Aerobic training versus mobile application based cognitive training: impact on cognition, aerobic capacity, and quality of life of older adults – An experimental study
Abstract
Objective. India is undergoing population ageing, with 7.7% of its population being more than 60 years old. Ageing brings age related degenerative changes which can bring cognitive impairments. Aerobic exercise is an effective intervention. Cognitive rehabilitation through mobile phone application is relatively unexplored. This study is carried out to compare the effect of aerobic exercise and mobile application training on cognition, aerobic capacity and quality of life of older adults.
Methods. 32 participants, 60-75 years of age, eligible to perform aerobic activities and having smart phone were enrolled. Those who had associated neurological conditions, or problem with vision and hearing, were excluded. ACE-III, NCPT, 6MWT and QoL-AD were analysed and those with Mild Cognitive Impairments were randomly allocated to two groups. Group one was given moderate intensity aerobic training for 30 minutes, five days/week, for eight weeks. Group two was given cognitive training through mobile application Lumosity. Participants were asked to achieve daily targets and were made to play it for eight weeks. Follow up of all the outcome measures was taken after eight weeks.
Results. All four outcomes show significant improvement for within group analysis (p < 0.05). In between group analysis, no significant difference between the groups for cognition (p = 0.42) and quality of life (p = 0.92). Aerobic capacity showed significant difference in between group analysis (p < 0.01).
Conclusions. Both aerobic capacity and mobile app training are equally effective for improving cognition and quality of life in older adults with MCI. Aerobic training group showed more improvement compared mobile training application group.
INTRODUCTION
India is the second largest populated country in the world with the population of 1.42 billion. Ageing of population is a global demographic trend. India too is experiencing “population ageing” 1. Age related changes may come in form of degeneration of musculoskeletal system, neurological system, cardio-pulmonary system, vision and hearing, etc. and the cumulative effect of these age-related changes causes a distinct impact on an individual’s life 2.
Nervous system plays the utmost important role throughout the life span 3. Cognition is the act or process of knowing, including awareness, reasoning, judgement, intuition, and memory. It serves as a foundation of one’s behaviour and it is a goal directed processing activity. Executive functions like capacity to plan, manipulate information, initiate, and terminate activities, recognize errors, problem solving, and abstract thinking are also included as cognitive functions 4.
Age related degenerative changes to nervous system might cause cognitive decline which decreases their efficiency of conducting their ADL 5. Mograbi and colleagues explains that executive functions play an important role in performing everyday tasks of instrumental ADLs. Due to same reason, decline in cognitive functions may cause decline in QoL of older adults 6.
Mild Cognitive Impairment (MCI) or dementia starts with symptoms of forgetfulness, lack of attention, drifting away from the task on hand, decreased speed of the decision making, visuospatial skill, perceptual speed and executive functioning 7.
Mini mental status examination, Montreal Cognitive Assessment, Rivermead Behavioural Memory test, Cognitive Assessment of Minnesota, Addenbrook’s Cognitive Examination, etc. are few frequently used tools for the assessment and screening. Addenbrook’s cognitive examination III (ACE III) is one such standardised tool to detect and monitor cognitive changes in dementia and mild cognitive impairment 8-10. NCPT is a web based cognitive examination which measures several domains of cognition 11.
In today’s era, with most people living beyond 60 years, continuous support and proper healthcare can enable them to live independently and positively impact society 12. Designing and implementing rehabilitation programs for those at risk of or experiencing cognitive decline is crucial, as current programs face irregular compliance due to cost, inadequate instruction, and a shift toward non-conventional treatments. Studies globally highlight the effectiveness of physical activity in promoting healthy aging and improving cognitive functions, especially executive functions, though there is a lack of coherent studies from India. Additionally, while video games may not suit older adults in India, mobile phones being widely accessible and convenient offer an effective and compliant medium for cognitive training through interactive applications 13-15.
Hence, this study was planned with the aim of comparing the effect of aerobic training and mobile application based cognitive training on cognition, NCPT, aerobic capacity and quality of life in older adults.
METHODS
In this experimental study, 32 older adults aged 60 to 75 years from old age homes, clubs operating for older adults and community dwelling older adults participated. Informed written consent was obtained from all the participants. After assessment, subjects were divided randomly using Flow chart is shown in Figure 1.
Sample size: N = 2(σ|∆)2[Zα+Z1-β]2
*N = sample size per group, σ = Standard Deviation, Δ = critical difference, Zα = level of significance, Z1-β = power.
