Influence of combined physical and cognitive training on cognition: a systematic review

A Comparison of the Effects of Short-Term Physical and Combined Multi-Modal Training on Cognitive Functions

Physical training has beneficial effects not only on physical fitness, but also on cognitive functions. The most effective way to improve cognitive functions via physical training as well as the degree to which training effects transfer to untrained cognitive functions is still unclear, however. Here, we investigated the effects of adaptive and multi-modal short-term training interventions on cognitive training gains and transfer effects. Over a period of 12 weeks, 102 employees of a car manufacturing company (age range 20 to 61 years) received trainer-guided exercises, consisting of either two adaptive training interventions, physical (strength) training and multi-modal (motor-cognitive) training, or non-adaptive strength training (active control group). For the multi-modal intervention, the "Agility Board" was employed, a novel, multi-modal training device. Pre- and post-training, psychometric tests were conducted to measure cognitive abilities, such as perceptual speed, attention, short-term memory, working memory, inhibition, and mental rotation. In addition, motor-cognitive performance was assessed. Compared with the active control group, both training groups showed enhanced performance at posttest. While multi-modal training yielded performance improvements only in trained tasks, physical training was associated with improvements in untrained working memory updating and immediate recall tasks, suggesting transfer effects to short-term and working memory functioning. In summary, the results demonstrate the importance of adaptive difficulty settings for short-term physical training interventions, at least for the enhancement of working memory.

Impact of Motor-Cognitive Interventions on Selected Gait and Balance Outcomes in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

Efficient performance of most daily activities requires intact and simultaneous execution of motor and cognitive tasks. To mitigate age-related functional decline, various combinations of motor and cognitive training have shown promising results. The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy of different types of motor-cognitive training interventions (e.g., sequential and simultaneous) on selected functional outcomes in healthy older adults.

Methods

Six online academic databases were used to retrieve eligible RCTs up to April 2021, following PRISMA guidelines and PICO criteria. A random-effects model was used for all meta-analyses conducted on selected functional outcomes: single- and dual-task gait speed, the Timed Up and Go Test (TUG), and Berg Balance Scale (BBS) score. Effect size (ES) was calculated as Hedges' g and interpreted as: trivial: <0.20, small: 0.20–0.60, moderate: 0.61–1.20, large: 1.21–2.00, very large: 2.01–4.00 or extremely large >4.00.

Results

From 2,546 retrieved records, 91 RCTs were included for meta-analysis (n = 3,745 participants; 64.7–86.9 years). The motor-cognitive interventions included differed according to the type of training (e.g., sequential, simultaneous with additional cognitive task or exergame training. The results showed that motor-cognitive interventions can improve gait speed under single-task conditions (small ES = 0.34, P = 0.003). The effect of the intervention was moderated by the type of control group (Q = 6.203, P = 0.013): passive (moderate ES = 0.941, P = 0.001) vs. active controls (trivial ES = 0.153, P = 0.180). No significant effect was found for dual-task walking outcomes (P = 0.063). Motor-cognitive intervention had a positive effect on TUG (small ES = 0.42, P < 0.001), where the effect of intervention was moderated by control group [passive (moderate ES = 0.73, P = 0.001) vs. active (small ES = 0.20, P = 0.020)], but not by the type of training (P = 0.064). Finally, BBS scores were positively affected by motor-cognitive interventions (small ES = 0.59, P < 0.001) with however no significant differences between type of control group (P = 0.529) or intervention modality (P = 0.585).

Conclusions

This study provides evidence for the effectiveness of various types of motor-cognitive interventions on performance-based measures of functional mobility in healthy older adults. With respect to significant effects, gait speed under single-task condition was improved by motor-cognitive interventions, but the evidence shows that this type of intervention is not necessarily more beneficial than motor training alone. On the other hand, motor-cognitive interventions are better at improving multicomponent tasks of dynamic balance and mobility function, as measured by the TUG. Because of substantial heterogeneity and the current limited availability of different types of interventions, the conclusions should be interpreted with caution.

Enhance VR: A Multisensory Approach to Cognitive Training and Monitoring

Cognitive training systems aim to improve specific domains or global cognition by engaging users in cognitively demanding tasks. While screen-based applications can improve performance in the trained cognitive abilities, they are often criticized for their poor transferability to activities of daily living. These systems, however, exclude the user's body and motor skills, which invariably serves to restrict the user experience. Immersive Virtual Reality (IVR) systems, in contrast, present the user with body-related information, such as proprioceptive and visuomotor information, allowing for an immersive and embodied experience of the environment. This feature renders VR a very appealing tool for cognitive training and neurorehabilitation applications. We present Enhance VR, an IVR-based cognitive training and monitoring application that offers short daily cognitive workouts. The games are designed to train and monitor specific cognitive domains such as memory, task flexibility, information processing, orientation, attention, problem-solving, and motor control. The aim is to test whether cognitively demanding tasks, presented in an IVR setting, provide a naturalistic system to train and monitor cognitive capabilities.

Study protocol for 'the effects of multimodal training of cognitive and/or physical functions on cognition and physical fitness of older adults: a cluster randomized controlled trial'

Background

The elderly population worldwide is increasing exponentially which will be associated with more people suffering from cognition and fitness declines. The well-established benefits of exercise training for the elderly’s cognitive and physical functioning have been observed. However, the amalgamated effect of combining cognitive and physical exercises on the older adults’ cognitive functions, physical fitness, or psycho-related health remains unclear. Thus, this study protocol was planned to conduct different combinations of cognitive and/or physical training interventions to community-dwelling older adults and expected to see the multifaceted effects of the varied combination of training on their health.

Methods

This study is a cluster randomized controlled trial (CRCT). A total of 285 older adults (age ≥ 60) from twenty elderly centres as clusters will be randomly selected and assigned to intervention groups (IGs, n = 16) or control groups (CGs, n = 4). Each IG will be randomly assigned to one of the four combinations of three training modes that include cognitive (A), physical (B), and combined cognitive and physical training (CCPT, i.e. C), namely Mixed ABC, A + B, C + A, B + C. The intervention will last for 4 months in which the training is conducted for 16 sessions, 2 sessions per week, and 60 min per session. Four repeated assessments (pre-test, two post-training tests after 2 months and 4 months, and a follow-up test) will be conducted. The CG will only receive the four repeated assessments but no intervention. The outcome measures include cognitive tests (tests of execution, memory, and psych-social status), physical fitness, and dynamic balance tests.

Discussion

This study will provide substantial evidence that the integrated format of cognitive and physical exercises training will have higher cognition and fitness impact than the single training modes, and all these mixed modalities will have greater positive outcomes than the control condition. If the effectiveness is proven, the intervention can be further explored and extended to the nation so that many more elderly would be benefited.

Trial registration

The trial has been registered in the ClinicalTrials.gov in U.S. NIH (ID: NCT04727450, date: January 27, 2021).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03031-5.

Associations of Multidomain Interventions With Improvements in Cognition in Mild Cognitive Impairment: A Systematic Review and Meta-analysis

IMPORTANCE

Older adults with mild cognitive impairment (MCI) have the highest risk of progressing to dementia. Evidence suggests that nonpharmacological, single-domain interventions can prevent or delay progressive declines, but it is unclear whether greater cognitive benefits arise from multidomain interventions.

OBJECTIVE

To determine whether multidomain interventions, composed of 2 or more interventions, are associated with greater improvements in cognition among older adults with MCI than a single intervention on its own.

DATA SOURCES

MEDLINE, Embase, PsycInfo, AgeLine, CINAHL, and Cochrane Central Register of Controlled Trials were systematically searched from database inception to December 20, 2021.

STUDY SELECTION

Included studies contained (1) an MCI diagnosis; (2) nonpharmacological, multidomain interventions that were compared with a single active control; (3) older adults aged 65 years and older; and (4) randomized clinical trials.

DATA EXTRACTION AND SYNTHESIS

Data were screened and extracted by 3 independent reviewers. Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, random-effects meta-analyses were used to calculate effect sizes from the standardized mean difference (SMD) and 95% CIs.

MAIN OUTCOMES AND MEASURES

Postintervention cognitive test scores in 7 cognitive domains were compared between single-domain and multidomain groups. Exposure to the intervention was analyzed.

RESULTS

A total of 28 studies published between 2011 and 2021, including 2711 older adults with MCI, reported greater effect sizes in the multidomain group for global cognition (SMD, 0.41; 95% CI, 0.23-0.59; P < .001), executive function (SMD, 0.20; 95% CI, 0.04-0.36; P = .01), memory (SMD, 0.29; 95% CI, 0.14-0.45; P < .001), and verbal fluency (SMD, 0.30; 95% CI, 0.12-0.49; P = .001). The Mini-Mental State Examination (SMD, 0.40; 95% CI, 0.17-0.64; P < .001), category verbal fluency test (SMD, 0.34; 95% CI, 0.13-0.56; P = .002), Trail Making Test-B (SMD, 0.46; 95% CI, 0.13-0.80; P = .007), and Wechsler Memory Scale-Logical Memory I (SMD, 0.47; 95% CI, 0.15-0.80; P < .001) and II (SMD, 0.26; 95% CI, 0.07-0.45; P < .001) favored the multidomain group. Exposure to the intervention varied between studies: the mean (SD) duration was 71.3 (36.0) minutes for 19.8 (14.6) weeks with sessions taking place 2.5 (1.1) times per week, and all interventions lasted less than 1 year.

