Effects of cognitive training with additional physical activity compared to pure cognitive training in healthy older adults

Figures & data

Table 1 Overview of the two intervention groups

	CPT	CT
Main cognitive domains trained	Memory, attention, and executive functions in both intervention groups
Typical session	1. Physical activity (20 min)a 2. Group games (15 min) 3. Psychoeducation (10 min) 4. Cognitive training in group setting (45 min)b	1. Group games (15 min) 2. Psychoeducation (10 min) 3. Cognitive training in group setting (45 min)^b 4. Single cognitive exercises (20 min)
Homework	Cognitive homework Single cognitive exercises as additional homework	Cognitive homework
Topic of the psychoeducation	Session #	Session #
Mental capacity: detriments and training	1	1
Physical activity and nutritionc	2
The meaning of attention	3	2
How does memory work?	4	3
Working memory	5	4
Memory and language	6	5
Memory strategies I	7	6
Memory strategies II	8	7
Memory for names and faces	9	8
Appointments and transactions	10	9
Understanding and remembering texts	11	10
Planning and problem solving	12	11
Risk and protective factors	13	12

Notes: NEUROvitalis^21,22 was used as CT, the new version of the CT named NEUROvitalis Plus was used as CPT. In CPT an additional physical activity program was performed over the course of the training. Both CT and CPT were performed in groups of five to eight participants led by a certified trainer.

a Exercises of a multicomponent program (strength, coordination/balance, flexibility, endurance) were used in the CPT.

b Paper/pencil tasks, verbal group exercises, and board games were used in the CT, and the difficulty level was adapted to the group’s performance where available in the training’s material.

c A session named Physical activity and nutrition was added in CPT.

Abbreviations: CPT, cognitive training with additional physical activity; CT, cognitive training; min, minutes.

Table 2 Baseline characteristics of the study sample

Demographics	CPT n=15		CT n=15		P
	Mean (SD)	Range	Mean (SD)	Range
Age	67.13 (4.09)	62–75	66.33 (5.33)	55–77	0.65a
Education	16.87 (4.22)	12–25	14.27 (4.08)	8–21	0.08b
Cognitive state: DemTect	15.60 (1.99)	13–18	16.80 (1.52)	14–18	0.12b
Sex	♀=10	♂=5	♀=11	♂=4	0.69c

Notes: DemTect is from Kalbe et al.^23,24 Range of DemTect norms for normal cognitive state: 13–18.

a Comparison of groups at baseline with t-test for independent samples.

b Comparisons of groups at baseline with Mann–Whitney tests.

c Comparison of groups at baseline with chi-square test.

Abbreviations: ♀, female; ♂, male; CPT, cognitive training with additional physical activity; CT, cognitive training; n, subsample.

Table 3 Test performance of the intervention groups at pretest, post-test, and at 1-year follow-up

Domain	Max score	CPT n=15			CT n=15
		Pretest	Post-test	Follow-up	Pretest	Post-test	Follow-up
		Mean (SD) or median (range)a			Mean (SD) or median (range)a
Cognitive state
DemTectb,c	18	15.00 (13–18)	18.00 (14–18)	18.00 (14–18)	17.00 (14–18)	18.00 (15–18)	18.00 (14–18)
Memory
Verbal memory
DemTect, IRb,c	20	13.00 (10–18)	16.00 (11–20)	14.00 (11–18)	14.00 (10–20)	17.00 (13–19)	17.00 (11–18)
DemTect, DRb,c	10	4.00 (0–10)	7.00 (1–10)	6.00 (2–10)	5.00 (1–10)	6.00 (4–10)	6.00 (2–10)
Figural memory
CFT, DRc	36	20.63 (6.07)	23.40 (4.39)	23.33 (4.37)	21.40 (6.73)	21.93 (6.84)	21.37 (6.19)
Attention
BTA	20	15.87 (3.02)	17.33 (2.80)	18.60 (1.68)	17.73 (2.60)	19.40 (1.55)	18.13 (1.84)
Executive functions
Working memory
DemTect, DSBb,c	6	5.00 (4–6)	6.00 (4–6)	6.00 (4–6)	5.00 (3–6)	6.00 (4–6)	5.00 (3–6)
Executive control
TMT B/A	–	2.21 (0.73)	2.44 (0.89)	2.00 (0.68)	2.05 (0.65)	1.99 (0.52)	2.15 (0.66)
Verbal fluency
Semantic: DemTect, S/Ab,c	4	4.00 (2–4)	4.00 (4)	4.00 (4)	4.00 (4)	4.00 (4)	4.00 (3–4)
Letter: COWA	–	37.80 (10.14)	49.33 (10.06)	46.87 (13.04)	44.13 (12.74)	49.00 (13.16)	51.00 (15.83)
Visuoconstruction
CFT, copyb,c	36	36.00 (30–36)	36.00 (32–36)	36.00 (34–36)	36.00 (34–36)	36.00 (34–36)	36.00 (31–36)
Number processing
DemTect, NTb,c	4	4.00 (3–4)	4.00 (3–4)	4.00 (3–4)	4.00 (3–4)	4.00 (0.00) 4.00 (4–4)d	4.00 (3–4)

Notes: The DemTect is from Kalbe et al.^23,24 CFT, BTA, TMT A and B, and COWA as described in Strauss et al were used.²⁷ Significant results are highlighted in bold.

a Median and range are only displayed for variables that had to be analyzed with nonparametric methods.

b Variable violates assumptions of normal distribution and homogeneity of variances; therefore, nonparametric statistical analysis was used.

c Parallel versions were used to minimize retest effects.

d All participants reached a score of 4.00 so that no variation can be reported for the range.

