About this trial

The aquatic environment has characteristics that favor the adherence of older adults to exercise programs, and studies have shown that programs in this setting are effective in enhancing various aspects of physical fitness as well as cognitive function in this population. Research has explored whether incorporating cognitive tasks into an aquatic exercise program could offer additional benefits, but it remains uncertain whether this approach leads to greater improvements in cognitive function compared to aquatic exercises alone. The present protocol reports the WaterCog Study, which aims to evaluate the effects of an aquatic aerobic exercise program combined with cognitive tasks, compared to a conventional aquatic aerobic exercise program and a control group, on cognitive function and other health-related outcomes in older adults. This trial is a randomized, single-blinded, three-arm, parallel, superiority trial. A total of 98 older adults are randomized into one of three groups: 1) an aquatic aerobic exercise program combined with cognitive tasks, 2) a conventional aquatic aerobic exercise program, and 3) a control group. Participants in both exercise groups complete a 12-week exercise program with two weekly sessions on non-consecutive days. The primary outcome is cognitive function, while secondary outcomes include physical function, cardiovascular, and psychosocial parameters. Outcomes are measured at baseline, post-intervention, and at the 12-week follow-up after the end of the intervention period. The analysis plan will employ an intention-to-treat approach and per-protocol criteria. The conceptual hypothesis of the study is that both training programs will significantly improve the investigated outcomes compared to the control group. Additionally, it is expected that aquatic exercises with cognitive tasks will promote additional benefits in cognitive function, with similar gains in physical function, cardiovascular, and psychosocial parameters compared to conventional aquatic aerobic exercises in post-intervention and follow-up measures.

Eligibility criteria

This trial accepts healthy volunteers

Qualifiers

Older women aged 60 and 75 years;

Being physically inactive, meaning not participating in physical exercise for at least six months (regular exercise is defined as engaging in any physical training for a minimum of 20 minutes on two or more days a week).

Disqualifiers

History of cardiovascular disease (except controlled hypertension);

Osteoarticular limitations for the practice of exercises;

Being illiterate due to the self-completion questionnaires and the characteristics of the intervention;

Diagnosis of dementia, schizophrenia, or major depressive disorder.

Trial design

Design model

Parallel

Treatments tested in this trial

Aquatic aerobic exercise program
Other intervention
The aquatic exercise sessions include the following exercises: butt kick, frontal kick, cross-country skiing, and stationary running. These exercises are commonly used in water aerobics classes and provide controlled osteoarticular impact, being safe for older women (Alberton et al., 2019). Training intensity is prescribed using Borg's 6-20 rating of perceived exertion (RPE) scale. The adopted strategy is based on interval training, which alternates between high-intensity effort and low-intensity active recovery phases. Each block consists of 4 minutes of effort (RPE 13 - 15), with one minute for each exercise (butt kick, frontal kick, cross-country skiing, and stationary running) followed by 1 minute of active recovery (RPE 11), performed with stationary running. To facilitate monitoring, an RPE scale (measuring 0.90 × 1.20 m) is fixed to the outside of the pool, in front of the participants.
Cognitive tasks
Other intervention
This group performs the same aerobic training protocol used by the conventional aquatic program group. Additionally, cognitive tasks are performed during the active recovery phases. Cognitive training encompasses different domains of cognition in all sessions, including semantic fluency, processing speed, cognitive flexibility, inhibitory control, memory, attention, and reasoning. The exercises vary in each class, with progression in complexity in each mesocycle.

Treatment groups

98 Participants

are divided into 3 treatment groups

Group A: Aquatic aerobic exercise program combined with cognitive tasksExperimental treatment 2 interventions

Group B: Conventional aquatic aerobic exercise programExperimental treatment 1 intervention

Group C: Control groupNo intervention 0 interventions

Trial outcomes

Primary outcomes

1

Objective cognitive function - Digit Span Test

The Digit Span Test is used to assess working memory and attention span (Schroeder et al., 2012). The Digit Span Test requires participants to verbally recall a sequence of numbers dictated by the examiner. The test begins with three numbers ranging from 0 to 9, read at 1-second intervals, which participants must remember in the correct order. The sequence increases by one digit if pronounced correctly. If participants fail to recall the correct sequence twice in a row, the test ends. The number of digits correctly recalled is recorded as the test result, with a higher score indicating better performance.

