Effects of movement music therapy with a percussion instrument on physical and frontal lobe function in older adults with mild cognitive impairment: a randomized controlled trial

Figures & data

Table 1. The cognitive function checklist in the health check section of the preventive care checklist.

1	Sometimes I get lost when I'm out	1. Yes	0. No
2	I have lost interest in things that I used to like or hobbies	1. Yes	0. No
3	I often forget where I put things and it troubles me	1. Yes	0. No
4	I sometimes have difficulty remembering recent events	1. Yes	0. No
5	I feel like I'm easily frustrated or my personality has changed (or I am told so)	1. Yes	0. No
6	Do people around you tell you, ‘You always ask the same thing’?	1. Yes	0. No
7	Do you look up phone numbers and make phone calls on your own?	0. Yes	0. No
8	Do you sometimes forget what month and day it is?	1. Yes	0. No

Note: MCI was defined as ≥1 affirmative answer (Petersen et al., 1999).

Figure 1. Flowchart showing enrollment, randomization, and data analysis of study participants.

Table 2. Schedule of the MMT exercise program using the Naruko clapper and the control exercise program.

	Objective and contents (MMT and STT)	MMT implementation	STT implementation
1) Greeting	Voice calling, recognition of partner, confirmation of participants	1. Participants and instructor greet each other	1. Participants and instructor greet each other
2) Warm-up (5 min)	1. Frictional stimulation of the palm Articulation of the upper extremities 2. Articulation and exchange motion of the upper limb 1) Elbow flexion exercise 2) Lifting and lowering of upper limbs 3) Tapping and body image:  a) back of hand  b) wrist to shoulder  c) shoulder  d) abdomen  e) front of lower limb  f) hip  g) rear of lower limb 3. Articulation of the upper extremities 1) Articular motion of the leg  a) right foot  b) left foot  c) both feet 2) Articulation and body image of finger 3) Flexion and extension movement of fingers and position recognition of fingers	1. The instructor encourages exercise to the rhythm of music. Songs include: a) Only one flower in the world (5 min) 2. Purpose of exercise: 1) Promote blood circulation 2) Stretch 3) Preparation of the mind gymnastics 4) Target group and instructor build a rapport by performing the same movement simultaneously with music	1. The instructor encourages exercise of the same kind as the MMT by calling out instructions (no music) Counting motions: ‘1, 2, 3, 4, 5, 6, 7, 8.’
3) Light exercise (15 min)	1. Fall prevention a) Sufficient bending of the thighs (abdominal muscles, reinforcement of the lumbar muscle; seated, lower limb elevation exercise, thigh lifting exercise) b) Sufficient bending of the ankle, dorsiflexion movement c) Reinforcement of the thigh, hamstrings, strengthening movement of the calves 2. Enhance flexibility a) Hip joint flexibility and quadriceps muscle (reinforcement of extended muscle group) b) Enhancement of flexibility of back and thigh flexor muscles c) Foreign shoulder prevention, improvement of range of shoulder joint movement 3. Muscle strengthening of lower body a) Prevention of back pain b) Gluteus maximus muscle strengthening 4. Light abdominal muscle 5. Other muscle strengthening movements a) Motility of the gluteal muscle b) Prevention of back pain c) Prevention of femoral neck fracture d) Inner adductor motion of thigh e) Reinforcement of inner thigh f) Reinforcement of groin area g) Bowleg prevention h) Pelvic correction	1. The instructor encourages exercise to background music. Songs include: a) Astro Boy (3 min) b) Boyhood (3 min) c) Seto's bride (3 min) d) Flamenco of the stars (3 min) e) Samba of ladybug (3 min) 2. Prevention of stumbling a) Sit lightly on the chair, toe up and down b) Apply the instep of the foot to the floor c) Fix the knee and pull the instep of the foot towards you d) Rotate the ankle 3. Enhance flexibility, frozen shoulder prevention: Front turn of the shoulder joint, back turn, arm turning 4. Muscle strengthening of lower body a) Go to the long position, move the floating left and right b) Walking in time with music 5. Light abdominal muscle a) Hold the front corner of the chair by the hand, while breathing out, close to the chest and knee at a time.  b) Roll up your back, increase strength such as on both sides. Low back pain attention 6. Other muscle strengthening movement 1) Motility of the gluteal muscle a) Stop holding onto the chair and pull back one foot b) Lift the legs at the back if possible 2) Inner adductor movement of thighs a) Set your knees with consciousness of your inner thighs. b) Hold the inner thigh with your hands and bring your knees inward while adding resistance. Aim of the exercises: To prevent falls, focusing on gymnastics to strengthen muscle strength of lower limbs. Movement does not necessarily match the tempo of the song so that the exercise intensity is up and the range of motion of the joint can be maximally extended.	1. The instructor encourages exercise by calling out instructions (no music) Counting motions: ‘1, 2, 3, 4, 5, 6, 7, 8.’ To prevent falls, focusing on gymnastics to strengthen muscles of lower limbs.
4) Main exercises (30 min)	Music movement using Naruko 1. Strengthening legs Reinforcement of quadriceps muscle (extensor muscle) 2. Balance of the body a) Muscular strength of the trunk (abdominal muscle, back muscles, lumbar muscle strengthening) b) Ankle strength (gastrocnemius, reinforcement of soleus muscle) 3. Prevention of stumbling a) Sufficient bending of the thighs b) Sufficient bending of the ankle, dorsiflexion movement c) Reinforcement of the thigh, hamstrings, strengthening movement of the calves 4. Strengthening flexibility a) Flexibility of the hip joint and reinforcement of the quadriceps muscle (extensor muscle) (large and open) b) Enhancement of flexibility of back and thigh flexor muscles c) Foreign shoulder prevention, shoulder joint movement range improvement 5. Light abdominal muscle 6. Balance movement (stand on one foot, hold for a long time) 7. Rhythm sense 8. Vocalization 9. Enhancement of leg strength a) Reinforcement of quadriceps muscle (extensor muscle) 10. Articulation of the upper limbs a) Circular motion of the forearm b) Flexion motion of elbow plus forearm rotation	1. The instructor goes out in advance. Participants have Naruko and play along with the music. Songs include: a) Yosakoi Icchorai Ondo (4 min) b) March of 365 steps (3 min) c) Hakodatenohito (3 min) d) Palm in the sun (3 min) e) Kiyoshi's Zundoko (4 min)	1. The instructor encourages exercise by calling out instructions (no music) Counting motions: ‘1, 2, 3, 4, 5, 6, 7, 8.’
5) Relaxation (10 min)	1. Gymnastics on the floor a) Lower limb extension/flexion b) Upper limb extension/flexion c) Human body stretching d) Shake the upper body to the left and right e) Close eyes, abdominal breathing f) Lower body massage	1. The instructor stands in front of the participants who sleep on mats (songs: Ombra Mines, Image 6, other healing music)	1. The instructor stands in front of the participants who sleep on mats (no music)