CONCLUSIONS AND RELEVANCE

In this study, short-term multidomain interventions (<1 year) were associated with improvements in global cognition, executive function, memory, and verbal fluency compared with single interventions in older adults with MCI.

Cognitive training program improves cognitive ability and daily living ability in elderly patients with mild cognitive impairment

BACKGROUND

Mild cognitive impairment (MCI) is a clinical syndrome of mild memory or other cognitive impairment without dementia and is a clinical transition state between normal aging and dementia. Careful and meticulous nursing intervention can improve the clinical symptoms of MCI and delay the progression of the disease.

AIMS

This research aimed to evaluate the efficacy of cognitive function training interventions in elderly patients with MCI.

METHODS

106 patients were randomized into the intervention group or the control group. They received conventional nursing intervention and those in the intervention group received additional cognitive training program for 6 weeks. The Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), activities of daily living (ADL) scales, and Barthel index (BI) were evaluated before and 6 weeks after the intervention, as well as the serum levels of S100β and neuron-specific enolase (NSE) at two time points.

RESULTS

After intervention, the MMSE scores and MoCA scores in both groups were significantly increased and the score in the intervention group was significantly higher. In the intervention group, the performance of conventional nursing intervention and cognitive training program significantly increased the scores of ADL and BI (p < 0.001). The serum levels of NSE and S100β in the intervention group were significantly lower.

DISCUSSION

The performance of cognitive training program alleviated the brain tissue damage in elderly patients with MCI.

CONCLUSIONS

The performance of cognitive training program in elderly patients with MCI improved their cognitive ability and daily living ability.

Effects of Exergames on Brain and Cognition in Older Adults: A Review Based on a New Categorization of Combined Training Intervention

The literature on exergames has reported inconsistent benefits on brain and cognitive functions. Moreover, it is still unknown whether they yield to equal or superior benefits as compared to other forms of physical exercise. However, until now, a review of exergaming literature was lacking, that would reverse the “product first” approach to replacing it with a “training first” approach that is, an analysis of the different studies based on a detailed description of the type of combined training interventions that was supported by the utilized exergames. In the present review, thanks to a structured framework build around seven interacting constructs (stimuli, settings, targets, markers, outcomes, moderators, and mechanisms), which collectively afford a global picture of the determining factors of exergames training, we aimed to determine whether and under which conditions exergames could be more effective than conventional training. Twenty three studies were finally selected for review and analyzed. We concluded that, in spite of their potential to improve brain and cognition, beneficial factors contributing to exergaming efficacy as well as its underlying mechanisms need to be investigated more systematically thanks to common experimental designs based on gold standards. We proposed some directions in this respect.

Acute Effect of a Simultaneous Exercise and Cognitive Task on Executive Functions and Prefrontal Cortex Oxygenation in Healthy Older Adults

The rapid increase in population aging and associated age-related cognitive decline requires identifying innovative and effective methods to prevent it. To manage this socio-economic challenge, physical, cognitive, and combined stimulations are proposed. The superiority of simultaneous training compared to passive control and physical training alone seems to be an efficient method, but very few studies assess the acute effect on executive function. This study aimed to investigate the acute effect of simultaneous physical and cognitive exercise on executive functions in healthy older adults, in comparison with either training alone. Seventeen healthy older adults performed three experimental conditions in randomized order: physical exercise, cognitive exercise, and simultaneous physical and cognitive exercise. The protocol involved a 30 min exercise duration at 60% of theoretical maximal heart rate or 30 min of cognitive exercise or both. Executive functions measured by the Stroop task and pre-frontal cortex oxygenation were assessed before and after the intervention. We found a main effect of time on executive function and all experimental condition seems to improve inhibition and flexibility scores (<0.05). We also found a decrease in cerebral oxygenation (Δ[HbO2]) in both hemispheres after each intervention in all cognitive performance assessed (p < 0.05). Simultaneous physical and cognitive exercise is as effective a method as either physical or cognitive exercise alone for improving executive function. The results of this study may have important clinical repercussions by allowing to optimize the interventions designed to maintain the cognitive health of older adults since simultaneous provide a time-efficient strategy to improve cognitive performance in older adults.

The Effects of Combined Cognitive-Physical Interventions on Cognitive Functioning in Healthy Older Adults: A Systematic Review and Multilevel Meta-Analysis

Research has shown that both physical exercise and cognitive training help to maintain cognition in older adults. The question is whether combined training might produce additive effects when the group comparisons are equated in terms of exercise intensity and modality. We conducted a systematic electronic search in MEDLINE, PsycInfo, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify relevant studies published up to February 2021. Seven hundred and eighty-three effect sizes were obtained from 50 published intervention studies, involving 6,164 healthy older adults, and submitted to a three-level meta-analysis. Results showed that combined training produced a small advantage in comparison to single cognitive training on executive functions, whereas both types of training achieved similar effects on attention, memory, language, processing speed, and global cognition. Combined training achieved higher training gains in balance than single physical training, indicating a transfer from cognitive training to balance. Performing cognitive and physical exercise simultaneously, and interactive training (e.g., exergames, square stepping) produced the largest gains in executive functions, speed, and global cognition, as well as the largest improvements in physical functions. Aerobic training was associated with higher effects in attention and fitness, whereas non-aerobic training produced larger effects in global cognition and balance. For all cognitive and physical outcomes, training resulted more advantageous when performed in a social context, even though individual training obtained similar results in balance as group training.

Systematic Review Registration:www.crd.york.ac.uk/prospero/, identifier: CRD42020175632.

The Impact of Exercise and Virtual Reality Executive Function Training on Cognition Among Heavy Drinking Veterans With Traumatic Brain Injury: A Pilot Feasibility Study

Executive function (EF) underlies self-control deficits in alcohol use disorder (AUD) and traumatic brain injury (TBI). Cognitive training is a promising adjunctive treatment targeting TBI- and AUD- related cognitive dysfunction. However, major limitations related to compliance and generalizability in the field of cognitive training exist. Physical activity is associated with enhanced cognitive performance across several executive functions and may enhance the benefits of cognitive training. Virtual reality provides multisensory embodied experiences which are likely to engage brain networks more efficiently than standard cognitive training systems, ultimately resulting in greater near- and far-transfer effects. This pilot study aimed to obtain feasibility data and a preliminary assessment of an enriched virtual reality (VR) EF training (EFT) intervention combined with exercise (NCT03786276). Using an 8-week randomized adaptive design study, 30 AUD treatment seeking U.S. Veterans completed nine sessions of exercise-only (n = 15) or gameplay control (n = 15) over 3 weeks, followed by a week-4 repeat assessment in Phase 1. Twenty-three participants completed and moved onto Phase II, where they completed up to nine sessions of VR-EFT plus exercise and completed a week-8 end-of-study assessment. Primary outcomes included feasibility to retain participants, usability, and satisfaction of using VR-EFT. Secondary and exploratory outcomes included within group assessment of change in cognitive function, alcohol use, alcohol craving, and post-concussive symptoms among the three treatment conditions.VR-EFT was feasible with moderate usability and high acceptability ratings.The most common VR-related adverse effect was motion sickness (n = 2/16, 12.5%). The VR-EFT condition was associated with significant improvement in inhibition-switching and visual scanning (both p < 0.05) during Phase II. Exercise-only was associated with significant improvements in cognitive inhibition, cognitive flexibility, reductions in alcohol craving, and number of standard alcohol drinks per week (all p ≤ 0.05). The gaming-control condition was associated with improvement in cognitive flexibility and visuospatial immediate recall (both p < 0.05) during Phase 1. Recruitment and retention of U.S. veterans with AUD and TBI into an exercise plus VR-EFT intervention is feasible, but technological barriers may impact usability. VR-EFT was associated with improvement in executive function domains that were targeted in as little as 3-week and nine sessions of VR-EFT exposure. Results are promising and indicate the need for a larger controlled investigation to assess the efficacy of VR-EFT to enhance treatment outcomes among AUD treatment-seeking U.S. veterans with co-occurring AUD and TBI.

Clinical Trial Registration

www.ClinicalTrials.gov, Identifier: NCT03786276.

