Exercise and Cognitive Functioning in Later Life

— An update on research, from Cay Anderson Hanley, Julia Dimitrova, and Michael Hogan

Despite the rewards of longevity, a significant societal concern is the exponential increased risk for cognitive decline and dementia that accompanies ageing in adulthood. While not an inevitable consequence ageing, the incidence of dementia increases rapidly after the 6th decade, with approximately 1 in 4 nonagenarians meeting criteria for dementia.

Given the range of possible causes of dementia, the search for a cure remains elusive and medications have little impact on halting or slowing decline. Over the past few decades, researchers have turned attention to behavioral interventions that might slow the rate of cognitive decline and forestall dementia. A compelling body of evidence has been amassed over three decades to demonstrate the benefits of physical exercise for improving brain health in later life and in particular, for preventing, slowing decline, or even improving cognitive function as one ages. Hundreds of high quality studies, including randomized clinical trials, some with neuroimaging and biomarker corroboration, have led to the conclusion that certainly, exercise is one smart thing to do if we wish to stay mentally intact in old age. While not a panacea, it increases the likelihood that we can maintain cognitive functions and remain living independently as long as possible.

Despite the clear research support and lay population acknowledgement that exercise is good for the body and the brain, most of us do not exercise at recommended levels. The American College of Sports Medicine increased recommended exercise levels a few years ago, such that now, all adults, including older adults, are to aim for 45 min of daily exercise, 5-7 days per week, including strenuous exercise. Only 7% of older adults meet even the prior lesser standard, so clearly we have an uphill battle for enlisting exercise as a tool to fight dementia onset.

Considering the difficulty in motivating exercise behavior, researchers in the USA and NUIG have teamed up to examine the possible role of exergaming to engage older adults in exercise and perhaps prevent or curb cognitive decline. A prior study conducted at the Health Aging & Neuropsychology Lab by professors at Union College and Skidmore College in NY (USA) explored the possible cognitive benefits for older adults of using an exergame. The two-year study was funded by the Robert Wood Johnson Foundation and was published in the American Journal of Preventive Medicine (2012). Older adults in the study were randomly assigned to exercise 3-5 sessions of exercise per week on a stationary bike. Half of the riders pedaled the bike in a traditional way, while the other half interacted with a virtual reality scene on a computer screen in front of the bike, steering their way along a scenic tour (e.g., with palm trees, a sunset, or village shops).

A videoclip of a participant pedaling the cybercycle can be viewed here.

Sixty-three participants completed the study and those pedaling the exergame or “cybercycle” had significantly greater cognitive benefit than those pedaling in the traditional way, that is, despite exercising for a similar number of miles and minutes at a similar intensity. This finding led the research team to hypothesize that the interactive combination of physical exercise with mental stimulation led to the increased cognitive benefit.

Follow-up research is underway to examine whether the nature of the “mental exercise” one does while physically exercising, might further enhance the cognitive benefits of exercise. The National Institute on Aging has funded a three-year randomized clinical trial: The Aerobic and Cognitive Exercise Study (ACES), which has opened enrollment at three hospitals in the USA. The focus is on persons with mild cognitive impairment (MCI), but normative individuals are also being invited to participate. A pilot version of the protocol was started two years ago when the PI (Anderson-Hanley) came to NUIG as a Fulbright Scholar and initiated a small scale version of the project in collaboration with Dr. Michael Hogan at NUIG and clinical staff at Galway University Hospital and St. Francis Adult Day Program. In the current protocol, the comparison is between types of exergaming activities, including the interactive tour along scenic bike paths, but also this time comparing a more videogame-like ‘dragon chase’ encounter, requiring effortful processing to steer through a target, find another matching target and thus earn points with a goal of increasing one’s score.

A brief videoclip of the videogame “dragon chase” condition can be viewed here.

Preliminary results from the pilot data collected in the USA and Ireland are being prepared for publication and are promising, indicating that among the twenty older adults completing these two randomized conditions, greater improvements in cognitive function were found in the game-like condition.

