Skip to main content
Top
Published in: BMC Geriatrics 1/2020

Open Access 01-12-2020 | Research article

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

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

Published in: BMC Geriatrics | Issue 1/2020

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
go back to reference 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.CrossRef 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.CrossRef
2.
go back to reference Park DC, Reuter-Lorenz P. The adaptive brain: aging and neurocognitive scaffolding. Annu Rev Psychol. 2009;60:173–96.CrossRef Park DC, Reuter-Lorenz P. The adaptive brain: aging and neurocognitive scaffolding. Annu Rev Psychol. 2009;60:173–96.CrossRef
3.
go back to reference 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):1961–8.CrossRef 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):1961–8.CrossRef
4.
go back to reference Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord. 2008;23(3):329–42.CrossRef Yogev-Seligmann G, Hausdorff JM, Giladi N. The role of executive function and attention in gait. Mov Disord. 2008;23(3):329–42.CrossRef
5.
go back to reference 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.CrossRef 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.CrossRef
6.
go back to reference 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.CrossRef 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.CrossRef
7.
go back to reference Raichlen DA, Alexander GE. Adaptive capacity: an evolutionary neuroscience model linking exercise, cognition, and brain health. Trends Neurosci. 2017;40(7):408–21.CrossRef Raichlen DA, Alexander GE. Adaptive capacity: an evolutionary neuroscience model linking exercise, cognition, and brain health. Trends Neurosci. 2017;40(7):408–21.CrossRef
8.
go back to reference 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.CrossRef 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.CrossRef
9.
go back to reference 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):177–87.CrossRef 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):177–87.CrossRef
10.
go back to reference 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):640–6.PubMed 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):640–6.PubMed
11.
go back to reference 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):622–9.CrossRef 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):622–9.CrossRef
12.
go back to reference 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.CrossRef 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.CrossRef
13.
go back to reference 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):109–19.CrossRef 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):109–19.CrossRef
14.
go back to reference 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.CrossRef 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.CrossRef
15.
go back to reference 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.CrossRef 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.CrossRef
16.
go back to reference 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):768–79.CrossRef 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):768–79.CrossRef
17.
go back to reference 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):154–60.CrossRef 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):154–60.CrossRef
18.
go back to reference 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):189–98.CrossRef 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):189–98.CrossRef
19.
go back to reference 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. 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.
20.
go back to reference Rogers RD, Monsell S. Costs of a predictible switch between simple cognitive tasks. J Exp Psychol Gen. 1995;124(2):207.CrossRef Rogers RD, Monsell S. Costs of a predictible switch between simple cognitive tasks. J Exp Psychol Gen. 1995;124(2):207.CrossRef
21.
go back to reference Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153–6.CrossRef Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153–6.CrossRef
22.
go back to reference 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):1050–6.CrossRef 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):1050–6.CrossRef
23.
go back to reference 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):310–7.CrossRef 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):310–7.CrossRef
24.
go back to reference 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.CrossRef 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.CrossRef
25.
go back to reference Bloem BR, Valkenburg VV, Slabbekoorn M, Willemsen MD. The multiple tasks test: development and normal strategies. Gait Posture. 2001;14(3):191–202.CrossRef Bloem BR, Valkenburg VV, Slabbekoorn M, Willemsen MD. The multiple tasks test: development and normal strategies. Gait Posture. 2001;14(3):191–202.CrossRef
26.
go back to reference 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):692–6.CrossRef 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):692–6.CrossRef
27.
go back to reference 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.CrossRef 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.CrossRef
28.
go back to reference 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.CrossRef 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.CrossRef
29.
go back to reference Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–30.CrossRef Colcombe S, Kramer AF. Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol Sci. 2003;14(2):125–30.CrossRef
30.
go back to reference 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):3017–22.CrossRef 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):3017–22.CrossRef
31.
go back to reference 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):469–83.CrossRef 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):469–83.CrossRef
32.
go back to reference 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):176–85.CrossRef 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):176–85.CrossRef
33.
go back to reference 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):1645–66.CrossRef 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):1645–66.CrossRef
34.
go back to reference 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.CrossRef 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.CrossRef
Metadata
Title
Effects of simultaneous cognitive and aerobic exercise training on dual-task walking performance in healthy older adults: results from a pilot randomized controlled trial
Authors
David A. Raichlen
Pradyumna K. Bharadwaj
Lauren A. Nguyen
Mary Kathryn Franchetti
Erika K. Zigman
Abigail R. Solorio
Gene E. Alexander
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2020
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-020-1484-5

Other articles of this Issue 1/2020

BMC Geriatrics 1/2020 Go to the issue