Mix-and-Match or Mismatch? Exploring the Perspectives of Older Adults About Zumba Dance and Its Potential Utilization for Dual-Task Training

Despite the popularity of Zumba dancing, research is scarce about its impact on older adults. Meanwhile, the integration of cognitive tasks with physical exercises, also known as dual tasking, is an evolving strategy to facilitate activities for older adults. This study investigated the perceptions of persons aged ≥55 years on Zumba and its potential to be incorporated into a dual-task program. We conducted a descriptive-qualitative study involving 44 Filipino older adults. Using content analysis, four themes were identified: moving toward match or mismatch, balancing benefits with burdens, dual tasking as innovative yet potentially challenging, and overcoming barriers with enablers. Although Zumba was perceived as an inclusive and beneficial activity, individual and contextual limitations could hinder its suitability. Moreover, dual tasking in Zumba was considered an innovative approach, although challenges should be addressed to promote its feasibility. Several strategies could enable the design and implementation of age-appropriate Zumba and dual-tasking programs for older adults.

Combined Motor and Cognitive Rehabilitation: The Impact on Motor Performance in Patients with Mild Cognitive Impairment. Systematic Review and Meta-Analysis

Mild cognitive impairment (MCI), a neurodegenerative disease leading to Alzheimer’s disease or dementia, is often associated with physical complaints. Combined physical and cognitive training (PCT) has been investigated to see the effects on cognitive function, but its impact on motor functions and activities of daily living has not been explored yet. The combination of physical and cognitive training may be a valuable non-pharmacological intervention that could preserve motor function and quality of life (QoL). We aimed, therefore, to analyze if combined PCT is effective at improving motor performance in patients with an MCI. A systematic electronic literature search and a meta-analysis were conducted. The following criteria were compulsory for inclusion in the study: (1) randomized controlled trial design; (2) combined PCT compared to motor training alone or no intervention; (3) motor outcomes as a study’s end point. Nine articles met the inclusion criteria. Results showed that PCT significantly enhances balance compared to motor training alone (SMD 0.56; 95% CI 0.07 to 1.06; I² = 59%; 160 participants), whereas a significant improvement was found for mobility in the PCT group when compared to no intervention (MD −1.80; 95% CI −2.70 to −0.90; I² = 0%; 81 participants). However, there is no evidence that people with MCI experience an increase in gait speed and QoL at the end of their practice sessions. Further investigation with larger samples and a longer period of monitoring after intervention should be undertaken.

A Review of Combined Training Studies in Older Adults According to a New Categorization of Conventional Interventions

Physical and cognitive training are effective to attenuate age-related declines of brain and cognition. Accordingly, interest in interventions that combine physical, motor, and cognitive exercises has recently grown. In the present review, we aimed to determine whether and under which conditions combined training could be more effective than separated cognitive and physical training, thanks to a structured framework build around seven interacting constructs (stimuli, settings, targets, markers, outcomes, moderators, and mechanisms), which collectively afford a global picture of the determining factors of combined training. We concluded that the general principles underlying the effectiveness of combined training were still difficult identify, due to the heterogeneity of the available studies. However, our analysis also suggested that, when they are well-designed and well-conducted, combined training interventions are more effective than separated physical and cognitive training to improve brain and cognition in older adults. Also, we identified still not answered questions, which could be addressed in futures studies. Finally, we showed that the new categorization of combined training could be also applied to review the literature on training with exergames.

A cognitively enhanced online Tai Ji Quan training intervention for community-dwelling older adults with mild cognitive impairment: A feasibility trial

Background

This study examines the feasibility, acceptability, and safety of a newly developed cognitive-enhancing Tai Ji Quan training intervention, delivered via remote videoconferencing, for older adults with mild cognitive impairment (MCI).

Methods

In a three-arm feasibility trial, community-dwelling older adults with MCI (N = 69; mean age = 74.6 years, 57% women) were randomized to a cognitively enhanced Tai Ji Quan (n = 23), standard Tai Ji Quan (n = 22), or stretching group (n = 24) and participated in a 60-minute online exercise session via Zoom, twice weekly for 16 weeks. Participants were recruited primarily in the state of Oregon through mass mailing and word of mouth. The primary outcomes were intervention feasibility (with respect to recruitment, online intervention delivery, fidelity and compliance, and attrition and retention rates), acceptability, and safety. We also assessed feasibility of online data collection and test-retest reliability and explored preliminary trends on secondary outcomes that included global cognitive function, dual-task cost, and domain-specific cognition function.

Results

The study had an average recruitment rate of 55%. Feasibility was demonstrated by the overall successful online program implementation, with good fidelity, acceptable compliance (76%), and excellent retention (94%). The cognitively enhanced Tai Ji Quan intervention was shown to be acceptable to participants as well as safe, with no major intervention-related moderate/severe events. At week 16, the group receiving cognitively enhanced Tai Ji Quan training showed a positive trend in the cognitive function and dual-task outcome measures whereas the group receiving standard Tai Ji Quan training exhibited positive trends on global and domain-specific cognitive measures.

Conclusions

Preliminary findings of this pilot study indicate the feasibility, acceptability, and safety of a tailored, cognitively enhanced Tai Ji Quan training intervention delivered remotely to home settings via videoconferencing for community-dwelling older adults with MCI.

Trial registration

Clinicaltrials.gov identifier NCT04070703

Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration

Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson’s disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor–cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II–III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment.

BDNF mediates improvement in cognitive performance after computerized cognitive training in healthy older adults

Introduction

The often‐cited mechanism linking brain‐derived neurotrophic factor (BDNF) to cognitive health has received limited experimental study. There is evidence that cognitive training, physical exercise, and mindfulness meditation may improve cognition. Here, we investigated whether improvements in cognition after these three types of structured interventions are facilitated by increases in BDNF.

Methods

A total of 144 heathy older adults completed a 5‐week intervention involving working memory/cognitive training, physical exercise, mindfulness meditation, or an active control condition. Serum BDNF levels and Digit Symbol Test (DST) performance were measured pre‐ and post‐intervention.

Results

Linear mixed models suggested that only the cognitive training group demonstrated augmentation of BDNF and DST performance relative to the control condition. Path analysis revealed that changes in BDNF mediate intervention‐related improvement in task performance. Regression analyses showed that, across all intervention conditions, increased BDNF levels were associated with increased DST scores.

Discussion

This study appears to be the first to suggest that BDNF helps mediate improvements in cognition after working memory training in healthy older adults.

Highlights

Older adults were randomized to physical activity, mindfulness, cognitive training (computerized cognitive training (CCT), or control.

CCT, but no other condition, led to increased serum brain‐derived neurotrophic factor (BDNF) levels.

CCT led to improvement on the untrained Digit Symbol Test (DST) of speed/working memory.

Path analysis: increases in BDNF mediate intervention‐related improvement on DST.

Increases in BDNF associated with improved DST across all experimental groups.

Beneficial Effects of a Short Course of Physical Prehabilitation on Neurophysiological Functioning and Neurovascular Biomarkers in Patients Undergoing Coronary Artery Bypass Grafting

This study aimed to evaluate the effects of a short course of physical prehabilitation on neurophysiological functioning and markers of the neurovascular unit in patients undergoing coronary artery bypass grafting (CABG). We performed a prospective randomized study involving 97 male CABG patients aged 45–70 years, 47 of whom underwent a 5–7-day preoperative course of aerobic physical training (PhT). Both groups of patients were comparable with respect to baseline clinical and anamnestic characteristics. An extended neuropsychological and electroencephalographic (EEG) study was performed before surgery and at 7–10 days after CABG. Markers of the neurovascular unit [S100β, neuron-specific enolase (NSE), and brain-derived neurotrophic factor (BDNF)] were examined as metabolic correlations of early postoperative cognitive dysfunction (POCD) at three time points: before surgery, within the first 24 h after surgery, and 7–10 days after CABG. POCD developed in 58% of patients who underwent preoperative PhT, and in 79.5% of patients who did not undergo training, 7–10 days after CABG. Patients without prehabilitation demonstrated a higher percentage of theta1 power increase in the relative change values as compared to the PhT patients (p = 0.015). The short preoperative course of PhT was associated with low plasma S100β concentration, but high BDNF levels in the postoperative period. Patients who underwent a short preoperative course of PhT had better cognitive and electrical cortical activity indicators. Markers of the neurovascular unit indicated lower perioperative brain injury after CABG in those who underwent training. A short course of PhT before CABG can decrease the brain’s susceptibility to ischemia and reduce the severity of cognitive impairments in cardiac surgery patients. Electrical brain activity indicators and neurovascular markers, such as S100β and BDNF, can be informative for the effectiveness of cardiac rehabilitation programs.

Making the Best Out of IT: Design and Development of Exergames for Older Adults With Mild Neurocognitive Disorder - A Methodological Paper

Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users' capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The 'Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health' (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in "real life" settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.

Different types of physical exercise in brain activity of older adults: A systematic review

BACKGROUND

To verify the effects of different modalities of physical exercise on brain activity of older adults.

METHODS

Systematic searches were conducted according to the PICOS strategy and the following databases were searched: PubMed, Web of Science, PsycInfo and Scielo. Two independent evaluators performed the initial selection from reading the title and abstract based on the stipulated eligibility criteria.

