CogniFit - Does combined cognitive training and physical activity training enhance cognitive abilities more than either alone? A four-condition randomized controlled trial among healthy older adults

Original Name: Does combined cognitive training and physical activity training enhance cognitive abilities more than either alone? A four-condition randomized controlled trial among healthy older adults.

Author: Evelyn Shatil1,2.

• 1. CogniFit Inc., New York, USA.
• 2. The Center for Psychological Research, Max Stern Academic College of Emek Yezreel, Jezreel Valler, Israel.

Journal: Frontiers in Aging Neuroscience (2013), vol. 5 (8): 1-12.

References to this article (APA style):

• Shatil, E. (2013). Does combined cognitive training and physical activity training enhance cognitive abilities more than either alone? A four-condition randomized controlled trial among healthy older adults. Frontiers in Aging Neuroscience, vol. 5 (8), pp.1-12.

Study Conclusion

Older people who use CogniFit, or who combine CogniFit with physical activity, improve their cognitive state more than people who only do physical activity or who only read. Divided attention (t=-3.48; p=0.001), Eye-hand coordination (t =-10.84; p<. 001), Naming (t =- 5.66; p<. 001), Processing speed (t =- 5.17; p<. 001), Visual scanning (t=- 3.41; p=0.002), and Working memory (t=- 4.56; p<. 001).

Study summary

The study's aim was to know how does CogniFit cognitive training (Cognitive Group) physical activity (Physical Training Group), both CogniFit and physical activity (Combined Group) and reading (Control Group) contribute to the improvement in the cognitive state of seniors.. Through this randomized, controlled trial of four conditions, it was seen that seniors in the Cognitive Group and the Combined Group achieved significantly greater improvement in their cognitive state than those in the Control Group and the Physical Training Group. Cognitive abilities that showed improvement were Hand-eye coordination, Working memory, Long-term memory, Processing speed, Visual scanning and Naming. In fact, the physical training group and control group people did not have any improvement in pretest to posttest. This means that CogniFit cognitive training is effective in improving cognitive abilities and is primarily responsible for the improvement in the Combined Group.

Context

Seniors are at high risk of losing autonomy and quality of life as a result of cognitive impairment due to increased age. To prevent or reduce this deterioration, various strategies have been sought. Research has mainly focused on three possibilities: cognitive training, physical training and training that combines cognitive and physical activities.

Physical activity has been linked to improvements in different aspects of health, including cognitively. Cognitive improvements derived from physical training have been found mainly in the areas of Attention and Executive Functions. However, research indicates that these improvements are not sustained over the long term. On the other hand, computerized cognitive training, such as CogniFit, has been shown on numerous occasions to be beneficial in different cognitive areas.

Methodology

Participants

All of the participants were volunteer healthy seniors, residents of the Lakeview retirement community in Lenexa, Kansas. They participated in response to emails, phone calls, pamphlets, or during an "informative day" when the study was discussed.

Seniors who had a stroke or heart attack in the last 5 years, who took drugs that could alter cognitive state, or who had a score of less than or equal to 23 on the MMSE (Mini-Mental State Examination) were excluded from the study. Instead, participants needed to have proper vision and hearing, and agree to participate in study activities.

Inclusion criteria included having corrected vision, being able to hear instructions correctly, communicating with experimenters, agreeing to participate in evaluations and training during the study, completing a medical history and obtaining medical approval.

Design

Through a controlled randomized design of four groups (Cognitive, Physical, Combined, and Control) the aim was to evaluate the efficacy of cognitive training, physical activity and the combination of these different training types, to improve the cognitive state of healthy seniors.

Once we have completed data collection for the study, we will be able to download the results of each participant to our computer for analysis.

Physical Training Group Intervention

Given the advanced age of the participants (59% were 80 years of age or older), they were unable to perform an intense aerobic exercise. Therefore, warm-up sessions (10 minutes), sitting and standing cardiovascular training (15 minutes), gentle aerobic exercise (5 minutes), strength training (10 minutes), flexibility training (5 minutes) and a brief relaxation session were designed. Those who were initially unable to complete the full exercise session did the activities that were feasible for them physically and healthily.

Combined Group Intervention

The Combined Group participants did the activities of the Cognitive Group training (using CogniFit) with Physical Training Group. As a result, these participants performed twice as many activities as the exclusively cognitive or physical training groups.

Control Group Intervention

The Control Group participants only read the book about active aging during the time the study lasted. Participants were asked to read fragments of the book at home and attend 60-minute meetings of discussion about the best ways to achieve the objectives proposed in the book.

Variables measured:

CogniFit general cognitive assessment battery (CAB) was used to perform pretest and posttest. Through 15 assessment tasks, different cognitive abilities were measured, such as focussed attention, divided attention, inhibition, cognitive flexibility, planning, working memory and hand-eye coordination. Three 15-minute sessions were used to apply the full assessment.

Analysis:

Through SPSS 18, general linear models for repeated measures were developed to investigate the effects of the interventions on each of the cognitive skills assessed. The variable in the intra-group analysis was Time, with two levels (pretest and posttest). The two inter-subject variables were Cognitive Training and Physical Training, with two levels (training completed and training not completed). This model made it possible to analyze the different interactions:

• Time x Cognitive Training.
• Time x Physical Training.
• Time x Cognitive Training x Physical Training.

Results and conclusions

Using Inter-group comparisons, it was known that all participants had similar performance at the beginning of the study in the pretest. Participants who underwent some type of cognitive training (Cognitive Group and Combined Group) with CogniFit improved various verbal and non-verbal cognitive skills compared to those who did not perform any type of cognitive training (Physical Group and Control Group). The skills in question were Hand-eye Coordination, Working Memory, Processing Speed, Visual Scanning, and Naming. Through Cohen's d, it was observed that the effect size for these improvements was medium (d of Cohen =. 6 or. 7) or large (d of Cohen =. 8).

In intra-group analysis it was observed that the Cognitive Group showed a significant improvement after CogniFit training in Divided Attention (t=-3.48; p=0.001), Eye-hand coordination (t =-10.84; p<. 001), Naming (t =- 5.66; p<. 001), Processing speed. In the Combined Group, the improvement was in Eye-hand Coordination (t =- 9.602; p<. 001), Naming (t =- 3.246; p=0.003), and Processing speed (t =-4.695; p<. 001). On the other hand, there was no significant improvements after training in the Physical Group and Control Group.

From all of this, it is clear that the people who did cognitive training with CogniFit had a significant improvement in various cognitive abilities. CogniFit's systematic cognitive training takes advantage of the brain plasticity and induces changes in cognitive functions. Scientific literature indicates that these cognitive improvements can have a positive impact on the quality of life and autonomy of seniors. Nonetheless, the data contradicts the belief that aerobic physical activity is the primary mechanism for cognitive improvement. In fact, according to the data, the most relevant mechanism for cognitive improvement would be cognitive training. In this way, seniors who do not have the possibility of aerobic exercise will be able to maintain their cognitive state through tools such as CogniFit.