Study: 8 weeks of computerized cognitive remediation improved gait in sedentary seniors

What the study tested

Mobility disability rises with age, and slow gait predicts morbidity, falls and loss of independence.^[1] Physical exercise is the standard recommendation, but adherence is poor, roughly 50% of people who start an exercise program drop out within the first 3–6 months.^[1] Attention and executive function are tightly linked to walking and respond to training, so this trial asked whether a cognitive program, rather than a physical one, could improve mobility.

From a referral pool of 45 screened individuals, 24 met criteria and were randomized using a table of random numbers, 12 per arm. Eligible participants were aged 70 and over, recruited from Bronx voter registration lists, physically inactive or exercising once weekly or less, with a baseline gait velocity below 1.0 m/s, a threshold flagging high risk of mobility decline. Dementia was excluded (Memory Impairment Screen score >5 and Mini-Mental State Examination score >25). At baseline the two groups did not differ on age (intervention mean 77.4, control 79.9 years), sex, education, illness burden or gait velocity.^[1]

The intervention was a commercial computerized cognitive program (Mindfit; CogniFit Inc., Yokneam, Israel). Participants trained for 45–60 minutes, three times weekly, over 8 weeks, up to 72 sessions, with each session mixing visual, auditory and cross-modality tasks aimed at attention and executive function, individually tailored after a 45-minute baseline assessment. The wait-list controls received a health-education session and a booklet on activity guidelines but no training. The primary outcome was change in gait velocity, measured on an instrumented walkway (GAITRite) under two conditions: usual normal-pace walking and a more demanding “walking while talking” (WWT) dual task in which participants recited alternate letters of the alphabet while walking. Speed of processing (reaction time) and the MMSE were assessed as secondary measures. An assessor blinded to group assignment performed all evaluations.

What it found

Two participants per arm did not complete the post-intervention visit, leaving 20 analyzed (10 per group; 83.3% of the randomized sample). Among the 10 intervention completers, gait velocity rose over the 8 weeks under both walking conditions, while the 10 controls did not change.^[1]

Within the remediation group, the rise from baseline reached significance under normal-pace walking (68.2 → 76.5 cm/s, p = .05) and under the WWT dual task (36.7 → 56.7 cm/s, p = .002). The change over the 8-week interval was +8.2 cm/s for normal walking (p = .10) and +19.9 cm/s for WWT (p = .05) when compared with the controls, whose gait was flat in both conditions (normal-pace p = .57; WWT p = .70).^[1]

The trial also counted “improvers”, participants gaining at least 4 cm/s, a change the authors call small but clinically meaningful. On normal-pace walking, 6 of 10 remediation participants improved versus 3 of 10 controls (odds ratio 3.0, 95% CI 0.5–19.6). On the WWT task, all 10 remediation participants improved versus 3 of 10 controls (odds ratio 3.5, 95% CI 1.5–8.0).^[1]

On secondary measures, speed of processing improved by 1,662 ms (95% CI 155–3,168 ms, p = .03) following remediation, a near-transfer effect the authors read as evidence that the program engaged the trained cognitive processes. The MMSE did not change significantly over the study period in either group (remediation mean change +0.6 points; control −0.3 points, p > .10). No adverse events related to the interventions were reported.^[1]

Adherence and feasibility

Despite being a frail, mostly computer-novice sample, only 2 of 12 intervention participants reported any prior computer use, so the first session taught basic computing skills, engagement was high. Participants attended 99.2% of the scheduled sessions. All intervention participants reported at the end that they enjoyed the program and gaining computer skills, and none in either group increased their physical-exercise frequency or joined an exercise facility over the 8 weeks, which the authors note makes a physical-activity explanation for the gait gains unlikely.^[1]

Limitations, what this does not show

The authors frame this explicitly as a pilot proof-of-concept trial and flag several limits. The sample was very small, 24 randomized, 20 analyzed, so the between-group difference in normal-pace gait was suggestive but not statistically significant, and intent-to-treat analysis was not performed. A simple randomization procedure left the controls with non-significantly higher baseline gait velocity, which may have underestimated the intervention effect. Conventional neuropsychological tests were not administered, so cognitive change beyond speed of processing was not characterized, and contact with study staff was not balanced between groups. The trial cannot say whether the gait gains were due to cognitive training itself versus unmeasured changes in mood, self-efficacy or motivation. By the authors' own power calculation, detecting a 4-cm/s between-group difference with 85% power would require about 400 sedentary seniors (200 per group), a confirmatory trial these pilot results have not yet replaced.^[1]

Where this fits in the broader evidence

The walking-while-talking dual task is an ecologically valid measure that reflects real-world function and predicts falls,^[2] and slow gait under such conditions is itself associated with later cognitive decline.^[5] Larger cognitive-training trials have shown durable transfer to everyday function,^[3] and speed-of-processing training has transferred to a distal real-world domain, driving.^[4] This trial extended that picture by reporting, in the authors' account, far transfer of cognitive remediation to mobility. It pairs with a later trial in which the same kind of training did not move gait in a lower-functioning sample, the companion study on cognition versus gait in seniors with cognitive impairment. For the full catalog, see the research index and the older-adults evidence guide.