Outdoor vs. Indoor Exercises and Cognitive Functions in Older Adults

July 23, 2026 updated by: Meliha Güçlü Saz, Muğla Sıtkı Koçman University

The Relationship of Outdoor and Indoor Exercises With Cognitive Functions in Older Individuals With Similar Physical Capacity: A Sample of Renewal Universities

This observational, cross-sectional study aims to comparatively investigate the effects of outdoor versus indoor exercise environments on overall cognitive performance and its specific sub-domains (attention, memory, and executive functions) in older adults with similar physical capacities. Utilizing a 2 (Exercise Environment: Outdoor vs. Indoor) x 2 (Center: Köyceğiz vs. Erzurum Tazelenme University) factorial design, a sample of 100-120 participants aged 60 and over will be recruited via purposive sampling. To ensure sample homogeneity regarding functional capacity, participants will undergo pre-screening with the 6-Minute Walk Test (6MWT) and the 30-Second Chair Stand Test, while individuals with advanced neurological disorders or severe physical impairments will be excluded. Data will be collected through a Sociodemographic Information Form, the Physical Activity Scale for the Elderly (PASE) to monitor baseline activity parameters, and the Addenbrooke's Cognitive Examination (ACE-III) Turkish Version A to assess cognitive outcomes. Ultimately, this study aims to elucidate the potential predictive role of the exercise environment on cognitive health in late life and explore whether the cognitive benefits of physical activity vary interactively across different geographic centers.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Not yet recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Detailed Description

This observational, cross-sectional study is designed with a comprehensive quality assurance and operational framework to rigorously investigate the impact of exercise environments on cognitive health in older adults. To ensure data integrity and minimize transcription errors, a multi-stage quality control protocol will be enforced, including double-data entry by two independent investigators and automated database range checks for score boundaries (e.g., restricting the total score of Addenbrooke's Cognitive Examination [ACE-III] between 0 and 100, and validating the age threshold as ≥ 60). Source data verification will be conducted by cross-referencing self-reported chronic conditions and pharmacological backgrounds with institutional health registries where applicable. Operationally, the study follows a strict six-stage Standard Operating Procedure (SOP). Potential participants from Köyceğiz and Erzurum Tazelenme Universities will first undergo a face-to-face pre-screening via a structured Participant Eligibility Form to confirm inclusion criteria, which mandate being aged 60 or older, participating in regular physical exercise, and possessing sufficient sensory and cognitive capacity to complete behavioral testing, while excluding individuals with advanced neurological disorders such as dementia.Following informed consent, participants' functional baseline homogeneity will be verified through validated physical performance metrics, specifically the 6-Minute Walk Test (6MWT) for cardiovascular endurance and the 30-Second Chair Stand Test for lower extremity muscle strength. Based on their primary exercise habits, participants will be classified into the primary independent variables: outdoor or indoor exercise environments. Subsequently, cognitive outcomes across domains of attention, memory, verbal fluency, language, and visuospatial skills will be assessed individually in a controlled, distraction-free environment using the ACE-III Turkish Version A, while past-week physical activity levels will be quantified using the Physical Activity Scale for the Elderly (PASE). Missing data will be managed strictly; variables with less than 15% missing items will be handled via sub-domain mean imputation, whereas cases exceeding this threshold or missing primary cognitive components will be excluded via listwise deletion. Statistical analyses will be executed using IBM SPSS Statistics, utilizing independent samples t-tests or non-parametric Mann-Whitney U tests depending on normality distributions evaluated via Kolmogorov-Smirnov and Shapiro-Wilk criteria. Ultimately, Pearson or Spearman correlation coefficients will assess the relationship between exercise parameters and cognitive scores, and multiple linear regression or analysis of covariance (ANCOVA) will be deployed to isolate the predictive value of the exercise environment on cognitive performance while strictly controlling for confounding covariates such as age, education, baseline physical activity (PASE), and functional capacities (6MWT and chair stand scores), with significance established at p < 0.05.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
100

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

The study population consists of older adults aged 60 and over who are actively enrolled as students at Köyceğiz Tazelenme University and Erzurum Tazelenme University in Türkiye. This population represents a unique cohort of older individuals engaged in lifelong learning and structured active aging programs. To investigate the specific role of the exercise environment on cognitive reserve, the sample will be drawn from this population using purposive sampling, selecting individuals who regularly participate in either structured outdoor or indoor physical activities. The population is structurally characterized by functionally independent older adults who exhibit homogeneous physical baseline capacities-verified via objective clinical performance benchmarks-and are free from advanced neurological or debilitating physical conditions.

Description

Inclusion Criteria:

  • Must be aged 60 years or older.
  • Must be currently enrolled as a student at Köyceğiz Tazelenme University or Erzurum Tazelenme University.
  • Must participate regularly in either structured outdoor or indoor physical exercises.
  • Must possess sufficient sensory, visual, hearing, and cognitive capacity to comprehend and complete the behavioral and cognitive tests.
  • Must demonstrate similar and homogenous functional physical capacity as verified by the pre-screening benchmarks of the 6-Minute Walk Test and the 30-Second Chair Stand Test.
  • Must provide written informed consent voluntarily.

Exclusion Criteria:

  • Being under the age of 60.
  • Having a clinical diagnosis of an advanced neurological disorder, including dementia or severe cognitive impairment.
  • Having severe acute or chronic physical disabilities, musculoskeletal injuries, or medical conditions that medically prevent or restrict safe exercise participation.
  • Having severe uncorrected sensory (visual or hearing) deficits or cognitive impairments that prevent the comprehension of test instructions or completion of the assessments.
  • Refusing to provide written informed consent or wishing to withdraw from the evaluation process.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Outdoor
This cohort consists of older adults aged 60 and over, enrolled in Tazelenme University, who regularly participate in physical exercises in outdoor environments. Participants in this group maintain similar functional and physical capacities as verified by the 6-Minute Walk Test and the 30-Second Chair Stand Test, and they do not have any advanced neurological or severe physical impairments.
Indoor
This cohort consists of older adults aged 60 and over, enrolled in Tazelenme University, who regularly participate in physical exercises in indoor environments. Participants in this group maintain similar functional and physical capacities as verified by the 6-Minute Walk Test and the 30-Second Chair Stand Test, and they do not have any advanced neurological or severe physical impairments.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Overall Cognitive Performance and Sub-domains via ACE-III
Time Frame: Baseline (Data will be collected during a single cross-sectional assessment session for each participant).
Cognitive functions will be assessed using the Addenbrooke's Cognitive Examination-III (ACE-III) Turkish Version A. The test comprehensively evaluates five cognitive domains: attention, memory, verbal fluency, language, and visuospatial skills. Total scores range from 0 to 100, and sub-domain scores range as follows: Attention (0-18), Memory (0-26), Verbal Fluency (0-14), Language (0-26), and Visuospatial (0-16). Higher total and sub-domain scores indicate better cognitive performance and higher cognitive reserve.
Baseline (Data will be collected during a single cross-sectional assessment session for each participant).

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Self-Reported Physical Activity Level via PASE
Time Frame: Baseline (Data will be collected during a single cross-sectional assessment session for each participant).
Participants' physical activity levels over the past week will be measured using the Physical Activity Scale for the Elderly (PASE). The scale evaluates leisure, household, and occupational physical activities through structured questions. Higher total scores on the scale indicate a higher level of physical activity and engagement in daily life movements.
Baseline (Data will be collected during a single cross-sectional assessment session for each participant).

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Muğla Sıtkı Koçman University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

  • Albinet, C. T., Boucard, G., Bouquet, C. A., & Audiffren, M. (2012). Processing speed and executive functions in cognitive aging: How to disentangle their mutual relationship? Brain and Cognition, 79(1), 1-11. https://doi.org/10.1016/j.bandc.2012.02.001 Alcazar, J., Kamper, R. S., Aagaard, P., Haddock, B., Prescott, E., Ara, I., & Suetta, C. (2020). Relation between leg extension power and 30-s sit-to-stand muscle power in older adults: validation and translation to functional performance. Scientific Reports, 10(1). https://doi.org/10.1038/s41598-020-73395-4 Bautmans, I., Lambert, M., & Mets, T. (2004). The six-minute walk test in community dwelling elderly: Influence of health status. BMC Geriatrics, 4, 1-9. https://doi.org/10.1186/1471-2318-4-6 Biazus-Sehn, L. F., Schuch, F. B., Firth, J., & Stigger, F. de S. (2020). Effects of physical exercise on cognitive function of older adults with mild cognitive impairment: A systematic review and meta-analysis. In Archives of Gerontology and Geriatrics (Vol. 89). Elsevier Ireland Ltd. https://doi.org/10.1016/j.archger.2020.104048 Falck, R. S., Davis, J. C., Best, J. R., Crockett, R. A., & Liu-Ambrose, T. (2019, July 1). Impact of exercise training on physical and cognitive function among older adults: a systematic review and meta-analysis. In Neurobiology of Aging. Elsevier Inc. https://doi.org/10.1016/j.neurobiolaging.2019.03.007 Gallardo-Gómez, D., del Pozo-Cruz, J., Noetel, M., Álvarez-Barbosa, F., Alfonso-Rosa, R. M., & del Pozo Cruz, B. (2022). Optimal dose and type of exercise to improve cognitive function in older adults: A systematic review and bayesian model-based network meta-analysis of RCTs. In Ageing Research Reviews (Vol. 76). Elsevier Ireland Ltd. https://doi.org/10.1016/j.arr.2022.101591 Glisky, E. L., Woolverton, C. B., McVeigh, K. S., & Grilli, M. D. (2022). Episodic Memory and Executive Function Are Differentially Affected by Retests but Similarly Affected by Age in a Longitudinal Study of Normally-Aging

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 1, 2026

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
December 1, 2026

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 31, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
June 16, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 23, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
July 27, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
July 27, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
July 23, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
July 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • 2026-ETÜ-0124

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data (IPD) will not be shared publicly to maintain participant confidentiality and strictly protect personal privacy in accordance with the national Personal Data Protection Law (KVKK) and the institutional ethics committee guidelines. Since the data collected includes comprehensive sociodemographic details and physical/cognitive functional health scores of vulnerable older adults, public sharing of raw individual datasets is restricted by the institutional ethical clearance. However, aggregated statistical results and study outcomes will be fully accessible through peer-reviewed academic publications.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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