Abstract
Objectives:
Preventing cognitive decline is a major challenge in aging research. While mind–body exercises and cognitive training each enhance cognitive function, their combined impact on cognitively normal older adults remains unclear. This study examined whether Baduanjin exercise and cognitive training exert interactive effects on global and domain-specific cognitive function.
Methods:
In a 12-week randomized controlled trial with a 2 × 2 factorial design, 162 community-dwelling adults aged 60–75 years with normal cognitive function were assigned to four groups: control (CON), Baduanjin (BG), cognitive training (CT), and combined intervention (BG + CT). Global cognition, memory, attention, executive function, language, and visuospatial ability were assessed at baseline and post-intervention. Changes within-group and main and interaction effects were analyzed.
Results:
One hundred thirty-eight participants completed the intervention. All intervention groups showed significant cognitive improvements from baseline. BG + CT demonstrated the most consistent improvements, including unique significant gains in long-delay memory. Factorial analyses revealed significant main effects of both Baduanjin and cognitive training on global cognition and multiple cognitive domains (p < 0.05), with notable interaction effects between the two interventions. Simple effects analyses confirmed that BG + CT led to greater improvements than individual interventions, particularly in long-delay memory, executive function, language, and visuospatial ability.
Conclusion:
Combined Baduanjin and cognitive training was associated with greater cognitive benefits than single interventions in cognitively normal older adults. These findings support the potential value of integrated behavioral interventions for maintaining cognitive health in later life.
1 Introduction
Population aging is a significant global phenomenon (Jakovljevic et al., 2018) and is accompanied by a progressive, widespread decline in age-related cognitive abilities (Dar et al., 2025). Even in older adults deemed cognitively normal, gradual declines in cognitive functions such as memory, attention, and executive function are commonly observed as part of the normal aging process (Kauppi et al., 2020). These subtle changes may negatively affect daily functioning, psychological well-being, and quality of life, and may increase the long-term risk of developing mild cognitive impairment (MCI) or dementia (Herrmann et al., 2025). Therefore, identifying safe and effective non-pharmacological interventions to mitigate cognitive decline in cognitively normal older individuals has emerged as a core priority in public health (Liu-Ambrose et al., 2019).
Cognitive aging is characterized as a continuous process, not as a discrete clinical condition. The stage of normal cognition represents a critical window for preventive intervention, during which cognitive plasticity and cognitive reserve remain relatively preserved (Cheng, 2016; Sun and Alkon, 2024). The intervention measures implemented during this period may help to slow down age-related cognitive decline, enhance cognitive reserve, and potentially reduce the risk of subsequent cognitive impairments (Lisko et al., 2021; Reijnders et al., 2013). Compared with interventions targeting individuals with established cognitive deficits, preventive approaches for cognitively normal older adults may offer broader and more sustainable benefits (Livingston et al., 2020; van der Flier et al., 2023).
Mind–body exercises have received growing attention for their potential cognitive benefits in older adults (Ye et al., 2021; Zhang et al., 2023). Baduanjin, a traditional Chinese Qigong exercise characterized by slow, regulated breathing and focused attention (Wang et al., 2021), has been shown to improve global cognitive function and specific cognitive domains, such as memory (Hong et al., 2024; Yu et al., 2021) and executive function (Lin S. et al., 2022; Wang et al., 2024). These improvements may be mediated through multiple mechanisms, including increased cerebral blood flow, reduced psychological stress, and enhanced mind–body integration (Hong et al., 2024; Lin et al., 2023; Shen et al., 2024). In parallel, cognitive training has demonstrated efficacy in improving targeted cognitive domains, such as attention, memory, and executive function, by repeatedly engaging cognitive processes and promoting neuroplasticity (Fang et al., 2024; Pieramico et al., 2012). Recent studies suggest that combining physical exercise with cognitive training may produce greater cognitive benefits than either intervention alone for adults with mild cognitive impairment and dementia (Castellote-Caballero et al., 2024; Cheng, 2016; Xue et al., 2023). Physical exercise may provide a favorable neurobiological environment by enhancing cerebral perfusion and neurotrophic factor expression (Hong et al., 2024; Lin et al., 2023; Zhang et al., 2024), whereas cognitive training directly stimulates cognitive processing and neural networks (Turnbull et al., 2022). From this perspective, integrating Baduanjin with cognitive training may exert additive and complementary effects by simultaneously targeting physical, emotional, and cognitive aspects of aging (Chen et al., 2023). However, most existing studies have focused on single-modality interventions, predominantly targeting individuals with mild cognitive impairment or dementia (Orgeta et al., 2020; Sung et al., 2023; Wang et al., 2021; Wang et al., 2024; Zhang et al., 2023). Empirical evidence regarding the effects of combined interventions on cognitively normal older adults remains scarce.
Therefore, this study aims to explore the effects of Baduanjin exercise, cognitive training, and their combined intervention on overall cognitive function and specific cognitive domains (including memory, attention, executive function, language, and visuospatial ability) in cognitively normal older individuals. Using a four-group randomized controlled design, cognitive performance was assessed before and after a three-month intervention period. We hypothesized that both Baduanjin and cognitive training would improve cognitive function compared with the control condition, and that the combined intervention would yield greater improvements in global and domain-specific cognitive functions than either single intervention alone.
