BACKGROUND: The role of adherence to an intervention is examined to further understand the relationship between performing new challenging activities (either mental or physical ones) and their putative cognitive benefits. METHOD: Healthy older women (n = 229, age range 70 to 93 years) took part in a six-month randomised controlled trial, covering either a physical or mental activity (three x weekly). They completed five tests, measuring episodic and working memory pre- and post-intervention. A moderated mediation model was specified to test the strength of the indirect effect of the activity mode (ie, physical versus mental) through adherence (ie, time spent on course attendance) on levels of baseline cognitive performance. RESULTS: Both physical and mental activity groups performed better over time than the control group (p < 0.001). Adherence predicted cognitive performance (p = 0.011). The indirect effect of the activity mode on cognitive performance through adherence was especially seen when levels of baseline composite scores were low (p = 0.023). CONCLUSION: Older healthy women can improve episodic and working memory through spending time on a challenging physical or mental activity. Results are most promising for cognitively less fit women. Time spent on course attendance can be interpreted as an adherence indicator that makes a difference for various cognitive outcomes of the intervention.

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