Figure 2. Measurement methods conducted during intervention (intervention and control groups were separated).

Figure 3. Research category and research period.

Figure 4. Regions measured with near-infrared spectroscopy (NIRS).

Figure 5. Specifying brain coordinate locations using NIRS-SPM.

Table 3. Participant characteristics.

	MMT	STT
Sex (n)
Male	6	1
Female	28	10
Analyzed participants	30	9
Age range (years)	65–84	65–82
Age (years ± SD)	74.90 ± 4.29	73.33 ± 7.31

Table 4. Results of physical function tests at baseline in the MMT and STT groups.

	MMT (n = 30)	STT (n = 9)	Student's t (p-value)
Age (years ± SD)	74.90 ± 4.29	73.33 ± 7.31	0.476
Attendance (no. of sessions)	12.23 ± 2.01	12.67 ± 1.50	0.622
	Before	Before
Body balance (one-leg standing eyes open) (s)	31.92 ± 20.66	42.38 ± 23.82	0.278
Flexibility (sit-and-reach test) (cm)	35.08 ± 8.31	34.00 ± 9.06	0.719
Gait (10 m walking speed) (s)	6.73± 1.16	6.19 ± 0.99	0.291
Muscle endurance (CS-30) (no. of times)	18.73± 2.57	18.33 ± 5.35	0.804
Muscle strength (right grip strength) (kg)	22.79 ± 5.84	18.17 ± 3.79	0.088
Functional mobility (timed Up & Go test) (s)	6.64 ± 1.18	6.24 ± 1.03	0.456
FAB score (each 3 point × 6 test) Total 18 points	14.90 ± 1.97	15.08 ± 1.94	0.905
Similarities (conceptualization)	2.90 ± 0.31	3.00 ± 0.00	0.433
Lexical fluency (mental flexibility)	2.27 ± 0.31	2.00 ± 0.89	0.416
Motor series (motor programming)	2.33 ± 0.80	2.83 ± 0.41	0.149
Conflicting instructions (sensitivity to interference)	2.63 ± 0.67	2.50 ± 0.84	0.671
Go-No Go (inhibitory control)	1.83 ± 0.91	2.00 ± 0.99	0.685
Prehension behavior (environmental autonomy)	2.97 ± 0.18	2.67 ± 0.52	0.204

Table 5. Results of physical function tests before and after interventions in each group (p < .05).

