Feasibility, safety, and effects of a step training program in community-dwelling older adults with mild-to-moderate dementia : a feasibility wait-list controlled trial

Abstract

Background: Stepping performance is a strong determinant of falls in older adults. Step training has been shown to be effective in improving fall-related outcomes in healthy older adults. However, step training has not been investigated in older adults with dementia. Objective: This study evaluates the feasibility, safety, and effects of a step training program in community-dwelling older adults with mild-to-moderate dementia. Methods: Participants were assigned to either a step training group or a wait-list control group. The step training group performed two 40-min exercise sessions per week, each consisting of a 5-min warm-up, 30 min of stepping exercises, and a 5-min cool-down, for 12 weeks. The control group received usual care during this time. The training involved repeatedly stepping onto specific targets on a plastic mat. The exercise intensity was progressed by increasing stepping distance and task complexity once participants could accurately complete the required steps. Feasibility, assessed as the percentage of participants completing the 12-week follow-up, safety, defined as the incidence of adverse events, and clinical outcomes were assessed. Results: Forty-seven participants (84%) completed the 12-week assessment. No adverse events were recorded. Significant improvements in choice stepping reaction time (p = 0.038), maximum step length [left leg backward stepping (p = 0.046) and side stepping (p = 0.020)], and alternate stepping time (p = 0.002) were found in the step training group compared to the control group. Conclusions: The step training program was feasible, safe, and potentially effective in improving the stepping performance of older adults with mild-to-moderate dementia.