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33

Review article       UDC: 796.012:612.67
received: 2017-07-13

benefits of motor and/or cognitive exercise: a 
review with recommendations for the third age

Mitja GERŽEVIČ1, Matej PlEVnIk2, Uroš MARUŠIČ3,4

1 Euro-Mediterranean University, kidričevo nabrežje 2, 6330 Piran, Slovenia
2 University of Primorska, Faculty of Health Sciences, Polje 42, 6310 Izola, Slovenia

3 Science and Research Centre koper, Institute for kinesiology Research, Garibaldijeva 1, 6000 
koper, Slovenia

4 Alma Mater Europaea – ECM, Department of Health Sciences, Slovenska ul. 17, 2000 
Maribor, Slovenia

Corresponding author:
Mitja GERŽEVIČ

Euro-Mediterranean University, 
kidričevo nabrežje 2, 6330 Piran, Slovenia

Tel.: +386 59 25 00 51
e-mail: mitja.gerzevic@emuni.si

ABSTRACT

Physical activity in the form of aerobic and resistance exercise, leading to a high 
level of cardio-respiratory fitness, represents a strong non-pharmacological preventive 
tool against cognitive decline and thus the occurrence of neuro-degenerative diseases 
in the third age. However, the effects are even greater if such exercise is performed on 
regular basis in the form of simultaneous combination of a motor and additional cogni-
tive task, dancing or interactive video dancing or as a body-mind meditative exercise 
like Tai Ji Quan.

The aim of this article is a review of benefits of motor / cognitive exercise with 
recommendations for older adults. In the first part, the benefits and effects of physical 
activity and exercise on cognitive functions are reviewed. Physical activity and exercise 
have an important role in mitigating age-related structural and behavioural changes 
within the brain, they increase BDNF levels in the hippocampus, enhance learning and 
neurogenesis in the hippocampal regions and optimize spatial abilities. The second 
part is expanded onto the benefits and effects of combined motor and / or cognitive 
exercise on cognitive functions with recommendations. This combination of motor and / 
or cognitive exercise could be achieved so that both activities are performed separately, 
one after another, named “motor and cognitive exercise” or simultaneously, named 



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ANNALES KINESIOLOGIAE • 8 • 2017 • 1

“motor-cognitive exercise.” Based on this premise, we divided the second part into 
three sub-topics: i) the effects of physical exercise / training followed by computerized 
and other forms of cognitive training, ii) the effects of simultaneously performed motor 
and cognitive exercise / training and iii) the effects of dancing, interactive video dan-
cing and ancient body-mind meditative techniques. Studies suggest that a combination 
of mental and physical training may result in greater cognitive gains, namely, in larger 
improvements in the executive control task and in the paired-associates task.

Keywords: ageing, neurogenesis, motor learning, computerized cognitive training, 
dancing, body-mind meditative techniques.

Prednosti in koristi gibalne in/ali kognitivne vadbe: 
PREGLED PODROČJA s PRiPOROČiLi zA tREtJE živLJEnJskO 

ObDObJE

IZVLEČEK

Telesna aktivnost v obliki aerobne vadbe in vadbe proti uporu, ki omogočata vi-
soko stopnjo kardio-respiratorne pripravljenosti, predstavlja močno nefarmakološko 
preventivno orodje proti upadu kognitivnih funkcij in s tem pojavljanju nevrodegene-
rativnih bolezni v tretjem življenjskem obdobju. Učinki vadbe pa so lahko še večji, če 
se ta izvaja redno v obliki sočasne kombinacije gibalne in dodatne kognitivne naloge, 
plesa ali interaktivne plesne videoigre ali v obliki meditativne vadbe za telo in um, kot 
je npr. Tai Ji Quan.

