Outdoor vs. Indoor Exercises and Cognitive Functions in Older Adults

This observational, cross-sectional study is designed with a comprehensive quality assurance and operational framework to rigorously investigate the impact of exercise environments on cognitive health in older adults. To ensure data integrity and minimize transcription errors, a multi-stage quality control protocol will be enforced, including double-data entry by two independent investigators and automated database range checks for score boundaries (e.g., restricting the total score of Addenbrooke's Cognitive Examination [ACE-III] between 0 and 100, and validating the age threshold as ≥ 60). Source data verification will be conducted by cross-referencing self-reported chronic conditions and pharmacological backgrounds with institutional health registries where applicable. Operationally, the study follows a strict six-stage Standard Operating Procedure (SOP). Potential participants from Köyceğiz and Erzurum Tazelenme Universities will first undergo a face-to-face pre-screening via a structured Participant Eligibility Form to confirm inclusion criteria, which mandate being aged 60 or older, participating in regular physical exercise, and possessing sufficient sensory and cognitive capacity to complete behavioral testing, while excluding individuals with advanced neurological disorders such as dementia.Following informed consent, participants' functional baseline homogeneity will be verified through validated physical performance metrics, specifically the 6-Minute Walk Test (6MWT) for cardiovascular endurance and the 30-Second Chair Stand Test for lower extremity muscle strength. Based on their primary exercise habits, participants will be classified into the primary independent variables: outdoor or indoor exercise environments. Subsequently, cognitive outcomes across domains of attention, memory, verbal fluency, language, and visuospatial skills will be assessed individually in a controlled, distraction-free environment using the ACE-III Turkish Version A, while past-week physical activity levels will be quantified using the Physical Activity Scale for the Elderly (PASE). Missing data will be managed strictly; variables with less than 15% missing items will be handled via sub-domain mean imputation, whereas cases exceeding this threshold or missing primary cognitive components will be excluded via listwise deletion. Statistical analyses will be executed using IBM SPSS Statistics, utilizing independent samples t-tests or non-parametric Mann-Whitney U tests depending on normality distributions evaluated via Kolmogorov-Smirnov and Shapiro-Wilk criteria. Ultimately, Pearson or Spearman correlation coefficients will assess the relationship between exercise parameters and cognitive scores, and multiple linear regression or analysis of covariance (ANCOVA) will be deployed to isolate the predictive value of the exercise environment on cognitive performance while strictly controlling for confounding covariates such as age, education, baseline physical activity (PASE), and functional capacities (6MWT and chair stand scores), with significance established at p < 0.05.

Inclusion criteria

• Must be aged 60 years or older.
• Must be currently enrolled as a student at Köyceğiz Tazelenme University or Erzurum Tazelenme University.
• Must participate regularly in either structured outdoor or indoor physical exercises.
• Must possess sufficient sensory, visual, hearing, and cognitive capacity to comprehend and complete the behavioral and cognitive tests.
• Must demonstrate similar and homogenous functional physical capacity as verified by the pre-screening benchmarks of the 6-Minute Walk Test and the 30-Second Chair Stand Test.
• Must provide written informed consent voluntarily.

Exclusion criteria

• Being under the age of 60.
• Having a clinical diagnosis of an advanced neurological disorder, including dementia or severe cognitive impairment.
• Having severe acute or chronic physical disabilities, musculoskeletal injuries, or medical conditions that medically prevent or restrict safe exercise participation.
• Having severe uncorrected sensory (visual or hearing) deficits or cognitive impairments that prevent the comprehension of test instructions or completion of the assessments.
• Refusing to provide written informed consent or wishing to withdraw from the evaluation process.