SMARTfit Dual-Task Exercise Improves Cognition and Physical Function in Older Adults With Mild Cognitive Impairment: Results of a Community-Based Pilot Study

Effects of exercise-cognitive dual-task training on elderly patients with cognitive frailty and depression

BACKGROUND

Cognitive frailty and depression are prevalent among the elderly, significantly impairing physical and cognitive functions, psychological well-being, and quality of life. Effective interventions are essential to mitigate these adverse effects and enhance overall health outcomes in this population.

AIM

To evaluate the effects of exercise-cognitive dual-task training on frailty, cognitive function, psychological status, and quality of life in elderly patients with cognitive frailty and depression.

METHODS

A retrospective study was conducted on 130 patients with cognitive frailty and depression admitted between December 2021 and December 2023. Patients were divided into a control group receiving routine intervention and an observation group undergoing exercise-cognitive dual-task training in addition to routine care. Frailty, cognitive function, balance and gait, psychological status, and quality of life were assessed before and after the intervention.

RESULTS

After the intervention, the frailty score of the observation group was (5.32 ± 0.69), lower than that of the control group (5.71 ± 0.55). The Montreal cognitive assessment basic scale score in the observation group was (24.06 ± 0.99), higher than the control group (23.43 ± 1.40). The performance oriented mobility assessment score in the observation group was (21.81 ± 1.24), higher than the control group (21.15 ± 1.26). The self-efficacy in the observation group was (28.27 ± 2.66), higher than the control group (30.05 ± 2.66). The anxiety score in the hospital anxiety and depression scale (HADS) for the observation group was (5.86 ± 0.68), lower than the control group (6.21 ± 0.64). The depression score in the HADS for the observation group was (5.67 ± 0.75), lower than the control group (6.27 ± 0.92). Additionally, the scores for each dimension of the 36-item short form survey in the observation group were higher than those in the control group, with statistically significant differences (P < 0.05).

CONCLUSION

Exercise-cognitive dual-task training is beneficial for improving frailty, enhancing cognitive function, and improving psychological status and quality of life in elderly patients with cognitive frailty and depression.

Multicomponent exercise improved cognitive flexibility and muscular fitness in community-dwelling older adults

ObjectiveCognitive flexibility is the ability to transition between various tasks flexibly, which declines in aging. The purpose of this quasi-experimental study was to investigate the effect of a 12-week multicomponent exercise intervention on cognitive flexibility and attention, measured by color trail test (CTT)-1, CTT-2, and CTT 2-1 difference, in community-dwelling older adults. The relationship between cognitive flexibility and muscular fitness was also examined.MethodsThe participants were assigned to either the exercise group (n = 41, aged 70.6 ± 5.9 years) or the control group (n = 18, aged 67.9 ± 4.9 years). The exercise group participated in a 90-minute multicomponent exercise session, including endurance, resistance, and stretching training, twice a week for 12 weeks. Participants in the control group maintained their sedentary lifestyle. CTT and muscular fitness, including 30-second arm curl, 30-second chair stand, and 2-minute step tests, were measured before and after the intervention.ResultsA significant group×time interaction effect was found in CTT-2, CTT 2-1 difference, chair stand, and step test. After the intervention, the exercise group showed a significantly better cognitive flexibility, indicated by faster completion time in CTT-2 (before: 140.3 ± 60.1 seconds, after: 127.0 ± 60.6 seconds) and improved CTT 2-1 difference (before: 82.8 ± 49.5 seconds, after: 72.2 ± 49.0 seconds). The exercise group also improved the number of repetitions in chair stand (before: 18.5 ± 5.0, after: 22.8 ± 5.5) and step test (before: 108.9 ± 16.2, after: 126.2 ± 19.0). The cognitive and muscular performance remained unchanged in the control group. Moreover, better performance in the 30-second chair stand test was associated with faster completion time in CTT-1 at baseline (r = -0.296).ConclusionsThe amelioration in cognitive flexibility coincided with improvements in muscular fitness after a 12-week multicomponent exercise intervention in older adults. Better muscular strength was associated with higher cognitive flexibility at the baseline.

