Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials

Background Large systematic reviews have pointed to the efficacy of cognitive training and physical exercise on cognitive performance in older adults, making them the most common interventions in multidomain dementia prevention trials. However, it remains unclear to which extent combinations of these interventions yield additive effects beyond their individual components and what combination strategies are most beneficial. Our aim therefore was to synthesize the evidence from randomized controlled trials of combined cognitive and physical training on cognitive, physical, psychosocial and functional outcomes in older adults with or without cognitive impairment, and to compare and rank the efficacy of the three main types of combined intervention delivery formats (simultaneous, sequential or exergaming) relative to either intervention alone or control conditions. Methods and Findings We systematically searched MEDLINE, Embase and PsyclNFO from inception to 23 July 2019. Change from baseline to post-intervention were extracted for each outcome and results were analyzed using random-effects models. The overall efficacy of combined interventions was assessed using multivariate pairwise meta-analysis and the comparative efficacy across different intervention delivery formats and control conditions was investigated using network meta-analysis. A total of 47 trials encompassing 4052 participants were eligible, including cognitively healthy older adults (k=30), mild cognitive impairment (k=13), dementia (k=2) and Parkinson’s disease (k=2). Due to the small number of identified studies in dementia and Parkinson’s disease, these were excluded from the pooled analyses and instead summarized narratively. Relative to any control condition, combined interventions were associated with small and heterogeneous effects on overall cognitive (k=41, Hedges’ g = 0.22, 95% CI 0.14 to 0.30, prediction interval - 0.34 to 0.78) and physical function (k=32, g = 0.25, 95% CI 0.13 to 0.37, prediction interval - 0.46 to 0.96). Cognitive and physical effects were similar for cognitively healthy older adults and those with mild cognitive impairment. No robust evidence for benefit on psychosocial function (k=9) or functional abilities (k=2) was found. The efficacy of simultaneous and sequential training for cognition exceeded all control conditions apart from cognitive training alone, with small to moderate effect estimates and moderate certainty of the evidence. The efficacy of simultaneous and sequential training on physical outcomes was comparable but not significantly greater than physical exercise alone. Exergaming was ranked low for both outcomes and superior only to passive control. The certainty of the evidence was low for physical outcomes, and we were not able to compare interventions in Parkinson’s disease and dementia. Conclusion Combined cognitive and physical training, delivered either simultaneously or sequentially, is efficacious for cognitive and physical outcomes in cognitively healthy and mildly impaired older adults, but not superior to cognitive or physical exercise alone in each domain. There is little systematic evidence to support potential additive effects of combined interventions or the use of exergaming in older adults. Given simultaneous training is as efficacious but less burdensome than sequential design, the former may be better suited for practical implementation to promote cognitive alongside physical health in late life. More research is needed to establish the effects of combined interventions on everyday function and well-being. PROSPERO registration number: CRD42020143509.

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A multi-component training program holds promises for the elderly, but still has to be tested on its feasibility and effect in nursing homes. The aim of this study was (1) to design a multi-component training program which improves physical functioning and psychosocial wellbeing and (2) to evaluate the feasibility of this intervention in nursing home residents. This study is a two-arm, stratified-randomized controlled feasibility trail. Twenty-four nursing home residents (aged 83.7 ± 6.4, 21 women) were divided into an intervention and a waiting-list control group. The intervention group completed a multi-component training (including dual-task, dynamic balance, endurance and strength exercises) for 16 weeks (twice per week for 45–60 min). Primary outcomes were lower extremity functionality (SPPB), gait performance (GAITRite), health-related quality of life (SF-12) as well as life satisfaction (SWLS). Life satisfaction (SWLS) and physical functioning (SPPB) increased in the intervention group after training whereas the control group showed a decrease. Gait parameters could only be analyzed for n = 5 participants of the intervention group and n = 2 of the control group and showed no time differences for the intervention group. The mean number of participants was 12.5 ± 1.9 per session (attendance ranged between 66% and 90%). A multi-component training seems (1) to lead to clinically relevant improvements in physical functioning as well as in psychosocial wellbeing and (2) to be feasible and well accepted in nursing home residents. Nevertheless, the complexity and progression of the program as well as the testing protocol have to be adapted. Further research should test the effectiveness of this adapted program in a larger sample size.

Can cognitive-motor training improve physical functioning and psychosocial wellbeing in nursing home residents? A randomized controlled feasibility study as part of the PROCARE project.

