Does multicomponent physical exercise with simultaneous cognitive training boost cognitive performance in older adults? A 6-month randomized controlled trial with a 1-year follow-up

Figures & data

Figure 1 Simultaneous cognitive–physical training components: video game dancing (A) and treadmill memory training (B). In (A) two participants perform steps on a pressure sensitive platform to the rhythm of the music. Step timing and direction is cued with arrows on a screen. In (B) a participant is walking on a treadmill while performing verbal memory exercises presented on a computer screen.

Figure 2 Examples of complementary balance (A) and strength (B) exercises.

Notes: The participant in (A) tries to maintain balance while stepping from one object to the next (objects are soft rubber “stones” and a skipping rope) and (B) shows a participant performing split leg squats wearing a weight vest.

Table 1 Baseline demographic characteristics and training compliance

Variable	DANCE	MEMORY	PHYS	P-value, two tailed
N	24	22	25
Sex, female	14, 58.3%	16, 72.7%	16, 64.0%	0.602
Age, years	77.3 (6.3)	78.5 (5.1)	80.8 (4.7)	0.079t
MMSE, score	28.4 (1.4)	28.3 (1.2)	28.0 (1.7)	0.533
Education, years	13.7 (1.5)	13.9 (2.1)	12.0 (2.1)	0.002**
Total training compliance (52 sessions)	84.3% (12.7%)	86.1% (9.1%)	87.1% (7.9%)	0.633
Home-training compliance (eight sessions)	79.9% (23.0%)	90.0% (14.8%)	83.5% (18.4%)	0.201

Notes: Data are means (standard deviation in brackets) or numbers. Bold values indicate significance or trend,

** P<0.01,

t P<0.10 trend.

Abbreviations: MMSE, Mini Mental State Examination; DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking.

Figure 3 Trial design and participants’ flow.

Notes: Participants were randomly assigned to one of two simultaneous cognitive–physical training groups (DANCE and MEMORY) or an exclusively physical multicomponent training group (PHYS) and were trained over 6 months twice weekly for 1 hour. Nine cognitive tests were assessed at pretest, 3-months test, and 6-months test. Four tests were repeated at 1-year follow-up.
Abbreviations: DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking.

Table 2 Multiple regression for the linear global time effect (from pretest to 3- and 6-months tests, N=71) and the interaction between orthogonal contrasts and time effect for the cognitive test battery

Dependent variable (cognitive domain)	Predictor	b	95% CI		SE b	β	P one tailed	R^2-change
Trail Making Part A (information processing speed)	ABC	−4.93	−6.81	−3.05	0.95	−0.22	<0.001***	0.049
	AB×C	0.78	−0.53	2.09	0.66	0.05	0.120	0.003
	A×B	0.06	−2.27	2.40	1.18	0.00	0.479	0.000
Trail Making Part B (executive function, shifting)	ABC	−5.57	−11.46	0.32	2.98	−0.08	0.032*	0.006
	AB×C	−0.93	−5.03	3.18	2.08	−0.02	0.328	0.000
	A×B	−1.76	−9.07	5.56	3.70	−0.02	0.318	0.000
Executive Control (executive function, working memory)	ABC	0.70	0.14	1.27	0.29	0.11	0.008**	0.013
	AB×C	−0.19	−0.58	0.20	0.20	−0.04	0.170	0.002
	A×B	0.58	−0.12	1.28	0.35	0.08	0.051t	0.006
Paired-Associates Learning (long-term visual memory)	ABC	0.51	0.26	0.76	0.13	0.21	<0.001***	0.043
	AB×C	0.05	−0.12	0.23	0.09	0.03	0.272	0.001
	A×B	−0.03	−0.34	0.28	0.16	−0.01	0.426	0.000
Story Recall (long-term verbal memory)	ABC	0.55	0.19	0.92	0.18	0.13	0.002**	0.017
	AB×C	−0.04	−0.29	0.22	0.13	−0.01	0.389	0.000
	A×B	0.11	−0.35	0.56	0.23	0.02	0.319	0.000
Digit Forward (short-term verbal memory)	ABC	0.00	−0.23	0.23	0.12	0.00	0.493	0.000
	AB×C	0.00	−0.16	0.16	0.08	0.00	0.487	0.000
	A×B	−0.11	−0.39	0.18	0.14	−0.04	0.225	0.002
Age Concentration Test A (concentration, attention)	ABC	0.03	0.02	0.05	0.01	0.20	<0.001***	0.040
	AB×C	0.00	−0.01	0.01	0.01	−0.02	0.366	0.000
	A×B	0.00	−0.02	0.02	0.01	−0.01	0.407	0.000
Age Concentration Test B (concentration, attention)	ABC	0.01	0.00	0.03	0.01	0.08	0.036*	0.007
	AB×C	0.00	−0.01	0.01	0.01	−0.01	0.433	0.000
	A×B	0.01	−0.01	0.03	0.01	0.05	0.140	0.002
Digit Symbol Substitution (information processing speed)	ABC	2.20	1.62	2.77	0.29	0.18	<0.001***	0.033
	AB×C	0.16	−0.24	0.56	0.20	0.02	0.216	0.000
	A×B	−0.44	−1.15	0.27	0.36	−0.03	0.113	−0.001

