Falls prevention through exercise and cognitive training among community-dwelling older persons with mild cognitive impairment

Abstract

Background: Mild cognitive impairment (MCI) increases fall risk of community-dwelling older adults. Objective: This research project aimed to determine the effectiveness of physical exercise and cognitive training in preventing falls among community-dwelling older adults with MCI. Methods: This was a 3-phase research project. Phase 1 was a systematic review. Phase 2 was a cross-sectional study. Phase 3 was a randomized controlled trial (RCT). Results: In the systematic review, 17 high-quality RCTs were included. It was found that in MCI: 1) exercise increased walking speed and general cognitive function, 2) cognitive training had no significant effect on cognitive function, and 3) combined physical and cognitive training improved balance. In the cross-sectional study, 230 community-living older persons (76.5% women) with a mean age of 69.8 ± 6.8 years participated. The prevalence rate of MCI is 81.7%. Older persons with MCI have statistically significantly higher risk for falling with higher Physiological Profile Assessment (PPA) scores (p = .002), independent of age as a confounding factor, compared to those without MCI. In the RCT, 92 community-living older adults (79.4% female) with MCI, with mean age of 69.5 ±5.6 years participated, and were randomly allocated into Physical and Cognitive Training (PACT) group (n = 23), Physical Training (PT) alone group (n = 23), Cognitive Training (CT) alone group (n = 23), and Waitlist Group (WG) (n = 23). PACT demonstrated lower overall fall risk, (p = .003), higher cognitive function (p <.001), and better dynamic balance (p = .004) over time. PT demonstrated significantly higher cognitive function (p <.001), and significant increase in walking speed (p = .001), and lower extremity muscle strength (p < .001) post-intervention. CT group did not improve on cognitive function over time (p = .058). No significant change was observed across time and groups on fall rate and psychological outcomes. Conclusions: Based on the systematic review, combined physical and cognitive training have demonstrated better outcomes in reducing balance risk of falling. In the cross-sectional study, MCI was found to be highly prevalent and those with MCI have higher risk off falling based on poorer physiological profile. In the RCT, combined physical and cognitive training reduced overall fall risk, increased cognitive function and increased balance control in older persons with MCI living in the community. Clinical Implications: Community-based fall prevention programmes for older persons particularly for those with MCI need to consider the positive effects of combining physical exercise and cognitive training interventions. Research Implications: A follow-up study must be done to determine the long-term effects of the interventions. A qualitative investigation of the interventions also needs to be conducted to gather information on how to improve future implementation of the programme.