The Effect of Integrated Aerobic and Cognitive Training (Activ4Brain) on Cognition and Neurophysiology in Older Adults: Protocol for a Controlled Trial.
Besikci H, Akalp K, et al. • JMIR research protocols • 2026
This protocol describes a 3-arm controlled trial investigating the effects of the Activ4Brain program—which integrates computerized cognitive training games with aerobic exercise in group sessions—on cognition, physical function, and neurobiological mechanisms in older adults.
Key Findings
Background
The Activ4Brain program combines group aerobic exercise classes with computerized cognitive training games designed to take advantage of exercise-induced arousal.
The intervention consists of 24 sessions delivered twice a week.
Cognitive training task difficulty is adapted throughout the intervention as users improve their performance.
The setup allows for simultaneous body movements to maintain aerobic activation during cognitive tasks.
Sessions are designed as 'fun group sessions' to promote long-term adherence.
Methods
The study uses a 3-arm controlled trial with parallel design and 1:1:1 allocation across experimental, active control, and passive control groups.
The experimental group participates in the Activ4Brain program (integrated aerobic and cognitive training).
The active control group participates in aerobic exercise sessions only.
The passive control group receives no intervention.
Participants are tested at baseline and after the intervention.
Methods
Seventy-three older adults were enrolled in the study across the three groups.
The sample included 40 women and 33 men.
The average age was 66 (SD 6) years.
Data collection started in January 2024 and finished in April 2025.
Data analyses are ongoing, with publication of results estimated for 2026 and 2027.
Methods
The primary outcome of the study is changes in cognition, with multiple secondary neurobiological and physical outcomes also assessed.
Additional outcomes include changes in brain and autonomic function.
Levels of inflammation and neuroprotective markers are measured as secondary outcomes.
Cardiovascular and physical functional fitness are assessed.
Body composition is also measured as an additional outcome.
Background
The study is designed to investigate neurobiological mechanisms underlying the effects of combined aerobic and cognitive training in older adults.
The protocol specifically explores 'the underlying neurobiological mechanisms' of the Activ4Brain intervention.
The design takes advantage of 'exercise-induced arousal' as a mechanism to potentiate cognitive training effects.
The study aims to produce 'knowledge important for the development of efficient strategies to fight age-related decline.'
The intervention targets both cognitive and physical function simultaneously.
What This Means
This paper describes the protocol for a clinical trial testing a new program called Activ4Brain, which combines aerobic exercise with computerized brain-training games in group fitness sessions for older adults. The idea is that the mental boost from physical exercise ('exercise-induced arousal') might make cognitive training more effective when the two are done at the same time. The trial enrolled 73 older adults (average age 66) who were divided into three groups: one doing the combined program, one doing aerobic exercise only, and one doing neither, allowing researchers to compare whether adding cognitive games to exercise provides extra benefit.
This research suggests that integrating mentally stimulating tasks into physical exercise routines—rather than doing them separately—could be a more efficient and enjoyable strategy for protecting the aging brain. The study measures not just thinking and memory, but also brain activity, stress hormone and inflammation markers in the blood, heart health, physical fitness, and body composition, which will help scientists understand why and how the program works at a biological level. The trial also emphasizes group participation and adaptive difficulty (games get harder as you improve) to keep older adults motivated over the 12-week program.
Because data collection has finished but analysis is still ongoing, this paper does not yet report results—those are expected in 2026 and 2027. Nevertheless, the study design addresses a practical challenge in aging research: finding interventions that are both scientifically effective and engaging enough that people will actually stick with them long-term. If the combined program proves superior to exercise alone, it could inform the development of widely accessible group fitness classes tailored to protect cognitive health in older populations.
Besikci H, Akalp K, Rama L, Gomes B, Ferreira J, Mouga S, et al.. (2026). The Effect of Integrated Aerobic and Cognitive Training (Activ4Brain) on Cognition and Neurophysiology in Older Adults: Protocol for a Controlled Trial.. JMIR research protocols. https://doi.org/10.2196/92631