Telephone interview for cognitive status (TICS) screening for clinical trials of physical activity and cognitive training: the seniors health and activity research program pilot (SHARP-P) study (2025)

Designing clinical trials for assessing the effects of cognitive training and physical activity interventions on cognitive outcomes: The Seniors Health and Activity Research Program Pilot (SHARP-P) Study, a randomized controlled trial

BMC Geriatrics, 2011

Background: The efficacy of non-pharmacological intervention approaches such as physical activity, strength, and cognitive training for improving brain health has not been established. Before definitive trials are mounted, important design questions on participation/adherence, training and interventions effects must be answered to more fully inform a full-scale trial. Methods: SHARP-P was a single-blinded randomized controlled pilot trial of a 4-month physical activity training intervention (PA) and/or cognitive training intervention (CT) in a 2 × 2 factorial design with a health education control condition in 73 community-dwelling persons, aged 70-85 years, who were at risk for cognitive decline but did not have mild cognitive impairment. Results: Intervention attendance rates were higher in the CT and PACT groups: CT: 96%, PA: 76%, PACT: 90% (p=0.004), the interventions produced marked changes in cognitive and physical performance measures (p≤0.05), and retention rates exceeded 90%. There were no statistically significant differences in 4-month changes in composite scores of cognitive, executive, and episodic memory function among arms. Four-month improvements in the composite measure increased with age among participants assigned to physical activity training but decreased with age for other participants (intervention*age interaction p = 0.01). Depending on the choice of outcome, two-armed full-scale trials may require fewer than 1,000 participants (continuous outcome) or 2,000 participants (categorical outcome). Conclusions: Good levels of participation, adherence, and retention appear to be achievable for participants through age 85 years. Care should be taken to ensure that an attention control condition does not attenuate intervention effects. Depending on the choice of outcome measures, the necessary sample sizes to conduct four-year trials appear to be feasible. Trial Registration: Clinicaltrials.gov Identifier: NCT00688155

Changes in Cognitive Function in a Randomized Trial of Physical Activity: Results of the Lifestyle Interventions and Independence for Elders Pilot Study

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 2009

Background. Cognitive impairment is an important contributor to disability. Limited clinical trial evidence exists regarding the impact of physical exercise on cognitive function (CF). We report results of a pilot study to provide estimates of the relative impact of physical activity (PA) on 1-year changes in cognitive outcomes and to characterize relationships between changes in mobility disability and changes in cognition in older adults at increased risk for disability. Methods. Sedentary persons (102) at increased risk for disability (aged 70-89 years) were randomized to moderate-intensity PA or health education. Participants were administered the Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), modifi ed Stroop test, and Modifi ed Mini-Mental State Examination at baseline and 1 year. Results. Group differences were not signifi cant but improvements in cognitive scores were associated with improvements in physical function. Specifi cally, the DSST signifi cantly correlated with change in the Short Physical Performance Battery score (r = .38, p = .0002), in chair stand score (r = .26, p = .012), in balance score (r = .21, p = .046), and in 400-m gait speed (r = .15, p = .147). Change recall on the RAVLT and in the Stroop test was also positively correlated with changes in chair stand and balance, respectively. Conclusions. These results provide further support for the benefi ts of exercise on CF in older adults. An adequately powered clinical trial of PA involving older adults at increased risk for cognitive disability is needed to expand the indications for prescribing exercise for prevention of decline in brain function .

Effect of a 24-Month Physical Activity Intervention vs Health Education on Cognitive Outcomes in Sedentary Older Adults

JAMA, 2015

IMPORTANCE Epidemiological evidence suggests that physical activity benefits cognition, but results from randomized trials are limited and mixed. OBJECTIVE To determine whether a 24-month physical activity program results in better cognitive function, lower risk of mild cognitive impairment (MCI) or dementia, or both, compared with a health education program. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial, the Lifestyle Interventions and Independence for Elders (LIFE) study, enrolled 1635 community-living participants at 8 US centers from February 2010 until December 2011. Participants were sedentary adults aged 70 to 89 years who were at risk for mobility disability but able to walk 400 m. INTERVENTIONS A structured, moderate-intensity physical activity program (n = 818) that included walking, resistance training, and flexibility exercises or a health education program (n = 817) of educational workshops and upper-extremity stretching. MAIN OUTCOMES AND MEASURES Prespecified secondary outcomes of the LIFE study included cognitive function measured by the Digit Symbol Coding (DSC) task subtest of the Wechsler Adult Intelligence Scale (score range: 0-133; higher scores indicate better function) and the revised Hopkins Verbal Learning Test (HVLT-R; 12-item word list recall task) assessed in 1476 participants (90.3%). Tertiary outcomes included global and executive cognitive function and incident MCI or dementia at 24 months. RESULTS At 24 months, DSC task and HVLT-R scores (adjusted for clinic site, sex, and baseline values) were not different between groups. The mean DSC task scores were 46.26 points for the physical activity group vs 46.28 for the health education group (mean difference, −0.01 points [95% CI, −0.80 to 0.77 points], P = .97). The mean HVLT-R delayed recall scores were 7.22 for the physical activity group vs 7.25 for the health education group (mean difference, −0.03 words [95% CI, −0.29 to 0.24 words], P = .84). No differences for any other cognitive or composite measures were observed. Participants in the physical activity group who were 80 years or older (n = 307) and those with poorer baseline physical performance (n = 328) had better changes in executive function composite scores compared with the health education group (P = .01 for interaction for both comparisons). Incident MCI or dementia occurred in 98 participants (13.2%) in the physical activity group and 91 participants (12.1%) in the health education group (odds ratio, 1.08 [95% CI, 0.80 to 1.46]). CONCLUSIONS AND RELEVANCE Among sedentary older adults, a 24-month moderate-intensity physical activity program compared with a health education program did not result in improvements in global or domain-specific cognitive function.