Time frame

Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)

2

Objective cognitive function - Controlled Oral Word Association Test

The Controlled Oral Word Association Test (COWAT) is used to assess verbal fluency, working memory, and inhibitory control (Ross et al., 2007). In this test, participants must say as many words as possible that start with the letters "F," "A," and "S" within 1 minute for each letter. Proper names, repeated words, and variations in gender, number, and conjugation are not considered. A higher number of words in each test indicates better verbal fluency.

Time frame

Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)

Secondary outcomes

1

Objective cognitive function - Trail Making Test (TMT)

The validated version of the Trail Making Test (TMT) for the Brazilian population is used to assess aspects of objective cognitive function (Carvalho \& Caramelli, 2020). In the first part of the instrument (TMT-A), which measures visual attention and processing speed, participants must draw a line connecting the numbers 1 to 25 in ascending order. In the second part (TMT-B), which measures cognitive flexibility and executive function, participants connect numbers (1-13) and letters (A-L) in an interleaved numerical and alphabetical order. Participants are instructed to maintain pencil-and-paper contact throughout the test, and shorter completion times indicate better performance.

Time frame

Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)

2

Self-perception of cognitive function

The Brazilian version of the Cognitive Failures Questionnaire (CFQ) is used to measure the frequency of cognitive failures in everyday life, such as lapses in attention, memory problems, and failures in executing intentional actions (Paula et al., 2017). The questionnaire consists of 25 self-administered items, with responses on a Likert-type scale from 0 to 4, which assess the frequency of cognitive failures in different everyday contexts. The total score ranges from 0 to 100 points, with higher scores indicating a greater perceived frequency of cognitive failures and, therefore, poorer self-perception of cognitive function.

Time frame

Baseline (week 0), post-intervention (week 13), and 12-week follow-up (week 25)

3

Aerobic fitness

The 6-minute Walk Test (6MWT) is performed to measure aerobic fitness. The course proposed in the original test is 45.72 m rectangular. The course will be adapted for a straight line of 30 m in length, demarcated with cones every 3 m. Participants are instructed to walk for 6 minutes in a flat 30m course, where the total distance walked "as fast as possible" is assessed

Time frame

Baseline (week 0) to post-training (week 13)

4

Lower limb strength

The 30-s Chair-Stand test is performed to measure the strength of the lower limbs. Participants are instructed to sit and stand up from a chair 43 cm high from the seat, without the aid of the upper limbs, as many times as possible for 30 s. The total number of complete repetitions performed within the 30 seconds is recorded as the result, with higher values indicating greater lower body strength.

Time frame

Baseline (week 0) to post-training (week 13)

Other outcomes

1

Cognitive status

The validated version of the Mini-Mental State Examination (MMSE) (Brucki et al., 2003) for the Brazilian population is used to screen for cognitive decline, and in this study, it is also used to stratify randomization. The questionnaire is divided into two sections: the first, with a maximum score of 21, requires vocal responses regarding temporal and spatial orientation, memory, and attention; the second, with a maximum score of 9, assesses the ability to name, follow commands, write, and copy a polygon. The maximum total score is 30 points, and the test is not timed. Participants' cognitive function is classified based on cutoff points adjusted for education, as proposed by Brucki et al. (2003). The score is formed by the sum of the items answered correctly; the higher the score, the better the cognitive function.

Time frame

Baseline (week 0)

2

Sociodemographic and clinical characteristics

Sociodemographic data, health history, medical conditions, and medication use are collected using a standardized questionnaire before the intervention.

Time frame

Baseline (week 0)

3

Body mass

Body mass measurements are performed using a digital scale with a stadiometer (Welmy, Santa Bárbara d'Oeste - São Paulo, Brazil). Body mass is measured in kilograms.

Time frame

Baseline (week 0) to post-training (week 13)

4

Height

Height measurements are performed using a digital scale with a stadiometer (WELMY, Santa Bárbara d'Oeste - São Paulo, Brazil). Height is measured in meters.

Time frame

Baseline (week 0) to post-training (week 13)

Aquatic Exercises Combined With Cognitive Tasks for Older Adults

About this trial

Eligibility criteria

Qualifiers

Disqualifiers

Trial design

Treatments tested in this trial

Treatment groups

Trial outcomes

Primary outcomes

Secondary outcomes

Other outcomes

Sponsors and contacts