Acute Effects of Square-Stepping Exercise onCardiorespiratory Fitness and Cognitive Function in Older Adults
Mikiko KUSUDA
Master's Program in Health and Sport Sciences

Supervisor: Tomohiro OKURAThe Square-Stepping Exercise (SSE), a multi-task exercise, is now done byolder people worldwide. However, it lacks basic data. This study investigatedits intensity and acute effects on cardiorespiratory fitness and cognitive
functions in older adults. Nineteen senior residents in Ibaraki were involved inthis study. It followed a crossover design, and included the control (CTR) andSSE experiments. The participants’ gas exchange and heart rate (HR) were
measured during interventions and two cognitive tests were conducted before
and after the interventions. The SSE was classified as a low-intensity exercise(2.1-2.7 METs, 14.3-17.3 %HRreserve). The results from a cognitive test showedthat reaction time improved in the SSE experiments. This showed that the SSE
may have helped improve information processing speed. SSE’s intensity was
low and it could bring some acute effects on cognitive function. This intensity
may be beneficial for high-risk older people to perform, and for healthy people
to enjoy the exercise while communicating with others.

【Introduction】

Many studies have demonstrated that daily exercise can be a way for individuals to prevent
unhealthy aging, lead an independent life, and reduce the risks of being bedridden and requiring
nursing care. Walking is the most popular exercise amongst senior citizens in Japan, and it has
a variety of health benefits. Studies have revealed that the Metabolic Equivalent (MET) valueof walking at 4km/h is 5.1 METs for older people, and that daily walking is related to better
cognitive function. Given this strong evidence, communities and local governments in Japan
have started implementing systems and exercise classes that encourage senior citizens to leave
their homes and become physically active. In addition to recommending daily exercise such as
walking, the local government in Kasama City, Ibaraki, Japan, introduced Square-Stepping
Exercise (SSE) to their exercise classes. Previous studies have shown that 3- and 4-month SSE
programs improved or maintained balance ability, lower-limb functions, and cognitive
functions in older adults. SSE also had a significant effect on fall prevention. This was first
introduced in 2008, and there are more than 16,000 people do it within the city. The exercise isalso done in many countries. Nevertheless, this growing exercise lacks basic data such as its
intensity and acute effects.
In order to provide new indexes of SSE, the main purpose of this study was to investigate
its intensity in METs and its acute effects on cardiorespiratory fitness in older adults, using
cardiopulmonary tests. A second aim was to investigate acute effects of SSE on cognitivefunctions.

【Methods】

The participants were 19 people aged 65 years and older who had been practicing SSE forat least 1 year in Tsukuba City, Ibaraki, Japan.
This study followed a crossover design, and included two experiments: the control (CTR)
and SSE. All the participants underwent both experiments in random order two days in a row.
Each experiment’s main components were pre-intervention cognitive tests, intervention (SSE:rest-SSE-rest, CTR: 40-minute rest), post-intervention cognitive tests. The cognitive tests werethe Stroop Test and the Trail Making Test part A (TMT-A). During the interventions, theparticipants’ gas exchange and heart rate (HR) were measured using a MetaMax® 3B-R2(CORTEX). For the cognitive tests, two-way repeated measures analysis of variance (ANOVA)
with experiment (SSE/CTR) and session (pre/post) was used to investigate the existence of asignificant difference (p < 0.05). Post hoc tests with a Bonferroni correction were conducted todetermine where and how the differences occurred. Effect size (Cohen’s d) was also estimated.

【Results and Discussion】

The MET value of SSE was between 2.1 and 2.7, and the %HRreserve was between14.3 and17.3. The energy expenditure during the SSE-intervention was 64.1 to 67.2 kcal. Therefore,
SSE was categorized as a low-intensity activity (1.5–3 METs, <40 %HRreserve). Although thisintensity and energy expenditure might not high enough for healthy individuals, this study has
proved that this exercise can be recommended for high-risk populations such as frail older
adults to start with as daily exercise. However, given SSE’s social features, this level of intensity
may be the best for older adults to have active conversations with friends while performing SSE
together.
In the TMT-A test, there was not significant difference at pre- and post-interventions
between the CTR and SSE experiment. However, the effect size was medium for only the CTRexperiment. In the Stroop Test, significant improvement was seen in reaction time in the SSE
experiment (Figure 1). The effect size was large or medium for only the SSE experiment.
Although acute effects on cognitive function were not consistent in the two tests, it can beconcluded that the SSE session may have helped information processing speed.

Figure 1: Results of the Stroop Test

【Conclusions】

The strengths of this study were that the detail of study protocol was shown, and that thevariables were investigated in detail. From the outcomes of the gas exchange analysis, this study
found that SSE is a low-intensity form of exercise. Its MET value was 2.1 to 2.7 METs,
and %HRreserve was 14.3% to 17.3%. Although its intensity was lower than that of many otherpopular exercises, these findings showed that SSE is an exercise that can be introduced to highrisk older people, such as those who are frail and inactive, as an introduction to a new exercise
habit.
Regarding effects on cognitive function, this study showed it was possible that SSE could
improve cognitive function, especially information processing speed. Even though theimprovement was small, if older people kept performing SSE repeatedly, the improvement
could become more visible. This could be a reason why previous longitudinal studies havefound improvements in cognitive function in older persons after SSE programs.
【Significance of the Study】

These basic data and findings of acute effects obtained in this study can be utilized as anindex of SSE by fitness professionals working with older adults, as well as workers at nursing
homes, when choosing appropriate exercises. The findings could also be useful for local
governments and communities with an interest in introducing SSE but who are yet to make adecision, helping them to be sure about this relatively new exercise. As the exercise intensityof SSE is low, this study has proved that it can be used with older people with a wide range ofhealth status, from high-risk older individuals to those who are healthy. In addition, the basic
indexes such as MET value and energy expenditure can be referred to when comparing theaptitude of SSE with that of other exercises. Furthermore, these findings will assist with better
understanding of the mechanisms underlying the long-term results acquired in previous studies.

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