Enhancing Cognitive Fitness in Adults: A Guide to the Use and Development of Community-Based Programs

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Areas of coverage include: Research bases for cognitive wellness interventions.

chapter and author info

Social programs designed to improve and sustain cognitive function. Enhancing cognition through the arts and cultural activities. Cognitive wellness interventions for adults with memory impairment. Community-based programs with positive societal impact. A cogent survey of a growing field, Enhancing Cognitive Fitness in Adults is a timely resource for professionals working toward this crucial goal,including clinical, health, and neuropsychologists, primary care physicians e.

Dewey: Psychology, clinical. Chicago: Hartman-Stein, Paula E. Set language NL EN. Contact Live chat online E-mail: libservice ugent. You are not connected to the UGent network. Several recent multimodal training endeavors have shown promise in positively changing cognition when supplementing cognitive training with physical exercise 8 , For example, Fabre and colleagues 11 found that a group that received combined cognitive training and physical exercise outperformed other unimodal training groups exercise-only and cognitive training-only on memory tasks, such as a story memory task and a paired associates task.

Likewise, Oswald and colleagues 12 found that individuals randomly assigned to a combined exercise and cognitive training group showed large improvements in a composite measure of cognitive abilities i. If this is true, then one might expect performance on theoretically motivated cognitive games, such as the ones in the current study, to be enhanced when paired with exercise compared to cognitive games that have not been supplemented with exercise. An emerging area of research in cognitive neuroscience investigates the combined effects of cognitive training and non-invasive brain stimulation via transcranial direct current stimulation or tDCS.

Many argue that active or anodal tDCS ultimately influences cognition by increasing cortical excitability For example, Martin and colleagues 20 found that individuals in an active stimulation group demonstrated better performance on attention and working memory tasks after 10 sessions of dual n-back training compared to those in a sham control group due to increased cortical excitability produced by the application of tDCS.

Similarly, Ditye and colleagues 21 found that individuals receiving active tDCS along with cognitive training outperformed individuals in a cognitive training-only group on measures of inhibition. To explain these results on a mechanistic level, some have argued that pairing tDCS with cognitive training can enhance plasticity and strengthen task related cortical networks, which has the potential to generate behavioral improvements on trained and possibly even untrained tasks 22 , The widespread advocacy and adoption of brain training software in the public eye — and what we perceive as an opportunity to strengthen the effects of computer-based training through the addition of multiple intervention modalities 24 , 25 — motivate a careful investigation of the evidential basis of brain training methods and an examination of the benefits of multimodal interventions to enhance new skill learning.

Our investigation examines whether contemporary approaches to brain training — including computer-based cognitive training, physical exercise training, and non-invasive brain stimulation — enhance learning of trained tasks and improve performance on untrained tests of intellectual ability within healthy, young adults. Our cognitive training protocol incorporates several training paradigms from cognitive psychology that have shown promise for enhancing executive functions 5 , 26 , 27 , 28 , 29 , 30 , 31 and is implemented within a software package that is adaptive user-dependent and dynamic task difficulty , novel training of unfamiliar tasks , engaging interesting and enjoyable , and comprehensive designed to improve critical building blocks of cognition relevant to a broad array of tasks and skills.

Prior research has shown that physical exercise and brain stimulation can enhance learning and memory, in both children and older adults, and therefore may amplify the effects of brain training in our population of healthy, young adults 21 , 22 , 32 , The University of Illinois at Urbana-Champaign Institutional Review Board approved all procedures used IRB , and all methods were performed in accordance with the relevant guidelines and regulations. Five hundred and eighteen participants were recruited from the local community and randomly assigned to one of five groups after giving informed written consent.

The Games group engaged in six computerized training games based on executive function and working memory tasks for all 48 sessions. The EG group engaged in physical exercise for 28 sessions as well as computerized training games for 20 sessions.

Enhancing Cognitive Fitness in Adults

The ESG group also engaged in 28 sessions of physical exercise similar to the EG group; however, they further received active HD-tDCS during their 20 sessions of computerized training games. The Active Control group AC engaged in different computerized training games based on visual search and change detection for the same duration and frequency as the Games group i.

Game order was randomized at each session for all computerized training. Finally, there was a no contact control group Passive Control or PC that completed pre- and post-tests but did not engage in training. In addition, all groups completed a battery of untrained transfer tasks prior to and following the training period.

On the basis of prior cognitive training research, the battery of tasks measured multiple cognitive abilities, including measures of executive function, working memory, episodic memory, and fluid intelligence. In addition to this battery of tasks, aerobic fitness was measured at pre-test and post-test for all participants using a graded exercise test designed to measure maximal oxygen consumption VO 2 max.

