Effects of simultaneous cognitive and aerobic exercise training on dual-task walking performance in healthy older adults: results from a pilot randomized controlled trial

David A Raichlen, Pradyumna K Bharadwaj, Lauren A Nguyen, Mary Kathryn Franchetti, Erika K Zigman, Abigail R Solorio, Gene E Alexander, David A Raichlen, Pradyumna K Bharadwaj, Lauren A Nguyen, Mary Kathryn Franchetti, Erika K Zigman, Abigail R Solorio, Gene E Alexander

Abstract

Background: The ability to walk and perform cognitive tasks simultaneously is a key aspect of daily life. Performance declines in these dual-tasks may be associated with early signs of neurodegenerative disease and increased risk of falls. Thus, interventions to improve dual-task walking performance are of great interest for promoting healthy aging. Here, we present results of a pilot randomized controlled trial (RCT) to evaluate the effects of a simultaneous aerobic exercise and cognitive training intervention on dual-task walking performance in healthy older adults.

Methods: Community-dwelling, healthy older adults were recruited to participate in a 12-week RCT. Participants were randomized into one of four groups (n = 74): 1) cognitive training (COG), 2) aerobic exercise (EX), 3) combined aerobic exercise and cognitive training (EXCOG), and 4) video-watching control (CON). The COG and EXCOG groups both used a tablet-based cognitive training program that challenged aspects of executive cognitive function, memory, and processing speed. Performance on a dual-task walking test (DTWT; serial subtraction during two-minute walk) was assessed by researchers blinded to groupings before the intervention, and at 6 and 12 weeks. We included all participants randomized with baseline measurements in an intention to treat analysis using linear mixed effects models.

Results: We found a significant group by time interaction for cognitive performance on the DTWT (p = 0.039). Specifically, participants in the EXCOG, EX, and COG groups significantly improved on the cognitive aspect of the DTWT following the full 12-week intervention (p = 3.5e-7, p = 0.048, p = 0.048, respectively). The improvements in EXCOG were twice as large as in the other groups, and were significant at 6 weeks (p = 0.019). The CON group did not show a significant change in cognitive performance on the DTWT, and no group significantly altered dual-task gait measures following the intervention.

Conclusions: A simultaneous aerobic exercise and cognitive training intervention significantly improved cognitive performance during a DTWT in healthy older adults. Despite no change in DTWT gait measures, significant improvements in cognitive performance indicate that further investigation in a larger RCT is warranted.

Trial registration: Clinicaltrials.gov, NCT04120792, Retrospectively Registered 08 October 2019.

Keywords: Aging; Cognition; Executive function; Exergame; Physical activity.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of screening, randomization, intervention, and data analysis
Fig. 2
Fig. 2
Cognitive performance across time and group. There was a significant interaction between group and time (p = 0.039). In post-hoc comparisons, EXCOG (combined exercise and cognitive training) showed significant improvements in the number of correct answers given during the 2-min dual task walking test. EX (exercise only) and COG (cognitive training only) each showed significant, but more modest, improvements only after the full 12-week intervention, CON (video-watching control) showed no significant improvements across any time points. P-values shown are corrected for multiple comparisons using FDR, p < 0.05. Error bars are SE of the mean

References

    1. Alexander GE, Ryan L, Bowers D, Foster TC, Bizon JL, Geldmacher DS, Glisky EL. Characterizing cognitive aging in humans with links to animal models. Front Aging Neurosci. 2012;4:21. doi: 10.3389/fnagi.2012.00021.
    1. Park DC, Reuter-Lorenz P. The adaptive brain: aging and neurocognitive scaffolding. Annu Rev Psychol. 2009;60:173–196. doi: 10.1146/annurev.psych.59.103006.093656.
    1. Schwenk M, Zieschang T, Oster P, Hauer K. Dual-task performances can be improved in patients with dementia: a randomized controlled trial. Neurology. 2010;74(24):1961–1968. doi: 10.1212/WNL.0b013e3181e39696.
    1. Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord. 2008;23(3):329–342. doi: 10.1002/mds.21720.
    1. Bruderer-Hofstetter M, Rausch-Osthoff A-K, Meichtry A, Münzer T, Niedermann K. Effective multicomponent interventions in comparison to active control and no interventions on physical capacity, cognitive function and instrumental activities of daily living in elderly people with and without mild impaired cognition–a systematic review and network meta-analysis. Ageing Res Rev. 2018;45:1–14. doi: 10.1016/j.arr.2018.04.002.
    1. Plummer P, Zukowski LA, Giuliani C, Hall AM, Zurakowski D. Effects of physical exercise interventions on gait-related dual-task interference in older adults: a systematic review and meta-analysis. Gerontology. 2016;62(1):94–117. doi: 10.1159/000371577.
    1. Raichlen DA, Alexander GE. Adaptive capacity: an evolutionary neuroscience model linking exercise, cognition, and brain health. Trends Neurosci. 2017;40(7):408–421. doi: 10.1016/j.tins.2017.05.001.
    1. Fraser SA, Li KZ-H, Berryman N, Desjardins-Crépeau L, Lussier M, Vadaga K, Lehr L, Vu M, Tuong T, Bosquet L. Does combined physical and cognitive training improve dual-task balance and gait outcomes in sedentary older adults? Front Hum Neurosci. 2017;10:688. doi: 10.3389/fnhum.2016.00688.
    1. Gobbo S, Bergamin M, Sieverdes JC, Ermolao A, Zaccaria M. Effects of exercise on dual-task ability and balance in older adults: a systematic review. Arch Gerontol Geriatr. 2014;58(2):177–187. doi: 10.1016/j.archger.2013.10.001.
    1. Makizako H, Doi T, Shimada H, Yoshida D, Tsutsumimoto K, Uemura K, Suzuki T. Does a multicomponent exercise program improve dual-task performance in amnestic mild cognitive impairment? A randomized controlled trial. Aging Clin Exp Res. 2012;24(6):640–646.
    1. Plummer-D'Amato P, Cohen Z, Daee NA, Lawson SE, Lizotte MR, Padilla A. Effects of once weekly dual-task training in older adults: a pilot randomized controlled trial. Geriatr Gerontol Int. 2012;12(4):622–629. doi: 10.1111/j.1447-0594.2011.00825.x.
    1. Wollesen B, Voelcker-Rehage C. Training effects on motor–cognitive dual-task performance in older adults. Eur Rev Aging Phys Act. 2014;11(1):5. doi: 10.1007/s11556-013-0122-z.
    1. Anderson-Hanley C, Arciero PJ, Brickman AM, Nimon JP, Okuma N, Westen SC, Merz ME, Pence BD, Woods JA, Kramer AF. Exergaming and older adult cognition: a cluster randomized clinical trial. Am J Prev Med. 2012;42(2):109–119. doi: 10.1016/j.amepre.2011.10.016.
    1. Anderson-Hanley C, Barcelos NM, Zimmerman EA, Gillen RW, Dunnam M, Cohen BD, Yerokhin V, Miller KE, Hayes DJ, Arciero PJ. The aerobic and cognitive exercise study (ACES) for community-dwelling older adults with or at-risk for mild cognitive impairment (MCI): neuropsychological, neurobiological and neuroimaging outcomes of a randomized clinical trial. Front Aging Neurosci. 2018;10:76. doi: 10.3389/fnagi.2018.00076.
    1. Anderson-Hanley C, Stark J, Wall KM, VanBrakle M, Michel M, Maloney M, Barcelos N, Striegnitz K, Cohen BD, Kramer AF. The interactive physical and cognitive exercise system (iPACes™): effects of a 3-month in-home pilot clinical trial for mild cognitive impairment and caregivers. Clin Interv Aging. 2018;13:1565. doi: 10.2147/CIA.S160756.
