Conceptualization of a cognitively enriched walking program for older adults: a co-design study with experts and end users

Abstract

Background Research in controlled laboratory settings shows that physical activity programs enriched with cognitive challenges enhance the benefits of physical activity on cognition in older adults. This translational study aimed to conceptualise a real-life, cognitively enriched walking program for older adults (65+) by investigating (a) which cognitive tasks are most suited for cognitive enrichment of a walking program, and (b) how to embed these tasks in a walking program to become feasible, enjoyable and effective. Methods A co-design process was followed with input of 34 academic experts and 535 end users. First, an online, three-rounds Delphi process was used to obtain consensus amongst academic experts on the key characteristics that a real-life cognitively enriched walking program should have. Next, end users provided feedback and suggestions on what the experts concluded, and gave more insight into their preferences and concerns by means of an online/telephone survey. Results Combined input from experts and end users resulted in a list of recommendations to guide the further development of the cognitively enriched walking program. First, it is important to provide a range of cognitive tasks to choose from. Each of these tasks should (a) provide variation and differentiation, (b) be implemented with increasing levels of difficulty, and (c) be integrated in the walk. Second, divide the walk into three parts: 5–10 min brisk walking, cognitive tasks for most of the walk, and 5–10 min free walking. Finally, the program should strive for a minimal session frequency of twice a week, include competition occasionally and carefully, ensure safety and keep the walks fun. Conclusions The co-design process resulted in recommendations to guide the next steps in the program development process. Additional studies will be performed to improve the enjoyability and feasibility, and to assess the effectiveness of the cognitively enriched walking program to improve cognitive functioning and physical activity in older adults (65+).

Association of Osteoarthritis and Functional Limitations With Cognitive Impairment Among Older Adults in the United States

“…The recently developed Active Brains (Mace, Gates, Bullard et al, 2021) program for older adults pairs mind-body skills with paced walking using a digital monitoring device, and has shown excellent feasibility and acceptability, as well as improvements in multimodal physical, cognitive, and emotional functioning (Mace, Doorley et al, 2021; Mace, Gates, Popok et al, 2021). A recent study utilizing input from experts and end-users compared various qualities of similar combined physical and cognitive activity programs (Marent et al, 2022) providing more specific guidance for new interventions. Future RCTs with long term follow-up are needed to determine whether increased physical activity during interventions can protect against future cognitive decline in at-risk older adults.…”

A Two-Phased Pilot Study Evaluating the Feasibility and Acceptability of the Cognitively Enriched Walking Program “Take a Walk with Your Brain” for Older Adults

“…We conducted this acceptability and feasibility study in two phases. Phase I was a preparatory phase during which walk-along interviews (i.e., questions posed while walking) with one or two older adults at a time were conducted to evaluate the feasibility and acceptability of the cognitive tasks conceptualized by Marent et al [ 33 ]. In Phase II, the group-based cognitively enriched walking program was piloted to evaluate the feasibility and acceptability of (i) the cognitive tasks (performed in group as opposed to alone or in pairs in Phase I) and (ii) the group program in general (i.e., a more general evaluation of performing cognitive tasks in group while walking, supervised by a coach).…”

“…The cognitive tasks were randomly assigned across participants. An overview of the cognitive tasks can be found in Table 1 (for detailed descriptions, see the article of Marent et al [ 33 ]). A standardized protocol for each cognitive task was prepared for the interviewers.…”

“…A standardized protocol for each cognitive task was prepared for the interviewers. It included a description of the content, instructions, materials, required preparations, and general attention points based on input from the developmental stage of this project [ 33 ]. Every walk-along session started with 10–15 minutes of brisk walking, after which the instructions for the first cognitive task were communicated, and the participant(s) performed the cognitive task.…”

“…Therefore, a real-life, group-based, simultaneous PA + CA intervention, more specifically a cognitively enriched walking program for older adults (i.e., aged 65 years and above), “Take a walk with your brain”, was recently codesigned using two complementary methodologies: (1) a multistage Delphi study with academic experts in the field of cognition, physical activity, and aging and (2) a survey study in older adults and walking coaches. This entire conceptualization process has been described in our earlier publication [ 33 ]. This newly developed cognitively enriched walking program consists of supervised group-based cognitively enriched walking sessions (i.e., simultaneously walking and performing cognitive tasks).…”