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

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, I = 15.85%], but not simple gait (ES = 0.35, 95% CI -0.01 to 0.71, P = .057, I = 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.