2 Methods
2.1 Experimental design
This study employed a 2 × 2 randomized controlled trial to explore the effects of Baduanjin exercise, cognitive training, and their combined intervention on the cognitive functions of older adults living in the community. According to inclusion/exclusion criteria, 162 participants were recruited. They were randomly assigned via computer-generated random numbers to four groups: control (n = 43), Baduanjin (n = 40), cognitive training (n = 41), and combined intervention (n = 38). Outcome assessments were conducted at baseline and immediately after the three-month intervention period by trained assessors who were blinded to group allocation. Intervention delivery and outcome assessments were conducted by different research staff to minimize potential assessment bias. Ultimately, 138 participants completed the study, with dropouts attributed to voluntary withdrawal, loss to follow-up, or health-related reasons. The study flowchart is shown in Figure 1.
Figure 1
2.2 Participants
Participants were recruited from six communities in the High-Tech Development Zone of Zhengzhou, Henan Province, China, through community health lectures and recruitment posters displayed at community activity centers and bulletin boards. Interested individuals were screened by trained research staff against the inclusion and exclusion criteria, and eligible participants provided written informed consent before the baseline assessment. Sample size estimation was performed using G*Power 3.1 software based on analysis of variance (four groups), assuming a medium effect size (ƒ = 0.25), a significance level of α = 0.05, and a statistical power of 0.80 (Kang, 2021). The estimated minimum sample size was 128 participants. Considering potential attrition, 162 participants were recruited and randomly allocated to the four study groups. All participants provided written informed consent before participating. This study was reviewed and approved by the Ethical Committee of the School of Physical Education, Zhengzhou University (Number: ZZUIRB2024-04).
The study’s inclusion criteria were as follows: (1) participants aged between 60 and 75 years; (2) independence in activities of daily living; (3) the ability to ambulate independently; and (4) a score of ≥ 26 on the Montreal Cognitive Assessment (MoCA), with an additional point added for individuals with ≤ 12 years of education. Exclusion criteria encompassed: a diagnosis of cognitive dysfunction or neurodegenerative disease; severe psychiatric disorders; the use of medications known to affect cognitive function; severe visual or auditory impairment; communication difficulties; mobility limitations; and any contraindication to physical exercise.
2.3 Group-specific interventions
Participants in the Baduanjin group engaged in supervised Baduanjin training for 12 weeks, with three 60-min sessions per week. Each session consisted of a 5-min warm-up, 50 min of Baduanjin practice, and a 5-min cool-down. The intervention employed standardized Baduanjin routines (Wang et al., 2024), emphasizing coordinated movements, controlled breathing, and focused attention. The Baduanjin intervention was delivered under the supervision of two certified instructors holding the Social Sports Instructor certification in Qigong. One instructor led the exercise sessions, while the second instructor provided on-site supervision and corrective feedback to ensure accurate and consistent movements.
Participants in the cognitive training group received structured cognitive training three times per week for 12 weeks, with each session lasting 60 min. The training was conducted in a group format by trained research staff following standardized protocols, in accordance with guidelines established by cognitive training experts. Task difficulty was progressively adjusted based on participant performance. The training content targeted five cognitive domains: (1) memory training, including word chain games, riddles, song recognition, paired associative learning, face-name memorization, and story recall; (2) attention training, including Schulte grid exercises, visual tracking, “spot-the-difference” games, forward and backward digit repetition, and digit-symbol substitution games; (3) language training, including tongue twisters, word chain games, general knowledge quizzes, and poetry recitation; (4) executive function training, including reasoning puzzles, jigsaw puzzles, Sudoku, “do the opposite” commands, and manual crafting activities; (5) visuospatial training, including maze navigation, direction identification, visual tracking tasks, route description, and block design/spatial combination tasks.
Participants in the combined intervention group received both Baduanjin exercise and cognitive training over 12 weeks, with the two interventions administered on alternate days, three times per week each, for a total of six 60-min sessions per week.
Participants in the control group continued with their regular daily activities throughout the study period and did not partake in any structured physical exercise or cognitive training interventions.
2.4 Outcomes
Assessments were administered at baseline and immediately following the intervention period by trained assessors utilizing standardized procedures. General demographic, health-related data, and physical activity level, were collected through a structured questionnaire. Physical activity was assessed using the Physical Activity Scale for the Elderly (PASE), a validated questionnaire that evaluates physical activity in older adults over the preceding week, including occupational, household, and leisure-time activities, with higher scores indicating greater levels of physical activity. Cognitive functions were evaluated using a comprehensive test battery. Overall cognitive function was assessed using the the MoCA. The threshold score for cognitive impairment is set at 26 points, with an additional point awarded to individuals with an educational duration of 6 years or less. Memory function was assessed using the Huashan Version of the Auditory Verbal Learning Test (AVLT-H), which involves the presentation of 12 words (e.g., coat, trousers, headscarf) followed by three immediate recall trials, short-delay (5 min) and long-delay (20 min) recall trials, and concludes with a recognition test. Attention was measured using the Digit Span Test (DST), which includes forward and backward components and is scored based on the longest sequence of digits correctly repeated. Executive function was evaluated using the Trail Making Test B (TMT-B), which required participants to alternately connect numbers and symbols, with the time taken for completion recorded in seconds. Language function was assessed through the Boston Naming Test (BNT), in which participants were tasked with naming 30 object pictures, with a maximum possible score of 30 points. Visuospatial function was measured using the Clock Drawing Test (CDT), which employed a 4-point scoring system evaluating the drawing of a closed disk, correct number placement, completion of all 12 numbers, and accurate pointer positioning, with participants instructed to depict a clock face showing the time “1:50.” The sequence of cognitive tests was standardized across all participants and assessment sessions. Short rest intervals were incorporated between tests to mitigate the effects of fatigue.
