Effects of cognitive motor dual task and multimodal exercises on fall risk, intrinsic capacity and quality of life in older adults with cognitive frailty a randomized controlled trial

Title of the Study Effects of Cognitive Motor Dual Task and Multimodal Exercise on Fall Risk Intrinsic Capacity and Quality of Life in Older Adults with Cognitive Frailty A Randomized Controlled Trial

Background Population aging in India is increasing the prevalence of functional limitations. Cognitive Frailty is a high risk geriatric syndrome characterized by the coexistence of physical frailty and cognitive impairment excluding dementia. It is a significant predictor of future falls. Intrinsic Capacity is an integrative measure of physiologic reserve across locomotion vitality cognition psychological and sensory domains. Evidence suggests that cognitive motor dual task training and multimodal exercises may improve functional capacity and reduce fall risk in this population.

Objectives The primary objective is to compare the effects of cognitive motor dual task training multimodal exercise and standard care on fall risk. Secondary objectives include comparing post intervention effects on the Intrinsic capacity composite score and overall quality of life among the three groups.

Methodology This is a three arm parallel group assessor blinded randomized controlled trial conducted in selected elderly homes in central Kerala. Participants aged 65 and above with cognitive frailty will be recruited and randomized into three groups using block randomization. The sample size is 126 participants with 42 per group. The intervention groups will receive either dual task training or multimodal exercises for twelve weeks three days per week for 50 minutes per session. Standard care includes health education.

Cognitive Motor Dual Task program focuses on performing cognitive tasks while simultaneously or sequentially performing motor training. Individualized 20-minute sessions focus on dual-task progression, while 30-minute group sessions involve functional circuits, resistance training, or dance. Cognitive stimuli include tasks involving speech, memory, arithmetic thinking, and attention. Complexity increases from sequential to simultaneous tasks based on participant achievement.

Multimodal Exercise Participants receive a supervised 12-week intervention comprising resistance, balance, cardiovascular, and flexibility exercises 3 times per week. Each 45 to 50-minute session includes individual and group-based training. Resistance training involves 3 sets of 12 repetitions using weights or resistance bands, while cardiovascular training consists of walking bouts. Balance training includes static and dynamic exercises such as walking on heels or toes. Flexibility training involves arm stretches held for 12 seconds. Intensity is tailored to each participant Rate of Perceived Exertion using the Borg Scale

Control Group receives health education on aging, nutrition, and social engagement and is advised to continue only their usual activity levels.

Primary outcome measures is Timed Up and Go for fall risk. Secondary outcomes intrinsic capacity will be calculated based on domain scores of Short Physical Performance Battery for locomotion hand grip for vitality MoCA for cognition GDS for depression. Quality of life is assessed using SF 12.

Expected Outcome Post intervention measures are taken at the end of 12 weeks. It is hypothesized that there will be a significant difference in post intervention effects between the three groups specifically that targeted exercise interventions will reduce fall risk and optimize intrinsic capacity and quality of life in cognitively frail older adults.