What are the effects of combined physical and cognitive interventions?

From the Guidelines

Combined physical and cognitive interventions are highly effective for managing various health conditions, particularly dementia and cognitive impairment, and should be implemented as a comprehensive treatment approach. These interventions typically include a structured exercise program, such as 30 minutes of moderate aerobic activity 3-5 times weekly, combined with resistance training 2-3 times weekly, as recommended by the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia 1. The physical activity interventions should be tailored to the individual's capabilities and gradually increased in intensity.

Key Components of Interventions

• Aerobic exercise and/or resistance training of at least moderate intensity to improve cognition outcomes among older adults 1
• Physical activity interventions involving aerobic exercise to improve cognitive outcomes among people with mild cognitive impairment (MCI) 1
• Mind-body exercise, such as Tai Chi or Qigong, may also be beneficial for improving cognitive outcomes among older adults with MCI, although more research is needed 1

Implementation and Monitoring

When implementing this combined approach, it's essential to establish clear goals, track progress using validated assessment tools, and ensure consistency across both intervention types. This integrated approach works by simultaneously addressing physiological factors (through improved cardiovascular health, increased muscle strength, enhanced neuroplasticity) and psychological factors (by restructuring negative thought patterns, developing coping strategies, and improving self-efficacy), as supported by recent guidelines on vascular cognitive impairment 1. The synergistic effect of targeting both physical and cognitive domains typically produces better outcomes than either approach alone, as physical activity enhances cognitive function while cognitive strategies improve adherence to physical regimens.

Additional Considerations

Multimodal approaches, including diet, social activities, music, and health education, may also be considered to improve cognitive performance or prevent cognitive decline 1. Additionally, modifying the social and physical environment and embedding structure and routine may be necessary to optimize specific cognitive rehabilitation techniques 1. Overall, combined physical and cognitive interventions should be a priority in the management of dementia and cognitive impairment, given their potential to improve cognitive outcomes, reduce the risk of dementia, and enhance overall quality of life.

From the Research

Effects of Combined Physical and Cognitive Interventions

• The combination of physical exercise and cognitive training has been shown to have positive effects on cognitive function in various populations, including stroke patients 2, older adults with and without cognitive impairment 3, and older adults with mild cognitive impairment 4.
• Studies have found that combined interventions can lead to improvements in global cognition, executive function, processing speed, memory, attention, and physical function, such as gait, balance, and mobility 3, 5, 4.
• The effectiveness of combined interventions may depend on factors such as training dosage and severity of neurocognitive disorder, with higher dosages and less severe disorders potentially leading to greater benefits 5.
• Compared to single-domain training, combined physical and cognitive interventions have been found to be more efficacious for promoting cognitive and physical health in older adults 3.
• The optimal combination strategy, such as simultaneous or sequential training, may vary depending on the population and outcomes of interest, with simultaneous training showing promise for cognitive outcomes 3.
• Long-term follow-up and comprehensive neuropsychological testing are needed to determine the sustainability and generalizability of the benefits of combined physical and cognitive interventions 2, 4.

Population-Specific Effects

• In stroke patients, combined physical and cognitive interventions have been found to improve cognitive function, with benefits maintained at six-month follow-up 6.
• In older adults with mild cognitive impairment, combined interventions have been shown to improve cognitive and physical function, with potential benefits for delaying or preventing dementia 4.
• In older adults with and without cognitive impairment, simultaneous and sequential combined interventions have been found to be efficacious for promoting cognitive and physical health 3.

Intervention Characteristics

• The intensity and duration of physical exercise and cognitive training may influence the effectiveness of combined interventions, with moderate-vigorous intensity and longer durations potentially leading to greater benefits 2, 6.
• The type of cognitive training, such as computer-based or game-based, may also impact the effectiveness of combined interventions 5.