Intervention
Training sessions were conducted in groups of 5 to 10 participants, led by a certified therapist. Participants engaged in physical exercise for 45 to 55 min, followed by 45 to 50 min of cognitive training. The participants performed 10 min of warm-up, followed by 30 to 35 min of physical exercise, and ended with 5 to 10 min of cool-down. The physical exercise programs involved aerobic exercises, resistance training, and balance training. For aerobic exercise, such as stepping and walking, the target heart rate was set at 40% to 70% of the maximal heart rate. Equipment for resistance and balance training included water bottles, wrist or ankle weights, Thera-Band, and exercise balls. The therapist increased the physical exercise intensity as the participants improved their performance throughout practice.After physical exercise training, the participants took part in 45 to 50 min of cognitive training. In addition to using a computerized cognitive program, BrainHQ (Posit Science Inc., San Francisco, CA, USA) for cognitive training, we designed a PowerPoint presentation with content derived from BrainHQ and incorporating the functional elements. The domains of cognitive training consisted of attention, memory, processing speed, visuospatial skill, and calculation. Participants practiced two or three cognitive domains in each training session. In the memory task, for example, participants were asked to memorize a series of numbers and then say them backward. Each session contained 10 min of warm-up (explaining the task rules and paying attention to the therapist), 30 to 35 min of cognitive training, and 5 min of cool-down (providing home programs and feedback to the tasks). The tasks were adjusted continuously based on the participant’s level of performance.