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Boosting the Brain Health of Older Adults

Research points to the effectiveness of “effortful learning,” which combines mental and physical exercises.

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Brain health and exercise.

Brain health is important to everyone, and exercise is good for the aging brain. Indeed, the right kind of exercise can protect against neurodegeneration, the natural decline of brain functions that accompanies aging.

You could encourage your older clients to play “brain games” on computers or mobile apps. Alas, multiple studies say this approach helps only with the specific cognitive functions the games use (Bamidis et al. 2014). Hence, a computer game that requires a lot of visuospatial processing tends to improve visuospatial processing—but not much else.

Effortful Learning: A Key to Brain Health

Fortunately, scientists have found a productive alternative to promoting brain health through effortful learning (see “Effortful Learning in Action,” below), which combines mental exercises with physical movement. Effortful exercises include learning to speak a new language, playing a musical instrument, performing dance steps or tai chi, or even figuring out how to juggle.

These tasks challenge and stimulate different areas of the brain. There is evidence that some types of effort can increase the amount of white and gray matter in the brain (Zivari Adab et al. 2018).

The key to effortful learning seems to be that the tasks are novel and challenging (Bamidis et al. 2015). Apparently, learning a new skill can release beneficial neurotransmitters such as dopamine and acetylcholine, which may accelerate neuroplasticity, the brain’s ability to adapt to new challenges.

We already know that physical exercise—especially aerobic and progressive resistance training—does great things for the health and function of the brain. Exercise increases cerebral blood flow, delivering nutrients and removing waste products. Exercise also boosts brain-derived neurotrophic factor (BDNF) and insulin-like growth factor-1 (IGF-1), two proteins that promote brain health (Churchill et al. 2002). Essentially, everything that keeps the heart healthy—diet, exercise and so on—also improves the well-being of the brain (Kramer & Colcombe 2018).

Why Simultaneous Cognitive and Physical Training Promotes Brain Health

Emerging research explores the benefits of combining physical and cognitive exercises to shape the body and sharpen the mind. Preliminary studies suggest that this type of dual tasking may be more beneficial than the sum of the activities’ separate gains. What’s more, the combined effects can have a profound impact on both ameliorating and preventing cognitive decline in older people (Shatil 2013). More research must be done to confirm some of these theories, but pilot studies on dual tasking are encouraging (McEwen et al. 2018).

Dual tasking has many real-world applications, such as talking while walking or driving while responding to multiple stimuli. The ability to dual-task deteriorates with age, reducing reaction times and walking speeds, causing more frequent run-ins with obstacles and increasing the risk of falls (Pichierri et al. 2011).

One promising dual-tasking strategy combines aerobic exercise with cognitive challenges to encourage cerebral blood flow and cell growth (Mozolic, Hayasaka & Laurienti 2010). The key challenge here is that these factors are interdependent: They must work in concert to achieve significant results.

Blood flow. The importance of healthy blood flow to the brain cannot be overstated. Aerobic exercise bathes the vital tissues of the brain with oxygen, glucose and other nutrients. Combining aerobic exercise and cognitive challenges increases the rate at which the brain receives these necessary ingredients.

Nerve birth. Combining cognitive and aerobic efforts encourages the growth of new neurons and synapses in the brain. But it’s not enough to make new cells; the cells must incorporate themselves into brain tissue to survive (Shors et al. 2014). Thus, many people call nerve birth a “use-it-or-lose-it” scenario.

Specific activities can generate new nerve cells, but the movements must continually recruit the nerves, or they will die in short order.

Luckily, physical exercise and cognitive challenges seem to be a perfect combination: Aerobic activity increases the proliferation of nerve cells (van Praag, Kempermann & Gage 1999), and effortful learning helps integrate them into the neural network (Shors et al. 2014). Preliminary studies on animals and humans support the hypothesis that combined physical and cognitive training is more effective at recruiting and maintaining new neurons than either intervention alone. In one study that combined aerobic exercise with an “enhanced environment” (similar to a human cognitive challenge, but for rodents), the increase in new neurons was as much as 30% greater than it was with the singular interventions (Fabel et al. 2009).

Exercise and cognitive challenges also aid in the birth of new synapses—spaces that exist between neurons, linking their activities together. The birth of new synapses—synaptogenesis—is rampant during early brain development, but the process slows later in life. Robust increases in the birth of neurons and synapses can increase brain volume, specifically in the gray matter of the cortex and cerebellum. Combining aerobic exercise and cognitive challenges therefore expands brain volume by encouraging cell birth (Colcombe et al. 2004).