Namen prispevka je pregled prednosti in koristi, ki jih ima gibalna/kognitivna vad-
ba, s priporočili za starejše odrasle osebe. V prvem delu so predstavljene prednosti in 
koristi ter vplivi telesne aktivnosti in vadbe na kognitivne funkcije. Telesna aktivnost 
in vadba imata pomembno vlogo pri zmanjševanju s starostjo povezanih strukturnih in 
vedenjskih sprememb v možganih, hkrati pa vplivata na povečanje BDNF vrednosti v 
hipokampusu, spodbujata procesa učenja in nevrogeneze in izboljšujeta sposobnosti 
prostorske predstave. Drugi del prispevka je razširjen na prednosti in koristi ter učinke 
kombinirane gibalne in/ali kognitivne vadbe na kognitivne funkcije starejših oseb, s 
priporočili. Kombinacijo gibalne in/ali kognitivne vadbe je mogoče doseči tako, da 
obe dejavnosti opravljamo ločeno, eno za drugo, kar imenujemo "gibalna in kogni-
tivna vadba/trening" ali pa sočasno, kar smo imenovali "gibalno-kognitivna vadba/
trening". Na tej osnovi smo razdelili drugi del na tri podteme: i) učinki telesne vadbe/
treninga, ki mu sledijo računalniško podprte in druge oblike kognitivne vadbe/treninga, 
ii) učinki sočasno opravljene gibalne in kognitivne vadbe/treninga in iii) učinki plesa, 
interaktivnih plesnih videoiger in meditativnih tehnik na telo in um. Študije poročajo, 



35

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Mitja GERŽEVIČ, Matej PLEVNIK, Uroš MARUŠIČ: BENEFITS OF MOTOR AND/OR COGNITIVE EXERCISE ..., 33–49

da se kombinacija gibalne in kognitivne vadbe odraža v povečanih kognitivnih učinkih, 
posebno v večjem izboljšanju izvršilnih funkcij.

Ključne besede: staranje, nevrogeneza, hipokampus, računalniško podprta kogni-
tivna vadba, ples, meditativne tehnike za um in telo

introdUction

Motor abilities, physical, functional and cognitive capacities decrease with ageing. 
However, with regular and adequate physical and cognitive exercise and training it is 
possible to reduce or even prevent such declines (Bherer, Erickson & liu-Ambrose, 
2013; Erickson, Gildengers & Butters, 2013; Erickson et al., 2014; Pišot et al., 2016). 
Health guidelines emphasize that all adults should avoid physical inactivity. Accor-
ding to the guidelines, one’s lifestyle should include at least some physical activity in 
order to obtain health benefits. Physical activity for adults and seniors should include 
strength, balance and flexibility training, as well as aerobic exercise. The general aim 
of exercise in late adulthood should be improving the stability and responsiveness of 
the body, with reduction of the risk of falls as one of the first effects. An appropriate 
approach in the context of “risk of falls” prevention is the combination of different con-
tents of exercise programs (strength, stability, responsiveness, flexibility etc.). Studies 
confirm that regular physical activity and high fitness level in the adulthood reduces the 
risk of negative effects of (primary) ageing as well as those, such as chronic diseases, 
related to the modern, sedentary lifestyle and environment pollution (secondary age-
ing) (Bherer, Erickson & liu-Ambrose, 2013; Chodzko-Zajko et al., 2009; Erickson, 
Gildengers & Butters, 2013).

The risk of falls increases with age and the falls are the main cause of death asso-
ciated with injury in the age over 65 years (Rubenstein, 2006). The falls are generally 
connected with serious consequences such as bone fractures and other injuries. The 
most common causes of falls are problems with walking and balance (Masud & Mor-
ris, 2001). These problems are often associated with neurological and skeletal muscle 
disorders, impaired ability of thinking, memory and vision as well as different risks in 
the environment (Richardson & Ashton-Miller, 1996). A sedentary lifestyle and / or 
lack of physical activity is a common cause, which provoke older people to lose muscle 
tone and bone mass, reduce their muscle strength and flexibility, which further contri-
butes to increasing the risk of falling. The problem is complex, which can be combined 
by physiological, biological, behavioural, physical and socio-economic factors (Sattin, 
1992). 

With ageing, we are also facing difficulties in cognitive functioning, which inc-
reases the risk of falls. Of course, being active and exercising regularly cannot stop 
the biological aging process; however, with proper training we can mitigate or even 
prevent the age-related cognitive decline. Epidemiological studies suggest that a well-



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ANNALES KINESIOLOGIAE • 8 • 2017 • 1

-functioning cardiovascular system and a high level of physical activity reduce the risk 
of cognitive decline and dementia in the old age (Gregory, Parker & Thompson, 2012). 
Aerobic exercise and strength training, but mostly a combination of both, have been 
shown to improve some cognitive performance measures among previously sedentary 
older adults. The effects of such exercises on fitness status are largest for the tasks that 
require complex processing requiring executive control (Chodzko-Zajko et al., 2009).

