title: The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults.
abstract: OBJECTIVE
  The prevalence of cognitive impairment and dementia are projected to rise dramatically during the next 40 years, and strategies for maintaining cognitive function with age are critically needed. Physical or mental activity alone result in relatively small, domain-specific improvements in cognitive function in older adults; combined interventions may have more global effects.
  
  
  OBJECTIVE
  To examine the combined effects of physical plus mental activity on cognitive function in older adults.
  
  
  METHODS
  Randomized controlled trial with a factorial design.
  
  
  METHODS
  San Francisco, California.
  
  
  METHODS
  A total of 126 inactive, community-residing older adults with cognitive complaints.
  
  
  METHODS
  All participants engaged in home-based mental activity (1 h/d, 3 d/wk) plus class-based physical activity (1 h/d, 3 d/wk) for 12 weeks and were randomized to either mental activity intervention (MA-I; intensive computer) or mental activity control (MA-C; educational DVDs) plus exercise intervention (EX-I; aerobic) or exercise control (EX-C; stretching and toning); a 2 × 2 factorial design was used so that there were 4 groups: MA-I/EX-I, MA-I/EX-C, MA-C/EX-1, and MA-C/EX-C.
  
  
  METHODS
  Global cognitive change based on a comprehensive neuropsychological test battery.
  
  
  RESULTS
  Participants had a mean age of 73.4 years; 62.7% were women, and 34.9% were Hispanic or nonwhite. There were no significant differences between the groups at baseline. Global cognitive scores improved significantly over time (mean, 0.16 SD; P < .001) but did not differ between groups in the comparison between MA-I and MA-C (ignoring exercise, P = .17), the comparison between EX-I and EX-C (ignoring mental activity, P = .74), or across all 4 randomization groups (P = .26).
  
  
  CONCLUSIONS
  In inactive older adults with cognitive complaints, 12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function with no evidence of difference between intervention and active control groups. These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject population.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00522899.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. deborah.barnes@ucsf.edu
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Barnes
authors.forename: Wendy
authors.initials: W
authors.lastname: Santos-Modesitt
authors.forename: Gina
authors.initials: G
authors.lastname: Poelke
authors.forename: Arthur F
authors.initials: AF
authors.lastname: Kramer
authors.forename: Cynthia
authors.initials: C
authors.lastname: Castro
authors.forename: Laura E
authors.initials: LE
authors.lastname: Middleton
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D060825:Cognitive Dysfunction / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D003704:Dementia / Q000453:epidemiology / Q000517:prevention & control*; D015444:Exercise; D005260:Female; D006293:Health Promotion; D006801:Humans; D057187:Independent Living; D007858:Learning; D008297:Male; D008606:Mental Processes; D009483:Neuropsychological Tests; D010809:Physical Fitness; D015995:Prevalence; D012495:San Francisco; D057566:Self Report; D013850:Thinking; D016896:Treatment Outcome
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