Impact of Nutrition, Sleep and Physical Activity on Cognitive Function in Older Frailty Adults: A Randomized Controlled Trial

BackgroundAs the global population ages, there is an increasing demand for effective strategies to maintain and improve health among older adults. Wearable technology presents a promising tool for health monitoring and management, yet its effectiveness in comprehensive health improvement for older adults remains uncertain. ObjectiveThis study aimed to evaluate the effectiveness of personalized lifestyle notifications, based on wearable device recorded data, in improving health outcomes, specifically cognitive and physical function, among older adults, compared to usual care. MethodsIn a 6-month randomized controlled trial, 355 older adults (aged 65+), including those with frailty, were randomly assigned to an intervention group (n=178) or a control group (n=177). The intervention group wore Fitbit Charge 5 devices and received personalized lifestyle alerts with rule-based personalization, using thresholds derived by human experts, throughout the 6-month period. The control group received no such notifications and were instructed not to use wearable devices. Some opt-in subjects, an intervention group (n=128) or a control group (n=116), were requested to record all meals using the application to deliver nutritional alerts. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Physical function was evaluated using Fried Frailty Phenotype criteria. Measurements were conducted at baseline and after 6 months. ResultsIn the intention-to-treat analysis, the intervention group showed significant improvements in general cognitive function (MoCA scores increased by 1.0 (95% CI: 0.6 to 1.3) vs 0.2 (-0.2 to 0.5) in the control group, p=0.011) and frailty status (Fried frailty phenotype index change: -0.3 (-0.5 to -0.2) vs -0.1 (-0.2 to 0.1) in the control group, p=0.029). Subgroup analysis of participants with nutritional tracking showed significant improvements in MoCA scores (1.2 (0.8 to 1.6) vs 0.2 (-0.2 to 0.5), p=0.0004) and frailty status (-0.3 (-0.5 to -0.2) vs 0.0 (-0.2 to 0.1) in the control group, p=0.009). The per-protocol analysis showed similar results. ConclusionThis study provides evidence that personalized, multifaceted Fitbit-based interventions can effectively enhance cognitive function, with notable improvements specifically in MoCA scores, and mitigate frailty progression in older adults as expected. These findings suggest that comprehensive lifestyle interventions including exercise, sleep and nutrition using wearable technology may be valuable for promoting healthy aging.