Effects of Multimodal Training of Combined Cognitive and Physical and Cognitive or Physical Training Only on Cognition and Physical Fitness of Older Adults: A Cluster Randomized Controlled Trial

The elderly population in worldwide is expected to increase exponentially. There will be a higher percentage of older adults suffering cognitive decline in the coming decades. Cognitive impairment, being the most common health problem associated with ageing, contributes to possible loss of functional independence and disability. The purpose of this study is to determine the effectiveness of four mixed modalities of three training programs (combined cognitive and physical training, cognitive or physical training only) on cognition and fitness of community-dwelling older adults in Hong Kong. The study hypotheses will be set as the integrated format of all three training will have higher cognition and fitness scores than other combinations of two training modes and all these mixed modalities will have greater positive outcomes than the active control subjects. The study design is a cluster randomized controlled trial. Twenty-four elderly centers as clusters will be randomly selected and assigned to be intervention (n=20) or control groups (n=4) in two study phases. A total of 18-20 older adults (age ≥ 60) meeting the inclusion/exclusion criteria from each cluster (total subjects = 480) will be invited to be study participants. Each intervention cluster will receive either an integrated training format or one out of three combinations of two training modes. Each intervention training mode will last for 2-month of 16 sessions in total, 2 sessions per wk and 60 min per session, hence, the total intervention will last for 4 months for two training modes or an integrated training format. Assessments will be conducted at pre-test, two post- training tests, and a 2-month follow-up test after completion of all training. The primary outcome measures in cognition include tests of execution and memory: Chinese nonverbal Stroop test, trail making test, Chinese Rey auditory learning test with a secondary measure of Montreal Cognitive Assessment (HK-MCoA). The outcome measures in physical fitness include chair stand, arm curl, 6-min walk, 8-feet up-&-go, and four square step test (for dynamic balance). Data analyses will be performed by mixed effects modeling