Breaking distance barriers for brain health

Associate Professor Dereck Salisbury sees focusing on exercise as key to reducing risk for Alzheimer’s disease.

One of the most important habits for reducing the risk of Alzheimer’s disease and related dementia (ADRD) is staying active, as exercise directly affects brain health and generally leads to better blood pressure, cholesterol and glucose levels.

For rural residents, the lack of facilities/equipment, travel and social support are barriers to participating in physical activity. At the same time, rural residents are at a higher risk for dementia and face barriers to accessing information, caregiving support and memory-related services.

The Minnesota Rehabilitation Intervention for Dementia Evasion (MN RIDE) pilot study conducted by Associate Professor Dereck Salisbury, PhD, FAACVPR, in partnership with the Center for Community Engaged Rural Dementia and Alzheimer’s Research and Memory Keepers Medical Discovery Team tested and assessed whether an online, real-time exercise program — delivered remotely — was practical and safe for people in rural areas who feel they are experiencing early memory problems.

“The pilot study provides the first evidence of preliminary feasibility of synchronous audiovisual, telerehabilitation programs delivered to rural residents at risk for ADRD,” says Salisbury. “Exercise telerehabilitation programs that focus on aerobic exercise could be viable and useful tools to overcome situations with limited access to health care services such as in rural communities.”

Memory Keepers Medical Discovery Team

MN RIDE was one of five pilot studies conducted through the Medical School’s Center for Community Engaged Rural Dementia and Alzheimer’s Research, in collaboration with the Memory Keepers Medical Discovery Team. The Memory Keepers Medical Discovery Team uses a community-based participatory research (CBPR) model, with a community advisory group, community-based researchers and a rural community engagement specialist to ensure research studies are aligned with rural community needs and to facilitate the recruitment of participants living in rural northern Minnesota. Salisbury was recruited to the Memory Keepers Medical Discovery Team because of his background in intervention science, particularly related to movement sciences and exercise.

“The success of the MN RIDE pilot speaks volumes to the CBPR model and the team that was there. That model is a great way to really make impact in our communities,” says Salisbury.

MN RIDE study

The MN RIDE study used a single group, pretest–post-test design to test the feasibility and safety the telerehabilitation program. All 36 aerobic exercise sessions, conducted over 12 weeks, were supervised remotely via smart devices and Zoom. 

“We tried to make it as barrier free as possible,” says Salisbury. Recumbent bikes were delivered directly to participants’ homes. Community-based researchers traveled to participants’ homes to complete baseline data collection, and the first session was completed with the community-based researcher present and an exercise interventionalist on Zoom. The remaining 35 sessions were conducted over Zoom, supervised by an exercise interventionist. After completing the program, community-based researchers completed data collection, and participants kept the bikes.

“Participants completed the entire screening process and intervention without ever leaving their house,” says Salisbury.

Expanding the pilot study to include education

Salisbury and his team, in collaboration with the Memory Keepers Medical Discovery Team, are gearing up to expand the pilot with a greater sample size. They’ve designed an aerobic exercise telerehabilitation program with more participants and a new component participants in the MN RIDE study asked for – more education.

“A key message we heard in interviews was that they wanted to know how to sustain exercise,” says Salisbury. “And given that this is Alzheimer’s related, they want to learn more about risk factors and behavior changes.” With that feedback, they created an enhanced program with 12 weeks of telerehabilitation, supervised over Zoom on a recumbent bike and included a bi-weekly education component. In total, it’s a nine-month study, with the first three months supervised and the remaining six months asynchronous. There are weekly check-ins with the interventionist to collect data and answer questions.

“I think the lifestyle side of things that I focus on is key. 40% of Alzheimer’s disease risk is related to potentially modifiable risk factors, like high blood pressure, diabetes and physical inactivity,” says Salisbury. “On the exercise side of things, obviously it tackles the physical inactivity piece, but it can also affect blood pressure, lipids, and glucose in a good way. Exercise is kind of like your poly-pill. It’s your blood pressure medication, your antiglycemic medication, your lipid medication all rolled into one.”