RESULTS

The searches resulted in 1935 titles, of which 97 were duplicated and 1793 were excluded based on reading the titles and abstracts. This phase resulted in 45 articles for detailed analysis. At this stage, 35 articles were excluded because they did not meet the eligibility criteria. The information for qualitative analysis was extracted from 10 articles that met the criteria.

CONCLUSION

There was improvement in the brain activity of older adults regardless of the type of physical exercise performed (aerobic, neuromuscular, flexibility or neuromotor), but with a discrete advantage for balance and coordination exercises (neuromotor).

Motor-cognitive intervention concepts can improve gait in chronic stroke, but their effect on cognitive functions is unclear: A systematic review with meta-analyses

Motor-cognitive intervention concepts are promising to counteract residual gait and cognitive impairments in chronic stroke. There is, however, considerable variation in motor-cognitive intervention types, which may lead to different effects. This systematic review strived to summarize and compare the effects of different motor-cognitive intervention concepts on gait and cognitive functions in chronic stroke. The systematic search identified twenty-nine articles, which were allocated to three types of motor-cognitive training concepts; SEQUENTIAL, SIMULTANEOUS-ADDITIONAL, and SIMULTANEOUS-INCORPORATED. Random-effects meta-analyses revealed that motor-cognitive interventions may be better than non-combined training approaches for improving gait function in chronic stroke (e.g. gait speed: g = 0.43, 95 % CI [0.22, 0.64], p < 0.0001). SIMULTANEOUS-INCORPORATED motor-cognitive training seems the most promising concept. As very few articles measured both, spatiotemporal gait parameters and cognitive outcomes, future studies are warranted to investigate the effects of motor-cognitive intervention concepts on gait control and cognitive functions in chronic stroke.

Beyond IQ: The Importance of Metacognition for the Promotion of Global Wellbeing

Global policy makers increasingly adopt subjective wellbeing as a framework within which to measure and address human development challenges, including policies to mitigate consequential societal problems. In this review, we take a systems-level perspective to assemble evidence from studies of wellbeing, of collective intelligence, and of metacognition and argue for a virtuous cycle for health promotion in which the increased collective intelligence of groups: (1) enhances the ability of such groups to address consequential societal problems; (2) promotes the wellbeing of societies and the individual wellbeing of people within groups; and, finally, (3) enables prosocial actions that further promote collective problem-solving and global wellbeing. Notably, evidence demonstrates that effective collaboration and teamwork largely depend on social skills for metacognitive awareness—the capacity to evaluate and control our own mental processes in the service of social problem-solving. Yet, despite their importance, metacognitive skills may not be well-captured by measures of general intelligence. These skills have instead been the focus of decades of research in the psychology of human judgment and decision-making. This literature provides well-validated tests of metacognitive awareness and demonstrates that the capacity to use analysis and deliberation to evaluate intuitive responses is an important source of individual differences in decision-making. Research in network neuroscience further elucidates the topology and dynamics of brain networks that enable metacognitive awareness, providing key targets for intervention. As such, we further discuss emerging scientific interventions to enhance metacognitive skills (e.g., based on mindfulness meditation, and physical activity and aerobic fitness), and how such interventions may catalyze the virtuous cycle to improve collective intelligence, societal problem-solving, and global wellbeing.

Personalized Motor-Cognitive Exergame Training in Chronic Stroke Patients-A Feasibility Study

Purpose: Exergame training may be beneficial for improving long-term outcome in stroke patients. Personalized training prescription applying progression rules, is missing. We adapted a theory-based taxonomy for a rehabilitation approach using user-centered exergames. The aims were primarily to investigate the feasibility of this rehabilitation approach, and secondarily to evaluate its performance of personalizing training progression, as well as explore the effects on secondary outcomes.

Methods: Chronic stroke patients (≥ 18 years) were included, who were able to walk 10 meters and stand for 3 min. The rehabilitation approach was administered twice per week for 8 weeks. As primary outcome, feasibility was evaluated by comparing achieved rates of inclusion, adherence, compliance, attrition, motivation, and satisfaction to pre-defined thresholds for acceptance. Secondary outcomes were (1) perceived motor and cognitive task difficulty throughout the intervention; (2) measures collected during baseline and post-measurements—a gait analysis, the Timed-up-and-go test (TUG), several cognitive tests assessing attentional, executive, and visuospatial functions.

Results: Thirteen patients [median: 68.0 (IQR: 49.5–73.5) years, median: 34.5 (IQR: 12.25–90.75) months post-stroke] were included, of whom ten completed the study. Rates for inclusion (57%), adherence (95%), compliance (99%), motivation (77%), and satisfaction (74%) were acceptable, however, the attrition rate was high (23%). The perceived motor and cognitive task difficulty predominantly moved below the targeted range. We found a significant change in the TUG (p = 0.05, r = 0.46) and medium-to-large effect sizes (p > 0.05) for swing time of the affected leg, the asymmetry index, time needed for the Trail-making test (TMT) A and accuracy for the TMT B and the Mental Rotation Test (MRT; 0.26 ≤ r ≤ 0.46).

Discussion: The intervention was feasible with minor modifications necessary, which warrants a larger trial investigating the effects of the rehabilitation approach following the adapted taxonomy on mobility, gait and cognitive functions. Two main limitations of the rehabilitation approach were; (1) the taxonomy decoupled motor and cognitive progression, which may be improper as motor and cognitive learning is coupled; (2) separate subjective ratings were used to guide the progression. Future studies should develop an instrument to objectively assess motor-cognitive task difficulty for monitoring the progression of an exergame-based training.

Does the combination of physical activity and attention training affect the motor skills and cognitive activities of individuals with mild intellectual disability?

Individuals with mild intellectual disability (MID) were worse than their peers who typically develop in motor skills and attention-demanding assignments. In this study, effect of a 14-week physical activity and attention training practise on the motor skills, visual retention, perception and attention levels of students with MID were analysed. Twenty-two individuals between 7 and 14 ages participated voluntarily. Activities based on developing attention skills and physical activities enhancing fine-gross motor skills (40 + 60 min./2 days/14 weeks) were given to the experimental group. d2 Test of Attention, Benton Visual Retention and Bruininks-Oseretsky Test of Motor Proficiency-2nd version tests were used as data collection tools. There was significant difference in terms of total number of items processed, commissions, raw score of errors, total number of items minus error scores, concentration performance, Benton visual retention test and perception, fine motor skill precision, fine motor skill integration, manual dexterity and upper-limb coordination values regarding group and time dependant (p< .05). However, there was no significant difference in omissions and fluctuation rate values (p> .05). As a result; it is determined that the combination of physical activity and attention training practises features a positive effect on visual retention, perception, attention and motor skill levels of students with MID.

Moderate intensity cycling combined with cognitive dual-task improves selective attention

Physical and cognitive exercises have positive long-term effects on cognitive capacities. However, acute effects still are controversial. Here we determine the acute effects of physical exercise combined with concurrent cognitive exercise on cognitive performance in young adults. Simple reaction time, selective attention, and memory were evaluated in 23 young men before and after 30 min of stationary cycling exercise, 30 min of stationary cycling exercise combined with cognitive exercise, and 30 min of rest. Exercise intensity was continuously controlled to ensure exercise at moderate intensity. We found that physical exercise combined with cognitive dual-task improves selective attention. Both exercise conditions showed similar effects on simple reaction time, and memory was not affected by the different exercise conditions. We conclude that the combination of cycling exercise at moderate intensity with a cognitive exercise acutely improves selective attention in young adults. These results can be of particular interest for interventions aiming at improving selective attention in sports and for older adults and individuals with difficulty to suppress and filter out task-irrelevant information, like when receiving instruction or learning a new task or concept.

Management of Cancer-Related Cognitive Impairment: A Systematic Review of Computerized Cognitive Stimulation and Computerized Physical Activity

Cancer-related cognitive impairment (CRCI) occurs frequently in patients living with cancer, with consequences on quality of life. Recently, research on the management of these difficulties has focused on computerized cognitive stimulation and computerized physical activity programs. This systematic review presents the state of knowledge about interventions based on computerized-cognitive stimulation and/or physical activity to reduce CRCI. The review followed the PRISMA guidelines. A search was conducted in PUBMED and Web of Science databases. Risk of bias analysis was conducted using the Rob2 tool and the quality of evidence was conducted following the GRADE approach. A total of 3776 articles were initially identified and 20 of them met the inclusion criteria. Among them, sixteen investigated computerized-cognitive stimulation and four computerized-physical activity. Most of the studies were randomized controlled trials and assessed the efficacy of a home-based intervention on objective cognition in adults with cancer. Overall, cognitive improvement was found in 11/16 computerized-cognitive stimulation studies and 2/4 computerized-physical activity studies. Cognitive stimulation or physical activity improved especially cognitive complaints, memory, and attention. These results suggest the efficacy of both computerized-cognitive stimulation and physical activity. However, we report a high risk of bias for the majority of studies and a low level of quality of evidence. Therefore, further investigations are needed to confirm the efficacy of these interventions and to investigate the possible added benefit on cognition of a combined computerized-cognitive/physical intervention.

