Effects of Mindfulness Training and Exercise on Cognitive Function in Older Adults

Abstract

ImportanceEpisodic memory and executive function are essential aspects of cognitive functioning that decline with aging. This decline may be ameliorable with lifestyle interventions.ObjectiveTo determine whether mindfulness-based stress reduction (MBSR), exercise, or a combination of both improve cognitive function in older adults.Design, Setting, and ParticipantsThis 2 × 2 factorial randomized clinical trial was conducted at 2 US sites (Washington University in St Louis and University of California, San Diego). A total of 585 older adults (aged 65-84 y) with subjective cognitive concerns, but not dementia, were randomized (enrollment from November 19, 2015, to January 23, 2019; final follow-up on March 16, 2020).InterventionsParticipants were randomized to undergo the following interventions: MBSR with a target of 60 minutes daily of meditation (n = 150); exercise with aerobic, strength, and functional components with a target of at least 300 minutes weekly (n = 138); combined MBSR and exercise (n = 144); or a health education control group (n = 153). Interventions lasted 18 months and consisted of group-based classes and home practice.Main Outcomes and MeasuresThe 2 primary outcomes were composites of episodic memory and executive function (standardized to a mean [SD] of 0 [1]; higher composite scores indicate better cognitive performance) from neuropsychological testing; the primary end point was 6 months and the secondary end point was 18 months. There were 5 reported secondary outcomes: hippocampal volume and dorsolateral prefrontal cortex thickness and surface area from structural magnetic resonance imaging and functional cognitive capacity and self-reported cognitive concerns.ResultsAmong 585 randomized participants (mean age, 71.5 years; 424 [72.5%] women), 568 (97.1%) completed 6 months in the trial and 475 (81.2%) completed 18 months. At 6 months, there was no significant effect of mindfulness training or exercise on episodic memory (MBSR vs no MBSR: 0.44 vs 0.48; mean difference, –0.04 points [95% CI, –0.15 to 0.07]; P = .50; exercise vs no exercise: 0.49 vs 0.42; difference, 0.07 [95% CI, –0.04 to 0.17]; P = .23) or executive function (MBSR vs no MBSR: 0.39 vs 0.31; mean difference, 0.08 points [95% CI, –0.02 to 0.19]; P = .12; exercise vs no exercise: 0.39 vs 0.32; difference, 0.07 [95% CI, –0.03 to 0.18]; P = .17) and there were no intervention effects at the secondary end point of 18 months. There was no significant interaction between mindfulness training and exercise (P = .93 for memory and P = .29 for executive function) at 6 months. Of the 5 prespecified secondary outcomes, none showed a significant improvement with either intervention compared with those not receiving the intervention.Conclusions and RelevanceAmong older adults with subjective cognitive concerns, mindfulness training, exercise, or both did not result in significant differences in improvement in episodic memory or executive function at 6 months. The findings do not support the use of these interventions for improving cognition in older adults with subjective cognitive concerns.Trial RegistrationClinicalTrials.gov Identifier: NCT02665481

Effects of Mindfulness-Based Interventions (MBIs) in Patients with Early-Stage Alzheimer’s Disease: A Pilot Study

“…On the other hand, in our study, one of the explanations of the effectiveness of MBI training for the emotional regulation of attention may be the effect of reducing mental distractions by focusing on the mental and emotional contents of the present moment with a non-judgmental attitude. Furthermore, MBI emotional regulation involves a greater ability to maintain a state of attention (alertness) to the activity and improved performance in executive control and memory enhancement tasks, as both behavioral and neuroimaging studies have determined [ 18 , 20 , 21 , 22 , 23 ]. This emotional regulation is effective in reducing stress and problematic psycho-emotional states (e.g., sleep disorders, stress, depression) [ 28 ], known as risk factors for the onset and worsening of cognitive performance, mental health, and well-being of the aging population and are associated with an increased risk and worsening of Alzheimer’s disease.…”

“…Promising interventions are mindfulness-based interventions (MBIs), which, as opposed to mere cognitive training, improve moment-to-moment attention control while simultaneously [ 20 , 21 , 22 , 23 , 24 , 25 ] reducing distractions due to internal and external interruptions. The other benefits of these meditation or mindfulness practices are a reduction in stress and an improvement in mood, quality of life, and socio-emotional and cognitive balance in general [ 23 , 26 ].…”

Causal Relationships between Daily Physical Activity, Physical Function, and Cognitive Function Ultimately Leading to Happiness

“…Accumulating reports indicate that elevated levels of insulin-like growth factor, brain-derived neurotrophic factor (BDNF), and other neurotrophic factors are involved in the improvement of cognitive function through exercise [ 7 , 8 , 9 , 10 , 11 ]. Meanwhile, an 18-month exercise intervention did not show any cognitive improvement in healthy older adults [ 12 ]. Comparing the effects of physical exercise in originally active and inactive older adults, the intervention was not effective on cognitive performance in both groups [ 13 ].…”

Mindfulness Training and Exercise and Cognitive Function in Older Adults—Reply

“…In Reply We thank Drs Salmoirago-Blotcher and Cohen for their interest in the MEDEX study, which showed that mindfulness training and/or exercise did not improve cognitive function in older adults with subjective cognitive concerns. However, we disagree with their concern that the negative findings “can be explained by…methodological limitations.”…”