Abbreviations: BTA, Brief Test of Attention; B/A, ratio of part B divided by part A; CFT, Complex Figure Test; COWA, Controlled Oral Word Association Test; CPT, cognitive training with additional physical activity; CT, cognitive training; DR, subtest delayed recall; DSB, subtest digit span backwards; IR, subtest immediate recall; Max, maximum; n, subsample; NT, subtest number transcoding; S/A, subtest supermarket/animal; SD, standard deviation; TMT, Trail Making Test.

Figure 1 Significant interaction effect Time × Training for divided attention measured with BTA.

Note: The BTA as described in Strauss et al was used.²⁷
Abbreviations: BTA, Brief Test of Attention; CPT, cognitive training with additional physical activity; CT, cognitive training.

Table 4 Results of the post hoc tests of the within-group differences

Domain		CPT n=15			CT n=15
		Test value	P	Effect size	Test value	P	Effect size
Cognitive state
DemTecta	Post–pre	z=1.99	0.03*	φ=0.51	z=1.55	0.07	φ=0.40
	FU–pre	z=2.69	0.00***	φ=0.69	z=0.31	0.41	φ=0.08
Memory
Verbal memory
DemTect, IRa	Post–pre	z=3.43	0.00***	φ=0.89	z=3.25	0.00***	φ=0.84
	FU–pre	z=1.61	0.07	φ=0.41	z=2.46	0.01**	φ=0.64
DemTect, DRa	Post–pre	z=2.25	0.01**	φ=0.58	z=1.35	0.10	φ=0.35
	FU–pre	z=2.54	0.01**	φ=0.66	z=0.98	0.19	φ=0.25
Executive functions
Verbal fluency
Letter: COWAb	Post–pre	meandiff=11.53	0.00***	d=2.04	meandiff=4.87	0.10	d=0.46
	FU–pre	meandiff=9.07	0.00***	d=1.21	meandiff=6.87	0.02*	d=0.66

Notes: The DemTect is from Kalbe et al.^23,24 The COWA as described in Strauss et al was used.²⁷ Significant results are highlighted in bold.

a Wilcoxon signed-rank test was used to compare the training gains within the groups. The Bonferroni procedure was applied manually to prevent an inflated type I error (0.05/6 comparisons per group; α=0.01) for the nonparametric variables. The effect size φ is reported, indicating a small (φ>0.10), moderate (φ>0.30), or strong effect (φ>0.50).

b Post hoc pairwise comparisons were calculated with an overall α=0.05 after the Bonferroni correction of SPSS. The effect size d is reported indicating a small (d>0.10), moderate (d>0.30), or strong effect (d>0.50).

* P≤0.05

** P≤0.01

*** P≤0.001.

Abbreviations: COWA, Controlled Oral Word Association Test; CPT, cognitive training with additional physical activity; CT, cognitive training; DR, subtest delayed recall; FU, 1-year follow-up; IR, subtest immediate recall; n, subsample; post, post-test; pre, pretest.

Table 5 Self-reported physical activity pretest, post-test, and at 1-year follow-up of the CPT group

	Self-reported physical activity
	Pretest		Post-test		Follow-up
	Mean (SD)	Range	Mean (SD)	Range	Mean (SD)	Range
IPAQ scores in MET
Walking	1,821.60 (1,869.16)	0–6,237	1,331.00 (766.16)	0–2,772	1,152.80 (1,194.27)	0–4,851
Moderate activities	1,804.00 (1,721.32)	0–5,580	3,758.40 (2,381.43)	0–8,340	2,160.87 (2,853.26)	0–5,040
Vigorous activities	1,120.00 (1,271.40)	0–4,080	1,522.67 (2,059.48)	0–6,720	736.00 (1,297.10)	160–10,920
Total MET score	4,745.60 (3,026.15)	319–9,642	6,612.07 (3,404.46)	1,782–14,073	4,048.13 (4,289.28)	1,089–15,021
IPAQ categories	n=2 mildly active		n=1 moderately active		n=9 moderately active
	n=4 moderately active		n=14 highly active		n=6 highly active
	n=9 highly active

Notes: The IPAQ is from Craig et al.²⁸ One MET corresponds to the resting metabolic rate obtained during quiet sitting.²⁹

Abbreviations: CPT, cognitive training with additional physical activity; IPAQ, International Physical Activity Questionnaire; MET, metabolic equivalent; SD, standard deviation.

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