2.5 Bias control and quality assurance
Cognitive assessments were conducted following standardized protocols to maintain consistency and comparability across participants and assessment time points. The randomization sequence was concealed from research staff, and outcome assessors were blinded to group assignments to minimize bias. Intervention staff underwent standardized training and adhered to uniform intervention manuals throughout the study. Data entry and management procedures were regularly monitored to ensure accuracy, and reasons for participant dropout were systematically documented.
2.6 Statistical analysis
Statistical analyses were performed utilizing SPSS software, version 25.0. The Shapiro–Wilk test was employed to assess the normality of continuous variables. Quantitative data conforming to a normal distribution were reported as mean ± standard deviation, whereas categorical data were presented as frequencies. For baseline group comparisons, continuous variables that satisfied normality assumptions were analyzed using one-way analysis of variance (ANOVA), and categorical variables were assessed via the chi-square test. Within-group changes from baseline to post-intervention were examined using paired t-tests. To assess the main effects of Baduanjin (yes/no) and cognitive training (yes/no), and their interaction, a 2 × 2 factorial ANOVA was conducted, with change scores (post-intervention minus baseline) as the dependent variable. Simple effects analysis with the Šidák correction was performed if a significant interaction effect was detected. All statistical tests were two-tailed, with the significance threshold set at p < 0.05.
3 Results
3.1 Participant characteristics at baseline
A total of 162 community-dwelling elderly individuals with normal cognitive function were randomly assigned to four groups: control (CON, n = 43), Baduanjin group (BG, n = 40), cognitive training (CT, n = 41), and combined intervention (BG + CT, n = 38). After 12 weeks, 138 participants completed the study (CON, n = 35; BG, n = 36; CT, n = 34; BG + CT, n = 33), with an overall attrition rate of 14.8%, primarily due to voluntary withdrawal, loss to follow-up, or health issues (Figure 1). Baseline demographic, cognitive, physical activity, and emotional characteristics were comparable across groups (p > 0.05; Table 1; Supplementary Table 1), confirming successful randomization.
Table 1
| Characteristics | CON (n = 35) | BG (n = 36) | CT (n = 34) | BG + CT (n = 33) | F/χ2 | p |
|---|---|---|---|---|---|---|
| Age, years | 66.2 ± 4.39 | 64.33 ± 4.09 | 66.06 ± 3.45 | 66.06 ± 4.63 | F = 1.621 | 0.187 |
| Gender (Male/Female) | 18/17 | 17/19 | 16/18 | 16/17 | χ2 = 0.172 | 0.982 |
| Education, n (%) | χ2 = 5.766 | 0.450 | ||||
| <9 years | 12 (34.3) | 4 (11.1) | 8 (23.5) | 8 (24.2) | ||
| 9–12 years | 15 (42.9) | 22 (61.1) | 16 (47.1) | 16 (48.5) | ||
| >12 years | 8 (22.9) | 10 (27.8) | 10 (29.4) | 9 (27.3) | ||
| Physical activity level (PASE) | 161.78 ± 28.48 | 158.29 ± 20.32 | 153.08 ± 22.50 | 155.18 ± 29.90 | F = 0.762 | 0.517 |
| Overall cognitive function (MoCA) | 26.54 ± 0.81 | 26.56 ± 0.69 | 26.59 ± 0.70 | 26.52 ± 0.57 | F = 0.063 | 0.979 |
| Memory function | ||||||
| Immediate memory | 5.46 ± 0.78 | 5.27 ± 0.75 | 5.39 ± 0.94 | 5.42 ± 0.74 | F = 0.372 | 0.773 |
| Short-delay memory | 5.17 ± 1.15 | 5.03 ± 0.84 | 5.09 ± 0.93 | 5.27 ± 0.63 | F = 0.466 | 0.707 |
| Long-delay memory | 5.00 ± 1.06 | 4.89 ± 1.01 | 4.94 ± 0.81 | 4.91 ± 0.52 | F = 0.106 | 0.956 |
| Recognition function | 10.17 ± 0.98 | 10.44 ± 1.18 | 10.24 ± 1.05 | 10.36 ± 1.17 | F = 0.443 | 0.723 |
| Attention | ||||||
| Forward digit span | 11.40 ± 1.40 | 11.64 ± 0.76 | 11.32 ± 1.25 | 11.52 ± 0.97 | F = 0.529 | 0.663 |
| Reverse digit span | 6.80 ± 1.39 | 7.14 ± 1.29 | 6.68 ± 0.94 | 6.97 ± 1.42 | F = 0.872 | 0.457 |
| Executive function (TMT-B)a | 168.34 ± 25.09 | 166.11 ± 17.58 | 163.82 ± 18.77 | 170.48 ± 29.20 | F = 0.522 | 0.668 |
| Language function (BNT) | 25.37 ± 1.82 | 25.94 ± 1.55 | 25.44 ± 1.50 | 25.27 ± 1.21 | F = 1.336 | 0.265 |
| Visuospatial function (CDT) | 2.97 ± 0.62 | 2.89 ± 0.62 | 3.05 ± 0.78 | 2.82 ± 0.67 | F = 0.797 | 0.497 |
Participant characteristics at baseline.
Continuous variables are presented as mean ± standard deviation and were compared using one-way ANOVA (reported as F); categorical variables are presented as count (n) with percentage in parentheses (%) and were compared using the chi-square test (reported as χ2). CON, control group; BG, Baduanjin group; CT, cognitive training group; BG+CT, combined group; PASE, the Physical Activity Scale for the Elderly; MoCA, Montreal Cognitive Assessment; TMT-B, Trail Making Test Part B; BNT, Boston Naming Test; CDT, Clock Drawing Test.
TMT-B (Trail Making Test Part B) is reported in seconds; all other cognitive outcomes are reported in raw test scores.
3.2 Changes in global and domain-specific cognitive function following the intervention
Following the 12-week intervention, within-group analyses (Table 2; Supplementary Table 2) revealed distinct patterns of cognitive change. The CON group showed no significant improvements in global cognition (MoCA: 26.54 ± 0.81 vs. 26.63 ± 0.81, p = 0.373), whereas BG, CT, and BG + CT groups demonstrated significant increases in MoCA scores (p < 0.001), with the largest improvement observed in BG + CT. Memory analyses indicated that immediate and short-delay memory improved significantly in BG, CT, and BG + CT (p < 0.05), but long-delay memory improved only in BG + CT (p < 0.001). Recognition memory increased significantly in CON (p = 0.033) and in all intervention groups (p < 0.05). All intervention groups also showed improvements in attention, executive function, and visuospatial ability, as reflected by forward and reverse digit span, TMT-B completion time, and CDT scores, with the most pronounced gains in BG + CT (p < 0.01). Language function (BNT) improved significantly in CT and BG + CT (p < 0.001), while BG exhibited a marginal increase (p = 0.058). Regarding emotional outcomes, depression and anxiety scores decreased significantly in BG and BG + CT (p < 0.001), with no significant changes in CON or CT (p > 0.05, Supplementary Table 3).
Table 2
| Outcomes | CON (n = 35) | BG (n = 36) | CT (n = 34) | BG + CT (n = 33) | |
|---|---|---|---|---|---|
| Overall cognitive function (MoCA) | Pre | 26.54 ± 0.81 | 26.56 ± 0.69 | 26.59 ± 0.70 | 26.52 ± 0.57 |
| Post | 26.63 ± 0.81 | 27.39 ± 0.60 | 27.35 ± 0.60 | 28.42 ± 0.61 | |
| t | −0.902 | −9.860 | −8.990 | −21.000 | |
| p | 0.373 | <0.001 | <0.001 | <0.001 | |
| Memory function | |||||
| Immediate memory | Pre | 5.46 ± 0.78 | 5.27 ± 0.75 | 5.39 ± 0.94 | 5.42 ± 0.74 |
| Post | 5.62 ± 0.90 | 6.42 ± 1.02 | 6.35 ± 1.15 | 6.86 ± 0.83 | |
| t | −1.495 | −9.350 | −7.599 | −10.436 | |
| p | 0.144 | <0.001 | <0.001 | <0.001 | |
| Short-delay memory | Pre | 5.17 ± 1.15 | 5.03 ± 0.84 | 5.09 ± 0.93 | 5.27 ± 0.63 |
| Post | 5.09 ± 1.12 | 5.58 ± 0.81 | 5.53 ± 0.93 | 5.91 ± 0.68 | |
| t | 0.828 | −5.493 | −3.651 | −5.600 | |
| p | 0.413 | <0.001 | <0.001 | <0.001 | |
| Long-delay memory | Pre | 5.00 ± 1.06 | 4.89 ± 1.01 | 4.94 ± 0.81 | 4.91 ± 0.52 |
| Post | 5.03 ± 1.22 | 5.08 ± 0.87 | 5.03 ± 1.06 | 5.70 ± 0.85 | |
| t | −0.239 | −1.420 | −0.828 | −5.520 | |
| p | 0.812 | 0.165 | 0.414 | <0.001 | |
| Recognition | Pre | 10.17 ± 0.98 | 10.44 ± 1.18 | 10.24 ± 1.05 | 10.36 ± 1.17 |
| Post | 10.37 ± 0.91 | 10.69 ± 0.92 | 10.53 ± 1.02 | 10.82 ± 0.98 | |
| t | −2.227 | −2.311 | −3.708 | −4.629 | |
| p | 0.033 | 0.027 | 0.001 | <0.001 | |
| Attention function | |||||
| Forward digit span | Pre | 11.40 ± 1.40 | 11.64 ± 0.76 | 11.32 ± 1.25 | 11.52 ± 0.97 |
| Post | 11.63 ± 1.35 | 12.14 ± 0.54 | 12.26 ± 0.83 | 12.63 ± 0.78 | |
| t | −1.961 | −3.550 | −5.263 | −9.250 | |
| p | 0.058 | 0.001 | <0.001 | <0.001 | |
| Reverse digit span | Pre | 6.80 ± 1.39 | 7.14 ± 1.29 | 6.68 ± 0.94 | 6.97 ± 1.42 |
| Post | 6.77 ± 1.42 | 8.17 ± 1.28 | 7.94 ± 1.25 | 8.45 ± 1.03 | |
| t | 0.442 | −5.700 | −7.270 | −9.800 | |
| p | 0.661 | <0.001 | <0.001 | <0.001 | |
| Executive function (TMT-B)a | Pre | 168.34 ± 25.09 | 166.11 ± 17.58 | 163.82 ± 18.77 | 170.48 ± 29.20 |
| Post | 165.74 ± 25.71 | 134.56 ± 17.56 | 143.82 ± 17.93 | 130.21 ± 24.66 | |
| t | 1.491 | 12.538 | 12.297 | 17.127 | |
| p | 0.145 | <0.001 | <0.001 | <0.001 | |
| Language function (BNT) | Pre | 25.37 ± 1.82 | 25.94 ± 1.55 | 25.44 ± 1.50 | 25.27 ± 1.21 |
| Post | 25.46 ± 1.67 | 26.08 ± 1.40 | 26.32 ± 1.30 | 26.52 ± 1.09 | |
| t | −1.358 | −1.963 | −10.771 | −16.4 | |
| p | 0.183 | 0.058 | <0.001 | <0.001 | |
| Visuospatial function (CDT) | Pre | 2.97 ± 0.62 | 2.89 ± 0.62 | 3.05 ± 0.78 | 2.82 ± 0.67 |
| Post | 3.03 ± 0.38 | 3.31 ± 0.47 | 3.29 ± 0.68 | 3.79 ± 0.48 | |
| t | −0.702 | −5.000 | −3.187 | −8.750 | |
| p | 0.487 | <0.001 | 0.003 | <0.001 | |
Cognitive function outcomes in each group before and after intervention.
