Objective: To investigate the brain activity induced by square-stepping exercise (SSE), as well as the relationships between brain activity change and SSE performance in older adults with cognitive frailty.

Background: Cognitive frailty is a co-existence of physical frailty and cognitive impairment, related to various adverse health outcomes. The shared mechanisms between frailty and cognitive impairment may affect brain, indicating the importance of addressing brain changes in cognitive frailty. In older adults with cognitive frailty, brain structural alteration is found in several regions, however, functional alteration is not well understood. SSE emphasizes both motor and cognitive aspects, documented to improve lower extremity function, balance, and cognitive function. However, brain changes induced by SSE are not yet explored. Thus, we investigated brain activity changes elicited by SSE in elders with cognitive frailty.

Method: This was a cross-sectional study, with 22 cognitive frailty participants involved. Brain activity of bilateral prefrontal (PFC), supplementary motor area (SMA), and premotor cortex (PMC) were measured by functional near-infrared spectroscopy system (fNIRS) during usual walking and two common SSE patterns with different difficulty levels. Brain activity was compared between each SSE pattern and usual walking. The correlations between brain activity change from usual walking to SSE and SSE performance were examined. Friedman’s rank test and Wilcoxon signed rank test were used to compare between tasks. Spearman’s correlation was used to establish the relationship between brain activity change and SSE performance. Significant level was set at p< .05.

Results: The brain activity increased in all of the measured brain regions during each SSE pattern compared to usual walking, while no significant difference was found between SSE patterns. Moreover, activity change of right PFC correlated positively to SSE performance.

Conclusion: SSE increased PFC, SMA and PMC activity than usual walking, and greater right prefrontal activation was related to better performance in elders with cognitive frailty. Therefore, we speculate that the effects of SSE on motor and cognitive function may be associated with brain activity changes in certain areas.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/influence-of-square-stepping-exercise-on-brain-activation-in-older-adults-with-cognitive-frailty/