The Effects of Exercise-Cognitive Combined Dual-Task Program on Cognitive Function and Depression in Elderly with Mild Cognitive Impairment

Kyoungah Kim; Oksoo Kim

doi:10.7475/kjan.2015.27.6.707

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The Effects of Exercise-Cognitive Combined Dual-Task Program on Cognitive Function and Depression in Elderly with Mild Cognitive Impairment

Kyoungah Kim¹, Oksoo Kim²

Korean Journal of Adult Nursing 2015;27(6):707-717.
Published online: December 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.6.707

¹Department of Nursing, Woosong University, Daejeon

²Division of Nursing Science, Collegeof Health Sciences, Ewha Womans University, Seoul, Korea

Corresponding author: Kim, Kyoungah Department of Nursing,Woosong University, 171 Dongdaejeon-ro, Dong-gu, Daejeon 300-718, Korea. Tel: +82-42-630-9297, Fax: +82-42-630-9299, E-mail: kamaria@wsu.ac.kr

• Received: October 1, 2015 • Accepted: December 12, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
This study was to develop and verify the effects of the exercise-cognitive combined dual-task training program on cognitive function and depression of the elderly with mild cognitive impairment (MCI).
Methods
A non-equivalent control group pretest-posttest design was used. The participants were assigned into two groups: an experimental group receiving an exercise-cognitive combined dual-task (n=20) and a control group receiving a simple-task (n=18). After 8 weeks of intervention (2 days per week), the change in depression and cognitive functions were compared between the groups.
Results
General cognitive function (t=-2.81, p=.011), frontal cognitive function (Z=-3.50, p .001), attention/working memory function (U=-2.91, p=.004), depression (t=4.96, p<001) of the experimental group were significantly increased than those of the control group.
Conclusion
The findings of the study showed that an exercise-cognitive combined dual-task program for MCI was effective in improving general cognitive function, frontal and executive function, attention/working memory function, and reducing depression.
Key Words: Mild cognitive impairment; Cognitive function; Depression; Dual-task program

Table 1.

The Exercise-Cognitive Combined Dual-Task Program

Session	Theme	Content	Min
1	Opening Cognitive stimulation	Introduction of program, Hand exercise & clapping	50
		Count the number (1 100, sequentially) →
		Naming of picture (ex. flowers) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, shoulder –
	Exercise	Strength exercise Pull the thera band by hand –
2	Opening Cognitive stimulation	Hand exercise & clapping	50
		Count the number (100 1, sequentially) →
		Naming of picture (ex. fruits) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, shoulder –
	Exercise	Strength exercise Pull the thera band by hand –
3	Opening Cognitive stimulation	Hand exercise & clapping	50
		Count the number (1 100, random) →
		Naming of picture (ex. animals) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, shoulder –
	Exercise	Strength exercise Pass the ball to the side –
4	Opening Cognitive stimulation	Hand exercise & clapping	50
		Count the number (100 1, random) →
		Naming of picture (ex.vegetables) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder –
	Exercise	Strength exercise-Pass the ball back & forth
5	Opening Cognitive stimulation	Hand exercise & clapping	50
		Calculation (addition, ones place)
		Naming backwards, find the common of each picture (ex, flowers)-match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder, –
	Exercise	Strength exercise Throw the ball –
6	Opening Cognitive stimulation	Hand exercise & clapping	50
		Calculation (addition, tens place)
		Naming backwards, find the common of each picture (ex, fruits) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder, –
	Exercise	Strength exercise Throw the ball –
7	Opening Cognitive stimulation	Hand exercise & clapping	50
		Calculation (subtraction, ones place)
		Naming backwards, find the common of each picture (ex. animals) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder, ankle, knee, walking motion –
	Exercise	Strength exercise Pull & push the thera band by leg –
8	Opening Cognitive stimulation	Hand exercise & clapping	e 50
		Calculation (subtraction, tens place)
		Naming backwards, find the common of each picture (ex. vegetables)-match/memorize
	Exercise	– Aerobic exercise Drawing of wrist, elbow, shoulder, ankle, knee, walking motion
	Exercise	Strength exercise-Pull & push the thera band by leg

Rest for 10min every 25 minutes

Table 2.

