Effects of Combining Physical and Cognitive Training on Older Adults’ Physical Performance and Functional Abilities: A Systematic Review

Xiao Yu, Tengku Fadilah Tengku Kamalden, Roxana Dev Omar Dev, Qais Gasibat, Babina Rani, Yuanliang Dai, Lixia Bao, Jiazhe Li


Background: The combination of physical and cognitive training effectively enhances the physical function of the elderly by preventing and reducing the incidence of falls as well as increasing independence in daily activities. However, the optimal combination of strategies to achieve the best physical performance and functional capacity in healthy elderly is still being explored. Objective: This study aimed to explore effective combinations to improve physical function. Methods: A comprehensive database search was done through Web of Science, Medline, Embase and PubMed, and was supplemented with Google scholar since September 2022. Titles and abstracts were used to search for keywords, and data were extracted using the Participants; Interventions; Comparisons, and Outcomes (PICO). Results: The 23 included studies recruited subjects aged 65 and older, comprising 872 females and 497 males, while some research did not identify the gender of 216 participants. Among the included studies, 16 were of high quality while 7 were of low quality. Ten studies showed a significant improvement in gait among older adults who underwent combined physical-cognitive training, while two studies found no positive effect on dual-task gait performance. All five studies showed a significant improvement in strength. Out of the four studies conducted, only one showed no improvement in endurance. All five studies showed improved mobility, while only one study found no effect on agility. However, eight out of the eleven papers showed a significant improvement in balance for older adults who underwent combined cognitive and physical training. The three papers that effectively reduced the fear of falling were also significant. Two studies showed that those who received combined training exhibited a significantly better quality of life compared to those who did not. Conclusion: Combined motor-cognitive training is an advanced, feasible and effective method that can promote the improvement of gait, balance and overall health in the elderly. This type of training has a more significant impact on the elderly’s fall response compared to general physical or cognitive training. Additionally, it contributes to promoting functional independence.


Combined Intervention, Dual-task Exercise, Cognitive Training, Physical Exercise, Older Adults, Physical Function

Full Text:



Adcock, M., Fankhauser, M., Post, J., Lutz, K., Zizlsperger, L., Luft, A. R., ... & de Bruin, E. D. (2020). Effects of an in-home multicomponent exergame training on physical functions, cognition, and brain volume of older adults: A randomized controlled trial. Frontiers in medicine, 6, 321. https://doi.org/10.3389/fmed.2019.00321

Alexander, N. B., & Hausdorff, J. M. (2008). Guest editorial: linking thinking, walking, and falling. The journals of gerontology. Series A, Biological sciences and medical sciences, 63(12), 1325–1328. https://doi.org/10.1093/gerona/63.12.1325

Amboni, M., Barone, P., & Hausdorff, J. M. (2013). Cognitive contributions to gait and falls: evidence and implications. Movement disorders, 28(11), 1520-1533. https://doi.org/10.1002/mds.25674

Bacha, J. M. R., Gomes, G. C. V., de Freitas, T. B., Viveiro, L. A. P., da Silva, K. G., Bueno, G. C., ... & Pompeu, J. E. (2018). Effects of kinect adventures games versus conventional physical therapy on postural control in elderlypeople: a randomized controlled trial. Games for health journal, 7(1), 24-36. https://doi.org/10.1089/g4h.2017.0065

Burns, P. B., Rohrich, R. J., and Chung, K. C. (2011). The levels of evidence and their role in evidence-based medicine. Plastic and Reconstructive Surgery, 128, 305–310. https://doi.org/10.1097/PRS.0b013e318219c171

Carvalho, G. F., Schwarz, A., Szikszay, T. M., Adamczyk, W. M., Bevilaqua-Grossi, D., & Luedtke, K. (2020). Physical therapy and migraine: musculoskeletal and balance dysfunctions and their relevance for clinical practice. Brazilian journal of physical therapy, 24(4), 306-317. https://doi.org/10.1016/j.bjpt.2019.11.001

Chen, Y., Zhang, Y., Guo, Z., Bao, D., & Zhou, J. (2021). Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta analysis. Journal of neuroengineering and rehabilitation, 18(1), 1-17. https://doi.org/10.1186/s12984-021-00917-0