Evidence-Based Exercise Recommendations for Older Adults With Cognitive Impairments

Innovation in Aging, 2020

Since the publishing of our meta-analysis evaluating the effects of randomized exercise trials on cognitive function of Older Adults with Cognitive Impairments (OAwCIs) (Heyn et al 2004), several meta-analysis reviews were published addressing similar question. We currently appraised this evidence and preliminary synthesis of twelve, well-designed meta-analysis reports resulted in 193 RCTs and 15,614 participants over the age of 65 years old diagnosed with MCI or Alzheimer’s disease (AD). Exercise prescription paradigms averaged 156 minutes per week for 20-week. The combined cognitive function outcome mean effect size was medium; 0.67 (0.06-1.34 95% CI). Grounded in this unique umbrella study results, sustained and prolonged exercise training might provide an effective intervention for the maintenance or enhancement of cognitive function for MCI and AD. This comprehensive meta-analysis umbrella offers valuable and strong exercise recommendations for OAwCIs. This study results will b...

Effect of Exercise on Cognitive Performance in Community-Dwelling Older Adults: Review of Intervention Trials and Recommendations for Public Health Practice and Research

Journal of the American Geriatrics Society, 2011

There is evidence from observational studies that increasing physical activity may reduce the risk of cognitive decline in older adults. Exercise intervention trials have found conflicting results. A systematic review of physical activity and exercise intervention trials on cognition in older adults was conducted. Six scientific databases and reference lists of previous reviews were searched. Thirty studies were eligible for inclusion. Articles were grouped into intervention-outcome pairings. Interventions were grouped as cardiorespiratory, strength, and multicomponent exercises. Cognitive outcomes were general cognition, executive function, memory, reaction time, attention, cognitive processing, visuospatial, and language. An eight-member multidisciplinary panel rated the quality and effectiveness of each pairing. Although there were some positive studies, the panel did not find sufficient evidence that physical activity or exercise improved cognition in older adults. Future research should report exercise adherence, use longer study durations, and determine the clinical relevance of measures used. J Am Geriatr Soc 59:704-716, 2011.

Effect of Exercise on Cognitive Performance in Community‐Dwelling Older Adults: Review of Intervention Trials and Recommendations for Public Health Practice and …

Journal of the …, 2011

Protocol for Fit Bodies, Fine Minds: a randomized controlled trial on the affect of exercise and cognitive training on cognitive functioning in older adults

BMC geriatrics, 2007

Background: Declines in cognitive functioning are a normal part of aging that can affect daily functioning and quality of life. This study will examine the impact of an exercise training program, and a combined exercise and cognitive training program, on the cognitive and physical functioning of older adults.

Exercise to Prevent Cognitive Decline and Alzheimer’s disease: For Whom, When, What, and (most importantly) How Much?

In several reviews, exercise was reported to be effective in reducing the risk for cognitive decline and dementia . However, not all reviews concluded this. One recent review stated that there was still insufficient evidence, as most studies were too small and had insufficient methodological information (intensity, duration) to enable appropriate evaluation. Here we discuss potential confounds or mediators that may explain these discrepancies.

Benefits of Physical Activity on Cognitive Functioning in Older Adults

Annual Review of Gerontology and Geriatrics, 2016

As the world becomes more populated and more medically advanced, more people are starting to live longer. There are growing concerns for the health and well-being of an ever-growing population. Aging is accompanied by a series of changes, cognitive decline being one of them. As health becomes more challenging, physical activity may become more cumbersome. However, in many instances, physical activity has been found to prevent and delay cognitive decline. In fact, exercise may prove to be a powerful preventative measure against cognitive impairment in older adults. The aim of this chapter is to explore the evidence base of the effects of physical activity on cognitive decline prevention as well as to review the recommended guidelines for physical activity in this population based on findings in the field.

The Effects of Physical Exercise on Cognitive Function in the Elderly: A Review

"More people are reaching an older age today than ever before and the incidence of dementia is thus expected to rise. It is therefore important to investigate possible prevention of dementia and cognitive decline using cost-effective life-style changes. In this chapter we present a literature review of observational studies into exercise and cognition in the elderly and treatment studies using different types of exercise interventions and the effect these have on cognitive function. Many studies reported that physical activity can help to maintain cognitive abilities into old age, but not all treatment studies have found positive effects of exercise. This could be related to a variety of factors. We discuss the use of different cognitive tests and different measures of exercise and the influence this can have on whether a beneficial effect of exercise is found or not. We also explore a variety of participant and intervention characteristics that may moderate the effect of exercise on cognitive function. The results of this review suggest that there may be a relationship between physical activity and cognition. However, more future work is required in this area to establish exactly what type of exercise is most efficient and who may benefit from it."