Examining the Real World Effectiveness of Combined Cognitive and Physical Activity Interventions in Healthy Older Adults: A Systematic Review and Clinical Trial

Abstract

Dementia risk reduction is one of seven aims of the World Health Organization’s Dementia Plan (WHO, 2018). Specifically, risk reduction encompasses the development and delivery of interventions, and a greater emphasis on health promotion programs, with training aims to proactively manage modifiable risk factors. Recent research suggests that combined physical and cognitive activity interventions yield more significant treatment gains than single modality interventions. However, early research has focused upon determining efficacy of these interventions with regard to cognition, examining these interventions under optimal conditions on outcomes closely related to the trained task. As a result, two questions of generalizability remained unanswered: do these interventions impact outcomes related to everyday life, and can they be translated into accessible, community-based interventions? This research addresses these questions. In Study 1, I conducted a systematic review and meta-analysis evaluating the everyday impact of combined interventions. I found that combined interventions lead to improvements in quality of life relative to a mixed group of passive and active controls, but these improvements do not extend to domains of mood, activities of daily living, or self-efficacy. In Study 2, I designed and evaluated a replicable, community-based intervention to investigate the effectiveness of a combined approach in a real-world setting. Specifically, I added a physical activity component, facilitated by wearable activity trackers, to a well-established memory intervention. The combined intervention was determined to be feasible and acceptable to participants who demonstrated an increase in physical activity, a decrease in sedentary behavior, and an improvement in subject knowledge of memory and aging. Relative to the original program, the combined program did not yield additional benefits on quantitative measures of metamemory, objective memory, psychological well-being, or health and lifestyle. With respect to the two types of generalizability addressed in this research, the findings indicate that combined interventions do impact everyday life and can be translated into accessible, community-based interventions. This research also underscores the importance of investigating patient-centered outcomes and conducting research with generalizability in mind to help with the translation from research to patient-centered care.