Motor-cognitive exercise, which is characterized by an additional cognitive (men-
tal) work during the execution of various motor exercises and tasks, can also represent 
the missing content, and perhaps even more effective upgrade of the usual forms of mo-
tor exercise. It has been shown that such exercise contributes to improving the mobility 
and may prevent falls in older adults (Shatil, 2013). However, the stability and focus of 
the movement is disrupted in the presence of additional cognitive demand.

The aim of this paper is to describe what are the benefits and effects of motor and 
/ or cognitive exercises on the cognitive function in older adults. Physical activity has 
favourable effects across numerous physical and mental-health outcomes. It enhan-
ces cognitive functioning and it delays age-related cognitive decline which, therefo-
re, results in a better quality of life and health outcomes. The fast developing area 
of brain-imaging techniques will continue revealing new insides into multiple neural 
mechanisms that occur at the corticospinal levels and beyond while being physically 
active per se. However, a growing body of literature in the recent years suggests that 
the combination of mental and physical training seems to have an additive effect on 
neurogenesis and it results in even greater increase in neurogenesis than either physical 
or mental activity alone. 

benefits of Physical activity and exercise on cognitive 
fUnction in older adUlts

Extensive evidence suggests that physical activity can maintain functional abilities, 
well-being, and independence in the older person, and it is an essential component of 
everyday life, and therefore, it is beneficial also for healthy ageing (netz, Wu, Becker 
& Tenenbaum, 2005; Penedo & Dahn, 2005; Rejeski & Mihalko, 2001; Gradari, Pal-
le, McGreevy, Fontan-lozano, & Trejo, 2016). Positive effects of physical activity on 
cognitive functioning are well reported as well, and are usually presented in two types 
of studies. The first are (longitudinal) randomized controlled trials that involve inter-
vention and control group(s), and the second are cross-sectional studies that correlate 
physical activity and exercise levels with cognitive function outcomes and brain struc-
tures. The literature overview is summarized in the forthcoming paragraphs with the 
discussion of possible mechanisms that are most likely to occur.

Ageing process in humans is accompanied by stereotypical structural as well as 
neurophysiological changes that happen within the brain and variable rates of cognitive 
decline (Bishop, lu, & Yankner, 2010). However, this degenerative process was shown 
to be operational in the older age (Dinse, 2006) and studies showed that physical ac-



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tivity and exercise could be one of the lifestyle factors that can successfully moderate 
age-related cognitive and neurophysiological declines (Hillman, Erickson, & kramer, 
2008; kramer & Erickson, 2007; Weuve et al., 2004). kempermann et al. (2010) su-
ggest that there is a need for a proper combination of physical activity and enriched 
environment for neurogenesis in adult brain. Physical activity and locomotion are be-
lieved to stimulate the proliferation of precursor cells in the hippocampus, while enri-
ched environment and learning are needed to promote the survival of immature neurons 
(kempermann et al., 2010). 

In the animal studies it was shown that physical exercise enhances angiogenesis, 
synaptogenesis and neurogenesis, and that it regulates several neurotrophic factors (Ca-
rro, nuñez, Busiguina, & Torres-Aleman, 2000; Cotman, Berchtold, & Christie, 2007; 
Van Praag, Shubert, Zhao, & Gage, 2005). namely, it was shown that exercising incre-
ases BDnF (Brain Derived neurotrophic Factor) levels in the hippocampus (Cotman 
& Berchtold, 2002), enhances learning and neurogenesis in the hippocampal regions 
(Van Praag et al., 2005) and optimizes spatial abilities (Creer, Romberg, Saksida, van 
Praag, & Bussey, 2010). The underlying protecting mechanism of physical activity and 
exercise on cognitive functioning in older age might be related to reduced inflammation 
and, therefore, not-impaired growth factor signalling in the brain and periphery (Cot-
man et al., 2007). 