Cheng, Y. C., Kuo, Y. C., Chang, P. C., Li, Y. C., Huang, W. T., Chen, W., & Chou, C. Y. (2021). Geriatric functional impairment using the integrated care for older people (ICOPE) approach in community-dwelling elderly and its association with dyslipidemia. Vascular Health and Risk Management, 389-394. https://doi.org/10.2147/VHRM.S305490

De Morton, N. A. (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Australian Journal of Physiotherapy, 55(2), 129-133. https://doi.org/10.1016/s0004-9514(09)70043-1

de Oliveira, V. M. A., Pirauá, A. L. T., Cavalcante, B. R., Beltrão, N. B., de Farias, W. M., Pitangui, A. C. R., & de Araújo, R. C. (2020). Additional Functional Performance Gains After 24-Week Unstable Strength Training With Cognitive Training in Community-Dwelling Healthy Older Adults: A Randomized Trial. Journal of Aging and Physical Activity, 29(3), 412-422. https://doi.org/10.1123/japa.2020-0050

Desjardins-Crépeau, L., Berryman, N., Fraser, S. A., Vu, T. T. M., Kergoat, M. J., Li, K. Z., ... & Bherer, L. (2016). Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults. Clinical interventions in aging, 1287-1299. https://doi.org/10.2147/cia.s115711

Eggenberger, P., Theill, N., Holenstein, S., Schumacher, V., & de Bruin, E. D. (2015). Multicomponent physical exercise with simultaneous cognitive training to enhance dual-task walking of older adults: a secondary analysis of a 6-month randomized controlled trial with 1-year follow-up. Clinical interventions in aging, 1711-1732. https://doi.org/ 10.2147/CIA.S91997

Falbo, S., Condello, G., Capranica, L., Forte, R., & Pesce, C. (2016). Effects of physical cognitive dual task training on executive function and gait performance in older adults: a randomized controlled trial. BioMed research international, 2016. https://doi.org/10.1155/2016/5812092

Fraser, S. A., Li, K. Z. H., Berryman, N., Desjardins-Crépeau, L., Lussier, M., Vadaga, K., ... & Bherer, L. (2017). Does combined physical and cognitive training improve dual-task balance and gait outcomes in sedentary older adults?. Frontiers in human neuroscience, 10, 688. https://doi.org/10.3389/fnhum.2016.00688

Gale, C. R., Cooper, C., & Aihie Sayer, A. (2016). Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing. Age and ageing, 45(6), 789-794. https://doi.org/10.1093/ageing/afw129

Gavelin, H. M., Dong, C., Minkov, R., Bahar-Fuchs, A., Ellis, K. A., Lautenschlager, N. T., ... & Lampit, A. (2021). Combined physical and cognitive training for older adults with and without cognitive impairment: A systematic review and network meta-analysis of randomized controlled trials. Ageing research reviews, 66, 101232. https://doi.org/10.1016/j.arr.2020.101232

Gill, T. M., Pahor, M., Guralnik, J. M., McDermott, M. M., King, A. C., Buford, T. W., ... & Miller, M. E. (2016). Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial (LIFE Study). bmj, 352. https://doi.org/10.1136/bmj.i245

Guo, W., Zang, M., Klich, S., Kawczyński, A., Smoter, M., & Wang, B. (2020). Effect of combined physical and cognitive interventions on executive functions in older adults: A meta-analysis of outcomes. International Journal of Environmental Research and Public Health, 17(17), 6166. https://doi.org/10.3390/ijerph17176166

Haripriya, S., Kumar, D., Samuel, S. E., & Soman, A. (2018). Effect of a Multi-Component Exercise Program on Functional Mobility, Exercise Capacity and Quality of Life in Older Adults. Journal of Clinical & Diagnostic Research, 12(7). https://doi.org/10.7860/JCDR/2018/30986.11782

Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., ... & Bauman, A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081. https://doi.org/10.1249/mss.0b013e3180616b27