Key accelerometry measures for understanding walking sway during dual-task exercises

Aim

This study aimed to identify optimal methods of acceleration analysis to accurately detect dual-task-related changes in walking sway.

Methods

Twenty-six healthy adults participated in this study, undergoing various cognitive dual-task conditions while walking. Accelerometers were attached to the lower back to record center-of-mass (COM) acceleration in anterior-posterior (AP) and mediolateral (ML) directions. Data analysis involved multiple computation methods applied to the acceleration data, with comparisons made using different frequency cutoffs and mean referencing.

Results

Analysis revealed significant effects of dual-tasking on walking sway, particularly in AP and combined directions. A 3.5Hz low-pass filter and mean referencing were found effective in capturing these changes. Computation methods, such as root mean square (which quantifies the variability of COM acceleration) and normalized path length (which measures the distance traveled by the COM over time), showed sensitivity to detect changes in sway amplitude during dual-task conditions.

Conclusion

The findings highlight the importance of considering both AP and ML sway in dual-task assessments. Furthermore, the choice of computation method, frequency cutoff, and mean referencing impacted the sensitivity to detect changes in walking sway during dual-tasking. These findings suggest that a 3.5Hz low-pass filter with mean referencing can enhance the sensitivity of dual-task assessments, which could be valuable for clinical balance evaluations or rehabilitation monitoring.

A 3-Month Dual-Task Exercise Randomized Pilot Trial Improves Dynamic Stability and Coordination in Community-Dwelling Older Adults

INTRODUCTION

Dual-task (DT) exercises combine both physical and cognitive activities and have the potential to efficiently enhance both physical and cognitive function.

BACKGROUND/OBJECTIVES

This study aimed to determine if, compared with exercise-only (EO) and control (C) groups, adults in a DT training program improved measures of cognitive and/or physical functioning.

METHODS

Thirty-five participants (Mage = 65.7 ± 8.5 years; 74.3% female, 25.7% male) were randomly sorted into EO (n = 15), DT (n = 10), and C (n = 10). EO and DT participated in 3 months of twice weekly, 50-min exercise. DT played cognitive games on a SMARTfit Cognitive-Motor Exercise System during exercise sessions. C did not participate in any supervised sessions. Cognition was assessed with a Cognivue Thrive program. Dynamic stability, coordination, and lower body strength were assessed. Linear mixed-effects models investigated effects for different groups. For outcomes showing significant (p < .05) differences, pairwise t tests were conducted between all treatment and time comparisons.

RESULTS

Dynamic stability and coordination improved in DT and EO (p = .002 and .04, respectively), but not in C in the first 6 weeks (p = .58). Cognition and memory did not change over time among the three groups.

CONCLUSION

Healthy, independent-living older adults in either DT or EO improved dynamic stability and coordination over time and DT improved balance and functional mobility more than either EO or C. No improvements in several standard cognition or memory measurements were observed. Significance/Implications: A DT exercise program improved balance and coordination, but not cognition or memory, in healthy, independent-living older adults.

The "FitBrain" program: implementing exergaming & dual-task exercise programs in outpatient clinical settings

Dual-task training and exergaming interventions are increasingly recognized for their potential to enhance cognitive, physical, and mood outcomes among older adults and individuals with neurological conditions. Despite this, clinical and community programs that use these interventions are limited in availability. This paper presents the "FitBrain" program, an outpatient clinical model that combines dual-task and exergaming interventions to promote cognitive and physical health. We review the scientific rationale supporting these methods, detail the structure and methodology of the FitBrain program, and provide examples of session designs that integrate dual-tasking through exergaming. The paper also addresses implementation considerations, such as tailoring interventions to specific populations, ensuring user-centered design, and leveraging accessible technologies. We discuss key challenges, including limited research on programs utilizing multiple technologies and cost constraints, and propose directions for future research to refine best practices and evaluate the comparative effectiveness of multimodal vs. singular interventions. This paper aims to inform clinicians and program developers on implementing dual-task and exergaming interventions within diverse clinical and community settings by offering a structured model and practical guidelines.