Aims and objectives Research examining the effectiveness of resistance band exercises for improving physical and psychological dimensions among frail older adults has been inconsistent. We aimed to examine the effects of resistance band exercises for improving outcomes in frail older adults. Background To provide robust evidence regarding the effectiveness of resistance band exercises and explore other potential outcomes in frail older adults, a systematic review of RCTs remains necessary. Design Systematic literature review and meta-analysis were conducted in accordance with the PRISMA guidelines. Methods Four databases were searched. English language papers were retrieved from 2006 to 2020. Three reviewers reviewed the methodology of the selected studies using the Joanna Briggs Institute tool for randomised controlled trials. The pooled standardised mean difference was calculated using a random-effects model. Heterogeneity among pooled studies was assessed using the τ2 , Q and I2 statistics, and publication bias was evaluated using Egger's test and the visual inspection of funnel plots. Results A total of 15 studies met the eligibility criteria for this study. Overall, resistance band exercise reduced frailty after 24 weeks (SMD: -0.29; 95% CI: -0.55 to -0.03) and reduced depression after both 12 weeks (SMD: -0.19; 95% CI: -0.38 to -0.01) and 24 weeks (SMD: -0.30; 95% CI: -0.52 to -0.09). However, no significant effects were observed for frailty after 12 weeks, and no significant effects were observed for grip strength, leg strength, activities of daily living or quality of life at any time. Conclusion Resistance band exercise might be considered a viable strategy for frail older adults in the community or in long-term care facilities. More research implementing a standardised protocol remains necessary to identify the effects of different training volumes and the dose-response relationship for the very old and frail population. Relevance to clinical practice As a safe complementary intervention for frail older adults, health providers should consider resistance band exercises when caring for frail older adults because this intervention has clinical benefits.

Effects of resistance bands exercise for frail older adults: A systematic review and meta-analysis of randomised controlled studies

Some nursing homes for the elderly provide holistic care that integrates several interventions, including physical exercise. The aim of this systematic review is to summarize the effects of physical exercise or multicomponent exercise programs on the mental health (wellbeing, anxiety and depression) and cognitive functions of older adults with/without dementia who live in a nursing home and do/do not require wheelchair assistance. To this end, PubMed, PsycInfo and Web of Science are using to identify clinical trials and randomized controlled studies conducted during the period January 2011 to December 2021 to examine the progression of research in this field over the past ten years. In total, 2597 articles are identifying and 21 are including in the systematic review. After selecting articles according to the PRISMA standards, the data extraction and methodological quality assessment of the eligible studies are performing individually by two reviewers and then pooled together. The synthesis of the studies shows that physical exercise or multicomponent exercise programs have a beneficial effect on mental health and cognitive functions. However, this effect is more common among older adults without dementia, compared to their counterparts who have dementia or use wheelchairs. The explanatory mechanisms, lack of benefits from physical exercise and the need to standardize methods are discussing in this regard. Finally, future studies must examine the effects of an innovative and adaptive physical activity program on the mental health and cognitive functions of older adults living in nursing homes.

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Effects of Chronic Physical Exercise or Multicomponent Exercise Programs on the Mental Health and Cognition of Older Adults Living in a Nursing Home: A Systematic Review of Studies From the Past 10 Years

BACKGROUND the potential benefits of dual-task interventions on older adults living in long-term nursing homes (LTNHs) from a multidimensional perspective are unknown. We sought to determine whether the addition of simultaneous cognitive training to a multicomponent exercise program offers further benefits to dual-task, physical and cognitive performance, psycho-affective status, quality of life and frailty in LTNH residents. Design: a single-blind randomized controlled trial. SETTING nine LTNHs in Gipuzkoa, Spain. SUBJECTS 85 men and women (ACTRN12618000536268). METHODS participants were randomly assigned to a multicomponent or dual-task training group. The multicomponent group performed two sessions per week of individualized and progressive strength and balance exercises for 3 months. The dual-task group performed simultaneous cognitive tasks to the same tasks as in the multicomponent group. Gait speed under single- and dual-task conditions, physical and cognitive performance, psycho-affective status, quality of life and frailty were measured at baseline and after 3 months of intervention. RESULTS both groups showed clinically significant improvements on gait performance under single- and dual-task conditions and on the short physical performance battery (P   0.05). Only the multicomponent group significantly improved quality of life, and reduced anxiety and Fried frailty score (P < 0.05). No group-by-time interactions were found except for the chair-stand test in favour of the multicomponent group (P < 0.05). CONCLUSIONS the addition of simultaneous cognitive training does not seem to offer significantly greater benefits to the evaluated multicomponent exercise program in older adults living in LTNHs.

Comparison between multicomponent and simultaneous dual-task exercise interventions in long-term nursing home residents: the Ageing-ONDUAL-TASK randomized controlled study.

Maria Antonia López

Papers

Comparison between multicomponent and simultaneous dual-task exercise interventions in long-term nursing home residents: the Ageing-ONDUAL-TASK randomized controlled study.