Heisz, J. J., Clark, I. B., Bonin, K., Paolucci, E. M., Michalski, B., Becker, S., & Fahnestock, M. (2017). The effects of physical exercise and cognitive training on memory and neurotrophic factors. Journal of cognitive neuroscience, 29(11), 1895-1907. https://doi.org/10.1162/jocn_a_01164

Htut, T. Z. C., Hiengkaew, V., Jalayondeja, C., & Vongsirinavarat, M. (2018). Effects of physical, virtual reality-based, and brain exercise on physical, cognition, and preference in older persons: a randomized controlled trial. European Review of Aging and Physical Activity, 15(1), 1-12. https://doi.org/10.1186/s11556-018-0199-5

Hwang, N. K., Choi, J. B., Choi, D. K., Park, J. M., Hong, C. W., Park, J. S., & Yoon, T. H. (2021, June). Effects of Semi-Immersive Virtual Reality-Based Cognitive Training Combined with Locomotor Activity on Cognitive Function and Gait Ability in Community-Dwelling Older Adults. In Healthcare (Vol. 9, No. 7, p. 814). MDPI. https://doi.org/10.3390/healthcare9070814

Jadczak, A. D., Makwana, N., Luscombe-Marsh, N., Visvanathan, R., & Schultz, T. J. (2018). Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews. JBI Evidence Synthesis, 16(3), 752-775. https://doi.org/10.11124/JBISRIR-2017-003551

Jardim, N. Y. V., Bento-Torres, N. V. O., Costa, V. O., Carvalho, J. P. R., Pontes, H. T. S., Tomás, A. M., ... & Diniz, C. W. P. (2021). Dual-task exercise to improve cognition and functional capacity of healthy older adults. Frontiers in Aging Neuroscience, 13, 589299. https://doi.org/10.3389/fnagi.2021.589299

Jia, H., Lubetkin, E. I., DeMichele, K., Stark, D. S., Zack, M. M., & Thompson, W. W. (2019). Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the US. Preventive medicine, 126, 105737. https://doi.org/10.1016/j.ypmed.2019.05.025

Joubert, C., & Chainay, H. (2018). Aging brain: the effect of combined cognitive and physical training on cognition as compared to cognitive and physical training alone–a systematic review. Clinical interventions in aging, 1267-1301. https://doi.org/10.2147/CIA.S165399

Kao, C. C., Chiu, H. L., Liu, D., Chan, P. T., Tseng, J., Chen, R., ... & Chou, K. R. (2018). Effect of interactive cognitive motor training on gait and balance among older adults: a randomized controlled trial. International journal of nursing studies, 82, 121-128. https://doi.org/10.1016/j.ijnurstu.2018.03.015

Karssemeijer, E. E., Aaronson, J. J., Bossers, W. W., Smits, T. T., & Kessels, R. R. (2017). Positive effects of combined cognitive and physical exercise training on cognitive function in older adults with mild cognitive impairment or dementia: A meta-analysis. Ageing research reviews, 40, 75-83. https://doi.org/10.1016/j.arr.2017.09.003

Kitazawa, K., Showa, S., Hiraoka, A., Fushiki, Y., Sakauchi, H., & Mori, M. (2015). Effect of a dual-task net-step exercise on cognitive and gait function in older adults. Journal of geriatric physical therapy, 38(3), 133-140. https://doi.org/10.1519/JPT.0000000000000029

Laatar, R., Kachouri, H., Borji, R., Rebai, H., & Sahli, S. (2018). Combined physical-cognitive training enhances postural performances during daily life tasks in older adults. Experimental gerontology, 107, 91-97. https://doi.org/10.1016/j.exger.2017.09.004

Lauenroth, A., Ioannidis, A. E., & Teichmann, B. (2016). Influence of combined physical and cognitive training on cognition: a systematic review. BMC geriatrics, 16, 1-14. https://doi.org/10.1186/s12877-016-0315-1

Law, L. L., Barnett, F., Yau, M. K., & Gray, M. A. (2014). Effects of combined cognitive and exercise interventions on cognition in older adults with and without cognitive impairment: a systematic review. Ageing research reviews, 15, 61-75. https://doi.org/10.1016/j.arr.2014.02.008

