Enhancing Neurocognitive Health via Activity, Nutrition and Cognitive Exercise (ENHANCE): A Randomized Controlled Trial
Bibliographic record
Abstract
ABSTRACT Background While multidomain interventions show promise for promoting healthy aging, their impact on brain structure remains unclear. This randomized controlled trial (ENHANCE) assessed the efficacy of a 12‐month group‐based multidomain intervention on brain structure and function in community‐dwelling older adults, with particular attention to urban–rural disparities. Methods The ENHANCE trial delivered twice‐weekly group‐based multidomain sessions (physical exercise, cognitive training and nutrition education) in urban and rural communities for 12 months, while the control group received quarterly telephone education. A total of 88 participants completed the trial (attendance rates > 60% across all sites), with 76 completing longitudinal MRI assessments (intervention: n = 35; control: n = 41). The intervention group ( n = 44; 75.0% female) was significantly older than the control group ( n = 44; 70.5% female) (75.0 ± 6.6 vs. 72.3 ± 5.0 years, p = 0.035) and had lower BMI (23.4 vs. 25.2 kg/m 2 , p = 0.016) at baseline. The primary outcomes were brain structures (voxel‐based changes in brain grey matter volume [GMV]), while secondary outcomes were functional outcomes (physical performance, nutritional status, cognitive function, psychosocial assessments and cardiometabolic biomarkers). Results Using two‐stage tensor‐based morphometry analysis, the intervention group demonstrated significantly less GMV reduction in regions over the left inferior temporal lobe compared with controls over 12 months ( p < 0.05). Using generalized estimating equation (GEE) model, the intervention group showed enhanced physical performance at 6 months (5‐time chair rise test: −1.19 s; 95% CI, −2.24 to −0.13; p = 0.028) and improved cognitive function by 12 months (Montreal Cognitive Assessment: +1.32 points; 95% CI, 0.10–2.54; p = 0.034). Cardiometabolic improvements included increased HDL‐C (+6.65 mg/dL, p < 0.001) and decreased triglycerides (−16.07 mg/dL, p = 0.025) at 12 months in GEE models. In subgroup analyses, rural participants showed preserved GMV in additional regions including the cerebellum (Crus I and II) and occipital cortex with greater cognitive improvements (MoCA: +3.06 points; 95% CI, 0.84–5.27; p = 0.007), while urban participants showed greater GMV reduction in the left temporal‐occipital fusiform cortex but achieved superior physical performance gains (5‐time chair rise test: −1.85 s; 95% CI, −3.07 to −0.64; p = 0.003). Conclusions This study demonstrates that multidomain interventions can induce neuroplasticity in older adults, with differential effects on brain structure and function between urban and rural participants, emphasizing the need for tailored approaches that consider sociocultural factors to optimize healthy aging across diverse populations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".