Studies in humans that have used brain-imaging techniques have revealed that 
physical activity and exercise have an important role in mitigating age-related structu-
ral and behavioural changes within the brain. In a study conducted by Colcombe et al. 
(2006) it was shown that a 6-month aerobic training resulted in significant increases of 
grey and white matter primarily located in prefrontal and temporal cortices. Further-
more, exercise was shown to increase hippocampal volumes, which were related to 
increased serum BDnF levels and improved memory as well (Erickson et al., 2011). 
Studies have also shown that aerobic exercise improves general cognitive functions 
(Weuve et al., 2004), and more specifically, aerobic exercise was shown to enhance 
visuospatial memory (Stroth, Hille, Spitzer, & Reinhardt, 2009) and executive control 
(kramer et al., 1999). Further, some studies reported the effects and benefits of com-
puterized cognitive training on executive functioning in older adults (Marusic et al., 
2018), as well as its benefits on motor functions (Marusic et al., 2015), plasma level of 
the BDnF (Passaro et al., 2017) or even on vascular function (Goswami et al., 2015) 
after prolonged physical inactivity. Finally, the participants who exercised regularly 
had faster reaction times, better attention and cognitive flexibility (Masley, Roetzheim 
& Gualtieri, 2009; Smith et al., 2010). 

Together with the above reported positive effects of physical activity on cognitive 
functioning in humans and animals, physical activity was shown also to have a pro-
tective effect against cognitive decline in the older age, as well as in some neurode-
generative diseases. A recent meta-analysis showed that greater amounts of physical 
activity earlier in life are associated with a 38% reduced risk of developing cognitive 
impairment later in life (Erickson et al., 2014). In a large-scale prospective cohort study 
that was carried out on Canadian older adult population, laurin and colleagues (2001) 



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showed a positive relation between physical activity and lower risk of cognitive impa-
irment, Alzheimer disease, and all types of dementia in the later life (laurin, Verreault, 
lindsay, MacPherson, & Rockwood, 2001). In a randomized controlled trial with 24-
week physical activity intervention, older adults with memory problems (but without 
diagnosed dementia) showed a modest improvement in cognition (lautenschlager et 
al., 2008). Positive effects of aerobic activity on medial temporal brain structures have 
been also registered in patients with Alzheimer’s disease (Erickson et al., 2011; Yuede 
et al., 2009) and schizophrenia patients (Pajonk et al., 2010).

benefits of combined motor and / or cognitive 
exercise on cognitive fUnction in older adUlts with 

recommendations

Physical activity and high levels of cardiorespiratory / cardiovascular fitness, achie-
ved with regular aerobic and resistance exercise / training as well as motor learning and 
coordinative exercise, have been shown to enhance cognitive function and decrease the 
risk of cognitive decline and dementia (Alzheimer’s disease) in older population (Bhe-
rer, Erickson & liu-Ambrose, 2013; Erickson, Gildengers & Butters, 2013; Erickson 
et al., 2014). new evidences emerge showing that the effects are even greater when 
physical activity and exercise are combined with (additional) cognitive tasks. This 
combination could be achieved so that both activities are performed separately, one 
after another (here we introduce the expression “motor and cognitive exercise / train-
ing”) or simultaneously (for this we will use the expression “motor-cognitive exercise 
/ training”). However, when there will be no emphasis on one of the above mentioned 
options, the term “motor / cognitive exercise/training” will be used.

Through the process of neurogenesis, many of new neuron cells are produced every 
day in the adult brain in the hippocampal formation, a brain structure necessary for 
many types of new learning, and one that is highly responsive to the effects of mental 
and physical training. These new neurons in the hippocampus are extremely responsi-
ve to the external environment, since physical activity and exercise have been shown 
to increase the number of cells that are produced, even after just one day of exercise 
(Curlik & Shors, 2011). Physical activity and exercise take advantage of neuroplasticity 
also in later life, which promotes neural, regional, and, possibly, total brain growth. 
The term neuroplasticity is usually used in reference to positive or adaptive (rather than 
maladaptive) changes to brain architecture that is above and beyond its current functi-
oning limits (Erickson et al., 2014). As already described, the most well characterized 
physical activities for slowing the rate of cognitive decline and preventing dementia 
are the aerobic as well as resistance exercise / training, motor learning and coordinative 
exercise (Bherer, Erickson & liu-Ambrose, 2013; Erickson et al., 2014). However, 
besides physical activity and exercise, Fratiglioni, Paillard-Borg and Winblad (2004) 
report that also a socially integrated network and cognitive leisure activities can play a 
significant role. 