Exergaming for dementia and mild cognitive impairment

BACKGROUND

Dementia and mild cognitive impairment are significant contributors to disability and dependency in older adults. Current treatments for managing these conditions are limited. Exergaming, a novel technology-driven intervention combining physical exercise with cognitive tasks, is a potential therapeutic approach.

OBJECTIVES

To assess the effects of exergaming interventions on physical and cognitive outcomes, and activities of daily living, in people with dementia and mild cognitive impairment.

SEARCH METHODS

On 22 December 2023, we searched the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science Core Collection (Clarivate), LILACS (BIREME), ClinicalTrials.gov, and the WHO (World Health Organization) meta-register the International Clinical Trials Registry Portal.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that recruited individuals diagnosed with dementia or mild cognitive impairment (MCI). Exergaming interventions involved participants being engaged in physical activity of at least moderate intensity, and used immersive and non-immersive virtual reality (VR) technology and real-time interaction. We planned to classify comparators as inactive control group (e.g. no treatment, waiting list), active control group (e.g. standard treatment, non-specific active control), or alternative treatment (e.g. physical activity, computerised cognitive training). Outcomes were to be measured using validated instruments.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias using the Cochrane risk of bias tool RoB 2, and assessed the certainty of the evidence using GRADE. We consulted a third author if required. Where possible, we pooled outcome data using a fixed-effect or random-effects model. We expressed treatment effects as standardised mean differences (SMDs) for continuous outcomes and as risk ratios (RRs) for dichotomous outcomes, along with 95% confidence intervals (CIs). When data could not be pooled, we presented a narrative synthesis.

MAIN RESULTS

We included 11 studies published between 2014 and 2023. Six of these studies were pre-registered. Seven studies involved 308 participants with mild cognitive impairment, and five studies included 228 individuals with dementia. One of the studies presented data for both MCI and dementia separately. Most comparisons exhibited a high risk or some concerns of bias. We have only low or very low certainty about all the results presented below. Effects of exergaming interventions for people with dementia Compared to a control group Exergaming may improve global cognitive functioning at the end of treatment, but the evidence is very uncertain (SMD 1.47, 95% 1.04 to 1.90; 2 studies, 113 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD -0.20, 95% -0.57 to 0.17; 2 studies, 113 participants) or activities of daily living (ADL) (SMD -0.28, 95% -0.65 to 0.09; 2 studies, 113 participants). The evidence is very uncertain about adverse effects due to the small sample size and no events. Findings are based on two studies (113 participants), but data could not be pooled; both studies reported no adverse reactions linked to the intervention or control group. Compared to an alternative treatment group At the end of treatment, the evidence is very uncertain about the effects of exergaming on global physical functioning (SMD 0.14, 95% -0.30 to 0.58; 2 studies, 85 participants) or global cognitive functioning (SMD 0.11, 95% -0.33 to 0.55; 2 studies, 85 participants). For ADL, only one study was available (n = 67), which provided low-certainty evidence of little to no difference between exergaming and exercise. The evidence is very uncertain about adverse effects of exergaming compared with alternative treatment (RR 7.50, 95% CI 0.41 to 136.52; 2 studies, 2/85 participants). Effects of exergaming interventions for people with mild cognitive impairment (MCI) Compared to a control group Exergaming may improve global cognitive functioning at the end of treatment for people with MCI, but the evidence is very uncertain, (SMD 0.79, 95% 0.05 to 1.53; 2 studies, 34 participants). The evidence is very uncertain about the effects of exergaming at the end of treatment on global physical functioning (SMD 0.27, 95% -0.41 to 0.94; 2 studies, 34 participants) and ADL (SMD 0.51, 95% -0.01 to 1.03; 2 studies, 60 participants). The evidence is very uncertain about the effects of exergaming on adverse effects due to a small sample size and no events (0/14 participants). Findings are based on one study. Compared to an alternative treatment group The evidence is very uncertain about global physical functioning at the end of treatment. Only one study was included (n = 45). For global cognitive functioning, we included four studies (n = 235 participants), but due to considerable heterogeneity (I² = 96%), we could not pool results. The evidence is very uncertain about the effects of exergaming on global cognitive functioning. No study evaluated ADL outcomes. The evidence is very uncertain about adverse effects of exergaming due to the small sample size and no events (n = 123 participants). Findings are based on one study.

