Empirically-supported interventions are sought to ameliorate cognitive decline and prevent conversion to dementia. Preliminary findings are reported from a clinical trial of the interactive Physical and Cognitive Exercise Study (iPACES).

Physical exercise combined with mental exercise has been found to yield greater cognitive benefit than physical exercise alone. The parameters to maximize such benefit are unclear. This clinical trial examined whether interactivity matters: does a fully interactive combination yield greater benefit than a disparate experience wherein the mental task is synchronous, but not linked to physical activity?

 From 2020-2024, as part of an NIA-funded national clinical trial, 80 persons identifying with mild cognitive impairment (MCI) and most of their partners/caregivers enrolled in a fully-remote, year-long, in-home study of effects of exercising with iPACES. Participants were shipped an under-desk pedaler and a tablet with the iPACES app installed, together comprising a pedal-n-play neuro-exergame which targeted executive functions. Participants were randomly assigned to either the fully interactive iPACES condition (pedaling controls speed on the virtual bike path; pedal-TO-play), or the PACE condition (interactivity is removed and speed is automatic; pedal-WHILE-play). The mental task was to learn a list of errands and pedal through a neighborhood, steering the tablet toward each target (e.g., grocery or library). 

After three months of pedal-n-play exercise, among all older adults that were minimally compliant (>1x/week for the first three months; MCI + caregivers), there appears to be greater benefit from iPACES (n=30) compared to PACE (n=20) for the targeted executive function (Digit Span Backward ratio, p=.02).

Interactivity appears to be an important. Pedal-to-play neuro-exergaming with iPACES appeared to stall cognitive decline, while those in PACE condition continued to decline. Consideration is being given for FDA clearance and healthcare reimbursement for iPACES to be utilized as a prescriptive digital therapeutic for MCI to stave off decline to dementia.