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On the other hand, Curlik and Shors (2013) emphasize that physical training by 
itself is not enough to rescue new neurons from death, but learning must occur du-
ring the training process. Even more, learning has to be difficult to master in order 
to rescue these cells. This could be, for example, learning to associate two stimuli 
that overlap, but are separated by long temporal window or learning to associate two 
stimuli that do not occur together in time with sufficiently long temporal gap between 
them or learning to find the platform using only spatial cues outside the maze (Curlik 
& Shors, 2013). Since individual animals and humans tend to learn at different rate, 
it is also important how many trials are necessary to learn. Thus, it has been repea-
tedly shown that there are strong positive correlations between the number of trials 
necessary to learn the task or skill and the number of surviving cells in the animals’ 
dentate gyrus (Curlik & Shors, 2013) – a part of the hippocampus thought to contri-
bute to the formation of new episodic memories (Amaral, Scharfman, & lavenex, 
2007; Saab et al., 2009) – the spontaneous exploration of novel environments (Saab 
et al., 2009) and other functions (Scharfman, 2007), being one of a selected few brain 
structures currently known to have high rates of neurogenesis in adult rats (Cameron 
& Mckay, 2001). This means that animals that need more trials of training in order to 
learn the skill tend to retain more cells than those that learn it with less effort. On the 
whole, these results show that learning has the greatest impact on neurogenesis when 
training task itself is challenging, and when many trials and / or days of training are 
required to master the skill (Curlik & Shors, 2011; Curlik & Shors, 2013). Therefore, 
the authors suggest that a combination of mental and physical training may result 
in greater cognitive gains and can have additive effects on the structure of the adult 
brain than either form alone, which may help to keep the brain fit for future learning. 
If we go a little further, greater cognitive gains could be achieved by using training 
regimens that combine physical and mental skill training, which in practice means 
motor learning. For example, learning to perform a new dance routine or when enga-
ged in any new sports activities. These activities influence many learning processes, 
including working memory and require some significant degree of cognitive effort, 
suggesting that the mental effort intrinsic to many athletic and sporting endeavours 
can produce long-lasting effects in the structure of the adult brain (Curlik & Shors, 
2013).

In the last 10–15 years, numerous studies (randomized exercise interventions, cross-
-sectional, prospective longitudinal and epidemiological studies) have been conducted 
to evaluate how physical activity and exercise (in the form of aerobic or resistance 
training, motor learning and coordinative exercise) in the adulthood and in the old age 
influences cognitive functions and brain structures in older adult population. However, 
only recently more emphasis has been given to motor / cognitive exercise strategies 
to maximize the effects on neural adaptations (neurogenesis) and cognitive function, 
in order to alleviate or prevent dementia and other neurodegenerative processes in the 
third age. All of them definitely require both mental and physical effort and are, thus, 
potentially useful to preserve or improve cognitive function in mid- and especially in 
late adulthood. Such strategies could include: 



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ANNALES KINESIOLOGIAE • 8 • 2017 • 1

1. any kind of physical exercise / training followed by computerized and other 
forms of cognitive training, 

2. simultaneously performed motor and cognitive exercise / training, 
3. dancing and interactive video dancing or even 
4. the ancient techniques such as Tai Ji Quan (Tai-Chi). 

effects of Physical exercise / training followed by com-
PutERizED AnD OthER fORms Of cOGnitivE tRAininG

