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National audience; INTRODUCTION. Les déséquilibres glycémiques accompagnant le diabète de type 1 (DT1) peuvent conduire, au long terme, à un léger déclin des fonctions cognitives[1]. Chez les personnes non diabétiques, l’activité physique (AP) est reconnue pour ses effets bénéfiques au niveau cérébral, notamment via l’augmentation de facteurs neurotrophiques (facteur neurotrophique dérivé du cerveau, BDNF, et IGF-1). METHODOLOGIE. Chez 95 adultes DT1, des régressions multiples ascendantes ont été réalisées pour estimer les liens entre les performances à une batterie de tests cognitifs et le niveau habituel d’AP et de sédentarité (questionnaires IPAQ et MAQ) en tenant compte des concentrations sériques de BDNF et d’IGF-1 total (prélèvement sanguin) et des facteurs classiques pouvant influencer les fonctions cognitives (démographiques : âge, sexe, IMC, niveau d’éducation ; liés au DT1 : mode d’administration de l’insuline, glycémie du moment, HbA1c, nombre d’épisodes hypoglycémiques sévères durant la vie, âge du diagnostic du DT1, durée du diabète, complications micro/macrovasculaires). RESULTATS. Le niveau d’AP prédisait positivement la flexibilité mentale (performance au TMT B-A: B– 0,05 ; SE(B) 0,03 ; P=0.05 pour le MAQ, MET-h/sem et B– 0,001 ; SE(B) 0,00 ; P=0.018 pour l’IPAQ, MET-min/sem) et ce indépendamment des niveaux de sédentarité, de BDNF et d’IGF-1.Le niveau d’AP n’influençait pas les autres domaines cognitifs évalués (i.e., la vitesse de traitement et la recherche visuo-spatiale avec le TMT-A, la résistance aux interférences avec le Stroop, la mémoire spatiale avec le SMT, la mémoire de travail avec le OPSPAN). Les autres facteurs qui influençaient la plupart des domaines cognitifs étaient l’âge, le niveau d’éducation, le nombre d’épisodes hypoglycémiques sévères, et les complications macrovasculaires. CONCLUSION. L’association entre le niveau d’AP et la flexibilité mentale chez les adultes DT1 souligne l’importance de mettre en place des programmes d’AP, en vue de préserver les fonctions exécutives au long terme.

Background Clinical practice and randomized trials often have disparate aims, despite involving similar interventions. Attitudes and expectancies of practitioners influence patient outcomes, and there is growing emphasis on optimizing provider–patient relationships. In this study, we evaluated the experiences of licensed massage therapists involved in a randomized controlled clinical trial using qualitative methodology. Methods Seven massage therapists who were interventionists in a randomized controlled trial participated in structured interviews approximately 30 minutes in length. Interviews focused on their experiences and perceptions regarding aspects of the clinical trial, as well as recommendations for future trials. Transcribed interviews were analyzed for emergent topics and themes using standard qualitative methods. Results Six themes emerged. Therapists discussed 1) promoting the profession of massage therapy through research, 2) mixed views on using standardized protocols, 3) challenges of sham interventions, 4) participant response to the sham intervention, 5) views on scheduling and compensation, and 6) unanticipated benefits of participating in research. Conclusions Therapists largely appreciated the opportunity to promote massage through research. They demonstrated insight and understanding of the rationale for a clinical trial adhering to a standardized protocol. Evaluating the experiences and ideas of complementary and alternative medicine practitioners provides valuable insight that is relevant for the implementation and design of randomized trials.

Contains fulltext : 174222.pdf (Publisher’s version ) (Open Access) BACKGROUND: Exercise interventions to prevent dementia and delay cognitive decline have gained considerable attention in recent years. Human and animal studies have demonstrated that regular physical activity targets brain function by increasing cognitive reserve. There is also evidence of structural changes caused by exercise in preventing or delaying the genesis of neurodegeneration. Although initial studies indicate enhanced cognitive performance in patients with mild cognitive impairment (MCI) following an exercise intervention, little is known about the effect of an extensive, controlled and regular exercise regimen on the neuropathology of patients with MCI. This study aims to determine the effects of an extensive exercise programme on the progression of MCI. METHODS/DESIGN: This randomised controlled clinical intervention study will take place across three European sites. Seventy-five previously sedentary patients with a clinical diagnosis of MCI will be recruited at each site. Participants will be randomised to one of three groups. One group will receive a standardised 1-year extensive aerobic exercise intervention (3 units of 45 min/week). The second group will complete stretching and toning (non-aerobic) exercise (3 units of 45 min/week) and the third group will act as the control group. Change in all outcomes will be measured at baseline (T0), after six months (T1) and after 12 months (T2). The primary outcome, cognitive performance, will be determined by a neuropsychological test battery (CogState battery, Trail Making Test and Verbal fluency). Secondary outcomes include Montreal Cognitive Assessment (MoCA), cardiovascular fitness, physical activity, structural changes of the brain, quality of life measures and measures of frailty. Furthermore, outcome variables will be related to genetic variations on genes related to neurogenesis and epigenetic changes in these genes caused by the exercise intervention programme. DISCUSSION: The results will add new insights into the prevailing notion that exercise may slow the rate of cognitive decline in MCI. TRIAL REGISTRATION: ClinicalTrials.gov NCT02913053. 10 p.