Cognitive-Based Interventions to Improve Mobility: A Systematic Review and Meta-analysis

Abstract

Objective: A strong relation between cognition and mobility has been identified in aging, supporting a role for enhancement mobility through cognitive-based interventions. However, a critical evaluation of the consistency of treatment effects of cognitive-based interventions is currently lacking. The objective of this study was 2-fold: (1) to review the existing literature on cognitive-based interventions aimed at improving mobility in older adults and (2) to assess the clinical effectiveness of cognitive interventions on gait performance.

Design: A systematic review of randomized controlled trials (RCT) of cognitive training interventions for improving simple (normal walking) and complex (dual task walking) gait was conducted in February 2018.

Setting and participants: Older adults without major cognitive, psychiatric, neurologic, and/or sensory impairments were included.

Measures: Random effect meta-analyses and a subsequent meta-regression were performed to generate overall cognitive intervention effects on single- and dual-task walking conditions.

Results: Ten RCTs met inclusion criteria, with a total of 351 participants included in this meta-analysis. Cognitive training interventions revealed a small effect of intervention on complex gait [effect size (ES) = 0.47, 95% confidence interval (CI) 0.13 to 0.81, P = .007, I2 = 15.85%], but not simple gait (ES = 0.35, 95% CI -0.01 to 0.71, P = .057, I2 = 57.32%). Moreover, a meta-regression analysis revealed that intervention duration, training frequency, total number of sessions, and total minutes spent in intervention were not significant predictors of improvement in dual-task walking speed, though there was a suggestive trend toward a negative association between dual-task walking speed improvements and individual training session duration (P = .067).

Conclusions/implications: This meta-analysis provides support for the fact that cognitive training interventions can improve mobility-related outcomes, especially during challenging walking conditions requiring higher-order executive functions. Additional evidence from well-designed large-scale randomized clinical trials is warranted to confirm the observed effects.

Keywords: Gait control; computerized cognitive training; elderly; fall risk; neurophysiological plasticity.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Figures

Fig. A1.

Funnel plot of standard difference in means vs standard error for single-task walking outcomes.

Fig. A2.

Funnel plot of standard difference in means vs standard error for dual-task walking outcomes.

Fig. A3.

Regression of single training duration on standard difference in means.

Fig. 1.

PRISMA flow diagram.

Fig. 2.

Single-task walking outcomes.

Fig. 3.

Dual-task walking outcomes.

Fig. 4.

Proposed model of cognitive trainingerelated gait improvements.