Effects of a step training program in community-dwelling older adults with dementia: an age, walking ability, and cognitive function subgroup analysis

Objective: The ability of older adults to take fast, large, and precise steps to maintain balance depends on both their physical and cognitive function. This study aimed to evaluate the effects of a step training program on stepping performance and physical and cognitive function in community-dwelling older adults with dementia across different age, walking ability, and dementia severity subgroups.

Materials and Methods: This study is a pilot, quasi-experimental, waitlist-controlled trial. Older adults with dementia who were able to walk 10 m were recruited. The step training program consisted of two 40-minute weekly exercise sessions and lasted for 12 weeks. Stepping performance (Choice Stepping Reaction Time Test [CSRTT], Maximal Step Length Test [MSLT], and Alternate Step Test [AST]), physical function (10-meter walk test [10WT]), and cognitive function (Montreal Cognitive Assessment [MoCA]) were assessed at the baseline and 12 weeks.

Results: Participants under 80 years old showed significant improvements in their CSRTT, MSLT, AST, and MoCA (p ≤ .026), whereas those aged 80 or above did not exhibit significant improvement. Participants who walked independently showed significant improvements in CSRTT, MSLT, and AST (p ≤ .049) while those who walked with a walking stick showed no significant improvement. Participants with mild dementia showed significant improvements in MSLT (p = .002), while those with moderate dementia demonstrated significant improvements in CSRTT, AST, and 10WT (p ≤ .024).

Conclusion: Older adults with dementia who are younger, can walk independently, and are more cognitively impaired are more likely to benefit from the step training program.