A randomized controlled pilot study assessing the feasibility of combined motor-cognitive training and its effect on gait characteristics in the elderly

Objective: (1) To develop a motor-cognition training programme; (2) to evaluate the ability to recruit and retain elderly people; (3) to assess the effects of the interventions. Design: Pilot randomized controlled trial. Setting: Assisted living facility. Participants: Sixteen subjects (11 female) living in an assisted living facility were randomized to a motor or motor-cognition group. Interventions: Both groups received machine-driven strength training and balance exercises for 45 minutes, twice weekly, for 12 weeks. In addition, the motor-cognition group received computerized training for attention 3-5 times per week for 10 weeks. Main outcome measures: Baseline and post-intervention (12 weeks) assessments focused on recruitment, attrition and adherence. Secondary outcome measures assessed dual-task costs of gait (velocity, cadence, step time, step length), expanded timed get-up-and-go, falls efficacy and reaction time. Results: Of 35 subjects initially approached, 16 started and 14 completed the study, resulting in 46% recruitment, 19% attrition and >80% adherence rates. There is more evidence of altered levels in the motor-cognitive treatment group with significant differences in average change for fear of falling (P = 0.017) and foot reaction time (P = 0.046). No statistical significance was reached for gait parameters. Conclusions: Motor-cognition training is feasible and shows trends to stronger improvement in walking and reaction time. The application in a main study is deemed feasible. A minimum of +/- 55 subjects per group are required to achieve a power of 80% at the 5% level of significance based on step length and considering the expectable attrition rate in a required larger scale study.