Physical Tasks That Target Specific Cognitive Functions

Physical movement helps the brain perpetually rewire itself. Thus, physical and cognitive challenges remain central to the health and function of the brain. We can say with confidence that we can shape our brain, much as we do the rest of our body, through combined physical and cognitive training.

The goal, therefore, is to challenge each person’s specific cognitive deficiencies. To stay generally healthy and in good shape, we all need a program of aerobic, strength and flexibility exercises. But becoming much more muscular, getting really lean or running faster requires a more specific physical challenge that aligns with clear goals. That’s the principle of specificity.

The brain is no different. How you challenge it determines which cognitive functions improve. As mentioned earlier, the tricky part is that cognitive training through, say, a brain game app makes you better at playing the game but doesn’t improve overall brain functions. Exercise, by contrast, affects multiple domains of cognitive ability—especially when we do effortful activities that challenge the brain and the body simultaneously.

Combined physical and cognitive training shows great promise as a tool for maximizing brain health and function. Indeed, it may be the next big innovation in the fitness industry as the world’s population continues to age and rates of dementia keep rising.

See also: B Strong for BFR Training–The Biohack for Aging Boomers.

Integrating Cognitive Training Into Exercise Programs

How can you “cognify” exercises to give your clients a big kick in the hippocampus? The basic ideas here can help you integrate cognitive stimuli into most exercises.

When you’re working with older adults, pay close attention to safety and cognitive load, keeping in mind acute variables in speed, duration, load, environment and direction. Ideally, the client already knows how to do certain movements. This knowledge provides a safe starting point from which to add layers of cognitive cues.

Remember that you need to link the cognitive task to the physical task. For instance, you might ask clients to calculate math problems while squatting or recite poetry while walking on a treadmill.

The following cognitive-physical exercise examples use the familiar lunge motion, but you can adapt any movement with stepping or reaching (even in multiple directions). Don’t worry that lunges are strength training movements. The main idea is to get clients to perform enough repetitions to increase their heart rate.

Many studies report improvement in cognitive outcomes at 60%–75% of the individual’s maximum heart rate. Some studies suggest higher intensity or maximal training is more effective, but before you add dual-task techniques at higher intensities, make sure you assess the client’s cardiovascular fitness.

Keep in mind that the client’s rating of perceived exertion reflects the complexity or difficulty of dual-task exercises. Also, strive for postural control and completion of the task with at least 75% movement accuracy. If a client can’t meet these guidelines, you’ll probably have to reduce the complexity of the task and/or aerobic load.


This exercise, which uses simple, fun cognitive cues, involves reasoning and memory. As the trainer, you call out a kind of food, and the client identifies whether it’s a vegetable or a fruit—and then moves accordingly. Example: When the client hears you say “apple,” she lunges, leading with the left foot because it’s a fruit. When you call out “carrot,” her lunge leads with the right foot because it’s a vegetable.

As the client’s proficiency with this cognitive load improves, call out the words more quickly or offer compound lists (quickly stating a fruit, another fruit, a vegetable and then a fruit, for example), challenging the client to remember the sequence.

Starting with a list can be helpful. Just make sure it does not become so predictable that clients can learn the pattern.


Select two balls with different colors (ideally tennis balls or tennis balls with different colored markings or tape on them). Assign each color to a client’s hand—for example, blue ball = right hand; pink ball = left hand.

Then throw either ball. The client must catch it with the appropriate hand, which challenges processing speed and impulse control. Progress the drill by instructing the client to perform a balance exercise or alternating lunges while responding to the correct ball.

Keep a tally of incorrect choices to encourage better attention and to reward improved engagement.


Using a functional loaded implement (or body weight), demonstrate a chain of two to five exercises the client must memorize and execute. Most clients will ask you to clarify the exercise sequence until they are perfectly clear. Tell them you will demonstrate it only once to encourage careful attention and challenge memory.

Provide feedback at the end of the set. Progress by adding different, longer, more complex or faster movement sequences. Examples you can tweak for memory purposes include Animal Flow®, ViPR® flows, tai chi, Zumba® moves or yoga flows.



“I am going to say a sequence of four numbers, and I want you to step on those numbers in the reverse order I say them with your right foot.”

The patient looks up at her trainer with attentive eyes, asking for a quick restatement of the instructions. Then she steps on the stated numbers on a mat with both vigor and safe instability. New sequences of numbers are then read to her, and she successfully completes each sequence. After 60 seconds, she takes a break and waits for the next “brain game.”

The woman, who has early-stage dementia, is paired with a brain health trainer in a one-of-a-kind “brain gym.” Her guide is Ryan Glatt, a certified personal trainer, psychometrist (skilled at assessing neuropsychological function) and brain health coach at the Pacific Brain Health Center (pacificbrainhealth.org), located in the Pacific Neuroscience Institute in Santa Monica, California. The center’s interdisciplinary team of medical experts uses a flagship brain-health intervention combining physical and cognitive exercises that reflect the principles of effortful learning.

Their innovative “Cog-Fit Program” was developed from the research of Sarah McEwen, PhD, director of research and programming at the Pacific Brain Health Center, and her research colleagues. McEwen is a cognitive psychologist at the University of California, San Diego, and a certified personal trainer who has studied the effects of combining cognitive training simultaneously with exercise to help people who are cognitively impaired (McEwen et al. 2018).

McEwen and Glatt joined forces to provide interventions to a population that the health and fitness industry often overlooks. But as people live longer and rates of Alzheimer’s disease rise (one-third of seniors will develop it) with no cure in sight, it’s becoming imperative that the fitness industry join the effort to develop treatments that can slow cognitive decline and combat Alzheimer’s and dementia.

“We feel that health and fitness professionals are set up to help address this brain-health epidemic, and all that remains to be done is to disperse the knowledge and practical application of how it can be done,” McEwen says. “The research, the need and the interest from professionals are all at the doorstep, so now is the time to take action.”


Bamidis, P.D., et al. 2014. A review of physical and cognitive interventions in aging. Neuroscience and Biobehavioral Reviews, 44, 206–20.

Bamidis, P.D., et al. 2015. Gains in cognition through combined cognitive and physical training: The role of training dosage and severity of neurocognitive disorder. Frontiers in Aging Neuroscience, 7 (152), 1–15.

Churchill, J.D., et al. 2002. Exercise, experience and the aging brain. Neurobiology of Aging, 23 (5), 941–55.

Colcombe, S.J., et al. 2004. Cardiovascular fitness, cortical plasticity, and aging. Proceedings of the National Academy of Sciences, 101 (9), 3316–21.

Fabel, K., et al. 2009. Additive effects of physical exercise and environmental enrichment on adult hippocampal neurogenesis in mice. Frontiers in Neuroscience, 3 (50).

Kramer, A.F., & Colcombe, S. 2018. Fitness effects on the cognitive function of older adults: A meta-analytic study—revisited. Perspectives on Psychological Science, 13 (2), 213–17.

McEwen, S.C., et al. 2018. Simultaneous aerobic exercise and memory training program in older adults with subjective memory impairments. Journal of Alzheimer’s Disease, 62 (2), 795–806.

Mozolic, J.L., Hayaska, S., & Laurienti, P.J. 2010. A cognitive training intervention increases resting cerebral blood flow in healthy older adults. Frontiers in Human Neuroscience, 4 (16).

Pichierri, G., et al. 2011. Cognitive and cognitive-motor interventions affecting physical functioning: A systematic review. BMC geriatrics, 11 (29).

Shatil, E. 2013. Does combined cognitive training and physical activity training enhance cognitive abilities more than either alone? A four-condition randomized controlled trial among healthy older adults. Frontiers in Aging Neuroscience, 5 (8).

Shors, T.J., et al. 2014. Mental and Physical (MAP) Training: A neurogenesis-inspired intervention that enhances health in humans. Neurobiology of Learning and Memory, 115, 3–9.

van Praag, H., Kempermann, G., & Gage, F.H. 1999. Running increases cell proliferation and neurogenesis in the adult mouse dentate gyrus. Nature Neuroscience, 2 (3), 266–70.

Zivari Adab, H., et al. 2018. White matter microstructural organisation of interhemispheric pathways predicts different stages of bimanual coordination learning in young and older adults. European Journal of Neuroscience, 47 (5), 446–59.

Cody Sipe, PhD

Cody Sipe, PhD, is a respected authority on fitness for older adults with 25 years in the industry. He is a professor, researcher, international educator and co-founder of the Functional Aging Institute. Cody is currently an associate professor and director of clinical research in the doctoral physical therapy program at Harding University. He was recognized as the IDEA Program Director of the Year in 2005 and was a finalist for the IDEA Fitness Innovator of the Year award in 2019.

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