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
Visual Abstract. 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
Tai ji quan, a moderate-intensity mind–body exercise, has been shown to improve cognition in healthy older adults. This study compares the effectiveness of cognitively enhanced tai ji quan with standard tai ji quan and with stretching exercise in improving cognition and task performance in older adults with mild cognitive impairment or self-reported memory concerns.
Abstract
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.
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Information & Authors
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Published In
Annals of Internal Medicine
Volume 176 • Number 11 • November 2023
Pages: 1498 - 1507
History
Published online: 31 October 2023
Published in issue: November 2023
Keywords
- Adults
- Adverse events
- Age groups
- Brain diseases
- Clinical trials
- Cognition
- Cognitive impairment
- Cognitive psychology
- Complementary and alternative medicine
- Dementia
- Drug research and development
- Exercise
- Health care
- Memory
- Neurology
- Pharmacology
- Physical activity
- Physical fitness
- Population statistics
- Prevention, policy, and public health
- Psychiatry and mental health
- Psychology
- Research and reporting methods
- Research design
- Sports and exercise medicine
Copyright
© 2023 American College of Physicians.
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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. Ann Intern Med.2023;176:1498-1507. [Epub 31 October 2023]. doi:10.7326/M23-1603
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. Ann Intern Med.2023;176:1498-1507. [Epub 31 October 2023]. doi:10.7326/M23-1603
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