Shatil (2013) performed a four-condition randomized controlled trial among healthy 
older adults in order to evaluate if a 4-month mild aerobic and / or cognitive training en-
hance cognitive abilities more than either alone. One hundred twenty-two community 
dwelling and healthy older adults (65 – 93 year olds) were divided into four groups: 
the first group was engaged in cognitive training, the second in mild aerobic training, 
the third in the combination of both, and the fourth, as a control, in book-reading and 
discussion activities. The cognitive training intervention was performed in 48 forty-
minute sessions three times per week for 16 consecutive weeks using a previously 
validated CogniFit® program. The mild aerobic training intervention consisted of 10 
minutes of aerobic warm-up, 15 minutes of cardiovascular workout seated and stand-
ing, 5 minutes of aerobic cool-down, 10 minutes of strength training and 5 minutes of 
flexibility training, followed by brief relaxation; a total of 45 minutes, three times per 
week for 16 consecutive weeks. The combined intervention consisted of both the above 
mentioned interventions, receiving twice as many training sessions as the previous two 
groups. The control group needed to read the book “Active living Everyday: Twenty 
Weeks to lifelong Vitality” at home and held one 60-minute weekly meeting for dis-
cussion about it. The results indicate that, compared to older adults who did not engage 
in cognitive training (the mild aerobic and control groups), those who did (separate or 
combined training group) showed significant improvement in cognitive performance, 
especially in hand-eye coordination, global visual memory (working memory and long-
term memory), speed of information processing, visual scanning, and naming words. 
These results and results of a similar study performed by Oswald, Gunzelmann, Rupre-
cht and Hagen (2006) suggest that it is the cognitive training (not mild aerobic training 
(Shatil, 2013) or physical training (Oswald et al., 2006)) which is driving the improve-
ment in the combined condition (performed on separate sessions) and somehow contra-
dict a research consensus that aerobic activity is a main mechanism in the enhancement 
of cognitive ability (Shatil, 2013). However, it is possible that the intensity and duration 
(four months only) of the interventions in the Shatil’s (2013) study were insufficiently 
high and long to induce cognitive gains or too broad-based (not sufficiently specific 
and intense) in the Oswald et al.’s (2006) study. On the other hand, positive effects of 
the combined interventions on cognitive function, independence of living, and some 
measures of health and emotional status (especially depression) could be observed up 
to five years after the intervention (Oswald et al., 2006). Future studies should aim to 



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investigate also the combination of different non-physical ways of training, such as ac-
tion observation and motor imagery with physical exercise (Eaves, Riach, Holmes, & 
Wright, 2016).

effects of simUltaneoUsly Performed motor and cogni-
tive exercise / training

Further, if the effects of a simultaneously performed, motor-cognitive training in-
tervention is compared to a single cognitive training intervention or to passive controls 
the motor-cognitive intervention results in larger cognitive and motor-cognitive (du-
al-task) improvements. In fact, Theill, Schumacher, Adelsberger, Martin and Jäncke 
(2013) looked at the effects of 10 weeks of simultaneously performed cognitive and 
physical training in 63 healthy older adults (65 – 84 year olds), who were divided in 
three groups. The first group simultaneously performed a verbal working memory and 
a cardiovascular training, while the second group performed only verbal working me-
mory training, both for 20 training sessions two times weekly. The third group attended 
no training at all and served as a control. The cognitive training session contained 15 
minutes of computer-based n-back training (continuous responses to a series of letters 
appearing all for three seconds, always comparing the subsequent letters with the letter 
in a given sequence n-times before) and 15 minutes of serial position training (learning 
a sequence of words in the correct order, presented for three seconds and followed by 
a distraction phase) – see Theill et al. (2013) for more details. On the other hand, the 
motor-cognitive training session consisted of 40-minute treadmill walking (including 
warm-up at a self-selected speed) at the intensity (walking speed) between 60 % and 80 
% of the individual’s age related maximum heart rate value (HRmax = 220 – age), while 
simultaneously performing the same cognitive training as described earlier. The results 
indicate similar training progress and larger improvements in the executive control task 
for both experimental groups compared to the passive control group. However, the si-
multaneous, motor-cognitive training group showed larger improvements in the paired-
-associates task compared to the single cognitive training group and was able to reduce 
the step-to-step variability during the motor-cognitive dual-task condition compared 
to the single cognitive training group and passive controls. Thus, the authors (Theill 
et al., 2013) conclude that the simultaneous training of cognitive and physical abilities 
presents a promising concept to improve cognitive and motor-cognitive dual-task per-
formance, offering greater potential on daily life functioning, which usually involves 
the recruitment of multiple abilities and resources rather than a single one.



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effects of dancing, interactive video dancing and ancient 
body-mind meditative techniqUes