Of the participants enrolled in the study, finished. These games were created as part of a cognitive training package in which the component tasks games were chosen because they have shown promise in engendering training and transfer effects in the extant literature 5 , though this is the first instance of them being used in a multimodal setting. Five of the six games were identical to those used in previous research 5 , and one of the six games was new to this study i.


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Participants in each class were divided into groups of 5 or fewer participants per trainer. During the exercise sessions, heart rate was monitored using a Polar heart rate monitor Participants completed a total of 28 exercise sessions 12 the 1 st month, eight the 2 nd month, four the 3 rd month, and four the 4 th month. The warm-up included dynamic stretching and light activity to prepare the body for exercise. In addition, there was a high intensity cardiovascular and resistance training HICRT protocol that was split into two segments of three sets of three-to-four exercises.

Participants completed one- to two-minutes of jump rope and a four-minute power series between the two segments. The HICRT exercises varied among sessions and included exercises involving bodyweight, resistance bands, kettlebells, body bars, and suspension training. There was also a drills-and-skills portion that varied among sessions and included whole-body training with equipment such as battle ropes, sand bags, ladders, medicine balls, and parachutes.

Every exercise session finished with dynamic stretching and a cool-down routine. In addition to the physical exercise sessions, participants in the EG group completed 20 sessions of the same computerized training games as the Games group. These game sessions started the 2 nd month with four sessions and then increased to eight sessions per month in the 3 rd and 4 th months.

During the game sessions, participants received sham tDCS. Electrode sites were prepared with highly conductive gel. For both groups, anodal electrodes were placed over left and right dorsolateral prefrontal cortex F3 and F4 while the cathodal electrodes were placed over the left and right occipital cortex O1 and O2 according to international 10—20 standards Participants experienced a short exposure period at the beginning of each session to acclimate to the stimulation sensation before the longer stimulation period began.

Participants in the ESG group received a total of 2. In prior research, training on these tasks has not led to changes on executive function, working memory, episodic memory, or fluid intelligence; however, participants did show substantial enhancements in visual search and change detection performance 6 , 7. The AC group followed the same training schedule as the Games group. Participants completed a battery of tasks both before and after the training intervention.

Pairwise comparisons indicated that only the two groups that engaged in physical exercise EG and ESG significantly increased their cardiorespiratory fitness levels, though they did not significantly differ from each other. At the end of the intervention, participants reported how much their participation in the study had changed their abilities. The 14 abilities e. The training and transfer results did not differ when this expectation score was included as a continuous covariate.

To examine the time-course of cognitive training, we calculated standardized improvement scores at each of the 20 training sessions by converting the average difficulty for each task to a standardized score for each of the four active training groups three experimental groups and an active control group. We then subtracted first session performance from subsequent sessions for each participant 7.

To examine the relative benefits of multimodal approaches to brain training, we compared standardized training curves across 20 sessions for each of the experimental groups Fig. Planned pairwise comparisons indicated that both multimodal groups ESG and EG achieved significantly greater performance compared to the unimodal Games group on Irrigator based on visuospatial reasoning , Ante Up based on mental planning , and Supply Run based on working memory updating.

Enhanced Training Performance Over Time.

Standardized improvement units are on y-axis. Enhanced Training Performance at Session Standardized improvement units on y-axis. In addition to testing for enhancement of learning as a result of multimodal training, analyses were conducted to explore whether enhanced training performance led to enhanced performance on untrained pre- and post-intervention assessment tasks.

A significant effect of Group at post-test while covarying pre-test performance would serve as evidence of transfer 7. Comparable post-intervention performance was observed across the unimodal and multimodal intervention groups for tests of general intelligence examined for latent constructs of executive function, working memory, episodic memory, and fluid intelligence. In each case, evidence for significant transfer to these constructs was not obtained.

These findings provide clear evidence for the strengths but also the limitations of a subset of contemporary brain training methods — establishing the beneficial effects of multimodal training on learning while also identifying the need for effective methods to engender transfer to general facets of intellectual ability. We have conducted one of the largest and most comprehensive randomized brain training studies performed to date and provided novel evidence that a multimodal intervention — based on cognitive training, brain stimulation, and exercise training — can enhance learning i.

For three of the games Irrigator, Ante Up, and Supply Run , exercise enhanced learning in terms of training game performance compared to the unimodal group. This extends previous training research that has found exercise-related enhancements on learning 18 , though to our knowledge this is the first study to show these enhancements in young adults using executive function and working memory training tasks.

In addition to the learning enhancements from exercise, adding brain stimulation as well as exercise to the intervention led to enhanced training performance on two of the games Sentry Duty and Pen Em Up compared to the other multimodal group and the unimodal group.

