A randomized controlled pilot study assessing the feasibility of combined motor–cognitive training and its effect on gait characteristics in the elderly

Abstract

Objective: (1) To develop a motor–cognition training programme; (2) to evaluate the ability to recruit and retain elderly people; (3) to assess the effects of the interventions. Design: Pilot randomized controlled trial. Setting: Assisted living facility. Participants: Sixteen subjects (11 female) living in an assisted living facility were randomized to a motor or motor–cognition group. Interventions: Both groups received machine-driven strength training and balance exercises for 45 minutes, twice weekly, for 12 weeks. In addition, the motor–cognition group received computerized training for attention 3–5 times per week for 10 weeks. Main outcome measures: Baseline and post-intervention (12 weeks) assessments focused on recruitment, attrition and adherence. Secondary outcome measures assessed dual-task costs of gait (velocity, cadence, step time, step length), expanded timed get-up-and-go, falls efficacy and reaction time. Results: Of 35 subjects initially approached, 16 started and 14 completed the study, resulting in 46% recruitment, 19% attrition and >80% adherence rates. There is more evidence of altered levels in the motor–cognitive treatment group with significant differences in average change for fear of falling (P = 0.017) and foot reaction time (P = 0.046). No statistical significance was reached for gait parameters. Conclusions: Motor–cognition training is feasible and shows trends to stronger improvement in walking and reaction time. The application in a main study is deemed feasible. A minimum of ±55 subjects per group are required to achieve a power of 80% at the 5% level of significance based on step length and considering the expectable attrition rate in a required larger scale study.