SYNERGIC-2 Trial (SYNchronizing, Exercises and Remedies to GaIn Cognition@home)

Global cognition will be assessed using the cognitive section of the Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog) with 13 items (ADASCog-13). This scale consists of 13 brief cognitive tests assessing attention, memory, language, executive function, praxis, orientation, and instrumental activities of daily living. The ADAS-Cog has been a significant outcome measure in numerous trials with MCI and AD to measure changes in cognitive performance in populations with cognitive impairment, it score ranges from 0 to 84, with higher scores indicating worse cognitive performance.

Measurements of weight and hip/waist circumference will be done at home and self-reported by the participant. This can be used to characterize participant's body dimension and determine body mass index as kg/m^2 which can be used to estimate whether participants have obesity. A BMI greater than 30 is the cut off for obesity. Changes in waist circumference may also indicate visceral fat and cardiovascular risk.

The Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) is a short questionnaire assessing midlife vascular risk for dementia, with scores ranging from 0 to 15 (higher scores suggesting higher risk) and has cut-off score of 5 for high risk.

The CCNA gait assessment includes preferred and fast pace gait, and dual-task gait that comprises walking while performing three cognitively demanding tasks: counting backwards by ones, counting backwards by sevens, and naming animals. Participants will be asked to walk on a designated walking path(4 meters) in sight of camera

The Clinical Dementia Rating (CDR) scale is a validated scale (0-3) used in longitudinal Alzheimer's Disease (AD) research to characterize the impact of cognitive decline on global function performance applicable to AD and related dementias. Information is obtained through a semi-structured interview of the patient and a reliable informant or collateral source (e.g. family member). A score of ) indicate no cognitive impairment; 0.5 for Mild cognitive impairment; 1 for early dementia; 2 for mild severe dementia; 3 for severe dementia

The Digit Symbol Modalities Test is a 90-second, timed task that asks participants to orally match geometric figures with specific numbers according to a defined key (specifying which symbols are assigned to which numbers) that is provided at the top of the stimulus page. The oral Digit Symbol Modalities Test measures processing speed capabilities. The total number of numbers correctly matched with symbols is the final score for this test ranging from 0-110 correct numbers sequentially spoken.

The Eating Pattern Self-Assessment (EPSA) is a 12-item questionnaire assessing participants' dietary intake profiles over the past 12 months. No score provided

The monthly falls calendar that will be sent to help track any participant falls. Participants are being asked to complete this calendar on a daily basis in order to help investigators better track whether or not they have fallen since last intervention. A fall is defined as any unintentional event in which a participant falls to the ground or onto an object (e.g., a chair) no caused by a syncope or loss of consciousness. Total number of falls and consequences of falls is provided.

A questionnaire to score the frequency the participant experiences anxiety symptoms in the past 7 days with higher scores indicating worse anxiety symptoms. Score ranges from 0-21.

A questionnaire to establish a participant's experience with depressive symptoms with higher score indicating more severe depressive symptoms. Score ranges from 0-30.

The HUI-3 provides descriptive health profile measures on a generic scale with higher scores indicating better quality of life and global functionality. HUI also provides single-attribute scores of morbidities for the following attributes; vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain. Score ranges from one 1 to 6 or 1 to 5 depending on the domain; and sum of all domains could range from 8 to 45.

The HRUQ provides an overall assessment of a participants utilization of health-related resource use and costs for elderly adults with and without mild cognitive impairment.There is no scoring for the HRUQ

The Insomnia Severity Index (ISI) is a 7-item questionnaire assessing sleep onset, sleep maintenance, sleep satisfaction, and sleep problems.

Modified for the elderly people, assesses older adults' level of physical activity, with a simple 7-item questionnaire. Scoring ranges from low, moderate and high.

Measures participant's ability to engage in instrumental activities of daily living via questionnaire assessing the ability to independently perform activities such as using the telephone, shopping, preparing meals, chores, household activities, managing prescriptions and medications, and managing personal finances. Score ranges from 0-23.

A 14-item questionnaire to help evaluate a participants Mediterranean ingredients in their diet. Score ranges from 0-14.

The MoCA is a brief screening instrument designed to detect global cognitive dysfunction. It assesses a range of different cognitive domains, including attention, executive functions, memory, language, visuo-constructional skills, abstract thinking, and orientation. Score ranges from 0-30.

