Feasibility and exploratory cognitive outcomes of three exercise modalities in oldest-old adults in assisted living facilities: A 24-week pilot randomized controlled trial.

OBJECTIVE

Cognitive decline is common among the oldest-old, particularly in assisted living facilities (ALFs). This pilot randomized controlled trial examined the effects of aerobic, resistance, and mind-body exercises on cognition in ALF residents aged ≥80 years, and the feasibility and safety of exercise programs.

METHODS

In a 24-week four-arm trial in one Shanghai ALF, 76 participants (aged 86.8 ± 4.1; 72.4% female) were randomized to aerobic, resistance, mind-body (simplified Tai Chi), or non-exercise control groups. Thirty-minute exercise sessions were delivered three times weekly for 24 weeks. Cognition was assessed at baseline, Week 12, and Week 24 using the Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Immediate Story Recall (ISR), Boston Naming Test (BNT), Trail Making Test-A (TMT-A), and Trail Making Test-B (TMTB). Data were analyzed using intention-to-treat baseline-adjusted linear mixed-effects models with Holm-adjusted pairwise contrasts.

RESULTS

Recruitment was 65.5%; mean exercise attendance was 90.1%, and no intervention-related serious adverse events occurred. At week 24, aerobic and mind-body groups showed higher MMSE scores than control (aerobic-control Δ = 3.45, 0.92 to 5.99, pHolm = 0.0481; mind-body-control Δ = 3.29, 0.81 to 5.77, pHolm = 0.0492). Mind-body exercise showed higher ISR scores than control (ISR Δ = 9.84, 3.22 to 16.46, pHolm = 0.0234), whereas aerobic exercise showed better TMT-B performance than control (TMT-B Δ = -25.66 s, -41.95 to -9.37, pHolm = 0.0137). MoCA, BNT, and TMT-A differences were not significant after multiple-comparison correction.

CONCLUSIONS

These exercise programs were feasible and safe in ALF residents aged ≥80. Aerobic and mind-body exercise improved specific cognitive outcomes, while larger trials are needed to confirm these findings.

TRIAL REGISTRATION: This study was registered on Chinese Clinical Trail Registry (ChiCTR2500111703).