Effects of Exercise Program Requiring Attention, Memory and Imitation on Cognitive Function in Elderly Persons: A Non-Randomized Pilot Study

Background: Square-Stepping Exercise (SSE) was developed as a novel exercise form that combines physical and cognitive training. Participants watch, recognize, memorize and follow step patterns which an instructor demonstrates on a 4 by 10 square-patterned SSE mat without viewing printed pattern diagrams. The purpose of this study was to examine the effects of SSE on cognitive function. Methods: Community-dwelling, healthy elderly persons were non-randomly divided into a weekly session group (WG) (26 participants) and a fortnightly session group (FG) (32 participants) for a six month intervention. SSE sessions lasted 50-60 minutes, and an SSE mat was provided to participants for home use. We asked participants to review printed pattern diagrams at home, then practice the SSE and record this in a log. Five cognitive tests were given preand post-intervention: cued recall, character position referencing, animal name listing, clock drawing and an analogy test. Results: Both groups significantly improved in the cued recall test (memory): 2.7 points [95% confidence interval (CI): 1.1-4.4] in the WG and 2.4 points [95%CI: 0.9-4.0] in the FG. Furthermore, the WG significantly improved in the character position referencing test (executive function) (5.6 points [95%CI: 2.8-8.3]). The three other cognitive function tests did not significantly improve. On the cued recall test, the rate of session participation and the rate of SSE performance for all designated days positively correlated in the WG/FG combined data. On the character position referencing test, the total SSE time and the number of days SSE was performed at home and in session were significant in the WG/FG combined data. Conclusion: The results of this pilot study indicate that SSE be could use as an intervention to promote cognitive function, especially memory and executive function. The amount and/or frequency of exposure to SSE would affect its impact on various types of cognitive function.