Notes: ABC, linear global time effect; AB×C, linear time×intervention interaction DANCE/MEMORY versus PHYS; A×B, linear time×intervention interaction DANCE versus MEMORY. A, DANCE; B, MEMORY; C, PHYS. Bold values indicate significance or trend,

* P<0.05,

** P<0.01,

*** P<0.001,

t P<0.10 trend.

Abbreviations: DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking; CI, confidence interval; SE, standard error of the mean.

Table 3 Repeated measures ANOVA from 6-months test to follow-up test, N=47

Dependent variable (cognitive domain)	Effect	F(2, 44)	P two tailed	r
Trail Making Part A	Time	0.104	0.748	0.05
(information processing speed)	Time×intervention	0.664	0.520	0.12
Trail Making Part B	Time	6.444	0.015*	0.36
(executive function, shifting)	Time×intervention	0.372	0.691	0.09
Executive Control	Time	0.110	0.741	0.05
(executive function, working memory)	Time×intervention	1.086	0.346	0.16
Paired-Associates Learning	Time	1.133	0.293	0.16
(long-term visual memory)	Time×intervention	0.216	0.807	0.07

Notes:

* P<0.05. Bold values indicate significance or trend.

Abbreviation: ANOVA, analysis of variance.

Figure 4 Cognitive performance developments in the four tests that included a 1-year follow-up measurement.

Notes: Significant overall improvements were shown in all tests over the 6-months training period (graphs A–D all P<0.05, one tailed). In Trail Making B (graph B), only the two groups with a cognitive training component (DANCE and MEMORY) improved from pretest to 3-months test (trend P=0.075, one tailed). In Executive Control (graph C), different time courses of adaptation between DANCE and MEMORY were found (trend P=0.051, one tailed). From 6-months test to 1-year follow-up test Trail Making B improved significantly (graph B, P=0.015), while performance was maintained in the three other tests (graphs A, C, and D). Error bars indicate ± standard error of the mean.

Abbreviations: DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking.

Figure 5 Cognitive performance developments in the five tests that did not include a 1-year follow-up measurement.

Notes: Significant overall improvements were shown in the tests in graphs (A, C, D, and E) (all P<0.05, one tailed) over the 6-months training period. No improvement was found in Digit Forward (graph B). Error bars indicate ± standard error of the mean.
Abbreviations: DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking.

Figure 6 Comparison of training enjoyment in the three interventions.

Notes: No group differences were shown for overall training enjoyment (PACES), strength, and balance training (all P>0.05). The two cognitive–physical training components (video game dancing and treadmill memory) tended to be enjoyed more than treadmill walking (trend P=0.069, one tailed). Scores system is from one to seven points (least to maximal enjoyment), ^tP<0.10 trend, error bars indicate ± standard error of the mean.
Abbreviations: PACES, Physical Activity Enjoyment Scale; TE, training enjoyment; DANCE, virtual reality video game dancing; MEMORY, treadmill walking with simultaneous verbal memory training; PHYS, treadmill walking.