Based on this premise it can be realized that even dancing and the ancient body-
-mind meditative exercise, such as Tai Ji Quan (Tai-Chi) is a form of motor-cognitive 
exercise, which requires substantial simultaneous mental and physical effort in order 
to be (adequately) performed. Their positive effects on physical and especially cogni-
tive functions in older adults have recently been confirmed by several studies (Olsson, 
2012). For example, Jovancevic, Rosano, Perera, Erickson and Studenski (2012) (a 
study protocol report) examined the effects of a 6-month interactive video dancing 
game intervention (using a commercially available Dance Dance Revolution system) 
in comparison to brisk walking (at least twice a week for 30 minutes, with a target of 
150 minutes per week) and passive controls on physical and mental health, balance, at-
tention and visual spatial skills in 168 overweight or obese, sedentary post-menopausal 
women (50 – 65 year olds). Similarly, Pichierri, Murer and de Bruin (2012) examined 
the effects of 12 weeks of additional dance video gaming to progressive strength and 
balance exercise on gait performance under single- and dual-task conditions (at nor-
mal and fast speed), foot placement accuracy (FPA), and falls efficacy (fear of falling 
questionnaire and gaze behaviour during FPA) in 31 community dwelling older adults 
(86.2 ± 4.6 years). Pilot findings of Jovancevic et al. (2012) suggest that interactive 
video dance is associated with increased fronto-parietal attention network activation 
and a trend towards improved reaction times, while the results of Pichierri et al. (2012) 
support previous findings that strength and balance exercise may lead to better walking 
performance in older untrained subjects. In addition, integrating a cognitive training 
(video dance gaming) to strength and balance exercise results in further improvements 
in walking performance under dual-task conditions (higher gait velocity and shorter 
single support time during fast dual-task walking), most likely due to functional or even 
structural changes in the brain (Pichierri et al., 2012). Furthermore, both interventions 
in the Pichierri’s study reduced the concerns about falling and only the dance group 
improved foot placement accuracy (in the medio-lateral direction) without significant 
differences between the two groups after 12 weeks.

Why is this so? Interactive video dance games are a form of action video games that 
also require physical activity besides constant monitoring of the periphery for frequent 
unpredictable events that require quick and accurate responses, thus, influencing posi-
tively physical and cognitive skills, abilities and functions such as hand-eye coordina-
tion, processing in the periphery, mental rotation, divided attention and reaction times 
(Jovancevic et al., 2012). In fact, monitoring of the periphery places heavy demands on 
visual-attentional systems, as players need to keep track of many moving objects while 
ignoring distracters. These games also require precise visual-motor control in order to 
aim steps in space and time according to the sequence of moving targets (Jovancevic 
et al., 2012).

What about usual dancing exercise / training? kattenstroth, kalisch, Holt, Te-
genthoff and Dinse, (2013) performed a study where 35 healthy older adults (60 – 94 



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Mitja GERŽEVIČ, Matej PLEVNIK, Uroš MARUŠIČ: BENEFITS OF MOTOR AND/OR COGNITIVE EXERCISE ..., 33–49

year olds) were engaged in a 6-month dance intervention group one hour per week 
(AgilandoTM dance program – it can be performed without a partner) or in a control 
group. Cognition, fluid intelligence, attention, reaction time, motor, tactile and postu-
ral performance, as well as subjective well-being and cardio-respiratory performan-
ce were assessed. Similarly, Hamacher, Hamacher, Rehfeld, Hökelmann and Sche-
ga (2015) examined the effects of a 6-month dancing program on motor-cognitive 
dual-task performance, where cognitive performance, stride-to-stride variability of 
minimum foot clearance, stride time and stride length while walking were measured 
in 35 older adults (years), who were assigned to a dancing group or a health-related 
exercise group. The results of kattenstroth et al. (2013) indicate no changes or further 
degradation of performance after six months in the control group. On the other hand, 
beneficial effects were found in the dance group for dance related parameters such as 
posture and reaction times, cognitive, tactile and motor performance, and subjective 
well-being, without alterations in cardio-respiratory performance (kattenstroth et al., 
2013). Furthermore, dancing also lowers gait variability and improves cognitive per-
formance in dual-task conditions in a greater extent than conventional health-related 
exercise (Hamacher et al., 2015). Thus, it could be concluded that the lack of changes 
of cardio-respiratory function found by kattenstroth et al. (2013) indicate that even 
moderate levels of physical activity in combination with rich sensorimotor, cognitive, 
social, and emotional challenges can act to ameliorate a wide spectrum of age-related 
decline. This shows that dancing could be a powerful tool to improve motor / cogni-
tive (dual-task) performance and it can play an important role in the maintenance of 
perceptual and cognitive abilities, contributing also to a reduced risk of falls in older 
adult population. In fact, learning new dance steps requires three-dimensional and 
geometric thinking, which has been associated with improved learning capabilities 
(kattenstroth et al., 2013), thus, stimulating neurogenesis and preservation of new 
neurons as noted by Curlik and Shors (2013).

