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The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults.
JAMA Intern Med. 2013 May 13; 173(9):797-804.JIM

Abstract

IMPORTANCE

The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in relatively small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects.

OBJECTIVE

To examine the combined effects of physical plus mental activity on cognitive function in older adults.

DESIGN

Randomized controlled trial with a factorial design.

SETTING

San Francisco, California.

PARTICIPANTS

A total of 126 inactive, community-residing older adults with cognitive complaints.

INTERVENTIONS

All participants engaged in home-based mental activity (1 h/d, 3 d/wk) plus class-based physical activity (1 h/d, 3 d/wk) for 12 weeks and were randomized to either mental activity intervention (MA-I; intensive computer) or mental activity control (MA-C; educational DVDs) plus exercise intervention (EX-I; aerobic) or exercise control (EX-C; stretching and toning); a 2 × 2 factorial design was used so that there were 4 groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1, and MA-C/EX-C.

MAIN OUTCOME MEASURES

Global cognitive change based on a comprehensive neuropsychological test battery.

RESULTS

Participants had a mean age of 73.4 years; 62.7% were women, and 34.9% were Hispanic or nonwhite. There were no significant differences between the groups at baseline. Global cognitive scores improved significantly over time (mean, 0.16 SD; P < .001) but did not differ between groups in the comparison between MA-I and MA-C (ignoring exercise, P = .17), the comparison between EX-I and EX-C (ignoring mental activity, P = .74), or across all 4 randomization groups (P = .26).

CONCLUSIONS AND RELEVANCE

In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function with no evidence of difference between intervention and active control groups. These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject population.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00522899.

Authors+Show Affiliations

Department of Psychiatry, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. deborah.barnes@ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23545598

Citation

Barnes, Deborah E., et al. "The Mental Activity and eXercise (MAX) Trial: a Randomized Controlled Trial to Enhance Cognitive Function in Older Adults." JAMA Internal Medicine, vol. 173, no. 9, 2013, pp. 797-804.
Barnes DE, Santos-Modesitt W, Poelke G, et al. The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA Intern Med. 2013;173(9):797-804.
Barnes, D. E., Santos-Modesitt, W., Poelke, G., Kramer, A. F., Castro, C., Middleton, L. E., & Yaffe, K. (2013). The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA Internal Medicine, 173(9), 797-804. https://doi.org/10.1001/jamainternmed.2013.189
Barnes DE, et al. The Mental Activity and eXercise (MAX) Trial: a Randomized Controlled Trial to Enhance Cognitive Function in Older Adults. JAMA Intern Med. 2013 May 13;173(9):797-804. PubMed PMID: 23545598.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. AU - Barnes,Deborah E, AU - Santos-Modesitt,Wendy, AU - Poelke,Gina, AU - Kramer,Arthur F, AU - Castro,Cynthia, AU - Middleton,Laura E, AU - Yaffe,Kristine, PY - 2013/4/3/entrez PY - 2013/4/3/pubmed PY - 2013/7/17/medline SP - 797 EP - 804 JF - JAMA internal medicine JO - JAMA Intern Med VL - 173 IS - 9 N2 - IMPORTANCE: The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in relatively small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects. OBJECTIVE: To examine the combined effects of physical plus mental activity on cognitive function in older adults. DESIGN: Randomized controlled trial with a factorial design. SETTING: San Francisco, California. PARTICIPANTS: A total of 126 inactive, community-residing older adults with cognitive complaints. INTERVENTIONS: All participants engaged in home-based mental activity (1 h/d, 3 d/wk) plus class-based physical activity (1 h/d, 3 d/wk) for 12 weeks and were randomized to either mental activity intervention (MA-I; intensive computer) or mental activity control (MA-C; educational DVDs) plus exercise intervention (EX-I; aerobic) or exercise control (EX-C; stretching and toning); a 2 × 2 factorial design was used so that there were 4 groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1, and MA-C/EX-C. MAIN OUTCOME MEASURES: Global cognitive change based on a comprehensive neuropsychological test battery. RESULTS: Participants had a mean age of 73.4 years; 62.7% were women, and 34.9% were Hispanic or nonwhite. There were no significant differences between the groups at baseline. Global cognitive scores improved significantly over time (mean, 0.16 SD; P < .001) but did not differ between groups in the comparison between MA-I and MA-C (ignoring exercise, P = .17), the comparison between EX-I and EX-C (ignoring mental activity, P = .74), or across all 4 randomization groups (P = .26). CONCLUSIONS AND RELEVANCE: In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function with no evidence of difference between intervention and active control groups. These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject population. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00522899. SN - 2168-6114 UR - https://www.unboundmedicine.com/medline/citation/23545598/The_Mental_Activity_and_eXercise__MAX__trial:_a_randomized_controlled_trial_to_enhance_cognitive_function_in_older_adults_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2013.189 DB - PRIME DP - Unbound Medicine ER -