Homogeneity Test for General Characteristics and Outcome Variables between Two Groups (N=38)

Characteristics	Categories	Exp. (n=20)	Cont. (n=18)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	5 (25.0)	2 (11.1)	1.22	.249
Gender	Female	15 (75.0)	16 (88.9)	1.22	.249
Age (year)		76.40±6.41	74.89±6.94	0.70	.490
	64~69	4 (20.0)	6 (33.3)	3.71	.447
	70~74	2 (10.0)	3 (16.7)
	75~79	7 (35.0)	2 (11.1)
	80~84	5 (25.0)	6 (33.3)
	85 ≥	2 (10.0)	1 (5.6)
Religion	Yes	16 (80.0)	14 (77.8)	0.03	.589
Religion	No	4 (20.0)	4 (22.2)	0.03	.589
Education	Uneducated	3 (15.0)	1 (5.6)	2.50	.644
	Elementary school	12 (60.0)	9 (50.0)
	Middle school	3 (15.0)	6 (33.3)
	High school ≥	2 (10.0)	2 (11.1)
Spouse	Yes	4 (20.0)	0 (0.0)	5.18	.075
Spouse	No	16 (80.0)	18 (100.0)	5.18	.075
Disease^†	Cardiovascular	11 (55.5)	13 (72.2)	1.21	.224
	Endocrine	7 (35.0)	3 (16.7)	1.64	.181
	Neurology	2 (10.0)	2 (11.1)	0.01	.656
	Skelectomuscular	1 (5.0)	1 (5.6)	0.01	.730
	Other	2 (10.0)	3 (16.7)	0.37	.448
Activity/day	1 hr	16 (80.0)	17 (94.4)	1.93	.381
	2 hr	3 (15.0)	1 (5.6)
	3 ≥ hr	1 (5.0)	0 (0.0)
Smoking	Yes	5 (25.0)	0 (0.0)	5.18	.031
Smoking	No	15 (75.0)	18 (100.0)	5.18	.031
Dringking	Yes	5 (25.0)	0 (0.0)	5.18	.031
Dringking	No	15 (75.0)	18 (100.0)	5.18	.031

^†Multi-response.

Table 3.

Homogeneity Test on Outcome Variables between the Two Groups (N=38)

Variables	Exp. (n=20)	Cont. (n=18)	t or U	p
Variables	M±SD	M±SD	t or U	p
MMSE-K	25.70±2.25	26.22±2.13	0.73	.469
MOCA-K	16.50±3.47	14.33±3.77	0.00	.073
FAB	10.35±3.51	10.22±3.14	0.12	1.000
K-CWST	53.25±7.97	53.33±6.01	-1.22	.223
DSF	5.10±1.12	3.67±0.49	-4.34	.001 ＜
DSB	2.80±0.89	2.61±0.61	-0.45	.654
GDS-K	13.60±1.88	12.72±3.51	0.98	.336

Exp.=experimental group; Cont.=control group; MMSE-K=Mini-Mental Status Examination version of Korean; MoCA-K=The korean version of montreal cognitive assesment; FAB=Frontal assessment battery; K-CWST=Korean color word stroop test; DSF=Digit span forward; DSB=Digit span backward; GDS-K=The Korean version of geriatric depression scale.

Table4.

Effect of the Exercise-Cognitive CombinedDual-TaskProgramonDependent Variablesinthe Experimental Group and the Control Group (N=38)

Variables	Categories	Pretest (n=20)	Posttest (n=18)	t or Z (p)	Mean difference	t or U (p)
Variables	Categories	M±SD	M±SD	t or Z (p)	M±SD	t or U (p)
MOCA-K	Exp.	16.50±3.47	17.70±3.73	-2.81 (.011)	1.20±1.91	3.34 (.002)
MOCA-K	Cont.	14.33±3.77	14.39±3.99	-0.18 (.863)	0.06±1.35	3.34 (.002)
FAB	Exp.	10.35±3.51	11.05±3.53	-3.50 (.001) ＜	0.70±0.57	-2.99 (.003)
FAB	Cont.	10.22±3.14	10.56±3.11	-1.73 (.083)	0.17±0.38	-2.99 (.003)
K-CWST	Exp.	53.25±7.97	53.85±8.03	-1.58 (.114)	0.60±1.64	-0.42 (.673)
K-CWST	Cont.	53.33±6.01	53.67±5.36	-1.14 (.256)	0.44±1.34	-0.42 (.673)
DSF	Exp.	5.10±1.12	5.35±1.46	-1.67 (.096)	0.25±0.64	-2.91 (.004)
DSF	Cont.	3.67±0.49	3.28±0.57	-2.33 (.020)	-0.39±0.61	-2.91 (.004)
DSB	Exp.	2.80±0.89	2.85±1.18	-0.30 (.763)	0.05±0.76	-1.36 (.174)
DSB	Cont.	2.61±0.61	2.33±0.49	-1.89 (.059)	-0.28±0.58	-1.36 (.174)
GDS-K	Exp.	13.60±1.88	11.70±2.64	4.96 (.001) ＜	-1.80±1.64	0.34 (.002)
GDS-K	Cont.	12.72±3.51	13.17±3.62	-1.46 (.163)	-0.11±1.37	0.34 (.002)

Exp.=experimental group, Cont.=control group; MoCA-K=The korean version of montreal cognitive assesment; FAB=Frontal assessment battery K-CWST=Korean color word stroop test; DSF=Digit span forward; DSB=Digit span backward; GDS-K=The Korean version of geriatric depression scale.

