This systematic review aims to consolidate the evidence on the effects of pure cognitive training on gait and balance among older adults. This systematic review aims to consolidate the evidence on the effects of pure cognitive training on gait and balance among older adults.
Electronic databases, including PubMed, Embase, CINAHL, and PsycINFO, were searched. Randomized controlled trials that investigated the effect of pure cognitive training on balance or gait among healthy older adults were included. The PEDro scale was used to evaluate the methodological qualities of the studies. Level of evidence for available outcomes were rated by GRADE. The data extraction and rating were performed by two researchers independently. Meta-analysis and sensitivity analysis of studies with high methodological quality (PEDro score ≥ 6) were performed if three or more studies of similar outcome were obtained.
Among the 1200 articles screened, sixteen articles satisfied the criteria and were included in this review. Methodological quality of one study was rated as excellent (PEDro score = 9-10), nine studies were rated as good (PEDro score = 6-8), while six studies were rated as fair (PEDro score = 4-5). Meta-analysis showed that cognitive training significantly increased dual-task gait speed (n=8, SMD=0.19 , 95%CI=-0.00 to 0.37, p=0.05, low-quality evidence) and single-task gait speed (n=13, SMD=0.19 , 95%CI=-0.00 to 0.39, low-quality evidence). In the sensitivity analyses that included only studies with good or above methodological quality, the effect of cognitive training remained significant for dual-task gait speed (n= 6, SMD=0.25, 95%CI= 0.00 to 0.49, low-quality evidence) but turned insignificant for single-task gait speed (n=8, SMD=0.03, 95%CI=-0.10 to 0.16, low-quality evidence) No significant improvement was found in functional mobility (n=5, SMD = 0.37, 95%CI = -0.84 to 1.58, low-quality evidence), or balance scales (n=3, SMD = 0.07, 95%CI = -0.37 to 0.50, moderate quality evidence).
Low to moderate-quality evidence suggests that cognitive training does not have a direct effect on improving gait and balance in single-task conditions for the healthy elderly. However, low-quality evidence shows that it can significantly improve gait speed in dual-task walking conditions possibly attributed to the reduce in cognitive load associated with the cognitive task after training. More high-quality cognitive training trials are required to improve the quality of evidence.
Our meta-analyses provide a basis on using pure cognitive training to improve dual-tasking performance in relatively healthy older people. All effective cognitive training protocols for improving dual-task walking used cognitive computer training to enhance executive function, with sessions lasting 40-60 minutes, 2-3 times a week, over 8-10 weeks. It also helped to delineate the potential causal relationship between cognitive and physical function in older people. Future studies should focus on people with physical or cognitive impairment to explore the effects of cognitive training on gait and balance in higher-risk individuals.
Gait
Older adults
