title: Interactive Cognitive-Motor Step Training Improves Cognitive Risk Factors of Falling in Older Adults - A Randomized Controlled Trial.
abstract: OBJECTIVE
  Interactive cognitive-motor training (ICMT) requires individuals to perform both gross motor movements and complex information processing. This study investigated the effectiveness of ICMT on cognitive functions associated with falls in older adults.
  
  
  METHODS
  A single-blinded randomized controlled trial was conducted in community-dwelling older adults (N = 90, mean age 81.5±7) without major cognitive impairment. Participants in the intervention group (IG) played four stepping games that required them to divide attention, inhibit irrelevant stimuli, switch between tasks, rotate objects and make rapid decisions. The recommended minimum dose was three 20-minute sessions per week over a period of 16 weeks unsupervised at home. Participants in the control group (CG) received an evidence-based brochure on fall prevention. Measures of processing speed, attention/executive function (EF), visuo-spatial ability, concerns about falling and depression were assessed before and after the intervention.
  
  
  RESULTS
  Eighty-one participants (90%) attended re-assessment. There were no improvements with respect to the Stroop Stepping Test (primary outcome) in the intervention group. Compared to the CG, the IG improved significantly in measures of processing speed, visuo-spatial ability and concern about falling. Significant interactions were observed for measures of EF and divided attention, indicating group differences varied for different levels of the covariate with larger improvements in IG participants with poorer baseline performance. The interaction for depression showed no change for the IG but an increase in the CG for those with low depressive symptoms at baseline. Additionally, low and high-adherer groups differed in their baseline performance and responded differently to the intervention. Compared to high adherers, low adherers improved more in processing speed and visual scanning while high-adherers improved more in tasks related to EF.
  
  
  CONCLUSIONS
  This study shows that unsupervised stepping ICMT led to improvements in specific cognitive functions associated with falls in older people. Low adherers improved in less complex functions while high-adherers improved in EF.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12613000671763.
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.|Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schoene
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.|Exercise Science Laboratory, School of Kinesiology, Faculty of Medicine Universidad Finis Terrae, Santiago, Chile.
authors.forename: Trinidad
authors.initials: T
authors.lastname: Valenzuela
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Toson
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Delbaere
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
authors.forename: Connie
authors.initials: C
authors.lastname: Severino
authors.affiliation: mHealth Laboratory, iNEXT, University of Technology Sydney, Sydney, Australia.
authors.forename: Jaime
authors.initials: J
authors.lastname: Garcia
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Davies
authors.affiliation: RSL LifeCare Chair of Ageing, Australian Catholic University, Sydney, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Russell
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.|Faculty of Arts and Business, University of the Sunshine Coast, Sippy Downs, Australia.
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Smith
authors.affiliation: Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D026241:Exercise Movement Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011597:Psychomotor Performance; D016138:Walking