Sample size came to 12. Considering the dropout scenario, the sample size for the current study was kept as 16 per group.
INCLUSION CRITERIA
Participants included in the study were males and females aged between 60 to 75 years who owned and were comfortable using smartphones. All participants exhibited mild cognitive impairment, diagnosed using the Addenbrooke’s Cognitive Examination – III (ACE-III), with scores ranging between 82 and 88. Additionally, only those individuals who were deemed eligible for aerobic training based on the Physical Activity Readiness Questionnaire were enrolled in the study.
EXCLUSION CRITERIA
Participants were excluded if they had any neurological condition causing cognitive impairment, impaired upper limb dexterity, or uncorrectable visual or hearing impairments that would interfere with communication or participation in the intervention.
OUTCOME MEASURES
The primary outcome measures used in the study were the Addenbrooke’s Cognitive Examination – III (ACE-III) for assessing cognitive function, the Six Minute Walk Test (6MWT) to evaluate aerobic capacity, the Quality of Life in Alzheimer’s Disease (QoL-AD) scale to measure overall quality of life, and the Neuro Cognitive Performance Test (NCPT) to assess various domains of neurocognitive performance.
PROCEDURE
Group 1. Aerobic training
Individuals were taught 30 minutes of exercise which included warm up and cool down. Tailor made protocol was used for all the individuals, which generally included exercises like, spot marching, brisk walking, star exercise, mini squatting, spot jogging, jumping jacks, stair climbing, static cycling, chair aerobic workout, etc. Exercises were of moderate intensity, five days a week for eight weeks as per ACSM guidelines for older adults 16.
Group 2. Mobile application based cognitive training Lumosity©
Permission to use Lumosity and NCPT was obtained. The application offered interactive games targeting various cognitive skills, such as planning, memory, attention, reasoning, and numerical estimation, with examples like Speed Pack, Lost in Migration, Ebb and Flow, Train of Thought, Tidal Treasure, Memory Matrix, Trouble Brewing, Star Search, Disillusion, Masterpiece, Fuse Clues, Pet Detective, Rain Drops, Chalkboard Challenge, Spatial Speed Match and Colour Match. It set daily reminders and targets, tracked gameplay frequency and variety, and monitored compliance. Weekly therapist follow-ups were conducted via phone, with in-person visits provided for resolving issues.
At the end of eight weeks, individuals from both the groups underwent an assessment with ACE-III, 6MWT, NCPT and QoL-AD. Completion of 80% of the protocol was considered as compliance, to be included in the post treatment analysis.
STATISTICAL ANALYSIS
The obtained data was then analysed using Microsoft Excel and SPSS version 16. Data was analysed for the test of normality with K-S Test. Level of significance was kept 5%.
RESULTS
In total there were 32 individuals who participated in the study. Each group had 16 participants. Table I shows demographic details of the participants.
Table II shows mean values of all the outcome measures.
DISCUSSION
The study was carried out to find out and compare the effect of aerobic exercise training and cognitive training through mobile application on level of cognition, aerobic capacity and quality of life in older adults.
It shows that both the groups showed significant improvements in level of cognition assessed through ACE-III as well as NCPT. But there was no significant difference on comparison of both the groups. Isabel Gomez-Soria et al. found that cognitive stimulation program for older adults with mild cognitive impairment effectively enhanced cognitive function, with improvements sustained at a 6-month follow-up. The program also temporarily improved basic daily living abilities, though it did not significantly affect instrumental activities of daily living, anxiety, or depression levels. No adverse effects were reported 17.
Basak C. et al. found that strategy-based video games improved older adults’ cognitive functions and facilitated transfer to other tasks, particularly those requiring attention switching. However, the transfer effect was weaker for tasks needing greater memory capacity. They noted that improvement in lab tasks after gaming itself represents effective training transfer. Similarly, in this study, participants improved cognitive performance through mobile application games 18.
Contrary to these findings, Joseph W. K. et al. reported no significant benefit from commercial cognitive training in young, healthy adults, possibly due to their already high cognitive baseline. In the present study, equal training in exercise and mobile application groups may explain the lack of significant differences between them 19.
Both the group improved in their aerobic capacities. Aerobic exercises improve cardiopulmonary endurance and capacity, supported by meta-analyses. Many of the meta-analysis too reports the same findings as present study. Interestingly, group B, with only cognitive training, also improved aerobic capacity. Kawagoe T. et al. explain this as enhanced brain network efficiency, integrating information better. Training across cognitive domains may have boosted overall brain function, improving everyday activities and physical performance, leading to increased aerobic capacity 15,20.
