Effects of physical and cognitive training on gait speed and cognition in older adults: A randomized controlled trial

Authors: SIPILA, SARIANNA - University Of Jyvaskyla; TIRKKONNEN, ANNA - University Of Jyvaskyla; SAVIKANGAS, TIINA - University Of Jyvaskyla; HANNINEN, TOUMO - Kuopio University Hospital; LAUKKANEN, PIA - University Of Jyvaskyla; ALEN, MARKKU - Oulu University Hospital; FIELDING, ROGER - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; KIVIPELTO, MIIA - Finnish Institute For Health And Welfare; KULMALA, JENNI - Finnish Institute For Health And Welfare; RANTANEN, TAINA - University Of Jyvaskyla; SIHVONEN, SANNA - Jamk University Of Applied Sciences; SILLANPAA, ELINA - University Of Jyvaskyla; STIGSDOTTER-NEELY, ANNA - Karlstad University; TORMAKANGAS, TIMO - University Of Jyvaskyla

Submitted to: Scandinavian Journal of Medicine & Science in Sports
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 3/23/2021
Publication Date: 3/27/2021
Citation: Sipila, S., Tirkkonnen, A., Savikangas, T., Hanninen, T., Laukkanen, P., Alen, M., Fielding, R.A., Kivipelto, M., Kulmala, J., Rantanen, T., Sihvonen, S.E., Sillanpaa, E., Stigsdotter-Neely, A., Tormakangas, T. 2021. Effects of physical and cognitive training on gait speed and cognition in older adults: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports. 31(7):1518-1533. https://doi.org/10.1111/sms.13960.
DOI: https://doi.org/10.1111/sms.13960

Interpretive Summary: Walking speed is a measure of health and functioning particularly in older adults. Walking speed is related to both physical and cognitive functioning. We investigated whether a 12 month physical and cognitive training program (PTCT) could have an effect on measures of physical and cognitive functioning in older adults compared to just a physical training program alone (PT). This study was conducted in Jyvaskyla Finland where we recruited 314 sedentary older men and women. The PT program included supervised walking/balance (once weekly) and strength training /balance training (once weekly), home exercises (2-3 times weekly) and moderate endurance activity (up to 15o total minutes per week). PTCT included the PT and computer training (CT) designed to challenge brain functions related to memory and thinking (15-20 minutes, 3-4 times weekly). We did not find that PTCT resulted in a greater improvement in walking speed compared to PT alone. However, some measures of memory improved more in PTCT compared to PT alone. These results suggest that complementing physical training exercise with cognitive training provides additional benefit on cognitive functioning.

Technical Abstract: Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12-month physical and cognitive training (PTCT) on gait speed, dual-task cost in gait speed, and executive functions (EFs) compared with physical training (PT) (ISRCTN52388040). Community-dwelling older adults, who did not meet physical activity recommendations, were recruited (n = 314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2-3 times weekly), and moderate aerobic activity 150 min/week in bouts of >10 min. PTCT included the PT and computer training (CT) on EFs 15-20 min, 3-4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6-min walking distance, dual-task cost in gait speed, and EF (Stroop and Trail Making B-A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59%-72% in PT and 62%-77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT-PT, 0.02; 95%CI -0.03, 0.08), walking distance (-3.8; -16.9, 9.3) or dual-task cost (-0.22; -1.74, 1.30). Stroop improvement was greater after PTCT than PT (-6.9; -13.0, -0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF's, complementing physical training with targeted cognitive training provides additional benefit.