Given the major medical and socioeconomic consequences of disability in U.S. seniors and the low compliance with recommended treatments such as physical exercise, investigation of alternate strategies to improve mobility and locomotion is a vital need. Emerging evidence indicates that Executive Functions play an important role in maintaining locomotion in aging and preventing mobility disabilities. However, use of cognitive training programs to improve executive functions as a strategy to increase mobility has not been explored. Exciting results from our preliminary study support the efficacy and feasibility of the cognitive remediation approach to improve locomotion in older adults. We propose to conduct the first single-blind randomized clinical trial to test the efficacy of a computerized cognitive remediation intervention program on improving locomotion in sedentary seniors, a group at an especially high risk for disability. For this study, two groups of 210 sedentary seniors (420 total) will be randomized into either eight-week cognitive remediation (individualized computerized cognitive training) or health education control programs. All participants will receive gait, mobility, and cognitive assessments at baseline, post-intervention, and at six and twelve months after intervention to assess durability of effects. Our primary outcome is post intervention change in gait velocity measured during normal pace walking (simple locomotion) and walking while talking (complex locomotion) conditions as well as performance on the Short Physical Performance Battery (SPPB). Additional outcomes include improvements in mobility related cognitive processes (neuropsychological measures), other quantitative gait assessments (gait variability and gait domains), and neuroplasticity (measured with functional near infra-red spectroscopy). Our hypothesis is that executive functions will respond to the cognitive remediation program and in turn enhance locomotion. The premise of this clinical trial is that disability among seniors is a potentially preventable chronic condition rather than an irreversible consequence of aging and disease. Our proposed novel approach to locomotion has the potential to shift treatment paradigms in the field of disability by introducing cognitive approaches to mobility that can be applied to prevention and rehabilitation in diverse settings. Through this 'proof of concept' secondary prevention trial we will fill an important gap n knowledge for practicing evidence-based medicine and developing effective interventions for a major health outcome affecting a substantial proportion of the U.S. aging population.
Ambulatory disabilities represent the most prevalent disability among US seniors. This 'proof of concept' clinical trial will fill an important gap in knowledge of the efficacy of cognitive remediation as a secondary prevention strategy to improve this debilitating condition. Demonstrating mobility gains through cognitive training will provide insigh for future mobility treatment options, and if successful will establish an accessible and low-risk method to enhance mobility among frail sedentary seniors.