Pilot testing of Dual-task Zumba Gold (DTZ) for community-dwelling people with mild cognitive impairment: A mixed-methods study

Dual-tasking (e.g., enrichment of physical activities with mental exercises) is an innovative strategy to enhance older adults' cognition. Meanwhile, Zumba is a popular dance program, but research is limited about its utility on older people or those with mild cognitive impairment (MCI). This study assessed the feasibility of a new intervention called dual-task Zumba Gold (DTZ) for people with MCI. A mixed-methods feasibility study involving ten people aged ≥55 years with MCI was conducted from December 2020 to March 2021. Nine participants completed the study (90%) with high intervention acceptability. Program adherence (90.3%) and implementation fidelity (92.2%) were high. Participants also expressed the program's benefits, challenges, and facilitators. Moreover, pilot test results suggested improvements in global cognition (Z=-2.680; p=0.007), quality of life (Z=-2.688; p=0.008), and mobility (Z=-2.333; p=0.020). Hence, DTZ is feasible and acceptable for people with MCI, offering potential multidomain effects. Future randomized controlled studies should confirm these outcomes.

Multimodal Web-Based Intervention for Cancer-Related Cognitive Impairment in Breast Cancer Patients: Cog-Stim Feasibility Study Protocol

Simple Summary

Cognitive difficulties and their impact on patients’ quality of life are frequently reported by patients treated for breast cancer, who ask for support to improve these difficulties. Cognitive stimulation and physical activity resulted as beneficial for cognitive difficulties, but they are challenging to generalize in hospitals. To overcome this limitation, home-based computerized interventions have been proposed. In this study, the feasibility of a combined intervention of web-based cognitive stimulation and physical activity among breast cancer patients undergoing radiotherapy will be investigated. The overall goal is to develop interventions for cognitive difficulties adapted to supportive care units.

Abstract

Cancer-related cognitive impairment (CRCI) is a frequent side-effect of cancer treatment, with important consequences on patients’ quality of life. Cognitive stimulation and physical activity are the most efficient in improving cognitive impairment, but they are challenging to generalize in hospitals’ routine and to patients’ needs and schedules. Moreover, the added value of a combination of these interventions needs to be more investigated. The Cog-Stim study is an interventional study investigating the feasibility of a web-based multimodal intervention (combining cognitive stimulation and physical activity for the improvement of cognitive complaints among breast-cancer patients currently treated with radiotherapy (n = 20). Patients will take part in a 12-week program, proposing two sessions per week of web-based cognitive stimulation (20 min/session with HappyNeuron^®) and two sessions per week of web-based physical activity (30 min/session with Mooven^® platform). Cognitive complaints (FACT-Cog) and objective cognitive functioning (CNS Vital Signs^®), anxiety, depression (HADS), sleep disorders (ISI) and fatigue (FACIT-Fatigue) will be assessed before and after the intervention. The primary endpoint is the adherence rate to the intervention program. Patients’ satisfaction, reasons for non-attrition and non-adherence to the program will also be assessed. The overall goal of this study is to collect information to develop web-based interventions for cognitive difficulties in supportive care units.

Influence of Single Bouts of Aerobic Exercise on Dual-Tasking Performance in Healthy Adults

Dual-tasking performance (DTP) is critical for most real-life activities. Interventions to improve DTP would be clinically valuable. This study investigated effects of single-bouts of two different aerobic exercises on the performance of Extended cognitive Timed-Up and Go (ETUGcog), a dual-task test involving concurrent performance of a physical (ETUG) and cognitive (counting backwards serial 7 s) task. Twenty-two adults performed single bouts of high-intensity interval training (HIIT) and moderate-intensity exercise (MIE), separately. ETUGcog was performed before, immediately following, and 24 hours after each exercise. Number and rates of correct serial 7 s were significantly higher 24 hours after HIIT, with no difference in times to complete ETUGcog. No such effects were found for MIE. Single bouts of HIIT could provide delayed improvements in DTP.

Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits

Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical-cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.

The Effects of Combined Physical and Cognitive Training on Inhibitory Control: A Systematic Review and Meta-Analysis

While strong inhibitory control is critical for health and wellbeing, there are no broadly applicable effective behavioural interventions that enhance it. This meta-analysis examined the neurocognitive rationale for combined physical and cognitive training and synthesised the rapidly growing body of evidence examining combined paradigms to enhance inhibitory control. Across the research to date, there was a small positive effect (n studies = 16, n participants = 832) of combined training on improving inhibitory control. Sub-group analyses showed small-moderate positive effects when the physical component of the combined training was moderately intense, as opposed to low or vigorous intensities; moderate positive effects were found in older adults, as compared to adolescents and adults; and healthy individuals and those with vascular cognitive impairment, as compared to ADHD, ASD, mild cognitive impairment and cancer survivors. This is the first meta-analysis to provide evidence that combined physical, specifically when moderately intense, and cognitive training has the capacity to improve inhibitory control, particularly when delivered to healthy individuals and those experiencing age-related decline.

Biopsychosocial Functions of Human Walking and Adherence to Behaviourally Demanding Belief Systems: A Narrative Review

Human walking is a socially embedded and shaped biological adaptation: it frees our hands, makes our minds mobile, and is deeply health promoting. Yet, today, physical inactivity is an unsolved, major public health problem. However, globally, tens of millions of people annually undertake ancient, significant and enduring traditions of physiologically and psychologically arduous walks (pilgrimages) of days-to-weeks extent. Pilgrim walking is a significant human activity requiring weighty commitments of time, action and belief, as well as community support. Paradoxically, human walking is most studied on treadmills, not ‘in the wild’, while mechanistically vital, treadmill studies of walking cannot, in principle, address why humans walk extraordinary distances together to demonstrate their adherence to a behaviourally demanding belief system.

Pilgrim walkers provide a rich ‘living laboratory’ bridging humanistic inquiries, to progressive theoretical and empirical investigations of human walking arising from a behaviourally demanding belief system. Pilgrims vary demographically and undertake arduous journeys on precisely mapped routes of tracked, titrated doses and durations on terrain of varying difficulty, allowing investigations from molecular to cultural levels of analysis. Using the reciprocal perspectives of ‘inside→out’ (where processes within brain and body initiate, support and entrain movement) and ‘outside→in’ (where processes in the world beyond brain and body drive activity within brain and body), we examine how pilgrim walking might shape personal, social and transcendental processes, revealing potential mechanisms supporting the body and brain in motion, to how pilgrim walking might offer policy solutions for physical inactivity.

Physical Activity Interventions and Their Effects on Cognitive Function in People with Dementia: A Systematic Review and Meta-Analysis

BACKGROUND

Physical activity (PA) has emerged as an alternative nonpharmacological approach to effectively address the effects of dementia. The primary aim was to identify and summarize PA interventions and their effects on cognitive function among persons with dementia (PwD).

METHODS

A systematic review was conducted with a meta-analysis using different electronic databases, such as PubMed, Embase, APA PsycNET, and the Web of Science. The identified and selected studies were randomized controlled trials (RCTs) that were written in English, published between 2000 and 2020, and implemented among PwD who received a PA intervention and whose cognitive function was measured at baseline and during a follow-up.

RESULTS

Twenty-two PA intervention studies met the eligibility criteria and showed a medium-size effect on the cognitive function of PwD, 0.4803 (95% CI = 0.1901-0.7704), with a high percentage of heterogeneity (I² = 86%, p ≤ 0.0001). Moreover, this review complements other reviews by including eight studies that have not previously been considered. Overall, studies have methodological limitations. However, six studies implemented in the past five years have shown more robust methodological designs, including larger sample sizes and more comprehensive measurement tools.

CONCLUSION

It is not yet possible to draw a conclusion on the ideal PA intervention for this population due to the high proportion of heterogeneity within the included studies. More emphasis is needed on the intensity of PA monitoring and adherence to such programs.

Mahjong Playing and Leisure Physical Activity Alleviate Cognitive Symptoms in Older Community Residents

Leisure activities, particularly physically and cognitively stimulating leisure activities, mitigate cognitive decline. The present study aimed to examine the relationship between mahjong playing, leisure physical activity, and mild cognitive impairment (MCI). Older adults with and without MCI were recruited (n = 489, healthy group; and n = 187, MCI group). The regression results showed that years of mahjong playing (odds ratio = 0.595, 95% confidence interval [0.376, 0.961], p = .032) and physical activity (odds ratio = 0.572, 95% confidence interval [0.381, 0.849], p = .012) were associated with reduced odds of having MCI after adjusting for a series of covariates. Leisure physical activity and mahjong playing interacted with each other and produced combined effects on the odds of having MCI. Combined cognitive and physical interventions may produce larger benefits on cognition than either intervention alone.

