Cognitive intervention to improve simple and complex walking

 描述（由申请人提供）：鉴于美国老年人残疾所造成的重大医疗和社会经济后果以及对体育锻炼等推荐治疗的依从性较低，因此迫切需要研究改善活动能力和运动能力的替代策略。新的证据表明，执行功能在维持衰老过程中的运动能力和预防行动障碍方面发挥着重要作用。然而，尚未探索使用认知训练计划来改善执行功能作为增加活动能力的策略。我们的初步研究令人兴奋的结果支持认知矫正方法改善老年人运动的有效性和可行性。我们建议进行第一个单盲随机临床试验，以测试计算机认知矫正干预计划对改善久坐老年人（残疾风险特别高的群体）运动能力的功效。在这项研究中，两组 210 名久坐的老年人（总共 420 名）将被随机分为为期八周的认知补救（个性化计算机化认知训练）或健康教育控制计划。所有参与者都将在基线、干预后、 并在干预后六个月和十二个月评估效果的持久性。我们的主要结果是在正常步速行走（简单运动）和边走边说话（复杂运动）条件下测量的步态速度的干预后变化，以及短体力表现电池（SPPB）的表现。其他结果包括与行动相关的认知过程（神经心理学测量）的改善、其他定量步态评估（步态变异性和步态域）和神经可塑性（通过功能性近红外光谱测量）。我们的假设是，执行功能将对认知矫正计划做出反应，进而增强运动能力。这项临床试验的前提是老年人的残疾是一种潜在可预防的慢性病 而不是衰老和疾病的不可逆转的后果。我们提出的新型运动方法有可能通过引入来改变残疾领域的治疗范式 认知移动方法可应用于不同环境中的预防和康复。通过这项“概念验证”二级预防试验，我们将填补循证医学实践的重要知识空白，并为影响美国大部分老龄化人口的主要健康结果制定有效的干预措施。

 DESCRIPTION (provided by applicant): Given the major medical and socioeconomic consequences of disability in U.S. seniors and the low compliance with recommended treatments such as physical exercise, investigation of alternate strategies to improve mobility and locomotion is a vital need. Emerging evidence indicates that Executive Functions play an important role in maintaining locomotion in aging and preventing mobility disabilities. However, use of cognitive training programs to improve executive functions as a strategy to increase mobility has not been explored. Exciting results from our preliminary study support the efficacy and feasibility of the cognitive remediation approach to improve locomotion in older adults. We propose to conduct the first single-blind randomized clinical trial to test the efficacy of a computerized cognitive remediation intervention program on improving locomotion in sedentary seniors, a group at an especially high risk for disability. For this study, two groups of 210 sedentary seniors (420 total) will be randomized into either eight-week cognitive remediation (individualized computerized cognitive training) or health education control programs. All participants will receive gait, mobility, and cognitive assessments at baseline, post-intervention, and at six and twelve months after intervention to assess durability of effects. Our primary outcome is post intervention change in gait velocity measured during normal pace walking (simple locomotion) and walking while talking (complex locomotion) conditions as well as performance on the Short Physical Performance Battery (SPPB). Additional outcomes include improvements in mobility related cognitive processes (neuropsychological measures), other quantitative gait assessments (gait variability and gait domains), and neuroplasticity (measured with functional near infra-red spectroscopy). Our hypothesis is that executive functions will respond to the cognitive remediation program and in turn enhance locomotion. The premise of this clinical trial is that disability among seniors is a potentially preventable chronic condition rather than an irreversible consequence of aging and disease. Our proposed novel approach to locomotion has the potential to shift treatment paradigms in the field of disability by introducing cognitive approaches to mobility that can be applied to prevention and rehabilitation in diverse settings. Through this 'proof of concept' secondary prevention trial we will fill an important gap n knowledge for practicing evidence-based medicine and developing effective interventions for a major health outcome affecting a substantial proportion of the U.S. aging population.