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The Effects of Exercise-Cognitive Combined Dual-Task Program on Cognitive Function and Depression in Elderly with Mild Cognitive Impairment

Korean J Adult Nurs. 2015;27(6):707-717. Published online December 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.6.707

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The Effects of Exercise-Cognitive Combined Dual-Task Program on Cognitive Function and Depression in Elderly with Mild Cognitive Impairment

Korean J Adult Nurs. 2015;27(6):707-717. Published online December 31, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.6.707

The Effects of Exercise-Cognitive Combined Dual-Task Program on Cognitive Function and Depression in Elderly with Mild Cognitive Impairment

Table 1.

The Exercise-Cognitive Combined Dual-Task Program

Session	Theme	Content	Min
1	Opening Cognitive stimulation	Introduction of program, Hand exercise & clapping	50
		Count the number (1 100, sequentially) →
		Naming of picture (ex. flowers) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, shoulder –
	Exercise	Strength exercise Pull the thera band by hand –
2	Opening Cognitive stimulation	Hand exercise & clapping	50
		Count the number (100 1, sequentially) →
		Naming of picture (ex. fruits) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, shoulder –
	Exercise	Strength exercise Pull the thera band by hand –
3	Opening Cognitive stimulation	Hand exercise & clapping	50
		Count the number (1 100, random) →
		Naming of picture (ex. animals) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, shoulder –
	Exercise	Strength exercise Pass the ball to the side –
4	Opening Cognitive stimulation	Hand exercise & clapping	50
		Count the number (100 1, random) →
		Naming of picture (ex.vegetables) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder –
	Exercise	Strength exercise-Pass the ball back & forth
5	Opening Cognitive stimulation	Hand exercise & clapping	50
		Calculation (addition, ones place)
		Naming backwards, find the common of each picture (ex, flowers)-match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder, –
	Exercise	Strength exercise Throw the ball –
6	Opening Cognitive stimulation	Hand exercise & clapping	50
		Calculation (addition, tens place)
		Naming backwards, find the common of each picture (ex, fruits) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder, –
	Exercise	Strength exercise Throw the ball –
7	Opening Cognitive stimulation	Hand exercise & clapping	50
		Calculation (subtraction, ones place)
		Naming backwards, find the common of each picture (ex. animals) -match/memorize
	Exercise	Aerobic exercise Drawing of wrist, elbow, shoulder, ankle, knee, walking motion –
	Exercise	Strength exercise Pull & push the thera band by leg –
8	Opening Cognitive stimulation	Hand exercise & clapping	e 50
		Calculation (subtraction, tens place)
		Naming backwards, find the common of each picture (ex. vegetables)-match/memorize
	Exercise	– Aerobic exercise Drawing of wrist, elbow, shoulder, ankle, knee, walking motion
	Exercise	Strength exercise-Pull & push the thera band by leg

Rest for 10min every 25 minutes

Table 2.

Homogeneity Test for General Characteristics and Outcome Variables between Two Groups (N=38)

