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Lipardo D1,2, Tsang W1
1The Hong Kong Polytechnic University, Department of Rehabilitation Sciences, Hong Kong, Hong Kong, 2University of Santo Tomas, College of Rehabilitation Sciences - Department of Physical Therapy, Manila, Philippines
Background: Older adults with mild cognitive impairment (MCI) are at risk of falling due to physical and cognitive decline. A combined physical exercise and cognitive training may be the best approach in addressing both the physical and cognitive risks of falling in this population.
Purpose: To evaluate the effects of combined physical and cognitive training on preventing falls and reducing risks for falling in community-dwelling older adults with MCI.
Methods: A multi-center randomized controlled trial was conducted and participated in by community-dwelling older adults aged 60 years or above with MCI from Manila, Philippines. Participants were randomly allocated to the combined physical and cognitive training group (PACT, n = 23), physical training alone group (PT, n = 23), cognitive training alone group (CT, n = 23), or waitlist group (WG, n = 23). The interventions were in group sessions of 12-week duration. Primary outcome was fall incidence. Secondary outcomes were overall fall risk, cognitive function, physical fall risks such as balance, gait speed and lower limb strength, and psychological fall risks such as quality of life, fear of falling and health status. Measurements were taken by blinded assessors in three occasions:
1) at baseline,
2) at the conclusion of the intervention period (12 weeks after baseline), and
3) six months post-intervention (36 weeks after baseline).
Results: A total of 92 older persons with mean age of 69.5 ±5.6 years old (79.4% female) participated in this study. Seventy-four (80.4%) participants had post-intervention assessment at 12 weeks, and 66 (71.7%) completed the follow-up assessment at 36 weeks. No statistically significant difference was found among the randomization groups on fall incidence three months (p = .152) and six months (p = .954) post intervention. PACT group demonstrated lower overall fall risk, (p = .003), higher cognitive function (p .001), and better dynamic balance (p = .004) overtime. PT group also demonstrated significantly higher cognitive function (p .001) post-intervention, and significant increase in walking speed (p = .001), and lower extremity muscle strength (p .001).CT group did not improve on cognitive function overtime (p = .058). No significant change was observed across time and groups on psychological outcomes.
Conclusion(s): There was no significant difference among groups on the reported fall incidence rate post-intervention. The combined physical and cognitive training, however, significantly resulted in lower overall fall risk, improved cognitive function and better dynamic balance over time. The physical training alone lead to enhanced cognitive function, as well as, faster walking speed and stronger lower extremity muscles over time. Cognitive training alone did not produce significant improvement in cognitive performance. A follow-up study to determine the long-term effects of the interventions of at least one year is warranted.
Implications: A community-based rehabilitation programme that combines physical exercise with elements of cognitive training is feasible and effective. The intervention may be implemented by physical therapists practising in the community setting in the general population of older people as a preventive measure to address age-related decline in cognitive and physical function.
Keywords: Older people, mild cognitive impairment, fall prevention
Funding acknowledgements: Associated Money from the Research Studentship Scholarship of The Hong Kong Polytechnic University.
Purpose: To evaluate the effects of combined physical and cognitive training on preventing falls and reducing risks for falling in community-dwelling older adults with MCI.
Methods: A multi-center randomized controlled trial was conducted and participated in by community-dwelling older adults aged 60 years or above with MCI from Manila, Philippines. Participants were randomly allocated to the combined physical and cognitive training group (PACT, n = 23), physical training alone group (PT, n = 23), cognitive training alone group (CT, n = 23), or waitlist group (WG, n = 23). The interventions were in group sessions of 12-week duration. Primary outcome was fall incidence. Secondary outcomes were overall fall risk, cognitive function, physical fall risks such as balance, gait speed and lower limb strength, and psychological fall risks such as quality of life, fear of falling and health status. Measurements were taken by blinded assessors in three occasions:
1) at baseline,
2) at the conclusion of the intervention period (12 weeks after baseline), and
3) six months post-intervention (36 weeks after baseline).
Results: A total of 92 older persons with mean age of 69.5 ±5.6 years old (79.4% female) participated in this study. Seventy-four (80.4%) participants had post-intervention assessment at 12 weeks, and 66 (71.7%) completed the follow-up assessment at 36 weeks. No statistically significant difference was found among the randomization groups on fall incidence three months (p = .152) and six months (p = .954) post intervention. PACT group demonstrated lower overall fall risk, (p = .003), higher cognitive function (p .001), and better dynamic balance (p = .004) overtime. PT group also demonstrated significantly higher cognitive function (p .001) post-intervention, and significant increase in walking speed (p = .001), and lower extremity muscle strength (p .001).CT group did not improve on cognitive function overtime (p = .058). No significant change was observed across time and groups on psychological outcomes.
Conclusion(s): There was no significant difference among groups on the reported fall incidence rate post-intervention. The combined physical and cognitive training, however, significantly resulted in lower overall fall risk, improved cognitive function and better dynamic balance over time. The physical training alone lead to enhanced cognitive function, as well as, faster walking speed and stronger lower extremity muscles over time. Cognitive training alone did not produce significant improvement in cognitive performance. A follow-up study to determine the long-term effects of the interventions of at least one year is warranted.
Implications: A community-based rehabilitation programme that combines physical exercise with elements of cognitive training is feasible and effective. The intervention may be implemented by physical therapists practising in the community setting in the general population of older people as a preventive measure to address age-related decline in cognitive and physical function.
Keywords: Older people, mild cognitive impairment, fall prevention
Funding acknowledgements: Associated Money from the Research Studentship Scholarship of The Hong Kong Polytechnic University.
Topic: Older people; Health promotion & wellbeing/healthy ageing; Disability & rehabilitation
Ethics approval required: Yes
Institution: University of Santo Tomas
Ethics committee: College of Rehabilitation Sciences Ethics Review Committee
Ethics number: FI-2017-002
All authors, affiliations and abstracts have been published as submitted.
