Not so long ago, it was assumed that cognitive decline was just a natural part of aging. Over the past decade, however, scientific and medical researchers have investigated ways to slow this process, and perhaps even prevent the severe decline of dementia through therapeutic and lifestyle interventions.
Physical activity and cognitive training are two lifestyle factors that have been widely studied, with each showing a degree of benefit. More recently, however, scientists and a few entrepreneurs have combined the two in hopes of achieving better results. In this article, we examine this science – and the emerging technology it spawns.
Some promising discoveries
A 2020 article published in the journal Aging Research Reviews reviewed more than 40 studies on the topic and concluded that doing physical and brain exercises simultaneously does indeed benefit cognitive performance more than doing either alone.
To learn more about these benefits, we spoke with Dr. Esther Karssemeijer from Nijmegen, the Netherlands, who wrote her Ph.D. thesis on the topic of combined physical and cognitive exercise at Radboud University, the Netherlands.
“There have been many studies on this,” Karssemeijer said, “and they found that combined training can improve cognitive function, perhaps to a greater extent than exercise alone, because the activities physical and cognitive can have positive synergistic effects. ”
Karssemeijer also noted that doing physical activity the same time because performing cognitive tasks, known in research as “simultaneous” training, appears to be more effective than doing physical activity just before or after a cognitive training session, known as “sequential” training.
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What counts as concurrent training?
Yoga is often considered a “mind-body” exercise: an activity that seeks to harmonize mind and body through movement and breath. It can be fantastic for reducing stress and improving focus, while also creating some movement and improving flexibility.
However, the simultaneous training studied by brain scientists is more like a “mind + body” exercise: two different activities performed at the same time, each requiring a different type of focus and attention.
It is this “dual task” training that appears to confer the greatest benefit. As an example, here are three companies that have created products or services based on the concept of concurrent training.
Business responds to science
Alison Weinlaeder is a speech-language pathologist in St. Paul, Minnesota who does cognitive rehabilitation with stroke and traumatic brain injury patients. She started her business CardioMelon amid the COVID-19 pandemic because she saw the need to get people moving at home.
Weinlaeder said, “I often get referrals from patients whose brains just change with age. They always ask what exercises they can do to strengthen their brains, and I ask them what they are currently doing. Usually they do not exercise. She wanted a tool that allowed patients to move their bodies while they worked their brains, but there was none, so she created it.
CardioMelon is a subscription service of over 100 videos, each around 30 minutes long, that combine different types of physical exercise with different types of cognitive challenges. In a sample video on YouTube, users are asked to answer basic math and word problems while walking, squatting and doing a number of other easy to moderate intensity exercises.
“I dive into a world knowing that maybe there isn’t enough research,” Weinlaeder said, “so maybe my product can help with that.” To this end, it has partnered with the American Heart Association in a study on the effects of CardioMelon on cognition.
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“A 360 degree cognitive gym”
In Camarillo, California, Cathi Lamberti, a former schoolteacher turned entrepreneur, came up with a very different approach to concurrent learning. SmartFit is an electronic gaming system that Lamberti describes as “a 360-degree cognitive gym that you respond to with your decision-making brain.” The system can be configured in countless different ways, making it accessible to people with varying physical abilities.
When he saw a demonstration of SmartFit four years ago, Dr. Charles Liu, professor of neurological surgery and director of the Neurorestoration Center at USC in Los Angeles, was curious about its potential for adults with cognitive disorders. . He asked Lamberti to let him and his collaborators use the device in a study involving patients with Parkinson’s disease.
“It was a very small study, involving only 10 patients,” Liu said, “just to assess the safety and feasibility of using the device with patients with Parkinson’s disease.” However, the results were promising enough to warrant the interest of conducting larger follow-up studies.
SmartFit is currently marketed only to institutions such as long-term care, retirement and memory care facilities, rehabilitation centers treating people with Parkinson’s disease or those who have suffered a stroke or head trauma, as well as for sports applications. Lamberti said the company is working on a home-use model that it hopes to roll out in 2023.
Another type of concurrent training device, the Integrated Physical and Cognitive Exercise System (iPACES) was created by Cay Anderson-Hanley, professor of psychology and co-director of neuroscience at Union College in Schenectady, New York.
Developed as a potential therapy for people with mild cognitive impairment (MCI), iPACES runs on a tablet, can be used with any home exercise bike, and looks like a video game, or in this case, a an “exercise game”.
“The main task is to ride through the neighborhood, on the virtual bike path to do some errands for the day,” Anderson-Hanley said.
Riders are given a list of tasks to complete, and as they pedal they come to a fork in the road or two exit signs. “Then they have to remember where they were going next and decide which route to take, but the most complex part is when they turn around and are asked to retrace their route back home. ”
In a small 2018 pilot study of people with MCI and their caregivers, results were favorable, prompting a larger follow-up study of more than 100 people, now underway. Anderson-Hanley said: “If this trial is positive, we hope other researchers will want to use the device in studies for independent verification.”
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What you can do at home
The three products reviewed above are all quite different from each other, so we wondered what kinds of things people can do at home to achieve similar positive effects.
Karssemeijer said: “The type of activity does not matter. There were all kinds of different interventions – dancing, biking, walking and doing cognitive training all at the same time.
In fact, variety may be key, as there are many different facets of cognitive function, and different activities stimulate different areas. It’s also important to keep challenging yourself rather than just repeating the same routine over and over.
A simpler example of simultaneous training might be pedaling a stationary bike or walking on a treadmill while watching an educational program on your TV or mobile device. Something a bit more challenging might be riding a bike or walking outside, where you have to negotiate terrain, while listening to a foreign language lesson. A difficult session might be juggling tennis balls while doing long divisions in your head or trying to spell difficult words.
The possibilities are almost endless, and the important thing is to choose activities that you can do safely and enjoy. As Karssemeijer said, “Just do what you love and are able to do.”
Limits of current research
When it comes to cognitive decline, and in particular dementia, a multitude of underlying genetic, epigenetic, environmental and lifestyle factors are at play. Therefore, this therapy or any other approach is unlikely to unique is the “miracle solution” that we are all hoping for. Additionally, the favorable outcomes seen in studies so far are mostly limited to healthy adults or those with only mild cognitive impairment.
“It depends on the combination of physical and mental exercise,” Anderson-Hanley said, “but generally the further the decline, the less significant the effects.”
Karssemeijer agreed and noted that his own studies involving people with dementia only found improvement in psychomotor speed, but not in other areas of cognition. She explained: “An increase in the severity of neurocognitive impairment may cause the effect to diminish.”
But positive results can be difficult to measure when it comes to cognitive decline.
Anderson-Hanley noted that “In MCI, a decline to lower functioning and dementia is roughly expected. So in my opinion, when we target the MCI for these interventions, we are not necessarily looking for a direct improvement. As for reversing it, I won’t rule that out entirely, because in some cases that may be the trajectory, but what we’re really trying to do is slow the decline.
In addition, Karrsemeijer’s research had another important positive result. “One of the most important findings was that, although we found no additional benefit over exercise, adherence to exercise in the combined group was significantly higher than in the group exercise only. It was more fun and interactive, so it’s a method to improve physical activity for people with dementia.
Anderson-Hanley summed it up nicely when she said, “Exercise, when you take it at any age, can have a significant impact on brain health. And if one could choose an activity that combines a physical and mental component with an attraction for more mental engagement, that would be better.
Rachelle Brown is a longtime fitness professional and freelance writer with hundreds of bylines in print and online. She is a regular contributor to NextAvenue and Active Network, and is the author of “Reboot Your Body: Unlocking the Genetic Secrets to Permanent Weight Loss” (Turner Publishing). Connect with her on Twitter and Instagram @RashelleBrownMN.
This article is reproduced with permission from NextAvenue.org© 2022 Twin Cities Public Television, Inc. All rights reserved.
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