Feasibility and Effects of Virtual Reality Motor-Cognitive Training in Community-Dwelling Older People With Cognitive Frailty: Pilot Randomized Controlled Trial

BACKGROUND

Cognitive frailty refers to the coexistence of physical frailty and cognitive impairment, and is associated with many adverse health outcomes. Although cognitive frailty is prevalent in older people, motor-cognitive training is effective at enhancing cognitive and physical function. We proposed a virtual reality (VR) simultaneous motor-cognitive training program, which allowed older people to perform daily activities in a virtual space mimicking real environments.

OBJECTIVE

We aimed to (1) explore the feasibility of offering VR simultaneous motor-cognitive training to older people with cognitive frailty and (2) compare its effects with an existing motor-cognitive training program in the community on the cognitive function and physical function of older people with cognitive frailty.

METHODS

A two-arm (1:1), assessor-blinded, parallel design, randomized controlled trial was employed. The eligibility criteria for participants were: (1) aged ≥60 years, (2) community dwelling, and (3) with cognitive frailty. Those in the intervention group received cognitive training (ie, cognitive games) and motor training (ie, cycling on an ergometer) simultaneously on a VR platform, mimicking the daily living activities of older people. Those in the control group received cognitive training (ie, cognitive games) on tablet computers and motor training (ie, cycling on the ergometer) sequentially on a non-VR platform. Both groups received a 30-minute session twice a week for 8 weeks. Feasibility was measured by adherence, adverse outcomes, and successful learning. The outcomes were cognitive function, physical frailty level, and walking speed.

RESULTS

Seventeen participants were recruited and randomized to either the control group (n=8) or intervention group (n=9). At baseline, the median age was 74.0 years (IQR 9.5) and the median Montreal Cognitive Assessment score was 20.0 (IQR 4.0). No significant between-group differences were found in baseline characteristics except in the number of chronic illnesses (P=.04). At postintervention, the intervention group (Z=-2.67, P=.01) showed a significantly larger improvement in cognitive function than the control group (Z=-1.19, P=.24). The reduction in physical frailty in the intervention group (Z=-1.73, P=.08) was similar to that in the control group (Z=-1.89, P=.06). Improvement in walking speed based on the Timed Up-and-Go test was moderate in the intervention group (Z=-0.16, P=.11) and greater in the control group (Z=-2.52, P=.01). The recruitment rate was acceptable (17/33, 52%). Both groups had a 100% attendance rate. The intervention group had a higher completion rate than the control group. Training was terminated for one participant (1/9, 11%) due to minimal VR sickness (Virtual Reality Sickness Questionnaire score=18.3/100). Two participants (2/8, 25%) in the control group withdrew due to moderate leg pain. No injuries were observed in either group.

CONCLUSIONS

This study provides preliminary evidence that the VR simultaneous motor-cognitive training is effective at enhancing the cognitive function of older people with cognitive frailty. The effect size on frailty was close to reaching a level of significance and was similar to that observed in the control group. VR training is feasible and safe for older people with cognitive frailty.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04467216; https://clinicaltrials.gov/ct2/show/NCT04467216.

Clinical efficacy of aerobic exercise combined with computer-based cognitive training in stroke: a multicenter randomized controlled trial

PURPOSE

The objectives are to evaluate the effects of a sequential combination of aerobic exercise and cognitive training, compared with exercise or cognitive training alone, on cognitive function, physical function, daily function, quality of life, and social participation in stroke survivors with cognitive impairment.

METHODS

This is a single-blind, parallel, randomized controlled trial. Stroke patients with mild cognitive impairment (n = 56) were randomly assigned to aerobic exercise training (n = 18), computerized cognitive training (n = 18), and the sequential combination of aerobic exercise and computerized cognitive training (n = 20) group. All groups underwent training 60 min/day, 3 days/week, for a total of 12 weeks. The primary outcomes included Montreal Cognitive Assessment (MoCA), Wechsler Memory Scale-Third Edition, and the Stroop color-word test. Secondary outcomes were the Timed Up and Go test, 6-Minute Walk Test, Functional Independence Measure, Lawton Instrumental Activities of Daily Living Scale, Community Integration Questionnaire, and Stroke Impact Scale.

RESULTS

56 participants completed the trial. Compared with a single type of aerobic exercise or cognitive training, the combined training group showed significant improvement in MoCA (P < .05, η2 = 0.13), and two sub-tests in WMS-III (both P's < 0.05) following the intervention. However, no between-group differences were observed for physical functions, daily function, quality of life, and social participation measures.

CONCLUSIONS

The findings provide evidence for the potential synergistic intervention in stroke survivors. Future studies investigating the transfer effects and the optimal training parameters with a larger sample is needed.

Can Reactivity of Heart Rate Variability Be a Potential Biomarker and Monitoring Tool to Promote Healthy Aging? A Systematic Review With Meta-Analyses

Background: Monitoring phasic responses of heart rate variability (HRV) in terms of HRV reactivity [i. e., the absolute change from resting state to on-task (i.e., absolute values of HRV measured during exercise)] might provide useful insights into the individual psychophysiological responses of healthy middle-aged to older adults (HOA) to cognitive and physical exercises. Objectives: To summarize the evidence of phasic HRV responses to cognitive and physical exercises, and to evaluate key moderating factors influencing these responses. Methods: A systematic review with meta-analyses was performed. Publications up to May 2020 of the databases Medline (EBSCO), Embase, Cochrane Library, CINAHL, Psycinfo, Web of Science, Scopus, and Pedro were considered. Controlled clinical trials and observational studies measuring phasic HRV responses to cognitive and/or physical exercises in HOA (≥50 years) were included. Results: The initial search identified 6,828 articles, of which 43 were included into the systematic review. Compared to resting state, vagally-mediated HRV indices were significantly reduced during all types of exercises [Hedge's g = -0.608, 95 % CI (-0.999 to -0.218), p = 0.002] indicating a significant parasympathetic withdrawal compared to rest. The key moderating variables of these responses identified included exercise intensity for physical exercises, and participant characteristics (i.e., level of cognitive functioning, physical fitness), task demands (i.e., task complexity and modality) and the individual responses to these cognitive challenges for cognitive exercises. In particular, higher task demands (task complexity and physical exercise intensity) were related to larger HRV reactivities. Better physical fitness and cognition were associated with lower HRV reactivities. Additionally, HRV reactivity appeared to be sensitive to training-induced cognitive and neural changes. Conclusion: HRV reactivity seems to be a promising biomarker for monitoring internal training load and evaluating neurobiological effects of training interventions. Further research is warranted to evaluate the potential of HRV reactivity as a monitoring parameter to guide cognitive-motor training interventions and/or as a biomarker for cognitive impairment. This may facilitate the early detection of cognitive impairment as well as allow individualized training adaptations that, in turn, support the healthy aging process by optimizing individual exercise dose and progression of cognitive-motor training.

Effects of Combined Physical Movement Activity and Multifaceted Cognitive Training in Older People with Mild Neurocognitive Disorder in a Rural Community: A Randomized Control Trial

INTRODUCTION

Cognitive deterioration in older people with mild neurocognitive disorders (mNCD) increases the risk of progress to major NCD. Health professionals worldwide are trying to find strategies for prevention. There is a limited number of studies that deal with cultural conditions in northern Thailand.

OBJECTIVES

This study aimed to investigate the effects of a combination of physical movement activity and multifaceted cognitive training on cognitive function in older people with mNCD.

METHODS

A randomized control trial involving 70 mNCD people, according to DSM-5 criteria, was conducted on an intervention group and a control group (n = 35 each). The program for the intervention group included 24 sessions (twice a week). The outcome measures on cognitive function were assessed before and after the intervention by means of composite cognitive measures for older people, i.e., the Trail-Making Test (TMT), Digit Span (DS), Verbal Fluency (VF), Word-List Learning (WLL), and Block Design (BD).

RESULTS

The combined intervention enhanced cognitive function. TMT-A was significantly improved in the intervention group. There were significant improvements in DS sequence scores, letter verbal fluency (LVF), and category verbal fluency (CVF). Comparing the groups, there were significant differences in LVF including immediate and delayed recall. BD improved significantly in the intervention group.

CONCLUSIONS

The combined intervention appeared to be effective in delaying/preventing cognitive deterioration and cognitive functional decline in people with mNCD. Further studies on a variation of treatments suited to cultural conditions and their effects are needed. Trials in other communities are also recommended.

Fine motor skills and attention level of individuals with mild intellectual disability getting education in inclusive classrooms and special education schools

In this study, the difference between fine motor skills and attention levels of children with mild intellectual disabilities (MID) who get education in inclusive classrooms and special education schools and the relationship between fine motor skills and attention levels were analysed. A total of 176 children with MID between the ages of 9-14, who get education in inclusive classrooms (n = 96) and special education schools (N = 80), participated in the study. Bruininks-Oseretsky Test of Motor Proficiency-Second Version (BOT-2) and Bourdon Attention Tests were applied as data tools. Fine Motor Precision (FMP), Fine Motor Integration (FMI) and Attention levels of the children in inclusive classrooms were higher than those who get education at special education schools (p < .05). In all parameters of the children of inclusive classrooms and special education schools (except the parameters of FMP-6: Folding Paper and FMI-8: Copying Overlapping Pencils), there was a positive correlation between attention and fine motor skill values (p < .05). The fact that children with MID get inclusive education with typically developing peers contributes more to these individuals in terms of fine motor skills and attention parameters. However, more extensive work is needed in this field.

Sedentary Lifestyle Matters as Past Sedentariness, Not Current Sedentariness, Predicts Cognitive Inhibition Performance among College Students: An Exploratory Study

Background: Currently, sedentariness is assessed over a short period of time, thus it is difficult to study its cognitive implications. To investigate the cognitive consequences of a sedentary lifestyle, the past level (i.e., the sedentary time accumulated over the years) and current level of sedentariness should be considered. This pilot study aimed to investigate the negative association between a sedentary lifestyle and cognition by considering both the current and past sedentariness. It was expected that the physical activity level moderates the potential negative association between sedentariness and cognition. Methods: 52 college students (M_age = 20.19, SD_age = 2; 36 women) participated in the study. Current sedentariness (ratio of sedentary time in the last year), past sedentariness (ratio of sedentary time accumulated in previous years), and physical activity (ratio of time spent in physical activity in years) were assessed using a questionnaire. Cognitive inhibition, cognitive flexibility, and working memory updating were measured through three specific tests. Results: Past sedentariness significantly explained the inhibition performance when controlled for physical activity, whereas current sedentariness did not. More precisely, past sedentariness only negatively predicted cognitive inhibition when the physical activity level was low (β = -3.15, z(48) = -2.62, p = 0.01). Conclusions: The impact of sedentariness on cognitive functioning might only be revealed when past sedentariness and physical activity are controlled.

Comparison of exergames versus conventional exercises on the cognitive skills of older adults: a systematic review with meta-analysis

PURPOSE

To compare the effects of exergames versus conventional physical training on the cognitive skills of older adults.

MATERIALS AND METHODS

Scientific studies published in PubMed, Web of Science, and Cochrane Library databases were searched. Individual studies were assessed using the Cochrane Risk-of-bias tool for randomized trials (RoB 2). The quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE Pro). The cognitive outcomes were Trail Making Test (TMT)-A, TMT-B, Stroop Word-Color test, Mini Mental State Examination (MMSE), and Montreal Cognitive Assessment (MoCA).

RESULTS

We identified 256 studies, in which 13 studies were included in the systematic review and 11 in the meta-analysis. The majority of the exergame interventions were based on the Xbox 360's Kinect, followed by the Impact Dance Platform, Nintendo Wii, and the Bike Labyrinth. We observed heterogeneity in the conventional exercise group and in the duration of training, which ranged from 12 to 52 sessions. There was no statistically significant difference between groups in TMT-A (p=0.083), TMT-B (p=0.122), and Stroop (p=0.191). There were differences in favor of exergames in MMSE (raw mean difference=-1.58, 95% CI: -2.87 to -0.28, p<0.001) and MoCA (raw mean difference=-1.22, 95% CI: -2.24 to -0.20, p=0.019).

CONCLUSIONS

Despite statistical differences in MMSE and MoCA, these results should be interpreted with caution due to methodological heterogeneity. Some studies reported possible neurophysiological benefits induced by exergames, which should be explored in future investigations.

Feasibility and effectiveness of interactive stepping exercise on community-dwelling older adults: A pilot randomized controlled trial

Recently, the interactive stepping exercise (ISE) was developed on the basis of square stepping exercise. The aim of this study was to examine the feasibility and effectiveness of ISE on executive function and gait variability among community-dwelling older adults. Fourteen participants were recruited and randomly assigned to the experimental group (n=7) or control group (n=7) and received ISE or home exercise program, respectively, three times a week for 12 weeks. The outcomes included retention rate, attendance rate, Trail Making Test, and dual-task walking. The results showed that participants had high retention and attendance rate for the ISE intervention. Moreover, significant improvement in the part A of Trail Making Test and stride length variability during cognitive dual-task walking after 12-week ISE intervention. The current results suggested that ISE is a feasible and effective intervention on executive function and gait variability in community-dwelling older adults.

Effects of Cognitive Versus Mind-Motor Training on Cognition and Functional Skills in the Community-Dwelling Older Adults

BACKGROUND

There is a decline in cognitive and functional skills in older adults. The objective of this study was to compare the effects of cognitive and mind-motor training (MMT) on cognition and functional skills in a community-dwelling sample of older adults.

METHODS

In this observer-blinded randomized clinical trial, 40 older adults with medical stability, ability to comprehend and respond to simple verbal instructions, no diagnosed psychological disorders, absence of severe visual and hearing problems, the capacity to walk independently, and a score of more than 46 in Berg Balance Scale were included. They were randomly allocated into cognitive or MMT groups. Cognitive training (CT) was practiced with activities for memory and attention, using paper-pencil tasks. MMT was practiced using a simple, indoor based square-stepping exercise. They practiced one-hour of training per day, three days a week, for eight weeks.

RESULTS

General linear model analysis showed that the time by groups was not statistically significant. The mean (standard deviation) scores in General Practitioner Assessment of Cognition Scale and Hindi Mental State Examination improved significantly (P < 0.001) following MMT [1.75 (1.29); 2.4 (1.34)] and CT [1.5 (1.36); 2.7 (0.99)]. The functional skills measured using Lawton Instrumental Activities of Daily Living Scale revealed beneficial changes for both the groups. None of the outcomes were statistically significant between the groups (P > 0.05).

CONCLUSION

Both cognitive and MMTs showed similar practice effects on cognition and functional skills in community-dwelling older adults.

The Effects of the Combination of High-Intensity Interval Training with 3D-Multiple Object Tracking Task on Perceptual-Cognitive Performance: A Randomized Controlled Intervention Trial

The ability to process goal-related visual information while ignoring goal-irrelevant information is essential for the human attention system. The study aimed to investigate how perceptual–cognitive performance was affected during high-intensity interval training (HIIT) using a 3D-multiple object tracking (3D-MOT) task called Neurotracker (NT). In an experimental design, 42 healthy adults (age M = 23.3 SD = 2.94, VO₂max 52.8 ± 5.66 mL·kg⁻¹·min⁻¹) were randomly assigned to an intervention (HIIT + NT, NT, HIIT) or control group. NT performance (20 trials per session) was measured pre-and post-test (at 5, 15, and 25 min while running on the treadmill). The participants trained twice a week for a 4-week intervention period. There was a significant interaction effect between pre/post-test and groups regarding perceptual-cognitive performance, indicating similar enhancements in the HIIT + NT and the NT group during exercise. HIIT influences physical fitness but did not show any impact on perceptual–cognitive performance. Due to the specific NT task characteristics, improved physical abilities may not directly impact sport-specific perceptual-cognitive performance. Our findings suggest that training resulted in substantial task-specific gains. Therefore, combination training may be proposed as a training program to improve perceptual–cognitive, and physical performance in a time-efficient way.

Effects of physical-cognitive training on physical and psychological functions among older adults with type 2 diabetes and balance impairment: a randomized controlled trial

Risks of falls among older adults are multifactorial in nature. A combined training program might be beneficial on fall-related outcomes. This study aimed to explore the effects of group-based physical-cognitive trainings on physical and psychological outcomes among older adults with type 2 diabetes mellitus (T2DM) and balance impairment. Fall incidence were also determined. Thirty-seven older adults with T2DM and balance impairment were randomly assigned to control and intervention groups. The intervention program comprised of 24 training sessions of 45–60 min exercise for 8 weeks. The exercise consisted of warm-up, aerobic exercise by nine square stepping, resistance exercise combined with cognitive training and cool down. All participants were assessed at baseline, 4 and 8 weeks after intervention, and 1-year follow-up. Both groups reported similar rates of falls. Global cognition, depressive symptoms, and fear of falling did not differ between groups at any time. The Timed Up & Go (TUG) test, alternate stepping test (AST), knee extensors, ankle plantarflexors, and dorsiflexors strength differed at 4 weeks. TUG, AST, hip abductors, knee flexors, ankle plantarflexors, and dorsiflexors strength differed at 8 weeks. The activity of daily living (ADL), TUG test (P=0.002) and AST, hip extensors and abductors, knee extensors and flexors, ankle plantarflexors and dorsiflexors were different at 1-year follow-up. The group-based physical-cognitive training could benefit older adults with T2DM in terms of maintaining ADL. The intervention could reduce fall risk factors by improving balance and lower limb muscle strength among older adults with T2DM and balance impairment.