The Oral Trail Making Test (TMT) A & B is a two-part test that assesses attention speed, and mental flexibility and has been widely used in clinical settings for assessing deficits in attention and executive functioning. Score from part A ranges from 0-180; part B from 0-300 seconds. Longer times mean worse performance in the test.

The Short-Form Quality of Life Questionnaire (SF-36) is a 36-item questionnaire assessing quality of life, with scores ranging from 0 to 100 and higher scores indicating better quality of life.

The Rey Auditory Verbal Learning Test (RAVLT) assesses episodic memory, in which the participant is presented with 15 words in five presentations or trials, after which they are asked to recall the words (immediately and after a delay). Score ranges from 0 to 15 words recalled.

It is a version developed by the CCNA to measures participant's expectancies about the cognitive benefits of the intervention. Score ranges from 1 to 88. This questionnaire measures the participant's perception about the interventions. The questionnaire outcome is not related to participant's cognition, but participant's subjective perception about the interventions.

The Sleep Diary is self-administered of 10-days of sleep patterns to assess sleep quality and total of sleep time. It also helps to identify possible sleep disruptions that may affect sleep quality and identify certain habits that may explain sleeping issues.

The Wrist (AX3) Accelerometer is used to detect movement, vibrations, and orientation changes to assess physical activity trends in older population.

This questionnaire asks about eleven health behaviors, to be rated on a 0 (low) to 10 (high) scale. Prior research has demonstrated that a 1-point change on these 0 to 10 items is clinically meaningful.

These questionnaires ask about cognition (6-item questionnaire), vascular health (4-item questionnaire), and social and psychological health (8-item questionnaire).

• BHPro Questionnaire - Cognition: This questionnaire asks about participant's engagement in activities such as reading, crafting, and instrument playing. It does not provide any quantitative range score.
• BHPro Questionnaire - Social and Psychological Health: This questionnaire asks about participant's emotions and mood. It does not provide any quantitative range score.
• BHPro Questionnaire - Vascular Health: This questionnaire asks about participant's updated medical history. It does not provide any quantitative range score.

Participants will use the MUSE-S EEG Headband for 3 consecutive nights. The MUSE S Headband is a commercially available consumer headband that has 7 sensors, 2 on the forehead, 2 behind the ears, plus 3 reference sensors, to detect and measure EEG signals when sleeping.

Participants will use the DNA-Genotek, which is a self-administered saliva collection kit to analyze saliva sample for possible identification of APO-E variants, a planned panel of 31 single nucleotide polymorphisms (SNPs), and untargeted metabolomics.

Questions 7 and 8 from the Resource Use Inventory (RUI)28 questionnaire assess health-related resource use for caregivers. This instrument has been used for tracking resource use and costs in cognitively intact older adults, as well as with Alzheimer disease (AD). This is a self-report questionnaire investigates if participants received any help while preforming daily living tasks e.g., bathing, brushing, and getting the phone. It does not provide any quantitative range score.

Participants will be performing the one-minute chair stand test while being assessed via video conferencing by a research team member to evaluate mobility.

The ABC questionnaire consists of 16 questions where the participants rate their confidence that they will not lose their balance or become unsteady while performing different activities. They need to rate 16 different activities from 0 to 100, 0 being not confident at all, and 100 being completely confident on their abilities to perform the activity.

The SPPB is an objective assessment tool for evaluating lower extremity functioning in older adults. Score ranges from 0 to 12. 0 being frail (disabled), and 12 being no mobility disability issues.

Defined as the total percent of enrolled participants relative to the number of people screened for eligibility. Score is calculated as the ratio of screened and enrolled participants per month. Higher scores = better recruitment rates.

Defined as the total percent of enrolled participants who continue throughout the trial and participate in outcomes assessments as follows:

• Enrollment retention: of those enrolled participants, the % who complete immediate 6-month post intervention assessment, and;
• Follow-up retention: of those who complete the immediate 6-month post intervention follow-up assessment, the % of participants who complete the 6-month post-intervention follow-up assessment at 12-months.

Defined as total percent of participants not voluntarily dropping out during baseline or between baseline assessment and prior to allocation to intervention group.

Frequency cross-tabulation of AE severity versus AE relation to trial

Defined as data lost due to technical failures, personnel errors or participant non-compliance and is calculated as percentages.

This measurement will be self-reported.

This measurement will be self-reported.

This measurement will be self-reported. And will be reported as individuals medications and total amount.

This measurement will be self-reported and will be monitored throughout the trial