Buffalo, NY, December 5, 2022: The University of Buffalo’s Center for Successful Aging, in cooperation with the William-Emslie Family YMCA, a branch of the Buffalo-Niagara YMCA, have announced the results of a community-based pilot study on the effects of dual-task (brain-body) exercise on older adults with Mild Cognitive Impairment (MCI). The Mayo Clinic says that “MCI may progress to Alzheimer’s disease dementia or another type of dementia”. The study, using gamified training technology from SMARTfit, a Camarillo California based company, found that dual-task exercise improves cognition and physical function in older adults with MCI.
“I will admit, 12 weeks ago my friends dragged me to that place. I did not want to carry that 6 lb. ball all over the place or stand on one foot, looking like a fool. But half-way through the first class, I was too busy laughing, sweating, and playing with my friends to think about any of that. And now, 12 weeks later, I can stand on one foot without being afraid of falling, I can walk farther than I could five years ago, and I have a new group of friends who laugh with me and support me“. – Study Participant, age 83.
“The key aims of the study”, said Dr. Nik Satchidanand, study director, “were to detect changes physical function (balance, walking, and lower-limb strength) and cognitive function (attention, interference inhibition, working memory, processing speed and task switching). We also want to assess the experience regarding enjoyment, appeal, and ease of participating, and ultimately gain a better understanding of what we can do to delay the progression to Alzheimer’s disease over time.”
“One of the most encouraging findings was that 100% of the participants completed the program. All found it very enjoyable, easy to do yet very challenging, said they felt better both mentally and physically, and want to return for further training. We wanted to be sure that people wanted to come back to these sessions time and again, and it was clear that by the way that they enjoyed it and felt really immersed in it and supported by it and were therefore very happy with this result. Results showed statistically significant improvements in five of six cognitive and physical measurements. These results, both measured and anecdotal, give us the confidence to move forward with a much large study which is already in the planning stages,” continued Dr. Satchidanand.
So what makes this study different? Science has known for years that exercise is good for the brain. Numerous studies over the past 30 years have also confirmed that dual tasking, or doing a physical and cognitive activity simultaneously, is even better, activating neuroplasticity faster and more effectively than training each separately to improve both brain and body performance. Dual task training has also proven to transfer to real-life results like activities of daily living better than single-task training. SMARTfit’s proprietary Dual Task Cost Test measures the difference and recommends a pathway to improve.
The University of Buffalo / YMCA study comes on the heels of another important dual-task study on Parkinson’s disease at the University of Southern California using SMARTfit. That study showed better results from SMARTfit’s dual-task programming versus traditional single-task interventions in over 87% of participants.
All participants in the Buffalo study were 65 years or older and had screened positive for mild cognitive impairment with a MoCA (Montreal Cognitive Assessment) score of 23 to 26. The study included Stroop and Trail-Making A and B cognitive assessments, plus physical balance, gait, and sit-to-stand assessments. The dual task training (DTT) using SMARTfit included both individual and group training to add a critical social component.
Nikhil Satchidanand is the Associate Director of the University of Buffalo’s Center for Successful Aging, which is part of the Jacobs School of Medicine and BioMedical Sciences. The UB Center for Successful Aging advances transdisciplinary knowledge about aging through community-responsive research. The Center strives to facilitate the translation of research quickly into local and regional policy and practice to make Buffalo and Western New York the best place to age for all its residents.
Addendum – Study Overview
SMARTfit Dual-Task Exercise Improves Cognition and Physical Function in Older Adults with Mild Cognitive Impairment: Results of a Community-Based Pilot Study
Abstract: Mild cognitive impairment (MCI) is an intermediate state between the cognitive decline often experienced in normal aging and dementia, that effects 15% of Americans over 65 years of age. Our communities have an opportunity to support the development and adoption of evidence-based programs to help older adults preserve cognition and physical function. In partnership with a local, urban YMCA in an underserved, predominantly minority neighborhood we tested the appeal and therapeutic benefits of SMARTfit training among older adults with MCI. The participants reported a positive training experience. After 12 weeks of dual-task training (DTT), Trail-Making Test (TMT) and Stroop Color-Word Interference Test (Stroop) scores improved, as did scores on the Short Physical Performance Battery (SPPB). Results of our SMARTfit DTT intervention are encouraging. Larger randomized controlled trials (RCTs) must further investigate the development, implementation, and therapeutic impacts of SMARTfit DTT on cognitive and physical function in aging.
BACKGROUND AND PURPOSE
Mild cognitive impairment (MCI) is an intermediate state between the cognitive decline associated with normal aging and more severe dementia that effects 15% of American adults over age 65 years (Anderson, 2019). MCI is also predictive of Alzheimer’s Disease (AD) with a rate of conversion from MCI to AD of 15% per year in the United States (Petersen et al., 1999). Coping with MCI in aging can be of significant burden as it is associated with increased fall risk, social isolation and anxiety, and poorer quality of life (Conrad et al., 2015; Hwang et al., 2022; Tyrovolas et al., 2016). With our rapidly aging society and increasing life expectancy, we are facing a public health crisis for which we are not fully prepared. To meet this challenge and help adults preserve their function and independence well into older age, we must support our communities with the expertise and resources to develop, adopt, and sustain both appealing and impactful evidence-based programs to preserve cognitive and physical function in aging.
The dual-task paradigm is an established methodology for studying cognitive performance under conditions wherein attention must be divided between two simultaneous tasks (Della Sala et al., 1995). Adults with MCI and AD often experience limitations in their ability to complete dual-task challenges (e.g., walking while counting backwards) (Makizako et al., 2013; Sobol et al., 2016). Further, dual-task ability is essential to maintaining independence in aging. For instance, Brustio et al. (2018) found that among older adults, dual-task performance mediates the association between fear of falling and ability to complete activities of daily living (ADLs). In addition, Muir-Hunter et al. (2016) found that deterioration in gait quality during dual-task walking compared to single-task walking was associated with increased fall risk in community-dwelling older adults. The evidence presented by Brustio et al. and Muir-Hunter et al. shows that dual-task ability is important to successfully meeting the challenges of daily life. Further investigation on the impacts of DTT on cognitive and physical function is still needed to adapt and integrate effective therapies into communities in need.
Increased focus has been placed on leveraging the dual-task paradigm to not only assess function, but also to design therapeutic strategies aimed at preserving cognition and physical function for a host of aging-related challenges (Choi et al., 2015; Falbo et al., 2016; Li et al., 2020; Wollesen et al., 2017). This method facilitates cognitive testing and training using tasks that better replicate the complex activities of daily life that often require divided attention. Exergaming is an engaging and immersive method that can be used to deliver DTT (Delbroek et al., 2017; Gallou-Guyot et al., 2020; Ogawa et al., 2015). Exergaming capitalizes on physical movement and subsequently critical thinking and decision-making, as a means of accomplishing a task presented in-game.
Evidence supports DTT as an effective therapy to help improve cognitive and physical function in older adults with MCI. In a recent systematic review and meta-analysis of the impacts of DTT, Ali et al. (2022) found among 21 studies, small to medium effect sizes (standardized mean differences) ranging from 0.19 to 0.56 for global cognition, memory, executive function, attention, gait speed, dual-task cost, and balance. For instance, Park et al. (2019) examined the impacts of aerobic exercise combined with simultaneous cognitive training (completion of word games, simple numerical calculations, and memory-span games); a program the team coined as “Cognicise”. In response to once weekly “Cognicise” for 24 weeks, participants demonstrated improved global cognitive function, working memory, and executive function.
In a randomized controlled trial (RCT), Liao et al. (2019) found that 12 weeks of virtual reality-based DTT in older adults with MCI improved performance on the Stroop Color-Word Test, motor dual-task gait, cognitive-motor dual-task gait, and dual-task cost. The authors contend that these improvements show that DTT has the potential to enhance executive function in older adults with MCI. Overall, the current evidence supports DTT as an effective therapy to assist older adults with MCI maintain or even enhance cognitive and physical function. Further, the nature of DTT interventions that bring people together increases social engagement and social support among participants, in-turn resulting in a higher likelihood of their long-term investment and ongoing participation (Christensen et al., 2006; Chu et al., 2021; Resnick et al., 2002).
While the underlying neurophysiological mechanisms of improved cognition in response to simultaneous exercise and cognitive training have not yet been fully characterized, exercise and cognitive training likely stimulate similar neurobiological processes and pathways which produce a synergistic therapeutic effect (Tait et al., 2017). Cognitive and motor training improve cerebral blood flow in humans, (Ide & Secher, 2000; Mozolic et al., 2010) and studies in rats show that they induce angiogenesis (Mu et al., 1999). Further, evidence demonstrates that areas of the brain underlying executive control processes such as the frontal and hippocampal regions are malleable and adaptive even in older age (Voelcker-Rehage & Niemann, 2013), responding to both physical exertional training and cognitive stimulation, thus enhancing neuroplasticity (Erickson et al., 2006; Maass et al., 2015) and preserving brain volume (Boyke et al., 2008). Moreover, physical activity and exercise increase release of brain-derived neurotrophic factor (BDNF); a member of the neurotrophin family of growth factors that promotes neuronal survival, neurite outgrowth, and synaptic plasticity in healthy older adults and those with AD (Coelho et al., 2013; Coelho et al., 2014; Marinus et al., 2019). BDNF is essential to cognitive performance and adaptations in brain morphology (Cirulli et al., 2004; Mu et al., 1999). The underlying mechanisms by which cognition improves with exercise and cognitive training are complex and multidimensional and concerted efforts must be made to better characterize this model. The objective of our study was to assess the appeal of SMARTfit DTT among key community stakeholders and to detect changes in cognitive and physical function with 12 weeks of training in adults 65 years or older who screened positive for MCI.
Our team seeks to contribute to the DTT evidence-base by exploring the participant training experience and therapeutic benefits associated with DTT using the SMARTfit Cognitive-Motor Exercise System (SMARTfit: Camarillo, CA). SMARTfit is an exergaming system that facilitates simultaneous cognitive and motor training using a series of touch-sensitive LED arrays embedded in a high-strength panel that can be wall-mounted or attached to a floor stand. The LED arrays are programmable to deliver cognitive challenges such as memory, numerical calculations, or counting, while simultaneously executing a given physical task such as walking while carrying a medicine ball, stance-switching, or stepping in place. Participants can interact with the device by striking the individual targets using their hands or feet, or throwing balls, or other objects that require manipulation and movement.
To test the appeal and impact of SMARTfit DTT we partnered with a local YMCA in an underserved, urban neighborhood, with a membership that is predominantly African American. With direct stakeholder input we have developed and conducted this pilot investigation. This project is important because it sought to address a pressing health issue that can profoundly impact function, independence, and quality of life in a community with a long history of health disparities and inequitable access to health-promoting resources.