# Neuromodulation for Exercise Adherence in Older Veterans

> **NIH VA I01** · CENTRAL ARKANSAS VETERANS HLTHCARE SYS · 2020 · —

## Abstract

Background: Fall-related hospitalizations and consequent morbidity and mortality continue to rise despite the
availability for over two decades of evidence-based fall-prevention programs. This is a major problem since
more than 2.5 million older adults are treated annually for fall-related injuries in the US. Fall-prevention
programs focusing on strength and balance exercises have been successful in facility settings but exercise
programs are ineffective at home due to lack of adherence. Estimates indicate that only 1 in 5 individuals
adhere to home exercise programs for fall prevention. Thus, there is an urgent need to improve adherence to
exercise performed at home by older adults seeking to improve balance for the sake of fall prevention.
Behavioral interventions have failed to consistently improve adherence to exercise. Biological reasons for poor
exercise adherence, such as executive dysfunction, have not been explored. Adherence to long-term exercise
is dependent on executive function (EF), which is controlled by the [dorsolateral prefrontal cortex (DLPFC)] of
the brain. EF influences choices in scheduling, forgoing competing activities, enduring subtle costs of time and
inconvenience, and the ability to delay gratification. Repetitive transcranial magnetic stimulation (rTMS) is a
non-invasive neuromodulation increasingly used for neural network specific interventions. rTMS of the DLPFC
improves EF, memory, motivation, and mental flexibility. rTMS studies to date have stimulated the motor cortex
for gait and balance improvements. The role of DLPFC in exercise adherence has not been explored. The
proposed study will be the first to test DLPFC stimulation for improving exercise adherence.
Objective: The study objective is to determine the effects of rTMS treatment of the dorsolateral prefrontal
cortex compared to sham on: [1. Short-term (2-wk) changes in executive function;] 2. Long-term (24-wk)
adherence to a home-based exercise program; 3. Long-term (24-wk) changes in balance and gait; and [4.
Short-term (2-wk) changes in self-efficacy and delay discounting.]
Methods: Sedentary community-dwelling older Veterans (age ≥ 65 years, [N=106]) will participate in a double-
blind randomized sham-controlled three-phase study. The proposed study will use Nintendo Wii-Fit exercises.
Phase I will include two weeks of facility-based exercise for safety assessment and learning the program,
followed by 12 weeks of home-based exercises. [Subjects with poor adherence and those with good
adherence with low EF] will then be randomized to rTMS or sham treatments. Phase II will include ten
consecutive weekdays of rTMS or sham treatment along with exercise training for subjects with poor
adherence [and for those with good adherence and low EF] and continuation of home-based exercises for
those with good adherence and EF. Phase III includes 24-weeks of a home-based exercise program. All
subjects will exercise for 45 minutes five days/week. [Objective measure of a...

## Key facts

- **NIH application ID:** 9910072
- **Project number:** 5I01RX002961-02
- **Recipient organization:** CENTRAL ARKANSAS VETERANS HLTHCARE SYS
- **Principal Investigator:** Kalpana P. Padala
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-04-01 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9910072

## Citation

> US National Institutes of Health, RePORTER application 9910072, Neuromodulation for Exercise Adherence in Older Veterans (5I01RX002961-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9910072. Licensed CC0.

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