Data are presented as mean ± standard deviation. “Pre” and “Post” denote assessment before and after the intervention, respectively. “t” refers to the statistic from paired-sample t-tests. CON, control group; BG, Baduanjin group; CT, cognitive training group; BG+CT, combined group; MoCA, Montreal Cognitive Assessment; TMT-B, Trail Making Test Part B; BNT, Boston Naming Test; CDT, Clock Drawing Test.
TMT-B (Trail Making Test Part B) is reported in seconds; all other cognitive outcomes are reported in raw test scores.
3.3 Interactive effects of Baduanjin exercise and cognitive training on cognitive outcomes
A 2 × 2 factorial ANOVA examining the main effects of Baduanjin and cognitive training revealed significant main effects of both interventions on global cognition (MoCA), memory (immediate, short-delay, long-delay), reverse digit span, executive function (TMT-B), language (BNT), and visuospatial function (CDT) (p < 0.05, partial η2 range 0.047–0.558; Table 3). Interaction effects (BG × CT) were significant for MoCA (η2 = 0.036, p = 0.027), memory subdomains (η2 = 0.030–0.032, p < 0.05), reverse digit span (η2 = 0.054, p = 0.006), TMT-B (η2 = 0.031, p = 0.041), BNT (η2 = 0.032, p = 0.038), and CDT (η2 = 0.033, p = 0.035). For recognition memory, no significant main or interaction effects were observed. For forward digit span, a significant main effect of cognitive training was observed (p < 0.001; Table 3), while no significant main effect of Baduanjin or interaction was detected. For emotional outcomes (Supplementary Table 4), BG showed large main effects on depression (η2 = 0.191, p < 0.01) and anxiety (η2 = 0.320, p < 0.01), whereas CT had no significant effects (p > 0.05).
Table 3
| Outcomes | Effect | F | p | η2 | Effect Size Interpretation |
|---|---|---|---|---|---|
| Overall Cognitive Function (MoCA) | BG | 112.958 | <0.001 | 0.457 | Very Large |
| CT | 97.163 | <0.001 | 0.420 | Very Large | |
| BG × CT | 4.968 | 0.027 | 0.036 | Small | |
| Memory function | |||||
| Immediate memory | BG | 34.650 | <0.001 | 0.205 | Large |
| CT | 19.151 | <0.001 | 0.125 | Medium/Large | |
| BG × CT | 4.368 | 0.039 | 0.032 | Small | |
| Short-delay memory | BG | 14.515 | <0.001 | 0.098 | Medium/Large |
| CT | 7.662 | 0.006 | 0.054 | Medium | |
| BG × CT | 4.128 | 0.044 | 0.030 | Small | |
| Long-delay memory | BG | 11.553 | 0.001 | 0.079 | Medium |
| CT | 6.578 | 0.011 | 0.047 | Medium | |
| BG × CT | 4.394 | 0.038 | 0.032 | Small | |
| Recognition | BG | 1.229 | 0.270 | 0.009 | – |
| CT | 2.476 | 0.118 | 0.018 | – | |
| BG × CT | 0.339 | 0.562 | 0.003 | – | |
| Attention function | |||||
| Forward digit span | BG | 2.542 | 0.113 | 0.019 | – |
| CT | 22.189 | <0.001 | 0.142 | Large | |
| BG × CT | 0.104 | 0.747 | 0.001 | – | |
| Reverse digit span | BG | 17.950 | <0.001 | 0.118 | Medium/Large |
| CT | 33.750 | <0.001 | 0.201 | Large | |
| BG × CT | 7.703 | 0.006 | 0.054 | Medium | |
| Executive function (TMT-B)a | BG | 137.128 | <0.001 | 0.506 | Very Large |
| CT | 38.596 | <0.001 | 0.224 | Large | |
| BG × CT | 4.266 | 0.041 | 0.031 | Small | |
| Language function (BNT) | BG | 8.002 | 0.005 | 0.056 | Medium |
| CT | 169.192 | <0.001 | 0.558 | Very Large | |
| BG × CT | 4.413 | 0.038 | 0.032 | Small | |
| Visuospatial function (CDT) | BG | 38.675 | <0.001 | 0.224 | Large |
| CT | 17.279 | <0.001 | 0.114 | Medium/Large | |
| BG × CT | 4.542 | 0.035 | 0.033 | Small | |
Main and interactive effects of the interventions on changes in cognitive outcomes.
This table presents the results of a 2 × 2 factorial analysis of variance (ANOVA). “Effect” indicates the factor tested: BG (main effect of Baduanjin), CT (main effect of cognitive training), and BG×CT (interaction effect). F and p values are reported for each effect. η2 represents partial eta squared and is reported as the measure of effect size (small effect: ≥0.01, medium effect: ≥0.06, large effect: ≥0.14). Dashes (−) indicate effect sizes below the threshold for a “Small” interpretation (η2 < 0.01). BG, Baduanjin; CT, cognitive training; MoCA, Montreal Cognitive Assessment; TMT-B, Trail Making Test Part B; BNT, Boston Naming Test; CDT, Clock Drawing Test.
TMT-B (Trail Making Test Part B) is reported in seconds; all other cognitive outcomes are reported in raw test scores.
3.4 Simple effects analyses of significant intervention interactions
Simple effects analyses confirmed that the combined BG + CT intervention outperformed the single interventions across multiple domains (Table 4). MoCA improvement in BG + CT (1.91 ± 0.09) was significantly greater than in BG (0.83 ± 0.09) and CT (0.77 ± 0.09) (p < 0.001). For long-delay memory, neither Baduanjin nor cognitive training alone produced significant gains relative to CON, whereas BG + CT significantly outperformed both single interventions (p < 0.01). Executive function (TMT-B), language (BNT), and visuospatial ability (CDT) also improved more in BG + CT than in either single intervention (p < 0.01). Reverse digit span improvement in BG + CT was significantly greater than BG (p = 0.034) but not CT (p = 0.310). These findings indicate that combining Baduanjin with cognitive training produced the largest gains across most cognitive domains.
Table 4
| Outcomes | CON | VS. | CT | BG | VS. | BG + CT | CON | VS. | BG | CT | VS. | BG + CT |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MoCA | 0.086 ± 0.088 | 0.765 ± 0.090 | 0.833 ± 0.087 | 1.909 ± 0.091 | 0.086 ± 0.088 | 0.833 ± 0.087 | 0.765 ± 0.090 | 1.909 ± 0.091 | ||||
| Δ | 0.679 | 1.076 | 0.748 | 1.144 | ||||||||
| F | 29.120 | 72.973 | 36.328 | 80.321 | ||||||||
| p | <0.001 | <0.001 | <0.001 | <0.001 | ||||||||
| Immediate memory | 0.161 ± 0.123 | 0.961 ± 0.125 | 1.148 ± 0.121 | 1.431 ± 0.126 | 0.161 ± 0.123 | 1.148 ± 0.121 | 0.961 ± 0.125 | 1.431 ± 0.126 | ||||
| Δ | 0.800 | 0.283 | 0.987 | 0.470 | ||||||||
| F | 20.922 | 2.611 | 32.761 | 7.004 | ||||||||
| p | <0.001 | 0.108 | <0.001 | <0.001 | ||||||||
| Short-Delay memory | −0.086 ± 0.109 | 0.441 ± 0.111 | 0.556 ± 0.107 | 0.636 ± 0.112 | −0.086 ± 0.109 | 0.556 ± 0.107 | 0.441 ± 0.111 | 0.636 ± 0.112 | ||||
| Δ | 0.527 | 0.081 | 0.641 | 0.195 | ||||||||
| F | 11.529 | 0.271 | 17.572 | 1.536 | ||||||||
| p | 0.001 | 0.604 | <0.001 | 0.217 | ||||||||
| Long-Delay memory | 0.029 ± 0.126 | 0.088 ± 0.128 | 0.194 ± 0.125 | 0.788 ± 0.130 | 0.029 ± 0.126 | 0.194 ± 0.125 | 0.088 ± 0.128 | 0.788 ± 0.130 | ||||
| Δ | 0.059 | 0.593 | 0.166 | 0.700 | ||||||||
| F | 0.110 | 10.853 | 0.874 | 14.673 | ||||||||
| p | 0.741 | 0.001 | 0.352 | <0.001 | ||||||||
| Reverse digit span | −0.029 ± 0.149 | 1.265 ± 0.152 | 1.028 ± 0.147 | 1.485 ± 0.154 | −0.029 ± 0.149 | 1.028 ± 0.147 | 1.265 ± 0.152 | 1.485 ± 0.154 | ||||
| Δ | 1.293 | 0.457 | 1.056 | 0.220 | ||||||||
| F | 36.882 | 4.599 | 25.320 | 1.038 | ||||||||
| p | <0.001 | 0.034 | <0.001 | 0.310 | ||||||||
| TMT-Ba | −2.600 ± 2.086 | −20.000 ± 2.116 | −31.556 ± 2.057 | −40.273 ± 2.148 | −2.600 ± 2.086 | −31.556 ± 2.057 | −20.000 ± 2.116 | −40.273 ± 2.148 | ||||
| Δ | −17.400 | −8.717 | −8.717 | −20.270 | ||||||||
| F | 34.292 | 8.592 | 97.717 | 45.200 | ||||||||
| p | <0.001 | 0.004 | <0.001 | <0.001 | ||||||||
| BNT | 0.086 ± 0.072 | 0.882 ± 0.074 | 0.139 ± 0.071 | 1.242 ± 0.075 | 0.086 ± 0.072 | 0.139 ± 0.071 | 0.882 ± 0.074 | 1.242 ± 0.075 | ||||
| Δ | 0.797 | 1.104 | 0.053 | 0.360 | ||||||||
| F | 59.527 | 114.033 | 0.273 | 11.808 | ||||||||
| p | <0.001 | <0.001 | 0.602 | <0.001 | ||||||||
| CDT | 0.057 ± 0.087 | 0.235 ± 0.089 | 0.417 ± 0.086 | 0.970 ± 0.090 | 0.057 ± 0.087 | 0.417 ± 0.086 | 0.235 ± 0.089 | 0.970 ± 0.090 | ||||
| Δ | 0.178 | 0.553 | 0.360 | 0.734 | ||||||||
| F | 2.053 | 19.752 | 8.604 | 33.880 | ||||||||
| p | 0.154 | <0.001 | 0.004 | <0.001 |
Simple effects of the interventions on cognitive outcomes.
Data are presented as mean change score ± standard error, the mean difference between groups (Δ), and the results of one-way ANOVA (F and P) for each pairwise comparison. “Δ” represents the difference in change scores between two groups. The p values reported are Šidák-corrected for multiple comparisons. CON, control group; BG, Baduanjin group; CT, cognitive training group; BG+CT, combined group; MoCA, Montreal Cognitive Assessment; TMT-B, Trail Making Test Part B; BNT, Boston Naming Test; CDT, Clock Drawing Test.
TMT-B (Trail Making Test Part B) is reported in seconds; all other cognitive outcomes are reported in raw test scores.
4 Discussion
This study investigated the effects of a 12-week Baduanjin exercise, cognitive training, and their combined application on global cognitive function and domain-specific cognitive performance in cognitively normal older adults. The core finding of this research is that while both Baduanjin and cognitive training independently resulted in significant improvements across multiple cognitive domains, the combined intervention was associated with broader cognitive benefits, particularly in global cognitive function, long-delay memory, executive function, language function, and visuospatial function. This study advances current understanding of non-pharmacological strategies for preventing cognitive decline by focusing on cognitively intact older adults, a demographic that is underrepresented in existing intervention research.
The superior efficacy of the combined Baduanjin and cognitive training intervention likely stems from the complementary neurobiological pathways through which Baduanjin and cognitive training collectively promote brain health. Baduanjin, as a traditional form of physical and mental exercise, harmoniously combines mental focus, body posture, movement, and breath control to enhance cognitive functions such as concentration, memory, executive function, and visuospatial skills (Koh, 1982). This coordinated practice lays a solid physiological foundation for cognitive improvement. The mechanisms involve enhancing cerebral blood flow (Lin et al., 2023), boosting BDNF levels (Zhou et al., 2025), modulating structural plasticity in hippocampal subregions (Wan et al., 2022), and improving resting-state functional connectivity between the hippocampus and medial prefrontal cortex (Tao et al., 2016). Additionally, Baduanjin influences intrinsic functional connectivity and affects the norepinephrine and dopamine systems (Liu et al., 2021). In contrast, cognitive training leverages the brain’s neuroplasticity to stimulate targeted remodeling of specific brain regions and networks (Wu et al., 2023), manifested as increased gray matter (Engvig et al., 2014), enhanced white matter fiber integrity (Dai et al., 2024), and strengthened functional connectivity in cognition-related brain networks (Anderson-Hanley et al., 2018; Bigliassi et al., 2025; Faraza et al., 2020; Hardcastle et al., 2022). The observed combined effects of Baduanjin and cognitive training may stem from the former establishing an improved foundation for overall brain health, enabling the latter to perform targeted fine-tuning of neural circuits. The effectiveness of the combined intervention of Baduanjin and cognitive training has been validated in elderly diabetic patients with cognitive frailty (Liu et al., 2023).
It is important to note that the small but statistically significant interaction effect of the combined Baduanjin and cognitive training on global cognition (MoCA) is both expected and meaningful in the context of a preventive intervention for cognitively normal older adults. This outcome is likely attributable to their already high baseline cognitive function, coupled with the relatively short 12-week intervention period, which inherently limits the scope for substantial cognitive gains. Therefore, detecting any positive synergistic effect under these conditions underscores the potential efficacy and sensitivity of the combined approach.
Both BG and CT effectively improved immediate memory, short-delay memory, and recognition. However, only BG + CT resulted in a significant improvement in long-delay memory, which stands out as one of the study’s noteworthy findings. This benefit likely arises from the synergy between Baduanjin enhancing brain neurophysiological function and cognitive training reshaping neural networks for long-term memory (Zotcheva et al., 2022). Their combination creates a “neurophysiological optimization + task-specific training” model that uniquely supports memory consolidation (Marin Vargas et al., 2024). In the context of immediate and short-delay memory, the lack of additional benefit from BG + CT in these domains could suggest a ceiling effect at the behavioral level. Recognition memory improved across all groups, likely due to test familiarity from repeated assessments. This familiarity may have caused a ceiling effect, especially with high baseline scores, limiting the clinical interpretation of the intervention’s impact. Future studies should adopt more challenging tasks to better capture intervention effects on memory retrieval (Ferguson, 2021).