Furthermore, in the collaboration with Julia Dimitrova, the team have recently explored the neural and electrophysiological mechanisms underlying the greater cognitive benefits derived from the game-like condition. A study was conducted with 60 healthy older and younger adults to determine the effects of a single session of interactive mental and aerobic exercise when compared to standard aerobic exercise on electrophysiology and neuropsychological performance. Participants were asked to complete a session of 20-minute exercise with electroencephalography (EEG) recording before and after the exercise, which involved riding the “cybercycle”. During the EEG recording, participants completed an executive function task to determine how and whether the session of interactive mental and aerobic exercise would differentially affect their cognitive functioning.

While the researchers did not find greater cognitive benefits after a session of combined interactive mental and aerobic exercise, it was found that exercise in general lead to enhanced performance both cognitively and at a neural level, with participants responding faster and with greater accuracy after both types of exercise. Additionally, the researchers examined how one’s fitness level may affect their ability to complete the exercise and the cognitive task afterwards. Fitness level was determined by a proxy of participants’ BMI (Body Mass Index), as well as their self-reported daily physical activity levels. The researchers found that older adults with greater BMI received less of the same cognitive benefits as their lower BMI counterparts.

Based on these findings, the researchers argue that a long-term intervention of exergaming extending over weeks and months, can lead to different cognitive effects than a single session of exergaming because the longer time frame facilitates familiarity with the different aspects of exergaming, both cognitive and physical. This in turn frees up cognitive resources allowing one to derive greater benefits from the cognitively stimulating portion of the exercise and on any tasks following the exercise. Future research should seek to determine how these two forms of exercise intervention differently affect our brain functioning and whether different forms of exergaming and in different contexts could help to optimize cognitive performance in single bout setting. Indeed, the area of exergaming research is a burgeoning field of exercise research and we can expect many new and exciting developments from this area in the near future.

Here is RTE clip: http://www.rte.ie/news/player/2013/0604/3543249-galway-researchers-conduct-brain-exercise-study/

References

(Anderson-Hanley & Maloney, 2015)

 

Interactive Mental and Physical Exercise

Anderson-Hanley, C., Arciero, P. J., Brickman, A. M.,…Zimmerman, E. A. (2012). Exergaming and Older Adult Cognition: A cluster randomized clinical trial. American Journal of Preventive Medicine, 42(2):109-119.

Anderson-Hanley C, Brickman AM, Wasserman BT, Provenzano FA, Romero SG, & Harmon E. (2012). Neuroimaging effects of exercise: Pilot results from the Cybercycle Study. [INS peer reviewed conference abstract] International Neuropsychological Society, Montreal. Journal of the International Neuropsychological Society, Supplement.

Barcelos, N., Cohen, K., Shah, N., Hogan, M., Mulkerrin, E., Arciero, P. & Anderson-Hanley, C. (in preparation). Aerobic and Cognitive Exercise (ACE) pilot study for older adults: Type of mental engagement may matter.

Cohen, K., Shah, N., Dunnam, M., Hogan, M., Arciero, P., & Anderson-Hanley, C. (2014, April). Cognitive effects of interactive mental tasks while exercising: Greater benefit for MCI. Presented at the Cognitive Aging Conference; Atlanta, GA.

Dimitrova, J., Hogan, M., Khader, P., O’Hora, D., Kilmartin, L., Walsh, J., & Anderson-Hanley, C. (invited revision). The Effect of an Acute Bout of Physical Exercise and an Acute Bout of Interactive Mental and Physical Exercise on Electrophysiology and Neuropsychological Functioning in Younger and Older Adults. PLOS ONE.

Shah, N., Cohen, K., Hogan, M., Arciero, P., & Anderson-Hanley, C. (2014, April). Interactive mental and physical exercise for older adults: Executive function benefit greater for Mild Cognitive Impairment. Presented at the annual meeting of the Cognitive Neuroscience Society; Boston, MA.

