title: Effects of exercise and horticultural intervention on the brain and mental health in older adults with depressive symptoms and memory problems: study protocol for a randomized controlled trial [UMIN000018547].
abstract: BACKGROUND
  Depressive symptoms and memory problems are significant risk factors for dementia. Exercise can reduce depressive symptoms and improve cognitive function in older people. In addition, the benefits of horticultural activity on physical and mental well-being have been demonstrated in people with dementia. Although evidence of such non-pharmacological interventions is mounting, no studies have examined whether physical exercise and horticultural activity exert a positive impact on brain and mental health (e.g., depressive symptoms) in non-demented older adults at high risk of cognitive impairment and depression. Therefore, we propose a randomized controlled trial to assess the efficacy and efficiency of physical exercise and horticultural activity in improving brain and mental health in community-dwelling older adults with memory problems and depressive symptoms.
  
  
  METHODS
  The 20-week randomized controlled trial will include 90 community-dwelling adults aged 65 years or older with memory problems and depressive symptoms. Participants will be randomized to one of three experiments: exercise, horticultural activity, or educational control group, using a 1:1:1 allocation ratio. The combined exercise program and horticultural activity program will consist of 20 weekly 90-minute sessions. Participants in the exercise group will practice aerobic exercise, muscle strength training, postural balance retraining, and dual-task training. The horticultural activity program will include crop-related activities, such as field cultivation, growing, and harvesting. Participants in the educational control group will attend two 90-minute educational classes during the 6-month trial period. Depressive symptoms and memory performance will be measured by the Geriatric Depression Scale-15, and the Logical Memory subtests of the Wechsler Memory Scale-Revised will be used to measure depressive symptoms and memory performance as primary outcomes, at baseline (prior to randomization), immediately following intervention (6 months from baseline), and 6 months after intervention. Hippocampal volume will be measured at baseline and immediately after intervention, using magnetic resonance imaging. Secondary outcomes will comprise cognitive function, including language, attention/executive performance, and processing speed; brain-derived neurotrophic-factor serum levels; and health-related quality of life.
  
  
  CONCLUSIONS
  This intervention study will determine the clinical importance and efficacy of physical exercise and horticultural activity as non-pharmacological interventions in community-dwelling older adults at high risk of poor brain and mental health.
  
  
  BACKGROUND
  UMIN000018547 ; registered 7 August 2015.
authors.affiliation: Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8551, Japan. makizako@ncgg.go.jp.
authors.forename: Hyuma
authors.initials: H
authors.lastname: Makizako
authors.affiliation: Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8551, Japan. k-tsutsu@ncgg.go.jp.
authors.forename: Kota
authors.initials: K
authors.lastname: Tsutsumimoto
authors.affiliation: Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8551, Japan. take-d@ncgg.go.jp.|Japan Society for the Promotion of Science, Kojimachi Business Center Building, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan. take-d@ncgg.go.jp.
authors.forename: Takehiko
authors.initials: T
authors.lastname: Doi
authors.affiliation: Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8551, Japan. ryo-h@ncgg.go.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Hotta
authors.affiliation: Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8551, Japan. sho-n@ncgg.go.jp.
authors.forename: Sho
authors.initials: S
authors.lastname: Nakakubo
authors.affiliation: Aging, Mobility, and Cognitive Neuroscience Laboratory, Djavad Mowafaghian Centre for Brain Health, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. teresa.ambrose@ubc.ca.
authors.forename: Teresa
authors.initials: T
authors.lastname: Liu-Ambrose
authors.affiliation: Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi, 474-8551, Japan. shimada@ncgg.go.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shimada
mesh_terms: D000339:Affect; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology*; D001921:Brain / Q000503:physiopathology*; D002985:Clinical Protocols; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D058611:Horticultural Therapy / Q000379:methods; D006801:Humans; D007564:Japan; D008297:Male; D008568:Memory; D008569:Memory Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008603:Mental Health; D053580:Muscle Strength; D009483:Neuropsychological Tests; D004856:Postural Balance; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012107:Research Design; D055070:Resistance Training; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome