Concurrent Aerobic Exercise and Cognitive Training to Prevent Alzheimer's in At-risk Older Adults (The Exergames Telerehabilitation Study)

Significance of Research Question/Purpose: Subjective cognitive decline (SCD) is regarded as the first clinical manifestation in the AD-dementia continuum and currently has a prevalence of 11.2% in adults over the age of 45, with incidence increasing with greater age. Furthermore, population-based studies suggest that between 50% and 80% of older individuals (aged 70 years and older) who perform normally on cognitive tests, report some form of perceived decline in cognitive functioning when asked. The SCD state is unique as this population is more likely than their healthy peers to present with AD biomarkers such as neurodegeneration and amyloid burden, and therefore represents probable preclinical AD relative to other causes of SCD. Likewise, growing evidence suggests that a significant proportion of those adults are subsequently found to develop MCI, or AD, following the classic SCD-MCI-AD trajectory, with SCD increasing MCI risk 1.5-3 fold. Preventing Alzheimer's disease (AD) is arguably the most important approach to address the dementia epidemic worldwide because 99.6% of drug trials failed and no drugs can yet prevent, cure, or even slow AD. A treatment that delays the onset of AD by five years could save $89 billion in 2030.This highlights an urgent and pressing need to develop behavioral interventions to prevent AD and slow its progression.

This study will use a randomized, 2-parallel group, trial design that is guided by the Consolidated Standards of Reporting Trials (CONSORT)and the SPIRIT checklist. We will randomize 104 community-dwelling older adults to one of two arms for 3 months: home-based (asynchronous telerehabilitation) Exergame (HbExergame) or home-based (asynchronous telerehabilitation) aerobic exercise (HbAEx). Randomization will allocate subjects on a 1:1 allocation ratio within each age stratum (65-74 and >75), and will use permuted blocks of 8 and 4. We do not expect equal numbers of subjects in each age stratum, but want to balance the groups for each age. Investigators will be blinded to group assignment. All participants will be blinded to study aims and reminded as needed not to discuss their experiences with outcome assessors. Outcome assessors (also blinded to group allocations) will measure: 1) feasibility (attendance, adherence to exercise dose, systems usability scale), 2) preliminary cognition: fluid cognition [primary outcome], attention, episodic memory, and processing speed [secondary outcomes] using the NIH Toolbox cognition battery and aerobic fitness [VO2peak and 6-minute walk distance], and 3) blood neurotrophic biomarkers.

Study Overview

• Status: Recruiting
• Conditions: At Risk for AD-dementia, With Subjective Cognitive Decline
• Intervention / Treatment: Behavioral: HbAEx; Behavioral: HbExergame

• Study Type: Interventional
• Enrollment (Estimated): 104
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Dereck Salisbury; Phone Number: 612-625-9308; Email: salis048@umn.edu

Study Locations

• United States
  • Minnesota
    • Minneapolis, Minnesota, United States, 55414
      • Recruiting
      • University of Minnesota
      • Contact: Dereck Salisbury, PhD; Phone Number: 612-625-9308; Email: salis048@umn.edu

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Cognitive complaint (defined as answering yes to the questions's "Do you perceive memory or cognitve difficulties?" and "In the last two years, has your cognition or memory declined?";
• Montreal Cognitive Assessement (MoCA) 26 or greater
• Age 65 years and older;
• English-speaking;
• Without ACSM contraindication to exercise

Exclusion Criteria:

• Dementia or mild cognitive impairment diagnosis;
• Neurological or major psychiatric disorder, alcohol/chemical dependency or recent medical condition (anethesia COVID-19 ["brain fog"]) likely causing cognitive impairment;
• Current enrollment in another intervention study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group 1; Subjects randomized to HbAEX	Behavioral: HbAEx; Participants will have a 1-week (3 session) on-boarding period where study interventionists will deliver all necessary equipment (bike, pulse oximeters, etc.) to the participants' home, review the AEx program and prescription, and supervise the first 3 sessions to ensure participant understanding and fidelity of the AEx program. Thereafter, the remaining 33 sessions will be conducted by the participant without the direct supervision (asynchronous telerehabilitation) of the study interventionists. Subjects will cycle on recumbent stationary cycles at moderate-vigorous intensity individualized as 50-70% of heart rate reserve (HRR) and/or 11-14 on Borg Category Ratio-15 Rating of Perceived Exertion (RPE) Scale, for 30-50 minutes per session. Following the completion of each session, during the check-in meeting with the participant, the study interventionist will gather information from the participant (including HR and RPE) for dose quantification.
Experimental: Group 2; Subjects randomized to HbExergame	Behavioral: HbExergame; Participants will cycle as described in the HbAEx protocol while engaging in cognitive training for the duration of cycling. Cognitive training will include 20 levels of difficulty with 8-10 task scenarios in the context of three virtual worlds (environments. In each of the environments, the participant must follow directions and navigate to a destination where the scenario (cognitive task) will be performed. The game will inform the participant of the assigned task and, automatically, determine and inform the participant of the fastest route from the starting point to the scenario destination where the task will be performed. The participant will be required to remember the assigned task, follow the directions and navigate to the destination, and then remember what action is required to complete the task. A scenario-specific cognitive task will be triggered once the destination has been reached. The cycling and cognitive tasks will be completed throughout the sessions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
fluid cognition (global cognition)	which refers to the overall cognitive ability and will be assessed with the NIH Toolbox Cognitive Battery (NIHTB-CB) and its Fluid Composite Score (convergent validity [r = 0.78] and test-retest reliability [r = 0.86)	12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Aerobic fitness	Aerobic fitness will be evaluated by the shuttle walk test (SWT) and followed guidelines as described by Singh and colleagues. Assistive devices will be permitted, such as ankle braces, walkers, crutches, or canes. Participants will be instructed to walk a distance of 10 meters around a marking between two cones, placed 0.5 m from each endpoint.	12 weeks
Neuroprotective biomarkers and ApoE status.	Blood samples will be obtained by venipuncture from the antecubital vein. perform biochemical analyses of the following biomarkers: 1) peripheral neuroprotective biomarkers serum brain-derived neurotrophic factor (BDNF) and plasma IGF-1; (neurotrophic) IL-6 (systemic inflammation); glial fibrillary acidic protein (GFAP) (neuroinflammation) and, 2) APOE genotypes at the end of the study to minimize the overall variance in biochemical analyses.	12 weeks
Exergame-specific usability and satisfaction	For individuals randomized to the HbExergame groups, usability and satisfaction of the Exergame will be assessed via questionnaire. The Systems Usability Survey contains 14 usability- related questions using Likert scale format from 1-5 with verbal anchors of strongly disagree (1), somewhat disagree (2), neutral (3), somewhat agree (4), and strongly agree (5); 4 items are reverse scored. In addition the questionnaire contains 5 satisfaction-related questions using similar scale. Verbal anchors include: very unsatisfied (1), somewhat unsatisfied (2), neutral (3), somewhat satisfied (4), and very satisfied (5). Composite scores for usability and satisfaction will be quantified. A second questionnaire, The User Engagement Scale (Long Form) will be used to assess a quality of user experience characterized by the depth of a participant's cognitive, temporal, affective and behavioral investment when interacting with a digital system. The User Engagement Scale has 3	12 weeks
SCD Symptoms	The Subjective Cognitive Decline Questionnaire (SCD-Q), a 27-item questionnaire, assesses both subject and informant self-perceived subjective decline in memory, language, and executive function in the last two years.	12 weeks
Anxiety Symptoms	Anxiety symptoms will be measured with the Geriatric Anxiety Scale (GAS-10) a 10-item version Likert scale (0-3 with 3 representing increased symptoms). The total GAS-10 scores range from 0 (no anxiety) to 30 (severe anxiety). It is a reliable and valid assessment for assessing anxiety symptoms with overall adequate internal consistency (Cronbach's alpha of 0.93)	12 weeks
Depressive Symptoms	Depression symptoms will assessed with the 15-item dichotomous (yes/no) Geriatric Depression Scale Short Form (GDS-SF). The GDS-SF scores range from 0 (no depression) to 15 (severe depression). It is a reliable and valid assessment for assessing depression symptoms with overall adequate internal consistency (Cronbach's alphas of 0.74-0.76) and statistically significant construct validity (dimensionality coefficients of 0.94).	12 weeks

Collaborators and Investigators

• Sponsor: University of Minnesota

Study record dates

Study Major Dates

• Study Start (Actual): August 14, 2024
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): September 30, 2026

Study Registration Dates

• First Submitted: March 8, 2024
• First Submitted That Met QC Criteria: March 28, 2024
• First Posted (Actual): April 1, 2024

Study Record Updates

• Last Update Posted (Actual): August 12, 2025
• Last Update Submitted That Met QC Criteria: August 8, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Neurocognitive Disorders; Cognition Disorders; Cognitive Dysfunction
• Other Study ID Numbers: AE and CT

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No