	MMT (n = 30)				STT (n = 9)
	Before	After	Paired-t (p-value^a)	Effect size (r)	Before	After	Paired-t (p-value^a)	Effect size (r)	ANOVA^c (p-value^b)	Effect size (r)
Body balance (one-leg standing eyes open) (s)	31.9 ± 20.7	39.0 ± 34.1	0.117	0.288	42.4 ± 23.8	22.7 ± 22.9	0.278	0.753	0.015	0.167
Flexibility (sit-and-reach test) (cm)	35.1 ± 8.31	36.1 ± 7.88	0.359	0.171	34.0 ± 9.06	35.9 ± 10.5	0.719	0.291	0.743	0.003
Gait (10 m walking speed) (s)	6.73 ± 1.16	6.11 ± 0.95	0.000	0.788	6.19 ± 0.99	5.93 ± 0.78	0.291	0.295	0.172	0.056
Muscle endurance (CS-30) (no. of times)	18.7 ± 2.57	20.8 ± 3.75	0.006	0.485	18.3 ± 5.35	20.2 ± 6.18	0.804	0.457	0.894	0.001
Muscle strength (right grip strength) (kg)	22.8 ± 5.84	23.7 ± 5.85	0.015	0.433	18.2 ± 3.79	18.5 ± 4.81	0.088	0.115	0.558	0.011
Functional mobility (timed Up & Go test) (s)	6.64 ± 1.18	6.16 ± 1.09	0.016	0.431	6.24 ± 1.03	6.33 ± 1.31	0.456	0.250	0.176	0.055
FAB score	14.9 ± 1.97	15.9 ± 1.66	0.008	0.459	15.1 ± 1.94	15.3 ± 1.16	0.084	0.649	0.805	0.002

^aValues before and after intervention were compared between the MMT and STT groups using paired t-tests.

^bDifferences in pre- and post-intervention values in relation to the presence/absence of MMT were examined by ANOVA.

^cAdjustment for multiple testing with the Bonferroni correction.

Figure 6. Brodmann area 10.

Table 6. Pre- and post-intervention results for the six subsets of the Frontal Assessment Battery in each group (p < .05).

	MMT (n = 30)				STT (n = 9)
	Before	After	Paired-t (p-value^a)	Effect size (r)	Before	After	Paired-t (p-value^a)	Effect size (r)	ANOVA^c (p-value^b)	Effect size (r)
Similarities (conceptualization)	2.90 ± 0.31	2.96 ± 0.18	0.326	0.183	42.4 ± 23.8	22.7 ± 22.8	0.278	0.753	0.015	0.167
Lexical fluency (mental flexibility)	2.27 ± 0.31	2.37 ± 0.18	0.557	0.110	34.0 ± 9.06	35.9 ± 10.5	0.719	0.291	0.743	0.003
Motor series (motor programming)	2.33± 0.80	2.73 ± 0.58	0.021	0.021	6.19 ± 0.99	5.93 ± 0.78	0.291	0.295	0.172	0.056
Conflicting instructions (sensitivity to interference)	2.63 ± 0.67	2.87 ± 0.43	0.070	0.330	18.3 ± 5.35	20.2 ± 6.18	0.804	0.457	0.894	0.001
Go-No Go (inhibitory control)	1.83 ± 0.91	1.87 ± 0.77	0.845	0.037	18.2 ± 3.79	18.5 ± 4.81	0.088	0.115	0.558	0.011
Prehension behavior (environmental autonomy)	2.97 ± 0.18	3.00 ± 0.00	0.326	0.183	6.24 ± 1.03	6.33 ± 1.31	0.456	0.250	0.176	0.055
FAB score	14.90 ± 1.97	15.87 ± 1.66	0.008	0.459	15.08 ± 1.94	15.25 ± 1.16	0.084	0.649	0.805	0.002

^aValues before and after intervention were compared between the MMT and STT groups using paired t-tests.

^bDifferences in the pre- and post-intervention values in relation to the presence/absence of MMT were examined by ANOVA.

^cAdjustment for multiple testing with the Bonferroni correction.

Table 7. Pre- and post-intervention differences in integral value (oxy-Hb^a) at channels in the left temporal region, i.e. task-related changes in the integral values of oxy-Hb concentrations (p < .05)

				MANOVA^b
	Channel	MMT (n = 30)	STT (n = 9)	F-value	p-value	Effect size (r)
Left temporal region	1	5.51 ± 4.81	9.15 ± 10.6	0.10	0.756	0.003
	2	1.66 ± 3.83	–6.72 ± 8.43	0.82	0.372	0.024
	7	1.08 ± 5.46	–9.64 ± 12.0	0.66	0.422	0.020
	8	7.61 ± 4.17	–1.77 ± 9.17	0.87	0.359	0.026
	20	12.5 ± 7.22	–0.15 ± 15.9	0.53	0.473	0.016
	27	6.13 ± 3.75	10.3 ± 8.23	0.22	0.645	0.007
	33	10.6 ± 5.50	–1.57 ± 12.1	0.83	0.368	0.025

^aTask-related changes in the integral values of oxy-Hb concentrations.

^bAdjustment for multiple testing with the Bonferroni correction.

Table 8. Pre- and post-intervention differences in integral value (oxy-Hb^a) at channels in the right temporal region (p < .05).

				MANOVA^b
	Channel	MMT (n = 30)	STT (n = 9)	F-value	p-value	Effect size (r)
Right temporal region	4	–0.43 ± 4.39	1.97± 9.65	0.05	0.822	0.002
	5	0.63 ± 3.69	10.2 ± 8.12	1.16	0.290	0.034
	12	3.78 ± 3.38	8.92 ± 7.44	0.40	0.534	0.012
	13	–8.09 ± 4.93	–19.7 ± 10.8	0.94	0.338	0.028
	19	–2.85 ± 3.39	–3.78 ± 7.45	0.01	0.909	0.000
	26	–2.19 ± 3.67	–0.24 ± 8.06	0.05	0.827	0.001
	32	1.48 ± 3.24	–7.00 ± 7.12	1.18	0.286	0.034

^aTask-related changes in the integral values of oxy-Hb concentrations.

^bAdjustment for multiple testing with the Bonferroni correction.

Table 9. Pre- and post-intervention differences in integral value (oxy-Hb^a) at channels in the frontal temporal region (p < .05).

				MANOVA^b
	Channel	MMT (n = 30)	STT (n = 9)	F-value	p-value	Effect size (r)
Frontal temporal region	14	8.15 ± 3.89	–7.76 ± 8.56	2.86	0.100	0.080
	22	4.25 ± 3.40	–14.9 ± 7.48	5.44	0.026	0.142
	24	3.17 ± 2.51	–10.5 ± 5.52	5.09	0.031	0.134
	25	3.75 ± 2.71	2.91 ± 5.96	0.02	0.899	0.000
	28	3.75 ± 3.82	–5.42 ± 8.40	0.99	0.328	0.029
	29	2.47 ± 2.16	–4.43 ± 4.74	1.76	0.194	0.051
	30	0.44 ± 2.70	–7.50 ± 5.94	1.48	0.232	0.043
	31	1.93± 2.45	2.56 ± 5.39	0.01	0.916	0.000
	34	6.42 ± 3.93	–5.72 ± 8.65	1.63	0.210	0.047
	35	3.94 ± 2.46	–1.01 ± 5.50	0.70	0.410	0.021
	36	–2.19 ± 3.01	–8.52 ± 6.66	0.75	0.393	0.022
	37	–1.11 ± 4.40	–0.88 ± 9.68	0.00	0.983	0.000
	38	1.59 ± 3.26	–7.65 ± 7.16	1.38	0.248	0.000
	39	–0.34 ± 3.24	–1.20 ± 7.12	0.01	0.913	0.000
	40	4.13± 3.62	3.66 ± 7.96	0.00	0.957	0.000

^aTask-related changes in the integral values of oxy-Hb concentrations.

^bAdjustment for multiple testing with the Bonferroni correction.

Figure 7. Pre- and post-intervention brain blood flow and correlations between channels in the MMT group (p < .05).

Figure 8. Pre- and post-intervention brain blood flow and correlations between channels in the STT group (p < .05).

Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G., & Kokmen, E. (1999). Mild cognitive impairment: Clinical characterization and outcome. Archives of Neurology, 56, 303–308. doi:10.1001/archneur.56.3.303

 PubMed Web of Science ®Google Scholar