Previous research with healthy younger adults has found that pairing active brain stimulation with cognitive tasks can enhance performance The current research extends these findings to multimodal interventions, demonstrating enhanced learning on executive function and working memory games using a combination of exercise and brain stimulation. Our experiment was designed to provide a rigorous investigation of the efficacy of multimodal approaches to brain training in healthy, young adults.

Our findings therefore inform scientific and public policy recommendations about the multimodal interventions investigated in the present study. Indeed, a key set of issues in the design of brain training methods pertains to the specific cognitive skills that are trained e. It remains possible, for example, that transfer effects may depend on a different cognitive training protocol not based on executive function and training for a longer duration more than 20 sessions. Participants may need greater exposure to each of the training games to engender transfer to general intelligence but see ref.

We believe these alternatives should be examined in future research given that the majority of studies reporting beneficial effects of cognitive training are consistent with the administered protocol i.


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  6. There are several other limitations that should be considered when evaluating multimodal training effects. For instance, given the high level of attrition in the current study, it is possible that those who dropped might have been less motivated or had different baseline abilities compared to those who completed the study. If that were the case, then perhaps those individuals would have more to gain from multimodal training efforts.

    Cognitive Fitness

    For those who did complete the study, we observed real-time multimodal training effects but only weak evidence for transfer. We used one program of exercise and one type of brain stimulation for our multimodal intervention to try to maximize our potential for observing transfer, but it is possible that a different type of exercise program and brain stimulation setup might lead to greater evidence of transfer.

    Indeed, most of the research on the efficacy of fitness training for cognition and brain health comes from exercise programs that are focused on improvements in cardiorespiratory fitness rather than mixed programs of resistance, skills, and cardiorespiratory fitness training as used in the present study 15 , Also, despite our large sample size and random assignment to training group, it is possible that individual differences in cognitive abilities obscured any potential transfer effects. While previous research has found robust transfer effects 26 , 27 , this has not always been the case 4 , 7.

    Furthermore, the current study differs from several of the previous studies in that our focus on was the effects of multimodal vs. We also included a battery of training tasks rather than a single task, and at least for our measures of fluid intelligence we used the BOMAT whereas some previous studies have used other matrix reasoning tasks. Given the wide variety of training and transfer results in the literature and the lack of multimodal interventions, further replication and studies of the size, scope, and duration of the present randomized controlled trial are needed.

    The importance of establishing methods to enhance cognitive and brain health has been increasingly recognized in the psychological and brain sciences, but the efficacy of state-of-the-art brain training methods remains the subject of continued research and debate. Our study provides evidence that the administered multimodal training protocol significantly enhances learning across multiple cognitive domains, spanning executive functions, working memory, and planning and problem solving.

    Our findings therefore motivate further investigation of how best to optimize multimodal interventions based on subject-specific tailoring e. Fernandez, A. The digital brain health market — web-based, mobile and biometrics-based technology to assess, monitor, and enhance congition and brain functioning. Sahakian, B. Editorial overview: cognitive enhancement.

    Curr Opin Behav Sci. Redick, T. Working memory training and interpreting interactions in intelligence interventions. Thompson, T. Failure of working memory training to enhance cognition or intelligence. PLoS One. Baniqued, P. Working memory, reasoning and task switching training: transfer effects, limitations, and great expectations? Gaspar, J. Change detection: training and transfer. Harrison, T.

    Working memory training may increase working memory capacity but not fluid intelligence. Psychol Sci. Bamidis, P. A review of physical and cognitive interventions in aging. Neurosci Biobehav Rev. Berryhill, M. Hits and misses: leveraging tDCS to advance cognitive research. Front Psychol. Ngandu, T. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people FINGER : a randomised controlled trial.

    Fabre, C. Int J Sports Med. Oswald, W. Differential effects of single versus combined cognitive and physical training with older adults: the SimA study in a 5-year perspective. Eur J Ageing. Erickson, K. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci. The effects of forced exercise on hippocampal plasticity in the rat: a comparison of LTP, spatial- and non-spatial learning. Behav Brain Res.

    Prakash, R. Physical activity and cognitive vitality. Annu Rev Psychol. Van Praag, H. Exercise enhances learning and hippocampal neurogenesis in aged mice. J Neurosci. Fabel, K. Additive effects of physical exercise and environmental enrichment on adult hippocampal neurogenesis in mice. Front Neurosci. Kempermann, G. Why and how physical activity promotes experience induced brain plasticity.

    Bestmann, S. Understanding the behavioural consequences of noninvasive brain stimulation. Trends Cogn Sc. Martin, D. Can transcranial direct current stimulation enhance outcomes from cognitive training? Int J Neuropsychopharmacol. Ditye, T. Modulating behavioral inhibition by tDCS combined with cognitive training.

    Exp Brain Res. Elmasry, C. A systematic review of transcranial electrical stimulation combined with cognitive training. Restor Neurol Neurosci. Jones, K.

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