Combined physical activity and brain training can improve cognitive function in older adults

Gheysen. Physical activity to improve cognition in older adults: Can physical activity programs enriched with cognitive challenges enhance the effects? A systematic review and meta-analysis Int J Behav Nutr Phys Act. 2018;15:63.

Review question

Does integrating brain training into physical activity programs produce greater benefits on cognitive function in older adults?

Background

Globally, around 47 million people have dementia, a number which is projected to triple within the next 30 years. Amongst older age groups, cognitive issues and decline—such as dementia—are the main drivers of death and disability. Past research has shown that physical activity is important in defending against cognitive decline, while new research suggests that adding brain training tasks to physical activity may enhance these protective effects. However, questions remain as to whether this combined strategy is more beneficial than either brain training or physical activity training alone.

How the review was done

This is a systematic review and meta-analysis of 41 randomized controlled trials, non-randomized controlled trials and cluster-randomized controlled trials published between 2002 and 2018.

• Participants were older adults with an average age of ≥ 65 years, living independently, and with or without mild cognitive impairments. These individuals did not have dementia, other mental health issues, or neurological disorders.
• Study participants took part in combined physical activity training (could include aerobic or strength components or both) and brain training (trained one or more areas of cognitive function). Physical activity and brain training sessions generally occurred separately and before or after one another or together (e.g., dance, tai chi, exercise-based computer games, dual-task exercises, and martial arts).
• Training sessions varied in duration [short (≤ 45 min), medium (> 45 to ≤60 min), long (> 60 min)] and frequency [low (1×/week), medium (2×/week), high (≥3×/week)], while programs as a whole varied in length [short (< 12 weeks), medium (12–23 weeks), long (≥ 24 weeks)].
• Researchers measured changes in cognitive function. 
• Results were compared to people in control groups (e.g., received nothing, usual care, stretching classes, etc.), physical activity only training sessions, or brain training only sessions.

What the researchers found

Amongst older adults, combined physical activity and brain training was more effective in improving cognitive function than control groups and physical activity training alone, but not brain training alone. This combined strategy was more beneficial when physical activity and brain training were done together, rather than separately and before or after each other. Those with or without mild cognitive impairment appeared to benefit from the combination of these two activities.

Short, medium, and long program lengths were found to be effective, as were low, medium, and high training session frequencies. Low and medium, but not long, training session durations had positive effects. Despite this, the overall difference between the three types of training session durations was not deemed to be significant. Taking all of this into consideration, it was concluded that characteristics such as program length and session frequency and duration may not impact the effectiveness of this combined strategy. Most of the included studies were of moderate to strong quality. More research is needed to gain a better understating of which combined physical activity and brain training programs work best, and the impact in the long-term.

Conclusion

Physical activity programs that also contain brain training can produce greater cognitive benefits in older adults; especially when the physical activity and brain training are done simultaneously, and regardless of program characteristics like length, session duration, and session frequency.