Shah, N., Dimitrova, J., Mulkerrin, E., Hogan, M., Arciero, P., & Anderson-Hanley, C. (2014, April). Aerobic and Cognitive Exercise Study (ACES): Pilot study in Ireland. Presented at the annual meeting of the Society for Behavioral Medicine (Philadelphia, PA). Annals of Behavioral Medicine, 47, S281.

 

Physical Activity

Ahlskog, J. E., Geda, Y. E., Graff-Radford, N. R., Petersen, R. C. (2011). Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging. Mayo Clinic, 86, 876-884.

Angervaren, M., Aufdemkampe, G., Verhaar, H. J., Aleman, A., Vanhees, L. (2008). Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database System Review, 2, doi: 10.1002/14651858.CD005381

Baker, L. D., Frank, L. L., Foster-Schubert, K., Green, P. S., Wilkinson, C. W. … & Craft, S. (2010). Effects of Aerobic Exercise on Mild Cognitive Impairment: A controlled trial. Archives of Neurology, 67, 71-79.

Coelho, F. G., Vital, T. M., Stein, A. M., Arantes, F. J., Rueda, A. V., … & Santos-Galduroz. (2014). Acute aerobic exercise increases brain-derived neurotrophic factor levels in elderly with alzheimer’s disease. Journal of Alzheimer’s Disease, 39, 401-408.

Colcombe, S., and Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults: a meta- analytic study. Psychological Science, 14, 125–130.

Colcombe, S. J., Erickson, K. I., Scalf, P. E., Kim, J. S., Prackash, R., … & Kramer, A. F. (2006). Aerobic exercise training increases brain volume in aging humans. The Journals of Gerontology, 61, 1166-1170.

Erickson, K. I., Voss, M. W., Prakash, R. S., Basak, C., Szabo, A., … & Kramer, A. F. (2010). Exercise training increases size of hippocampus and improves memory. Proceedings of the National Academy of Sciences, 7, 3017-3022.

Etnier, J.R., Salazar, W., Landers, D.M., Petruzzello, S.J., Han, M., & Nowell, P. (1997). The influence of physical fitness and exercise upon cognitive functioning: A meta- analysis. Journal of Sport and Exercise Psychology, 19, 249–277.

Gates, Nicola. (2013). The effect of exercise training on cognitive function in older adults with mild cognitive impairment: A meta-analysis of randomized controlled trials. American Journal of Geriatric Psychiatry, 21, 1086-1098.

Hess, N. C. L., Dieberg, G., McFarlane, J. R., Smart, N. A. The effect of exercise intervention on cognitive performance in persons at risk for, or with, dementia: A systematic review and meta-analysis. Healthy Aging Research 3:3. doi:10.12715/har.2014.3.3

Heyn, P., Abreu, B. C., Ottenbacher, K. J. (2004). The effects of exercise training on elderly persons with cognitive impairment and dementia: a meta-analysis. Archives of Physical Medicine and Rehabilitation, 85, 1694-1704.

Hillman, C. H., Belopolsky, A. V., Snook, E. M., Kramer, A. F., McAuley, E. (2004). Physical Activity and Executive Control: Implications for Increased Cognitive Health during Older Adulthood. Research Quarterly for Exercise and Sport, 75, 2, 176-185.

Kramer, A., Hahn, S., Cohen, N. J., Banich, M. T., McAuley, E., … Colcombe, A. (1999). Ageing, Fitness and neurocognitive function. Nature, 400, 418-419.

Larson, E. B. (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine, 144, 73-81.

Pajonk, F. G., Wobrock, T., Gruber, O., Scherk, H., Berner, C., … & Falkai, P. (2010). Hippocampal plasticity in response to exercise in schizophrenia. Archives of General Psychiatry, 67, 133-143.

Sofi, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G. F., … & Macchi, C. (2011). Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. Journal of Internal Medicine, 269, 107-117.

 

Additional References:

Bamidis, P. D., Vivas, A. B., Styliadis, C., Frantzidis, C., Klados, M., … & Papageorgiou. A review of physical and cognitive interventions in aging. Neuroscience and biobehavioral reviews, 44, 206-220.