Characteristics	Categories	Exp. (n=20)	Cont. (n=18)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Gender	Male	5 (25.0)	2 (11.1)	1.22	.249
Gender	Female	15 (75.0)	16 (88.9)	1.22	.249
Age (year)		76.40±6.41	74.89±6.94	0.70	.490
	64~69	4 (20.0)	6 (33.3)	3.71	.447
	70~74	2 (10.0)	3 (16.7)
	75~79	7 (35.0)	2 (11.1)
	80~84	5 (25.0)	6 (33.3)
	85 ≥	2 (10.0)	1 (5.6)
Religion	Yes	16 (80.0)	14 (77.8)	0.03	.589
Religion	No	4 (20.0)	4 (22.2)	0.03	.589
Education	Uneducated	3 (15.0)	1 (5.6)	2.50	.644
	Elementary school	12 (60.0)	9 (50.0)
	Middle school	3 (15.0)	6 (33.3)
	High school ≥	2 (10.0)	2 (11.1)
Spouse	Yes	4 (20.0)	0 (0.0)	5.18	.075
Spouse	No	16 (80.0)	18 (100.0)	5.18	.075
Disease^†	Cardiovascular	11 (55.5)	13 (72.2)	1.21	.224
	Endocrine	7 (35.0)	3 (16.7)	1.64	.181
	Neurology	2 (10.0)	2 (11.1)	0.01	.656
	Skelectomuscular	1 (5.0)	1 (5.6)	0.01	.730
	Other	2 (10.0)	3 (16.7)	0.37	.448
Activity/day	1 hr	16 (80.0)	17 (94.4)	1.93	.381
	2 hr	3 (15.0)	1 (5.6)
	3 ≥ hr	1 (5.0)	0 (0.0)
Smoking	Yes	5 (25.0)	0 (0.0)	5.18	.031
Smoking	No	15 (75.0)	18 (100.0)	5.18	.031
Dringking	Yes	5 (25.0)	0 (0.0)	5.18	.031
Dringking	No	15 (75.0)	18 (100.0)	5.18	.031

^†Multi-response.

Table 3.

Homogeneity Test on Outcome Variables between the Two Groups (N=38)

Variables	Exp. (n=20)	Cont. (n=18)	t or U	p
Variables	M±SD	M±SD	t or U	p
MMSE-K	25.70±2.25	26.22±2.13	0.73	.469
MOCA-K	16.50±3.47	14.33±3.77	0.00	.073
FAB	10.35±3.51	10.22±3.14	0.12	1.000
K-CWST	53.25±7.97	53.33±6.01	-1.22	.223
DSF	5.10±1.12	3.67±0.49	-4.34	.001 ＜
DSB	2.80±0.89	2.61±0.61	-0.45	.654
GDS-K	13.60±1.88	12.72±3.51	0.98	.336

Table4.

Effect of the Exercise-Cognitive CombinedDual-TaskProgramonDependent Variablesinthe Experimental Group and the Control Group (N=38)

Variables	Categories	Pretest (n=20)	Posttest (n=18)	t or Z (p)	Mean difference	t or U (p)
Variables	Categories	M±SD	M±SD	t or Z (p)	M±SD	t or U (p)
MOCA-K	Exp.	16.50±3.47	17.70±3.73	-2.81 (.011)	1.20±1.91	3.34 (.002)
MOCA-K	Cont.	14.33±3.77	14.39±3.99	-0.18 (.863)	0.06±1.35	3.34 (.002)
FAB	Exp.	10.35±3.51	11.05±3.53	-3.50 (.001) ＜	0.70±0.57	-2.99 (.003)
FAB	Cont.	10.22±3.14	10.56±3.11	-1.73 (.083)	0.17±0.38	-2.99 (.003)
K-CWST	Exp.	53.25±7.97	53.85±8.03	-1.58 (.114)	0.60±1.64	-0.42 (.673)
K-CWST	Cont.	53.33±6.01	53.67±5.36	-1.14 (.256)	0.44±1.34	-0.42 (.673)
DSF	Exp.	5.10±1.12	5.35±1.46	-1.67 (.096)	0.25±0.64	-2.91 (.004)
DSF	Cont.	3.67±0.49	3.28±0.57	-2.33 (.020)	-0.39±0.61	-2.91 (.004)
DSB	Exp.	2.80±0.89	2.85±1.18	-0.30 (.763)	0.05±0.76	-1.36 (.174)
DSB	Cont.	2.61±0.61	2.33±0.49	-1.89 (.059)	-0.28±0.58	-1.36 (.174)
GDS-K	Exp.	13.60±1.88	11.70±2.64	4.96 (.001) ＜	-1.80±1.64	0.34 (.002)
GDS-K	Cont.	12.72±3.51	13.17±3.62	-1.46 (.163)	-0.11±1.37	0.34 (.002)

Table 1. The Exercise-Cognitive Combined Dual-Task Program

Rest for 10min every 25 minutes

Table 2. Homogeneity Test for General Characteristics and Outcome Variables between Two Groups (N=38)

†

Multi-response.

Table 3. Homogeneity Test on Outcome Variables between the Two Groups (N=38)

Table4. Effect of the Exercise-Cognitive CombinedDual-TaskProgramonDependent Variablesinthe Experimental Group and the Control Group (N=38)

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The Effects of Exercise-Cognitive Combined Dual-Task Program on Cognitive Function and Depression in Elderly with Mild Cognitive Impairment

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