A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics

Andrew Pipingas; Karen J Murphy; Courtney R Davis; Catherine Itsiopoulos; Michael Kingsley; Andrew Scholey; Helen Macpherson; Leonie Segal; Jeff Breckon; Anne-Marie Minihane; Denny Meyer; Edward Ogden; Kathryn A Dyer; Emily Eversteyn; Roy J Hardman; Kaylass Poorun; Keri Justice; Maher Hana; Jonathan D Buckley; David White; Kade Davison; Jessie S Clark; Ella L Bracci; Greg Kennedy; MedWalk collaborative team

doi:10.3233/JAD-230641

A Mediterranean Diet and Walking Intervention to Reduce Cognitive Decline and Dementia Risk in Independently Living Older Australians: The MedWalk Randomized Controlled Trial Experimental Protocol, Including COVID-19 Related Modifications and Baseline Characteristics

J Alzheimers Dis. 2023;96(1):409-427. doi: 10.3233/JAD-230641.

Authors

Andrew Pipingas¹, Karen J Murphy², Courtney R Davis², Catherine Itsiopoulos³, Michael Kingsley^{4

5}, Andrew Scholey^{1

6}, Helen Macpherson⁷, Leonie Segal⁸, Jeff Breckon⁹, Anne-Marie Minihane¹⁰, Denny Meyer¹, Edward Ogden¹, Kathryn A Dyer², Emily Eversteyn¹, Roy J Hardman¹, Kaylass Poorun¹, Keri Justice¹, Maher Hana¹, Jonathan D Buckley², David White¹, Kade Davison², Jessie S Clark², Ella L Bracci², Greg Kennedy¹; MedWalk collaborative team

Affiliations

¹ Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia.
² Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance & UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.
³ School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC, Australia.
⁴ Department of Exercise Sciences, The University of Auckland, Newmarket, New Zealand.
⁵ Holsworth Research Initiative, La Trobe University, Bendigo, VIC, Australia.
⁶ Nutrition Dietetics and Food, School of Clinical Sciences, Monash University, Notting Hill, VIC, Australia.
⁷ School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia.
⁸ Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.
⁹ School of Health and Life Sciences, Teesside University, Middlesbrough, UK.
¹⁰ Norwich Medical School, University of East Anglia, Norwich, UK.

Abstract

Background: Several clinical trials have examined diet and physical activity lifestyle changes as mitigation strategies for risk factors linked to cognitive decline and dementias such as Alzheimer's disease. However, the ability to modify these behaviors longer term, to impact cognitive health has remained elusive.

Objective: The MedWalk trial's primary aim is to investigate whether longer-term adherence to a Mediterranean-style diet and regular walking, delivered through motivational interviewing and cognitive-behavioral therapy (MI-CBT), can reduce age-associated cognitive decline and other dementia risk factors in older, independently living individuals without cognitive impairment.

Methods: MedWalk, a one-year cluster-randomized controlled trial across two Australian states, recruited 60-90-year-old people from independent living retirement villages and the wider community. Participants were assigned to either the MedWalk intervention or a control group (maintaining their usual diet and physical activity). The primary outcome is 12-month change in visual memory and learning assessed from errors on the Paired Associates Learning Task of the Cambridge Neuropsychological Test Automated Battery. Secondary outcomes include cognition, mood, cardiovascular function, biomarkers related to nutrient status and cognitive decline, MI-CBT effectiveness, Mediterranean diet adherence, physical activity, quality of life, cost-effectiveness, and health economic evaluation.Progress and Discussion:Although COVID-19 impacts over two years necessitated a reduced timeline and sample size, MedWalk retains sufficient power to address its aims and hypotheses. Baseline testing has been completed with 157 participants, who will be followed over 12 months. If successful, MedWalk will inform interventions that could substantially reduce dementia incidence and ameliorate cognitive decline in the community.

Trial registration: Registered on the Australia New Zealand Clinical Trials Registry ANZCTR 12620000978965 (https://www.anzctr.org.au).

Keywords: Alzheimer’s disease; Mediterranean diet; cardiovascular; cluster-randomized clinical trial; cognition; cognitive behavioral therapy; dementia; exercise; mood; motivational interviewing; physical activity.

Publication types

Clinical Trial Protocol
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Australia / epidemiology
COVID-19*
Cognition
Cognitive Dysfunction* / epidemiology
Cognitive Dysfunction* / prevention & control
Dementia* / epidemiology
Dementia* / prevention & control
Diet, Mediterranean*
Humans
Quality of Life
Randomized Controlled Trials as Topic
Walking

Associated data

ANZCTR/ACTRN12620000978965