The effect of the Mediterranean diet-integrated gamified home-based cognitive-nutritional (GAHOCON) training programme for older people with cognitive frailty : pilot randomized controlled trial

Abstract

Background: Cognitivefrailtyis known tobeassociatedwith both nutrition and cognitivetraining. However,effectivetreatments that engage older adults with cognitive frailty in both the Mediterranean diet and cognitive training are lacking. Objective: This study aims to examine the feasibility and preliminary effects of Gamified Home-Based Cognitive-Nutritional (GAHOCON) on older adults with cognitivefrailty, focusing on Mediterranean diet knowledge, adherenceto the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Methods: This study applied a 2-center, assessor-blinded, 2-parallel-group, noninferiority, randomized controlled trial design. Eligible participants were community-dwelling adults aged 60 years or older, living with cognitive frailty, and exhibiting poor adherence to the Mediterranean diet. Participants were randomly assigned to the intervention or control group in a 1:1 ratio. In the intervention group, participants received 4 weeks of center-based training (health education) followed by 8 weeks of home-based training (GAHOCON). In the control group, participants received only the 4 weeks of center-based training and 8 weeks of self-revision of health educational materialsat home. During the intervention period, time spent by the participants and the levels of difficulty completed by them weekly on GAHOCON were measured as markers of feasibility. The outcomesincluded Mediterranean diet knowledge, adherence to the Mediterranean diet, cognitive function, physical frailty, grip strength, walking speed, memory, and body composition. Data werecollected at baseline (T0) and 1 week postintervention (T1). The Wilcoxon signed rank test was used to examine within-group effects for the outcome variables in each group separately. Results: A total of 25 participants were recruited, with 13 allocated to the intervention group and 12 to the control group. The median cumulative minutes spent on GAHOCON training increased from 117 to 926 minutes. The median level of difficulty completed for game 1 increased from level 14 to level 20, while for game 2, it increased from level 2 to level 24. After the completion of the interventions, Mediterranean diet knowledge was retained in the intervention group but significantly decreased in the control group (r=-0.606, P =.04). Significant improvements were observed in the intervention group in Mediterranean diet adherence (r=-0.728, P =.009), cognitive function (r=-0.752, P =.007), physical frailty (r=-0.668, P =.02), and walking speed (r=-0.587, P =.03), but no such improvements were seen in the control group. Conclusions: GAHOCON is feasible in engaging older adults with cognitivefrailty to regularly participate in the intervention. Preliminary evidencesuggests that it can retain Mediterranean diet knowledgefollowing nutritional education, improve adherence to the Mediterranean diet, and enhanceglobal cognitivefunction, physical frailty, and walking speed. However, the difficulty of the later levels of game 1 may be too high. Future studies should adjust the difficulty level of game 1. Additionally, trials with larger sample sizes and longer follow-up periods are needed to confirm its effects. Trial Registration: ClinicalTrials.gov NCT05207930; https://clinicaltrials.gov/ct2/show/NCT05207930