Integrated cognitive and physical fitness training enhances attention abilities in older adults

Age-related decline in attention is a significant concern for older adults, impacting their quality of life. While cognitive and physical interventions have been explored individually, their combined effect is a compelling strategy to improve both cognitive and physical health efficiently. This study examined the efficacy of a novel closed-loop, motion-capture video game, the Body-Brain Trainer (BBT), designed to integrate cognitive and physical challenges in a personalized manner. Previous research has shown that closed-loop, adaptive cognitive interventions can improve cognitive performance and neural measures, with some effects persisting after the intervention. While physical fitness interventions are known to improve overall health, the extent of their benefit on cognitive control abilities remains unclear. Combining cognitive and physical training is a potentially time- and resource-efficient method for addressing multiple risks in older adults and enhancing practical enjoyment. However, the effectiveness of such combined approaches on cognitive and physical outcomes in aging populations requires further investigation. The study aimed to evaluate BBT's efficacy by comparing it to an expectancy-matched active placebo control group, a methodological advancement over previous studies in this area. Secondary research questions included the persistence of improvements after the intervention, whether BBT would help older adults achieve young adult levels of performance, and the impact of the intervention on working memory.

Existing literature supports the use of cognitive interventions to harness neuroplasticity for improving cognitive abilities in older adults, although the long-term benefits are debated due to a lack of appropriate control groups and follow-up testing. In contrast, the benefits of physical fitness interventions for older adults' health are well-established, and some studies suggest a potential positive impact on cognitive control. Combining these approaches is attractive due to potential resource efficiency and synergistic effects, potentially leading to greater enjoyment compared to either modality alone. However, the typical protocols for cognitive training are resource-intensive. Studies using closed-loop adaptive video games as interventions show positive effects on cognitive performance and neural measures across various populations, even restoring performance to young adult levels in some cases.

A double-blinded, randomized, placebo-controlled study was conducted with 49 healthy older adults (mean age 68.5). Participants were randomly assigned to either the BBT intervention group (n=24) or an active, expectancy-matched control group (Mind-Body Trainer, MBT; n=25). The BBT involved 8 weeks of 3 days a week, 1-hour sessions using a motion-capture video game that adapted cognitive and physical demands based on real-time feedback (heart rate and accuracy). The MBT group used commercially available apps (language learning, Tai Chi, logic games) for 6 weeks, 5 days a week for 30 minutes each session. A vigilance task (Continuous Performance Task, CPT), a modified version of a validated sustained attention outcome measure, served as the primary cognitive outcome measure. EEG recordings during the CPT task measured midline frontal theta power, a neural metric associated with sustained attention. Working memory and basic response time tasks served as secondary outcome measures. Physical fitness measures included limits of stability and diastolic blood pressure. An untrained group of young adults (n=51) served as a comparison group. Expectancy matching between groups was ensured through a survey to ensure that the observed effects were not driven by expectations. Statistical analysis involved repeated measures ANOVAs, paired t-tests, and independent t-tests to compare performance between groups and across time points (pre-training, post-training, 1-year follow-up).

The BBT group showed significant improvements in CPT performance (reduced response time) compared to the MBT group. The BBT group's post-training performance surpassed that of the young adult group. The improvement in attention performance persisted for one year. The BBT group also demonstrated a significant increase in midline frontal theta power post-training, reaching levels equivalent to those of young adults. Improvements were also observed in physical fitness measures (balance and diastolic blood pressure) in the BBT group. No significant differences were found in basic response time between the groups, suggesting that observed improvements were not simply due to general motor speed enhancements. While the working memory task showed a trend toward improvement in the BBT group, it did not reach statistical significance. Exploratory analysis of a complex visual discrimination task with varying levels of distraction also showed improvements in the BBT group, similar to the primary CPT findings.

The findings demonstrate the effectiveness of the BBT integrated cognitive-physical training in significantly improving attention abilities in older adults beyond those seen in an expectancy-matched active control group. The longer-term maintenance of these gains, lasting a year, is a notable achievement, challenging the common observation of limited persistence in cognitive training effects. The achievement of performance levels comparable to or exceeding those of young adults emphasizes the intervention’s capacity to potentially mitigate age-related cognitive decline. While the study design cannot definitively isolate the individual contributions of cognitive and physical training, the results support the potential synergistic benefit of an integrated approach. The observed neural changes (increased midline frontal theta power) further support the effectiveness of the intervention. The results are consistent with prior studies suggesting the positive effects of combined interventions on sustained attention, yet the current study achieved this with a shorter intervention duration.

The BBT intervention effectively enhanced attention abilities in older adults, with improvements sustained a year later. The integrated approach surpassed an expectancy-matched active control, suggesting a synergistic effect. Future research could investigate the relative contributions of cognitive and physical training components and explore the potential for BBT as a sustainable preventative measure for age-related cognitive decline. Incorporating booster sessions could further optimize long-term benefits.

The study design does not directly compare BBT with isolated cognitive or physical training, hindering definitive conclusions about synergistic effects. The inability to fully isolate the contribution of each training component limits a complete understanding of the mechanisms. While improvements in attention were observed, improvements in working memory were not statistically significant, possibly due to the intervention's primary focus on attentional flexibility. The small sample size at the 1-year follow-up warrants caution in interpreting long-term results.