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Original Article

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

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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

Copyright © 2015 Korean Society of Adult Nursing

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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  • 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 –
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 –
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 –
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 –
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, –
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, –
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 –
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
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
n (%) or M±SD n (%) or M±SD
Gender Male 5 (25.0) 2 (11.1) 1.22 .249
Female 15 (75.0) 16 (88.9)
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
No 4 (20.0) 4 (22.2)
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
No 16 (80.0) 18 (100.0)
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
No 15 (75.0) 18 (100.0)
Dringking Yes 5 (25.0) 0 (0.0) 5.18 .031
No 15 (75.0) 18 (100.0)

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

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

    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 –
    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 –
    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 –
    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 –
    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, –
    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, –
    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 –
    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
    Strength exercise-Pull & push the thera band by leg

    Rest for 10min every 25 minutes

    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
    n (%) or M±SD n (%) or M±SD
    Gender Male 5 (25.0) 2 (11.1) 1.22 .249
    Female 15 (75.0) 16 (88.9)
    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
    No 4 (20.0) 4 (22.2)
    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
    No 16 (80.0) 18 (100.0)
    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
    No 15 (75.0) 18 (100.0)
    Dringking Yes 5 (25.0) 0 (0.0) 5.18 .031
    No 15 (75.0) 18 (100.0)

    †Multi-response.

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

    Variables Exp. (n=20) Cont. (n=18) t or U p
    M±SD M±SD
    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.

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

    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.
    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)

    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)

    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.

    Table 1.

    Table 2.

    Table 3.

    Table4.

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