Both groups improved in QoL-AD scores also. Genoveva Montoya-Murillo et al. found that cognitive rehabilitation program enhanced cognition, quality of life, and reduced apathy and subjective complaints in elderly participants. These findings support the integration of structured cognitive rehabilitation interventions in addressing cognitive and emotional needs in older adults, underscoring their potential to improve overall well-being 4. Teixeira et al. found that cognitive stimulation program led to clinically significant improvements in cognition, quality of life, and functional skills among older adults with dementia, even though these changes were not statistically significant. Observations by healthcare providers highlighted better social interactions, behaviours, and engagement in daily routines 22,23.
In this study, mobile application games required quick decisions, focus switching, attention, and short-term memory, stimulating frontal lobe functions. These skills are similar to those needed in daily tasks, such as navigation, cooking, or managing schedules, potentially contributing to improved quality of life. Chao Yang et al. found that video game interventions are effective in improving cognitive functions and performance in older adults, particularly enhancing general cognitive abilities and processing speed and games with higher interactivity and rich visual stimulation provide more significant therapeutic benefits 24. Present study highlights the importance of assessing and rehabilitating cognitive impairments in older adults to promote functional independence.
Limitations include some participants using computers for the first time during the NCPT, which may have affected results despite familiarization. Non-random convenience sample with random allocation was used, partly due to fewer smartphone users in this age group, and had more male participants than females.
Strength is the culturally adapted ACE-III for Gujarati population, following WHO protocols. Therapists delivering aerobic training were blinded to the study, and exercises were supervised. The mobile app’s use of diverse cognitive games also ensured better compliance.
Future studies could include longer follow-ups, extended treatment durations, and functional MRI to track cerebral changes linked to cognitive improvement. Research could also explore these interventions in populations with traumatic brain injury, stroke, or Parkinson’s disease.
CONCLUSIONS
For level of cognition, aerobic capacity and quality of life both aerobic exercise and cognition training with mobile application are equally effective for older adults having mild cognitive impairments. Aerobic training showed better results in improving aerobic capacity compared to mobile app training.
Acknowledgements
We extend our heartfelt gratitude to all those who contributed to the successful completion of this work especially all the participants. Our sincere appreciation goes to all our mentors, colleagues, and students, whose valuable insights and feedback enriched this work.
We are especially grateful to our families for their constant encouragement, patience, and understanding throughout this journey.
Conflict of interest statement
The authors declare no conflict of interest.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions
DS: conceptualised the work, contributed significantly to the content development, literature review, and formatting the final version for submission, ensuring alignment with academic and publishing standards and led the coordination and review process throughout all stages of the project; MS: provided critical inputs in manuscript development and clinical applicability of the topic. She also assisted in editing and refining the manuscript; DD: was involved in compiling relevant data.
Ethical considerations
The ethics approval was obtained from Institutional Ethics Committee of Ahmedabad Institute of Medical Sciences with ethics approval number AIMS/2016/75 and from Sharda College of Physiotherapy with ethics approval number SCP/2017/001.
The study has been registered with Clinical Trial Registry of India with registration number CTRI/2018/01/011090.
The study was conducted over a period of three years.
History
Received: February 3, 2025
Accepted: April 10, 2025
Figures and tables
Figure 1.CONSORT flow diagram.