    1. Barcelos N, Shah N, Cohen K, Hogan MJ, Mulkerrin E, Arciero PJ, Cohen BD, Kramer AF, Anderson-Hanley C. Aerobic and cognitive exercise (ACE) pilot study for older adults: executive function improves with cognitive challenge while exergaming. J Int Neuropsychol Soc. 2015;21(10):768–779. doi: 10.1017/S1355617715001083.
    1. Northey JM, Cherbuin N, Pumpa KL, Smee DJ, Rattray B. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med. 2018;52(3):154–160. doi: 10.1136/bjsports-2016-096587.
    1. Folstein MF, Folstein SE, Mchugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Simon JR. The effects of an irrelevant directional cue on human information processing. In: Proctor RW, Reeves TG, editors. Advances in psychology. Stimulus-response compatibility: An integrated perspective. North-Holland, Oxford; 1990. p. 31–86.
    1. Rogers RD, Monsell S. Costs of a predictible switch between simple cognitive tasks. J Exp Psychol Gen. 1995;124(2):207. doi: 10.1037/0096-3445.124.2.207.
    1. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153–156. doi: 10.1016/S0735-1097(00)01054-8.
    1. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Rehabil. 2001;82(8):1050–1056. doi: 10.1053/apmr.2001.24893.
    1. Gueorguieva R, Krystal JH. Move over anova: progress in analyzing repeated-measures data andits reflection in papers published in the archives of general psychiatry. Arch Gen Psychiatry. 2004;61(3):310–317. doi: 10.1001/archpsyc.61.3.310.
    1. Bell ML, Kenward MG, Fairclough DL, Horton NJ. Differential dropout and bias in randomised controlled trials: when it matters and when it may not. BMJ. 2013;346:e8668. doi: 10.1136/bmj.e8668.
    1. Bloem BR, Valkenburg VV, Slabbekoorn M, Willemsen MD. The multiple tasks test: development and normal strategies. Gait Posture. 2001;14(3):191–202. doi: 10.1016/S0966-6362(01)00141-2.
    1. Simoni D, Rubbieri G, Baccini M, Rinaldi L, Becheri D, Forconi T, Mossello E, Zanieri S, Marchionni N, Di Bari M. Different motor tasks impact differently on cognitive performance of older persons during dual task tests. Clin Biomech. 2013;28(6):692–696. doi: 10.1016/j.clinbiomech.2013.05.011.
    1. Anderson-Hanley C, Nimon JP, Westen SC. Cognitive health benefits of strengthening exercise for community-dwelling older adults. J Clin Exp Neuropsychol. 2010;32(9):996–1001. doi: 10.1080/13803391003662702.
    1. Best JR, Nagamatsu LS, Liu-Ambrose T. Improvements to executive function during exercise training predict maintenance of physical activity over the following year. Front Hum Neurosci. 2014;8:353. doi: 10.3389/fnhum.2014.00353.
    1. Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–130. doi: 10.1111/1467-9280.t01-1-01430.
    1. Erickson KI, Voss MW, Prakash RS, Basak C, Szabo A, Chaddock L, Kim JS, Heo S, Alves H, White SM. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci. 2011;108(7):3017–3022. doi: 10.1073/pnas.1015950108.
    1. Etnier JL, Chang Y-K. The effect of physical activity on executive function: a brief commentary on definitions, measurement issues, and the current state of the literature. J Sport Exer Psychol. 2009;31(4):469–483. doi: 10.1123/jsep.31.4.469.
    1. Hillman CH, Belopolsky AV, Snook EM, Kramer AF, McAuley E. Physical activity and executive control: implications for increased cognitive health during older adulthood. Res Q Exerc Sport. 2004;75(2):176–185. doi: 10.1080/02701367.2004.10609149.
    1. Roig M, Nordbrandt S, Geertsen SS, Nielsen JB. The effects of cardiovascular exercise on human memory: a review with meta-analysis. Neurosci Biobehav Rev. 2013;37(8):1645–1666. doi: 10.1016/j.neubiorev.2013.06.012.
    1. Theill N, Schumacher V, Adelsberger R, Martin M, Jäncke L. Effects of simultaneously performed cognitive and physical training in older adults. BMC Neurosci. 2013;14(1):103. doi: 10.1186/1471-2202-14-103.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir