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The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults
Barnes DE, Santos-Modesitt W, Poelke G, Kramer AF, Castro C, Middleton LE, Yaffe K.. JAMA internal medicine, 2013-05-01
Topic: Risk, prevention and care in population studies
Importance 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. Design Randomized controlled trial with a factorial design. Setting San Francisco, California. Participants A total of 126 inactive, community-residing older adults with cognitive complaints. Interventions 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. Main outcome measures 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 Conclusions and relevance 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. Trial registration clinicaltrials.gov Identifier: NCT00522899.
Key findings
- 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.
- 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).
- These findings may reflect practice effects or may suggest that the amount of activity is more important than the type in this subject population.
Why it matters
In this 12-week trial of 126 inactive older adults with cognitive complaints, global cognitive scores improved significantly over time in all groups, but there were no significant differences between the groups. This means the study did not show that combining physical and mental activity produced better cognitive results than either alone.
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Study details
- Study designrandomized controlled trial
- Participants126
- Effect size62.7%; 34.9%
- Evidence strengthHigh
How this study scored 78/100
Published in a leading specialty journal, and it is a randomised controlled trial.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA internal medicine) |
| Journal's citation record | 3 / 4 | JAMA Internal Medicine: journal h-index 258 (OpenAlex, 2026-10-29) |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 2 / 4 | 126 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 6 / 7 | Cited 379 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 25.3 citations a year over 15 year(s) since 2013 |
| Impact for its field and year | 5 / 6 | Cited 22.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 17 other studies in this library |
| Still being cited | 2 / 4 | Cited 36 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Kristine S. Yaffe: h-index 155 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Stanford University: institution h-index 2,684 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 23545598) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 78 / 100 | — |
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Read the original
- DOI: 10.1001/jamainternmed.2013.189
- PubMed: 23545598
- Original source →
- Free full text: PubMed Central →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Barnes, D. E., Santos-Modesitt, W., Poelke, G., Kramer, A. F., Castro, C., Middleton, L. E., et al. (2013). The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA internal medicine. https://doi.org/10.1001/jamainternmed.2013.189
Vancouver
Barnes DE, Santos-Modesitt W, Poelke G, Kramer AF, Castro C, Middleton LE, et al. The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults. JAMA internal medicine. 2013. doi:10.1001/jamainternmed.2013.189. PMID: 23545598.
BibTeX
@article{barnes2013-23545598,
author = {Barnes, D. E. and Santos-Modesitt, W. and Poelke, G. and Kramer, A. F. and Castro, C. and Middleton, L. E. and Yaffe, K.},
title = {{The Mental Activity and eXercise (MAX) trial: a randomized controlled trial to enhance cognitive function in older adults}},
journal = {JAMA internal medicine},
year = {2013},
doi = {10.1001/jamainternmed.2013.189},
pmid = {23545598},
url = {https://doi.org/10.1001/jamainternmed.2013.189}
}
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