between individuals with and without decline in cognitive function have been observed. Our data showed a significant decrease in the control group but not in the RSD group, and found a significant difference in strength between the groups. These results were similar to those of a previous study on Tai Chi (
For gait speed, the 5-m HWS score could possibly may be a more of a sensitive detector than the 10-m NWS score because as no significant decrease in the 5-m HWS score was found in the RSD group and while a significant decrease with a medium ES was detected in the control group. Our results were consistent with those of
In conclusion, RSD, or traditional Thai exercise, has the potential to improve cognitive function and physical performance and reduce the risk of cognitive decline associated with any type of dementia, especially MCI. To the best of our knowledge, this is the first randomized controlled study on the effects of RSD exercise on individuals with MCI, that also examined cognitive and physical functions.
There were several limitations to this study. First, there was no screening for temporary MCI diagnoses, such as vitamin D and thyroid deficiency testing. Second, we could not limit confounding factors such as ADL and occupational activity performed by both groups. One participant in the control group experienced improvements in all parameters because of changes in behaviour (improved diet and increased exercise) upon being diagnosed with hypertension. Finally, there were limitations to the quality and quantity of mind-body exercise, particularly RSD exercise, performed by individuals with MCI. This study provides preliminary evidence that RSD exercise may be relevant in the prevention of cognitive decline, particularly for complex tasks, in the context of MCI. Furthermore, RSD exercise might lead to improvements in memory, balance, and speed; however, a larger study is required to confirm these results.
The authors wish to thank the Thai Traditional Medical Knowledge Fund and the Thai Ministry of Public Health for funding this study.
No potential conflict of interest to this article was reported.
Consort flow chart. RSD, Ruesi Dadton.
Baseline characteristics of participants who completed posttesting (N=71)
Characteristic | RSD (n=35) | Control (n=36) | |
---|---|---|---|
Age (yr) | 60.26±5.67 | 61.47±7.49 | 0.67 |
Female sex | 31 (88.57) | 25 (69.44) | 0.02 |
Primary school | 25 (71.43) | 21 (58.33) | 0.40 |
Weight (kg) | 54.63±6.58 | 56.14±6.67 | 0.19 |
BMI (kg/m2) | 23.08±2.28 | 23.40±2.31 | 0.56 |
Waist circumference (cm) | 81.87±7.52 | 82.89±5.36 | 0.86 |
Agriculture | 23 (65.71) | 24 (66.67) | 0.59 |
Chronic diseases | 15 (42.86) | 12 (33.33) | 0.40 |
MMSE | 26.91±1.85 | 26.19±1.67 | 0.06 |
Values are presented as mean±standard deviation or number (%).
RSD, Ruesi Dadton; BMI, body mass index; MMSE, Mini-Mental State Examination.
Pre-post assessment
Variable | RSD (n=35) | Control (n=36) | ||||
---|---|---|---|---|---|---|
|
| |||||
Pre | Post | Effect size | Pre | Post | Effect size | |
Cognition | ||||||
MoCA | 20.31±3.31 |
22.09±3.47 |
0.503 | 18.50±2.92 |
19.33±2.77 |
0.367 |
VF test (n) | 17.03±3.75 | 19.51±4.03 |
0.517 | 16.28±4.02 | 17.28±2.99 | 0.265 |
TMT-A (sec) | 61.07±26.83 | 58.20±21.27 | 0.044 | 64.85±31.05 | 62.95±25.78 | 0.060 |
TMT-B (sec) | 174.14±84.24 | 133.11±69.60 |
0.710 | 191.67±118.07 | 172.61±83.88 | 0.633 |
| ||||||
Physical | ||||||
TUG test (sec) | 10.23±1.18 | 9.81±1.22 |
0.381 | 10.57±1.96 | 10.58±1.85 | 0.033 |
Handgrip (kg) | 26.08±5.49 | 26.18±5.64 | 0.006 | 27.35±7.59 | 25.71±7.79 |
0.322 |
5-m HWS (sec) | 3.65±0.43 | 3.72±0.54 | 0.103 | 3.68±0.59 | 3.81±0.44 |
0.395 |
10-m NWS (sec) | 8.88±0.84 | 7.88±0.94 |
0.838 | 8.99±1.21 | 7.98±1.02 |
0.973 |
Values are presented as mean±standard deviation.
RSD, Ruesi Dadton; MoCA, Montreal cognitive assessment; VF, verbal fluency; TMT-A, trail making test part A; TMT-B, trail making test part B; TUG, Timed Up and Go; HWS, high walking speed; NWS, normal walking speed.
Comparison of change scores
Variable | RSD (n=35) | Control (n=36) | Effect size | |
---|---|---|---|---|
Cognition | ||||
MoCA | 1.77±2.91 | 0.83±2.13 | 0.16 | 0.189 |
VF test (n) | 2.49±3.85 | 1.00±4.48 | 0.18 | 0.182 |
TMT-A (sec) | 2.86±24.53 | 1.61±21.69 | 0.95 | 0.009 |
TMT-B (sec) | 41.09±57.33 | 19.06±99.52 | 0.02 |
0.312 |
| ||||
Physical | ||||
TUG test (sec) | 0.42±1.11 | −0.01±1.28 | 0.25 | 0.157 |
Handgrip (kg) | 0.10±2.56 | −1.62±3.83 | 0.04 |
0.283 |
5-m HWS (sec) | −0.06±0.52 | −0.14±0.43 | 0.33 | 0.133 |
10-m NWS (sec) | 0.98±1.00 | 1.01±0.90 | 0.66 | 0.061 |
Values are presented as mean±standard deviation.
RSD, Ruesi Dadton; MoCA, Montreal cognitive assessment; VF, verbal fluency; TMT-A, trail making test part A; TMT-B, trail making test part B; TUG, Timed Up and Go; HWS, high walking speed; NWS, normal walking speed.
Correlation among changes in the Montreal cognitive assessment scores
Variable | RSD (n=35) | Control (n=36) | ||
---|---|---|---|---|
|
| |||
TUG test | −0.38 | 0.02 |
0.25 | 0.13 |
| ||||
Handgrip | −0.05 | 0.77 | −0.06 | 0.72 |
| ||||
5-m HWS | −0.14 | 0.41 | −0.02 | 0.87 |
| ||||
10-m NWS | −0.12 | 0.47 | −0.06 | 0.68 |
Comparisons were tested using Pearson correlation coefficient analysis.
RSD, Ruesi Dadton; TUG, Timed Up and Go; HWS, high walking speed; NWS, normal walking speed.