Clinical Effectiveness of Cognitively Enhanced Tai Ji Quan Training on Global Cognition and Dual-Task Performance During Walking in Older Adults With Mild Cognitive Impairment or Self-Reported Memory Concerns : A Randomized Controlled Trial
Author: Fuzhong Li1, Peter Harmer1, Elizabeth Eckstrom2, Kathleen Fitzgerald3, Kerri Winters-Stone4
Affiliation:
1 Oregon Research Institute, Springfield, Oregon (F.L., P.H.).
2 Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, Oregon (E.E.).
3 McKenzie-Willamette Medical Center, Springfield, Oregon (K.F.).
4 Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon (K.W.).
Conference/Journal: Ann Intern Med
Date published: 2023 Oct 31
Other:
Special Notes: doi: 10.7326/M23-1603. , Word Count: 302
Background:
Mild cognitive impairment (MCI) negatively impacts cognition and dual-task abilities. A physical-cognitive integrated treatment approach could mitigate this risk for dementia.
Objective:
To compare the effectiveness of cognitively enhanced tai ji quan versus standard tai ji quan or stretching exercise in improving global cognition and reducing dual-task walking costs in older adults with MCI or self-reported memory concerns.
Design:
3-group, randomized (1:1:1), superiority trial. (ClinicalTrials.gov: NCT04070703).
Setting:
Community residential homes.
Participants:
318 older adults with self-reported memory decline or concern and a Clinical Dementia Rating (CDR) global score of 0.5 or lower at baseline.
Intervention:
Cognitively enhanced tai ji quan (n = 105), standard tai ji quan (n = 107), or stretching (n = 106). All groups exercised at home via real-time videoconferencing, 1 hour semiweekly for 24 weeks.
Measurements:
The co-primary endpoints were change in Montreal Cognitive Assessment (MoCA; range, 0 to 30) and dual-task walking costs (difference between single- and dual-task gait speed, expressed in percentage) from baseline to 24 weeks. Secondary outcomes included CDR-Sum of Boxes (CDR-SB), Trail Making Test B, Digit Span Backward (DSB), and physical performance tests. Outcomes were assessed at 16, 24 (primary endpoint), and 48 weeks (6 months after intervention).
Results:
A total of 304 participants (96%) completed the 24-week assessment. Cognitively enhanced tai ji quan outperformed standard tai ji quan and stretching with a greater improvement in MoCA score (mean difference, 1.5 points [98.75% CI, 0.7 to 2.2 points] and 2.8 points [CI, 2.1 to 3.6 points], respectively) and in dual-task walking (mean difference, 9.9% [CI, 2.8% to 16.6%] and 22% [CI, 13% to 31%], respectively). The intervention effects persisted at 48-week follow-up.
Limitation:
There was no nonexercise control group; participants had subjective or mild cognitive impairment.
Conclusion:
Among community-dwelling older adults with MCI, cognitively enriched tai ji quan therapy was superior to standard tai ji quan and stretching exercise in improving global cognition and reducing dual-task gait interference, with outcomes sustained at 48 weeks.
Primary funding source:
National Institute on Aging.
PMID: 37903365 DOI: 10.7326/M23-1603
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