Similarly, even the ancient body-mind meditative techniques like Tai Ji Quan (Tai-
-Chi) represent an efficient exercise mode to preserve or improve motor / cognitive 
functions and performance. Recent studies demonstrate that it improves cognitive and 
physical function (Bherer, Erickson & liu-Ambrose, 2013; Sun et al., 2015), coordi-
nation (Qiu & Zhu, 2003), visual span (Bherer, Erickson & liu-Ambrose, 2013) and 
through improved balance (Qiu & Zhu, 2003) also the efficiency of postural control 
(Zhou et al., 2015). It relieves stress, reduces pain and muscle stiffness (Qiu & Zhu, 
2003) and it is effective in reducing blood pressure and body mass index, maintaining 
normal renal function, and improving physical health of health-related quality of life 
(Sun & Buys, 2015). Furthermore, long-term Tai Ji Quan (Tai-Chi) exercising can also 
improve vagal modulations, it tends to reduce sympathetic modulations (Guo, 2015) 
and has shown to be the cost most effective strategy (compared to resistance training or 
stretching) for optimizing fall prevention in Parkinson disease patients (li & Harmer, 
2015). All of this is the scientific confirmation why our ancestors’ knowledge should 
not be forgotten and why we should stand on their shoulders to further improve our 
knowledge, ourselves as human beings and to direct our actions into helping each other 



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ANNALES KINESIOLOGIAE • 8 • 2017 • 1

as well as generations that still have to come to live a better, healthier and, thus, more 
contended and successful life.

conclUsion

Physical activity in the form of aerobic and resistance exercise leading to a high level 
of cardio-respiratory fitness represents a strong non-pharmacological preventive tool in 
the third age (Bherer, Erickson & liu-Ambrose, 2013; Hökelmann et al., 2015). The 
effects are even greater if any type in this paper mentioned motor-cognitive exercise / 
training are performed on regular basis. It could be performed either as a simultaneous 
combination of a motor task (movements) with an additional cognitive task (Gerževič 
& Dobnik, 2014; Gerževič, Dobnik, & Pišot, 2014; Theill et al., 2013), as dancing or 
video dancing (Hamacher et al., 2015; Hökelmann et al., 2015; Jovancevic et al., 2012; 
kattenstroth et al., 2013; Pichierri et al., 2012) or as a body-mind meditative exercise 
like Tai Ji Quan (Bherer, Erickson & liu-Ambrose, 2013; Guo, 2015; li & Harmer, 
2015; Qiu & Zhu, 2003; Sun & Buys, 2015; Sun et al., 2015; Zhou et al., 2015).

Despite an increasing number of studies indicate a strong connection between physi-
cal activity and brain health and plasticity in late adulthood, many questions remain still 
open for future research. Although positive effects were found with moderate intensity 
exercise for several months, Bherer, Erickson and liu-Ambrose (2013), Erickson, Gil-
dengers & Butters (2013) and Erickson et al. (2014) noted, that the exact dose-response 
relationship between physical activity and mood, cognitive or brain health in older 
adults remains unknown. This means there is a very poor understanding of the types 
(aerobic exercise alone like walking, tennis, swimming or cycling; anaerobic alone like 
resistance exercise; combined motor and cognitive exercise, such as (simultaneous) 
motor-cognitive exercise, dancing or Tai Ji Quan etc.; competitive or non-competitive 
sports), intensity (low, moderate, high) and duration of exercise that might be most 
useful to promote a healthier brain. There is also a very poor understanding of what 
age is optimal to start exercising, as well as a poor understanding of the retention of 
the effects, since individuals stop exercising for a variety of different reasons including 
injuries, illnesses, and personal issues (e.g., mourning). It is still unknown whether 
the increased grey matter volume or improved white matter integrity persists after the 
completion of the exercise intervention or after some period of inactivity (follow-up 
assessments of the effects). And finally, the effects still need to be fully understood in 
cognitively impaired populations including persons with Alzheimer’s disease, depres-
sion, and Parkinson’s disease (de Dreu, kwakkel, & van Wegen, 2015).

In the end, it could be concluded that physical activity and exercise hold great po-
tential as inexpensive and effective methods of elevating cognitive function, impro-
ving brain health, and restoring brain function after atrophy or disease (Erickson et al., 
2014).



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