Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up

Effects of combined cognitive and resistance training on physical and cognitive performance and psychosocial well-being of older adults ≥65: study protocol for a randomised controlled trial

INTRODUCTION

With increasing life expectancy of older adult population, maintaining independence and well-being in later years is of paramount importance. This study aims to investigate the impact of three distinct interventions: cognitive training, resistance training and a combination of both, compared with an inactive control group, on cognitive performance, mobility and quality of life in adults aged ≥65 years.

METHODS AND ANALYSIS

This trial will investigate healthy older adults aged ≥65 years living independently without cognitive impairments. Participants will be randomly assigned to one of four groups: (1) cognitive training, (2) resistance training, (3) combined cognitive and resistance training, and (4) control group (n=136 participants with 34 participants per group). The interventions will be conducted over 12 weeks. The cognitive training group will receive group-based activities for 45-60 min two times a week. The resistance training group exercises will target six muscle groups and the combined group will integrate cognitive tasks into the resistance training sessions. Primary outcomes are: Short Physical Performance Battery, Sit-to-Stand Test, Montreal Cognitive Assessment, Trail Making Test and Stroop Test combined with gait on a treadmill (dual task). Life satisfaction will be measured by the Satisfaction With Life Scale. Secondary outcomes encompass hand grip strength and the Functional Independence Measure.

ETHICS AND DISSEMINATION

Ethical approval was provided by the local Ethics Committee at the University of Hamburg (no. 2023_009). Informed consent will be obtained from all study participants. The results of the study will be distributed for review and discussion in academic journals and conferences.

TRIAL REGISTRATION NUMBER

DRKS00032587.

A Two-Phased Pilot Study Evaluating the Feasibility and Acceptability of the Cognitively Enriched Walking Program "Take a Walk with Your Brain" for Older Adults

Given the aging population, finding solutions to retain optimal cognitive capacity is a research priority. The potential of physical activity to reduce the risk of cognitive decline and to enhance cognitive functioning is established. Combining physical with cognitive activity has been put forward as a potentially even more effective way to promote healthy cognitive aging. Most studies on combined interventions have however been conducted in laboratory settings. This paper reports on a two-phased pilot study evaluating the acceptability and feasibility of a newly developed real-life cognitively enriched walking program for adults aged 65+ years. In Phase I, the feasibility and enjoyability of the cognitive tasks was evaluated by conducting walk-along interviews with older adults (n = 163). In Phase II, the cognitively enriched walking program was piloted in two groups of older adults (n = 19), and the feasibility and acceptability of the program and cognitive tasks was evaluated by means of questionnaires and focus groups. The cognitive tasks (i.e., median scores of ≥3 on a total of 4 (Phase I) and ≥6 on a total of 10 (Phase II) for most of the tasks) and the cognitively enriched walking program (i.e., median scores of ≥7 on a total of 10) were considered feasible and acceptable. Based on the input of the participants, key considerations for a feasible and acceptable program were defined: participants should be sufficiently challenged cognitively and physically, social interaction is an important motivator, cognitive tasks should make use of stimuli reflecting daily life and be conducted in group, the rationale for the tasks should be explained to participants, the frequency of the group sessions should be maximum 2 times a week, and the program should be supervised by a trained coach. These results warrant future research to establish the effectiveness of this program.

Assimilation of socially assistive robots' by older adults: an interplay of uses, constraints and outcomes

By supporting autonomy, aging in place, and wellbeing in later life, Socially Assistive Robots are expected to help humanity face the challenges posed by the rapid aging of the world's population. For the successful acceptance and assimilation of SARs by older adults, it is necessary to understand the factors affecting their Quality Evaluations Previous studies examining Human-Robot Interaction in later life indicated that three aspects shape older adults' overall QEs of robots: uses, constraints, and outcomes. However, studies were usually limited in duration, focused on acceptance rather than assimilation, and typically explored only one aspect of the interaction. In the present study, we examined uses, constraints, and outcomes simultaneously and over a long period. Nineteen community-dwelling older adults aged 75-97 were given a SAR for physical training for 6 weeks. Their experiences were documented via in-depth interviews conducted before and after the study period, short weekly telephone surveys, and reports produced by the robots. Analysis revealed two distinct groups: (A) The 'Fans' - participants who enjoyed using the SAR, attributed added value to it, and experienced a successful assimilation process; and (B) The 'Skeptics' - participants who did not like it, negatively evaluated its use, and experienced a disappointing assimilation process. Despite the vast differences between the groups, both reported more positive evaluations of SARs at the end of the study than before it began. Overall, the results indicated that the process of SARs' assimilation is not homogeneous and provided a profound understanding of the factors shaping older adults' QE of SARs following actual use. Additionally, the findings demonstrated the theoretical and practical usefulness of a holistic approach in researching older SARs users.

Intrinsic functional brain connectivity changes following aerobic exercise, computerized cognitive training, and their combination in physically inactive healthy late-middle-aged adults: the Projecte Moviment

Lifestyle interventions have positive neuroprotective effects in aging. However, there are still open questions about how changes in resting-state functional connectivity (rsFC) contribute to cognitive improvements. The Projecte Moviment is a 12-week randomized controlled trial of a multimodal data acquisition protocol that investigated the effects of aerobic exercise (AE), computerized cognitive training (CCT), and their combination (COMB). An initial list of 109 participants was recruited from which a total of 82 participants (62% female; age = 58.38 ± 5.47) finished the intervention with a level of adherence > 80%. Only in the COMB group, we revealed an extended network of 33 connections that involved an increased and decreased rsFC within and between the aDMN/pDMN and a reduced rsFC between the bilateral supplementary motor areas and the right thalamus. No global and especially local rsFC changes due to any intervention mediated the cognitive benefits detected in the AE and COMB groups. Projecte Moviment provides evidence of the clinical relevance of lifestyle interventions and the potential benefits when combining them.

Efficacy of cognitive training on executive functions in healthy older adults: a systematic review with meta-analysis of randomized controlled trials

OBJECTIVE

Systematically review randomized controlled trials on the efficacy of cognitive training on executive functions in healthy older people.

MEASURES

The outcome measures were related to inhibitory control, working memory, and cognitive flexibility.

RESULTS

Thirty-one trials were included in the systematic review and thirteen trials in the meta-analysis. In the overall analysis, the cognitive training enhanced inhibitory control when measured by the Stroop task (p < .001, d = 1.64) and working memory when measured by the Corsi Block task (p = .002, d = .16). A marginal significance was found for working memory in the Digit Span task - Forward (p = .06, d = .92). However, cognitive training did not enhance inhibitory control when measured by the Go/No-Go task (p = .76, d = .59), working memory when measured by the Digit Span - Backward (p = .72, d = .95) and N-Back (p = .10, d = .26) tasks, and cognitive flexibility when measured by Trail Making - Part B (p = .08, d = .27) and Semantic Fluency (p = .49, d = .06) tasks.

CONCLUSION

Mixed evidence was found for inhibitory control and working memory; cognitive flexibility showed no evidence of improvement.

Examining technology-assisted rehabilitation for older adults' functional mobility: a network meta-analysis on efficacy and acceptability

Technological advancements facilitate feedback adaptation in rehabilitation through virtual reality (VR) exergaming, serious gaming, wearables, and telerehabilitation for older adults fall prevention. Although studies have evaluated these technologies, no comparisons of their effectiveness have been conducted to date. Thus, this study aims to assess the differences in effectiveness of these interventions on balance and functional mobility in the older adults. A systematic review and network meta-analysis (NMA) were conducted to identify the most effective interventions for improving balance and functional mobility in adults aged 60 and over. The search was conducted in five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science) up to June 10, 2023. The eligibility criteria were: (1) older adults, (2) functional mobility, balance, or gait as the primary outcome, (3) new technology intervention, and (4) randomized study design. New technology interventions were classified into five categories: exergaming with balance platforms or motion capture technologies, other serious gaming, interventions with wearables, and telerehabilitation. Additionally, two categories of control interventions (conventional exercises and no treatment) were extracted. The NMA was performed for the aggregated results of all outcomes, and separately for clinical functional scales, functional mobility, and gait speed results. Fifty-two RCTs with 3081 participants were included. Exergaming with motion capture was found to be statistically significant in producing a better effect than no treatment in the analysis of the functional mobility with an SMD of -0.70 (P < 0.01). The network meta-analysis revealed that exergaming with motion capture offers greater therapeutic benefits for functional mobility and balance compared to no treatment control. The effectiveness of this approach is similar to that of conventional exercises. Further RCTs are needed to provide a more definitive conclusion, particularly with respect to the effectiveness of serious games, telerehabilitation, and interventions with wearables.

Neuroprotection in metabolic syndrome by environmental enrichment. A lifespan perspective

Metabolic syndrome (MetS) is defined by the concurrence of different metabolic conditions: obesity, hypertension, dyslipidemia, and hyperglycemia. Its incidence has been increasingly rising over the past decades and has become a global health problem. MetS has deleterious consequences on the central nervous system (CNS) and neurological development. MetS can last several years or be lifelong, affecting the CNS in different ways and treatments can help manage condition, though there is no known cure. The early childhood years are extremely important in neurodevelopment, which extends beyond, encompassing a lifetime. Neuroplastic changes take place all life through - childhood, adolescence, adulthood, and old age - are highly sensitive to environmental input. Environmental factors have an important role in the etiopathogenesis and treatment of MetS, so environmental enrichment (EE) stands as a promising non-invasive therapeutic approach. While the EE paradigm has been designed for animal housing, its principles can be and actually are applied in cognitive, sensory, social, and physical stimulation programs for humans. Here, we briefly review the central milestones in neurodevelopment at each life stage, along with the research studies carried out on how MetS affects neurodevelopment at each life stage and the contributions that EE models can provide to improve health over the lifespan.

Central features in health-related quality of life in older adults: network analysis using nationwide survey data

BACKGROUND

Population ageing is a global phenomenon that necessitates consideration of health-related quality of life (HRQoL) in older adults. Previous studies have investigated related factors including mobility, social support and living situations.

AIMS

This study aimed to provide a network perspective on factors related to HRQoL.

METHOD

Cross-sectional nationwide data were obtained from the Korean National Health and Nutrition Examination Survey conducted from 2018 to 2020 for network analyses. Data for participants aged 65 years or above were analysed, resulting in a total of 4317 eligible cases. The variables included were EQ-5D (a measure of HRQoL), household income, education, living situation, subjective perceived health, Charlson Comorbidity Index (a measure of medical comorbidities), stress, exercise per week, alcohol consumption and smoking. Three networks were produced: (a) EQ-5D dimensions network, (2) EQ-5D dimensions, lifestyle and psychosocial factors network, and (3) overall EQ-5D index, lifestyle and psychosocial factors network. Node centralities, bridge centralities and edges of the networks were examined.

RESULTS

The most central EQ-5D dimension was the ability to carry out usual activities. In the second network, subjective health, stress and anxiety/depression were revealed as nodes with high bridge centralities. Subjective health, exercise, and Charlson Comorbidity Index were nodes closely linked to the overall EQ-5D index.

CONCLUSIONS

The results emphasise the importance of enhancing functional independence and subjective health cognition, increasing routine exercise and reducing stress as targets for interventions to improve HRQoL in older adults.

Behaviour Change Techniques in Computerized Cognitive Training for Cognitively Healthy Older Adults: A Systematic Review

We aimed to describe behaviour change techniques (BCT) used in trials evaluating computerised cognitive training (CCT) in cognitively healthy older adults, and explore whether BCTs are associated with improved adherence and efficacy. The 90 papers included in a recent meta-analysis were reviewed for information about adherence and use of BCTs in accordance with the Behaviour Change Taxonomy. Studies using a specific BCT were compared with studies not using that BCT on efficacy (difference in Hedges' g [Δg]) using three level meta-regression models and on median adherence using the Wilcoxon test. The median number of BCTs per study was 3 (interquartile range [IQR] = 2-5). 'Feedback on behaviour' (if provided by a person; Δg = -0.19, 95% confidence interval [CI] = -0.31;-0.07) and 'non-specific reward' (Δg = -0.19, CI = -0.34;-0.05) were associated with lower efficacy. Certain BCTs that involve personal contact may be beneficial, although none were statistically significantly associated with greater efficacy. The median percentage of adherence was 90% (IQR = 81-95). Adherence was higher in studies using the BCT 'self-monitoring of behaviour' and lower in studies using the BCT 'graded tasks' than studies not using these BCTs (p < 0.001). These findings provide first evidence that BCTs can influence both adherence to and efficacy of CCT programs in cognitively healthy older adults.

Effects of exergames on mood and cognition in healthy older adults: A randomized pilot study

The elderly population is increasing and the implementation of stimulating training to promote active aging has become a research issue. This study aimed at investigating the effects of a cognitive-motor exergame training on cognitive functions and mood, in healthy older adults. A randomized controlled pilot study was conducted to compare a cognitive-motor exergame training with a passive control group. The training consisted of 8 sessions of 45 min each, including 10 interactive activities focused on several cognitive functions such as memory, processing speed and executive functions, all requiring motor planning and execution. A total of 57 participants were administered a battery of cognitive tests before and after the training. A mixed-effect ANOVA with group (experimental vs. control) as between factor and time (pre-and post-test) as within factor, was performed to evaluate the effect of the exergame training on cognitive abilities and mood. Results showed significant interaction effects in processing speed [STROOPC: F (1,53.4) = 9.04, p = 0.004, R 2 = 0.82], inhibition [3backs' false alarms: F (1,47.5) = 5.5, p = 0.02, R 2 = 0.79], and mood [Beck Depression Inventory: F (1,55) = 4.15, p = 0.04, R 2 = 0.6]. Even though post-hoc analyses did not provide statistical evidence supporting the interactions, overall data showed a trend toward better scores only for the experimental group, suggesting a potential improvement in information processing speed, working memory and mood. Exergaming may be a motivating and enjoyable approach to healthy and active aging.

Rationale and methodology for examining the acute effects of aerobic exercise combined with varying degrees of virtual reality immersion on cognition in persons with TBI

Persons with Traumatic Brain Injury (TBI) commonly present with long-term cognitive deficits in executive function, processing speed, attention, and learning and memory. While specific cognitive rehabilitation techniques have shown significant success for deficits in individual domains, aerobic exercise training represents a promising approach for an efficient and general treatment modality that might improve many cognitive domains concurrently. Existing studies in TBI report equivocal results, however, and are hampered by methodological concerns, including small sample sizes, uncontrolled single-group designs, and the use of suboptimal exercise modalities for eliciting cognitive improvements in this population. One particularly promising modality involves the application of environmental enrichment via virtual reality (VR) during aerobic exercise in persons with TBI, but this has yet to be investigated. One approach for systematically developing an optimal aerobic exercise intervention for persons with TBI involves the examination of single bouts of aerobic exercise (i.e., acute aerobic exercise) on cognition. Acute exercise research is a necessary first step for informing the development of high-quality exercise training interventions that are more likely to induce meaningful beneficial effects. To date, such an acute exercise paradigm has yet to be conducted in persons with TBI. To that end, we propose an acute exercise study that will investigate the acute effects of aerobic exercise with incremental degrees of environmental enrichment (VR) relative to a control comparison condition on executive function (divided attention and working memory) and processing speed in 24 people with TBI.

Effects of exercise intervention on executive function of middle-aged and elderly people: A systematic review of randomized controlled trials

Background

Executive function will gradually decline with the increase of age, which will have a negative impact on the quality of life and general health. Exercise intervention can improve executive function and prevent its deterioration, but the evidence from randomized controlled trials is not consistent.

Aim

To assess the effect of exercise intervention on executive function of healthy middle-aged and elderly people, and briefly describe its mechanism.

Methods

A search was conducted using PubMed, Web of science and EBSCO. The searches were limited to English articles published from January 2010 to January 2022. The information is extracted from searched articles included or excluded based on certain criteria.

Results

The search returned 2,746 records, of which 11 articles were included in the systematic review, and 8 articles were supplemented according to the references included and related reviews. The results show that different types of exercise intervention have positive effects on the executive function of the middle-aged and elderly people. The intervention prescriptions in most studies are executed in medium to low frequency, medium intensity and medium duration, while only 11% of the studies were followed up.

Conclusions

The intervention, which was executed twice a week with 30-60 min single intervention time and over 12 weeks total duration, showed a good intervention effect. Exercise intervention is to improve executive function by affecting the activation of brain network and the synthesis of neurotransmitters.

The application of technology to improve cognition in older adults: A review and suggestions for future directions

The rapidly increasing worldwide population of older adults, along with the increasing prevalence of cognitive impairment and dementia in this population, is a growing health‐care problem. As such, advances in technology‐based cognitive interventions and games are playing an increasingly key role in preserving and improving older adults' cognitive function, especially during the COVID‐19 pandemic when opportunities for face‐to‐face activities or training are few. In this paper, we summarize from previous studies systematic reviews and meta‐analyses on the various types of technology used in cognitive interventions (namely, computerized cognitive training, virtual‐reality interventions and robot‐assisted interventions) and the empirical evidence on the effects of these technologies on global and specific cognitive functions in healthy and clinical populations of older adults (e.g., older adults with mild cognitive impairment or dementia). We also describe older adults' perceptions, experiences and acceptance of these technologies. Finally, we discuss the limitations, challenges and future avenues of research in this field.

A Randomized Controlled Trial Study of a Multimodal Intervention vs. Cognitive Training to Foster Cognitive and Affective Health in Older Adults

Research over the past few decades has shown the positive influence that cognitive, social, and physical activities have on older adults’ cognitive and affective health. Especially interventions in health-related behaviors, such as cognitive activation, physical activity, social activity, nutrition, mindfulness, and creativity, have shown to be particularly beneficial. Whereas most intervention studies apply unimodal interventions, such as cognitive training (CT), this study investigates the potential to foster cognitive and affective health factors of older adults by means of an autonomy-supportive multimodal intervention (MMI). The intervention integrates everyday life recommendations for six evidence-based areas combined with psychoeducational information. This randomized controlled trial study compares the effects of a MMI and CT on those of a waiting control group (WCG) on cognitive and affective factors, everyday life memory performance, and activity in everyday life. Three groups, including a total of 119 adults aged 65–86 years, attended a 5- or 10-week intervention. Specifically, one group completed a 10-week MMI, the second group completed 5-week of computer-based CT followed by a 5-week MMI, whereas the third group paused before completing the MMI for the last 5 weeks. All participants completed online surveys and cognitive tests at three test points. The findings showed an increase in the number and variability of activities in the everyday lives of all participants. Post hoc analysis on cognitive performance of MMI to CT indicate similar (classic memory and attention) or better (working memory) effects. Furthermore, results on far transfer variables showed interesting trends in favor of the MMI, such as increased well-being and attitude toward the aging brain. Also, the MMI group showed the biggest perceived improvements out of all groups for all self-reported personal variables (memory in everyday life and stress). The results implicate a positive trend toward MMI on cognitive and affective factors of older adults. These tendencies show the potential of a multimodal approach compared to training a specific cognitive function. Moreover, the findings suggest that information about MMI motivates participants to increase activity variability and frequency in everyday life. Finally, the results could also have implications for the primary prevention of neurocognitive deficits and degenerative diseases.

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.

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.

A Conceptual View of Cognitive Intervention in Older Adults With and Without Cognitive Decline-A Systemic Review

Background: Dementia is the one of the most common and prominent disease in the elderly person that results in the Cognitive interventions. In this study, we aim to conceptualize the cognitive intervention for older adults with and without cognitive dysfunction and to clarify the heterogeneity existing in this literature field by determining the main variables implicated. Methods: We conducted a study analysis using previous literature highlighting the significant data reporting empirical results from cognitive intervention for healthy older adults and other seniors with different types of dementia. Each paper was reviewed in terms of compensatory cognitive training, cognitive remediation, enrichment, cognitive activation, brain training, cognitive stimulation, cognitive training, and cognitive rehabilitation. The research analysis was performed following rigorous inclusion and exclusion criteria with the purpose of collecting relevant answers to our research questions. Results: We included a total of 168 studies in our review. Our findings indicated heterogeneity regarding methods, concepts, and procedures. Additionally, the values were integrated using different information existing in this field. Conclusion: In conclusion, we highlighted that this is the first review that clarify the discrepancy of various existing definitions, methods, and procedures, as well as the overlapping information in the cognitive interventions.

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.

The Effect of Video Game-Based Interventions on Performance and Cognitive Function in Older Adults: Bayesian Network Meta-analysis

Background

The decline in performance of older people includes balance function, physical function, and fear of falling and depression. General cognitive function decline is described in terms of processing speed, working memory, attention, and executive functioning, and video game interventions may be effective.

Objective

This study evaluates the effect of video game interventions on performance and cognitive function in older participants in terms of 6 indicators: balance function, executive function, general cognitive function, physical function, processing speed, and fear of falling and depression.

Methods

Electronic databases were searched for studies from inception to June 30, 2020. Randomized controlled trials and case-controlled trials comparing video game interventions versus nonvideo game control in terms of performance and cognitive function outcomes were incorporated into a Bayesian network meta-analysis. All data were continuous variables.

Results

In total, 47 studies (3244 participants) were included. In pairwise meta-analysis, compared with nonvideo game control, video game interventions improved processing speed, general cognitive function, and depression scores. In the Bayesian network meta-analysis, interventions with video games improved balance function time (standardized mean difference [SMD] –3.34, 95% credible interval [CrI] –5.54 to –2.56), the cognitive function score (SMD 1.23, 95% CrI 0.82-1.86), processing speed time (SMD –0.29, 95% CrI –0.49 to –0.08), and processing speed number (SMD 0.72, 95% CrI 0.36-1.09), similar to the pairwise meta-analysis. Interventions with video games with strong visual senses and good interactivity ranked first, and these might be more beneficial for the elderly.

Conclusions

Our comprehensive Bayesian network meta-analysis provides evidence that video game interventions could be considered for the elderly for improving performance and cognitive function, especially general cognitive scores and processing speed. Games with better interactivity and visual stimulation have better curative effects. Based on the available evidence, we recommend video game interventions for the elderly.

Trial Registration

PROSPERO CRD42020197158; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197158

The Effect of an 8-Week Aerobic Dance Program on Executive Function in Children

In the current study, we examined the effect of an aerobic dance program as part of physical education (PE) classes on aspects of primary school children's executive functions (EFs) (inhibition, working memory, and cognitive flexibility). Participants were 41 children (21 boys and 20 girls; M age =10.30, SD = 0.50 years, M height = 134.09, SD= 3.9 cm; M weight = 35.61, SD = 7.85 kg) who were divided into an experimental group (EG) and a no-PE control group (CG). The EG followed an aerobic dance intervention as part of their PE program (45 minute sessions two days per week over eight weeks). Participants in both groups performed EF tests before and after the intervention period to evaluate their mental flexibility, inhibition, and working memory. A two-way mixed model repeated measures ANOVA revealed a significant effect of the aerobic dance program on participants' cognitive flexibility (i.e., on Trails Making Tests _B-A times and committed errors) (p <0.001), and on Stroop measures of inhibition (corrected number of words and corrected errors) (p <0.001 and p <0.01, respectively), with post-hoc analyses showing an improved performance by the EG in working memory (digit recall score) from pre-test to post-test and in comparsion to the CG (p < 0.001). Thus, this 8-week aerobic dance program promoted EF development among primary school children.

The effectiveness of cognitive-motor training on reconstructing cognitive health components in older male adults, recovered from the COVID-19

Objective

The incidence of COVID-19 disease in the elderly can accelerate normal degenerative process of cognitive functions. Interactive cognitive-motor training (CMT) is an intervention that integrates cognitive and motor tasks to promote individuals’ physical and psychological health. The present study aimed to examine the effect of CMT on reconstructing cognitive health components in older men, who have recently recovered from COVID-19.

Materials and methods

This study is a quasi-experimental repeated measure (without control group). Participants were 42 elderly men (65–80 years) who recovered from the COVID-19 disease that individually participated in a 4-week CMT program twice a week. The cognitive health components of the participants were assessed by the General Health Questionnaire (GHQ-2) and the Mini-Mental State Examination (MMSE) at 3 stages before the beginning of the intervention (baseline assessment); 2 weeks after the intervention (short-term follow-up); and 3 months after the intervention (long-term follow-up).

Results

The results showed that the scores of depression, anxiety, physical symptoms, and social performance components and the overall GHQ score improved significantly in short-term follow-up (P < 0.05) and also in long-term follow-up compared to baseline assessment (P < 0.05). It was also found that attention and calculation, recall, lingual skill, and action performance components and the overall score of MMSE were also improved at three stages of assessments. Other components did not differ among stages.

Conclusions

This study adds to the research on the effectiveness of using CMT for reconstructing cognitive health components in older adults, recovered from the COVID-19, and supports CMT as a viable intervention practice.

Benefits of VR Physical Exercise on Cognition in Older Adults with and without Mild Cognitive Decline: A Systematic Review of Randomized Controlled Trials

It is well known that physical exercise has beneficial effects on cognitive function in older adults. Recently, several physical exercise programs with virtual reality (VR) have been proposed to support physical exercise benefits. However, it is still unclear whether VR physical exercise (VR-PE) has positive effects on cognitive function in older adults. The purpose of this study was to conduct a systematic review (SR) of the effects of VR-PE on cognitive function in older adults with and without cognitive decline. We used academic databases to search for research papers. The criteria were intervention study using any VR-PE, participants were older adults with and without mild cognitive decline (not dementia), and cognitive functions were assessed. We found that 6 of 11 eligible studies reported the significant benefits of the VR-PE on a wide range of cognitive functions in aging populations. The SR revealed that VR-PE has beneficial effects on the inhibition of executive functions in older adults with and without mild cognitive decline. Moreover, VR-PE selectively leads to improvements in shifting and general cognitive performance in healthy older adults. The SR suggests that VR-PE could be a successful approach to improve cognitive function in older adults with and without cognitive decline.

Effects of a Multicomponent Exercise Program on Groups of Community-Dwelling Older Adults with Low Schooling: A Pilot Study

The aim of this study was to analyze the effects of a multicomponent exercise program on the physical and hemodynamic functions of community-dwelling older adults with low schooling levels in relation to simple multicomponent group exercises. Twenty-one older people were randomly assigned to two groups: G1 (n = 11) and G2 (n = 10); sixteen of whom completed the sixteen sessions over a six-week period, three times a week. During eight sessions, G1 performed adapted dual-task multicomponent exercises (strengthening, balance, and cognition) and G2 simple multicomponent exercises (strengthening and balance), and both groups engaged in eight additional sessions of simple multicomponent exercises. The dual-task multicomponent exercises exhibited similar effects to those of their simple multicomponent counterparts. The older adults from both groups improved mobility, frailty, static postural control, balance, and hemodynamic stability. The adapted program was beneficial to the community-dwelling older people with low schooling in the group intervention.

Can Exergames Be Improved to Better Enhance Behavioral Adaptability in Older Adults? An Ecological Dynamics Perspective

Finding effective training solutions to attenuate the alterations of behavior and cognition in the growing number of older adults is an important challenge for Science and Society. By offering 3D computer-simulated environments to combine perceptual-motor and cognitive exercise, exergames are promising in this respect. However, a careful analysis of meta-analytic reviews suggests that they failed to be more effective than conventional motor-cognitive training. We analyzed the reasons for this situation, and we proposed new directions to design new, conceptually grounded, exergames. Consistent with the evolutionary neuroscience approach, we contend that new solutions should better combine high level of metabolic activity with (neuro)muscular, physical, perceptual-motor, and cognitive stimulations. According to the Ecological Dynamics rationale, we assume that new exergames should act at the agent-environment scale to allow individuals to explore, discover, and adapt to immersive and informationally rich environments that should include cognitively challenging tasks, while being representative of daily living situations.

Effects of Combined Physical Activity and Cognitive Training on Cognitive Function in Older Adults with Subjective Cognitive Decline: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background. Subjective cognitive decline (SCD) is recognized as the earliest prodromal stage of Alzheimer’s disease (AD). Emerging studies explored the effects of combined physical activity and cognitive training interventions on cognitive ability, psychological well-being, and emotion of older adults with SCD, but the results are now still controversial. Objective. This study systematically evaluated the enhancement effects of the combined physical-cognitive interventions on memory self-efficacy, objective cognitive function, psychological well-being, and emotion of older adults with SCD. Methods. Data sources PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang degree and conference papers database, Chinese Science and Technology Periodical (VIP) databases from their inception to 28 February 2020, the Cochrane Central Register of Controlled Trials (Cochrane Library, 2020, Issue 3), and the reference lists of all retrieved articles were searched. Data analysis and bias risk evaluation were conducted in 2020. Two reviewers (SG and YY) independently evaluated the risk of bias of the included studies using the RoB 2 tool. Results. Eleven RCTs involving 1713 participants with SCD (age 68.0 ± 6.1) were included for review and meta-analysis. The interventions in the included studies were physical activity combined with cognitive training. Multiple-modality exercise with mind-motor training, supervised strategy-based memory training sequentially after stationary cycling, Dejian Mind-Body intervention, and physical activity and cognitive stimulation were also practiced. Conclusions. Compared to the active or nonactive control groups, the combined interventions are effective in improving objective cognitive function in SCD which may show the potential value of combined physical-cognitive interventions in improving objective cognitive ability and preventing the conversion of SCD to MCI or AD and no adverse effects. However, owing to the limitations of the included studies, these findings should be interpreted cautiously.

Cognitive training using the abacus: a literature review study on the benefits for different age groups

The literature indicates that cognitive stimulation interventions have shown promising results. Abacus represents a tool with great potential in such interventions.

A randomized controlled trial into the cognitive effects of a computer-tailored physical activity intervention in older adults with chronic disease(s)

Background

Cognitive functioning (CF) is important for wellbeing and an independent life. However, older adults with chronic diseases are at a higher risk of poorer CF levels. Although, research suggests that physical activity (PA) could play an essential role in maintaining good CF, older adults with chronic diseases have low levels of PA. PA interventions to prevent cognitive decline for this specific group exist. Yet, until now these interventions focused on a single specific chronic disease. Active Plus is a proven effective computer-tailored PA stimulating intervention focused on increasing PA in daily life for the older adult population suffering from a broad range of chronic diseases. This study tests the cognitive effects of Active Plus in older adults with chronic diseases.

Methods

In this RCT older adults with at least one chronic disease (≥65 years) were allocated to the intervention group (N = 260, mean age = 74.2) or waiting list control group (N = 325, mean age = 74.5). In total, intervention group participants received three times computer-tailored PA stimulating advice within four months (i.e., at baseline, after two months, and after three to four months). The online and print delivered advice were tailored to the specific needs and wishes of the participant and focused on incorporating PA in daily life. Baseline and follow-up measurements of the CF verbal memory (Verbal Learning Test), shifting (Trailmaking Test), inhibition (Stop-signal Task) and processing speed (Letter Digit Substitution Test) were assessed after six and 12 months. Intervention effects were analyzed with multilevel linear mixed-effects models adjusted for the clustered design and confounding variables.

Results

The dropout rate was 19.1% after 6 months and 25.1% after 12 months. Although both conditions improved on all verbal memory outcomes after 6 months, and all CF outcomes except inhibition after 12 months, no intervention effects were found, not even in subgroups (p > .05).

Conclusions

To our knowledge this is the first study to test the cognitive effects of a computer-tailored PA stimulating intervention in older adults suffering from a broad range of chronic diseases. The effects of the Active Plus intervention were not strong enough to improve CF or prevent cognitive decline. A blended approach, in which this computer-tailored intervention is combined with a face-to-face PA intervention and / or cognitive training, might be a good suggestion to increase the effects of Active Plus on PA and CF in older adults with chronic diseases.

Trial registration

Netherlands Trial Register NL6005; Date of Registration 03-21-2017; https://www.trialregister.nl/trial/6005

Behavioral and ERP Correlates of Long-Term Physical and Mental Training on a Demanding Switch Task

Physical and mental training are associated with positive effects on executive functions throughout the lifespan. However, evidence of the benefits of combined physical and mental regimes over a sedentary lifestyle remain sparse. The goal of this study was to investigate potential mechanisms, from a source-resolved event-related-potential perspective, that could explain how practicing long-term physical and mental exercise can benefit neural processing during the execution of an attention switching task. Fifty-three healthy community volunteers who self-reported long-term practice of Tai Chi (n = 10), meditation + exercise (n = 16), simple aerobics (n = 15), or a sedentary lifestyle (n = 12), aged 47.8 ± 14.6 (SD) were included in this analysis. All participants undertook high-density electroencephalography recording during a switch paradigm. Our results indicate that people who practice physical and mental exercise perform better in a task-switching paradigm. Our analysis revealed an additive effect of the combined practice of physical and mental exercise over physical exercise only. In addition, we confirmed the participation of frontal, parietal and cingulate areas as generators of event-related-potential components (N2-like and P3-like) commonly associated to the performance of switch tasks. Particularly, the N2-like component of the parietal and frontal domains showed significantly greater amplitudes in the exercise and mental training groups compared with aerobics and sedentary groups. Furthermore, we showed better performance associated with greater N2-like amplitudes. Our multivariate analysis revealed that activity type was the most relevant factor to explain the difference between groups, with an important influence of age, and body mass index, and with small effects of educational years, cardiovascular capacity, and sex. These results suggest that chronic combined physical and mental training may confer significant benefits to executive function in normally aging adults, probably through more efficient early attentional processing. Future experimental studies are needed to confirm our results and understand the mechanisms on parieto-frontal networks that contribute to the cognitive improvement associated with practicing combined mental and aerobic exercise, while carefully controlling confounding factors, such as age and body mass index.

Effects of a multimodal exercise protocol on functional outcomes, epigenetic modulation and brain-derived neurotrophic factor levels in institutionalized older adults: a quasi-experimental pilot study

Epigenetic changes have been shown to be associated with both aging process and aging-related diseases. There is evidence regarding the benefits of physical activity on the functionality, cognition, and quality of life of institutionalized older adults, however, the molecular mechanisms involved are not elucidated. The purpose of this pilot study was to investigate the effects of a multimodal exercise intervention on functional outcomes, cognitive performance, quality of life (QOL), epigenetic markers and brain-derived neurotrophic factor (BDNF) levels among institutionalized older adult individuals. Participants (n = 8) without dementia who were aged 73.38 ± 11.28 years and predominantly female (87.5%) were included in this quasi-experimental pilot study. A multimodal exercise protocol (cardiovascular capacity, strength, balance/agility and flexibility, perception and cognition) consisted of twice weekly sessions (60 minutes each) over 8 weeks. Balance (Berg Scale), mobility (Timed Up and Go test), functional capacity (Six-Minute Walk test), cognitive function (Mini-Mental State Examination) and QOL (the World Health Organization Quality of Life-BREF Scale questionnaire) were evaluated before and after the intervention. Blood sample (15 mL) was also collected before and after intervention for analysis of biomarkers global histone H3 acetylation and brain-derived neurotrophic factor levels. Significant improvements were observed in cognitive function, balance, mobility, functional capacity and QOL after the intervention. In addition, a tendency toward an increase in global histone H3 acetylation levels was observed, while brain-derived neurotrophic factor level remained unchanged. This study provided evidence that an 8-week multimodal exercise protocol has a significant effect on ameliorating functional outcomes and QOL in institutionalized older adult individuals. In addition, it was also able to promote cognitive improvement, which seems to be partially related to histone hyperacetylation status. The Ethics Research Committee of Centro Universitário Metodista-IPA, Brazil approved the current study on June 6, 2019 (approval No. 3.376.078).

Effect of Aerobic Exercise on Mental Health in Older Adults: A Meta-Analysis of Randomized Controlled Trials

Introduction: The recommendation of exercise programs in the senior population may benefit inactive and sedentary individuals and improve and help to treat specific health conditions. The purpose of this review is to summarize the published evidence from RCT studies of aerobic exercise interventions for mental health in older adults over the last 20 years. Methods: A literature search was conducted using electronic databases including Web of Science, PubMed/Medline, and ProQuest. Results: A total of 15 studies met the inclusion criteria. The subjects of these studies were aged 60 years or older and had various physical health statuses. In 15 studies, the mean effect size for the experimental outcome was 0.56 ± 0.39 (95%CI: 0.36-0.76). One-way ANOVA indicated no significant differences in the intervention duration [F _(2,15) = 0.919, p = 0.420], subject category [F _(2,15) = 0.046, p = 0.955], or measurement category [F _(3,14) = 0.967, p = 0.436]. However, there were significant differences in exercise frequencies [F _(2,15) = 6.03, p = 0.012]. Conclusion: The available evidence suggests that aerobic exercise is beneficial for improving the mental health of adults aged 60 years and older. The intervention effect can be achieved regardless of the type of subject and the duration of the intervention. Further, the present study indicates that low-frequency, long-term and regular aerobic exercise is more effective for older adults. Therefore, we recommend that older adults to exercise at a low frequency depending on their physical condition.

The Impact of a Multitasking-Based Virtual Reality Motion Video Game on the Cognitive and Physical Abilities of Older Adults

This study demonstrates how playing a well-designed multitasking motion video game in a virtual reality (VR) environment can positively impact the cognitive and physical health of older players. We developed a video game that combines cognitive and physical training in a VR environment. The impact of playing the game was measured through a four-week longitudinal experiment. Twenty healthy older adults were randomly assigned to either an intervention group (i.e., game training) or a control group (i.e., no contact). Participants played three 45-min sessions per week completing cognitive tests for attention, working memory, reasoning and a test for physical balance before and after the intervention. Results showed that compared to the control group, the game group showed significant improvements in working memory and a potential for enhancing reasoning and balance ability. Furthermore, while the older adults enjoyed playing the video game, ability enhancements were associated with their intrinsic motivation to play. Overall, cognitive training with multitasking VR motion video games has positive impacts on the cognitive and physical health of older adults.

Current Cognition Tests, Potential Virtual Reality Applications, and Serious Games in Cognitive Assessment and Non-Pharmacological Therapy for Neurocognitive Disorders

As the global population ages, the incidence of major neurocognitive disorders (major NCDs), such as the most common geriatric major NCD, Alzheimer's disease (AD), has grown. Thus, the need for more definitive cognitive assessment or even effective non-pharmacological intervention for age-related NCDs is becoming more and more pressing given that no definitive diagnostics or efficacious therapeutics are currently unavailable for them. We evaluate the current state of the art of cognitive assessment for major NCDs, and then briefly glance ahead at potential application of virtual reality (VR) technologies in major NCD assessment and in cognition training of visuospatial reasoning in a 3D environment, as well as in the alleviation of depression and other symptoms of cognitive disorders. We believe that VR-based technologies have tremendous potentials in cognitive assessment and non-pharmacological therapy for major NCDs.

Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial

Background

Training effects reported for stepping exergames on stepping performances in older adults often based on not comprehensively validated outcomes measures, and follow-up data on their sustainability are lacking. The aim of this study is to evaluate the effectiveness and sustainability of a motor-cognitive stepping exergame training on the stepping performance in older adults.

Methods

Fifty-eight older adults (78.3 ± 6.5 years) participated in the randomized controlled trial with a 10-week intervention and 10-week follow-up period. The intervention group (IG: n = 29) took part in a once-weekly exercise program including strength and balance exercises supplemented with an additional stepping exergame training. The control group (CG: n = 29) only performed the strength and balance exercises. Outcome measures included stepping reaction times (SRTs) and games scores for individual stepping exergame levels and for the overall exergame performance, as measured by an assessment strategy previously validated in older adults.

Results

SRTs and/or games scores for 7 out of 10 levels and the overall exergame performance significantly improved in the IG compared to the CG during the intervention (p ≤ 0.001–0.039, η_p² = 0.090–0.445). Training gains were sustained for 2 levels and for the overall exergame performance (p = 0.017–0.033, η_p² = 0.127–0.193).

Conclusion

The study demonstrates that the additional stepping exergame training effectively and sustainably improves the performance in complex motor-cognitive stepping exergame tasks in older adults, which can be relevant for preventing falls. Future research is needed to evaluate the effectiveness of such training on reducing the number of falls.

Trial registration

ISRCTN registry, ISRCTN14855620, 06/06/2019 (retrospectively registered).

Effect of Combined Physical and Cognitive Interventions on Executive Functions in OLDER Adults: A Meta-Analysis of Outcomes

Background: Both physical exercise and cognitive training can effectively improve executive functions in older adults. However, whether physical activity combined with cognitive training is more effective than a single intervention remains controversial. The aim of this study was to perform a meta-analysis to evaluate the effect of combined physical and cognitive interventions on executive functions in older adults aged 65–80 years old. Methods: Randomized controlled trials of combined physical and cognitive interventions on executive functions in older adults were searched using the Web of Science, Elsevier Science, PubMed, EBSCO, Springer-Link, and NATURE databases. Data extraction and quality evaluation were done by Comprehensive Meta-Analysis, V3. Results: A total of 21 studies were included. The results showed that the combined physical and cognitive interventions produced significantly larger gains in executive functions, compared to the control group (standardized mean difference (SMD) = 0.26, 95% confidence interval (CI) [0.14, 0.39], p < 0.01). Furthermore, the effects of the combined physical and cognitive interventions were moderated by the study quality, intervention length, and intervention frequency. No significant differences were found between the combined interventions and the physical intervention alone (SMD = 0.13, 95% CI [−0.07, 0.33], p > 0.05) or the cognitive intervention alone (SMD = 0.13, 95% CI [−0.05, 0.30], p > 0.05). Conclusions: The combined physical and cognitive interventions effectively delayed the decrease of executive functions in older adults and this effect was influenced by the length and frequency of the intervention as well as the research quality. However, the effect of the combined physical and cognitive interventions was not significantly better than that of each intervention alone.

Beneficial Effects of Interactive Physical-Cognitive Game-Based Training on Fall Risk and Cognitive Performance of Older Adults

Physical and cognitive declines are significant risk factors for falls. Promising evidence suggests that combined physical-cognitive training would be an effective fall risk reduction and cognitive improvement intervention. However, a limited number of studies have been conducted and findings have been inconclusive. This study investigated the effects of interactive physical-cognitive game-based training on the fall risk and cognitive performance of older adults. Forty participants were randomly allocated to the intervention (n = 20) and control (n = 20) groups. Participants in the intervention group performed a 1 h session, 3 times a week for 12 weeks of the interactive physical-cognitive game-based training program. Fall risk (Physiological Profile Assessment, PPA; and Timed Up and Go, TUG) and cognitive outcome (Montreal Cognitive Assessment, MoCA) were assessed at pre- and post-intervention. Thirty-nine participants (mean age = 69.81 ± 3.78 years) completed the study (97.5%). At the end of the trial, participants in the intervention group demonstrated significant improvement in the PPA fall risk score (p = 0.015), postural sway (p = 0.005), MoCA score (p = 0.001), and TUG-dual task (p = 0.045) compared to controls. In conclusion, the interactive physical-cognitive, game-based training was effective in reducing physiological fall risk and improving cognitive function in community-dwelling older adults.

Continuous Compared to Accumulated Walking-Training on Physical Function and Health-Related Quality of Life in Sedentary Older Persons

The present study aimed to analyze the impact of overground walking interval training (WIT) in a group of sedentary older adults, comparing two different dose-distributions. In this quasi-experimental and longitudinal study, we recruited twenty-three sedentary older adults (71.00 ± 4.10 years) who were assigned to two groups of WIT. The continuous group (CWIT) trained for 60 min/session in the morning, while the accumulated group (AWIT) performed the same duration and intensity of exercise, but it was distributed twice a day (30 min in the morning and 30 more in the afternoon). After 15 weeks of an equal external-load training (3 days/week), Bonferroni post-hoc comparisons revealed significant (p < 0.050) and similar large improvements in both groups in cardiorespiratory fitness and lower limb strength; even larger gains in preferred walking speed and instrumental daily life activity, which was slightly superior for CWIT; and improvements in agility, which were moderate for CWIT and large for AWIT. However, none of the training protocols had an impact on the executive function in the individuals, and only the AWIT group improved health-related quality of life. Although both training protocols induced a general significant improvement in physical function in older adults, our results showed that the accumulative strategy should be recommended when health-related quality of life is the main target, and the continuous strategy should be recommended when weakness may be a threat in the short or medium term.

Heart Rate Variability Mainly Relates to Cognitive Executive Functions and Improves Through Exergame Training in Older Adults: A Secondary Analysis of a 6-Month Randomized Controlled Trial

Heart rate variability (HRV) mirrors autonomic nervous system activities and might serve as a parameter to monitor health status in older adults. However, it is currently unknown which functional health measures, including cognitive, physical, and gait performance parameters, are most strongly related to HRV indices. This knowledge would enable implementing HRV assessments into health monitoring routines and training planning for older adults. Simultaneous cognitive-motor and exergame training may be effective to improve HRV indices but has not been investigated yet. Eighty-nine healthy older adults (≥70 years of age) were randomized into three groups: (1) virtual reality video game dancing, i.e., exergaming (DANCE); (2) treadmill walking with simultaneous verbal memory training (MEMORY); or (3) treadmill walking only (PHYS). Strength and balance exercises complemented each program. Over 6 months, two weekly 1-h training sessions were performed. HRV indices (standard deviation of N-N intervals, SDNN; root mean square of successive R-R interval differences, RMSSD; and absolute power of high-frequency band (0.15-0.4 Hz), HF power) and various measures of cognitive, physical, and gait performance were assessed at baseline and after 3 months and 6 months. Multiple linear regression analyses with planned comparisons were calculated. At baseline, 8-12% of HRV variance was significantly explained by cognitive executive functions and leg strength (inversely related). Verbal long-term memory, aerobic and functional fitness, and gait performance did not contribute to the model (SDNN: R² = 0.082, p = 0.016; RMSSD: R² = 0.121, p = 0.013; HF power: R² = 0.119, p = 0.015). After 6 months, DANCE improved HRV indices, while MEMORY and PHYS did not (time × intervention interactions: first-contrast DANCE/MEMORY vs. PHYS: SDNN p = 0.014 one-tailed, ΔR ² = 0.020 and RMSSD p = 0.052 one-tailed (trend), ΔR ² = 0.007; second-contrast DANCE vs. MEMORY: SDNN p = 0.002 one-tailed, ΔR ² = 0.035, RMSSD p = 0.017 one-tailed, ΔR ² = 0.012, and HF power p = 0.011 one-tailed, ΔR ² = 0.013). We conclude that mainly cognitive executive functions are associated with HRV indices and that exergame training improves global and parasympathetic autonomic nervous system activities in older adults. Periodic assessments of HRV in older citizens could be particularly beneficial to monitor cognitive health and provide indications for preventative exercise measures.

The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis

Background

Ageing is associated with physical and cognitive decline, affecting independence and quality of life in older people. Recent studies show that in particular executive functions are important for daily-life function and mobility. This systematic review investigated the effectiveness of cognitive-motor training including exergaming on executive function (EF, set-shifting, working memory, inhibitory control) in healthy older people.

Methods

An electronic database search for randomised controlled trials (RCT), controlled clinical trials (CCT) and parallel group trials was performed using MEDLINE, EMBASE, and PsychINFO following PRISMA guidelines. Inclusion criteria were: (1) community-dwelling participants > 60 years without a medical condition or medical treatment, (2) reporting at least one cognitive-motor intervention while standing or walking, (3) use of dual-task interventions using traditional methods or modern technology to deliver a cognitive-motor task, (4) inclusion of at least one cognitive outcome. The PEDro scale was used for quality assessment.

Results

A total of 1557 studies were retrieved, of which 25 studies were included in this review. Eleven studies used a technology-based dual-task intervention, while 14 trials conducted a general cognitive-motor training. The age range of the cohort was 69 to 87 years. The interventions demonstrated positive effects on global cognitive function [mean difference 0.6, 95% CI 0.29–0.90] and inhibitory control [mean difference 0.61, 95% CI 0.28–0.94]. Effects were heterogeneous (I² range: 60–95) and did not remain after a sensitivity analysis. Processing speed and dual-task costs also improved, but meta-analysis was not possible.

Conclusion

Cognitive-motor and technology-based interventions had a positive impact on some cognitive functions. Dual-task interventions led to improvements of domains related global cognitive functions and inhibitory control. Likewise, technology-based exergame interventions improved functions related to processing speed, attentional and inhibitory control. Training interventions with a certain level of exercise load such as progression in difficulty and task specificity were more effective to gain task-related adaptations on cognitive functions.

Study protocol of a randomized intervention study to explore effects of a pure physical training and a mind-body exercise on cognitive executive function in independent living adults age 65-85

BACKGROUND

Decline in cognitive function associated with aging is one of the greatest concerns of older adults and often leads to a significant burden for individuals, families, and the health care system. Executive functions are most susceptible to age-related decline. Despite the well-known benefits of regular exercise on cognitive health, older adults tend to be less physically active than other age groups. Thus, there is a need to identify strategies that attract older adults and can enhance cognitive vitality.

AIMS

This article describes the protocol of a study designed to evaluate whether two interventions, a pure physical exercise and a mind-body exercise, can improve cognitive executive function in independent-living older adults. In addition, the study will explore barriers/facilitators related to adherence.

METHODS

After baseline assessment, participants will be randomly assigned to one of three groups (strength training, Awareness Through Movement^®, or a control group). Participants of the two active groups will attend the interventions for 12 weeks. The control group continues with the usual everyday life. Assessments will include three measures of executive function of the NIH Toolbox, and are administered at baseline, post-intervention and at 3-month follow-up. The primary outcomes are the changes in cognitive executive function performances. Secondary outcomes include adherence, self-efficacy for exercise, symptoms of depression, mindfulness and enjoyment. Attendance will be used as a measure of adherence.

DISCUSSION AND CONCLUSION

If successful, the interventions could provide low-cost strategies for older adults to maintain cognitive vitality and has the potential to impact current exercise guidelines.

Virtual Reality Games and the Role of Body Involvement in Enhancing Positive Emotions and Decreasing Anxiety: Within-Subjects Pilot Study

Background

In the last few years, the introduction of immersive technologies, especially virtual reality, into the gaming market has dramatically altered the traditional concept of video games. Given the unique features of virtual reality in terms of interaction and its ability to completely immerse the individual into the game, this technology should increase the propensity for video games to effectively elicit positive emotions and decrease negative emotions and anxiety in the players. However, to date, few studies have investigated the ability of virtual reality games to induce positive emotions, and the possible effect of this new type of video game in diminishing negative emotions and anxiety has not yet been tested. Furthermore, given the critical role of body movement in individuals’ well-being and in emotional responses to video games, it seems critical to investigate how body involvement can be exploited to modulate the psychological benefits of virtual reality games in terms of enhancing players’ positive emotions and decreasing negative emotions and anxiety.

Objective

This within-subjects study aimed to explore the ability of commercial virtual reality games to induce positive emotions and diminish negative emotions and state anxiety of the players, investigating the effects of the level of body involvement requested by the game (ie, high vs low).

Methods

A total of 36 young adults played a low body-involvement (ie, Fruit Ninja VR) and a high body-involvement (ie, Audioshield) video game in virtual reality. The Visual Analogue Scale (VAS) and the State-Trait Anxiety Inventory, Form-Y1 (STAI-Y1) were used to assess positive and negative emotions and state anxiety.

Results

Results of the generalized linear model (GLM) for repeated-measures multivariate analysis of variance (MANOVA) revealed a statistically significant increase in the intensity of happiness (P<.001) and surprise (P=.003) and, in parallel, a significant decrease in fear (P=.01) and sadness (P<.001) reported by the users. Regarding the ability to improve anxiety in the players, the results showed a significant decrease in perceived state anxiety after game play, assessed with both the STAI-Y1 (P=.003) and the VAS-anxiety (P=.002). Finally, the results of the GLM MANOVA showed a greater efficacy of the high body-involvement game (ie, Audioshield) compared to the low body-involvement game (ie, Fruit Ninja VR), both for eliciting positive emotions (happiness, P<.001; and surprise, P=.01) and in reducing negative emotions (fear, P=.05; and sadness, P=.05) and state anxiety, as measured by the STAI-Y1 (P=.05).

Conclusions

The two main principal findings of this study are as follows: (1) virtual reality video games appear to be effective tools to elicit positive emotions and to decrease negative emotions and state anxiety in individuals and (2) the level of body involvement of the virtual video game has an important effect in determining the ability of the game to improve positive emotions and decrease negative emotions and state anxiety of the players.

Effect of combined aquatic and cognitive training on quality of life, fall self-efficacy, and motor performance in aged with varying cognitive status: a proof-of-concept study

With the increasing number of aged individuals, research pertaining to their cognitive functions and physical-motor has become exponentially imperative. The purpose of the study was to investigate the effect com-bined aquatic and cognitive training on quality of life (QoL), fall self-effi-cacy and motor performance (static and dynamic balance) in aged with varying cognitive status levels. Thirty participants were assigned to a high cognitive status group (n=10), low cognitive status group (n=10), or nonintervention control group (n=10). Participants completed a 6-week motor-cognitive training regime with increasing intensity. QoL, fall self-efficacy, static balance, and dynamic balance were assessed. Preliminary results suggest proof-of-concept significant (P<0.05) im-provements were found in both the high and low cognitive status groups for static and dynamic balance and fall self-efficacy. However, QoL was only found to be significantly improved in the low cognitive status group. Aqua training along with cognitive training can effectively be used to prevent falls in the elderly and to improve their physical-motor perfor-mance. However, when attempting to improve QoL, the cognitive status of the individual should be considered.

Effects of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus: A systematic review and meta-analysis

Introduction

Previous evidence has shown significant effects of exercise, cognitive and dual-task training for improving cognition in healthy cohorts. The effects of these types of interventions in type 2 diabetes mellitus is unclear. The aim of this research was to systematically review evidence, and estimate the effect, of exercise, cognitive, and dual-task interventions on cognition in type 2 diabetes mellitus.

Method

Electronic databases including PubMed, EMBASE, CINAHL, PsycINFO, SPORTDiscus, and MEDLINE were searched for ongoing and completed interventional trials investigating the effect of either an exercise, cognitive or dual-task intervention on cognition in type 2 diabetes mellitus.

Results

Nine trials met the inclusion criteria–one dual-task, two cognitive, and six exercise. Meta-analyses of exercise trials showed no significant effects of exercise on measures of executive function (Stroop task, SMD = -0.31, 95% CI -0.71–0.09, P = 0.13, trail making test part A SMD = 0.28, 95% CI -0.20–0.77 P = 0.25, trail making test part B SMD = -0.15, 95% CI -0.64–0.34 P = 0.54, digit symbol SMD = 0.09, 95% CI -0.39–0.57 P = 0.72), and memory (immediate memory SMD = 0.20, 95% CI -0.28–0.69, P = 0.41 and delayed memory SMD = -0.06, 95% CI -0.55–0.42, P = 0.80). A meta-analysis could not be conducted using cognitive or dual-task data, but individual trials did report a favourable effect of interventions on cognition. Risk of bias was considered moderate to high for the majority of included trials.

Conclusions

Meta-analyses of exercise trials identified a small effect size (0.31), which whilst not significant warrants further investigation. Larger and more robust trials are needed that report evidence using appropriate reporting guidelines (e.g. CONSORT) to increase confidence in the validity of results.

Trial registration

Protocol was registered (CRD42017058526) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).

Effects of an In-home Multicomponent Exergame Training on Physical Functions, Cognition, and Brain Volume of Older Adults: A Randomized Controlled Trial

Aging is associated with a decline in physical functions, cognition and brain structure. Considering that human life is based on an inseparable physical-cognitive interplay, combined physical-cognitive training through exergames is a promising approach to counteract age-related impairments. The aim of this study was to assess the effects of an in-home multicomponent exergame training on [i] physical and cognitive functions and [ii] brain volume of older adults compared to a usual care control group. Thirty-seven healthy and independently living older adults aged 65 years and older were randomly assigned to an intervention (exergame training) or a control (usual care) group. Over 16 weeks, the participants of the intervention group absolved three home-based exergame sessions per week (à 30–40 min) including Tai Chi-inspired exercises, dancing and step-based cognitive games. The control participants continued with their normal daily living. Pre- and post-measurements included assessments of physical (gait parameters, functional muscle strength, balance, aerobic endurance) and cognitive (processing speed, short-term attention span, working memory, inhibition, mental flexibility) functions. T1-weighted magnetic resonance imaging was conducted to assess brain volume. Thirty-one participants (mean age = 73.9 ± 6.4 years, range = 65–90 years, 16 female) completed the study. Inhibition and working memory significantly improved post-intervention in favor of the intervention group [inhibition: F₍₁₎ = 2.537, p = 0.046, np2 = 0.11, working memory: F₍₁₎ = 5.872, p = 0.015, np2 = 0.02]. Two measures of short-term attentional span showed improvements after training in favor of the control group [F₍₁₎ = 4.309, p = 0.038, np2 = 0.03, F₍₁₎ = 8.504, p = 0.004, np2 = 0.04]. No significant training effects were evident for physical functions or brain volume. Both groups exhibited a significant decrease in gray matter volume of frontal areas and the hippocampus over time. The findings indicate a positive influence of exergame training on executive functioning. No improvements in physical functions or brain volume were evident in this study. Better adapted individualized training challenge and a longer training period are suggested. Further studies are needed that assess training-related structural brain plasticity and its effect on performance, daily life functioning and healthy aging.

A usability study of a multicomponent video game-based training for older adults

Background

Aging is often accompanied by a decline in sensory, motor and cognitive functions. These age- and lifestyle-related impairments may lead to reduced daily life functioning including gait disturbances, falling and injuries. Most daily life activities, e.g. walking, are tasks which require the concurrent interplay of physical and cognitive functions. Promising options for combined physical-cognitive training are video game-based physical exercises, so-called exergames. This study aimed to [i] determine the usability of a newly developed multicomponent exergame and [ii] explore its effects on physical functions, cognition and cortical activity.

Methods

Twenty-one healthy and independently living older adults were included (10 female, 71.4 ± 5.8 years, range: 65–91) and performed 21 training sessions (each 40 min) over seven weeks. The multicomponent exergame included strength and balance training with Tai Chi-inspired and dance exercises. Participants rated the usability of the exergame (System Usability Scale) and reported on their emotional experience (Game Experience Questionnaire). Attendance and attrition rates were calculated to determine training compliance. Before and after the intervention, physical and cognitive functions as well as resting state electroencephalography (EEG) were assessed.

Results

Results showed a high training attendance rate (87.1%, 18/21 training sessions on average) and a low attrition rate (9.5%, 2 drop-outs). System usability was rated high with a mean score of 75/100. Affective game experience was rated favorable. Gait speed under dual-task condition, lower extremity muscle strength and reaction times in a cognitive task (divided attention) showed significant improvements (p < .05). No significant pre-post differences were found for resting state EEG.

Conclusions

The newly developed exergame seems usable for healthy older adults. Nevertheless, some aspects of the exergame prototype can and should be improved. The training showed to positively influence physical and cognitive functions in a small convenience sample. Future trials are warranted which evaluate the feasibility and usability of the exergame training in a more “real-life” in-home setting and assess the behavioral and neuroplastic changes in a larger population after a longer training period with comparison to a control group.

Effects of Combined Aerobic Exercise and Cognitive Training on Verbal Fluency in Older Adults

We have previously shown that aerobic exercise improves measures of verbal fluency in older adults, and such an improvement is correlated with improved cardiovascular reserve (i.e., estimates of VO2). Due to increasing popularity in computer-based cognitive training, we explored whether the addition of cognitive training to aerobic exercise would further enhance the beneficial cognitive impact of exercise. Therefore, this study sought to test the hypothesis that a cognitive training regimen alone would directly improve executive function and that this effect would be potentiated with the addition of aerobic exercise. The interventions lasted 12 weeks, and cognitive assessments were taken immediately prior to and after the interventions. We found that only the groups employing aerobic exercise showed improvements in verbal fluency (semantic and letter) and cardiovascular fitness with no other executive functions being significantly impacted. Cognitive training alone was associated with decreased verbal fluency. These data replicate previous findings which indicate that aerobic exercise may have a remedial or mitigating effect of cognitive decline. In addition, they provide evidence that the addition of concurrent cognitive training to an aerobic exercise program does not provide synergistic improvement in executive functions.

Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition

Alzheimer's disease and related dementias (ADRD) represent an increasingly urgent public health concern, with an increasing number of baby boomers now at risk. Due to a lack of efficacious therapies among symptomatic older adults, an increasing emphasis has been placed on preventive measures that can curb or even prevent ADRD development among middle-aged adults. Lifestyle modification using aerobic exercise and dietary modification represents one of the primary treatment modalities used to mitigate ADRD risk, with an increasing number of trials demonstrating that exercise and dietary change, individually and together, improve neurocognitive performance among middle-aged and older adults. Despite several optimistic findings, examination of treatment changes across lifestyle interventions reveals a variable pattern of improvements, with large individual differences across trials. The present review attempts to synthesize available literature linking lifestyle modification to neurocognitive changes, outline putative mechanisms of treatment improvement, and discuss discrepant trial findings. In addition, previous mechanistic assumptions linking lifestyle to neurocognition are discussed, with a focus on potential solutions to improve our understanding of individual neurocognitive differences in response to lifestyle modification. Specific recommendations include integration of contemporary causal inference approaches for analyzing parallel mechanistic pathways and treatment-exposure interactions. Methodological recommendations include trial multiphase optimization strategy (MOST) design approaches that leverage individual differences for improved treatment outcomes.

Study Protocol: Does an Acute Intervention of High-Intensity Physical Exercise Followed by a Brain Training Video Game Have Immediate Effects on Brain Activity of Older People During Stroop Task in fMRI?-A Randomized Controlled Trial With Crossover Design

Background: Elderly people are affected by processes leading to decline in various aspects of daily living that impair their quality of life. Regarding neurological aspects, executive functions have been shown to be valuable for daily life and to slow decline during aging. Most intervention studies intended to improve cognitive functions during aging specifically address long-term destructive processes and countermeasures. However, to an increasing degree, studies also investigate the acute benefits that prove to be useful for daily life, such as physical exercise or video games in the form of exercise video gaming (“exergaming”). Because little is known about the change in cognitive ability following acute intervention of a combination of physical exercise and video gaming, especially for older people, this work is designed as an attempt to address this matter.

Methods: This study is a randomized crossover controlled trial to test the response to an acute bout of high-intensity physical exercise followed by a short session with a brain training (Brain Age) video game in physically active and cognitively healthy older adults (60–70 years). The response is measured using Stroop task performance (cognitive task for executive function) and related brain activity assessed with functional magnetic resonance imaging (fMRI). The control conditions are low-intensity physical exercise and Tetris for video gaming.

Discussion: This study is intended to provide insight into the alteration of executive function and its related brain activity from an acute intervention with a combination of physical exercise and video gaming in older people. The protocol might not be implementable in daily life to improve cognitive abilities. However, the results can support future studies that investigate cognition and the combination of physical exercise and video gaming. Moreover, it can provide real-life implications.

Trial registration: This trial was registered in The University Hospital Medical Information Network Clinical Trials Registry (UMIN000033054). Registered 19 July 2018, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000037687.

Episodic memory boosting in older adults: exploring the association of encoding strategies and physical activity

Background: Contextual memory is susceptible to the effects of aging and its impairment compromises episodic memories and quality of life in older adults. Objective: Compare the effects of cognitive support on incidental contextual memory free recall and recognition with a naturalistic experimental paradigm and explore the association of encoding strategies and physical activity on memory improvement. Methods: Subjects (≥60 years, n = 52) were assigned to one of two encoding conditions for the contextual memory task: with or without an incidental associative instruction to encourage association of an item to its spatial context. Immediate free recall and recognition tests were run to assess the encoding instruction efficiency. The association of memory performance and physical activity was analyzed using the scores on the International Physical Activity Questionnaire (IPAQ) to subdivide each experimental group into Low IPAQ (below median) and High IPAQ (above median) subgroups. Results: The associative encoding instruction increased contextual memory free recall and recognition, with greater effects on free recall. The most robust associations between physical activity and contextual memory were also seen on free recall, in which higher levels of physical activity corresponded to increased baseline performance (non-associative encoding condition) and greater improvement of memory by the encoding support (associative encoding condition). Conclusion: Cognitive support at encoding can improve contextual memory free recall and recognition, suggesting they are prone to rehabilitation. Moreover, higher physical activity levels were positively associated with encoding strategies on contextual memory improvement, increasing the availability of latent process-based components of the cognitive reserve.