All intervention groups showed significant improvements in reverse digit span (attention) and TMT-B performance (executive function), with BG + CT outperforming single interventions. The practice of Baduanjin necessitates mental tranquility and focused intention, thereby augmenting attentional concentration. During practice, practitioners must standardize their movements and consciously suppress unnecessary or incorrect actions, relying on the inhibition function, a key part of executive function (Bigliassi et al., 2025; Wang et al., 2021; Wang et al., 2024). Combined with cognitive training demanding high-level cognitive control (e.g., reasoning, puzzle-solving), this forms a “dual-task” paradigm that strengthens prefrontal cortex-dominated cognitive control abilities (Duverne and Koechlin, 2017; Luciana and Collins, 2022; Miller, 2000). For forward digit span, no significant interaction effect was observed, suggesting basic attentional processes can be sufficiently improved by single interventions. In terms of language function, CT and BG + CT significantly improved BNT scores, while BG alone showed only a marginal effect, indicating language retrieval relies heavily on specialized cortical networks activated by targeted cognitive training (Jones et al., 2021). Nevertheless, BG + CT achieved the largest BNT gains, suggesting Baduanjin indirectly supports language performance by enhancing cognitive vitality and reducing anxiety. For visuospatial function, BG and BG + CT produced significant CDT score improvements, while CT alone had limited effects. Baduanjin’s directional shift movements, such as those performed in “Drawing a Bow to Both Sides Like Shooting an Eagle” (which involves coordinated torso rotation and contralateral limb movement), stimulate spatial perception and visuomotor integration, complementing cognitive training’s focus on visual planning (Lin L. Y. et al., 2022). CT’s limited effects may relate to insufficient task specificity or insufficient duration of the intervention (Orgeta et al., 2020). A secondary finding is that BG alone or combined with CT significantly reduced depression and anxiety scores. The reduction in negative affect may have contributed to cognitive gains by freeing up cognitive resources otherwise occupied by emotional regulation, thereby creating a more conducive state for cognitive training to take effect (Long et al., 2020).
It is necessary to acknowledge several limitations. First, participants were recruited from only one region, which may limit the generalizability of the funding to different populations. Second, the study lacked long-term follow-up, making it impossible to verify the sustainability of intervention effects, which is critical for a preventive strategy targeting cognitive decline. Third, participants in the combined intervention group received a higher overall intervention dose than those in the single-intervention groups. Therefore, the observed superiority of the combined intervention should be interpreted with caution due to potential differences in intervention exposure. Fourth, participants’ unsupervised physical activity outside the intervention sessions was not objectively monitored, which may have introduced confounding effects. Finally, neuroimaging and biomarker data were not collected, limiting the ability to directly validate the proposed neural mechanisms.
Future research should prolong intervention and follow-up periods to explore whether BG + CT delays the transition from normal cognition to MCI. Multi-modal assessments should be incorporated to elucidate the neural underpinnings of combined intervention benefits. Large-scale multi-center trials with diverse cohorts are needed to strengthen generalizability, while accelerometers or activity logs should be used to objectively capture all physical activity throughout the intervention period.
In conclusion, the 12-week Baduanjin, cognitive training, and combined interventions all improved global cognitive function and multiple specific cognitive domains in cognitively normal older adults. Critically, the combined intervention yielded greater improvements in global cognition, long-delay memory, executive function, language function, and visuospatial abilities than the single interventions. These findings underscore the importance of multidimensional strategies that integrate physical exercise with cognitive stimulation for preventing age-related cognitive decline. Given its feasibility, safety, and cost-effectiveness as a non-pharmacological intervention, the combination of Baduanjin and cognitive training should be prioritized in community-based geriatric health promotion programs. This approach holds promise for addressing the growing challenge of cognitive decline in aging populations and for improving brain health and quality of life among older adults.
Statements
Data availability statement
The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.
Ethics statement
The studies involving humans were approved by Ethical Committee of the School of Physical Education, Zhengzhou University. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.
Author contributions
CL: Writing – review & editing, Conceptualization, Funding acquisition, Project administration. YH: Writing – original draft, Formal analysis, Validation, Visualization. XiZ: Visualization, Writing – original draft, Validation, Formal Analysis. XC: Formal analysis, Investigation, Writing – review & editing. XuZ: Data curation, Investigation, Writing – review & editing. HeZ: Investigation, Writing – review & editing, Data curation. HaZ: Investigation, Writing – review & editing. BF: Investigation, Writing – review & editing. YW: Investigation, Writing – review & editing. JL: Investigation, Writing – review & editing. NW: Writing – review & editing, Conceptualization, Supervision.
Funding
The author(s) declared that financial support was received for this work and/or its publication. This study was supported by the Key Scientific Research Projects of Higher Education Institutions in Henan Province (Grant No. 24A890003 to CL).
Conflict of interest
The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Generative AI statement
The author(s) declared that Generative AI was not used in the creation of this manuscript.
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Supplementary material
The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2026.1903040/full#supplementary-material
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Summary
Keywords
aging, cognitive decline, cognitive intervention, mind–body exercise, prevention
Citation
Li C, He Y, Zhang X, Chen X, Zhang X, Zhang H, Zhang H, Fu B, Wei Y, Li J and Wang N (2026) Effects of combined Baduanjin and cognitive training on cognitive function in cognitively normal older adults. Front. Psychol. 17:1903040. doi: 10.3389/fpsyg.2026.1903040
Received
08 June 2026
Revised
08 July 2026
Accepted
27 July 2026
Published
14 August 2026
Volume
17 - 2026
Edited by
Lingxiao He, Xiamen University, China
Reviewed by
Zhengfa Han, Guangdong University of Education, China
Xin Li, Chengdu Sport University, China
Updates
Copyright
© 2026 Li, He, Zhang, Chen, Zhang, Zhang, Zhang, Fu, Wei, Li and Wang.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Nan Wang, wswn@zzu.edu.cn
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.