Effects of Pure Cognitive Training on Gait and Balance in Older Adults: Systematic Review and Meta-Analysis

Physical and cognitive function, both of which decline with aging, are significantly interrelated. Although numerous studies have investigated the effect of physical exercise on cognitive function, relatively few have examined the impact of pure cognitive training on physical performance.

This review aimed to summarize the effects of pure cognitive training on balance and mobility in older adults.

Electronic databases (PubMed, Embase, CINAHL, and PsycInfo) were searched in February 2025. Randomized controlled trials that investigated the effect of pure cognitive training on balance and mobility in older adults were included. Pure cognitive training refers to a strictly nonphysical approach involving guided practice on a standardized set of cognitive tasks aimed at optimizing cognitive functioning. For the outcomes, balance performance focused on standing balance tests and comprehensive balance assessment scales. Mobility performance primarily focused on gait speed under a single-task condition (ie, walking only), gait speed under a dual-task condition (ie, conducting cognitive tasks while walking), and the Timed Up and Go test. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate methodological quality. The level of evidence for the available outcomes was rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Meta-analyses and sensitivity analyses of studies with high methodological quality were performed if 3 or more studies were obtained.

Fourteen studies were eventually included. The methodological qualities of 8 (57%) studies were rated as good, while those of 6 (43%) studies were rated as fair. A meta-analysis of studies with high methodological quality showed that pure cognitive training has a significant effect on cognitive-motor dual-task gait speed (standardized mean difference [SMD] 0.39, 95% CI 0.04-0.75; n=376 participants; moderate-quality evidence) but not single-task gait speed (SMD 0.12, 95% CI -0.05 to 0.30; n=506 participants; moderate-quality evidence). No significant improvements were found in functional mobility (SMD 0.29, 95% CI -0.60 to 1.18; n=566 participants; low-quality evidence) or balance (SMD 0.18, 95% CI -0.34 to 0.69; n=139 participants; very low-quality evidence).

Cognitive training does not improve balance or mobility under single-task conditions but does improve walking speed under cognitive-motor dual-task conditions in older adults. A cognitive training protocol targeting executive function, consisting of 40- to 60-minute sessions conducted 2 to 3 times per week over a period of 8 to 10 weeks, has been shown to be effective.