The effects of cognitive-motor training interventions on executive functions in older people: a systematic review and meta-analysis

Abstract

Background: Ageing is associated with physical and cognitive decline, affecting independence and quality of life in older people. Recent studies show that in particular executive functions are important for daily-life function and mobility. This systematic review investigated the effectiveness of cognitive-motor training including exergaming on executive function (EF, set-shifting, working memory, inhibitory control) in healthy older people. Methods: An electronic database search for randomised controlled trials (RCT), controlled clinical trials (CCT) and parallel group trials was performed using MEDLINE, EMBASE, and PsychINFO following PRISMA guidelines. Inclusion criteria were: (1) community-dwelling participants > 60 years without a medical condition or medical treatment, (2) reporting at least one cognitive-motor intervention while standing or walking, (3) use of dual-task interventions using traditional methods or modern technology to deliver a cognitive-motor task, (4) inclusion of at least one cognitive outcome. The PEDro scale was used for quality assessment. Results: A total of 1557 studies were retrieved, of which 25 studies were included in this review. Eleven studies used a technology-based dual-task intervention, while 14 trials conducted a general cognitive-motor training. The age range of the cohort was 69 to 87 years. The interventions demonstrated positive effects on global cognitive function [mean difference 0.6, 95% CI 0.29-0.90] and inhibitory control [mean difference 0.61, 95% CI 0.28-0.94]. Effects were heterogeneous (I 2 range: 60-95) and did not remain after a sensitivity analysis. Processing speed and dual-task costs also improved, but meta-analysis was not possible. Conclusion: Cognitive-motor and technology-based interventions had a positive impact on some cognitive functions. Dual-task interventions led to improvements of domains related global cognitive functions and inhibitory control. Likewise, technology-based exergame interventions improved functions related to processing speed, attentional and inhibitory control. Training interventions with a certain level of exercise load such as progression in difficulty and task specificity were more effective to gain task-related adaptations on cognitive functions.

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

“…However, differently from the results shown in the present study, some studies have not found benefits using dual-task protocols ( Legault et al, 2011 ; Ansai et al, 2017 ; Boa Sorte Silva et al, 2018 ). 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 ). 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.…”

“…It is an efficient, safe, and low-cost non-pharmacological strategy broadly investigated: aerobic and strength training or the combination of both, show positive effects on brain structure and function, behavior, and cognition ( Erickson et al, 2019 ). Recommendations suggest multimodal training ( Chodzko-Zajko et al, 2009 ; Gregory et al, 2013 ; Northey et al, 2018 ; Wollesen et al, 2020 ). This recommendation is based on the different types of training contributions to cognition ( Liu-Ambrose and Donaldson, 2009 ; Forte et al, 2013 ) and physical function ( Cadore and Izquierdo, 2013 ).…”

“…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.…”

The Effects of COVID-19 Traumatic Stress on Executive Functions: The Case of Syrian Refugees in Turkey

“…Clinically, current results emphasized the need for urgent cognitive intervention with victims of COVID-19, especially with refugees and Syrian refugees, to enhance their executive functions, which may be a key to their emotional and behavioral health. Cognitive training was effective in enhancing executive functions (for meta-analyses, see Nguyen et al, 2019;Webb et al, 2018;Wollesen et al, 2020). Also, the research found that moderate-intensity exercise enhances the inhibitory aspect of executive function (e.g., Aly & Kojima, 2020).…”