The effect of physical activity with and without cognitive demand on the improvement of executive functions and behavioral symptoms in children with ADHD

Background: Purposeful physical activities improve cognitive functions. Two possible mechanisms are available for this intervention including the impact of the physical component of exercise and goal-directedness as a cognitive component. In the present study, we aimed to compare the effect of physical activity with and without cognitive demand on executive functions and behavioral symptoms in children with ADHD.Methods: Thirty children with ADHD were randomly assigned to two equal groups of physical activity training with and without cognitive demand. Exercise for cognitive improvement and rehabilitation (EXCIR) or running, as an aerobic exercise, were used for intervention in two groups. Executive functions and ADHD symptoms were measured in three sessions including baseline, post-intervention, and follow-up assessments, using 1-back, Wisconsin Card Sorting, and Go/No-Go tests and Conner's Teacher and Parent Rating scales. Repeated measures ANOVAs were used for analysis.Results: The results showed physical activity with cognitive demand, compared to the physical activity without cognitive demand, has a better and longer impact on the improvement of executive functions and ADHD symptoms.Conclusions: Cognitive rehabilitation with combined physical and cognitive tasks has a beneficial and lasting impact on impaired executive functions and behavioral symptoms in children with ADHD.

Effects of Combined Interventions with Aerobic Physical Exercise and Cognitive Training on Cognitive Function in Stroke Patients: A Systematic Review

(1) Background: Stroke is a major cause of permanent disability in multiple functions, including the cognitive domain. Since both cognitive training and aerobic physical exercise may exert positive effects on cognition after stroke, one may expect synergistic benefits when combining both interventions. (2) Methods: We carried out a systematic search of studies testing, in adult stroke patients, whether structured aerobic exercise combined with cognitive training led to higher cognitive benefits than either of these interventions when applied singly, or than interventions not including aerobic exercise or cognitive training. (3) Results: Five fair-quality randomized controlled trials fulfilled the search criteria. Exercise intensity was moderate-vigorous and cognitive training was mainly computer-based. The studies were heterogeneous regarding the cognitive tests used, and for this reason, a meta-analysis was not performed. Only three studies included follow-up assessment. The combined intervention was associated with pre-post improvement in at least one cognitive test in all the studies, and with higher positive effects compared to other conditions (although statistical significance was not always reached) in four studies. (4) Conclusions: Further trials including a long-term follow-up and comprehensive neuropsychological testing should be undertaken to determine whether combined aerobic exercise and cognitive training leads to additive cognitive benefits after stroke.

Physical and Cognitive Training to Enhance Intensive Care Unit Survivors' Cognition: A Mapping Review

PURPOSE

The aim of this study was to examine current literature regarding effects of physical or cognitive training and simultaneous (dual-task) physical and cognitive training on cognition in adults surviving an intensive care unit (ICU) stay.

DESIGN

Systematic mapping.

METHODS

A literature search was conducted to examine effects of physical and/or cognitive training on cognitive processes.

RESULTS

Few studies targeted adults surviving ICU. Independently, physical and cognitive interventions improved cognition in healthy older adults with and without cognitive impairment. Simultaneous interventions may improve executive function. Small sample size and heterogeneity of interventions limited the ability to make inferences.

CONCLUSION

Literature supports positive effects of single- and dual-task training on recovering cognition in adults. This training could benefit ICU survivors who need to regain cognitive function and prevent future decline.

RELEVANCE TO PRACTICE

With the growing number of ICU survivors experiencing cognitive deficits, it is essential to develop and test interventions that restore cognitive function in this understudied population.

The Beneficial Effects of Cognitive Walking Program on Improving Cognitive Function and Physical Fitness in Older Adults

Exercise and cognitive training can improve the brain-related health of the elderly. We investigated the effects of a cognitive walking program (CWP) involving simultaneous performance of indoor walking and cognitive training on cognitive function and physical fitness compared to normal walking (NW) outdoors. Participants were grouped according to whether they performed regular exercise for at least 3 months prior to the participation in this study. Active participants were assigned to the CWP-active group (CWPAG). Sedentary participants were randomly assigned to the CWP (CWPSG) or NW group (NWSG). CWP and NW were performed for 60 min, 3 times a week, for 6 months. Cognitive function (attention, visuospatial function, memory, and frontal/executive function) and physical fitness (cardiorespiratory fitness, lower extremity muscular strength, and active balance ability) were measured at baseline, 3 months, and 6 months after the program onset. Cognitive function showed improvements over time in all three groups, especially in CWPAG. No clear difference was observed between CWPSG and NWSG. Improvements in all fitness measures were also observed in all three groups. These findings collectively indicate the beneficial effects of CWP, as well as NW, on improving cognitive function and physical fitness in older adults, especially those who are physically active.

Α Virtual Reality App for Physical and Cognitive Training of Older People With Mild Cognitive Impairment: Mixed Methods Feasibility Study

Background

Therapeutic virtual reality (VR) has emerged as an effective treatment modality for cognitive and physical training in people with mild cognitive impairment (MCI). However, to replace existing nonpharmaceutical treatment training protocols, VR platforms need significant improvement if they are to appeal to older people with symptoms of cognitive decline and meet their specific needs.

Objective

This study aims to design and test the acceptability, usability, and tolerability of an immersive VR platform that allows older people with MCI symptoms to simultaneously practice physical and cognitive skills on a dual task.

Methods

On the basis of interviews with 20 older people with MCI symptoms (15 females; mean age 76.25, SD 5.03 years) and inputs from their health care providers (formative study VR1), an interdisciplinary group of experts developed a VR system called VRADA (VR Exercise App for Dementia and Alzheimer’s Patients). Using an identical training protocol, the VRADA system was first tested with a group of 30 university students (16 females; mean age 20.86, SD 1.17 years) and then with 27 older people (19 females; mean age 73.22, SD 9.26 years) who had been diagnosed with MCI (feasibility studies VR2a and VR2b). Those in the latter group attended two Hellenic Association Day Care Centers for Alzheimer’s Disease and Related Disorders. Participants in both groups were asked to perform a dual task training protocol that combined physical and cognitive exercises in two different training conditions. In condition A, participants performed a cycling task in a lab environment while being asked by the researcher to perform oral math calculations (single-digit additions and subtractions). In condition B, participants performed a cycling task in the virtual environment while performing calculations that appeared within the VR app. Participants in both groups were assessed in the same way; this included questionnaires and semistructured interviews immediately after the experiment to capture perceptions of acceptability, usability, and tolerability, and to determine which of the two training conditions each participant preferred.

Results

Participants in both groups showed a significant preference for the VR condition (students: mean 0.66, SD 0.41, t₂₉=8.74, P<.001; patients with MCI: mean 0.72, SD 0.51, t₂₆=7.36, P<.001), as well as high acceptance scores for intended future use, attitude toward VR training, and enjoyment. System usability scale scores (82.66 for the students and 77.96 for the older group) were well above the acceptability threshold (75/100). The perceived adverse effects were minimal, indicating a satisfactory tolerability.

Conclusions

The findings suggest that VRADA is an acceptable, usable, and tolerable system for physical and cognitive training of older people with MCI and university students. Randomized controlled trial studies are needed to assess the efficacy of VRADA as a tool to promote physical and cognitive health in patients with MCI.

Dual-Task Exercise to Improve Cognition and Functional Capacity of Healthy Older Adults

Background

It has been suggested that physical inactivity and lack of stimulating cognitive activity are the two most significant modifiable risk factors to impair cognitive function. Although many studies that investigated the cognitive effects of physical exercise and cognitive stimuli in dual-task conditions showed improved cognitive performance, others have not confirmed these findings. The main aim of the present work is to analyze the effects of a dual-task multimodal physical exercise training, at moderate intensity, and cognitive stimulation on cognitive and physical function in healthy older adults.

Methods

This clinical trial was registered on the Brazilian Registry of Clinical Trials (RBR-9zrx3d). Here we tested the effects of a dual-task multimodal physical exercise training, at moderate intensity, on cognitive and physical function and quality of life in community dwelling older adults. The training protocol included 24 group sessions, 2/week, per 75 min. Cognition was assessed using CANTAB automated neuropsychological tests and Functional Capacity to Exercise tests. Performance was compared from baseline to post intervention and to a non-exercise control group using Mixed Linear Model for repeated measures.

Results

Control (CG) and dual-task (DTEx) groups progressed differentially over time on performance of episodic memory, sustained visual attention, functional mobility, cardiorespiratory fitness, lower limbs strength resistance, agility, quality of life and dual-task performance with significant improved DTEx performance. Control group did not show any significant changes on these tests except for showing a reduction in dual-task performance.

Conclusion

We suggest that the dual-task combination of multisensory cognitive stimulation and multimodal moderate physical exercise training, twice a week, may be adopted as an effective program to reduce progression of age-related cognitive decline and improve physical fitness and quality of life on healthy older adults.

Clinical Trial Registration

Brazilian Registry of Clinical Trials: https://ensaiosclinicos.gov.br/rg/RBR-9zrx3d -UTN code: U1111-1233-6349.