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

Abstract

Preserving attention abilities is of great concern to older adults who are motivated to maintain their quality of life. Both cognitive and physical fitness interventions have been utilized in intervention studies to assess maintenance and enhancement of attention abilities in seniors, and a coupling of these approaches is a compelling strategy to buttress both cognitive and physical health in a time- and resource-effective manner. With this perspective, we created a closed-loop, motion-capture video game (Body-Brain Trainer: BBT) that adapts a player's cognitive and physical demands in an integrated approach, thus creating a personalized and cohesive experience across both domains. Older adults who engaged in two months of BBT improved on both physical fitness (measures of blood pressure and balance) and attention (behavioral and neural metrics of attention on a continuous performance task) outcome measures beyond that of an expectancy matched, active, placebo control group, with maintenance of improved attention performance evidenced 1 year later. Following training, the BBT group's improvement on the attention outcome measure exceeded performance levels attained by an untrained group of 20-year olds, and showed age-equilibration of a neural signature of attention shown to decline with age: midline frontal theta power. These findings highlight the potential benefits of an integrated, cognitive-physical, closed-loop training platform as a powerful tool for both cognitive and physical enhancement in older adults.

Fig. 1. Body-Brain Trainer (BBT) platform.

a Image of participant playing BBT. Highlighted is the use of a heart rate monitor to assess and adapt the physical intensity of gameplay in real-time, as well as the Microsoft Kinect™ motion-capture technology used to collect responses with one’s hands and/or feet based on the cognitive task presented on the monitor, and adapt the cognitive difficulty of each game in real-time. b Image of the task-switching module. c Image of the attention module. d Image of the working memory module.

Fig. 2. CPT task.

a Stimuli and protocol for the attention without distraction (CPT) task. b Bar graphs illustrating the group mean change in ex-gaussian tau (pre - post, with + values demonstrating improvement in tau over time) for each group, with the dashed line (1-year diff = pre - 1-year) illustrating the change in tau at the 1-year mark. c Bar graphs and topographic plots illustrating the group mean change in midline frontal theta power (post - pre) for each group, with the dashed line on the bar graphs illustrating the change in power at the 1-year mark (1-year - pre). The dashed circle on the topographic plot illustrates the electrodes where statistical analyses took place. *p < 0.05. Error bars represent s.e.m.

Fig. 3. Comparison of BBT and MBT performance versus younger adults.

⇒ performance significantly lesser than that of young adults. ⇒ performance significantly better than that of young adults. ⇒ performance equivalent to that of young adults. Green = Significant improvement from pre-training. Red = Significant decline from pre-training.

Fig. 4. Improvements in Physical Outcomes Assessments.

a Limits of Stability (LoS) assessment on the NeuroCom balance manager system^,. The LoS is a center-out postural stability test that serves as a basic balance quantification metric. During this task, increases in movement velocity have been associated with decreases in fall risk in older adults. b There was a significant group x time interaction in movement velocity of the LoS task (repeated measures ANOVA: F_1,40 = 7.814, p = 0.008, Cohen’s d = 0.90). A paired t-test analysis revealed that the BBT group showed a significant increase from pre to post (t₁₈ = 4.53, p < 0.001), whereas the control participants showed no difference (t₂₂ = −1.02, p = 0.32). Note there was no difference at baseline between groups (independent t-test: t₄₃ = 1.77, p = 0.08.) c Diastolic blood pressure assessment. Diastolic blood pressure is a predictor of overall physical health and has been found to be decreased through exercise interventions^,. d There was a significant group x time interaction (repeated measures ANOVA: F_1,40 = 8.43, p = 0.006, Cohen’s d = 0.78). A paired t-test analysis revealed that the BBT group showed a significant decrease from pre to post (t₁₉ = 4.31, p < 0.001), whereas the control participants showed no significant change following their intervention (t₂₁ = 0.46, p = 0.65). Note there was no difference at baseline between groups (independent t-test: t₄₄ = 1.05, p = 0.30). Error bars represent s.e.m.