From the Guidelines
Combined physical and cognitive interventions, including at least 150 minutes of moderate-intensity aerobic exercise per week and structured cognitive training, are recommended to improve cognitive outcomes in older adults, as they have been shown to have a positive impact on cognition and physical function 1. The most recent and highest quality study, a systematic review and Bayesian model-based network meta-analysis of RCTs published in 2022, found that multicomponent exercise interventions, including aerobic exercise, resistance training, and mind-body activities, were the most effective in improving cognitive function in older adults with mild cognitive impairment 1. Key components of an effective program include:
- Aerobic exercise, such as brisk walking, swimming, or cycling, for at least 30 minutes, 3-5 times weekly at moderate intensity
- Structured cognitive training, incorporating tasks targeting memory, attention, processing speed, and executive function, for 15-30 minutes daily
- Dual-task training, where cognitive challenges are performed during physical activity, to create synergistic effects and enhance cognitive benefits
- A comprehensive program that includes both physical and cognitive components, as this integrated approach is more effective than either intervention alone The evidence suggests that the type and dose of exercise, as well as individual factors such as sex and obesity status, may influence the relationship between exercise and cognition 1. However, the current evidence supports the use of combined physical and cognitive interventions as a cornerstone strategy for the prevention and treatment of dementia, and for improving cognitive function in older adults 1. It is essential to maintain consistency, gradually increase difficulty levels, and ensure activities remain challenging but achievable to achieve optimal results.
From the Research
Effects of Combined Physical and Cognitive Interventions
The effects of combined physical and cognitive interventions on patients have been studied in various research papers. The key findings are:
- Combined physical and cognitive training can improve cognitive and physical outcomes in older adults with and without cognitive impairment 2.
- Simultaneous training is the most efficacious approach for cognition, followed by sequential combinations and cognitive training alone 2.
- Combined interventions are superior to exercise in improving response inhibition, working memory, and delayed recall, but are not superior to cognitive interventions in all outcomes 3.
- Combined interventions are superior to active/passive controls in improving global cognition, response inhibition, immediate recall, delayed recall, category fluency, processing speed, and visuospatial ability 3.
Intervention Characteristics
The characteristics of combined physical and cognitive interventions that determine their effectiveness are:
- Length, frequency, duration, intensity, and level of task difficulty 4.
- Combination format (simultaneous vs sequential combination) 3.
- Mode of delivery (group-based vs individual-based vs mixed) 3.
- Training duration (short: ≤12 weeks vs medium: 13-24 weeks vs long: >24 weeks) 3.
Outcomes
The outcomes of combined physical and cognitive interventions include:
- Improved cognitive function, including global cognition, executive function, processing speed, memory, attention, and mood 2, 5.
- Improved physical function, including gait, balance, mobility, and cardiorespiratory fitness 2, 5.
- Reduced brain atrophy in amnestic mild cognitive impairment 6.
Study Designs
The study designs used to investigate the effects of combined physical and cognitive interventions include: