The Effect of Different Attention-Focused Training on Physical Performance and Cognitive Function in Geriatric Individuals

The ability to walk safely and efficiently is crucial for older adults to maintain their independence and minimize the risk of falls. In healthy geriatric individuals, walking typically occurs as an automatic process involving motor skills, meaning the movement is generally performed with minimal conscious thought. However, attention can influence motor performance; a lack of focus or distraction can lead to loss of balance and increase the risk of falling during walking. The effects of attention focus on geriatric individuals remain uncertain. Therefore, this study aims to investigate the effects of different attention-focused training on physical performance and cognitive function in geriatric individuals. In this randomized controlled trial, 60 participants will be randomly assigned to four groups: the internal focus exercise group (n = 15), the external focus exercise group (n = 15), the no attention focus group (n = 15), and the control group (n = 15). The control group will consist of participants from a different institution to prevent contamination. Participants in the non-control groups will attend training sessions twice a week (approximately 40 minutes each) for 12 weeks. The experimental groups will complete a total of 24 exercise sessions. All training sessions will be conducted by an experienced physiotherapist. Pre- and post-assessments will be conducted. The sociodemographic characteristics of all participants will be assessed using a descriptive form. Participants' physical performance will be evaluated using the Short Physical Performance Battery (SPPB), the Stair Climbing Test, the Timed Up and Go Test (TUG), a static balance test (single-leg stance test), and a dynamic balance test (Berg Balance Scale). Cognitive function will be assessed using the Central Nervous System Vital Signs (CNSVS) Cognitive Performance and Attention Tests. Additionally, participants' walking will be analyzed using Kinect V2 camera-based software. The data collected from the study will be analyzed using SPSS (Statistical Program for the Social Sciences). Descriptive statistics will include frequencies, percentages, means, and standard deviations. For comparisons, the significance level (p) will be set at 0.05.

Aging is an inevitable phase characterized by physiological and mental changes, including a decline in perception and awareness, as well as progressive deterioration of memory functions. According to the United Nations World Social Report (2023), the population aged 65 and older is expected to reach 1.6 billion by 2050.

With aging, motor performance, including balance, walking stability, postural stability, and movement speed, gradually declines. The literature indicates that one-third of individuals aged 65 and older experience a fall once or more per year, with the rate rising to 40% among those aged 85 and above. The risk of falling in older adults may be related to a decrease in the integration of physiological systems (cardiac, respiratory, and neuromuscular) that influence physical performance.

Physical performance is the objective measurement of an individual's ability to integrate various physiological systems (cardiac, respiratory, neuromuscular) to perform coordinated and effective movements. Due to its importance in evaluating mobility and overall physical well-being, it is considered a critical health indicator in older adults. The decline in physical performance can result from the complex interaction of physiological factors (e.g., declines in cardiovascular, musculoskeletal, and neuromuscular systems, leading to progressive loss of muscle mass and strength, reduced testosterone levels), clinical factors (e.g., depressive symptoms, multimorbidity, polypharmacy), lifestyle factors (e.g., physical activity levels), and sociodemographic factors (e.g., age, gender). This decline is evident not only in physical performance but also in cognitive function. With normal aging, the brain typically experiences shrinkage, a widely observed phenomenon, affecting both gray and white matter. This reduction in brain size is attributed to a decline in the development of dendrites, dendritic spines, axons, and synapses. As a result, cognitive abilities such as attention, memory, executive functions, language, and visuospatial skills decline with aging.

The decline in physical performance and cognitive function due to aging significantly impacts the ability to perform activities of daily living. The ability to walk safely and efficiently, which is essential for daily life, is necessary for older adults to maintain their independence and minimize the risk of falls. In healthy older adults, walking typically occurs with minimal conscious thought about the movement process. It is known that the focus of attention affects the performance of motor skills. The term "focus of attention" refers to the location of an individual's attention relative to the performance environment or task. This focus can be internal or external. An internal focus directs attention to the components of body movement during an action, whereas an external focus directs attention to the effect of the movement on the environment or the final goal. For example, during a ball throw, the individual may focus internally on the movement of the wrist, elbow, and shoulder, or externally on the ball and the target.

In recent years, various attention-focused approaches have been implemented to enhance functional and cognitive capacity in geriatric individualsProvidi. ng different attention-focus instructions to geriatric individuals has been shown to be an effective strategy for improving motor performance. A study examining the effects of internal focus, external focus, and no focus walking training during rehabilitation on conscious motor processing, balance, walking ability, and fear of falling in older adults at risk of falling found that focus reduced conscious motor processing while improving functional balance and walking (8). Furthermore, substantial evidence shows that using attention-focus methods results in improvements in physical performance. However, the effects of focus instructions on physical performance and cognitive function in geriatric individuals remain uncertain.

To address this gap in the literature, this study will investigate the effects of different attention-focus training on physical performance and cognitive function in geriatric individuals. We hypothesize that individuals who undergo attention-focused walking training during rehabilitation will demonstrate better physical performance and cognitive function compared to those who do not receive attention-focused walking training. Our study will provide data and contribute to filling this gap in the existing literature.

Eligibility Criteria:
Inclusion Criteria:

* Aged 65 years or older
* Willingness to participate in the study
* Ability to read and write
* Mini-Mental State Examination (MMSE) score \> 24
* Ability to independently perform the tests administered as part of the study
* Ability to walk independently in the community (without a walking aid and able to walk at least 40 meters)

Exclusion Criteria:

* Presence of orthopedic, neurological, vestibular, cognitive, or other medical conditions that may affect the applicability of the assessment methods or training interventions used in the study
* History of myocardial infarction and/or coronary bypass surgery within the past year
* Severe visual or auditory impairments causing communication difficulties
* Polypharmacy (use of five or more medications per day)