| Group 1 | Group 2 | |
|---|---|---|
| Males | 10 | 9 |
| Females | 6 | 7 |
| Age in years | 67.62 (4.06) | 65.93 (3.71) |
| Number of participants having formal education of 12 years or more | 16 | 16 |
| Data of ACE – III and Trail B was not found to be normally distributed; hence non parametric tests were carried out for them. | ||
| Outcome measures | Group 1 | Group 2 | ||||
|---|---|---|---|---|---|---|
| Pre values | Post values | Mean difference | Pre values | Post values | Mean difference | |
| (Mean + SD) | (Mean + SD) | (SD) | (Mean + SD) | (Mean + SD) | (SD) | |
| ACE-III | 84.75 (2.74) | 89.75 (3.54) | 5 (0.80) | 85.75 (2.59) | 91.25 (3.31) | 5.5 (0.72) |
| Aerobic capacity (ml/kg/min) | 12.9 (1.08) | 13.94 (0.98) | 1.04 (0.56) | 12.16 (0.74) | 12.52 (0.90) | 0.90 (0.58) |
| QoL - AD | 37.68 (3.94) | 40 (3.63) | 2.32 (0.31) | 41.12 (5.5) | 43.43 (4.30) | 2.31 (1.2) |
| NCPT - Immediate recall | 14.68 (3.59) | 16.62 (2.87) | 1.94 (0.72) | 14.43 (3.86) | 16.62 (3.03) | 2.19 (0.83) |
| NCPT - Dual search | 32.31 (5.70) | 35.43 (4.77) | 3.12 (0.93) | 28.87 (5.84) | 32.31 (5.74) | 3.44 (0.1) |
| NCPT - go – no go | 694.31 (183.38) | 634.37 (202.84) | 59.94 (19.46) | 622.12 (106.55) | 523.12 (117.30) | 99 (10.75) |
| NCPT - scale balance | 5.68 (5.81) | 8.75(5) | 3.07 (0.81) | 5.06 (2.95) | 7.93 (2.90) | 2.87 (0.05) |
| NCPT - trail B | 113.75 (60.30) | 94.06 (41.33) | 126.5 (60.12) | 113.75 (52.42) | ||
| NCPT - delayed recall | 12.81 (3.37) | 15.31 (3.03) | 2.5 (1.36) | 12.87 (3.36) | 15.37 (3.00) | 2.5 (1.26) |
| *SD: standard deviation; ACE-III: Addenbrook’s Cognitive Examination – III; QoL-AD: Quality of Life – Alzheimer’s disease; NCPT: Neuro Cognitive Performance Test. | ||||||
| Outcome measure | Group 1 | Group 2 | ||||
|---|---|---|---|---|---|---|
| Z/t value | p value | Effect size r/d | Z/t value | p value | Effect size r/d | |
| ACE-III | Z= 3.526 | < 0.01 | 0.623 | Z = 3.526 | < 0.01 | r = 0.623 |
| Aerobic capacity | t= 7.413 | < 0.01 | 1.04 | t = 2.91 | 0.011 | d = 0.44 |
| QoL - AD | t= -4.498 | < 0.01 | 0.63 | t = -4.299 | 0.001 | d = 0.53 |
| NCPT - immediate recall | t= -5.23 | < 0.01 | 0.67 | t = -6.591 | < 0.01 | d = 0.72 |
| NCPT - dual search | t= -6.603 | < 0.01 | 0.65 | t = -8.646 | < 0.01 | d = 0.59 |
| NCPT - go – no go | t= 2.562 | 0.022 | 0.32 | t = 4.695 | < 0.01 | d = 0.92 |
| NCPT - scale balance | t= -7.240 | < 0.01 | 0.61 | t = -6.191 | < 0.01 | d = 0.98 |
| NCPT - trail B | Z= 3.185 | 0.001 | -0.563 | Z = 3.521 | < 0.001 | r = -0.623 |
| NCPT - delayed recall | t= -7.319 | < 0.01 | 0.75 | t = -7.906 | < 0.01 | d = 0.83 |
| *SD: standard deviation; ACE-III: Addenbrook’s Cognitive Examination – III; QoL-AD: Quality of Life – Alzheimer’s disease; NCPT: Neuro Cognitive Performance Test. | ||||||
| Outcome measure | Z/t value | p value | Effect size r/d |
|---|---|---|---|
| ACE-III | Z = 0.81 | 0.42 | r = -0.14 |
| Aerobic capacity | t = 0.232 | 0.171 | d = 0.082 |
| QoL - AD | t = 2.75 | 0.553 | d = 0.00 |
| NCPT - immediate recall | t = -0.503 | 0.775 | d = 0.17 |
| NCPT - dual search | t = -0.83 | 0.445 | d = 0.17 |
| NCPT - go – no go | t = -1.240 | 0.614 | d = 0.43 |
| NCPT - Scale balance | t = 0.299 | 0.585 | d = 0.10 |
| NCPT - Trail B | Z = -0.302 | 0.78 | r = 0.05 |
| NCPT - Delayed Recall | t = 0.052 | 0.821 | d = 0.00 |
| *SD: standard deviation; ACE-III: Addenbrook’s Cognitive Examination – III; QoL-AD: Quality of Life – Alzheimer’s disease; NCPT: Neuro Cognitive Performance Test. | |||
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