Levin, O., Netz, Y., & Ziv, G. (2017). The beneficial effects of different types of exercise interventions on motor and cognitive functions in older age: a systematic review. European Review of Aging and Physical Activity, 14(1), 1-23. https://doi.org/10.1186/s11556-017-0189-z

Li, X., Niksirat, K. S., Chen, S., Weng, D., Sarcar, S., & Ren, X. (2020). The impact of a multitasking-based virtual reality motion video game on the cognitive and physical abilities of older adults. Sustainability, 12(21), 9106. https://doi.org/10.3390/su12219106

Lord, S. R., Menz, H. B., & Tiedemann, A. (2003). A physiological profile approach to falls risk assessment and prevention. Physical therapy, 83(3), 237-252. https://doi.org/10.1093/ptj/83.3.237

Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy, 83(8), 713-721. https://doi.org/10.1093/ptj/83.8.713

Molina, K. I., Ricci, N. A., de Moraes, S. A., & Perracini, M. R. (2014). Virtual reality using games for improving physical functioning in older adults: a systematic review. Journal of neuroengineering and rehabilitation, 11(1), 1-20. https://doi.org/10.1186/1743-0003-11-156

Montero-Odasso, M., Oteng-Amoako, A., Speechley, M., Gopaul, K., Beauchet, O., Annweiler, C., & Muir-Hunter, S. W. (2014). The motor signature of mild cognitive impairment: results from the gait and brain study. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 69(11), 1415-1421. https://doi.org/10.1093/gerona/glu155

Norouzi, E., Vaezmosavi, M., Gerber, M., Pühse, U., & Brand, S. (2019). Dual-task training on cognition and resistance training improved both balance and working memory in older people. The Physician and sportsmedicine, 47(4), 471-478.

Párraga-Montilla, J. A., Aibar-Almazán, A., Cabrera-Linares, J. C., Lozano-Aguilera, E., Serrano Huete, V., Escarabajal Arrieta, M. D., & Latorre-Román, P. Á. (2021). A randomized controlled trial protocol to test the efficacy of a dual-task multicomponent exercise program vs. A simple program on cognitive and fitness performance in elderly people. International Journal of Environmental Research and Public Health, 18(12), 6507. https://doi.org/10.3390/ijerph18126507

Peng, H. T., Tien, C. W., Lin, P. S., Peng, H. Y., & Song, C. Y. (2020). Novel mat exergaming to improve the physical performance, cognitive function, and dual-task walking and decrease the fall risk of community-dwelling older adults. Frontiers in psychology, 11, 1620. https://doi.org/10.3389/fpsyg.2020.01620

Pichierri, G., Murer, K., & de Bruin, E. D. (2012). A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial. BMC geriatrics, 12(1), 1-14. https://doi.org/10.1186/1471-2318-12-74

Piotrowska, J., Guszkowska, M., Leś, A., & Rutkowska, I. (2020). Changes in the static balance of older women participating in regular nordic walking sessions and nordic walking combined with cognitive training. International journal of environmental research and public health, 17(15), 5617. https://doi.org/10.3390/ijerph17155617

Plummer, P., Zukowski, L. A., Giuliani, C., Hall, A. M., & Zurakowski, D. (2015). Effects of physical exercise interventions on gait-related dual-task interference in older adults: a systematic review and meta-analysis. Gerontology, 62(1), 94-117. https://doi.org/10.1159/000371577

Pothier, K., Gagnon, C., Fraser, S. A., Lussier, M., Desjardins-Crépeau, L., Berryman, N., ... & Bherer, L. (2018). A comparison of the impact of physical exercise, cognitive training and combined intervention on spontaneous walking speed in older adults. Aging clinical and experimental research, 30, 921-925. https://doi.org/10.1007/s40520-017-0878-5

Raichlen, D. A., Bharadwaj, P. K., Nguyen, L. A., Franchetti, M. K., Zigman, E. K., Solorio, A. R., & Alexander, G. E. (2020). Effects of simultaneous cognitive and aerobic exercise training on dual-task walking performance in healthy older adults: results from a pilot randomized controlled trial. BMC geriatrics, 20(1), 1-10. https://doi.org/10.1186/s12877-020-1484-5

