This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on https://aging.jmir.org, as well as this copyright and license information must be included.
A healthy lifestyle can be an important prerequisite to prevent or at least delay the onset of dementia. However, the large number of physically inactive adults underscores the need for developing and evaluating intervention approaches aimed at improving adherence to a physically active lifestyle. In this regard, hybrid physical training, which usually combines center- and home-based physical exercise sessions and has proven successful in rehabilitative settings, could offer a promising approach to preserving cognitive health in the aging population. Despite its potential, research in this area is limited as hybrid physical training interventions have been underused in promoting healthy cognitive aging. Furthermore, the absence of a universally accepted definition or a classification framework for hybrid physical training interventions poses a challenge to future progress in this direction. To address this gap, this article informs the reader about hybrid physical training by providing a definition and classification approach of different types, discussing their specific advantages and disadvantages, and offering recommendations for future research. Specifically, we focus on applying digital technologies to deliver home-based exercises, as their use holds significant potential for reaching underserved and marginalized groups, such as older adults with mobility impairments living in rural areas.
Dementia is a brain disease that is characterized by an acquired loss of cognitive abilities in different domains which is sufficiently severe to interfere with both activities of daily living and the ability of an individual to live independently [1,2]. As a result, individuals affected by dementia cause high health care expenditures [3-6]. Given the expected worldwide rise in dementia cases from 57.4 million cases in 2019 to 152.8 million cases in 2050 [7], it seems reasonable to assume that the already relatively high health care–related expenditures for dementia (ie, US $1313.4 in 2019 [3]) will dramatically increase in the upcoming years. Thus, preventing dementia should be a priority of public health actions [8,9]. Based on the evidence that the individual dementia risk is substantially influenced by several lifestyle factors (eg, regular engagement in physical activity), a positive modification of these is important to lower the global prevalence and, in turn, the societal and economic costs of dementia [3,8,9]. This assumption is reinforced by the fact that the effectiveness of pharmacological interventions to treat dementia is limited [10,11]. Although lifestyle-related interventions (eg, targeting physical activity, sedentary behavior, diet, or sleep) can be effective and implemented along the entire continuum of dementia [9,12-14], preventive approaches should focus on healthy middle-aged and older adults, and preclinical stages of dementia including adults at-risk (eg, adults with subjective cognitive decline [SCD], mild cognitive impairment [MCI], or with the motoric cognitive risk syndrome [MCR]) [9,15-20] to avoid that cognitive impairment and neurodegenerative changes of the central nervous system become too serious which, in turn, might negatively influence adherence and increase the cost of the implementation of the intervention. At-risk groups for dementia comprise, among others, adults with SCD who have a self-reported or informant-reported worsening of cognitive performance (especially memory) but normal performance on specific clinical cognitive tests [21,22], adults with MCI who have objective cognitive deficits determined by a clinical cognitive test battery [23-25], and adults with MCR who have subjective cognitive complaints and a slow gait speed [17,20,26-28]. SCD, MCI, and MCR are preclinical stages of dementia that are unrelated to an acute event, do not interfere with activities of daily living, and thus allow the individual to live independently [17,20,21,24-27]. Current estimates suggest that worldwide 315 million individuals aged 50 years or older are in a preclinical stage of dementia [29] emphasizing the pressing need to develop and implement appropriate intervention strategies to prevent or at least delay the onset of dementia in the general and at-risk populations.
In the literature, there is some evidence showing that among other factors such as sedentary behavior, sleep, and diet, especially regular physical activity including planned and structured forms such as physical exercise and physical training [6,30-35] can be an important factor to preserve cognitive functions [36-44] and to prevent or at least delay the onset of dementia in older adults [6,9,45,46] although future high-quality randomized controlled trials (RCTs) are required to further substantiate the evidence in this direction [47,48]. Hence, the high prevalence of physical inactivity among the general adult population [6,49] which increases with age [50-52] and low cognitive status [53], necessitates the development of new, more efficient, and sustainable intervention approaches to preserve and maintain cognitive health across the life span, especially in adults-at-risk to develop dementia (eg, adults with MCI) [9,16].
Concerning new approaches to support healthy cognitive aging, there is the opinion in the literature that using digital technologies is a promising and cost-saving option that can support healthy aging in place (eg, by providing lifestyle interventions) [54-56]. In this context, digital technologies can be a valuable instrument to remotely assess and monitor changes in cognitive health [57-63] and to facilitate positive lifestyle changes [57,63-65] by fostering a higher level of regular physical activity (eg, via wearable physical activity trackers [66,67] or via apps or online classes to remotely deliver home-based exercise sessions [64]), which is especially relevant for adults living in rural and remote areas [64,68-71].
Digital technologies can be applied in a wide range of contexts and in recent years they have become a popular instrument for delivering physical exercises and physical training to the general population [64,72-75]. For instance, in center-based exercise sessions, the application of digital technologies encompasses but, is not limited to (1) monitoring and controlling exercise intensity (eg, via wearables recording heart rate) [76-78], or (2) delivering specific physical exercises (eg, via exergames [79-81] or videoconference-based online classes, in which the exercise professional is remotely connected to the groups of trainees being located in a center [82]). However, digital technologies provide also several advantages making them extremely well-situated for delivering home-based exercise sessions. This assumption is supported by the latest editions of the Worldwide Survey of Fitness Trends revealing that digital applications such as wearable technologies, online training, and mobile exercise apps are among the top 20 fitness trends in recent years [72-75]. More specifically, the Worldwide Survey of Fitness Trends also showed that exercising at home is the number 2 trend for 2022 [73] probably due to the consequences of the COVID-19 pandemic (eg, home confinement). Even from a more general point of view, exercising at home provides some benefits for older adults (eg, no need to commute to a training facility) because home-based approaches can help to circumvent frequently mentioned barriers to engaging in planned and structured forms of physical activity (eg, the lack of opportunity or transport [83-86]).
Compared with traditional options, the use of digital technologies can be a promising alternative (1) to remotely recruit and assess a large number of (diverse) participants (eg, in decentralized trials instead of centralized trials) [87], and (2) to deliver home-based interventions (eg, via video capsules instead of booklets) [64]. In particular, remotely delivered home-based interventions via digital technologies can provide several advantages such as better visualization of exercises or gamification (eg, exergames) as compared with nondigital solutions (eg, booklets) [64]. Thus, digital technologies can play an important role in reducing inequalities arising from various reasons (eg, living in a rural area without a driving license) which, in turn, might contribute to increased robustness of the findings of the trials because of the inclusion of larger and more diverse samples of older adults at-risk or with cognitive impairment [87-91]. Further empirical data supporting our claims have been published recently [90-93]. However, using digital technologies and home-based interventions does not come without limitations [87,94]. For instance, home-based physical exercise sessions provided via digital technologies are typically associated with lower levels of supervision, and social interaction (ie, social support and relatedness such as the feelings of belonging to a group) [95] although the level of supervision and social interaction depends on the type of digital technology used for that purpose [64]. Given that the social factors are important for adhering to an intervention [96], the unique characteristics of different types of digital technologies being used for delivering home-based physical exercises should be considered when designing and implementing future trials [87] and suggest that establishing a classification framework to improve the structuring of knowledge is required (eg, as started in [64]) to better inform the application in practical settings.
Since factors such as supervision, social support, and relatedness can be more easily promoted in center-based physical exercise sessions (eg, in clinical settings) because of the interaction with health professionals (eg, certified trainers, physiotherapists) and peers, several studies have combined both center-based physical exercise sessions and home-based physical exercise sessions. For instance, especially in rehabilitative settings such as cardiac rehabilitation [97-99] or orthopedic rehabilitation (eg, hip or knee osteoarthritis [100]) interventions that combine center- and home-based physical exercise sessions are widely used. Such interventions are typically referred to as hybrid. With regard to healthy cognitive aging, hybrid physical training interventions have been somewhat neglected [64] but have been highlighted as a promising option for future studies (eg, for older adults at risk or with cognitive impairment) [87]. Moreover, neither a generally accepted definition nor a classification framework for hybrid physical training interventions is available. As such a classification framework allows for better structuring of knowledge and might foster research in the field of healthy cognitive aging (eg, by increasing the awareness of research in which different types of hybrid physical training interventions exist), this article aims to inform the reader about this intervention approach by providing a definition and classification approach of hybrid physical training and by narratively summarizing the current state of the literature. In accordance with the literature [31-35,101], we use in the forthcoming sections of this article the term “physical training” to refer to chronic forms of planned and structured forms of physical activity. Furthermore, we focus on hybrid physical training approaches that use digital technologies for delivering home-based exercises because their application holds great potential to reach needy but underserved and marginalized groups (eg, older adults with mobility impairments living in rural areas). The latter is related to the facts (1) that reaching and including such cohorts is highly relevant from a public health perspective given the paucity of research in this direction and the existing rural health disparities [68-71,102], and (2) that research in this direction will improve our understanding of whether the effects of physical training on cognitive health typically observed in laboratory setting extend to ecologically valid settings (eg, community-dwelling older adults living in rural areas) for which the evidence base is currently relatively scant [103].
Hybrid Physical Training: A Definition and Classification ApproachOverview
Hybrid interventions have been recently highlighted as a promising option to improve health-related outcomes, especially in rehabilitation settings [87,98,100,104] but, to the best of our knowledge, neither a generally accepted definition nor a classification approach exists. To address this issue and avoid ambiguity which can be a major source of difficulty in scientific communication, we define the term “hybrid physical training” as an intervention that combines center-based physical exercise sessions, that is, conducted in a clinical setting (eg, health care facility) or community setting (eg, local gym) [105] and home-based physical exercise sessions, that is, undertaken inside or within the immediate vicinity of the home (eg, apartment, park) [100,104,105].
To derive a classification approach for different types of hybrid physical training interventions, we orient on recommendations on constructing, conducting, and analyzing physical interventions [105,106] and recent literature in this field [64,107]. In this context, we propose that hybrid physical training interventions can be differentiated based on (1) temporal characteristics, that is, how the center-based exercise sessions and home-based physical exercise sessions are combined, and (2) specific intervention-related characteristics, that is, how center-based physical exercise sessions and home-based physical exercise sessions are delivered.
Temporal Characteristics
Concerning the temporal characteristics, we propose that hybrid physical training can be differentiated as (1) alternating hybrid physical training interventions, and (2) subsequent hybrid physical training interventions (Figures 1A and 1B). First, in alternating hybrid physical training interventions, center-based physical exercise sessions are alternated with home-based physical exercise sessions. While this alternation provides, on the one hand, the advantage that the participant has frequent contact with health professionals and peers fostering higher levels of supervision and social interaction (ie, especially in center-based physical exercise sessions) that might positively influence compliance and adherence to the intervention [108], it is, on the other hand, a clear disadvantage because it demands the participants to commute to attend the center-based physical exercise sessions. However, the alternating hybrid physical training can also unburden the participants because it reduces the number of travels (eg, 1 travel per week if there are 2 sessions per week) and thus allows for a higher frequency (eg, 2 exercise sessions instead of 1 per week), which has been linked to larger improvements of cognitive performance in adults aged 50 years or older [44]. Second, in subsequent hybrid physical training interventions, a phase of center-based exercise sessions is followed by a phase of home-based exercise sessions (Figure 1B). This type of intervention can be further divided into (1) subsequent hybrid physical training interventions with alternating follow-up or (2) subsequent hybrid physical training interventions with home-based follow-up. The advantages and disadvantages of subsequent hybrid physical training interventions strongly depend on the type of follow-up (Figure 1B) and the implementation of the home-based physical exercise sessions (Figure 2B). For instance, subsequent hybrid training interventions with alternating follow-up can enable relatively high levels of supervision and social interactions due to frequent contact with health professionals and peers during the center-based physical exercise sessions. On the downside, to attend center-based physical exercise sessions, the participants are obliged to commute to the training facility, which is in some studies mentioned as a barrier, especially by older women [84]. A home-based follow-up offers the advantage that the participants are not obliged to commute to the training facility but comes at the cost of lower levels of supervision (eg, by the health professional) and limited social interactions (ie, with peers) during the home-based physical exercise sessions in the follow-up, although the latter can be influenced by the implementation (eg, higher levels of supervision and social interaction may be achievable via online classes [64]; Figure 2B).
Overview of possible temporal organizations of hybrid physical training interventions which can be divided into (A) alternating hybrid physical training interventions and (B) subsequent hybrid physical training interventions.
Overview by which means (A) center-based physical exercise sessions and (B) home-based physical exercise sessions can be delivered.
Specific Intervention-Related Characteristics
Based on a recent systematic review of our group, in which we propose a classification approach for digital- and home-based physical training interventions [64], we used the type of interaction and the level of supervision to differentiate between different types of hybrid physical training interventions.
Before we discuss the different types of hybrid physical training interventions and their strengths and limitations in more detail, we provide the reader with a brief description of the different types of interaction and the different levels of supervision.
Regarding the type of interaction, one can distinguish between asynchronous interaction and synchronous interaction. Synchronous interaction refers to an interaction that occurs in real-time, whereas asynchronous interaction refers to a decoupled interaction (eg, at different times) [64,109-113]. Thus, a synchronous interaction allows for the immediate exchange of information (eg, immediate feedback on specific exercises—direct supervision) but is limited concerning time flexibility [64,109]. Vice versa, asynchronous interaction provides the advantage of on-demand information exchange at the convenience of the participating parties but bears—as a consequence of the decoupled communication—the risk that specific information is not received on time (eg, short-term adjustment of a physical exercise session due to quality of exercise execution or acute pain of the trainee is difficult) [64,109].
Regarding supervision, one can distinguish between direct supervision (ie, each exercise session is monitored by a health professional or digitally via sensors allowing for immediate feedback on exercise execution), general supervision (ie, no direct supervision of each exercise session but regular in-person or web-based contact with a health professional to support the trainee; also referred to as “facilitated”), and no supervision (ie, the trainee has no direct contact with a health professional throughout the intervention period; also referred to as “unsupervised”) [64,105]. In general, there is some evidence suggesting that higher levels of supervision (ie, direct supervision) can facilitate adherence to physical training interventions [96,114,115] although, on the downside, higher levels of direct supervision can increase the cost of the intervention (ie, to pay the health professional who supervises the physical exercise sessions) and lower the time flexibility (ie, as result of the synchronous interaction) [96].
As shown in Figure 2A, center-based exercise sessions are typically supervised and are based on synchronous interactions with health professionals and other peers. In addition, center-based exercise sessions can be conducted individually or in a group. Individual meetings provide the advantage that a high level of individualization can be achieved because of close contact with the health professional. In individual meetings, the social interaction with peers, in contrast, to exercise classes, might be somewhat limited. In this context, it is worth noting that in older adults’ social factors such as loneliness are associated with worse cognitive functioning [116-119] and increased risk of dementia [8,120-123]. Furthermore, in a cross-sectional study of older adults with MCI, a higher level of perceived loneliness was observed as compared with age-, sex-, and education-matched controls with slightly less pronounced cognitive deficits [124]. In addition, social factors are also important promotors for regular engagement in specific forms of physical training (eg, sports) [84,125-127] and long-term adherence to interventions [96,128]. Accordingly, promoting social participation (eg, via group-based physical training), especially in at-risk cohorts for dementia (eg, older adults with MCI), seems to be an important factor for fostering adherence to physical training interventions [96,128], preventing cognitive decline, and potentially reducing the risk of dementia [129]. Indeed, there is evidence that in healthy older adults’ group-based physical training interventions can counteract social isolation and loneliness [130,131]. Moreover, there is evidence from cross-sectional studies that older adults who exercise alone and exercise with others (eg, team or partner sports activities) showed better cognitive performance and have a lower risk of cognitive impairment, but that exercising with others is slightly more beneficial than exercising alone [132-134] even after adjusting for important influencing factors (eg, accelerometer-derived physical activity or time spent for other social engagements [133]). Based on these findings, group-based physical training, which can lead to a higher level of social interaction (ie, with peers) and perhaps trigger specific psychosocial-related changes [133] on multiple levels of analysis [129,135-137], might provide some additional benefits to preserve cognitive health as compared with exercising alone or without peers (eg, individual meetings).
The level of social interaction (eg, with peers) depends, among other factors, on the type of digital technology that is used to deliver the home-based physical exercise sessions. As shown in Figure 2B, home-based physical exercise sessions can be broadly categorized based on the instruments being used to deliver and prescribe the physical exercises—namely digital and nondigital solutions.
Nondigital Solutions to Deliver Home-Based Physical Exercise Sessions
We propose that nondigital solutions can be divided into two different types: (1) the term “home visits” refers to physical training interventions in which the health professional provides the physical training at the participant’s home. Although home visits ensure a high level of individualization because of the direct supervision (ie, synchronous interaction), they are relatively costly as the health professional provides 1:1 supervision and needs to commute to the participant’s home [96]; and (2) the term “print-based materials” characterize interventions in which the exercise and training prescription is provided via nondigital solutions such as booklets. This type of intervention provides the advantage that it can be disseminated on a broad scale even in low-resource settings (eg, with limited access to digital technologies). Owing to the asynchronous interaction, this intervention type is, in general, unsupervised, and thus it cannot be controlled for a proper exercise execution [64].
Digital Solutions to Deliver Home-Based Physical Exercise Sessions
In general, digital solutions, as compared with nondigital solutions, can be less costly (ie, online communication in comparison to home visits), allow for better visualization of how the exercises should be conducted (ie, by video instructions which provide more appropriate exercise execution cues than print-based material), allow clinician-based digital care to replace or complement traditional in-person visits in a health care center due to synchronous video or audio visits, and potentially allow for a “gamification” of exercise programs (ie, in comparison to print-based materials) [64]. For instance, there is some evidence that “gamification” can positively influence the promotion of physical activity [138,139]. Because of the aforementioned advantages especially digital solutions to deliver home-based exercise sessions within a hybrid physical training intervention seem to be a promising approach to facilitate the implementation and improve the effectiveness of such an intervention program. In the following, we will discuss in more detail the different types of digital solutions to deliver home-based physical training using a classification approach that has been previously proposed by our group [64]. For a more comprehensive overview of the physical exercise and training characteristics and effectiveness of digital and home-based physical training interventions to improve cognitive functions, we refer the interested reader to a recent systematic review of our group [64].
First, the term “digital databases” comprises digital and home-based physical training interventions that rely on the storage of the exercise prescriptions (eg, via video capsules) on specific digital media platforms (eg, smartphone or tablet-based apps) [64] and thus, can be considered as the digital alternative to print-based materials (eg, booklets). This type of digital and home-based physical training provides the advantage that it can be delivered to a relatively large number of individuals and allows for on-demand training based on asynchronous interaction [64]. A drawback of asynchronous interaction, the inherent feature of digital databases, typically no direct supervision of the single exercise sessions during the home-based training exists [64]. Concerning the implementation of digital databases to support healthy cognitive aging, different digital platforms or applications such as YouTube video capsules [140,141], DVDs [142,143], and tablet-based [144-147] or smartphone-based app [148] have so far been used to deliver a wide range of different types of physical exercises (eg, endurance, resistance, flexibility, or coordinative exercise such balance, or dancing exercises) to diverse cohorts including healthy-middle-aged and older adults [141] or middle-aged and older adults with MCI [144], cardiovascular disorders [140], or Parkinson disease [147,148]. Given that hand-eye coordination, visual acuity, and mental acuity are frequently reported barriers to the use of digital health technologies in older adults [149], commercially available devices with voice-controlled intelligent personal assistants (eg, Amazon Alexa) can be a promising alternative to remotely delivering physical exercises because the voice control helps older adults to access the exercise instructions more easily. Indeed, several small-scale studies (n=15) showed that applying voice-controlled digital solutions to remotely deliver physical exercise instruction and feedback is feasible in older adults [150-152] and is associated with high completion adherence (ie, 100%) and attendance adherence rates (ie, 115% of the prescribed exercise sessions) [152]. Thus, investigating the cognitive health effects of remotely delivered physical training, which uses devices with voice-controlled intelligent personal assistants (eg, Amazon Alexa), seems to be a promising area for further investigation.
Second, the term “online classes” refers to digital and home-based physical training interventions that are characterized by a synchronous and remote interaction of the trainees with the health professional via videoconference software [64]. Hence, it can be considered as some kind of digital alternative to home visits, typically used to supervise a single trainee or a group of trainees who exercise individually at their homes. In this context, it is worth noting that online classes can be delivered via static videoconferencing (eg, PC with camera) or dynamic videoconference (eg, via a mobile telepresence robot [MTR]) [153,154]. MTRs are typically wheeled devices that are remotely controlled by the operator (eg, exercise professional) and which allows them to be present through the robotic embodiment at remote locations, move throughout the environment, and interact with persons (eg, trainee) in the environment by 2-way audio-visual communication [154,155]. Using MTRs to deliver online classes provides the advantage of superior mobility that enables the remote controller (ie, exercise professional) to change the point of view (eg, when the trainee leaves the field of view of the camera) and thus allows for better direct supervision of single trainees or the direct supervision of several trainees exercising as a group at the same location (eg, gym in a retirement home) as compared with static videoconferencing [153,154]. While online classes provide a relatively high level of direct supervision, they are, on the downside, limited with regard to the number of trainees (eg, to ensure an appropriate level of direct supervision) and time flexibility (ie, because of fixed time schedules) [64]. In intervention studies that implement physical training via online classes (ie, static videoconference) to support healthy cognitive aging, different types of directly supervised physical exercises including endurance exercises such as cycling [156], resistance exercises [157], chair-based motor-cognitive exercises [158], or Tai Ji Quan [159] were remotely delivered to healthy older adults [157] or older adults with SCD [156], MCI [159], and Alzheimer disease [158]. In future studies, dynamic videoconference solutions using MTR could be a promising alternative to static videoconference because of their specific advantages over static videoconferencing (eg, the opportunity to change the point of view by moving the robot), and the findings (1) that older adults found MTRs useful, easy to use, and pleasant for remote supervision of physical exercises [153] and (2) that MTRs can be as effective as face-to-face interaction with an exercise professional to learn a new motor cognitive task within a single session [154]. Although these findings are encouraging, future long-term studies are needed to substantiate the evidence on the applicability of MTRs to deliver and supervise physical exercise sessions before they can be unreservedly recommended.
Third, the term “technology-based exercise devices” covers a wide range of instruments that can be used to remind individuals to be physically active (eg, just-in-time adaptive physical activity interventions using real-life data of wearables such as smartwatches or smartphones to provide real-time recommendations for opportunities to be physically active [160-162]) or that are used to conduct physical exercises (eg, virtual reality–enhanced stationary ergometer [163-166]) [64]. Such technology-based exercise devices include but are not limited to exergames. The term “exergames” (ie, also referred to as active video games or gamercizing) is a portmanteau consisting of the terms “physical exercise” and “gaming” [167] and refers to technology-driven physical activities in a gaming environment requiring participants to become physically active to play the game [168-170]. Technology-based exercise devices offer the advantage that they allow for on-demand training, but the level of direct supervision is constrained by the implementation of technical features (eg, integration of different sensors or camera-based information allowing for the assessment of behavioral, physiological, and kinematic data) [64]. In this regard, technology-based exercise devices fulfill the criteria of asynchronous interaction (eg, can be used on-demand) and synchronous interaction (ie, can provide immediate feedback to the user through integrated sensors or camera-based information), although the latter strongly depends on the technological features of the device [64]. Studies aiming to support healthy cognitive aging via technology-based exercise devices typically used specifically designed step-based exergames [171-178] or cycling-based exergames [163-166] in older adults with different health statuses (eg, in healthy older adults [171-175,178], older adults with Parkinson disease [163,164,176], multiple sclerosis [177], or MCI [165,166]), whereas the application of other technology-based exercise devices (eg, wearables such as activity trackers) is less common [64]. Given (1) that wearables (eg, activity trackers) can increase the level of regular physical activity [66,67] and (2) that physical activity is an important factor for preserving cognitive performance [36-44] and lowering dementia risk in older adults [6,9,45,46], wearables (eg, to deliver just-in-time adaptive physical activity interventions [160-162]) may hold some promise to support healthy cognitive aging, although they have so far been underused to prescribe and monitor physical activity in the context of healthy cognitive aging [64].
In summary, we proposed a classification framework and provided definitions for different types of nondigital and digital solutions to remotely deliver home-based physical exercise sessions that can guide future research in the field of healthy cognitive aging. In this context, we wish to acknowledge that in practical and research settings different nondigital and digital solutions (eg, home visits and online classes), different nondigital solutions (eg, home visits and booklet [179]), or different digital solutions (eg, digital database and online classes [180,181]) can be combined to deliver home-based physical exercises but we intentionally refrained from discussing or visualizing all possible combinations (Figure 2) for reasons of clarity and comprehensibility.
Challenges of Implementing Hybrid Physical Training Interventions Using Digital Technologies to Deliver Physical Exercise Sessions Remotely
Digital technologies provide several advantages when they are used to remotely deliver physical exercise sessions (see Digital Solutions to Deliver Home-Based Physical Exercise Sessions section) [64]. However, the use of digital technologies in older adults without and with cognitive impairment is also associated with some challenges including but not limited to (1) infrastructural- and device-related factors (eg, absence of stable internet coverage and unequal availability of digital technology or devices in rural or socioeconomically deprived areas), and (2) user-related factors (eg, digital literacy, privacy concerns, perceived usefulness and ease of use of the digital application, support of the social network) [57,94,150,182-188]. In this context, there is, on the one hand, some evidence that older adults with cognitive complaints or decline and who did not regularly use a computer show a lower engagement in a digital intervention aiming to reduce dementia risk through lifestyle changes [189]. On the other hand, several studies provided evidence that digital technologies can be successfully used to remotely deliver physical exercise sessions in diverse cohorts [64] including healthy older adults [142,143,145,171-175,190-192], older adults with MCI [144,159,180] and SCD [146], and even older adults with dementia [193,194]. Although the latter evidence clearly supports the feasibility of such approaches, future studies aiming to implement hybrid physical training interventions by using digital technologies to remotely deliver home-based exercise sessions should consider (1) infrastructural prerequisites (eg, in the absence of a stable internet coverage the application of digital databases instead of online classes to remotely deliver physical exercise sessions) and (2) use a user-centered and participatory approach when designing and tailoring the intervention to the specific needs of older users (eg, group-based physical training to ensure higher levels of social interaction) [57,65,70,91,92,195]. In addition, from a theoretical point of view and compared with a fully remote implementation, hybrid physical training interventions (ie, with alternating center- and home-based physical exercise sessions) provide the advantage that the regular social interaction between health professional, trainee, and peers during the center-based physical exercise sessions might lead to the development of a social network that allows to more easily overcome barriers or difficulties emerging from the use of digital technologies to remotely deliver the home-based physical exercise sessions. For instance, the possibility of receiving social and technological support, if needed, by the health professional and peers during center visits might foster the implementation and adherence to hybrid physical training interventions as compared with fully remote interventions which are characterized by somewhat looser social interactions. This assumption is supported by the fact that the lack of support is often named as a barrier to the use of digital technologies by older adults without and with cognitive impairment [182,185], although future empirical studies are needed to verify (or refute) our idea that such a lack of technological support can be reduced by hybrid physical training interventions.
Another important point that needs to be considered when providing home-based physical training with and without digital solutions is safety. In general, there is evidence that home-based physical training interventions are safe [196] even when using digital solutions [64] or when conducted in vulnerable cohorts such as adults with cardiac diseases [197,198]. In this context, the findings of a recent systematic review and meta-analysis provide evidence that there is no difference in safety-related measures (eg, dropouts) between home- and center-based physical training [196] buttressing the assumption that home-based physical training is a safe alternative to center-based physical training. However, intuitively we suggest that a higher level of direct supervision (eg, online classes) should be used to further minimize the risk of negative health events in vulnerable groups (eg, older adults with chronic diseases and high risk of falls). However, future research studying the influence of different moderators on safety outcomes (eg, level of supervision, specific setting, and trainees’ characteristics such as age and health status) is needed to provide evidence-based and more nuanced recommendations in terms of the safety of remotely delivered and home-based physical training.
Current State of Evidence on Hybrid Physical Training Interventions to Support Healthy Cognitive AgingOverview
Hybrid physical training is a novel and promising form of delivering physical training to support healthy cognitive aging and thus the evidence of its effectiveness is, as far as we know, relatively scant [64] because only a small quantity of trials has been conducted to study the effects of hybrid physical training approaches on cognitive performance [190,199,200]. The characteristics and findings of these studies will be briefly summarized in the following.
Alternating Hybrid Physical Training
In the RCT of Auerswald et al [190] the effect of a 10-week hybrid physical training in alternating mode (Figure 1A) on different health-related outcomes (ie, including cognition) was investigated in a larger sample of healthy older adults (n=551, included in the final statistical analysis). The participants were randomly allocated to a waitlist control group (CG), an intervention group 1 (IG1) that received physical exercise prescription via print-based material or digital database, or an intervention group 2 (IG2) that received physical exercise prescription via digital database and also used a wearable (ie, physical activity tracker) [190]. The physical exercise prescription for the home-based program was individualized based on the individual fitness level of the participants and follows the recommendations of the World Health Organization for regular physical activity in adults [6,201,202] (eg, balance and flexibility exercise 2 times per week, resistance exercises at 2 nonconsecutive days per week, and endurance exercise for at least 150 minutes with moderate intensity) [190]. In IG1 and IG2, the home-based physical exercises were complemented by once-weekly center-based group meetings in which health education and group-based physical exercise sessions were performed [190]. In IG2, the wearable was used to provide the participants with objective feedback on the regular physical activity level [190]. Although the participants in the IG2 and CG showed better executive functions (ie, faster reaction time in the Simon task) in the posttest compared with the pretest, no significant group differences regarding cognitive performance were observed between CG, IG1, and IG2 [190].
Moon et al [200] conducted a 24-week-long RCT in older adults with one or more modifiable dementia risk factors, but no manifest dementia [200]. The participants (n=140, included in the final statistical analysis) were randomized to a CG (ie, receiving general health education), or 1 of 2 multimodal IGs (eg, including elements such as monitoring and management of metabolic and vascular risk factors, cognitive training and social activity, physical exercise, nutritional guidance, and motivational enhancement) that received 3 times a week a 60-minute session of only supervised center-based physical training or alternating hybrid physical training (Figure 1A). The unsupervised home-based physical exercise sessions consisted of endurance, resistance, flexibility, balance, and finger-and-toe exercises that were delivered via booklets or videos (ie, digital database) [200]. In the first 2 months, the hybrid physical training group performed 1 supervised group- and center-based physical exercise session per week (ie, 2 physical exercise sessions per week at home); whereas in the remaining 4 months, 1 supervised group- and center-based physical exercise session was conducted every 2 weeks (ie, 2 home-based physical exercise sessions in a week with a center visit and 3 home-based physical exercise sessions in a week without a center visit) [200]. Regarding cognitive outcomes, the hybrid physical training group showed (1) a better performance in visuoconstruction, attention, and total scale index score in the Repeatable Battery for the Assessment of Neuropsychological Status, and (2) a better score in the Prospective Retrospective Memory Questionnaire (ie, both as compared with the CG) [200].
Subsequent Hybrid Physical Training With Home-Based Follow-Up
In the randomized controlled pilot study of Wiebking et al [199], which can be classified as subsequent hybrid physical training with home-based follow-up (Figure 1B), a 12-week long intervention (ie, 3 weeks center-based and 9 weeks home-based; 3 exercise sessions per week each lasting 30-40 minutes) was conducted in a small sample (n=21, included in the final statistical analysis) of middle-aged adults with chronic unspecific low-back pain. The participants were randomly allocated to the CG receiving usual care, a unimodal intervention group receiving sensorimotor training (SMT) consisting of stability and resistance exercises, and a multidisciplinary intervention group receiving sensorimotor training supplemented by behavioral therapy (SMT+BT) that includes cognitive distraction during sensorimotor exercises, psychoeducation, and a body scan [199]. The center-based physical exercise sessions were group-based and directly supervised by an exercise professional, whereas the home-based physical exercise sessions were delivered via a digital database (ie, DVD) [199]. Concerning cognitive measures, a faster processing speed (ie, assessed via Trail Making Test A) was observed after the intervention and at the 3-month follow-up only in the SMT+BT group but not in the SMT or the CG group [199].
Interim Summary
Collectively, the findings of the aforementioned studies suggest that hybrid physical training is a promising approach to fostering healthy cognitive aging. However, the limited number of trials that have studied the effect of hybrid physical training on cognitive performance in the aging population does not allow for drawing more nuanced conclusions (eg, which type of hybrid physical training is most suitable for a specific context and setting). Thus, future research is needed to derive more robust and nuanced conclusions on the effectiveness of specific types of hybrid physical training to support healthy cognitive aging. In this context, our classification framework of hybrid physical training interventions provides researchers with an orientation that can help them to (1) structure findings and knowledge and (2) elucidate which type of hybrid physical training is most suitable for the specific context and setting. In prompting the direction of future research, we provide in the next section recommendations for research priorities concerning hybrid physical training and healthy cognitive aging.
Recommendations for Future Research
Considering the facts that (1) hybrid physical training interventions, especially those that use digital solutions to provide home-based physical exercise sessions, have been underused to promote planned and structured forms of physical activity in healthy middle-aged and older adults and adults at higher risk to develop dementia (eg, adults with MCI) [64] and (2) hybrid physical training provides some specific advantages depending on their implementation (see Interim Summary section for a detailed discussion), we recommend that future research should aim to answer the following research questions:
Do the positive effects of physical training on cognitive health and dementia risk, as seen for traditional physical training intervention approaches, extend to hybrid physical training interventions?
Is the potential effectiveness of hybrid physical training interventions influenced by their implementation (eg, temporal and intervention-related characteristics)?
Do hybrid physical training interventions, as compared with traditional physical training approaches, improve measures of adherence?
Are hybrid physical training interventions using digital technology feasible, safe, and effective in special populations with lower digital health literacy (eg, older adults with MCI)?
In the context of the aforementioned research questions, we propose that future studies should especially focus on, but are not limited to, measures of cognitive performance (eg, global cognition and memory), dementia-related risk factors and biomarkers (eg, blood-based parameters), ability to live independently (eg, activities of daily living, life-space mobility), adherence (eg, attendance and completion adherence [64,203,204]), social interaction (eg, social isolation, social connectedness), and cost use. To get a more comprehensive understanding of the neurobiological mechanisms that drive the positive effects of physical activity on cognitive health and to gain a deeper understanding of how physical training interventions can be effectively tailored to fit the individual needs of healthy middle-aged and older adults, and older adults with existing health conditions (eg, MCI), future studies should (1) use a rigorous study design [205-207] including a transparent reporting of the intervention-related characteristics [34,35,106,208], (2) conduct analysis on multiple levels (ie, level 1: changes on a molecular and cellular level, level 2: functional and structural brain changes, and level 3: socioemotional changes) [36,38,64], and (3) consider potential moderators such as sex or genetic status [209-213].
Conclusions
Hybrid physical training interventions, which consist of both center-based physical exercise sessions and home-based physical exercise sessions, can be a promising option to better tailor physical training-based approaches aiming to promote healthy cognitive aging to the individual needs of a person because they combine the strengths of a center-based approach (eg, supervision and social contact) and a home-based approach (eg, on-demand training), which, in turn, may increase the efficacy of such a form of intervention. To advance research in this direction, this article (1) provides a definition of hybrid physical training, (2) proposes a classification approach of different types of hybrid physical training interventions, (3) discusses the specific advantages and disadvantages of the different types of hybrid physical training interventions, and (4) provides recommendations for future research on hybrid physical training interventions in the context of healthy cognitive aging.
AbbreviationsCG
control group
IG1
intervention group 1
IG2
intervention group 2
MCI
mild cognitive impairment
MCR
motoric cognitive risk syndrome
MTR
mobile telepresence robot
RCT
randomized controlled trial
SCD
subjective cognitive decline
SMT
sensorimotor training
SMT+BT
sensorimotor training supplemented by behavioral therapy
The open access costs were funded by the Open Access Fund of the University of Potsdam provided by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)—Projektnummer 491466077. The funder had no role in the preparation of the manuscript or the decision to publish.
FH was responsible for the conceptualization, writing the original draft, and visualization. PT, TG, NK, LZ, EDB, LB, and NGM reviewed and edited the original draft. TG and NGM provided supervision, with NGM also contributing resources. All authors read and approved the final manuscript.
None declared.
MajMSartoriusNDementia2000Chichester, United KingdomWileyArvanitakisZShahRCBennettDADiagnosis and management of dementia: reviewJAMA2019322161589159910.1001/jama.2019.4782316386862753376PMC7462122WimoASeeherKCataldiRCyhlarovaEDielemannJLFrisellOGuerchetMJönssonLMalahaAKNicholsEPedrozaPPrinceMKnappMDuaTThe worldwide costs of dementia in 2019Alzheimers Dement20231972865287310.1002/alz.1290136617519Cantarero-PrietoDLeonPLBlazquez-FernandezCJuanPSCoboCSThe economic cost of dementia: a systematic reviewDementia20191982637265710.1177/147130121983777630909718MeijerECasanovaMKimHLlena-NozalALeeJEconomic costs of dementia in 11 countries in Europe: estimates from nationally representative cohorts of a panel studyLancet Reg Health Eur20222010044510.1016/j.lanepe.2022.10044535781926S2666-7762(22)00139-9PMC9241060Global status report on physical activity 2022World Health Organization20222024-06-19https://www.who.int/publications/i/item/9789240059153NicholsESteinmetzJDVollsetSEFukutakiKChalekJAbd-AllahFAbdoliAAbualhasanAAbu-GharbiehEAkramTTAl HamadHAlahdabFAlaneziFMAlipourVAlmustanyirSAmuHAnsariIArablooJAshrafTAstell-BurtTAyanoGAyuso-MateosJLBaigAABarnettABarrowABauneBTBéjotYBezabheWMMBezabihYMBhagavathulaASBhaskarSBhattacharyyaKBijaniABiswasABollaSRBoloorABrayneCBrennerHBurkartKBurnsRACámeraLACaoCCarvalhoFCastro-de-AraujoLFSCatalá-LópezFCerinEChavanPPCherbuinNChuDCostaVMCoutoRASDadrasODaiXDandonaLDandonaRDe la Cruz-GóngoraVDhamnetiyaDDias da SilvaDDiazDDouiriAEdvardssonDEkholuenetaleMEl SayedIEl-JaafarySIEskandariKEskandariehSEsmaeilnejadSFaresJFaroAFarooqueUFeiginVLFengXFereshtehnejadSFernandesEFerraraPFilipIFillitHFischerFGaidhaneSGalluzzoLGhashghaeeAGhithNGialluisiAGilaniSAGlavanIGnedovskayaEVGolechhaMGuptaRGuptaVBGuptaVKHaiderMRHallBJHamidiSHanifAHankeyGJHaqueSHartonoRKHasaballahAIHasanMTHassanAHaySIHayatKHegazyMIHeidariGHeidari-SoureshjaniRHerteliuCHousehMHussainRHwangBIacovielloLIavicoliIIlesanmiOSIlicIMIlicMDIrvaniSSNIsoHIwagamiMJabbarinejadRJacobLJainVJayapalSKJayawardenaRJhaRPJonasJBJosephNKalaniRKandelAKandelHKarchAKasaASKassieGMKeshavarzPKhanMAKhatibMNKhojaTAMKhubchandaniJKimMSKimYJKisaAKisaSKivimäkiMKoroshetzWJKoyanagiAKumarGAKumarMLakHMLeonardiMLiBLimSSLiuXLiuYLogroscinoGLorkowskiSLucchettiGLutzky SauteRMagnaniFGMalikAAMassanoJMehndirattaMMMenezesRGMeretojaAMohajerBMohamed IbrahimNMohammadYMohammedAMokdadAHMondelloSMoniMAAMoniruzzamanMMossieTBNagelGNaveedMNayakVCNeupane KandelSNguyenTHOanceaBOtstavnovNOtstavnovSSOwolabiMOPanda-JonasSPashazadeh KanFPasovicMPatelUKPathakMPeresMFPPerianayagamAPetersonCBPhillipsMRPinheiroMPiradovMAPondCDPotashmanMHPottooFHPradaSIRadfarARaggiARahimFRahmanMRamPRanasinghePRawafDLRawafSRezaeiNRezapourARobinsonSRRomoliMRoshandelGSahathevanRSahebkarASahraianMASathianBSattinDSawhneyMSaylanMSchiavolinSSeylaniAShaFShaikhMAShajiKShannawazMShettyJKShigematsuMShinJIShiriRSilvaDASSilvaJPSilvaRSinghJASkryabinVYSkryabinaAASmithAESoshnikovSSpurlockEESteinDJSunJTabarés-SeisdedosRThakurBTimalsinaBTovani-PaloneMRTranBXTsegayeGWValadan TahbazSValdezPRVenketasubramanianNVlassovVVuGTVuLGWangYWimoAWinklerASYadavLYahyazadeh JabbariSHYamagishiKYangLYanoYYonemotoNYuCYunusaIZadeySZastrozhinMSZastrozhinaAZhangZJMurrayCJLVosTEstimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the global burden of disease study 2019Lancet Public Health202272e105e12510.1016/S2468-2667(21)00249-834998485S2468-2667(21)00249-8PMC8810394LivingstonGHuntleyJSommerladAAmesDBallardCBanerjeeSBrayneCBurnsACohen-MansfieldJCooperCCostafredaSGDiasAFoxNGitlinLNHowardRKalesHCKivimäkiMLarsonEBOgunniyiAOrgetaVRitchieKRockwoodKSampsonELSamusQSchneiderLSSelbækGTeriLMukadamNDementia prevention, intervention, and care: 2020 report of the Lancet commissionLancet20203961024841344610.1016/s0140-6736(20)30367-632738937KivipeltoMMangialascheFNganduTLifestyle interventions to prevent cognitive impairment, dementia and Alzheimer diseaseNat Rev Neurol2018141165366610.1038/s41582-018-0070-33029131710.1038/s41582-018-0070-3RingmanJMCummingsJLCurrent and emerging pharmacological treatment options for dementiaBehav Neurol200617151610.1155/2006/315386CummingsJLMorstorfTZhongKAlzheimer’s disease drug-development pipeline: few candidates, frequent failuresAlzheimers Res Ther2014643710.1186/alzrt26925024750alzrt269PMC4095696AltyJFarrowMLawlerKExercise and dementia preventionPract Neurol202020323424010.1136/practneurol-2019-00233531964800practneurol-2019-002335GrootCHooghiemstraAMRaijmakersPGHMvan BerckelBNMScheltensPScherderEJAvan der FlierWMOssenkoppeleRThe effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trialsAgeing Res Rev201625132310.1016/j.arr.2015.11.00526607411S1568-1637(15)30034-9ZouLHeroldFChevalBWheelerMJPindusDMEricksonKIRaichlenDAAlexanderGEMüllerNGDunstanDWKramerAFHillmanCHHallgrenMEkelundUMaltagliatiSOwenNSedentary behavior and lifespan brain healthTrends Cogn Sci202428436938210.1016/j.tics.2024.02.00338431428S1364-6613(24)00030-5De la RosaAOlaso-GonzalezGArc-ChagnaudCMillanFSalvador-PascualAGarcía-LucergaCBlasco-LafargaCGarcia-DominguezECarreteroACorreasAGViñaJGomez-CabreraMCPhysical exercise in the prevention and treatment of Alzheimer's diseaseJ Sport Health Sci20209539440410.1016/j.jshs.2020.01.004RichardEAndrieuSSolomonAMangialascheFAhtiluotoSvan CharanteEPMColeyNFratiglioniLNeelyASVellasBvan GoolWAKivipeltoMMethodological challenges in designing dementia prevention trials—the European Dementia Prevention Initiative (EDPI)J Neurol Sci20123221-2647010.1016/j.jns.2012.06.01222818266S0022-510X(12)00320-6TheobaldPHeroldFGronwaldTMüllerNGMotoric cognitive risk syndrome—setting the course for dementia prevention?Nervenarzt2023941094495010.1007/s00115-023-01487-33714060610.1007/s00115-023-01487-3PMC10575804MullinDSGaddDRussTCLucianoMMuniz-TerreraGMotoric cognitive risk syndrome trajectories and incident dementia over 10 yearsCereb Circ Cogn Behav2023510017810.1016/j.cccb.2023.100178VergheseJMotoric cognitive risk syndrome: next stepsEur J Neurol20212882467246810.1111/ene.1494934057808VergheseJAyersEBarzilaiNBennettDABuchmanASHoltzerRKatzMJLiptonRBWangCMotoric cognitive risk syndrome: multicenter incidence studyNeurology201483242278228410.1212/WNL.000000000000108425361778WNL.0000000000001084PMC4277675JessenFAmariglioREvan BoxtelMBretelerMCeccaldiMChételatGDuboisBDufouilCEllisKAvan der FlierWMGlodzikLvan HartenACde LeonMJMcHughPMielkeMMMolinuevoJLMosconiLOsorioRSPerrotinAPetersenRCRabinLARamiLReisbergBRentzDMSachdevPSde la SayetteVSaykinAJScheltensPShulmanMBSlavinMJSperlingRAStewartRUspenskayaOVellasBVisserPJWagnerMA conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's diseaseAlzheimers Dement201410684485210.1016/j.jalz.2014.01.00124798886S1552-5260(14)00002-8PMC4317324JessenFAmariglioREBuckleyRFvan der FlierWMHanYMolinuevoJLRabinLRentzDMRodriguez-GomezOSaykinAJSikkesSAMSmartCMWolfsgruberSWagnerMThe characterisation of subjective cognitive declineLancet Neurol202019327127810.1016/S1474-4422(19)30368-031958406S1474-4422(19)30368-0PMC7062546GauthierSReisbergBZaudigMPetersenRCRitchieKBroichKBellevilleSBrodatyHBennettDChertkowHCummingsJLde LeonMFeldmanHGanguliMHampelHScheltensPTierneyMCWhitehousePWinbladBMild cognitive impairmentLancet200636795181262127010.1016/S0140-6736(06)68542-5WinbladBPalmerKKivipeltoMJelicVFratiglioniLWahlundLNordbergABäckmanLAlbertMAlmkvistOAraiHBasunHBlennowKDe LeonMDeCarliCErkinjunttiTGiacobiniEGraffCHardyJJackCJormARitchieKVan DuijnCVisserPPetersenRCMild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on mild cognitive impairmentJ Intern Med2004256324024610.1111/j.1365-2796.2004.01380.x15324367JIM1380PetersenRCSmithGEWaringSCIvnikRJTangalosEGKokmenEMild cognitive impairment: clinical characterization and outcomeArch Neurol199956330330810.1001/archneur.56.3.30310190820MullinDSCockburnAWelsteadMLucianoMRussTCMuniz‐TerreraGMechanisms of motoric cognitive risk—hypotheses based on a systematic review and meta‐analysis of longitudinal cohort studies of older adultsAlzheimers Dement202218122413242710.1002/alz.1254735142038PMC10078717VergheseJAnnweilerCAyersEBarzilaiNBeauchetOBennettDABridenbaughSABuchmanASCallisayaMLCamicioliRCapistrantBChatterjiSDe CockAFerrucciLGiladiNGuralnikJMHausdorffJMHoltzerRKimKWKowalPKressigRWLimJLordSMeguroKMontero-OdassoMMuir-HunterSWNooneMLRochesterLSrikanthVWangCMotoric cognitive risk syndrome: multicountry prevalence and dementia riskNeurology201483871872610.1212/WNL.000000000000071725031288WNL.0000000000000717PMC4150127BeauchetOSekhonHLaunayCPRollandYSchottAMAllaliGMotoric cognitive risk syndrome and incident dementia: results from a population‐based prospective and observational cohort studyEur J Neurol201927346847410.1111/ene.1409331571342GustavssonANortonNFastTFrölichLGeorgesJHolzapfelDKirabaliTKrolak‐SalmonPRossiniPMFerrettiMTLanmanLChadhaASvan der FlierWMGlobal estimates on the number of persons across the Alzheimer's disease continuumAlzheimers Dement202219265867010.1002/alz.1269435652476CaspersenCJPowellKEChristensonGMPhysical activity, exercise, and physical fitness: definitions and distinctions for health-related researchPublic Health Rep198510021261313920711PMC1424733BuddeHSchwarzRVelasquesBRibeiroPHolzwegMMachadoSBrazaitisMStaackFWegnerMThe need for differentiating between exercise, physical activity, and trainingAutoimmun Rev201615111011110.1016/j.autrev.2015.09.00426384527S1568-9972(15)00199-8HeroldFTheobaldPGronwaldTRappMAMüllerNGGoing digital—a commentary on the terminology used at the intersection of physical activity and digital healthEur Rev Aging Phys Act20221911710.1186/s11556-022-00296-yHeroldFHamacherDSchegaLMüllerNGThinking while moving or moving while thinking—concepts of motor-cognitive training for cognitive performance enhancementFront Aging Neurosci20181022810.3389/fnagi.2018.00228HeroldFMüllerPGronwaldTMüllerNGDose–response matters!—a perspective on the exercise prescription in exercise–cognition researchFront Psychol201910233810.3389/fpsyg.2019.0233831736815PMC6839278HeroldFTörpelAHamacherDBuddeHGronwaldTA discussion on different approaches for prescribing physical interventions—four roads lead to rome, but which one should we choose?J Per Med20201035510.3390/jpm1003005532605044jpm10030055PMC7565695EricksonKIDonofrySDSewellKRBrownBMStillmanCMCognitive aging and the promise of physical activityAnnu Rev Clin Psychol202218141744210.1146/annurev-clinpsy-072720-01421335044793HillmanCHEricksonKIKramerAFBe smart, exercise your heart: exercise effects on brain and cognitionNat Rev Neurosci200891586510.1038/nrn229818094706nrn2298StillmanCMEsteban-CornejoIBrownBBenderCMEricksonKIEffects of exercise on brain and cognition across age groups and health statesTrends Neurosci202043753354310.1016/j.tins.2020.04.01032409017S0166-2236(20)30101-6PMC9068803LudygaSGerberMPühseULooserVNKamijoKSystematic review and meta-analysis investigating moderators of long-term effects of exercise on cognition in healthy individualsNat Hum Behav20204660361210.1038/s41562-020-0851-83223128010.1038/s41562-020-0851-8BhererLEricksonKILiu-AmbroseTA review of the effects of physical activity and exercise on cognitive and brain functions in older adultsJ Aging Res2013201365750810.1155/2013/65750824102028PMC3786463Liu-AmbroseTBarhaCFalckRSActive body, healthy brain: exercise for healthy cognitive agingInt Rev Neurobiol20191479512010.1016/bs.irn.2019.07.00431607364S0074-7742(19)30050-9Liu-AmbroseTBarhaCKBestJRPhysical activity for brain health in older adultsAppl Physiol Nutr Metab201843111105111210.1139/apnm-2018-026030306793FalckRSDavisJCBestJRCrockettRALiu-AmbroseTImpact of exercise training on physical and cognitive function among older adults: a systematic review and meta-analysisNeurobiol Aging20197911913010.1016/j.neurobiolaging.2019.03.007NortheyJMCherbuinNPumpaKLSmeeDJRattrayBExercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysisBr J Sports Med201752315416010.1136/bjsports-2016-09658728438770bjsports-2016-096587BlondellSJHammersley-MatherRVeermanJLDoes physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studiesBMC Public Health201414151010.1186/1471-2458-14-510248852501471-2458-14-510PMC4064273PaillardTPreventive effects of regular physical exercise against cognitive decline and the risk of dementia with age advancementSports Med Open2015112010.1186/s40798-015-0016-x2628416116PMC5005681VeroneseNSoysalPBarbagalloMShenkinSDQuinnTJCommentary on: physical activity and exercise for mild cognitive impairment and dementia: a collaborative international guidelineAging Clin Exp Res20243619910.1007/s40520-024-02747-13865238010.1007/s40520-024-02747-1PMC11039492VeroneseNSoysalPDemurtasJSolmiMBruyèreOChristodoulouNRamalhoRFusar-PoliPLappasASPintoDFrederiksenKSCorbiGMKarpenkoOGeorgesJDurãesJSchlöglMYilmazOSieberCShenkinSDSmithLReginsterJMaggiSLimongiFArsJBarbagalloMCherubiniAQuinnTPhysical activity and exercise for the prevention and management of mild cognitive impairment and dementia: a collaborative international guidelineEur Geriatr Med202314592595210.1007/s41999-023-00858-y3776849910.1007/s41999-023-00858-yPMC10587099GutholdRStevensGARileyLMBullFCWorldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participantsLancet Glob Health2018610e1077e108610.1016/s2214-109x(18)30357-7HallalPCAndersenLBBullFCGutholdRHaskellWEkelundUGlobal physical activity levels: surveillance progress, pitfalls, and prospectsLancet2012380983824725710.1016/S0140-6736(12)60646-1GutholdROnoTStrongKLChatterjiSMorabiaAWorldwide variability in physical inactivity: a 51-country surveyAm J Prev Med200834648649410.1016/j.amepre.2008.02.01318471584S0749-3797(08)00257-2GomesMFigueiredoDTeixeiraLPovedaVPaúlCSantos-SilvaACostaEPhysical inactivity among older adults across Europe based on the SHARE databaseAge Ageing2017461717710.1093/ageing/afw165281816372281655PMC6402309FalckRSLandryGJBestJRDavisJCChiuBKLiu-AmbroseTCross-sectional relationships of physical activity and sedentary behavior with cognitive function in older adults with probable mild cognitive impairmentPhys Ther2017971097598410.1093/ptj/pzx074290295543979353PMC5803762KimKIGollamudiSSSteinhublSDigital technology to enable aging in placeExp Gerontol201788253110.1016/j.exger.2016.11.01328025126S0531-5565(16)30376-XChowdharyNBarbuiCAnsteyKJKivipeltoMBarberaMPetersRZhengLKulmalaJStephenRFerriCPJoanetteYWangHComas-HerreraAAlessiCSuharyaKMwangiKJPetersenRCMotalaAAMendisSPrabhakaranDBibi Mia SorefanADiasAGouiderRShaharSAshby-MitchellKPrinceMDuaTReducing the risk of cognitive decline and dementia: WHO recommendationsFront Neurol20221276558410.3389/fneur.2021.765584BE MOBILE BE HE@LTHY: A Handbook on How to Implement mAgeing2018GenevaWorld Health OrganizationChenCDingSWangJDigital health for aging populationsNat Med20232971623163010.1038/s41591-023-02391-83746402910.1038/s41591-023-02391-8BerronDGlanzWClarkLBascheKGrandeXGüstenJBilletteOVHempenINaveedMHDierschNButrynMSpottkeABuergerKPerneczkyRSchneiderATeipelSWiltfangJJohnsonSWagnerMJessenFDüzelEA remote digital memory composite to detect cognitive impairment in memory clinic samples in unsupervised settings using mobile devicesNPJ Digit Med2024717910.1038/s41746-024-00999-93853208010.1038/s41746-024-00999-9PMC10965892BerronDZieglerGViewegPBilletteOGüstenJGrandeXHenekaMTSchneiderATeipelSJessenFWagnerMDüzelEFeasibility of digital memory assessments in an unsupervised and remote study settingFront Digit Health2022489299710.3389/fdgth.2022.89299735721797PMC9199443SabbaghMNBoadaMBorsonSDoraiswamyPMDuboisBIngramJIwataAPorsteinssonAPPossinKLRabinoviciGDVellasBChaoSVergalloAHampelHEarly detection of mild cognitive impairment (MCI) in an at-home settingJ Prev Alzheimers Dis20207317117810.14283/jpad.2020.2232463070KooBMVizerLMMobile technology for cognitive assessment of older adults: a scoping reviewInnov Aging201931igy03810.1093/geroni/igy03830619948igy038PMC6312550DanielsKBonnechèreBHarnessing digital health interventions to bridge the gap in prevention for older adultsFront Public Health202411128192310.3389/fpubh.2023.128192338259780PMC10800474SietteJAdamPJBuilding digital solutions to support brain health prescribing in primary care: where to begin?Alzheimers Dement (N Y)2024101e1244710.1002/trc2.1244738356479TRC212447PMC10865480HeroldFTheobaldPGronwaldTKaushalNZouLde BruinEDBhererLMüllerNGAlexa, let's train now!—a systematic review and classification approach to digital and home-based physical training interventions aiming to support healthy cognitive agingJ Sport Health Sci2024131304610.1016/j.jshs.2023.01.00436736727S2095-2546(23)00005-4Di LoritoCBoscoARaiHCravenMMcNallyDToddCBoothVCowleyAHoweLHarwoodRHA systematic literature review and meta‐analysis on digital health interventions for people living with dementia and mild cognitive impairmentInt J Geriatr Psychiatry202237612510.1002/gps.573035588315PMC9321868FergusonTOldsTCurtisRBlakeHCrozierAJDankiwKDumuidDKasaiDO'ConnorEVirgaraRMaherCEffectiveness of wearable activity trackers to increase physical activity and improve health: a systematic review of systematic reviews and meta-analysesLancet Digit Health202248e615e62610.1016/S2589-7500(22)00111-X35868813S2589-7500(22)00111-XLonghiniJMarzaroCBargeriSPaleseADell’IsolaATurollaAPillastriniPBattistaSCastelliniGCookCGianolaSRossettiniGWearable devices to improve physical activity and reduce sedentary behaviour: an umbrella reviewSports Med Open2024101910.1186/s40798-024-00678-93821926910.1186/s40798-024-00678-9PMC10788327DoddsLSietteJChallenges, solutions and future directions for public health innovations targeting dementia prevention for rural and remote populationsAustralas J Ageing202241346647210.1111/ajag.1310535844068WedenMMShihRAKabetoMULangaKMSecular trends in dementia and cognitive impairment of U.S. rural and urban older adultsAm J Prev Med201854216417210.1016/j.amepre.2017.10.02129246677S0749-3797(17)30644-XPMC5783777WieseLAKGibsonAGuestMANelsonARWeaverRGuptaACarmichaelOLewisJPLindauerALoiSPetersonRRadfordKRhodusEKWongCGZuelsdorffMSaidiLGValdivieso‐MoraEFranzenSPopeCNKillianTSShresthaHLHeynPCNgTKSPrusaczykBJohnSKulshreshthaAShefflerJLBesserLDanielVToleaMIMillerJMusyimiCCorkeyJYankVWilliamsCLRahemiZParkJMagzamenSNewtonRLHarringtonCFlattJDAroraSWalterSGriffinPBabulalGMGlobal rural health disparities in Alzheimer's disease and related dementias: state of the scienceAlzheimers Dement20231994204422510.1002/alz.1310437218539PMC10524180GlauberRRural depopulation and the rural‐urban gap in cognitive functioning among older adultsJ Rural Health202238469670410.1111/jrh.1265035257439PMC10268026ThompsonWRWorldwide survey of fitness trends for 2021ACSM Health Fitness J2021251101910.1249/fit.0000000000000631ThompsonWRWorldwide survey of fitness trends for 2022ACSM Health Fitness J2022261112010.1249/FIT.0000000000000732ThompsonWRWorldwide survey of fitness trends for 2023ACSM Health Fitness J202327191810.1249/fit.0000000000000834NewsomeAMReedRSansoneJBatrakoulisAMcAvoyCW. ParrottM2024 ACSM worldwide fitness trends: future directions of the health and fitness industryACSM Health Fitness J2024281142610.1249/fit.0000000000000933AmmarABoukhrisOHalfpaapNLabottBKLanghansCHeroldFGrässlerBMüllerPTrabelsiKChtourouHZmijewskiPDrissTGlennJMMüllerNGHoekelmannAFour weeks of detraining induced by COVID-19 reverse cardiac improvements from eight weeks of fitness-dance training in older adults with mild cognitive impairmentInt J Environ Res Public Health20211811593010.3390/ijerph1811593034073051ijerph18115930PMC8198940BassoJCOberlinDJSatyalMKO’BrienCECrostaCPsarasZMetpallyASuzukiWAExamining the effect of increased aerobic exercise in moderately fit adults on psychological state and cognitive functionFront Hum Neurosci20221683314910.3389/fnhum.2022.833149TsaiCLPanCYChenFCTsengYTOpen- and closed-skill exercise interventions produce different neurocognitive effects on executive functions in the elderly: a 6-month randomized, controlled trialFront Aging Neurosci2017929410.3389/fnagi.2017.0029428959200PMC5604064EggenbergerPWolfMSchumannMde BruinEDExergame and balance training modulate prefrontal brain activity during walking and enhance executive function in older adultsFront Aging Neurosci201686610.3389/fnagi.2016.00066EggenbergerPAnnaheimSKündigKARossiRMMünzerTde BruinEDHeart rate variability mainly relates to cognitive executive functions and improves through exergame training in older adults: a secondary analysis of a 6-month randomized controlled trialFront Aging Neurosci20201219710.3389/fnagi.2020.00197SchättinAArnerRGennaroFde BruinEDAdaptations of prefrontal brain activity, executive functions, and gait in healthy elderly following exergame and balance training: a randomized-controlled studyFront Aging Neurosci2016827810.3389/fnagi.2016.0027827932975PMC5120107KawabataMGanSRShen-HsingACEffects of square stepping exercise on cognitive, physical, psychological, and group functioning in sedentary older adults: a center-based hybrid trialBMC Geriatr202424137410.1186/s12877-024-04904-73866461310.1186/s12877-024-04904-7PMC11046944JustineMAzizanAHassanVSallehZManafHBarriers to participation in physical activity and exercise among middle-aged and elderly individualsSingapore Med J2013541058158610.11622/smedj.201320324154584MoschnyAPlatenPKlaaßen-MielkeRTrampischUHinrichsTBarriers to physical activity in older adults in Germany: a cross-sectional studyInt J Behav Nutr Phys Act20118112110.1186/1479-5868-8-121220470241479-5868-8-121PMC3225299JaarsmaEADijkstraPUGeertzenJHBDekkerRBarriers to and facilitators of sports participation for people with physical disabilities: a systematic reviewScand J Med Sci Sports201424687188110.1111/sms.1221824730752HobsonNDupuisSLGiangregorioLMMiddletonLEPerceived facilitators and barriers to exercise among older adults with mild cognitive impairment and early dementiaJ Aging Phys Act202028220821810.1123/japa.2019-001031621645japa.2019-0010LeroyVGanaWAïdoudAN’kodoJABalageasACBlancPBomiaDDebacqCFougèreBDigital health technologies and Alzheimer’s disease clinical trials: might decentralized clinical trials increase participation by people with cognitive impairment?Alzheimers Res Ther20231518710.1186/s13195-023-01227-43710642910.1186/s13195-023-01227-4PMC10133908SeinscheJde BruinEDHinrichsTGiannouliEEffects of home-based interventions using exergames on physical and cognitive functions in community-dwelling older adults: a PRISMA-P-compliant protocol for a systematic reviewFront Public Health202411129112010.3389/fpubh.2023.1291120SeinscheJde BruinEDSaibeneERizzoFCarpinellaIFerrarinMIfangerSMozaSGiannouliEFeasibility and effectiveness of a personalized home-based motor-cognitive training program in community-dwelling older adults: protocol for a pragmatic pilot randomized controlled trialJMIR Res Protoc202312e4937710.2196/4937737943591v12i1e49377PMC10667977ManserPPoikonenHde BruinEDFeasibility, usability, and acceptance of “brain-IT”—a newly developed exergame-based training concept for the secondary prevention of mild neurocognitive disorder: a pilot randomized controlled trialFront Aging Neurosci202315116338810.3389/fnagi.2023.1163388ManserPAdcock-OmlinMde BruinEDDesign considerations for an exergame-based training intervention for older adults with mild neurocognitive disorder: qualitative study including focus groups with experts and health care professionals and individual semistructured in-depth patient interviewsJMIR Serious Games202311e3761610.2196/3761636602851v11i1e37616PMC9853342ManserPde BruinEDMaking the best out of IT: design and development of exergames for older adults with mild neurocognitive disorder—a methodological paperFront Aging Neurosci20211373401210.3389/fnagi.2021.734012ManserPMichelsLSchmidtABarinkaFde BruinEDEffectiveness of an individualized exergame-based motor-cognitive training concept targeted to improve cognitive functioning in older adults with mild neurocognitive disorder: study protocol for a randomized controlled trialJMIR Res Protoc202312e4117310.2196/4117336745483v12i1e41173PMC9941909EbertBStreicherHNotthoffNOnline exercise during the COVID-19 pandemic and factors promoting or hindering participation in adults: a scoping reviewInt J Sport Exerc Psychol202413210.1080/1612197x.2024.2314107BekJGrovesMLeventhalDPoliakoffEDance at home for people with Parkinson's during COVID-19 and beyond: participation, perceptions, and prospectsFront Neurol20211267812410.3389/fneur.2021.67812434140925PMC8204717Collado-MateoDLavín-PérezAMPeñacobaCDel CosoJLeyton-RománMLuque-CasadoAGasquePFernández-Del-OlmoMAAmado-AlonsoDKey factors associated with adherence to physical exercise in patients with chronic diseases and older adults: an umbrella reviewInt J Environ Res Public Health2021184202310.3390/ijerph1804202333669679ijerph18042023PMC7922504GaneshanSJacksonHGrandisDJJankeDMurrayMLValleVBeattyALClinical outcomes and qualitative perceptions of in-person, hybrid, and virtual cardiac rehabilitationJ Cardiopulm Rehabil Prev202242533834610.1097/HCR.00000000000006883542056301273116-990000000-00008ImranHMBaigMErqouSTaveiraTHShahNRMorrisonAChoudharyGWuWHome‐based cardiac rehabilitation alone and hybrid with center‐based cardiac rehabilitation in heart failure: a systematic review and meta‐analysisJ Am Heart Assoc2019816e01277910.1161/JAHA.119.01277931423874PMC6759908KeteyianSJGrimshawCBrawnerCAKerriganDJReasonsLBerryRPetersonELEhrmanJKA comparison of exercise intensity in hybrid versus standard phase two cardiac rehabilitationJ Cardiopulm Rehabil Prev2021411192210.1097/HCR.00000000000005693335154001273116-202101000-00004PMC7768817HirthammerRBreitkopfAHollmannMSchifferdecker-HochFThe hybrid therapeutic approach for hip and knee osteoarthritis: a pilot study for a novel healthcare concept [Der hybride Therapieansatz bei Hüft- und Kniearthrose: Eine Pilotstudie zu einem neuartigen Versorgungskonzept]B&G Bewegungstherapie und Gesundheitssport2021370417217810.1055/a-1528-5216HeroldFTörpelAHamacherDBuddeHZouLStrobachTMüllerNGGronwaldTCauses and consequences of interindividual response variability: a call to apply a more rigorous research design in acute exercise-cognition studiesFront Physiol20211268289110.3389/fphys.2021.68289134366881PMC8339555ArandaMPKremerINHintonLZissimopoulosJWhitmerRAHummelCHTrejoLFabiusCImpact of dementia: health disparities, population trends, care interventions, and economic costsJ Am Geriatr Soc20216971774178310.1111/jgs.1734534245588PMC8608182BrachMde BruinEDLevinOHinrichsTZijlstraWNetzYEvidence-based yet still challenging! research on physical activity in old ageEur Rev Aging Phys Act2023201710.1186/s11556-023-00318-33693232010.1186/s11556-023-00318-3PMC10022149BreitkopfAKöppelMHirthammerRHollmannMSchifferdecker-HochFScheerJPetersSObjectives, methodology and content of a new hybrid therapy for people with osteoporosis in different advanced stages [Ziele, Methodik und Inhalte einer neuen hybriden Therapie für Personen mit Osteoporose in unterschiedlich fortgeschrittenen Stadien]B&G Bewegungstherapie und Gesundheitssport2021370419020010.1055/a-1528-9080DentonFPowerSWaddellABirkettSDuncanMHarwoodAMcGregorGRowleyNBroomDIs it really home-based? a commentary on the necessity for accurate definitions across exercise and physical activity programmesInt J Environ Res Public Health20211817924410.3390/ijerph1817924434501833ijerph18179244PMC8431042HeckstedenAFaudeOMeyerTDonathLHow to construct, conduct and analyze an exercise training study?Front Physiol20189100710.3389/fphys.2018.01007ŠlosarLVoelcker-RehageCParavlićAHAbazovicEde BruinEDMarusicUCombining physical and virtual worlds for motor-cognitive training interventions: position paper with guidelines on technology classification in movement-related researchFront Psychol202213100905210.3389/fpsyg.2022.1009052EynonMFoadJDowneyJBowmerYMillsHAssessing the psychosocial factors associated with adherence to exercise referral schemes: a systematic reviewScand J Med Sci Sports201929563865010.1111/sms.1340330742334TolksDRomeikeBFMEhlersJKuhnSKleinsorgenCHuberJFischerMRBohneCHegeIThe online inverted classroom model (oICM). a blueprint to adapt the inverted classroom to an online learning setting in medical and health educationMedEdPublish2020911310.15694/mep.2020.000113.138073851PMC10702666CostaRRGDornelesJRVelosoJHGonçalvesCWPNetoFRSynchronous and asynchronous tele-exercise during the coronavirus disease 2019 pandemic: comparisons of implementation and training load in individuals with spinal cord injuryJ Telemed Telecare202329430831710.1177/1357633X2098273233461399PMC10090522WilsonLSMaederAJRecent directions in telemedicine: review of trends in research and practiceHealthc Inform Res201521421322210.4258/hir.2015.21.4.21326618026PMC4659877MalasanosTRamnitzMSDiabetes clinic at a distance: telemedicine bridges the gapDiabetes Spectrum201326422623110.2337/diaspect.26.4.226ChanSLiLTorousJGratzerDYellowleesPMReview of use of asynchronous technologies incorporated in mental health careCurr Psychiatry Rep201820108510.1007/s11920-018-0954-33015559310.1007/s11920-018-0954-3LemstraMBirdYNwankwoCRogersMMorarosJWeight loss intervention adherence and factors promoting adherence: a meta-analysisPatient Prefer Adherence2016101547155910.2147/PPA.S10364927574404ppa-10-1547PMC4990387DriessenEJPeetersMEBongersBCMaasHABootsmaGPvan MeeterenNLJanssen-HeijnenMLEffects of prehabilitation and rehabilitation including a home-based component on physical fitness, adherence, treatment tolerance, and recovery in patients with non-small cell lung cancer: a systematic reviewCrit Rev Oncol Hematol2017114637610.1016/j.critrevonc.2017.03.03128477748S1040-8428(16)30363-8LaraECaballeroFFRico-UribeLAOlayaBHaroJMAyuso-MateosJLMiretMAre loneliness and social isolation associated with cognitive decline?Int J Geriatr Psychiatry201934111613162210.1002/gps.517431304639LuchettiMTerraccianoAAschwandenDLeeJHStephanYSutinARLoneliness is associated with risk of cognitive impairment in the survey of health, ageing and retirement in EuropeInt J Geriatr Psychiatry202035779480110.1002/gps.530432250480PMC7755119ShankarAHamerMMcMunnASteptoeASocial isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English longitudinal study of ageingPsychosom Med20137521617010.1097/PSY.0b013e31827f09cd23362501PSY.0b013e31827f09cdYinJLassaleCSteptoeACadarDExploring the bidirectional associations between loneliness and cognitive functioning over 10 years: the English longitudinal study of ageingInt J Epidemiol20194861937194810.1093/ije/dyz085310566415485775PMC6929532LaraEMartín-MaríaNDe la Torre-LuqueAKoyanagiAVancampfortDIzquierdoAMiretMDoes loneliness contribute to mild cognitive impairment and dementia? a systematic review and meta-analysis of longitudinal studiesAgeing Res Rev20195271610.1016/j.arr.2019.03.00230914351S1568-1637(18)30247-2SalinasJBeiserASSamraJKO'DonnellADeCarliCSGonzalesMMAparicioHJSeshadriSAssociation of loneliness with 10-year dementia risk and early markers of vulnerability for neurocognitive declineNeurology20229813e1337e134810.1212/WNL.000000000020003935131906WNL.0000000000200039PMC8967424ShafighiKVilleneuveSRosa NetoPBadhwarAPoirierJSharmaVMedinaYISilveiraPPDubeLGlahnDBzdokDSocial isolation is linked to classical risk factors of Alzheimer's disease-related dementiasPLoS One2023182e028047110.1371/journal.pone.028047136724157PONE-D-22-08803PMC9891507SutinARStephanYLuchettiMTerraccianoALoneliness and risk of dementiaJ Gerontol B Psychol Sci Soc Sci20207571414142210.1093/geronb/gby112303650235133324PMC7424267YuJLamCLMLeeTMCPerceived loneliness among older adults with mild cognitive impairmentInt Psychogeriatr201628101681168510.1017/S104161021600043027073010S1041610216000430JenkinCREimeRMvan UffelenJGZWesterbeekHHow to re-engage older adults in community sport? reasons for drop-out and re-engagementLeisure Stud202140444145310.1080/02614367.2021.1888310JenkinCREimeRMWesterbeekHvan UffelenJGZSport for adults aged 50+ years: participation benefits and barriersJ Aging Phys Act201826336337110.1123/japa.2017-009228952860FrancoMRTongAHowardKSherringtonCFerreiraPHPintoRZFerreiraMLOlder people's perspectives on participation in physical activity: a systematic review and thematic synthesis of qualitative literatureBr J Sports Med201549191268127610.1136/bjsports-2014-09401525586911bjsports-2014-094015RhodesREMartinADTauntonJERhodesECDonnellyMElliotJFactors associated with exercise adherence among older adults: an individual perspectiveSports Med199928639741110.2165/00007256-199928060-0000310623983SommerladAKivimäkiMLarsonEBRöhrSShiraiKSingh-ManouxALivingstonGSocial participation and risk of developing dementiaNat Aging20233553254510.1038/s43587-023-00387-03720251310.1038/s43587-023-00387-0BradySD'AmbrosioLAFeltsARulaEYKellKPCoughlinJFReducing isolation and loneliness through membership in a fitness program for older adults: implications for healthJ Appl Gerontol202039330131010.1177/073346481880782030392420PMC7005930SebastiãoEMirdaDGroup-based physical activity as a means to reduce social isolation and loneliness among older adultsAging Clin Exp Res20213372003200610.1007/s40520-020-01722-w3338736310.1007/s40520-020-01722-wNagataKTsunodaKFujiiYJindoTOkuraTImpact of exercising alone and exercising with others on the risk of cognitive impairment among older Japanese adultsArch Gerontol Geriatr202310710490810.1016/j.archger.2022.10490836565607S0167-4943(22)00295-3MitchellJJHamerMBlodgettJMWannametheeGSJefferisBJAssociations between sporting physical activity and cognition in mid and later-life: evidence from two cohortsScand J Med Sci Sports20233381570157510.1111/sms.1441237254468PMC10947539FujiiYSeolJJohoKLiuJInoueTNagataKOkuraTAssociations between exercising in a group and physical and cognitive functions in community-dwelling older adults: a cross-sectional study using data from the Kasama studyJ Phys Ther Sci2021331152110.1589/jpts.33.15335190682020-178PMC7829564LamJAMurrayERYuKERamseyMNguyenTTMishraJMartisBThomasMLLeeEENeurobiology of loneliness: a systematic reviewNeuropsychopharmacology202146111873188710.1038/s41386-021-01058-73423060710.1038/s41386-021-01058-7PMC8258736DabiriSMwendwaDTCampbellAPsychological and neurobiological mechanisms involved in the relationship between loneliness and cognitive decline in older adultsBrain Behav Immun2024116102110.1016/j.bbi.2023.11.03438008386S0889-1591(23)00368-9HawkleyLCCacioppoJTLoneliness matters: a theoretical and empirical review of consequences and mechanismsAnn Behav Med201040221822710.1007/s12160-010-9210-820652462PMC3874845MaherCAOldsTVandelanotteCPlotnikoffREdneySMRyanJCDeSmetACurtisRGGamification in a physical activity app: what gamification features are being used, by whom, and does it make a difference?Games Health J202211319319910.1089/g4h.2021.020735501981MazeasADuclosMPereiraBChalabaevAEvaluating the effectiveness of gamification on physical activity: systematic review and meta-analysis of randomized controlled trialsJ Med Internet Res2022241e2677910.2196/2677934982715v24i1e26779PMC8767479BesnierFDupuyEGGagnonCVincentTGrégoireCABlanchetteCSaillantKBouabdallaouiNGrauJIBérubéBOlmandMMarinMFBellevilleSJuneauMVitaliPGaydaMNigamABhererLInvestigation of the effects of home-based exercise and cognitive training on cognitive and physical functions in cardiac patients: the COVEPICARDIO study protocol of a randomized clinical trialFront Cardiovasc Med2021874083410.3389/fcvm.2021.74083434938780PMC8685268DupuyEGBesnierFGagnonCVincentTGrégoireCABlanchetteCSaillantKBouabdallaouiNIglesies-GrauJPayerMMarinMFBellevilleSJuneauMVitaliPGaydaMNigamABhererLCOVEPIC (cognitive and sport virtual epic training) investigating the effects of home-based physical exercise and cognitive training on cognitive and physical functions in community-dwelling older adults: study protocol of a randomized single-blinded clinical trialTrials202122150510.1186/s13063-021-05476-23432571010.1186/s13063-021-05476-2PMC8319877MiyazakiAOkuyamaTMoriHSatoKKumamotoKHiyamaAEffects of two short-term aerobic exercises on cognitive function in healthy older adults during COVID-19 confinement in Japan: a pilot randomized controlled trialInt J Environ Res Public Health20221910620210.3390/ijerph1910620235627740ijerph19106202PMC9140575YangLGallantSNWilkinsLKDysonBCognitive and psychosocial outcomes of self-guided executive function training and low-intensity aerobic exercise in healthy older adultsFront Aging Neurosci20201257674410.3389/fnagi.2020.57674433328958CallisayaMLJayakodyOVaidyaASrikanthVFarrowMDelbaereKA novel cognitive-motor exercise program delivered via a tablet to improve mobility in older people with cognitive impairment—StandingTall cognition and MobilityExp Gerontol202115211143410.1016/j.exger.2021.11143434098009S0531-5565(21)00216-3DelbaereKValenzuelaTLordSRClemsonLZijlstraGARCloseJCTLungTWoodburyAChowJMcInerneyGMilesLTosonBBriggsNvan SchootenKSE-health StandingTall balance exercise for fall prevention in older people: results of a two year randomised controlled trialBMJ2021373n74010.1136/bmj.n74033824131PMC8022322de Souto BarretoPPothierKSorianoGLussierMBhererLGuyonnetSPiauAOussetPJVellasBA web-based multidomain lifestyle intervention for older adults: the eMIND randomized controlled trialJ Prev Alzheimers Dis2020821910.14283/jpad.2020.7033569560PMC7754697SedhedJJohanssonHAnderssonNÅkessonEKalbeEFranzénELeavyBFeasibility of a novel eHealth intervention for Parkinson’s disease targeting motor-cognitive function in the homeBMC Neurol202424111410.1186/s12883-024-03614-23858091310.1186/s12883-024-03614-2PMC10996106PutzoluMManziniVGambaroMCosentinoCBonassiGBottaARavizzottiEAvanzinoLPelosinEMezzarobbaSHome-based exercise training by using a smartphone app in patients with Parkinson’s disease: a feasibility studyFront Neurol202314120538610.3389/fneur.2023.120538637448748PMC10338039KruseCFohnJWilsonNNunez PatlanEZippSMileskiMUtilization barriers and medical outcomes commensurate with the use of telehealth among older adults: systematic reviewJMIR Med Inform202088e2035910.2196/2035932784177v8i8e20359PMC7450384JansonsPFyfeJViaJDDalyRMGvozdenkoEScottDBarriers and enablers for older adults participating in a home-based pragmatic exercise program delivered and monitored by Amazon Alexa: a qualitative studyBMC Geriatr202222124810.1186/s12877-022-02963-23533728410.1186/s12877-022-02963-2PMC8953055JansonsPFyfeJJDalla ViaJDalyRMScottDBarriers and enablers associated with participation in a home-based pragmatic exercise snacking program in older adults delivered and monitored by Amazon Alexa: a qualitative studyAging Clin Exp Res202335356156910.1007/s40520-022-02327-13664874610.1007/s40520-022-02327-1PMC9843655JansonsPDalla ViaJDalyRMFyfeJJGvozdenkoEScottDDelivery of home-based exercise interventions in older adults facilitated by Amazon Alexa: a 12-week feasibility trialJ Nutr Health Aging20222619610210.1007/s12603-021-1717-035067710MascretNTempradoJJAcceptance of a mobile telepresence robot, before use, to remotely supervise older adults’ adapted physical activityInt J Environ Res Public Health2023204301210.3390/ijerph2004301236833706MascretNVorsOTempradoJJMobile telepresence robot as a new service to remotely supervise older adults’ physical activity: effectiveness, acceptance, and perceptionInt J of Soc Robotics202310.1007/s12369-023-01025-wWuXNixLCBrummettAMAguillonCOltmanDJBeerJMThe design, development, and evaluation of telepresence interfaces for aging adults: investigating user perceptions of privacy and usabilityInt J Human-Computer Stud202115610269510.1016/j.ijhcs.2021.102695SalisburyDLWarryWFergenJCruikshankKSoderlundPDJacklinKThe MN RIDE pilot: feasibility of a synchronous, remotely delivered, aerobic exercise training program for rural-dwelling adults with subjective cognitive declineRural Remote Health2023234835110.22605/RRH8351380860578351Candido Mendes MaranhãoDDaniele de Araújo SilvaJQuintella FarahBBarros Beltrão PirauáNCappato de AraújoRRemígio CavalcanteBLuiz Torres PirauáAEffects of 12-weeks of home-based exercise training on physical and cognitive function of older adults: randomized trial comparing virtual versus minimal supervision in the context of the COVID-19 pandemic in BrazilCan Geriatr J2024271475510.5770/cgj.27.70538433880cgj-27-47PMC10896203Menengi ÇKNYeldanÇınarNŞahinerTEffectiveness of motor-cognitive dual-task exercise via telerehabilitation in Alzheimer's disease: an online pilot randomized controlled studyClin Neurol Neurosurg202222310750110.1016/j.clineuro.2022.10750136368169S0303-8467(22)00382-1LiFHarmerPFitzgeraldKWinters-StoneKA cognitively enhanced online Tai Ji Quan training intervention for community-dwelling older adults with mild cognitive impairment: a feasibility trialBMC Geriatr20222217610.1186/s12877-021-02747-03507840710.1186/s12877-021-02747-0PMC8787180WunschKEckertTFiedlerJWollAJust-in-time adaptive interventions in mobile physical activity interventions—a synthesis of frameworks and future directionsEur Health Psychol2022224834842MüllerAMBlandfordAYardleyLThe conceptualization of a just-in-time adaptive intervention (JITAI) for the reduction of sedentary behavior in older adultsmHealth201733710.21037/mhealth.2017.08.0529184889mh-03-2017.08.05PMC5682389HardemanWHoughtonJLaneKJonesANaughtonFA systematic review of just-in-time adaptive interventions (JITAIs) to promote physical activityInt J Behav Nutr Phys Act20191613110.1186/s12966-019-0792-73094398310.1186/s12966-019-0792-7PMC6448257van der KolkNMde VriesNMKesselsRPCJoostenHZwindermanAHPostBBloemBREffectiveness of home-based and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomised controlled trialLancet Neurol20191811998100810.1016/S1474-4422(19)30285-631521532S1474-4422(19)30285-6van der KolkNMde VriesNMPenkoALvan der VlugtMMulderAAPostBAlbertsJLBloemBRA remotely supervised home-based aerobic exercise programme is feasible for patients with Parkinson’s disease: results of a small randomised feasibility trialJ Neurol Neurosurg Psychiatry20178991003100510.1136/jnnp-2017-31572828607121jnnp-2017-315728Anderson-HanleyCStarkJWallKMVanBrakleMMichelMMaloneyMBarcelosNStriegnitzKCohenBDKramerAFThe interactive Physical and Cognitive Exercise System (iPACES™): effects of a 3-month in-home pilot clinical trial for mild cognitive impairment and caregiversClin Interv Aging2018131565157710.2147/CIA.S16075630233154cia-13-1565PMC6130272WallKStarkJSchillaciASaulnierETMcLarenEStriegnitzKCohenBDArcieroPJKramerAFAnderson-HanleyCThe enhanced interactive Physical and Cognitive Exercise System (iPACES™ v2.0): pilot clinical trial of an in-home iPad-based neuro-exergame for mild cognitive impairment (MCI)J Clin Med20187924910.3390/jcm7090249BestJRExergaming in youth: effects on physical and cognitive healthZ Psychol20132212727810.1027/2151-2604/a00013725097828PMC4119754KappenDLMirza-BabaeiPNackeLEOlder adults’ physical activity and exergames: a systematic reviewInt J Hum Comput Interact201935214016710.1080/10447318.2018.1441253van SantenJDröesRMHolstegeMHenkemansOBvan RijnAde VriesRvan StratenAMeilandFEffects of exergaming in people with dementia: results of a systematic literature reviewJ Alzheimers Dis201863274176010.3233/JAD-17066729689716JAD170667PMC5929299ACSM information on exergamingHealthySD.gov20132024-06-19http://healthysd.gov/wp-content/uploads/2014/11/exergaming.pdfAdcockMFankhauserMPostJLutzKZizlspergerLLuftARGuimarãesVSchättinAde BruinEDEffects of an in-home multicomponent exergame training on physical functions, cognition, and brain volume of older adults: a randomized controlled trialFront Med2020632110.3389/fmed.2019.00321GschwindYJEichbergSEjupiAde RosarioHKrollMMarstonHRDrobicsMAnnegarnJWiechingRLordSRAalKVaziriDWoodburyAFinkDDelbaereKICT-based system to predict and prevent falls (iStoppFalls): results from an international multicenter randomized controlled trialEur Rev Aging Phys Act20151211010.1186/s11556-015-0155-626865874155PMC4748323GschwindYJSchoeneDLordSREjupiAValenzuelaTAalKWoodburyADelbaereKThe effect of sensor-based exercise at home on functional performance associated with fall risk in older people—a comparison of two exergame interventionsEur Rev Aging Phys Act20151211110.1186/s11556-015-0156-526865875156PMC4748327SchoeneDLordSRDelbaereKSeverinoCDaviesTASmithSTA randomized controlled pilot study of home-based step training in older people using videogame technologyPLoS ONE201383e5773410.1371/journal.pone.005773423472104PONE-D-12-31063PMC3589451SchoeneDValenzuelaTTosonBDelbaereKSeverinoCGarciaJDaviesTARussellFSmithSTLordSRInteractive cognitive-motor step training improves cognitive risk factors of falling in older adults—a randomized controlled trialPLoS ONE20151012e014516110.1371/journal.pone.014516126673919PONE-D-14-55720PMC4682965SongJPaulSSCaetanoMJDSmithSDibbleLELoveRSchoeneDMenantJCSherringtonCLordSRCanningCGAllenNEHome-based step training using videogame technology in people with Parkinson’s disease: a single-blinded randomised controlled trialClin Rehabil201732329931110.1177/026921551772159328745063HoangPSchoeneDGandeviaSSmithSLordSREffects of a home-based step training programme on balance, stepping, cognition and functional performance in people with multiple sclerosis—a randomized controlled trialMult Scler20152219410310.1177/1352458515579442259210351352458515579442SturnieksDLHicksCSmithNRatanaponglekaMMenantJTurnerJLoJChaplinCGarciaJValenzuelaMJDelbaereKHerbertRDSherringtonCTosonBLordSRExergame and cognitive training for preventing falls in community-dwelling older people: a randomized controlled trialNat Med20243019810510.1038/s41591-023-02739-03822891310.1038/s41591-023-02739-0Liu‐AmbroseTDonaldsonMGAhamedYGrafPCookWLCloseJLordSRKhanKMOtago home‐based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trialJ Am Geriatr Soc200856101821183010.1111/j.1532-5415.2008.01931.x18795987JGS1931HuangXZhangSLiBZhaoXXuJCaoTWanQThe feasibility and efficacy of the home-based exercise programs in patients with cognitive impairment: a pilot studyGeriatr Nurs20224510811710.1016/j.gerinurse.2022.03.01035395598S0197-4572(22)00076-3PeixotoCMatioliMNPDSTakanoSAFTeixeiraMSPassos NetoCEBBruckiSMDFeasibility, safety, and adherence of a remote physical and cognitive exercise protocol for older womenArq Neuropsiquiatr202482041910.1055/s-0044-178569038653483PMC11039073BlokMvan IngenEde BoerAHSlootmanMThe use of information and communication technologies by older people with cognitive impairments: from barriers to benefitsComput Hum Behav202010410617310.1016/j.chb.2019.106173Jang-JaccardJNepalSAlemLLiJBarriers for delivering telehealth in rural Australia: a review based on Australian trials and studiesTelemed E Health201420549650410.1089/tmj.2013.018924801522WhitelawSPellegriniDMMamasMACowieMVan SpallHGCBarriers and facilitators of the uptake of digital health technology in cardiovascular care: a systematic scoping reviewEur Heart J Digit Health202121627410.1093/ehjdh/ztab00534048508ztab005PMC8139413WilsonJHeinschMBettsDBoothDKay-LambkinFBarriers and facilitators to the use of e-health by older adults: a scoping reviewBMC Public Health2021211155610.1186/s12889-021-11623-w3439971610.1186/s12889-021-11623-wPMC8369710TurcotteSBouchardCRousseauJDeBroux LeducRBierNKairyDDang‐VuTtSarimanukogluKDubéFBourgeois RacineCRiouxCSheaCFiliatraultJFactors influencing older adults' participation in telehealth interventions for primary prevention and health promotion: a rapid reviewAustralas J Ageing2023431113010.1111/ajag.1324438014903KampmeijerRPavlovaMTamborMGolinowskaSGrootWThe use of e-health and m-health tools in health promotion and primary prevention among older adults: a systematic literature reviewBMC Health Serv Res201616S529010.1186/s12913-016-1522-32760867710.1186/s12913-016-1522-3PMC5016733SaleminkKStrijkerDBosworthGRural development in the digital age: a systematic literature review on unequal ICT availability, adoption, and use in rural areasJ Rural Stud20175436037110.1016/j.jrurstud.2015.09.001ColeyNAndreLHoevenaar-BlomMPNganduTBeishuizenCBarberaMvan WanrooijLKivipeltoMSoininenHvan GoolWBrayneCMoll van CharanteERichardEAndrieuSFactors predicting engagement of older adults with a coach-supported eHealth intervention promoting lifestyle change and associations between engagement and changes in cardiovascular and dementia risk: secondary analysis of an 18-month multinational randomized controlled trialJ Med Internet Res2022245e3200610.2196/3200635385395v24i5e32006PMC9127655AuerswaldTHendkerARatzTLippkeSPischkeCRPetersMMeyerJHoldtKVVoelcker-RehageCImpact of activity tracker usage in combination with a physical activity intervention on physical and cognitive parameters in healthy adults aged 60+: a randomized controlled trialInt J Environ Res Public Health2022197378510.3390/ijerph19073785SowLCLiuHHWangRYWeiSHWuHKYangYRFeasibility and effectiveness of interactive stepping exercise on community-dwelling older adults: a pilot randomized controlled trialGeriatr Nurs20214251099110410.1016/j.gerinurse.2021.06.02134274687S0197-4572(21)00238-XWangRYHuangYCZhouJHChengSJYangYREffects of exergame-based dual-task training on executive function and dual-task performance in community-dwelling older people: a randomized-controlled trialGames Health J202110534735410.1089/g4h.2021.005734491113PadalaKPPadalaPRLensingSYDennisRABoppMMRobersonPKSullivanDHHome-based exercise program improves balance and fear of falling in community-dwelling older adults with mild Alzheimer’s disease: a pilot studyJ Alzheimers Dis201759256557410.3233/JAD-17012028655135JAD170120PetersenJDLarsenELla CourKvon BülowCSkouboeMChristensenJRWaldorffFBMotion-based technology for people with dementia training at home: three-phase pilot study assessing feasibility and efficacyJMIR Ment Health202078e1949510.2196/1949532845243v7i8e19495PMC7481868van LimburgMvan Gemert-PijnenJEWCNijlandNOssebaardHCHendrixRMGSeydelERWhy business modeling is crucial in the development of eHealth technologiesJ Med Internet Res2011134e12410.2196/jmir.167422204896v13i4e124PMC3278110García-HermosoARamirez-VélezRSáez de AsteasuMLMartínez-VelillaNZambom-FerraresiFValenzuelaPLLuciaAIzquierdoMSafety and effectiveness of long-term exercise interventions in older adults: a systematic review and meta-analysis of randomized controlled trialsSports Med20205061095110610.1007/s40279-020-01259-yStefanakisMBatalikLAntoniouVPeperaGSafety of home-based cardiac rehabilitation: a systematic reviewHeart Lung20225511712610.1016/j.hrtlng.2022.04.01635533492S0147-9563(22)00097-8AntoniouVKapreliEDavosCHBatalikLPeperaGSafety and long-term outcomes of remote cardiac rehabilitation in coronary heart disease patients: a systematic reviewDigit Health2024102055207624123766110.1177/205520762412376613853330810.1177_20552076241237661PMC10964460WiebkingCLinCIWippertPMTraining intervention effects on cognitive performance and neuronal plasticity—a pilot studyFront Neurol20221377381310.3389/fneur.2022.77381336003302PMC9393784MoonSYHongCHJeongJHParkYKNaHRSongHKimBCParkKWParkHKChoiMLeeSMChunBKohSParkSAParkHJinJLeeEKimSMHanSMKimJSHaJChoiSHFacility-based and home-based multidomain interventions including cognitive training, exercise, diet, vascular risk management, and motivation for older adults: a randomized controlled feasibility trialAging20211312158981591610.18632/aging.20321334148030203213PMC8266338World Health OrganizationWHO Guidelines on Physical Activity and Sedentary Behaviour2020GenevaWorld Health OrganizationBullFCAl-AnsariSSBiddleSBorodulinKBumanMPCardonGCartyCChaputJChastinSChouRDempseyPCDiPietroLEkelundUFirthJFriedenreichCMGarciaLGichuMJagoRKatzmarzykPTLambertELeitzmannMMiltonKOrtegaFBRanasingheCStamatakisETiedemannATroianoRPvan der PloegHPWariVWillumsenJFWorld Health Organization 2020 guidelines on physical activity and sedentary behaviourBr J Sports Med202054241451146210.1136/bjsports-2020-102955Hawley-HagueHHorneMSkeltonDAToddCReview of how we should define (and measure) adherence in studies examining older adults' participation in exercise classesBMJ Open201666e01156010.1136/bmjopen-2016-01156027338884bmjopen-2016-011560PMC4932302Rivera-TorresSFaheyTDRiveraMAAdherence to exercise programs in older adults: informative reportGerontol Geriatr Med2019523337214188236010.1177/23337214188236043073397710.1177_2333721418823604PMC6343518DwanKLiTAltmanDGElbourneDCONSORT 2010 statement: extension to randomised crossover trialsBMJ2019366l437810.1136/bmj.l437831366597PMC6667942SchulzKFAltmanDGMoherDCONSORT 2010 statement: updated guidelines for reporting parallel group randomised trialsBMC Med2010811810.1186/1741-7015-8-18203346331741-7015-8-18PMC2860339BoutronIAltmanDGMoherDSchulzKFRavaudPCONSORT statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstractsAnn Intern Med20171671404710.7326/M17-0046286309732633220GronwaldTde Bem AlvesACMurillo-RodríguezELatiniASchuetteJBuddeHStandardization of exercise intensity and consideration of a dose-response is essential. commentary on “exercise-linked FNDC5/irisin rescues synaptic plasticity and memory defects in Alzheimer's models”, by Lourenco et al., published 2019 in Nature MedicineJ Sport Health Sci20198435335410.1016/j.jshs.2019.03.00631333889S2095-2546(19)30034-1PMC6620472BarhaCKFalckRSSkouSTLiu-AmbroseTPersonalising exercise recommendations for healthy cognition and mobility in aging: time to address sex and gender (part 1)Br J Sports Med202055630030110.1136/bjsports-2020-10286433023883bjsports-2020-102864BarhaCKLiu‐AmbroseTSex differences in exercise efficacy: is midlife a critical window for promoting healthy cognitive aging?FASEB J2020349113291133610.1096/fj.202000857R32761860BarhaCKDavisJCFalckRSNagamatsuLSLiu-AmbroseTSex differences in exercise efficacy to improve cognition: a systematic review and meta-analysis of randomized controlled trials in older humansFront Neuroendocrinol201746718510.1016/j.yfrne.2017.04.00228442274S0091-3022(17)30021-3BarhaCKHsuCLTen BrinkeLLiu-AmbroseTBiological sex: a potential moderator of physical activity efficacy on brain healthFront Aging Neurosci20191132910.3389/fnagi.2019.0032931866852PMC6908464BarhaCKLiu-AmbroseTExercise and the aging brain: considerations for sex differencesBPL201811110.3233/bpl-1867