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Running head: PROSPECTUS 1
Prospectus:
A study to measure the effects of fencing as an intervention in inducing neurocognitive plasticity
to improve cognitive function in elderly adults
Jonathan Riddle
Public Health - Epidemiology
Walden University
2016
Revised: August 30, 2016
PROSPECTUS 2
Prospectus:
A study to measure the effects of fencing as an intervention in inducing neurocognitive
plasticity to improve cognitive function in elderly adults
Problem Statement
In the United States, people 65 years or older are the fastest growing population. It has
been expected that beginning in the 1970 through 2030 that the amount of adults with mental and
behavioral health issues will indisputably multiply, which encompasses from anxiety to
depression (American Psychological Association, 2015), and as people age there will be a certain
range of deterioration in cognition that will occur, which comprises: diminished ability to
sustain focus, forgetfulness, and diminished problem solving capability (Life Extension, 2015;
Deary et al., 2009). While the benefits of physical activity on cognitive function has been well
documented (Colcombe, & Kramer, 2003), the study conducted by Taddei et al. (2012) showed
that older fencers demonstrated higher levels of executive function, and that open-skilled sports
such as fencing may contribute to a decreased age-related decline.
Fencing is an athletic, combative sport practiced by all ages (Granshaw, 2014) which is
based off swordplay, and involves three weapons: épée, foil, and saber. Typically a fencer will
choose one weapon to compete in, but a fencer can compete in all three (United State Fencing
Association, 2015). Swordplay or swordsmanship has been around for several millennia,
depictions of sword based sports were found in the tomb walls from ancient Egypt, while the
modern art of fencing started as a military exercise, along with the development of the fencing
master’s guilds which was established in the 1400’s, the sport evolved during the same century,
with the formation of the rules in the 1600’s (Yoffe, 2009), and it has been a continuous part of
the modern Olympics starting in 1896.
PROSPECTUS 3
Foil is normally the first weapon taught to beginners. The classes are taught in parts, and
depending on the instructor’s preference, footwork, and bladework is typically taught first with
each element building upon the other. Footwork consists of learning how to move forwards
(advancing) or backwards (retreating), along with other footwork techniques such as the balestra
or jump lunge. While bladework consists of learning how to move the blade either as an attack
on the opponent i.e. a thrust or coupé (cut-over), or an attack on the blade i.e. beating or as a
defense i.e. parry-riposte. Within the weapons of foil and saber there are rules of right way,
which determines who established an attack, versus épée which is a form of free fencing (United
States Fencing Association, 2015).
Fencing as an activity either for leisurely recreation, or for competition, which offers a lot
of health benefits (Sandoz, 1935). It has been described as physical chess, and according to
Jenkins (n.d.) editor of Breaking Muscle, that post-interview with Olympic silver medalist, Jason
Rogers, Rogers stated that fencing offers several physical health benefits which include:
improvements in coordination, agility, balance, flexibility, strength and cardio-fitness, while the
mental health benefits include: focus, eye-hand coordination, and problems solving (WebMD,
2014; Dale, 2010; Health Fitness Revolution, 2015).
Purpose
The study is an intervention that should improve mental cognition amongst ageing
adults, and this will comprise of studying and measuring the effects that fencing has had on the
cognition of ageing adults. The program would involve teaching an eight week fencing course
followed by another eight weeks of open fencing. Alternatively, a safer form of fencing would
include the use of foam swords, and plastic safety glasses.
PROSPECTUS 4
The participants will be given a pencil and paper cognitive test, along with reaction
timing tests, which will consist of discriminative reaction tasks, and simple reaction tasks that
involved stimuli displayed on a computer.
The design that is most highly probable to be utilized for the research study will be the
pretest-posttest design, which would contain randomization of one group receiving the
intervention (fencing group), while a different group would not receive the intervention (the
control group), in this case, one group would be taught fencing, followed by several months of
open fencing, while the other group would not participate. Utilizing statistical analysis, a pre-
test-post-test will be used as a determination, which will be established, and that will formulate
the significant effect of the intervention (Shuttleworth, 2009).
Background
The Centers for Disease Control and Prevention (2005) suggested that mental illness will
contribute a significant burden of disease globally, which will be around 450 million people who
suffer from mental disorders (World Health Organization, 2001).
Mental health is an essential part of health and well-being (WHO, 2001), and it is
multifactorial which comprises of genetics, nutrition and physical activity. Changes in
metabolism can influence mental health, and that it is dependent on the amount and type of the
physical activity, which subsequently can prevent mental health problems (CDC, 2005;
Simopoulos, 2005).
The World Health Organization (2015) announced that individuals over the age 65 should
integrate physical activity within their daily, family, and community life, and it should
PROSPECTUS 5
encompass a diversity of activities which include: leisure, transportation, job-related, household
duties, recreational games, play, or organized exercises.
It has been revealed that there is a significant association between physical activity and
mental status as suggested by Stephens (1988), this includes a gross sense of well-being, lowered
levels of anxiety, and depression, succeeding by a positive mood, and this has been displayed
regardless of socioeconomic status, or the physical health of younger and of older members of
both sexes, while this relationship was shown strongest with women, and individuals over the
age of 40. It has been denoted that physical activity may play a significant role in improving
mental health which includes reducing depression and anxiety (Paluska, & Schwenk, 2000).