Cassilhas, R. C., Viana, W. A. R., Grassmann, V., Santos, R. T., Santos, R. F., … & Mello, M. T. (2007). The impact of resistance exercise on the cognitive function of the elderly. Medicine and Science in Sports and Exercise, 39, 1401-1406.

Chang, Y. K., Labban, J. D., Etnier, J. L. (2012). The effects of acute exercise on cognitive performance: A meta-analysis. Brain Research, 1453, 87-101.

Chapman, S. B., Aslan, S., Spence, J. S., DeFina, L. F., Keebler, M. W., … & Lu, H. (2013). Shorter term aerobic exercise improves brain, cognition, and cardiovascular fitness in aging. Frontiers in Aging Neuroscience, 5, doi: 10.3389/fnagi.2013.00075.

Churchill, J. D., Galvez, R., Colcombe, S., Swain, R. A., Kramer, A. F., Greenough, W. T. (2002). Exercise, experience and the aging brain. Neurobiology of Aging, 23, 941-955.

Hogan, Candice L. Mata, Jutta Carstensen, Laura L. (2013). Exercise holds immediate benefits for affect and cognition in younger and older adults. Psychology and Aging, 28, 587-594.

Lautenshlager, N. T., Cox, K. L., Flicker, L., Foster, J. K., van Bockxmeer, F. M. (2008). Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: A randomized trial. Journal of American Medicine (JAMA), 300, 1027-1037.

Liu-Ambrose, T., Nagamatsu, L. A., Graf, P., Beattie, L., Ashe, M. C., … Handy, T. C. (2010). Resistance training and executive functions. A 12-month randomized controlled trial. Archives of Internal Medicine, 170, 170-178.

Martins, A. Q., Kavussanu, M., Willoughby, A., Ring, Christopher. (2013). Moderate intensity exercise facilitates working memory. Psychology of Sport and Exercise, 14, 323-328.

Nagamatsu, L. S., Handy, T. C., Hsu, C. L., Voss, M., Liu-Ambrose, T. (2012). Resistance training promotes cognitive and functional brain plasticity in seniors with probable mild cognitive impairment. Archives of Internal Medicine, 172, 666-668.

Smith, P. J., Blumenthal, J. A., Hoffman, B. M., Cooper, H., Strauman, T. A., et al. (2010). Aerobic exercise and neurocognitive performance: A meta-analytic review of randomized control trials. Psychosomatic Medicine, 72, 239-252.

Mental Exercise

Anguera, J.A., Boccanfuso, J., Rintoul, J.L., Al-Hashimi, O., Faraji, F., … & Gazzaley, A. (2013). Video game training enhances cognitive control in older adults. Nature 501, 97– 101.

Bahar-Fuchs, A., Clare, L., Woods, B. (2013). Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer’s disease and vascular dementia: A review. Alzheimer’s Research & Therapy, 5, 1-14.

Ball, K., Berch, D. B., Helmers, K. F., Jobe, J. B., Leveck, M. D., … & Willis, S. L. (2002). Effects of cognitive training interventions with older adults: A randomized controlled trial. Journal of the American Medial Association, 288, 2271-2281.

Ballesteros, S., Prieto, A., Mayas, J., Toril, P., Pita, C., … & Waterworth, J. (2014). Brain training with non-action video games enhances aspects of cognition in older adults: A randomized controlled trial. Frontiers in Human Neuroscience, 6, 1-14.

Belleville, S., Gilbert, B., Fontaine, F., Gagnon, L., Menard, E., Gauthier, S. (2006). Improvement of episodic memory in persons with cognitive impairment and healthy older adults: Evidence from a cognitive intervention program. Dementia and Geriatric Cognitive Disorders, 22, 486-499.

Brum, P. S., Forlenza, O. V., Yassuda, M. S. (2009). Cognitive training in older adults with mild cognitive impairment. Impact on cognitive and functional performance. Dementia & Neuropsychologia, 3, 124-131.

Dustman, R. E., Emmerson, R. Y., Steinhaus, L.A., Shearer, D.E., Dustman, T. J. (1992). The effects of videogame playing on neuropsychological performance of elderly individuals. Journal of Gerontology, 47, 168–171.