AUTHORS' CONCLUSIONS

Overall, the evidence is very uncertain about the effects of exergaming on global physical and cognitive functioning, and ADL. There may be an improvement in global cognitive functioning at the end of treatment for both people with dementia and people with MCI, but the evidence is very uncertain. The potential benefit is observed only when exergaming is compared with a control intervention (e.g. usual care, listening to music, health education), and not when compared with an alternative treatment with a specific effect, such as physical activity (e.g. standing and sitting exercises or cycling). The evidence is very uncertain about the effects of exergaming on adverse effects. All sessions took place in a controlled and supervised environment. Therefore, we do not know if exergaming can be safely used in a home environment, unsupervised.

Technology-based group exercise interventions for people living with dementia or mild cognitive impairment: A scoping review

Older people living with dementia or mild cognitive impairment (MCI) are more vulnerable to experiencing social isolation and loneliness due to their cognitive and physical impairments. Increasingly integrating technology into group exercises contributed to the improved resilience and well-being of older adults living with dementia and MCI. The purpose of this scoping review was to identify the various types, feasibility, outcome measures, and impacts of technology-based group exercise interventions for people with dementia or MCI. We utilized the Joanna Briggs Institute approach, a three-step process. A comprehensive literature search on five databases-CINAHL, MEDLINE, Embase, Web of Science, and PsycInfo-until January 2024 yielded 1,585 publications; the final review included 14 publications that recruited a total of 379 participants, with mean age of 69 (SD = 4.21) years to 87.07 (SD = 3.92) years. Analysis of data showed three types of technology-based group exercise interventions for people with dementia or MCI: (a) exergames, (b) virtual cycling or kayak paddling, and (c) video-conferencing platforms. In addition, we identified three key impacts: (a) feasibility and accessibility; (b) physical, psychosocial, and cognitive benefits; and (c) adaptations necessary for persons with dementia or MCI. Our study suggests that technology-based group exercise interventions are feasible and acceptable to persons with dementia or MCI. Future studies should involve individuals with dementia and their caregivers in the design and implementation of technology-based group exercise programs.

Effects of dual-task resistance exercise on cognition, mood, depression, functional fitness, and activities of daily living in older adults with cognitive impairment: a single-blinded, randomized controlled trial

BACKGROUND

Regular exercise is emphasized for the improvement of functional capacity and independence of older adults. This study aimed to compare the effects of a dual-task resistance exercise program and resistance exercise on cognition, mood, depression, physical function, and activities of daily living (ADL) in older adults with cognitive impairment.

METHODS

A total of 44 older adults participated in the study. Participants were randomly allocated to an experimental group (n = 22) performing a dual-task resistance exercise program for cognitive function improvement and a control group (n = 22) performing a resistance exercise program. Both groups performed the exercise for 40 min per session, three times a week, for 6 weeks (18 sessions). Cognition, mood, depression, functional fitness, and ADL were quantified before and after the intervention using the Mini-Mental State Examination (MMSE), profile of mood states (POMS), geriatric depression scale (GDS), senior fitness test (SFT), and Korean version of ADL, respectively.

RESULTS

There was a significant time and group interaction on the MMSE (p = 0.044). There were no significant time and group interactions in the POMS, GDS, SFT, or ADL. Cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after dual-task resistance exercise, and cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after resistance exercise.

CONCLUSIONS

Dual-task resistance exercise is more effective than resistance exercise in improving cognitive function in older adults with cognitive impairment. Both dual-task resistance exercise and resistance exercise improves mood, depression, functional fitness, and ADL after the intervention. We propose using dual-task resistance exercises for cognitive and physical health management in the older adults with cognitive impairment.

TRIAL REGISTRATION

This study was registered with the Clinical Research Information Service (WHO International Clinical Trials Registry Platform) (Registration ID, KCT0005389; Registration date, 09/09/2020).