Chan et al. (2011) examined fitness levels and executive functions among older adults,
and determined that fencers committed fewer errors than non-fencers, and that fitness and sports
training are associated with improved executive control, while the goal of the study was to better
understand the relationship between the collective effect of physical fitness, and sport experience
on cognitive capability. Previous studies have examined physical fitness and sports experience
independently, however the relationship between both phenomena have not been researched.
The study participants were required to perform simple reaction tasks which involved a
100 trials, there were five random interval delays to prevent anticipation, along with a line
pattern block that was used for the go/no-go task, which involved responding as quickly and
accurately as possible.
It has been noted by Kramer, and Erickson (2007) that exercise can induce
neurocognitive plasticity. A meta-analysis administered by Kramer, and Erickson (2007) which
entailed randomized design of aerobic fitness training, and controls, the researchers established
that fitness training had a positive influence on cognition. Within cognitive research there have
PROSPECTUS 6
been numerous types of studies conducted, which comprise human observational studies of
physical activity and exercise.
In addition to randomized clinical trials, and animal research which concentrated on
cellular and molecular mechanisms, the mechanism involving how physical activity raised
cognition in elderly adults that have a risk of dementia was not well-defined, nonetheless within
animal models it has been revealed that physical activity can accelerate angiogenesis, brain
perfusion, and neurovascular integrity inside of three to four weeks, while the animal models
decreased confounding of these kind of studies.
Kramer and Erickson (2007) had also inquired some significant questions about lifestyle,
and its effect on cognitive function in older adults. A central concept within this type of research
was that exercise prompted neurocognitive plasticity (Kramer, Erickson, & Colcombe, 2006).
As the population ages, it is elemental to understanding that lifestyle has an influence on
cognitive function, and that applying interventions to avert the risk of age-related neurological
disorders i.e. Alzheimer’s disease is critical. Kramer, and Erickson (2009) hypothesized that
physical activity and exercise may deliver cognitive protection, as well as improve cognitive and
brain function during the course of the adult lifespan.
And as an example of one of the mental health benefit of fencing, some research has
revealed that fencing and other sports that require rapid decision making improved cognition in a
wide range of ages. Taddei et al. (2012) presented that older fencers’ executive function
improved even though they were previously deteriorated by middle age. While the amount of
aerobic activity was only moderate, Taddei et al. (2012) verified that senior fencers displayed
heighten executive function enhancement although by middle age there was various levels of
PROSPECTUS 7
degeneration, however open-skilled sports such as fencing may have contributed to decreased
age-related decline as a result of improved afferent visual signaling.
Taddei et al. (2012) had the participants perform two tasks, a discriminative reaction task,
DRT and a simple reaction test, SRT. The discriminative reaction task involved using four
different configurations vertical and horizontal bars, two were target, and two were non-target.
The participants were required to press a key as quickly as possible for the target, while
withholding for the non-target. While the simple reaction test, the participant would react to any
of the targets, while electroencephalograms were performed.
Tsolakis, and Remoundou (2010) acknowledged the importance of understanding the
relationship between high cognitive function, and sports performance, he goes on to argue that
examining neurocognitive function in athletes is not a standard practice, that these assessments
are performed to better assess brain injuries, especially involving football. Their study compared
national level fencers with swimmers involving spatial rule detection, and in short term memory
task.
Tsolakis and Remoundou (2010) chose fencers because the sport is an interactive open
skilled activity, and that it is practiced individually. An important aspect of this study was the
type of tested used the spatial rule detection which included the Brixton Spatial Anticipation Test
(BSAT), and the Visual Patterns Test, which measured visual short term memory. They also
included an intelligence test as a part of study.
As a part of study design it will be critical to determine the types of test to be used by
participants, along with determining the types of participants to include in the study.
PROSPECTUS 8
Framework
Jin et al. (2015) pointed out the theoretical basis for performance as a variable was
established by Yerkes and Dodson (1908), also known as Yerkes and Dodson’s Law, in which
there is an optimal level of arousal or activation. This is shown as an inverted U, and that over-
activation, or under-activation of physiological stress would result in poor performance,
therefore in this case, it would cause a prolonged reaction time.
In this particular study, the researchers examined aerobic fitness, and intensity levels and
their impact on reaction time. It was noted that while exercising below maximum intensities
yielded positive cognitive function, and that at higher intensities yielded prolonged reaction
times. The authors also pointed out that in this study, performance did not follow Yerkes and
Dodson’s law.
An important aspect of cognitive research involves understanding the physiological
relationship between sensory input and motor organization which results in consciousness. This
relationship forms the basis in which cognition functions (Llinas et al., 1998).
The article by McMorris et al. (2016) examined the physiological basis between exercise
and cognitive interaction, while the practical application which would include measuring
catecholamine levels in participants, this may shed some light on how physiological changes can
improve reaction timing through the participation of open skilled sports.
Significance
The importance of this particular study is to see if open skilled sports (fencing) can
prevent or reduce the number of individuals suffering with dementia. Globally there are 47.5
million people afflicted with dementia, and there are 7.7 new cases per year, and it is a major
PROSPECTUS 9
contributor of disability and dependency among older adults (World Health Organizations,
2016).
While the goal in mind is to teach fencing to elder adults with dementia, there is the
individual cost, which if one calculate for equipment cost, it was around $1, 098 (Stewart, 2015),
which is a little high, but in the case of this particular intervention, the cost could be reduced to
$2.00 for the equipment cost per person.
Also using foam swords, and safety glasses should improve overall all safety for the
study. Most fencing actions translate well with foam swords. Although for this particular study
there is enough actual fencing equipment for class, however this was done for obvious practical
reasons ( it is also possible to order equipment from a Chinese supplier at very low cost as well).
Research Questions
Does fencing as a physical activity improve cognitive function in elderly adults, 65 years
or older that are residing in assisted living housing after 8 weeks of training plus 8 weeks of open
fencing?
Does fencing as a physical activity decrease depression or anxiety in elderly adults, 65
years or older that residing in assisted living housing after 8 weeks of training plus 8 weeks of
open fencing?
Does fencing as a physical activity improve cognitive function in non-athletic young
adults after 8 weeks of training plus 8 weeks of open fencing?
Does fencing as a physical activity decrease depression and anxiety in non-athletic young
adults after 8 weeks of training plus 8 weeks of open fencing?
PROSPECTUS 10
Nature of the Study
The study conducted Taddei et al. (2012) showed that there was a correlation between
fencing and improved cognition, this study used experienced older fencers as participants, the
planned study would involve adults who are experiencing mild cognitive dysfunction and to see
if learning and participant in fencing would improve their cognition.
The study by Huang et al. (2014) examined reaction time by comparing elderly adults
that participated in open sport like fencing versus closed sports such as biking which showed
improved neural efficiency.
While the interest of this study extends beyond public health, as both as a fencer and as a
fencing instructor, often it is asked what are some of the benefits in participating in fencing. It
would be more interesting than expounding upon the pleasure, and the fun of the sport, but rather
that what additional health benefits it offers such as improving how the brain performs tasks as
we age. While improved reaction times, the ability to make quick decisions can also impact a
person’s life in other ways, such as being able to drive later in life, which can affect quality of
life.
While this study will be utilize surveys, as well as questionnaires, it is most likely that
itwill use a paper based survey and questionnaire. An example of one of the questionnaires that
will probably be utilized includes the patient health questionnaire (PQH-9) (Pfizer, 1999) which
is a paper based questionnaire, along with online cognitive function test (Flynn, n.d.).
In additions to the questionnaire and surveys, study participants will also be required to
perform both simple reaction tasks, and go/no-go task (or discriminative reaction task) these will
measure the performance of executive function (Taddei et al., 2012; Chan et al., 2011).
PROSPECTUS 11
Possible Types and Sources of Data
With regard to the area of research and this particular dissertation topic, deciding upon an
appropriate method of analysis for both the dissertation research is critical, while there are other
additional methods which should be considered, and that could be appropriate and effective for
the research which will produce valid and reliable results, the most logical choice is the
ANCOVA, or analysis of covariance.
The statistical test that is being reviewed for the dissertation is the ANCOVA, while the
pre-test measurement is not a result, but a covariate, and that the dependent variable is post-test
measurement, while an ANOVA will be performed as well (Grace-Martin, 2016).
In this specific study pre-test and post-test of the discriminative research tasks, and the
simple reaction tasks will be measured, then a one-way ANOVA using the treatment as the only
factor (treatment vs. control), which will show if the treatments main effect was significant, then
the difference between pre-test and post-test will be examined as compared with the between
groups (gain score) (Becker, 2000).
Córdova et al. (2009) used an alternative to the ANCOVA which was used to control for
bias in learning a task. This might be critical in consideration of the nature of the task to be
taught. They also used an ANOVA (which will be used in this study) to compare groups, in this
case, Bonferroni’s multiple comparison test was done in order to identify relevant contrasts.
This study conducted by Kwok et al. (2011) utilized SPSS software v 15 (IBM Corp,
Somers, NY) was used for data analyses, along with independent sample t-tests were performed
to differentiate the pre-test scores (obtained in pre-test period) between CT and TE groups.
Paired sample t-tests were performed to compare the post-test scores with the pre-test scores in
each group.
PROSPECTUS 12
While the Analysis of covariance (ANCOVA) was utilize to compare the scores of the
Chinese Mini-Mental State Examination, or the CMMSE, the Chinese Dementia Rating Scale, or
the CDRS, and the Timed Up-and-Go test, or the TUG of the two groups post training, utilizing
the participants’ age and the pre-test scores as covariates. While these particular tests conducted
will probably not be used, similar test might be considered for the study.
PROSPECTUS 13
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PROSPECTUS 14
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PROSPECTUS 15
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PROSPECTUS 16
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PROSPECTUS 17