Ruscheweyh, R., Willemer, C., Krüger, K., Duning, T., Warnecke, T., Sommer, J., ... & Flöel, A. (2011). Physical activity and memory functions: an interventional study. Neurobiology of aging, 32(7), 1304-1319. https://doi.org/10.1016/j.neurobiolaging.2009.08.001

Schättin, A., Arner, R., Gennaro, F., & de Bruin, E. D. (2016). Adaptations of prefrontal brain activity, executive functions, and gait in healthy elderly following exergame and balance training: a randomized-controlled study. Frontiers in aging neuroscience, 8, 278. https://doi.org/10.3389/fnagi.2016.00278

Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., ... & Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British journal of sports medicine, 51(24), 1750-1758. https://doi.org/10.1136/bjsports-2016-096547

Sipilä, S., Tirkkonen, A., Savikangas, T., Hänninen, T., Laukkanen, P., Alen, M., ... & Törmäkangas, T. (2021). Effects of physical and cognitive training on gait speed and cognition in older adults: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 31(7), 1518-1533. https://doi.org/10.1111/sms.13960

Stillman, C. M., Esteban-Cornejo, I., Brown, B., Bender, C. M., & Erickson, K. I. (2020). Effects of exercise on brain and cognition across age groups and health states. Trends in neurosciences, 43(7), 533-543. https://doi.org/10.1016/j.tins.2020.04.010

Studenski, S., Perera, S., Patel, K., Rosano, C., Faulkner, K., Inzitari, M., ... & Guralnik, J. (2011). Gait speed and survival in older adults. Jama, 305(1), 50-58. https://doi.org/10.1001/jama.2010.1923

Theill, N., Schumacher, V., Adelsberger, R., Martin, M., & Jäncke, L. (2013). Effects of simultaneously performed cognitive and physical training in older adults. BMC neuroscience, 14(1), 1-14. https://doi.org/10.1186/1471-2202-14-103

van Het Reve, E., & de Bruin, E. D. (2014). Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC geriatrics, 14(1), 1-15. https://doi.org/10.1186/1471-2318-14-134

Viana, R. B., de Oliveira, V. N., Dankel, S. J., Loenneke, J. P., Abe, T., da Silva, W. F., ... & de Lira, C. A. B. (2021). The effects of exergames on muscle strength: A systematic review and meta‐analysis. Scandinavian Journal of Medicine & Science in Sports, 31(8), 1592-1611. https://doi.org/10.1111/sms.13964

Wang, Y. H., Liu, Y. H., Yang, Y. R., & Wang, R. Y. (2021). Effects of square-stepping exercise on motor and cognitive function in older adults—A systematic review and meta-analysis. Geriatric Nursing, 42(6), 1583-1593. https://doi.org/10.1016/j.gerinurse.2021.10.022

Wongcharoen, S., Sungkarat, S., Munkhetvit, P., Lugade, V., & Silsupadol, P. (2017). Home-based interventions improve trained, but not novel, dual-task balance performance in older adults: A randomized controlled trial. Gait & posture, 52, 147-152. https://doi.org/10.1016/j.gaitpost.2016.11.036

World Health Organization (2021). Falls. World Health Organization. Available online at: https://www.who.int/newsroom/fact-sheets/detail/falls# (accessed December 26, 2021).

Yang, C. C., & Hsu, Y. L. (2010). A review of accelerometry-based wearable motion detectors for physical activity monitoring. Sensors, 10(8), 7772-7788. https://doi.org/10.3390/s100807772

DOI: https://doi.org/10.7575/aiac.ijkss.v.11n.2p.35


  • There are currently no refbacks.

License URL: https://creativecommons.org/licenses/by/4.0/

2013-2023 (CC-BY) Australian International Academic Centre PTY.LTD.

International Journal of Kinesiology and Sports Science

You may require to add the 'aiac.org.au' domain to your e-mail 'safe list’ If you do not receive e-mail in your 'inbox'. Otherwise, you may check your 'Spam mail' or 'junk mail' folders.