The effects of a physical and cognitive training intervention vs. physical training alone on older adults' physical activity: A randomized controlled trial with extended follow-up during COVID-19.

Tiina Savikangas,Anna Stigsdotter Neely,Miia Kivipelto,Timo Rantalainen,Anna Tirkkonen,Sarianna Sipilä,Markku Alen,Roger A Fielding,Timo Törmäkangas

doi:10.1371/journal.pone.0258559

Abstract

BackgroundExecutive functions underlie self-regulation and are thus important for physical activity and adaptation to new situations. The aim was to investigate, if yearlong physical and cognitive training (PTCT) had greater effects on physical activity among older adults than physical training (PT) alone, and if executive functions predicted physical activity at baseline, after six (6m) and twelve months (12m) of the interventions, one-year post-intervention follow-up and an extended follow-up during COVID-19 lockdown.MethodsData from a single-blinded, parallel-group randomized controlled trial (PASSWORD-study, ISRCTN52388040) were utilized. Participants were 70–85 years old community-dwelling men and women from Jyväskylä, Finland. PT (n = 159) included supervised resistance, walking and balance training, home-exercises and self-administered moderate activity. PTCT (n = 155) included PT and cognitive training targeting executive functions on a computer program. Physical activity was assessed with a one-item, seven-scale question. Executive functions were assessed with color-word Stroop, Trail Making Test (TMT) B-A and Letter Fluency. Changes in physical activity were modeled with multinomial logistic models and the impact of executive functions on physical activity with latent change score models.ResultsNo significant group-by-time interaction was observed for physical activity (p>0.1). The subjects were likely to select an activity category higher than baseline throughout the study (pooled data: B = 0.720–1.614, p<0.001–0.046). Higher baseline Stroop predicted higher physical activity through all subsequent time-points (pooled data: B = 0.011–0.013, p = 0.015–0.030). Higher baseline TMT B–A predicted higher physical activity at 6m (pooled data: B = 0.007, p = 0.006) and during COVID-19 (B = 0.005, p = 0.030). In the PT group, higher baseline Letter Fluency predicted higher physical activity at 12m (B = -0.028, p = 0.030) and follow-up (B = -0.042, p = 0.002).ConclusionsCognitive training did not have additive effects over physical training alone on physical activity, but multicomponent training and higher executive function at baseline may support adaptation to and maintenance of a physically active lifestyle among older adults.

Highlights

Physical activity is crucial for older adults’ health, functioning and well-being [1, 2]
In a 12-month randomized controlled trial, we found that some aspects of executive functions improved more in older adults, who participated in targeted executive functions training in addition to physical training compared to those, who were assigned to physical training alone [21]
Attrition analyses showed that participants who had dropped out at the one year post-intervention follow-up belonged more often to the least physically active category, perceived more often difficulties in outdoor mobility and performed worse in the SPPB test at the baseline than participants who remained in the study (Table 2)

Summary

Introduction

Physical activity is crucial for older adults’ health, functioning and well-being [1, 2]. Group exercise interventions may be an effective tool to increase older adults’ physical activity [1, 7, 8], since they enable e.g., social support, perceived health benefits, feeling better and getting up, out and going [9]. The aim was to investigate, if yearlong physical and cognitive training (PTCT) had greater effects on physical activity among older adults than physical training (PT) alone, and if executive functions predicted physical activity at baseline, after six (6m) and twelve months (12m) of the interventions, one-year post-intervention follow-up and an extended follow-up during COVID-19 lockdown. Physical function was assessed with Short Physical Performance Battery (SPPB, total score range 0–12, higher score indicates better performance), including five-time chair rise, habitual walking speed over four meters and standing balance tests [42].

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