Gates, N. J., Sachdev, P. S., Singh, M. A., Valenzuela, M. (2011). Cognitive and memory training in adults at risk of dementia: A systematic review. BioMed Central Geriatrics, 11, doi: 10.1186/1471-2318-11-55

Jean, L., Bergeron, M. E., Thivierge, S., Simard, M. (2010). Cognitive intervention for individuals with mild cognitive impairment: Systematic review of the literature. The American Journal of Geriatric Psychiatry, 18, 281-296.

Smith, G. E., Housen, P., Yaffe, K., Ruff, R., Kennison, R. F., … & Zelinksi, E. M. (2009). A cognitive training program based on principles of brain plasticity: Results from the improvement in memory with plasticity-based adaptive cognitive training study (IMPACT). Journal of the American Geriatric Society, 57, 594-603.

Stern, Y., Blumen, H. M., Rich, L. W., Richards, A., Herzberg, G., Gopher, D. (2011). Space fortress game training and executive control in older adults: A pilot intervention. Aging, Neuropsychology, and Cognition: A Journal on Normal and Dysfunctional Development, 18, 653-677.

Toril, P., Reales, J. M., Ballesteros, S. (2014). Video game training enhances cognition of older adults: A meta-analytic study. Psychology and Aging, 29, 706-716.

Valenzuela, M., Sachdev, P. (2009). Can cognitive exercise prevent the onset of dementia? Systematic review of randomized clinical trials with longitudinal follow-up. American Journal of Geriatric Psychiatry, 17, 179-187.

Wenisch, E., Cantegreil-Kallen, I., De Retrou, J., Garrigue, P., Moulin, F., … & Rigaud, A. S. (2007). Cognitive stimulation intervention for elders with mild cognitive impairment compared with normal aged subjects: Preliminary results. Aging Clinical and Experimental Research, 19, 316-317.

Additional References

Basak, C., Boot, W. R., Voss, M. W., Kramer, A. F. (2008). Can training in a real-time strategy videogame attenuate cognitive decline in older adults? Psychology of Aging, 23, 765-777.

Green, C. S., Bavelier, D. (2008). Exercising your brain: A review of human brain plasticity and training-induced learning. Psychology of Aging, 23, 692-701.

Karr, J. E., Areshenkoff, C. N., Rast, P., Garcia-Barrera, M. A. (2014). An empirical comparison of the therapeutic benefits of physical exercise and cognitive training on the executive functions of older adults: A meta-analysis of controlled trials. Neuropsychology, 1-17.

Muijden, J. V., Band, G. P. H., Hommel, B. (2012). Online games training aging brains: Limited transfer to cognitive control functions. Frontiers in Human Neuroscience, 6, doi: 10.3389/fnhum.2012.00221

Nouchi, R., Takin, Y., Takeuchi, H., Hashizume, H., Akitsuki, Y., … & Kawashima, Y. (2012). Brain training game improves executive functions and processing speed in the elderly: A randomized controlled trial. PLoS ONE 7(1): e29676. doi:10.1371/journal.pone.0029676

Rebok, G. W., Ball, K., Guey, L. T., Jones, R. N., Kim, H-Y., … & Willis, S. L. (2014). Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday function in older adults. Journal of the American Geriatric Society, 62, 16-24.

Redick, T. S., Shipstead, Z., Harrison, T. L., Hicks, K. L., Fried, D. E., Hambrick, D. Z., et al. (2013). No evidence of intelligence improvement after working memory training: a randomized, placebo-controlled study. Journal of Experimental Psychology: General, 142, 359–379.

Shipstead, Z., Redick, T. S., Engle, R. W. (2012). Is working memory training effective? Psychological Bulletin, 138, 628-654.

Unverzagt, F. W., Guey, L. T., Jones, R. N., Marsiske, M., King, J. W., … & Tennstedt, S. L. (2012). ACTIVE cognitive training and rates of incident dementia. Journal of the International Neuropsychological Society, 18, 669-677.

 

 

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