Effect of Combined Physical and Cognitive Interventions on Executive Functions in Older Adults: A Meta-Analysis of Outcomes

Abstract

Background: Both physical exercise and cognitive training can effectively improve executive functions in older adults. However, whether physical activity combined with cognitive training is more effective than a single intervention remains controversial. The aim of this study was to perform a meta-analysis to evaluate the effect of combined physical and cognitive interventions on executive functions in older adults aged 65–80 years old. Methods: Randomized controlled trials of combined physical and cognitive interventions on executive functions in older adults were searched using the Web of Science, Elsevier Science, PubMed, EBSCO, Springer-Link, and NATURE databases. Data extraction and quality evaluation were done by Comprehensive Meta-Analysis, V3. Results: A total of 21 studies were included. The results showed that the combined physical and cognitive interventions produced significantly larger gains in executive functions, compared to the control group (standardized mean difference (SMD) = 0.26, 95% confidence interval (CI) [0.14, 0.39], p < 0.01). Furthermore, the effects of the combined physical and cognitive interventions were moderated by the study quality, intervention length, and intervention frequency. No significant differences were found between the combined interventions and the physical intervention alone (SMD = 0.13, 95% CI [−0.07, 0.33], p > 0.05) or the cognitive intervention alone (SMD = 0.13, 95% CI [−0.05, 0.30], p > 0.05). Conclusions: The combined physical and cognitive interventions effectively delayed the decrease of executive functions in older adults and this effect was influenced by the length and frequency of the intervention as well as the research quality. However, the effect of the combined physical and cognitive interventions was not significantly better than that of each intervention alone.

Dual-Task Exercise to Improve Cognition and Functional Capacity of Healthy Older Adults

“…The absence of results may be related to the different protocol characteristics such as exercise intensity, frequency, and duration ( Gheysen et al, 2018 ; Stojan and Voelcker-Rehage, 2019 ; Wollesen et al, 2020 ). These components seem to mediate the relationship with cognitive performance ( Guo et al, 2020 ). Medium (12–23 weeks) or short (<12 weeks) interventions appear to be more effective in promoting cognitive improvements than longer interventions (≥24 weeks), as well as lower frequencies (≤3 session/week) compared to higher frequencies ( Guo et al, 2020 ).…”

“…These components seem to mediate the relationship with cognitive performance ( Guo et al, 2020 ). Medium (12–23 weeks) or short (<12 weeks) interventions appear to be more effective in promoting cognitive improvements than longer interventions (≥24 weeks), as well as lower frequencies (≤3 session/week) compared to higher frequencies ( Guo et al, 2020 ). However, it should be considered that some studies, even with similar duration and frequencies, present different results ( Wollesen et al, 2020 ), which has led increasingly to consider the content of the intervention itself, such as the type of exercise and the complexity of the cognitive task.…”

“…The differential efficiency of dual-task intervention in comparison to single stimulation is unclear ( Bruderer-Hofstetter et al, 2018 ; Guo et al, 2020 ), but in healthy older adults the simultaneous conduction of a mental and a physical task (dual-task) seems to be particularly efficient to increase cognitive function ( Eggenberger et al, 2015 ; Falbo et al, 2016 ; Lauenroth et al, 2016 ; Tait et al, 2017 ; Gheysen et al, 2018 ; Herold et al, 2018 ), in particular if mentally challenging activities are simultaneously performed with multimodal physical exercises ( Gheysen et al, 2018 ; Li et al, 2018 ; Northey et al, 2018 ). However, because of the wide variation between protocols, the lack of detailed methodological description (e.g., baseline levels of physical fitness, and training intensity) and small sample sizes in some studies ( Stojan and Voelcker-Rehage, 2019 ; Guo et al, 2020 ), there is still a need for more research for an optimal protocol and information on detraining effects ( Gheysen et al, 2018 ).…”

“…Because cognitive effects of exercise and cognitive stimulation in dual-task paradigms are ambiguous ( Ansai et al, 2017 ; Tait et al, 2017 ; Guo et al, 2020 ; Wollesen et al, 2020 ) there is a need for more sensitive cognitive testing batteries rather than using screening tests as outcome measures to assess the influence of dual-task interventions ( Wollesen et al, 2020 ). Thus, with a highly sensitive evaluation battery, we have gathered quantitative and qualitative characteristics based on the most recent recommendations to investigate whether a dual-task protocol following these guidelines is effective.…”

Effects of Open-Skill Exercises on Cognition on Community Dwelling Older Adults: Protocol of a Randomized Controlled Trial

“…The simultaneous approach is usually conducted in dual-tasks, such as completing the cognitive task during physical exercise [ 17 , 18 , 19 , 20 ] or in exergames, which combine physical exercise with computer-simulated environments and interactive videogame features [ 7 , 21 ]. In general, that simultaneous approach tends to have a larger effect size than the separate approach on cognition [ 22 , 23 ]. However, concerns exist that the similarity between cognitive assessments and dual-tasks produce a learning effect that impacts the reliability of the results.…”